Part 2 book “Review of preventive and social medicine” has contents: Preventive obstetrics, paediatrics and geriatrics, nutrition and health, nutrition and health, environment and health, health education and communication, health care in india, health planning and management,… and other contents.
CHAPTER Preventive Obstetrics, Paediatrics and Geriatrics MCH I Ante-natal and Post-natal Visits (RCH Program) • Ideal recommended ante-natal visitsQ: 13 – 14 Period of gestation – months 8th month 9th month onwards • Frequency of visitQ Once every month Twice a month Once a week Minimum recommended ante-natal visitsQ: Visit Period of gestationQ First AN visit Early registration Second AN visit 14-26 weeks POG Third AN visit 28-34 weeks POG Fourth AN visit • 36 weeks POG - Term Minimum recommended post-natal visits : Q Visit First PN visit Second PN visit Third PN visit Period of gestation – Artificial feeding – Weight < 70% of expected (II and III degrees of malnutrition) – Failure to thrive (failure to gain weight in successive months) – Children with PEM, diarrhea – Working mother/single parent At risk mothersQ: Basic criteria for identifying these mothers include: – Elderly primi (> 30 years) Q – Short statured primi (< 140 cms) Q – Malpresentations (breech, transverse lie, etc.) – Antepartum hemorrhage, threatened abortion – Preeclampsia, Eclampsia – Anemia – Twins, hydramnios – Previous still birth, IUD, manual removal of placenta – Elderly grandmultipara (> parity) Q I Minimum recommended postnatal visitsQ: Preventive Obstetrics, Paediatrics and Geriatrics I I Pregnancy + 350 Kcal Q • Lactation First monthsQ + 600 Kcal – Prolonged pregnancy (> 14 days after EDD) – History of previous CS or instrumental delivery – Pregnancy associated with general diseases (diabetes, TB, etc.) Danger signals during labour: Basic criteria for identifying these mothers (so that they can be transferred to nearest PHC) includeQ: – Sluggish or no pains after rupture of membranes – No progress after rupture of membranes (only good pains for hour) – Prolapse of hand or cord – Meconium stained liquor or slow irregular or fast fetal heart sound – Excessive show or bleeding during labour – Collapse during labour – Placenta not separated within half hour after deliveryQ – PPH or collapse – Temperature > 38° C Nutritional Requirements • Recommended daily energy intake: [NEW GUIDELINES 2011] Energy Allowance per day (Kcal) 92 Kcal/kg/day 80 Kcal/kg/day 2320 2730 3490 Adult Reference Female (Wt: 55 kg) Sedentary/Light workQ Moderate Work Heavy Work 1900 2230 2850 PregnancyQ Lactation First monthsQ 6-12 months + 350 + 600 + 520 (+ indicates ‘over and above the daily requirement’) • Requirements in pregnancy and lactation: Group Requirement per day Energy (Kcal/day) Q Proteins (g/day) Woman Sedentary workQ Moderate work Heavy work 1900 2230 2850 55 55 55 PregnancyQ + 350 +23 Lactation – monthsQ – 12 months +600 +520 +19 +13 Preventive Obstetrics, Paediatrics and Geriatrics Group Infancy 0-6 monthsQ 6-12 monthsQ Adult Reference Male (Wt: 60 Kg) Sedentary/Light workQ Moderate Work Heavy Work (+ indicates ‘over and above the daily requirement’) I Five cleans Clean delivery surface Clean hands (of birth attendants) Clean cord cut (blade or instrument) Clean cord tie Clean cord stump • Other requirements in pregnancy and lactation: Pregnancy Proteins +23 g/dayQ – months +19 g/day Calcium Iron Vitamin A 1200 mg/dayQ 35 mg/dayQ 800 mcg/dayQ 1200 mg/dayQ 21 mg/day 950 mcg/day Lactation – 12 months +13 g/day 1200 mg/day 21 mg/day 950 mcg/day (+ indicates ‘over and above the daily requirement’) 559 Review of Preventive and Social Medicine Cleans of Safe Delivery • • Preventive Obstetrics, Paediatrics and Geriatrics • • ‘Five cleans’ (practices) under strategies for elimination of neonatal tetanus includeQ, – Clean delivery surface – Clean hands (of birth attendants) – Clean cord cut (blade or instrument) – Clean cord tie – Clean cord stump (no applicant) Procedures undertaken to ensure cleans: – Clean delivery surface: A clean plastic sheet – Clean hands: Soap and clean water – Clean cord cut: A new razor blade – Clean cord tie: A clean piece of thread – Clean cord stump: Nothing to be applied to cord Sometimes these practices are called as ‘3 cleans’: – Clean delivery surface – Clean hands – Clean cord care (cut, tie and stump) Suggested ‘Seven cleans’Q (include five cleans) – Clean delivery surface – Clean hands (of birth attendants) – Clean cord cut (blade or instrument) – Clean cord tie – Clean cord stump (no applicant) – Clean water, and – Clean towel, for hand washing IFA Tablets • • An adult tablet of IFA containsQ: 100 mg elemental Iron and 500 mcg Folic acid (to be given for 100 days minimum in pregnancy) – Schedule: Tablet per day in 4-5-6 month POG (Total 100 tablets) A pediatric tablet of IFA containsQ: 20 mg elemental Iron and 100 mcg Folic acid (to be given for 100 days minimum every year till years age of child) I Adult tablet of IFA containsQ: 100 mg elemental Iron and 500 mcg Folic acid TT in Pregnancy Refer to Chapter 3, Theory Mother to Child Transmission (MTCT) Refer to Chapter 5, Theory Birth Weight • • • • • • • • • 560 Birth weight of an infant is the ‘single most important determinant of its chances of survival, healthy growth and development’Q Single best measure to assess physical growth: WeightQ Birth weight preferably be measured within: 1st hour of lifeQ Average birth weight in India: 2.8 kg (2.7 – 2.9 kg) Q Majority of LBW in India is due to: Maternal malnutrition associated with fetal growth retardation Relationship between maternal nutrition and birth weight of babies: LinearQ Smoking during pregnancy reduces birth weight by an average: 170 grams LBW is not a contraindication for any vaccination EXCEPT Hepatitis B: Hepatitis B vaccine is contraindicated in preterm children with birth weight 294 days) Low birth weight:‘Less than 2500 grams IRRESPECTIVE of gestational age’ Pre-term babies: Born at < 37 weeks POG Small-for-date (SFD) babiesQ: Born at term or post-term – weigh ‘less than 10th percentile for gestational age’Q – as a result of IUGRQ – high risk of dying in neonatal and infancy period MCH INDICATORS Infant Mortality Rate (IMR) I IMR is usually expressed as a rate per 1000 live births (LB)Q I Preventive Obstetrics, Paediatrics and Geriatrics • Low Birth Weight (LBW) Q: Birth weight less than 2500 grams ( 35 years – Birth order: Infant mortality is greatest for birth order and least for 2; It increases from birth order onwardsQ - Birth spacing: IMR reduces with wider birth spacing - Multiple births: IMR increases in multiple births - Family size: IMR increases as family size increases - High fertility: IMR increases with high fertility – Economic factors: - Socio-economic status (SES): IMR higher in lower SES – Cultural and social factors: - Breast feeding: IMR higher in early weaning and bottle fed infants living in poor hygienic conditions - Religion and caste: IMR is affected by patterns, habits, customs, child care, etc - Early marriages: IMR higher in teen age pregnancy – Other factors: - Sex of the child: IMRgirls > IMRboysQ - Quality of mothering: IMR low in good quality of mothering - Quality of health care: IMR high in improper obstetric and pediatric care - Maternal education: IMR low in mother with high literacy rate - Broken family: IMR higher - Illegitimacy: IMR higher - Brutal habits and customs: IMR high (Not feeding colostrum, applying cowdung to umbilical-stump, faulty feeding practices) - Untrained dai: High IMR - Bad environmental sanitation: High IMR Neonatal Mortality Rate (NNMR) • • • 562 Neonatal mortality rate (NNMR): Is the number of neonatal deaths (deaths within completed 28 days after birth) per 1000 live births in that yearQ No of neonatal deaths in a given year × 1000 Total no of live births in the same year – Early neonatal mortality (ENNM): Neonatal mortality in first week (1-7 days) of lifeQ – Late neonatal mortality (LNNM): Neonatal mortality in first to fourth week (8 – 28 days) of life NNMR (India): 29 per 1000 LB [2014] Q NNMR is directly related with birth weight and gestational age NNMR = I MCC of NNMR in India is preterm birth Preventive Obstetrics, Paediatrics and Geriatrics • • • NNMRboys > NNMRgirlsQ MCC of NNMR in India is preterm birth - MCC of ENNMR: Prematurity and congenital anomaliesQ - MCC of LNNMR: Infections (diarrhea and tetanus)Q Causes of Neonatal mortality (0 – weeks): Low birth weight and prematurity - - Birth injury and difficult labour Sepsis - Congenital anomalies - Hemolytic diseases of newborn - Conditions of placenta and cord - - Diarrhoeal diseases Acute respiratory infections - Tetanus - Maternal Mortality Rate (MMR) • (MMR): Maternal deaths expressed as per 100,000 live births • • • I • MMR is a ratio MMR = No of maternal deaths in a given year × 100,000 Total no of live births in the same year MMR World: 210 per 100,000 live births; Causes of MMR (globally): – Hemorrhage (25%)Q – Indirect causes (20%) – Infection (15%) – Unsafe abortion (13%) – Eclampsia (12%) – Obstructed labour (8%) MMR India: 178 per 100,000 live births [2014]Q; Causes of MMR (India) [SRS 200103]: – Hemorrhage (38%)Q – Other conditions (34%) – Sepsis (11%) – Abortion (8%) – Obstructed labour (5%) – Hypertensive disorders (5%) Millennium Development Goal (MDG) as: Reduce maternal mortality by threefourths by 2015 RHIMEQ - ‘Representative, re-sampled, routine household interview of mortality, with medical evaluation’: Is a new method for MMR estimation introduced in India from 2003 SRS - RHIME is an enhanced form of verbal autopsyQ Preventive Obstetrics, Paediatrics and Geriatrics I Maternal Mortality rate (MMR): Maternal deaths expressed as per 100,000 live births, where a ‘maternal death’ is defined as ‘death of a woman while pregnant or during delivery or within 42 days (6 weeks) of termination of pregnancy, irrespective of duration or site of pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes’Q – Maternal deaths expressed as per 100,000 live births (earlier it was expressed per 1000 live births but that yielded fractions like 4.08 maternal deaths per 1000 LB; so denominator was extrapolated to 100,000 to make MMR value more sensible) Q – MMR is a ratioQ (Maternal mortality rate is a misnomer; MMR is not a rate) Child Mortality Rate, CMR (Under mortality rate, U5MR) CMR = No of deaths of children less than 5 years age in a year × 1000 No of live births in a year 563 Review of Preventive and Social Medicine • • • • U5MR (India): 53 per 1000 LB [2013] Q U5MR (World): 46 per 1000 LB [2013] Single MCC of U5MR or CMR is Pneumonia (19%) [diarrhoea – 17%; malaria – 8%]Q Neonatal conditions lead to 37% of total U5MR or CMRQ: – Infections (MC neonatal condition leading to U5MR) – Preterm births – Asphyxia Child Death Rate, CDR (1 – year Mortality Rate) Preventive Obstetrics, Paediatrics and Geriatrics CDR = • • • • • • • CDR is a more refined indicator of social situation in a country than infant mortality Highest risk of death in -4 years age: 2nd year of life CDR (India): 3.6% of total deaths [2010] Q MCC CDR (Developing countries): Diarrhoel diseases and respiratory infectionsQ MCC CDR (Developed countries): Accidents Millennium Development Goal (MDG) 4: Reduce child mortality by two-thirds by 2015 UNICEF considers U5MR or CMR as ‘single best indicator of socio-economic development and well being’Q Child Survival Rate (CSR) [Child Survival Index]Q • 1000—U5MR 10 CSR (India): 94.7 [2013] CSR = Post Neonatal Mortality Rate (PNNMR) • Post-neonatal mortality rate (PNNMR): Is the number of neonatal deaths (deaths within completed 28 days after birth) per 1000 live births in that yearQ PNNMR = No of deaths between age 28 days to 1 year in a given year × 1000 Total no of live births in the same year Perinatal Mortality Rate (PNMR) • Perinatal Mortality rate (PNMR): Includes both late fetal deaths (stillbirths) and early neonatal deathsQ Late fetal deaths and early neonatal deaths in a given year × 1000 PNMR = Total no of live births in the same year • • • • 564 No of deaths of children aged 1—4 years in a year × 1000 Mid year population of children aged 1—4 years Perinatal period is from 28 weeks period of gestation to 7th completed days of life (But the WHO definition of perinatal period is from 22 completed weeks gestation to 7th completed days of lifeQ) – PNMR is the sum of the fetal mortality and the neonatal mortality PNMR is a major marker to assess the quality of health care deliveryQ PNMR (India): 32 per 1000 LB [2010] P ListQ (ICD 10): 100 causes of perinatal mortality and morbidity I Perinatal period is from 28 weeks period of gestation to 7th completed days of life Preventive Obstetrics, Paediatrics and Geriatrics I BREAST FEEDING Exclusive breast feeding till months ageQ WHO Guidelines for India • • I WHO recommends, in developing countries, exclusive breast feeding till months ageQ WHO recommends, in developing countries, breast feeding till minimum years ageQ Nutritional Importance of Breast-milk Energy content of breast milk: 65 Kcal/ 100 ml Protein content of breast milk: 1.1 grams/ 100 ml • • • • • Months of lactation Mean output (ml) 0–2 530 3–4 640 5–6 730Q 7–8 660 – 10 600 11 – 12 525 Nutritive values of milk (per 100 gms): Cow’s milk Human milk Lactose (g) 4.4 7.4 Proteins (g) 3.2 1.1 Fat (g) 4.1 3.4 Calcium (mg) 120 28 Iron (mg) 0.2 0.35 Water (g) 87 88 Energy (Kcal) 67 65 Human Milk is richer in Carbohydrate (lactose), Iron and Water content WHILE Cow’s milk is richer in Fat, Protein, Calcium and energy contentQ – Human milk proteins: More cystine and taurine; less methionine; better digested than cow’s milk proteinsQ – Human milk fats: Higher levels of PUFAs, esp., linoleic acid and -linoleic acid; better digested and absorbed; low calcium content but better absorbed than cow’s milkQ – Human milk vitamins and minerals: Human milk is richer in Vitamin A, C; richer in copper, cobalt and selenium; richer in iron and higher bioavailability; high calcium/phosphorus ratio; Human milk has lesser sodiumQ Comparative contents of nutrients in different types of milk: – Fat content of milk: Buffalo > Goat > Cow > Human – Protein content of milk: Buffalo > Goat > Cow > Human – Energy content of milk: Buffalo > Goat > Cow > Human – Lactose content of milkQ: Human > Buffalo > Goat > Cow Preventive Obstetrics, Paediatrics and Geriatrics • Energy content of breast milk: 65 Kcal/ 100 mlQ Protein content of breast milk: 1.1 grams/ 100 mlQ Mean output of breast milk per day (ml): Colostrum • Is the most suitable food immediately after birth of the baby; Regular milk comes 3-6 days after birth • Also known as ‘Beestings’, ‘First milk’ or ‘Immune Milk’Q 565 Review of Preventive and Social Medicine • • • High in carbohydrates, protein, and antibodies and low in fat Contains all five immunoglobulins found in all mammals, IgA, IgD, IgE, IgG and IgMQ Few occassions when breast feeding might harm the infantQ: – Infants with classic galactosemia – Mother has untreated pulmonary tuberculosis – Mother is taking certain medications that suppress the immune system – Mother has had unusually excessive exposure to heavy metals such as mercury – Mother has HIV – Mother uses potentially harmful substances such as cocaine, heroin, and amphetamines I ‘Underweight’ (Acute + Chronic Malnutrition) GROWTH AND DEVELOPMENT Indicators of Malnutrition Preventive Obstetrics, Paediatrics and Geriatrics • • • • • Indicators of malnutrition: – Single best parameter for assessment of physical growth: Weight (and rate of weight gain)Q – Single most sensitive measure of growth: WeightQ – Single most reliable criterion of assessment of health and nutritional status: WeightQ – Weight for height is considered more important than weight alone, for the measurement of physical growth – Height is a stable measurement of growth as opposed to body weightQ – Weight: Reflects only present health status – Height: Indicates events in past also Acute and Chronic MalnutritionQ: – Low weight for age: Is known as ‘Underweight’Q (Acute + Chronic MalnutritionQ) – Low weight for height: Is known as ‘Nutritional wasting’Q or ‘Emaciation’ (Acute MalnutritionQ) – Low height for age: Is known as ‘Nutritional stunting’Q or ‘Dwarfing’ (Chronic malnutritionQ) Age independent parameters for growth assessment: – Weight for height – Mid arm circumference (MAC) – Thickness of subcutaneous fat – Body ratios – Weight : Height – MAC : Head circumference Gomez Classification of malnutrition: Is based on ‘weight for age’ Weight for age* Grade of malnutrition 90 – 110% Normal 75 – 89% 1st degree (MILD) 60 – 74% 2nd degree (MODERATE) < 60% 3rd degree (SEVERE) Waterlow classification: Weight/ height > Mean – 2SD < Mean – 2SD Height/ age 566 > Mean – 2SD Normal Wasted < Mean – 2SD Stunted Wasted & Stunted I I Wasting (Acute MalnutritionQ) Stunting (Chronic malnutritionQ) Preventive Obstetrics, Paediatrics and Geriatrics Milestones of DevelopmentQ Age Motor development Language development Adaptive development Socio-personal development 6-8wks – – – look/smiles at mother 3m holds head erect – – 4-5m – listening reach for objects recognizes mother 6-8m sits without support experiment with noises hand-transfer object enjoys hide & seek 9-10m crawls increase soundrange releases objects stranger suspicion 10-11m stands with support first words – – 12-14m walks wide base – builds – 18-21m walks narrow base joining words begins to explore – 24m runs short sentences – dry by day Birth Weight LBW in India: 28% BW doubles at months, triples by year • • Average birth weight in India: 2.8 kg (2.7 – 2.9 kg) Q – Low Birth Weight (LBW): BW < 2.5 kgQ – LBW in India: 28%Q BW doubles at months, triples by year and quadruples by years ageQ – Minimum expected weight gain per month: 500 grams Weight gain pattern in children: Age Weight increments – months 200 grams per week – months 150 grams per week – months 100 grams per week 10 – 12 months 50 grams per week – years 2.5 kg per year – years 2.0 kg per year Birth Length/ Height • • • I BL doubles at: years age • Average birth length in India: 50 cmsQ BL doubles at: years ageQ Height increase pattern in children: Age Height increments 1st year 25 cms per yearQ 2nd year 12 cms per year 3rd year cms per year 4th year cms per year 5th year cms per year Preventive Obstetrics, Paediatrics and Geriatrics I • Near-final height attainmentQ: – Indian boys attain 98% of final height by 17.75 years – Indian girls attain 98% of final height by 16.5 years 567 Review of Preventive and Social Medicine 231 Ans (b) Correlation analysis/Bland and Altmann test [Ref Statistical analysis quick reference guide, 1/e p78] Refer to Ans 171 Biostatistics 232 Ans (b) Previously significant data becomes insignificant [Ref Defence Counsel Journal, Vol 66, p55] If Confidence limit is increased: • Then degree of assurance of intervals containing the population mean is increased, BUT getting the value of population mean become less precise • Previously significant data will now become less significant 936 Section Image Based Questions Image Based Questions Image Based Questions Plate Plate Q1 Identify the symbol as given in PLATE-1? (a) MDT (b) DOTS (c) ART (d) ASHA Q2 Identify the symbol as given in PLATE-2? (a) Tuberculosis (b) Malaria (c) Leprosy (d) HIV/ AIDS Plate Plate Q3 Identify the program symbol as given in PLATE-3? (a) RNTCP (b) NLEP (c) NVBDCP (d) NACP Q4 Identify the program symbol as given in PLATE-4? (a) RNTCP (b) NLEP (c) NRHM (d) NACP Ans (b) DOTS Ans (d) HIV/ AIDS Ans (b) NLEP Ans (c) NRHM Plate Plate Q5 Identify the program depicted by symbol as given in PLATE-5? (a) NRHM (b) NVBDCP (c) RCH (d) NPCDCS Q6 dentify the program depicted by symbol as given in PLATE-6? (a) NRHM (b) NPCB (c) NPCDCS (d) RCH Plate Plate Q7 Identify the program symbol as given in PLATE-7? (a) NUHM (b) PMJDY (c) NPCDCS (d) IDSP Q8 Identify component of NACP as shown in PLATE-8? (a) ART (b) ICTC (c) PPTCT (d) Blood transfusion Ans (b) NVBDCP Ans (b) NPCB Ans (d) IDSP Ans (c) PPTCT Plate Plate 10 Q9 Identify services provided at clinic shown in symbol in PLATE-9? (a) ARI (b) Diarrhoea (c) RTI/ STI (d) Blood transfusion Q10 Chairman of agency shown in PLATE-10? (a) Minister of Labour (b) Defence Minister (c) Prime Minister (d) Minister of Health-FW Plate 11 Plate 12 Q11 Act pertaining to symbol shown in PLATE-11 was enacted in? (a) 1995 (b) 2005 (c) 2006 (d) 2014 Q12 PLATE-12 is symbol of (a) Vaccine safety labels (b) Contraceptive efficacy labels (c) Drugs toxicity labels (d) Pesticide toxicity labels Ans (c) RTI/ STI Ans 10 (c) Prime Minister Ans 11 (c) 2006 Ans 12 (d) Pesticide toxicity labels Plate 13 Plate 14 Q13 Identify the symbol as given in PLATE-13? (a) Organ Transplantation Act 1994 (b) RTI Act 2005 (c) MTP Act 1971 (d) NREGA Act 2005 Q14 Identify the organization depicted by symbol as given in PLATE-14? (a) WHO (b) UNICEF (c) UNDP (d) UNAIDS Plate 15 Plate 16 Q15 Identify the organization depicted by symbol as given in PLATE-15? (a) WHO (b) UNICEF (c) UNDP (d) UNAIDS Q16 Headquarters location of international health agency depicted in PLATE-16? (a) New Delhi (b) Geneva (c) New York (d) Rome Ans 13 (d) NREGA Act 2005 Ans 14 (a) WHO Ans 15 (b) UNICEF Ans 16 (d) Rome Plate 17 Plate 18 Q17 Identify the organization depicted by symbol as given in PLATE-17? (a) DFID (b) World Bank (c) UNDP (d) UNAIDS Q18 Identify the organization depicted by symbol as given in PLATE-18? (a) UNAIDS (b) World Bank (c) UNDP (d) UNFPA Plate 19 Plate 20 Q19 Identify the scientist as given in PLATE-19? (a) Louis Pasteur (b) Edward Jenner (c) James Lind (d) Hippocrates Q20 Identify the scientist as given in PLATE-20? (a) Louis Pasteur (b) Edward Jenner (c) James Lind (d) Hippocrates Ans 17 (b) World Bank Ans 18 (d) UNFPA Ans 19 (a) Louis Pasteur Ans 20 (b) Edward Jenner Plate 21 Plate 22 Q21 Identify the scientist as given in PLATE-21? (a) John Snow (b) Edward Jenner (c) James Watson (d) Robert Koch Q22 Identify the scientist as given in PLATE-22? (a) John Snow (b) Alexander Fleming (c) James Lind (d) Hippocrates Plate 23 Plate 24 Q23 Identify the scientist as given in PLATE-23? (a) John Snow (b) Alexander Fleming (c) James Lind (d) Hippocrates Q24 Identify person as given in PLATE-24? (a) Hargobind Khorana (b) Alexander Fleming (c) Joseph Bhore (d) Hippocrates Ans 21 (d) Robert Koch Ans 22 (a) John Snow Ans 23 (c) James Lind Ans 24 (c) Joseph Bhore Plate 25 Plate 26 Q25 Identify PLATE-25? (a) Diaphragm (b) Vaginal ring (c) Vaginal sponge (d) IUD Q26 Identify PLATE-26? (a) Iron folic acid (IFA) tablets (b) DOTS Category (c) MDT PBL blister (d) Combined OCPs Plate 27 Plate 28 Q27 Identify PLATE-27? (a) CuT 380 A (b) Progestasert (c) Lippes loop (d) Mirena Q28 Identify PLATE-28? (a) DMPA (b) Vaginal ring (c) Diaphragm (d) Vaginal sponge Ans 25 (d) IUD Ans 26 (d) Combined OCPs Ans 27 (c) Lippes loop Ans 28 (d) Vaginal sponge Plate 29 Plate 30 Q29 Identify PLATE-29? (a) Male condom (b) Female condom (c) Diaphragm (d) Vaginal sponge Q30 Identify PLATE-30? (a) Rhythm method (b) Cervical mucus method (c) BBT method (d) Coitus interruptus Plate 31 Plate 32 Q31 Identify vector given in PLATE-31? (a) Sandfly (b) Anopheles mosquito (c) Aedes mosquito (d) Culex mosquito Q32 Identify vector given in PLATE-32? (a) Sandfly (b) Anopheles mosquito (c) Aedes mosquito (d) Culex mosquito Ans 29 (b) Female condom Ans 30 (a) Rhythm method Ans 31 (b) Anopheles mosquito Ans 32 (c) Aedes mosquito Plate 33 Plate 34 Q33 Identify vector given in PLATE-33? (a) Sandfly (b) Housefly (c) Hard tick (d) Rat flea Q34 Identify vector given in PLATE-34? (a) Simulum (b) Musca domestica (c) Phlebotamus (d) Reduviid bug Plate 35 Plate 36 Q35 Identify vector given in PLATE-35? (a) Soft tick (b) Hard tick (c) Louse (d) Rat flea Q36 Identify larva of mosquito given in PLATE-36? (a) Anopheles (b) Clulex (c) Aedes (d) Mansonia Ans 33 (d) Rat flea Ans 34 (b) Musca domestica Ans 35 (c) Louse Ans 36 (a) Anopheles Plate 37 Plate 38 Q37 Identify organism given in PLATE-37? (a) Rabies virus (b) Ebola virus (c) H1N1 virus (d) HIV virus Q38 Identify organism given in PLATE-38? (a) Rabies virus (b) Ebola virus (c) H1N1 virus (d) HIV virus Plate 39 Plate 40 Q39 Identify organism given in PLATE-39? (a) H7N9 virus (b) Ebola virus (c) H1N1 virus (d) H5N1 virus Q40 Identify injection technique in PLATE-40? (a) Subcutaneous (b) Intradermal (c) Intramuscular (d) Intravenous Ans 37 (d) HIV virus Ans 38 (a) Rabies virus Ans 39 (b) Ebola virus Ans 40 (b) Intradermal Plate 41 Plate 42 Q41 Identify symbol given in PLATE-41? (a) Disaster management (b) Occupational health (c) Biomedical waste management (d) Family planning and contraception Q42 Identify symbol given in PLATE-42? (a) Medical professionals (b) Nursing staff (c) International Red Cross (d) Colombo plan Plate43 Plate 44 Q43 Identify PLATE-43? (a) WHO Growth chart (b) ICDS Growth chart (c) Tracking phenomena (d) Rule of halves Q44 Identify statistical diagram given in PLATE-44? (a) Bar chart (b) Histogram (c) Frequency polygon (d) OGIVE Ans 41 (c) Biomedical waste management Ans 42 (c) International Red Cross Ans 43 (c) Tracking phenomena Ans 44 (b) Histogram Plate 45 Q45 Identify statistical diagram given in PLATE-45? (a) Pictogram (b) Scatter diagram (c) Box and whisker plot (d) Pie chart Ans 45 (d) Pie chart ... years, and is regarded as a method of training and reformation 573 Review of Preventive and Social Medicine • Borstals • • Preventive Obstetrics, Paediatrics and Geriatrics • 574 • Remand Homes:... Children (6- 72 months) 300 8-10 500 12- 15 Severely malnourished children (6- 72 m) 600 20 800 20 -25 Pregnant women and Nursing mothers 500 15 -20 600 18 -20 Preventive Obstetrics, Paediatrics and Geriatrics... months +13 g/day 120 0 mg/day 21 mg/day 950 mcg/day (+ indicates ‘over and above the daily requirement’) 559 Review of Preventive and Social Medicine Cleans of Safe Delivery • • Preventive Obstetrics,