(BQ) Part 2 book “Community medicine with recent advances” has contents: Epidemiology of noncommunicable diseases, family planning, maternal and child health services, social science, preventive geriatrics, human genetics, mental health, adolescent health,… and other contents.
Free ebooks ==> www.ebook777.com CH A P T E R 21 Epidemiology of Noncommunicable Diseases NONCOMMUNICABLE DISEASES Burden, Socioeconomic Implications, Policies and Program for Prevention and Control of Noncommunicable Diseases in India—A Report on National Summit on NCDs Noncommunicable diseases (NCDs) and injuries are replacing communicable diseases as the most common causes of disability, morbidity and premature mortality, thus showing an epidemiological transition in low and middle income countries including India The leading causes are cancer, diabetes, hypertension, cardiovascular disease, stroke, chronic obstructive pulmonary disease, chronic kidney disease, mental disorders and trauma Besides presenting a serious threat to public health, NCDs hamper socioeconomic development of the country They account for 52 percent of deaths, 43 percent of disability adjusted life years (DALYs) and 62 percent of total disease burden in India This burden is likely to increase in the years to come Cardiovascular diseases (CVDs) figure at the top among the ten leading causes of adult (25–69 years) deaths in India WHO has projected that by the year 2030, CVDs will emerge as the main cause of death (36%) in India and majority of these deaths are premature The expenditure associated with the long-term effects of NCDs is high and about 10 to 25 percent of families with CVDs or Cancer respectively are driven to poverty The economic burden would be in the range of to 10 percent of GDP, which is significant and this slowing down of GDP hampers the development of the country Associated with this, the demographic transition (i.e raise in aged population), the epidemiological transition (i.e increase in the incidence of NCDs compared to com municable diseases) and social transition (like eating habits, smoking and alcoholism) pose serious challenge to the health system for providing treatment, care and support Besides, the industrialization, urbanization and globalization are also contributing to the epidemic of NCDs by increasing the risk factor levels As a result of this multidimensional effect at individual household, health system and macroeconomic level, NCDs are being labeled as global ‘Chronic Emergency’ Since health sector alone cannot deal with the chronic emergency of NCDs a multisectoral action is required with a high political commitment The estimated burden and trends of NCDs in India is shown in the Table 21.1 National Response to Noncommunicable Diseases Government of India had supported the States in the prevention and control of NCDs through several vertical programs National Health Programs for Cancer and Blindness were started as early as 1975 and 1976 respectively, followed by program on Mental Health in 1982 However there was considerable upsurge to prevent and control NCDs New programs were started on a low scale in limited number of districts Convergence with public sector health system was a feature of these programs National Health Programs www.ebook777.com Free ebooks ==> www.ebook777.com 524 Section Epidemiology Table 21.1 Estimated burden and trends of noncommunicable diseases in India Diseases Existing burden and trends Cancer 28 lakh (2010); incidence of 10 lakh in a year; 20–25 percent increase in years CVD 2.9 crore (2000); expected to rise to 6.4 crore by 2015 Stroke 20 lakh Diabetes 5.1 crore (2010); expected to rise to crore by 2030 COPD Burden: 3.9 crore; Prevalence 405/lakh; projected 596/lakh by 2015 Mental disorders 6–7 percent of population 1–2 percent have severe mental disorders Blindness Estimated blind persons: 1.21 crore; prevalence reduced from 1.49 percent (1976) to percent (2006–07) Deafness Estimate prevalence 6.3 percent of population; 2.91 crore with profound hearing loss There is increasing frend Iodine deficiency More than 7.1 crore persons with IDD; 263 districts with prevalence >10 percent Fluorosis Nearly 6.6 crore persons affected with fluorosis; endemic in 230 districts Bone and joint disorders Rheumatoid arthritis: 16.4–17.8 percent in females aged 30–59, osteoarthritis of knee 15 percent males and 14.4 percent in females aged 60–69 years Burn injury Annual incidence 70 lakh (10 percent require hospitalization) deaths 1.40 lakh per year; disability 2.5 lakh per year Road traffic accidents Annual deaths 1,18,239; injured 4,69,100 50 percent injured aged 25–65 years Disabilities 2.19 crore (2.13 percent of population) suffering from various disabilities Oral diseases 50–60% children have dental caries Periodontal diseases in 40–45% population implemented during the 11th plan and their status is given in the Table 21.2 FUTURE PLAN TO PREVENT AND CONTROL NONCOMMUNICABLE DISEASES There is adequate evidence that NCDs are the major contributors to high morbidity and mortality in the country Risk factors like tobacco and alcohol use, lack of physical activity, unhealthy diet, obesity, stress and environmental factors contribute to high disease burden of NCDs, which are modifiable factors and can be controlled to reduce the incidence of NCDs and better outcomes for those having NCDs Costs borne by the affected individuals and families may be catastrophic as treatment is longterm and expensive The efforts made by the Government of India and the States have not been able to check the rising burden of NCDs Investments during the 11th plan and earlier plans have been more on provisions of medical services, which have not been adequate in the public sector Private sector has grown particularly in urban settings but is beyond the reach of the poor and middle sections of the society There is urgent need for a comprehensive scheme that should focus on health promotion and prevention of NCDs and their risk factors and comprehensive management of NCDs at various levels across the country Lessons learnt during the 11th Plan should be addressed and the programs for various NCDs and their risk factors should be integrated and converged with public sector health system Approach A comprehensive approach would be required through the following key strategies: • Health promotion for healthy life styles • Strategies to reduce exposure to risk factors • Early diagnosis through periodic screening of the population • Development of infrastructures for the management of NCDs including rehabilitation • Capacity building of human resources • Establishment of emergency medical services including referral services • Health legislation • Surveillance, monitoring and research in these areas Programs The recommended integrated and comprehensive interven tion programs are grouped under three headings Free ebooks ==> www.ebook777.com Chapter 21 Epidemiology of Noncommunicable Diseases Table 21.2 Status of National Health Programs on NCDs in India Year of launch National Health Programs Current status 1975 National Cancer Control Programs Integrated with NPCDCS in 2010–11 1976 National Blindness Control Programs Ongoing in all districts 1982 National Mental Health Programs Revised programs (2003) being implemented in 123 districts 1986 National Iodine Deficiency Disorders Control Programs Availability of iodated salt 100 percent At present, 71 percent population using iodated salt 2007 National Tobacco Control Programs Being implemented in 42 districts in 21 states 9th Plan Trauma Care Facility on National Highways 140 trauma care centers set up along golden quadrilateral highways and NE and SW highways 2006–07 National Deafness Control Programs Initiated in 25 districts Expanded to cover 203 districts by March 2012 2007–08 National Programs for Prevention and Control of Fluorosis Initiated to cover 100 districts 2010–11 National Programs for Prevention and Control of Cancer, Initiated to cover 100 districts by March 2012 Diabetes, CVD, Stroke 2010–11 National Programs for Health Care of the Elderly Initiated to cover 100 districts by March 2012 2010–11 Pilot Programs for Prevention of Burn Injuries Piloted in Assam, Haryana and Himachal Pradesh 2010–11 Up-gradation of department of PMH in medical colleges In 28 medical colleges 2010–11 Disaster management/Mobile hospitals/CBRN Technical specifications and operational details finalized 2010–11 Organ and tissue transplant Model network for organ procurement and distribution in progress Biomaterial center for tissue being established Programs for lifestyle chronic diseases • Cancer • Diabetes, cardiovascular diseases (CVDs) and stroke • Chronic obstructive pulmonary diseases (COPDs) • Chronic kidney diseases • Organ and tissue transplant • Mental disorders • Iodine deficiency disorders • Fluorosis • Oral dental disorders Programs for disability prevention and rehabilitation • Trauma (including road traffic accidents) • Burn injuries • Disaster response • Emergency medical services • Musculoskeletal disorders (bone and joint) • Physical medicine and rehabilitation • Blindness • Deafness • Health care of the elderly (geriatric disorders) • Neurological disorders (epilepsy, autism) • Congenital diseases • Hereditary blood disorders (Sickle cell anemia, thalassemia and hemophilia) Health promotion and prevention of NCDs • Tobacco control • Prevention of nutritional disorders and obesity • National Institute for Health Promotion and Control of Chronic Diseases • Patient safety program • Establishment of air port/port health offices To ensure long-term sustainability of interventions, the programs should be built within existing public sector health system and feasible public private partnership models in all the 640 districts of the country The ‘Best buys’ for NCD prevention and control are shown in Table 21.3 For the cost effective and high impact interventions for the prevention and control of NCDs, integrated approach is necessary This consists of engaging multiple government ministries to influence public health policy with clear intersections to work on NCDs control and the Prime Minister at the core of this mechanism to ensure smooth coordination is required (Fig 21.1) Monitoring and evaluation is essential to improve the services further The proposed long-term targets for key indicators for the prevention and control of NCDs (Table 21.4) www.ebook777.com 525 Free ebooks ==> www.ebook777.com 526 Section Epidemiology Table 21.3 ‘Best buys’ for NCD prevention and control Risk factor/Disease Intervention Tobacco Tax increase Smoke-free indoor home, workplace and public place Adequate health information and warnings Ban on tobacco advertising, promotion and sponsorship Harmful alcohol use Tax increase Restricted access to retailed alcohol Ban on alcohol advertising Unhealthy diet and physical inactivity Enforcement of norms for reduced salt intake in food Replacement of trans fat with polyunsaturated fat Public awareness through mass media on diet and physical activity Cardiovascular disease and diabetes Counseling and multidrug therapy for people with high risk of developing heart attacks and stroke (including those with established CVD) Treatment of heart attacks with aspirin Cancer Hepatitis B immunization to prevent liver cancer Screening and treatment of precancerous lesions to prevent cervical cancer Source: Global status report of NCDs, 2010 Fig 21.1 Model for a multisectoral partnership with political commitment Free ebooks ==> www.ebook777.com Chapter 21 Epidemiology of Noncommunicable Diseases Table 21.4 Proposed long-term targets for prevention and control of NCDs Indicator Target 2025 Premature mortality from cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases from age 30 to 70 15 percent relative decline Prevalence of diabetes mellitus among persons aged 25+ 10 percent relative reduction Prevalence of raised blood pressure among persons aged 25+ 20 percent absolute reduction Prevalence of current daily tobacco smoking among persons aged 15+ 25 percent relative reduction and below 20 percent prevalence Prevalence of obesity No increase compared to 2010 levels Prevalence of physical inactivity 10 percent relative reduction Prevalence of raised total cholesterol among 25+ persons 20 percent relative reduction Primary care management of cardiovascular risks 50 percent reduction in coverage gap Coverage of cervical cancer screening 50 percent reduction in coverage gap Comprehensive tobacco control measures Cover all States/UTs Regulations and controls on the reduction of salt and replacement of trans fatty acids with PUFA in manufactured food Cover all States/UTs Comprehensive alcohol control measures Cover all States/UTs CARDIOVASCULAR DISEASES CORONARY ARTERY DISEASE ISCHEMIC HEART DISEASE It is the impairment of the function of the heart due to inadequate blood flow to the myocardium, as a result of obstruction in the coronary circulation Coronary artery disease (CAD) is manifested in any of the following forms: • Angina pectoris of effort • Myocardial infarction • Irregularities of the heart • Cardiac failure • Cardiac arrest Coronary artery disease (CAD) is the leading cause of death in all the developed countries, accounting for 25 to 30 percent of total deaths In the developing countries like India, there has been an increasing trend in the incidence of CAD because of changes in the lifestyle and behavior pattern of the people, so much so CAD accounts for nearly 15 percent of all deaths Therefore, CAD is considered as ‘modern epidemic’ This trend is increasing in India The incidence is to times greater in urban areas than rural areas It is one and a half times more among men than among women Incidence is maximum in the age group of 50 to 60 years Coronary artery disease is a local manifestation of progressive and generalized disorder of the arteries, namely atherosclerosis The disease is produced from the blockage of the lumen of the coronary arteries A plaque is formed inside the arteries, which gradually grows to form a thrombus that fills up the lumen and causes obstruction to the flow of blood Predisposing Factors These are grouped into nonmodifiable and modifiable risk factors Nonmodifiable Risk Factors • Age: Incidence of CAD is high above 50 years and maximum between 50 and 60 years of age • Sex: It is more among men than among women • Family history: Coronary artery disease has been seen to run in families • Genetic factors: Play a role indirectly by determining the total cholesterol and low density lipoprotein levels Modifiable Risk Factors • Cigarette smoking: This has been considered as a major risk factor, because of the following mechanisms involved – Carbon monoxide, induces atherogenesis – Nicotine stimulates the release of adrenaline resulting in hypertension – Nicotine also increases myocardial oxygen demand and decreases high density lipoprotein (HDL) level The risk of developing CAD is directly proportional to the number of cigarettes smoking per day and the duration of exposure (i.e earlier the smoking is started, greater is the risk) Smoking acts not only independently but also synergistically with other factors like hypertension and elevated serum www.ebook777.com 527 Free ebooks ==> www.ebook777.com 528 Section Epidemiology cholesterol The risk however comes down once smoking is given up, but after a few years • Hypertension (HTN): It increases the risk of CAD by accelerating the atherosclerotic process • Serum cholesterol: It is proved beyond doubt that increase in serum cholesterol level increases the risk of CAD The threshold level is 220 mg/dl, beyond which the risk increases The risk increases progressively with higher levels of low density lipoprotein (LDL) cholesterol, because LDL is atherogenic [On the other-hand, very low density lipoprotein (VLDL) cholesterol is associated with the atherosclerosis of peripheral vessels resulting in intermittent claudication rather than CAD] However the risk of CAD decreases with higher levels of high density lipoprotein (HDL) cholesterol because HDL transports cholesterol from the tissues to liver, thus prevents atherosclerosis The ratio of LDL to HDL more than indicates the risk Recent studies indicate that the level of plasma apolipoprotein-A (a fraction of HDL protein) and apolipoprotein-B (a fraction of LDL protein) are better predictors of CAD than HDL and LDL cholesterol respectively Thus apolipoproteins are replacing lipoproteins • Serum homocystine: High serum levels of this aminoacid more than 15.5 mol/liter, damages the intima of the arteries, thus correlating positively with the presence of coronary artery disease Such levels are related to a diet low in pyridoxine and folates • Diabetes mellitus: The risk of CAD is to times higher among diabetics than among nondiabetics • Obesity: Obesity increases the risk of CAD because of its association with LDL cholesterol level, HTN and diabetes • Exercise: Regular physical exercise increases the concentration of HDL, a protective factor, and decreases both body-weight (obesity) and blood pressure, which are beneficial to cardiovascular health • Hormones: Hyperestrogenemia favors the development of CAD Women on oral contraceptives are more to develop CAD than those not using them • Type A personality: Such people with type A behavior are characterized by competitive drive, restlessness, impatience, irritability, short-temper, sense of urgency, overthinking, etc are at a higher risk of CAD than the calmer type B personality people • Alcohol: CAD is common in heavy drinkers • Soft water: Incidence of CAD has been found to be higher among those consuming soft water than those consuming hard-water The salts in the latter are protective to the cardiac muscle • Noise: Chronic exposure to noise over 110 db increases serum cholesterol level and thus the risk of CAD • Drugs: Misuse of fenfluramine and phentermine used for reduction of weight can be damaging to the heart Prevention of Coronary Artery Disease • Primary prevention • Primordial prevention • Secondary prevention Primary Prevention This consists of elimination or modification of ‘Risk factors’ of disease, with the following approaches • Population strategy • High-risk strategy Population strategy (mass primary prevention): This is directed towards the whole population focusing mainly on the control of underlying risk factors, irrespective of individual risk levels This is based on the principle that a small reduction in the blood pressure or serum cholesterol level in a population, would go a longway in reducing the incidence of CAD This requires a large community-wide efforts, to alter the lifestyle practices, as follows Dietary Changes • Consumption of saturated fats should be less than 10 percent of total energy intake • The average intake of cholesterol should be less than 300 mg/day/adult • The serum cholesterol level should be less than 200 mg/dl • The consumption of carbohydrates must be propor tionately increased Smoking changes: The goal is to achieve ‘Smoke-free’ society and many countries are at it To achieve this, it requires educational activities, legislative measures and other programs Blood pressure: Studies have shown that a small reduction in the blood pressure in the population would produce a large reduction in the incidence of CAD This involves a multifactorial approach based on prudent diet (reduced salt intake and avoidance of high alcohol intake), regular physical activity and control of weight Physical activity: Regular physical exercise will go a longway in preventing obesity, hypertension and thus indirectly coronary artery disease High-risk strategy: This consists of identifying the ‘at-risk’ group of persons for CAD and providing preventive care The ‘at-risk’ or high-risk group of individuals can be identified by simple screening tests such as recording BP, estimation of serum cholesterol, history of smoking, strong family history of CAD and history of taking oral pills among women and estimation of fasting blood sugar to detect diabetics Having identified such high-risk persons, preventive care is taken by motivating them to take action against the Free ebooks ==> www.ebook777.com 529 Chapter 21 Epidemiology of Noncommunicable Diseases risk factors Individuals with HTN are given treatment, smokers to give-up smoking, persons with hyperlipidemia are treated Sometimes this strategy will not help, for instance the treatment of hypertension does not reduce the risk of CAD Primordial Prevention This consists of prevention of the emergence or development of risk factors among the population groups, in whom they have not yet appeared Since many adult health problems like HTN, Obesity, have their early origins in childhood, efforts are directed towards discouraging the children from adapting harmful lifestyle such as smoking, eating pattern, physical exercise, alcoholism, etc The main intervention is through mass education Secondary Prevention This is the action which stops the progress of the disease in its early stage and prevents complications With ref to CAD, this consists of prevention of recurrence of CAD by cessation of exposure to risk factors as mentioned in high-risk strategy, e.g giving up smoking after an attack of myocardial infarction, followed by bypass surgery, prompt treatment with antihypertensives after detecting hypertension, similarly starting antidiabetic drugs after detection of diabetes mellitus, etc CONGENITAL HEART DISEASES A congenital heart disease (CHD) is a defect in the structure and function of the heart, developed during fetal growth, present at birth, often detected during later life These malformations occur as a result of a complex interaction between genetic and environmental system It constitute an important cause of infant morbidity and mortality The prevalence of CHD is estimated to be about 5-9/1000 children below 10 years Congenital heart diseases are grouped into acyanotic and cyanotic heart diseases Acyanotic Heart Diseases (Left-to-Right Shunt) • • • • Atrial septal defect (ASD) Ventricular septal defect (VSD) Patent ductus arteriosus (PDA) Persistent trunkus arteriosus Acyanotic Heart Diseases without a Shunt • Congenital aortic stenosis • Coarctation of aorta • Congenital aortic incompetence; mitral incompetence Cyanotic Heart Diseases (Right-to-Left Shunt) • • • • • • • Tetralogy of Fallot Complete transposition of great arteries Tricuspid atresia Coarctation of aorta VSD with reversed shunt (Eisenmenger’s complex) PDA with reversed shunt ASD with reversed shunt A child with CHD is suspected if there is history of apnea, growth failure and repeated attacks of respiratory infections The child is physically retarded and often cyanotic Cardiac murmurs are common Anomalies of other organs in the body may coexist The etiology of CHD is multifactorial The intrinsic agents are chromosomal aberration, defects of T lympho cytes, systemic lupus erythematosus The external agents are rubellavirus, X-rays, alcohol, drugs acting on women during pregnancy Often they (CHD) occur themselves or be a part of syndrome like Down’s syndrome, Trisomy 13 syndrome, Turner’s syndrome, Marfan syndrome, etc Other determinants (influencing factors) are altitude at birth, prematurity, maternal age, sex of the child, consa quinous marriage, etc Altitude at Birth Persistence of the ductus arteriosus is six times more frequent among the children born at high altitudes than those born at sea level Prematurity Ventricular septal defect and PDA are relatively common among premature infants Maternal Age Late maternal age seems to increase the risk of Fallot’s tetralogy Sex of the Child The bicuspid aortic valve is predominantly a male disease Aortic atresia is almost exclusively a disease of male infants www.ebook777.com Free ebooks ==> www.ebook777.com 530 Section Epidemiology PDA and ostium secondum atrial septal defect are higher among females Congenital aneurysms of sinuses of Valsalva carry a male to female ratio of 4:1 prevalence of the disease and the socioeconomic factors Thus it indicates that RHD is one of the most readily preventable chronic disease Prevention Agent Factor In about 90 percent of CHD, the cause is not known clearly Therefore prevention is possible only in about 10 percent of cases by the following measures • Health education: People are educated to avoid sanguineous marriages Women are advised not to postpone marriages and first pregnancy beyond 30 years Pregnant women are advised to avoid infections, alcohol, smoking, X-rays, drugs and chemicals They should consume only iodized salt Diabetic women should keep the disease under control during pregnancy • Rubella vaccine to be given to all potential mothers before becoming pregnant • Genetic counseling is offered to the parents who have given birth to a child suffering from CHD • Detected cases of CHD are referred to pediatric surgeons for the corrections by surgery if any • Efficient antenatal care to be taken to prevent prematurity • Deliveries at high altitudes are avoided RHEUMATIC HEART DISEASE Rheumatic heart disease (RHD) is the ultimate, sequelae and crippling stage of rheumatic (Rh) fever, which in turn is the result of streptococcal pharyngitis Rheumatic fever is an acute febrile disease, affecting the connective tissues particularly in the heart and joints, which occurs following the infection of throat (pharynx) group A beta-hemolytic streptococci Thus although Rh fever is a noncommunicable disease, it results from communicable pharyngitis Rheumatic heart disease is a major public health problem in India About 20 percent of all sore throats among children are due to streptococcal infection and of these about percent result in rheumatic fever Almost 80 percent of those who get Rh fever, end up with Rh heart disease Thus RHD is the most common and most widely prevalent heart disease (30–50 percent of all cardiac cases) among children in India Its prevalence is about 6/1000 children in the age group of to 15 years In absolute numbers, about million children in India are suffering from RHD and RHD is responsible for about 30 percent of all cardiovascular deaths It is estimated that about to 3/1000 of the overall population in the country, including people of all the age group and both the sexes, are suffering from RHD In the last two decades, the incidence of Rh fever and the prevalence of RHD have fallen remarkably as the living conditions improved, indicating relation between the Agent: RHD is the late sequel of Rh fever, which in turn is the result of the infection of tonsils, pharynx, adenoids, etc caused by Group A, β-hemolytic streptococci (also called S pyogenes) Particularly of the serotype ‘M-type 5’ has been incriminated as the causative agent, because of its rheumatogenic potential They are gram-positive, nonmotile, nonspore forming, spherical bacilli, 0.5 to 1.0 µ in diameter, arranged in the form of chains They are called hemolytic streptococci because they cause lysis of RBCs due to the presence of a heat stable toxin called ‘Streptolysin-O.’ They also have a heat labile, mildly antigenic toxin, called ‘Streptolysin-S.’ Because of the presence of many strains of the streptococci, it has not been possible to prepare an effective vaccine Reservoir of infection: All the cases and the carriers of streptococcal pharyngitis are the reservoirs Among the carriers, both temporary and chronic carrier state occurs Cases of strep pharyngitis are at a greater risk of developing Rh fever than the carriers Age incidence: Incidence is maximum among school children, in the age group of to 15 Sex incidence: It is equal in both the sexes Immunity: There has been an immunological basis for the development of Rh fever and RHD According to toxic immunological hypothesis, the streptococci have certain toxic products leading to immunological process, resulting in Rh fever Another concept is that it requires repeated exposure to precipitate the illness Another belief is that RHD is an autoimmune disease Predisposing factors: Rh fever and RHD is considered as ‘Social disease’, because many social factors are responsible for the prevalence of this disease such as poverty, poor housing, undernutrition, illiteracy, ignorance, large families, over crowding, etc This disease is therefore common among slum dwellers and inmates of barracks Prevalence declines sharply as the standard of living improves Pathogenesis: Aschoff’s nodule is the pathognomonic sign of Rh fever The nodule is a perivascular aggregate of lymphocytes and plasma cells surrounding a fibrinoid core So the basic disease process is that of an inflammatory vasculitis In the heart, mitral valvulitis is the most common lesion Later, as the fibrosis of valve takes place results in mitral stenosis and incompetence Free ebooks ==> www.ebook777.com Chapter 21 Epidemiology of Noncommunicable Diseases Clinical Features Minor Manifestations • Fever: Usually low grade fever, lasts for about months • Polyarthritis: This occurs in 80 to 90 percent of the cases The arthritis is asymmetrical, migratory and nondeforming type Large joints like knees, ankles and elbows and wrists are affected Rarely smaller joints of hands and feet are affected There will be painful swelling of these joints which later subside spontaneously after about one week There is no residual damage to the joints The movements of the affected joints is limited because of the pain As it subsides, it appears in another joint (migratory) • Carditis: Heart is affected in 60 to 70 percent of the cases of Rh fever All layers of the heart—pericardium, myocardium and valves are affected The damage is permanent The manifestations are tachycardia, cardiomegaly, pericarditis, and heart failure The common cardiac murmur indicating the involvement of mitral valve is soft, mid-diastolic mur mur called ‘Carey-Coombs murmur.’ The most common ECG finding is prolonged P-R interval and first degree AV block Thus in Rh fever, the organisms ‘lick the joints and bite the heart.’ Involvement of the heart is the last stage of Rh fever • Subcutaneous nodules: These are round, firm and painless nodules appearing below the skin, over the bony prominences such as occiput, elbow, ankle or wrist joints, about four weeks after the onset of Rh fever The skin over the nodules move freely and is not inflamed The nodules last for a variable period of time and then disappear, leaving no residual damage This is also called as ‘erythema nodosum.’ • Chorea: This is a late manifestation occurring due to involvement of brain, which can occur alone or with carditis, characterized by purposeless, abnormal, jerky movements of arms, often associated with muscular weakness and/or behavioral abnormalities It is seen in about 10 percent of cases It disappears gradually leaving no residual damage • Erythema marginatum: It is a nonpruritic, pink colored, skin rashes, appearing in about percent of the cases of Rh fever They appear for a transient period of time over the trunk and extremities but never on the face, the center being pale and margin being serpiginous and they blanch on pressure They disappear later without any damage Thus except carditis, all other manifestations of Rh fever not cause permanent damage According to J Duckett Jones, the clinical feature of Rh fever are grouped into major and minor manifestations (Table 21.5) Fever, polyarthralgia, past history of Rh fever, raised ESR, leukocytosis, raised C-reactive protein WHO criteria (2002-03) for the diagnosis of Rh fever and RHD based on revised Jones criteria is shown in Table 21.5 Table 21.5 WHO criteria (2002–03) for the diagnosis of Rh fever and RHD based on revised Jones criteria Category Criteria • Primary episode of Rh fever One or two major and two minor manifestations plus evidence of preceding group A streptococcal infection (such as prolonged P-R interval in ECG, rise in anti-streptolysin –‘O’– titer, a positive throat culture) • Recurrent attack of One or two major and two minor Rh fever in a patient manifestations plus evidence of without established RHD preceding Gr A streptococcal infection • Recurrent attack of Rh fever in a patient with established RHD Two minor manifestations plus evidence of preceding Gr A streptococcal infection Prevention of Rheumatic Fever and Rheumatic Heart Disease Health Promotion Measures necessary for primordial prevention are: • Improvement in the living conditions • Improvement of sanitation in and around the house • Prevention of overcrowding • Prevention of malnutrition among children • Improvement in the socioeconomic condition • Health education of the people regarding dangers of sore throat • ‘Health-Fair’ should be conducted in the schools to make the children health conscious Specific Protection • No vaccine is available • Chemoprophylaxis of the contacts of a case of pharyngitis or scarlet fever with Benzathine penicillin • ‘Secondary prophylaxis’ is given for all cases of Rh fever to prevent RHD with 1.2 million units of Benzathine Penicillin, once in weeks, regularly for years or until the age of 18 years, whichever is later If they have developed RHD, prophylaxis is continued for life Major Manifestations Early Diagnosis and Treatment Carditis, polyarthritis, chorea, erythema nodosum (nodules) and erythema marginatum • By conducting periodical ‘School health survey’, to detect the cases of sore throat www.ebook777.com 531 Free ebooks ==> www.ebook777.com 532 Section Epidemiology • By surveillance of ‘high-risk’ groups such as slum dwellers • Detected cases of sore throat (or acute pharyngitis) are treated by dose of 1.2 million units of Benzathine penicillin, a long acting one This essentially prevents the subsequent development of Rh fever and RHD Disability Limitation This consists of limiting the development of disability in an individual who has already developed RHD This consists of giving intensive treatment with Aspirin for joint pains and prednisolone for carditis, life long Benzathine Penicillin, 1.2 million units, once in weeks and Balloon valvotomy or valve replacement • At least readings should be taken over a period of minutes and the lowest reading is recorded Classification Hypertension is classified into two types, primary and secondary It is ‘primary’ (or essential) when the causes are generally unknown This accounts for nearly 90 percent of cases It is called as ‘secondary’, when the cause is known, such as diseases of the kidney, tumors of adrenal gland, consumption of drugs like steroids, oral pills, congenital narrowing of the aorta, etc This accounts for about 10 percent of all cases Magnitude Rehabilitation By social, vocational and psychological measures of those who are suffering from RHD HYPERTENSION It is a condition characterized by an increase in the arterial pressure of the individual It is the most common cardiovascular disease all over the world and constitutes an important risk factor for the cardiovascular deaths Higher the blood pressure, higher is the risk of complications like stroke, myocardial infarction and renal failure Classification of blood pressure according to WHO is shown in Table 21.6 Table 21.6 Classification of blood pressure (WHO) Category Systolic (mm Hg) Diastolic (mm Hg) Normal 110 Hypertension (HTN) is a global problem In India, it is estimated to range from to percent and the trend is increasing due to changes in lifestyle A recent report indicates that nearly billion adults globally had HTN in 2000 and this is predicted to increase to 1.56 billion by 2025 Rule of Halves Hypertension is an ‘Iceberg disease’ and constitutes the tip of the iceberg The submerged portion corresponds to undiagnosed cases, asymptomatic cases, inadequately treated cases etc which are all represented diagrammatically as ‘Rule of Halves’ (Fig 21.2) The whole community Normotensive subjects Hypertensive subjects Undiagnosed HTN subjects Hypertension ‘Isolated systolic hypertension’ is defined as a systolic pressure of 140 mm Hg or more and a diastolic blood pressure of less than 90 mm Hg WHO Expert committee has also recommended that: • Blood pressure should be recorded in the sitting position of the patient • Only one arm (either right or left) to be used consistently • The reading at which ‘Korotkoff sound’ is first heard is considered as systolic pressure and at which the K-sound disappears, as diastolic pressure Fig 21.2 Hypertension in the community Source: Park K Park’s Textbook of Preventive and Social Medicine, 18 edn 2005 Free ebooks ==> www.ebook777.com 927 Annexure In 1878, Pasteur suggested a modified version, i.e ‘Aseptic Surgery’, wherein the instruments used for surgery were thoroughly sterilized before surgery Lister was appointed as queen Victoria’s personnel surgeon He was the first doctor to receive the rare Honor of title ‘Baron Lister’ he died on Feb 10, 1912 at Walmer, England Lister is called as the father of antiseptic surgery ROBERT KOCH (1843–1910) Born is Clausthal, Hannover, he took his medical degree at Gottingen in 1866 As a district physician at Wallstein, he began his studies with anthrax bacillus His bacteriological results were violently opposed by Paul Bert but completely confirmed by Pasteur In November 1877, Koch published his staining methods In 1882, he discovered Tubercle bacillus and published his postulates (Koch’s postulates) meanwhile he and his assistants perfected the idea of steam sterilization In 1883, he visited Egypt and India and discovered cholera Vibrio and its transmission through water and food Incidentally he found the organisms of Egyptian ophthalmia in 1883, which is named after him as Koch’s week’s bacillus, for which he received a donation of 1,00,000 marks from Prussian state In 1885, he was appointed as Professor of hygiene and bacteriology at the University of Berlin In 1891, he became the Director of the Institute for Infectious Diseases In 1893, he wrote an important paper on water-borne epidemics, showing how they may be prevented by proper filtration In 1896, he investigated Rinderpest in South Africa In 1897, he produced new tuberculin In 1898, he investigated malarial fever in Italy In 1902, he studied Rhodesian Red Water Fever, horse sickness, trypanosomiasis and in the same year established methods of controlling typhoid In 1905, Robert Koch received Nobel Prize In 1906, he introduced ‘Atoxyl’ for the treatment of sleeping sickness He died of heart failure on May 27, 1910 at the age of seventy-seven RONALD ROSS (1857–1932) He was born on May 15, 1857, at Almora in India He had his education at London After graduating in medicine, he returned to India in 1879 First he tried music Later he shifted to literature and wrote novels He was discouraged when they were not published Later he joined Indian Medical Service He saw Indians dying of cholera, small pox, malaria and plague Yet, he had not an eye for microbes After literature, he chose mathematics as his past time With failure again he resolved to take microbe hunting as his main mission He went to London, studied bacteriology and returned to India in 1892 with a vow to combat malaria He was discouraged because he could find nothing in the blood smear of malarias So he went back to London to give up medicine But this time Dr Patrick Manson, who was greatly obsessed with mosquitoes showed him development of Laveran’s plasmodium parasites in the smear Ross returned to India in 1895 and carried out his research study at Secunderabad In 1897, he discovered the development of the malarial parasites as oocyst on the stomach wall of the infected female Anopheline mosquito Later he also tracked down the malarial parasites from the blood of infected birds through anopheles mosquito In 1902, Ross received the Nobel Prize He returned to England, became the Director of Ross Institute and Hospital, founded in his honor He died on September 16, 1932 CALENDAR OF IMPORTANT DATES AND EVENTS Month Date January 30 Event New Year Day Anti-Leprosy Day February 28 Deaf and Dumb Day World Cancer Day National Science Day March 10 15 16 22 24 World Science Day International Women’s Day Anganwadi Worker’s Day World Kidney Day World Consumer Rights Day World Immunization Day/ Measles Day; World Glaucoma Day World Water Day World Tuberculosis Day April 17 25 30 World Health Day Hemophilia Day World Malaria Day Child Labor Day May 12 13 15 17 31 World Labor Day (May Day) Red Cross Day Mother’s Day International Day of the Family World Hypertension Day World No Tobacco Day June 14 26 World Environment Day World Blood Donors’ Day International Day of Drug Abuse and Illicit Trafficking www.ebook777.com Free ebooks ==> www.ebook777.com 928 Community Medicine with Recent Advances Month July August September October November Date Event 1997 – Breastfeeding; Nature’s Way 11 Doctor’s Day (India) World Zoonotic Day World Population Day 1998 – Breastfeeding; The Best Investment 1-7 15 20 World Breastfeeding Day World Breastfeeding Week Independence Day (India) World Mosquito Day 1-7 10 20 21 28 National Nutrition Week Teachers’ Day International Literacy Day World Suicide Prevention Day International Peace Day Alzheimer’s Day World Rabies Day; World Heart Day 10 11 13 14 16 29 Blood Donation Day; World Elders Day World Habitat Day World Sight Day World Mental Health Day (Second Thursday) National No Tobacco Day Anti-Natural Disaster Day World Standards Day World Food Day World Stroke Day 11 14 16 18 19 Red Cross Flag Day Legal Service Day National Filaria Day World Diabetes Day World Day of Remembrance for Road Traffic Victims World Epilepsy Day World Chronic Obstructive Pulmonary Disease Day; National Integration Day NCC Day International Day for the Elimination of Violence against Women 24 25 December 10 11 World AIDS Day; International Pollution Prevention Day National Pollution Prevention Day World Disabled Day National Day for the Mentally Retarded World Human Rights Day UNICEF Day 1999 – Breastfeeding; Education for Life 2000 – Breastfeeding; It Is Your Right 2001 – Breastfeeding; In The ‘Information Age’ 2002 – Breastfeeding; Healthy Mothers And Healthy Babies 2003 – Breastfeeding In A Globalized World For Peace And Justice 2004 – Exclusive Breastfeeding; The Gold Standard; Safe, Sound, Sustainable 2005 – Breastfeeding and Family Foods—Loving and Healthy 2006 – Infant Milk Food (IMF) Act; Making it Known to People 2007 – Breastfeeding: The 1st hour: Save one million babies 2008 – Breastfeeding: Mother support; Going for the Gold 2009 – Breastfeeding: A Vital Emergency Response; Are you Ready? 2010 – Breastfeeding: Just 10 Steps! The Baby Friendly Way!! 2011 – Talk to me! Breastfeeding a 3D experience 2012 – Taking Stock of Policies and Programs 2013 – Breastfeeding support: Close to Mothers LIST OF WORLD HEALTH DAY THEMES 1950 – Know Your Own Health Services 1951 – Health for Your Child and the World’s Children 1952 – Healthy Surroundings Make Healthy People 1953 – Health is Wealth 1954 – The Nurse, Pioneer of Health 1955 – Clean Water Means Better Health 1956 – Destroy Disease Carrying Insects 1957 – Food for Health 1958 – Ten Years of Health Progress 1959 – Mental Illness and Mental Health in the World Today 1960 – Malaria Eradication—A World Challenge LIST OF WORLD BREASTFEEDING WEEK THEMES SINCE 1992 1961 – Accidents Need Not Happen 1962 – Preserve Sight—Prevent Blindness 1963 – Hunger, Disease of Millions 1964 – No Truce for Tuberculosis 1992 – Baby Friendly Hospital Initiative 1965 – Smallpox—Constant Alert 1993 – Mother Friendly Work Place 1966 – Man and His Cities 1994 – Infantfeeding Act; Making the Act Work 1967 – Partners in Health 1995 – Breastfeeding; Empowering Women 1968 – Health in the World of Tomorrow 1996 – Breastfeeding; A Community Responsibility 1969 – Health, Labor and Productivity Free ebooks ==> www.ebook777.com 929 Annexure 1970 – Early Detection of Cancer Saves Lives 2009 – Save Lives, Make Hospital Safe in Emergencies 1971 – A Full Life Despite Diabetes 2010 – Join the Global Movement to Make Cities Healthier 1972 – Your Heart is your Health 1973 – Health Begins at Home 2011 – Combat Drug Resistance—No Action Today; No Cure Tomorrow 1974 – Better Food for a Healthier World 2012 – Ageing and Health: Good Health Adds Life to Years 1975 – Smallpox—Point of no Return 2013 – High Blood Pressure 1976 – Foresight Prevents Blindness GOALS TO BE ACHIEVED BY 2000–2015 1977 – Immunize and Protect Your Child 1978 – Down with High Blood Pressure 1979 – A Healthy Child, a Sure Future 1980 – Smoking or Health ; Choice is Yours Year 1981 – Health For All by the Year 2000 1982 – Add Life to Years 1983 – Health For All by the Year 2000; The Count-down has Begun Goal to be achieved 2003 • Enactment of legislation for regulating minimum standard in Clinical Establishment/Medical Institutions 2005 • Eradication of Poliomyelitis and Yaws 1984 – Children’s Health ; Tomorrow’s Wealth • Elimination of Leprosy 1985 – Healthy Youth ; Our Best Resource • Establishment of an integrated system of surveillance, National Health Accounts and Health Statistics • Increase State sector Health spending from 5.5 to 7% of the budget • 1% of total health budget for Medical Research • Decentralization of implementation of public health programs 2007 • Achieve Zero level growth of HIV/AIDS 2010 • Elimination of Kala-Azar Reduction of Mortality by 50% on account of TB, Malaria and other Vector and Water borne diseases 1994 – Oral Hygiene • Reduction of Prevalence of Blindness to 0.5% 1995 – World Free Polio By 2000 AD • Reduction of IMR to 30/1000 LB and MMR to 100/lakh LB 1996 – Healthy City For Better Living • 1997 – Emerging Infectious Diseases ; Global Alert and Global Response Increase utilization of public health facilities from current level of < 20 to > 75% • Increase health expenditure by Government from the existing 0.9 to 2.0% GDP 1999 – Active Ageing Makes the Difference • 2% of total health budget for Medical Research 2000 – Safe Blood Starts With Me; Blood Saves Lives • Increase share of central grants to constitute at least 25% of total health spending • Further increase of State Sector health spending to 8% • Elimination of Lymphatic Filariasis 1986 – Healthy Living ; Everyone a Winner 1987 – Immunizing Chance for Every Child 1988 – Health For All; All For Health 1989 – Let Us Talk Health 1990 – Think Globally Act Locally; Our Planet (One Earth One Family) 1991 – Should Disaster Occur Be Prepared 1992 – Heart Beat; Rhythm of Life 1993 – Handle Life With Care ; Present Violence and Negligence 1998 – Pregnancy is Precious; Let Us Make it Safe 2001 – Mental Health; Stop Exclusion – Dare to Care 2002 – Move For Health; Prevention of Noncommunicable Diseases 2003 – Shape the Future of Life ; Healthy Environments for Children 2004 – Road Safety is No Accident 2005 – Make Every Mother and Child Count 2006 – Working Together For Better Health 2007 – Invest in Health; Build a Safer Future (International Health Security 2008 – Protect Health from Climate Change (60th Anniversary of WHO) 2015 MILESTONES IN VACCINATION 1976 – First vaccination by Edward Jenner against small-pox 1985 – Successful immunization by Sir Louis Pasteur against rabies 1892 – Cholera vaccine 1913 – Toxoid, Antitoxin immunization against diphtheria 1921 – BCG vaccine www.ebook777.com Free ebooks ==> www.ebook777.com 930 Community Medicine with Recent Advances 1923 – Diphtheria toxoid 1968 – Type C Meningococcus vaccine 1923 – Pertussis vaccine 1970 – 1927 – Tetanus toxoid 1937 – Influenza vaccine Researchers in Israel proved that injection of a peptide from a virus can induce the production of antibodies that recognize the entire virus or disease 1937 – Yellow fever vaccine 1971 – Type A Meningococcus vaccine 1949 – Mumps vaccine 1975 – Live vaccine against typhoid developed by Germanier and Furer 1954 – Salk’s polio vaccine 1980 – First commercial vaccine for hepatitis B 1957 – Sabin’s oral polio vaccine 1982 – 1960 – Measles vaccine First vaccine produced through genetic engineering (vaccines for diarrhea in pigs) 1964 – Purified Chick Embryo Cell-Culture Vaccine by Kondo Human Diploid Cell Vaccine by Wiktor 1982 – First synthetic vaccine produced from diphtheria toxin 1985 – Purified Vero-cell Rabies Vaccine by Merieux Institute 1962 – Rubella vaccine Free ebooks ==> www.ebook777.com Index Page numbers followed by f refer to figure and t refer to table A Abdomen 116, 127, 134, 138 Abortion rate 625 ratio 625 Acarus scabiei 145 Acculturation 701, 705 Acoustic barrier 53 Acquired immunodeficiency syndrome 471 Action of chlorine 31 Active and passive immunization 280t immunization 313, 402, 496 surveillance 822 Acute diarrheal diseases 381 flaccid paralysis surveillance 838 respiratory infections 314 retroviral syndrome 477 Acyanotic heart diseases 529 Administrative set-up of ICDs 611 NRHM 779 Adolescent health 746, 868 reproductive and sexual health 750 Advantages of community participation 762 domiciliary care 570 hard water 39 hydroclave 103 institutional care 571 oral polio vaccine 404 short course chemotherapy 357 syndromic case management 465 telemedicine in India 914 Aflatoxicosis 197 Aga Khan Foundation 818 Age specific fertility rate 623 marital fertility rate 624 AIDS vaccine 483 Air movement 72 pollution 48, 541 temperature 46, 68 Airborne diseases 310 Alcoholic beverages 176 Alimentary canal of flea 136f All India Blind Relief Society 807 Hospital Postpartum Program 870 Women’s Conference 807 Alpha viruses 442 Aluminum phosphate 420f Amoebiasis 408 Amoebic liver abscess 409 Anatomy of breast 582f Ancylostomiasis 413 Aneroid barometer 66, 66f Anganwadi worker/teacher 610 Angular stomatitis 163 Annapurna scheme 741 Anopheles larva 117f Anorexia 163 Antenatal care 770 Anthracosis 218 Antiadult measures 124, 450 Antilarval measures 118 Antirabies immunization 495 vaccines 496 Anti-retroviral drugs 481, 482t Anti-TB drugs 370, 370t Apgar score 574t Aphthous ulcers 542 Arboviral diseases 442 Argemone poisoning 196 Arrangement of vaccines in refrigerator 291f Artesian well 25, 25f Artesunate 827 Arthropod borne diseases 113 Artificial lighting 54 ventilation 51 Asbestosis 218 Ascariasis 412 Aschoff’s nodule 530 Ascorbic acid 164 Assessment of socioeconomic status 706 Atmospheric pressure 66 Attributes of primary health care 763f surveillance 271 Autoclave 100f Auto-disable syringes 780 Autoimmune theory 738 Autosomal dominant diseases 734 recessive diseases 734 Avian flu 335 influenza 328, 329t, 330, 332 B Baby Friendly Hospital Initiative 588 with smallpox disease 310f Bacillus anthracis 890 Bacteriological index 507f Bailleul single chamber incinerator 99f Balanced diets 178t Bar diagrams/charts 656 Barograph 67 Barrier methods 630 of communication 722 surgery 539 Basal body temperature method 647 BCG vaccine 358, 358 Bedbugs 139 Beehive incinerator 77f Behavioral disorders 744 Below poverty line 708 Benefits of Kangaroo mother care 581 Berkefeld filter 34f Bharat Sevak Samaj 807 Bhore Committee Report 791 Billing’s method 647 Binomial distribution 671 Biochemical oxygen demand 87 Biogas plant 84f Biological examination of water 43 www.ebook777.com Free ebooks ==> www.ebook777.com 932 Community Medicine with Recent Advances hazards 26, 215 pollutants 48 Biomedical research 812 waste 96t Biosafety measures 332 Bird flu 328 Birth control measures 627 pills 638 control vaccines 648 rate 628 Black fly 133, 133f Blindness 553 Blocking channel of transmission 391, 419 Blood boiling and drying 228 sucking mite 147 Body language 729 mass index 537 Borderline lepromatous 509f tuberculoid 509f Bore hole latrine 78 Bottom-up planning 863 Brainstorming 728 Breast problems 586 Breastfeeding 582 Promotion Network of India 590 Bridging generation gap 703 Bubonic plague 438 Bugs 139 Bulbar poliomyelitis 401 Burden of occupational diseases 213 and injuries 857 Byssinosis 218 C Calcium 165 Calculation of standardized death rate 248t Calendar method 646 Cancer 538, 540 Cannabinoids 753 Carbohydrate 157 and disease 158 Cardinal signs of leprosy 511f Cardiovascular diseases 527, 538 Care of environment 375 eyes 574 infants 771 low birth weight babies 578 nose and throat 574 people living with AIDS 843 rectum 574 sick and injured 705 skin 574 umbilical cord 574 Case fatality rate 246 study method 716 Cataract 554 Catarrhal stage 348 Categories of biomedical waste 94t exposure 486 waste 94 Categorization of wastes 95t Causes of diarrhea 382 high birth rate 626 infant mortality 604 low death rate 626 maternal mortality 601 PMR 603 prostitution 713 Cell culture vaccines 497 Cellular extract vaccine 380 Central Council of Health and Family Welfare 796 Government Health Scheme 775 Level Organization 840 Social Welfare Board 807 Cerebrospinal fever 348 Cerebrospinal meningitis 348 Cervical cap 633, 633f intraepithelial neoplasia 543 mucus method 647, 647f Chadah Committee Report 792 Cheilosis 163 Chemical closet 83f disinfection 99 examination of water 41 hazards 26, 215 methods 33, 633 oxygen demand 88 pollutants 48 purifier 36, 36f tests 182 Chemoprophylaxis 282, 335, 439, 517, 827 Chemotherapy 355, 513 Chickenpox 311 Chikungunya fever 452 Child development project officer 610 guidance clinic 597 labor and child abandonment 712 neglect and child abuse 712 survival index 606 rate 606 welfare agencies 608 woman ratio 624 Chi-square test 684 Chloroscope 32 Chlorotex apparatus 32, 33f Cholera 388 Chromium 169 Chromosomal abnormalities 732 disorders 733 Chronic filariasis 432f Circular and rectangular ice-packs 289f Classification for dehydration 901t ear problem 903t malnutrition and anemia 903t measles 902t Classification of arboviruses 442 arthropods 112 blood pressure 532t diabetes mellitus 545 disasters 881 disinfectants 298 food 153 poisoning 198 genetic disorders 733 handicapped children 595 leprosy 505, 505t mosquitoes 118 obesity according to body mass index 537t PEM 186 socioeconomic status 706 Clinical spectrum of leprosy 505 Clostridium botulinum 890 perfringens 44 Coal workers’ pneumoconiosis 218 Coaltar disinfectants 300 Cocaine 753 Cohort study 256, 259, 260 Coitus interruptus 646 Cold box 289 chain 288 Collection of sample of water 41 wastes 97 Colombo plan 816 Color coding for waste containers 94t Free ebooks ==> www.ebook777.com 933 Index Combined methods 634 oral contraceptive pills 638 vaccine 320 Community development program 797 diagnosis of diphtheria 346, 347t ophthalmology 556 Components of AFP surveillance 839 antenatal care 563 Kangaroo mother care 579 MCH services 562 MNP 871 NACP 843t NMHP 855 school health program 598 Composition of population 617 Concept of disease 12 family welfare 629 health Concomitant disinfection 298 Concurrent disinfection 298 Condom 630, 631f Congenital heart diseases 529 rubella 323, 553 Conservation of nutrients 181 water resources 40 Containment of infection 375 Contents of health education 723 Continuous method of chlorination 37 Contraceptive methods 630 Control of air pollution 542 animal reservoirs 439 leprosy 513 lymphatic filariasis 433 mosquitoes 118 RTIS/STIS 869 Control panel of ice-lined refrigerators 290f Convergence of services 611 Coronary artery disease 527, 549 Corpuscular radiations 58 Cost benefit analysis 789 Couple protection rate 630 Crab louse 138 Creutzfeldt-Jakob disease 878 Criteria of vitamin A deficiency 160t Critical path method 788 Crude birth rate 622 death rate 245 Cumulative frequency curve 659 distribution of heights of boys 656t table 656 Current price index for industrial worker 707t Cyanocobalamin 164 Cyanotic heart diseases 529 Cyclops 147 Cyst 410 D Daily requirement amount of vitamin D 161t Danger of artificial feeding 585 signs of newborn 576 Danida Assisted National Leprosy Eradication Program 816 Program for Control of Blindness 817 Revised National Tuberculosis Control Program 817 Danish International Development Agency 816 Deep well 25 Deficiency diseases 186 Definition of slum 782 Degree of dehydration 383 Delphi method 729 Dementia 163 Demerits 641, 644 of ground water 24 of reverse osmosis purifiers 36 Demic plague 438 Demographic cycle 615 stages 615 Dengue fever 445, 879 Hemorrhagic Fever Control Program 830 Dental fluorosis 168f Deoxyribonucleic acid 732 Dermatitis 163 Dermatophagoides pteronyssinus 146, 146f Detection of argemone oil 197 Determinants of birth weight 577 health Diabetes mellitus 544, 545 Diagnostic test 294t Diaphragm 631, 632f Diarrhea 163, 899 Dietary fiber 158 Diphtheria 341 Directly Observed Treatment-Short Course 361 Disaster management cycle 883 Discussion methods 726 Disinfection of wells 36 procedures 303 Disinsection equipment 149 methods 149 Disposal of AD syringes 780 excreta 77 sewage 87 sullage 86 wastes 75, 485 District Health Plan 778 District Level Organization 840 District Mental Health Program 855 Domestic accidents 551 Domiciliary treatment 357 Dot diagram 660 DOTS plus 370 strategy 361f Double chamber incinerator 98f pyrolitic incinerator 98 Dowry system 713 DPT vaccine 346, 345f Driven well 25 Dry and wet bulb hygrometer 72 thermometers 68f thermal treatment 100 Duck embryo vaccine 497 Dumas cap 633 Duration of abortion process 645 Kangaroo mother care 581 Dust mite 146 Dutch cap 631 diaphragm 631 Dysmenorrhea 229 Dyspepsia 163 Dysphagia 163 E Earth pit deep latrine 78 Earthquakes 881 Ebola www.ebook777.com Free ebooks ==> www.ebook777.com 934 Community Medicine with Recent Advances hemorrhagic fever 878 virus 890 Ectopic pregnancy 644 Eighth five-year-plan 794 Electronic devices 556 equipment 108f waste management 107 Elementary and adult education 871 Elements of primary health care 761 surveillance system 270 Eleventh five year plan 782 Elimination of lymphatic filariasis in India 828 neonatal tetanus 422 Emergency obstetric care 865 oral contraception 641 Emerging infectious diseases 877 Employees State Insurance Act 234 Hospitals 775 Endemic ascites 197 typhus 457 Entropion 554 Epidemic curve 250f of cholera 388f disease 277 dropsy 196 polyarthritis 452 typhus 456 Epidemiological triad 13f Epidemiology of cancer cervix 542 communicable diseases 310 infectious diseases 267 Eradication of poliomyelitis 405 yaws 522 Erythema nodosum leprosum 510f Essen schedule 498f, 499f Essential amino acid score 155 infrastructure 767 obstetric care 865 Estimation of cold chain requirements 293 requirements of immunization cards 293 Estrogen 641 Ethinyl estradiol 639 Evaluation of contraceptive methods 651 family planning 860 E-waste disposal 110 recycling 110 Examination of blood 409, 548 stool 409, 416 urine 548 Excess of food consumption 195 Exclusive breastfeeding 584 External anatomy of male rat flea 134f carriage system 130 Extrinsic incubation period 13, 452, 454 F Family and Child Welfare 813 planning 628 Association of India 806 methods 627 services 771 size 621 system 701 types 702 welfare linked health insurance scheme 651 services 772 Farmer’s lung 219 Fat and tallow melting 228 soluble vitamins 159 Fecal streptococci 43 Feco-oral route of transmission 379f Feeding of infant 582 Female anopheles mosquito 115f condom 631, 632f sterilization 650 triatoma infestans 140f Femidom 631 Fertility 622 awareness-based methods 646 regulating methods 630 Fetal health 629 signals 568 Fever 899 Field workers’ classification 505 Fifth five-year-plan 794 Filaria survey 432 Filarial indices 433 First five-year-plan 793 Flavi-viruses 442 Flea 133, 137 indices 136, 437 Flies 126, 126 Flip chart 725 Fluoride testing 168 Fluorine 167 Flury’s vaccine 497 Folic acid 164 Food allergy 185 and agricultural organization 813 borne diseases 199 intoxications 195 fortification 181 hygiene 178 list method 204 poisoning 198 sources of vitamin D 161t Ford foundation 817 Format of international death certificate 625t Fourth five-year-plan 794 Framework of cohort study 258 DOTS-plus 370 Framingham heart study 257 Frequency curve 658 distribution of heights of boys 656t of disease 353 of infection 352 polygon 658 Functions of auxillary nurse midwife of primary urban health center 783 Mahila Arogya Samiti 783 organizations 853 primary health center 766 urban health center 783 proteins 154 tuberculosis unit 367 USHA 783 voluntary health agencies 806 WHO 811 G Gallbladder 379 Gantt chart 787f Gardner and Venkataraman’s classification 389 Gaseous disinfectants 302 Gathering information for syndromic diagnosis of STDs 462 Genital ulcers 463f Geographic spot map 661 Geographical spot map 278f Germ theory of disease 12 German measles 322 Free ebooks ==> www.ebook777.com 935 Index Giardiasis 410 Glaucoma 553, 554 Global burden 535 problem 550 warming 892 Globe thermometer 70f Glossina palpalis 132f Glossitis 163 Glucose memory test 549 Glycosylated hemoglobin 549 Grading of goiter 167 hardness of water 39 Granules 149 Gross reproduction rate 624 Group A viruses 442 B viruses 442 Guillain-Barre’ syndrome 406t Guinea worm disease 406 Gut scraping 228 H Haemophilus influenzae meningitis 350 Hallucinogens 753 Hand hygiene 375 Handflush waterseal latrine 81f Hanta virus pulmonary syndrome 878 Hardness of water 39 Harvest mites 143 Hashimoto’s disease 195 Hayflick’s theory 738 Hazards of air pollution 48 global warming 892 iodization 195 noise pollution 53 population explosion 626 urbanization 622 Heads of anopheles and culex 118f Health care 760, 771 delivery indicators 11t education 518, 539, 541, 600, 722, 771 hazards of air temperature 70 ionizing radiations 59 lighting 55 obesity 539 poverty 708 tobacco 917 water contamination 26 Organization of League of Nations 809 promotion 17, 222, 223, 315, 420, 531, 739 research 812 services 9, 598, 811 status indicators 759 of industry 230 Healthful school environment 598 living 598 Hemorrhagic stroke 535 Hepatitis A 392 B 395 C 399, 878 D 399 E 399, 878 G 400 Hind Kusht Nivaran Sangh 806 HIV life cycle 477f structure 473f testing 846 Hookworm infestation 416 Hormonal contraceptive methods 638 Horrock’s apparatus 37 Hospital waste disposal 95 acquired infections 304 Housefly 126, 127, 128f Household purification of water 33 Human development index diploid cell vaccine 497f genetics 731 immunodeficiency virus 471 monkeypox 311, 877 papilloma virus vaccine 543f seasonal influenza 328 Hydroclave 102, 102f, 103f Hydrogen peroxide 302 Hydrotherapy 402 Hyperlipidemia 538 Hypertension 532 Hypervitaminosis A 160 D 161 I Iceberg of diseases 16f phenomenon of disease 15 ICRC vaccine 517 Ileum 378 Immune reconstitution syndrome 483 Immunity 358, 401, 418, 503, 521 Immunization 280, 334, 402, 772 against pandemic flu 334 program 283 Immunoprophylaxis 439 Important growth charts 591 Incidence rates of malaria 426 Incinerator 77f, 111f Incubation period 217, 275, 276f, 312, 318, 348, 349, 354, 374, 379, 383, 390, 407, 409, 411, 412, 418, 425, 438, 441, 454, 492, 505, 521 Indian Council for Child Welfare 807 diabetic risk score 547 Factories Act 233 public health standards for community health centers 773 primary health centers 766 Red Cross Society 806 tick typhus 457 Indicators of air pollution 49 health housing 64 malnutrition 205 MCH care 601 thermal comfort 46 Indigenous system of medicine 775 Indira Gandhi National Old Age Pension Scheme 740 Indirect modes of transmission 274 standardization 247 Induction of abortion 644 Industrial cancers 541, 541t Infant mortality rate 604, 605f, 625 Infected mosquito 113 Infection control measures 862 Infectious diarrhea 382 waste treatment system 102 Influenza 325 virus anatomy 326f Infrastructures of telemedicine centers 912 Inguinal bubo 467 Injectable contraceptives 642 Inorganic lead poisoning 221 Insecticide toxicity 150 Insertion of norplant capsules 643f Integrated disease surveillance project 886 mother and child development services scheme 608 rural development program 797 vector control 126, 435 Intensive neonatal care 578 Internal carriage system 130 International Atomic Energy Agency 815 death certificate 625 www.ebook777.com Free ebooks ==> www.ebook777.com 936 Community Medicine with Recent Advances health organizations 808, 819 regulations 307 labor organization 814 Intersectoral co-ordination of primary health care 763f Intestinal amoebiasis 409 Intradermal schedules 498 Intramuscular schedules 498 Intranatal care 568, 770 Intrauterine devices 634 ring devices 634f Intrinsic and extrinsic incubation period 276t Iodine 166 cycle 167 deficiency disorders 193 Iron 165 Ischemic heart disease 527 stroke 535 Itch mites 145 IUD insertion 636 J Janani Shishu Suraksha Karyakrama 867 Suraksha Yojana 866 Japanese encephalitis 447 Joint extended family 702 family 702 JSY and JSSY schemes 779 Jungalwala Committee Report 792 Juvenile delinquency 597 K Kala-azar 879 Kangaroo feeding policy 581 mother care 579, 581 position 579 Karman cannula 644 Kartar Singh Committee report 792 Kata thermometer, dry and wet 73f Kendall’s table 699 Killed JE vaccine 451, 451t Kishori Shakti Yojana 611 Kuppuswamy’s socioeconomic scale 708t Kwashiorkor 186f, 187t Kyasanur Forest disease 453 L Lactational amenorrhea method 647 Laparoscopy procedure 650 Larva 129 Laser radiations 57 Lathyriasis 195 Lathyrism 195 Layout of operation theater 769f primary health center 768f Lead poisoning 220, 222t Leg of mosquito 116f Legionellosis 878 Legionnaires’ disease 878 Leishmaniases 440 Lepra reactions 512 Lepromatous leprosy 510f Lepromin test 507 Leprosy 501, 772 control unit 831 day 520 elimination monitoring 833 organizations in India 519 Leptotrombidium akamushi 144f deliense 144f Levels in health education 724 Levonorgestrel 639 Lice 137, 139 Life cycle of ancylostoma duodenale 415f HIV 474 trombiculid mites 144f virus 474f Life-history of flea 135f housefly 129f mosquito 118f Limitations of germ theory 13 Lippe’s loop 634f, 635 Liquid disinfectants 300 List of food-borne diseases 201t Live JE vaccine 451, 451t Liver aspirate 409 diseases 545 Long acting pill 642 Low birth weight baby 576, 587 Lower abdominal pain 470f Lymphadenopathy 486 Lymphatic filariasis 429 Lymphocytic thyroiditis 195 M Magnitude of avian influenza 328 iron deficiency anemia 191t pandemic influenza 328 seasonal influenza 328 Maintenance of cleanliness 38 hydration 385 Malaria 422, 771, 879 Malnutrition 502, 747 Management of acute attack 435 HIV and TB 368 hospital waste 92 hydrophobia case 493 leprosy reaction 516 social constraints 713 deviance 714 evils 713 Man-made disasters 882 Mann-Whitney test 689 Mantoux test 355 Marasmus 186f, 187t Mass blood survey 432 burn technology 97 drug administration 828 screening 295 sociogenic illness 220 Master chart of classification of PEM 188t Maternal health 861, 865 mortality rate 601 signals 568 Maternity benefit 236 McArdle’s maximum allowable sweat rate 47 Measles 317 vaccine 319f, 320 Measurement of disease 252 fertility 622 light 54 malaria 425 morbidity 243 mortality 245, 625 accidents and injuries 550 Mechanical hazards 215 method 34 of emergency contraception 642 ventilation 51 Mechanism of protection 404 transmission of diseases 129 Medical abortion 644 and MTP-Act 645 termination of pregnancy Act 645 Meditation 719 Free ebooks ==> www.ebook777.com 937 Index Mendelian diseases 734 Meningitis plague 438 Meningococcal meningitis 348 Menopause 230 Menstrual induction 644 irregularities 644 regulation 644 Menstruation 229 Mental deficiency 744 dimension diseases 744 health 743 retardation 167f, 744 Merits of biogas plant 84 breastfeeding 584 ground water 24 ORT 385 Metal fume fever 222 Metamorphosis 114 Meteorology 66 Methods of collection of water 390 disposal of excreta 78 MTP 646 pasteurization 183 refuse disposal 75 Micronutrients 154, 158 Microwave irradiation 101 technology 102f Mid-day meal 600 Migration 252, 625, 710 Milk hygiene 183 products 174 standards 174 Mineral deficiency diseases 190 Minilaparotomy 650 Missed pills 639f, 640 MMR vaccine 320f Mobile leprosy treatment unit 831 Modern telemedicine system 911f Modes of transmission of disease 135 Modified BG Prasad’s classification 706t leprosy elimination campaign 832 plan of operation of malaria control 824 Monkeypox 311t Monogenic disorders 734 Monophasic pills 638 Morbidity management of lymphatic filarasis 434 Morphology of trombiculid mite 143f virus 325 Mudaliar Committee Report 791 Mukerji Committee report 792 Multibacillary leprosy 830 Multidrug treatment 830 Multiple indicator method 647 Multisectoral collaboration 843 Mumps 324 Musca 127f domestica 126 Mycotoxin 891 N Nalgonda technique 168f Nasolabial dyssebacia 163 National Acute Respiratory Infections Control Program 841 AIDS Control Program 842 Antimalaria Program 429, 821 Balwadi Nutrition Program 858 Cancer Control Program 853 Dengue Fever 830 Developmental Plans 793 Diarrheal Diseases Control Program 842 Family Welfare Program 859 Filaria Control Program 436, 828 Guinea Worm Eradication Program 408, 833 Health Planning 791 Policy 798, 799 Programs 820 Housing Policy 800 Integrated Child Development Services 858 Iodine Deficiency Disorders Control Program 856 Japanese Encephalitis Control Program 830 Kala-Azar Control Program (Nkcp) 829 Leprosy Control Program 830 Elimination Campaign 520 Eradication Program 519, 830 Malaria Eradication Program 822 Mental Health Program 854 Mid-Day School Meal Program 858 Nutrition Policy 206, 802 Nutritional Anemia Control Program 858 Poliomyelitis Eradication Program 834 Population Policy 802 Reproductive and Child Health Program 860 Rural Health Mission 776, 777 Special Nutrition Program 858 TB Control Program 840 Tobacco Control Program 858, 920 Trachoma Control Program 554 Tuberculosis Control Program 359 Urban Health Mission 781 Water Supply and Sanitation Program 870 Natural cycle of Kyasanur Forest disease 455f disasters 881 disinfectants 298 Nausea 163 Neonatal conjunctivitis 469f mortality rate 603 tetanus 421, 422f Nerve tissue vaccines 496 Net protein utilization 155 reproduction rate 624 New types of diarrheal diseases 877 Newer antidiarrheal vaccines 386 anti-TB drugs 359 Niacin 163 Nicotinic acid 163 Ninth five-year-plan 794 No scalpel vasectomy 649 Nodular goiter 167f Nonbirth control measures 627 Noncommunicable diseases 523, 879 Nonionizing radiations 56 Nonlinear regression 692 Nonparametric tests 688 Nonverbal communication 721 Normal distribution curve 670f Norms of color coding containers 95t Norplant implants 643 Nosocomial infections 304 Notable arthropod borne diseases 113t Nuclear family 702 Null hypothesis 677 Nutrition promotion 862 Nutritional anemia 190 status 553 indicators 11 surveillance 205 Nutritive value of cereals 170t milk 173t millets 171t www.ebook777.com Free ebooks ==> www.ebook777.com 938 Community Medicine with Recent Advances nuts and oil seeds 173t pulses 172t O Obesity 537, 546 Obstetric care 861 Occupational cancers 223, 541 dermatoses 224 eye health services 554 hazards 214 health 213 hazards of tobacco industry 918 in agricultural industry 225 Ophthalmia neonatorum 469, 553 Ophthalmic complications 319 Opioids 753 Opisthotonus position 419f Oral glucose tolerance test 548f hygiene 542 polio vaccine 403f questionnaire method 204 typhoid vaccine 381f Organic lead poisoning 221 Organization of Indian health administration 795 MCH and FP services 607 Organizational framework of health care systems 763 Ornithodorus moubata 142f Orthotoluidine test 32 Osmotic diarrhea 382 Osteoarthritis 538 Osteomalacia 161 Ozonation 33 P Painful scrotal swelling 468f Pancreatic pathology 545 Pandemic influenza 328, 331, 332 Paralytic poliomyelitis 402f rabies 493 Pareek’s method of socioeconomic classification 709t Passive immunization 314, 321, 404, 499 surveillance 823 Pasteur-Chamberland filter 34f Pathogenesis of cervical cancer 543 leprosy 504f Paucibacillary leprosy 831 Pellagra 163 Pentavalent vaccine 345f Perinatal mortality rate 603 Period of communicability 349, 378, 408, 443, 521 Periodic fluctuations 250 Peripheral organization 841 Permutit water softener 40f Personal protection against rabies 500 Pertussis 346 Pestis siderans 438 Pharyngitis 486 Phthirus pubis 138, 139f Phyllum arthropoda 112t Pictogram 661 Pie diagram 660 Plague 436, 879 Plasma torch technology 101 Plastic waste management 105 Pneumococcal vaccine 316f Pneumoconioses 216 Pneumonic plague 438 Polar lepromatous 510f Polioencephalitis 401 Poliomyelitis 400, 405, 406t Polygamy 460 Polygenic disorders 735 Pomeroy technique 650 Population bomb 626 explosion 626 pyramid 657 stabilization 627, 865 strategy 18, 528, 534, 549 trend in India 617 trend in World 617 Postcoital pills 641 Postconceptional methods 644 Postexposure prophylaxis 485, 494 Postnatal care 571, 771 yoga exercises 572f Postneonatal mortality rate 604 PPD test 355 Precurrent disinfection 298 Pre-exposure immunization 500 Pregnancy rate 624 Prematurity 529 Prenatal diagnostic techniques 802 Preterm baby 577 Prevalence rates of malaria 425 Prevention and control of agricultural hazards 226 AIDS 479 air pollution 49 cancer cervix 543 drug abuse 754 epidemic disease 278 meningitis 350 food adulteration 182 health hazards of smoking 919 hereditary disorders 735 kala-azar 441 lathyrism 196 mental illness 744 noise pollution 53 nosocomial infections 305 nutritional blindness 189 occupational hazards 230 protein energy malnutrition in community 188 radiation hazards 59 Prevention of carrier state 378 control of pneumoconioses 219 coronary artery disease 528 dehydration 383 handicap 596 hypertension 534 industrial cancers 223 infant mortality rate 606 infections 568 LBW baby 579 mother to child transmission of HIV 488, 567 neonatal mortality rate 604 parent to child transmission services 847 PMR 603 rheumatic fever and rheumatic heart disease 531 spread of MDR-TB 371 yellow fever in India 444 Primaquine 826, 827 Primary eye care 554 health care 761, 763 urban health center 783 Principles of antiretroviral therapy 481 arthropod control 114 breastfeeding 584 chlorination 31 food preservation 179 health education 723 PEP 494 primary health care 761 Procedure of disinfection of well 37 Production of new novel virus 327f Progesterone combination 641 Progestin only pills 640 Progress of National Leprosy Eradication Program 831 Free ebooks ==> www.ebook777.com 939 Index Prophylactic disinfection 298 Prostitution 460, 712 Protein efficiency ratio 155 energy malnutrition 186 ratio 156 Psychological barriers 722 hazards 226 Psychosocial hazards 215 Psychosomatic disorders 744 Pteroylglutamic acid 164 Pubic louse 138 Public health importance of hookworm infection 413 noise meter 52f Pulse polio immunization 406 Pupa 129 of mosquito 117f Purification of water 27 on large scale 27 on small scale 33 Pyogenes 530 Pyrethrins 150 Pyrethroids 150 Pyridoxine 164 Pyrimethamine 827 Q Q-fever 458 Quantity of health care waste 92 Quaternary ammonia compounds 301 Questionnaire method 204, 716 R Rabies 489 vaccine history 495 Radiation units 58 Radiofrequency waves 57 Radiological examination of water 45 Randomized controlled trial 260 Rapid sand filter 29f Rat fleas 134 RCA latrine 80f Reasons of drug abuse 752 vaccine failures 404 Recommended energy requirement 177t Recycling of refuse 77 Red cross 818 Reduction of birth rate 627 exposure time 53 maternal mortality rate 602 Reduviid bugs 140 Re-emerging infectious diseases 877, 879 Refractive error 553 Regional measles elimination 321 Rehabilitation 542 Reorientation of medical education 779 Reproductive and child health program 864 behavior 705 health 862 targets 803 Reservoir of infection 317, 329, 349, 353, 377, 389, 400, 407, 417, 424, 430, 441, 443, 491, 502, 521, 530 Respiratory apparatus 116 tract infections 331f Restoration of nutritional status 386 Resurgence of malaria 824 Retrospective cohort study 257 Revised National Tuberculosis Control Program 360, 362, 369, 840 Rheumatic heart disease 530 Rhythm method 646 Riboflavin 163 Rickets 161 Rickettsial diseases 456, 456t Rickettsial pox 458 Rights of child 606 Rockefeller Foundation 817 Rocky mountain spotted fever 458 Role of family and cultural factors in health and disease 703 Roll back malaria 826 Rota virus vaccine 386 Rotarix vaccine 386f Rotary kiln incinerator 99 Rubella syndrome 323 vaccine 324f Rubeola-Koplik spots 318f Rules of group discussion 726 halves 532 personal hygiene 718 Rural development 797 electrification 871 health 871 housing 872 nutrition 871 roads 872 sanitation 872 water supply 871 S Sabin vaccine 403f Safe motherhood 861 period method 646 Safety of environment 60 machine 60 worker 60 Salt-sugar solution 384 Sampling designs 672 methods 672 technique 41, 672 Sandfly 130, 132f Sanitary analysis of water 40 landfill 76 latrine 380f well 26, 26f Sanitation barrier 78, 78f, 380 of food establishments 180 of swimming pool 38 Sarcoptes scabiei 145, 145f, 146f SARS 373f, 376 Scatter diagram 660, 689 Schick test 343 School eye health services 554 health services 597 Scope of epidemiology 242 family planning services 629 Screening of contacts 367 test 294, 294t, 295 Screw feed technology 100 Scrub typhus 457 Seasonal influenza 330 Second five-year-plan 793 generation IUDs 635 Secondary attack rate 243 eye care 554 Secretory diarrhea 382 Selection of control cohorts 258 study cohorts 257 Self care in diabetes mellitus 549 Sensory training and mobility 556 Septic tank latrine 82, 82f Septicemic plague 438 Seventh five-year-plan 794 www.ebook777.com Free ebooks ==> www.ebook777.com 940 Community Medicine with Recent Advances Severe acute respiratory syndrome 371, 878 Sewage farming 91 lagoon 90, 91f Sewerage system 84 Sex linked dominant diseases 734 recessive diseases 734 specific death rate 246 Sexual disharmony 460 Sexually transmitted infections 459, 748 Shakir’s arm tapes 203f Short course chemotherapy 357 Sickness absenteeism 228 benefit 235 Sign test 688 Silicosis 216 Simple random sampling 673 Single chamber incinerator 99 Siphon flushing cistern 85f Siphonic closet 85f Sixth five-year-plan 794 Skeletal fluorosis 168f Sling psychrometer 72, 72f Smallpox 311t virus 890 Snowballing 728 Soakage pit 87, 87f Social defense 714 deviance 713 dimension disruption 460 environment 23 evils 711 factors in health and disease 710 hazards 226 insurance 237 medicine security 237, 714 stigma 460 stratification 706 therapy Socioeconomic status scale of Kuppu swamy 707 Soil-borne diseases 412 Solid disinfectants 300 Somatic mutation theory 738 Sources of air pollution 48 E-waste 108 fats 156 health statistics 654 infection 329, 378, 408 ionizing radiations 58 lead 220 vitamin A 159f Space spraying 149 Spastic pseudoparalysis 878 Spearman’s rank correlation test 692 Specific death rate 245 ophthalmic programs 554 Spectrum of health 8, 8f iodine deficiency disorders 193t Spermicides 634f Spiritual dimension Spleen 379 Spores 417 Spot map 661 Spotted wing of Anopheles 115f Srivastav Committee report 793 Stabilization of adult personality 705 Staff pattern of community health center 773 primary urban health center 783 Stages of demographic cycle 615, 616f Standard child treatment regimen 514 error of mean 676, 678 Standardized death rate 247 Status of national health programs on NCDS in India 525t Steps of direct standardization 247 Sterilization 183 Steroidal contraceptives 638 Stevenson’s screen 68f STI treatment 843 Story of smallpox 310 Strategies of polio eradication 834 Stratified random sampling 673 Strengthening community health centers 778 disease control programs 779 primary health centers 778 Stroke 535 Structure of DNA molecule 733f human immunodeficiency virus 473f analysis 729, 730f Subcutaneous implants 643 Suckling mouse brain vaccine 497 Suicide 713 Sulfadoxine 827 Swedish International Development Cooperation 816 Swine flu 334 Symptothermal method 647 swot Systematic random sampling 673 sampling 673 Systems of ventilation 50 T Targets of NRHM 779 under National Urban Health Mission 782 TB mortality rate 353 Techniques of birth control 630 Teenage pregnancy 747 Telemedicine in India 912 in public health 910 programs 914f Tenth five-year-plan 794 Terminal disinfection 298 methods 649 Tertiary eye care 554 level of health care 761 Tetanus 416 Tetravalent vaccine 345f Theory of multifactorial causation 13 Thiamine 162 content of common foods 163t Thickness of skin-fold 202 Third five-year-plan 793 generation IUDs 635 Thorax 114, 116, 127, 134, 137 Three-tier system of health care 760, 760f Tissue anthropometry 202 Tocopherol 161 Tongue depressor 422f Total fertility rate 624 marital fertility rate 624 Toxic polyphenols 197 Trachoma control 554 Tracking of blood pressure 533 Transverse myelitis 405 Traumatic neuritis 405 Treatment of carriers 378 MDR-TB/XDR-TB 370 severe dehydration 385 sewage 88 Treatment regimens under RNTCP 362f Trench fever 458 Trend of malaria 423 Triatoma bugs 140 Trichiasis 654 Trickling filter 89f Free ebooks ==> www.ebook777.com 941 Index Trimodality distribution of tuberculosis disease 252f Triphasic pills 638, 639f Triple packaging system 331f Trombiculid mites 143 Trophozoite 410 Tsetse fly 132, 132f Tsunamis 882 Tubectomy 649, 650 Tuberculin test 355 Tuberculoid 509f Tuberculosis 351, 772 and HIV 367 Association of India 806 Twenty Point Program 872 Two way communication 721 interactive television 912 Types of accidents 551 cohort studies 256 communication 721 disinfection 298 drug abuse 752 epidemic curves 277f ICTCS 845 IUDs 635 leprosy 514 mental disorders 744 milk 174 occupational cancers 223t sampling techniques 672 screening 295 study designs 262 surveillance 271 tobacco 917 Typhoid fever 377 vaccine 381f U Ulcers 486 Ultratrace minerals 169 Ultraviolet irradiation 33 purifier 36, 36f rays 56 Under fives clinic 593 United Nations Development Program 813 Educational Scientific and Cultural Organization 814 Environment Program 815 Fund for Population Activities 814 High Commission for Refugees 814 International Drug Control Program 815 Joint Program on AIDS 815 Relief and Rehabilitation Administration 809 Universal Immunization Program 833 Unspotted wing of culex 115f Urban health 869 insurance model 783 leprosy centers 831 malaria scheme 824 social health activist 782 Urethral discharge 464-466 Urgent prereferral treatment 905 Uses of census 617 epidemiology 265 incubation period 276 life table 694 surveillance 271 Utility of telemedicine 911 Utilization rates 11 V Vaccine 280, 404 carrier 292 of multiple antigen 320 Vacuum or solar radiation thermometer 69f Vaginal diaphragm 631 rings 643 Varicella 311, 313f vaccine 313f Vasectomy 649, 650f Vault cap 633 Vector-borne diseases 422 Verbal communication 721 Vibrio cholerae 890 Vicious cycle of malnutrition 186f Vimule cap 633 Viral hepatitis 392 A and B 398t Virological examination of water 45 Visceral leishmaniasis 440, 879 Vision 2020 555 Vitamin 159 A 159 deficiency 160, 553 prophylaxis schedule 189t, 858t B complex group 162 C 164 D 160 deficiency diseases 189 E 161 K 162 Voluntary health agencies 805 in India 806 association of India 806, 807 Vomiting 163 W Waist circumference 537, 547 -hip ratio 538 Waste assessment strategy 95 management of primary health center 768 minimization techniques 110 recycling strategy 95 reduction and management strategy 95 sharps management 104 Water borne diseases 377 carriage system 84 flea 147 soluble vitamins 162 Waterlow’s classification of PEM 188t Waterpox 311 Weighment of cooked foods 205 raw foods 204 Welcome’s classification of PEM 187t Wet thermal treatment 100 WHO guidelines for postexposure treatment 496 phasing of pandemic influenza 337 recommended regimen of leprosy 514 Regional Organizations 811 Whooping cough 346 Wilcoxon’s signed rank test 688 Wind anemometer 73f Workmen’s Compensation Act 237 World Food Program 815 Health Organization 809 mdt X Xerophthalmia 189, 554 X-ray of chest 354 Y Yate’s correction 686 Year-wise reference indices 707t Yellow fever 442 Yersinia pestis 890 Yuzpe method 641 Z Zagreb schedule 499f Zoonotic plague 438 www.ebook777.com ... lakh in a year; 20 25 percent increase in years CVD 2. 9 crore (20 00); expected to rise to 6.4 crore by 20 15 Stroke 20 lakh Diabetes 5.1 crore (20 10); expected to rise to crore by 20 30 COPD Burden:... of NCDs, 20 10 Fig 21 .1 Model for a multisectoral partnership with political commitment Free ebooks ==> www .ebook7 77.com Chapter 21 Epidemiology of Noncommunicable Diseases Table 21 .4 Proposed... diastolic pressure Fig 21 .2 Hypertension in the community Source: Park K Park’s Textbook of Preventive and Social Medicine, 18 edn 20 05 Free ebooks ==> www .ebook7 77.com Chapter 21 Epidemiology of