from reportlab.lib.pagesizes import A4
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import cm
from reportlab.lib import colors
from reportlab.platypus import (SimpleDocTemplate, Paragraph, Spacer, Table,
                                 TableStyle, PageBreak, HRFlowable)
from reportlab.platypus import KeepTogether
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY
from reportlab.pdfgen import canvas
from reportlab.platypus.doctemplate import PageTemplate, BaseDocTemplate, Frame

OUTPUT = "/home/daytona/workspace/community-health-nursing/CHN1_Study_Guide.pdf"

# ── Custom page template with header/footer ──────────────────────────────────
class MyDocTemplate(BaseDocTemplate):
    def __init__(self, filename, **kwargs):
        BaseDocTemplate.__init__(self, filename, **kwargs)
        frame = Frame(1.5*cm, 2*cm, 18*cm, 25.7*cm, id='normal')
        template = PageTemplate(id='main', frames=frame, onPage=self.add_page_decorations)
        self.addPageTemplates([template])

    def add_page_decorations(self, canvas, doc):
        canvas.saveState()
        # Header bar
        canvas.setFillColor(colors.HexColor('#1a5276'))
        canvas.rect(0, 28.5*cm, 21*cm, 1.2*cm, fill=1, stroke=0)
        canvas.setFillColor(colors.white)
        canvas.setFont('Helvetica-Bold', 9)
        canvas.drawString(1.5*cm, 28.9*cm, 'Community Health Nursing - I  |  B.Sc Nursing 5th Semester  |  INC Syllabus 2021')
        canvas.drawRightString(19.5*cm, 28.9*cm, 'Study Guide')
        # Footer
        canvas.setFillColor(colors.HexColor('#1a5276'))
        canvas.rect(0, 0, 21*cm, 1.2*cm, fill=1, stroke=0)
        canvas.setFillColor(colors.white)
        canvas.setFont('Helvetica', 8)
        canvas.drawString(1.5*cm, 0.45*cm, 'Prepared for Exam Preparation | July 2026')
        canvas.drawRightString(19.5*cm, 0.45*cm, f'Page {doc.page}')
        canvas.restoreState()

# ── Styles ────────────────────────────────────────────────────────────────────
styles = getSampleStyleSheet()

cover_title = ParagraphStyle('cover_title', fontSize=28, fontName='Helvetica-Bold',
                              textColor=colors.white, alignment=TA_CENTER, spaceAfter=10)
cover_sub = ParagraphStyle('cover_sub', fontSize=16, fontName='Helvetica',
                            textColor=colors.HexColor('#aed6f1'), alignment=TA_CENTER, spaceAfter=6)
cover_info = ParagraphStyle('cover_info', fontSize=12, fontName='Helvetica',
                             textColor=colors.HexColor('#d5e8d4'), alignment=TA_CENTER, spaceAfter=4)

unit_heading = ParagraphStyle('unit_heading', fontSize=16, fontName='Helvetica-Bold',
                               textColor=colors.white, backColor=colors.HexColor('#1a5276'),
                               spaceBefore=16, spaceAfter=8, leftIndent=0,
                               borderPad=8, leading=22)
section_heading = ParagraphStyle('section_heading', fontSize=13, fontName='Helvetica-Bold',
                                  textColor=colors.HexColor('#1a5276'),
                                  spaceBefore=12, spaceAfter=4)
sub_heading = ParagraphStyle('sub_heading', fontSize=11, fontName='Helvetica-Bold',
                              textColor=colors.HexColor('#2e86c1'),
                              spaceBefore=8, spaceAfter=3)
body = ParagraphStyle('body_text', fontSize=10, fontName='Helvetica',
                       textColor=colors.HexColor('#2c3e50'), leading=15,
                       spaceAfter=4, alignment=TA_JUSTIFY)
bullet = ParagraphStyle('bullet', fontSize=10, fontName='Helvetica',
                         textColor=colors.HexColor('#2c3e50'), leading=14,
                         leftIndent=16, spaceAfter=3, bulletIndent=6)
key_point = ParagraphStyle('key_point', fontSize=10, fontName='Helvetica-Bold',
                            textColor=colors.HexColor('#922b21'),
                            backColor=colors.HexColor('#fdedec'),
                            leftIndent=8, rightIndent=8, spaceAfter=5,
                            borderPad=5, leading=14)
note_style = ParagraphStyle('note', fontSize=9.5, fontName='Helvetica-Oblique',
                             textColor=colors.HexColor('#515a5a'),
                             backColor=colors.HexColor('#fdfefe'),
                             leftIndent=10, spaceAfter=4, leading=13)
toc_style = ParagraphStyle('toc', fontSize=11, fontName='Helvetica',
                            textColor=colors.HexColor('#1a5276'), leading=18,
                            leftIndent=10)

def B(text): return f'<b>{text}</b>'
def unit_title_para(text):
    return Paragraph(f'  {text}', unit_heading)
def sec(text): return Paragraph(text, section_heading)
def sub(text): return Paragraph(text, sub_heading)
def p(text): return Paragraph(text, body)
def bp(text): return Paragraph(f'• {text}', bullet)
def kp(text): return Paragraph(f'★ {text}', key_point)
def note(text): return Paragraph(f'📝 {text}', note_style)
def sp(n=1): return Spacer(1, n*0.3*cm)
def hr(): return HRFlowable(width='100%', thickness=0.5, color=colors.HexColor('#aed6f1'), spaceAfter=4)

def make_table(headers, rows, col_widths=None):
    data = [headers] + rows
    if col_widths is None:
        col_widths = [18*cm / len(headers)] * len(headers)
    t = Table(data, colWidths=col_widths)
    t.setStyle(TableStyle([
        ('BACKGROUND', (0,0), (-1,0), colors.HexColor('#1a5276')),
        ('TEXTCOLOR', (0,0), (-1,0), colors.white),
        ('FONTNAME', (0,0), (-1,0), 'Helvetica-Bold'),
        ('FONTSIZE', (0,0), (-1,0), 10),
        ('ALIGN', (0,0), (-1,-1), 'LEFT'),
        ('VALIGN', (0,0), (-1,-1), 'MIDDLE'),
        ('FONTNAME', (0,1), (-1,-1), 'Helvetica'),
        ('FONTSIZE', (0,1), (-1,-1), 9),
        ('ROWBACKGROUNDS', (0,1), (-1,-1), [colors.HexColor('#eaf4fb'), colors.white]),
        ('GRID', (0,0), (-1,-1), 0.4, colors.HexColor('#aed6f1')),
        ('TOPPADDING', (0,0), (-1,-1), 5),
        ('BOTTOMPADDING', (0,0), (-1,-1), 5),
        ('LEFTPADDING', (0,0), (-1,-1), 6),
    ]))
    return t

# ═════════════════════════════════════════════════════════════════════════════
# BUILD CONTENT
# ═════════════════════════════════════════════════════════════════════════════
story = []

# ── COVER PAGE ────────────────────────────────────────────────────────────────
def cover_page(canvas, doc):
    canvas.saveState()
    # Background gradient simulation
    canvas.setFillColor(colors.HexColor('#1a5276'))
    canvas.rect(0, 0, 21*cm, 29.7*cm, fill=1, stroke=0)
    canvas.setFillColor(colors.HexColor('#154360'))
    canvas.rect(0, 0, 21*cm, 10*cm, fill=1, stroke=0)
    # Decorative circles
    canvas.setFillColor(colors.HexColor('#2e86c1'))
    canvas.setFillAlpha(0.3)
    canvas.circle(18*cm, 26*cm, 4*cm, fill=1, stroke=0)
    canvas.circle(3*cm, 5*cm, 3*cm, fill=1, stroke=0)
    canvas.setFillAlpha(1)
    # Title
    canvas.setFillColor(colors.white)
    canvas.setFont('Helvetica-Bold', 32)
    canvas.drawCentredString(10.5*cm, 22*cm, 'Community Health')
    canvas.drawCentredString(10.5*cm, 18.5*cm, 'Nursing - I')
    canvas.setFont('Helvetica-Bold', 16)
    canvas.setFillColor(colors.HexColor('#aed6f1'))
    canvas.drawCentredString(10.5*cm, 17*cm, 'Complete Study Guide')
    canvas.setFont('Helvetica', 13)
    canvas.setFillColor(colors.HexColor('#d5e8d4'))
    canvas.drawCentredString(10.5*cm, 15.5*cm, 'B.Sc Nursing | 5th Semester | INC Syllabus 2021')
    canvas.drawCentredString(10.5*cm, 14.5*cm, 'All 11 Units | 100 Theory Hours')
    # Divider
    canvas.setStrokeColor(colors.HexColor('#aed6f1'))
    canvas.setLineWidth(1)
    canvas.line(3*cm, 13.8*cm, 18*cm, 13.8*cm)
    # Info
    canvas.setFont('Helvetica', 11)
    canvas.setFillColor(colors.white)
    canvas.drawCentredString(10.5*cm, 13*cm, 'Prepared: July 2026  |  Exam Target: Late July / August 2026')
    canvas.setFont('Helvetica-Bold', 12)
    canvas.setFillColor(colors.HexColor('#f9e79f'))
    canvas.drawCentredString(10.5*cm, 11.5*cm, '★  Park\'s Preventive & Social Medicine  ★')
    canvas.drawCentredString(10.5*cm, 10.5*cm, '★  INC Official Curriculum  ★')
    canvas.restoreState()

# ── TABLE OF CONTENTS ─────────────────────────────────────────────────────────
story.append(Spacer(1, 1.5*cm))
story.append(Paragraph('<b>TABLE OF CONTENTS</b>', ParagraphStyle('toc_title', fontSize=18,
    fontName='Helvetica-Bold', textColor=colors.HexColor('#1a5276'), alignment=TA_CENTER, spaceAfter=12)))
story.append(hr())
story.append(sp())

toc_data = [
    ['Unit', 'Topic', 'Hours'],
    ['1', 'Concepts of Community Health & Community Health Nursing', '4 hrs'],
    ['2', 'Health Care Planning & Organization of Health Care', '8 hrs'],
    ['3', 'Environmental Science, Environmental Health & Sanitation', '15 hrs'],
    ['4', 'Nutrition Assessment & Nutrition Education', '7 hrs'],
    ['5', 'Communication Management & Health Education', '6 hrs'],
    ['6', 'Community Health Nursing Approaches, Roles & Responsibilities', '7 hrs'],
    ['7', 'Assisting Individuals & Families to Promote & Maintain Health', '10 hrs'],
    ['8', 'Introduction to Epidemiology – Approaches & Processes', '10 hrs'],
    ['9', 'Communicable Diseases & National Health Programs', '15 hrs'],
    ['10', 'Non-Communicable Diseases & National Health Programs (NCD)', '15 hrs'],
    ['11', 'School Health Services', '3 hrs'],
    ['', 'TOTAL THEORY HOURS', '100 hrs'],
]
story.append(make_table(toc_data[0], toc_data[1:], [1.5*cm, 13*cm, 3.5*cm]))
story.append(sp(2))
story.append(kp('High Priority Units (Most Exam Questions): Units 3, 8, 9, 10 — each worth 15 hrs of study!'))
story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════════
# UNIT 1
# ═══════════════════════════════════════════════════════════════════════════════
story.append(unit_title_para('UNIT 1 — Concepts of Community Health & Community Health Nursing  (4 hrs)'))
story.append(sp())

story.append(sec('1.1 Key Definitions'))
story.append(make_table(
    ['Term', 'Definition'],
    [
        ['Public Health', 'The science and art of preventing disease, prolonging life, and promoting health through organized community effort (Winslow, 1920)'],
        ['Community Health', 'Health of a community as a whole; focuses on population-level health rather than individual patients'],
        ['Community Health Nursing', 'A synthesis of nursing practice and public health applied to promoting and preserving the health of populations (ANA)'],
        ['Health', 'A state of complete physical, mental and social well-being, not merely absence of disease (WHO, 1948)'],
        ['Primary Health Care (PHC)', 'Essential health care made universally accessible to individuals and families at a cost the community can afford (Alma-Ata, 1978)'],
    ],
    [4*cm, 14*cm]
))
story.append(sp())

story.append(sec('1.2 Dimensions of Health'))
dims = [
    ['Physical', 'Proper functioning of body systems, absence of disease'],
    ['Mental', 'Ability to think clearly, cope with stress, emotional balance'],
    ['Social', 'Ability to interact with others and fulfill social roles'],
    ['Spiritual', 'Sense of purpose, moral values, inner peace'],
    ['Emotional', 'Ability to express feelings appropriately'],
    ['Vocational', 'Ability to perform one\'s work effectively'],
]
story.append(make_table(['Dimension', 'Description'], dims, [4*cm, 14*cm]))
story.append(sp())

story.append(sec('1.3 Determinants of Health'))
story.append(p('Health is influenced by multiple factors categorized as:'))
story.append(bp(B('Biological factors:') + ' Age, sex, genetic makeup, immunity'))
story.append(bp(B('Behavioural/Lifestyle factors:') + ' Diet, physical activity, smoking, alcohol'))
story.append(bp(B('Socioeconomic factors:') + ' Income, education, employment, poverty'))
story.append(bp(B('Environmental factors:') + ' Safe water, sanitation, air quality, housing'))
story.append(bp(B('Health services:') + ' Availability, accessibility, quality of health care'))
story.append(sp())

story.append(sec('1.4 Natural History of Disease'))
story.append(p('Disease progresses through predictable stages:'))
ndh_data = [
    ['Stage', 'Description', 'Level of Prevention'],
    ['Susceptibility', 'Host, agent, environment factors present but no disease yet', 'Primary Prevention'],
    ['Pre-symptomatic', 'Pathological changes occur but no symptoms visible', 'Primary/Secondary'],
    ['Clinical Disease', 'Signs and symptoms appear', 'Secondary Prevention'],
    ['Disability/Death', 'Advanced disease with complications', 'Tertiary Prevention'],
]
story.append(make_table(ndh_data[0], ndh_data[1:], [4*cm, 9*cm, 5*cm]))
story.append(sp())

story.append(sec('1.5 Levels of Prevention'))
prev_data = [
    ['Level', 'Goal', 'Actions', 'Examples'],
    ['Primary', 'Prevent disease before it occurs', 'Health promotion, specific protection', 'Immunization, health education, proper nutrition, condom use'],
    ['Secondary', 'Early detection and prompt treatment', 'Early diagnosis, treatment', 'Screening camps, Pap smear, PPD test for TB, mammography'],
    ['Tertiary', 'Reduce disability, restore function', 'Rehabilitation, disability limitation', 'Physiotherapy, prosthetics, vocational rehab, self-help groups'],
]
story.append(make_table(prev_data[0], prev_data[1:], [3*cm, 4*cm, 4.5*cm, 6.5*cm]))
story.append(sp())
story.append(kp('EXAM TIP: Always give examples for each level of prevention. Leavell & Clark model is the standard reference.'))
story.append(sp())
story.append(sec('1.6 Health Problems of India'))
story.append(bp('Communicable diseases: TB, Malaria, HIV, Dengue, Filariasis'))
story.append(bp('Non-communicable diseases: Diabetes, Hypertension, Cancer, CVD'))
story.append(bp('Nutritional problems: PEM, Anaemia, Vitamin A deficiency, Iodine deficiency'))
story.append(bp('Maternal & child health issues: High MMR, IMR, malnutrition'))
story.append(bp('Mental health: Increasing burden of depression, suicide'))
story.append(bp('Environmental issues: Pollution, unsafe water, poor sanitation'))
story.append(kp('India\'s current MMR ≈ 97/100,000 live births | IMR ≈ 28/1000 live births (2020 data)'))
story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════════
# UNIT 2
# ═══════════════════════════════════════════════════════════════════════════════
story.append(unit_title_para('UNIT 2 — Health Care Planning & Organization of Health Care  (8 hrs)'))
story.append(sp())

story.append(sec('2.1 Health Planning'))
story.append(p('Health planning is the process of defining community health problems, identifying needs and resources, and establishing priorities to provide services that address those needs.'))
story.append(bp(B('Steps in Health Planning:') + ' Assessment → Diagnosis → Planning → Implementation → Evaluation'))
story.append(sp())

story.append(sec('2.2 Health Care Delivery System in India'))
sub_centre = [
    ['Level', 'Facility', 'Population Served', 'Staff'],
    ['Sub-Centre (SC)', 'First contact point', 'Plain: 5000 | Hilly: 3000', '1 ANM + 1 MPW (Male)'],
    ['Primary Health Centre (PHC)', 'Referral unit for 6 SCs', 'Plain: 30,000 | Hilly: 20,000', '1 Medical Officer + 14 paramedical staff'],
    ['Community Health Centre (CHC)', 'Referral for 4 PHCs', 'Plain: 1,20,000 | Hilly: 80,000', '4 specialists + 21 paramedical staff (IPHS norms)'],
    ['District Hospital', 'Apex referral in district', '1 per district', 'Specialists in all departments'],
]
story.append(make_table(sub_centre[0], sub_centre[1:], [4*cm, 4cm, 5*cm, 5*cm]))
story.append(sp())
story.append(kp('EXAM FREQUENTLY ASKED: Population norms for SC, PHC, CHC — memorize these numbers!'))
story.append(sp())

story.append(sec('2.3 National Health Mission (NHM)'))
story.append(bp(B('Launched:') + ' 2005 (NRHM) → expanded to NHM in 2013 (includes NUHM)'))
story.append(bp(B('Goal:') + ' Attain highest possible level of health for all, especially rural and vulnerable populations'))
story.append(bp(B('Components:') + ' RMNCH+A (Reproductive, Maternal, Newborn, Child, Adolescent Health + Nutrition)'))
story.append(bp(B('Key Features:') + ' ASHA workers, Janani Suraksha Yojana (JSY), Janani Shishu Suraksha Karyakram (JSSK), Village Health & Sanitation Committees'))
story.append(sp())

story.append(sec('2.4 Sustainable Development Goals (SDGs)'))
story.append(p('SDGs replaced MDGs in 2015. India is committed to achieving all 17 SDGs by 2030.'))
story.append(p(B('Health-related SDGs:')))
story.append(bp('SDG 1 — No Poverty'))
story.append(bp('SDG 2 — Zero Hunger'))
story.append(bp('SDG 3 — Good Health & Well-Being (Most important for nurses!)'))
story.append(bp('SDG 6 — Clean Water & Sanitation'))
story.append(bp('SDG 13 — Climate Action'))
story.append(sp())
story.append(p(B('SDG 3 targets include:') + ' End AIDS, TB, Malaria; reduce MMR to < 70/lakh; end preventable neonatal deaths; achieve UHC (Universal Health Coverage)'))
story.append(sp())

story.append(sec('2.5 Primary Health Care (PHC) — Alma-Ata Declaration 1978'))
story.append(bp(B('Theme:') + ' "Health for All by 2000 AD"'))
story.append(bp(B('8 Elements of PHC (MENACESH):') + ' Maternal & Child Health, Education, Nutrition, Anti-epidemic measures, Community participation, Essential drugs, Safe water & Sanitation, Treatment of common diseases'))
story.append(bp(B('Principles:') + ' Equitable distribution, Community participation, Intersectoral coordination, Appropriate technology'))
story.append(kp('Comprehensive Primary Health Care (CPHC) under Ayushman Bharat — 1.5 lakh Health & Wellness Centres operational'))
story.append(sp())

story.append(sec('2.6 Health Policies & Important Committees'))
comm_data = [
    ['Committee/Policy', 'Year', 'Key Recommendation'],
    ['Bhore Committee', '1946', 'Short-term/long-term plans for health; PHC concept introduced; 3-tier system'],
    ['Mudaliar Committee', '1962', 'Strengthen existing PHCs before creating new ones; quality over quantity'],
    ['Chadha Committee', '1963', 'Malaria eradication programme'],
    ['Shrivastava Committee', '1975', 'Community health workers (CHWs) at village level'],
    ['National Health Policy', '1983', 'Health for All by 2000 AD; primary health care approach'],
    ['National Health Policy', '2002', 'Increase public spending on health; ASHA concept'],
    ['National Health Policy', '2017', 'Universal Health Coverage; Health & Wellness Centres; 2.5% GDP on health'],
]
story.append(make_table(comm_data[0], comm_data[1:], [5*cm, 2.5*cm, 10.5*cm]))
story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════════
# UNIT 3
# ═══════════════════════════════════════════════════════════════════════════════
story.append(unit_title_para('UNIT 3 — Environmental Science, Environmental Health & Sanitation  (15 hrs)'))
story.append(sp())
story.append(kp('This is the LARGEST unit (15 hrs). Expect 1-2 long questions in exam. Master all subtopics!'))
story.append(sp())

story.append(sec('3.1 Water Supply & Purification'))
story.append(p(B('Safe Water Criteria (WHO):') + ' No harmful microorganisms, no toxic substances, acceptable taste/odour/colour, pH 6.5–8.5'))
story.append(sp())
story.append(p(B('Sources of Water:')))
story.append(bp('Surface water: Rivers, lakes, ponds — high contamination risk'))
story.append(bp('Underground water: Wells, springs, borewells — generally safer'))
story.append(bp('Rain water: Purest natural water'))
story.append(sp())
story.append(p(B('Steps in Municipal Water Purification:')))
story.append(make_table(
    ['Step', 'Process', 'Purpose'],
    [
        ['1. Sedimentation', 'Water stored in large tanks/reservoirs', 'Large particles settle by gravity'],
        ['2. Coagulation', 'Alum (potassium aluminium sulphate) added', 'Fine particles clump together and settle'],
        ['3. Filtration', 'Slow sand filter or rapid sand filter', 'Remove remaining suspended particles & bacteria'],
        ['4. Disinfection', 'Chlorination (0.5 ppm residual chlorine)', 'Kill remaining pathogens'],
    ],
    [3.5*cm, 7*cm, 7.5*cm]
))
story.append(sp())
story.append(kp('Residual chlorine in water at point of use = 0.2 mg/L (0.2 ppm) minimum'))
story.append(sp())

story.append(p(B('Household Water Purification Methods:')))
story.append(bp('Boiling — most effective; kills all pathogens'))
story.append(bp('Chlorination — bleaching powder (1% solution); potassium permanganate'))
story.append(bp('Filtration — candle filter, Pasteur-Chamberland filter'))
story.append(bp('Solar disinfection (SODIS) — UV rays from sunlight'))
story.append(sp())

story.append(sec('3.2 Sanitation & Excreta Disposal'))
story.append(p('Proper excreta disposal prevents faeco-oral diseases like typhoid, cholera, dysentery, polio.'))
story.append(p(B('Types of Latrines:')))
story.append(bp(B('Pit latrine:') + ' Simple dug pit; cheapest; not water-seal'))
story.append(bp(B('VIP latrine (Ventilated Improved Pit):') + ' Fly-free; ventilation pipe with mesh cover'))
story.append(bp(B('Water seal latrine (Pour flush):') + ' Most common in India; prevents odour and flies'))
story.append(bp(B('Septic tank:') + ' Underground tank + soak pit; safe for individual homes'))
story.append(sp())
story.append(kp('Swachh Bharat Mission (SBM) — 2014: Aim to make India Open Defecation Free (ODF). India declared ODF in 2019.'))
story.append(sp())

story.append(sec('3.3 Waste Disposal'))
story.append(p(B('Solid Waste Management Methods:')))
story.append(make_table(
    ['Method', 'Description'],
    [
        ['Sanitary Landfill', 'Waste deposited in low-lying area, covered with earth daily; most common method'],
        ['Composting', 'Biological decomposition of organic waste; produces manure'],
        ['Incineration', 'Burning at high temperature; reduces volume; generates energy; used for biomedical waste'],
        ['Biogas', 'Anaerobic digestion of organic waste; produces methane gas'],
        ['Recycling', 'Reprocessing of waste materials'],
    ],
    [4.5*cm, 13.5*cm]
))
story.append(sp())

story.append(sec('3.4 Biomedical Waste Management'))
story.append(p('Governed by Biomedical Waste Management Rules, 2016 (amended 2019)'))
story.append(make_table(
    ['Category (Colour)', 'Type of Waste', 'Disposal Method'],
    [
        ['Yellow bag', 'Anatomical waste, soiled bandages, cytotoxic drugs', 'Incineration or deep burial'],
        ['Red bag', 'Recyclable waste — IV sets, syringes (without needle), catheters', 'Autoclaving then recycling'],
        ['White/Translucent box', 'Sharps — needles, blades, lancets', 'Sharp pit or encapsulation'],
        ['Blue bag', 'Glass waste — ampoules, vials', 'Autoclaving then recycling'],
    ],
    [4*cm, 7*cm, 7*cm]
))
story.append(sp())
story.append(kp('EXAM TIP: Yellow = incinerate. Red = autoclave + recycle. White = sharps pit. Blue = glass.'))
story.append(sp())

story.append(sec('3.5 Air Pollution'))
story.append(p(B('Major Air Pollutants & Health Effects:')))
story.append(make_table(
    ['Pollutant', 'Source', 'Health Effect'],
    [
        ['Carbon monoxide (CO)', 'Vehicle exhaust, incomplete combustion', 'Binds Hb, causes hypoxia, death'],
        ['Sulphur dioxide (SO₂)', 'Burning coal, industries', 'Respiratory irritation, acid rain'],
        ['Nitrogen oxides (NOx)', 'Vehicle exhaust, power plants', 'Smog, respiratory disease'],
        ['Particulate Matter (PM2.5/PM10)', 'Dust, smoke, construction', 'Deep lung penetration, COPD, cancer'],
        ['Lead', 'Old paints, leaded fuel', 'Neurotoxicity, esp. in children'],
        ['Ozone (O₃)', 'Photochemical smog', 'Eye irritation, respiratory damage'],
    ],
    [4*cm, 5.5*cm, 8.5*cm]
))
story.append(sp())

story.append(sec('3.6 Housing & Health'))
story.append(bp(B('Healthy housing criteria:') + ' Adequate space (9 sq m/person), ventilation, lighting, safe water, sanitation, free from pests'))
story.append(bp(B('Housing density:') + ' Overcrowding → spread of TB, meningitis, influenza'))
story.append(bp(B('Sick Building Syndrome (SBS):') + ' Symptoms from poor ventilation, mold, chemicals in buildings'))
story.append(sp())

story.append(sec('3.7 Food Hygiene & Safety'))
story.append(bp('Proper storage, preparation, and handling of food prevents foodborne illnesses'))
story.append(bp(B('Common foodborne illnesses:') + ' Salmonellosis, Staphylococcal food poisoning, Botulism, E. coli infection'))
story.append(bp(B('Temperature danger zone:') + ' 5°C – 60°C (bacteria multiply rapidly)'))
story.append(bp(B('Safe food temperature:') + ' Cook to >70°C; refrigerate at <5°C'))
story.append(sp())

story.append(sec('3.8 Vector Control'))
story.append(make_table(
    ['Vector', 'Disease Transmitted', 'Control Method'],
    [
        ['Mosquito (Anopheles)', 'Malaria', 'Drain stagnant water, insecticides, bed nets, DDT (indoor residual spraying)'],
        ['Mosquito (Aedes aegypti)', 'Dengue, Chikungunya, Zika', 'Eliminate breeding sites, fogging, larvicidal oil'],
        ['Mosquito (Culex)', 'Filariasis, Japanese Encephalitis', 'Larviciding, biological control (Gambusia fish)'],
        ['Housefly', 'Typhoid, Cholera, Dysentery', 'Proper waste disposal, fly traps, insecticides'],
        ['Rat', 'Plague, Leptospirosis', 'Rodenticides, rat-proofing, traps'],
        ['Sandfly', 'Kala-azar (Leishmaniasis)', 'DDT spraying, bed nets'],
    ],
    [3.5*cm, 5*cm, 9.5*cm]
))
story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════════
# UNIT 4
# ═══════════════════════════════════════════════════════════════════════════════
story.append(unit_title_para('UNIT 4 — Nutrition Assessment & Nutrition Education  (7 hrs)'))
story.append(sp())

story.append(sec('4.1 Nutritional Assessment Methods (ABCD)'))
story.append(make_table(
    ['Method', 'Description', 'Examples'],
    [
        ['A — Anthropometric', 'Measurement of body size & composition', 'Weight, Height, BMI, MUAC, Skinfold thickness, Head circumference'],
        ['B — Biochemical', 'Lab tests for nutrient levels', 'Serum albumin, Hb level, serum ferritin, urine tests'],
        ['C — Clinical', 'Physical signs of nutritional status', 'Hair, skin, eyes, mouth, nails examination'],
        ['D — Dietary', 'Food intake assessment', '24-hr recall, food frequency questionnaire, diet history'],
    ],
    [2.5*cm, 6*cm, 9.5*cm]
))
story.append(sp())

story.append(sec('4.2 Malnutrition — Protein Energy Malnutrition (PEM)'))
story.append(make_table(
    ['Type', 'Features', 'Age Group'],
    [
        ['Marasmus', 'Severe wasting; low calories AND protein; "old man face"; no oedema; irritable', '< 1 year'],
        ['Kwashiorkor', 'Adequate calories but protein deficient; oedema (pitting); pot belly; depigmented hair; "flaky paint" skin; apathetic', '1–3 years'],
        ['Marasmic Kwashiorkor', 'Features of both; most severe form', 'Any age'],
    ],
    [4*cm, 10*cm, 4*cm]
))
story.append(sp())
story.append(kp('Wellcome Classification: Weight for age < 60% = Marasmus (no oedema) or Marasmic-Kwashiorkor (with oedema); 60-80% = Underweight (no oedema) or Kwashiorkor (with oedema)'))
story.append(sp())

story.append(sec('4.3 Common Nutritional Deficiency Diseases'))
story.append(make_table(
    ['Nutrient', 'Deficiency Disease', 'Key Features', 'Prevention/Treatment'],
    [
        ['Iron', 'Iron Deficiency Anaemia', 'Pallor, fatigue, koilonychia (spoon nails), pica', 'Iron + Folic Acid (IFA) tablets; green leafy vegetables'],
        ['Vitamin A', 'Xerophthalmia', 'Night blindness → Bitot\'s spots → corneal ulcer → keratomalacia → blindness', 'Vitamin A supplementation (NVS program)'],
        ['Iodine', 'Goitre, Cretinism', 'Enlarged thyroid, hypothyroidism; cretinism in child of iodine-deficient mother', 'Iodized salt'],
        ['Vitamin D', 'Rickets (child), Osteomalacia (adult)', 'Bow legs, Harrison\'s sulcus, delayed teething', 'Sunlight, Vitamin D supplements'],
        ['Vitamin C', 'Scurvy', 'Bleeding gums, perifollicular haemorrhage, poor wound healing', 'Fresh fruits and vegetables'],
        ['Vitamin B1 (Thiamine)', 'Beriberi', 'Wet (cardiac), Dry (neurological), Infantile', 'Thiamine supplements; avoid polished rice'],
        ['Vitamin B3 (Niacin)', 'Pellagra', '3Ds: Dermatitis, Diarrhoea, Dementia (+Death = 4th D)', 'Nicotinic acid; eggs, groundnuts'],
        ['Folic Acid', 'Megaloblastic Anaemia; Neural Tube Defects', 'Macrocytic anaemia; NTD in fetus', 'Folic acid supplementation pre-conception'],
    ],
    [3*cm, 4*cm, 6*cm, 5*cm]
))
story.append(sp())

story.append(sec('4.4 ICDS — Integrated Child Development Services'))
story.append(bp(B('Started:') + ' 1975 (India\'s oldest nutrition programme)'))
story.append(bp(B('Target group:') + ' Children < 6 years, pregnant & lactating mothers, adolescent girls'))
story.append(bp(B('Services (6):') + ' Supplementary nutrition, Immunization, Health check-up, Referral, NFE (Non-formal education), Nutrition & health education'))
story.append(bp(B('Delivery point:') + ' Anganwadi Centre (AWC); run by Anganwadi Worker (AWW)'))
story.append(kp('ICDS targets — Reduce IMR, MMR, malnutrition, school dropout rates'))
story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════════
# UNIT 5
# ═══════════════════════════════════════════════════════════════════════════════
story.append(unit_title_para('UNIT 5 — Communication Management & Health Education  (6 hrs)'))
story.append(sp())

story.append(sec('5.1 Communication — Definitions & Process'))
story.append(p(B('Communication:') + ' Process of transmitting information, ideas, feelings from sender to receiver.'))
story.append(p(B('Elements of Communication:')))
story.append(bp('Sender (Source) → Message → Channel/Medium → Receiver → Feedback → Noise'))
story.append(sp())
story.append(make_table(
    ['Type', 'Description', 'Example'],
    [
        ['Verbal', 'Use of words, spoken or written', 'Counseling, health talks, pamphlets'],
        ['Non-verbal', 'Body language, gestures, facial expression', 'Nodding, eye contact, touch'],
        ['Visual', 'Images, charts, demonstrations', 'Posters, flip charts, videos'],
        ['Mass communication', 'Reaching large populations', 'TV, radio, social media, newspaper'],
    ],
    [3.5*cm, 7*cm, 7.5*cm]
))
story.append(sp())

story.append(sec('5.2 Health Education'))
story.append(p(B('Definition:') + ' Any combination of learning experiences designed to help individuals and communities improve their health by increasing knowledge or influencing attitudes (WHO).'))
story.append(sp())
story.append(p(B('Principles of Health Education:')))
story.append(bp('Interest — Based on felt needs of the community'))
story.append(bp('Participation — Active involvement of community'))
story.append(bp('Known to unknown — Build on existing knowledge'))
story.append(bp('Comprehension — Simple language'))
story.append(bp('Reinforcement — Repeat key messages'))
story.append(sp())

story.append(sec('5.3 Health Education Methods'))
story.append(make_table(
    ['Category', 'Methods'],
    [
        ['Individual methods', 'Health counselling, home visit, clinical consultation'],
        ['Group methods', 'Health talk, group discussion, panel discussion, role play, demonstration, symposium, workshop, seminar, conference'],
        ['Mass methods', 'Posters, pamphlets, newspapers, radio, TV, social media, exhibitions, film shows'],
    ],
    [4.5*cm, 13.5*cm]
))
story.append(sp())

story.append(sec('5.4 IEC & BCC'))
story.append(p(B('IEC (Information, Education, Communication):') + ' Traditional approach; one-way; provides information'))
story.append(p(B('BCC (Behaviour Change Communication):') + ' Modern approach; two-way; aims to change behaviour, not just knowledge'))
story.append(bp('BCC uses: Social marketing, community mobilization, interpersonal communication, folk media'))
story.append(sp())

story.append(sec('5.5 Health Talk — Steps'))
story.append(bp('1. Introduction — greet, build rapport'))
story.append(bp('2. State objective/purpose'))
story.append(bp('3. Present content in simple language'))
story.append(bp('4. Use audiovisual aids'))
story.append(bp('5. Question and answer session'))
story.append(bp('6. Summary and conclusion'))
story.append(bp('7. Evaluate — feedback from audience'))
story.append(kp('EXAM TIP: Health talk is the most common community nursing intervention — know its steps thoroughly!'))
story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════════
# UNIT 6
# ═══════════════════════════════════════════════════════════════════════════════
story.append(unit_title_para('UNIT 6 — Community Health Nursing: Approaches, Roles & Responsibilities  (7 hrs)'))
story.append(sp())

story.append(sec('6.1 Community Health Nursing Approaches'))
story.append(make_table(
    ['Approach', 'Description'],
    [
        ['Promotive', 'Promoting positive health — health education, proper nutrition, exercise, mental well-being'],
        ['Preventive', 'Preventing disease — immunization, environmental sanitation, safe water, early detection'],
        ['Curative', 'Treating the sick — providing basic treatment, first aid, referral services'],
        ['Rehabilitative', 'Restoring function — physiotherapy referral, counselling, helping disabled lead productive lives'],
    ],
    [3.5*cm, 14.5*cm]
))
story.append(sp())

story.append(sec('6.2 Roles & Responsibilities of Community Health Nurse'))
roles = [
    ['Role', 'Activities'],
    ['Care Provider', 'Nursing care to sick, injured, disabled individuals and families at home/community'],
    ['Educator', 'Health teaching to individuals, families, groups; conduct health talks, demonstrations'],
    ['Counsellor', 'Guide clients in decision-making; provide emotional support'],
    ['Advocate', 'Speak up for patient rights; help access services'],
    ['Case Finder', 'Active case detection; screening for diseases in community'],
    ['Coordinator', 'Coordinate with other health team members and agencies'],
    ['Researcher', 'Participate in research; apply evidence-based practice'],
    ['Change Agent', 'Initiate changes in community health practices and behaviours'],
    ['Supervisor', 'Supervise ANMs, ASHAs, AWWs; monitor program implementation'],
    ['Administrator/Manager', 'Manage PHC/CHC activities; health records, reporting'],
]
story.append(make_table(roles[0], roles[1:], [4*cm, 14*cm]))
story.append(sp())

story.append(sec('6.3 Home Visit'))
story.append(p(B('Purpose:') + ' To give nursing care, health education, assessment, and follow-up in the client\'s own home environment.'))
story.append(p(B('Purposes of Home Visit:')))
story.append(bp('Health assessment of family members'))
story.append(bp('Provide skilled nursing care to the sick'))
story.append(bp('Health education and demonstration'))
story.append(bp('Collect data for records'))
story.append(bp('Detect early signs of disease'))
story.append(bp('Follow-up of referred cases'))
story.append(sp())
story.append(p(B('Steps in Home Visit:')))
story.append(bp('1. Preparation — review records, prepare bag, plan visit'))
story.append(bp('2. Introduction — greet family, establish rapport'))
story.append(bp('3. Assessment — observe home, interview family members'))
story.append(bp('4. Care provision — nursing procedures, treatments'))
story.append(bp('5. Health education — relevant health teaching'))
story.append(bp('6. Recording — document findings and care given'))
story.append(bp('7. Evaluation — assess outcome of visit'))
story.append(sp())
story.append(kp('The Public Health Bag is essential for home visits — contains stethoscope, BP cuff, thermometer, dressings, medications, educational materials'))
story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════════
# UNIT 7
# ═══════════════════════════════════════════════════════════════════════════════
story.append(unit_title_para('UNIT 7 — Assisting Individuals & Families to Promote & Maintain Health  (10 hrs)'))
story.append(sp())

story.append(sec('7.1 Family Health'))
story.append(p(B('Family:') + ' A group of people related by blood, marriage or adoption, living together and sharing resources.'))
story.append(p(B('Family Types:')))
story.append(bp(B('Nuclear family:') + ' Husband, wife, and unmarried children'))
story.append(bp(B('Joint/Extended family:') + ' Multiple generations living together'))
story.append(bp(B('Single parent family:') + ' One parent with children'))
story.append(bp(B('Reconstituted family:') + ' Remarried couples with children from previous marriages'))
story.append(sp())

story.append(sec('7.2 Family Assessment'))
story.append(p('Comprehensive assessment includes:'))
story.append(bp(B('Demographic data:') + ' Names, ages, relationships, occupation, religion'))
story.append(bp(B('Housing & environment:') + ' Type of house, sanitation, water supply, ventilation'))
story.append(bp(B('Health history:') + ' Past illnesses, hospitalizations, immunization status'))
story.append(bp(B('Nutritional assessment:') + ' Dietary habits, malnutrition indicators'))
story.append(bp(B('Psychosocial:') + ' Family dynamics, coping, economic status'))
story.append(bp(B('Health-seeking behaviour:') + ' Use of health services, traditional practices'))
story.append(sp())

story.append(sec('7.3 Family Life Cycle (Duvall\'s 8 Stages)'))
story.append(make_table(
    ['Stage', 'Description'],
    [
        ['1. Beginning family', 'Newly married couple without children'],
        ['2. Early childbearing', 'Oldest child < 30 months'],
        ['3. Pre-school age family', 'Oldest child 2.5–6 years'],
        ['4. School-age family', 'Oldest child 6–13 years'],
        ['5. Teenage family', 'Oldest child 13–20 years'],
        ['6. Launching centre family', 'First child leaves home to last child leaving'],
        ['7. Middle-age family', 'Empty nest to retirement'],
        ['8. Aging family', 'Retirement to death of both spouses'],
    ],
    [5*cm, 13*cm]
))
story.append(sp())

story.append(sec('7.4 Maternal & Child Health (MCH) Services'))
story.append(p(B('Reproductive, Maternal, Newborn, Child & Adolescent Health (RMNCH+A):')))
story.append(bp(B('Antenatal Care:') + ' Minimum 4 ANC visits (WHO recommends 8); Iron Folic Acid (IFA), TT vaccination, blood pressure monitoring'))
story.append(bp(B('Janani Suraksha Yojana (JSY):') + ' Cash incentive for institutional delivery; reduces MMR'))
story.append(bp(B('Janani Shishu Suraksha Karyakram (JSSK):') + ' Free delivery, free C-section, free drugs, free transport for pregnant women'))
story.append(bp(B('Postnatal Care:') + ' Check for bleeding, infection, breastfeeding support; visits at 24 hrs, 48 hrs, 7 days, 28 days'))
story.append(sp())

story.append(sec('7.5 Immunization Schedule (UIP)'))
story.append(make_table(
    ['Age', 'Vaccines Given'],
    [
        ['Birth', 'BCG, OPV-0, Hepatitis B-1'],
        ['6 weeks', 'OPV-1, IPV-1, Pentavalent-1 (DPT+HepB+Hib), Rotavirus-1, PCV-1'],
        ['10 weeks', 'OPV-2, Pentavalent-2, Rotavirus-2, PCV-2'],
        ['14 weeks', 'OPV-3, IPV-2, Pentavalent-3, Rotavirus-3, PCV-3'],
        ['9–12 months', 'MR-1 (Measles-Rubella), JE-1 (endemic areas)'],
        ['16–24 months', 'MR-2, OPV Booster, DPT Booster-1, JE-2'],
        ['5–6 years', 'DPT Booster-2'],
        ['10–16 years', 'TT'],
        ['Pregnant women', 'TT-1 (early pregnancy), TT-2 (4 weeks after), TT Booster (if vaccinated in last 3 yrs)'],
    ],
    [4*cm, 14*cm]
))
story.append(sp())
story.append(kp('Universal Immunization Programme (UIP) — India; Mission Indradhanush launched 2015 to cover left-out children'))
story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════════
# UNIT 8
# ═══════════════════════════════════════════════════════════════════════════════
story.append(unit_title_para('UNIT 8 — Introduction to Epidemiology — Approaches & Processes  (10 hrs)'))
story.append(sp())
story.append(kp('Epidemiology carries numerical questions in exams — practice ALL formulas!'))
story.append(sp())

story.append(sec('8.1 Basic Definitions'))
story.append(p(B('Epidemiology:') + ' Study of distribution and determinants of health-related states or events in specified populations, and application to control of health problems (John Last, 2001)'))
story.append(p(B('Epidemic:') + ' Occurrence of disease in a community above normally expected level'))
story.append(p(B('Pandemic:') + ' Worldwide epidemic (e.g., COVID-19, Influenza)'))
story.append(p(B('Endemic:') + ' Disease constantly present in a community at a predictable rate (e.g., Malaria in India)'))
story.append(p(B('Sporadic:') + ' Disease occurs occasionally and irregularly'))
story.append(sp())

story.append(sec('8.2 Epidemiological Triad (Epidemiological Triangle)'))
story.append(p('Disease results from interaction of three factors:'))
story.append(bp(B('Host:') + ' Person affected — age, sex, genetic factors, immunity, nutritional status, occupation'))
story.append(bp(B('Agent:') + ' Causative factor — biological (bacteria, virus), chemical (poison), physical (radiation), nutritional deficiency'))
story.append(bp(B('Environment:') + ' Physical (climate, geography), biological (vectors), social (poverty, overcrowding)'))
story.append(sp())

story.append(sec('8.3 Important Rates & Formulas'))
rates_data = [
    ['Rate/Index', 'Formula', 'Reference Value'],
    ['Birth Rate (CBR)', '(Live births / Mid-year population) × 1000', 'India ≈ 18.7/1000'],
    ['Death Rate (CDR)', '(Deaths / Mid-year population) × 1000', 'India ≈ 6.2/1000'],
    ['Infant Mortality Rate (IMR)', '(Deaths < 1 yr / Live births in same yr) × 1000', 'India ≈ 28/1000'],
    ['Neonatal Mortality Rate', '(Deaths < 28 days / Live births) × 1000', 'India ≈ 20/1000'],
    ['Under-5 Mortality Rate', '(Deaths < 5 yrs / Live births) × 1000', 'India ≈ 34/1000'],
    ['Maternal Mortality Ratio (MMR)', '(Maternal deaths / Live births) × 100,000', 'India ≈ 97/100,000'],
    ['Incidence Rate', '(New cases in period / Population at risk) × 1000', 'Measures new disease'],
    ['Prevalence Rate', '(All existing cases / Total population) × 1000', 'Measures existing disease'],
    ['Case Fatality Rate', '(Deaths from disease / Cases of disease) × 100', 'Disease severity indicator'],
    ['Attack Rate', '(New cases / Population exposed) × 100', 'Used in outbreaks/epidemics'],
    ['Natural Growth Rate', 'CBR − CDR', 'India ≈ 12.5/1000'],
]
story.append(make_table(rates_data[0], rates_data[1:], [5*cm, 8*cm, 5*cm]))
story.append(sp())
story.append(kp('KEY DIFFERENCE: Incidence = NEW cases only. Prevalence = ALL existing cases (new + old). Prevalence = Incidence × Duration of disease'))
story.append(sp())

story.append(sec('8.4 Types of Epidemiological Studies'))
story.append(make_table(
    ['Study Type', 'Description', 'Key Feature'],
    [
        ['Descriptive', 'Describes disease distribution by person, place, time', 'Hypothesis generating; WHO does what, when, where?'],
        ['Analytical — Case-Control', 'Compare cases with controls; look backward', 'Retrospective; OR (Odds Ratio) used; cheaper; for rare diseases'],
        ['Analytical — Cohort', 'Follow exposed vs unexposed groups forward', 'Prospective; RR (Relative Risk) used; expensive; for common diseases'],
        ['Experimental — RCT', 'Randomly assign treatment; gold standard', 'Best evidence; reduces bias'],
        ['Cross-sectional', 'Data collected at one point in time', 'Prevalence study; quick and cheap'],
    ],
    [4*cm, 7*cm, 7*cm]
))
story.append(sp())

story.append(sec('8.5 Disease Surveillance'))
story.append(p(B('Surveillance:') + ' Continuous, systematic collection, analysis, interpretation and dissemination of health data.'))
story.append(bp(B('Passive surveillance:') + ' Routine reporting by health facilities (most common)'))
story.append(bp(B('Active surveillance:') + ' Active search for cases by health workers'))
story.append(bp(B('Sentinel surveillance:') + ' Selected sites monitor specific conditions'))
story.append(bp(B('IDSP (Integrated Disease Surveillance Programme):') + ' India\'s main disease surveillance programme since 2004'))
story.append(sp())
story.append(kp('IDSP uses S, P, L forms: S (Syndromic) — ANMs, ASHAs; P (Presumptive) — Medical officers; L (Laboratory) — Lab data'))
story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════════
# UNIT 9
# ═══════════════════════════════════════════════════════════════════════════════
story.append(unit_title_para('UNIT 9 — Communicable Diseases & National Health Programs  (15 hrs)'))
story.append(sp())
story.append(kp('MOST IMPORTANT UNIT for exams! Know each program: full name, year launched, target, key drugs/vaccines, nurse\'s role'))
story.append(sp())

story.append(sec('9.1 Tuberculosis — NTEP (National Tuberculosis Elimination Programme)'))
story.append(make_table(
    ['Aspect', 'Details'],
    [
        ['Earlier name', 'RNTCP (Revised National TB Control Programme); renamed NTEP in 2020'],
        ['Goal', 'Eliminate TB by 2025 (5 years ahead of global SDG target of 2030)'],
        ['Strategy', 'DOTS (Directly Observed Treatment, Short-course)'],
        ['Diagnosis', 'CBNAAT (cartridge-based nucleic acid amplification test), Xpert MTB/RIF, LPA, culture'],
        ['Treatment (DS-TB)', 'HRZE × 2 months (intensive) → HRE × 4 months (continuation); total 6 months'],
        ['Treatment (DR-TB)', 'BPaL regimen (Bedaquiline, Pretomanid, Linezolid); 6–9 months'],
        ['Nikshay Poshan Yojana', 'Rs 500/month nutritional support to TB patients'],
        ['Notification', 'Mandatory — all TB cases must be notified to NTEP'],
        ['BCG vaccine', 'Given at birth; protects against severe forms of childhood TB'],
        ['Nurse\'s role', 'DOT provider, case finding, contact tracing, treatment adherence, nutritional counselling'],
    ],
    [5*cm, 13*cm]
))
story.append(sp())

story.append(sec('9.2 HIV/AIDS — NACP (National AIDS Control Programme)'))
story.append(make_table(
    ['Aspect', 'Details'],
    [
        ['Current phase', 'NACP-V (2021-2026); earlier NACP-IV (2012-2017)'],
        ['Goal', '90-90-90 target: 90% diagnosed, 90% on ART, 90% virally suppressed'],
        ['Transmission', 'Unprotected sex, contaminated blood/needles, mother-to-child (MTCT)'],
        ['Diagnosis', 'ELISA (screening), Western Blot (confirmatory), Rapid tests'],
        ['Treatment', 'ART (Antiretroviral Therapy) — free through ART centres; TLE regimen (Tenofovir+Lamivudine+Efavirenz) first line'],
        ['PPTCT', 'Prevention of Parent-to-Child Transmission; ART given to HIV+ pregnant women'],
        ['ICTC', 'Integrated Counselling & Testing Centres — free HIV testing with pre/post-test counselling'],
        ['NACO', 'National AIDS Control Organisation — apex body for NACP'],
        ['Nurse\'s role', 'Counselling, non-judgmental care, promoting testing, supporting ART adherence, PPTCT'],
    ],
    [5*cm, 13*cm]
))
story.append(sp())

story.append(sec('9.3 Malaria — NVBDCP (National Vector Borne Disease Control Programme)'))
story.append(make_table(
    ['Aspect', 'Details'],
    [
        ['Parasite', 'Plasmodium falciparum (severe/cerebral malaria) and P. vivax (benign tertian)'],
        ['Vector', 'Female Anopheles mosquito; breeds in clean stagnant water; bites at night'],
        ['Symptoms', 'Cold stage → Hot stage → Sweating stage; rigors, fever, chills; P.falciparum — cerebral malaria, severe anaemia'],
        ['Diagnosis', 'Blood smear (thick and thin film), RDK (Rapid Diagnostic Kit)'],
        ['Treatment P.vivax', 'Chloroquine (3 days) + Primaquine (14 days to clear liver stage)'],
        ['Treatment P.falciparum', 'Artemisinin Combination Therapy (ACT) — Artesunate + SP; Primaquine single dose'],
        ['Prevention', 'Insecticide-treated bed nets (ITN/LLIN), IRS (Indoor Residual Spraying), larval control, personal protection'],
        ['API', 'Annual Parasite Incidence = confirmed malaria cases/1000 population/year'],
    ],
    [5*cm, 13*cm]
))
story.append(sp())

story.append(sec('9.4 Leprosy — NLEP (National Leprosy Eradication Programme)'))
story.append(make_table(
    ['Aspect', 'Details'],
    [
        ['Causative agent', 'Mycobacterium leprae (Hansen\'s bacillus)'],
        ['Types', 'Paucibacillary (PB): 1-5 patches; Multibacillary (MB): >5 patches'],
        ['Treatment (PB)', 'Rifampicin (monthly supervised) + Dapsone (daily); 6 months'],
        ['Treatment (MB)', 'Rifampicin + Dapsone + Clofazimine; 12 months'],
        ['MDT', 'Multi-Drug Therapy — eliminates drug resistance; provided FREE'],
        ['India status', 'Eliminated (< 1 case/10,000 population) at national level in 2005; some pockets remain'],
        ['Nurse\'s role', 'Case detection, MDT administration, prevention of disability (POD), rehabilitation, stigma reduction'],
    ],
    [5*cm, 13*cm]
))
story.append(sp())

story.append(sec('9.5 Dengue & Chikungunya'))
story.append(bp(B('Vector:') + ' Aedes aegypti (day-biting mosquito); breeds in clean stored water'))
story.append(bp(B('Dengue features:') + ' High fever, severe headache, retro-orbital pain, rash, thrombocytopenia, bleeding, "breakbone fever"'))
story.append(bp(B('Dengue Haemorrhagic Fever (DHF):') + ' Severe form with plasma leakage, shock (DSS)'))
story.append(bp(B('Treatment:') + ' No specific antiviral; supportive — IV fluids, paracetamol (NOT NSAIDs/Aspirin), platelet transfusion if needed'))
story.append(bp(B('Prevention:') + ' Eliminate breeding sites; fogging; cover water containers; use repellents'))
story.append(sp())

story.append(sec('9.6 Filariasis (Lymphatic Filariasis) — NVBDCP'))
story.append(bp(B('Causative agent:') + ' Wuchereria bancrofti; transmitted by Culex mosquito'))
story.append(bp(B('Features:') + ' Elephantiasis (lymphoedema), hydrocele, chyluria'))
story.append(bp(B('Treatment:') + ' DEC (Diethylcarbamazine) + Albendazole; annual Mass Drug Administration (MDA)'))
story.append(bp(B('Morbidity management:') + ' Lymphoedema management, hygiene, exercise'))
story.append(sp())

story.append(sec('9.7 National Immunization Schedule Summary'))
story.append(note('Universal Immunization Programme (UIP) covers 12 vaccine-preventable diseases. Mission Indradhanush (2015) intensifies coverage.'))
story.append(make_table(
    ['Disease', 'Vaccine', 'Schedule'],
    [
        ['Tuberculosis', 'BCG', 'Birth'],
        ['Polio', 'OPV + IPV', '0, 6, 10, 14 weeks; boosters'],
        ['Diphtheria, Pertussis, Tetanus', 'DPT (in Pentavalent)', '6, 10, 14 weeks; boosters at 16-24m, 5-6 yr'],
        ['Hepatitis B', 'HepB (in Pentavalent)', '6, 10, 14 weeks'],
        ['Hib', 'Hib (in Pentavalent)', '6, 10, 14 weeks'],
        ['Rotavirus', 'Rotavirus vaccine', '6, 10, 14 weeks'],
        ['Pneumococcal', 'PCV13', '6, 10, 14 weeks; booster 9-12 m'],
        ['Measles-Rubella', 'MR vaccine', '9-12 months; 16-24 months'],
        ['Japanese Encephalitis', 'JE vaccine', '9-12 months; 16-24 months (endemic areas)'],
    ],
    [5*cm, 5*cm, 8*cm]
))
story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════════
# UNIT 10
# ═══════════════════════════════════════════════════════════════════════════════
story.append(unit_title_para('UNIT 10 — Non-Communicable Diseases & National Health Programs (NCD)  (15 hrs)'))
story.append(sp())
story.append(kp('NCDs cause 60-65% of all deaths in India. Diabetes, Hypertension, Cancer, CVD, COPD are the BIG FIVE.'))
story.append(sp())

story.append(sec('10.1 National Programme for Prevention & Control of Cancer, Diabetes, CVD & Stroke (NPCDCS)'))
story.append(make_table(
    ['Aspect', 'Details'],
    [
        ['Launched', '2010 under NHM'],
        ['Target diseases', 'Cancer, Diabetes Mellitus, Cardiovascular diseases, Stroke'],
        ['Aim', 'Prevention, early detection, management of NCDs at community level'],
        ['Population screening', 'Opportunistic screening at Sub-Centre and PHC level for: Oral cancer (visual inspection), Cervical cancer (VIA/VILI), Breast cancer (clinical breast exam), Diabetes (fasting glucose), Hypertension (BP measurement)'],
        ['NCD Clinics', 'Established at district level; provide diagnosis, treatment, follow-up'],
        ['Nurse\'s role', 'Screening, health education, medication adherence counselling, referral, follow-up'],
    ],
    [4.5*cm, 13.5*cm]
))
story.append(sp())

story.append(sec('10.2 Diabetes Mellitus'))
story.append(make_table(
    ['Aspect', 'Details'],
    [
        ['Definition', 'Metabolic disorder characterized by chronic hyperglycaemia resulting from defects in insulin secretion, insulin action, or both'],
        ['Type 1 DM', 'Autoimmune destruction of beta cells; insulin dependent; usually childhood onset'],
        ['Type 2 DM', 'Insulin resistance + relative insulin deficiency; most common (90%); lifestyle related'],
        ['Gestational DM (GDM)', 'Hyperglycaemia during pregnancy; screened at 24-28 weeks with OGTT'],
        ['Diagnostic criteria', 'FBS ≥ 126 mg/dL, or PPBS ≥ 200 mg/dL, or HbA1c ≥ 6.5%, or Random BS ≥ 200 with symptoms'],
        ['Treatment T2DM', 'Lifestyle modification + Metformin (first line) → add other OHAs/insulin as needed'],
        ['Complications', 'Microvascular: Retinopathy, Nephropathy, Neuropathy; Macrovascular: CAD, stroke, PVD'],
        ['Nursing care', 'Blood glucose monitoring, foot care, diet education, insulin technique, hypoglycaemia management'],
    ],
    [5*cm, 13*cm]
))
story.append(sp())

story.append(sec('10.3 Hypertension'))
story.append(make_table(
    ['Aspect', 'Details'],
    [
        ['Definition', 'Sustained elevation of blood pressure ≥ 140/90 mmHg'],
        ['JNC 8 Classification', 'Normal: < 120/<80; Elevated: 120-129/<80; HTN Stage 1: 130-139/80-89; HTN Stage 2: ≥ 140/≥ 90'],
        ['Risk factors', 'Age, obesity, family history, high salt intake, sedentary lifestyle, smoking, alcohol, diabetes'],
        ['Symptoms', '"Silent killer" — usually asymptomatic; headache, dizziness in severe cases'],
        ['Treatment', 'Lifestyle changes (DASH diet, exercise, weight loss, salt restriction) + Antihypertensives (ACE inhibitors, ARBs, CCBs, diuretics, beta-blockers)'],
        ['Complications', 'Stroke, MI, heart failure, renal failure, retinopathy, aortic aneurysm'],
        ['Nursing care', 'Regular BP monitoring, medication adherence, low sodium diet teaching, stress management'],
    ],
    [5*cm, 13*cm]
))
story.append(sp())

story.append(sec('10.4 Cancer — National Cancer Control Programme (NCCP)'))
story.append(make_table(
    ['Aspect', 'Details'],
    [
        ['Common cancers (India)', 'Women: Cervical, Breast, Ovarian; Men: Oral, Lung, Colorectal'],
        ['Cervical cancer', 'Caused by HPV (Human Papillomavirus); Screened by Pap smear, VIA/VILI; HPV vaccine available (Cervarix, Gardasil) 9-14 yrs girls'],
        ['Breast cancer', 'Screened by BSE (Breast Self Examination), Clinical Breast Exam, Mammography'],
        ['Warning signs (7 Cs)', 'Change in bowel/bladder habits, A sore that does not heal, Unusual bleeding, Thickening/lump, Indigestion, Obvious change in wart/mole, Nagging cough'],
        ['Treatment', 'Surgery, Radiation therapy, Chemotherapy, Hormonal therapy, Targeted therapy, Immunotherapy'],
        ['Nurse\'s role', 'Early detection through screening, patient education, chemo side effect management, palliative care, psychosocial support'],
    ],
    [5*cm, 13*cm]
))
story.append(sp())

story.append(sec('10.5 National Tobacco Control Programme (NTCP)'))
story.append(bp(B('Launched:') + ' 2007-08 under NHM'))
story.append(bp(B('Aim:') + ' Reduce tobacco use; enforce COTPA (Cigarettes and Other Tobacco Products Act, 2003)'))
story.append(bp(B('COTPA provisions:') + ' No smoking in public places, no sale to minors, pictorial warnings on packaging, no tobacco ads'))
story.append(bp(B('Cessation support:') + ' National Tobacco Quitline: 1800-11-2356; tobacco cessation clinics'))
story.append(bp(B('Health effects of tobacco:') + ' Lung cancer, oral cancer, COPD, CVD, stroke, reproductive harm'))
story.append(sp())

story.append(sec('10.6 National Programme for Control of Blindness & Visual Impairment (NPCBVI)'))
story.append(bp(B('Launched:') + ' 1976; one of India\'s oldest health programmes'))
story.append(bp(B('Goal:') + ' Reduce prevalence of blindness from 1% to 0.3%'))
story.append(bp(B('Common causes of blindness in India:') + ' Cataract (most common ~66%), Refractive errors, Glaucoma, Corneal blindness, Diabetic retinopathy'))
story.append(bp(B('Key interventions:') + ' Free cataract surgery, school eye screening, spectacle distribution, vitamin A supplementation'))
story.append(sp())

story.append(sec('10.7 National Mental Health Programme (NMHP)'))
story.append(bp(B('Launched:') + ' 1982; District Mental Health Programme (DMHP) — 1996'))
story.append(bp(B('Aim:') + ' Provide accessible, affordable mental health care; integrate mental health with general health services'))
story.append(bp(B('Burden:') + ' 1 in 5 Indians affected by mental illness; depression and anxiety most common'))
story.append(bp(B('Mental Health Act:') + ' 2017 — Right to treatment; decriminalizes suicide attempt; right to make advance directive'))
story.append(bp(B('iCall, Vandrevala Foundation, NIMHANS:') + ' National mental health resources'))
story.append(kp('Suicide attempt is NO LONGER a criminal offence in India since Mental Healthcare Act, 2017 — Section 309 IPC reconsidered'))
story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════════
# UNIT 11
# ═══════════════════════════════════════════════════════════════════════════════
story.append(unit_title_para('UNIT 11 — School Health Services  (3 hrs)'))
story.append(sp())

story.append(sec('11.1 School Health Services'))
story.append(p(B('Definition:') + ' A component of comprehensive health care that targets the school-going population to promote health and prevent disease.'))
story.append(sp())
story.append(p(B('Objectives:')))
story.append(bp('Promote physical, mental, social health of school children'))
story.append(bp('Early detection and correction of health problems'))
story.append(bp('Prevent spread of communicable diseases in schools'))
story.append(bp('Promote healthy nutrition'))
story.append(bp('Health education to children and parents'))
story.append(sp())

story.append(sec('11.2 Components of School Health Programme'))
story.append(make_table(
    ['Component', 'Activities'],
    [
        ['Health appraisal', 'Annual health check-up; record height, weight, vision, hearing, dental health, immunization status'],
        ['Remedial measures', 'Treatment/referral for detected problems; spectacles for refractive errors; deworming'],
        ['Healthful school environment', 'Safe water, sanitation, playground, noise-free, proper lighting and ventilation'],
        ['Prevention of communicable diseases', 'Immunization in schools, early case detection, exclusion of sick students'],
        ['Nutrition services', 'Mid-day meal (PM POSHAN scheme), nutrition assessment, anaemia screening (Weekly IFA for adolescent girls — WIFS)'],
        ['Health instruction', 'Health education as part of curriculum; hygiene habits, puberty education, first aid'],
        ['Mental health services', 'Counselling for emotional problems, learning disabilities, peer pressure, substance abuse'],
        ['First aid', 'First aid room, trained teachers and students'],
        ['School health records', 'Maintain health cards for each student'],
        ['School health nurse role', 'Health assessment, screening, immunization, health education, first aid, referral'],
    ],
    [5*cm, 13*cm]
))
story.append(sp())

story.append(sec('11.3 Rashtriya Bal Swasthya Karyakram (RBSK)'))
story.append(bp(B('Launched:') + ' 2013 under NHM'))
story.append(bp(B('Target:') + ' Children 0–18 years — newborns, children attending Anganwadis and government schools'))
story.append(bp(B('Screens for 4 Ds:') + ' Defects at birth, Deficiencies, Diseases, Developmental delays including disabilities'))
story.append(bp(B('Team:') + ' Mobile Health Teams (one MBBS doctor + ANM/Staff Nurse + Pharmacist) visit schools and AWCs'))
story.append(bp(B('Referral:') + ' Children with detected conditions referred to District Early Intervention Centres (DEICs) for free treatment'))
story.append(kp('RBSK covers 30 health conditions including congenital heart disease, congenital deafness, neural tube defects, cleft lip/palate, club foot, developmental delays, vision problems, dental defects, anaemia, malnutrition'))
story.append(sp())

story.append(sec('11.4 Weekly Iron and Folic Acid Supplementation (WIFS)'))
story.append(bp(B('Target:') + ' Adolescent girls 10-19 years (school and out-of-school)'))
story.append(bp(B('IFA dose:') + ' 1 tablet (100 mg elemental iron + 500 mcg folic acid) per week'))
story.append(bp(B('Deworming:') + ' Albendazole 400 mg, twice a year (National Deworming Day — February 10)'))
story.append(bp(B('Aim:') + ' Reduce prevalence of anaemia among adolescent girls'))
story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════════
# QUICK REVISION / MNEMONICS PAGE
# ═══════════════════════════════════════════════════════════════════════════════
story.append(Paragraph('<b>QUICK REVISION — Mnemonics & High-Yield Points</b>',
    ParagraphStyle('qr_title', fontSize=16, fontName='Helvetica-Bold',
                   textColor=colors.white, backColor=colors.HexColor('#922b21'),
                   alignment=TA_CENTER, spaceAfter=10, borderPad=8, leading=22)))
story.append(sp())

story.append(sec('Key Mnemonics'))
story.append(make_table(
    ['Mnemonic', 'Stands For', 'Topic'],
    [
        ['MENACESH', 'Maternal health, Education, Nutrition, Anti-epidemic, Community participation, Essential drugs, Safe water, Health', '8 Elements of PHC'],
        ['ABCD', 'Anthropometric, Biochemical, Clinical, Dietary', 'Nutritional Assessment methods'],
        ['3Ds (+D)', 'Dermatitis, Diarrhoea, Dementia (+Death)', 'Pellagra (Niacin deficiency)'],
        ['7Cs', 'Change in bowel, A sore, Unusual bleeding, Thickening, Indigestion, Change in wart, Nagging cough', 'Cancer warning signs'],
        ['DOTS', 'Directly Observed Treatment, Short-course', 'TB treatment strategy'],
        ['MDT', 'Multi-Drug Therapy', 'Leprosy treatment'],
        ['HRZE', 'Isoniazid, Rifampicin, Pyrazinamide, Ethambutol', 'TB Intensive phase drugs'],
        ['4 Ds of RBSK', 'Defects at birth, Deficiencies, Diseases, Developmental delays', 'RBSK screening'],
        ['ACT', 'Artemisinin Combination Therapy', 'P. falciparum malaria treatment'],
        ['TLE', 'Tenofovir, Lamivudine, Efavirenz', 'First-line ART regimen'],
    ],
    [3.5*cm, 9*cm, 5.5*cm]
))
story.append(sp())

story.append(sec('Important Numbers to Remember'))
story.append(make_table(
    ['Parameter', 'Value'],
    [
        ['Sub-centre serves (plain areas)', '5,000 population'],
        ['PHC serves (plain areas)', '30,000 population'],
        ['CHC serves (plain areas)', '1,20,000 population'],
        ['Residual chlorine in water (point of use)', '0.2 mg/L (minimum)'],
        ['Alum added to water for coagulation', 'For purification step 2'],
        ['India MMR (2018-20)', '≈ 97 per 1,00,000 live births'],
        ['India IMR (2020)', '≈ 28 per 1,000 live births'],
        ['India CBR (2021)', '≈ 18.7 per 1,000 population'],
        ['India CDR (2021)', '≈ 6.2 per 1,000 population'],
        ['TB treatment DS-TB (total duration)', '6 months (2 HRZE + 4 HRE)'],
        ['Leprosy PB treatment', '6 months MDT'],
        ['Leprosy MB treatment', '12 months MDT'],
        ['Leprosy elimination (India)', '2005 (< 1 case / 10,000 population)'],
        ['ICDS started', '1975'],
        ['NHM launched', '2005'],
        ['SDG timeline', '2015–2030'],
        ['NTEP goal: TB elimination', '2025'],
        ['Dengue NS1 antigen detectable', 'Days 1–5 of fever'],
        ['Daily DEC for Filariasis MDA', 'DEC + Albendazole, annual'],
        ['WIFS dose', '100mg iron + 500 mcg folic acid, weekly'],
    ],
    [9*cm, 9*cm]
))
story.append(sp())
story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════════
# PRACTICE QUESTIONS
# ═══════════════════════════════════════════════════════════════════════════════
story.append(Paragraph('<b>PRACTICE EXAM QUESTIONS</b>',
    ParagraphStyle('pq_title', fontSize=16, fontName='Helvetica-Bold',
                   textColor=colors.white, backColor=colors.HexColor('#1e8449'),
                   alignment=TA_CENTER, spaceAfter=10, borderPad=8, leading=22)))
story.append(sp())

story.append(sec('Long Answer Questions (10 marks each)'))
laq = [
    '1. Describe the health care delivery system in India. Explain the role of Primary Health Centre (PHC).',
    '2. Explain the steps of municipal water purification. What are the methods of household water purification?',
    '3. Discuss the NTEP (National Tuberculosis Elimination Programme). Explain the DOTS strategy and nurse\'s role.',
    '4. Describe the epidemiological triad. Explain different types of epidemiological studies with examples.',
    '5. Explain the Integrated Child Development Services (ICDS). What are its components and beneficiaries?',
    '6. Describe the levels of prevention with suitable examples for each level.',
    '7. Discuss NPCDCS. Explain the screening protocol for NCDs at community level.',
    '8. Explain the roles and responsibilities of a Community Health Nurse.',
]
for q in laq:
    story.append(p(q))
    story.append(sp(0.5))

story.append(sp())
story.append(sec('Short Answer Questions (5 marks each)'))
saq_list = [
    ['1. Biomedical Waste Management (colour coding)', '2. Swachh Bharat Mission — goals and achievement'],
    ['3. Epidemiological rates — IMR, MMR, CDR formulas', '4. Primary Health Care — Alma-Ata Declaration 1978'],
    ['5. Dengue fever — clinical features and nursing care', '6. National Immunization Schedule'],
    ['7. Nutritional deficiency diseases — table', '8. NACP — 90-90-90 targets'],
    ['9. Home visit — purpose and steps', '10. Sustainable Development Goal 3'],
    ['11. Types of latrines', '12. Health education methods'],
    ['13. Marasmus vs Kwashiorkor — differences', '14. RBSK — 4 Ds screened'],
    ['15. WIFS programme', '16. Vector control methods'],
]
for pair in saq_list:
    story.append(make_table(['', ''], [pair], [9*cm, 9*cm]))
    story.append(sp(0.3))

story.append(sp())
story.append(sec('Objective / MCQ Focus Areas'))
story.append(bp('Population norms for Sub-centre, PHC, CHC'))
story.append(bp('Year of launch for each National Health Programme'))
story.append(bp('Biomedical waste colour coding'))
story.append(bp('Residual chlorine value, water purification steps'))
story.append(bp('IMR, MMR current values for India'))
story.append(bp('Vaccine schedules — which vaccine at what age'))
story.append(bp('Leprosy — PB vs MB classification and treatment duration'))
story.append(bp('TB treatment drug abbreviations (HRZE)'))
story.append(bp('Nutritional deficiency diseases and their features'))
story.append(bp('8 elements of Primary Health Care (PHC)'))

story.append(sp(2))
story.append(Paragraph('All the best for your exam! You\'ve got this! 💙',
    ParagraphStyle('footer_msg', fontSize=14, fontName='Helvetica-Bold',
                   textColor=colors.HexColor('#1a5276'), alignment=TA_CENTER, spaceAfter=5)))
story.append(Paragraph('Study smart, revise regularly, and practice writing answers.',
    ParagraphStyle('footer_sub', fontSize=11, fontName='Helvetica',
                   textColor=colors.HexColor('#515a5a'), alignment=TA_CENTER)))

# ═════════════════════════════════════════════════════════════════════════════
# BUILD PDF
# ═════════════════════════════════════════════════════════════════════════════
doc = MyDocTemplate(OUTPUT, pagesize=A4, topMargin=2*cm, bottomMargin=2*cm,
                    leftMargin=1.5*cm, rightMargin=1.5*cm)

# Build with cover page on page 1
def build_doc():
    doc.build(story, onFirstPage=cover_page, onLaterPages=lambda c, d: None)

build_doc()
print(f"PDF generated: {OUTPUT}")

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/community-health-nursing/generate_pdf.py'

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/community-health-nursing/generate_pdf.py'

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/community-health-nursing/generate_pdf.py'