1. Anaemia Mukt Bharat (AMB) Strategy

Six interventions

1. Prophylactic iron-folic acid (IFA) supplementation.
2. Deworming.
3. Year-round behaviour-change communication, called “Solid Body, Smart Mind”, promoting:
   • adherence to IFA and deworming;
   • appropriate infant and young-child feeding;
   • greater intake of iron-rich, diverse, locally available and fortified foods;
   • delayed cord clamping, by 3 minutes, after delivery.
4. Testing and treatment of anaemia, using digital methods and point-of-care treatment, especially for pregnant women and school-going adolescents.
5. Mandatory provision of iron-folic-acid fortified foods in government-funded public-health programmes.
6. Detection and treatment of non-nutritional causes of anaemia in endemic areas, especially malaria, haemoglobinopathies, and fluorosis.

Exam point: The current programme is also commonly described as the 7x7x7 strategy: seven beneficiary groups, seven interventions, and seven institutional mechanisms. Park lists the six core intervention areas above.

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2. POSHAN Abhiyaan

• Children aged 0-6 years
• Adolescent girls
• Pregnant women
• Lactating mothers

Targets under POSHAN Abhiyaan

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3. Mission POSHAN 2.0

• Anganwadi Services
• POSHAN Abhiyaan
• Scheme for Adolescent Girls

Main focus

• Address malnutrition through a life-cycle approach, with special attention to the first 1,000 days of life.
• Provide supplementary nutrition to children 6 months to 6 years, pregnant women, lactating mothers, and eligible adolescent girls.
• Give additional nutrition support, including take-home rations, for children with severe acute malnutrition.
• Strengthen Anganwadi Centres and nutrition service delivery.
• Promote nutrition awareness, behaviour change, growth monitoring, and community participation.
• Use technology, particularly the POSHAN Tracker, for real-time monitoring of beneficiaries and services.
• Ensure convergence of health, sanitation, education, food, and women-and-child-development services.

National Programme for Prevention and Control of Non-Communicable Diseases

• Hypertension and cardiovascular diseases
• Diabetes mellitus
• Stroke
• Common cancers: oral, breast, and cervical
• Chronic respiratory diseases
• Chronic kidney disease and non-alcoholic fatty liver disease are also covered in current operational guidance.

Objectives

1. Prevention and control of common NCDs through behaviour and lifestyle modification.
2. Health promotion through community awareness and reduction of risk factors.
3. Early detection, diagnosis, treatment, referral, and follow-up of common NCDs.
4. Capacity-building of doctors, nurses, paramedics, and other health workers.
5. Development of facilities for rehabilitative and palliative care.
6. Strengthening the supply of essential drugs, diagnostics, equipment, and logistics.
7. Monitoring, surveillance, research, and evaluation of NCD services.

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Major strategies

1. Health promotion and risk-factor reduction

• Eat healthy food
• Increase physical activity
• Avoid tobacco and alcohol
• Manage stress

2. Screening

• Hypertension
• Diabetes
• Oral cancer
• Breast cancer
• Cervical cancer

3. Diagnosis, treatment, referral, and follow-up

4. Cancer-control component

• Early identification and referral of suspected cancer cases
• Screening for oral, breast, and cervical cancer
• Teaching breast self-examination and oral self-examination
• Cervical-cancer screening as per programme protocols
• Diagnosis, treatment, follow-up, rehabilitation, and palliative care

5. Palliative and rehabilitative care

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Organisation

1. National level
2. State level
3. District level

Short exam summary

NP-NCD/NPCDCS is India’s national programme for prevention and control of major NCDs. Its pillars are health promotion, risk-factor reduction, population-based screening of adults aged 30 years and above, early diagnosis, treatment, referral, follow-up, rehabilitation, palliative care, capacity-building, and surveillance.

WHO Global NCD Targets

1. 25% relative reduction in premature mortality from cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases.
2. At least 10% relative reduction in harmful use of alcohol.
3. 10% relative reduction in prevalence of insufficient physical activity.
4. 30% relative reduction in mean population intake of salt/sodium.
5. 30% relative reduction in prevalence of current tobacco use among persons aged 15 years and above.
6. 25% relative reduction in prevalence of raised blood pressure, or contain the prevalence of raised blood pressure according to national circumstances.
7. Halt the rise in diabetes and obesity.
8. Ensure that at least 50% of eligible people receive drug therapy and counselling, including glycaemic control, to prevent heart attacks and strokes.
9. Ensure 80% availability of affordable basic technologies and essential medicines, including generics, required to treat major NCDs in both public and private facilities.

Screening of Cervical, Breast, and Oral Cancer in India

Target population

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1. Cervical cancer screening

Methods

1. Pap smear/cervical cytology
   • Detects the long pre-invasive stage, carcinoma in situ.
   • Park mentions Pap testing from the start of sexual activity and then every 3 years. However, this is a general textbook description and should not be confused with the current Indian population-screening protocol.
2. Visual inspection with acetic acid (VIA)
   • This is the practical, low-cost screening method used in India’s public programme.
   • Apply freshly prepared 5% acetic acid to the cervix.
   • A positive test is indicated by a well-defined opaque acetowhite lesion near the squamocolumnar junction, a circum-orificial acetowhite lesion, or dense acetowhitening over an ulceroproliferative growth.
3. Other visual methods
   • VIAM: Visual inspection with acetic acid and magnification.
   • VILI: Visual inspection after Lugol iodine application.

Follow-up of VIA-positive women

• Refer for further assessment at PHC/CHC/district hospital.
• Colposcopy and biopsy provide diagnostic confirmation where indicated.
• Eligible precancerous lesions may be treated using a single-visit approach, such as cryotherapy.
• Lesions not suitable for ablative treatment, suspected invasive cancer, or high-grade lesions require biopsy and referral to a specialist/tertiary cancer centre.

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2. Breast cancer screening

Methods of early detection

1. Breast self-examination (BSE)
   • Women should be taught breast awareness/self-examination.
   • It helps women identify a lump, thickening, nipple change, or other abnormality early.
   • Park considers it a useful adjunct for early case detection.
2. Clinical breast examination (CBE)
   • Systematic inspection and palpation of both breasts and axillary lymph nodes by a trained health worker.
   • This is the main population-based screening method in the Indian public-health programme.
3. Mammography
   • Most sensitive and specific method for detecting small tumours that may be missed on palpation.
   • It is not suitable for universal mass screening in resource-constrained areas because it requires good equipment and experienced radiologists.
   • Park also highlights radiation exposure and false-positive results as limitations.
   • Women under 35 years should not have mammography/X-ray screening unless symptomatic or with a family history of early-onset breast cancer.
4. Thermography
   • No radiation exposure, but it is not sufficiently sensitive.

Referral

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3. Oral cancer screening

Method: Oral visual examination (OVE)

• The oral cavity is easily accessible for direct inspection.
• Trained health workers inspect the lips, buccal mucosa, gingiva, tongue, floor of mouth, palate, and oropharynx using adequate light and gloves.
• It is particularly important for high-risk persons:
  • tobacco smokers;
  • smokeless-tobacco users;
  • betel quid/areca nut users;
  • alcohol users.

Suspicious findings

• Non-healing ulcer or sore, especially lasting more than 2 weeks
• White patch: leukoplakia
• Red patch: erythroplakia
• Red-and-white lesion
• Induration, swelling, nodule, or unexplained bleeding
• Restricted tongue movement, difficulty chewing/swallowing, or persistent hoarseness

Follow-up

• A suspected lesion should be referred to PHC/CHC/district hospital for detailed intra-oral examination.
• Biopsy and histopathology confirm the diagnosis.
• Tobacco cessation counselling and referral to tobacco-cessation services are essential.
• Precancerous oral lesions can be detected long before invasive cancer develops. Tobacco cessation may reverse or prevent progression of lesions such as leukoplakia.

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One-line comparison for exams

Role of ASHA and ANM

1. ASHA: Accredited Social Health Activist

Functions of ASHA

1. Health education and awareness
   • Creates awareness about nutrition, sanitation, hygiene, healthy living and working conditions.
   • Informs people about available health services and encourages their timely use.
2. Maternal and child health counselling
   • Counsels women on birth preparedness, safe delivery, breastfeeding, complementary feeding, immunization, contraception, newborn and child care.
   • Educates about prevention of RTIs/STIs and common infections.
3. Mobilization and link worker role
   • Mobilizes people to use Anganwadi, sub-centre, PHC and other government services.
   • Facilitates ANC, PNC, immunization, supplementary nutrition, sanitation and family-planning services.
4. Village health planning
   • Works with the Village Health, Sanitation and Nutrition Committee/Gram Panchayat to prepare the village health plan.
5. Escort and referral
   • Accompanies pregnant women and sick children to PHC, CHC, First Referral Unit, or hospital when needed.
6. Basic care and treatment
   • Provides first aid and care for minor ailments such as diarrhoea and fever.
   • Works as a DOTS provider for tuberculosis treatment.
7. Drug-depot holder
   • Keeps and provides essential supplies such as ORS, IFA tablets, condoms, oral contraceptive pills, disposable delivery kits, and other drugs in the ASHA kit.
8. Disease surveillance
   • Reports births, deaths, unusual health events, and suspected disease outbreaks to the sub-centre/PHC.
9. Sanitation promotion
   • Promotes household toilet construction and use under sanitation programmes.

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2. ANM: Auxiliary Nurse Midwife/Health Worker Female

Functions of ANM

A. Maternal health

• Registers every pregnant woman and provides antenatal care.
• Ensures at least four antenatal check-ups.
• Tests urine for albumin and sugar and estimates haemoglobin.
• Refers pregnant women for RPR testing for syphilis.
• Identifies and refers high-risk or abnormal pregnancies.
• Conducts deliveries where necessary and supervises deliveries by dais.
• Refers difficult labour and sick/abnormal newborns for institutional care.
• Helps implement Janani Suraksha Yojana.
• Tracks pregnancies for scheduled ANC and PNC services.

B. Postnatal and newborn care

• Makes postnatal visits:
  • Home/sub-centre delivery: day 0, 3, 7, and 42
  • Institutional delivery: day 3, 7, and 42
• Makes extra visits for low-birth-weight babies.
• Promotes breastfeeding within one hour of birth, exclusive breastfeeding for six months, and appropriate complementary feeding after six months.
• Assesses child growth and development and refers when necessary.

C. Child health and nutrition

• Treats minor ailments such as diarrhoea and ARI/pneumonia according to guidelines.
• Identifies and refers severe dehydration, respiratory distress, severe acute malnutrition, and serious illness.
• Educates mothers regarding nutrition, child care, hygiene, immunization, and prevention of communicable diseases.

D. Family planning

• Maintains and updates the eligible-couple register.
• Distributes condoms and oral contraceptive pills.
• Motivates couples for family planning and arranges referral where needed.
• Provides follow-up to family-planning acceptors and manages or refers side effects.
• Maintains contraceptive supply through depot holders.

E. Immunization and communicable-disease control

• Conducts/supports immunization activities.
• Maintains cold chain and vaccine supplies.
• Participates in surveillance, reporting, and control activities for communicable diseases.

F. Health education and records

• Provides individual and group health education on MCH, family planning, nutrition, sanitation, immunization, and disease prevention.
• Maintains records, registers, reports, and surveys required for health programmes.

G. Guidance of ASHA

• Holds weekly or fortnightly meetings with ASHA.
• Trains and guides ASHA.
• Informs ASHA about outreach sessions and helps mobilize beneficiaries.
• Uses ASHA to update eligible-couple registers, motivate women for ANC, IFA consumption, tetanus vaccination, institutional delivery, and family planning.
• Trains ASHA to recognize danger signs in pregnancy and labour.

Key difference

Health Planning Cycle According to Park

Steps of the health planning cycle

1. Analysis of the health situation
   • Collect, assess, and interpret data to identify health problems, needs, and demands.
   • Data include:
     • Population size and age-sex structure
     • Morbidity and mortality statistics
     • Distribution and epidemiology of diseases
     • Existing health facilities and agencies
     • Available manpower and training facilities
     • Community attitudes and beliefs
2. Establishment of objectives and goals
   • Objectives guide action and provide standards for later assessment.
   • They should be clear, realistic, feasible, and time-bound.
   • Goals are the ultimate desired health state towards which objectives and resources are directed.
3. Assessment of resources
   • Assess available and required:
     • Manpower
     • Money
     • Materials
     • Skills
     • Knowledge
     • Techniques
     • Time
   • A balance is made between resources needed and those available or likely to become available.
4. Fixing priorities
   • Since resources are limited, health problems are ranked in order of importance.
   • Consider:
     • Magnitude of morbidity and mortality
     • Financial constraints
     • Cost and feasibility of prevention
     • Social value, such as saving younger lives
     • Political and community interests
   • Alternative plans are formulated and the most practicable and effective one is selected.
5. Write-up of the formulated plan
   • Prepare a detailed written plan.
   • Specify:
     • Inputs or resources required
     • Expected outputs
     • Activities and stages
     • Costs
     • Time schedule
     • Responsibilities
     • Built-in evaluation system
6. Programming and implementation
   • After approval, the plan is put into action.
   • It requires:
     • Clearly defined roles and tasks
     • Selection, training, motivation, and supervision of staff
     • Good organization and communication
     • Delegation of authority and fixation of responsibility
7. Monitoring
   • Continuous day-to-day follow-up during implementation.
   • It checks whether activities are proceeding according to the plan and schedule.
   • Deviations are identified and corrected promptly.
8. Evaluation
   • Assesses whether stated objectives and targets have been achieved.
   • Measures adequacy, efficiency, effectiveness, acceptance, productivity, and cost-effectiveness.
   • Provides feedback for revising priorities, reallocating resources, and improving future plans.

Flowchart

Levels of Health Care in India According to Park

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1. Primary Health Care

• Sub-centres
• Primary Health Centres (PHCs)
• Village-level workers such as ASHA and Anganwadi workers

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A. Sub-centre

Definition

Population norms

Staff

• One Health Worker Female/ANM
• One Health Worker Male/MPW
• ASHA supports community-level work.

Main services

• Maternal and child health care
• Antenatal and postnatal care
• Family planning and contraceptive services
• Immunization
• Nutrition education, IFA supplementation, and growth monitoring
• Prevention and control of communicable diseases
• Basic treatment for minor ailments and first aid
• Health education, sanitation, and safe-water promotion
• Disease surveillance, reporting of births and deaths
• Referral of high-risk pregnancy, sick newborns, severe illness, and other cases.

Types of sub-centres

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B. Primary Health Centre (PHC)

Definition

Population norms

Bed strength

Functions of PHC

1. Medical care for common illnesses
2. Maternal and child health services, including family planning
3. Safe water and basic sanitation
4. Control of locally endemic diseases
5. Collection and reporting of vital statistics
6. Health education
7. Implementation of national health programmes
8. Referral services
9. Training of health guides, health workers, local dais, and health assistants
10. Basic laboratory services

Services

• OPD services
• Basic inpatient care
• First aid, emergency stabilization, and referral
• ANC, PNC, normal delivery services where available
• Immunization
• Contraceptive and family-planning services
• Basic laboratory investigations
• Implementation of disease-control programmes
• NCD screening and follow-up.

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2. Secondary Health Care

Definition

Institutions

• Community Health Centre (CHC)
• Sub-district/sub-divisional hospital
• District hospital

Community Health Centre

• Medicine
• Surgery
• Obstetrics and gynaecology
• Paediatrics

Functions

• Manages referred obstetric, medical, surgical, paediatric, and emergency cases.
• Provides comprehensive emergency obstetric and newborn care where designated.
• Provides inpatient care, diagnostics, and specialist services.
• Supports PHCs through referral, supervision, training, and programme implementation.
• Refers super-specialty or highly complicated cases to tertiary hospitals.

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3. Tertiary Health Care

Definition

Institutions

• Medical college hospitals
• Regional hospitals
• Central government hospitals
• AIIMS and other apex institutions
• Speciality and super-speciality hospitals

Services

• Advanced investigations and procedures
• Super-specialist medical and surgical care
• Intensive care and management of complicated referred cases
• Cancer treatment, neurosurgery, cardiothoracic surgery, renal replacement therapy, etc.
• Teaching and training of specialist staff
• Research, planning, managerial support, and technical guidance for lower health-care levels.

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Comparison Table

NACO

Aim of National AIDS Control Programme

1. Prevent further transmission of HIV.
2. Reduce morbidity and mortality associated with HIV infection.
3. Minimize the socioeconomic impact of HIV/AIDS.

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Brief history and phases

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Components/activities under NACO

1. HIV surveillance

• Establish surveillance centres throughout the country.
• Monitor HIV prevalence and trends through sentinel surveillance.
• Identify geographical areas and population groups at higher risk.

2. Targeted interventions

• Female sex workers
• Men who have sex with men
• Transgender persons
• Injecting-drug users
• Migrant and bridge populations

3. Information, education and communication

• Create awareness about HIV transmission and prevention.
• Promote safe sexual behaviour and condom use.
• Reduce HIV-related stigma and discrimination.
• Encourage voluntary HIV testing, treatment adherence, and care seeking.
• Conduct youth and school-focused awareness programmes.

4. HIV testing services

• Integrated Counselling and Testing Centres (ICTCs).
• Provider-initiated testing and counselling where indicated.
• Community-based screening and linkage to care.
• Pre-test and post-test counselling.

5. Prevention of parent-to-child transmission

• HIV testing and counselling for pregnant women.
• Antiretroviral therapy for HIV-positive pregnant/breastfeeding women.
• Early diagnosis and treatment of HIV-exposed infants.
• Counselling on infant feeding and follow-up.

6. Care, support and treatment

• Free antiretroviral therapy through ART centres.
• Management of opportunistic infections.
• Viral-load testing and treatment monitoring.
• Adherence counselling, psychosocial support, and referral services.
• Linkage with TB services for HIV-TB collaborative activities.

7. Sexually transmitted infection/reproductive tract infection control

• Establish and support STI/RTI clinics up to district level.
• Syndromic case management, laboratory support, training, and drug kits.
• Promote early diagnosis and treatment of STIs, which reduce the risk of HIV transmission.

8. Blood safety

• Ensure safe blood and blood products.
• Promote voluntary non-remunerated blood donation.
• Screen donated blood for HIV and other transfusion-transmissible infections.
• Strengthen blood banks, blood-component separation units, and quality assurance.

9. Condom programme

• Ensure availability and promotion of condoms for HIV and STI prevention.
• Social marketing and free distribution in high-risk settings.

10. Strategic information

• Monitoring and evaluation
• Surveillance
• Programme research
• Data analysis
• Recording and reporting

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Organizational structure

• Targeted Intervention and Link Worker Scheme
• Basic services: ICTC, PPTCT, and HIV-TB coordination
• STI/RTI management
• Blood safety
• Laboratory services
• Care, support, and treatment
• Information, education, and communication
• Strategic information: surveillance, monitoring, evaluation, research, and data analysis
• Finance, administration, and procurement

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NACP-IV goal

Halt and reverse the HIV epidemic in India by integrating prevention, care, support, and treatment services.

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Current update

Visual Impairment and Blindness

Definition

ICD-11 classification of distance visual impairment

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Epidemiology of Blindness

Major global causes

1. Unoperated cataract: 35%
2. Uncorrected refractive error: 21%
3. Glaucoma: 8%

Causes of blindness in India

Epidemiological determinants

1. Age
   • Children and young people: refractive errors, trachoma, conjunctivitis, and vitamin A deficiency.
   • Middle age: cataract, refractive errors, glaucoma, and diabetes.
   • Injury and trauma occur at all ages, especially 20-40 years.
2. Sex
   • Blindness is reported more commonly in females than males in India, partly due to a higher prevalence of cataract, conjunctivitis, and trachoma.
3. Malnutrition
   • Vitamin A deficiency, especially with measles, diarrhoea, and protein-energy malnutrition, may cause xerophthalmia and keratomalacia.
   • Severe corneal destruction due to vitamin A deficiency mainly affects children aged 6 months to 3 years.
4. Occupation
   • Factory, workshop, and cottage-industry workers are exposed to dust, flying particles, chemicals, fumes, welding flash, radiation, and trauma.
5. Social class and social factors
   • Blindness is more common among poorer populations.
   • Important factors are poverty, ignorance, poor hygiene, inadequate eye-care services, and harmful treatment by unqualified persons.

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Vision 2020: The Right to Sight

Central concept

Objective

• Cataract
• Xerophthalmia and other causes of childhood blindness
• Refractive errors and low vision
• Trachoma
• Other causes of corneal blindness

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National Programme for Control of Blindness and Visual Impairment

NPCBVI

Goal

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Objectives of NPCBVI

1. Continue the three signature activities:
   • About 66 lakh cataract operations per year
   • School eye screening and distribution of 9 lakh free spectacles annually to children with refractive error
   • Collection of 50,000 donated eyes per year for keratoplasty
2. Reduce the backlog of avoidable blindness through identification and treatment of curable blindness at primary, secondary, and tertiary levels.
3. Provide comprehensive universal eye-care services and quality service delivery under the concept of Eye Health for All.
4. Strengthen Regional Institutes of Ophthalmology, medical colleges, district hospitals, sub-district hospitals, vision centres, NGO eye hospitals, and other eye-care institutions.
5. Strengthen infrastructure and develop human resources for comprehensive eye care in all districts.
6. Enhance community awareness and preventive eye-care practices.
7. Promote research on prevention of blindness and visual impairment.
8. Ensure participation of voluntary organizations and private practitioners in eye-care delivery.

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Major strategies

1. Free cataract surgery, including intraocular lens implantation, through government, NGO, and private-sector participation.
2. Comprehensive eye care for diseases other than cataract:
   • Diabetic retinopathy
   • Glaucoma
   • Corneal blindness and corneal transplantation
   • Vitreo-retinal disorders
   • Childhood blindness
3. Active screening of people above 50 years, eye camps, and transport of operable cataract cases to fixed facilities.
4. School eye screening to detect refractive errors and provide free spectacles to eligible children.
5. Public-private partnership to cover underserved regions.
6. Training and capacity-building of health personnel.
7. Information, education, and communication activities for eye-care awareness.
8. Upgrading Regional Institutes of Ophthalmology and medical colleges as centres of excellence.
9. Strengthening district hospitals with ophthalmologists, ophthalmic assistants, equipment, drugs, and infrastructure.
10. Establishing vision centres at PHCs, with a paramedical ophthalmic assistant.
11. Use of mobile ophthalmic units for remote areas.

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Organisation and service-delivery system

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School Eye Screening Programme

• Approximately 6-7% of children aged 10-14 years have visual problems affecting learning.
• Teachers are trained to screen children initially.
• Children suspected of refractive error are examined by ophthalmic assistants.
• Spectacles are prescribed or provided free to children from below-poverty-line families.

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Other components

• Eye donation and eye banking
• Corneal transplantation
• Vitamin A prophylaxis
• Community health education
• Regular eye check-ups
• Eye camps, especially in remote and tribal areas
• Prevention and treatment of childhood blindness
• Rehabilitation for visual impairment

Fertility Rates and Contraceptive Methods

A. Fertility Rates

1. Crude Birth Rate (CBR)

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2. General Fertility Rate (GFR)

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3. General Marital Fertility Rate (GMFR)

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4. Age-Specific Fertility Rate (ASFR)

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5. Age-Specific Marital Fertility Rate (ASMFR)

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6. Total Fertility Rate (TFR)

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7. Total Marital Fertility Rate (TMFR)

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8. Gross Reproduction Rate (GRR)

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9. Net Reproduction Rate (NRR)

• NRR = 1: Replacement-level reproduction, approximately the two-child norm.
• NRR < 1: Below replacement level.
• NRR > 1: Population is more than replacing itself.

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10. Child-Woman Ratio

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B. Contraceptive Methods

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I. Temporary or Spacing Methods

1. Natural methods

• Periodic abstinence/rhythm method: Avoid intercourse during the fertile period.
• Withdrawal/coitus interruptus: Withdrawal of penis before ejaculation.
• Lactational amenorrhoea method (LAM): Temporary contraception during exclusive breastfeeding, when the woman remains amenorrhoeic and the infant is less than 6 months old.
• Cervical mucus/Billings method
• Basal body-temperature method
• Symptothermal method

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2. Barrier methods

Physical barrier methods

• Male condom
• Female condom
• Diaphragm
• Cervical cap
• Vaginal sponge

Chemical barrier methods

• Spermicidal creams
• Jellies
• Foams
• Tablets
• Pessaries

Combined barrier methods

• Condom plus spermicide
• Diaphragm plus spermicide

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3. Intrauterine devices (IUDs)

• Copper-bearing IUDs, such as Cu-T 380A
• Hormone-releasing IUDs, such as levonorgestrel intrauterine system

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4. Hormonal methods

Oral contraceptive pills

• Combined oral contraceptive pills
• Progestin-only pills
• Centchroman, a non-steroidal oral contraceptive used in India

Injectable contraceptives

• Depot medroxyprogesterone acetate, DMPA
• Other progestin injectables

Implants

• Subdermal progestin implants providing long-term reversible contraception.

Emergency contraception

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5. Post-conceptional methods

• Emergency contraception
• Medical termination of pregnancy under legally permitted conditions

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II. Permanent or Terminal Methods

1. Male sterilization: Vasectomy

• Vas deferens are cut and ligated to prevent sperm from entering semen.
• The no-scalpel vasectomy technique is commonly used.
• It is simpler, faster, safer, and less costly than female sterilization.
• It does not cause immediate sterility. Another contraceptive method is required until azoospermia is confirmed after the procedure.

2. Female sterilization: Tubectomy/Tubal ligation

• Fallopian tubes are cut, ligated, clipped, or blocked to prevent meeting of sperm and ovum.
• Types include:
  • Interval tubectomy
  • Postpartum tubectomy
  • Laparoscopic tubectomy
  • Minilaparotomy

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Classification at a Glance

1. Hypertension
   • Definition and classification
   • Risk factors, complications, prevention, screening, and control
2. Diabetes mellitus
   • Diagnosis, epidemiology, risk factors, complications, prevention, and control
3. Obesity
   • BMI and central obesity criteria
   • Causes, health effects, prevention, and management
4. Accidents
   • Epidemiology, types, host-agent-environment factors
   • Road-traffic accidents and prevention using the Haddon matrix
5. Coronary heart disease
   • Epidemiology, risk factors, prevention, screening, and rehabilitation

1. Anaemia Mukt Bharat (AMB) Strategy

Six interventions

1. Prophylactic iron-folic acid (IFA) supplementation.
2. Deworming.
3. Year-round behaviour-change communication, called “Solid Body, Smart Mind”, promoting:
   • adherence to IFA and deworming;
   • appropriate infant and young-child feeding;
   • greater intake of iron-rich, diverse, locally available and fortified foods;
   • delayed cord clamping, by 3 minutes, after delivery.
4. Testing and treatment of anaemia, using digital methods and point-of-care treatment, especially for pregnant women and school-going adolescents.
5. Mandatory provision of iron-folic-acid fortified foods in government-funded public-health programmes.
6. Detection and treatment of non-nutritional causes of anaemia in endemic areas, especially malaria, haemoglobinopathies, and fluorosis.

Exam point: The current programme is also commonly described as the 7x7x7 strategy: seven beneficiary groups, seven interventions, and seven institutional mechanisms. Park lists the six core intervention areas above.

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2. POSHAN Abhiyaan

• Children aged 0-6 years
• Adolescent girls
• Pregnant women
• Lactating mothers

Targets under POSHAN Abhiyaan

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3. Mission POSHAN 2.0

• Anganwadi Services
• POSHAN Abhiyaan
• Scheme for Adolescent Girls

Main focus

• Address malnutrition through a life-cycle approach, with special attention to the first 1,000 days of life.
• Provide supplementary nutrition to children 6 months to 6 years, pregnant women, lactating mothers, and eligible adolescent girls.
• Give additional nutrition support, including take-home rations, for children with severe acute malnutrition.
• Strengthen Anganwadi Centres and nutrition service delivery.
• Promote nutrition awareness, behaviour change, growth monitoring, and community participation.
• Use technology, particularly the POSHAN Tracker, for real-time monitoring of beneficiaries and services.
• Ensure convergence of health, sanitation, education, food, and women-and-child-development services.

• Hypertension and cardiovascular diseases
• Diabetes mellitus
• Stroke
• Common cancers: oral, breast, and cervical
• Chronic respiratory diseases
• Chronic kidney disease and non-alcoholic fatty liver disease are also covered in current operational guidance.

Objectives

1. Prevention and control of common NCDs through behaviour and lifestyle modification.
2. Health promotion through community awareness and reduction of risk factors.
3. Early detection, diagnosis, treatment, referral, and follow-up of common NCDs.
4. Capacity-building of doctors, nurses, paramedics, and other health workers.
5. Development of facilities for rehabilitative and palliative care.
6. Strengthening the supply of essential drugs, diagnostics, equipment, and logistics.
7. Monitoring, surveillance, research, and evaluation of NCD services.

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Major strategies

1. Health promotion and risk-factor reduction

• Eat healthy food
• Increase physical activity
• Avoid tobacco and alcohol
• Manage stress

2. Screening

• Hypertension
• Diabetes
• Oral cancer
• Breast cancer
• Cervical cancer

3. Diagnosis, treatment, referral, and follow-up

4. Cancer-control component

• Early identification and referral of suspected cancer cases
• Screening for oral, breast, and cervical cancer
• Teaching breast self-examination and oral self-examination
• Cervical-cancer screening as per programme protocols
• Diagnosis, treatment, follow-up, rehabilitation, and palliative care

5. Palliative and rehabilitative care

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Organisation

1. National level
2. State level
3. District level

Short exam summary

NP-NCD/NPCDCS is India’s national programme for prevention and control of major NCDs. Its pillars are health promotion, risk-factor reduction, population-based screening of adults aged 30 years and above, early diagnosis, treatment, referral, follow-up, rehabilitation, palliative care, capacity-building, and surveillance.## WHO Global NCD Targets

1. 25% relative reduction in premature mortality from cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases.
2. At least 10% relative reduction in harmful use of alcohol.
3. 10% relative reduction in prevalence of insufficient physical activity.
4. 30% relative reduction in mean population intake of salt/sodium.
5. 30% relative reduction in prevalence of current tobacco use among persons aged 15 years and above.
6. 25% relative reduction in prevalence of raised blood pressure, or contain the prevalence of raised blood pressure according to national circumstances.
7. Halt the rise in diabetes and obesity.
8. Ensure that at least 50% of eligible people receive drug therapy and counselling, including glycaemic control, to prevent heart attacks and strokes.
9. Ensure 80% availability of affordable basic technologies and essential medicines, including generics, required to treat major NCDs in both public and private facilities.

Target population

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1. Cervical cancer screening

Methods

1. Pap smear/cervical cytology
   • Detects the long pre-invasive stage, carcinoma in situ.
   • Park mentions Pap testing from the start of sexual activity and then every 3 years. However, this is a general textbook description and should not be confused with the current Indian population-screening protocol.
2. Visual inspection with acetic acid (VIA)
   • This is the practical, low-cost screening method used in India’s public programme.
   • Apply freshly prepared 5% acetic acid to the cervix.
   • A positive test is indicated by a well-defined opaque acetowhite lesion near the squamocolumnar junction, a circum-orificial acetowhite lesion, or dense acetowhitening over an ulceroproliferative growth.
3. Other visual methods
   • VIAM: Visual inspection with acetic acid and magnification.
   • VILI: Visual inspection after Lugol iodine application.

Follow-up of VIA-positive women

• Refer for further assessment at PHC/CHC/district hospital.
• Colposcopy and biopsy provide diagnostic confirmation where indicated.
• Eligible precancerous lesions may be treated using a single-visit approach, such as cryotherapy.
• Lesions not suitable for ablative treatment, suspected invasive cancer, or high-grade lesions require biopsy and referral to a specialist/tertiary cancer centre.

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2. Breast cancer screening

Methods of early detection

1. Breast self-examination (BSE)
   • Women should be taught breast awareness/self-examination.
   • It helps women identify a lump, thickening, nipple change, or other abnormality early.
   • Park considers it a useful adjunct for early case detection.
2. Clinical breast examination (CBE)
   • Systematic inspection and palpation of both breasts and axillary lymph nodes by a trained health worker.
   • This is the main population-based screening method in the Indian public-health programme.
3. Mammography
   • Most sensitive and specific method for detecting small tumours that may be missed on palpation.
   • It is not suitable for universal mass screening in resource-constrained areas because it requires good equipment and experienced radiologists.
   • Park also highlights radiation exposure and false-positive results as limitations.
   • Women under 35 years should not have mammography/X-ray screening unless symptomatic or with a family history of early-onset breast cancer.
4. Thermography
   • No radiation exposure, but it is not sufficiently sensitive.

Referral

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3. Oral cancer screening

Method: Oral visual examination (OVE)

• The oral cavity is easily accessible for direct inspection.
• Trained health workers inspect the lips, buccal mucosa, gingiva, tongue, floor of mouth, palate, and oropharynx using adequate light and gloves.
• It is particularly important for high-risk persons:
  • tobacco smokers;
  • smokeless-tobacco users;
  • betel quid/areca nut users;
  • alcohol users.

Suspicious findings

• Non-healing ulcer or sore, especially lasting more than 2 weeks
• White patch: leukoplakia
• Red patch: erythroplakia
• Red-and-white lesion
• Induration, swelling, nodule, or unexplained bleeding
• Restricted tongue movement, difficulty chewing/swallowing, or persistent hoarseness

Follow-up

• A suspected lesion should be referred to PHC/CHC/district hospital for detailed intra-oral examination.
• Biopsy and histopathology confirm the diagnosis.
• Tobacco cessation counselling and referral to tobacco-cessation services are essential.
• Precancerous oral lesions can be detected long before invasive cancer develops. Tobacco cessation may reverse or prevent progression of lesions such as leukoplakia.

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One-line comparison for exams

1. ASHA: Accredited Social Health Activist

Functions of ASHA

1. Health education and awareness
   • Creates awareness about nutrition, sanitation, hygiene, healthy living and working conditions.
   • Informs people about available health services and encourages their timely use.
2. Maternal and child health counselling
   • Counsels women on birth preparedness, safe delivery, breastfeeding, complementary feeding, immunization, contraception, newborn and child care.
   • Educates about prevention of RTIs/STIs and common infections.
3. Mobilization and link worker role
   • Mobilizes people to use Anganwadi, sub-centre, PHC and other government services.
   • Facilitates ANC, PNC, immunization, supplementary nutrition, sanitation and family-planning services.
4. Village health planning
   • Works with the Village Health, Sanitation and Nutrition Committee/Gram Panchayat to prepare the village health plan.
5. Escort and referral
   • Accompanies pregnant women and sick children to PHC, CHC, First Referral Unit, or hospital when needed.
6. Basic care and treatment
   • Provides first aid and care for minor ailments such as diarrhoea and fever.
   • Works as a DOTS provider for tuberculosis treatment.
7. Drug-depot holder
   • Keeps and provides essential supplies such as ORS, IFA tablets, condoms, oral contraceptive pills, disposable delivery kits, and other drugs in the ASHA kit.
8. Disease surveillance
   • Reports births, deaths, unusual health events, and suspected disease outbreaks to the sub-centre/PHC.
9. Sanitation promotion
   • Promotes household toilet construction and use under sanitation programmes.

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2. ANM: Auxiliary Nurse Midwife/Health Worker Female

Functions of ANM

A. Maternal health

• Registers every pregnant woman and provides antenatal care.
• Ensures at least four antenatal check-ups.
• Tests urine for albumin and sugar and estimates haemoglobin.
• Refers pregnant women for RPR testing for syphilis.
• Identifies and refers high-risk or abnormal pregnancies.
• Conducts deliveries where necessary and supervises deliveries by dais.
• Refers difficult labour and sick/abnormal newborns for institutional care.
• Helps implement Janani Suraksha Yojana.
• Tracks pregnancies for scheduled ANC and PNC services.

B. Postnatal and newborn care

• Makes postnatal visits:
  • Home/sub-centre delivery: day 0, 3, 7, and 42
  • Institutional delivery: day 3, 7, and 42
• Makes extra visits for low-birth-weight babies.
• Promotes breastfeeding within one hour of birth, exclusive breastfeeding for six months, and appropriate complementary feeding after six months.
• Assesses child growth and development and refers when necessary.

C. Child health and nutrition

• Treats minor ailments such as diarrhoea and ARI/pneumonia according to guidelines.
• Identifies and refers severe dehydration, respiratory distress, severe acute malnutrition, and serious illness.
• Educates mothers regarding nutrition, child care, hygiene, immunization, and prevention of communicable diseases.

D. Family planning

• Maintains and updates the eligible-couple register.
• Distributes condoms and oral contraceptive pills.
• Motivates couples for family planning and arranges referral where needed.
• Provides follow-up to family-planning acceptors and manages or refers side effects.
• Maintains contraceptive supply through depot holders.

E. Immunization and communicable-disease control

• Conducts/supports immunization activities.
• Maintains cold chain and vaccine supplies.
• Participates in surveillance, reporting, and control activities for communicable diseases.

F. Health education and records

• Provides individual and group health education on MCH, family planning, nutrition, sanitation, immunization, and disease prevention.
• Maintains records, registers, reports, and surveys required for health programmes.

G. Guidance of ASHA

• Holds weekly or fortnightly meetings with ASHA.
• Trains and guides ASHA.
• Informs ASHA about outreach sessions and helps mobilize beneficiaries.
• Uses ASHA to update eligible-couple registers, motivate women for ANC, IFA consumption, tetanus vaccination, institutional delivery, and family planning.
• Trains ASHA to recognize danger signs in pregnancy and labour.

Key difference

Steps of the health planning cycle

1. Analysis of the health situation
   • Collect, assess, and interpret data to identify health problems, needs, and demands.
   • Data include:
     • Population size and age-sex structure
     • Morbidity and mortality statistics
     • Distribution and epidemiology of diseases
     • Existing health facilities and agencies
     • Available manpower and training facilities
     • Community attitudes and beliefs
2. Establishment of objectives and goals
   • Objectives guide action and provide standards for later assessment.
   • They should be clear, realistic, feasible, and time-bound.
   • Goals are the ultimate desired health state towards which objectives and resources are directed.
3. Assessment of resources
   • Assess available and required:
     • Manpower
     • Money
     • Materials
     • Skills
     • Knowledge
     • Techniques
     • Time
   • A balance is made between resources needed and those available or likely to become available.
4. Fixing priorities
   • Since resources are limited, health problems are ranked in order of importance.
   • Consider:
     • Magnitude of morbidity and mortality
     • Financial constraints
     • Cost and feasibility of prevention
     • Social value, such as saving younger lives
     • Political and community interests
   • Alternative plans are formulated and the most practicable and effective one is selected.
5. Write-up of the formulated plan
   • Prepare a detailed written plan.
   • Specify:
     • Inputs or resources required
     • Expected outputs
     • Activities and stages
     • Costs
     • Time schedule
     • Responsibilities
     • Built-in evaluation system
6. Programming and implementation
   • After approval, the plan is put into action.
   • It requires:
     • Clearly defined roles and tasks
     • Selection, training, motivation, and supervision of staff
     • Good organization and communication
     • Delegation of authority and fixation of responsibility
7. Monitoring
   • Continuous day-to-day follow-up during implementation.
   • It checks whether activities are proceeding according to the plan and schedule.
   • Deviations are identified and corrected promptly.
8. Evaluation
   • Assesses whether stated objectives and targets have been achieved.
   • Measures adequacy, efficiency, effectiveness, acceptance, productivity, and cost-effectiveness.
   • Provides feedback for revising priorities, reallocating resources, and improving future plans.

Flowchart

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1. Primary Health Care

• Sub-centres
• Primary Health Centres (PHCs)
• Village-level workers such as ASHA and Anganwadi workers

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A. Sub-centre

Definition

Population norms

Staff

• One Health Worker Female/ANM
• One Health Worker Male/MPW
• ASHA supports community-level work.

Main services

• Maternal and child health care
• Antenatal and postnatal care
• Family planning and contraceptive services
• Immunization
• Nutrition education, IFA supplementation, and growth monitoring
• Prevention and control of communicable diseases
• Basic treatment for minor ailments and first aid
• Health education, sanitation, and safe-water promotion
• Disease surveillance, reporting of births and deaths
• Referral of high-risk pregnancy, sick newborns, severe illness, and other cases.

Types of sub-centres

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B. Primary Health Centre (PHC)

Definition

Population norms

Bed strength

Functions of PHC

1. Medical care for common illnesses
2. Maternal and child health services, including family planning
3. Safe water and basic sanitation
4. Control of locally endemic diseases
5. Collection and reporting of vital statistics
6. Health education
7. Implementation of national health programmes
8. Referral services
9. Training of health guides, health workers, local dais, and health assistants
10. Basic laboratory services

Services

• OPD services
• Basic inpatient care
• First aid, emergency stabilization, and referral
• ANC, PNC, normal delivery services where available
• Immunization
• Contraceptive and family-planning services
• Basic laboratory investigations
• Implementation of disease-control programmes
• NCD screening and follow-up.

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2. Secondary Health Care

Definition

Institutions

• Community Health Centre (CHC)
• Sub-district/sub-divisional hospital
• District hospital

Community Health Centre

• Medicine
• Surgery
• Obstetrics and gynaecology
• Paediatrics

Functions

• Manages referred obstetric, medical, surgical, paediatric, and emergency cases.
• Provides comprehensive emergency obstetric and newborn care where designated.
• Provides inpatient care, diagnostics, and specialist services.
• Supports PHCs through referral, supervision, training, and programme implementation.
• Refers super-specialty or highly complicated cases to tertiary hospitals.

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3. Tertiary Health Care

Definition

Institutions

• Medical college hospitals
• Regional hospitals
• Central government hospitals
• AIIMS and other apex institutions
• Speciality and super-speciality hospitals

Services

• Advanced investigations and procedures
• Super-specialist medical and surgical care
• Intensive care and management of complicated referred cases
• Cancer treatment, neurosurgery, cardiothoracic surgery, renal replacement therapy, etc.
• Teaching and training of specialist staff
• Research, planning, managerial support, and technical guidance for lower health-care levels.

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Comparison Table

Aim of National AIDS Control Programme

1. Prevent further transmission of HIV.
2. Reduce morbidity and mortality associated with HIV infection.
3. Minimize the socioeconomic impact of HIV/AIDS.

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Brief history and phases

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Components/activities under NACO

1. HIV surveillance

• Establish surveillance centres throughout the country.
• Monitor HIV prevalence and trends through sentinel surveillance.
• Identify geographical areas and population groups at higher risk.

2. Targeted interventions

• Female sex workers
• Men who have sex with men
• Transgender persons
• Injecting-drug users
• Migrant and bridge populations

3. Information, education and communication

• Create awareness about HIV transmission and prevention.
• Promote safe sexual behaviour and condom use.
• Reduce HIV-related stigma and discrimination.
• Encourage voluntary HIV testing, treatment adherence, and care seeking.
• Conduct youth and school-focused awareness programmes.

4. HIV testing services

• Integrated Counselling and Testing Centres (ICTCs).
• Provider-initiated testing and counselling where indicated.
• Community-based screening and linkage to care.
• Pre-test and post-test counselling.

5. Prevention of parent-to-child transmission

• HIV testing and counselling for pregnant women.
• Antiretroviral therapy for HIV-positive pregnant/breastfeeding women.
• Early diagnosis and treatment of HIV-exposed infants.
• Counselling on infant feeding and follow-up.

6. Care, support and treatment

• Free antiretroviral therapy through ART centres.
• Management of opportunistic infections.
• Viral-load testing and treatment monitoring.
• Adherence counselling, psychosocial support, and referral services.
• Linkage with TB services for HIV-TB collaborative activities.

7. Sexually transmitted infection/reproductive tract infection control

• Establish and support STI/RTI clinics up to district level.
• Syndromic case management, laboratory support, training, and drug kits.
• Promote early diagnosis and treatment of STIs, which reduce the risk of HIV transmission.

8. Blood safety

• Ensure safe blood and blood products.
• Promote voluntary non-remunerated blood donation.
• Screen donated blood for HIV and other transfusion-transmissible infections.
• Strengthen blood banks, blood-component separation units, and quality assurance.

9. Condom programme

• Ensure availability and promotion of condoms for HIV and STI prevention.
• Social marketing and free distribution in high-risk settings.

10. Strategic information

• Monitoring and evaluation
• Surveillance
• Programme research
• Data analysis
• Recording and reporting

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Organizational structure

• Targeted Intervention and Link Worker Scheme
• Basic services: ICTC, PPTCT, and HIV-TB coordination
• STI/RTI management
• Blood safety
• Laboratory services
• Care, support, and treatment
• Information, education, and communication
• Strategic information: surveillance, monitoring, evaluation, research, and data analysis
• Finance, administration, and procurement

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NACP-IV goal

Halt and reverse the HIV epidemic in India by integrating prevention, care, support, and treatment services.

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Current update

Definition

ICD-11 classification of distance visual impairment

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Epidemiology of Blindness

Major global causes

1. Unoperated cataract: 35%
2. Uncorrected refractive error: 21%
3. Glaucoma: 8%

Causes of blindness in India

Epidemiological determinants

1. Age
   • Children and young people: refractive errors, trachoma, conjunctivitis, and vitamin A deficiency.
   • Middle age: cataract, refractive errors, glaucoma, and diabetes.
   • Injury and trauma occur at all ages, especially 20-40 years.
2. Sex
   • Blindness is reported more commonly in females than males in India, partly due to a higher prevalence of cataract, conjunctivitis, and trachoma.
3. Malnutrition
   • Vitamin A deficiency, especially with measles, diarrhoea, and protein-energy malnutrition, may cause xerophthalmia and keratomalacia.
   • Severe corneal destruction due to vitamin A deficiency mainly affects children aged 6 months to 3 years.
4. Occupation
   • Factory, workshop, and cottage-industry workers are exposed to dust, flying particles, chemicals, fumes, welding flash, radiation, and trauma.
5. Social class and social factors
   • Blindness is more common among poorer populations.
   • Important factors are poverty, ignorance, poor hygiene, inadequate eye-care services, and harmful treatment by unqualified persons.

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Vision 2020: The Right to Sight

Central concept

Objective

• Cataract
• Xerophthalmia and other causes of childhood blindness
• Refractive errors and low vision
• Trachoma
• Other causes of corneal blindness

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National Programme for Control of Blindness and Visual Impairment

NPCBVI

Goal

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Objectives of NPCBVI

1. Continue the three signature activities:
   • About 66 lakh cataract operations per year
   • School eye screening and distribution of 9 lakh free spectacles annually to children with refractive error
   • Collection of 50,000 donated eyes per year for keratoplasty
2. Reduce the backlog of avoidable blindness through identification and treatment of curable blindness at primary, secondary, and tertiary levels.
3. Provide comprehensive universal eye-care services and quality service delivery under the concept of Eye Health for All.
4. Strengthen Regional Institutes of Ophthalmology, medical colleges, district hospitals, sub-district hospitals, vision centres, NGO eye hospitals, and other eye-care institutions.
5. Strengthen infrastructure and develop human resources for comprehensive eye care in all districts.
6. Enhance community awareness and preventive eye-care practices.
7. Promote research on prevention of blindness and visual impairment.
8. Ensure participation of voluntary organizations and private practitioners in eye-care delivery.

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Major strategies

1. Free cataract surgery, including intraocular lens implantation, through government, NGO, and private-sector participation.
2. Comprehensive eye care for diseases other than cataract:
   • Diabetic retinopathy
   • Glaucoma
   • Corneal blindness and corneal transplantation
   • Vitreo-retinal disorders
   • Childhood blindness
3. Active screening of people above 50 years, eye camps, and transport of operable cataract cases to fixed facilities.
4. School eye screening to detect refractive errors and provide free spectacles to eligible children.
5. Public-private partnership to cover underserved regions.
6. Training and capacity-building of health personnel.
7. Information, education, and communication activities for eye-care awareness.
8. Upgrading Regional Institutes of Ophthalmology and medical colleges as centres of excellence.
9. Strengthening district hospitals with ophthalmologists, ophthalmic assistants, equipment, drugs, and infrastructure.
10. Establishing vision centres at PHCs, with a paramedical ophthalmic assistant.
11. Use of mobile ophthalmic units for remote areas.

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Organisation and service-delivery system

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School Eye Screening Programme

• Approximately 6-7% of children aged 10-14 years have visual problems affecting learning.
• Teachers are trained to screen children initially.
• Children suspected of refractive error are examined by ophthalmic assistants.
• Spectacles are prescribed or provided free to children from below-poverty-line families.

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Other components

• Eye donation and eye banking
• Corneal transplantation
• Vitamin A prophylaxis
• Community health education
• Regular eye check-ups
• Eye camps, especially in remote and tribal areas
• Prevention and treatment of childhood blindness
• Rehabilitation for visual impairment

A. Fertility Rates

1. Crude Birth Rate (CBR)

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2. General Fertility Rate (GFR)

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3. General Marital Fertility Rate (GMFR)

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4. Age-Specific Fertility Rate (ASFR)

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5. Age-Specific Marital Fertility Rate (ASMFR)

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6. Total Fertility Rate (TFR)

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7. Total Marital Fertility Rate (TMFR)

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8. Gross Reproduction Rate (GRR)

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9. Net Reproduction Rate (NRR)

• NRR = 1: Replacement-level reproduction, approximately the two-child norm.
• NRR < 1: Below replacement level.
• NRR > 1: Population is more than replacing itself.

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10. Child-Woman Ratio

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B. Contraceptive Methods

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I. Temporary or Spacing Methods

1. Natural methods

• Periodic abstinence/rhythm method: Avoid intercourse during the fertile period.
• Withdrawal/coitus interruptus: Withdrawal of penis before ejaculation.
• Lactational amenorrhoea method (LAM): Temporary contraception during exclusive breastfeeding, when the woman remains amenorrhoeic and the infant is less than 6 months old.
• Cervical mucus/Billings method
• Basal body-temperature method
• Symptothermal method

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2. Barrier methods

Physical barrier methods

• Male condom
• Female condom
• Diaphragm
• Cervical cap
• Vaginal sponge

Chemical barrier methods

• Spermicidal creams
• Jellies
• Foams
• Tablets
• Pessaries

Combined barrier methods

• Condom plus spermicide
• Diaphragm plus spermicide

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3. Intrauterine devices (IUDs)

• Copper-bearing IUDs, such as Cu-T 380A
• Hormone-releasing IUDs, such as levonorgestrel intrauterine system

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4. Hormonal methods

Oral contraceptive pills

• Combined oral contraceptive pills
• Progestin-only pills
• Centchroman, a non-steroidal oral contraceptive used in India

Injectable contraceptives

• Depot medroxyprogesterone acetate, DMPA
• Other progestin injectables

Implants

• Subdermal progestin implants providing long-term reversible contraception.

Emergency contraception

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5. Post-conceptional methods

• Emergency contraception
• Medical termination of pregnancy under legally permitted conditions

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II. Permanent or Terminal Methods

1. Male sterilization: Vasectomy

• Vas deferens are cut and ligated to prevent sperm from entering semen.
• The no-scalpel vasectomy technique is commonly used.
• It is simpler, faster, safer, and less costly than female sterilization.
• It does not cause immediate sterility. Another contraceptive method is required until azoospermia is confirmed after the procedure.

2. Female sterilization: Tubectomy/Tubal ligation

• Fallopian tubes are cut, ligated, clipped, or blocked to prevent meeting of sperm and ovum.
• Types include:
  • Interval tubectomy
  • Postpartum tubectomy
  • Laparoscopic tubectomy
  • Minilaparotomy

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Classification at a Glance

1. Hypertension
   • Definition and classification
   • Risk factors, complications, prevention, screening, and control
2. Diabetes mellitus
   • Diagnosis, epidemiology, risk factors, complications, prevention, and control
3. Obesity
   • BMI and central obesity criteria
   • Causes, health effects, prevention, and management
4. Accidents
   • Epidemiology, types, host-agent-environment factors
   • Road-traffic accidents and prevention using the Haddon matrix
5. Coronary heart disease
   • Epidemiology, risk factors, prevention, screening, and rehabilitation

1. Hypertension: definition, classification, risk factors, complications, prevention and control.
2. Diabetes mellitus: diagnostic criteria, risk factors, complications, prevention and screening.
3. Obesity: BMI and waist criteria, causes, consequences, prevention and management.
4. Accidents: epidemiology, types, Haddon matrix, and prevention of road traffic injuries.
5. Coronary heart disease: epidemiology, risk factors, prevention, rehabilitation, and control.