Measures of Dispersion

The measures of dispersion are:

Census
- The Range - It is an important source of health information
- The Mean, or Average Deviation - It is taken in most countries of the world at regular intervals
- The standard deviation - It is defined by the UN as ‘the total process of collecting, compiling and publishing
THE RANGE demographic, economic and social data pertaining at a specified time or times, to all
persons in a country or delimited territory’
- The range is the simplest measure of dispersion - Census is a massive undertaking to contact every member of the population in a given
- It is defined as the difference between the highest and lowest figures in a given sample time and collect every member of the population in a given time and collect a variety of
- In grouped data, the range is taken as the difference between the midpoints of the information
extreme categories - It needs considerable organization, a vast preparation and several years to analyse the
- The range is not as much practical importance, because it indicates only the extreme results
values between the 2 values and nothing about the dispersion of values between the two - This is the main drawback census as a data sources
extreme values - The first regular census in India was taken in 1881 and others took place at 10-year intervals
- The last census was held in March 2011
THE MEAN DEVIATION
- It is usually conducted at the end of the first quarter of the first year in each decade
- It is the average of the deviations from the arithmetic mean - The legal basis of the census is provided by the Census Act of 1948
- It is given by the formula: - The supreme officer, who directs, guides and operates the census is the Census
o
∑ (ᵉ − ̅ᵉ ) Commissioner for India.
ᵇᵆ =
ᵳ Birth and Death Registration Act
THE STANDARD DEVIATION - In an effort to improve the civil registration system, the Govt of India promulgated the
Central Births and Deaths Registration Act in 1969
- The most frequently used measure of deviation - The Act came into force on 1st April 1970
- It is defined as the “Root-Means-Square-Deviation”. - It provides for compulsory registration of births and deaths throughout the country and
- It is denoted by the Greek letter – Sigma. compilation of vital statistics
- It is calculated by the basic formula - The implementation of the Act required adoption of rules for which model guidelines have
o
ᵇᵆ = ∑ ̅ )
(ᵉ − ᵉ
-
been provided
The act also fixes the responsibility for reporting births and deaths
ᵳ
- The time limit for registering the event of births and deaths is 21 days uniformly all over
- The meaning of standard deviation can only be appreciated fully when we study it with India.
reference to what is described as a ‘normal curve’. - In case of default a late fee can be imposed.
- It is an abstract number; that it gives us an idea of the spread of the dispersion that the
larger the standard deviation, the greater the dispersion of values about the mean.

Registration of Vital Events

- Much importance is given to the registration of vital events in all countries
- It is the precursor of health statistics and over the years it has dominated the health
information system
- The United Nation defines a vital events registration system as “legal registration,
statistical recording and reporting of the occurrence of, and the collection, compilation,
presentation, analysis and distribution of statistics pertaining to vital events”.
- Registration of vital events has been the foundation of vital statistics
- In 1873, India passed the ‘Births, Deaths, and Marriages Registration Act, but the Act
provided only for voluntary registration’
ESSAY SHORT NOTES
Define Health Education. Explain the principles & methods of Health Education. Barriers of Effective Communication
Health Education is the translation of what is known about health, into desirable individual and - Health education may often fail due to communication barriers between the educator and
community behaviour patterns by means of an educational process. The definition by John M Last the community – these may be:
is the “process by which individuals and groups of people learn to behave in a manner conducive
to the promotion, maintenance or restoration of health”. - PHYSIOLOGICAL
o Difficulties in hearing
PRINCIPLES OF HEALTH EDUCATION:
o Expression
- To encourage people to adopt and sustain health promoting lifestyle and practices - PSYCHOLOGICAL
- To promote the proper use of health services available to them o Emotional disturbances
- To arouse interest, provide new knowledge, improve skills and change attitudes in making o Neurosis
rational decisions to solve their own problems o Levels of intelligence
- To stimulate individuals and community self-reliance and participation to achieve health o Language
development through individual and community involvement at every step from o Comprehension difficulties
identifying problems to solving them. - ENVIRONMENTAL
o Noise
METHODS OF HEALTH EDUCATION o Invisibility
- Regulatory Approach (Managed prevention) o Congestion
o This approach seeks change in health behaviour and improvement in health through - CULTURAL
a variety of external control or laws placed on people o Illiteracy
o The legislative approach may seem to be simplest and quickest way to improve o Levels of knowledge and understanding
health or bring about desired changes in society, but there are also important o Customs, beliefs, religion, attitudes, economic and social class differences
failures of laws, e.g., prohibition of alcohol. o Language variations, cultural difficulties between foreigners and nationals
- Service Approach o Cultural difficulties b/w urban education and the rural population
o This approach was tried by the Basic Health Services in 1960s
Key Elements in Communication Process
o It aimed at providing all the health services needed by the people at their door
The main components in the communication process are:
steps on the assumption that people would use them to improve their own health
o This approach proved a failure because it was not based on the felt-needs of the - Sender
people. o The sender is the originator of the message
o For example, when water seal latrines were provided by the government, free of o to be an effective communicator, he must know
cost, many people in the rural areas did not make use of them because it was not  his objectives, audience, message, channels of communication,
their habit to use latrine professional abilities and limitations
- Health Education Approach o the impact of the message will depend on his own social status, knowledge and
o There are many problems which can be solved only through health education prestige
o It is a general belief in western democracies that people will be better off if they - Receiver
have autonomy over their own lives, including health affairs on which an informed o All communicators must have an audience
person should be able to make decisions to protect his own health o It is the element of audience and their frame of mind which lends meaning to all the
o This approach is consistent with democratic philosophy which does not order the different types of communication
individual - Message
- Primary Health Care Approach o The information which the communicator transmits to his audience to receive,
o this is radically new approach starting from the people with their full participation understand, accept and act upon.
and active involvement in the planning and delivery of health services based on - Channels of Communication
principals of primary health care o The physical bridges or the medica of communication between the sender and
o the objective is to help individuals to become self-reliant in matters of health receiver
o this can be done if the people receive the necessary guidance from health care - Feedback
providers in identifying their health problems and finding workable solutions o It is the flow of information from the audience to the sender
o this approach is a fundamental shift from the earlier approaches o It is the reaction of the audience to the message.
 Audio-Visual Aids Principles of Health Education
- Audio visual aids help to simplify unfamiliar concepts and bring about understanding where 1) Credibility
words fail o It is the degree to which the message to be communicated is perceived as
- They reinforce learning by appealing to more than one sense and provides a dynamic way trustworthy by the receiver
of avoiding monotony o Good health education is based on facts – that means it must be consistent and
- Audio-visual aids are classified into 3 groups: compatible with scientific knowledge and also with the local culture, educational
o Auditory Aids system and social goals
 Radio 2) Interest
 Tape recorder o It is a psychological principle that people are unlikely to listen to those things which
 Microphones are not to their interest
 Amplifiers o It is salutary to remind ourselves that health teaching should relate to the interests
 Earphones of the people.
o Visual Aids 3) Participation
 Not requiring projection o It is a key word in health education
 Chalkboard, leaflets, posters, charts, flannelgraph, exhibits, o It is based on the psychological principle of active learning
models, specimens o Health education should aim at encouraging people to work actively with heath
 Requiring projection workers and others in identifying their own health problems and also in developing
 Slides, film strips solutions and plans to work out
o Combined A-V Aids 4) Motivation
 Television, o In everyone, there is a fundamental desire to learn
 sound films, o Primary – driving forces initiating people in action
 slide-tape combination o Secondary – based on desires created by outside forces or incentives
5) Comprehension
Group Discussion o In health education, we must know the level of understanding, education and literacy
- Considered a very effective method of health communication of people to whom the teaching is directed.
- It permits the individuals to learn by freely exchanging their knowledge, ideas and opinions o One barrier to communication is using words which cannot be understood
- It provides wider interaction among members than is possible with other methods 6) Reinforcement
- For effective group discussion, the group should comprise not less than 6 and not more o Few people can learn all that is new in a single period
than 12 members o Repetition at intervals is necessary
- A well conducted group discussion with adequate resources is very effective in reaching o There is no reinforcement, there is every possibility of the individual going back to
decisions, based on the ideas of all people. The decision taken by the group tends to be the pre-awareness stage
adopted more readily than in situations where the decision is a solitary one o If the message is repeated in different ways, people are more likely to remember it.
- The group acceptance has a binding effect on the individual member to translate their 7) Learning by Doing
acceptance into action o Learning is an action-process; not a memorizing one in a narrow sense
- a well conducted group discussion is effective for changing attitudes and the health 8) Known to Unknown
behaviour of people. o Start where the people are and with what they understand and then proceed to new
knowledge
- LIMITATIONS: o It is a long process full of obstacles and resistance, and we must not expect quick
o Group discussion is not without limitations results.
o Those who are shy may not take part in the discussions 9) Setting an example
o Some may dominate the discussion o The health educator should set a good example in the things he is teaching
o There may be unequal participations of members in group discussion, unless 10) Good human relations
properly guided o Ideas and feeling happen most easily between people who have a good relationship
o Some members may deviate from the subject and make the discussion irrelevant or 11) Feedback
unprofitable o The health educator can modify the elements of the system in light of the feedback
12) Leaders
o Leaders are agents of chance and they can be made use of in health education.
o We learn best from people who we respect and hold in a high regard.
 Health Education in Schools Internet as a Health Education Medium
The method of health education used in schools is the “GROUP APPROACH”. - The internet is a tool belonging to the Mass Approach to Health Education with the aim of
providing education to the general public
- It is an effective way of educating the community
- Internet has opened vast capability of knowledge transfer and has made it possible to get
- The choice of subject must be important and must relate to the interest of the group
into direct and instant communication across the world by means of email and online chat
- The different types of group education are:
- It is a fast-growing communication media and holds very large potential to become a
o Chalk and Talk (Lecture)
major health education tool
 Carefully prepared oral presentation of facts, organised thoughts and ideas
- Vast amounts of health-related literature from WHO and other heath agencies are available
by a qualified person
online
 The chalk lends the visual component
- The health-related Information from the Ministry of Health and Family Welfare is also
o Demonstrations
available on their website.
 Carefully prepared presentation to show how to perform a skill or
procedure
 The procedure is carried out step by step before an audience or target group
 The demonstrator involves the audience in the discussion
 Advantages:
 Dramatizes by arousing interest
 Persuades the onlookers to adopt recommended practices
 Follows the principles of “seeing is believing” & “learning by doing”
 Brings desirable changes in the behaviour pertaining to the use of
new practice
 As a means of communication has been found to have a high educational
value in programmes such as sanitation, MCH and control of diseases
o Discussion Methods
 A very effective method of health communication
 It permits the individuals to learn by freely exchanging their knowledge,
ideas and opinions
 Provides a wider interaction among members than is possible with other
methods
 Types of discussion methods include:
 Group and Panel Discussions
 Symposium
 Workshops and Conferences
 Seminars
 Roleplay

Roleplay as a Health Education Method

- Based on the assumption that many values in a situation cannot be expressed in words,
and the communication can be more effective if the situation is dramatized by the group
- The group members enact their roles as they have observed or experienced them and the
audience is not passive but actively concerned with the drama.
- They are supposed to pay sympathetic attention to what is going on, suggest alternative
solutions and come up and take an active role in demonstrating how they feel a role
should be handle
- Roleplay is a useful technique to use in providing discussion of problems of human
relationship
- It is a particularly useful educational device for school children
- It is usually followed by discussion of the problem
ESSAY o Impurities
 Upland surface water derives its impurities from the catchment area
Define the term ‘Potable Water’. Enumerate & classify the sources of drinking water.  The sources being human habitations and animal keeping or grazing
Add a note on Purification of water in rural areas.  Therefore, necessary to keep the catchment area free from humans or
Potable Water is defined as ‘water that is suitable for human consumption’. The term implies that animal intrusions
the water is drinkable as well as safe. It is free of unpleasant odours, tastes and colours, and is - Rivers
within reasonable limits of temperature. Safe water means it contains no toxins, carcinogens, o Chief drawback is that it is always grossly polluted and is quite unfit for drinking
pathogenic microorganisms or other health hazards. without treatment
o Characteristics
Sources of Drinking Water
 River water is turbid during rainy seasons
The 3 main sources of drinking water are:  It may be clear in other seasons
 Clarity of water is no guarantee that the river water is safe for drinking
- Rain
 River water contains dissolved and suspended impurities of all kids
- Surface Water  Bacterial count may be very high
o Impounding reservoirs
o Impurities
o Rivers and Streams
 Rivers are described as a direct connection between the alimentary canal of
o Tanks, ponds and laks
the people living upstream and the mouths of those
- Ground Water  Impurities are derived from surface washings, sewage and sullage water,
o Shallow wells
industrial and trade wastes, and drainage from agricultural areas.
o Deep Wells
o Self-Purification
o Springs
 Certain amount of self-purification does occur in river water by natural
Rain: forces of purification such as dilution, sedimentation, aeration, oxidation,
sunlight, plant and animal life but these agencies are not sufficient to
- The prime source of all water render the water potable
- Part of the rain sinks into the ground to form ground water, part of it evaporates into the  River water needs purification before it can be used for drinking purposes
atmosphere, and some of it forms streams and rivers which flow ultimately into the sea - Tanks
- Characteristics: o Large excavations in which surface water is stored
o Rainwater is the purest water in nature o Thery are an important source of water supply in some Indian villages
o It is clear, bright and sparkling o Tanks are recipients of contamination of all sorts
o It is very soft water containing only traces of dissolved solids o They are full of silt and colloidal matter, especially immediately after the rains
o It has a corrosive action on lead pipes o Older tanks may be full of aquatic vegetation
- Impurities o Tanks are thus subjected to unlimited possibilities of contamination and are highly
o Rain tends to become impure as it passes through the atmosphere dangerous, as a source of drinking water, even at the best of times
o It picks up suspended impurities from the atmosphere such as dust, soot and
microorganisms and gases such as CO2, Nitrogen, oxygen and ammonia Ground Water:
 These gases react with rain to form a dilute solution of sulphuric and nitric
- Wells
acid o Shallow Wells
 The precipitation of these acids has begun to have an impact on surface
 Shallow wells tap subsoil water
water quality and on plants.
 They yield limited quantities of water, and the water is notoriously liable to
Surface Water: pollution unless care is taken in well construction
o Deep Wells
- Impounding Reservoirs  Deep well is one which taps water from the water-bearing stratum below
o There are artificial lakes constructed usually of earthwork or masonry in which large the 1st impervious layer in the ground
quantities of surface water is stored  Usually machine dug and may be several hundred metres deep
o Characteristics: o Tube Wells
 Impounding reservoirs usually furnish a fairly good quality of water  Successful source of drinking water in many parts of india
 The water is usually clear, palatable and ranks next to rain water in purity  Yields cheap and bacteriologically safe water
 Consists of a pipe sunk into the water-bearing stratum, strainer and pump
 o Springs Enumerate the various air pollutants. Explain about monitoring, control & prevention
 When group water comes to the surface and flows freely under natural of Air pollution.
pressure, it is called a spring The various air pollutants include:
 May be of 2 types
 Shallow springs - Carbon Monoxide
 Deep Springs - Sulphur Dioxide
 Shallow springs dry up quickly during summer months, whereas deep - Lead
springs do not show seasonal fluctuations in the flow of water - Carbon Dioxide
 Springs constitute an important source of water - Hydrocarbons
 Springs are simpler to exploit, as no pumping is needed to bring the water - Cadmium
to the surface - Hydrogen sulphide
 They are exposed to contamination - Ozone
 Well built protective structures are necessary to safeguard water quality - Oxides of nitrogen
- Polycyclic aromatic hydrocarbons
Purification of Water - Particulate matters
Purification of water is of great importance in community medicine. It may be considered under 2 Monitoring of Air Pollution
headings:
The best indicators of air pollution are sulphur dioxide, smoke and suspended particles. These are
- Purification of water on a large scale best monitored on a daily basis over several sites. The results are then collected by a central agency.
- Purification of water on a small scale
Sulphur Dioxide:
Purification of Water on a Large Scale
- This gas is a major containment in many urban and industrial areas
- Methods include - Its concentration is estimated in all air pollution survey
o Storage
 Provides a reserve if water from which further pollution is excluded Smoke or Soiling Index:
o Filtration - Known volume of air is filtered through a white filter paper under specified conditions and
 Second stage of purification
the stain is measured by photoelectric meter
 Uses 2 types of filters – Biological (slow sand) Filters & Mechanical (Rapid
- Smoke concentration is estimated and expressed as micrograms cubic metre of air as an
Sand) filters average level over a period of time
o Disinfection
 Chemicals or agents are useful as a disinfectant in water supplies Grit and Dust Measurements
 In water works practice, the term disinfection is synonymous with
- Deposit gauges collect grit, dust and other solids
chlorination
- These are analysed monthly
Purification of Water on a Small Scale
Coefficient of Haze:
- Household purification of Water
- Factor used, in assessing the amount of smoke, or other aerosols in the air
o Boiling
o Chemical Disinfection Air Pollution Index:
o Filtration
- It is an arbitrary index which takes into account one or more pollutants as a measure of the
o Ultraviolet Irradiation
severity of pollution
o Multi-stage Reverse Osmosis Purification of Water
- For example, in the USA, 10 times the sulphur dioxide concentration + twice the carbon
- Disinfection of Wells
monoxide concentration + twice the coefficient of haze
- It was considered to be a cause for alarm when the value of the index rose from its value of
about 12-50 or more
Air Pollution Monitoring in India Enumerate the Arthropods of Medical Importance. Discuss briefly the Mosquito
- The National Air Quality Monitoring Programme, has generated database over the last 14 control measures in Urban Areas.
years in the 10 major cities The arthropods of medical importance are:
- The programme facilitates evaluation of long-term air quality trends for health-related - Class: Insecta
criteria pollutants such as inhalable dust, sulphur dioxide, nitrogen dioxide, lead, hydrogen o Mosquitoes
sulphide, ammonia and PAH.  Anophelines
- The trend analysis shows that suspended particulate matter exceeds the CPCB standards in  Culicines
all cities most of the time o Flies
- The concentration of respirable suspended particulate matter is invariably higher at the  Houseflies
industrial sites  Sandflies
Prevention and Control of Air Pollution:  Tsetse flies
 Blackflies
- Control o Human Lice
o The control of air pollution is an engineering problem  Head and Body lice
o The WHO has recommended the following procedures:  Crab lice
 Containment o Fleas
 Prevention of escape of toxic substances into the ambient air  Rat fleas
 Containment can be achieved by enclosure, ventilation and air  Sand Fleas
cleaning o Reduviid bugs
 Replacement - Class: Arachnida
 Replacing a technological process causing air pollution, by a new o Ticks
process that does not  Hard ticks
 Increased use of electricity, solar power generation, natural gas,  Soft ticks
central heating in place of coal o Mites (Chiggers)
 There is move to reduce lead in petrol which is a cumulative poison  Leptotrombidium
 Dilution  Trombiculid mites
 Valid so long as it is within the self-cleaning capacity of the  Itch mite
environment - Class: Crustacea
 For example, some air pollutants are readily removed by o Cyclops
vegetation
 The establishment of green belts between industrial and residential
areas Mosquito Control Measures
 Legislation
- Anti-Larval Measures
 Air pollution is controlled in many countries by suitable legislation
o Environmental Control
 Covers such matters as height of chimneys, power to local
 Most important step is to eliminate their breeding places
authorities to carry out investigations, research and education
 This is known as source reduction and comprises minor engineering
concerning air pollution, creation of smokeless zone and
methods such as filling, levelling and drainage of breeding palces, and
enforcement of standard for ambient air quality
water management
 International Action
 These are proven methods of larval control
 To deal with air pollution, WHO has established an international
o Chemical Control
network of labs for the monitoring and study of air pollution
 Mineral Oils (diesel oil, fuel oil, kerosene, various fractions of crude oils)
 The network consists of two international centres at London and
 Application of oil to water is one of the oldest known mosquito
Washington, three centres at Moscow, Nagpur and Tokyo and 20
control measures
labs in various parts of the world
 When applied on water, oil spreads and forms a thin film, which cuts
 These centres with issue warnings of air pollution where and when
off the air supply to the mosquito larvae and pupae
necessary
-
  Paris Green SHORT NOTES
 Paris green or copper acetoarsenite is an emerald green, micro-
crystalline powder practically insoluble in water Activated Sludge Process
 Stomach poison and to be effective it must be ingested by the - Modern process of purifying sewage, in place of the trickling filter
larvae - The ‘Heart’ of the activated sludge process is the aeration tank.
 Kills mainly Anopheles larvae because they are surface feeders. - The effluent from the primary sedimentation tank is mixed with sludge drawn from the
final setting tank
 Bottom feeding larvae are also killed when paris green is applied as
a special granular formation - The proportion of activated sludge to the incoming effluent is of the order of 20-30%
- the mixture is subjected to aeration in the aeration chamber for about 6-8 hours
 Synthetic Insecticides
- the aeration is accomplished by mechanical agitation or by forcing compressed air
 Fenthion, chlorpyrifos and Abate
continuously from the bottom of the aeration tank
 OPCs that hydrolyse in water
o latter method is considered the better method of aeration
o Biological Control
- during the process, the organic matter of the sewage gets oxidized into carbon dioxide,
 Wide range of fish readily on mosquito larvae
nitrates and water with the help of the aerobic bacteria in the activated sludge
 The best known are Gambusia affinis and Lebister reticulatus
- the typhoid and cholera organisms are definitely destroyed
 These fish can be used in burrow pits, sewage oxidation ponds, ornamental
- activated sludge plants occupy less space, requires skilled operations,
ponds, cisterns and farm ponds
- one acre of activated sludge plant does the work of 10 acres of percolating filters
 It is however recognized that biological control can be effective only when
- Activated sludge process is best suited for larger cities and the percolating filter for smaller
used in conjunction with other methods
towns because they are cheaper to install and easier to operate.
- Anti-Adult Measures:
o Residual Sprays Rat Fleas
 Adult mosquitoes are controlled by spraying houses with residual - The body of the flea is divided into head, thorax and abdomen
insecticides - Head
 DDT is the insecticide of choice and dosages of 1-2 grams of pure DDT per o The head is conical in shape and is attached to the thorax without a neck
sq. metre are applied 1-3 times a year to walls and other surfaces where o The head bears short, piercing mouth parts which are conspicuous and project
moquitoes rest downwards from the head
o Space Sprays o The mouth parts are adapted for piercing and sucking blood
 Insecticidal formulation is sprayed into the atmosphere in the form of a mist - Thorax
or fog to kill insects o The thorax is composed of 3 segments – prothorax, mesothorax and metathorax
 The common space sprays are o There are 3 pairs of strong legs attached to the thorax
 Pyrethrum extract o The flea has no wings
 Residual insecticides - Abdomen
o Genetic Control o The abdomen consists of 10 segments
 In recent years, control of mosquitoes have been explored o The sexes are easily distinguished
 Their use is still in the research phase  The male has a coiled structure (the penis), in the abdomen
 Techniques have great potential in mosquito control  The female has a short, stumpy structure (spermatheca) in the posterior
 They also have certain advantages over chemical methods, being cheaper part of the abdomen
and potentially more efficient and above all subject to vector resistance o The shape of the spermatheca helps in the identification of the species
- Protection against Mosquito Bites - Diseases that are transmitted by the fleas:
o Mosquito Nets o Plague (bubonic)
 Offers protection against mosquito bites during sleep o Endemic or murine typhus
 Material of the net should be white, to allow easy detection of mosquitoes o Chiggerosis
o Screening o Hymenolepis diminuta
 Screening with copper or bronze gauze with 16 meshes to the inch is - Transmission of Diseases
recommended o Biting
 The aperture should not be larger than 0.0475 inch o Mechanical transmission
 Screening is costly, but gives excellent results o Faeces
o Repellents – diethyltoluamide
 Integrated Vector Control Approach Prevention of Air Pollution
- Since no method of control is likely to provide a solution in all solutions, the present trend is - The control of air pollution is an engineering problem
to adopt an ‘integrated approach’ for vector control combining 2 or more methods with a - The WHO has recommended the following procedures:
view to obtain maximum results with the minimum effort and to avoid the excessive use of o Containment
any one method  Prevention of escape of toxic substances into the ambient air
- The integrated approach includes a combination of:  Containment can be achieved by enclosure, ventilation and air cleaning
o Environmental control o Replacement
o Chemical control  Replacing a technological process causing air pollution, by a new process
o Biological control that does not
o Genetic control  Increased use of electricity, solar power generation, natural gas, central
heating in place of coal
Indices of Heat Stress  There is move to reduce lead in petrol which is a cumulative poison
- Heat Stress is the burden or load of heat that must be dissipated if the body is to remain in o Dilution
thermal equilibrium  Valid so long as it is within the self-cleaning capacity of the environment
- The factors which influence heat stress are metabolic rate, air temperature, humidity, air  For example, some air pollutants are readily removed by vegetation
movement and radiant temperature  The establishment of green belts between industrial and residential areas
- The amount of heat gained from the body must be equalled by the amount of heat lost o Legislation
from it  Air pollution is controlled in many countries by suitable legislation
- Indices of Heat Stress include  Covers such matters as height of chimneys, power to local authorities to
o Equatorial Comfort Index carry out investigations, research and education concerning air pollution,
 Denotes the temperature of still and saturated air which is equivalent creation of smokeless zone and enforcement of standard for ambient air
physiologically to the climate under consideration quality
o Heat Stress Index o International Action
 Takes into consideration the metabolic rate and principal channels of heat  To deal with air pollution, WHO has established an international network of
exchange between the human body and the environment labs for the monitoring and study of air pollution
 Represents the percentage of the heat storage capacity of an average man  The network consists of two international centres at London and
o Predicated Four Hour Sweat Rate Washington, three centres at Moscow, Nagpur and Tokyo and 20 labs in
 Rate at which a man sweats is a good index of the heat stress to which he is various parts of the world
subjected  These centres with issue warnings of air pollution where and when necessary
 Sweat rate of 4.5 litres in 4 hours is the upper limit of tolerance in health for
work in hot environment Horrock’s Test
 Sweat rate of 2.5 litres in 4 hours is considered optimal for a working man - Designed to find out the dose of bleaching powder required for disinfection of water
- Contents
Indices of Thermal Comfort o 6 white cups & 1 black cup with a circular mask on the inside
- Air Temperature o 2 metal spoons & 7 glass stirring rods
o It was realised that air temperature alone was not an adequate index o 1 special pipette
- Air Temperature and Humidity o 2 droppers
o Considered together to express thermal comfort o Starch-iodide indicator solution
- Cooling power - Procedure
o Humidity and air movement were considered together and expressed as cooling o Take one level spoonful of bleaching powder in the black cup and make it into a thin
power of the air paste with a little water. Add more water to the paste and make up the volume upto
- Effective temperature the mark with vigorous stirring. Allow to settle to make a stock solution
o Arbitrary index that combines a single value the effect of temperature, humidity and o Fill the 6 white cups with water to be tested, upto about a centimetre below the brim
movement of the internal air on the sensation of warmth or cold o Add one drop of the stock solution to the 1st cup, 2 drops to the 2nd cup, 3 drops to
- Corrected effective temperature the 3rd etc.
o Improvement over the effective temperature index o Stir the water in each cup using a separate rod and wait 30 mins for action of Cl
o Reading of the globe thermometer is used to allow for radiant heat o Add 3 drops of starch iodide indictor to each cup and observe blue colour change
o CET scales are widely used as indices of thermal comfort  Development of blue colour indicates presence of free residual chlorine
 Global Warming
- Emission of greenhouse gases into the atmosphere have been increasing since the start of
the industrial revolution
- Major component of emission of carbon dioxide is from combustion of fossil fuels
o it is conceded that the main effects of this include an
 increase of 3°C in the average global surface temperature by the year 2030,
 rise in the sea level of 0.1-0.3 metres by 2050
 increase in the occurrence of extreme climatic events such as cyclones,
heatwaves, draughts
- temperature rise could overwhelm the capacity of many species to adapt
- change of this magnitude would effect the local, regional and global ecosystem, sea levels
and ocean currents, prevailing winds, fresh water supplies and human health
- some effects are mutually reinforcing, so a small additional change in the existing trend
could have massive consequences, in accordance with the mathematics of catastrophe
theory
- Changes in the configuration of jet streams, prevailing winds and ocean currents could
alter the distribution of rainfall in many regions, making some wetter and others drier
- The summers are becoming hotter
- Temperature zone warming induces a decline in soil moisture that impairs grain production
- This will also change the distribution of vegetation
- The distribution of insect vectors of disease will change
- The heat island phenomenon that makes cities warmer than surrounding rural areas will
lead no longer and more severe heat waves than we are accustomed to now.
Chlorination
- Method of disinfection of water. It is a supplement, not a substitute to sand filtration
- Chlorine kills pathogenic bacteria, but is has no effect on spores and certain viruses except
in high doses
- Apart from the germicidal effect, chlorine has several important secondary properties of
value in water treatment
o It oxidises iron, manganese and hydrogen sulphide
o It destroys some taste and odour-producing constituents
o It controls algae and slime organisms and aids coagulation
- The disinfecting action of chlorine is mainly due to hydrochlorous acid, and to a small extent
due to the hypochlorite ions.
- The hypochlorous acid is the most effective form of chlorine for water disinfection
Principles of Chlorination:
- The water to be chlorinated should be clear and free from turbidity as it impedes efficient
chlorination
- The chlorine demand of the water should be estimated
o CHLORINE DEMAND – difference between the amount of chlorine added to the
water, and the amount of residual chlorine remaining at the end of a specific period
of contact
- Contact period – presence of free residual chlorine for a contact period of at least 1 hour is
essential to kill bacteria and viruses
- Minimum recommended concentration of free chlorine is 0.5mg/L for one hour
- The sum of the chlorine demand of the specific water + free residual chlorine of 0.5mg/L
Household Purification of Water
Boiling
- Satisfactory method of purifying water for household purposes
- The water must be brought to a rolling boil for 10-20 minutes
- It kills all bacteria, spores, cysts and ova and yields sterilized water
- It removes temporary hardness by driving off carbon dioxide and precipitating the calcium
carbonate
- Taste of water is unaltered, but this is harmless
- Water should be boiled preferably in the same container in which it is to be stored to avoid
contamination during storage
Chemical Disinfection
- Bleaching Powder
o White amorphous powder with a pungent smell of chlorine
o It contains 33% of available chlorine
o It is an unstable compound
o It should be stored in a dark, cool, dry place in a closed container that is resistant to
corrosion
o The chlorine content should be frequently checked
- Chlorine Solution
o May be prepared from bleaching powder
o Ready-made chlorine solutions are also available in the market
- High Test Hypochlorite
o HTH is a calcium compound which contains 60-70% available chlorine
o More stable than bleaching powder and deteriorates much less on storage
- Chlorine Tablets
o Good for disinfecting small quantities of water, but they are costly
- Iodine
o Used for emergency disinfection of water
o Does not react with ammonia or organic compounds
 It remains in its active molecular form, over a wide range of pH values and
water conditions and persists longer than either chlorine or bromine
Filtration
- Water can be purified on a small scale by filtering through ceramic filters
- The essential part of the filter is the candle
- Only clean water should be used with ceramic filters
Ultraviolet Irradiation
- Effective against most microorganisms known to contaminate water supplies like bacteria,
yeast, viruses, fungi, algae, protozoa
- Advantages are that the exposure is for short period, no foreign matter introduced and no
taste and odour produced. Overexposure does not result in any harmful effects
- Disadvantages are that no residual effect is available and there is a lack of rapid field test
for assessing the treatment efficiency
 Housefly Control Measures Water Harvesting Method
Environmental Control: - Method to preserve and build-up underground water reserves in urban and semi-urban
areas,
- Best method is to eliminate their breeding places and to bring about an overall
- Considerable water is drawn out by tube wells for domestic consumption
improvement in the environmental sanitation on a community-wide basis
- Vast quantities of rainwater are normally discharged into drains
- This implies the following
- This rainwater can be easily added to the underground reserves by diversion of rainwater
o Storing garbage, kitchen wastes and other refuse in bins with tight lids, pending
from rooftops and courtyard into soaking pits or trenches, instead of drains
disposal
- It is also viable to clean and filter this water and divert it into existing tube wells or wells.
o Efficient collection, removal and disposal of refuse by incineration, composting or
- Various economic designs are suggested by agencies like Central Ground Water Board
sanitary landfill
(CGWB), UNICEF etc.
o Provision of sanitary latrines
- Suitably large pit is filled in layers with big stones, followed by gravel and sand
o Stopping open air defecation
- Collected rainwater from rooftops is brought into the pit by a PVC pipe
o Sanitary disposal of animal excreta
- The rainwater filtered through these layers, then travels by a PVC pipe connecting bottom
o Stepping up general sanitation
of the pit into the nearby well or tube well.
Insecticidal Control:
Hazards of Noise Pollution & its Control
- Residual Sprays Hazards of Noise Pollution:
- Baits
- Cords and Ribbons - Auditory Effects
- Space Sprays o Auditory fatigue
- Larvicides o Deafness
- Non-auditory effects
Fly Papers: o Interference with speech
o Annoyance
- Sticky fly papers are useful adjuncts to other methods of control
o Efficiency
- These papers can be easily made and smear on paper using an ordinary paint brush
o Physiological changes – rise in BP, rise in ICP, increase in HR, breathing and sweating
- The adhesive mixture can also be applied to strips of wire and hung up in places where flies
o Economic losses
abound
- Slight reduction of flies may occur Control of Noise Pollution:
o No lasting benefits will result from the use of fly papers
- Careful planning of Cities
Protection against Flies: o Division of city into zones with separation of areas
o Separation of residential areas from main streets
- Screening of houses, hospitals, food markets, restaurants and all other similar
o Widening of main streets to reduce the level of noise penetration into dwellings
establishments will give considerable relief from houseflies
- Control of Vehicles
- Screens with 14 meshes to the inch will keep out houseflies but finer screens will also keep
o Heavy vehicles should not be routed into narrow streets
out other insects
o Vehicular traffic on residential streets should be reduced
- Screening is expensive for general use
o Indiscriminate blowing of the horn and use of pressure horn should be prohibited
Health Education: - To improve Acoustic Insulation of Building
o Construction of detached buildings rather than a single large building or one that is
- It is difficult to achieve fly control without the willing cooperation of the people
continuous
- A fly consciousness should be created among the people, through health education
o Installations that produce noise or disturb the occupants within dwellings should be
- Fly control campaigns require organised individual and community effort which is the basis
prohibited
of a successful public health programme
- Industries and Railways
- It is only through health education that people can be motivated with a desire to get rid of
- Protection of Exposed Persons
flies permanently
o Hearing protection is advised for all workers who are exposed to noise louder than
85 decibels in the frequency bands above 150Hz
- Legislation
o Many states have adopted legislations providing controls
ESSAY - Specific Protection
o Child’s diet must contain protein and energy rich foods
Enumerate the common nutritional disorders in India. Describe the problem of  milk, eggs, fresh fruit should be given if possible
‘Protein Energy Malnutrition’ and its prevention in the community. o Immunization
The common nutritional disorders in India are: o Food fortification
- Early diagnosis and treatment
- Low Birth Weight
o Periodic surveillance
- Under nutrition
o Early diagnosis of any lag in growth
o Protein-energy malnutrition
o Early diagnosis and treatment of infections and diarrhoea
o Micronutrient deficiencies
o Development of programmes for early rehydration of children with diarrhoea
- Xerophthalmia (ocular manifestations of Vitamin A deficiency)
o Development of supplementary feeding programmes
- Nutritional Anaemia
o Deworming of heavily infested children
- Iodine Deficiency Disorders
- Rehabilitation
- Endemic fluorosis
o Nutritional rehabilitation services
o Dental fluorosis
o Hospital treatment
o Skeletal fluorosis
o Follow up care
o Genu valgum
- Lathyrism

PROTEIN-ENERGY MALNUTRITION

- Kwashiorkor and marasmus are the 2 different forms of protein-energy malnutrition.

- The main cause of this is inadequate protein and energy intake
- It is a form of cachexia with weight loss as a result of infancy and severe wasting, with little
or no oedema, minimal subcutaneous fat, severe muscle wasting and non-normal serum
albumin levels

Early detection of PEM:

- First indicator of PEM is under-weight for age

- Most practical method to detect this to maintain growth charts that indicate at a glance
whether the child is gaining or losing weight
- Arm circumference
o Yields a relatively reliable estimation of the body’s muscle mass, the reduction of
which is the most striking mechanism
o Cannot be used before the age of one year; between 1 and 5 years

Preventive Measures of PEM:

- Health Promotion
o Measures directed to pregnant and lactating women
o Promotion of breast feeding
o Development of low-cost weaning foods
 Child should be made to eat more food at frequent intervals
o Measures to improve family diet
o Nutrition education
 Promotion of correct feeding practices
o Home economics
o Family planning and spacing of births
o Family environment
 What are the trace elements? Describe in detail the manifestations & prevention of Prevention of Iodine Deficiency Disorders:
Iodine Deficiency Disorders. - Daily requirement
The trace elements are required by the body in quantities of less than a few milligrams per day. The o The daily requirement of iodine is 150 micrograms
trace elements include: o The recommendations of WHO of 250 mcg per day for iodine during pregnancy
- Iron o The amount is normally supplied by well-balanced diet and drinking water except in
- Manganese
- Iodine regions where food and water are deficient in iodine.
- Molybdenum
- Fluorine - Selenium
- Zinc - Epidemiological Assessment of Iodine Deficiency:
- Nickel
- Copper o the following indicators are useful for assessing iodine deficiency:
- Tin
- Cobalt  Prevalence of goitre
- Silicon
 Prevalence of cretinism
- Chromium - Vanadium
 Urinary iodine excretion
IODINE DEFICIENCY DISORDERS:  Measurement of thyroid function by determination of serum levels of
thyroxine and pituitary thyrotropic hormone (TSH)
Manifestations of Iodine Deficiency Disorders:
 Prevalence of neonatal hypothyroidism
- The most obvious consequence of iodine deficiency is goitre but recent studies have indicated o Since the objective of goitre control is to increase iodine intake, indices of urinary
that there is a much wider spread of disorders, some of them so severe as to be disabling: excretion are particularly recommended for use in surveillance.
o Hypothyroidism o Neonatal hypothyroidism has been found to be a sensitive indicator of
o Retarded physical development and impaired mental function environmental iodine deficiency
o Increased rate of spontaneous abortion and stillbirth o Serum T4 level is a more sensitive indicator of thyroid insufficiency than T3
o Neurological cretinism
 Deaf mutism
o Myxoedematous cretinism
 Dwarfism
 Severe mental retardation
- To express this state of affairs, ‘endemic goitre’ is now replaced by the term Iodine
Deficiency Disorders to refer to all the effects of iodine deficiency on human growth and
development which can be prevented by correction of iodine deficiency.

Spectrum of Iodine-Deficiency Disorders:

DISORDERS LEVELS OF SEVERITY

Goitre - Grade I
- Grade II
- Grade III
- Multinodular
Hypothyroidism Varying combinations of clinical signs
Subnormal
Delayed motor milestones
Mental deficiency Variable Severity
Hearing defects
Speech defects
Strabismus (squint) - Unilateral
Nystagmus - Bilateral
Spasticity (Extrapyrimidal) - Muscle weakness in legs, arms and
Neuromuscular weakness trunks
- Spastic diplegia and quadriplegia
Endemic cretinism - Hypothyroid cretinism
- Neurological Cretinism
 Define Nutritional Surveillance. Describe in detail the methods of assessing the SHORT NOTES
nutritional status of a community. Endemic Fluorosis
Nutritional Surveillance is defined as ‘Keeping watch over nutrition, in order to make decisions
- An important health problem in certain parts of the country – Andhra Pradesh, Punjab,
that will lead to improvement in nutrition in population’.
Haryana, Karnataka, Kerala and Tamil Nadu
Three distinct objectives have been defined for surveillance systems: - The toxic manifestations of fluorosis are:
o Dental Fluorosis:
- To aid long term planning in health and development  Fluorosis of dental enamel occurs when excess fluoride is ingested during
- To provide input for programme management and evaluation the years of tooth calcification
- To give timely warning and intervention to prevent short-term food consumption crises  It is characterised by mottling of dental enamel, which has been reported at
It can be carried out on a representative sample of children in the community and gives a reliable levels above 1.5mg/L intake
idea of the overall nutritional condition of the village A – whether it is good or bad, is better or  the teeth lose their shiny appearance and chalk-white patches develop on
worse than that of village B or C, and whether it is improving or deteriorating with time. them
 this is the early sign of dental fluorosis
It can help to diagnose malnutrition and assess the impact of occurrence like drought or measures  later, the white patches become yellow and sometimes brown or black
designed to alleviate malnutrition in the community at large.  in severe cases, loss of enamel gives the tooth a ‘corroded appearance’
Nutritional Status Indicators:  mottling is best seen on the incisors of the upper jaw
 it is almost entirely confined to the permanent teeth and develops only
There is an increasing trend to use nutritional indicators to measure the quality of life, especially as during the period of formation
a means of evaluating both development programmes and health programmes. o Skeletal Fluorosis:
 This is associated with lifetime daily intake of 3-6mg/L or more
Many of the indicators used in nutritional surveillance are the same as the socio-economic and
 There is heavy fluoride deposition in the skeleton
health status indictors recommended for monitoring progress in health.
 When a concentration of 10mg/L is exceeded, crippling fluorosis can ensue
PHENOMENON INDICATOR  it leads to permanent disability
Maternal Nutrition Birth weight o Genu Valgum
Infant and Pre-school child nutrition Proportion being breast feed  New form of fluorosis
Proportion on weaning food, by age in months  It is characterised by genu valgum and osteoporosis
Mortality rates in children aged 1,2,3 and 4  It has been reported in some districts of Andhra Pradesh and Tamil Nadu
years, with emphasis on 2-year-olds  The syndrome was observed among people whose staple was sorghum
If age is known:
 Further studies showed that diets based on sorghum promoted a higher
- Height for age
retention of ingested fluoride than do diets based on rice.
- Weight for age
- Intervention
If age is unknown:
- Weight for height o Changing the water source
- Arm circumference  One solution to the problem is to find a new source of drinking water, with
- Clinical signs and syndromes a lower fluoride content if that is possible
School child nutrition Height for age  Running surface water contains lower quantities of fluorides than ground
Weight for heigh at 7 years or school admission water sources such as wells
Clinical signs o Chemical Treatment
 The water can be chemical defluorinated in a water treatment plant. Even
though such treatment is moderately expensive
Food Surveillance:
 The National Environmental Engineering Research Institute, Nagpur
Food surveillance is essential for protection and maintenance of community health. It implies the developed a new technique for removing fluoride by chemical treatment
monitoring of food safety/food hygiene. The WHO defined food safety/food hygiene as all called the NALGONDA TECHNIQUE
conditions and measures that are necessary during the production, processing, storage,  Addition of two chemicals in sequence followed by flocculation,
distribution and preparation of food to ensure that it is safe, sound, wholesome and fit for human sedimentation and filtration
consumption. o Other measures
 Fluoride supplements should not be prescribed for children who drink
fluoridated water
 Food Fortification & Food Additives
FOOD ADDITIVES:
- Non-nutritious substances which are added intentionally to food, generally in small quantity
- It improves its appearance, flavour, texture or storage properties
- It also includes animal food adjuncts which may result in residues in human food and
components of packing materials which may find their way into food
- It may be classified into 2 categories
o First Category
 Colouring agents – saffron, turmeric
 Flavouring agents – Vanilla extract
 Sweeteners – saccharin
 Preservatives – sorbic acid, sodium benzoate
 Acidity imparting agents – citric acid, acetic acid
o Second Category
 Contaminants incidental through
 Packing
 Processing steps
 Farming practices
- Use is subjected to government regulation throughout the world
- Any food that contains food additives that are not permitted is considered to be
adulterated
- If the permissible amount exceeds, the food is considered adulterated
FOOD FORTIFICATION:
- It is a public health measure aimed at reinforcing the usual dietary intake of nutrients with
additional supplies
- This prevents/controls some nutritional disorders
- WHO has defined food fortification as ‘the process whereby nutrients are added to foods to
maintain or improve the quality of the diet of the group, a community, or a population’.
- Programmes of demonstration effectiveness are:
o Fluoridation of water as a prevention of dental caries
o Iodization of salt for combating the problem of endemic goitre
o Food fortification with vitamins A and D
- In order to qualify as a suitable for fortification, the vehicle and nutrient must fulfil certain
criteria
o The vehicle fortified must be consumed consistently as part of the regular daily diet
by the relevant sections of the population or total population
o The amount of nutrient added must provide an effective supplement for low
consumers of the vehicle, without contributing a hazardous excess to high
consumers
o Addition of the nutrient should not cause the food to change in taste, smell,
appearance or consistency
o Cost of fortification must not raise the price of the food beyond the reach of the
population in greatest needs
- An adequate system of surveillance and control is indispensable for the effectiveness of
food fortification
- It is a long-term measure for mitigating problems of malnutrition in the community.
Mid-Day Meal Programme
- Also known as National Programme of Nutritional Support to primary education
- It was launched in 1995 and revised in 2004
- Its objective being universalisation of primary education by increasing enrolment,
retention and attendance and simultaneously impacting on nutrition of students in primary
classes
- It was implemented in 2,408 blocks in the 1st year
- Programme originally covered children of primary stage in government, local body and
government aided schools
- It was extended to cover children studying in Education Guarantee Scheme and Alternative
and Innovative Education Centres
- The central assistance provided to states under the programme is by way of free supply of
food grain from Food corporation of India
- Suggestions for the Mid-Day meal programme
o Food grains must be stored in a place away from moisture, in air tight
containers/bins to avoid infestation
o Use whole wheat or broken wheat for preparing mid-day meals
o Rice should preferably be par-boiled or unpolished
o Single dish meals using broken wheat or rice and incorporating some amount of
pulse or soyabeans
o Cereal pulse combination is necessary to have good quality protein
o Sprouted pulses have more nutrients and should be incorporated in single dish meals
o Leafy vegetables should be thoroughly washed before cutting and should not be
subjected to washing after cutting
o Soaking of rice, dal, Bengal gram reduces cooking time
o Rice water if left after cooking should be mixed with dal if these are cooked
separately and should never be thrown away
o Fermentation improves nutritive value
o Cooking must be done with the lid on to avoid loss of nutrients
o Overcooking should be avoided
o Reheating of oil should be avoided
o Leafy tops of carrots, radish, turnips should not be thrown but utilized in preparing
mid-day meals
Food Adulteration
- Consists of large number of practices e.g. mixing, substitution, concealing the quality,
putting up decomposed foods for sale, misbranding or giving false labels and addition of
toxicants
- Results in 2 disadvantages for the consumers
o Paying more money for a foodstuff of lower quality
o Some forms are injurious to health, even resulting in death,
- Practices vary from one part of the country to another, and from time to time
- Our knowledge about current practices of food adulteration is by no means complete
- Prevention of Food Adulteration Act 1954
o Enacted by the Indian Parliament in 1954 with the objective of ensuring pure and
wholesome food to the consumers and to protect them from fraudulent and
deceptive trade practices
o cases that lead to grievous hurt may result in life imprisonment and Rs.5000 fine
 Nutritional Anaemia Balanced Diet for a Pregnant Mother
- disease caused by malnutrition in its widest sense Balanced Diet for Pregnant Mother includes:
- it has been defined as a condition in which the haemoglobin content of blood is lower than
- Vitamin A
normal as a result of a deficiency of one or more essential nutrients, regardless of the cause
o Retinol – 800 mcg per day
of such deficiency
o Beta-carotene – 6400 mcg per day
- it is established if the haemoglobin is below the cut-off points recommended by WHO
- Thiamine - +0.2 mg per day
- the most frequent cause of nutritional anaemia is iron deficiency and less frequently folate
- Riboflavin - +0.3 mg per day
or Vitamin B12
- Niacin equivalent - +2 mg per day
Detrimental Effects - Vitamin B6 – 2.5 mg per day
- Ascorbic Acid – 60 mg per day
- can be seen in important areas
- Dietary Folate – 500 mcg per day
- Pregnancy
- Vitamin B12 – 1.2 mcg per day
o Increases the risk of maternal and foetal mortality and morbidity
o In India, 19% of maternal deaths were found to be due to anaemia Nutritional Gap
o Conditions such as abortions, premature births, post-partum haemorrhage, low - Gap between the nutrients we need and those that we actually consume
birth weight - Nutritional gaps occur due to consumption of food that are high in some types of nutrients,
- Infection whilst not eating enough foods that contain other important nutrients
o Anaemia can be caused by or aggravated by parasitic diseases - Eating more fruits and vegetables may not mean you achieve your daily recommended
o such as malaria, intestinal parasites allowance for vitamins and minerals
o further, iron deficiency may impair cellular responses and immune functions and
increase susceptibility to infection Assessment of Malnutrition
- Work Capacity - In children, undernutrition is synonymous with growth failure
o Anaemia causes a significant impairment of maximal work capacity - To get a measure of malnutrition in a population, young children are weight and height is
o the more severe the anaemia, the greater the reduction in work performance, and measured and the results compared to those of a reference population known to have
thereby productivity grown well.
o this has a great significance on the economy of the country - Measuring weight and height is the most common way of assessing malnutrition in a given
population
Interventions - Such use of measurement of dimensions of the human body is known as Anthropometry
- Iron and Folic Acid Supplements - Anthropometry is widely used, inexpensive and non-invasive measure of the general
o In order to prevent nutritional anaemia among the mothers and children, nutritional status of an individual or a population group
Government of India sponsored a National Nutritional Anaemia Prophylaxis - The 3 commonly used anthropometric indices are
Programme during the Fourth Five Year Plan o Weight-for-age (WFA)
o It is based on basic daily supplementation with iron and folic acid tablets to o Length-for-Age, or Height-For-Age (HFA)
prevent mild and moderate cases of anaemia o Weight-for-Length, or Weight-for-Height (WFH)
o The beneficiaries are at risk groups (pregnant women, lactating mothers and
Balanced Diet
children under 12)
- Balanced diet is defined as one which contains a variety of foods in such quantities and
- Iron Fortification
proportions that the need for energy, amino acids, vitamins, minerals, fats, carbohydrate
o WHO experts did not recommend iron fortification strategy for control of anaemia
and other nutrients is adequately met for maintaining health, vitality and general well-
in regions where its prevalence is high
being and also makes a small provision for extra nutrients to withstand short duration of
o Studies in India at the National Institute of Nutrition showed that simple addition
leanness
of ferric ortho-phosphate or ferrous sulphate with sodium bisulphate was enough
- It has become an accepted means to safeguard a population from nutritional deficiencies.
to fortify salt with iron
- in constructing the balanced diet:
o Iron fortified salt was found to reduce the prevalence of anaemia significantly
o daily protein requirement should be 10-15% of the daily energy intake
- Other strategies
o fat requirement should be limited to 15-30% of the daily energy intake
o Changing dietary habits
o Carbohydrates rich in natural in natural fibre should constitute the remaining food
o Control of parasites
energy
o Health education
 Lathyrism ESSAY
- Lathyrism is a paralyzing disease of humans and animals
Define Family Planning. List the different methods of family planning. Describe
- In humans, it is referred to as neurolathyrism because it affects the nervous system and in
animals as osteolathyrism (odoratism) because the pathological changes occurs in the Intrauterine Contraceptive Device (IUD) in detail.
bones resulting in skeletal deformities Family Planning is defined by WHO as “a way of thinking and living that is adopted voluntarily,
- Neurolathyrism is a crippling disease of the nervous system upon the basis of knowledge, attitudes and responsible decisions by individuals and couples, in
o Characterised by gradually developing spastic paralysis of lower limbs order to promote the health and welfare of the family group, and thus contribute effectively to
o Occurs mostly in adults that consume the pulse, Lathyrus sativus in large quantities the social development of a country”.
- The toxin It can also be defined as “practices that help individuals or couples attain certain objectives:
o The toxin present in the lathyrus seeds has been identified as Beta Oxalyl Amino
Alanine (BOAA) - To avoid unwanted births
o It has been isolated in crystalline form and is water soluble - To bring about wanted births
o Studies indicate that there is blood brain barrier to this toxin - To regulate intervals between pregnancies
- The disease - To control the time at which births occur in relation to the ages of the parent
o Latent Stage - To determine the number of children in the family
 Individual is apparently healthy, but when subjected to physical stress
Methods of Family Planning
exhibits ungainly gait
 Neurological examination shows characteristic physical signs The methods of family planning are classified into:
 It is considered important from the preventive aspect since at this stage, if
- Spacing Methods
the pulse is withdrawn from the diet, it will result in complete remission of
o Barrier Methods
the disease
 Physical Methods – Condoms, Diaphragms
o No-stick Stage
 Chemical Methods – Jellies, creams, suppositories, soluble films
 Patient waits with short jerky steps without the aid of a stick
 Combined methods
 Large number of patients are found in this stage
o One-Stick Stage
o Intrauterine Devices
 Patient walks with a crossed gait with a tendency to walk on toes
 Lippes Loop,
 Muscular stiffness makes it necessary to use a stick to maintain balance
 Cu-T,
o Two-Stick Stage
 Nova T,
 Symptoms are more severe
 Copper 7,
 Due to excessive bending of knees and crossed legs, the patient needs 2
 Multiload 375,
crutches for support
 Progestasert,
 The gait is slow and clumsy and the patient gets tired easily after walking a
 Levonorgestrel
short distance
o Crawler Stage
o Hormonal Methods
 Finally the erect posture becomes impossible as the knee joints cannot
 Oral pills – combined, POP, Post-coital, Male pill, once a month pill
support the weight of the body
 Depot formulations – injectables, subcutaneous implants, vaginal rings
 There is atrophy of the thigh and leg muscles
 Patient is reduced to crawling by throwing his weight on his hands
o Post-conceptional Methods
- Interventions
 MTP,
o Vitamin C Prophylaxis
 Abortion
o Banning the Crop
 Extreme step and not feasible for immediate implementation
- Terminal Methods
o Removal of Toxin
o Male sterilization
 Steeping Method – toxins are removed by soaking in hot water
 Vasectomy
 Parboiling – soaking in lime water over night, followed by boilin
o Female sterilization
 Education – public must be educated on the dangers of consuming this
 Laparoscopy,
pulse and the need for removing it toxin before consumption
 Mini-Laparotomy
 Genetic approach – selective propagation and cultivation of strains
INTRAUTERINE DEVICES (IUDS) Mechanism of Action of IUDs:

Types: - The most accepted view is that IUD causes a foreign body reaction in the uterus causing
cellular and biochemical changes in the endometrium and uterine fluids.
- There are 2 basic types of IUD; non-medicated and medicated
o It is believed that these changes impair the viability of the gamete and thus
- They are further classified into 3 generations of IUD
reduces the chances of fertilization, rather than its implantation.
- Medicated IUDs produce local effects that contribution to the contraceptive effects
- First Generation IUDs (Lippes Loop)
o Copper seems to enhance the cellular response in the endometrium
o Comprise of the non-medicated devices
o It also affects the enzymes in the uterus
o Usually made of polyethylene or other polymers
 Alters the biochemical composition of cervical mucous
o They appear in different shapes and sizes
 Thus, affecting the sperm motility, capacitation and survival
 Loops, spirals, coils, rings, bows
- Hormone releasing devices increases the viscosity of the cervical mucous, thereby
o Of all the models the Lippes Loop is the best known and commonly used device in
preventing the sperm from entering the cervix
developing countries
o Also maintains high levels of progesterone in the endometrium and relatively low
o Lippes Loop:
levels of oestrogen thus sustaining an unfavourable environment in the
 Double S shaped device made of polyethylene
endometrium for implantation
 It contains a small amount of barium sulfate to allow X-ray observation
 It has attached threads made of fine nylon, which project into the vagina Advantages of IUDs:
after insertion
- Simplicity
 This can be easily felt and is a reassurance that the device is still in place
- Insertion takes only a few minutes
 The thread also makes it easier for removal when desired
- Once inserted, IUD can stay in place for as long as required
- Inexpensive
- Second Generation IUDs (Copper-7, Copper T, ML-Cu-250, ML-Cu-375)
- Contraceptive effect is reversible by removal
o It was found that metallic copper has a ‘strong anti-fertility effect’
- Virtually free of systemic metabolic side-effects
o This makes it possible to develop smaller devices which are easier to fit, even in
- Highest continuation rate
nulliparous women
- No need for the continual motivation required
o The newer copper devices are significantly more effective in preventing pregnancy
than the earlier copper ones Contraindications of IUDs:
o Advantages:
 Low expulsion rate - Absolute
 Lower incidence of side effects o Suspected pregnancy
 Easier to fit in nulliparous women o Pelvic Inflammatory Disease
 Better tolerated by nullipara o Vaginal Bleeding of undiagnosed aetiology
 Increased contraceptive effectiveness o Cancer of cervix, uterus or adnexia
 Effective as post-coital contraceptives, if inserted within 3-5 days of o Previous ectopic pregnancy
unprotected intercourse - Relative
o Anaemia and Menorrhagia
- Third Generation IUDs (Progestasert, Levonorgestrel) o History of Pelvic Inflammatory Disease since last pregnancy
o Based on the principle of release of a hormone o Purulent cervical discharge
o The most widely accepted device is progestasert o Distortions of uterine cavity due to malformations and fibroids
 T shaped device filled with 38 mg of progesterone o Unmotivated persons.
 The hormone is slowly released into the uterus at the rate of 65 mcg daily The Ideal IUD Candidate:
 It has a direct local effect on the uterus lining, cervical mucous and possibly
sperm cells - Borne at least one child
 As there is gradual depletion of the hormone, regular replacement of the - No history of pelvic disease
device is necessary - Normal menstrual periods
o Another hormonal device LNG-20 is available - Willing to check IUD tail
 It is a T shaped device that releases 20 mcg of levonorgestrel - Access to follow ups and treatment of potential complications
- In a monogamous relationship
Side-effects of IUDs: SHORT NOTES
- Bleeding Demographic Cycle
o Most common complaint is increased vaginal bleeding The history of the world population suggests that there is demographic cycle of 5 stages through
o Patient should receive Iron supplement which a nation passes:
 Ferrous Sulphate 200 mg, three times daily
o In most women, removal of device will resolve the issue - First Stage (High Stationary)
o If it persists, full gynaecological examination is required to rule out pelvic o Characterized by high birth rate and high death rate
pathology o These cancel each other out and the population stays stationary
- Pain o India was in this stage until 1920
o Second major side effect - Second Stage (Early Expanding)
o May manifest as low backache, cramps in lower abdomen, and occasionally pain o Death rate begins to decline
down the thighs o Birth rate remains unchanged
o This tends to disappear by the 3rd month o Many countries in South Asia, and Africa are in this phase
o Pain during insertion may be due to incorrect placement in the uterus o Birth rates have increased as a result of improved health conditions and
o Severe pain indicates uterus perforation or infection shortening periods of breast feeding
o More often observed in nullipara - Third Stage (Late Expanding)
- Pelvic Infection o Death rate declines still further
o Pelvic Inflammatory Disease should be treated with broad-spectrum antibiotics o Birth rate tends to fall
o Most clinicians suggest removal of the IUD o Population continues to grow because birth exceeds deaths
- Uterine Perforation o India has entered this phase
- Pregnancy - Fourth Stage (Low Stationary)
o The IUD may fail and pregnancy may still occur o Characterized by low birth and low death rate with the result that population
o This should be considered as a complication with dangers of infection and becomes stationary
spontaneous abortion o Zero population growth has already been recorded in Austria during 1980-1985
- Ectopic Pregnancy o Most industrialized countries have undergone a demographic transition shifting
o Possibility of ectopic pregnancy is considered when an IUD user becomes pregnant from a high stationary phase to a low birth and low death rate phase
o With Levonorgestrel, the chances are much less due to partial suppression of - Fifth Stage (Declining)
gonadotrophins with subsequent disruption of normal follicular growth and o Population begins to decline
inhibition of ovulation o Birth rate is less than death rate
- Expulsion o Germany and Hungary are experiencing this stage
o Occurs during the first few weeks following insertion or during menstruation
Medical Termination of Pregnancy Act 1971
o Expulsion is common among young women, nulliparous women and women who
There are 5 conditions that have been identified:
have a post-partum insertion
- Mortality - Medical – continuation of pregnancy may endanger the mother’s life or her physical or
o Death associated with use of IUD is extremely rare mental health
- Eugenic – substantial risk of the child being born with serious handicaps
- Humanitarian – pregnancy as a result of rape
- Socio-economic – actual or reasonably foreseeable environments may lead to injury to
mother
- Failure of Contraceptive devices – can constitute a grave mental injury to the health of the
mother; it is a unique feature of the Indian Law and allows abortion on request

Persons that can perform the abortion include Registered Medical Practitioner with experience in
OBG to perform the abortion when the pregnancy is less than 12 weeks long. If the pregnancy is
more than 12 weeks along, 2 medical practitioners are required to give an opinion.
The abortion can only be performed at a hospital established and maintained by the
government, or a hospital approved for the purpose of this Act by the Government.
 Barrier Contraceptive Methods Fertility Indicators
- The aim of barrier contraceptive methods is to prevent live sperm from meeting the ovum - Birth Rate
- They have increased in popularity due to certain contraceptive and non-contraceptive o Simplest indicator
advantages o Number of live births per 1000 estimated midyear population
- The main contraceptive advantage is the absence of side effects associated with the pill 𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝐿𝑖𝑣𝑒 𝐵𝑖𝑟𝑡ℎ𝑠 𝑑𝑢𝑟𝑖𝑛𝑔 𝑡ℎ𝑒 𝑦𝑒𝑎𝑟
o 𝐵𝑖𝑟𝑡ℎ 𝑅𝑎𝑡𝑒 = 𝑥 1000
𝐸𝑠𝑡𝑖𝑚𝑎𝑡𝑒𝑑 𝑀𝑖𝑑 𝑌𝑒𝑎𝑟 𝑃𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛
and IUDs.
- General Fertility Rate
- The non-contraceptive advantages include protection from sexually transmitted
o Number of live births per 1000 women in the reproductive age group per year
diseases, a reduction in incidence of PID, and possibly some protection from the risk of 𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝐿𝑖𝑣𝑒 𝑏𝑖𝑟𝑡ℎ𝑠 𝑖𝑛 𝑎𝑛 𝑎𝑟𝑒𝑎 𝑑𝑢𝑟𝑖𝑛𝑔 𝑡ℎ𝑒 𝑦𝑒𝑎𝑟
cervical cancer. o 𝐺𝐹𝑅 = 𝑥 1000
𝑀𝑖𝑑 𝑦𝑒𝑎𝑟 𝑓𝑒𝑚𝑎𝑙𝑒 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑎𝑔𝑒 15−44 𝑖𝑛 𝑡ℎ𝑒 𝑠𝑎𝑚𝑒 𝑎𝑟𝑒𝑎 𝑖𝑛 𝑠𝑎𝑚𝑒 𝑦𝑒𝑎𝑟
- Barrier methods require a high degree of motivation on the part of the user - General Marital Fertility Rate
- They are generally less effective than the pill or the loop o Number of live births per 1000 married women in the reproductive age group in
- They are only effective if used consistently and carefully a given year
𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝐿𝑖𝑣𝑒 𝐵𝐼𝑟𝑡ℎ𝑠 𝑖𝑛 𝑎 𝑦𝑒𝑎𝑟
o 𝐺𝑀𝐹𝑅 = 𝑥 1000
Examples: 𝑀𝑖𝑑−𝑦𝑒𝑎𝑟 𝑚𝑎𝑟𝑟𝑖𝑒𝑑 𝑓𝑒𝑚𝑎𝑙𝑒 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑖𝑛 𝑡ℎ𝑒 𝑎𝑔𝑒 𝑔𝑟𝑜𝑢𝑝 15−49
- Age-specific Fertility Rate
- Physical Methods
o Number of live births in a year to 1000 women in any specified age group
o Condoms 𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝐿𝑖𝑣𝑒 𝑏𝑖𝑟𝑡ℎ𝑠 𝑖𝑛 𝑎 𝑝𝑎𝑟𝑡𝑖𝑐𝑢𝑙𝑎𝑟 𝑎𝑔𝑒 𝑔𝑟𝑜𝑢𝑝
o 𝐴𝑆𝐹𝑅 = 𝑥 1000
o Diaphragms 𝑀𝑖𝑑−𝑦𝑒𝑎𝑟 𝑓𝑒𝑚𝑎𝑙𝑒 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑜𝑓 𝑡ℎ𝑒 𝑠𝑎𝑚𝑒 𝑎𝑔𝑒 𝑔𝑟𝑜𝑢𝑝
o Vaginal Sponge - Age-specific Marital Fertility Rate
- Chemical Methods o Number of live births in a year to 1000 married women in any specified age
o Foams – foam tablets, foam aerosols group
𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑙𝑖𝑣𝑒 𝑏𝑖𝑟𝑡ℎ𝑠 𝑖𝑛 𝑎 𝑝𝑎𝑟𝑡𝑖𝑐𝑢𝑙𝑎𝑟 𝑎𝑔𝑒 𝑔𝑟𝑜𝑢𝑝
o Creams, Jellies and Pastes – squeezed from a tube o 𝐴𝑆𝑀𝐹𝑅 = 𝑥 1000
𝑀𝑖𝑑 𝑦𝑒𝑎𝑟 𝑚𝑎𝑟𝑟𝑖𝑒𝑑 𝑓𝑒𝑚𝑎𝑙𝑒 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑜𝑓 𝑡ℎ𝑒 𝑠𝑎𝑚𝑒 𝑎𝑔𝑒 𝑔𝑟𝑜𝑢𝑝
o Suppositories – inserted manually - Total Fertility Rate
o Soluble films – C films inserted manually o Average number of children a woman would have if she were to pass through her
Factors affecting Fertility reproductive years bearing children at the same rates as the women now in each
- Age at marriage age group
5 𝑥 ∑45−49
15−19 𝐴𝑆𝑀𝐹𝑅
o Females who marry before the age of 18 gave birth to a larger number of o 𝑇𝑀𝐹𝑅 =
1000
children than those who married after 18. - Gross Reproductive Rate
- Duration of Married Life o Average number of girls that would be born to a woman
o births after 25 years of married life are very few 5 𝑥 ∑45−49
15−19 𝐴𝑆𝐹𝑅 𝑓𝑜𝑟 𝑓𝑒𝑚𝑎𝑙𝑒 𝑙𝑖𝑣𝑒 𝑏𝑖𝑟𝑡ℎ𝑠
o 𝐺𝑅𝑅 = 1000
o suggests that family planning efforts should be concentrated in the first few
methods of married life to achieve tangible results - Net Reproductive Rate
- Spacing of Children o Number of daughters a newborn girl will bear during her lifetime
o When births are postponed by one year, there was a decline in total fertility - Child-women ratio
- Education o Number of children aged 0-4 per 1000 women of child-bearing age
o Inverse association between fertility and educational status - Pregnancy Rate
o TFR is higher in illiterate women than educated women o Ratio of number of pregnancies in a year to married women in the reproductive
- Economic Status age group
o Economic status bears an inverse relationship with fertility - Abortion Rate
o Total number of children born decreases with an increase in per capita expenditure o Annual number of all types of abortions, per 1000 women of child bearing age
of the household - Marriage Rate
- Caste and religion o Number of marriages in the year per 1000 population
𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑀𝑎𝑟𝑟𝑖𝑎𝑔𝑒𝑠 𝑖𝑛 𝑡ℎ𝑒 𝑦𝑒𝑎𝑟
o Muslims have a higher fertility than Hindus o 𝐶𝑟𝑢𝑑𝑒 𝑀𝑎𝑟𝑟𝑖𝑎𝑔𝑒 𝑅𝑎𝑡𝑒 = 𝑀𝑖𝑑−𝑦𝑒𝑎𝑟 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛
𝑥 1000
o Lower castes have a higher fertility rate than the higher castes 𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑚𝑎𝑟𝑟𝑖𝑎𝑔𝑒𝑠 𝑤𝑖𝑡ℎ𝑖𝑛 1 𝑦𝑒𝑎𝑟
o 𝐺𝑒𝑛𝑒𝑟𝑎𝑙 𝑀𝑎𝑟𝑟𝑖𝑎𝑔𝑒 𝑅𝑎𝑡𝑒 = 𝑥 1000
- Nutrition 𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑢𝑛𝑚𝑎𝑟𝑟𝑖𝑒𝑑 𝑝𝑒𝑟𝑠𝑜𝑛𝑠 𝑎𝑔𝑒 15−49 𝑦𝑒𝑎𝑟𝑠

o There is some relationship between nutrition and fertility

o Well-fed societies have low fertility and poorly fed societies have high fertility
- Family Planning – causes a reduction in fertility
 Oral Contraception Demographic Gap
- Form of hormonal contraception as a method of family planning. - Demographic gap is the difference between birth rate and death rate that develops when
- Classified into a country undergoes demographic transition
o Combined Pills - In a demographic cycle, as the country develops and the living conditions improve, there is
o Progestogen only pill (POP) an initial decrease in the death rate in the population
o Post-coital Pill - But the birth rate continues to remain at a high level
o Once-a-month Pill - This results in a demographic gap and a resultant increase in the total size of population
o Male pill - The demographic gap is maintained till the birth rate and death rates become equal and
the population size becomes stable
Combined Pills:

- Contains no more than 30-35 mcg of the synthetic oestrogen and 0.5-1.0 mg of
progestogen
- It is given orally for 21 consecutive fays beginning on the 5th day of the menstrual cycle,
followed by a break of 7 days, when period menstruation occurs
- Taken every day at a fixed time before going to bed at night

Progestogen Only Pill (POP)

- Referred to as minipill or micropill

- Contains only progesterone which is given in small doses throughout the cycle
- Commonly used progestogens are norethisterone and levonorgestrel

Post-Coital Contraception

- Also known as morning after pill

- It is recommended within 72 hours of unprotected intercourse
- 2 methods are available
o IUD
o Levonorgestrel 0.75 tablet
- Other methods include
o 2 oral contraceptive pills containing 50 mcg of ethinyl estradiol within 72 hours of
intercourse and same time 12 hours later
o 4 oral contraceptive pills containing 30-35 mcg of ethinyl estradiol within 72 hours
and 4 tablets after 12 hours
o Mifepristone 10 mg once within 72 hours
Population Explosion
Once-a-month Pill - Rapid increase in the population of an area.
- Situation in which the economy is not capable of coping with the increasing demand of
- Quinestrol, a long acting oestrogen, is given in combination with a short acting progestogen its population
- Experiments have been disappointing - Causes
Male Pill o Increase in birth rate
o Decrease in infant mortality rate
- Research is being made into male contraception following 4 lines of approach o Growth of the life expectancy
o Preventing spermatogenesis o Poor education on family planning methods
o Interfering with sperm storage and maturation - Effects
o Preventing sperm transport in the vas deferens o Unemployment
o Affecting the constituents of seminal fluid o Poverty
- Male pill made of gossypol has been made which produces azoospermia or severe - Prevention
oligospermia but may leave males permanent azoospermic after 6 months of taking the o Campaigns to promote education on family planning methods and birth control
pill.
ESSAY
Define the objectives of the School Health Programme. Discuss the various services
provided under the School Health Programme.
The objectives of the School Health Service are:
- Promotion of positive health
- Prevention of diseases
- Early diagnosis, treatment and follow-up of defects
- Awakening health consciousness in children
- Provision of healthful environment
Health Appraisal:
- Consists of periodic medical examinations and observation of children by the class teacher
- Periodic Medical Examination
o Initial examination should be thorough and unhastened
o It should include a careful history and physical examination of the child, with tests
for vision, hearing and speech
o Routine examination of blood and urine should be carried out
o Examination for nutritional deficiency and examination of faeces for intestinal
parasites are important in India
o Teacher should record medical history, height and weight regularly, annual testing
of vision and prepare the children for the examination
- School Personnel
o Medical examination should also be given to teachers and other school personnel as
they form the environment to which the child is exposed
- Daily Morning Inspection
o Teacher can conduct daily inspections to note any changes in the child’s appearance
or behaviour to suggest an illness, or improper growth and development
Remedial Measures and Follow Up:
- Examinations are followed by appropriate treatment and follow up
- Special clinics should be conducted for children at PHCs in rural areas, and in one of the
selected schools in the urban areas
- Special clinics should be secured or provided for exclusive use of children for examination
and treatment
- There should be a provision for beds in the existing referral hospitals for the children to be
admitted for investigation and treatment as and when required
Prevention of Communicable Diseases:
- Control through immunization is the most emphasised school health service function
- An immunization programme should be drawn up against the communicable diseases
- Record of all immunizations should be maintained as part of the student’s health record
which will accompany the student when they leave school
Healthful school environment:
- Healthful school environment is necessary for the best emotional, social and personal
health of the pupils
Nutritional services:
- Children who are physically weak will be mentally weak and therefore not be able to take
full advantage of schooling
- The diet of the school child should contain all the nutrients in proper proportions, adequate
for the maintenance of optimum health.
- In order to combat malnutrition, the school health committee recommended the school
children should be assured of at least one nourishing meal that provides at least one-third
of the daily calorie requirement and half of the daily protein requirement of the child
- UNICEF implemented the Applied Nutrition Programme to provide facilities that is utilised
in developing school gardens and the produce should be used in the school feeding
programmes.
First-Aid and Emergency Care:
- Responsibility for first aid and emergency care rests with the teachers and therefore all
teachers should receive adequate training during “Teacher Training Programmes” or “In-
service training programmes” to prepare them to carry out this responsibility
- Every school is fully equipped with First Aid Post as per regulations of St John Ambulance
Association of India
Mental Health:
- Mental health of a child affects their physical health and their learning process
- Juvenile delinquency, maladjustment and drug addiction are rising problems among school
children.
- The school teacher should have a positive and preventive role
- The school routine should be planned to allow enough relaxation between periods of
intense work, and every effort should be made to relieve tedium in the class room
- There is an increasing realization that schools need vocational counsellors and psychologists
to guide the children to the careers they are suited to.
Dental Health:
- Children frequently suffer from dental diseases and defects.
- School health programme should have provision for dental examination at least once a year
- In developed countries, schools employ dental hygienists to do preliminary inspection and
prophylactic cleansing of the teach
o This prevents gum troubles and in improving personal appearance
- They also take part in teaching dental hygiene and its importance to the children
Eye Health Services:
- Schools should be responsible for the early detection of refractive errors, treatment of
squint and amblyopia, and the detection and treatment of eye infections such as trachoma
- Administration of vitamin A has shown results
- Basic eye health services should be provided in schools
Health Education:
- The most important element of school health programme is health education
- The goal is to bring about desirable changes in health knowledge, in attitudes and in
practice and not merely to teach the children a set of rules of hygiene.
Education of handicapped children: Enumerate the common problems in the geriatric population. Discuss in detail the
- The ultimate goal is to assist the handicapped child and his family so that the child will be care of geriatric population.
able to reach his maximum potential, to lead as normal a life as possible, to become as Common Problems among the Geriatric Population
independent as possible, and to become a productive and self-supporting member of - Problems due to ageing process
society o Senile cataract
- The resources for managing handicapped children vary between countries o Glaucoma
- It requires cooperation of health, welfare, social and educational agencies o Nerve deafness
School Health Records: o Osteoporosis affecting mobility
o Emphysema
- Cumulative health records of each student should be maintained o Failure of special senses
- It should contain o Changes in mental outlook
o Identifying data – name, DoB, parent’s name, address
o Past health history - Problems associated with long-term illness
o Record of findings of physical examination, screening tests, record of services o Degenerative diseases of heart and blood vessels
provided o Cancer
- This provides cumulative information on the health aspects of school children in order to o Accidents
give continuing intelligent health supervision o Diabetes
- It will help in analysing and evaluating school health programmes and provides a useful o Diseases of Locomotor system
link between home, school and the community.  Fibrositis, myositis, neuritis, gout, rheumatoid arthritis, osteoarthritis,
spondylitis
o Respiratory illness
 Chronic bronchitis,
 asthma,
 emphysema
o Genitourinary diseases
 Enlargement of prostate
 Dysuria, nocturia,
 Frequent and urgent micturition

- Psychological problems
o Mental Changes
 Impaired memory
 Rigidity of outlook and dislike of change
o Sexual adjustment
 Between 40-50 years, there is cessation of reproduction by women and
diminution of sexual activity on part of men
 Irritability, jealousy and despondency are frequent
o Emotional disorders
 Results from social maladjustment
 Failure to adapt can result in bitterness, inner withdrawal, depression,
weariness of life, and even suicide
Lifestyle and Healthy Ageing: Health Status of the Aged in India
- Diet and Nutrition - The main causes of illness among the elderly are:
o A good diet reduces the chances of developing the diseases of old age o Arthritis, cataract, bronchitis, avitaminosis, ear diseases, hypertension, diabetes,
o a major problem is excessive fat intake rheumatism, helminthic infestations and accidents
o saturated fats and trans-fatty acids are linked to increased risk of cardiovascular - The government announced a National Policy on Older persons in January 1999
disease o It identifies the principal areas of intervention
o to avoid this, people should eat a healthy diet since a very early age to avoid or o It provides for a broad framework for collaboration and cooperation, both within as
delay diseases well as between governmental and non-governmental agencies
o it should be balanced with less saturated fats and oils, lots of fruits and vegetables, - A National Council for Older persons (NCOP) was commissioned to operationalise the policy
less salt and sugar and more calcium and fibre - An integrated programme for older persons has been formulated with the objective of
promoting a society for all ages, to empower and improve the quality of life of older
- Exercise persons
o Exercise helps to maintain good health, as it helps to control weight, and improves - As part of the National Social Assistance Programme, old age pension is being provided to
emotional well-being and relieves stress, improves blood circulation and pressure, more than 4 million destitute elderly all over the country
increases flexibility and energy levels, improves balance - Health care is being provided to the older persons through Bhavishya Arogya Mediclaim and
o Thus, it reduces the dangers of falls, lowers blood sugar levels and helps in Rural Group Life Insurance Schemes
diabetes, improves bone density and thus helps prevent osteoporosis - In 2007, the Indira Gandhi National Old Age Pension Scheme was launched to provide
monthly pension to people over 65 years and living below the poverty line
- Weight
o Overweight and obese people are at risk of developing heart disease, stroke,
diabetes mellitus, hypertension, arthritis later in life
o To avoid this they should do regular exercise and follow a balanced diet
Potential for Disease Prevention in the Elderly
- Smoking PRIMARY SECONDARY TERTIARY
o Older people have usually smoked for longer and tend to continue being heavy Health Habits Screening for: Rehabilitation
smokers - Smoking - Hypertension - Physical deficits
o As a result, they are more likely to have chronic diseases, with smoking causing - Alcohol abuse - Diabetes - Cognitive deficits
further deterioration - Obesity - Periodontal disease - Functional deficits
- Nutrition - Dental caries
- Alcohol - Physical activity - Sensory impairment Caretaker Support
o Drinking beyond a specified amount contributes to later life diseases - Sleep - Medication side effects
o Older people achieve a higher blood alcohol concentration, than young people due Coronary Heart Disease Risk - Colorectal, breast, Introduction of support
to the reduction in body water which helps to dilute the alcohol. Factors cervical, prostate necessary to prevent the loss
cancer of autonomy
o Older people have a decreased ability to develop tolerance to alcohol
Immunization - Depression, stress
o Drinking is linked to liver diseases, gout, stomach ulcers, depression, osteoporosis,
- Influenza - Nutritionally-induced
heart disease, breast cancer, diabetes, hypertension etc. - Pneumovax Anaemias
- Tetanus - Urinary incontinence
- Social Activities Injury prevention - Podiatric problems
o People are become socially isolated, rarely go out and join the community in - Fall risk
activities Iatrogenesis prevention - Tuberculosis
o Going out and getting involved with the community creates a sense of belonging and - Syphilis
aids in maintenance of good mental health Osteoporosis prevention - Stroke prevention
o The support gained from others can also aid in recovering from illness by simply - Myocardial infarction
knowing that others care
 List out the indicators of maternal and child health. Define ‘Maternal Mortality Rate’. SHORT NOTES
Describe the preventive & social measures in place to reduce the high maternal Integrated Child Development Services Scheme (ICDS Scheme)
mortality rate in India. - The most important scheme in the field of child welfare
The indicators of MCH are: - The scheme was sanctioned in 1975 to the aim to lay a solid foundation for the
- Maternal Mortality Rate development of the nation’s human resource by providing an integrated package of early
- Mortality in Infancy and Childhood childhood services
o Perinatal mortality rate - The objectives of the ICDS are:
o Neonatal mortality rate o Improve the nutritional and health status of children in the 0-6 age group
o Post-neonatal mortality rate o Lay the foundations for proper psychological, physical and social development of
o Infant mortality rate the child
o 1–4 year mortality rate o Reduce mortality, and morbidity, malnutrition and school dropouts
o Under 5 mortality rate o Achieve an effective coordination of policy and implementation among the various
o Child Survival rate departments working for promotion of child development
o Enhance the capability of the mother and nutritional needs of the child through
Maternal Mortality Rate proper nutrition and health education
- DELIVERY OF SERVICES
Maternal Mortality Rate is defined as “number of maternal deaths in a given period per 100,000
o Supplementary Nutrition
women of reproductive age during the same time period”
 Given to children below 6 years
Preventive & Social Measures to Reduce Maternal Mortality Rate  Aim is to supplement nutritional intake as:
 Child between 6-72 months to get 500 calories and 12-15g of
- High maternal mortality reflects inadequacy of health care services for mothers, and also
protein
the low standard of living and socioeconomic status in the community.
 Severely malnourished child 6-72 months to get 800 calories and
- The problem of maternal mortality is one of applying obstetric knowledge through
20-25g of protein
antenatal, intranatal and post-natal services rather than developing new skills
 Each pregnant and nursing women to get 600 calories and 18-20g
Any attempt to lower the MMR must take into consideration: of protein
o Nutrition and Health Education
1) Early Registration of Pregnancy
 Given to all women in the age group of 15-45 years
2) At least 4 antenatal check ups
 Gives priority to nursing and pregnant mothers
3) Dietary supplementations, including correction of anaemia
 It is imparted by specially organised courses in village during home visits
4) Prevention of infection and haemorrhage during puerperium
o Immunization
5) Prevention of complications
 Immunisation against 6 vaccine preventable diseases is being done
a. Eclampsia
 For expectant mothers, immunisation against tetanus is recommended.
b. Malpresentations
o Health Check-Up
c. Ruptured uterus
 Antenatal care of expectant mothers
6) Treatment of Medical conditions
 Postnatal care of nursing mothers and care of newborn infants
a. Hypertension
 Care of children under 6 years of age
b. Diabetes
 Expectant mothers are given iron and folic acid along with protein
c. Tuberculosis
supplements & minimum of 3 physical examinations are done
7) Anti-malaria and tetanus prophylaxis
 High risk mothers are referred to appropriate institutions for special care
8) Clean delivery practice
 Health care of children under 6 consists of:
9) In India, a large number of maternal deaths can be avoided with the help of trained
 Record of weight and height, watch over milestones, immunizations,
village level health workers
general check up every 3-6 months, treatment for diseases,
10) Institutional deliveries for women with bad obstetric history and risk factors
deworming, prophylaxis against nutritional deficiencies
11) Promotion of family planning – control the number of children to no more than 2, and
o Non-formal Pre-school education
spacing of births
 Children between 3-6 years are imparted non-formal preschool education
12) Identification of every maternal death and searching for its cause
 Provides opportunities for children to develop desirable attitude, values
13) Safe abortion services
and behaviour pattern among children
 Psycho-social problems of the Elderly Weaning of a Child
Mental Changes: - Gradual process starting around the age of 6 months, because the mother’s milk alone is
not sufficient to sustain growth beyond 6 months
- Impaired memory, rigidity of outlook and dislike of change are some of the mental changes
- It should be supplemented by suitable foods rich in protein and other nutrients
seen in the aged
- Suitable supplement foods include
- Reduced income leads to a fall in the living standards of the elderly
o Cow’s milk
- It does have mental and social consequences
o Fruit juice
Sexual Adjustment: o Soft cooked rice
o Suji
- Between the age of 40-50, there is cessation of reproduction by women and diminution of o Vegetables
sexual activity on the part of men - The weaning period is the most crucial period in child development
- During this phase, physical and emotional disturbances may occur o During this period, children are particularly exposed to deleterious synergistic
- Irritability, jealousy and despondency are very frequent interaction of malnutrition and infection
Emotional Disorders: - Improper weaning is followed by diarrhoea and months of growth failure leading to
kwashiorkor, marasmus and immunodeficiency marked by recurrent and persistent
- Emotional disorders result from social maladjustment infections
- The degree of adaptation to the fact of ageing is crucial to a person’s happiness in this - Knowledge of weaning foods and practices is an important aspect of preventive and social
phase of life pediatrics
- Failure to adapt can result in bitterness, inner withdrawal, depression, weariness of life, - There is enough evidence to show that children can be properly weaned by local foods of a
and even suicide kind usually consumed by the older children and adults in their families.
- Efforts should be made to design and promote the use of adequate home-made weaning
Uses of Growth Chart
foods
1) For growth monitoring, which is of great value in child health care
Infant Mortality Rate
2) Diagnostic tool, for identifying ‘high risk’ children. - The ratio of infant deaths registered in a given year to the total number of live births
a. For example, malnutrition can be detected long before signs and symptoms of it registered in the same year; usually expressed as a rate per 1000 live births
become apparent
𝐼𝑛𝑓𝑎𝑛𝑡 𝑀𝑜𝑟𝑡𝑎𝑙𝑖𝑡𝑦 𝑅𝑎𝑡𝑒
3) Planning and policy making 𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝐷𝑒𝑎𝑡ℎ𝑠 𝑜𝑓 𝐶ℎ𝑖𝑙𝑑𝑟𝑒𝑛 𝑙𝑒𝑠𝑠 𝑡ℎ𝑎𝑛 1 𝑦𝑒𝑎𝑟 𝑜𝑓 𝑎𝑔𝑒 𝑖𝑛 𝑎 𝑦𝑒𝑎𝑟
= 𝑥 1000
a. By grading malnutrition, it provides an objective basis for planning and policy 𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑙𝑖𝑣𝑒 𝑏𝑖𝑟𝑡ℎ𝑠 𝑖𝑛 𝑡ℎ𝑒 𝑠𝑎𝑚𝑒 𝑦𝑒𝑎𝑟
making in relation to child health care at the local and central levels - It is universally regarded not only as a most important indicator of the health status at a
community but also of the level of living of people in general
4) Educational Tool - It is given a separate treatment by demographers:
a. It is a visual character and thus allows the mother to be educated in the care of her o Infant mortality is the largest single age-category of mortality
own child o Deaths at this age is due to peculiar set of diseases and conditions to which the
b. It will encourage her to participate more actively in growth monitoring adult population is less exposed or less vulnerable
o Infant mortality is affected rather quickly and directly by specific health programmes
5) Tool for action and hence may change more rapidly than the general death rate
a. It helps the health worker on the type of intervention that is needed - Factors affecting IMR
b. It will help to make referrals easier o Birth weight, birth order, birth spacing, multiple births, family size, high fertility
o Economic factors
6) Evaluation o Cultural factors - breast feeding, religion and caste, early marriages, quality of
a. It provides a good method to evaluate the effectiveness of corrective measures mothering, maternal education, quality of health care, broken families, illegitimacy,
and the impact of a programme or of special interventions for improving child brutal habits and customs, indigenous dai, bad environmental sanitation
growth and development - Preventive and Social Measures
7) Tool for teaching o Prenatal nutrition, prevention of infection, breast feeding, growth monitoring,
a. It can be used for teaching family planning, sanitation, provision of primary health care, socioeconomic
b. For example, importance of adequate feeding, deleterious effects of diarrhoea development, education
 Baby Friendly Hospital Initiative Juvenile Delinquency
- BFHI was created and promoted by WHO and UNICEF, and has proved highly successful in - Not merely juvenile crime
encouraging proper infant feeding practices, starting at birth - It embraces all deviations from normal youthful behaviour and includes the incorrigible,
- It is supported by the major professional medical and nursing bodies in India ungovernable, habitually disobedient and those who desert their homes and mix with
- The implementation guidelines have been revised recently in the year 2018 immoral people, those with behaviour problems and indulge in antisocial practices
- The 10 steps summarise a package of policies and procedures that facilities providing
Incidence:
maternal and newborn services should implement to support breastfeeding
- It is reported that 2% of children between 7 and 17 years attend juvenile courts
The steps are:
- Highest incidence is found in children aged 15 and above
- Comply fully with international code of marketing of breast-milk substitutes and relevant - The incidence among boys is 4-5 times more than among girls
World Health Assembly resolutions
Causes:
- Have a written infant feeding policy that is routinely communicated to staff and parents
- Establish ongoing monitoring and data management system - Biological Cause
- Ensure that staff have sufficient knowledge, competence and skills to support breastfeeding o Hereditary defects
with pregnant women and their families o Feeble mindedness
- Facilitate immediate and uninterrupted skin to skin contact and support mothers to initiate o Physical defects
breastfeeding as soon as possible after birth o Glandular imbalance
- Support mothers to initiate and maintain breastfeeding and manage common difficulties - Social Causes
- Do not provide breastfed newborns any food or fluids other than breast milks o Broken homes
- Enable mothers and their infants to remain together and to practice rooming in 24 hours o Disturbed home conditions
- Support mothers to recognize and respond to their infants cues for feeding - Other causes
- Coordinate discharge so that parents and their infants have timely access to ongoing support o Absence of recreation facilities
and care o Cheap recreation
o Sex thrillers
Low Birth Weight o Urbanization
- Birth weight is the single most important determinant of its chances of survival, healthy o Industrialization
growth and development o Cinemas and television
- There are 2 main groups o Slum dwelling
o Those born prematurely (short gestation)
o Those with foetal growth retardation Preventive Measures:
- Short gestation period is the major cause
- Improvement of family life
- The majority of cases can be attributed to foetal growth retardation
- Schooling
- Low birth weight is defined as birth weight of less than 2.5 kg (upto and including 2499g)
- Social welfare services
- Measurement being taken preferably within the 1st hour of life, before significant postnatal
o Recreation facilities, parent-counselling, child guidance, educational facilities,
weight loss has occurred
adequate general health services
- An LBW infant, is any infant with a birth weight of less than 2.5 kg regardless of gestational
age.
- This includes 2 kinds of infants; Preterm Babies, Small-for-date Babies

Exclusive Breast Feeding

- Breast milk provides the main source of nourishment in the first year of life
- Lactation continues to make an important contribution to the child’s nutrition for 18
months or longer
- In the world’s more affluent societies, breast feeding appears to have become a lost art and
the feeding bottle has usurped the breast
- The content of the feeding bottle is likely to be as nutritionally poor as it is
bacteriologically dangerous
- It is therefore very important to advise the mothers to avoid the feeding bottles