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Part 1 book “Review of preventive and social medicine” has contents: Annexures, history of medicine, concepts of health and disease, epidemiology and vaccines, screening of disease, communicable and non-communicable diseases, national health programmes, policies and legislations in india, demography, family planning and contraception.
Review of Preventive and Social Medicine (Including Biostatistics) (Thoroughly revised and updated edition including latest exam pattern questions) Seventh Edition Vivek Jain MBBS (Maulana Azad Medical College), Delhi MD Community Medicine (PSM) (Lady Hardinge Medical College), Delhi Ex Senior Resident UCMS & GTBH, VMMC & SJH, Delhi Ex Faculty GFIMSR, Faridabad, Haryana Ex Consultant UN Office on Drugs & Crime, South Asia The Health Sciences Publisher New Delhi | London | Philadelphia | Panama Jaypee Brothers Medical Publishers (P) Ltd Headquarters Jaypee Brothers Medical Publishers (P) Ltd 4838/24, Ansari Road, Daryaganj New Delhi 110 002, India Phone: +91-11-43574357 Fax: +91-11-43574314 Email: jaypee@jaypeebrothers.com Overseas Offices J.P Medical Ltd 83, Victoria Street, London SW1H 0HW (UK) Phone: +44-20 3170 8910 Fax: +44-(0)20 3008 6180 Email: info@jpmedpub.com Jaypee-Highlights Medical Publishers Inc City of Knowledge, Bld 237, Clayton Panama City, Panama Phone: +1 507-301-0496 Fax: +1 507-301-0499 Email: cservice@jphmedical.com Jaypee Medical Inc The Bourse 111, South Independence Mall East Suite 835, Philadelphia, PA 19106, USA Phone: +1 267-519-9789 Email: joe.rusko@jaypeebrothers.com Jaypee Brothers Medical Publishers (P) Ltd 17/1-B, Babar Road, Block-B, Shaymali Mohammadpur, Dhaka-1207 Bangladesh Mobile: +08801912003485 Email: jaypeedhaka@gmail.com Jaypee Brothers Medical Publishers (P) Ltd Bhotahity, Kathmandu, Nepal Phone: +977-9741283608 Email: Kathmandu@jaypeebrothers.com Website: www.jaypeebrothers.com Website: www.jaypeedigital.com © 2015, Jaypee Brothers Medical Publishers The views and opinions expressed in this book are solely those of the original contributor(s)/author(s) and not necessarily represent those of editor(s) of the book All rights reserved No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission in writing of the publishers All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners The publisher is not associated with any product or vendor mentioned in this book Medical knowledge and practice change constantly This book is designed to provide accurate, authoritative information about the subject matter in question However, readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contraindications It is the responsibility of the practitioner to take all appropriate safety precautions Neither the publisher nor the author(s)/editor(s) assume any liability for any injury and/or damage to persons or property arising from or related to use of material in this book This book is sold on the understanding that the publisher is not engaged in providing professional medical services If such advice or services are required, the services of a competent medical professional should be sought Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material If any have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity Inquiries for bulk sales may be solicited at: jaypee@jaypeebrothers.com Review of Preventive and Social Medicine (Including Biostatistics) Third Edition: 2011 Fourth Edition: 2012 Fifth Edition: 2013 Sixth Edition: 2014 Seventh Edition: 2015 ISBN : 978-93-5152-730-5 Printed at Preface Dear Students, Let me first thank you for your overwhelming support to the 6th edition of the book, making it the best-seller book on the subject in India It again reiterates my belief that good content by a subject-speciality author is always appreciated by students It now gives me immense pleasure to share with you the NEW (Seventh) edition of the book Key features of Sixth edition retained in Seventh edition • Theory given at start of each chapter (Theory divided chapter-, topic-, sub-topic wise – Small/one-liner points in each topic/Important previous MCQs marked as Q) • Key REVISION Points given on side of each topic for MUST-KNOW MCQs facts • New NBE based pattern has been adopted chapter-wise (Focus on wider coverage, concept development, one-liner approach, value-based MCQs, applied aspect MCQs, image based MCQs, updated golden points) In the 7th edition of the book following NEW ADDITIONS have been done to make a student stay ahead in this competitive era with changing pattern of Examinations: • Additional PICTURE MCQs with Answers (According to Recent Examinations) • Recent most solved MCQs papers – AIIMS May/November 2014, PGI May/November 2014, JIPMER PG 2014, Bihar PG 2014, APPG 2014 – ALL Recent Questions 2013, 2014 • Recent/New topics and changing concepts in PSM – New National Immunisation Schedule 2015 – New Health Programmes: RBSK, NSSK, JSSK, RKSK, PMJDY, PMSSY, NUHM – New Strategies (RMNCH+A, BeMONC, CeMONC, End-TB, AMMRS) – New Acts, Policies (NMHP 2014, FSSA 2006, POCSO 2012) – Newer/Emerging Diseases (H7N9, Ebola, MERS-CoV) – New Changes in RTI/STI Treatment 2015 (STD color kits, Suraksha clinic) – New Malaria Treatment Guidelines 2013 – New PPTCT Guidelines 2015 (Triple ARV Prophylaxis) – New Rabies Prophylaxis Guidelines 2015 (Essen, Thai Red Cross Regimen) – New Protein Quality Assessment Guidelines 2015 (DIAAS) – New AN visits, PN visits Guidelines – Changes in Epidemiology of Various Diseases – Changes in National Health Programmes (NRHM, MDMP, JSSK, HNBC, ICDS) – New Clinical Trial Guidelines (Phase 0) – New NACP Guidelines (HIV district classification, LAC, LAC PLUS, ART PLUS) – Twelfth Five Year Plan 2012–17 – New Establishments (NIDM, NDRF) • New Annexure: HLEG on UHC (Recent Examinations based) • An Updated compilation of Public Health Statistics of India • Rural Health Statistics India 2014 • Other New Inclusions/Upcoming Topics: Triangle of Epidemiology and Advanced Model of Epidemiological Triangle, Health Promotion, Matrix of Levels of Prevention, Diluents, VVM in Vaccines, NEW DRAFT PROPOSED Biomedical Waste Management Guidelines, 2011, HDI New Calculation Guidelines, DALY, QALY, YPLL, New Sterilisation Guidelines 2013, New Cardiovascular Risk Indicators (Waist Height Ratio), New Semen Analysis (WHO) Guidelines, Newer Visual Impairment Guidelines Review of Preventive and Social Medicine ‘Understanding PSM is difficult, owing to the vastness of the subject, but enjoyable, if you come across a good teacher and a useful book!’ A student While preparing for PG entrance examination, I myself realised that most of the PSM MCQs, related text and even the referenced answers given in books were invariably unable to satisfy me as a student Most of the times, there were questions from ‘topics not given in standard textbooks’ (for example, nested case control study, case series report, statistical errors, probability, odds and likelihood ratios, health legislations, water washed diseases, golden rice, COPRA, Punnett square, Dixon’s Q-test, Evidence based medicine, etc.—all together are just the tip of an iceberg of such MCQs) Every year there were ‘new unheard questions from unexplored fields’, overlapping choices of MCQs from other fields of medicine accompanied with futile search for ‘recent most data of Public Health Statistics’, etc This all made me realise that PSM is a vast and varied subject to conceptualise and memorise Elaborate books also confused me regarding the relative importance of each topic in the subject I also realised that students face maximum difficulty in understanding the concepts of ‘Biostatistics’ and in obtaining precise, concise and useful data from ‘National Health Programmes of India’ Also, PG entrance examinations have a sizeable chunk of direct MCQs from PSM subject (Just subject out of 19 total subjects), ranging from 10 to 14% of total (20–25% in CMS-UPSC) Moreover, PSM helps in solving several allied questions (partly or totally) of Paediatrics, Obstetrics, Pharmacology, Medicine, Microbiology, Ophthalmology, etc So, there is no denying the fact that ‘PSM is of paramount importance’ to successfully tackle any PG Entrance Examination Thus, I have written this book keeping a student’s, a teacher’s and an examiner’s perspective in mind Each chapter has been divided into topics and sub-topics, Theory and MCQs have been arranged section-wise for more comprehensive understanding of topics In Theory, Important previous years MCQs have been highlighted (asQ) and MUSTKNOW facts have been given separately Book includes PG Entrance Examination MCQs of AIIMS (1991–2014) and AIPGME (1991–2012 + ‘Recent MCQs’) with referenced, authenticated, full explanatory answers Solved explanatory MCQs from DPG, PGI, JIPMER PG Entrance Examinations (2000–2011) have been added to help students grasp subject better Over 2500 solved MCQs from UPSC CMS and Several State Medical PG Entrance Examinations (Rajasthan, MP, Andhra Pradesh, Tamil Nadu, Maharashtra, Bihar, DNB, JIPMER, Kolkata, Karnataka PGMEE) have been added for wider coverage Recent most changes in National Health Programmes with updates in Communicable and Noncommunicable diseases provided for competitive edge Many answers have been followed by a section on ‘Also Remember’—A compilation of various important noteworthy points based on previous questions from several fields Golden Points (Five sets) have been included for a quick revision just before the examination Several Annexures (Incubation period and modes of transmission of diseases, important days of public health, instruments of importance in public health, important health legislations and programmes in India, Vectors, NHP 2002 and NPP 2000, proposed BMW guidelines and public health related statistics of India) have been included towards the end of the book to give the student an edge over others Please remember there is no substitute to theory books, but hopefully you will find all relevant theory in this user-friendly book Despite every possible effort been undertaken to ensure no technical or typographical errors in the book, such are bound to be present in any book If you come across another such error or if you have any comment, suggestions, queries or views, you are most welcome to e-mail to me for a prompt response All contributions will be duly acknowledged Do share your experiences while reading this book and the subject Hope you have a successful career ahead Wish you Success, not just in PSM but in Life! Dr Vivek Jain MBBS MD (Community Medicine) Email: docvivekjain@gmail.com docvivekjain2@gmail.com Visit website: www.docvivekjain.hpage.com Join me on Facebook: type ‘Dr Vivek Jain’ in search box For updates: Like ‘Dr Vivek Jain’ page on Facebook New Delhi 2015–16 iv Acknowledgements I am sincerely thankful to Late Mr RD Jain, my maternal grandfather and my wife Dr Rashmi Naudiyal for being a constant source of inspiration for completion of this book Without support of Dr Rashmi and Baby Mischka, this book would not have seen light of the day Without the blessing of my Parents, Parents-in-law and God, this endeavour would not have been successful Firstly I thank Padmashree Dr Jagdish Prasad, DGHS for organising a grand launch of first edition of the book at New Delhi I am grateful to Dr Saudan Singh, former DG (Medical Education), Government of Uttar Pradesh, Director Professor and Head, Department of Community Medicine, Vardhman Mahavir Medical College (VMMC), New Delhi for being a source of support, guidance and motivation for myself I am thankful to Dr SK Pradhan, former Director Professor, Department of Community Medicine, VMMC, New Delhi for providing me with academic opportunities to help me understand the finer nuances of the subject throughout my PGship and SRship I also appreciate the support and encouragement by Dr DK Raut, former Director Professor, VMMC & SJH, Dr AT Kannan, Director Professor and Head, Department of Community Medicine, UCMS, Dr GK Ingle, Director Professor and Head, Department of Community Medicine, MAMC, Dr Vibha, former Professor and Head, Department of Community Medicine, LHMC and respected Faculty of Department of Community Medicine of these colleges respectively Dr Rajesh Kumar, Faculty, MAMC has always inspired me to excel academically I am sincerely thankful to Dr P Sai Kumar, MPH (UK), for motivating me to write this book, and for his unparallel support as my mentor I am ever thankful to Dr Surabhi, Dr Shagun, Dr Isha and Dr Nidhi, former undergraduates and other students of LHMC and VMMC, for helping me develop my teaching capabilities Mr Rajesh Sharma, Director, PG-DIAMS and Dr Deepak Marwah, MD (Medicine) have been quite instrumental in helping me realise my potential as an academician, and I am immensely pleased to share this book with them and thank them for their wholehearted support Words of thanks to Dr Sethi and Dr Bhatia for helping me gain entry into the competitive world of academics I am highly grateful to Shri Jitendar P Vij, Group Chairman, M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India for his wholehearted support in publication of this book I thank Ms Chetna Malhotra Vohra (Associate Director), Ms Saima Rashid (Project Manager) and their Team at Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India for work on the current edition Acknowledgement is also due to Mr Anurag, M/s Medical Book Store, MAMC and LHMC for his suggestions I also take this opportunity to thank the following students/doctors for sharing their invaluable constructive criticisms for the improvement of the book: • Dr Aarav Kumar • Dr Abhishek Prasad Dash, Bhubaneshwar, Odisha • Dr Afeefa Hanif, MES Medical College, Kerala • Dr Ajeet Singh, Patna Medical College • Dr Akanksha Jain, MVPs Dr Vasantrao Pawar Medical College • Dr Amit Kumar Gupta, DNB Family Medicine, Maharaja Agrasen Hospital, Delhi • Dr Amit Kumar Yadav, PTJNM Medical College, Raipur • Dr Amit Polara, Civil Hospital, Surat • Dr Ananta Narayan Panda • Dr Animesh Agrawal • Dr Ankit Madan • Dr Ankit Thukral, SGRRIHMS, Dehradun • Dr Anubhav Srivastava, SNMC, Agra • Dr Ankush Koul, Darbhanga Medical College, Bihar • Dr Anupriya Thadani, Era’s Medical College and Hospital, Lucknow • Dr Arpan Ray, Birbhum, West Bengal • Dr Ashutosh Sahu • Dr Ashwini Gupta, Darbhanga Medical College and Hospital Review of Preventive and Social Medicine • Dr Avi Singh • Dr Bharat Vantekunta, Kaktiya Medical College, Warangal • Dr Deepa Grover, GMC, Miraj, Maharashtra • Dr Eftekhar Mohd • Dr Gopal Singh Bhati, SMS Jaipur • Dr Indraneel Sharma, Guwahati • Dr Jeyakumar Meyyappan • Dr Jujhar Singh Mann, Rajshahi University, Bangladesh • Dr Kumar Rohit, SKMCH, Muzaffarpur • Dr Kunal Tatte • Dr Lucky Singh, Kanpur • Dr Mahanthesh Gidaveer • Dr Mahendra, SIMS, Karnataka • Dr Mahender Kumar • Dr Manish Sahu, JNMC, Raipur • Dr Manosij Maity • Dr Mareddy Mahesh, Dali University • Dr (Md) Matin Khan, MGM Medical College, Jamshedpur • Dr Narendra HR • Dr Neel Choksi, BJ Medical College, Ahmedabad • Dr Nilesh Sonawane, Civil hospital, Sangli • Dr Nissy Motupalli • Dr Om Shrivastava, CIMS, Bilaspur • Dr Opalina Roy, Burdwan Medical College • Dr Piyush Gadegone • Dr Preeti Chopra • Dr Prerna Upadhyay • Dr Rachit Kapoor, Regional Advisor The Lancet Student • Dr Rajesh Kumar, Faculty, Department of Community Medicine, MAMC, New Delhi • Dr Ravi Kumar Gupta, RUHS and RNT Medical College, Udaipur • Dr Sagar Gandhi, NKP Institute of Medical Sciences • Dr Saikat Mitra, Kolkata • Dr Sakil Ahmed • Dr Samcy Arora • Dr Sanket Agrawal • Dr Saraswata Mitra, Grodno State Medical University, Belarus • Dr Sarweshwar Sripada • Dr Sharaff Dileep, Dalian University, China • Dr Shashank Saurabh • Dr Sherinsha Sharafudeen • Dr Siva Vicky • Dr Surendra Chaudhary, China Medical University • Dr Tapaprakash Behera, VSS Medical College, Burla • Dr Vishnu M Satheesan, Thiruvananthapuram, Kerala • Dr Vismay Deshani, Smolensk State Medical Academy, Russia • Dr Vitrag N Shah, New Civil Hospital, Surat A special vote of thanks to Dr Praveen K, Calicut Medical College, who took out his valuable time to mark out spelling errors in such a voluminous book Last but definitely not the least, no words can describe the role of all medical students, with whom I ever have had interacted, in helping me give this book, its final shape From the Publisher’s Desk We request all the readers to provide us their valuable suggestions/errors (if any) at: jaypeemcqproduction@gmail.com so as to help us in further improvement of this book in the subsequent edition vi Contents SECTION : ANNEXURES Annexure Annexure Annexure Annexure Annexure Annexure Annexure Annexure Annexure Annexure Annexure Annexure Annexure Annexure Annexure Annexure Annexure Annexure 1: 2: 3: 4: 5: 6: 7: 8: 9: 10: 11: 12: 13: 14: 15: 16: 17: 18: Incubation Period of Diseases Important Days of Public Health Importance Instruments of Importance in Public Health Mode(s) of Transmission of Diseases Some Important Health Legislations Passed in India Some Important Health Programmes of India Vectors and Diseases Transmitted New Tuberculosis Diagnosis (RNTCP) Guidelines in India (w.e.f 01 April, 2009 onwards) National Population Policy (NPP) 2000 National Health Policy (NHP) 2002 Millennium Development Goals (MDGs) New Malaria Treatment Guidelines in India (2013 onwards) Draft Guidelines: Biomedical Waste Management Guidelines 2011 Golden Points (Sets 1–5) Current Public Health Related Statistics of India Newer Concepts in Preventive and Social Medicine Honors in Health and Medicine High Level Expert Group (HLEG) Report on Universal Health Coverage (UHC) 10 11 12 13 14 15 17 18 31 34 40 41 SECTION : TOPIC-WISE THEORY MCQs AND EXPLANATIONS Chapter 1: History of Medicine Theory Multiple Choice Questions Explanations 45 45 50 53 Chapter 2: Concepts of Health and Disease Theory Multiple Choice Questions Explanations 57 57 66 77 Chapter 3: Epidemiology and Vaccines Theory Multiple Choice Questions Explanations 91 91 125 156 Chapter 4: Screening of Disease Theory Multiple Choice Questions Explanations 217 217 223 230 Chapter 5: Communicable and Non-communicable Diseases Theory Multiple Choice Questions Explanations 245 245 306 344 Review of Preventive and Social Medicine Chapter 6: National Health Programmes, Policies and Legislations in India Theory Multiple Choice Questions Explanations 405 405 443 460 Chapter 7: Demography, Family Planning and Contraception Theory Multiple Choice Questions Explanations 493 493 519 533 Chapter 8: Preventive Obstetrics, Paediatrics and Geriatrics Theory Multiple Choice Questions Explanations 558 558 575 587 Chapter 9: Nutrition and Health Theory Multiple Choice Questions Explanations 608 608 626 643 Chapter 10: Social Sciences and Health Theory Multiple Choice Questions Explanations 668 668 676 681 Chapter 11: Environment and Health Theory Multiple Choice Questions Explanations 693 693 712 729 Chapter 12: Biomedical Waste Management, Disaster Management, Occupational Health, Genetics and Health, Mental Health Theory Multiple Choice Questions Explanations 755 755 769 780 Chapter 13: Health Education and Communication Theory Multiple Choice Questions Explanations 798 798 804 807 Chapter 14: Health Care in India, Health Planning and Management Theory Multiple Choice Questions Explanations 813 813 822 831 Chapter 15: International Health Theory Multiple Choice Questions Explanations 842 842 846 849 Chapter 16: Biostatistics Theory Multiple Choice Questions Explanations 855 855 874 890 SECTION : IMAGE BASED QUESTIONS Image Based Questions viii 939 SECTION 10 11 12 13 14 15 16 17 18 Annexures Incubation Period of Diseases Important Days of Public Health Importance Instruments of Importance in Public Health Mode(s) of Transmission of Diseases Some Important Health Legislations Passed in India Some Important Health Programmes of India Vectors and Diseases Transmitted New Tuberculosis Diagnosis (RNTCP) Guidelines in India (w.e.f 01 April, 2009 onwards) National Population Policy (NPP) 2000 National Health Policy (NHP) 2002 Millennium Development Goals (MDGs) New Malaria Treatment Guidelines in India (2013 onwards) Draft Guidelines: Biomedical Waste Management Guidelines 2011 Golden Points (Sets 1–5) Current Public Health Related Statistics of India* Newer Concepts in Preventive and Social Medicine Honors in Health and Medicine High Level Expert Group (HLEG) Report on Universal Health Coverage (UHC) National Health Programmes, Policies and Legislations in India • Follow-up smears examination timings: Category If SS –ve at end of IPQ If SS +ve at end of IPQ Category I 2m, 4m, 6m 2m, 3m*, 5m, 7m Category II 3m, 5m, 8m 3m, 4m*, 6m, 9m Category IV IP: Once/month CP: Once/3 months - (*Irrespective of SS examination results, patients is started with CP treatment) Some Important Working Definitions in RNTCP I FailureQ: A person on treatment who is SS +ve at or after months of treatment Drug Resistance in TB • Primary (Initial) Resistance: When a person contract infection from a person with resistant bacilli of TB • Secondary (Acquired) Resistance: Resistance developing during the course of treatment for TB • Multidrug Resistant TB (MDR–TB)Q: Resistance to Isoniazid and Rifampicin ‘with or without resistance to other drugs’ –– Treatment of MDR-TBQ: - DOTS PLUS (Category IV) - Must be done on basis of sensitivity testing –– Directly observed therapy certainly helps to improve outcomes and is considered an integral part of MDR-TB treatment –– When sensitivities are known and the isolate is confirmed as resistant to both INH and RMP, five drugs should chosen in the following orderQ (based on known sensitivities): - Aminoglycoside (e.g., amikacin, kanamycin) or polypeptide antibiotic (e.g., capreomycin) - pyrazimamide - ethambutol - fluoroquinolones: moxifloxacin preferred - rifabutin - cycloserine - thioamide: prothionamide or ethionamide - PAS - macrolide: e.g clarithromycin - linezolid - high-dose INH (if low-level resistance) - interferon-alpha - thioridazine • Extensive Drug Resistant TB (XDR–TB)Q: Resistance to rifampicin and isoniazid AND to any member of the quinolone family AND to one of the injectable second-line drugs (kanamycin, capreomycin, or amikacin) –– XDR–TB is MDR TB with further resistance to – classes of second line drugs (Older definitionQ) I Treatment of MDR-TBQ: • DOTS PLUS (Category IV) National Health Programmes, Policies and Legislations in India • New CaseQ: A person suffering from TB who has ‘never taken treatment or took treatment for 10 mm: Positive –– Reactions 6-9 mm: Doubtful –– Reactions 10 mm within a 2-year period, regardless of age • False Mantoux Reactions: False negative MantouxQ Faulty technique of injection Using degraded tuberculin Too deep injection Infection of other mycobacterium Repeated tuberculin testing Prior BCG vaccineQ Pre-allergic phase High fever Measles and chicken pox Whooping cough Malnutrition HIV/AIDSQ Use of anti-allergic drugs Use of immuno-suppressants Antitubercular Drugs Bactericidal drugsQ Bacteriostatic drugsQ Isoniazid Rifampicin Streptomycin Pyrizinamide Ethambutol Ciprofloxacin Ofloxacin Kanamycin Thiaacetazone Cycloserine PAS Ethionamide • • 410 False positive MantouxQ Isoniazid: –– First effective bactericidal drug used to treat tuberculosis –– May be bacteriostatic at lower concentrations –– Acts on extracellular as well as intracellular organisms Rifampicin: –– Only bactericidal drug effective against ‘persisters’ or dormant bacilli in solid caseous lesionsQ –– Acts on extracellular as well as intracellular organismsQ –– Acts best on slowly or intermittently dividing (spurters)Q National Health Programmes, Policies and Legislations in India • Pyrazinamide: –– Acts on intracellular bacilli –– Acts on bacilli at sites of inflammatory response Dosages of Antitubercular Drugs Drugs Daily therapyQ Thrice weekly therapyQ Isoniazid mg/kg 10 – 15 mg/kg Rifampicin 10 mg/kg 10 mg/kg Pyrizinamide 25 mg/kg 35 mg/kg Streptomycin 15 mg/kg 15 mg/kg Ethambutol 15 mg/kg 30 mg/kg • • • • • • • • • • • • • • Most effective anti-tubercular drug: RifampicinQ Most bactericidal antitubercular drug: RifampicinQ Most toxic antitubercular drug: Isoniazid Antitubercular drug causing rapid sputum conversion: Isoniozid Antitubercular drug causing orange discoloration of urine: RifampicinQ Antitubercular drug first to develop resistance: IsoniazidQ Antitubercular drug contraindicated AIDS patients on Protease Inhibitors: RifampicinQ Antitubercular drug contraindicated in HIV: ThiacetazoneQ (Exfoliative dermatitis) Antitubercular drugs contained in all phases of all categories of DOTS: Rifampicin and IsoniazidQ Injectable Antitubercular drug: StreptomycinQ Antitubercular drug contraindicated in pregnancy: StreptomycinQ Antitubercular drug contraindicated in children < years age: EthambutolQ Antitubercular drug causing Optic neuritis (Red-Green color blindness): EthambutolQ Antitubercular drug causing vestibular damage: StreptomycinQ NATIONAL POLIO ELIMINATION PROGRAMME (NPEP) Pulse Polio Immunization (PPI) Programme in India • Launched in India: 1995–96Q (1st round on 9th Dec 1995 and 20th Jan 1996) –– First PPI targeted children < years age –– Later on WHO recommended age group be 0-5 years (1996-97) • Meaning of ‘Pulse’Q: Sudden, simultaneous mass administration of Oral Polio Vaccine (OPV) on a single day to ‘all children 0–5 years age’, irrespective of their previous immunization status –– PPI replaces wild virus with vaccine virus from the community –– PPI is over and above routine immunization • Intensive Pulse Polio Immunization (IPPI)Q: Intensification of PPI has been done by adding additional rounds at fixed booths followed by ‘house-to-house search-andvaccinate’ component • Success of PPI (India): 35000 cases annually in 1995-96 to NIL case in 2013 I Antitubercular drug causing Optic neuritis (RedGreen color blindness): Ethambutol National Health Programmes, Policies and Legislations in India Important Facts of Antitubercular Drugs Basic Strategies to Eradicate Poliomyelitis from IndiaQ • • • • Routine immunization PPI/National Immunization Day (NID)/ Sub-NID (SNID) Surveillance of acute flaccid paralysis (AFP) Conduct extensive house-to-house immunization mopping-up campaigns 411 Review of Preventive and Social Medicine Vaccine Vial Monitor (VVM) • Description: A simple tool (sticker on OPV vial) which enables vaccinator to know ‘whether vaccine is potent’ at the time of administrationQ • Mandatory since 1998 for quality assurance • WHO Grading of VVM (OPV): National Health Programmes, Policies and Legislations in India Figure: VVM (Vaccine Vial Monitor) Acute Flaccid Paralysis (AFP) Case InvestigationQ I 412 Transport to laboratory in ‘Reverse cold chain’Q (+2° to +8°C) • Acute Flaccid Paralysis (AFP): Acute onset (< weeks) in a child aged 80%) • Other Indicators: –– Timeliness of weekly ‘zero reporting’ (Target > 80%) –– Reported cases investigated < 48 hours of report (Target > 80%) –– Completeness of weekly ‘zero reporting’ (Target > 90%Q) –– Reported AFP cases with a follow-up exam at least 60 days after paralysis onset to verify the presence of residual paralysis or weakness (Target > 80%): AFP cases that should undergo 60-day follow-up include - cases with inadequate or no stool specimens - cases with isolation of vaccine virus from the stool - cases with isolation of wild poliovirus from the stool - any case that the investigator thought was strongly suggestive of poliomyelitis on initial examination (‘hot case’) –– Specimens arriving at the national lab < days of being sent (Target > 80%) –– Specimens arriving at the laboratory in ‘good condition’Q (Target > 80%) - there are frozen ice packs or ice, or a temperature indicator (showing < 8° C) in the container - the specimen volume is adequate (> grams) - there is no evidence of leakage or desiccation - appropriate documentation (laboratory request/reporting form) is completed –– Specimens with a ‘turn-around time’ < 28 days (Target > 80%): The turn-around time is the time between specimen receipt and reporting of results –– Stool specimens from which a non-polio enterovirus is isolated (Target > 10%): An indicator of the quality of the ‘reverse cold chain’ (i.e that the specimen has been continuously maintained at temperatures 60%’Q: Thus goal under the earlier National Population Policy was CPR 60% by 2000 • Effective Couple Protection Rate (ECPR): Is defined as the percent of eligible couples ‘effectively’ protected against childbirth by one of the approved methods of family planning, i.e condoms, oral pills, IUDs or sterilization IFA Tablets & Iron Deficiency Anaemia • Iron and Folic Acid content per IFA tablet: –– Adult tablet: 100 mg elemental iron and 500 mcg folic acidQ –– Pediatric tablet: 20 mg elemental iron and 100 mcg folic acidQ –– For preterm infants, recommended Iron and Folic Acid content per IFA tablet: 10 – 15 mg elemental iron and 100 mcg folic acid • ‘National Nutritional Anemia Prophylaxis Programme’ was launched in 1970 to prevent nutritional anaemia in mothers and children –– This programme is being taken up by Maternal and Child Health (MCH) Division of Ministry of Health and Family Welfare; now it is part of RCH programme • Prevalence of Iron Deficiency Anemia (IDA) in India: [NFHS – 3, 2005 – 06] I Adult tablet: 100 mg elemental iron and 500 mcg folic acidQ 415 National Health Programmes, Policies and Legislations in India Review of Preventive and Social Medicine 416 Group Anemia cut off level Anemia type Prevalence Children (6 – 59 months) < 11.0 gm/dl 10.0 – 10.9 gm/dl 7.0 – 9.9 gm/dl < 7.0 gm/dl Any Mild Moderate Severe 70% 27% 40% 03% Women (15 – 49 years) < 12.0 gm/dlQ 10.0 – 11.9 gm/dl 7.0 – 9.9 gm/dl < 7.0 gm/dl Any Mild Moderate Severe 55% 38% 15% 02% Men (15 – 49 years) < 13.0 gm/dlQ 12.0 – 12.9 gm/dl 9.0 – 11.9 gm/dl < 9.0 gm/dl Any Mild Moderate Severe 24% 13% 10% 01% Q Integrated Management of Neonatal and Childness Illness (IMNCI) I Curative component includes: • Diarrhoea • Measles • Pneumonia • Malaria • Severe malnutrition and nutritional counseling I Colour Coding: • Pink: Pre-referral treatment + Refer urgently to hospital • YELLOW: Specific treatment at PHC • GREEN: Home based management • IMNCI is a ‘strategy for reducing morbidity and mortality associated with major causes of childhood illness’ • Curative component includes management of Q: –– Diarrhoea –– Measles –– Pneumonia –– Malaria –– Severe malnutrition and nutritional counseling • Health promotive and preventive component: –– Breast feeding –– Nutritional counseling –– Vitamin A and iron supplementation –– Immunization –– Treatment of helminthic infestation • Target: Children < years ageQ –– Children < months age –– Children aged months – years • Components of IMNCI strategy: –– Improving case management skills of health care staff –– Improving overall health systems –– Improving family and community health practices • Case management processQ: Is presented in a series of charts (Mnemonic: A Case Is Treated & Care Given) –– Assess the young infant or child –– Classify the illness –– Identify the treatment –– Treat the infant or child –– Counsel the mother –– Give follow-up care • IMNCI is the Indian adaptation of IMCI (Integrated Management of Childhood Illness); major highlights of Indian adaptation areQ, –– Inclusion of early neonatal age (0 – days age) in programme –– Incorporating national guidelines on malaria, anemia, Vitamin-A supplementation and immunization schedule –– Training of health workers begin with sick young infants up to months –– Proportion of training time devoted to sick young infant and sick child is almost equal –– Is skill based National Health Programmes, Policies and Legislations in India Quality Indicators to Monitor and Evaluate RCH ProgramQ No of RTI/STI cases detected, treated, referred No of ANC cases registered – Total and less than 12 weeks No of pregnant females with antenatal checkups No of high risk pregnant females referred No of pregnant females who had received doses of TT No of pregnant females under anaemia prophylaxis and treatment No of ANC cases with complication referred to PHC/ FRU No of deliveries by trained and untrained birth attendant No of women given Post natal checkups No of newborns with birth weight recorded No of children fully immunised No of adverse effects following immunization (AEFI) No of cases of ARI and diarrhoea under years treated, referred, deaths No of cases motivated, followed up for contraception NATIONAL PROGRAM FOR CONTROL OF BLINDNESS (NPCB) Blindness in India • India is single largest contributor to global blind pool –– Measured according to: NPCB criterion (50 years: 8.5% –– Prevalence of one-eyed blindness: 0.8% (MCC: Cataract – 73%) • India is ‘overestimating the no of blinds as per WHO definitionQ’ –– If WHO cutoff (