Comunity Medicine

Question 1 Briefly describe new philosophy of health. Write determinants of health New philosophy of health 1. Health is a fundamental human right 2. Health is the essence of productive life, and not the result of ever increasing expenditure of medical care 3. Health is intersectoral 4. Health is an integral part of development 5. Health is central to the concept of quality of life 6. Health involves, state and international responsibilities 7. Health and its maintenance is a major social investment 8. Health is a world wide social goal DETERMINANTS OF HEALTH The factors which influence health lie both within the individual and externally in the society in which he or she lives are collectively known as determinants of health 1. Heredity a). physical and mental traits are determined by an individuals genes b). disease of genetic origin e.g.: mental retardation, hemophilia 2. Environment a) Internal(tissue & organ) b) External (macro environment) Those things which man is exposes to after conception • Physical – water, housing • Biological-man, animal, microorganism • Psychosocial-stress , family 3. Life style • the way people live • cultural pattern • personal habits - harmful life style-smoking Healthy life style-exercise 4. socio-economic condition a) Economic status Determines purchasing power, standard of living, quality of life family size & pattern of disease and deviant behavior in the community b) Education (especially female education) Illiteracy poverty poor health c) Occupation Employment promotes health Unemployment ill health 5. Health and family welfare services • Immunization • Safe water supply • MCH service 6. Other factors Health related factors e.g. agriculture, Education, social welfare

Question 2. Describe levels of health care, write features of ideal health care delivery system Levels of health care Health care services are normally organized at three levels , each level supported by a higher level to which the patient can be referred 1. Primary health care First level of contact between the individual and the health system. Essential health care is provided. E.g.: thana health complex and their union sub centers 2. Secondary health care More complex problems are dealt with, care comprises essentially of curative services. Eg: district hospitals First referral level of health systems 3. Tertiary healthcare Super specialist care provided by regional or central level institutions Eg: medical college hospitals Referral support for primary and secretary levels Features of an ideal health care delivery system 1. Appropriateness: whether the service is needed at all in relation to essential human needs at all in relation to essential human needs, priorities and policies 2. Comprehensiveness: optimum mix of preventive curative and promotional service 3. Adequacy: if the service is proportionate to the requirement 4. Availability: ratio between administrative unit and the health facility E.g.: doctor population ratio 5. Accessibility: Geograpghic ac 6. Affordability: Cost of health care should be within the individual and the state. 7. Feasibility – Operational efficiency of certain procedures, logistic support, man power

Question 3 Define screening. write comparison between screening test and diagnostic test

Definition of screening The search for unrecognized disease or defect by means of rapidity applied tests, examinations or other procedures in apparently health individuals Eg:pap smear for cervical cancer Chest x-ray for TB

Comparison between screening test and diagnostic test Screening test

Diagnostic test

1. Done on apparently health

1.Done on those with indications or sick

2. Applied to groups

2.applied to single patients, disease consider

3. Based on one criterion

3.based on evaluation of a number of symptoms, signs, and laboratory findings

4. Less accurate

4.less accurate

5. Less expensive

5.more expensive

6. Not a basis for treatment

6.used for basis for treatment

7. The initiative comes from the investigator 7.the initiative comes from a patient with a comor agency providing care plaint

Question 4 Write importance of studying community medicine, what is family medicine? Importance of studying community medicine 1.Community medicine is the total health care be it physical, mental, and social for the individual, the family, the community and the nation as a whole through collaborative and coordinated efforts or integration of various discipline and profession to achieve community health prospective 2.It is concerned with the identification and assessment of health needs of the people, health problems affecting them and to devise appropriate measures to meet these requirements as best as possible with available resources 3.The working concept of community medicine is concerned with the delivery of comprehensive health care to the people 4.Since community medicine is oriented towards people, there is also profound concern within organization of health care and with factors influencing its distribution, use and effectiveness Family medicine A field of specialization in medicine which is neither diseased nor organ oriented. It is a family oriented medicine or health care centered on the family as the unit, from first contact to the ongoing care of chronic problems

Question 5 Define disaster; describe pre disaster preparedness activities of a hospital Disaster “Any occurrence that causes damage, economic disruption, loss of human life and deterioration in health and the health services on a scale sufficient to warrant an extraordinary response from outside the affected community or area Pre disaster preparedness of hospital 1. Improvement of hospital site and building • Make road access easier • Make more open spaces at hospital premises • Find out and correct architectural or engineering false if any • National building code should be followed while construction new building • Provisions for exits and alternative exits 2. Improvement of utility services • Overhauling of electricity, gas, water supply and telecommunication systems • Alternative arrangements of above service s if present system fails • Arrangement of citizen band radio network • Manpower training with above service 3. Improvement of emergency and casualty department • Make size and site of emergency department more accessible • Installation of resuscitating and life saving equipment • Stocking of life saving medicine eg: gauz, bandages etc… • Establishment of new operating theaters • Make mobile health team standby • Arrangement of special training for emergency doctors, nurses and staff • Establishment of a fully pledged casualty/trauma center if fund is available • Modernization of blood bank and transfusion system

Question 6 Define epidemiology. Write objectives and uses of epidemiology Epidemiology “Study of the distribution and determinants of health related states or events in specified populations and the application of this study to the control of health problems” Objective s of epidemiology *according to the international epidemiological association 1. To describe the distribution and size of disease problems in human populations 2. To identify etiological factors in pathogenesis of disease 3. To provide data essential to the planning implementation and evaluation of services fort the prevention ,control and treatment of disease and to the setting up of priorities among those services *ultimate objectives of epidemiology 1. To eliminate or reduce the health problem or its consequences 2. To promote the health and well being of society as a whole by preventing of its occurrence in the future Uses of epidemiology 1) 2) 3) 4) 5)

Describe causation of disease To know the natural history of disease Describes people’s health status Evaluation of intervention program Evaluation of health care services

Question 7 Classify epidemiological study methods. Compare case, control and cohort study Epidemiological study methods 1. Observational studies a) Descriptive studies b) Analytical studies 1) Ecological 2) Cross sectional 3) Case control 4) cohort 2. Experimental or intervention studies 1) Clinical trials 2) Field trials 3) Community trials Descriptive epidemiology Concerned with observing distribution of disease or health related characteristics in human populations and identifying the characteristics with which disease in question seems to be associated. Analytical epidemiology Subject of interest is the individual within the population • case control study • Cohort study Experimental epidemiology • Randomized control trials • Non randomized or non experimental trials Compare case control and cohort study Case control 1. proceeds from effect to cause 2. Starts with the disease 3. Test weather the suspected cause occurs more frequently in those with the disease than those with out the disease 4. Usually first approaches of a testing of a hypothesis 5. Involves fewer number of subjects 6. yield relatively quick results 7. Suitable for study of rare disease 8.Generally yields only relative risk(Odd

Cohort study 1.Proceeds from cause to effect 2. Starts with people exposed to risk factors or suspected cause 3. test weather disease occurs more frequently in those exposed to it than those similarly exposed 4. reserved for testing precisely formulated hypothesis 5. involves large number of subjects 6. long follow up period needed involving delayed results 7.in appropriate when the disease or exposure under investigation is rare 8.yeilds incidents rates, relative risks as

ratio) 9. Can not yield information about diseases other than that selected for studying 10.relatively in expensive

well as attributable risks 9. Can yield information about more than one disease out come 10. relatively expensive

Question 8 What are the public health emergencies? ‘Any incident that causes break down of public health by any means is called public health emergency’ 1. Any epidemic outbreak • Cholera 2. Natural calamities • Cyclone • Flood • Tsunami 3. Accidents • Serious road traffic accidents • Aircraft crash

Question 9 Define endemic, epidemic, pandemic and sporadic with examples. Endemic ( En= In, Demos=people) It refers to the constant presence of a disease or infectious agent within a given geographic area or the population group, without importation from outside, may also refer to the “Usual” or Expected frequency of the disease within such a area or population group. E.g.:-Cholera is endemic in Bangladesh Malaria in hill tracks Goiter at Rangpur Epidemic (Epi=Upon, Demos= people) The unusual occurrence in a community or region of disease, specific health related behavior (Eg:smoking) or their health related events(traffic accidents) clearly in excess of “expected occurrences” Eg:- Communicable – measles, Cholera, Chicken pox Non communicable disease – IHD, Lung cancer Health related behavior – smoking Pandemic An epidemic usually affecting a large proportion of the population occurring over a wide geographical area, Such as e section a nation, entire nation, a continent or the world. Eg:- Influenza pandemic of 1918 and 1957 Cholera in 1962 (Still continuing) Acute hemorrhagic conjunctivitis 1917 and 1981 Sporadic When a disease occurs irregularly, haphazardly from time to time and generally infrequently with out having common sources of infection. Eg:- Polio Tetanus Herpes - zoster

Question 10 Write levels of disease prevention, why prevention is better than cure Levels of disease prevention 1. Primordial prevention • Prevention of emergence or development of risk factors in countries or population groups in which they have not yet appeared • The main intervention is through individual and education eg: adult health problems (obesity, hypertension,) by encouraging healthy lifestyle in childhood 2. Primary prevention It signifies intervention in prepathognic phase of disease or health problem a) Health promotion • health education • nutritional intervention • environmental modification • lifestyles and behavioral changes b) Specific changes • Immunization • protection against accident • chemoprophylaxis • protection against occupational hazards 3.Secondary prevention “Action which cause the progress of a disease at its incipient stage and prevents complications.” The specific interventions are early diagnosis and treatment The methods employed for early diagnosis 1) case finding measures 2) screening surveys 3) surveillance techniques 4) Periodic examinations 5) Selective examination of people at high risk 4. Tertiary prevention “All measures available to reduce or limit impairments and disabilities ,minimize sufferings caused by existing departures from good health and to promote the patients adjustment to irremediable condition It signifies intervention in the late pathogeneses phase a) Disability limitation b) Rehabilitation

Why prevention is better than cure 1. Preventive measures are taken prior to the onset of a disease to remove all possibilities of disease and damage. 2. Includes early diagnosis and treatment. • Prevents secondary complications • further disability • development of secondary cases • mortality 3. Prevention requires fewer resources 4. Prevents loss of man power 5. Side effects not present 6. Less costly

Question 11 Define statistics, write its uses Statistics : The science of collection, presentation, analysis, and interpretation of numerical data Uses of statistics 1. To define - Normal Healthy eg : pulse rate 2. To define the difference between means and proportions of normal at two places or in different periods Eg: Mean height - urban & rural Mean IDD - in northern area 3. To find out variability Eg : weight increases / decreases proportion to height 4. To produce action of a drug Eg: drug given to produce changes 5. To find out relative potency of a new drug with respect to standard drug 6. To test usefulness of vaccine in the field 1% attack or death prevented 7. Role of a aetiological factor Eg: IDD is confirmed by rate of goiter before and after giving iodized salts

Question 12 Define and classify data Data Discrete observations of attributes or events that carry little meaning when considered alone Classification of data 1. on the basis of source • primary data-data obtained directly from a individual eg: data about health and sickness of a population • secondary data –data obtained from outside source e.g.: census used during studying hospital records 2. on the basis of nature A) Variables 1. continuous variables eg: height in feet 2. discrete variables eg: number of beds in a hospital B) Attributes (qualititative) e.g. occupation, sex 3. on the basis of processing • ungrouped – weight of 4 boys in kg’s 20,22,18,16 • grouped- height of 10 boys in feet 4’X4 , 4.5’X4, 5’X2

Question 13 How can u collect and present data Methods of collecting data 1. document reviews 2. observation • naturalistic observation • performance observation • habitual observation a) participants observations b) non participants observation 3. asking questions a) interviewing b) mail questionnaire 4. measurement 5. combined method presentation of data 1. tabulation 1) simple 2) complex 2. charts and diagrams a) bars and charts • simple bar charts • multiple bar charts • component bar charts b) histogram c) frequency polygon d) line diagram e) pie chart f) pictogram 3. statistical maps • spot map • scatter map

Question 14 Write formula of growth rate calculation and population doubling time calculation Growth rate = CBR – CDR / 10 CBR = Crude birth rate CDR = Crude Death Rate Population doubling time = 70/growth rate of population

Question 15 Write the measures of central Tendency and measures of dispersion Measure of central tendency Characteristics that describe the middle or most commonly occurring value in a series 1. Mean i. Arithmetic mean It’s the sum of all the values in a series divided by the number of values in the series X = ∑ Xi ¯¯¯ n X = Arithmatic mean ∑ = The sum of Xi = Each of the values in a series n = The number of values in the series 2. Median: Value which divides the distribution to equal two values The data is first arranged in an ascending or descending order of magnitude and the value of the middle observation is located 72 76 76 78 80 82 II Median

83 84

If the number of values are even the arithmetic mean of the two middle values are taken 72 76 76

77 78 80 82 83 I___I I (78 + 88)/2 = 79

89

90

3. Mode 76

Mode is the value which occurs most frequently in a distribution of data 80 72 76 74 79 76 81 76 Mode = 76

Measures of dispersion It’s the measure of the variation of the observation 1) Range Def:- The difference between the highest and the lowest values in a series

2) Mean deviation Def:- It is the average of the deviations from the arithmetic mean. __

M.D = ∑(X – X ) ¯¯¯¯¯¯¯¯¯ n

3) Standard deviation Root mean square deviation.

SD=

Question 16 Define and classify sampling Sampling The process, method or technique of selecting sample.

Methods of sampling 1. random sample It is are which is drawn in a such a way that every individual in the population has known and non zero chance of being selecting in the sample 2. simple random sample It is one which is selected in such a way that every individual in the population has the equal chance of being selected in the sample 3. stratified random sample It is one which deliberately drawn in a systemic way so that even portion of the sample represents a corresponding strata of the universe 4. cluster sample It is one which groups of elements rather than single elements are selected at random 5. systemic random sample It is done by selecting the first unit at random and subsequent unit s is selected at a certain interval 6. two stage sample In this type selection takes place in 2 stages

Question 17 What are the sources of health information, write differences between data and information Sources of health information 1. Census 2. registration of vital events 3. Sample – registration system 4. Notification of diseases 5. Hospital records 6. disease registers 7. record linkage 8. Epidemiological surveillance 9. Environmental health data 10. Health man power statistics Difference between data and information • data consists of discrete observation s of attributes or events that carry no meaning when considered alone: data as collected from operating health care systems or institutions are inadequate for planning • information is data transformed into formation by reducing them, summarizing and adjusting them for variations such as age ,sex, composition of population so that comparison over time and place are possible

Question 18 Define balance diet, calculate energy requirement of a student weighing 60kg Balanced diet Diet which contains a variety of foods in such quantities and proportions that the need for energy, amino acids, vitamins, minerals, fats, carbohydrates and other nutrients are adequately met for maintaining health, vitality and general well being and also makes a small provision for extra nutrients to withstand short duration of leanness Energy requirement Energy requirement of 60kg student Energy requirement per kg per 24 hrs for men Energy requirement per kg per 24 hours for women Weight s of student Daily energy requirement of 60kg male student Daily energy requirement of 60kg female student

=45 kcal/24hrs/kg = 40 kCal/24hrs/kg =60kg =45 X 60 =2700kcal/24hrs =40 x 60 =2400kcal/24hrs

Question 19 What are the common nutritional problems in Bangladesh? How can you prevent PEM? Common nutritional problems in Bangladesh 1. Protein energy malnutrition a. Kwashiokor b. Marasmus 2. Vitamin A deficiency a. Night blindness b. Xeropthalmia c. Total blindness 3. Nutritional anaemia a. iron deficiency anaemia b. Folate, Vitamin B12 deficiency anaemia c. 4. Iodine deficiency disorders a. Goiter 5. Khesari dhal intoxication a. Neurolathyrism How can you prevent PEM *According to the UNICEF G – For growth monitoring O – For oral re hydration B – For breast feeding I – For immunization F – For female education F – For food supplementation F – Family spacing *According to the FAO/WHO • Health promotion • Specific protection • Early diagnosis and treatment • Rehabilitation

Question 20 Briefly discuss ante-natal care. Definition It is the care of woman during pregnancy Objectives 1. To promote, protect and maintain the health of the mother during pregnancy 2. To detect high risk cases and give them special attention 3. To foresee complications and prevent them 4. To remove anxiety and dread associated with delivery 5. To reduce maternal and infant mortality and morbidity 6. To teach the mother elements of child care, nutrition, personal hygiene and environmental sanitation 7. To sensitize the mother to the need for family planning including advise to cases seeking medical termination of pregnancy 8. To attend to the under fives accompanying the mother

Question 21 Tabulate EPI schedule for Bangladesh

Disease

TB

POLIO

Vaccines

BCG

OPV

First dose

After birth.

After birth

Single

4- Doses

0.05ml

2/3 drops

----------------

4-Wks

Number of doses Quantity of each dose Interval between doses Route/Site Time of completion Vitamin-A capsule

ID,left deltoid 1 year -----------------

Per oral 1 year ----------------

Diptheria, Tetanus, Pertusis DPT 6 Wks after birth. 3- Doses 0.5ml 4-Wks IM thigh 1 year 1 drop of 25000IU within DPT1 &DPT3

MEASLES

Hepatitis-B

Measles Vacc.

Hepatitis-B vaccine 9 Months after 6 Wks After birth. birth . Single 3-Doses 0.5ml

0.5ml

---------------

4-Wks

SC thigh After 290 days 1 capsule with measles vaccine

IM thigh 1 year -----------------

*BCG and measles vaccines have to be reconstituted in prescribed dilutents before administration

Question 22. Define reproductive health care. What are the areas of reproductive health care? A state of complete physical, mental and social well being and not merely the absence of disease or infirmity in all matters relating the reproductive system and the functions and processes. Areas –Avoiding unwanted pregnancies Postponing birth Services for safe pregnancies and deliveries Fertility regulation Treatment of abortion patient Managing reproductive mortality Prevention, control and Tx of STD/AIDS. Managing maternal and adolescent health Involvement of female education Employment and empowerment programme

Question 23. How can you prevent occupational health hazards. Write offensive trades. 1. Medical measures 2. Engineering measures 3. Legislative measures 1. Medical measures – 1. Pre placement examination – Each worker is subjected to a thorough medical examination which includes CXR, ECG, blood examination wire, vision etc. at the time of employment 2. Periodic health examination. 3. First aid and medical care. 4. Notification - Certain occupational diseases. E.g.: Pb poisoning, silicone are notifiable 5. Working environment Periodic environment of working environment. All aspects – temp. , lighting, noise, ventilation, humidity, cubic space, air pollution should receive attention. 6. Health education. 7. Maintenance of records 2. Engineering measures – 1. Location – all industries should be located in an industrial area which should be sufficiently away from the residential area. 2. Proper designing factory building 3. Good house keeping 4. Enclosures – dangerous machines or parts should be protected by enclosing it 5. Personal protective equipment – working clothes, helmets, goggles, eye shields, foot, leg, arm protection. 6. Control of dust, fumes, gases and other offensive material. 7. Substitution – replacement of a harmful material of poisonous chemical by harmless or non – poisonous one 8. Mechanization – all the processes should be mechanized to the fullest possible extent to avoid danger. 9. Periodical monitoring – environmental surveys, including testing the factor air for toxic substances. 3. Legislation – 1. Factory laws should be strictly followed. 2. Industried health regulations should be strictly observed. 3. Smoking should be dis allowed. Offensive trades – Any trade which is a source of nuisance from public health point of view; or any trade which is ugly to look, smell or sound is likely to injure health in someway. 1. Slaughtering of animals 2. Tannery and leather processing industries 3. Keeping domestic animals 4. Animal trading 5. Gut scrapping 6. Fat melting or boiling or grease factory 7. Bone boiling and drying in fertilizer factory and for pigment production 8. Brick fields, fertilizer, lime factories 9. Acid producing factory 10. All dusty mills – rice, flour, sugar, wool, cotton, jute, tobacco factory, rayon mills, paper mills.

Question 24. What are the STDs? How can you prevent them? Group of communicable diseases caused by a wide range of bacterial, viral, protozoal and fungal infections transferred predominantly through sexual contact. Bacterial – Gonorrhea Syphilis Chancroid Lymphogranuloma venereum Non – gonococcal urethritis Cervicitis and PID Granuloma inguinali Viral – Anogenital herpes Hepatitis B AIDS Genital warts Genital molluscum contagiosum Fungal – Genital candidiasis Protozoal – Trichomonas vaginalis Arthropods – Pubic pediculosis Scabies Prevention & Control 1. Early diagnosis & treatment 2. Health & sex education 3. Control of prostitution 4 Case follow up-For gonorrhoea,culture of secretions & serological tests. 5. Contact tracing-If repeated infections, PID,sexually active female 6. Preventive measures-Condom,1%-Teracycline eye ointment(for ophthalmic neonatorum) 7. Religious upliftment 8. Legislative measures 25. Briefly discuss investigation of an epidemic It is to describe the magnitude of the out break and to determine how and why the outbreak took place as well as to suggest measures for its control and prevent future occurrence Step1 –Confirm diagnosis through history clinical exam& labtests. Step2 –Confirm epidemic reviewing records. Step3 –Characterize epidemic in terms of time, place & person Step4 –Develop hypothesis in terms of agent , source, mode of transmission, environmental factors Step5 –Testing hypothesis using different statistical tests & procedures. Step6 –Drawing conclusion & compilation of report. Step7 –Institution of control measures a) Treatment of cases. b) Prevent spread- isolation, chemoprophylaxis, vaccine, control tracing c) Surveillance of the population at risk.

Question 26. Define Medicalstatistics. What are the vital events of life? Facts systematically collected and compiled in numerical form related to or derived from records of vital events such as births, deaths, marriage, divorces, sicknesses that occur in our community. Vital Events – Birth Death Marriages Divorce Sicknesses Fertility Morbidity Natality

Question 27. Tabulate levels of prevention and modes of intervention 1. Primordial prevention 2. Primary prevention 3. Secondary prevention 4. Tertiary prevention 1. Primordial – Prevention of development of risk factors 2. Primary - Intervention in pre-pathogenesis phase By, 1. Health promotion 2. Specific protection 3. Secondary – Action which halts the progress of a disease and its incident stage and prevents complications 4. Tertiary - All measures available to reduce giant impairments and disabilities Modes of intervention 1. Health promotion 2. Specific protection 3. Early Dx and Tx 4. Disability limitation 5. Rehabilitation

Question 28. Write Short notes on a). Incubation period b). Carrier A).Incubation period. Def.. The time interval between invasion by an infectious agent & appearance of the first symptoms Imp: 1- Helpful in tracing the source of infection & contacts. 2- Useful in determining the period of quarantine 3- Helps to know the preventive measures by immunization 4-Helps to identify the point source or propagated epidemics 5- Useful in estimating the prognosis of a disease. Types: 1.Minimum incubation period. 2.Median incubation period. 3.Estimate of average incubation period. B)Carrier An infected person or animal that harbors a specific infectious agent in the absence of discernible clinical disease and serve as a potential source of infection for others. Classification a) By Types 1. Incubator y – Who sheds the infectious agent during the incubation period of disease. Eg; Measles, Mumps, Polio 2. Convalescent – Who continues to shed the disease agent during the period of convalescence. Eg: Typhoid fever, dysentery, cholera, diphtheria, and whooping cough. 3. Healthy – Victims of sub-clinical infections and shed the disease agent. Eg: polio myelitis, cholera, diphtheria, salmonellosis, etc. b) By duration 1. Temporary – incubation, convalescent and healthy 2. Chronic – Typhoid, hepatitis B, malaria, dysentery, gonorrhea c) By portal of exit 1. Urinary 2. Intestinal 3. Respiratory 4. Nasal 5. Others – Skin eruptions, open wounds, blood. Question 29. Define demography. What are the demographic processes? It is the scientific study of human population. Processes – 1. Fertility 2. Mortality 3. Mobility 4. Migration 5. Social mobility

Question 30. Write basic principles and essential components of primary health care. Principles 1. Equitable distribution of health services 2. Community participation 3. Multi sectorial approach 4. Appropriate technology . Elements 1. Health education 2. Promotion of food supply and proper nutrition 3. Adequate supply of safe water and sanitation 4. MCH an FP 5. Immunization 6. Prevention and control of endemic diseases 7. Appropriate Tx for common diseases and injuries 8. Provision of essential drugs.

Question 30. What are the pregnancy induced danger signs and symptoms. Who are risky infants? 1. Anti partum hemorrhage 2. Hypertension 3.Tachycardia. 4. Respiratory distress 5. Proteinuria. 6.Convulsions 7.Ankle edoema 8.Fever 9.Restlessness 10.Early rupture of membrane with per vaginal discharge of liquer amnii High risk infants 1. Birth weight less than 2.5kg 2. Twins 3. Birth order 5 or more 4. Artificial feeding 5. Weight below 70% of the expected weight 6. Failure to gain weight during 3 successive months 7. Children with PEM, diarrhea 8. Working mother one parent Anti natal lab tests – 1. Blood – Rh and ABO grouping 2. Hb examination 3. Urine – Sugar and albumin. Pregnancy test 4. InVx for hepatitis B, HIV 5. VDRL for syphilis 6. Ultrasonography

31. Define Arthropod. Classify arthropod borne disease. It is invertebrate insects with jointed legs Arthropod borne diseases – Mosquitoes – Malaria, Filaria, Viral encephalitis, Viral fever (eg: dengue, west niles), viral hemorrhagic fever, (eg: yellow fever, dengue) House fly – Typhoid and paratyphoid, diarrhea, dysentery, cholera, gastro enteritis, amoebiosis, helminthic infestations, poliomyelitis, anthrax Sand fly – Kala azher Louses – Epidemic typhoid, relapsing fever, Trench fever, pediculosis Tsetse fly – Sleeping sickness Black fly – onchocerciasis Reduvid bud – Chagas disease Rat flea – Bubonic plague, Endemic typhoid, Chigerosis, hymenolepsis Tick—1.Hard-Tick typhus, viral encephalitis, viral fevers, viral hemorrhagic fevers 2.. Soft – Q. fever, relapsing feverMite 1. Trombiculid mite- Scrub typhus, Rickettsial pox 2 Itch mite – scabies Cyclops – Fish tape worm disease Cockroaches – Enteric pathogens

Question 32. How can you control housefly and mosquito Housefly – 1. Environmental control – a). Storing garbage, kitchen waste and other refuses in bins with tight lids lids b) Efficient collection, removal and disposal of refuse by incineration, compostity and sanitary landfill. c) Provision of sanitary latrines d) Stopping open air defaecation e) Stopping general sanitation 2. Insecticidal control 3. fly papers 4. using meshes 5. Health education Mosquito control _ 1. Anti larval – a) Environmental control-Filling,leveling &drainage of breeding places b) Chemical control-Mineral oils, Paris green, Synthetic insecticides c) Biological control-Small fish which feed on mosquito larvae. 2. Anti adult measures – a) Residual sprays b) Space sprays c) Genetic control 3. Protection against mosquito bite – a) Nets b) Screening c) Repellants

Question 33. Write new concept of health. Why good health is good investment 1.Biomedical concept – A person is considered healthy if he was free from disease or absent from disease. 2.Ecological concept – It is a dynamic equilibrium between man and his environmental disease maladjustment of the human organism to the environment 3.Psychological concept – Health is not only a biomedical phenomenon, but one which is influenced by social, psychological, cultural, economic and political factors of the people concerned 4.Holistic concept – A synthesis of all of the above concepts

Question 34. What are the components of health education? Write basics of communication 1. Information – It is informing, disseminating scientific knowledge, about health to the people and as well as collecting information from people. Information are collected through, a) Observation b) Interviewing people c) Using documents and records 2. Learning – Continuous, dynamic and ongoing process requiring some basic ingredients (e.g.: a stimulus, a trial response, and rewarding consequence of trial response) 3. Motivation – Every person has a desire to learn, and awakening of this is called motivation Basics of communication – 1.Motivation 2. Repitition 3.Reinforcement 4.Citing examples from day to day life.

Question 35. Write short notes on a) Pneumoconiosis b) GOBI FFF A) Pneumoconiosis – A disease caused by chronic inhalation of dust within the size range of 0.5 to 3micron which may gradually cripple a man by reducing his working capacity due to lung fibrosis and other complications. Types – Silicosis – Due to chronic inhalation of silica and silicon dioxide Anthracosis – Due to coal dust Byssinosis – Due to cotton fiber dust Bagassosis – Sugar cane dust Asbestosis – Asbestos dust Farmers lung – hay or grain dust B) GOBI FFF – The unicef has put forward a set of strategies for child health revolution G – Growth monitoring O – Oral rehydration B – Breast feeding I – Immunization F – Female education F – Frequent feeding F – Family planning

Question 36. Define control, elimination and eradication. Control -means ongoing operations aimed at reducing, , 1. Incidence of disease 2. Duration and risk of transmission 3. Effects of infection – physical and psycho social 4. Financial burden to the community. Elimination –It is the interruption of transmission of disease Eradication – it is the termination of all transmission of infection by extermination of the infectious agent.

Question 37:- Write short notes on i.)WHO ii.) UNICEF WHO • World health organization is a speacialised, non political agency of the united nations with headquaters in Geneva. • Birth of WHO – Origin in April 1945 • Structure – It consist of 3 structural groups 1. The world health assembly 2. The executive board 3. The secretariat • Membership - -By 1996 the organization had 190 member states and 2 associate members, At present the organization has 192 member states • Activities 1. Prevention and control of specific diseases 2. Developmental and comprehensive services 3. Family health 4. Environmental health 5. health Statistics 6. Bio-Medical research 7. Health literature and information 8. Corporation with other organizations • •

Constitution – The constitution of the WHO was drafted in 1946 by an international health conference of 51 member nations of the United Nations in New York and came into force on the 7th April 1948 Objectives – The constitution of the WHO defines the organization and objectives are the attainment by all the people of the world the highest possible level of health. The organization is now striving to achieve a common objective, the goal of health for all

UNICEF • UNICEF (United Nations International Children Emergency Fund) is one of the specialized organizations of the United Nations • It was established on December 11, 1946 by the United Nations

•

•

In 1953 the general assembly gave it a new name,UNITED NATIONS CHILDRENS FUND • Regional office : New Delhi (INDIA) • Organization: 2 Parts 1. Governing body (The Executive Board) – Composed of 36 members from the region 2. Secretariat – Is the staff of UNICEF Content of service 1. Child health 2. Child nutrition 3. family and child welfare 4. Education : Formal and Non formal

Question 38: Define disaster. How can you prevent a catastrophe? Define catastrophe? Any occurrence that causes damage, economic disruption, loss of human life and deterioration in health and the health services on a scale sufficient to warrant an extraordinary response from outside the affected area To minimize the catastrophe 4. Prevention and alleviation of consequences a. Forecasting the disaster using modern technology b. Promoting community preparedness by such activities like first aid exercises 5. Immediate emergency care 6. Management of the aftermath • • • •

Environmental sanitation Public health monitoring and prevention of epidemics Vaccination against six major child disease Food and nutrition

7. Rehabilitation and reconstruction

Question 39 What are the determinants and indicators of health Determinants of health 1. Heredity 2. Environment 3. Life style 4. Socio-economic considerations 5. Health and family welfare services 6. Other factors Indications of health 1) Mortality indicator i. Crude death rate ii. Expectation of life iii. Infant mortality rate iv. Child mortality rate v. under 5 proportionate mortality rate vi. Maternal mortality rate 2) Morbidity indicator 3) Disability rates 4) Nutritional state indicator 5) Health care delivery indicators 6) Environmental indicators 7) Socio-economic indicators 8) Indicators of quality of life. 9) Utilization rates !0) Health policy indicators

Question 40 Briefly describe different methods of Epidemiological study 1) Observational studies a)Descriptive studies b)Analytical studies. 1.Ecological study. 2.Cross-sectional study. 3.Case-control study. 4.Cohort study. 2)Experimental or intervention studies 1.Clinical trials. 2.Field trials. 3.Community trials. a. Descriptive Epidemiology – Descriptive studies are concerned with observing the distribution of disease or health related characteristics with which disease in question seem to be associated b. Analytical epidemiology – In analytical studies the subject of interest is the individual within the population. Analytical studies comprises to distinct types of observational studies i. Case control study ii. Cohort study c. Experimental epidemiology – In modern usage experimental epidemiology is often equated with randomized control trials Types o Randomized control trials o Non randomized or non experimental trials

Question 41 Classify Data, How can you present Data Classify data 1. On the basis of source • Primary data • Secondary data 2. On the basis of nature • Variables • Attributes 3. On the basis of processing • Ungrouped • Grouped Methods of Data presentation • Tabulation • Charts and diagrams: a)Bar charts- Simple bar chart. Multiple bar chart. Component bar chart. b)Histogram. c)Frequency polygon. d)Linegram. e)Pie chart. f)Pictogram. •

Statistical maps a)Shaded maps. b)Dot maps.

Question 42 What are the measures of central tendency? Find out standard deviation 10, 20, 30 There are 3 main measures of central tendency 1) The mean 2) The median 3) The mode 1) The mean Arithmetic mean:It’s obtained by adding up the individual observations & dividing the summation by the number of observations. 2) The median When all the observation arranged in ascending or desecing order the middle observation is known . 3) The mode This is the most frequently occurring observation in a series The standard deviation The standard deviation is the root mean square deviation. Calculation SD=

x 10 20 30

∑(X-X2) ---------n

x 20 20 20

x-x -10 0 10

(x-x) 100 0 100

Question 43 Briefly describe scabies Scabies Scabies is an infectious disease of the skin caused by the mite sarcotopes scabei It is characterized by pruritc papular lesions along the burrows containing the mites and their eggs Clinical features Intense itching, more at night, initially between the fingers or on the buttocks or genitals, and later all over the body, where the mite burrows, the head , neck , palm , and sole are spared ,except in infants Mode of spread of scabies: 1. Close contact with the infected person 2. Contaminated clothes Diagnosis of scabies 1. Patients complains of itching , which is coarse at night 2. Examination reveals follicular lesions at the affected sites 3. Secondary infections leads to crusted papules and pustules 4. Searching for parasite in te skin debris under microscope Control of scabies • Sanitation control a) Improvement of sanitation b) Improvement of personal hygine • Chemical control Benzyl benzoate, emulsion

Question 44 Write epidemiology and prevention of tetanus Epidemiology of tetanus A) occurrence Tetanus is found world wide with high incidence in some parts of the tropics. B) Ecological triad 1. Agent: Clostridium tetani 2. Host: • Age and sex → all ages and both sexes are susceptible to tetanus. But males are more prone to this disease. • occupation: agricultural workers • high risk groups: female and infants • immunity-first attack does not confer immunity against second attack 3. Environmental and social factors Tetanus is an outcome of environmental hazard There is a direct relationship with fertile soil and a warm climate C) natural history 1. Reservoir: man and animals 2. Source of infection • Soil • Dust • Earth • Human and animal excreta 3. Carrier • •

air dust

4. Mode of transmission Not communicable from person to person. But one may get tetanus, if the injured area is contaminated by spores Methods • trivial wounds • nail pricks • after operation • after burn • after circumcision 5. Incubation period: 6 – 10 days.

Prevention 1. Active immunization with tetanus toxoid. 2. Passive immunization with Human tetanus hyperimmunoglobulins, 250-500IU 3. Active-Passive immunization. 4. Antibiotic therapy.

Question 45 What are the levels of disease prevention? Levels of prevention 1. Primordial prevention 2. Primary prevention 3. Secondary prevention 4. Tertiary prevention Primordial prevention Prevention of the emergence or development of risk factors in factors in countries or population groups in which they have not yet appeared Primary prevention It signifies intervention in the pre pathogenesis phase of a disease or health problem Secondary prevention It may be defined as “action which halts the progress of a disease at its incipient stage and prevents complications Tertiary prevention It may be defined as “all measures available to reduce or limit impairments and disabilities, minimize suffering caused by existing departures from good health and to promote the patients adjustment to irremediable conditions

Question 46 What is communicable disease? Write principles of prevention of communicable disease Definition Communicable disease is a disease which can be transmitted from one host or reservoir to another through transference of a sufficient quantity of the causative agent Principles of prevention A) Controlling the reservoir • early diagnosis and treatment • notification • epidemiological investigation • isolation B) Interruption of transmission of disease C) Measures taken in hospital • Immunization • Chemoprophylaxis • Non specific measures

Question 47 What is disaster? How can you reduce consequences of disaster Disaster According to WHO “any occurrence that causes damage ,economic disruption ,loss of human life and deterioration in health and the health services on a scale sufficient to warrant an extra ordinary response from outside the affected community Reduction of consequences A)pre disaster preparedness

1) Improvement of hospital site & building. 2) Improvement of utility services

3)Improvement of emergency & casualty department. B)Measures during disaster & aftermath 1)Send mobile health team to disaster scene as soon as possible. 2)Assembling of trauma team. 3)Readiness of extra beds & OTs. 4)Setting of triage. 5)Quick DX of problem, resuscitation . 6)Referral of casualties according to casualties. 7)Controlling of traffic C)Post disaster measures 1)Follw up programme for casualties. 2)Physio therapy & psycho therapy. 3)Social therapy & occupational therapy. 4)Special measures to prevent communicable diseas outbreak. 5)special measures to prevent nutritional problems. 6)Evaluation of total disaster preparedness & response programme & correction of faults as far as possible.

Question 48 Write 4 diseases with their causative agents and vector Malaria Kalazaar Plague Shigellosis

Causative agent plasmodioum vivax leishmaniadonovani yersenia pestis shigella

vector mosquitio-anophiles sand fly rodents house fly

Question 49 Write 4 media and methods of health education Media of health education A) Traditional media • Folk plays. • Puppet shows B) Visual media • chalk and black board • charts ,maps ,graphs • posters ,journals ,papers , pampletes • text book ,work book • photographs • flannel graph • exhibits C) Auditory media • Tape • Recorders • Microphones • Radio • Amplifiers • Ear phones D) Combined AV media • Closed circuit TV • Computer • Sound film cinema Methods of health education 1. Two way method or Socratic methods • Panel discussion. • Group discussion. • Brain storming.

2. One way method or didactic. Lecture. Talkes. Demonstrations.

Question 50 Briefly describe health care delivery system in Bangladesh Health care delivery system of Bangladesh is based on primary health care concept health services are usually organized at three level ,primary ,secondary ,and tertiary care levels, each level being supported by referral services at the next higher level primary level health care This is the first level of contact b/w an individual and the health care delivery system. A majority of the health complaints and problems of the community can be met satisfaction at this level in Bangladesh the upazila health complex and union health sub centers constitute this level. Secondary level health care This level deals with comparatively more complicated health problems which are beyond the scope and capacity of the primary level .those level serves as the first referral level in the health system . The secondary level health care is provided by the district hospital Tertiary level health care This level deals with a super specialist care provided by the regional /central level serves as the referral to primary and secondary level. In Bangladesh there are regional medical college hospitals and national level hospital

Question 51 What are the water borne diseases Water borne diseases 1. Those caused by the presence of an infective agent • viral →viral hepatitis A,hepatitis E, poliomyelititis, rota virus norwalkvirus • bacterial → typhoid and paratyphoid fever ,bacillary dysentery ,esch.coli diarrhea cholera • protozoal→amoebiasis,giardiasis • Helmenthic→round worm , thread worm ,hydatid disease • leptospiral→leptospirosis. 2. Those due to the presence of an aquatic host • snail→Schistosmiasis • cyclops→Guinworm,fish tape worm

Question 52 How can you ensure safe water for rural community? 1. Safe drinking water should be collected from tube well. for this adequate supply of tube well must be ensured, in Bangladesh rural water supply project of UNICEF is serving the purpose of safe water drinking supply 2. Proper maintenance of the tube well s also a part of safe water supply programmed 3. In lacking or shortage of tube well bathing ,washing, cleaning , etc…can be done by the water of pond , spring or such kind of any source 4. Health education of the village people regarding water pollution and provision of safe water 5. Disinfection of wells with bleaching powder. 6. Filtration – Chamberland filter,Berkefeld filter. 7. Boiling-“rolling boil” for 5-10 minutes..

Question 53 Manage case of rabies dog bite Once the disease is established therapy is symptomatic 1. Isolation: the patient should be isolated in a quiet, darkened room protected as far as possible from external stimuli, such as bright light , noise or cold 2. Local treatment of wound: a)Cleansing-thoroughly with soap water or antiseptics. b)Local application of anti rabies serum. c)Antibiotics & Antitetanus measures(PenicillinG ,TT/ TIG) d)Observe the animal for 10 days .If the animal shows signs & symptoms the animal should be humanly killed. 3. Immunization a)Active-HDCV or Inactivated sheep brain vaccine. b)Passive-Anti rabies human immunoglobulins. c)Active-Passive immunization.

Community medicine

Clinical medicine

it is preventive , promotive curative and rehabilitative health care it serves the individuals and families at the community level it is field oriented team work is extremely necessary field trial and surveys are very important skill is very important in controlling epidemics monitoring condition is poor surveillance is needed for control of disease treatment is done as apart of prevention

1. it is a treatment of diverse individual 2. it serves the individual at his personal level 3.it is hospital oriented 4. team works needed only in few occasion 5. only clinical trial is needed 6. Skill is necessary to tackle emergency 7. monitoring condition is rich 8. surveillance is not required 9. Preventive care depends upon the good will of the patient

Question 54 Differentiate community medicine and clinical medicine. \Write 4 public health emergencies

Question 55 Draw organogram of upazila health complex, what are the services available at upazilla health complex

Question 56 What is behavior? What are the factors for human behavior name 3 behavioral problems? Behavior Human behavior is the result of physical and mental (body and mind ) interacting in complicated ways Behavioral problems 1) Antisocial problems – stealing, lying, gambling, cruelty, sexual offences, destructiveness 2) Habit disorders - Thumb sucking, nail biting, bed wetting, masturbation 3) Personality disorders – Jealousy, temper tantrums, timidity, shyness, day dreaming, fear and anxiety, unsociability, hysterical manifestations 4) Psychosomatic complaints – Tremors, headache, asthma, depression, delusions, hallucinations 5) Educational difficulties – Backwardness in studies, school phobia, school failures etc Factors human behavior 1) Health behavior • Compliance behavior

•

Avoidance behavior

2) Illness behavior 3) Treatment behavior

Question 57 What is rational use of drugs? What is essential drug? According to WHO rational use of drugs requires that patients receive medications appropriate to their clinical need s in doses that meet their own requirements for an adequate period of time and the lowest cost to them and their community Criteria assessing rational use of drug 1. only the essential drugs should be prescribed (decide whether the drug is really necessary or not at all) 2. prescribe the effective preparation (selected drug) which provides aspect therapeutic benefit 3. prescribe it at the right time 4. quantity of drug should be enough 5. patient compliance : the patient should follow the instruction of the physician 6. prescribe easily available ones 7. prescribe a cost effective drug

Question 58 Name 5 occupational health hazards , how can you prevent them Occupational hazard s • Physical hazards • Chemical hazards • Biological hazards • Mechanical hazards • Psychological hazards Medical measures Pre placement examinations

Engineering measures Design of building

Periodical examination Medical and health care services Notification of occupational diseases Supervision of working

Good house keeping General ventilation Mechanization Substitution

Legislations Factory laws and by laws has been framed to govern the conditions in the industries and protect workers from industrial hazards Eg: factory(amendment act) Workman’s compensation act)

environment Maintenance and analysis of records Health education and counseling

Dust control Enclosure of the harmful material Isolation of the offensive process Protective devices Environmental monitoring Statistical monitoring research

Question 59 Classify vitamins? Name deficiency disorder of vitamin A Classification 1. Fat soluble vitamins • Vitamin A • Vitamin D • Vitamin E • Vitamin K 2. Water soluble vitamins a) Vitamin B complex • Thiamin (Vitamin B1) • Riboflavin (Vitamin B2) • Niacin (nicotinic acid) • Biotin • Pyridoxine (Vitamin B 6) • Pantothenic acid • Folic acid • Lipoic acid • Vitamin B 12(cobalamin) b) Ascorbic acid (vit C)

Deficiency disorder of vitamin-A 1. Ocular: Xeropthlmia,Night blindness. 2. Extra ocular • Follicular hyperkeratosis • Increased susceptibility to infections due to squamous metaplasia of respiratory,urinary & vaginal epithelium. 3. Growth failure

Question 60. Discuss the changing concepts of health Changing concepts of health. 1. Biomedical concepts 2. Ecological concepts 3. Psychological concepts 4. holistic concepts 1. Biomedical concepts – A person was considered as healthy if he was free from disease or absence of disease Concept is based on ‘germ theory of disease’ Criticism:Role of environment, social, psychological and cultural aspects were ignored 2. Ecological concepts An ecologist’s view of health is equilibrium, man and his environment and disease. • Imperfect man • Imperfect environment 3. Psycological concepts

Health is not a biomedical phenomenon but also one which is influenced by social, psychological, cultural, economical and political factors are concerned. 4. Holistic concepts According to this concept all sectors of the society have an effect on health. 1. Vehicle borne 2. Vector bone – a) mechanical 2. Biological 3. 3. Air bone - a) Droplet nuclei i. b) Dust 1. Fomite borne 4. Unclean hands and fingers

Question 61. Write down the mode of transmission of communicable disease. How can you prevent communicable disease? Communicable disease:An illness due to specific infectious agents or its toxic products, being directly or indirectly transmitted from man to man, animal to man, animal to animal or from environment to animal or man. A. Direct transmission 1. Direct contact 2. Droplet infection 3. Contact with soil 4. Inoculation into skin or mucus Transplacental (Vertical) B. Indirect transmission 1. Vehical borne 2. Vector borne. a) Mechanical b) Biological 3. Air borne a) Droplet nuclei b) Dust Prevention of communicable disease A).CONTROLLING THE RESERVOIR Early diagnosis and treatment Notification Epidemiological investigations Isolation B).INTERRUPTION OF TRANSMISSION OF DISEASE C). MEASURES TAKEN IN HAST Immunization Chemoprophylexin Non specific measures

Question 62 Describe the stages of demographic cycle The history of world population since 1650 suggest that there is a demographic cycle of 5 stages through which a nation passes 1st stage (High stationary) This stage is characterized by a high birth rate and a high death rate, which cancel each other and the population remain stationary. India till the 1920s. 2nd stage (Early expanding) The death rate begins to decline while the birth rate remain unchanged leading to an increased population growth. South Asia and Africa 3rd stage (Late expanding) Death rate decline still further and the birth rate tends to fall. Population continues to grow Bangladesh, India, China,and Srilanka. 4th stage (Low stationary) In this stage both the death rate and the birth rate fall, as a result growth of population becomes stationary UK, Denmark, Sweden 5th stage (Declining) Population begins to decline because birth rate is lower than death rate. Germany, Hungary

Question 63 Common nutrition problems of Bangladesh, Why breast feeding is better than artificial feeding. Common nutritional problems in Bangladesh. 1). Protein energy malnutrition (PEM) * Kwashiokor * Marasmus 2). Vitamin A deficiency * Night blndness * Xeropthalmia * Total Blindness 3). Nutritional Anaemia * Iron Deficiency * Folate and VitB12 Deficiency 4). Iodine deficiency disorders * Iodine deficiency Goiter 5).Khesari dhal intoxication. * Neurolathyrism Why breast feeding is better then artificial feeding B →best for baby R→ reduces allergy for body E→ eccconomical A→antibodies S→stool is inoffensive T→available at proper temp F→ fresh E→emotional bonding between mother and baby E→easy to use D→ easily digestible I→ immediately available N→nutritionally balanced G→Gasteroenteritis greatly reduced

Question 64 Classify disaster ,write effects of natural disaster Types of disaster 1. Man made - war Riot Famine Nuclear accident 2. Natural disaster - cyclone Flood Earth quake Tsunami Effects of natural disaster 1. Deaths A great number of people and animals 2. Severe injuries Bodily injuries, bone fracture, loss of organs etc.. 3. Malnutrition Scarcity of food will cause malnutrition 4. Risk of infection By water pollution and environmental pollution Water pollution →flood deterioration of sanitation by human excreta, dead bodies of animals and humans 5. Mass movement Many people need shelter in tidal wave, cyclone, etc... 6. Others 1, Destruction of houses and educational institute, roads, markets 2. Damage of stored food, clothing, and water supply 3. Economical dead lock 4. Psycological damage

Question 65 Risk of high risk mothers and babies High risk mothers 1). Elderly primi (30yrs& above) 2). Height below 140cm 3). Malpresentaions, breech, transeverse lie 4). Primigranida, Granal multipreda 5). Pre-eclampsia &. Eclampsia 6). Prolonged pregnancy (14 days-after expected date of delivery. 7). Antepartum hemorrhage, threatened abortion. 8). Anemia. 9) Previous still birth, intrauterine death, manual removal of placenta. 10) Twins , hydraminous. 11) Previous repeated abortions 12) Prolonged labor 13) Manual removal of placenta 14)Birth spacing shorter than one year. 15)Ay associated general diseases-cvs diseases, kidney diseases,DM ,tuberculosis, liver diseases High risk babies 1. Birth weight less than 2.5kg 2. Twins 3. Birth order 5 and more 4. Artificial feeding. 5. Weight below 70% of expected weight 6. Children with knee ache 7. Diarrhea 8. Working mother, Single parent

Question 66 Write the causes of clinical STD’s and how to prevent them Causes of clinical STD’s 1. Prostitution 2. Broken families 3. Divorce, separation or stranded family life 4. Easy money – prostitution 5. Emotional immaturity of teenagers 6. Low I.Q 7. Sexual disharmony 8. Urbanization 9. Industrialization 10. Low economic condition 11. Alcoholism 12. less education 13. Homosexuality 14. Use of O.C.P and of condoms 15. Greater sexual encounters Prevention and control of STD’s 1. Early accurate diagnosis by screening, contact tracing and cinster testing 2. Effective treatment and close follow up 3. Personal prophylaxis 4. Condoms, vaccine 5. Partner notification 6. Health and sex education 7. Screening – all risk patients should be screened 8. Support services 9. STD Clinic 10. Primary health care 11. Laboratory services 12. Social welfare measures

Question 67 Tabulate health care delivery system of Bangladesh, what is comprehensive health care Comprehensive health care ‘As the provision of preventive, curative, promotive and rehabilitative health services from womb to tomb to every individual residing in a defined geographic area’ Health care delivery system of Bangladesh SUPER SPECIALIZED CARE ↑ TERTIARY HEALTH CARE ↑ SECONDARY HEALTH CARE ↑ PRIMARY HEALTH CARE

Village ↓ District hospital ↓ Regional teaching hospital ↓ National special institution

Question 68 How can you investigate an epidemic? What are the public health emergencies? Principle reasons-1) To control the epidemic. 2) To prevent further epidemic. Step-1 : Confirm Dx through history clinical exam, & lab tests Step-2 : Confirm epidemic reviewing records. Step-3 : Characterize epidemic in terms of time, place & person Step-4 : Develop hypothesis in terms of agent, source,mode of transmission, environment Step-5 : Testing hypothesis using different statistical tests & procedures Step-6 : Drawing conclusions & compilation of report Step-7 : Institution of control measures a)Treatment of cases. b)Prevention-Isolation, chemoprophylaxis, vaccine, contact tracing, etc. c)Surveillance of the population at risk.

Public health emergencies Any incident which causes break down of public health by any means. 1. Epidemic out break 2. Natural disaster, cyclone, blood 3. Accidents 4. Road, transport, aircraft accident Question 69 What is primordial prevention? “Prevention of the emergencies or development of risk factors in countries or population group in which they have not appeared.” Main intervention in primordial prevention is through individual and education e.g.: obesity, hypertension They are developed by smoking, food habits , lifestyle

Question 70 Write measures of central tendency. Measures of dispersion, central tendency, for 2,3,3,4 Measures for central tendency 1. Mean 2. Median 3. Mode Mean Obtain observation are first added together and then divided by the number of observations 2,3,3,4 =12/4 = 3 Median Middle most value of the series 2,3,3,4 (3+3)/2=3 Mode Commonly occurring value in distribution of data 2,3,3,4 = 3 Measurement of dispersion Scattering of values of the variable it measures the variation of the observation 1) Range 2)Mean deviation 3)Standard deviation

Question 71 What is balanced diet, tabulate food composition of any 3 foods? Defn :A diet which contains a variety of foods ion such quantities and proportions that the need for energy aminoacids vitamins, minerals, fats, carbohydrates and other nutrients is adequately met for maintaining health, vitality and general well-being and also makes a small provision for extra nutrients to withstand short duration of leanness. Criteria of a balanced diet Easily available Satisfy taste and appetite Diet should be palatable It should be easily digestible and absorbable Vitamins and minerals should be there Certain amounts of fibers there Nutrition value Protein Fat Carbohydrate Thiamine Minerals Energy ( kCal)

Raw rice 6.8 0.5 78.2 0.06 0.6 345

Wheat 11.81 1.5 71.2 0.45 1.5 346

Maize dry 11.1 3.6 66.2 0.42 1.5 342

Question 72 Briefly describe epidemiology of diarrhea? How can you prevent diarrhea. Epidemiology of diarrhea 1. Occurrence It occurs in almost all the countries of the world, Specially in 3rd world countries. 2. Ecological triad Agent:Gastrointestinal

:- Ecoli, Rotavim, Salmonella, Campyhobacter

Cholera

:- Vibrio Cholerae

Bacillay Dysentry

:- Shigella

Amoebic Dysentry

:- Entamoeaba histolitica

Host:Age Sex

: - All ages : - Both sexes

Environment : -

More dense population Poor sanitation

Natural History Reservoir Source of infection Infection period Transmission

: - cases and carriers : - Stools, Vomit : - varies with organisms : - Vehicle transmission Person to person transmission (Orofaecal) Mechanical (House fly) Fomites (Inanimate objects)

Prevention of diarrhea 1. Verification and diagnosis 2. Notification (Locally or internationally) 3. Early case findings 4. Establishment of treatment 5. Rhydration therapy 6. Adjunct therapy 7. Epidemiological investigations 8. Sanitation measures 9. Chemoprophylaxis 10. Vaccination 11. Health education

Question 73 Give the pen picture of good school environment 1. The school should be situated in a safe place, in an area free from excessive noise and other nuisances such as smoke or soot. 2. Buildings should be well constructed so as minimizing accidents 3. The classrooms should be adequate in size, well lighted and ventilated 4. The blackboard, ceilings and walls should be glare proof 5. Sanitary facilities for disposable of waste should be provided 6. Adequate supply of safe water for drinking and washing 7. Adequate facilities for recreation such as common room, play ground How can you prevent Scabies 1. Sanitation control 2. Improvement of sanitation 3. Improvement of personal hygiene 4. Early diagnosis and treatment 5. Isolation of infected patients 6. Chemical control 7. Benzyl benzoate 25% emulsion

Question 74 How to reduce the Growth rate of Bangladesh 1. Reduce early marriage 2. Develop the standard of living 3. Increase the level of literacy 4. Increase family planning habits 5. Proper spacing between children 6. Proper education 7. Using contraceptive methods 8. Proper education about contraceptives

Question 75 Classify family planning (Contraceptive) methods, what are the criteria of an ideal contraceptive method A). Permanent methods( Terminal methods ) B). Temporary methods( Spacing methods ) A Permanent methods/Terminal methods Male sterilization : - Vasectomy Female sterilization : - Tubectomy B. Temporary methods/Spacing methods 1. Barrier methods  Physical – Condoms, vaginal diaphragm, Cervical cap  Chemical - Cream, Jelly  Combined both chemical and physical 2. Mechanical methods Intrauterine contraceptive devise (IUCD) 3. Hormonal methods Oral pills - Combined pill, mini pill, Male pill, post coital pill Depot preparations - Depot provera, S/C, Implant 4. Post concept ional methods MR – Menstrual regulation Menstrual induction Abortion 5. Traditional methods A). Behavioral - Incomplete coitus Sex without coitus Abstinance B). Natural methods - Safe period Criteria of ideal contraceptive methods 1). Effective 2). Safe and free from side effects 3). Acceptable to all 4). Inexpensive and easy to get 5). Simple to administer 6). Independent of coitus 7). Reversible 8). Require little or no medical supervision.

Question 76 What are the water borne diseases, How can you ensure safe water for flood affected areas A). Infective water borne disease Viral →Hepatitis, poliomyelitis, Rotavirus Bacterial

→Cholera, Typhoid, bacillary dysentery, Ecoli diarrhea

Protozoal

→Amoebiasis, Giardiasis

Helminth

→Round worm, whip worm, hydatid disease

B). Non infective water borne disease Arsenicosis, due to arsenics Constipation due to Pb, Zn, Fe Goiter due to low iodine Dental carries due to fluoride deficiency Safe water for flood area 1. Water by boiling 2. Water by filtering 3. Using chlorine tablets with drinking water 4. Distribution of mineral water (Bottled) 5. Tube well water is safe

Question 77 What are the methods and media of health education, Barriers of health education? Methods of health education 1. Two way method or Socratic Method Questions are asked and answers are obtained 2. One way method or Didactic method Delivery of lecture no exchange of ideas Media of health education 1. Spoken words Didactic - Lecture, projectors, chalk and black board Socratic - Seminar, Group discussion 2. Visual media Photography, slides, text books, chart, maps, graphs 3. Mass media Television, film, radio, Health magazines Barriers of health education 1. Socio-cultural barrier Religion, superstition, habits 2. Environmental Noise, congestion, invisibility 3. Physical Deaf and dumps Physical abnormalities 4. Psychological Emotional disturbances Neurosis