CONTROL OF COMMUNICABLE

DISEASES
(CHE 225)
DURATION: 30 HOURS
Programme DIPLOMA IN COMMUNITY HEALTH Course Code CHE 225 UNITS 2.0

Course Title Duration 30 HOURS

CONTROL OF COMMUNICABLE
DISEASES
Course Communicable diseases are the leading cause of death and disability worldwide. Many of these diseases can
be prevented or managed by improving access to primitive, preventive and curative services.
Description

Goal This course is designed to enhance the knowledge of students on Communicable Diseases.

At the end of the unit, the learners should be able to:

1.0 Explain the concept of communicable diseases
Objectives 2.0 Discuss the prevention and control of communicable diseases
3.0 Discuss current policies and intervention strategies in disease control
TOPIC PERFORMANCE OBJECTIVES CONTENT

1.0 On completion of this course

the student should be able to:

1.1
Concept of Definition of communicable diseases
communicable 1.1 Define
disease communicable
diseases

1.1.2 1.1 Define key Definition of the following terms:

epidemiological  Incidence
terms  Prevalence
 Endemic
 Epidemic
 Control of diseases
 Prevention
 Resistance
1.3 Classify communicable Classification of communicable diseases as:
diseases
 Viral (measles, hepatitis, HIV/AIDS,
poliomyelitis etc.)
 Bacterial (tuberculosis, leprosy, typhoid and
cholera etc.)
 Rickettsial (syphilis, yaws, dengue fever etc.)
 Protozoan (malaria, amoebisis, balantidiasis,
etc.)
 Fungal (teaniapedis etc.)
 Helminthics (onchocerciasis, ankylostomiasis,
dracontiasis etc.)
 Ectoparasitic (scabies, borella, ptiris-pubis)

1.4 Discuss the causative agents, Causative agents, routes of transmission, signs and
routes of transmission, signs symptoms and management of the diseases listed
and symptoms and above
management of the diseases
listed above

1.5 List notifiable communicable

diseases and their
epidemiologic importance

2.0 2.1 Discuss current approaches in Current approaches in planning and implementing
The prevention and planning and implementing community interventions to prevent and control
control of community interventions to communicable diseases
communicable diseases prevent and control
communicable diseases

3.0 3.1
Current policies and
intervention strategies
in disease control
3. Explain the current national
/state policies and intervention
strategies in disease control
3. Current national / state policies and intervention
strategies in disease control in respect of the following:
 National Malaria Elimination Programme
 National TBL Control Programme’
 HIV and AIDS programmes,
 Neglected Tropical Disease Control Program
(NTDCP)
 Delivery method Teacher’s Students’ Resources Method of References
activity activities evaluation

Brainstorming, Lecture Questioning and Active listening Visuals Questions Relevant

clarification of points Responding to (Newspapers, (oral) publications
teacher’s Journal articles) in the
questions approaches

Discussion/debates Explanation Observing the Audio-visuals Written Current,

teacher’s (video, compact assignments correct and
demonstration disc, DVD, complete list
Internet) of reading
materials

Role play Demonstration using Describing and Group work

diagnostic tools, models critically and
and visuals analysing the presentation
Displaying/projecting scenes in the
audio-visuals audio-visuals

Demonstration with Questioning Describing and Short quizzes

visuals (pictures, critically
charts, etc.) analysing the
reports of field
visits

Audio-visuals (video, Responding to students’ Field visit

compact disc, questions reports
DVD, Internet)

Field visits to agencies Role plays Long essays

such as the State
TBL control
programme’

MCQs

COURSE TITLE: CONTROL OF COMMUNICABLE DISEASES

COURSE CODE: CHE: 225
DURATION: 30 HOURS
UNIT: 2.0

Course description: communicable diseases are leading cause of death and disability
worldwide. Many of these diseases can be prevented or managed by improving access to
primitive, preventive and curative services.

Goal: This course is designed to enhance the knowledge of students on communicable Diseases.
Objectives:

1.0 Explain the concept of communicable Diseases

1.0 Discuss the concept prevention and control of communicable
2.0 Discuss current policies and intervention strategies in disease control
1.1 Define communicable Diseases: simply refers to the diseases that can be spreads or
transmit from one person to another or from animal to man, either directly or indirectly
and equally communicable diseases are those diseases that either has been in our
environment or that has broken out affecting many people, so as to minimize or stop its
occurrence and effect.
1.2 Define key epidemiological terms
 Incidence
 Prevalence
 Endemic
 Epidemic
 Control of Disease
 Prevention
 Resistance
 Incidence: An instance of something happening, and can also defined as the number of
new cases of a particular disease that occur in a stated period of time out of a known
population at risk over an arbitrary whole, e.g number of new cases within a stated of
time divided by population at risk times 1000.Incidence rate shows the rate at which
Healthy people develop the disease over a given period.
 Prevalence: The quality of prevailing something being widespread, Epidemiology the
ratio (for given time period) of the occurrences of a disease or event to the number of
units at risk in the population.
 Endemic Disease: simply means is the disease that is always in an environment. E.g. of
an endemic diseases in our community are malaria, Diarrhea, skin problem, Dysentery,
conjunctivitis.
  Epidemic Diseases: can be defined as a kind of disease that suddenly broken out and also
spreads very rapidly and affecting many people at once, e.g. measles, meningitis,
whooping cough, cholera.
 Control of Diseases: This can be defined as the method introduced in or to manage or
minimized and/or stop the occurrence of the ill Health.
 Prevention: This can be as the measures adopted to avoid the occurrence of the Diseases
condition.
 Resistance: This the method employed so as not allow the inversion or multiplication of
the disease agent. Resistance method can be no specific or natural, in that case many
diseases are resisted, or can be specified or arterial, and in that case only a specified
disease is resisted.

1.3 Classify communicable Diseases

Classification of communicable Diseases as:

 Viral (measles, Hepatitis, HIV And AIDS, poliomyelitis)

 Bacterial (Tuberculosis, leprosy, Typhoid and cholera etc)
 Rickettsial (sylphs, yaws, Dengue fever etc)
 Protozoa (malaria, Amoebiasis, balantidiasis etc)
 Fungal (Tinea paedis)
 Helmentics (onchocercisis, anklytosomiasis,Drancontiasis)
 Ector parasitic (scabies, Borelle, ptiris pubis)

1.4 Discuss the causative agents, route of transmission, signs and symptoms,
management of diseases listed above.
  MEASLES: Is a highly infections, acute viral of children characterized by fever, cough,
sore eyes, and rashes appearing all over the body after third day of the sickness.
 Causative agent: measles virus
 Route of transmission: By droplets and close contact, measles is a highly infectious
disease.
 Signs and symptoms: There are three stages in the natural history of measles, viz
prodromal, eruptive, and post measles stage.
i. Prodromal: It begins 10 days after infection and last until 14
days.characterised by fever, coryza, with sneezing and nasal discharge,
redness of eyes; lacrimination and often photophobia, there may be
vomiting or diarrhea. A day or two before the appearance of the rash
kopliks spots appears on the buccal mucosa opposite the first and second
molar. They are small, bluish-whitish spot on a red base.
ii. Eruptive stage: This is the stage characterized by a typical, dusty –red
macular rash which begins behind the and spreads in a few hours over the
and neck and extend down the body taking 2-3 days to progress to the
lower extremities. The rash may remain discrete, but often it becomes
confluent and blotchy.
iii. Post measles: The child will have lost of weight and will remain weak for
a number of days. There may be failure to recover and a gradual
deterioration into chronic illness due to increase susceptibility to other
bacterial and viral infections. Nutrition and metabolic effect and the tissue
destructive effect of the virus. There may be retarded growth and
diarrhoea, cancrum oris, pyugenic infection, candidiasis, etc.

MANAGEMENT

Refer to standing orders

TUBERCULOSIS: Is a specific bacterial infectious disease that primarily or usually affects

lungs, BUT can also affect other part of the body including bones, joints, and brain, when it
affect the lungs and cause pulmonary tuberculosis. The disease also affect animal like cattle
(zoonosis) This is known as Bovine tuberculosis or cattle Tb, which may sometimes be
communicated to man.

Causative Agent: mycobacterium Tuberculosis

Route of Transmission:

i. Person to person through air when an infected person coughs or sneezes.

ii. By consuming raw milk from infected cattle (Bovine TB)
iii. Living in crowded conditions.

Signs and symptoms

i. General weakness
ii. Weight loss
iii. Fever
iv. Night sweet
v. Persistent cough
vi. Coughing up of blood (Haemoptysis)
vii. Chest pain
viii. In TB of the bones there is swelling, pain with crippling effects on the hips, knees and
spine.

MANAGEMENT

i. Management of cases is divided

ii. The full management into two phases i.e
a. Intensive phase: where rifampicin, isoniazide, pyrazinamide and ethambutol are given
daily for 2 months and followed.
b. Continuation phase: where thialetazon and isoniazid are daily for 6 months.

MALARIA: Is a parasitic infection due to protozoa of the genus plasmodium.

MALARIA: Is an infectious disease caused by the parasite of the genus plasmodium,
transmitted mostly by the bite of an infected female Anopheles mosquito. There are five species
of the parasite causing human malaria, namely, plasmodium falcifarum, p. vivax, p. ovale, p.
malariae and p. knowlesi. Malaria in Nigeria is principally due to plasmodium falcifarum and, to
a lesser extends to plasmodium malariae and plasmodium ovale. However recently there the first
report of every cases of p. vivax in duffy antigen receptor negative in indigenous Nigeria from
the southwestern zone of the country. Plasmodium is accounts for the 97% of the uncomplicated
malaria and is also the species most responsible for the severe form of the disease that lead to
death.

Malaria transmission is stable in Nigeria but with high seasonal variation in the northern half of
the country. Young children, pregnant women and non-immune visitors from non-endemic areas
are particularly more susceptible than the general population. In 2018, of the six countries
accounting for than half the 228 million of malaria cases worldwide, Nigeria contributed 25%,
(MIS 2015 and NDHS 2018).

Causative Agent: malaria caused by a parasite called plasmodium.

Four (4) species

i. Plasmodium falciparum
ii. Plasmodium vivax
iii. Plasmodium ovale
iv. Plasmodium malariae.

Mode of Transmissions

i. Transmitted human by the bite of of anophelates mosquito

ii. Transmission by transfusion of parasite infected blood
iii. Tran placental transmission is also possible.

Signs and symptoms

i. Fever is frequently associated with chills

ii. Sweating
 iii. Headache
iv. Muscles pain
v. Malaise
vi. Anorexia
vii. Nausea/vomiting

N.B in children, fever may be associated with

 Abdominal pain
 Diarrhoea
 Vomiting
 Anaemia is frequent in children and pregnant women.

MANAGEMENT

i. Pregnant women should be tested for malaria at regular interval during ANC
ii. Use of long lasting insecticide net
iii. Clearing of grasses around the houses
iv. Analgesics
v. Anti-Malaria
vi. High fluid intake
vii. Haematics

CANDIDIASIS

A fungal infection of typically on the skin or mucous membrane; fungal is an infection due to
any type of Candida (a type of yeast). When it affects the mouth is commonly called thrush,
when it affects the vagina is called yeast infection.

Causative Agents: Candida Albicans.

Signs and symptoms: When it affects the mouth the following signs and symptoms are
recognized:

i. White patches on the tongue or other area of the mouth and throat.
ii. Soreness and problems of swallowing.
 iii. fever

When it affects vagina signs and symptoms commonly seen are

i. Genital itching
ii. Burning of genital parts
iii. Discharge from the private part
iv. Fever may be very rare

ROUTE OF TRANSMISSION

i. Contact with infected person through sex

ii. Contact with infected person through kiss
iii. Contact with soiled under/inner wears
iv. Contact/sharing of infected person brush

MANAGEMENT

i. Health education on signs and symptoms, personal hygiene, route of transmission,

preventive measures
ii. A diet to support the immune system
iii. Control of sugar
iv. Wearing cotton wear
v. Oral hygiene
vi. Treatment of patient
vii. Safe delivery to avoid infecting new born
viii. Avoidance of kiss or sex with infected person.
ASCARIS

Ascaris is also known as lumbrocoides it is the most common worms of man especially among
younger generation. It is tapered at both ends, the anterior end being thinner than the posterior
worms 3 lips. The male worms is much shorter and is measured about 150-300cm times 2-
4metre, while the female worm are much longer and measured about 200-400mm times 3-
6metre.

Distribution: Worldwide, mainly in tropical and sub-tropical especially in unsanitary condition.

Route of Transmission: Ingestion of ascaris eggs.

Signs and symptoms

Once adult worm are present in the intestine there is

i. Abdominal pain
ii. Abdominal distension
iii. Nausea and vomiting
iv. Constipation
v. Disturbed sleep

MANAGEMENT

i. Provision of adequate facility for disposal of feces

ii. Avoid eating uncooked vegetables, green salad leaves, fruit which may contain ascaris
eggs
iii. Construction of latrines in manner so as to prevent dissemination of ascaris eggs
iv. Prevention of soil contamination in area to human dwelling particularly playing area of
children
v. Health education to care parents or care givers
vi. Use of anti-worms is advisable.

SCABIES: Is a cutaneous (skin infection) parasitoids due to the presence of mite

SCABIES: Is an infectious disease most commonly family affairs. Friends and family are the
commonest point’s source.

Causative agent: Sarcopti scabiei hormonis.

Route of Transmission

i. Person to person transmission takes place chiefly through direct skin contact.
ii. Sometimes by indirect contact e.g. sharing of clothing, bedding.

Signs and symptoms

i. Itching ,worse at night

ii. Reddish brown nodules
iii. Typical skin
iv. Vesicular eruption
v. Skin scratching

NB: Lesion are found at the dorsal surface of the inter-digital, bottom, elbow, face, palm of the
hands and feet, the thigh, srcotum, knee joint are all involve.

MANAGEMENT

i. Close contact of the patients are treated simultaneously even in the of symptoms.
ii. Proper washing, drying in the sun, or expose to sunlight for 72hours, or sealed in a plastic
bag 72hours of clothing and bedding materials.
iii. Daily bath with antiseptic soap.
iv. Topical application of B.B. lotion.
v. Advise patient and family to wash and dry material in the sun and iron if possible.
vi. All house hold contact and sex partners should be treated.
vii. Since eggs may survive, a second treatment may be necessary if no improvement.
viii. Oral treatment with ivermectin (as single dose).
ix. Personal hygiene.
x. Decontamination of clothing and bedding material.

SYPHILLIS
Syphilis is chronic infections caused trepamoma palladium. Untreated syphilis occurs in three
states: primary, secondary, and Tertiary. It must be noted, however that the disease is
generalized and continuous from time of infection and that may almost complete latent during its
long course which last over 30years.

Causative Agent: Trepanema palladium

Route of Transmission: syphilis can be transmitted sexually in adults, via sexually by close
contact with an open lesion of early acquired syphilis, and direct blood transfusion from an
infected individual. It can also be passed on from an infected mother to her fetus.

Signs and symptoms

General (men and women)
i. A skin rash that causes small, reddish brown sores
ii. Sores in the mouth, vagina or anus
iii. Fever
iv. Swelling glands
v. Weight loss
vi. Hair loss
vii. Headache
viii. Extreme tidiness(fatigue)

MANAGEMANT

i. Use of condom
ii. Identification and treatment of infected persons
iii. Health Education
iv. Abstinence from free marital and extra marital sex
v. Regular checkup of higher risks individuals for identification and treatment
vi. Screening of blood before infusion
vii. Contact tracing

2.1 Discuss current approaches in planning and implementing community intervention to

prevent and control communicable diseases.
 The current approaches in planning and implementing community intervention to prevent and
control communicable diseases include the following

i. Handle and prepare food safely

ii. Wash Hands often
iii. Clean and disinfect commonly used surfaces
iv. Cough and sneeze into sleeve
v. Don’t share personal items
vi. Get vaccinated
vii. Avoid touching wild animal.
viii. Stay home when sick

Keeping personal hygiene, like taking a daily bath and washing hand frequently, hand washing
with soap and water is the simplest and one of most effective way to prevent transmission of
many communicable diseases.

i. Handle and prepare food safely: food can carry germs. Wash hands, utensils and surfaces
often when preparing any foods, especially raw meats. Always wash fruits and vegetables.
Cook and keep foods at proper temperature. Do not leave foods out refrigerate promptly.
ii. Wash Hands often: learn how to clean hands and help prevent and control communicable
diseases.
iii. Clean and disinfect commonly used surfaces: Germs can leave in surfaces, cleaning with
soap and water is usually enough. However, always disinfect bath room and kitchen
regularly; disinfect other areas if someone in the house is ill.
iv. Cough and sneeze in your sleeve: learn how and when to cover your cough and sneeze.
v. Do share personal items: Avoid sharing personal items that cannot be disinfected, like
tooth brushes and razor or sharing towel between washes, Needle should never be shared,
should only used once and then thrown away properly.
vi. Get vaccinated: vaccines can prevent many infectious diseases. There are vaccines for
children and adults design to provide protections against many communicable diseases,
 there are also vaccines that are recommended or require for travel to certain part of the
world. Our immunization programme can advise individuals on immunization and clinic
was to access shots.
vii. Avoid touching wild animals: Be cautious around animals as their can spread infectious to
humans and pets.

3.1 Explain the current National/ state policies and interventions strategies in Disease
control in respect of the following

i. National malaria elimination programme

ii. National TBL control programme
iii. HIV AAND AIDS programmes
iv. Neglected Tropical Disease control programmes (NTDCP)

National TBL control programme

Definition: National Tuberculosis and leprosy control programmes is a planned series of events
that are designed to promote Health and better quality of life by preventing, controlling and
possible measures for eliminating TBL cases at global, regional and local levels.

Objectives of National TBL control programmes

i. It helps to developed evidence based on policies, strategies and standard for TBL
prevention, care, control and monitored their implementation.
ii. It provides global leadership on matters critical to TBL control.
iii. Jointly with governmental and nongovernmental organizations to provide technical
support and sustainable capacity on prevention the TBL cases.
iv. It monitor the global tuberculosis and leprosy case and measures the progress and
achievement on TBL cases/management, control and financing.
 v. Facilitate and engage in partnership for TBL action.

EPIDEMIOLOGY

Nigeria ranked the 10th largest burden of Tuberculosis cases and 4th in Africa. In 2012 world
Health organization estimated.

CURRENT POLICY ON NTBLCP

i. Review of the activities of NTBLCP

ii. Review managerial and technical problem and proffer solution
iii. Development and recommendations to the federal government on matters relating to TBL
control in the state
iv. Discuss problems relating to TBL control activities to states and advise accordingly
v. Exchange knowledge and ideas on practical aspect of the programmes
vi. Identifying and topics for operational research
vii. Share results of operational research and base practice
viii. Secure political commitment for TBL control.
ix. Platform for stakeholders to contribute to the fight against TBL.

HIV AND AIDS programmes

DEFINITION: Human immune deficiency virus (HIV) is a virus that attacks the immune
system, the body natural defense system.

OBJECTIVES: The objectives of HIV AND AIDS scale-up programmes is to reduce the risk of
HIV infection by scaling up prevention, intervention and to increases access to utilization of HIV
counseling, testing , care and support services.

CURRENT POLICY: The national current policy will include the necessary information to
determine the existence of a country policy and a range of policy components (UNAIDS 2000).
DATA SOURCE: surveys reports and interviews from ministry of Health and collaborating
programmes (including private and nongovernmental organization) on HIV/AIDS policies, frame
work or guidelines where available data collected for NCPI can be used.

HIV/AIDS prevention, treatment, care and support recommendation to be fully integrated into
HIV/AIDS and reproductive Health services and programmes, this outcome indicator measures
the success of advocacy efforts to increase HIV/AIDS awareness and education among policy
makers leading to the adoption and formalization of recommendation at the national, provincial
and district levels.

TARGET GOAL: The HIV/AIDS target goal by 2030 in December 2013, the UNAIDS
programme, coordinating board called on UNAIDS to support country and region led efforts to
establish new targets for HIV treatment scale up.

EPIDIMIOLOGY: HIV/AIDS is a global pandemic, as of 2016 approximately 36.7 million

people are living with HIV globally; South Africa has the largest population of people with HIV
of any country in the world, at 5.9 million. In Tanzania, HIV was reported to have a prevalence
of 6% among Tanzanian adults agent 15-49 in 2007-2008.

National malaria elimination programme

The national malaria elimination programme (NMEP) in Nigeria is the body responsible for
formulating and facilitating policy and guidelines, coordinate the activities of partners and
stakeholders on malaria control activities, provide technical support to states malaria programs,
LGAS and stakeholders, mobilize resources, monitor and evaluate progress and outcomes in
malaria elimination efforts across the country.

The control policies and intervention strategies on malaria elimination of malaria programmes
come within two major domains:

i. Prevention
ii. Case management
Together these strategies work against the transmission of the parasite from mosquito vector to
humans and the development illness and severe disease

The policies are:

1. Malaria prevention through malaria vector control

i. To protect individual people against infective malaria mosquito bites
ii. To reduce the intensity of local malaria transmission at community level
by reducing the longitivity, density and human vector contact of the local
vector mosquito population. The two most powerful intervention policies
are long lasting insecticidal nets (LLINS) and indoor residual sprayer
(IRS)
2. Achieve universal access to utilization of (LLINS)
3. Achieve universal access to case management (using RDT)
4. Appropriate referral system
5. Achieve universal access to community case management (CCM) 2015
6. Accelerate development of seivellance system
7. Insecticide treated net (ITNS)
8. Indoor residual sprayer which is more rapid in controlling malaria.

Neglected Tropical Disease control programmes (NTDCP)

Neglected tropical diseases (NTDS) are a diverse group of communicable diseases that prevail in
tropical and subtropical conditions in 149 countries, affect more than one million people and cost
developing economies billions of dollars every year.

Population living in poverty, without adequate sanitation and in close contact with infectious
vectors and domestic animals and livestock are those worst affected.

Among all the African nations, Nigeria has the greatest number of people affected with neglected
tropical diseases (NTDS). With the right political will, the country has sufficient resources to
expand its current investment for the important work of Nigerians NTD program.
In 2019 analysis of NTDS in sub-Saharan African, one of us identified Nigeria as the country
with the greatest number of cases of the so called high prevalence NTDS, such as the intestinal
helminthes infections, schistosomiasis, and lymphatic filariasis (LF)

Health and development support programme (HANDS, we are distributing antibiotics to whole
communities to treat the diseases can prevent re-infection.

The targeted NTD are preventable with proven, cost effective interventions.

i. Mass drugs distribution

ii. Health Education
iii. Vector control (were necessary)
iv. Community awareness/sensitization
v. Established a NTDS and civil society engagement framework that provides strategies for
collaborating toward budget advocacy for NTDS
vi. Facilitate state governments’ endorsement of strategic plans to address NTDS in 2015 -
2020.
vii. Implemented capacity building plans at national and sub national level.