Last moment revision

Health : Health is state of complete physical and mental well being not merely an absence of disease or
infirmity.
Sullivan’s index: This index (expectation of life free of disability) is computed by subtracting from
the life expectancy the probable duration of bed disability and inability to perform major activities.

Determinants of health

 Heredity
 Environment
 Life-style
 Socioeconomic
 Health and family welfare
 Other factors like health related systems ( eg: food and agriculture, education, industry,
social welfare, rural development )

Indicators of health

Characteristics

1. Valid
2. Reliable
3. Sensitive
4. Specific

Indicators may be classified as

1. Mortality indicators

1. Crude death rate: The number of deaths per 1000 population per year in given community
2. Expectation of life: Life expectancy at birth is “the average number of years that will be
lived by those born alive into a population if the current-age specific mortality persists.
3. Infant mortality rate: Ratio of deaths under 1 year of age in a given year to the total
number of live births in the same year.
4. Child mortality rate: Number of deaths at ages 1-4 years in a given year per 1000 children
in that age group at the mid point of the year concerned.
5. Under-5 proportionate mortality rate: Proportion of total deaths occurring in the under 5
age group.
6. Maternal (puerperal) mortality rate:
7. Disease specific mortality
8. Proportional mortality rateMorbidity indicators

They are

1. Incidence and prevalence

2. Notification rates
3. Attendance rates at out patient departments, health centres, etc
4. Admission readmission and discharge rates
5. Duration of stay in hospital
 6. Spells of sickness of absence from work or school

2. Disability rates

a) Event type indicators

(i) Number of days of restricted activity

(ii) Bed disability days

(iii) Work loss days (or school loss days) with in a special period

b) Person type indicators

(i) Limitation of mobility

(ii) Limitation of activity

3. Nutritional status indicators

1. Anthropometric measurements of pre school children

2. Heights (and some weights) of school children at school entry
3. Prevalence of low birth weight (less than 2.5 kg)

4. Health care delivery indicators

 Doctor population ratio

 Doctor-nurse ratio
 Population-bed ratio
 Population per health/subcentre
 Population per traditional birth attendant

5. Utilization rates

6. Indicators of social mental health

7. Environmental indicators

8. Socio-economic indicators

9. Health policy indicators

10. Indicators of quality of life

11. Other indicators

VECTOR BORNE DISEASE CONTROL PROGRAMME

1. National Anti-Malaria Programme

 National Malaria Control Programme (NMCP) was launched in India in April 1953. it was in
operation for 5 years( 1953-58).
  National Malaria Eradication Progamme (NMEP) launched in 1958.
 New approach to malaria control was approved by WHO in 1978, ie. Implementation of
malaria control in the context of the primary health care strategy.
 An Enhanced Malaria Control Project with world bank support launched on 30thSeptember
1997.
 In 1999, the government of India decided to drop the term “National Malaria Eradication
Progamme” and renamed it “National anti-malaria programme”

2. National Filaria Control Programme

National Filaria Control Programme (NFCP) has been in operation since 1955.

3. Kala-Azar Control Programme

Centrally sponsored programme was lunched in

4. Japanese Encephalitis Control

5. Dengue Fever Control

QUESTION : In demographic cycle stage/stages in which population remains stationary

a) first b) fourth c) both a & b d) none

FERTILITY

The actual bearing of children

Reproductive period of women 15-45 years-a period of 30 years

Factors affecting fertility

1. Age at marriage
2. Duration of married life
3. Spacing of children
4. Education
5. Economic status
6. Caste and religion
7. Nutrition
8. Family planning

9. Other factors like place of women in the society, value of children in the society, widow
remarriage, breast feeding, customs and believes, industrialization and urbanization, better health
conditions, housing, opportunities fro women and local community involvement.

Fertility related statistics

Number of live birth in the year X1000

1. Birth rate Estimated mid-year population

2. General fertility rate
 3. General marital fertility rate
4. Age specific fertility rate
5. Age specific marital fertility rate
6. Total fertility rate
7. Total marital fertility rate
8. Net reproduction rate
9. Child women ratio
10. Pregnancy rate
11. Abortion rate
12. Abortion ratio
13. Marriage rate

MILESTONES OF DEVELOPMENT

The ‘milestones’ given here are approximations and to assess any individual child, all types of
growth development and behaviour must be taken into account

DETERMINANTS OF MATERNAL MORTALITY IN INDIA

Medical Causes Social Factors

Obstetric causes:
Toxaemias of pregnancy Age at child birth
Haemorrhage Parity
Infection Too close pregnancies
Obstructed labour Family size
Malnutrition

Neonatal mortality Post-neonatal mortality

(0-4 weeks) (1-12 months)
l. Low birth weight 1. Diarrhoeal diseases
2. Birth injury and difficult labour 2. Acute respiratory infections
3. Congenital anomalies 3. Other communicable diseases
4. Haemolytic diseases of newborn 4. Malnutrition
5. Conditions of placenta and cord 5. Congenital anomalies
6. Diarrhoeal diseases 6. Accidents
7. Acute respiratory infections
8. Tetanus
LEADING CA– USES OF DEATH IN 1 -4 YEAR AGE GROUP

Developing countries Developed countries

Diarrhoeal diseases Accidents
Respiratory infections Congenital anomalies
Malnutrition Malignant neoplasms
Infectious diseases Influenza
(e.g., measles, whooping cough) Pneumonia
Other febrile diseases
Accidents and injuries

SUGGESTED INTAKE OF DIETARY FAT

Essential fatty
Fat intake acids
(energy per
g/day Energy % cent)
Adults : Man & Woman 20* 9 3
Pregnant woman 30 12.5 4.5
Lactating mother 45 17.5 5.7
Older children 22 9 3
Young children 25 15 3
 About half of this will come from invisible fat present in the foods.

ADULTERATION OF FOODS

Food materials Common adulterants

Cereals such as wheat, rice Mud, grits, soapstone bits.
Dals Coaltar dyes, khesari dal
Haldi (Turmeric) powder Lead chromate powder
Dhania powder Starch, cow dung or horse dung powder
Black pepper Dried seeds of papaya,
Chilli powder Saw dust, brick powder
Tea dust/leaves Blackgram husk, tamarind seeds powder,
saw dust, used tea dust
Coffee powder Date husk, tamarind husk, Chicory,
Asafoetida (Hing) Sand, grit, resins, gums
Mustard seeds Seeds of prickly poppy-Argemone
Edible oils Mineral oils, argemone oil,
Butter Starch, animal fat.
Ice -cream Cellulose, starch, non-permitted colours,
Sweetmeats Non-permitted colours.
Fresh green peas in packing Green dye
Extraction of fat, addition of starch and
Milk water
Ghee Vanaspati

NUTRITION PROGRAMMES IN INDIA

 Vitamin A prophylaxis programme

 Prophylaxis against nutritional anaemia
 Iodine deficiency disorders control programme
 Special nutrition programme
 Balwadi nutrition programme
 ICDS programme
 Midday meal programme

A MID-DAY SCHOOL MEAL

Foodstuffs g/day/child
Cereals and millets 75
Pulses 30
Oils and fats 8
Leafy vegetables 30
Non-leafy vegetables 30

SOURCES OF INDOOR AIR POLLUTANTS

Noxious
Agents Sources Adverse effects
Automobile exhaust, gas Respiratory tract irritation,
stoves and heaters, wood- bronchial hyperactivity,
Oxides of burning stoves, kerosene impaired lung defences,
Nitrogen space heaters bronchialitis obliterans
Automobile exhaust,
Hydrocarbons cigarette smoke Lung cancer
OCCUPATIONAL DISEASES

There is no internationally accepted definition for the term “occupational disease” However,
occupational diseases are usually defined as diseases arising out of or in the course of
employment. For convenience, they may be grouped as under:

I. Diseases due to physical agents:

(1) Heat Heat hyperpyrexia, heat exhaustion, heat syncope, heat cramps,burns and local effects
such as prickly heat.

(2) Cold Trench foot, frostbite, chilblains

(3) Light Occupational cataract, miner’s nystagmus

(4) Pressure Caisson disease, air embolism, blast (explosion)

(5) Noise Occupational deafness

(6) Radiation Cancer, leukaemia, aplastic anaemia, pancytopenia

(7) Mechanical factors Injuries, accidents.

(8) Electricity Burns

II. Diseases due to chemical agents:

(1)Gases: C02, CO, HCN, CS2, NH3, N2, H2S, HCI, SO2 – these cause gas poisoning.

(2)Dusts (Pneumoconiosis) :
(i) Inorganic Dusts :

(a) Coal dust Ahthracosis

(b) Silica .. Silicosis

(c) Asbestos Asbestosis, cancer lung

(d) Iron .. iderosis

(ii) Organic (vegetable) Dusts :

(a) Cane fibre Bagassosis

(b) Cotton dust Byssinosis

(c) Tobacco Tobacossis

(d) Hay or grain dust .. Farmers’lung

(3) Metals and their compounds:

Toxic hazards from lead, mercury, cadmium, manganese, beryllium, arsenic, chromium etc.
(4) Chemicals : Acids, alkalies, pesticides

(5) Solvents : Carbon bisulphide, benzene, trichloroethylene, chloroform, etc.

III. Diseases due to biological agents:

Brucellosis, leptospirosis, anthrax, actinomycosis, hydatidosis, psittacosis, tetanus, encephalitis,

fungal infections, etc.

IV. Occupational cancers:

Cancer of skin, lungs, bladder

V..Occupational dermatosis:

Dermatitis, eczema

VI..Diseases of psychological origin:

Industrial neurosis, hypertension, peptic ulcer, etc.