Community Medicine By

DR. Zulfiqar Ali

Contents
Chapter No.1 Basic Definition & Introduction Definitions 1 Health and its dimensions 3 Spectrum of disease 4 Iceberg of disease 4 Natural history of disease 5 Levels of prevention 7 Apply 5-levels of prevention on T.B & hypertension 9 WHO (World Health Organization) 10 UNICEF 10 Important days of the year 11 Viva Questions 11

Chapter No.2 PHC & Rural Health Definition & Elements of PHC 13 Principles of PCH 13 Health for all by year 2000 15 Health planning cycle 15 5-Star Doctor 16 Levels of prevention & health care 16 Major diseases 16 FLCF (First level care facilities) 17 BHU & RHC 18 Duties of LHV 21 Rural health problems 22 Viva questions 23 MCQS 23

Chapter No.3 Demography Demography 25 Population Dynamics 25 Population growth rate 26 Reason for population change 26 Calculation of population in b/w census years Components of population growth 27 Causes of highest mortality 28 Causes of decrease mortality 28 Causes of high fertility 29 Basic fertility measures 29 Population pyramid 30 Dependency & Sex ratio 31 Demographic transition 31 Demographic Cycle 31 Demographic trap 32 Population momentum 33 Implications of high population growth 33 Demographic features of Pakistan 34 Vital index & population density 35 Viva questions 35 MCQS 35

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Chapter No.4 Biostatistics Introduction & functions Important terms Data & its type Sources of data Presentation of data Types of measurements applied on data Measurement of central tendency
Arithmetic mean Median Mode

37 37 38 38 39 43 43

Measures of dispersion
Range Mean deviation Standard deviation

44

Hypothesis Probability or p value Chi-Square test Life Table Viva questions MCQS

45 45 46 46 47 47

Chapter No.5 Environment Water Air & ventilation Soil Housing Noise Climate & health Viva questions MCQS Chapter No.6 Nuclear Medicine Radiation, sources & its types Units of radiation Maximum permissible dose Penetration ability Effects of radiation Uses of radiation Protection from radiation ALARA principle & Bays rule Viva Questions MCQS 49 67 73 75 77 79 83 83

85 85 86 86 86 87 87 87 88 88

Chapter No.7 Hospital & Biomedical Wastes management & Sold waste disposal Introduction & Types of wastes 89 Waste management team & plan 90 Steps in hospital wastes Management 91 solid wastes disposal 92 Methods of disposal of wastes 93 Health Hazards of Human excreta 93 Methods of human excreta disposal 94 Septic tank 94 Definitions 95 Strength of sewage (BOD& COD) 95 Activated sludge process 95 Viva Questions 96 MCQS 96

Chapter No.8 Epidemiology Definition, aim & uses 97 Epidemiological approach 97 Basic measurements in Epidemiology 98 Tool of measurement 98
Rates Ratio Proportion

Epidemiological methods 102

Numerator & denominator 99 Mortality rates & ratios 100 Measurement in morbidity 101
Incidence Prevalence

111 Association & causation 111 Web of causation & Wheel 112 Investigation of an epidemic 113 KAP studies 114 Uses of Epidemiology 114 Viva questions 115 MCQS 115

Blinding

Chapter No.9 School Health Services Introductions & aims 117 Situation of school health service 117 School health team 118 Duties of school medical officer 118 Duties of school nurse & an attendant 118 Drugs & equipment of school clinic119 Role of school teacher 119 Profiles of School health program 119 School health problems 121 Functions of school health Services 121 Advantages and disadvantages of school health services 121 Viva questions 122 MCQS 122

Chapter No.10 Health Education Definitions & aim 123 Stages of health education 123 Strategies, communication 124 Methods of health education 125 Methods of maintaining behavioral change 126 Models 126 Principals of health education 127 Programme plan 127 Evaluation 127 Viva questions 128 MCQS 128

Chapter No.11 Immunization Immunology and its uses Immunity & its types Important terms Herd immunity Immunizing agents
Vaccines Immunoglobulins Antisera/antitoxin

129 129 130 131 131

Cold chain 134 Shake test & thawing 135 EPI schedule 135 Vaccination schedule of 9 months & 2 years child 135 Contraindication of vaccines 135 Abnormal reactions & Complications of vaccines 137 Tetanus toxoid 137 Polio 137 Causes of failure of vaccine 138 Vaccines descriptions 138 Pre- exposure prophylaxis 139 Immunization recommends for travelers to endemic area Optional & compulsory vaccines 140 Important terms 140 Vaccine schedule for rabies 141 Viva questions 142 MCQS 142

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Chapter No.12 Disaster Management & Control Definition & types of disaster 143 Steps of disaster management 143 Organization model for disaster 145 Social reaction following a Disaster 145 Duties of health team 145 Viva questions 145 Surveillance cycle

Chapter No.13 Screening & Sampling Definition, aims, objectives & uses of screening 147 Type of screening 148 Dif. b/w screening & diagnostic test 148 Criteria for screening 148 Sensitivity, specificity & predictive value 150 Yield 151 Definition & methods of sampling 151 Probability & non-probability Sampling 152 Sampling errors 153 Viva questions 153 MCQS 154

Chapter No.14 IMCI & Child survival IMCI strategy & its aims 155 Components of IMCI 155 Advantages of IMCI study 155 Situation of children in Pakistan 156 women conditions in Pakistan 156 Major killers of children 157 Composition of ORS 158 Indigenous ORS 158 Viva questions 158 MCQS 158

Chapter No.15 CH NO. 15 chdfdf Reproductive Health (MCHC) Definition & components 159 Maternal Mortality and morbidity 159 Health problems of females 160 High risk cases 161 MCHC & its components 161
Antenatal care Intra-natal care Postnatal care Infant care

Training programmes 165 Birth weight and low birth wt. 166 Growth monitoring and promotion 166 Growth chart 167 Under five clinics 168 Brest feeding 169 Artificial milk. 169 Humanization of milk 170 Weaning 170 Maternity & child Welfare center 170 Social obstetrician 171 Mother and child on units 171 Indications of MCH care 172 Infant mortality rate 172 NMR 173 PNMR 174 Safe motherhood 175 Viva Questions 176 MCQS 176

Chapter No.16 Family Planning Definition, aims & objectives 179 Family limitation 179 Cafeteria choice 180 Classification of fertility regulation 180 Barrier methods 180 Intrauterine contraceptive devices (IUCD) Hormonal methods 183 Oral pills 183 Non-contraceptive uses of oral pills184 Deport-formulation 185 Post conceptional methods 186 Miscellaneous methods 187
Absentinence Coitus interrupts

181

Birth control vaccines 187 Safe period 187 Breast feeding 187 Terminal methods. 188 Family planning and health scope of family planning services 188 Viva questions 189 MCQS 190

Chapter No.17 Occupational Health Occupation 191 Occupational health 192 Occupational diseases 193 Pneumoconiosis 193 Prevention & control of pneumoconiosis 196 Occupational hazards 196 Viva Questions 200 MCQS 200

Chapter No.18 Social & behavioral science Definition 201 Sociology 201 Family, joint family society, Culture, community Class & association 201 Cast system in Islam & Pakistan 202 Social mobility & its types 203 Social evils 203 Health problems and diseases & prevention 203 Psychology & social psychology 204 Personality and its components 205 Medical anthropology & its components Genetics 205 Ecology 206 Political science 206 Social pathology 206 Viva questions 207

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Chapter No.19 Food, Nutrition & Health Definition & classification of food 209 Nutrients & its types Balanced diet Caloric requirements of male, female & infants Food caloric values Factors affecting caloric needs 211 Macronutrients Micronutrients Vitamins Minerals Diet Adult male & female Infants, children & old age Pregnancy & lactation Food fortification Food adulteration Food poisoning, infection & toxemia Preservation of foods 219 Animal foods & inspection of meat 219 Characteristics of Good meat, Fresh fish & egg Meat born diseases Composition of milk Humanization of milk 221 Advantages of Breast-feeding 222 Adulteration of milk Common preparation from milk 222 Methods for rendering milk safe 223 Pasteurization & boiling 223 Dangerous food & control 223 Assessment of nutritional status 224 Malnutrition Protein energy malnutrition 226 Kwashiorkor & marasmus 227 Obesity & its complications 228 Via questions 229 MCQS

210 210 211 211 212 213

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220 220 221

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Chapter No.20 Mental Health Definition & introduction 231 Etiology of mental illness 232 Mental health service 232 Prevention of common mental health problems in Pakistan 232 Team in C.M.H. center 233 Intelligence & I.Q. 233 Diff. b/w mental illness and mental Deficiency 234 Viva questions 235 IMCQS 235

Chapter No.21 Communicable diseases Introduction and Communicable diseases Incubation period & Infective Period. 239 Dynamics of diseases 240 Control of c. diseases 242 Sterilization & disinfection and their procedures 243 Malaria 245 Small pox & chick pox 247 Polio 248 SARS. 249 Anthrax 249 Yellow fever 250 Rabies 251 T.B 252 Typhoid fever 254 Sexually transmitted disease 255
AIDS Hepatitis B

237

Viva questions

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Chapter No.22 Non-Communicable Diseases Introduction Hypertension 261 Coronary heart disease 262 Diabetes mellitus 263 Blindness Accidents Obesity 265 Rheumatic heart disease 266 Smoking 267 Snake-bite Cancer 269 Viva Question 270 MCQS 271 Chapter No.23 Miscellaneous Alcohol & addiction Drug dependence 273 Research 274 Health management information System Medical entomology 277 Parasitology 282 Insecticides (DDT) 282 Viva Questions 283 MCQS 283

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Chapter No.24 Tables of Differences 286- 294 Chapter No.25 Professional Evaluation 295-297 Models Tray Visits Slides Note-book Viva