ILO - 3 Purposes (as per Park's PSM)

1. To contribute to the establishment of lasting peace by promoting social justice.
2. To improve, through international action, labour conditions and living standards.
3. To promote economic and social stability.

• The International Labour Code is a collection of international minimum standards related to health, welfare, living and working conditions of workers worldwide.
• The ILO provides assistance to organizations interested in the betterment of living and employment standards.
• There is close collaboration between ILO and WHO in the field of health and labour.
• Headquarters: Geneva, Switzerland.

International Red Cross - Activities/Contributions (Park's PSM)

Background / Origin

• The Red Cross is a non-political, non-official international humanitarian organization devoted to the service of mankind in peace and war.
• Founded by Henry Dunant, a young Swiss businessman, who witnessed the Battle of Solferino (1859) in North Italy - one of the most savage battles of history. Appalled by the neglect of thousands of wounded and dying soldiers, he recruited local volunteers to help relieve their suffering.
• In his book "Un Souvenir de Solferino", Dunant urged that voluntary national societies be founded to render aid to the wounded without distinction of nationality, with a protective emblem and trained workers protected by international treaty.
• The First Geneva Convention (1864) signed a treaty for relief of the wounded and sick armies in the field, giving birth to the International Committee of the Red Cross (ICRC) - an independent, neutral institution and founder organization of the Red Cross.
• In 1919, the League of the Red Cross Society was created with headquarters in Geneva to coordinate the work of national societies (numbering more than 90).

Role of the Red Cross

1. Service to armed forces
2. Service to war veterans
3. Disaster service - relief during natural disasters (floods, famines, etc.)
4. First aid and nursing
5. Health education
6. Maternity and child welfare services

Indian Red Cross Society

• Established by an Act of the Indian Legislature in 1920 with three objectives:
  1. Improvement of health
  2. Prevention of disease
  3. Mitigation of suffering
• In peacetime: provides military hospitals with amenities (newspapers, periodicals, musical instruments, comfort goods).
• Red Cross Home at Bangalore for disabled ex-servicemen - one of the pioneer institutions of its kind in Asia.
• Disaster services: distribution of milk, medicines, Vitamin tablets, cod liver oil, and other items to famine-stricken people and flood victims.
• Maternity and child welfare services: pioneering work as an auxiliary of the country's health services.

Junior Red Cross

• One of the most active sections of the Society.
• Gives opportunity to lakhs of boys and girls across India to participate in:
  • Village uplift
  • First aid
  • Anti-epidemic work
  • Building international fraternity of youth - promoting international friendliness, understanding, and cooperation.

Q2: World Health Organization (WHO) - Functions/Responsibilities

Functions/Work of WHO

1. Prevention and Control of Specific Diseases

• Activities cover almost all communicable diseases - global eradication of smallpox is an outstanding example.
• Epidemiological surveillance of communicable diseases - data disseminated via Weekly Epidemiological Record (WER) and Automatic Telex Reply Service (ATRS).
• International Health Regulations - to ensure maximum security against international spread of diseases with minimum interference with world traffic.
• Non-communicable diseases: cancer, cardiovascular diseases, diabetes, mental disorders, blindness, etc.
• Vector biology and control, drug quality control, immunization (Expanded Programme on Immunization - EPI).

2. Development of Comprehensive Health Services

• Promotes and supports national health policy development and comprehensive national health programmes.
• Activities: organizing health systems based on primary health care, health manpower development, building national capability, health services research.
• Appropriate Technology for Health (ATH) - launched to encourage self-sufficiency in solving health problems.

3. Family Health

• Major programme since 1970 - covers:
  • Maternal and child health care
  • Human reproduction
  • Nutrition
  • Health education
• Chief concern: improvement of quality of life of the family as a unit.

4. Environmental Health

• Advises governments on national programmes for basic sanitary services.
• Protection of quality of air, water, and food; health conditions of work; radiation protection; identification of new hazards.
• Programmes: WHO Environmental Health Criteria Programme and WHO Environmental Health Monitoring Programme.

5. Health Statistics

• Publishes: (a) Weekly Epidemiological Record, (b) World Health Statistics Quarterly, (c) World Health Statistics Annual.
• Publishes International Classification of Diseases (ICD) - updated every 10 years (ICD-10 came into effect 1st January 1993).
• Assists countries in improving medical records and national health information systems.

6. Biomedical Research

• WHO does not do research itself, but stimulates and coordinates research.
• Established a worldwide network of WHO Collaborating Centres; awards grants to researchers and institutions.
• Special Programme for Research and Training in Tropical Diseases - targeting 6 diseases: malaria, schistosomiasis, trypanosomiasis, filariasis, leishmaniasis, and leprosy.

7. Health Literature and Information

• Acts as a clearing house for information on health problems; hundreds of publications on health subjects.
• WHO library is a satellite centre of MEDLARS (Medical Literature Analysis and Retrieval System).

Q6: UNICEF - Expand; Describe Activities in India (Child Nutrition/Child Health/Improving Child Survival)

• Headquarters: United Nations, New York
• Regional office for South Asia (SCAR): Kathmandu, Nepal - covers India, Afghanistan, Sri Lanka, Maldives, Pakistan, Bhutan, Bangladesh, Nepal.
• Governed by a 36-nation Executive Board.
• Works in close collaboration with WHO, UNDP, FAO, and UNESCO.

Activities of UNICEF in India

(a) Child Health

• Provided substantial aid for production of vaccines and sera in many countries.
• Supported India's BCG vaccination programme from its inception.
• Assisted in erection of a penicillin plant near Pune; donated a DDT plant; two plants for manufacture of triple vaccine and iodized salt.
• Environmental sanitation - safe and sufficient water for drinking and household use in rural areas.
• Currently focusing on primary health care for mothers and children - emphasis on:
  • Immunization
  • Infant and young child care
  • Family planning aspects of family health
  • Safe water and adequate sanitation
• Services delivered at village level through resident volunteers/part-time primary health workers selected with community agreement.

(b) Child Nutrition

• High priority to improving child nutrition.
• Developed low-cost protein-rich food mixtures (from mid-1950s).
• In collaboration with FAO - aided "applied nutrition" programmes through community development, agricultural extension, schools and health services.
• Supplied equipment for modern dairy plants in Maharashtra, Gujarat, Karnataka, UP, West Bengal, Andhra Pradesh.
• Specific aid for nutritional deficiency diseases:
  • Large doses of Vitamin A in areas where xerophthalmia is prevalent
  • Iodized salt in areas of endemic goitre
  • Iron and folate supplements to combat anaemias
  • Food enrichment programmes

(c) Family and Child Welfare

• Improve care of children within and outside their homes through:
  • Parent education
  • Day-care centres
  • Child welfare and youth agencies
  • Women's clubs
• Carried out as part of health, nutrition, education and home economics extension programmes.

(d) Education - Formal and Non-formal

• In collaboration with UNESCO - expanding and improving science teaching in India.
• Science lab equipment, workshop tools, library books, and audiovisual aids provided to educational institutions.

GOBI Campaign

Urban Basic Services (UBS)

• Since 1976, UNICEF has participated in Urban Basic Services (UBS).
• Aim: to upgrade basic services (health, nutrition, water supply, sanitation, education) - especially for children and women - in selected cities and towns.
• Overall objective: improve degree and quality of survival and development of children of urban low-income families.

Summary of UNICEF Activities

• Child survival, protection and development
• Immunization
• Improved infant feeding practices
• Child growth monitoring
• Home-based diarrhoea management
• Drinking water and environmental sanitation
• Birth spacing
• Education of girls
• Income-generating activities for women

Q18. Record Linkage

Q19. Bar Diagram (Bar Charts) and Its Uses

1. Simple bar chart - bars may be vertical or horizontal; separated by appropriate spaces. Used to compare one variable.
2. Multiple (compound) bar chart - two or more bars grouped together; used to compare more than one variable simultaneously (e.g., population and land area by region).
3. Component bar chart - bars divided into two or more parts; each part represents a certain item and is proportional to the magnitude of that item (e.g., India's growth of population 1901-2011).

Q20. Histogram

• The class intervals are given along the horizontal axis.
• The frequencies are given along the vertical axis.
• The area of each block is proportional to the frequency.

Q21. Pie Chart - Advantages and Disadvantages

• Simple and visually appealing
• Easy to understand at a glance
• Extremely popular with the laity (non-statisticians)
• Shows proportions clearly as parts of a whole

• Not preferred by statisticians - considered inferior to bar charts
• Difficult to compare the areas of segments visually without labelling
• It is often necessary to indicate percentages in segments because it may not be easy to visually compare areas
• Cannot show trends over time
• Becomes confusing when many segments are used

Q22. What is a Spot Map?

• Inner and outer city variations in disease frequency are best studied with spot maps or shaded maps.
• These maps show at a glance areas of high or low frequency, and the boundaries and patterns of disease distribution.
• If the map shows clustering of cases, it may suggest a common source of infection or a common risk factor shared by all the cases.

Q23. Measures of Central Tendency

1. Mean (Arithmetic Mean)

• Individual observations are added together and divided by the number of observations.
• Formula: x̄ = Σx / n
• Advantages: Easy to calculate and understand; most useful of the statistical averages.
• Disadvantages: May be unduly influenced by abnormal (extreme) values.

2. Median

• Data is arranged in ascending or descending order; the middle value is the median.
• Advantages: Not affected by extreme values; more representative when extreme values distort the mean.
• Disadvantages: Does not use all values in its calculation.

3. Mode

• The most frequently occurring value in a distribution.
• Advantages: Easy to understand; not affected by extreme items.
• Disadvantages: Exact location is often uncertain and not clearly defined; therefore not often used in biological or medical statistics.

Q24. Standard Normal Curve - Properties / Draw

1. Smooth, bell-shaped, perfectly symmetrical curve.
2. Based on an infinitely large number of observations.
3. Total area of the curve = 1 (100%).
4. Mean = 0; Standard deviation = 1.
5. Mean, median and mode all coincide at the centre.
6. The curve is asymptotic to the baseline (never touches the x-axis).
7. The standard normal deviate (Z) is given by:

Z = (x - x̄) / σ

Q25. Sampling Methods/Types

1. Simple Random Sample

• Each unit is assigned a number; a table of random numbers is used to select units.
• Each unit has an equal chance of being drawn.
• Provides the greatest number of possible samples.

2. Systematic Random Sample

• Every 5th or 10th unit is picked at regular intervals.
• Example: to carry out a filaria survey, houses are numbered; a starting number is chosen at random between 1 and 10 (say 4), then every 10th number is selected: 4, 14, 24, 34...
• Each unit has the same chance of selection, but the number of possible samples is reduced.

3. Stratified Random Sample

• The sample is deliberately drawn so that each portion represents a corresponding strata (sub-group) of the universe.
• Useful when one is interested in analysing data by a characteristic - e.g., religion (Hindus, Christians, Muslims), age groups, etc.
• Ensures proportional representation of each subgroup.

Q28. Name the Tests of Significance

1. (a) Standard Error of the Mean - tests whether the sample mean accurately represents the population mean; used to set confidence limits.
2. (b) Standard Error of Proportion - tests significance when data is expressed as proportions or percentages.
3. (c) Standard Error of Difference (between two means) - tests whether the difference between means of two groups is significant (i.e., whether the two samples represent different universes).
4. (d) Standard Error of Difference between two Proportions - tests significance of the difference between two proportions or ratios.
5. Chi-square (χ²) Test - an alternate method; used when two or more groups (proportions) are to be compared.

Q29. Chi-Square Test (χ²)

χ² = Σ (O - E)² / E

d.f. = (c - 1)(r - 1)

• For 1 d.f., χ² value at P = 0.05 is 3.84
• If calculated χ² > 3.84 → result is significant (reject null hypothesis)
• If calculated χ² < 3.84 → result is not significant (accept null hypothesis)

Vital Event Registration

Definition

"Legal registration, statistical recording and reporting of the occurrence of, and the collection, compilation, presentation, analysis and distribution of statistics pertaining to vital events - i.e., live births, deaths, foetal deaths, marriages, divorces, adoptions, legitimations, recognitions, annulments and legal separations."

Registration in India

• India has a long tradition of registration of births and deaths.
• In 1873, the Govt. of India passed the Births, Deaths and Marriages Registration Act - but it provided only for voluntary registration.
• The registration system in India was very unreliable - data was grossly deficient in accuracy, timeliness, completeness and coverage.
• Reasons for deficiency: illiteracy, ignorance, lack of motivation, lack of uniformity in data collection, and multiple registration agencies (health agency, panchayat agency, police agency, revenue agency).

The Central Births and Deaths Registration Act, 1969

• To improve the civil registration system, Govt. of India promulgated the Central Births and Deaths Registration Act, 1969.
• Came into force on 1 April 1970.
• Provisions:
  • Compulsory registration of births and deaths throughout the country.
  • Ensures uniformity and comparability of data across states.
  • Fixes responsibility for reporting - public (parents/relatives) report household events; heads of institutions (hospitals, nursing homes, hotels, jails) report institutional events.
  • Time limit for registration: 21 days uniformly all over India.
  • Late fee imposed in case of default.
  • From October 2018 - Aadhaar number is mandatory for registration of death.

Lay Reporting

• Due to slow progress in developing a comprehensive vital registration system, some countries employ first-line health workers (e.g., village health guides) to record births and deaths.
• Lay reporting = collection of information, its use, and transmission to other levels of the health system by non-professional health workers.
• Where vital events registration system is not functioning, demographic surveys should be regarded as a temporary substitute (not a replacement).