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Summary of Answers

LONG ESSAYS (10 marks each)

SHORT ESSAYS (5 marks each)

SHORT ANSWERS (3 marks each)

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Summary of All Answers

LONG ESSAYS (10 marks each)

SHORT ESSAYS (5 marks each)

SHORT ANSWERS (3 marks each)

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Summary of All Answers

LONG ESSAYS (10 marks each)

SHORT ESSAYS (5 marks each)

SHORT ANSWERS (3 marks each)

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Your Answers Are Already Written Above - Here's a Guide:

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Paper 1 (IMG_0782) - First paper in this conversation

• Long Essays: Road Traffic Accidents, Infant Mortality
• Short Essays: Planning Cycle, Cancer Registries, NBCP, Poor Lifestyle Effects, ASHA Worker, BFHI
• Short Answers: Cost-Effective Analysis, Zinc in Diarrhoea, PCPNDT Act, Disaster Mitigation, DASH, Indian Red Cross, Incineration, Counterfeit Medicines, ICTC, BMI

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Paper 2 (IMG_0783 + IMG_0784) - Second paper in this conversation

• Long Essays: Dog Bite/Rabies Management, MCH Mortality Indicators + Maternal Mortality
• Short Essays: Demography/Demographic Cycle, Primary Health Care, Doctor-Patient Communication, Objective/Goal + Network Analysis, WHO BP Guidelines + Non-pharmacological HTN, Nikshay + End TB Strategy
• Short Answers: Malaria Vector Control, Plague Prevention, Cancer Danger Signals, Lepra Reaction, Breastfeeding Advantages, Levels of Health Care, Neonatal Tetanus Prevention, DOTS, Recent MCH Trends, Ideal IUD Candidate

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Paper 3 (IMG_0786) - Third paper in this conversation

• Long Essays: STI Syndromic Approach (vaginal discharge case), ICDS + Road to Health Chart
• Short Essays: Contraceptive Methods + Barrier Methods, ASHA + ANM Roles, Doctor-Patient Communication, Planning + Planning Cycle, ANC Examination + Subcentre Investigations, Prevention of Rabies
• Short Answers: HIV Key Populations + Transmission, Nosocomial Infection, Self-care in Diabetes, BCG Vaccination, Exclusive Breastfeeding + BFHI, Basic Resources for Health Care, Soil-Transmitted Helminths, Japanese Encephalitis, RBSK, Sex Ratio

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PAPER 1 (IMG_0782) - COMPLETE ANSWERS

K. Park's Textbook of Preventive and Social Medicine

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LONG ESSAYS (2 x 10 = 20 Marks)

Q1. Causes of Road Traffic Accidents + Educational Content for School Children (10 marks)

• Speeding and rash driving
• Driving under influence of alcohol/drugs
• Fatigue and drowsiness
• Inexperience and lack of skill
• Visual defects (poor night vision, colour blindness)
• Use of mobile phones while driving
• Non-use of seatbelts and helmets
• Emotional disturbances and stress

• Jaywalking / crossing at wrong places
• Walking on the wrong side of the road
• Children running onto road unexpectedly
• Inattention to traffic

• Overloading of vehicles

• Defective brakes, lights, tyres, steering
• Poor vehicle maintenance
• Absence of safety devices (airbags, seatbelts)
• Overloading beyond capacity

• Poor road design (sharp curves, narrow roads)
• Absence of road signs, signals, markings
• Poor night-time lighting
• Adverse weather (rain, fog, mist)
• Encroachments on roads
• Stray animals on roads

• Rapid motorization without adequate infrastructure
• Inadequate enforcement of traffic laws
• Inadequate emergency medical services

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• Always walk on the LEFT side of the road / footpath
• Cross ONLY at zebra crossings or pedestrian signals
• Look LEFT, then RIGHT, then LEFT again before crossing
• Never run onto the road suddenly
• Make eye contact with driver before crossing

• Red = Stop; Yellow = Ready; Green = Go
• Always obey traffic lights and police signals

• Always wear a helmet on a bicycle/two-wheeler
• Wear seatbelt in a car at ALL times

• Never play on the road
• Do not use mobile phones/earphones while walking on road
• Wear bright/reflective clothing at night
• Never hang on the back of moving vehicles

• Do not travel in overloaded vehicles
• Never ride in back of open trucks
• Do not distract the driver

• Call 108 (ambulance) immediately after accident
• Do not move an injured person unless absolutely necessary
• Inform nearest police station

• Encourage classmates to follow road safety rules
• Report unsafe road conditions to teachers and parents

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Q2. Causes of Infant Mortality + Preventive and Social Measures to Reduce IMR in India (10 marks)

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1. Low birth weight and prematurity
2. Birth injury and difficult labour
3. Sepsis
4. Congenital anomalies
5. Haemolytic disease of newborn
6. Conditions of placenta and cord
7. Diarrhoeal diseases
8. Acute respiratory infections
9. Neonatal tetanus

1. Diarrhoeal diseases
2. Acute respiratory infections
3. Other communicable diseases
4. Malnutrition
5. Congenital anomalies
6. Accidents

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• (a) Birth weight - LBW <2.5 kg is major risk
• (b) Age of mother - extremes of age (very young/old)
• (c) Birth order and birth interval - high parity, short intervals
• (d) Sex of child
• (e) Quality of mothering

• (f) Maternal education - illiteracy greatest barrier
• (g) Quality of health care - inadequate prenatal care
• (h) Broken families
• (i) Illegitimacy
• (j) Brutal customs - denying colostrum, cowdung on cord, early weaning
• (k) Indigenous (untrained) dai
• (l) Bad environmental sanitation

• Poverty leads to malnutrition, poor healthcare, overcrowding

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1. Prenatal Nutrition: Food supplementation (ICDS); additional 500 kcal + 10g protein in last trimester
2. Prevention of Infection: Universal Immunization Programme - 9 vaccine-preventable diseases; Mission Indradhanush
3. Breast-feeding: Exclusive breastfeeding for 6 months; BFHI
4. Growth Monitoring: Monthly weighing; Road to Health chart; early identification of malnourished children
5. Family Planning: Spacing births 2-3 years; limiting family size
6. Sanitation: Safe water supply, improved housing, drainage, fly control
7. Primary Health Care: ASHA at village level; ORS+zinc for diarrhoea; cotrimoxazole for ARI
8. Maternal Health Care: 4+ ANC visits; institutional deliveries; training of dais; JSSK
9. Social Measures: Female literacy (Kerala model); poverty alleviation; prevent child marriage
10. National Programmes: IMNCI, NSSK, HBNC, India Newborn Action Plan (INAP), NRCs for SAM

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SHORT ESSAYS (6 x 5 = 30 Marks)

Q3. Planning Cycle (5 marks)

• Collection/interpretation of data: population structure, morbidity/mortality, disease epidemiology, health facilities, manpower, community attitudes

• Objectives = SMART (Specific, Measurable, Achievable, Relevant, Time-bound)
• Short-term and long-term; general at upper levels, specific at lower levels

• Manpower, money, materials, skills, knowledge, techniques
• Balance between what is required and what is available

• Based on: mortality/morbidity data, cost of prevention, financial constraints, political/community interests

• Detailed plan for each programme; resources (inputs) matched to expected results (outputs)
• Each stage costed and time-specified; built-in evaluation mechanism

• Roles and tasks defined; selection, training, motivation, supervision of manpower

• Day-to-day follow-up during implementation; continuous observing, recording, reporting

• Systematic assessment of relevance, adequacy, progress, efficiency, effectiveness, impact
• Feeds back into the next planning cycle

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Q4. Types of Cancer Registries (5 marks)

• Records all cancer patients (inpatients + outpatients) treated at a specific institution
• Collects uniform minimum data set per WHO Handbook for Standardized Cancer Registers
• Useful for: evaluating treatment outcomes, quality of cancer care, survival analysis
• Limitation: Hospital population = selected/biased; limited epidemiological use

• Records ALL cancer cases occurring in a defined geographic area
• Optimal base population: 2-7 million
• Provides cancer incidence rates
• Uses: epidemiological enquiries, time trend surveillance, planning and evaluation of cancer control
• Examples in India (NCRP - ICMR, since 1981): Bangalore, Chennai, Mumbai, Delhi, Bhopal

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Q5. National Blindness Control Programme (NPCB) (5 marks)

1. Continue 3 signature activities: 66 lakh cataract operations/year; school eye screening + 9 lakh free spectacles/year; 50,000 donated eyes/year
2. Reduce backlog of avoidable blindness
3. Develop strategy for "Eye Health for All"
4. Strengthen Regional Institutes of Ophthalmology (RIOs)
5. Develop human resources for comprehensive eye care in all districts
6. Enhance community awareness on eye care
7. Expand research for prevention of blindness
8. Secure participation of voluntary organizations and private practitioners

1. Free cataract surgery through health system + NGO + private sector
2. Comprehensive eye care (diabetic retinopathy, glaucoma, corneal transplant, paediatric blindness)
3. Active screening of population >50 years
4. Screening children for refractive errors; free spectacles to BPL children
5. Public-private partnership for underserved areas
6. Capacity building of health personnel
7. IEC activities for community awareness
8. Eye donation fortnight: 25th August to 8th September every year

• Tertiary: Regional Institutes of Ophthalmology + Centres of Excellence
• Secondary: District Hospitals + NGO Eye Hospitals
• Primary: Sub-district hospitals/CHCs, Mobile Ophthalmic Units, Upgraded PHCs

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Q6. Adverse Effects of Poor Lifestyle on Health - Salient Points for School Children (5 marks)

• Excessive junk food, fast food, processed food
• High salt, sugar, saturated fat → obesity, hypertension, diabetes type 2, dyslipidaemia, dental caries
• Skipping breakfast → poor concentration and academic performance
• Adequate fruits, vegetables, whole grains, water are essential

• Prolonged screen time (TV, mobile, computer) = sedentary behaviour
• Lack of exercise → obesity, CVD, musculoskeletal problems, mental health issues
• Recommended: minimum 60 minutes of moderate-to-vigorous activity per day for children

• Experimentation begins in school age
• Causes: lung cancer, oral cancer, COPD, cardiovascular disease
• Second-hand smoke also harmful
• All forms - cigarettes, beedis, gutka, khaini - are dangerous

• Alcohol damages liver, brain, social functioning
• Gateway to harder drugs
• Impairs judgement → accidents

• Children need 8-10 hours of sleep
• Late-night screen use disturbs sleep; impairs growth, learning, immunity

• Academic pressure, social media → anxiety, depression
• Coping: exercise, talking to trusted adults, hobbies, yoga

• BMI >25 (overweight), >30 (obese)
• Linked to diabetes type 2, hypertension, joint problems, poor self-esteem
• Small changes: replace cold drinks with water, use stairs

• Unprotected sex → STIs, unwanted pregnancies
• Age-appropriate education on safe practices

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Q7. Job Responsibilities of ASHA Worker (5 marks)

• Promoter of good health practices
• Awareness on RCH services, sexuality, gender equality, age at marriage

• Early registration of pregnancies
• Motivate for minimum 4 ANC visits
• Motivate institutional delivery under JSY (escort woman + receive incentive)
• Nutritional care during pregnancy; IFA tablets distribution
• Postnatal care - identify complications

• HBNC: 6 postnatal home visits (days 1,3,7,14,21,28) - assess newborn, promote exclusive breastfeeding
• Ensure complete immunization of children
• Distribute ORS and Zinc for diarrhoea
• Identify and refer severely malnourished children (SAM) to NRCs

• Counselling on contraception
• Distribute OCPs, condoms, emergency contraceptive pills
• Motivate for sterilization where appropriate

• Identify TB suspects (>2 weeks cough); refer for sputum examination
• DOTS support for TB patients
• Malaria - distribute LLINs, collect blood smears
• HIV/AIDS awareness; referral to ICTC

• Community screening for hypertension, diabetes, cancer

• Maintain village health register
• Escort patients to health facilities
• Facilitate Mahila Arogya Samiti (MAS) meetings

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Q8. Components of Baby Friendly Hospital Initiative (BFHI) (5 marks)

1. Have a written breastfeeding policy communicated routinely to all health care staff
2. Train all health care staff in skills necessary to implement the policy
3. Inform all pregnant women about the benefits and management of breastfeeding
4. Initiate breastfeeding within 30 minutes of birth - skin-to-skin contact
5. Show mothers how to breastfeed and maintain lactation even if separated from infants
6. Give no food or fluid other than breast milk - no prelacteal feeds, no glucose/water (unless medically indicated)
7. Practice rooming-in - mother and infant together 24 hours a day
8. Encourage breastfeeding on demand - unrestricted, whenever baby wants
9. Give no artificial teats or pacifiers (dummies/soothers) to breastfeeding infants
10. Foster breastfeeding support groups - refer mothers to them on discharge

• Reduces neonatal morbidity and mortality
• Protects against diarrhoea, respiratory infections, otitis media
• Promotes mother-infant bonding
• Economical and always available at correct temperature

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SHORT ANSWERS (10 x 3 = 30 Marks)

Q9. Cost-Effective Analysis

• A management technique for evaluation of health programmes
• Similar to cost-benefit analysis except benefit expressed not in monetary terms but in results achieved - e.g., number of lives saved, number of days free from disease, DALYs averted
• More promising tool for application in health field than cost-benefit analysis
• Helps compare alternative programmes to determine which achieves desired result most economically
• Limitation: Even cost-effective analysis is not possible in many cases
• Example: Cost per case of TB cured under DOTS vs. non-DOTS regimen
• Used in PPBS (Planning-Programming-Budgeting System) and Health Technology Assessment

Q10. Zinc Supplementation in Acute Diarrhoea

• Zinc is essential for immune function, protein synthesis, cell division
• Zinc deficiency common in developing countries, especially malnourished children
• WHO/UNICEF recommend zinc as universal standard of care for acute diarrhoea in children
• Dose: Children <6 months = 10 mg/day for 10-14 days; Children ≥6 months = 20 mg/day for 10-14 days
• Given along with ORS
• Benefits: Reduces duration of diarrhoea by ~25%; reduces stool volume and frequency; reduces risk of recurrence for 2-3 months; reduces all-cause mortality
• India: Intensified Diarrhoea Control Fortnight (IDCF) observed in July-August with ORS + zinc distribution

Q11. PCPNDT Act

• Full form: Pre-Conception and Pre-Natal Diagnostic Techniques Act
• Enacted 1994, amended 2003; renamed from PNDT Act
• Objective: Prevent sex-selective abortions and female foeticide
• Regulates use of ultrasound, amniocentesis, CVS for prenatal diagnosis
• Key provisions:
  • No sex determination of foetus for any purpose
  • All genetic labs/clinics must be registered
  • No advertisement offering sex determination
  • Pregnant woman cannot be compelled to undergo tests
  • First conviction: imprisonment up to 3 years + fine Rs. 10,000
  • Subsequent conviction: up to 5 years + Rs. 50,000
  • 2003 amendment extended to pre-conception sex selection techniques

Q12. Disaster Mitigation

• Definition: Any action taken to reduce or eliminate long-term risk to human life and property from disasters
• Risk = Hazard × Vulnerability - mitigation reduces vulnerability
• Types:
  • Structural: Earthquake-resistant buildings, flood embankments, dykes, cyclone shelters, retrofitting
  • Non-structural: Land use planning/zoning, building codes, early warning systems, public awareness, disaster preparedness training
• Key concepts: Hazard = potentially damaging physical event; Vulnerability = degree of risk; Mitigation = first phase (before preparedness, response, recovery)
• India: NDMA set up under Disaster Management Act 2005; Sendai Framework (2015-2030)

Q13. DASH (Dietary Approaches to Stop Hypertension)

• Dietary pattern designed to prevent and treat hypertension; endorsed by WHO, JNC-8
• High in: Fruits, vegetables, whole grains, low-fat dairy, nuts, seeds, legumes, fish, poultry
• Low in: Saturated fat, red meat, sweets, sugar-containing beverages, sodium
• Key nutrients: High potassium, calcium, magnesium (natural vasodilators), high fibre; low sodium (1500-2300 mg/day)
• Effect on BP: Reduces SBP by 8-14 mmHg in hypertensives; 2-4 mmHg in normotensives
• Other benefits: Reduces LDL cholesterol, prevents type 2 diabetes, reduces CVD risk, weight management

Q14. Indian Red Cross Society

• Founded: 1920 under the Indian Red Cross Society Act
• Affiliated with: ICRC (International Committee of the Red Cross) and IFRC
• Activities:
  1. Blood Bank Services: Maintains blood banks; promotes voluntary blood donation
  2. Disaster Relief: Food, clothing, shelter, medical aid during floods/earthquakes/cyclones
  3. Medical First Aid Training: First aid courses and certification; school first aid training
  4. Ambulance Services
  5. Junior Red Cross (JRC): School-based; trains students in first aid, hygiene; Motto: "I will try"
  6. Nursing Services: Trains nurses; maintains emergency nursing reserve
  7. Tracing Services: Links separated families/missing persons (war, disasters)
  8. Social Welfare: Maternity and child welfare services

Q15. Incineration

• High-temperature dry oxidation converting combustible waste to ash, flue gas, heat
• Types: Fixed hearth (simple), Rotary kiln (most effective for chemical/hazardous waste), Double-chamber pyrolytic incinerator (recommended for biomedical waste)
  • Primary chamber: 800°C (waste burnt)
  • Secondary chamber: 1000°C (gases combusted) - minimum 2-second residence time
• Advantages: Reduces waste volume by 90-95%; destroys pathogens; suitable for anatomical waste, sharps, blood products
• Disadvantages: Air pollution (dioxins, furans, heavy metals); high cost; toxic ash; skilled operators needed
• BMW Rules 2016: Yellow bags (anatomical waste, expired medicines) - incinerated; Red bags (recyclable) - not incinerated

Q16. Counterfeit Medicines

• WHO Definition: Medicine deliberately and fraudulently mislabelled with respect to identity and/or source
• May contain: wrong/absent/substandard active ingredients, wrong quantity, toxic ingredients, fake packaging
• Consequences: Treatment failure; drug resistance (subtherapeutic antibiotics → AMR); adverse reactions; death; economic loss; erosion of trust
• Control measures:
  1. Strengthen drug regulatory authorities (CDSCO in India)
  2. Track and trace systems (barcoding, holograms, serialization)
  3. Random sampling and testing of medicines
  4. Severe penalties under Drugs and Cosmetics Act
  5. WHO IMPACT (International Medical Products Anti-Counterfeiting Taskforce)
  6. Public awareness campaigns
  7. Prescription-only drugs from licensed pharmacies only

Q17. ICTC (Integrated Counselling and Testing Centre)

• Set up under National AIDS Control Programme (NACP) by NACO
• Provides HIV counselling and testing in an integrated manner
• Services:
  1. Pre-test counselling (HIV info, risk assessment, implications)
  2. HIV testing - ELISA/Rapid tests
  3. Post-test counselling (negative: risk reduction; positive: disclosure, referral, ART linkage)
  4. PPTCT - All pregnant women offered HIV testing
  5. Referral to ART centres, STI clinics
  6. Condom distribution
• Types: Standalone ICTC, Facility-Integrated ICTC (FICTC), Mobile ICTC
• Principles - "3 Cs": Consent (voluntary, informed), Confidentiality, Counselling; free of cost

Q18. Body Mass Index (BMI)

• Formula: BMI = Weight (kg) / Height (m²) - devised by Adolphe Quetelet
• WHO Classification:

• Asian/Indian cut-offs (ICMR): Normal: 18.5-22.9; Overweight: 23-24.9; Obese: ≥25
• Uses: Nutritional assessment, epidemiological surveys, CVD risk stratification, monitoring weight management
• Limitations: Does not distinguish fat from muscle; does not indicate fat distribution; not for children (use BMI-for-age percentiles), pregnant women, elderly

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PAPER 2 (IMG_0783 + IMG_0784) - COMPLETE ANSWERS

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LONG ESSAYS

Q1. Dog Bite Case Management + Contraindications + Urban Rabies Control (6+1+3)

• Thorough washing with soap and water for minimum 15 minutes under running water
• Apply viricidal agent: 70% alcohol OR tincture iodine OR povidone-iodine
• Do NOT suture immediately; if suturing needed, give RIG first, suture after 2 hours
• Avoid occlusive dressings
• Local wound care alone reduces rabies risk by 50%

• HRIG (Human RIG): 20 IU/kg body weight (preferred - no sensitivity test needed)
• ERIG (Equine RIG): 40 IU/kg (after sensitivity test)
• Maximum dose infiltrated INTO and AROUND the wound
• Remaining dose given IM at site distant from vaccine
• Must be given within 7 days of starting vaccine

• Cell culture vaccines: PCECV, PVRV, HDCV

• Essen IM regimen (5-dose): Days 0, 3, 7, 14, 28 - deltoid (NOT gluteal)
• Zagreb IM (2-1-1): 2 injections Day 0, then Days 7 and 21
• Thai Red Cross Intradermal: 0.1 ml ID at 2 sites on Days 0, 3, 7, 28

• TT injection if not recently immunized
• TIG if unimmunized + heavily contaminated wound

• Prophylactic amoxicillin-clavulanate (especially important for facial wounds)

• NO absolute contraindication to PEP - rabies is 100% fatal once symptomatic
• PEP mandatory even in pregnant women, infants, immunocompromised
• Old NTV/Semple nerve tissue vaccines = contraindicated (neurological complications)
• History of hypersensitivity to egg protein (PCECV) = use another vaccine
• Avoid live vaccines within 4 weeks of rabies PEP

1. Mass dog vaccination: ≥70% coverage breaks transmission (herd immunity)
2. ABC Programme (Animal Birth Control): Sterilization of stray dogs (WHO-endorsed - killing causes population rebound)
3. Registration and compulsory vaccination of pet dogs
4. Pre-exposure prophylaxis (PrEP): For veterinarians, animal handlers, lab workers, forest officers - Days 0, 7, 21/28
5. Health education: Immediate wound washing; where to seek PEP; handling sick animals
6. Surveillance: FAT (Fluorescent Antibody Test) for diagnosis; reporting of bites; monitoring dog vaccination coverage
7. Legislation: Prevention of Cruelty to Animals Act; ABC (Dogs) Rules 2001

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Q2. MCH Mortality Indicators + Causes + Prevention of Maternal Mortality (2+3+5)

1. Maternal Mortality Rate (MMR) = Maternal deaths per 1,00,000 live births (India: 97/1,00,000 - 2018-20)
2. Infant Mortality Rate (IMR) = Deaths <1 year per 1000 live births (India: 32)
3. Neonatal Mortality Rate (NMR) = Deaths in first 28 days per 1000 live births
4. Early NMR = Deaths in first 7 days; Late NMR = Deaths days 7-28
5. Perinatal Mortality Rate (PMR) = (Stillbirths + Early neonatal deaths) per 1000 total births
6. Under-5 Mortality Rate (U5MR) = Deaths <5 years per 1000 live births (India: 36)
7. Stillbirth Rate = Stillbirths per 1000 total births
8. Child Mortality Rate (CMR) = Deaths 1-4 years per 1000 children aged 1-4 years

1. Haemorrhage (38%) - APH, PPH (most common)
2. Sepsis/Puerperal infections (11%)
3. Hypertensive disorders - pre-eclampsia, eclampsia (11%)
4. Obstructed/prolonged labour
5. Unsafe abortion
6. Ectopic pregnancy
7. Embolism

• Anaemia (most important in India - contributes to ~20% deaths)
• Cardiac disease, hepatitis, malaria, tuberculosis, diabetes

• Delay 1: Delay in seeking care (lack of education, low status of women)
• Delay 2: Delay in reaching care (poor transport, distance, poverty)
• Delay 3: Delay in receiving care at facility (inadequate staff, drugs, equipment)

1. ANC: Minimum 4 visits (WHO: 8 contacts); early registration <12 weeks; IFA 180 tablets; TT immunization; screening for anaemia/HTN/GDM
2. Skilled Attendance: JSY (cash incentive for institutional delivery); JSSK (free drugs, diagnostics, blood, diet); training ANMs in skilled birth attendance; EmOC at FRUs
3. Postnatal Care: Visits at 48h, 7 days, 42 days; detect PPH, infection
4. Safe Abortion: MTP Act 1971 (amended 2021); mifepristone + misoprostol up to 20 weeks
5. Anaemia Management: WIFS for adolescent girls; deworming; dietary counselling
6. Pre-eclampsia/Eclampsia: MgSO4 at PHC level; antihypertensives; calcium supplementation
7. PPH Prevention: AMTSL - oxytocin 10 IU IM within 1 minute of delivery; misoprostol to ASHAs for home deliveries
8. Social Measures: Raise age at marriage (PCMA Act); women's education; poverty alleviation; improve transport
9. National Programmes: PMSMA (free ANC on 9th of every month); LaQshya; SUMAN; Midwifery Services Initiative

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SHORT ESSAYS

Q3. Demography + Demographic Gap + Demographic Cycle Stages (1+4)

• Demography: Scientific study of human population - its size, composition, distribution, density, growth, and factors causing changes (fertility, mortality, migration). From Greek "demos" (people) + "graphos" (writing).
• Demographic Gap: The widening difference between birth rate and death rate when death rate falls faster than birth rate - causes "population explosion." Widest gap = maximum population growth = Stage 2 of demographic cycle.

• Both BR and DR are HIGH (35-40/1000); population remains stationary
• Characteristic of primitive/pre-agricultural societies

• DR begins to FALL (better sanitation, nutrition, medical care); BR remains HIGH
• Population GROWS RAPIDLY; Demographic gap is WIDEST
• Example: Sub-Saharan Africa

• DR falls further; BR begins to FALL (urbanization, education, FP)
• Population still grows but at slower rate
• Example: India (currently in transition between Stage 3 and 4)

• Both BR and DR LOW (~10-15/1000); population stationary again
• Example: Western Europe, USA, Japan

• DR exceeds BR; population DECLINES
• Example: Germany, Russia

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Q4. Primary Health Care - Definition + Elements + Principles (1+2+2)

1. Education about prevailing health problems and methods of their prevention and control
2. Promotion of food supply and proper nutrition
3. Adequate supply of safe water and basic sanitation
4. Maternal and child health care including family planning
5. Immunization against the major infectious diseases
6. Prevention and control of locally endemic diseases
7. Appropriate treatment of common diseases and injuries
8. Provision of essential drugs

1. Equitable distribution - reach all including most underserved
2. Community participation - active community involvement in planning and operating PHC
3. Intersectoral coordination - collaboration with agriculture, education, housing, public works
4. Appropriate technology - scientifically valid, locally adaptable, affordable (e.g., ORS over IV fluids)
5. Decentralization - decision-making at lowest appropriate administrative level

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Q5. Levels of Communication in Doctor-Patient Relationship

1. Intrapersonal Communication: Within oneself - internal reasoning, decision-making (doctor reasoning through diagnosis; patient deciding whether to comply)
2. Interpersonal Communication (PRIMARY LEVEL): Face-to-face between two individuals; direct, personal, allows immediate two-way feedback; history taking, counselling, breaking bad news, consent; quality depends on active listening, empathy, cultural sensitivity
3. Small Group Communication: Groups of 3-12 people; family counselling, ward rounds, group health education sessions
4. Organizational Communication: Formal institutional channels; referral letters, discharge summaries, interdepartmental notes; vertical (hierarchy) and horizontal (peers)
5. Mass Communication: Large heterogeneous populations via media (TV, radio, newspapers, social media); one-directional; health awareness campaigns

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Q6. Objective and Goal + Network Analysis (1+4)

• Goal: Broad, long-term aim; general, not precisely measurable. Example: "Health for All"
• Objective: Specific, measurable, time-bound statement; operational translation of goal; must be SMART. Example: "Reduce IMR to 25/1000 live births by 2017"

• Makes detailed planning and comprehensive supervision possible
• Essence: Constructing an Arrow Diagram representing logical sequence of events
• "Every housewife who plans a meal so that each part is ready at the same time is using PERT" (K. Park)
• Steps: Identify activities → determine sequence → draw network → estimate time → calculate critical path → monitor
• Advantages: Aids planning/scheduling/monitoring; better communication between management levels; identifies potential problems early; continuous progress reports; better resource allocation
• Uses 3 time estimates: optimistic, pessimistic, most likely

• Critical Path = longest path through the network
• Any delay along critical path = entire project delayed
• Activities NOT on critical path have "float" time
• Uses deterministic time estimates (vs PERT's probabilistic)

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Q7. WHO Guidelines for BP Measurement + Non-pharmacological Management of Hypertension (2+3)

1. Patient seated, comfortably for 5 minutes before measurement
2. No smoking, coffee, exercise for 30 minutes before
3. Arm at heart level (4th ICS), bare and unsupported
4. Cuff bladder encircles ≥80% of arm circumference; standard adult: 12-13 cm wide × 35 cm long
5. Inflate 20-30 mmHg above palpatory SBP; deflate at 2-3 mmHg/second
6. SBP = Korotkoff Phase I (first sound); DBP = Phase V (disappearance)
7. Take at least 2 readings 1-2 minutes apart; average if >5 mmHg difference
8. First visit: measure both arms; use higher reading arm subsequently
9. Record to nearest 2 mmHg

• Hypertension: SBP ≥140 mmHg and/or DBP ≥90 mmHg on two separate occasions

1. DASH Diet: High fruits/vegetables/whole grains/low-fat dairy → reduces SBP by 8-14 mmHg
2. Sodium restriction: <2.4 g/day (6 g common salt) → reduces SBP by 2-8 mmHg
3. Weight reduction: BMI <23 (Asian); 10 kg weight loss → reduces SBP by 5-20 mmHg
4. Physical activity: 30-45 min aerobic exercise, 5 days/week → reduces SBP by 4-9 mmHg
5. Cessation of smoking: Reduces CVD risk; nicotine causes acute BP rise
6. Moderation of alcohol: ≤2 drinks/day men, ≤1/day women → reduces SBP by 2-4 mmHg
7. Stress management: Yoga, meditation, relaxation, biofeedback
8. Potassium supplementation: Increase dietary potassium (fruits, vegetables)

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Q8. Nikshay + End TB Strategy (1+4)

• Web-based case notification and monitoring system for TB patients in India
• Launched by Central TB Division, Ministry of Health & Family Welfare
• Mandatory notification of ALL TB patients (public and private sector)
• Features: Real-time data entry, electronic case records, drug supply management, treatment outcome monitoring
• Nikshay Poshan Yojana: DBT of Rs. 500/month to TB patients for nutritional support

• 95% reduction in TB deaths
• 90% reduction in TB incidence (<10/1,00,000 population)
• Zero TB-affected families facing catastrophic costs

1. Early diagnosis + universal drug susceptibility testing; systematic screening of contacts
2. Treatment of ALL TB including drug-resistant TB, with patient support
3. Collaborative TB/HIV activities and management of co-morbidities
4. Preventive therapy for high-risk persons; vaccination against TB

• Target: Eliminate TB (incidence <1/1,00,000) by 2025 (5 years ahead of global target)
• "TB Harega, Desh Jeetega" campaign
• Four pillars: Detect - Treat - Prevent - Build (DTPB)

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SHORT ANSWERS

Q9. Malaria Vector Control

• Environmental: Source reduction - drain stagnant water, fill pits; intermittent irrigation of rice fields
• Biological: Larvivorous fish (Gambusia affinis, Poecilia reticulata/Guppy); Bacillus thuringiensis israelensis (Bti)
• Chemical larvicides: Temephos (abate) in water bodies
• Indoor Residual Spraying (IRS): DDT (still used in India per WHO approval); synthetic pyrethroids (deltamethrin, alpha-cypermethrin) where DDT resistance exists
• Space spraying/fogging: Malathion for rapid knockdown during outbreaks
• LLINs (Long Lasting Insecticidal Nets): Treated with pyrethroids; last 3+ years
• Personal protection: DEET repellents, protective clothing (long sleeves at dusk/dawn), window screens

Q10. Prevention and Control of Plague

• Flea control FIRST (before rat control - to prevent fleas deserting dead rats and biting humans)
• DDT/BHC dusting of rat runs, burrows, homes; insecticide dusting of dead rats before handling
• Rat control: Rodenticides (zinc phosphide, warfarin); trapping; rat-proofing buildings/granaries
• Surveillance: Monitor rat populations; "rat fall" (sudden mass death of rats) = warning sign; plague is notifiable under IHR 2005
• Chemoprophylaxis: Contacts of pneumonic plague: doxycycline 100 mg BD × 7 days
• Treatment: Streptomycin/Gentamicin; alternatives: doxycycline, tetracycline, chloramphenicol
• Vaccination: Killed whole-cell plague vaccine - for high-risk individuals and endemic areas
• Quarantine: Isolation of pneumonic plague cases; quarantine of contacts

Q11. Cancer Danger Signals + Cancer Registration (1+2)

1. C - Change in bowel or bladder habits
2. A - A sore that does not heal
3. U - Unusual bleeding or discharge
4. T - Thickening or lump in breast/testis/elsewhere
5. I - Indigestion or difficulty swallowing
6. O - Obvious change in wart or mole
7. N - Nagging cough or hoarseness

• Hospital-Based: Records all cases at specific institution; evaluates treatment outcomes; limited epidemiological use (selected population)
• Population-Based: Records all cancer in a defined geographic area; base population 2-7 million; provides incidence rates; used for epidemiology, time trends, planning
• India: NCRP by ICMR since 1981 - 30+ registries

Q12. Lepra Reaction

• Leprosy type: Borderline (BT, BB, BL)
• Mechanism: Type IV CMI hypersensitivity - sudden increase in delayed-type hypersensitivity
• Features: Erythema and oedema of existing skin lesions; new lesions; acute neuritis (commonest cause of nerve damage); nerve pain and swelling
• Treatment: Prednisolone 40-60 mg/day, tapered over 12-24 weeks; continue MDT

• Leprosy type: BL/LL (lepromatous)
• Mechanism: Type III immune complex (antibody-antigen complex deposition)
• Features: Tender erythematous nodules (crops); fever, malaise; neuritis, uveitis, orchitis, arthritis, lymphadenopathy
• Treatment: Thalidomide (DOC for males); Clofazimine (females/where thalidomide unavailable); Prednisolone for acute severe cases; continue MDT

Q13. Advantages of Breastfeeding to Newborn (2 marks) and Mother (1 mark)

1. Nutritional - species-specific, ideal composition
2. Immunological - colostrum rich in secretory IgA; lactoferrin, lysozyme, macrophages - protects against diarrhoea, ARI, otitis media
3. Prevents PEM and malnutrition
4. DHA/AA support brain and retinal development
5. Always available, correct temperature, sterile
6. Reduces risk of SIDS
7. Promotes mother-infant bonding
8. Long-term: lower risk of obesity, type 1 diabetes, asthma

1. Lactational Amenorrhoea - natural contraception (LAM method)
2. Uterine involution - oxytocin contracts uterus, reduces PPH
3. Reduces risk of breast and ovarian cancer
4. Helps return to pre-pregnancy weight
5. Economical - no cost of formula

Q14. Levels of Health Care in India

• Sub-Centre: 1/5000 population (plains), 1/3000 (hilly); ANM + MPW; MCH, FP, immunization, first aid
• PHC: 1/30,000 population (plains); Medical Officer; OPD, MCH, FP, disease control, health education
• CHC: 1/1,20,000 population; 4 specialists (surgeon, physician, OBG, paediatrician); 30 beds; FRU

• District Hospital: 100-500 beds; specialist services; serves ~2 million population
• Sub-district/Taluka hospitals: 50-100 beds

• Medical colleges and teaching hospitals; national institutes (AIIMS, PGI, JIPMER, NIMHANS)

Q15. Prevention of Neonatal Tetanus

1. TT vaccination of pregnant women (MOST IMPORTANT):
   • Women with no prior immunization: TT1 (as early as possible) + TT2 (4 weeks after TT1)
   • Previous pregnancy <3 years: 1 booster dose
   • Maternal antibodies transferred to fetus via placenta
2. Three Cleans: Clean hands, clean delivery surface, clean cord cutting (sterile blade)
3. Dry cord care: Do NOT apply cowdung, ghee, oil - keep cord dry and clean (chlorhexidine 7.1% gel in high-risk settings)
4. Training of TBAs/Dais in clean delivery techniques; supply of clean delivery kits
5. Institutional deliveries: JSY and JSSK schemes
6. Surveillance: Neonatal tetanus is notifiable; "zero reporting" from PHCs monthly

Q16. DOTS Strategy

1. Government commitment: Sustained political, administrative, and financial commitment
2. Case detection by sputum smear microscopy: Passive case finding; ZN-stained smear; CBNAAT/GeneXpert for DR-TB
3. Standardized short-course chemotherapy under direct observation:
   • Category I (new): 2(HRZE)/4(HR)
   • Category II (retreatment): 2(HRZES)/1(HRZE)/5(HRE)
   • Supervised by health worker; Fixed Dose Combinations (FDCs) used
4. Regular, uninterrupted supply of quality anti-TB drugs: Reliable procurement; cold chain; FDCs
5. Standardized recording and reporting: Case registration; cohort analysis; quarterly reports; Nikshay portal

Q17. Recent Trends in MCH Care

1. Continuum of Care approach (pre-conception → antenatal → delivery → postnatal → newborn → infant → child → adolescent)
2. Skilled Birth Attendance (SBA) - institutional deliveries through JSY/JSSK
3. HBNC (Home Based Newborn Care) - 6 ASHA home visits in first 42 days
4. Kangaroo Mother Care (KMC) - skin-to-skin for LBW/preterm babies
5. IMNCI/C-IMNCI - integrated assessment and management of sick children
6. SNCUs, NBSUs, NBCCs - facility-based newborn care
7. MCTS/ANMOL App - digital mother and child tracking
8. RKSK - Rashtriya Kishor Swasthya Karyakram for adolescents
9. India Newborn Action Plan (INAP) 2014 - NMR ≤10, stillbirth ≤10 by 2030
10. PMSMA - free quality ANC on 9th of every month; LaQshya for quality labour room care

Q18. Ideal IUD Candidate

1. Parous woman - uterine cavity accommodates IUD; less expulsion
2. Wants long-term contraception (3-10 years) but wishes to retain fertility
3. Stable mutually monogamous relationship (low STI risk)
4. Postpartum: PPIUCD within 48 hours of delivery (widely promoted under national FP programme)
5. Post-abortion: Immediately following uncomplicated abortion
6. Women with contraindication to hormonal methods (hypertension, DM, smokers >35, migraine with aura, liver disease)
7. Breastfeeding women (Cu-T does not affect milk production)

• Pregnancy; unexplained vaginal bleeding; active PID/STI in last 3 months; distorted uterine cavity; copper allergy/Wilson's disease; genital malignancy; puerperal sepsis

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PAPER 3 (IMG_0786) - COMPLETE ANSWERS

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LONG ESSAYS

Q1. STI OPD Case - Syndromic Approach: Name + Advantages + Management + STD Community Control (1+2+4+3)

1. Accessible - immediate treatment at first visit; no waiting for lab results
2. Cost-effective - cheaper than laboratory-based diagnosis
3. Covers dual infection - treats all organisms causing a syndrome simultaneously
4. Reduces transmission - immediate treatment reduces infectivity window
5. Partner treatment integrated into the approach
6. Applicable at PHC level without sophisticated lab infrastructure
7. Standardized flowcharts reduce treatment errors
8. Covers asymptomatic partners through contact tracing

• Tab. Cefixime 400 mg orally, single dose
• Plus Tab. Azithromycin 1 g orally, single dose

• Tab. Metronidazole 400 mg BD × 7 days OR Tab. Secnidazole 2 g single dose

• Clotrimazole 500 mg vaginal pessary single dose OR Tab. Fluconazole 150 mg

• Husband MUST be treated simultaneously (for gonorrhea + chlamydia)
• Contact notification card given

• ABC strategy (Abstinence, Be faithful, Condom use)
• Advise sexual abstinence during treatment
• Follow-up after 7 days

• Offer HIV testing + HBV + syphilis (VDRL) at ICTC

1. Syndromic management at STD clinics at PHC/CHC level; free drugs
2. Partner notification - all recent contacts treated simultaneously
3. Condom promotion - free distribution + social marketing (Nirodh); vending machines at high-risk areas; female condom
4. Targeted Interventions (TIs) for high-risk populations: FSWs, truck drivers, migrant workers, IDUs, MSM - peer-led education, outreach, STI management
5. Health education - awareness about symptoms, transmission, prevention; reduce stigma
6. Integration with HIV control - STIs increase HIV transmission 3-5 times; ICTC linked to STI clinics
7. Blood safety - mandatory screening of all blood donations for HIV, HBV, HCV, syphilis, malaria
8. Safe injection practices/harm reduction for IDUs - needle/syringe exchange

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Q2. ICDS - Objectives + Beneficiaries + Services + Road to Health Chart (2+1+5+2)

1. Improve nutritional and health status of children 0-6 years
2. Lay foundation for proper psychological, physical, and social development of the child
3. Reduce incidence of mortality, morbidity, malnutrition, and school dropout
4. Achieve effective coordination of policy and implementation among departments
5. Enhance capability of the mother to look after normal health and nutritional needs of the child

1. Children 0-6 years
2. Pregnant women
3. Lactating mothers
4. Women 15-45 years (nutrition and health education)
5. Adolescent girls (under SABLA/Kishori Shakti Yojana)

• Children 6m-3yr: 500 kcal + 12-15 g protein/day
• Children 3-6yr (malnourished): 800 kcal + 20-25 g protein/day
• Pregnant/Lactating women: 600 kcal + 18-20 g protein/day
• 300 days/year

• Designed by David Morley, later modified by WHO
• India adopted WHO Child Growth Standards 2006 (MGRS data) as national standard since February 2009
• Plots weight-for-age as primary indicator (weight = most sensitive measure of growth)

1. Growth monitoring - longitudinal follow-up; detects growth faltering early
2. Nutritional assessment - children below -2 SD = underweight
3. Identifying at-risk children - flat/falling weight curve = at risk
4. Communication tool - visual display understood by mothers and health workers
5. Immunization record - vaccine schedule recorded on same card
6. Feeding guidance - records introduction of complementary feeding
7. Health worker guidance - enables timely referral of malnourished children
8. Programme monitoring - tracks nutritional status of children in community

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SHORT ESSAYS

Q3. Classification of Contraceptive Methods + Barrier Methods (1+4)

• Spacing (Temporary): Barrier methods; Hormonal methods (OCP, injectables, patches, rings); IUDs (Cu-T, LNG-IUS); Natural methods (safe period, LAM, coitus interruptus); Emergency contraception
• Terminal (Permanent): Female sterilization (tubectomy); Male sterilization (vasectomy)

• Latex/polyurethane; failure rate 2-15/100 woman-years
• ONLY method providing dual protection against pregnancy AND STIs/HIV
• Advantages: no hormonal side effects, widely available, inexpensive, promotes male participation
• India: Nirodh (free under national FP programme)

• Polyurethane pouch inserted into vagina; female-controlled; protects against STIs
• More expensive, less aesthetically acceptable

• Dome-shaped rubber cap covering cervix; used WITH spermicidal cream/jelly
• Inserted up to 6 hours before, kept 6-8 hours after intercourse
• Failure rate: 5-20/100 woman-years; requires fitting by healthcare provider

• Thimble-shaped cap fitting directly over cervix; smaller than diaphragm
• Used with spermicide; can be left in place up to 48 hours

• Chemical agents (nonoxynol-9) as creams, foams, jellies, films, suppositories
• Failure rate: 20-30/100 woman-years when used ALONE (high)
• Best combined with other barrier methods; do NOT protect against HIV

• Polyurethane sponge containing nonoxynol-9; provides protection for 24 hours (multiple acts)
• Failure rate: 9-20%

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Q4. ASHA and ANM Full Forms + Roles and Responsibilities of ASHA (1+4)

• ASHA = Accredited Social Health Activist
• ANM = Auxiliary Nurse Midwife

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Q5. Levels of Communication in Doctor-Patient Relationship

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Q6. Definition of Planning + Steps in Planning Cycle (1+4)

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Q7. ANC Physical and Abdominal Examination + Subcentre Investigations (4+1)

1. Haemoglobin estimation (Sahli's haemoglobinometer/colour scale)
2. Urine for albumin (detect pre-eclampsia)
3. Urine for sugar (detect GDM)
4. Blood pressure measurement
5. Weight measurement
6. Urine pregnancy test (UPT)

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Q8. Prevention of Human Rabies

• For: veterinarians, animal handlers, lab workers, forest officers
• Schedule: 3 doses of CCV on Days 0, 7, and 21/28 (IM deltoid)
• Regular booster when titre falls below protective level

• Category I: Touching/feeding animal - wash hands; no PEP
• Category II: Minor scratches, no bleeding - wound treatment + vaccine
• Category III: Transdermal bites/bleeding/mucous membrane - wound treatment + RIG + vaccine

1. Wound washing with soap and water 15 minutes + povidone-iodine
2. RIG: HRIG 20 IU/kg or ERIG 40 IU/kg - infiltrate into and around wound
3. Cell culture vaccine: Essen IM 5-dose (Days 0,3,7,14,28) or Zagreb (2-1-1) or Thai ID regimen
4. TT + antibiotics

• Mass vaccination of dogs ≥70% coverage; ABC programme (sterilization); registration of pet dogs; compulsory vaccination

• Immediate wound washing; where to seek PEP
• No absolute contraindication to PEP; rabies 100% fatal once symptomatic

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SHORT ANSWERS

Q9. Key Populations + HIV Transmission (1+2)

1. Sexual (87% in India): Unprotected heterosexual (most common); anal intercourse (highest risk per act); STIs increase risk 3-5 times
2. Parenteral (~1.5%): Sharing needles (IDUs); blood transfusion (before screening); needlestick injuries (HCW - 0.3% risk); unsterilized instruments; tattooing
3. MTCT/Vertical (~5%): Pregnancy (transplacental); delivery (most common - 65%); breastfeeding (14-22%); without intervention overall MTCT 25-45%; PPTCT reduces to <2%

Q10. Nosocomial Infection + Prevention (1+2)

1. Hand hygiene (MOST important) - WHO 5 Moments; ABHR or soap + water
2. Standard precautions - gloves, gown, mask, eye protection as needed; dispose sharps immediately
3. Aseptic technique - for catheterization, IV lines, wound dressing
4. Sterilization/disinfection - autoclaving; chemical disinfection; single-use disposables
5. Environmental sanitation - regular cleaning; biomedical waste management; proper ventilation in OTs
6. Isolation - source isolation (infectious patients); cohort isolation
7. Antibiotic stewardship - rational use; follow antibiotic policies to reduce MDROs
8. Surveillance - active HAI surveillance; infection control committees

Q11. Self-care in Diabetes Management

1. SMBG - regular self-monitoring; fasting target 80-130 mg/dl; HbA1c <7%
2. Diet - diabetes plate method; fixed meal timing; avoid refined carbs/sugary drinks; high fibre; DASH/Mediterranean pattern
3. Physical activity - 150 min/week aerobic; resistance training 2-3 times/week; check glucose before/after exercise
4. Medication adherence - oral hypoglycaemics; insulin technique; correct site rotation
5. Foot care - daily inspection; clean and dry feet; well-fitting footwear; no bare feet; trim nails straight across
6. Regular check-ups - BP (target <130/80); annual fundoscopy; annual urine microalbumin; lipid profile
7. Smoking cessation - accelerates diabetic complications
8. Stress management - yoga, meditation

Q12. BCG Vaccination

• BCG = Bacillus Calmette-Guérin - live attenuated vaccine from Mycobacterium bovis (Calmette and Guérin, 1921)
• Strain in India: Danish 1331 (Serum Institute of India)
• Schedule: Single dose at birth (or up to 5 years); no booster needed
• Route/Dose: 0.05 ml intradermally (newborn); 0.1 ml ID (>1 year); Left upper arm (deltoid insertion); strict ID - produces bleb
• Efficacy: 75-86% against TB meningitis and miliary TB in children; variable against pulmonary TB (0-80%)
• Reaction: Papule at 2-3 weeks → ulcerates → scar by 6-12 weeks = confirms successful vaccination
• Contraindications: Immunodeficiency states (HIV with low CD4); high-dose corticosteroids
• Storage: 2-8°C; protected from light; discard within 4 hours of reconstitution

Q13. Exclusive Breastfeeding + Baby Friendly Hospital Initiatives (1+2)

1. Written breastfeeding policy communicated to all staff
2. Train all health care staff in breastfeeding skills
3. Inform all pregnant women about benefits of breastfeeding
4. Initiate breastfeeding within 30 minutes of birth (skin-to-skin)
5. Show mothers how to breastfeed and maintain lactation
6. No prelacteal feeds - no food/fluid other than breast milk (unless medically indicated)
7. Rooming-in - mother and infant together 24 hours/day
8. Breastfeeding on demand - unrestricted
9. No artificial teats or pacifiers
10. Foster breastfeeding support groups; refer mothers on discharge

Q14. Basic Resources for Health Care

1. Manpower - doctors, nurses, paramedics (ANM, ASHA), administrative staff; most critical resource
2. Money - government budget, insurance, user fees, donor funding; India: ~2.1% GDP on health (target 2.5%)
3. Materials/Supplies - drugs (NLEM), vaccines (cold chain), instruments, equipment, infrastructure (hospitals, PHCs)
4. Information/Knowledge - health information systems (HMIS, Nikshay), epidemiological surveillance, research evidence, guidelines
5. Time - sufficient time for consultations, community health activities
6. Technology - appropriate technology (POC diagnostics, telemedicine, renewable energy for health facilities)

Q15. Prevention and Control of Soil-Transmitted Helminths

• Major STH: Ascaris lumbricoides, Trichuris trichiura, hookworm (Ancylostoma duodenale/Necator americanus), Strongyloides stercoralis

1. Environmental sanitation (most important): Safe disposal of faeces (toilets); Swachh Bharat Mission - ODF; safe water supply; avoid night soil as fertilizer
2. Personal hygiene: Handwashing with soap after defecation/before eating; wearing footwear (hookworm - prevents larval skin penetration); short nails
3. Food hygiene: Wash fruits/vegetables; avoid raw/soil-contaminated vegetables; cook food properly
4. Mass Drug Administration (National Deworming Day): 10th August and 10th February every year; Albendazole 400 mg chewable single dose to all children 1-19 years in schools; under RBSK; WHO recommends in areas where STH prevalence >20%
5. Health education: Importance of sanitation, footwear, personal hygiene

Q16. Control of Japanese Encephalitis

• Causative agent: JE virus (Flavivirus); Vector: Culex tritaeniorhynchus; Reservoir: Pigs, water birds

1. Vaccination (MOST IMPORTANT): SA-14-14-2 live attenuated vaccine; part of UIP in endemic states; 2 doses at 9 months and 16 months; endemic states: Assam, Bihar, Karnataka, Maharashtra, TN, UP, WB
2. Vector control: Larvicides (temephos, Bti) in rice fields/water bodies; IRS (malathion); environmental management (alternate wetting/drying of paddy fields); biological control (larvivorous fish)
3. Personal protection: LLINs, DEET repellents, protective clothing at dusk/dawn, window/door screens
4. Reservoir control: Separation of piggeries from human habitation
5. Surveillance: Sentinel surveillance in endemic areas; vector surveillance
6. Case management: No specific antiviral; supportive care (ICU, anti-convulsants, mannitol)

Q17. Rashtriya Bal Swasthya Karyakram (RBSK)

• Launched: February 2013 under NHM
• Purpose: Child Health Screening and Early Intervention Services; early identification and intervention for children birth to 18 years
• 4 Ds: Defects at birth, Deficiencies, Diseases, Development delays (including disability)
• Screening by Mobile Health Teams (MHTs): 1 MHT per block; 4 members (AYUSH doctor, staff nurse, ANM, pharmacist); cover 30 schools; screen 30 conditions
  • 0-6 weeks: by ASHA/AWW at home
  • 6 weeks to 6 years: at AWC
  • 6-18 years: at government/aided schools
• Referral: To DEIC (District Early Intervention Centre) - services at zero cost to family
• Additional: WIFS, National Deworming Day, school eye screening, menstrual hygiene management
• Significance: Largest child health screening programme in the world; covers ~270 million children

Q18. Sex Ratio + Reasons for Low Sex Ratio in India (1+2)

• India (2011 Census): 943 females per 1000 males
• Child Sex Ratio (CSR, 0-6 years, 2011): 914 females per 1000 males (most alarming indicator; declined from 945 in 2001)

1. Female foeticide (primary cause): Misuse of prenatal diagnostic techniques (ultrasound) for sex determination and selective abortion of female foetuses despite PCPNDT Act 1994
2. Son preference: Deep-rooted patriarchal attitude - son preferred for economic support, family name, last rites; daughter seen as burden (dowry)
3. Female infanticide: Killing of girl infants after birth; more common in some communities (Tamil Nadu, Rajasthan)
4. Differential neglect of girls: Less food, healthcare, medical attention; higher preventable mortality
5. High maternal mortality: Pregnancy-related deaths disproportionately reduce female numbers
6. Child marriage: Early marriage → early pregnancy → increased maternal mortality

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