---

LONG ESSAYS (10 marks each)

---

Q1. Clinical Case Classification & Criteria for Clinical Diagnosis of Dengue; Preventive & Control Measures

Etiology and Transmission

---

WHO 2009 Clinical Classification

• Fever of 2-7 days duration
• Nausea, vomiting
• Rash
• Aches and pains (headache, retro-orbital pain, myalgia, arthralgia)
• Leukopenia
• Positive tourniquet test

• Abdominal pain or tenderness
• Persistent vomiting
• Clinical fluid accumulation (ascites, pleural effusion)
• Mucosal bleed
• Lethargy/restlessness
• Liver enlargement >2 cm
• Increase in hematocrit concurrent with rapid decrease in platelet count

• Severe plasma leakage leading to: dengue shock syndrome, fluid accumulation with respiratory distress
• Severe bleeding (as evaluated by clinician)
• Severe organ involvement:
  • Liver: AST or ALT ≥1000 IU/L
  • CNS: impaired consciousness
  • Heart and other organs

---

Clinical Phases of Dengue

---

Criteria for Clinical Diagnosis

• Live in/travel to dengue endemic area
• Fever + 2 or more of: nausea/vomiting, rash, headache, retro-orbital pain, myalgia, arthralgia, leukopenia
• Positive tourniquet test (inflated to midpoint between systolic and diastolic BP for 5 minutes; >10-20 petechiae/sq inch = positive)

• Days 1-5 (febrile phase): NS1 antigen, RT-PCR
• After Day 5: IgM/IgG antibody serology (ELISA, seroconversion)
• CBC: leukopenia, thrombocytopenia (platelet <100,000/mm³), rising hematocrit

---

Preventive and Control Measures

1. Source reduction - emptying/covering water-holding containers, removing breeding sites (flower pots, tyres, coolers)
2. Biological control - introduction of Bacillus thuringiensis israelensis (Bti), larvivorous fish (Gambusia, Guppy)
3. Chemical control - larviciding (temephos), adulticiding (pyrethroid space spraying)
4. Integrated Vector Management (IVM) - combining biological, chemical, and environmental measures

• Wear long-sleeved clothes, use insect repellents (DEET-based)
• Use bed nets (especially during daytime sleep)
• Install window/door screens

• Health education and awareness about dengue symptoms and vector control
• Community participation in larval source reduction
• "Dry Day" - one day/week when all water storage containers are emptied and cleaned
• Solid waste management

• Epidemiological surveillance (case notification)
• Entomological surveillance: Larval indices - Breteau Index (BI), House Index (HI), Container Index (CI)
• Stegomyia Index thresholds for outbreak risk

• Dengvaxia (CYD-TDV) - approved but with restrictions (only for seropositive individuals aged 9-45 years in endemic areas)

• No specific antiviral; management is symptomatic
• Oral rehydration for Group A; IV fluids (crystalloid - NS or Ringer's lactate) for Groups B and C
• Avoid NSAIDs, aspirin (risk of bleeding)

---

Q2. NP-NCD Programme: Implementation at PHC Level and Newer Initiatives

Background

1. Prevent and control NCDs (cancer, diabetes, CVDs, stroke) and newer additions
2. Provide universal access to NCD services
3. Reduce premature mortality from NCDs by 25% by 2025
4. Build capacity at all levels of healthcare

---

Implementation at PHC Level

• History taking: family history of NCDs, behavioural risk factors (tobacco, alcohol, unhealthy diet, physical inactivity)
• General examination: BMI calculation, blood pressure measurement, blood glucose estimation
• Cancer screening: oral cavity (all), breast (women 30+), cervix (women 30+)

• Medical Officer - supervises screening and management
• Staff Nurse / ANM - conducts screening
• ASHA - community-level mobilization, register maintenance

• Population-based screening at sub-centre level (through ASHA and ANMs)
• NCD clinics at PHC: weekly/twice-weekly
• Referral to CHC/District Hospital NCD clinic for confirmed cases requiring higher management
• Follow-up and continued care for those on treatment

• Maintenance of NCD register for diagnosed patients
• Regular tracking and follow-up
• Use of NCD portal/digital tools for data entry

• Screening for 12 diseases (hypertension, diabetes, 3 cancers, oral health, eye health, hearing, mental health, COPD, CKD)
• Wellness activities: yoga, health education sessions

---

Newer Initiatives under NP-NCD

1. India Hypertension Control Initiative (IHCI) - Launched 2017; protocol-based treatment for hypertension; expanded to all districts
2. National Multisectoral Action Plan (NMAP) - From 2016; inter-ministerial action plan involving Education, Food, Finance, Sports ministries
3. COPD and Asthma - Included in NP-NCD in phased manner
4. Chronic Kidney Disease (CKD) - Included for early detection and management
5. Stroke management - STEMI protocols, telemedicine for stroke care
6. Non-Alcoholic Fatty Liver Disease (NAFLD) - Newly included
7. ST-Elevated Myocardial Infarction (STEMI) programme (e.g., STEMI Maharashtra - ECG and thrombolysis network)
8. Digital health tools - NCD portal, mobile applications for tracking beneficiaries, tele-consultations
9. Tele-NCD consultations - use of telemedicine for remote areas
10. Cancer screening expanded - cervical cancer screening using VIA/VILI, HPV testing
11. 75 by 25 Roadmap - Target to bring 75 million patients with DM and HTN under care by 2025

---

SHORT ESSAYS (5 marks each)

---

Q3. Disaster Mitigation: Definition and Community-Level Measures

Definition

Mitigation vs Other Phases

• Prevention - prevents the hazard itself
• Mitigation - reduces the impact of hazard
• Preparedness - planning before disaster
• Response - actions during disaster
• Recovery/Rehabilitation - actions after disaster

Community-Level Disaster Mitigation Measures

• Improved building codes and enforcement (earthquake-resistant buildings)
• Flood mitigation works (levees, embankments, drainage systems)
• Appropriate land-use planning (no construction in flood plains or landslide-prone areas)
• Protection of critical infrastructure (hospitals, water supply, power stations)

1. Public awareness and community education - training communities in first aid, evacuation procedures
2. Community Disaster Management Committees - village/ward level committees for local response
3. Early Warning Systems - cyclone/flood warning dissemination at community level
4. Mock drills and simulation exercises - testing community response mechanisms
5. Vulnerability mapping - identification of high-risk households (elderly, disabled, BPL)
6. Community resource pooling - identification of local resources (vehicles, manpower, storage)
7. Trained community volunteers - CERT (Community Emergency Response Teams)
8. Safe schools and health facilities - structural assessment and retrofitting

• Ensuring safety of health facilities and public health services
• Protection of water supply and sewerage systems
• Pre-positioning of essential medicines and supplies
• Preventing contamination of drinking water sources

---

Q4. 6×6×6 Strategy of Anemia Mukt Bharat

Background

6×6×6 Strategy

1. Children 6-59 months
2. Children 5-9 years
3. Adolescents 10-19 years (boys and girls)
4. Women of Reproductive Age (15-49 years)
5. Pregnant women
6. Lactating women

1. Prophylactic Iron and Folic Acid (IFA) supplementation across all 6 target groups
2. Deworming - biannual for children 1-19 years (National Deworming Day)
3. Intensified year-round Behaviour Change Communication (BCC) - dietary diversity, iron-rich foods
4. Testing and treatment of anemia - point-of-care hemoglobin testing using digital hemoglobinometer
5. Delayed cord clamping - for newborns (prevents neonatal anemia)
6. Addressing non-nutritional causes - malaria, hemoglobinopathies, fluorosis

1. Ministry of Health and Family Welfare (MoHFW)
2. Ministry of Women and Child Development (MoWCD) - for children under 5 and pregnant/lactating women
3. Ministry of Human Resource Development / Education - for school children and adolescents
4. Ministry of Drinking Water and Sanitation - for WASH interventions
5. POSHAN Abhiyaan / National Nutrition Mission (NNM)
6. NITI Aayog - for overall coordination and monitoring

---

Q5. Healthy Ageing: Definition and Actions

Definition

Actions Towards Healthy Ageing (Lifestyle Factors)

1. Diet and Nutrition - Balanced diet with less saturated fats, more fruits and vegetables, less salt and sugar, calcium-rich foods, high-fibre diet. Overnutrition (especially saturated fats) links to cardiovascular disease in later life.
2. Physical Exercise - Regular exercise: controls weight, improves emotional well-being, improves circulation, lowers BP, lowers blood sugar, improves bone density (prevents osteoporosis), reduces risk of falls.
3. Weight Management - Avoid overweight/obesity; reduces risk of heart disease, stroke, hypertension, diabetes, arthritis, breast cancer.
4. Avoidance of Tobacco (Smoking Cessation) - Smoking cessation at age 50 reduces the risk of dying within the next 15 years by 50%.
5. Alcohol Restriction - Older people achieve higher blood alcohol levels for same intake (reduced body water); alcohol linked to liver disease, gout, depression, osteoporosis, heart disease, hypertension.
6. Social Activities and Social Engagement - Socially active elderly are healthier; group activities, community engagement, and social support improve recovery from illness and mental well-being.

• National Programme for Health Care of the Elderly (NPHCE)
• Pradhan Mantri Vaya Vandana Yojana (financial security)
• Rashtriya Vayoshri Yojana (assistive devices)
• Senior Citizen Health Insurance Scheme under Ayushman Bharat
• Dedicated geriatric wards in District Hospitals
• National Policy for Senior Citizens, 2011

---

Q6. District Mental Health Programme (DMHP)

Background

Objectives

1. Provide basic mental health services in the community
2. Early detection and treatment of mental illness at the peripheral level
3. Ensure availability of psychotropic drugs at primary level
4. Train general health staff in mental health
5. Reduce stigma associated with mental illness
6. Rehabilitation of mentally ill in the community

Components of DMHP

• Outpatient (OPD) mental health services at district hospital
• Mobile mental health teams visiting PHC/CHC level
• Inpatient services for acute psychiatric emergencies
• De-addiction services

• Training of medical officers at PHC in mental health (recognition and first-line management)
• Training of paramedicals, ANMs, ASHAs in mental health basics and referral

• Awareness campaigns to reduce stigma
• School mental health programmes
• Community education

• Day care centres
• Half-way homes
• Family counselling and psychosocial support

Activities under DMHP

• Weekly/fortnightly mental health OPD at district hospital by psychiatrist
• Monthly visits by mobile team to CHC/PHC
• Maintaining mental health register
• Distribution of essential psychotropic drugs free of cost
• Suicide prevention programmes
• Integration with primary care (collaborative care model)

Under NHM:

---

Q7. Emerging Infectious Diseases (EIDs): Definition and Factors

Definition

Examples

• New/novel: COVID-19 (SARS-CoV-2), SARS, MERS, Nipah, Hendra, Ebola
• Re-emerging: Multi-drug resistant TB, Dengue, Mpox (Monkeypox), Leptospirosis

Factors Responsible for Emergence

• Deforestation and land-use change (increased human-animal interface)
• Climate change (expanding vector habitats - e.g., Aedes mosquito moving to new areas)
• Flooding and drought (altering transmission patterns)
• Urbanization (slums, crowding, poor sanitation)

• Increasing immunocompromised populations (HIV/AIDS, organ transplants, chemotherapy)
• Aging populations (greater susceptibility)
• Malnutrition

• Genetic mutation and evolution of pathogens (antigenic shift/drift)
• Antimicrobial resistance (AMR)
• Cross-species transmission (zoonotic spillover)

• Increased international travel and trade (rapid global spread)
• Mass gatherings (pilgrimages, festivals)
• Bushmeat consumption
• Poor food safety practices (factory farming, wet markets)

• Breakdown of public health infrastructure
• Increased use of broad-spectrum antibiotics (AMR)
• Nosocomial transmission in healthcare settings
• Inadequate vector control

• Large-scale monoculture farming
• Global food distribution networks
• Blood and tissue banking

---

Q8. Newer Initiatives in Treatment of Tuberculosis under NTEP

Newer Initiatives

• All diagnosed TB patients get drug sensitivity testing (DST) before starting treatment
• Use of CBNAAT (Cartridge-Based Nucleic Acid Amplification Test / GeneXpert) for rapid diagnosis and rifampicin resistance detection

• Bedaquiline, Linezolid, Pretomanid (BPaL regimen) - newer 6-month regimen for XDR-TB (extensively drug-resistant TB)
• BPaLM regimen (adding Moxifloxacin) - WHO endorsed
• Shorter MDR-TB regimen (6-9 months) using Bedaquiline, replacing old 24-month regimens

• Direct benefit transfer of Rs. 500/month to every TB patient for nutritional support throughout treatment

• IT-based patient notification and monitoring system
• All TB cases mandatorily notified (since 2012)
• Private sector notification mandatory since 2012 under Revised Notification framework

• Meri TB Dawa platform - free drugs to private sector patients
• Partnerships with private providers under PPP model

• Line Probe Assay (LPA) for rapid MDR-TB detection
• Truenat platform (molecular test for peripheral use)
• Liquid culture (MGIT)

• TB Preventive Treatment (TPT) with Isoniazid (6H) or 3HP (3 months isoniazid + rifapentine) for high-risk contacts

• Intensified active case finding
• Household contact screening
• Pradhan Mantri TB Mukt Bharat Abhiyan - social support from community members (Ni-kshay Mitras)

---

Q9. Types of ICTC and Their Functions

Definition

Types of ICTC

• Located in government hospitals, medical colleges, and health centres
• Has dedicated infrastructure, personnel, and equipment
• Services: pre-test counselling, HIV testing, post-test counselling, referral
• Counsellor and laboratory technician posted full-time

• Integrated within existing health facility (PHC, CHC, district hospital)
• Services provided by existing staff trained in ICTC services
• Aims to expand coverage to lower levels of healthcare

• Mobile van-based service for remote/inaccessible areas
• Reaches population who cannot access fixed facilities
• Especially used for migrant workers, truckers, sex workers

• Located at antenatal care (ANC) clinics
• All pregnant women offered HIV testing
• Linked to ART centres for seropositive mothers

Functions of ICTC

• Pre-test counselling: information about HIV, meaning of test results, risk assessment, informed consent
• HIV testing: using rapid test kits as per NACO testing algorithm (3 tests - screening, confirmatory, tie-breaker)
• Post-test counselling: disclosure, partner notification, safe sex counselling, adherence preparation
• Referral linkages: to ART centres, DOTS, STI clinics, VCTC services
• Support for vulnerable groups: special services for sex workers, MSM, IDU, truckers (bridge populations)
• Maintaining confidentiality of all test results

---

Q10. Management Methods Based on Behavioural Sciences

Key Theories and Models

• People change behaviour based on: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, self-efficacy
• Application: anti-smoking campaigns (perceived severity of lung cancer)

• Pre-contemplation → Contemplation → Preparation → Action → Maintenance → Relapse
• Application: tailoring counselling to patient's readiness to change

• Learning through observation and self-efficacy
• Peer education programmes; role models in health promotion

• Systematic planning for health education programs considering predisposing, enabling, and reinforcing factors

Management Methods Based on Behavioural Sciences

• Mass media campaigns (TV, radio, social media)
• IEC (Information Education Communication) materials
• Street plays, folk media, wall paintings

• Individual counselling (e.g., ICTC counselling for HIV)
• Group counselling (e.g., family planning camps)
• Motivational Interviewing (MI) for lifestyle modification

• Self-help groups (SHGs) for behaviour change
• Community leaders as change agents
• Village Health and Nutrition Days (VHNDs)

• Modifying environment to make healthy choices easier (default healthy options in cafeterias)

• Conditional cash transfers (e.g., Janani Suraksha Yojana for institutional delivery)
• Nikshay Poshan Yojana (financial incentive for TB adherence)

• Changing thought patterns to change behaviour
• Used in mental health, addiction management

• Directly Observed Treatment (DOT) in TB
• Pill boxes, reminder calls/SMS for medication adherence

---

SHORT ANSWERS (3 marks each)

---

Q11. Acculturation

• Migrants and minority communities adopt practices of the host culture (e.g., dietary changes, smoking, alcohol use)
• Can be positive (improved healthcare seeking) or negative (adoption of unhealthy Western diets, sedentary lifestyle)
• "Acculturation paradox" or "Healthy Immigrant Effect" - newly arrived immigrants often healthier than native-born, but health declines with longer stay
• Measured by Berry's Four Strategies: Integration, Assimilation, Separation, Marginalization

---

Q12. Catastrophic Health Expenditure

• Major cause of impoverishment in India (60% of health spending is OOP)
• Leads to "medical poverty trap" - families forced to sell assets or borrow to pay for care
• NFHS-5 and NSSO data show high CHE burden in India, especially for hospitalization and cancer care
• Indicators: Incidence and intensity of CHE
• Mitigation: Ayushman Bharat - PM-JAY (cashless hospitalization up to Rs. 5 lakh/year for BPL families), government hospitals, Jan Aushadhi scheme

---

Q13. PERT

• Developed by US Navy in 1958 for Polaris missile project
• Represents projects as networks of tasks (nodes and arrows)
• Uses three time estimates for each activity:
  • Optimistic time (O)
  • Pessimistic time (P)
  • Most likely time (M)
• Expected time = (O + 4M + P) / 6
• Identifies Critical Path - longest sequence of tasks determining minimum project duration
• Useful for novel projects with uncertain timelines
• Used in health programmes (e.g., national immunization schedules, hospital construction planning)

---

Q14. NITI Aayog

1. Develop long-term vision documents and strategic plans (e.g., India@2047 Viksit Bharat)
2. Cooperative federalism - foster participation of States in national development
3. Policy research and provide evidence-based recommendations
4. Monitoring and evaluation of government programmes
5. Technology forecasting and dissemination
6. Health-related roles: Health Index (ranking states), Population Index, Sustainable Development Goals monitoring
7. Oversees POSHAN Abhiyaan (nutrition mission) coordination
8. Atal Innovation Mission (AIM) - to promote innovation and entrepreneurship

---

Q15. Combating Counterfeit Medicines

1. Legal framework: Drugs and Cosmetics Act 1940 (amended); penalties for manufacture/sale of spurious drugs
2. Drug regulatory bodies: Central Drugs Standard Control Organization (CDSCO), State Drug Controllers
3. Track and Trace system: Drug barcoding and serialization (QR codes on packaging)
4. e-Aushadhi portal: Real-time drug licensing and recall information
5. Random sampling of drugs from market by Drug Inspectors; laboratory testing
6. Jan Aushadhi Scheme: Government-certified generic medicines at affordable prices
7. WHO IMPACT (International Medical Products Anti-Counterfeiting Taskforce) - global coordination
8. Patient awareness: advising public to buy from licensed pharmacies, check expiry, look for hologram seals
9. Mobile app verification: some manufacturers provide SMS/app-based verification codes

---

Q16. World Health Day 2026 Theme

• Reduce preventable maternal and neonatal mortality
• Improve access to skilled birth attendants
• Strengthen antenatal care services globally
• Address leading causes of maternal death (hemorrhage, sepsis, hypertensive disorders, unsafe abortion)

---

Q17. Syndromic Case Management of RTI/STI

---

Q18. Rashtriya Bal Swasthya Karyakram (RBSK)

1. Defects at birth - congenital heart disease, cleft lip/palate, Down's syndrome
2. Deficiencies - anemia, Vitamin D deficiency, nutritional deficiencies
3. Diseases - skin conditions, dental caries, hearing/vision impairment, rheumatic heart disease
4. Development delays including Disabilities - neuromotor impairment, autism, learning disability

• Newborns (at facility and home)
• Children 6 weeks to 6 years at Anganwadi Centres
• Children 6-18 years at government and government-aided schools

• Mobile Health Teams (MHTs) - each team has 2 AYUSH doctors, 1 ASHA companion
• Screening covers 30 defined health conditions
• Referral to District Early Intervention Centres (DEICs) for confirmatory diagnosis and management
• Free surgical correction (e.g., cleft lip repair, heart surgery) under RBSK

---

Q19. Cancer Registry

Types

• Data collected from patients attending a specific hospital
• Useful for monitoring treatment outcomes, survival rates
• Limitations: does not give true incidence; biased toward referred cases

• Collects data on all new cancer cases occurring in a defined geographic population
• Provides true incidence rates and prevalence
• More complex and expensive

• Part of ICMR; coordinates cancer registries under National Cancer Registry Programme (NCRP)
• 30+ PBCRs across India (e.g., Mumbai, Chennai, Delhi, Bangalore, Bhopal)
• Publishes "Cancer Incidence in Five Continents" (IARC)

• Determine magnitude and trends of cancer burden
• Identify high-risk groups and geographic clusters
• Guide cancer prevention and screening programmes
• Monitor effectiveness of cancer control programmes
• Research and epidemiological studies

---

Q20. Social Security

1. Social Insurance - contributory schemes (workers and employers pay premiums); benefits as entitlements (e.g., ESI, EPF, NPS)
2. Social Assistance - non-contributory; tax-funded; means-tested grants for poor (e.g., NSAP, PMAY)
3. Universal Schemes - available to all regardless of income (e.g., ICDS, mid-day meal, immunization)

---