Contents

Chapter 1 Concept of Health and Disease.............................................................. 1

Chapter 2 Principles of Epidemiology and Epidemiologic Methods......................... 21

Chapter 3 Screening of Diseases............................................................................ 65

Chapter 4 Epidemiology of Communicable Diseases.............................................. 71

Chapter 5 Epidemiology of Chronic Non-communicable Diseases and Conditions.. 189

Chapter 6 Health Programmes in India................................................................... 215

Chapter 7 Demography and Family Planning.......................................................... 255

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Chapter 8 Preventive Medicine in Obstetrics, Paediatrics and Geriatrics................ 273

Chapter 9 Nutrition and Health.............................................................................. 303

Chapter 10 Medicine and Social Sciences................................................................. 343

Chapter 11 Environment and Health........................................................................ 357

Chapter 12 Hospital Waste Management................................................................. 403

Chapter 13 Disaster Management............................................................................ 407

Chapter 14 Occupational Health.............................................................................. 413

Chapter 15 Genetics and Health............................................................................... 429

Chapter 16 Mental Health....................................................................................... 433

Chapter 17 Health Information and Basic Medical Statistics..................................... 437

Chapter 18 Communication for Health Education..................................................... 451

Chapter 19 Health Planning and Management......................................................... 463

Chapter 20 Health Care of the Community............................................................... 471

Chapter 21 International Health.............................................................................. 485

Practicals .......................................................................................... 493

Index .......................................................................................... 561

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 CHAPTER

1 CONCEPT OF HEALTH AND DISEASE

SURVEILLANCE
• It has been defined as "the continuous scrutiny of the factors that determine the occurrence and spread of
diseases and other conditions of ill health which are pertinent of effective control".
Uses
(i) To estimate the prevalence of health problem in a community.
(ii) To study the natural history of a disease.
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(iii) To detect the disease epidemics.

(iv) To generate the hypotheses in research.
(v) To facilitate emergency planning.
• Surveillance is considered the best weapon to avert epidemics.
• Surveillance can be conducted at the following levels,
(i) Individual surveillance
(ii) Local population surveillance
(iii) National population surveillance
(iv) International surveillance
Uses
(i) Active Surveillance : In this, health functionaries or any designated persons visit the community and collect
data on predefined indicators; It is used when there is an indication that something unusual is occurring
or disease is highly contagious, fatal or in the process of elimination or eradication.
Example: Malaria (done fortnightly)
Leprosy (endemic)
Tuberculosis
(ii) Passive Surveillance : Criteria are established for reporting diseases, risk factors or health-related event;
Health practitioners are notified of the requirements and they report events as they come to their attention;
this is the more common type of surveillance.
(iii) Sentinel Surveillance: No routine notification system can identify all cases of infection or disease; A method
for identifying the missing cases and thereby supplementing the notified cases is required; this is known
as "sentinel surveillance".
• We do extrapolation analysis or mathematical modelling with the data gathered from sentinel sites
to arrive at an estimated no. of total cases.
• Example: HIV, Hep-B and Hep-C
Outdoor air quality monitoring
Water quality monitoring
(iv) Behaviour Surveillance: It is defined as ongoing systematic collection, analysis, and interpretation of
behavioural data relevant to understanding trends in the transmission of HIV and STIs.
(v) Nutritional Surveillance: It include routine collection and compilation of data to know about the details of
nutrition related disease.
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 Monitoring Surveillance
Performance and analysis of routine Continuous scrutiny of factors that deter-
measurements aimed at detecting mine the occurrence and distribution of
changes in environment or health status disease and other conditions of ill health.
of a population.
One time linear activity Continuous cycle
No feedback present Feedback present
Smaller concept Broader concept
QUALITY OF LIFE
• WHO defines it as "the condition of life resulting from the combination of the effects of the complete range of
factors such as those determining health, happiness, education, social and intellectual attainments, freedom
of action, justice and freedom of expression".
• A recent definition of quality of life by WHO is "the product of the interplay between social, health,
economic, and environmental conditions which effect human and social development.
• There are various indices to measure the quality of life

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(i) Physical quality of life index (PQLI)
(ii) Human development index (HDI)
(iii) Human poverty index (HPI)
(iv) Gender - related development index (GDI)
(v) Gender empowerment measure (GEM)
Physical Quality of Life Index (PQLI)
• The quality of life can be evaluated by a composite index called "physical quality of life index" which
consolidates three indicators viz.
Infant mortality rate (IMR)
(i)
Life expectancy at the age of 1 year
(ii)
(iii) Literacy
• The composite index is calculated by taking the average of all the three indicators, giving equal weight to
each of them; the resulting PQLI is thus scaled from 0 to 100.
• India has a PQLI value of 65.
Human Development Index
• It is a composite index; focusing on three basic dimensions of human development.
(i) Longevity: Life expectancy at birth.
(ii) Knowledge: Adult literacy rate and mean years of schooling.
(iii) Income: Gross national income (GNI) per capita in purchasing power parity (PPP) in US dollars.
• Value range between 0 and 1; it allows for international comparison.
• India has HDI value of 0.640. (rank 130 out of 189 countries).
Multi-Dimensional Poverty Index (MDPI)
• It measures acute poverty covering over 100 developing countries.
• MDPI has replaced human poverty index.
• MDPI uses 3 dimensions measured using 10 indicators.
• MDPI of India 0.121

Dimension Indicator
Health Nutrition, child mortality
Education Years of schooling, school attendance
Standard of living Cooking fuel, sanitation, drinking water, electricity, housing, assets.

3
 CHAPTER

2 PRINCIPLES OF EPIDEMIOLOGY AND

EPIDEMIOLOGIC METHODS

Elements of a Cohort Study

Selection of Obtaining data Selection of Follow up Analysis

study subjects on exposure comparison
group
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OPEN VIAL POLICY / VACCINE VIAL MONITOR

OPEN VIAL POLICY
• To minimize vaccine wastage, this policy allows reuse of partially used multidose vials of applicable
vaccines under UIP in subsequent sessions fixed and outreach.
• They can be used upto 4 weeks.
• The guidelines on open vial policy are
Applicable for vaccines: OPV, DPT, Hepatitis B, TT, liquid pentavalent.
(i)
Not applicable for vaccines: BCG, JE, Measles.
(ii) Expiry date should not pass.
(iii) Vaccines stored strictly under appropriate temperature range during transportation and storage.
(iv) Aseptic technique used to withdraw doses.
(v) Open vials should never be submerged in water or contaminated.
(vi) Record date and time of each vial opening.
(vii) Non reusable (measles, BCG and JE) should be discarded after 48 hours or before subsequent sessions
which ever earlier.
(viii) Vaccine viol monitor (vvm) should not reach discard point.
(ix) All vaccines should be transported in zipper bag in the vaccine carrier and recorded in stock register.
VACCINE VIAL MONITOR

4
• A vvm is a chemical indicator label attached to vaccine container.
• It is a temperature monitoring device.
• The main purpose of vvm is to ensure that heat damaged vaccines are not administered.
• vvm indicates efficiency of cold chain (temperature maintenance).
• vvm is a mark on OPV vial consisting of
(i) An outer circle
(ii) An inner square (made of heat sensitive material)
• WHO grading of vvm in opv
(i) It is based on colour changes in vvm; only inner square changes colour, circle always remain blue.
(ii) Based on vvm, OPV is usable upto grade II.

Who Grade Outer circle Inner Square Inference

Grade I Blue White OPV can be used

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Grade II Blue Light blue OPV can be used

Grade III Blue Blue OPV cannot be used

Grade IV Blue Purple/Black OPV cannot be used

• Grade III is discard point

EXAM PREPARATION QUESTIONS

LONG QUESTIONS
1. Explain the “chain of disease transmission”. Outline the general control measures of 
communicable diseases against each of the link in disease transmission.
2. Define epidemiology. Describe its uses in the field of community health. 
3. Mention different types of epidemiological studies. Write about Randomized controlled 
trials.
25. Describe the epidemiology and prevention of lymphatic filariasis 
SHORT QUESTIONS
33. Mention the uses of epidemiology 
34. Cold Chain 
35. Herd immunity 
36. Attributable risk 
37. Source & reservoir of infection. 
38. Advantages and disadvantages of case control studies 
39. Non-Randomized Trials 
40. Cohort study. 
41. Emporiatrics 
42. Uses of incubation period in epidemiological studies 
43. Bias in case control studies 
5
 CHAPTER

4 EPIDEMIOLOGY OF COMMUNICABLE DISEASES

CHICKENPOX (VARICELLA)
• It is an acute highly infections disease caused by Varicella Zoster (V - Z) virus.
• It is characterized by vesicular rash that may be accompanied by fever and malaise
EPIDEMIOLOGICAL DETERMINATES
Agent Factors
Agent : Causative agent is Varicella Zoster virus (Human alpha herpes virus)
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Source of Infection : Case (person to person contact); through oropharyngeal secretions, skin and mucosal
lesions.
Infectivity : Period of communicability is 1 to 2 days before appearance of rash to 4-5 days after
appearance of rash
1-2 days before Rash 4-5 days after
Infective Period

Secondary attack rate : 90% (Highly Communicable)

Host Factors
Age : Mostly in children under 10 years of age;
Immunity : Infection provides life long immunity; maternal antibody protect infant during the
first few months of life.
Pregnancy : Infection during pregnancy can cause congenital Varicella syndrome (Limb hypoplasia,
cicatrising lesions, chorioretinitis, microcephaly).
Environmental Factors : Chicken pox shows seasonal trend in India; high temperature and humidity prevents
transmission of the virus; it occur mostly during the first half of the year.
Transmission : It is through air droplets (respiratory); Person to person contact; virus can cross
placental barriers and infect fetus, a condition known as congenital varicella.
Incubation period : Usually 14-16 days (2-3 weeks)
Clinical Features
(i) Pre-eruptive stage : Onset is sudden with fever, pain in the back,
shivering and malaise; lasts for about 24 hrs.

(ii) Eruptive stage : Rash appear in first day of fever; symmetrical

and centripetal in distribution. Rash first appear on trunk
and then comes on face, arms and legs. Mucosal surfaces are
generally involved. Stage of rash [macule → papule → vesicle
→ scab]. Figure

Pleomorphism [characteristic features; all stages of rash may be seen simultaneously at one time, in the
same area]
6
 The first to attract attention are often the vesicle filed with clear fluid and looking like 'dew-drops' on skin.
Complications : Secondary bacterial infections.
Varicella Pneumonia (most dangerous complication)
Shingles (most common late complication of chickenpox)
Mortality is less than 1% in uncomplicated cases.
Diagnosis : By clinical findings.
PCR technique
Examination of vesicle fluid under electron microscope
(shows round particles) (most rapid and sensitive)
Prevention : Vaccine (live attenuated chickenpox monovalent vaccine)
OKA strain; For children of age between 12 months to 12 years, 2 doss
are given with minimum interval between doses is from 4 weeks to 3
months. Figure

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Varicella Zoster immunoglobulins (given within 72 hrs of exposure; dose - 12.5 units/kg body weight up
to maximum of 625 units intramuscularly); it is given to newborn and immunosuppressed persons
Combination vaccines (MMRV) can be administered to children from 9 months to 12 years.
Control measures include notification, isolation of case, disinfection of articles, and antiviral therapy like
acyclovir, valaciclovir, farmiciclovir and foscarnet

Chickenpox Smallpox
Incubation Period : 7 – 21 days 7 - 17 days
Prodromal Symptoms : Usually mild Severe
Rash : Centripetal distribution, Pleomorphic Centrifugal distribution, non pleomorphic,
rash, Superficial, unilocular, rapid evolution. deep seated, multilocular, slow evolution

TAENIASIS
• Three parasites of importance in taeniasis are Taenia saginata, T.solium and T.asciatica.
EPIDEMIOLOGICAL DETERMINATES
Agent
Taenia Saginata - Beef tapeworm
Taenia Solium - Pork tapeworm

Taenia Saginata Taenia Solium
Length 5-10 m 2-3 m
Disease Cause intestinal taeniasis Cause intestinal taeniasis and cysticercosis
Larva Cysticercus bovis; present in cow Cysticercus cellulosae; Present in pig and
not in man. also in Man
Host of Infection

Taenia Saginata Taenia Solium
Definitive host Man Man
Intermediate host Cattle (Cow or buffalo) Pig
Infective Stage Cysticercus bovis (larva) Cysticercus cellulosae (larva)

7
 Modes of Transmission
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Figure
These infections are acquired through:
(i) Ingestion of infective cysticerci in undercooked beef (T.saginata) or pork(T.Solium).
(ii) Ingestion of food, water or vegetables contaminated with eggs.
(iii) Reinfection by the transport of eggs from the bowel to the stomach by retroperistalsis.
Incubation Period
For the adult tapeworm, from 8 to 14 weeks.
Clinical Features
(i) Intestinal Taeniasis
• It is caused by adult worm of both T. saginata and T. solium.
• When the infection is symptomatic, Vague abdominal discomfort, indigestion, nausea, diarrhea and
weight loss may be present.
• Acute intestinal obstruction, acute appendicitis and pancreatitis have also been reported.
8
(ii) Cysticercosis
• It is caused by larval stage (Cysticercus Cellulosae) of T.solium
• Clinical features depends on the site affected:
• Subcutaneous nodules are mostly asymptomatic.
• Mascular cysticercosis may cause acute myositis.
• Neurocysticercosis (Cysticercosis of brain) is the most common and most serious form of
cysticercosis; it causes epilepsy, increased intracranial tension, hydrocephalus, behavioural
disorders etc.
• Ocular cysticercosis (eye).
Control Measures
• The methods usually employed for control are
(i) Treatment of infected persons.
(ii) Meat inspection
(iii) Health education
(iv) Adequate sewage treatment and disposal.

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• Thorough cooking of beef and pork is the most effective method to prevent food borne infections.
• Early detection and early treatment of T. Solium cases is essential to prevent human cysticercosis.
• Effective drugs are praziquantel, Niclosamide and albendazole (cysticercosis).
• Medical treatment is more effective for parenchymal cysts and less effective for intraventricular,
subarachnoid, or racemose cysts.
National Deworming Day (NDD)
• 10th February
• Deworm all preschool-school aged children.
• Target beneficiaries are 1-19 years of age.
• Linkage with Vitamin A prophylaxis program.
Dosage
• 1-2years - 200 mg albendazole stat.
• 2-19years - 400 mg albendazole stat.

LEISHMANIASIS

• Leishmaniasis are a group of protozoal disease caused by parasites of the genus Leishmania, and
transmitted to man by bite of female phlebotomine sandfly.
• Visceral leishmaniasis or Kala-azar is an important disease in India.
EPIDEMIOLOGICAL DETERMINATES
Agent Factors
Agent
Types of Leishmaniasis Causative Agent
Visceral leishmaniasis (kala-azar) → Leishmania donovani
Cutaneous leishmaniasis (oriental sore) → Leishmania tropica
Mucocutaneous leishmaniasis → Leishmania braziliensis
• Life Cycle is Completed in 2 Hosts:
Definitive host - Man, Dog, and other mammals.
Vector - Female sandfly, phlebotomus species.
Infective from - promastigote form present in midgut of female sandfly.
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 CHAPTER

5 EPIDEMIOLOGY OF CHRONIC
NON-COMMUNICABLE DISEASES AND CONDITIONS

Screening for Breast Cancer

• There is evidence that screening for breast cancer has a favourable effort on mortality from breast cancer.

• The basic technique for early detection of breast cancer are:

(i) Breast self examination (BSE) by the patient

(ii) Palpation by a physician

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(iii) Thermography.

(iv) Mammography.

• Breast cancer are more frequently found by women themselves than by a physician during a routine
Breast self examination.

• Palpation is unreliable for large fatty breasts.

• Mammography is most sensitive and specific in detecting small tumours that are sometimes missed on
palpation; potential drawback of mammography are exposure to radiation, requirement of high standard
technical equipment and experienced radiologists, and false positivity.

• Thermography has the advantage that patient is not exposed to radiation.

• Women under 35 years of age should not have x-rays unless they are symptomatic or a family history of
early onset of breast cancer.

10
 ORAL CANCER
• Oral cancer is one of the ten most common cancers in the world.
Epidemiological Features
(i) Tobacco
• Approximately 90% of oral cancer in south east asia are
linked to tobacco chewing and tobacco smoking.
• Cancer almost always occured on the side of the mouth
where the tobacco quid was kept, and the risk was 36
times higher than for non chewers if the quid was kept in
the mouth during sleep.
(ii) Alcohol
• Oral cancer can also be caused by high concentration of
alcohol, and that alcohol appears to have a synergistic
effect in tobacco users.
(iii) Pre Cancerous Stage

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• The pre cancerous lesions (Leukoplakia, erythroplakia) can be detected for upto 15 years prior to
their change to an invasive carcinoma.
(iv) High Risk Group
• These include tobacco chewers and smokers, bidi smokers, people using tobacco in other forms such
as betel quid.
(v) Cultural Patterns
• Tobacco is smoked in the form of manufactured cigarettes; the indigenous forms of smoking are bidi,
chutta (Cigar), chilum, hookah; Tobacco in powdered form is inhaled as snuff.
Prevention
Primary Prevention
• If tobacco habits are eliminated from the community, a great deal of reduction in the incidence of oral
cancer can be achieved.
• This require public education, motivation for changing lifestyle and legislative measures.
Secondary Prevention
• Oral cancers are easily accessible for inspection allowing early detection; if detected at precancerous stage,
they can be treated or cured.
• The main treatment modalities that offer hope are surgery and radiotherapy.

DIABETES MELLITUS
• Diabetes is a group of metabolic disorders characterized by hyperglycemia resulting from defects in
insulin secretion, insulin action or both.
• Diabetes is a long term disease with variable clinical manifestations and progression.
Classification
(i) Diabetes Mellitus (DM)
(a) Type 1 or insulin dependent diabetes mellitus
(b) Type 2 or Non-insulin dependent diabetes mellitus.
(c) Malnutrition related diabetes Mellitus
(d) Other types (Secondary to pancreatic, harmonal, drug induced, genetic and other abnormalities).
(ii) Impaired glucose tolerance (IGT).
(iiii) Gestational diabetes mellitus (GDM)
• Insulin resistance syndrome (Syndrome X): In obese patients with type 2 diabetes, the association of
hyperglycaemia, hyperinsulinaemia, dyslipidaemia and hypertension which leads to coronary artery
disease and stroke, may result from a genetic defect producing insulin resistance, with the latter being
exaggerated by obesity.
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 CHAPTER

6 HEALTH PROGRAMMES IN INDIA

SUMAN
Vision
To create a responsive health care system
which strives to achieve zero maternal and infant
deaths through quality care provided with dignity
and respect.
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Goal

To end all preventable maternal and

newborn deaths.

Objectives

Assured, dignified, respectful and quality

healthcare at no cost and zero tolerance for denial
of services for every woman and newborn visiting
the public health facility to end all preventable
maternal and newborn deaths and morbidities and
provide a positive birthing experience.

• To provide high quality medical, surgical

and emergency care services in a dignified
and respectful manner as per SUMAN
service package at no cost to the beneflaries.

• To leverage institutional and community-

based platforms to help create awareness in
the community on the entitlements under
SUMAN.

• To strengthen Grievance Redressal Mecha- nism by incorporating client feedback.

• To orient service providers and build their capacity for delivering SUMAN package.

• To ensure reporting and review of all maternal and infant deaths.

Beneficiaries of the Initiative

All pregnant All mothers

upto 6 months All sick infants
women post delivery

12
NAVJAT SHISHU SURAKSHA KARYAKRAM (NSSK)

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• Objective : to address care at birth issue i.e., prevention of hypothermia, prevention of infection, early
initiation of breast feeding and basic newborn resuscitation.
• Strategy : to have a trained health person in basic newborn care and resuscitation unit at every delivery
point.

RASHTRIYA BAL SWASTHYA KARYAKRAM (RBSK)

• RBSK is a new initiative launched in 2013.
• It includes provision for child health screening and
early intervention services through early detection &
management of 4 D's, prevalent in children.
• These are defects at birth, disease in children, deficiency
conditions and development delays including disabilities.
• Programme implementation
(i) For newborn
(a) Facility based newborn screening at public health facilities, by existing health manpower.
(b) Community based newborn screening at home through ASHA's for newborn till 6 weeks of age
during home visits.
(ii) For children 6 weeks to 6 years:
• Anganwadi centre based screening by dedicated mobile health teams.
(iii) For children 6 years to 18 years:
Government and Government aided school based screening by dedicated mobile health teams.

NATIONAL GUINEA WORM ERADICATION PROGRAMME

• The programme was launched in 1984; the country has
reported zero cases since August 1996; In the year 2000,
the international commission for the certification of
Dracunculiasis Eradication recommended that India be
certified free of dracunculiasis transmission.
• The following activities are continuing like health education activities, rumour registration and
investigation, Surveillance in previously infected areas, careful supervision of functioning of hand
pumps and other sources of safe drinking water, and provision of additional units etc.
13
 CHAPTER

7 DEMOGRAPHY AND FAMILY PLANNING

DEMOGRAPHY

• It is the scientific study of human population; it focus its attention on

(i) Change in population size
(ii) Composition of population
(iii) Distribution of population in space
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• Types of demography are formal demography (Measurement of populations process) and social
demography (Also analyze relationship between economical, Social, cultural and biological processes
influencing a population).
• Demographic Process: 5 processes continuously work in a population, thus determining its size,
composition and distribution.
Ex: Fertility, marriage, mortality, migration, social mobility.
DEMOGRAPHIC CYCLE

Figure
• Demography cycle is closely related to socioeconomic progress of a country.
• 5 stages (phases) of demographic cycle through which a Nation passes:
(i) First Stage (High Stationary)
• This stage is characterized by a high birth rate and a high death rate which cancel each other and the
population remains stationary; India was in this stage till 1920.
(ii)
Second Stage (Early Expanding)
• The death rate begins to decline, while the birth rate remains unchanged; population starts to grow;
Example: Some countries of Africa and Southeast Asia.
14
(iii) Third Stage (Late Expanding)
• The death rate declines still further, and the birth rate tends to fall; the population continues to grow
because births exceed death.
Example: India, China and Singapore
(iv) Fourth Stage (Low Stationary)
• This stage is characterized by a low birth and low death rate with the result that the population
becomes stationary.
Example: Austria, UK, Denmark, Belgium, Sweden
(v) Fifth Stage (Declining)
• The population begins to decline because birth rate is lower than the death rate.
Example: Germany, Hungary, Japan.
DEMOGRAPHIC INDICATES
(i) Age Pyramids
• Population pyramid (age-sex pyramid and age structure diagram) is a graphical illustration that
shows the distribution of various age groups in a population which normally forms the shape of a

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pyramid.
• Shape of population pyramid indicate fertility pattern:
(i) Broad base narrow top, upright triangle (High proportion of younger population, seen in
developing countries).
Example: India.
(ii) Bulge in middle, spindle shape (High proportion of adults, seen in developed countries).
Example: Switzerland
• Height of population pyramid indicate life expectancy.
- Taller pyramid - higher life expectancy (developed countries)
- Shorter pyramid - lower life expectancy (developing countries)
(ii) Sex Ratio
• Sex ratio is defined as number of females per thousand males
No.of Females
Sex ratio = ×1000
No. of Males
• Sex ratio in India according to census 2011 is 943; in rural India 947; Urban India 926.
• Importance of Sex Ratio
 Important & Sensitive Indicator of Status of women.
 Indicator of sex preference among populations.
 Indicator of female feticide (if any)
 Indicator to assess impact of public health programs related to girl child and women overall.
(iii) Dependency Ratio
• The proportion of persons above 65 years of age and children below 15 years of age are considered
to be dependent on economically productive age group (15-64) years.
•
It is also know as "Societal Dependency Ratio" (SDR).
Population < 15 years + population > 65 years
Dependency Ratio =
Population 15 - 65 years
• As dependency ratio increases, there is increased strain on the productive part of the population to
support the upbringing and pensions of the economically dependent.
• Dependency ratio (India) = 53 per 100; 100 earning people in India are supporting 153 people (100
themselves and 53 non-earning dependents on them).
15
 • Demographic bonus: The period when the dependency ratio in a population declines because of
decline in fertility, until it starts to rise again because of increasing longevity.
• Demographic Burden: Increase in total dependency ratio during any period of time, mostly caused by
increased old age dependency ratio.
(iv) Density of Population
• Density is defined as the number of persons living per square kilometre.
• It is the ratio between total population and surface (land) area.
• Density of population (India) = 464 persons/km2.
(v) Urbanization
• Urban population is the number of persons residing in Urban localities.
• Urban areas are the towns (places with municipal corporation, municipal area committee, town
committee, notified area committee or cantonment board); also, all places having 5,000 or more
inhabitants, a density of not less than 1,000 persons per square mile or 390 per square kilometre,
pronounced urban characteristics and at least 3/4th of the adult male population employed in
pursuits other than agriculture.
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(vi) Family Size

• In demography, family size means the total number of children a women has borne at a point in time.
• The completed family size indicates the total numbers of children borne by a women during her
child bearing age, which is generally assumed to be between 15 & 45 years.
• Family size depends upon numerous factors like duration of marriage, education of the couple, the
number of live birth and living children, desired family size, etc.
(vii) Literacy
• Literate : Any person who can read and write, with understanding in any language of India and who
is > 7 years of age.
Number o f literate person × 100
Crude literacy rate =
Total population in a given year

• Literacy rate in India is 74.04% (census 2011).

Number o f literate persons aged 7 and above × 100
Effective literacy rate =
Population aged 7 and above in a given year
(viii) Life Expectancy
• Life expectancy or expectation of life 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 prevalent in that country.
• Life expectancy to birth has continued to increase globally over the years.
• The life expectancy at birth for male is 68 years & 70 years for female in 2020.
FERTILITY
• Fertility means the actual bearing of children.
• A Woman's reproductive period is roughly from 15-45 years a period of 30 years;
• Fertility depends on several factors like age at marriage, Duration of marrieds life, spacing of children
Education, economic status, cast and religion, Nutrition, Family planning etc.
Fertility Related Indicators
• Fertility may be measured by a number of indicators:
(i) Birth Rate
• It is the simplest indicator of fertility.
16
 • Defined as "the number of live births per 1000 estimated mid year population, in a given year".
Number of lives births during the year
Birth Rate = ×1000
Estimated mid year population
(ii) General Fertility Rate
• It is the number of live births per 1000 women in the reproductive age group (15-44 or 49 years) in a
given year".
Number of live births in an area during the years
GFR = ×1000
Mid year female population age 15 - 44 years in the same area in same year
• GFR is a better measure of fertility than CBR (Crude Birth Rate).

(iii) General Marital Fertility Rate (GMFR)

• It is the number of live births per 1000 married women in the reproductive age group (15-44 or 49) in a
given year.
Number of live births in a year
GMFR = ×1000
Mid year married female population in the age group 15 - 49 years

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(iv) Age Specific Fertility Rate
• A more precise measure of fertility is age specific fertility rate, defined as the "number of live births
in a year to 1000 women in any specific age group".
Number of live births in a particular age group
ASFR = ×1000
Mid year female population of the same age group
(v) Total Fertility Rate (TFR)
• Average no. of children a woman would bear in her reproductive life span; also known as "Period
total fertility rate".
• Gives magnitude of approximately 'completed family size', number of alive children in a family.
• TFR in India = 2.2
• Our goal is to bring it down to 2.1 which is equivalent to two child norm (replacement level).
(vi) Gross Reproductive Rate (GRR)
• Measures the number of daughters a women would have in her lifetime if the experiences prevailing
age specific fertility, assuming no mortality.
• GRR is same as the NRR, except that, like the TFR, it ignores life expectancy.
• GRR of India is 1.0.
(vii) Net Reproductive Rate
• Measures the number of daughters a woman would have in her lifetime if the experiences prevailing
age specific fertility and mortality rates.
• Most important demographic fertility indicator.
• NRR = 1 (of India).
• To achieve NRR = 1 couple protection rate (CPR) should be > 60%.
• GRR or NRR = ½TFR(approx)
(viii) Pregnancy Rate
• It is the ratio of number of pregnancy in a year to married woman in the ages 15-44 (or 49) years;
• The number of pregnancies includes all pregnancies, whether these has terminated as live birth, still
births or abortions or had not yet terminated.
(ix) Abortion Rate
• The annual number of all types of abortions, usually per 1000 women of child bearing age (usually
defined as age 15-44).

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 CHAPTER

8 PREVENTIVE MEDICINE IN OBSTETRICS,

PAEDIATRICS AND GERIATRICS

BABY FRIENDLY HOSPITAL INITIATIVE 2018

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Figure
 A "Baby friendly hospital initiative (BFHL), created and promoted by WHO and UNICEF, has proved
highly successful in encouraging proper infant feeding practices, starting at birth.
 A package of policies and procedures that facilities providing maternity and newborn services should
implement to support breast feeding.
 There steps to successful breast feeding :-
(i) (a) Comply fully with the international code of marketing of breast milk substitutes and relevant
world health assembly resolutions.
(b) Have a written infant feeding policy that is routinely communicated to staff and parents.
(c) Establish ongoing monitoring and data management system.
(ii) Ensure that staff have sufficient knowledge, competence & skills to support breast feeding.
(iii) Discuss the importance and management of breast feeding with pregnant women and their families.
(iv) Facilitate immediate and uninterrupted skin to skin contact and support mothers to initiate breast
feeding as soon as possible after birth.
(v) Support mother to initiate and maintain breast feeding & manage common difficulties.
(vi) Do not provide breast fed new borns any food or fluids other than breast milk, unless medically
indicated.
(vii) Enable mother and their infants to remain together and to practice rooming in 24 hours a day.
(viii) Support mother to recognize and respond to their infants cues for feeding.
(ix) Counsel mothers on the use and risk of feeding bottles, teats and pacifiers.
(x) Coordinate discharge so that parents and their infants have timely access to ongoing support and
care.
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 SCHOOL HEALTH SERVICES

• School health is an important branch of community health.

• While the health problems of school children vary from one place to another, surveys carried out in India
indicate that the main emphasis will fall in the following categories.

(i) Malnutrition (ii) Infectious diseases.

(iii) Intestinal parasites. (iv) Disease of skin, eye and ear.

(v) Dental caries.

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Figure
Objectives of School Health Service
The objectives of the programme of a school health service are as follow :
(i) The promotion of positive health.
(ii) The prevention of disease.
(iii) Early diagnosis, treatment and follow up of defects.
(iv) Awakening health consciousness in children, and
(v) The provision of healthful environment.
ASPECTS OF SCHOOL HEALTH SERVICE
(i) Health Appraisal
It consists of periodic medical examinations and observation of children by class teacher.
(a) Periodic Medical Examination : School health committee in India recommended medical examination
of children at the time of entry and there after every 4 years.
 Initial examination should be through and include a careful history, physical examination, tests
for vision, hearing & speech, clinical examination for nutritional deficiency, intestinal parasitosis
etc.
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 (b) School Personnel : Medical examination should be given to teachers and other school personnel as
they form part of the environment to which the child is exposed.
(c) Daily Morning Inspection : The teacher carry out the "daily inspection", as he is familiar with children
and can detect changes in the child's appearance or behaviour that suggest illness or improper
growth & development.
(ii) Remedial Measures and Follow Up
 Medical examination should be followed by appropriate treatment & follow up.
 Special clinics should be conducted exclusively for school children at the primary health centres in
the rural areas, and in one of the selected schools or dispensaries for a group of about 5,000 children in
the urban area.
(iii) Prevention of Communicable Diseases
• Communicable disease control through immunization is the most emphasized school health service
function.
• A record of all immunizations should be maintained as part of the school health records; when the
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child leaves school, the health record should accompany him.

(iv) Healthful School Environment
• Minimum standards for sanitation of school and its environment in India include.
• Location : Away from noisy surrounding ; kept fenced.
Site : 5 acres for primary school ; 10 acres for higher elementary school.
Structure : Exterior walls 10 inch thick & heat resistant.
Classroom : 1 classroom per 40 students maximum.
Per capita Space : > 10 square feet.
Furniture : Single desks of minus (–) type.
Doors & window : Doors and windows are > 25% of floor area.
Colour : Inside colour of walls should be white.
Lighting : Natural light from left side.
Water Supply : Safe and potable and continuous supply through taps.
Lavatory : 1 Urinal per 60 students and 1 latrine per 100 students.
(v) Nutritional Services
(a) Mid Day School Meal : School health committee recommended that school children should be assured
of at least one nourishing meal.
Those who can afford it may bring their lunch packets from home, otherwise schools should have
some arrangement for providing mid-day meals through their own cafeteria on a 'no profit no loss'
basis.
(b) Applied Nutrition Programme : UNICEF is assisting in the implementation of the applied nutrition
programme in the form of implements, seeds, manure and water supply equipment.
(c) Specific Nutrients : Use of specific nutrients is indicated where nutrient disorders are problems in a
community.
(vi) First aid and emergency Care
Teachers should receive adequate training during "teacher training programmes" or "In service training
programme" to provide first aid and emergency care to pupils who become sick or injured on school premises.

20
(vii) Mental Health
The mental health of the child affects his physical health and the learning process ; Juvenile delinquency,
maladjustment and drug addiction are becoming problems among school children.
(viii) Dental Health
Dental caries and periodontal disease are the two common dental diseases in India ; A school health
programme should have provision for dental examination, at least once a year.
(ix) Eye Health Services
• Schools should be responsible for the early detection of refractive errors, treatment of squint and
amblyopia, and detection and treatment of eye infections such as trachoma.
• Basic eye health services should be provided in schools.
(x) Health Education
Health education in schools should cover the following areas.
(a) Personal Hygiene : The need for hygiene of skin, hair, teeth and clothing should be impressed upon

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them; attention to posture is also important.
(b) Environmental Health : Encouraging young people to take part in health activities and keep their
environment clean important function of school health services.
(c) Family Life : The school health services is concerned not only with the development of healthy lives
but also with healthy attitudes towards human reproduction.
(xi) Education of Handicapped Children
The ultimate goal is to assist the handicapped child and his family so that the child will be able to reach his
maximum potential, to lead as normal as possible, to become as independent as possible, and to become a
productive and self supporting member of society.
(xii) School Health Records
It should contain identifying data (name, date of birth, parent's name & address), past health history and
record of findings of physical examination.

EXAM PREPARATION QUESTIONS

LONG QUESTIONS
1. Explain the levels of Prevention and modes of intervention with suitable examples. 
8. What are the causes for perinatal mortality in India? Describe the preventive measures. 
22. Discuss the role of growth of monitoring in pre-school children 
SHORT QUESTIONS
26. Immediate care of new born 
27. Under-fives’ clinic. 
28. Low birth weight 
29. Juvenile delinquency 
30. Integrated Child Development Scheme (ICDS) 
31. Objectives of Under Five’s Clinic 
32. Healthful school environment 
33. Identification of ‘at risk’ infants 
34. School Health Programme 
21
 CHAPTER

9 NUTRITION AND HEALTH

POSHAN ABHIYAAN

In 2018, the Government of India launched its flagship programme, the POSHAN (Prime Minister’s Over-
arching Scheme for Holistic Nourishment) Abhiyaan, to draw national attention to and take action against mal-
nutrition, in a mission-mode.

POSHAN Abhiyaan is the Government of India’s flagship programme to improve nutritional outcomes
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for children, pregnant women and lactating mothers, and adolescents.

Figure: Pillars of POSHAN Abhiyaan

Figure: Targets of POSHAN Abhiyaan

Recognizing that malnutrition levels in India are high, POSHAN Abhiyaan attempts to deliver the
following features to fight against malnutrition.
22
1. A high impact package of interventions, focusing on (but not limited to) the first 1,000 days of child’s life.
2. Strengthening the delivery of a high impact package of interventions through:
 Remodelling nutrition monitoring by leveraging technology and management through the integrated
child development services common application software (ICDS-CAS) (now POSHAN Tracker Tool).
 Improving capacities of frontline workers through the incremental learning approach (ILA)
mechanism.
 Enphasising convergent actions among the frontline workforce.
3. A focus on cross-sectoral convergence to emphasise the multi-dimensional nature of malnutrition,
mapping of various schemes contributing towards addressing malnutrition.
 Convergence committees at the state, district and block levels will support decentralized and
convergent planning and implementation, supported by flexi-pool and innovation funds to encourage
contextualised solutions.
4. Ramping up behaviour change communication and community mobilisation through Jain Andolan, a
national nutrition behaviour change compaign that uses community-based events, mass media and other
approaches.
MID DAY MEAL PROGRAMME

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l The mid day meal programme is also known as school lunch programme.
l It has been in operation since 1961
l Objectives
l Improves the nutritional status of school children.
l Encourage poor children to attend school more regularly and
help them concentrate on class room activities.
l Provide nutritional support to children of primary stage in
drought affected areas during summer vacation.
Principles for Formulating Mid day Meals
l Meal should be a supplement only, not a substitute for home diet.
l Meal should provide 1/3 calorie and 1/2 proteins.
l Meal cost should be low.
l Complicated cooking process must not be involved.
l Use locally available foods.
l Keep changing menu frequently.
l Model Menu

Food Stuff g/day/child

Cereals & Millets 75

Pulses 30

Oils & fats 8

Leafy vegetables 30

Non leafy vegetable 30

l The National institute of Nutrients is of the view that the minimum number of feeding days in a year
should be 250 to have the desired impact on the children.
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 CHAPTER

11 ENVIRONMENT AND HEALTH

HORROCK'S APPARATUS
• Horrock's Apparatus is used to find out the dose of bleaching powder required for disinfection of water
(chlorine demand of water).

• Content :
6 White cups (200 ml capacity each)
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1 black cup with a circular mark on inside

2 metal spoons
7 glass stirring rods
1 pipette, 2 droppers
Figure
Starch iodide indicator solution
Procedure
Take one level spoonful (2g) of bleaching powder in the black cup; add water and make up the volume
upto circular mark with vigorous stirring.
↓
Allow to settle; this is stock solution
↓
Fill the 6 white cups with water to be tested, upto about a cm below the brim
↓
With pipette add 1 drop of stock solution to 1st cup, 2 drops of stock solution to 2nd cup, 3 drop to 3rd cup & so
on.
↓
Stir the water in each cup using a separate rod.
↓
Wait for half an hour for action of chlorine
↓
Add 3 drops of starch iodide indicator to each white cup and stir again
↓
Note the first cup which shows distinct blue colour
• Development of blue colour indicates the presence of free residual chlorine.
• Suppose 3rd cup shows blue colour first, then 3 level spoonfuls or 6 grams of bleaching powder would be
required to disinfect 455 litres of water.
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CONTROLLED TIPPING
• It differs from ordinary dumping in that the Material is placed in a trench or other prepared area,
adequately compacted, and covered with earth at the end of the working day.
• Normally it takes 4 to 6 months for complete decomposition of organic matter into an innocuous mass.
Methods of controlled Tipping

The trench method Ramp method The area method

A long trench is dug out 2-3 m

deep & 4-12 m wide; refuse is
compacted & covered with exca-
vated earth; it is estimated that
one acre of land per year will be
required for 10,000 population;
this method is used where level
This method is well suited where
the terrain is moderately sloping;
some excavation is done to secure
the covering material.
It is used for filling land depres-
sion, disused quarries and clay
pits; the refuse is deposited,
packed and consolidated in uni-
form layers; Each layer is sealed
on its exposed surface with a

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ground is available mud cover at least 30 cm thick

Figure

EXAM PREPARATION QUESTIONS

LONG QUESTIONS
1. Describe the effects of heat stress and their prevention. 
2. What are the sources of air pollution in India. Describe the strategies for prevention and 
control of air pollution
SHORT QUESTIONS
12. Break Point Chlorination. 
13. Oxidation pond 
14. Sanitation Barrier. 
15. Swimming pool sanitation 
16. Rapid sand filters 
17. Effects of noise 
18. Anti – Rodent measures. 
19. Noise control measures. 
20. Superchlorination 
21. Antimosquito measures. 
22. R.C.A. type of Latrine 
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 CHAPTER

14 OCCUPATIONAL HEALTH

LEAD POISONING
• Lead poisoning is known as plumbism, saturnism or painter's colic.
• Greatest source: Gasoline / Petrol / Vehicular exhaust / Automobile exhausts.
• All lead compounds are toxic - lead arsenate, lead oxide and lead carbonate are most dangerous, lead
sulphide is least toxic.
The body store of lead in the average adult population is about 150-400 mg and blood levels average about
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•
25 µg / 100 ml.
• An increase to 70 µg / 100 ml blood is generally associated with clinical symptoms.
Lead is used widely because of its properties.
(i) Low boiling point.
(ii) Anticorrosive.
(iii) Easily oxidised.
(iv) Mixes with other metals easily to form alloys.
Modes of absorption
(i) Inhalation (Most common mode)
(ii) Ingestion (Less common)
(iii) Skin (Absorption through skin occurs only in respect of the organic compounds of lead).
Clinical features
(i) Facial pallor: Earliest and most consistent sign.
(ii) Anemia: Microcytic hypochromic
(iii) Punctate basophilia or basophilic stippling of RBC.
(iv) Burtonian line: blue line on gums.
(v) Lead colic: Constipation.
(vi) Lead palsy: Wrist drop or foot drop.
Figure
(vii) Lead encephalopathy.
Diagnosis

History (History of lead Clinical features Laboratory findings

exposure) (Abdominal colic, • Coproporphyrin in urine > 150 mcg/L
constipation, loss of • Amino levulinic acid in urine > 5mg/L
appetite, wrist drops, • Lead in blood > 70 mcg/100 ml.
stippling of red cells) • Lead in urine > 0.8 mg/L

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 CHAPTER

17
BAR CHARTS
HEALTH INFORMATION AND BASIC MEDICAL
STATISTICS

• Bar charts are merely a way of presenting a set of numbers by the length of a bar – the length of the bar is
proportional to the frequency of the variable.
• Bars can be drawn horizontally or vertically.
• There are three types of bar diagram: Simple, multiple and component bar diagram.

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Figure
Bar Chart

Simple bar chart Multiple bar chart Component bar chart

Bars may be vertical or
horizontal
Width of each bar is same
Distance between two
bars is at least half the
width of the bars.
Two or more bars can
be grouped together.
The bars may be divided
in two or more parts,
each part representing a
certain item and propor-
tional to the magnitude of
that particular item.

SAMPLING

• Selection of a subset of individuals from within a statistical population to estimate characteristics of the
whole population.

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 Types of Sampling
Sampling Method

Non purposive sampling/Probability Non probability sampling method/Non

Sampling Method/Random sampling random sampling/Purposive sampling

Simple random sampling Quota sampling

Systematic random sampling
Covenience sampling
Stratified random sampling
Snow ball sampling
Multistage random sampling
Cluster random sampling Clinical trial sampling
Multiphase random sampling

Simple Random Sampling

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• Every unit of population has equal and known chance of being selected
• It is also known as "unrestricted random sampling".
• Applicable for small, homogenous and readily available population.
• Methods of simple random sampling:
(i) Lottery method (ii) Random number of tables (iii) Computer softwares.
• Used in clinical trials.
Systematic Random Sampling
• This is done by picking every 5th or 10th unit at regular intervals
• Sampling interval (k) = total number of units in population / total number of units in sample
• Applicable for large, non homogenous population where complete list of individuals is available.
Stratified Random Sampling
• Non homogenous population is converted to homogenous groups / classes (strata); sample is drawn from
each strata at random, in proportion to its size.
• Applicable for large non-homogenous population.
• This method is particularly useful where one is interested in analysing the data by a certain characteristic
of the population, viz Hindus, Christian, Muslims, age-groups etc as we know these groups are not equally
distributed in the population.
Multistage Random Sampling
• It is done in successive stages: each successive sampling unit is nested in the previous sampling unit.
• This method is useful in situations where a large population is to be covered.
• Advantage: introduces flexibility in sampling
• For example, in large country surveys, states are chosen, then districts, then villages, then every 10th
persons in village as final sampling unit.
Cluster Random Sampling
• Applicable when units of population are natural groups or clusters.
• Use: Evaluation of immunization coverage
• Clusters are heterogenous within themselves but homogenous with respect to each other
• Accuracy : Low error rate of only ±5%.
• Limitations : Clusters cannot be compared with each other.
Convenience Sampling
• Patients are selected, in part or in whole, at the convenience of the researcher;
• For example, standing at a shopping mall and selecting shoppers as they walk by to fill out a survey
Quota Sampling
• Population is first segmented into mutually exclusive subgroups (quotas) just as in stratified sampling;
then judgement is used to select the units from each group non-randomly.
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 CHAPTER

18 COMMUNICATION FOR HEALTH EDUCATION

HEALTH EDUCATION

• DEFINITION : Health education is defined as "a process aimed at encouraging people to want to be healthy,
to know how to stay healthy, to do what they can individually and collectively to maintain health, and to
seek help when needed".
• The definition adopted by John M last is "the process by which individuals and groups of people learn to

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behave in a manner conducive to the promotion, maintenance or restoration of health".
• Health education is the part of health care that is concerned with promoting healthy behaviour.
• CHANGING CONCEPTS : (Alma - Ata Declaration, 1978);
Old Emphasis → New Emphasis
Prevention of disease → Promotion of healthy lifestyle
Modification of individual behaviour → Modification of social environment
Community Participation → Community involvement. Promotion of
individual & community self reliance
Group Discussion
• A group is an aggregation of people interacting in face to face situation.
• For effective group discussion
 Group should comprise 6-12 members
 1 group leader (to initiate discussion, help discussion in a proper manner, prevent side
conversation, encourage everyone to participate & sums up the discussion)
 1 recorder (to record, report on issues discussed and agreements reached).
• Rules to be followed
 Listen to what others are saying
 Express idea clearly & concisely
 Do not interrupt when others are saying
 Accept critism gracefully A Well Conducted A Dominated
 Help to reach conclusion. Group Discussion Group Discussion

• Advantages
 Effective method of health communications
 Permits learning by free exchange of ideas, knowledge and opinion.
 Provides a wider interaction among members.
• Limitations
 Those shy may not take part in discussion.
 Some may deviate from subject & make discussion unprofitable.

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 CHAPTER

19
JUNGALWALLA COMMITTEE, 1967
HEALTH PLANNING AND MANAGEMENT

This committee, known as the “Committee on Integration of Health Services” was set up in 1964 under the
chairmanship of Dr. N Jungalwalla, the then Director of National Institute of Health Administration and Edu-
cation (Currently NIHFW). It was asked to look into various problems related to integration of health services,
abolition of private practice by doctors in government services, and the service conditions of Doctors. The com-
mittee defined “Integrated health services” as:
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a) A service with a unified approach for all problems instead of a segmented approach for different prob-
lems.

b) Medical care and public health programmes should be put under charge of a single administrator at all
levels of hierarchy.
Following steps were recommended for the integration at all levels of health organisation in the country.
 Unified Cadre
 Common Seniority
 Recognition of extra qualifications
 Equal pay for equal work
 Special pay for special work
 Abolition of private practice by government doctors
 Improvement in their service conditions.

CHADHA COMMITTEE, 1963

This committee was appointed under chairmanship of Dr. M.S. Chadha, the then Director General of
Health Services, to advice about the necessary arrangements for the maintenance phase of National Malaria
Eradication Programme.
The Committee Recommended
• ‘Vigilance’ operations under NMEP Should be the responsibility of the general health services i.e. Primary
health centres at the block level.
• Vigilance operations included:
– Monthly home visits to identify fever cases to be carry out through separate workers the ‘basic health
workers’.
– One basic health worker per 10,000 population was recommended.

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 CHAPTER

20 HEALTH CARE OF THE COMMUNITY

Millennium Development Goals

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Figure
• Members & representatives of 189 countries met at the headquarters of the United Nations in New York
in September 2000 in the "Millennium Summit".
• They discussed the world situation and recognized that, there is a collective responsibility of all society
and community to uphold the principles of human equality, human equality and human dignity at global
level.
• To fulfil the responsibilities and duties towards world's people, they set a global development agenda
with 8 goals to be achieved by 2015, which are known as Millennium development goals (MDG).
• A revised indicatory - framework on MDGs came into effect from January 2008; this framework had 8
goals, 21 targets and 60 indicators.
• The 8 goals are
(i) Eradicate extreme poverty and hunger
(ii) Achieve universal primary education
(iii) Promote gender equality and empower women
(iv) Reduce child mortality
(v) Improve maternal health
(vi) Combat HIV/AIDS, malaria and other communicable diseases.
(vii) Ensure environmental sustainability
(viii) Develop a global partnership for development.
• However, all the set could not be achieved; none the less, some of the silent achievement are as follows;
 Number of people living in extreme poverty has declined by more than half.
 Increase in primary school enrolment rate and enrolment of girls.
 Decrease in child mortality rate
 Death related to pregnancy and childbirth fell by more than 40%
 HIV, Tuberculosis and Malaria targets were mets.
 Target for drinking water was met, with 91% of the global population using an improved drinking
water source.

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 INDEX

A Biomedical Concept 1 Counselling and Appropriate Referral for Safe

abortion Services (MTP) 477
Botulism 122
Country Scenario 223
Active Surveillance 14 Breast Feeding 282
Couple Protection Rate (CPR) 259
Acute Flaccid Paralysis (AFP) 105
COVID-19 Dead Body Management 94
Adolescent Health 249 C Criteria for Screening 67
Adolescent Health Programme 250 Criteria of Disease 67
Advantages and Disadvantages in Cohort Study Carriers 44 Criteria of Screening Test 68
35 Case Definitions 91 Acceptability 68
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Advantages Over ICD -10 18 Case Detection 67 Repeatability 68

Validity (accuracy) 68
Age Specific Death Rate 7 Case Fatality Rate 23
Crude Death Rate 6, 23
Aims and Objective 66 Case Fatality Rate (CFR) 7
Cutaneous Diphtheria 81
Air Borne 46 Cessation Experiment 39
Cessation of Exposure 42
Air Pollution 371 D
Amrit 239 Chadha Committee, 1963 468
Characteristics of indicators 6 Data Analysis 60
Analysis 31, 35
Chemical Agents 57 Day Carriers 53
Animal Reservoir 45
Chemical Hazards 414 Decontamination 56
Anmol 237
Child Health 249 Deep Freezer (DF) 51
Antenatal Visits 274
Classical Dengue Fever [Break-bone Fever] 132 Defining The Disease Under Study 27
Anthropology 343
Classification of Leprosy 219 Defining The Population 27
Anti Adult Method 395 Defining The Population at Risk 59
Cleaning 56
Antiseptics 56 Clinical Manifestation 90 Demographic Cycle 255
Antiviral drugs 80 Clinical Trial 39 Demographic Indicates 256
Artificial Feeding 282 Cold Boxes 53 Dengue Fever 134
Asepsis 55 Combinations 50 Dengue Haemorrhagic Fever 132, 134
Aspects of School Health Service 293 Combination Vaccine 50 Dengue Shock Syndrome 134
Design of COHORT STUDY 36
Assessment 39 Community Diagnosis 42
Design of RCT 40
Community Intervention Trial 39
Determinants of Disease 21
B Comparison With Known Indices 30
Diagnosis of COVID-19 91
Completing The Natural History of Disease 43
Diagnosis of Tuberculosis in RNTCP 221
Bacillus Cereus Food Poisoning 123 Condom 261
Diaphragm 262
Bar Charts 440 Confirmation of The Existence of an
Difference Between Case Controls Study and
Epidemic 59
Basic steps in case control study 30 Cohort Study 36
Confounding 37
Baye's Theorem 69 Diphtheria Immunization 82
Consistency of Association 42 Direct contact 45
BCG Vaccination 102
Contact With Soil 46 Disability Adjusted Life Years (DALY) 8
Before and After Comparison Studies 40
Control of AIDS 182 Disability Limitation 17
Behavioural and Socio-cultural Condition 5
Control of Cholera 115 Disability Rates 8
Behaviour Surveillance 14
Control of Diphtheria 81 Disease Frequency 21
Bhore Committee, 1946 466
Control of Disease 67 Disinfection 55
Bias 37
Control of Reservoir 120 Distribution of Disease 21
Bias in Case Control Study 32 Control of Typhoid Fever 119 Domestic Refrigerator (Front Load
Biological Determinant 5 Control of Yellow Fever 153 Refrigerator) 52
Biological Hazards 414 Cost Benefit Analysis (CBA) 465 Dose Response Relationship 42
Biological Plausibility 42 Cost Effective Analysis (CEA) 465 Droplet Infection 45

32