Community Medicine - Internal Assessment 1 Notes (from Park's Textbook)

1. EPIDEMIOLOGY OF COMMUNICABLE DISEASE

Definition of Communicable Disease

"An illness due to a specific infectious agent or its toxic products that arises through transmission of that agent or its products from an infected person, animal, or reservoir to a susceptible host, either directly or indirectly through an intermediate plant or animal host, vector, or the inanimate environment." - Park

Key Terminology (must-know for MCQs)

Types of Zoonoses (Park)

• Anthropozoonoses - transmitted from animals to man (rabies, plague, anthrax)
• Zooanthroponoses - transmitted from man to animals (human TB in cattle)
• Amphixenoses - maintained in both, transmitted in either direction (T. cruzi, S. japonicum)

Communicable Period

Prevention of Communicable Diseases (3 levels)

1. Primary - immunization, vector control, health education
2. Secondary - early diagnosis and treatment
3. Tertiary - rehabilitation, preventing complications

2. EPIDEMIOLOGY OF NON-COMMUNICABLE DISEASE (NCD)

WHO NCD Risk Factor Indicators (Park's)

• Tobacco use (age 15+ years) - SDG 3.a.1
• Total alcohol per capita consumption (age 15+) - SDG 3.5.2
• Raised blood pressure among adults
• Overweight and obesity (adults + school-age children)
• Raised blood glucose/diabetes among adults
• Salt intake
• Insufficient physical activity

Epidemiological Transition

• An early epidemiologic transition is now being observed even in tribal areas with increasing NCD burden
• NCDs now account for the major burden of disease globally - replacing communicable diseases

Key NCDs and their epidemiology

• 1 out of every 4 tribal adults suffers from hypertension
• Prevalence increases with: age, tobacco, alcohol, sedentary lifestyle
• 2 out of 3 hypertensive tribal adults did NOT know their signs/symptoms

• Multiple causation - no single cause (web of causation)
• Long latent period before clinical disease
• Non-transmissible person-to-person
• Require lifestyle modification as primary prevention
• Prevention is based on risk factor control

3. DEMOGRAPHY AND FAMILY PLANNING

WHO Definitions of Family Planning (Park)

1. 1971 Expert Committee: "A way of thinking and living adopted voluntarily, on the basis of knowledge, attitudes and responsible decisions by individuals and couples, to promote health and welfare of the family group and contribute to social development."
2. Second Expert Committee: Family planning refers to practices that help to:
   • (a) Avoid unwanted births
   • (b) Bring about wanted births
   • (c) Regulate intervals between pregnancies
   • (d) Control the time at which births occur relative to parental age
   • (e) Determine the number of children in the family

Family Planning as a Human Right

• UN Conference on Human Rights, Tehran (1968) - recognized FP as a basic human right
• Bucharest Conference (1974) - "All couples and individuals have the basic human right to decide freely and responsibly the number and spacing of their children"
• World Conference, International Women's Year (1975) - declared the right of women to decide freely on number and spacing of children

Scope of Family Planning (WHO Expert Committee, 1970) - 13 components

1. Proper spacing and limitation of births
2. Advice on sterility
3. Education for parenthood
4. Sex education
5. Screening for pathological conditions (e.g., cervical cancer)
6. Genetic counselling
7. Premarital consultation and examination
8. Pregnancy tests
9. Marriage counselling
10. Preparation of couples for first child
11. Services for unmarried mothers
12. Teaching home economics and nutrition
13. Adoption services

"Family planning is NOT synonymous with birth control; it is MORE than mere birth control." - Park

Health Aspects of Family Planning

• Family planning and health have a two-way relationship
• It protects maternal health, child health, and contributes to social development

4. HOSPITAL WASTE MANAGEMENT

Sources of Bio-Medical Waste (Park)

• Government & private hospitals, nursing homes
• Physician/dentist clinics, dispensaries, PHCs
• Medical research/training establishments
• Blood banks, mortuaries, animal houses, slaughter houses
• Laboratories, research organizations, vaccinating centres
• Biotechnology institutions

Average Composition of Health-Care Waste (Park)

• 80% - General health-care waste (managed by normal domestic system)
• 15% - Pathological and infectious waste
• 1% - Sharps waste
• 3% - Chemical and pharmacological waste
• <1% - Special waste (radioactive, cytotoxic, pressurized containers)

Average Hospital Waste Composition in India (10 large hospitals, NEERI 1997):

Health Hazards of Health-Care Waste (Park)

• Doctors, nurses, health-care auxiliaries, hospital maintenance staff
• Patients in health-care establishments
• Visitors to hospitals
• Laundry, waste handling, and transportation workers
• Workers in waste disposal facilities (landfills, incinerators) including scavengers

1. Infectious waste and sharps - HIV, Hepatitis B and C transmission; entry via skin puncture, mucous membranes, inhalation, or ingestion
2. Chemical/pharmaceutical waste - toxic, genotoxic, corrosive, flammable; disinfectants especially important
3. Genotoxic waste - exposure via inhalation of dust/aerosols, skin absorption, accidental food ingestion (cytotoxic drugs)
4. Radioactive waste - causes headache, dizziness, vomiting to serious disease; may affect genetic material

5. COMMUNICATION FOR HEALTH EDUCATION

Definitions of Health Education (Park)

1. "The translation of what is known about health into desirable individual and community behaviour patterns by means of an educational process."
2. John M. Last: "The process by which individuals and groups of people learn to behave in a manner conducive to the promotion, maintenance or restoration of health."
3. National Conference on Preventive Medicine (USA): "Health education is a process that informs, motivates and helps people to adopt and maintain healthy practices and lifestyles, advocates environmental changes as needed to facilitate this goal, and conducts professional training and research to the same end."

Alma-Ata Declaration (1978) - Dynamic Definition

"A process aimed at encouraging people to want to be healthy, to know how to stay healthy, to do what they can individually and collectively to maintain health, and to seek help when needed."

• Disease prevention → Promotion of healthy lifestyles
• Modifying individual behaviour → Modifying social environment
• Community participation → Community involvement
• Emphasis on individual and community self-reliance

Aims and Objectives of Health Education (Park)

1. Encourage people to adopt and sustain health-promoting lifestyles
2. Promote proper use of available health services
3. Arouse interest, provide knowledge, improve skills and change attitudes for rational decision-making
4. Stimulate individual and community self-reliance and participation

Role of Health Care Providers

• Provide learning opportunities for identifying and analysing health problems
• Make health information easily accessible
• Indicate alternative solutions
• "Education is necessary, but education alone is insufficient to achieve optimum health" - Park

Quick Revision Summary for MCQs