DIPLOMA IN COMMUNITY HEALTH

(COMMUNITY HEALTH EXTENSION WORKER

PAPER 3

Section A: objective question

1. A baby with apgar score of 3-4 at one or five minute after birth is said to have
a. Mild asphyxia
b. Moderate asphyxia√
c. No asphyxia
d. Severe asphyxia
2. A child between 1-5 years is said to be well nourished when his arm circumference strip
read.
a. 12.5-13.5cm
b. 16cm-17.5cm
c. 13.5cm and above √
d. 7.5cm-12.cm
3. One of the following is NOT a condition that can expose a child to grave danger
a. Pneumonia
b. Meningitis
c. Severe dehydration
d. Malnutrition √
4. Direct assessment of nutritional status include all EXCEPT:
a. Anthropometric measurement
b. The number of times a child is fed per day √
c. Chemical analysis of the blood
d. Skin fold thickness
5. Nutrition education programmes are aimed at the following EXCEPT:
a. Discouraging advertisement of alcohol √
b. Giving preference to children when serving food
c. Discouraging food taboos
d. Encouraging balance diet.
6. One of the following condition is a deficiency condition of calcium
a. Cheilosis
b. Goiter
c. Fluorosis
d. Tetany √
7. The best and most common source of folic acid in Nigeria is:
a. Dark green leafy vegetable√
b. Beans
c. Legumes and pulses
d. Oranges
8. A positive sign of establishment of true labour is:
a. Frequent lower abdominal pains and back ache
b. Rupture of the membrane
c. Bleeding per vagina
d. Dilatation of the cervix. √
9. The most effective method of natural family planning is:
a. Mucus method or billing method √
b. Basal body temperature
c. Symptom-thermal method
d. Lactation amenorrhoea method (LAM)
10. Among the most significant solid contaminants is:
a. Hydrocarbons √
b. Herbicides
c. Germicides
d. Heavy metals.
11. Among the most significant solid contaminants is:
a. Hydrocarbons
b. Herbicides √
c. Germicides
d. Heavy metals
12. The disease process of dental caries starts in the:
a. Tongue
b. Stomach
c. Mouth √
d. Gum
13. Which teeth does NOT appear in the deciduous or milk teeth:
a. Incisor
b. Canines
c. Molars
d. Premolars√
14. Ringing sensation in the ear is referred to as:
a. Otorrhoea
b. Otalgia
c. Redness of the tympanic membrane
d. Tinnitus√
15. Painful swelling on the eyelid margin is called:
a. Stye √
b. Chelazion
c. Pterygum
d. iritis
16. adolescents are known to have several development challenges. One of the following is
a biological challenge
a. mental cognition
b. wisdom
c. change in sexual characteristics √
d. selective stimulation
17. one of these is strategy of school, home and community relationship
a. participation√
b. education
c. communication
d. policy based action
18. one of the following is important for the elderly:
a. involvement in politics, religious activities, and executive positions
b. Prevention of accidents, adequate treatment and follow up. √
c. Leisure time, affluence and socializing
d. Good jobs, vigorous exercise and promotion
19. One of the following is common medical problem of the elderly:
a. Diarrhea, malaria, asthma.
b. Scabies failing sight, pneumonia
c. Failing sight, poor dentition, reduced mobility √
d. Cardiac problems, diabetes, hypertension asthma.
20. The following handicapping condition affects the limbs EXCEPT:
a. Poliomyelitis
b. Cerebral palsy √
c. Rickets
d. Ostomyelitis

SECTION B: ESSAY MODEL ANSWERS (2018)

1a. Define congenital abnormalities of new born:

Congenital abnormalities of the newborn are defect in form of structure or function

which is present at birth and recognizable in early life.

1b. Enumerate four (4) abnormalities of the cardiovascular system:

1. Atrial septal defect

2. Ventricular septal defect
3. Patent ductusarterious
4. Pulmonary stenosis
5. Transposition of great arteries

1.c Enumerate 6 ways of preventing congenital abnormalities in the new born:

1. Genetic counseling before manage pregnancy beyond 35 years of age.

2. Prevention of maternal disease
3. Avoidance of active and passive tobacco smoking by pregnant woman
4. Anti –D immunoglobulin should be given to Rhesus negative mothers within 72
hours after abortion or first child birth to prevent hemolytic disease of the newborn.
5. Pregnant woman should avoid drugs not prescribed by qualified health workers
6. Promotion of therapeutic abortion of abnormal fetus
7. Prevention of intra uterine infection and promotion of sexual hygiene along with
general hygiene measures.

1d. Enumerate four (4) objectives of integrated management of childhood illness (IMCI)

1. To contribute to reduction of morbidity and mortality in children less than 5 years.

2. To contribute to and promote healthy growth and development of under 5.
3. To reduce significantly global morbidity and mortality associated with major causes
of disease in children.
4. To reduce the frequency and severity of illness and disability in under five children.

1e. State five (5) advantage of integrated management of childhood illnesses (IMCI)

1. It is a key strategy for addressing common childhood diseases.

2. It reduces morbidity and mortality rate among under five children.
3. It makes use of available resources
4. It involves the health workers in giving comprehensive care to the children.
5. It improves nutrition, breastfeeding and immunization coverage.
6. It gives the people access to basic preventive measure early diagnosis and proper
management of under five children
 7. It makes for effective referral system
8. It allows counseling of the mother
9. It incorporates existing WHO guidelines e.g. management of diarrhoeal diseases

2a. state 5 importance of growth monitoring chart:

1. It allows graphical presentation o child’s growth pattern therefore enhancing

knowledge of both the health care worker and the mother.
2. Provides opportunity to detect growth faltering at a glance
3. Provides the prediction of nutritional and health status of child before sign and
symptom of illness appear.
4. It allows opportunity of instituting corrective measures and observing the effect of
those measures.
5. It gives more light to know if the child nutritional status is improving his condition or
not.

2b. itemize six (6) steps to successful breastfeeding:

1. Have a written breastfeeding policy

2. Tran all health worker with skill necessary to implement the policy.
3. Inform all pregnant women about the benefit of management of breast feeding
4. Help mothers to initiate breastfeeding within 30 minutes of birth
5. Show mothers how to breastfeed
6. Give newborn infants no other food or drink except breast milk.
7. Practice rooming-in
8. Encourage breastfeeding on demand
9. Give no pacifiers to breastfeeding infants
10. foster the establishment of breast feeding support groups and refer mothers to
them on discharge from the hospital or health centers.

2c. List three (3) diseases condition associated with vitamin A deficiency.

1. Night blindness.
2. Keratomalacia-destruction of the cornea
3. Xerophthalmia- dryness or hardening of the cornea.

2d. Discuss six (6) factors affecting the nutritional status of a community:

1. Season variation: in the developing tropical countries of the world such as Nigeria,
food production occurs during raining seasons thereby making food very abundant
 and cheap e.g. yams, cassava, vegetables, cereal legumes etc. however, during the
dry season harvesting is already completed, food crops becomes scares and costly.
2. Cultural belief about food: culture determines our language and even the food we
eat, clothes that we wear, where we even seek medical care, religious practices etc.
in some communities culture forbids eating of certain meat e.g. cows, snails, pork,
snake, cat, rabbit, monkeys and edible insects. In some of these places, forbidden
meats are the major available source of animal protein, hence people suffer in the
midst of plenty.
3. Family size: A large family size often puts a lot of economic and social burden on the
head of the house hold i.e. the father. Since resources are often more limited than
the number of people to feed this result into negligence of care on the part of the
fathers. Children are often left for their mothers to care for.
4. Illiteracy and misplacement of priorities: people tends to give more attention to
social activities such as burial ceremonies, club activities e.t.c. at expenses of
providing adequate nutrition for their family. They don’t always budget for food so
they often live on cheap, high carbohydrate foods consequently, leading to poor
nutritional status.
5. Political factors: After independence, most developing countries concentrate on
how to generate foreign exchange, hence cash crops e.g. cocoa, coffee, cotton,
timber e.t.c. were encouraged instead of food crops like yam, cassava beans e.t.c.
this led to scarcity of food in the market depite our agricultural climate and land.
6. Natural disasters: Recurrent or persistent natural disasters in a country such as
drought, flood and soil erosion has drastically reduce the availability of food items
leading to famine and starvation. War which is a man made disaster can also lead to
famine.
7. Environmental hygiene: Environmental condition under which human beings live is
one of the factors that dictates his nutritional status, poor environmental hygiene
such as poor sewage disposal, housing, drainage e.t.c. can easily contaminate food
and water through feaco oral transmission. People’s slow resistance to infections
can also be caused by poor environmental sanitation thereby making them
susceptible to epidemics.
8. Socio-economic factors: The social and economic status affects the nutritional status
as related to their life styles and financial status can affect the nutritional status of
members of the community.
9. Lack of storage facilities: inadequate or lack of storage facilities in the communities
can affect the nutritional status because contamination spoilage food may occur.
 10. Lack of adequate transport facilities: transportation of food is important in the
maintenance of the nutritional status of a community therefore is such facilities are
not available the nutritional status of the community will be affected drastically.

3a. list six (6) women who can use progestin only injectable contraceptives without
restriction.

1. Women who are between 18 and 45 year old

2. Women who are smoking at any time
3. Women who are nuliparous (women who have not given birth)
4. Women who have puerperal and post abortion sepsis
5. Women who have current and past pelvic inflammatory disease
6. Women who are at increased risk of STIs or have current STI, including gonorrhea
and Chlamydia infection
7. Women who have non-migrainous headache
8. Women who are obese
9. Women who have depressive disorders
10. Women who have acute/flare hepatitis, chronic hepatistis or are carriers
11. Women who take any medications, including anti T.B. and anti-seizure medications
12. Women who have severe gonorrhea
13. Women who have endometrial or ovarian cancer.

3b. list five (5) cause of infertility in males:

1. Poor quality of semen (low count, poor quality of morphology)

2. Reproductive tract infection such as epididymisorchitis
3. Physical factors e.g. excessive drinking and smoking
4. Un-descended testes
5. Chromosomal disorders
6. Vassal or duct blockage, STIs, tuberculosis, surgery
7. Premature ejaculation
8. Hypospadias
9. Occupational hazard e.g. radiation in radiographic
10. Chronic medical conditions e.g. liver cirrhosis, diabetes

3c. State six (6) danger sign in pregnancy and their implication:

1. Oedema: as sign of pre-eclamptic toxaemia and may lead to death

2. Anaemia: may lead to abortion, premature labour and maternal death
3. Raised in blood pressure: a sign of pre-eclamptic toxaemia
4. Albumin: a sign of pre-eclamtictoxaemia
 5. Jaundice: may lead to intra-uterine death or maternal death
6. Excessive weight gain and fundal height: result in hydramios and twin pregnancy
7. Liquior drainage: cause premature labour
8. Sugar in urine: as a sign of diabetes mellitus which may lead to prematurity and still
birth
9. Contraction with pain in pregnancy: cause premature labour
10. Excessive featal movement: premature labour
11. Absence of foetal heart beat and movement- is an indication of intra-uterine death

3d list 5 common causes of obstructed labour:

1. Cephalopelvic disproportion (CPD)

2. Occipito-posterior position (OPP)
3. Abnormal lie
4. Pelvic tumours
5. Pelvic deformities.

4a. list six (6) ways of protecting sources of water:

1. Keeping waste disposal away from water sources

2. Keeping people and animals away from contaminating source of water
3. Installing fence or other means to prevent contamination sources
4. Installing parapet at least 90cm above groud level
5. Installing concrete or impervious the well apron by constructing proper drainage
6. Educating the communities on use of the two buckets system to fetch water from
the well
7. Training VHW on methods of protecting water sources
8. Acting as resource person to the VHWs and providing technical advice on protection
of water source.
9. Obtaining random sample of water for analysis using special dip and sterilized
containers, collecting results of water analysis from the ward laboratory
10. Discussing result of water analysis with VHW and VDCs
11. Advising on appropriate action to take

4b. state four (4) factors affecting methods of refuse disposal:

1. The level of development of the community

2. Topography- presence of low laying ground and pit to le filled
3. The occupation of the majority of the people as the organic waste can be
transformed into manure
4. Resources available to the people.
4c. list five (5) effects of poor solid waste management in a community

1. Accident fire outbreak

2. Atmospheric air pollution
3. Emission of offensive odour
4. Attraction of rodent and flies infestation
5. of Flooding and blockage of drains
6. Traffic accidents
7. Pollution and contamination of water source, typoid fever
8. Breeding of mosquitoes leading to spread of malaria fever and dangue
9. Lung and throat irritation

4d. Discuss five (5) pollutants that may be present in a typical city in Nigeria:

1. Soot: from industrial processes, heavy duty machines, locomotive engines e.t.c.
highly toxic hazardous with high dispensability or high dispersal totential
2. Dust: from whirlwind, sweeping, road construction and such as other activities, it
provides medium for habitation of micro organisms and other hazardous material
3. Smoke: from burning of fossil fuel, e.g. wood, stove etc.
4. Carbon monoxide: from exhaust of vehicles very toxic and hazardous.
5. Sulphur dixide: a toxic gas with a pungent initiating smell released naturally by
volcanic activities and coal combustion.
6. Pollen grains: from plants and vegetation increases the dust-laden capacity of the
industrial environment.
7. Industrial effluents: from cooling and steaming processes in the industry it has high
thermal characteristics as well as varying degrees of odour.
8. Other particuletes: from industrial and similar processes like also fumes and mist.
9. Other are S02, C02 , bacteria, viruses, sewage etc.
10. Noise
11. Radiation
12. Heavy metal

5a. list five (5) factors that cause plaque retention

1. Cracked teeth
2. Overhanging edges of filling
3. Poorly contained teeth filling
4. Calculus (hardened plaque)
5. Tartar.
5b. identify six (6) factors associated with oral diseases

1. Hereditary
2. Nutrional causese due to lack of protein and vitamin A,B,C,D, and K
3. Tobacco use
4. Excessive alcohol intake
5. Poor oral hygiene
6. Poor dentition
7. Excessive exposure to high concentarated fluoride
8. Endocrine disturbences
9. Environment cause such as injury
10. Infection which may be bacterial fungal or viral
11. Disease of blood.

5.c list five (5) effects urbanization, civilization, mass media and advanced technology on
the adolescents in Nigeria:

1. Early sexual activities (unprotected sex)

2. Education: positive- more knowledgeable- negative- withdrawal from school.
3. Teenage pregnancy
4. Criminal tendencies
5. Drug abuse/ alcoholism
6. Infection (STD, HIV/AIDs)
7. Abortion
8. Mental disorders
9. Single parenthood.

5d. state five (5) sign and symptoms of drug/ substance abuse

1. Moodiness
2. Euphoria/elation
3. Frequent bashes with law enforcement agent
4. Loss of appetite with a rapid loss of weight or increase in weight due to increase in
appetite
5. Stealing/robbery
6. Redness of eyes
7. Insomnia
8. Suicidal tendencies
9. Anxiety
10. Irritability and apathy
 11. Physical, emotional and socially withdrawn
12. Unkempt appearance.
13. Drowsness.

6a. list five (5) cause of laryngitis

1. Allergies
2. Bacterial or fungal infection
3. Excessive coughing
4. Use of inhaled corticosteroid for asthma treatment
5. Viral infection
6. Injuries
7. Acid reflux disease

6b. list five (5) dangers and risk following local unvulectomy:

1. Heamorrhage
2. Shock
3. Cellulitis
4. Peri-tonsilar abscess
5. Tongue laceration
6. Trismus
7. Tetanus
8. Nasal speech and nasal regurgitation
9. Hepatitis
10. HIV and AIDs
11. Neck swelling
12. Lower respiratory tract infection
13. Death can result from the procedure.

6c. Discuss under the following

i. Glaucoma:
ii. Type
iii. Sign and symptoms
iv. Prevention
 Definition of Glaucoma:

Glaucoma: Is a condition where there is loss of vision dupressure in e to an abnormally

high pressure in the eye. It occurs increasingly with age and is an important cause of
blindness.

Type of Glaucoma

1. Acute glaucoma or open angle glaucoma

2. Chronic glaucoma or close angle glaucoma.

Sign and symptoms of glaucoma:

a. Gradual loss of peripheral vision, usually in both eyes

b. Tunnel vision in the advanced stages
c. Eye pain
d. Nausea and vomiting (accompanying with severe eye pain)
e. Sudden onset of visual disturbance often in low light
f. Blurred vision
g. Hallow amid light
h. Reddening of the eye

Prevention measures of glaucoma

a. Early detection can prevent vision loss and control the disease
b. Regular eye examinations are recommended especially for people with family history of
glaucoma and over the age of 35. After age 40, eye examination should be done every 2
to 4 years and after age 60 every 1 to 2 years.
c. Glaucoma testing is recommended every 1 to 2 years after age 35 for those of high risk
d. Prompt treatment with eye drops to improve the flow of aqueous humour and prevent
further damage of the eye.
e. Eating vitamin- rich fruits and vegetables
f. Taking a vitamin supplement
g. Protecting eyes from injury
h. Medical treatment for systemic illnesses
i. Promote good eye health.

7a. state six (6) duties of CHO in a school health clinic

a. Physical examination: periodic medical examination at least twice a year for primary
or post primary schools by doctors or community health worker who is also a staff
of the school.
 b. Height and weight measurement
c. General examination of skin for rashes, ringworm and ulcer
d. Examination of eyes, ear and throat for infection
e. Visual acuity test to detect deficiency
f. Hearing test to measure hearing ability of children
g. Simple laboratory investigation like stool, urine, PCV.
h. Radiological examination, chest x-ray, screening for tuberculosis and all new
entrance and final year pupil
i. Mouth examination for dental caries, dental hygiene etc.
j. Psychological examination by child psychologies among others.

7b. list four (4) characteristics of school feeding services:

a. Provide of at least one adequate meal a day to school children

b. Adequate sanitation and hygiene practices among food handlers including routine
medical examination and vaccination
c. Food fortification and supplementation
d. Regular de-worming
e. Promotion of health related school policies

7c list six occupational health activities aimed at promoting workers well-being:

1. Provision of balanced diet

2. Adequate rest and relaxation
3. Job satisfaction, motivation
4. Understanding and cooperation mong employers, management and employees
5. Promotion of personal hygiene
6. Pre-employment and periodic medical examination
7. Provision of accommodation and transport to work
8. Adequate training and health education

7d. list four (4) preventive measures of anthrax:

1. If anthrax is suspected, infected animal must be isolated until cured, if death occurs the
animal must be cremated and buried in a deep lime pit.
2. The workers who are occupationally exposed to this disease must be educated in the
recognition of the lesion so that treatment can commence as soon as this is detected.
3. The workers should be provided with protective clothing and they should be scrupulous
in personal hygiene
 4. Dust control must be vigorous in wool industries
5. Occupationally exposed workers should be immunized (anthrax antigen is available)
6. Infected person must be isolated until cured and contaminated materials should be
disinfected.

8a. list six (6) interventions for care of the age in the community:

1. Home help
2. Good neighbor schemes
3. Day care center
4. Financial assistance from individual and family
5. Outing and holidays
6. Early payment for pension and gratuity
7. Rate rebate/ tax exemptions
8. Luncheon club/ recreational centers for the ages
9. Old people home or hostels for old people
10. Visiting by family, friends and religious leaders
11. Meals on wheels
12. Special medical care (e.g. free medical care)

8b. Discuss causes of premature aging:

1. Drinking other liquids e.g. caffeinated coffee or sodas in place of the recommended six
to eight glasses of water daily.
2. Lack of sleep- Not getting enough sleep speeds up the aging process. It can lead to
anxiety and depression as well. The body experiences a surge of cortisol which is a stress
hormone.
3. Bad habits e.g. smoking, drinking of alcohol triggers the aging process within the body
4. Stress- major stressors e.g. loss of loved ones or jobs can lead to premature aging,
disease or death
5. Low body body index can cause loss of body tissue- the collagen production slows
down, sagging skin, develops and wrinkles as a younger age.
6. Diet- Eating inadequate diet such as high carbohydrate low protein can breakdown the
body’s ability to produce collagen leading to premature aging on the skin
7. Depression- chronic bouts of depression can cause the body’s cell to age faster, which
can than cause inflammation and other health prolems.
8. Prolong exposure to sun- being in the sun for long period can cause sagging skin, fine
lines and wrinkles and skin cancer.
8c. list five (5) handicapping conditions which might make a child eligible for special
education services:

1. Blindness
2. Deafness
3. Autism
4. Hearing impairment
5. Mental retardation
6. Orthopedic impairment
7. Specific learning disability
8. Speech or language impairment
9. Traumatic brain injury

8d. list four (4) early sign that will suggest mental retardation in a child.

1. Lack of interest
2. Failure to smile and recognize mother by the expected age
3. Sleeping all the time
4. Excessive hyperactivity or irritability
5. Does not respond to sound
6. Does not lift head off pillow by 2-3 month.