Community Medicine with Recent Advances

1. Introduction to Community Medicine 3
Hygiene  3 •  Preventive Medicine  3 •  Social Medicine  4 •  Community Diagnosis  4
2. Concept of Health 6
Physical Dimension  6 •  Mental Dimension  6 •  Social Dimension  6
•  Spiritual Dimension  6 •  Emotional Dimension  6 •  Vocational Dimension  7
•  Positive Health  7 •  Well-being  7 •  Human Development Index  7
•  Spectrum of Health  8 •  Determinants of Health  8 •  Indicators of Health  9
3. Concept of Disease 12
Theories of Disease Causation  12 •  Epidemiological Triad  13
•  Natural History of Disease  13 •  Iceberg Phenomenon of Disease  15
4. Concept of Prevention 17
Primary Prevention  17 •  Primordial Prevention  18 •  Secondary Prevention  19
•  Tertiary Prevention  19
Section 2: Environment and Health
5. Environment and Water 23
Physical Environment  23 •  Biological Environment  23 •  Social Environment  23
•  Cultural Environment  23 •  Water  23 •  Water Cycle  24 •  Well  24 •  Health Hazards
of Water Contamination  26 •  Purification of Water  27 •  Hardness of Water  38
•  Conservation of Water Resources  40 •  Sanitary Analysis of Water  40
•  Laboratory Examination of Water  41
6. Air and Ventilation 46
Changes in the Air Due to Human Occupancy  46 •  Effects of Vitiated Air  46
•  Indicators of Thermal Comfort  46 •  Air Pollution  48 •  Prevention and
Control of Air Pollution  49 •  Ventilation  50
7. Noise 52
Noise Level Values  52 •  Instruments Used in the Study of Noise  52
•  Hazards of Noise Pollution  53 •  Prevention and Control of Noise Pollution  53
Contents
xii Community Medicine with Recent Advances
8. Light 54
Measurement of Light  54 •  Natural Lighting  54 •  Artificial Lighting  54
•  Health Hazards of Lighting  55
9. Radiation 56
Nonionizing Radiations  56 •  Ionizing Radiations   57
•  Prevention and Control of Radiation Hazards  60
10. Housing 62
Requirements of a House  62 •  Housing Standards   62 •  Housing and Health  63
•  Indicators of Housing  64 •  Housing Problem  64
11. Meteorology 66
Atmospheric Pressure  66 •  Air Temperature   68 •  Humidity   71 •  Air Movement  72
12. Disposal of Wastes 75
Refuse  75 •  Methods of Refuse Disposal  75 •  Recycling of Refuse  77
•  Disposal of Excreta  77 •  e-Toilets  84 •  Water Carriage System (Sewerage System)   85
•  Disposal of Sullage  87 •  Disposal of Sewage (Sewage Treatment)  88
13. Management of Hospital Waste 93
Characteristics of Health Care Waste   93 •  Quantity of Health Care Waste   93
•  Objectives of the Waste Management System  94 •  Safe Waste Management
Practices Helps   94 •  Legislative Framework   94 •  Strategies Adopted for Hospital
Waste Management  95 •  Available Treatment and Disposal Technologies   98
•  Newer Technologies  98 •  Do’s and Don’ts of Health Care Waste  105
14. Electronic Waste Management 108
E-waste Burden Globally  108 •  Burden in India  108 •  Sources of E-waste  109
•  Impacts/Hazards of E-waste  109 •  Basel Convention  110 •  Waste Minimization
Techniques  111 •  Management of Options  111 •  E-waste Disposal  111
15. Medical Entomology 113
Classification of Arthropods  113 •  Arthropod Borne Diseases  114
•  Principles of Arthropod Control  115 •  Class Insecta  115 •  Mosquitoes  115
•  Flies  127 •  Fleas  134 •  Lice  138 •  Bugs  140 •  Class Arachnida  141
•  Ticks  141 •  Mites (Chiggers)  144 •  Class Crustacea  148 •  Cyclops (Water Flea)  148
•  Disinsection  149 •  Insecticide Toxicity  151
Section 3: Nutrition and Health
16. Nutrition and Health 155
Classification of Foods  155 •  Nutrients  156 •  Macronutrients  156 •  Proteins  156
•  Fats  158 •  Carbohydrates  159 •  Micronutrients  160 •  Vitamins  161 •  Fat Soluble
Vitamins  161 •  Water Soluble Vitamins  164 •  Minerals  167 •  Other Trace Elements   171
Contents xiii
•  Food Groups  172 •  Energy Requirements   178 •  Balanced Diet  180 •  Food Hygiene  180
•  Food-related Diseases (Public Health Nutrition Problems)  187 •  Deficiency Diseases  188
•  Guidelines for the Control of Iron Deficiency Anemia National Iron Plus Initiative  194
•  Excess of Food Consumption  201 •  Food-borne Intoxications  201 •  Food Poisoning  204
•  Food-borne Diseases  206 •  Diet Survey  210 •  Indicators of Malnutrition  211
•  Nutritional Surveillance  211 •  National Nutrition Policy  212 •  Annexure  213
Section 4: Occupational Health
17. Occupational Health 219
Burden of Occupational Diseases  219 •  Ergonomics   220 •  Occupational Hazards   220
•  Pneumoconioses  222 •  Lead Poisoning (Plumbism)  226 •  Occupational Cancers  229
•  Occupational Dermatoses  230 •  Occupational Health in Agricultural Industry  231
•  Hazards due to Industrialization and Urbanization   232 •  Accidents in Industries  232
•  Offensive Trades and Occupations   233 •  Sickness Absenteeism  234 •  Women in
Industry  235 •  Health Status of Industry  236 •  Prevention and Control of Occupational
Hazards   236 •  Legislation  239 •  Social Security  243
Section 5: Epidemiology
18. Principles and Practice of Epidemiology 247
Epidemiology  247 •  Objectives of Epidemiology  247 •  Epidemiological Approach   248
•  Scope of Epidemiology  248 •  Measurement of Morbidity   249 •  Measurement of
Mortality  251 •  Epidemiological Studies (Methods)  255 •  Time Distribution  255
•  Place Distribution  257 •  Person Distribution   258 •  Analytical Studies (Analytical
Epidemiology)  259 •  Experimental Epidemiology (Experimental Epidemiological
Studies)   266 •  Nonrandomized Trials  268 •  Association and Causation  269
•  Uses of Epidemiology   271
19. Epidemiology of Infectious Diseases 273
Commonly used terms   273 •  Surveillance  275 •  Dynamics of Disease Transmission  2
xiv Community Medicine with Recent Advances
•  Meningococcal Meningitis (Cerebrospinal Fever or Cerebrospinal Meningitis)  360
•  Tuberculosis  363 •  Revised Case Definitions of Tuberculosis and their
Treatment Outcomes  376 •  Childhood Tuberculosis  383 •  Tuberculosis and HIV  387
•  Recent Advances in Multidrug Resistant TB Cases and Revised National Tuberculosis
Control Program  388 •  Five Priority Actions to Address the Global MDR-TB Crisis  391
•  Severe Acute Respiratory Syndrome  393 •  Water-borne Diseases  398 •  Typhoid Fever  398
•  Acute Diarrheal Diseases   402 •  Cholera  409 •  Viral Hepatitis  413 •  Poliomyelitis  421
•  Dracunculiasis  428 •  Amebiasis  430 •  Giardiasis  432 •  Soil-borne Diseases  434
•  Ascariasis  434 •  Ancylostomiasis  435 •  Tetanus  438 •  Neonatal Tetanus  443
•  Vector-borne Diseases  444 •  Malaria  444 •  Malaria Control Strategies  453
•  Malaria Vaccine  454 •  Lymphatic Filariasis  455 •  Plague  462 •  Leishmaniases  466
•  Arboviral Diseases  468 •  Yellow Fever  468 •  Dengue Fever  471 •  Japanese
Encephalitis  474 •  Chikungunya Fever (Epidemic Polyarthritis)  478 •  Kyasanur Forest
Disease  479 •  Rickettsial Diseases  482 •  Epidemic Typhus  482 •  Endemic Typhus  483
•  Scrub Typhus  483 •  Indian Tick Typhus  484 •  Rocky Mountain Spotted Fever  484
•  Rickettsial Pox  484 •  Trench Fever  484 •  Q-Fever  484 •  Sexually Transmitted
Infections  486 •  Extent of the Problem  486 •  Syndromic Case Management of RTIs/STIs
(Syndromic Approach)   489 •  Human Immunodeficiency Virus/Acquired Immunodeficiency
Syndrome  498 •  History   498 •  Magnitude of the Problem   499 •  India  499
•  Antiretroviral Treatment  508 •  AIDS Vaccine  511 •  Clinical Trial on AIDS Vaccine  512
•  Postexposure Prophylaxis for HIV  514 •  Prevention of Parent to Child Transmission
of HIV in India  516 •  Cotrimoxazole Prophylaxis for HIV-related Infections Among Children,
Adolescents and Adults  519 •  Surface Infections  521 •  Rabies  521 •  Leprosy  532
•  Control of Leprosy  545 •  Standard Child Treatment Regimen (10–14 years)  546 •  Yaws  552
21. Epidemiology of Noncommunicable Diseases 555
Noncommunicable Diseases  555 •  Future Plan to Prevent and Control Noncommunicable
Diseases  556 •  Cardiovascular Diseases  559 •  Coronary Artery Disease Ischemic Heart
Disease   559 •  Congenital Heart Diseases  561 •  Rheumatic Heart Disease  562
•  Hypertension  564 •  Stroke  567 •  Obesity  569 •  Cancer  572 •  Magnitude  572
•  Distribution  572 •  Risk Factors  572 •  Pre-existing Conditions  573 •  Prevention and
Control  574 •  Epidemiology of Cancer Cervix  574 •  Diabetes Mellitus  577 •  Classification  577
•  Indian Diabetic Risk Score (IDRS)(Developed by Madras Diabetes Research Foundation)  580
•  Accidents  583 •  Global Problem  583 •  India  583 •  Measurements of Accidents
and Injuries   583 •  Agent Factors  584 •  Host Factors   584 •  Other Factors  584
•  Environmental Factors   584 •  Prevention   585 •  Blindness  585 •  Extent of the
Problem   585 •  Host Factors  586 •  Environmental Factors   586 •  Other Factors  586
•  Prevention and Control  586 •  Other Preventive Measures  587 •  Vision 2020: The Right
to Sight   587 •  Mobility of Blind  588 •  Community Ophthalmology  589
Section 6: Health-related Disciplines
22. Maternal and Child Health Services (Preventive Obstetrics and Pediatrics) 595
Mother and Child—One Unit   595 •  Services to the Mothers   596 •  Antenatal Care
(Care of the Mother During Pregnancy)  596 •  Essential and Immediate Care of the Newborn  610
Contents xv
•  Low Birth Weight Baby  613 •  Kangaroo Mother Care  615 •  Feeding of Infant  618
•  Relactation  624 •  Induced Lactation  625 •  Growth Monitoring  627 •  Under Five Clinics  630
•  Handicapped Children  631 •  Juvenile Delinquency  633 •  Child Guidance Clinic  633
•  School Health Services  634 •  Indicators of MCH Care  637 •  Rights of the Child  643
•  Child Welfare Agencies  644 •  Integrated Mother and Child Development Services Scheme
(IMCDS Scheme)   644 •  Street Children  648
23. Demography 651
Demographic Cycle (Demographic Stages)   651 •  Size of the Population
(Magnitude of the Population)   652 •  Population Trend in the World  653
•  Population Trend in India  653 •  Composition of the Population   653
•  Demographics of India  657 •  Distribution of the Population  658
•  Population Dynamics  658 •  Measurement of Fertility (Fertility Indicators)   659
•  Measurement of Mortality  661 •  Population Explosion (Population Bomb)  662
•  Population Stabilization  663
24. Family Planning 665
Need for Family Planning  665 •  Scope of Family Planning Services  666
•  Contraceptive Methods (Fertility Regulating Methods; Techniques of Birth Control)  667
•  Temporary Methods  667 •  Terminal Methods  686 •  Male Contraception  688
•  Evaluation of Contraceptive Methods  689
25. Biostatistics 691
Variability  691 •  Applications of Biostatistics  691 •  Presentation of Statistical Data  692
•  Measures of Central Tendency  701 •  Measures of Location: Quantiles  703 •  Measures
of Dispersion  704 •  Probability  707 •  Sampling  710 •  Sampling Variation  714
•  Null Hypothesis (Denoted as H0)  715 •  Tests of Significance  716 •  Analysis of Variance  726
•  Nonparametric Tests  726 •  Correlation and Regression Correlation  727 •  Regression  729
•  Life Table  731
26. Social Science 738
Community  739 •  Culture  739 •  Acculturation  739 •  Family System  739
•  Family Cycle  739 •  Family Types  740 •  Family Functions  741 •  Role of Family
and Cultural Factors in Health and Disease  741 •  Social Process  743 •  Social Factors
in Health and Disease (Social Pathology)  748 •  Management or Prevention of
Social Pathology   751 •  Social Research  752 •  Operational research   755
•  Medicosocial Worker   755 •  Personal Hygiene  756
27. Information, Education and Communication 758
Information  758 •  Education  758 •  Communication  758 •  Steps in IEC:
Planning, Implementation and Evaluation  759 •  Types of Communication  759
•  Barriers of Communication  760 •  Health Education  760 •  Approaches in
Health Education  760 •  Contents of Health Education  761 •  Practice in
Health Education  762 •  Methods in Health Education  762 •  Lecture  763
•  Demonstration  764 •  Demerits  764 •  Delphi Method  767
xvi Community Medicine with Recent Advances
28. Human Genetics 769
Multiplication  769 •  Chromosomes  770 •  Chromosomal Abnormalities  770
•  Deoxyribonucleic Acid  770 •  Population Genetics  771 •  Classification of
Genetic Disorders  771 •  Prevention and Control of Hereditary Disorders  773
29. Preventive Geriatrics 775
Population of the Aged  775 •  Theories of Aging Process   776 •  Health Problems
of the Aged  776 •  Care of the Aged  777 •  Old Age Social and Income Security  778
•  Helpage India  779 •  National Policy on Older Persons  779 •  Benefits Given to
Senior Citizens of India  779
30. Mental Health 781
Magnitude of the Problem   781 •  Causative Factors   781 •  Types of Mental Disorders   782
•  Prevention and Control of Mental Illness   782
31. Adolescent Health 784
Changes During Adolescence  784 •  Importance  784 •  Challenges in Adolescent
Health in India  785 •  Impacts of Adolescence  785 •  Adolescent Health Problems  785
Contents xvii
•  Janani Suraksha Yojana  840 •  Janani Shishu Suraksha Karyakram  842
•  Navjaat Shishu Suraksha Karyakram  843 •  Rashtriya Bal Swasthya Karyakram  844
•  Rashtriya Kishor Swasthya Karyakram  845 •  Operationalization of the Interventions
of RKSK  846 •  Rogi Kalyan Samiti  847 •  National Rural Health Mission: 2005–2012  849
•  National Urban Health Mission  853 •  National Urban Health Mission—New Scheme  857
38. Health Planning and Management 858
Planning  858 •  Management (Network Analysis)  859 •  Cost Benefit Analysis  861
•  Cost-effective Analysis  861 •  Manager  861
39. National Health Planning 863
Bhore Committee Report, 1946   863 •  Mudaliar Committee Report, 1962  863
•  Chadah Committee Report, 1963   864 •  Mukherjee Committee Report, 1965  864
•  Mukherjee Committee Report, 1966  864 •  Jungalwalla Committee Report, 1967  864
•  Kartar Singh Committee Report, 1973  864 •  Srivastav Committee Report  865
•  National Developmental Plans  865 •  Twelfth Five-year Plan (2012–2017)  867
•  Organization of Indian Health Administration  868 •  Rural Development  871
40. National Health Policy 872
Priority Areas of the Policy   872 •  National Health Policy, 2002  873 •  National
Housing Policy  873 •  National Nutrition Policy  873 •  National Population Policy–2000:
An Overview  874 •  National Policy for Children—2013  875 •  National Policy for Older
Persons  877 •  National Mental Health Policy of India  877
41. National Voluntary Health Agencies/Organizations 881
Voluntary Health Agencies  881 •  Voluntary Health Association of India  882
•  Voluntary Health Agencies in India  882
42. International Health Organizations 884
First International Sanitary Conference (1851)  884 •  Pan American Sanitary
Bureau (1902)  884 •  Office International d’Hygiène Publique (1907)  884
•  Health Organization of the League of Nations (1923)  885 •  United Nations
Relief and Rehabilitation Administration  885 •  World Health Organization  885
•  UNICEF  888 •  United Nations Development Program  889 •  Food and Agricultural
Organization  889 •  International Labor Organization  890 •  United Nations
Fund for Population Activities  890 •  United Nations Educational Scientific
and Cultural Organization  890 •  United Nations High Commission for Refugees  890
•  World Bank  890 •  United Nations Joint Program on AIDS  891 •  United Nations
International Drug Control Program  891 •  United Nations Environment Program  891
•  International Atomic Energy Agency  891 •  World Food Program  891
43. Bilateral Agencies 892
Colombo Plan  892 •  United States Agency for International Development  892
•  Swedish International Development Cooperation Agency  892 •  Danish International
Development Agency  892 •  Nongovernment (Non-UN) Agencies  893 •  Cooperative for
American Relief Everywhere  893 •  Red Cross  894
xviii Community Medicine with Recent Advances
44. National Health Programs 896
Related to Communicable Diseases  897 •  Related to Noncommunicable
Diseases  897 •  Related to Nutrition  897 •  Other Health Programs  897
•  National Antimalaria Program  898 •  National Malaria Eradication Program  898
•  Revised Malaria Control Strategies  903 •  National Framework for Malaria
Elimination (NFME)  903 •  National Filaria Control Program  904 •  National Kala-azar
Control Program  906 •  National Japanese Encephalitis Control Program  906
•  National Dengue Fever/Dengue Hemorrhagic Fever Control Program  906
•  National Leprosy Control Program  906 •  National Leprosy Eradication Program  907
•  National Guinea Worm Eradication Program  910 •  Universal Immunization Program  910
•  National Poliomyelitis Eradication Program  911 •  Polio Eradication: A Land Mark Achievement
for India  917 •  Global Polio Eradication Initiative  919 •  Revised National Tuberculosis
Control Program  921 •  National Acute Respiratory Infections Control Program  923
•  National Diarrheal Diseases Control Program  923 •  National AIDS Control Program  924
•  ‘3 by 5’ Initiative  930 •  National Program on Prevention and Control of Viral Hepatitis  930
•  National Program for the Control of Blindness  931 •  National Program for Prevention
and Control of Deafness  933 •  National Cancer Control Program   935 •  National Program
for Prevention and Control of Diabetes, Cardiovascular Diseases and Stroke  935 •  National
Mental Health Program  937 •  District Mental Health Program  937 •  National Iodine
Deficiency Disorders Control Program  938 •  National Program for Control and Treatment
of Occupational Diseases  939 •  National Program on Prevention and Control of Fluorosis  940
•  National Vitamin‘A’Prophylaxis Program  942 •  National Nutritional Anemia Control Program   943
•  National Special Nutrition Program  943 •  National Balwadi Nutrition Program  943
•  National Mid-day School Meal Program   943 •  National Integrated Child Development
Services Scheme   943 •  National Program for Health Care of the Elderly  943
•  National Tobacco Control Program  944 •  National Family Welfare Program  948
•  National Family Planning Indemnity Scheme  949 •  National Reproductive and
Child Health Program  950 •  Reproductive and Child Health Program-II  955
•  Components of Reproductive and Child Health Program-II  955 •  All India Hospital
Postpartum Program  958 •  National Water Supply and Sanitation Program  958
•  Minimum Needs Program  959 •  Twenty Point Program  960
Section 8: Allied Subjects
45. Emerging and Re-emerging Infectious Diseases 965
Emerging Infectious Diseases  965 •  Re-emerging Infectious Diseases  969
•  Control of Emerging and Re-emerging Diseases  970
46. Disaster Management 971
Impact  971 •  Classification of Disasters   971 •  Disaster Management Cycle  973
47. Integrated Disease Surveillance Project: 2004–2009 976
Surveillance   976
Contents xix
48. Bioterrorism 979
Historical Background  979 •  Evolution of Chemical and Biological Weapons  979
49. Global Warming 982
History of Global Warming  982 •  Hazards of Global Warming  982 •  Who is the
Worst Polluter?  983 •  Kyoto Protocol  984 •  Action Needs to be Taken Now  984
•  Containment Measures  984
50. Integrated Management of Childhood Illness 985
Objectives  985 •  Components  985 •  Principles  986 •  Assess and Classify
the Sick Child  988 •  Identification of the Treatment  995 •  Counsel the Mother  997
51. Telemedicine in Public Health 1000
Aim of Telemedicine  1000 •  Utility of Telemedicine  1001 •  Types of Technology  1001
•  Telemedicine in India  1002 •  Current Efforts in India  1004
52. Tobacco and Health 1006
Prevalence of Smoking  1006 •  Public Health Importance  1006 •  Types of Tobacco  1007
•  Composition of Smoke  1007 •  Health Hazards of Tobacco  1008 •  Health Benefits
of Smoking  1009 •  National Tobacco Control Program (NTCP)   1010
53. Public Health Acts 1011
The Consumer Protection Act, 1986  1012 •  Registration of Births
and Deaths Act, 1969  1012 •  Pre-conception and Prenatal Diagnostic
Techniques (PC PNDT) Act, 1994  1013
Annexure 1015
Some Stalwarts and their Contribution to Community Medicine  1015
•  Edward Jenner (1749–1823)  1016 •  Sir Edwin Chadwick (1800–1890)  1016
•  Louis Pasteur (1822–1895)  1016 •  Joseph Lister (1827–1912)  1016
•  Robert Koch (1843–1910)  1017 •  Ronald Ross (1857–1932)  1017
•  Calendar of Important Dates and Events  1017 •  List of World Breastfeeding
Week Themes Since 1992  1018 •  List of World Health Day Themes  1018
•  Goals to be Achieved by 2000–2015  1019 •  Milestones in Vaccination  1020
Index 1021