Principles of Community Health PDF

11-Nov-22
‫ﻣﺑﺎﺩﺉ ﺻﺣﺔ ﺍﻟﻣﺟﺗﻣﻊ‬

Principles of Community Health (Code:100637)
1- Health and disease
Prof. Dr. Wael M. Lotfy
Acting Dean of Faculty of Nursing
Alexandria University – Matrouh Branch
waelotfy@alexu.edu.eg
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1- Health
• It is a dynamic state of complete physical ‫ﺟﺴﺪﻱ‬, mental ‫ ﻋﻘﻠﻲ‬, spiritual ‫ﺭﻭﺣﺎﻧﻲ‬, and social
‫ ﺍﺟﺘﻤﺎﻋﻲ‬well-being, and not merely the absence of disease or infirmity ‫( ﻋﺠﺰ‬World Health
Organization, 1998).
Models of health:
1- The biomedical model: Health has been viewed as an absence of disease. Developments
in medical and social sciences lead to the conclusion that the biomedical concept of health
was inadequate.
2. The ecological model: Health is a dynamic equilibrium between man and his
environment. Disease: maladjustment of man to the environment. The concept supports the
need for clean air, safe water, ozonic layer in the atmosphere, etc. to protect us from
exposure to unhealthy factors.
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3- The psychological model: Health is not only a biomedical phenomenon, but also is
influenced by social psychological cultural, economic and political factors of the people
concerned. Health is both biological and social phenomenon.
4- The holistic ‫ ﻛﻠﻲ‬model: The holistic model is a synthesis ‫ ﺑﻨﺎء‬of all the above concepts. It
is a multidimensional process involving the well-being of person in relation of his
environment. It means that all sectors of the society have an effect on health.
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Health components/dimensions:
1. Physical component:
• It is the state of perfect functioning of body, or the state in which every
cell and every organ is functioning at optimum capacity and in perfect
harmony with the rest of the body.
2. Mental component:
• It is a state of balance between the individual and the surrounding
world.
• Easy to notice if its grossly ‫ ﺑﺸﻜﻞ ﺿﺨﻢ‬abnormal but difficult in minor
disturbances.
• Distinction between mental and physical health is artificial.
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Health components/dimensions (cont.):

3. Social component:
• It is an aspect of health that includes social relationships as part of
broader concept of health.
• Social component includes trust, social interactions and social
connections.
4. Spiritual component: it includes integrity ‫ﺍﻻﺳﺘﻘﺎﻣﺔ‬, ethics and

principles and the purpose of life.
5. Emotional component: it is related to feelings.
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Health components/dimensions (cont.):

6. Vocational ‫ ﻣﻬﻨﻲ‬component: it is related to work. Work is associated
with improvement in physical capacity and considered source of
satisfaction and self esteem, in other words, it is part of human
existence.
7. Socioeconomic component.
8. Cultural component.
9. Environmental component.
10. Educational component.
11. Nutritional component.
12. Curative component.
13. Preventive component.
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Factors influencing health:

1. Internal factors:
• Biologic factors: genetic makeup ‫ ﺑﻨﻴﺔ‬, sex, and age.
• Psychological emotional factors: include mind-body interactions and self-
concept ‫ﻣﻔﻬﻮﻡ ﺍﻟﺬﺍﺕ‬.
• Cognitive factors ‫ﻋﻮﺍﻣﻞ ﻣﻌﺮﻓﻴﺔ‬: include lifestyle choices, religions, and beliefs.
2. External factors:
• Environment: include safe water, clean air, safe house and healthy work place
• Standards of living: occupation, income, and education.
• Family and cultural beliefs: patterns of daily living and lifestyle.
• Social support networks: family, friends, or confidant (best friend) and job
satisfaction helps people avoid illness.
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2- Disease
• Is a medical term, meaning that there is a pathological condition in the structure, or
function of body or mind.
Illness:
• It is an abnormal process in which the person’s level of functioning is changed when
compared with a previous level. Illness is classified as either acute or chronic.
• Patients suffer “illnesses”; doctors diagnose and treat “diseases”.
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• Acute illness: An acute illness generally has rapid onset of symptoms and lasts only
relatively short time (does not last longer than six months).
• Chronic illness: It is a broad term that encompasses ‫ ﻳﺸﻤﻞ‬many different physical

and mental alterations in health. It has one of the following characteristics:
1. It is a permanent change.
2. It is caused by irreversible alterations in normal anatomy and physiology.
3. It requires special patient education for rehabilitation.
4. It requires a long period of care or support.
Wellness ‫ﺍﻟﻌﺎﻓﻴﺔ‬:
• It is a more active state, oriented toward maximizing the potential ‫ ﺟﻬﺪ‬of the
individual, regardless of his or her state of health.
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• Disease control aims at reducing:

1. The incidence of the disease
2. The duration of the disease and the risk of transmission
3. The effects of infection including both the physical and psychological
complication.
4. The financial burden to the community.
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Thanks for your attention
Wael M. Lotfy
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2- The family
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The family
• The family is the basic unit of the society.
• It is a group of individuals sharing emotional bonds, a history, and a future.
• This group accomplishes special functions or tasks, including; provision for
security and survival, socialization of children, and support for individual growth.
Structure of the family: There are three main structural types of the family:
a) Nuclear family: A family composed of male and female partners in a socially
and religiously accepted sexual, relationships, and their own biological
offspring.
b) Extended family: A family of more than two generations. This occurs when
tile two partners live with their children’s grandparents.
c) Polygamous family: A family of more than one wife (i.e. two or more wives)
living together.
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• Family lifecycle:
There are three main developmental stages that characterize family cycle:
a) Evolution phase: Starts by the courtship ‫ ﻣﻐﺎﺯﻟﺔ‬and ends by marriage.
b) Maturation phase: Starts by the birth of the 1st child (extension) and ends by the birth
of the last one (complete extension).
c) Degeneration phase: Starts when one of the children leaves home, by marriage,
travel, or death (contraction), and ends by the dissolution of the family by the death
of the spouses (dissolution).
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Functions of the family

1. Biological:
a) Reproduction and childbearing ‫ﺍﻹﻧﺠﺎﺏ‬.
b) Rearing children.
c) Nutrition of family members.
d) Protection of health.
e) Recreation.
2. Psychological:
a) Emotional security.
b) Sense of identity.
c) Maturation of personality.
d) Psychological protection.
e) Ability to make relationships outside the family.
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Functions of the family (cont.)

3. Socio-cultural:
a) Traditions ‫ ﺍﻟﺘﻘﺎﻟﻴﺪ‬and morals ‫ﺍﻷﺧﻼﻕ‬.
b) Socialization of children.
4. Economic:
a) Resources.
Factors affecting the family health

a) Family size.
b) The age distribution.
c) Educational status of family members.
d) Socioeconomic conditions.
e) Housing conditions.
f) Social interactions.
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High risk families
a) Very poor family.

b) The young family with working mother.
c) The migrant ‫ ﺍﻟﻤﻬﺎﺟﺮ‬families.
d) Family with genetic risk or handicapped members.
e) Mother under 16 or over 40 years of age.
f) Mothers have nutritional problems such as anemic, under weight or
over weight.
g) Mothers with health problem: such as hypotension, infectious
diseases and cardiac diseases.
h) Infant with low birth weight.
i) Infant with congenital malformation.
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3- Community health
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Definitions:
• Community: Group of people who have common characteristics.
• Community health: the health status of a defined group of people, and the actions
and conditions, both private and public, to promote, protect and preserve their
health.
Importance of community health:

1. Promotion and protection of the population’s health.
2. Improving quality of life to enable members of the community to be productive,
and to do things with enjoyment ‫ ﺍﺳﺘﻤﺘﺎﻉ‬and gratification ‫ ﺭﺿﺎ‬.
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Factors affecting community health:

1. Environmental factors.
2. Social, cultural and behavioral factors: such as beliefs, traditions
and socioeconomic status.
3. Organizational factors.
4. Agricultural and technological factors.
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Community health services and facilities:

I. Community health services:
1. Family health services: services for..
• Children such as vaccination and care for sick child.
• Women such as family planning & antenatal care.
• All ages such as dental and emergencies service.
• Public health such as registration birth and deaths.
• Establishing centers for continuous medical training and education.
2. School health services: includes..

• Provision of healthy environment in schools.
• Preventive health services such as medical examination, and students’ health
assessment.
• Curative health services.
• School health education.
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I. Community health services (cont.):

3. Communicable disease control: is responsible for controlling and preventing disease
such as health education, immunization, protection of water and milk and other food
supplies.
4. Endemics and parasitic disease control: treatment of endemic and parasitic diseases.
5. Environmental sanitation: it means control of all factors in the environment that affect
the health of the public, which includes control noise and air pollution, insect control
and waste disposal.
6. Health education: to increase public knowledge, attitudes and practices.
7. Medical care: diagnosis, treatment and follow up of diseases.
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II. Community health facilities:

1. Family health services such as family health centers and units.
2. School health services: such as school health clinics and students’
hospitals.
3. Communicable disease control: health offices, fever hospitals,
infectious disease.
4. Endemic and parasitic diseases control: units of malaria and specialized
hospital.
5. Health education: health education offices.
6. Environmental sanitation: environmental sanitation units and health
offices.
7. Medical care: such as health centers, specialized and general hospitals.
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III. Health facilities in rural areas:

1. Rural health units (provide outpatient health services).
2. Rural health centers (provide inpatient health services).
3. Rural hospitals.
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4- Health promotion
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Health promotion
• It is the process of enabling people to increase control over and to improve their
health.
• Health promotion is described as the science and art of helping people change
their lifestyle to move toward a state of optimal health (WHO).
• Optimal health is defined as a balance of physical, emotion, social, spiritual and
intellectual health.
• Lifestyle change can be made easier through a combination of efforts to
increase knowledge, change behavior and create environments that support
good health practices.
• Health promotion is guided by the principle: “making healthy choices easy,
early, exciting and everywhere”.
• Good health is essential to enable us to concentrate on everyday life, work,
family, hobbies etc.
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Healthy lifestyle
• Lifestyle is a way of living based on identifiable patterns of behavior which are

determined by the interplay between an individual’s personal characteristics,
social interactions, and socioeconomic and environmental living conditions
(WHO).
• The WHO definition further stated that there is no one optimal lifestyle and that
many factors determine which way of living is appropriate for each individual.
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Factors affecting choice of a healthy lifestyle
1. Socioeconomic status
2. Level of education
3. Family, kin ‫ﺍﻟﻌﺸﻴﺮﺓ‬/‫ ﺍﻷﻫﻞ‬and social networks
4. Gender
5. Age
6. Interpersonal influences ‫ﺍﻟﺘﺄﺛﻴﺮﺍﺕ ﺍﻟﺸﺨﺼﻴﺔ‬
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Lifestyles conducive ‫ ﻳﺆﺩﻱ‬to health
• Lifestyle consists of a person’s usual daily activities and routines that are
acceptable practices in the person's life.
• Such routines and habits influence health status. For example, consumption of
large amounts of caffeine, cigarette smoking, consistent intake of high-fat
foods, and a sedentary ‫ ﻛﺜﻴﺮ ﺍﻟﺠﻠﻮﺱ‬routine can adversely affect health status.
• Lifestyles are developed within one’s family and one’s cultural environment.
• The family is the primary influence on a child’s development of health-
promoting (or health-defeating) behaviors.
• When lifestyle modifications are necessary to improve health, many individuals
have difficulty in implementing the suggested changes.
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Components of healthy lifestyle
1. Proper nutrition (eating a healthy diet and weight control)

2. Regular exercises
3. Self care (personal hygiene)
4. Risk taking behaviors
a. Substance abuse
b. Smoking
c. Violence
5. Disease and injury prevention
6. Stress management
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5- Proper nutrition
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a. Substance abuse
b. Smoking
c. Violence
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Proper nutrition (eating a healthy diet and weight control)

Types of nutrients:
1. Macronutrients : proteins , fats and carbohydrate.
2. Micronutrients : vitamins and minerals.
Components of healthy diet:

1. Eating a variety of different foods.
2. Eating the right amount to maintain a healthy weight.
3. Eating enough amount of food rich in fibers.
4. Eating enough amount of fruits and vegetables.
5. Avoidance of food that contains a lot of fat.
6. Avoidance of too much sugar.
N.B. Overweight and obesity are considered consequences of unbalanced diet that
has high fat and sugar contents.
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The food pyramid
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Hazards of excess weight and physical inactivity

1. Heart disease.
2. Stroke ‫ﺍﻟﺴﻜﺘﺔ ﺍﻟﺪﻣﺎﻏﻴﺔ‬.
3. High blood pressure.
4. Diabetes.
5. Gallbladder disease.
6. Joint pain caused by excess uric acid.
7. Overweight and obesity can also cause interrupted breathing during sleep.
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Proper Nutrition
• Definition of nutrition: It is the process by which the body metabolizes and

utilizes nutrients.
• Importance of nutrition:
1. Maintain normal growth and development.
2. Maintain good health, both physically and mentally.
3. Decreases morbidity and mortality.
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Proper Nutrition (cont.)
• Factors affecting nutrition:

1. Age
2. Lifestyle
3. Culture and religious
4. Food preferences
5. Gender
6. Income
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Classification of nutrients
Types of nutrients Description Function
Release energy for maintenance

1. Energy nutrients Carbohydrates, Proteins and Fats.
of homeostasis ‫ﺍﻟﺗﻭﺍﺯﻥ‬.
1. Build and maintain body

2. Organic nutrients Carbohydrates, Proteins, Fats, Vitamins. tissues
2. Regulate body processes.
1. Provide a medium for

chemical reactions.
2. Transport materials.
3. Inorganic nutrients Water, Minerals.
3. Maintain body temperature.
4. Promote bone formation, and
conduct nerve impulses.
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Nutrients requirements:
• Understanding the role of basic nutrients provides the foundation for selecting
foods that promote health.
• There are six categories of nutrients: water, vitamins, minerals, carbohydrates,
proteins, and lipids (fats).
• Selecting the healthiest forms of each of these nutrients and eating them in
proper balance: enables the body to function at its optimal level of health.
• Nutrients work synergistically; for example, there is a cooperative action
between certain vitamins and minerals, that work as catalysts, promoting the
absorption and assimilation of other vitamins and minerals.
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Proteins
Clinical significances
Types Functions Dietary sources
(deficiencies)
1. Essential amino acids (8) 1. Building blocks of the 1. Animal sources : eggs, 1. Malnutrition in infants
cannot synthesized by the body. milk , meat, chicken and and children.
human body and must be 2. Provide structure fish. 2. Undergrowth in
provided by diet. framework for the skin, 2. Plant sources: dried children.
2. Non-essential amino acids hair, nails, cartilage, beans, peas, cereals, 3. Impaired immune
(12) when missing in diet, tendons and muscles. flour, rice and nuts. response.
they can be synthesized 3. Provide an important 4. More susceptibility to
by the body. structural part the infection.
3. High biological value bones 5. General weakness and
proteins (HBV): provides 4. Fluid balance: early fatigue.
the body needs of amino intracellular osmotic
acids. pressure.
4. Low biological value 5. Energy source
proteins: it is the protein
where some of essential
amino acids are either
missing or inadequate in
amount, so it cannot
maintain growth and
support life by itself.
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Carbohydrates
(deficiencies)
1. Simple sugars are either Primary source of energy 1. Foods containing sugar 1. Impaired brain
monosaccharides and starch: potatoes, functions.
(glucose, galactose, sweet potatoes, rice, 2. Increased ketone
fructose) or bananas, honey and dried bodies, producing
disaccharides (sucrose, fruits. acidosis.
maltose, lactose) 2. Refined products: sugar, 3. Poor wound healing.
2. Polysaccharides starch, cakes, macaroni.
(glycogen, cellulose,
starch)
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Fats
Functions Dietary sources Clinical significances
1. Essential for body’s absorption of fat soluble vitamins A, 1. Animal sources: full cream High cholesterol diet can
D, E and K. milk, cheese, egg yolk, lead to cardiovascular
2. Provide essential fatty acids needed for maintenance of fatty meat, fish and butter. diseases.
skin structure in young children. 2. Plant sources: olives, soya
3. Used to prepare and cook food to become more beans and nuts.
palatable. 3. Margarine is manufactured
4. Prolong emptying time of stomach. from vegetable oils.
5. Form the normal subcutaneous fat layer for insulation.
6. Give fat support of some organs.
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Vitamins
Types Functions Clinical significances (deficiencies)
1. Fat soluble vitamins Are tools used by the body to process 1. Poor wound healing.
(A,D,E,K). food. 2. Dry scaly skin.
2. Water soluble Vitamins 3. Increased risk of bruising ‫ﻛﺩﻣﺎﺕ‬ and
(B, C). hemorrhage.
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Minerals
(deficiencies)
1. Calcium 1. Calcium: Formation and 1. Calcium: milk products, shellfish, 1. Calcium: rickets (‫ )ﺍﻟﻛﺳﺎﺡ‬in
maintenance of bones and canned fish, some green children and osteoporosis
2. Iron teeth. vegetables. Vitamin D is needed for (‫)ﻫﺷﺎﺷﺔ ﺍﻟﻌﻅﺎﻡ‬.
absorption of calcium. 2. Iron:
3. Iodine 2. Iron: Normal functioning of vital 2. Iron: • Anemia due to diminished
process. • Animal: organ meat (heart, liver, hemoglobin content.
kidney), egg yolk, shellfish and lean • Hypoxemia (low oxygen
3. Iodine: an essential component meat. levels).
of thyroid hormones which • Plant: dried beans, nuts, green leafy 3. Iodine:
needed for tissue metabolism vegetables and molasses ( ‫ﺍﻟﻌﺳﻝ‬ • Goiter (enlarged thyroid )
and regulation of metabolic ‫)ﺍﻷﺳﻭﺩ‬. • Cretinism: due to
rate. • Vitamin C is needed for absorption of inadequate supply of fetus
iron. with iodine.
3. Iodine: seafood especially fish, raw
common salt, chiefly vegetables.
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Water
Functions Clinical significances

An important content of all living cells. Forms about 70% of the body weight.
It is necessary for life and needed for normal body Approximately 2.5 litters of water is needed daily for the
functioning. normal body functions.
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Malnutrition
• Definition: Is an impairment of health resulting from deficiency, excess or

imbalance of nutrient intake or body utilization. it includes over or under
nutrition.
• Over nutrition: as obesity and overweight
• Under nutrition: as anemia, rickets and goiter.
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Obesity
• Overweight and obesity are defined as

“abnormal or excessive fat accumulation that
may impair health”.
• Body mass index (BMI) – the weight in
kilograms divided by the square of the height
in meters (kg/m2) – is a commonly used index
to classify overweight and obesity in adults.
WHO defines overweight as a BMI equal to
or more than 25, and obesity as a BMI equal
to or more than 30.
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6- Regular exercises
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a. Substance abuse
b. Smoking
c. Violence
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Regular exercises
• Physical exercise is the performance of movements in order to develop or

maintain physical fitness and overall health.
• Frequent and regular physical exercise is an important component in the
prevention of some diseases such as cancer, heart diseases, cardiovascular
diseases, type 2 diabetes and obesity.
• Benefits:
1. Improve heart function and circulation.
2. Lowers blood pressure and blood cholesterol.
3. Helps manage diabetes.
4. Helps control weight.
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• Exercise is generally divided into three types depending on the overall effect
they have on the human body:
1. Flexibility exercises: such as stretching improve the range of motion of
muscle and joints.
2. Aerobic exercises: such as walking and running focus on increasing
cardiovascular endurance (‫ )ﻗﺪﺭﺓ ﺍﻟﺘﺤﻤﻞ‬and muscle density.
3. Anaerobic exercises: such as weight training increase muscle mass and
strength.
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7- Self care (personal hygiene)
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a. Substance abuse
b. Smoking
c. Violence
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Self care (personal hygiene)
1. Dental care: such as good tooth brushing habits, limited consumption of sugar
and sweets, avoid use of tobacco and regular dental examination.
2. Sleep: the average sleeping hours are 8 hours per day.
3. Check up: a routine physical examination is recommended at least twice
per year.
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Personal hygiene
• Hygiene is the science of health. Nurses are responsible for assuring that the
person’s hygienic needs are met. The type of hygienic care provided depends on
the person’s ability, needs, and practices.
• Definition: is the practice of keeping the body clean to prevent infection and
illness, and the avoidance of contact with infectious agents.
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• Importance of hygiene:
1. Promotes cleanliness.
2. Provide comfort and relaxation.
3. Improves self-image.
4. Increase personal moral.
5. Help in maintain normal body temperature.
6. Promotes good nutrition by keep mouth and gums healthy.
7. Promotes healthy skin by prevent infection and injuries of skin.
8. Reducing risk of infection by removing substances from the skin which help in
growing bacteria.
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• Hygiene practices :.
1. Bathing, brushing and flossing teeth.
2. Washing hands especially before eating.
3. Washing food before its consumption.
4. Clean food preparation surfaces before and after preparation of meals.
• Components of personal hygiene:

1. Hair care
2. Mouth care
3. Tooth brushing
4. Nail care
5. Foot care
6. Bathing
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• Factors influencing hygienic practices:

1. Body image: Body image is associated with the person’s emotions, mood, attitude
and values.
2. Social and cultural practices:
a. Social practices: Persons are socialized to their hygiene practices by family
practices in early childhood and socialization with people outside the family .
b. Cultural practices and beliefs: that are derived from family, religious, and
personal values developed during life.
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• Factors influencing hygiene practices (cont.):

3. Personal preference: Personal preferences influence when bathing occurs, what
products are used, and what type of bath is performed. For example, some persons
prefer to bathe in the morning to facilitate waking, while others prefer to bathe
before bedtime to encourage relaxation and sleep.
4. Socioeconomic status: The person’s hygienic practices may be influenced by his

socioeconomic status. Limited economic resources may affect the type, frequency,
and extent of hygiene practiced.
5. Knowledge: Its level influences the person’s understanding about the relationship
between hygiene and health.
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8- Risk taking behaviors
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a. Substance abuse
b. Smoking
c. Violence
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Risk taking behavior
It is defined as certain practice with potentially ‫ ﻣﺤﺘﻤﻞ‬destructive activity without

understanding the consequences.
• Substance abuse
• Smoking
• Violence
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Substance abuse:
Factors contribute to initial decision to use a substance:
1. Gender: since males use drugs more often and more highly than
females.
2. Increase leisure ‫ ﺍﻟﺮﺍﺣﺔ‬time.
3. Financial resources with lack of other recreational alternatives.
4. Poor self-esteem ‫ﺍﺣﺘﺮﺍﻡ ﺍﻟﺬﺍﺕ‬.
5. Psychological distress ‫ﻣﺤﻨﺔ‬.
6. Poor academic achievements.
7. Low religiosity ‫ﺗﻘﻮﻯ‬.
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Health hazards of smoking:

1. Increase risk of coronary heart disease.
2. Heart attacks ‫ﺃﺯﻣﺎﺕ ﻗﻠﺒﻴﺔ‬.
3. Cancer.
4. COPD (chronic obstructive pulmonary disease).
5. Stroke.
6. Narrow and damage blood vessels.
7. Special risks to pregnant women and their babies.
8. Blindness and other problems
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9- Disease and injury prevention
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a. Substance abuse
b. Smoking
c. Violence
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Disease and injury prevention
• Injury is a major cause of permanent disability and is associated with grief and
suffering.
• The key approaches to prevent injury:
1. Education.
2. Environment and product changes.
3. Legislation or regulations.
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Immunity and immunization
I. Immunity
Definition: Immunity refers to the ability of the human body to resist disease
agents and their toxins.
• Types of immunity:
a) Natural immunity: not depends on the presence of specific antibodies or antitoxins but
depends on anatomy and physiology of the body as tears , saliva and GIT secretions.
b) Acquired immunity: depends on formation of antibodies whether active or passive
immunity.
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I. Immunity (cont.)
A. Active immunity: The body has active role in the formation of antibodies:
• Naturally acquired active immunity (post infection community): the antibodies
formed as result of antigen invade the body through infection such as measles ,
mumps, rubella and meningitis.
• Artificially acquired active immunity (post vaccine active immunity): as result
of vaccine in which specific antigen is introduced to body that stimulate
antibody production.
B. Passive immunity: Immunity conferred by an antibody produced in another host.
It may be acquired naturally or artificially:
• Naturally acquired passive immunity: infant immunity from the mother as the
antibodies through the placenta.
• Artificially acquired passive immunity: the immunity induced by
immunoglobin of short duration, remain for 3 weeks, to neutralize toxins
already present in the body such as anti-tetanus serum.
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II. Immunization (vaccination)
• Definition:
• Vaccination is a method of giving antigen to stimulate the immune response through
active immunization.
• A vaccine is an immuno-biological substance designed to produce specific protection
against a given disease.
• A vaccine is "antigenic" but not "pathogenic".
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• Types of vaccines:
1. Live vaccines: which are made from live infectious agents without any amendment
(‫ )ﺗﻌﺪﻳﻞ‬as small pox, measles, mumps and polio (the Sabin) vaccines.
2. Attenuated live vaccines: virulent pathogenic organisms are treated to become attenuated
and avirulent but antigenic as BCG vaccine (‫)ﺗﻄﻌﻴﻢ ﺍﻟﺴﻞ‬.
3. Inactivated (killed vaccines): organisms are killed (or inactivated) by heat or chemicals,
but remain antigenic. They are usually safe but less effective than live attenuated
vaccines as typhoid and cholera vaccines.
4. Toxoids: They are prepared by detoxifying the exotoxins of some bacteria rendering
them antigenic but not pathogenic, as diphtheria and tetanus vaccines.
5. Polysaccharide and polypeptide (cellular fraction) vaccines: They are prepared from
extracted cellular fractions, e.g. meningococcal vaccine, from the polysaccharide antigen
of the cell wall, the pneumococcal vaccine from the polysaccharide contained in the
capsule of the organism, and hepatitis B polypeptide vaccine.
6. Surface antigen (recombinant) vaccines: It is prepared by cloning HBs Ag gene in yeast
cells where it is expressed. HBs Ag produced is then used for vaccine preparations as
hepatitis B vaccine.
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Routine immunization schedule
Vaccines Disease Age

BCG Tuberculosis ‫ﻣﺭﺽ ﺍﻟﺳﻝ‬ At birth until 3 months
DPT Diphtheria, pertussis ‫ ﺍﻟﺳﻌﺎﻝ ﺍﻟﺩﻳﻛﻲ‬, tetanus 2,4 and 6 months and booster does at 18
months
OPV Polio ‫ﺷﻠﻝ ﺍﻷﻁﻔﺎﻝ‬ At birth, 2, 4, 6, 9 months and booster dose at
18 months
Measles Measles ‫ﺍﻟﺣﺻﺑﺔ‬ 9 months
MMR Measles, mumps ‫ ﺍﻟﻧﻛﺎﻑ‬, rubella ‫ﺍﻟﺣﺻﺑﺔ‬ 18 months
‫ﺍﻻﻟﻣﺎﻧﻳﺔ‬
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10- Stress management
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a. Substance abuse
b. Smoking
c. Violence
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Stress management
Stress: is the body’s reaction to any changes that require an adjustment or response.
Stress management: is the application of methods to either reduce stress or increase

tolerance to stress.
Source of stress:
1. Physical stressors: such as hunger , thirst, heat, pain, cold , illness and injury.
2. Psychological stressors: frustration ‫ﺇﺣﺒﺎﻁ‬, anger, and worry.
3. Environmental stressors: polluted air, water, noise and crowding.
4. Social stressors: religion , unemployment.
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Mental health and stress

1-Mental health:
• It is a level of psychological well-being, or an absence of a mental disorder.
• It is the psychological state of someone who is functioning at a satisfactory
level of emotional and behavioral adjustment
• It is an absence of a mental disorder.
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Characteristics of mental health persons:

I. They feel good about themselves:
1. They are not overwhelmed ‫ ﻣﺜﻘﻠﻴﻦ‬by their own emotions fears, anger,
love, jealousy, guilt or worries.
2. They can take life’s disappointments in their strides ‫ﺧﻄﻮﺍﺕ‬.
3. They have a tolerant, easy-going attitude towards themselves as well
as others, and they can laugh at themselves.
4. They neither underestimate nor overestimate their abilities.
5. They can accept heir own shortcomings ‫ﻧﻘﺎﺋﺺ‬.
6. They have self-respect.
7. They feel able to deal with most situations.
8. They can take pleasure in simple everyday things.
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Characteristics of mental health persons (cont.):

II. They feel comfortable with other people:
1. They are able to give love and consider the interests of others.
2. They have personal relationships that are satisfying and lasting.
3. They like and trust others, and feel that others will like and trust
them.
4. They respect the many differences they find in people.
5. They do not take advantage (‫ )ﻳﺴﺘﻐﻞ‬of others nor allow others to take
advantage of them.
6. They feel they can be part of a group. They feel a sense of
responsibility to fellow human beings.
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Characteristics of mental health persons (cont.):

III. They are able to meet the demands of life:
1. They do something about their problems as they arise.
2. They accept their responsibilities.
3. They shape their environment whenever possible; they adjust to it
whenever necessary.
4. They do not fear the future.
5. They welcome new experiences and new ideas.
6. They use heir talents (‫)ﻣﻮﻫﺒﺔ‬.
7. They set realistic goals for themselves.
8. They are able to make their own decisions.
9. They put their best effort into what they do, and get satisfaction from
doing it.
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Factors influencing developing mental disorders:

1. Biological factors: family history of mental illness, birth defects,
genetic predisposition, gender and age.
2. Psychological factors: personality style, attitudes, psychological
stress, child neglect and abuse.
3. Socio-cultural factors: poverty, lack of social skills, rejecting
cultural or ethic group.
4. Environmental factors: exposure to toxins , drugs and pollution.
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Factors preventing mental disorders:

1. Internal protective factors: good health, high stress tolerance , average
or better intelligence, adequate learned skills, competence and
flexibility and positive perception and attitude towards events.
2. External protective factors: include healthy caring

family/friends/culture, supportive teacher, adequate income and
recreation.
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11- Food Hygiene
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Food safety and food-borne illness
• Food safety is an increasingly important public health issue.

• Governments allover the world are intensifying their efforts to improve food
safety.
• These efforts are in response to an increasing number of food safety problems and
rising consumer concerns.
• Food hygiene: It is the sanitary science which aims at studying methods for
production, preparation and presentation of food which is safe for the consumer
and of good keeping quality.
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Food safety and food-borne illness (cont.)

• Objectives of food hygiene:
1. To promote a safe and honestly presented food supply.
2. To protect consumers against being offered foods which are:
(a) Injuries to health.
(b) Unfit for human consumption.
(c) Adulterated ‫ ﻣﻐﺸﻮﺷﺔ‬or presented in a deceived ‫ ﺧﺎﺩﻋﺔ‬manner.
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• Definition of food contamination: Refers to the presence of harmful chemicals
and microorganisms in food which can cause consumer illness.
• Sources of food contamination:
1. Chemical contamination of foods such as radioactive, pesticide, asbestos,
antibiotics.
2. Sources of food contamination with microorganisms:
a) The human reservoir: when the skin and hands are not clean or lesions on
the hands such as boils, ulcers, abrasions, septic cuts and burns, sneeze or
coughing. The fecal excreta of diseases person and contaminated paper
with saliva when used for wrapping food.
b) The animal reservoir: rats, mice, cockroaches, flies, cat and dogs.
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• Sources of food contamination (cont.):
3. The environment:
a) Soil: animal waste, contaminated water, animal bodies and sewage.
b) Water: typhoid fever and cholera may be disseminated through food
contaminated from polluted waters.
c) Sewage: fish and other seafood may be also contaminated with pathogens
through sewage going to water.
d) Air: spoilage organisms as well as human pathogens may contaminate the
food through the air.
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Food poisoning
• Food poisoning is an acute illness caused by the ingestion of food containing
harmful bacteria. However, food may already have some bacteria when you
buy them.
• The term food poisoning describes a state in which the victim suffers an
acute attack of abdominal pain and diarrhea, which are sometimes
accompanied by vomiting and lasting usually 1-2 days (but sometimes a
week or more). The onset is usually sudden and may start as early as 2 hours
and up to 40 or more hours after eating the contaminated food.
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Types of food poisoning

1. Food itself may be poisonous, for example, some plants, fungi, and shellfish.
2. Allergic or sensitivity reactions to certain foods.
3. Microorganisms, most commonly bacteria or the poisons they form (called
toxins), present in food or drink, some of which survive the heat of cooking.
4. Chemical contamination may occur during food preparation. Acid foods can
dissolve metal from containers or utensil, for example, apples left in a
galvanized container could cause zinc poisoning.
5. Viral cause of food poisoning
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Food preservation
• Most kinds of food are readily decomposed by microorganisms unless special
methods are used for their preservation.
• Methods of food preservation:
1. Asepsis, or keeping out microorganisms.
2. Removal of microorganisms as filtration
3. Maintenance of anaerobic conditions.
4. Use of high temperatures: such as canning
5. Use of low temperatures such as freezing
6. Drying.
7. Use of chemical preservatives.
8. Mechanical destruction of microorganism, e.g., by grinding, high pressure, etc.
9. Irradiation.
10. Smoking
11. Heat treatment as pasteurization of milk
12. Combination of two or more of the above methods.
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12- Environmental Sanitation
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Environmental Sanitation
• Environment: includes all the physical, social, cultural, political and economics
conditions that influence life of the individual and community.
• Environmental sanitation: identification of both positive and negative factors in

the environment that may affect human being.
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Types of environmental sanitation
I. Housing
II. Ventilation
III. Lighting
IV. Water purification
V. Solid waste
VI. Water waste
VII.Vector control
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I. Housing
Principles of Healthy housing:
1. Provision of the safe water supply.
2. Provision of toilet facilities with minimal danger of transmitting disease.
3. Provision against sewage contamination.
4. Avoidance of unsanitary conditions.
5. Provision of facilities for keeping milk and food un- decomposed.
6. Provision of. sufficient space in sleeping rooms to minimize the dangers of
contact infection.
7. protection against accidents.
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II. Ventilation
Definition: is the process of providing and removing air by natural or mechanical
means.
Types of ventilation:
1. Natural ventilation: as windows.
2. Artificial ventilation: as fans and air conditions.
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Air pollution
• Air pollution is the introduction of chemicals, particulate matter, or biological

materials that cause harm or discomfort to humans or other living organisms, or
cause damage to the natural environment or built environment, into the
atmosphere.
• An air pollutant is known as a substance in the air that can cause harm to humans
and the environment. Pollutants can be in the form of solid particles, liquid
droplets, or gases. In addition, they may be natural or man-made.
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Air pollution (cont.)
• Health effects:
1. Increase mortality.
2. Increase morbidity.
3. Cystic fibrosis, an increased risk of pulmonary exacerbations, and
decrease in lung function.
4. Chronic obstructive pulmonary disease (COPD).
5. Effects on children: asthma, pneumonia and other lower respiratory
infections as well as a low initial birth rate.
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III. Lighting
• Basic types of lighting:
1. Natural light, e.g. sunlight
2. Artificial light, e.g. electricity, candles and oil lamps.
• Effects of lighting:
1. Eye and body fatigue.
2. Irritability.
3. Accidents.
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IV. Water purification

• Water resources:
1. Springs and wells
2. Shallow wells
3. Rains
4. Surface water as rivers.
• Characteristics of portable water:

A- Physical: odorless , colorless , clear, agreeable taste
B- Chemical:
1. Neutral or slightly alkaline.
2. No nitrites.
3. Metals within standards.
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IV. Water purification (cont.)

• Water treatment:
1. Coagulation : addition of a chemical coagulant as iron chloride.
2. Sedimentation (‫ﺍﻟﺘﺮﺳﻴﺐ‬: water is retained from 2-6 hours depending on the
water to be treated.
3. Filtration.
4. Disinfection with chlorine.
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V. Waste disposal
• Definition of waste:
1. Waste (also known as rubbish, trash, refuse, garbage, junk) is unwanted or
useless materials.
2. In biology, waste is any of the many unwanted substances or toxins that are
expelled from living organisms; such as urea, sweat or feces.
• Classification of waste:
1. Solid waste: kitchen garbage, rubbish, such as waste paper, bottle, and
other solid material.
2. Liquid waste: waste water from wash basins and kitchen sink .
3. Gaseous waste: They contain nuisance ‫ﺿﺎﺭ‬/‫ ﻣﺰﻋﺞ‬gases and dusts which
are produced in industries. Usually these wastes dispersed directly into
the atmosphere unless special treatment process are required.
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V. Waste disposal (cont.)

• Methods of waste disposal:
1. Dumping : It is the filling of low land with waste.
‫ﺇﻟﻘﺎء ﺍﻟﻨﻔﺎﻳﺎﺕ ﻓﻲ ﺍﻷﺭﺍﺿﻲ ﺍﻟﻤﺨﻔﻀﺔ‬
2. Sanitary landfill: earth fill in which the waste is isolated from the
environment until it is safe.
3. Compositing: It is a way of using the natural process of decomposition to
speed up the decay of waste.
4. Reduction : Treatment of the organic component of waste to produce grease
and solid residue as tankage which is used in some fertilizers.
5. Grinding and disposal with sewage : Garage is either ground in the house and
drained into the sewer or it is collected and ground in central municipal
grinding station or at the sewage treatment plant.
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V. Waste disposal (cont.)

• Methods of waste disposal (cont.):
6. Hog feeding : ‫ﺗﺮﺑﻴﺔ ﺍﻟﺨﻨﺎﺯﻳﺮ‬
7. Barging: Sea disposal.
8. Recycling: This method is based on the fact that city refuse often contains
many articles that can be effectively utilized if properly treated such as :
 Paper and rags are used in paper industry.
 Broken glass in molten and shaped into new glassware.
 Tins, sheet iron, scrap iron and other metals are effectively removed or
molten.
 Rubber and other unstable materials are also picked.
9. Incineration: ‫ﺍﻟﺤﺮﻕ‬
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Dumping
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Dumping
127
Sanitary landfill
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Compositing and Reduction
129
Grinding and disposal with sewage
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Grinding and disposal with sewage
131
Barging
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Barging
133
Barging
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Hog feeding
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Recycling
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Incineration
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VI. Vector control

• Vector:
An arthropod capable of transmitting a pathogen to man, or capable of causing
food to become unclean, unwholesome (‫)ﺿﺎﺭ‬, spoiled (‫)ﻓﺎﺳﺪ‬, adulterated (‫)ﻣﻐﺸﻮﺵ‬,
or unsafe for human consumption. The term “vector” refers to any arthropod that
transmits a disease through the feeding activity.
• Methods of Vector control:

a) Proper disposal of human and animal excreta.
b) Proper disposal of refuse/garbage to control flies and rodents.
c) Proper drainage to control breeding-place of mosquitoes.
d) cover water storage container and latrines to prevent them of becoming mosquito-
breeding places.
e) Establishing, physical barriers (house screens and bed nets) and wearing appropriate
clothing.
f) Using insecticides.
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11-Nov-22

‫ﻣﺑﺎﺩﺉ ﺻﺣﺔ ﺍﻟﻣﺟﺗﻣﻊ‬

Dr. Wael M. Lotfy 4

Health components/dimensions (cont.):

4. Spiritual component: it includes integrity ‫ﺍﻻﺳﺘﻘﺎﻣﺔ‬, ethics and

5. Emotional component: it is related to feelings.

Dr. Wael M. Lotfy 6

Health components/dimensions (cont.):

Factors influencing health:

Dr. Wael M. Lotfy 8

Dr. Wael M. Lotfy 9

• Chronic illness: It is a broad term that encompasses ‫ ﻳﺸﻤﻞ‬many different physical

Dr. Wael M. Lotfy 10

Dr. Wael M. Lotfy 11

• Disease control aims at reducing:

Dr. Wael M. Lotfy 12

Thanks for your attention

Dr. Wael M. Lotfy 13

‫ﻣﺑﺎﺩﺉ ﺻﺣﺔ ﺍﻟﻣﺟﺗﻣﻊ‬

Dr. Wael M. Lotfy 16

Dr. Wael M. Lotfy 17

Functions of the family

Dr. Wael M. Lotfy 18

Functions of the family (cont.)

Factors affecting the family health

Dr. Wael M. Lotfy 19

High risk families

a) Very poor family.

Dr. Wael M. Lotfy 20

Thanks for your attention

Dr. Wael M. Lotfy 21

‫ﻣﺑﺎﺩﺉ ﺻﺣﺔ ﺍﻟﻣﺟﺗﻣﻊ‬

Importance of community health:

Dr. Wael M. Lotfy 24

Factors affecting community health:

Dr. Wael M. Lotfy 25

Community health services and facilities:

2. School health services: includes..

I. Community health services (cont.):

6. Health education: to increase public knowledge, attitudes and practices.

7. Medical care: diagnosis, treatment and follow up of diseases.

Dr. Wael M. Lotfy 27

II. Community health facilities:

Dr. Wael M. Lotfy 28

III. Health facilities in rural areas:

Dr. Wael M. Lotfy 29

Thanks for your attention

Dr. Wael M. Lotfy 30

‫ﻣﺑﺎﺩﺉ ﺻﺣﺔ ﺍﻟﻣﺟﺗﻣﻊ‬

• Lifestyle is a way of living based on identifiable patterns of behavior which are

Dr. Wael M. Lotfy 34

Factors affecting choice of a healthy lifestyle

Dr. Wael M. Lotfy 35

Lifestyles conducive ‫ ﻳﺆﺩﻱ‬to health

Dr. Wael M. Lotfy 36

Components of healthy lifestyle

1. Proper nutrition (eating a healthy diet and weight control)