Abdirahman Mohamed Ali

abdirahmancmc2@gmail.com
August 25 2022

Assignment for MoPH, July intake, 2022

Instruction

Dear students, this is the assignment for the semester MoPH sessions. Do the
assignment and send it to the email address- teferi26@yahoo.com before August 27.
Please read the instructions carefully on each part.

Part one-Essay Questions-10 points each-50%

1. Explain the Aims of public Health in not more than 300 words.
The answer to Question ONE
Public health is a science that is aimed at protecting and improving the health of individuals,
communities and greater populations, which may be as small as a neighborhood or as big as a
region of the world.
Regardless of the size of the populations they serve, public health professionals, work to prevent
health problems from occurring or reoccurring, and mitigate the effects when problems do occur.
They accomplish this task through educational programs, the creation and implementation of
policies, the administration of services, and through research. Therefore, a major objective of
public health is to promote healthcare equity, quality, and accessibility.
The objectives of public health may be carried out through public or private endeavors, and
many times efforts are coordinated among a number of private and public entities. According to
the World Health Organization (WHO), the goal of public health is to prevent disease, promote
health, and prolong life among the population as a whole. Therefore, public health initiatives are
aimed at fostering conditions in which people can be healthy within specific populations.
The World Health Organization recognizes the main objectives of public health initiatives to be:

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  To assess and monitor the health of communities and populations at risk so as to identify
health problems and priorities
 To formulate public policies designed to solve local and national health problems and
priorities
 To assure that all populations have access to cost-effective and appropriate care, which
includes health promotion and disease prevention services

In short, the goals of public health are to save money, improve the quality of life, help children
thrive, and reduce human suffering by:

 Assuring the quality and accessibility of health services

 Preventing epidemics and the spread of disease
 Preventing injuries
 Promoting and encouraging healthy behaviors
 Protecting against environmental hazards
 Responding to disasters and assisting communities in recovery

Public Health is important due to aiding and prolonging life. Through the prevention of
health issues, individuals can spend more of their years in good health. 4. Public Health helps
detect health issues as early as possible and responds appropriately to avoid the development
of disease.

2. Describe the components of public health approaches in not more than 400 words.
The answer to Question Two
In step one, the problem is defined. This involves systematically collecting data to determine the
“who”, “what, “where,” “when,” and “how.” Data are typically gathered from a variety of
sources such as death certificates, medical or coroner reports, hospital records, child welfare
records, law enforcement or other records. Data can also be collected using population-based
surveys or other methods.

In step two, the reasons why one person or community experiences violence while another does
not are explored. Scientific research methods are used to identify the factors that increase the risk
for violence (risk factors). Factors that may buffer against these risk factors are also identified;
these protective factors decrease the likelihood of violence in the face of risk. The goal of
violence prevention is to decrease risk factors and increase protective factors.

In step three, prevention strategies are developed and rigorously tested to see if they prevent
violence. This information is shared with others, usually through activities related to step four.

Step four is where the rubber meets the road. The strategies shown to be effective in step three
are disseminated and implemented broadly. While many prevention practitioners may not have
the skills or resources necessary to conduct steps one, two, and three, knowing where to look for
the findings of others, such as registries for evidence based practice in the field, will satisfy
similar goals for implementation. Training and/or technical assistance often is offered to

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practitioners when implementing effective strategies or programs to ensure that the strategies are
implemented as they were intended. Though this is considered the final step of the public health
model, it doesn’t mean that the process is complete. Additional assessments and evaluation are
done to assure that all components of the strategy fit within the particular community context and
have the desired effect of preventing violence.

o Surveillance is the monitoring of behavior, many activities, or information for the purpose of
information gathering, influencing, managing or directing.
o Protective factors are characteristics associated with a lower likelihood of negative
outcomes or that reduce a risk factor's impact. Protective factors may be seen as positive
countering events. Some risk and protective factors are fixed: they don't change over time.

Risk factors are characteristics at the biological, psychological, family, community, or cultural
level that precede and are associated with a higher likelihood of negative outcomes.

o Preventive intervention is a response not to actual aggression, but to aggression expected at
some indefinite time in the future. Generally, the intervener expects future aggression
because it perceives the target state as an opponent whose military power is on the rise
relative to the intervener.
o Implementation evaluation determines whether program activities have been implemented
as intended. • Outcome/effectiveness evaluation measures program effects on the target
population by assessing the progress in the outcomes or outcome objectives that the program
is to achieve.

3. List the common environmental pollutants and their effect on the health of the
community in not more than 300 words.
The answer to Question Tree
The common environmental pollutants are carbon monoxide,
hydrocarbons, nitrogen oxides, sulfur oxides, and particulates.
Airborne solid particles and liquid droplets.
The most common air pollutants are ground-level ozone and Particulates Matter (PM). Air
pollution is distinguished into two main types:
Outdoor pollution is ambient air pollution.
Indoor pollution is the pollution generated by the household combustion of fuels.
People exposed to high concentrations of air pollutants experience disease symptoms and states
of greater and lesser seriousness. These effects are grouped into short- and long-term effects
affecting health.
Susceptible populations that need to be aware of health protection measures include old people,
children, and people with diabetes and predisposing heart or lung disease, especially asthma.

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Carbon monoxide affects the greenhouse gases that are tightly connected to global warming and
climate. This should lead to an increase in soil and water temperatures, extreme weather
conditions or storms may occur, and also effects of sulfur oxides are Environmental adverse
effects, such as acidification of soil and acid rain, which seem to be associated with sulfur
dioxide emissions. 
It increases the risk of respiratory infections, heart disease, and lung cancer. Both short and long-
term exposure to air pollutants has been associated with health impacts. More severe impacts
affect people who are already ill. Children, the elderly, and poor people are more susceptible.
These problems can be aggravated by extended long-term exposure to the pollutants, which is
harmful to the neurological, reproductive, and respiratory systems and causes cancer and even,
rarely, deaths.
The long-term effects are chronic, lasting for years or the whole life, and can even lead to death.
Furthermore, the toxicity of several air pollutants may also induce a variety of cancers in the
long term.
Neurological effects have been observed in adults and children after extended-term exposure to
air pollutants.
Psychological complications, autism, retinopathy, fetal growth, and low birth weight seem to be
related to long-term air pollution.

4. Define the Primary Prevention of diseases and list at least four examples in not more
than 200 words.
The answer to Question Four
Primary Prevention refers to those activities that are undertaken to prevent disease and injury
from occurring. It works with both the individual and the community. It may be directed at
the host, to increase resistance to the agent (such as immunization or cessation of smoking).
Primary prevention includes measures that all patients can take to avoid some diseases from
manifesting, such as immunization, birth control and condom usage, regular dental cleanings
and care, and hand-washing. Primary prevention must start before the patient’s diagnosis
occurs. Since the patient has a higher risk of developing type 2 diabetes, the attending
physician recommends healthy lifestyle suggestions, including avoidance of high
carbohydrate and sugar-rich foods and weight loss if overweight. Researchers at the Mayo
Clinic report that a reduction of five percent of body weight can greatly reduce the patient’s
risk of developing diabetes.
 legislation and enforcement to ban or control the use of hazardous products (e.g. asbestos) or
to mandate safe and healthy practices (e.g. use of seatbelts and bike helmets)

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 education about healthy and safe habits (e.g. eating well, exercising regularly, not smoking)
 Immunization against infectious diseases.
 May be directed at environmental activities to reduce conditions favorable to the vector for a
biological agent, such as mosquito vectors of malaria.
5. Describe the Classification of Epidemiological Studies in not more than 300 words.
The answer to Question Five
 In an experiment, those who are exposed to the agent or putative cause are exposed only
because the investigator has assigned the exposure to the subject. Furthermore, the reason for
assigning the specific exposure to the particular subject must be simply the pursuit of the
study protocol-that is, the only reason for the assignment must be to conform to the protocol
rather than to meet the needs of the subject. For example, suppose that a physician treating
headache had prescribed a patented drug to her wealthy patients and a generic counterpart to
her indigent patients, because the presumed greater reliability of the patented version was in
her judgment not worth the greater cost for those of modest means. Should the physician later
want to compare the effects of the two medications, she could not consider herself to be
conducting an experiment, despite the fact that the investigator herself had assigned the
exposures. To conduct a proper experiment, she would have to assign the drugs according to
a protocol that would reduce variation between the treatment groups with respect to other
potential causes of headache. The assignment of exposure in experiments is designed to help
the study rather than the individual subject. If it is done to help the subject, then a
nonexperimental study is still possible, but it should not be called an experiment. Sometimes
the term quasi-experiment is used to refer to controlled studies in which exposure was
assigned but not according to a randomized experimental protocol (Cook and Campbell,
1979). Because the goals of the study rather than the subject's needs determine the exposure
assignment, ethical constraints limit the circumstances in- which epidemiologic experiments
are feasible. Experiments are ethically permissible only when adherence to the scientific
protocol does not conflict with the subject's best interests. Specifically, there should be
reasonable assurance that no participating subject could be treated better than the two or
more treatment possibilities that the protocol provides. From this requirement comes the
obvious constraint that any exposures or treatments given to subjects should be limited to
potential preventives of disease or disease consequences. This limitation alone confines most

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 etiologic research to the nonexperimental variety. A second constraint is that all of the
treatment alternatives should be equally acceptable under present knowledge. A third
constraint is that subjects admitted to the study should not be thereby deprived of some
preferable form of treatment or preventive that is not included in the study. For example, it is
unethical to include a placebo therapy as one of the arms of a clinical trial if an accepted
remedy or preventive of the outcome already exists. The best available therapy should be the
comparison for any new treatment. Additionally, subjects must be fully informed of their
participation in an experiment and of the possible consequences. Even with these limitations,
many epidemiologic experiments are conducted. Most fall into the specialized area of clinical
trials, which are epidemiologic studies of different treatments for patients who already have
some disease (trial is used as a synonym for experiment). Epidemiologic experiments that
aim to evaluate primary preventives (agents intended to prevent disease onset in the first
place) are less common than clinical trials; these studies are usually field trials or community
intervention trials.
 In an observational study, the epidemiologist simply observes the exposure and disease
status of each study participant. John Snow’s studies of cholera in London were
observational studies. The two most common types of observational studies are cohort
studies and case-control studies; a third type is cross-sectional studies.
In the classic cohort study, the investigator defines two or more groups of people that are
free of disease and that differ according to the extent of their exposure to a potential cause of the
disease. These groups are referred to as the study cohorts (from the Latin word for one of the ten
divisions of a Roman legion). In such studies, there is at least one cohort thought of as the
exposed cohort-those individuals who have experienced the putative causal event or condition-
and another cohort thought of as the unexposed, or reference cohort. There may be more than
just two cohorts, but each cohort would represent a group with a different level or type of
exposure. For example, an occupational cohort study of chemical workers might comprise
cohorts of workers in a plant who work in different departments of the plant, with each cohort
being exposed to a different set of chemicals. The investigator measures and compares the
incidence rate of the disease in each of the study cohorts.
Case-control studies are best understood by defining a source population, which represents a
hypothetical study population in which a cohort study might have been conducted. If a cohort

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 study were undertaken, the primary tasks would be to identify the exposed and unexposed
denominator experience, measured in person-time units of experience or as the number of people
in each study cohort, and then to identify the number of cases occurring in each person-time
category or study cohort. In a case-control study, the cases are identified and their exposure
status is determined just as in a cohort study, but denominators from which rates could be
calculated are not measured. Instead, a control group of study subjects is sampled from the entire
source population that gives rise to the cases. The purpose of the control group is to determine
the relative (as opposed to absolute) size of the exposed and unexposed denominators within the
source population. From the relative size of the denominators, the relative size of the incidence
rates (or incidence proportion, depending on the nature of the data) can be estimated. Thus, case-
control studies yield estimates of relative effect measures. Because the control group is used to
estimate the distribution of exposure in the source population, the cardinal requirement of control
selection is that the controls must be sampled independently of their exposure status.
A study that includes as subjects all persons in the population at the time of ascertain ment or a
representative sample of all such persons, including those who have the disease, and that has an
objective limited to describing the population at that time, is usually referred to as a cross-
sectional study. A cross-sectional study conducted to estimate prevalence is called
prevalence study. Usually, the exposure information is ascertained simultaneously with the
disease information, so that different exposure subpopulations may be compared with respect to
their disease prevalence. Cross-sectional studies need not have etiologic objectives. For example,
delivery of health services often requires knowledge only of how many items will be needed
(such as number of hospital beds), without reference to the causes of the disease. Nevertheless,
prevalence data are so often used for etiologic inferences that a thorough understanding of their
limitations is essential.

Part Two-Multiple choice Questions, each questions has got only one answer each
one point 30%

1. A Public health interventions that locates populations of interest or populations at risk

and provides information about the nature of the concern, what can be done about it,
and how to obtain services is,
A. Screening

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B. Case-finding
C. Outreach
D. Disease and health event investigation

2. A particular form of longitudinal study that samples a group of people who share a
defining characteristic, typically those who experienced a common event in a selected
period, such as birth or graduation, performing a cross-section at intervals through time
is
A.Case control
B. Cohort (retrospective or prospective)
C. Randomized controlled trials
D.A and C

3. The Major stake holders in the health care system include-

A. Government
B.NGOs
C.Health care providers
D.All

4. A Public health core area that determines what causes disease or injury, what the
risks are, who is at risk, and how to prevent further incidences, analyse and interpret
trends in surveillance data, helps understand the measurement of disease and
measuring of risk is
A. Environmental Health

B. Epidemiology

C. Health Services Administration/Management

D. Public Health Policy

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5. The Level of Prevention that manages existing conditions – Reduce disability &
promote rehabilitation and aims to soften the impact of an ongoing illness or injury that
has lasting effects is
A. Tertiary Prevention

B. Secondary Prevention

C. Primary Prevention

D. Primordial prevention

6. The Health Planning steps are

A. Execution- Plan formulation-evaluation

B. Plan formulation- Execution- evaluation
C. Plan formulation- evaluation- Execution
D. Evaluation- Plan formulation- Execution
7. The Purpose of a Cross-Sectional Study as a Descriptive Study is
A. To measure the effectiveness of a new intervention or treatment.
B. To examine the temporal relationship between the exposure and the outcome.
C. To learn about the characteristics of a population at one point in time (like a photo
“snap shot”).
D. To learn about multiple outcomes due to a single exposure.

8. Statistics as a root Of Modern Epidemiology emphasis on

A. Empirical systematic investigation, biology, and
environment/host manipulation.
B. The scientific method, quantification and measurement, and hypothesis testing.
C. Investigation of human behavior in relation to disease, and methods
of data collection
D. Acquisition of grants, research collaboration, and management of clinical trials.

9. Assessment as a core function of Public Health,

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A. Diagnose and investigate health problems and health hazards in the community

B. Helps develop policies and plans

C. Monitor health status to identify and solve community health problems

D. A and C
10. As a Measure of Morbidity, Incidence proportion (or attack rate or risk) is calculated
with the Numerator being
A. Number of current cases (new and pre-existing) over a specified period of time

B. Number of new cases of disease during specified time interval

C. Average or mid-interval population

D. A and C

Part Three-True or False Questions-Two points each 10%

1. In some ways epidemiology can be seen as a bridge between the medical sciences
and the social sciences. True
2. In Non-probability Sampling Results are not generalizable. False
3. Many factors can be associated with a disease but are not causal. True
4. Interventions at the top tiers of the Health Impact Pyramid are designed to help the
entire populations rather than individuals. True
5. Efficiency of Health interventions is the ratio of the output to the inputs of any system
(good input to output ratio). True
Par Four-Fill in the blank- Two points each 10%

1…… Incidence ……….. Is the number of new cases of a disease or condition that

occur in a given population over a specified period of time.
2. …… epidemic………..is the occurrence in a community or region of cases of an
illness, specific health-related behavior, or other health-related event clearly in excess
of normal expectancy.
3 Preventive medicine.is a medical discipline that focuses on preventing diseases and
promoting a general state of health and well-being.

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4…morbidity..is the proportion of people with a disease or condition in a given
population at specified time.
5… bias…….. Is an error in the conception and design of a study – or in the collection,
analysis, interpretation, reporting, publication, or review or data – leading to results or
conclusions that are systematically (as opposed to randomly) different from truth.

Good Luck!!!

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