UNIT: INTRODUCTION TO COMMUNITY HEALTH

Introduction:
Community health refers to the part of healthcare that is concerned with the health of the whole population and
the prevention of disease.It involves establishing the health status of the community and planning and
management of the community level services that enhance health and well being.They include
promotive,preventive,curative and rehabilitation services.

-A field within public health concerned with the study and improvement of the health of communities
.Community health tends to focus on geographic areas rather than people with shared characteristics.

Unit objectives:
By the end of this unit the learner will be able to:
 Describe community health concepts.
 Explain the principles,aims and values of community health.
 Discuss the factors that affect the health status of a community.
 Outline the roles of the health team and various health workers in the delivery of community heath.
 Explain MDG,S and their relationship to the health of the community.
 CHAPTER ONE
COMMUNITY EDUCATION

Objectives:
At the end of the chapter,the student should be able to:
1.Define the roles f community education within the society.
2.Understand how to carry out a community diagnosis.
3.Define indicators of health within a community.
4.Understand how health indicators are classified.
5.Define adult learners.
6.Understand the characteristics of adult learners.
7.Learn the teaching strategies for adult leaners
8.Describe the role of a family in prevention of illnesses

1.0 Introduction
Education is the key to eradicating extreme poverty around the world. Community education is a process of
personal and community transformation, empowerment, challenge, social change and collective responsiveness.
It is community-led reflecting and valuing the lived experiences of individuals and their community. Through
its ethos and holistic approach community education builds the capacity of groups to engage in developing a
social teaching and learning process that is creative, participative and needs-based. Community education is
grounded on principles of justice, equality and inclusiveness. It differs from general adult education provision
due to its political and radical methodologies. Below are the importances of community education:
 Community education enables participants to emerge with more than just new personal skills and
knowledge; it leads to an increased ability to act as part of a united community for improved social
justice.
 It provides learning opportunities that address the needs of the community and the individual whilst
ensuring that the learners' experiences are recognized, valued and used as part of the learning process.
 The wellbeing of the participants and their community is nurtured during the learning process. This
process also ensures that the tutor and participant are on an equal level as the learner identifies the
knowledge which would be useful to them and the tutor responds by creating a collaborative, creative
learning experience that facilitates and supports learner involvement.
 The values of community education are put into practice by the group and are promoted locally and
nationally: justice, equality and inclusiveness.
 Community education supports the empowerment of people to identify action that is needed regarding
their issues and also to understand why such collective action should be taken. It also supports the
challenging of the existing social and economic structures.

1.2 Adult learners:

Adult learner (mature student) is a term used to describe any person socially accepted as an adult who is in a
learning process, whether it is formal education informal learning, or corporate-sponsored learning.

1.2.1 Characteristics of adult learners

 Adults are autonomous and self-directed. They need to be free to direct themselves. Their teachers must
actively involve adult participants in the learning process and serve as facilitators for them. Specifically,
they must get participants' perspectives about what topics to cover and let them work on projects that
reflect their interests. They should allow the participants to assume responsibility for presentations and
group leadership. They have to be sure to act as facilitators, guiding participants to their own knowledge
rather than supplying them with facts. Finally, they must show participants how the class will help them
reach their goals (e.g., via a personal goals sheet).
 Adults have accumulated a foundation of life experiences and knowledge that may include work-related
activities, family responsibilities, and previous education. They need to connect learning to this
knowledge/experience base. To help them do so, they should draw out participants' experience and
knowledge which is relevant to the topic. They must relate theories and concepts to the participants and
recognize the value of experience in learning.
 Adults are goal-oriented. Upon enrolling in a course, they usually know what goal they want to attain.
They, therefore, appreciate an educational program that is organized and has clearly defined elements.
Instructors must show participants how this class will help them attain their goals. This classification of
goals and course objectives must be done early in the course.
 Adults are relevancy-oriented. They must see a reason for learning something. Learning has to be
applicable to their work or other responsibilities to be of value to them. Therefore, instructors must
identify objectives for adult participants before the course begins. This means, also, that theories and
concepts must be related to a setting familiar to participants. This need can be fulfilled by letting
participants choose projects that reflect their own interests.
 Adults are practical, focusing on the aspects of a lesson most useful to them in their work. They may not
be interested in knowledge for its own sake. Instructors must tell participants explicitly how the lesson
will be useful to them on the job.
 As do all learners, adults need to be shown respect. Instructors must acknowledge the wealth of
experiences that adult participants bring to the classroom. These adults should be treated as equals in
experience and knowledge and allowed to voice their opinions freely in class.

1.2.2 Teaching Strategies for Adult Learners

 Use the adult students as resources for yourself and for other students; use open-ended questions to draw
out students' knowledge and experiences; provide many opportunities for dialogue among students.
 Take time to clarify student expectations of the course; permit debate and the challenge of ideas; be
careful to protect minority opinions within the class.

 Treat questions and comments with respect; acknowledge contributions students make to the class; do
not expect students to necessarily agree with your plan for the course
 Engage students in designing the learning process; expect students to want more than one medium for
learning and to want control over the learning pace and start/stop times

 Show immediately how new knowledge or skills can be applied to current problems or situations; use
participatory techniques such as case studies and problem-solving groups
 Focus on theories and concepts within the context of their applications to relevant problems; orient the
course content toward direct applications rather than toward theory
1.3 Role Of the family in prevention of illness

A family comprises of two or more individuals who are involved in a continous living arrangement,usually
residing in the same houlsehold and experiencing common emotional bonds.

As a basic unit in the society,the family represents the cornerstone of community health.The family provides
children with basic education in language,beliefs and customs, in addition to food,shelter and
clothing.Specifically,the family can play the following roles in prvention of illness:

 Psychological support-counselling and support for each other.

 Prevention of infection:Environment sanitation,provision of safe water,proper housing,utilization of
immunization services.
 Good nutrition-by provision of kitchen gardens,provision of balanced meals,income generating activies
to improve of socio- economic status.
 Utilization of health services e.g immunization,seeking medical attention incase of a sick member.
 Health education-New ideas and knowledge disseminated and shared among family members.

Revision questions

1.Define the term community health.

2.Outline the importance of education within the community

3.Describe the characteristics of adult learners.

4.Describe the different teaching strategies for adult learners.

5.Descibe the role of a family in prevention of illnesses.

Activity 1

a).Identify different education programmes for adult learners within your community and the roles they have
played in developing the community
 CHAPTER TWO

COMMUNITY DIAGNOSIS:
Objectives:

At the end of this unit the student should be able to:

1.Define a community diagnosis.

2.Understand the misssion of a community diagnosis.

3.Understand how a community is diagnosed.

4.Define health indicators.

5.Describe the classification of health indicators.

2.0 Introduction

Community diagnosis generally refers to the identification and quantification of health problems in a
community as a whole in terms of mortality and morbidity rates and ratios, and identification of their correlates

for the purpose of defining those at risk or those in need of health care. The mission of community diagnosis is
to:

 Analyze the health status of the community

 Evaluate the health resources, services, and systems of care within the community
 Assess attitudes toward community health services and issues
 Identify priorities, establish goals, and determine courses of action to improve the health status of
the community
 Establish an epidemiologic baseline for measuring improvement over time.

2.1 How is the community diagnosed?

This is usually done through the community analysis. Community analysis is the process of examining data
to define needs strengths, barriers, opportunities, readiness, and resources. To analyze assessment data is
helpful to categorize the data. This may be done as following:

 Demographic
 Environmental
 Socioeconomic
 Health resources and services
 Health policies
 Study of target groups.
2.2 Health indicators:

A Health indicator is a characteristic of an individual, population, or environment which is subject to measurement

(directly or indirectly) and can be used to describe one or more aspects of the health of an individual or population
(quality, quantity and time).Health indicators can be used to define public health problems at a particular point in time, to
indicate change over time in the level of the health of a population or individual, to define differences in the health of
populations, and to assess the extent to which the objectives of a program are being reached. Health indicators may
include:

 Measurements of illness or disease which are more commonly used to measure health outcomes, or positive
aspects of health (such as quality of life, life skills, or health expectancy), and of behaviors and actions by
individuals which are related to health.
 Indicators which measure the social and economic conditions and the physical environment as it relates to
health, measures of health literacy and healthy public policy. This latter group of indicators may be used to
measure intermediate health outcomes, and health promotion outcomes.

2.2.1 Classification of health indicators:

Mortality indicators: This may involve the measurement of life expectancy, infant mortality rate, measurement
causes of the deaths, maternal mortality rate, case fatality rate and specific death rates e.t.c.

Morbidity indicators: Data on morbidity is preferable to work with, though it is difficult to obtain. Examples of
morbidity indicators include hospital attendants rates, admission and discharge rates for inpatients, attendance rates:
out-patient clinics or health centers e.t.c.

Disability rates: Include number of days of restricted activity, bed disability days, work/School loss days within
a specified period, expectation of life free of disability

Nutritional status indicators: It is an indicator of positive health. It includes the measurement of height of
children at school entry, prevalence of low birth weight, clinical surveys: Anemia, Hypothyroidism, night blindness

Health care delivery indicators: Reflect the Equity / Provision of health care. They include; doctor / population
ratio, doctor / nurse ratio, population / bed ratio, population / per health center.

Utilization rates: Defines the extent of use of health services and the proportion of people in need of service who
actually receive it in a given period. Include proportion of infants who are fully immunized in the 1st year of life i.e.
immunization coverage, Proportion of pregnant women who receive ANC, hospital-Beds occupancy rate.

Indicators of social and mental health: Valid positive indicators does not often exist, hence indirect measures are
commonly used. They include suicide & homicide rates, road traffic accidents, and alcohol and drug abuse.

Environmental indicators: Reflect the quality of environment. Include measures of Pollution, The proportion of
people having access to safe water and sanitation facilities, vectors density.

Socio-economic indicators: It is not a direct measure of health status but for interpretation of health care indicators.
Include rate of population increase, level of unemployment, literacy rates - females, family size housing condition e.g.
No. of persons per room e.t.c

Health policy indicators: Allocation of adequate resources. include proportion of total health resources
devoted to primary health care.
Revision questions

1.Define community diagnosis.

2.What is the aim of community diagnosis?

3.Discuss how to conduct a community diagnosis.

4.Define the term health indicators.

5.How are health indicators classified?

Activity 2

a).Conduct a brief community diagnosis within your community.

CHAPTER THREE
PRIMARY HEALTH CARE (PHC)

Objectives:
At the end of this unit,the student should be able to:
1.Define primary health care.
2.Define the elements of primary health care.
3.Define the principle/pillars of primary health care.
4.Discuss the different ways of health care financing.
5.Describe the millenium development goals.

3.0 Introduction
For a long time,many countries have been tying to put greator emphasies on the prevention of disease and on
extending health services to underrdesrved communities,but these effort have been met with limited success.In
1978,the Alma Ata International conference on PHC provided a great stimulus to these efforts.The conference
set as it targets”Health for all by the year 2000”.The Alma Ata declaration states: Primary Health Care is
essential health care made accessible to the community at an affordable cost by using methods that are practical,
scientifically sound and socially acceptable methods and technology made universally accessible to individuals
to individuals and families in the community through their full participation and at a cost that the community
and the country can afford to maintain at every stage of their development in the spirit of self reliance.

The Alma Ata declaration also listed the following 8 key elements of PHC.
1.Education concerning primary prevailing health problems and the methods of preventing and
controling them.
2.Promotion of food supply and proper nutrition.
3.An adequate supply of safe water and basic sanitation.
4.Maternal and child healthcare including family planning.
5 Immunisation against major infectious diseases.
6.Prevention and controll of locally endemic diseases.
8.Provision of essential drugs.

3.1 Principles /Pillars of Primary Health Care(PHC)

Equity:
The declaration highlighted the inequity between the developed and the developing countries and termed it politically,
socially and economically unacceptable.
Promoting equity is one of the greatest challenges facing many countries. Great progress has been achieved in many
countries in recent years. In the health sector, the fastest and most effective way to reduce the social gaps that affect many
countries is to apply the primary care strategy, because decentralizing care and reaching out to people generate enormous
benefits for individuals, families, and society as a whole.

Intersectoral collaboration
This is the coordination of health activities with other sectors; such sectors include Education, Finance, Agriculture,
Information etc. There should be a working relationship these bodies and the health ministry. It is essential for much
health related activities e.g. water sanitation, housing, food supply e.t.c

Community participation:
Only when a community fully understands and is committed to a programme will that program stand a chance of success
and sustainability. A community participation approach is a cost effective way to extend a health care system to the
geographical and social periphery of a country; communities that begin to understand their health status objectively rather
than fatalistically may be moved to take a series of preventive measures. Communities that invest labor, time, money, and
materials in health promoting activities are more committed to the use and maintenance of the things they produce, such
as water supplies. Promoting community participation is a skill which must be taught to community health workers, and
backed up with support services.

Decentralization:
This refers to the transfer of authority from planning, decision making and management (including social and financial
management) from a higher to a lower level such as the central government headquarters (ministries) to the districts or
some local organization.
Decentralization is an important element in the policy formulation and implementation of Primary Health Care (PHC) in
developing countries. While this may well be the case, certain forms of “decentralization” policies can have negative
implications for the development of PHC. It can be associated with a reduced role of the public sector, weaken the central
Ministry of Health, be instrumental in producing inequity and facilitate political domination. It is necessary to examine
decentralization with a view to securing its effective formulation and implementation.

Accessibility
Accessibility can be defined as the opportunity or ease with which consumers or communities are able to use appropriate
services in proportion to their need.
Access to primary health care is a key policy issue in many countries, and is of particular importance in those countries
committed to equitable access to primary health care as a strategy for addressing health inequity. Making sure primary
health care systems are equitable and accessible to those who need them most is more complex than equal use by all
people or population groups.

Health promotion and disease prevention:

Health Promotion is the provision of information and/or education to individuals, families, and communities that-
encourage family unity, community commitment, and traditional spirituality that make positive contributions to their
health status. Health Promotion is also the promotion of healthy ideas and concepts to motivate individuals to adopt
healthy behaviors. According to the World Health Organization, Health promotion is the process of enabling people to
increase control over, and to improve their health. Health promotion is a broad concept that includes behavior change in
relation to many activities such as nutrition, environment and recreation, rather than the prevention of a specific disease.
Prevention implies identification of a risk group and implementing appropriate preventive measures.

Effectiveness

Implies that the technologies and the strategies used in health care do work,that is,they reduce risk and prevent or cure
diseases.

Integration of health programs

Primary health care in many low and middle-income countries is organised through a series of vertical programmes for
specific health problems such as tuberculosis control or immunizations of children. Vertical programmes can help deliver
particular technologies, but may lead to service duplication, inefficiency and service fragmentation. The World Health
Organization and other organizations promote integration, where inputs, delivery, management and organization of
particular service functions are brought together, as a solution to such problems.

Efficiency
Means that the methods used to achieve a given result use the minimum resources facilities, manpower, money and time
required to do the job.

3.2 Health care financing.

Over the past decades many kinds of treatments have been developed for several illnessses.These treatments are
frequently expensive. Different methods of financing of financing health services have been developed.Sometimes,sick
people have to pay for treatment when sick; sometimes services are paid out of taxes(often mistakenly called “free”
medical care because it is free at the time you need it).Other methods of payment have included cost sharing insurance
schemes or by making employers pay. It is essential when formulating priorities and making choices to realize that there
is no such thing as free medical care.Politicicans may like to talk about it and about the right to the free medical care. All
the things that make up the costs of health and medical care. There are various ways in which costs can be spread
throughout the community and over time, but in the end someone may pay or the service will cease.

1. Fee for service.

This is the oldest and most widespread method of payment. If you are sick, you go to the hospital and pay the required
fee. This is the market approach. It tends to make healthcare providers concentrate on what the community wants, but has
the disadvantage that those who cannot pay will not get the service when they need it.
2. Payment from taxes.
For many years, all government services have been paid out of money collected as taxes or donated. Some of the
government health services provided are free to the patient at the time they need the services.

2. Insurance:
The principle of insurance is sharing risks. Those who belong to an insurance scheme pay a fixed amount every month or
year whether they are ill or not. When an insured person needs service, it is paid for out of the funds which have been
collected from members of the insurance scheme on a regular basis. The amount paid, as premiums match the type of
service provided. There are very expensive insurance plans that will for almost all medical expenses and there are less
expensive ones that will pay for limited services

3. Employment related payment:

Some employers provide some health services to their employees, and sometimes to the employees’ families. Such
services may be considered part of the workers wage or salary. They may be provided by the company running an
occupational health service itself or by contracting out to others to other health care providers. This type of payment for
healthcare is only available to those who are employment.

3.4 The Millennium Development Goals (MDGs)

The Millennium Development Goals (MDGs) are the most broadly supported, comprehensive and specific development
goals the world has ever agreed upon. These eight time-bound goals provide concrete, numerical benchmarks for tackling
extreme poverty in its many dimensions. Adopted by world leaders in the year 2000 and set to be achieved by 2015, the
MDGs are both global and local, tailored by each country to suit specific development needs. The Millennium
Development Goals (MDGs) were developed out of the eight chapters of the United Nations Millennium Declaration
signed in September 2000. There are eight goals with 21 targets, and a series of measurable indicators for each target.

There are eight Millennium Development Goals namely:

Goal 1: Eradicate extreme poverty and hunger:

 Halve, between 1990 and 2015, the proportion of people whose income is less than $1 a day.
 Halve, between 1990 and 2015, the proportion of people who suffer from hunger.

Goal 2: Achieve Universal Primary Education:

 Ensure that, by 2015, children everywhere, boys and girls alike, will be able to complete a full course of primary
schooling

Goal 3: Promote Gender Equality and Empower Women:

 Eliminate gender disparity in primary and secondary education, preferably by 2005, and in all levels of education
no later than 2015.

Goal 4: Reduce Child Mortality:

 Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate.
Goal 5: Improve Maternal Health:

 Reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio.

Goal 6: Combat HIV/AIDS, Malaria and other diseases:

 Have halted by 2015 and begun to reverse the spread of HIV/AIDS.

Goal 7: Ensure Environmental Sustainability:

 Integrate the principles of sustainable development into country policies and programs and reverse the loss of
environmental resources.

Goal 8: Develop a Global Partnership for Development:

 Develop further an open, rule-based, predictable, nondiscriminatory trading and financial system (includes a
commitment to good governance, development, and poverty reduction, both nationally and internationally)

3.4.1 Millennium development goals and the progress of public health

While some countries have made impressive gains in achieving health-related targets, others are falling behind. Often the
countries making the least progress are those affected by high levels of HIV/AIDS, economic hardship or conflict.
Children's nutrition has improved. The percentage of underweight children is estimated to have declined from 25% in
1990 to 16% in 2010. But 104 million children are still undernourished. Stunting in children under five years old has
decreased globally from 40% to 27% over the same period. However, in the UN Africa Region, the number of stunted
children is projected to increase from 45 million in 1990 to 60 million in 2010. Annual deaths of children under five years
of age in 2008 fell to 8.8 million, down by 30% from 1990. The pace of decline has accelerated since 2000. In the WHO
African Region the rate of decline in child deaths doubled from 2000–2008, compared to the previous decade. The deaths
of nearly 3 million children under five each year worldwide can be attributed to diarrhoea and pneumonia. An estimated
40% of deaths in children under five occur in the first month of life, so improving newborn care is essential for further
progress. The number of infants immunized against measles increased from 94 million to 107 million from 1990 to 2008,
a rise in coverage of 73% to 83%. Maternal health remains the MDG target for which progress has been most
disappointing. Recent academic estimates1 suggest that maternal mortality has fallen since 1990 though at a pace well
short of the annual 5.5% reduction needed to achieve the MDG targets. The study reports an global annual average rate of
decline over the period 1990-2008 of 1.3% compared with the 0.4% decline reported by the UN between 1990-2005. The
UN estimates are currently being updated and this will involve a process of country consultation so that the final results
will not be available until later in the year. Preliminary evidence indicates modest reductions in maternal mortality and
improvements in use of skilled attendant at birth in several countries. It is critical to note that all such estimates are
uncertain due to different statistical assumptions and modeling approaches. There is an urgent need for better country
level data and for support to building information systems able to identify and monitor all births and deaths.

From 2000 to 2008 fewer than half of all pregnant women made the WHO-recommended minimum of four antenatal
visits. While the global proportion of births attended by a skilled health worker has increased, in the WHO regions of
Africa and South-East Asia fewer than half of all births had skilled assistance.

Women in developing countries are increasingly able to plan their families due to contraceptive use. The proportion of
women in developing countries who report using contraceptives increased from 50% in 1990 to 62% in 2005. From 2000
to 2007 there were 47 births per 1000 adolescent girls aged 15–19 globally. From 2001 to 2008 new HIV infections
worldwide declined by 16%. In 2008, 2.7 million people contracted the virus and there were 2 million HIV/AIDS-related
deaths. In 2008, around 45% of the 1.4 million HIV-positive, pregnant women in low- and middle-income countries
received antiretroviral therapy (ART) to prevent the transmission of HIV to their babies. More than 4 million people in
low- and middle-income countries were receiving ART by the end of 2008 but that left more than 5 million untreated
HIV-positive people in these countries. Despite a rise in the number of new tuberculosis (TB) cases worldwide – due to an
increase in population – more people are being successfully treated. TB mortality among HIV-negative people has
dropped from 30 deaths per 100 000 people in 1990 to 21 deaths per 100 000 in 2008. However, HIV-associated TB and
multidrug-resistant TB are harder to diagnose and cure. Indications are that 38 countries are on course to meet the MDG
target for reducing malaria; in 2008 an estimated 243 million cases of malaria caused 863 000 deaths, mostly of children
under five. The supply of insecticide-treated nets increased but need outweighed availability almost everywhere. Access
to ant malarial medicines (especially artemisinin-based combination therapy) increased but it was inadequate in all
countries surveyed in 2007 and 2008. Globally, the percentage of the world’s population with access to safe drinking-
water increased from 77% to 87%, which is sufficient to reach the MDG target if the rate of improvement is maintained.
In low-income countries, however, the annual rate of increase needs to double in order to reach the target and a gap
persists between urban and rural areas in many countries.

In 2008, 2.6 billion people had no access to a hygienic toilet or latrine and 1.1 billion were defecating in the open. The
slowest improvement has been in the WHO African Region, where the percentage of the population using toilets or
latrines increased from 30% in 1990 to 34% in 2008. Inadequate sewerage spreads infections such as schistosomiasis,
trachoma, viral hepatitis and cholera.

Revision Questions

1 Define primary health care.

2.Define the elements of primary health care.
3.Define the principle/pillars of primary health care.
4.Discuss the different ways of health care financing.
5.Describe the millenium development goals.

Activity 3
a).Descibe whether the millenium development golas have been achieved within your community.
b).What are the different ways that are being used to finance health care within your community.
CHAPTER FOUR
WATER AND SANITATION:
Objectives:
At the end of this chapter the student should be able to:

1.Describe the sources of water in the community.

2.Define the term sanitation.

3.Descibe sanitation in the developng world.

4.Describe the different ways of excreta disposal.

5.Descibe the different ways of controlling vermin and rodents within the community.

4.0 Introduction:

Sanitation is the hygienic means of promoting health through prevention of human contact with the hazards of wastes.
Hazards can be physical, microbiological, biological or chemical agents of disease. Wastes that can cause health problems
are human and animal feces, solid wastes, domestic wastewater (sewage, sullage, and greywater), industrial wastes, and
agricultural wastes. Hygienic means of prevention can be by using engineering solutions (e.g. sewerage and wastewater
treatment), simple technologies (e.g. latrines, septic tanks), or even by personal hygiene practices (e.g. simple hand
washing with soap). Sanitation as defined by World Health Organization refers to the provision of facilities and services
for the safe disposal of human urine and faeces. Inadequate sanitation is a major cause of disease world-wide and
improving sanitation is known to have a significant beneficial impact on health both in households and across
communities.

More than 1.1 billion people lack access to safe water, and 2.6 billion lack accesses to basic sanitation. The Millennium
Development Goals (MDGs) include a target to halve the fraction of the world’s population without access to water and
sanitation by 2015. The world is roughly on course to reach the target for water supply, but will fall short by half a billion
people in sanitation. The costs of inadequate water supply and sanitation (WSS) are high: 1.6 million children die every
year from diarrhea, mainly as a result of inadequate sanitation, water supply, and hygiene. And the economic costs of lost
time in fetching water and environmental degradation from wastewater pollution are high. Challenges and opportunities in
water supply differ from those in sanitation, and these in turn differ in rural and urban contexts. This is reflected not only
costs and economies of scale, but also differences in poverty and institutional capacity for investment and management.

4.1 Sources of water

1. Rainwater:

Rain water takes up the dust and gases from the air, and organic matter from the roofs over which it is collected. The long
storing in a cistern gives bacteria opportunity to grow in large numbers, causing the water to be unsafe for drinking
purposes.

2. Springs:

Springs are a source of pure water supply if they are not contaminated by passing through soil which is polluted.
3. Rivers and lakes:

Rivers and lakes are a common source of water supply, but they may be made very unfit for drinking if the surface water
and sewage from towns and cities is allowed to drain into them.

4. Surface wells:

Surface wells are a very unsafe source of drinking water supply, and the water should never be used when there are
cesspools, drains, barnyards, or any other sources of contamination within a radius of 200 feet of them.

5. Deep or artesian wells:

Deep artesian wells furnish pure water as a rule, unless the piping is not tightly jointed, when impure water from a subsoil
stream near the surface may enter the pipes.

4.2 Hard and Soft Water

Soft water is water in which no mineral matter is dissolved. Hard water is water in which such minerals as lime,
magnesium, and iron are dissolved. Boiling precipitates some of the mineral matter, thus tending to soften the water. This
mineral deposit may be seen on the inside of a teakettle. Hard water that is to be used for cleansing purposes may be
softened by the addition of washing soda, borax, ammonia, potash, or soda lye.

4.3 Sanitation in the developing world

Adequate sanitation is the foundation of development—but a decent toilet or latrine is an unknown luxury to half the
people on earth. The percentage of those with access to hygienic sanitation facilities has declined slightly over the 1990s,
as construction has fallen behind population growth. The main result can be summed up in one deadly word: diarrhea that
kills 2.2 million children a year and consumes funds in health care costs, preventing families and nations from climbing
the ladder of development. The most affected are the populations in developing countries, living in extreme conditions of
poverty, normally peri-urban dwellers or rural inhabitants. Among the main problems which are responsible for this
situation are: lack of priority given to the sector, lack of financial resources, lack of sustainability of water supply and
sanitation services, poor hygiene behaviors, and inadequate sanitation in public places including hospitals, health centers
and schools. Providing access to sufficient quantities of safe water, the provision of facilities for a sanitary disposal of
excreta, and introducing sound hygiene behaviors are of capital importance to reduce the burden of disease caused by
these risk factors. Household water treatment and safe storage (HWTS) interventions can lead to dramatic improvements
in drinking water quality and reductions in diarrhoeal disease—making an immediate difference to the lives of those who
rely on water from polluted rivers, lakes and, in some cases, unsafe wells or piped water supplies.

4.4 Sanitation and housing:

More than a decade after the UN Conference on Sustainable Development in Rio de Janeiro, Brazil, the world is still
scrambling to meet its ambitious targets. An estimated 1.5 billion people remain without safe drinking water and about 2.5
billion have no access to adequate sanitation. Almost 1 billion people, most of them in developing countries, live in slums,
a figure expected to double over the next 30 years. While the global picture is far from encouraging, that of Africa is
much worse. On most indicators on the provision of water, sanitation and human settlements, progress remains slowest in
the world's poorest region.

Water problems in Africa are acute and complex. Water bodies in Africa are shrinking. Meanwhile, Africa has seemingly
abundant water resources that are not being efficiently utilized. With 17 large rivers and more than 160 major lakes,
Africa only uses about 4 per cent of its total annual renewable water resources for agriculture, industry and domestic
purposes. The challenge, says Mr. Shagari, is getting water to where it is needed most, affordably and efficiently.
Currently, about 50 per cent of urban water is wasted, as is 75 per cent of irrigation water.
4.5 Excreta disposal:

Excreta disposal without water carriage include:

1.sanitary pit privy

2. bored-hole latrine
3. cat-hole
4. water-sealed latrine
5. chemical toilet
6. pail system
7. overhung latrine

Human excreta always contain large numbers of germs, some of which may cause diarrhoea. When people become
infected with diseases such as cholera, typhoid and hepatitis, their excreta will contain large amounts of the germs which
cause the disease.

When people defecate in the open, flies will feed on the excreta and can carry small amounts of the excreta away on their
bodies and feet. When they touch food, the excreta and the germs in the excreta are passed onto the food, which may later
be eaten by another person. Some germs can grow on food and in a few hours their numbers can increase very quickly.
Where there are germs there is always a risk of disease.

During the rainy season, excreta may be washed away by rain-water and can run into wells and streams. The germs in the
excreta will then be carried into the water which may be used for drinking.

Many common diseases that can give diarrhoea can spread from one person to another when people defecate in the open
air. Disposing of excreta safely, isolating excreta from flies and other insects, and preventing faecal contamination of
water supplies will greatly reduce the spread of diseases.

In many cultures it is believed that children's faeces are harmless and do not cause disease. This is not true. A child's
faeces contain as many germs as an adult's, and it is very important to collect and dispose of children's faeces quickly and
safely.

The disposal of excreta alone is, however, not enough to control the spread of cholera and other diarrhoea diseases.
Personal hygiene is very important particularly washing hands after defecation and before eating and cooking.

Defecation fields

In many cases, the only immediate solution to excreta containment is to designate defecation fields. These fields localise
contamination and make it easier to manage the safe disposal of excreta. Defecation fields have a limited life-span and can
only be used once in a short term, so prepare new fields well in advance of existing fields filling up. Defecation fields
become difficult to supervise over time, they take up a lot of space and they are not easy to keep in a hygienically
acceptable state. They are only a short-term measure until alternative solutions are developed.

Key points are:-

• Defecation fields should be made as large as possible to manage safely.

• Space fields according to distribution of people in the camp, easy access without too far to walk.

• Locate on land sloping away from shelters, water sources,.etc.

• The soil should be easy to dig to cover faeces.

• Defecation fields need supervision, appoint sanitary assistants to do the job.

• Ensure polluted surface run-off is disposed safely, does not contaminate water sources downstream.

• Designate male and female defecation fields.

• Provide water and soap for handwashing at the exits.

Trench latrine

Trench latrines can be quickly prepared to provide a short- to medium-term solution. There are two basic types: shallow
and deep trench latrines. Their lifespan will depend on the number of users and the latrine size. A shallow trench latrine
may last 2 - 4 weeks while a deep trench latrine may last for 1 - 2 months.
Provide sufficient number of latrines to cope with peak use in the morning and evening. Design for a maximum of 50
people per meter length of trench per day (better 25).

Communal trench latrines must be supervised and maintained if they are to remain in sanitary conditions. Latrine
supervisors must regularly clean the foot boards and surrounding area, and periodically cover the trench content with 5-10
cm soil.

Provide anal cleansing material, soil for covering excreta, and water and soap for handwashing.

Simple pit latrine

This is the most basic form of improved sanitation available, and is often only supplied on a household basis. It consists of
a square, rectangular or circular pit dug into the ground, which is covered by a hygienic cover, slab or floor. This slab has
a hole through which excreta fall into the pit. Depending on user preference, a seat or squat hole with footrests can be
installed, and a lid should be supplied to cover the hole. The latrine is covered with a shelter and should be situated well
away from water sources and some distance from the home.

As well as isolating the excreta, the simple pit latrine has the advantage of being easy and cheap to construct. Depending
on the material used for their construction, the slab and shelter can be re-used. Simple pit latrines can, however, produce
unpleasant smells and allow flies to breed easily.

Ventilated improved pit latrine (VIP)

This is an improved type of pit latrine which aim to remove smells and flies from the latrine using a vent pipe. The one
type is wholly offset from the slab and connected to it by a chute, whereas the usual VIP pit is generally directly under the
cover slab.

As with the simple pit latrine, a pit is dug into which the excreta fall. A cover slab with squat hole and a hole for a vent
pipe is cast. A shelter is built, which must be kept semi-dark, and the vent pipe is raised to at least 0.5 metres above the
top of the shelter. It is important that the latrine is well away from high buildings or trees.

These latrines share certain advantages: there are few problems with smell or flies; the slab, vent pipe and shelter are re-
usable; and the excreta are isolated. Their disadvantages include the necessity of keeping the inside of the shelter semi-
dark, which may discourage use of the latrine, and the maintenance required to ensure that the vent pipe remains in good
working order.

Another common problem with the VIP latrine is the difficulty of obtaining a durable fly screen for the vent pipe.
4.6 Vermin and rodent control:

Pest control is not as simple as we'd like it to be. For health and comfort reasons, it's better to deal with them sooner than
later. The problem becomes sever if the rodents and vermins are not dealt with. The easiest solution is to go for the
chemical approach. The bad thing is that more and more research is revealing that pesticides and other man-made
chemicals can be as bad for us human types as they are for bugs. Pesticides are toxic and, while often effective against
pests, can be dangerous for your family and pets. Outdoors, sprayed pesticides might drift on a breeze and dust your
vegetable garden or your neighbor's yard. Indoors, pesticides can linger in the air, exposing the family to harmful
chemicals. For these reasons, many people are turning to nontoxic pest control methods.
Prevention is the best way to control pests, but there are times when even the most tho

4.6.1 Preventative Pest Control Methods

Sanitation:

Cleanliness keeps pests out.. Keeping your home clean is the most effective pest control method. If you don't leave food
or dirty dishes lying around the house, animals and insects won't be attracted to the smell. Sweep and vacuum regularly.
Remember, just because you can't see crumbs doesn't mean they don't exist. Clean inside pantries and cabinets cabinets,
under and around the stove and refrigerator at least once a year.

Screens:

This may seem obvious, but screens on doors and windows are a simple and relatively cheap way to keep insects out of
the house. Also, screens on crawlspaces keep rodents from obtaining easy access routes into the house.

Caulking:

By caulking cracks in your house, you can minimize places for insects to hide and nest. Target bathrooms and the kitchen,
especially doors and windows.

4.7 Nontoxic Pest Control Products

Traps:

There are many kinds of traps available that target many kinds of pests. Some examples are sticky traps for cockroaches,
glueboards for mice, flypaper, bug zappers, and traps specifically for rats, gophers, or moles. You can usually pick up
traps at your local Home and Garden store.

Pheromones:

Pheromones, essentially insect scent hormones, can be used in traps as bait. By emitting the scent of the female insect,
pheromones can be used to lure males into a trap, where they are caught in a sticky glue. Insects are only attracted by
pheromones emitted by their own kind, so you need to know exactly what kind of insects you're trying to eliminate and
plan accordingly.

Biological Control:

Biological control is more often used in agriculture but can sometimes be used in home and garden situations as well.
Basically it means using desirable organisms to eliminate undesirable organisms. For instance, planting certain plants in
your garden can deter certain pests. For example, spearmint repels ants. Garlic repels Japanese Beetles. Indoors, spiders
eat fruit flies and houseflies, so it may be worth leaving some of those webs around.

Repellents:

There are nontoxic repellents available for pest control. Mosquito repellents are the most popular, but if you look around,
you can find repellents that target other pests. Some herbs, like eucalyptus and wormwood, are known for repelling
animals and insects.rough preventative measures will not save you from them.

Revision questions

1.Describe the sources of water in the community.

2.Define the term sanitation.

3.Descibe sanitation in the developng world.

4.Describe the different ways of excreta disposal.

5.Descibe the different ways of controlling vermin and rodents within the community.
CHAPTER FIVE

MATERNAL AND CHILD HEALTH AND FAMILY PLANNING (MCH/FP)

OBJECTIVES
1.Define different terms used in MCH/FP.

2.Understand the problems experienced during pregnancy.

3.Describe the different approaches of antenatal and post natal care within the community.

4.Define traditional birth attendants and their role in the community.

5.Define family planning and its impact in Kenya.

6.Describe the different methods of famly planning.

Terms defination:

Pregnancy: Pregnancy is the carrying of one or more offspring, known as a fetus or embryo, inside the womb of a female.

Ante-natal care: Care/ treatment given to women during pregnancy, labor, childbirth .

Post-natal care: The care provided a woman following the birth of a child.

Labour: Labour or parturition is the process whereby the products of conception are expelled from the uterine cavity after
the 24th week of gestation.

5.1 Introduction

Maternal and child health is a particularly important concern in developing country contextsas 99 per cent of maternal
deaths occur in poor countries and mostly around childbirth. Mother-baby interventions require a functioning health
system that can provide skilled care during pregnancy and childbirth, responsive referral systems and emergency care in
the event of an obstetric or neonatal emergency. However, access and demand issues complicate service provision, which
is exacerbated by issues of culture, status and finances, as well as other health care barriers such as restricted transport to
clinics. Monitoring and evaluation of maternal and child health programming is challenging and methods continue to
evolve. Some methods are provided.Kenya is currently losing more than 7,000 women annually, a rate of 21 daily, to
pregnancy related complications, a new report has said.About eleven million African women could be saved in the next
five years if life saving interventions are made available,

5.2 Problems during pregnancy and their management:

 Sciatica in pregnancy

The sciatic nerve is the longest nerve in your body. Running from your lower back all the way down to your feet it's
the nerve primarily responsible for providing sensation and movement in your legs.
 The term sciatica is used to describe any sensation of pain, discomfort or numbness in your lower back, legs or feet
that is caused by the inflammation or compression of the sciatic nerve.

Most commonly sciatica is caused by a slipped disc, however, other back problems can also cause the condition by
applying pressure to the nerve as it leaves the spine.

 Morning sickness

Morning sickness is a completely normal part of pregnancy experience by upto 80% of pregnant womenIt is characterised
by nausea, vomiting, headaches, tiredness and light headedness.Many women start to experience morning sickness
approximately 6 weeks after their last period as it is during these very early weeks that the levels of hCG, oestrogen and
other related hormones rise rapidly to help the pregnancy become established and baby to develop.

Bleeding in pregnancy

Bleeding may occur at various times in pregnancy. Although bleeding is alarming, it may or may not be a serious
complication. The time of bleeding in the pregnancy, the amount, and whether or not there is pain may vary depending on
the cause.

It is important to contact your doctor if you have any bleeding at all during your pregnancy.

Bleeding in the first trimester of pregnancy is quite common and may be due to the following:

-Miscarriage (pregnancy loss)

-Ectopic or Tubal pregnancy (pregnancy in the fallopian tube)

-Gestational trophoblastic disease (a rare condition that may be cancerous in which a grape-like mass of foetal and
placental tissues develops)

-Implantation of the placenta in the uterus

-Infection

-Placenta previa (placenta is near or covers the cervical opening)

-Placental abruption (placenta detaches prematurely from the uterus)

-Unknown causes

 Diabetes in pregnancy:

Some women develop a type of diabetes in pregnancy known as 'gestational diabetes' which can be controlled during
pregnancy usually by a change of diet and, possibly, insulin; the condition usually disappears once the baby is born.

 Indigestion and heartburn:

Indigestion is partly caused by hormonal changes and later the growing womb pressing on the stomach. Indigestion
can be managed by:

-Try eating smaller meals more often;

 -Sit up straight when you are eating as this takes the pressure off your stomach;

-Avoid particular foods, which cause trouble, for example fried foods.

Heartburn is more than just indigestion. It is a strong, burning pain in the chest. It is caused by the valve between your
stomach and the tube leading to your stomach relaxing in pregnancy, so that stomach acid passes into the tube. It is often
brought on by lying flat. To avoid heartburn you could:

-Sleep well propped up, try raising the head of your bed with bricks or have plenty of pillows;

-Try drinking a glass of milk, have one by your bed in case you wake with heartburn in the night;

-Avoiding eating or drinking for a few hours before you go to bed;

-Ask your doctor or midwife for advice;

Do not take antacid tablets or mixture before checking that they are safe in pregnancy.

Appropriate antenatal

care is a key element of programs to improve the health of mothers and newborns. To promote the health and survival of
mothers and babies, Kenya has adapted the WHO goal-oriented Antenatal Care (ANC) package, popularly known as
focused ANC (FANC). The Ministry of Health (MOH) has designed new guidelines for ANC services, placing emphasis
on refocusing antenatal care, birth planning and emergency preparedness, and the identification, prevention and
management of life threatening complications during pregnancy and childbirth. ANC visits are now used as an entry point
for a range of other services, thus promoting comprehensive integrated service delivery. A major challenge, however, is
whether the Kenyan health care system cannot cope with the implementation of this package.
5.3 Approaches to antenatal care
On the whole, antenatal care programs in developing countries have been modeled on those in developed countries. These
programs, however, have been poorly implemented and largely ineffective. In response, the World Health Organization
(WHO) designed and tested a focused antenatal care package that includes only counseling, examinations, and tests that
serve an immediate purpose and have a proven health benefit. For example, many antenatal care programs screen for
suspected risk factors for pregnancy complications. However, this approach has been challenged and WHO's focused
approach does not use it. The WHO recommends reducing the number of antenatal care visits to four, and this has not
been found to pose a risk to the health of mother or baby.

The first appointment needs to be earlier in pregnancy (prior to 12 weeks) than may have
traditionally occurred and, because of the large volume of information needs in early pregnancy.
Examples of services offered in the ANC clinic include:

• Give information, with an opportunity to discuss issues and ask questions; offer verbal
information supported by written information (on topics such as diet and lifestyle
considerations, pregnancy care services available, maternity benefits and sufficient
information to enable informed decision making about screening tests)
• Identify women who may need additional care (see Algorithm and Section 1.2) and plan
pattern of care for the pregnancy
• Check blood group and rhesus D (RhD) status
•Screening for anaemia, red-cell alloantibodies, Hepatitis B virus, HIV, rubella
susceptibility and syphilis
• Screening for asymptomatic bacteriuria (ASB)(presence of bacteria in the urine)
• Offering screening for Down’s syndrome
• Early ultrasound scan for gestational age assessment
• Ultrasound screening for structural anomalies (20 weeks)
• Measure BMI and blood pressure (BP) and test urine for proteinuria.

5.4 Post-natal care:

This is the period beginning immediately after the birthof a child and extending for about six weeks. Over 60% of
maternal deaths occur in the first 48 hours after childbirth (WHO), 2005). For many women in eastern and southern Africa
the postnatal period is a time of increased susceptibility to HIV and STIs. It has been estimated that if 90% of babies and
mothers received routine PNC, 10% to 27% of newborn deaths could be averted. In Kenya, skilled health personnel assist
42% of births. Eighty-one percent of women delivering at home do not receive a postnatal check-up, and only 12% of
those women who do receive PNC are seen within 6 days of the birth.

The mother is assessed for tears, and is sutured if necessary. Also, she may suffer from constipation or hemorrhoids, both
of which would be managed. The bladder is also assessed for infection, retention and any problems in the muscles.

The major focus of postpartum care is ensuring that the mother is healthy and capable of taking care of her newborn,
equipped with all the information she needs about breastfeeding reproductive health and contraception, and the imminent
life adjustment.In some cases, this adjustment is not made easily, and women may suffer from postpartum depression,
posttraumatic stress disorder or even puerperal psychosis.

5.5 Tradional birth attendants(TBA)

They are also known as a traditional midwife (TMs). Traditional birth attendants provide the majority of primary
maternity care in developing countries, and may function within specific communities in developed countries. A
traditional birth attendant (TBA) is usually an elderly and at times illiterate woman who gained her midwifery skills
through an older traditional midwife or through her own initiative although some may be wholly self-taught. They are not
certified or licensed. TBAs are said to be ill-equipped to notice danger signs that could be fatal. The government has
proposed banning traditional midwives altogether.

According to the last demographic health survey, released by the government in 2009, Kenya has one of the highest
maternal death rates in the world at 448 per 100,000 live births. Home deliveries are believed to be a major contributor. In
one trial, the most promising interventions for reducing perinatal mortality and morbidity were training traditional birth
attendants in better perinatal care practices and strengthening linkages with, and improving the quality of, maternal health-
care services. Health personnel are encouraged to teach traditional midwives safer methods and practices. Training
programmes can be organized locally by government and voluntary organizations. It is important therefore for health
workers to teach the traditional birth attendants safe practices because it is quite evident that they cannot be stopped from
conducting deliveries because clients go to seek their services.

There are several reasons as to why pregnant women choose to deliver with traditional birth attendants. For instance,
some do not have access to health facilities while others do not afford the cost. Some health facilities are just too far away
for the mothers to reach. ome women are scared of strange environment and the attitude of health workers at times. Some
cultures consider it a disgrace if a woman fails to deliver at home.

Also some religious groups have their traditional birth attendants and they do not use health facilities. They prefer to have
their women use their own birth attendance rather than go to health centres.

Traditional birth attendants should not be absorbed into the modern system entirely but efforts should be made to stop
harmful traditional practices and rituals.

Traditional midwives must be allowed to practice but they should be encouraged to conduct their duties with the safety of
their clients at heart.

UNICEF designed a traditional midwife programme used in many countries. It includes a basic kit whose contents are
mackintosh, soap, razor, blade, clean strings to tie the cord, brush to clean nails and a small spring scale. The kit also
includes small rags for cleaning and a baby blanket to cover the baby. A certificate is issued following the basic training
and basically it involves hygiene.

Perinatal mortality rate is falling as most traditional birth attendants recognize complications and refer the cases to
hospitals or any other health centres in time. Statistically, neonatal tetanus infections are on the decline.

The role of the traditional birth attendant apart from helping the mother deliver the baby is to help the mother during the
antenatal and postnatal periods.

Trained traditional birth attendants recognize and refer women of first pregnancy, those who delivered by caesarian
section and those who might have had any other difficulties during delivery.

They also check foetal heart and carry out physical examination. They also check on discharges or bleeding. Also, upon
realizing complications like malpresentation of foetus, oedema, they refer the women to health centres.

They also observe hygiene by delivering the women on clean mats, washing their hands and using boiled and cooled
water. They also take care of the cord hygienically as well as take good care of the woman.

They encourage exclusive breastfeeding and immunization, adequate sanitation, control of malaria and the importance of
oral rehydration solution. They also advise on prevention of diarrhea.

They also give advice on family planning and encourage mothers to use rural health centres and they keep records.
Therefore one can actually see that traditional birth attendants do provide service to women who either cannot access
hospitals or cannot afford the cost.

However, they have some limitations in the way they conduct their duties, for instance, due to illiteracy some of them
cannot keep records, neither can they prescribe drugs. Illiteracy also prevents them from communicating effectively with
other stakeholders. Some of them fail to attend courses due to lack of funds.

Thus efforts should be made to ensure that TBAs get minimum training on modern and safe methods because they do help
women.

5.6 Family planning:

Family planning is the planning of when to have children, and the use of birth control and other techniques to implement
such plans. Other techniques commonly used include sexuality education,prevention and management of sexually
transmitted infection, pre-conception counseling and management, and infertility management.

5.6 1 Impact of family planning in kenya

As efforts begin to shift toward integrating family planning into HIV/AIDS services, voluntary counseling and testing
(VCT) centers are emerging as primary targets for integration. Research from Africa and the Caribbean shows that such
integration is feasible and acceptable, and large-scale integration efforts are being launched and expanded there. The
potential benefits of integrating family planning services into VCT services are apparent, and international support for
such integration is growing. Despite this progress, the idea of such integration is still relatively new, and, generally,
implementation is just beginning. Kenya is a promising setting for integration because its Ministry of Health (MOH)
already has an ambitious program to expand VCT services. Nearly 300 VCT centers have been registered, and Kenya is
one of few countries to have developed country-specific VCT guidelines. The government also recognizes the benefits of
family planning; Kenya was identified in the recent analysis as one of six countries to mention family planning in its VCT
guidelines.

5.6.2 Family planning methods

There are two types of family planning one of them refers to the usage of artificial methods and the other is called natural
Family planning
5.6.2.1 Artificial family planning method:

Artificial birth control methods include:

· Contraceptive ring

· Diaphragm

· Emergency contraception

· Female condom

· Hormone implants

· Intrauterine device (IUD)

· Male condom

· Spermicide

· Tubal sterilization

· Vasectomy etc

5.6.2.2 Natural family planning method:

The rhythm method

The rhythm method is based on calendar calculations of previous menstrual cycles. This method doesn't allow for normal
changes in the menstrual cycle, which are common. The rhythm method isn't as reliable as the mucus method or the
symptothermal method and is generally not recommended. Women who have no variation in the length of their menstrual
cycles can use the rhythm method to know when they are ovulating (usually 14 days before the start of their period).

Withdrawal/coitus interruption

Withdrawal, also knows as “coitus interruptus,” is the removal of the penis from a partner’s vagina before ejaculation, or
coming. Withdrawal may be the most common method of birth control since it’s free and always an option for preventing
contact between egg and sperm, reducing the possibility of an unintended pregnancy. While withdrawal has been
criticized as a non-method, it is 73-96% effective for birth control, depending on the male partner’s self-knowledge and
self-control. While 85% of heterosexual partners who use chance are likely to become pregnant in a year, only19% of
partners who use withdrawal are. Withdrawal does not protect against sexually transmitted infections (STIs), including
HIV/AIDS).

Revision questions

1.Describe problems experienced during pregnancy.

2.Describe the different approaches of antenatal and post natal care within the community.
3 .Define traditional birth attendants and their role in the community.

4..Define family planning and its impact in Kenya.

5 .Describe the different methods of famly planning.

Activity 4

a).Conduct a survey within your community to find out the different antenatal and post natal programs in the hospipta.

b).Identify if there are any traditianakl birth attendants within the community and if there are,find out why some women
still prefer them.

CHAPTER SIX

COMMUNICABLE DISEASES
Objectives

By the end of this chapter the student should be able to:

1 .Describe what communicable diseases are

2 .Explain the epidemiologic principles in control and prevention of communicable diseases

3.Describe the surveillance concepts as applied in communicable diseases

4. Name the notifiable diseases as stipulated in the public health act

5. Explain the approaches used in responding to epidemics.

Terms defination:

Communicable diseases: An infectious disease that can be transmitted from one individual to another either
directly by contact or indirectly by fomites and vectors.

Non –communicable diseases: A disease which is not contagious. Risk factors include a person's lifestyle,
genetics, or environment are known to increase the likelihood of certain non-communicable diseases. Examples
of non-communicable diseases include heart disease cancer, asthma, diabetes, allergies, stroke,.

Formite: Any inanimate objec(e.g a cloth,needle, mop,towel) or substance capable of carrying infectious
organisms (such as germs or parasites) and hence transferring them from one individual to another.

Vector: An insect or any living carrier that transmits an infectious agents .Vectors are vehicles by which
infections are transmitted from one host to another(e.g flies,mosquitoes,ticks,lice).

Zoonoses: Diseases that can be transmitted from animals to humans.

Epidemiology : The study of distribution and determinants of disease and conditions among populations.

Prophylaxis: A measure taken for the prevention of a disease or condition.

6.1 Introduction

Communicable diseases are diseases that are as a result of the causative organism spreading from one person to
another or from animals to people. They are among the major causes of illnesses in Kenya and the entire Africa.
These diseases affect people of all ages but more so children due to their exposure to environmental conditions
that support the spread. Communicable diseases are preventable base on interventions placed on various levels
of transmission of the disease.

This region is also faced with new and emerging diseases which are challenging public health as never before.
Unfortunately, many of these diseases affect the poor and marginalized sections of society, and contribute not
only to ill health and poverty at micro-level but also have serious socio-economic implications at the macro-
level. Health workers have an important role to play in the control of these diseases by applying effective and
efficient management, prevention and control measures. Health workers need to be equipped with capacity to
target communicable diseases for eradication.

6.2 Characteristics of communicable diseases:

1.They are very common.

2.Some of the cause death and disability.

3.Some of the cause epidemics.

4.Most of them are preventable fairly simple interventions.

5.Many of the affect infants and children.

6.3 Classification of communicable disease

There are different ways of classifying communicable diseases:

6.3.1 .Depending on the disease causing agent:

1. Bacteria Eg: food poisoning, enteric fever, Cholera, Diphtheria etc

2. Viral Eg : Mumps, Chicken pox, Measles, etc
3. Fungal Eg : Candidiasis, Actinomycosis, etc
4. Parasitic Eg : Ascariasis, Filariasis, Malaria, etc.

6.3.2 . Depending on the site of infection:

1. Surface infections Eg : Scabies, Pediculosis, etc

2. Respiratory infections Eg: Influenza, Whooping cough, Tuberculosis, etc
3. Intestinal diseases Eg: Amoebiasis, Hepatitis, Acute Diarrheal diseases, etc
 4. Uninary tract diseases caused by E. coli, Klebsiella, Pseudomonas, etc
5. Reproductive tract diseases/Sexually transmitted diseases (STDs) Eg: AIDS, Syphilis, Gonorrhea, etc.

6.3.3 mode of spread:

1. Air borne - Spread through contaminated air. Eg: Influenza, Tuberculosis, Leprosy
2. Soil borne - Spread through soil contaning the infectious organism. Eg: Hookworm disease, Tetanus, etc
3. Food borne - Spreads through contaminated food. Eg: food poisoning, Typhoid, etc
4. Water borne - Spreads through unclean, contaminated water. Eg: Hepatitis, Cholera, Drancunculosis, etc
5. Vector borne - Spread via mosquitoes, mites and various other arthropodes. Eg: Malaria, Filaria,
Leishmaniasis, etc
6. Direct contact spread Eg: surface infections, STDs,warts, through fomites of diseased persons.
7. Faecal oral (ingesting contaminated food and water.E.g cholera,hepatitis A,polio.

8.Viral Droplet Nuclei Transmission.E.g Common cold ,Influenza,Measles,SARS

9. Vertical Transmission:HIV,syphillis,hepatitis B

6.4 Control of communicable diseases.

The prevention, management and control of communicable diseases requires the active participation and
cooperation of all health-care professionals and practitioners.

 Primary prevention

This is the most common especially for communicable disease. This level is targeted at the pre-pathogenesis
period or the period before the disease infects the individual. The interventions include General measures such
as health education, safety measures and healthy behaviour.

Specific measures such as vaccination, prophylaxis medication etc.

 Secondary prevention

This mainly happen during the early stages of disease process. The purpose is to prevent further damage to host
cells and tissues and thus avoid disease complications. Measures would include early diagnosis, screening and
prompt treatment.

 Tertiary prevention

This takes place during the advanced stages of the disease progression to minimise the complications or reverse
the effects. Main interventions are rehabilitative in nature and include physical therapy, occupational therapy,
psychotherapy, corrective/rehabilitative surgery etc.
6.5 Measures of disease in populations

Epidemiologists use various methods and approaches in quantifying disease cases in a population such as;
counts, ratio, proportion, percentage, and rates.

 Count- : number of individuals with a specified quality in a defined population.

 A ratio- expresses the relationship between two numbers in the form of

x: y E.g. Ratio of males to female is1:3

 Proportion-is a specific type of ratio in which the numerator is included in the denominator and the
resultant value is expressed as a part of the whole.

x/x+y or x per x+y E.g. proportion of males in the class is 4 per 10 students, or 40 per 100 students or 400 per
1000 etc.

 Percentage- is a proportion that is expressed per 100.

X per 100
E.g. 40 percent of the community members are males

It is a very common measure of disease in various epidemiological descriptive studies.

 Rate

It is a special form of proportion that includes specification of time and population. It is the basic measure that
most clearly expresses probability or risk of disease in a defined population over a specific period of time. The
rate is defined as follows;

Rate = no of events in a specified period x K

Population at risk of the specific event in a specified period

Where k is a constant that may be set (fixed) for certain rates or set by the investigator for convenience.

Revision questions

1 .Define communicable diseases

2 .Explain the epidemiologic principles in control and prevention of communicable diseases .

3.Describe the surveillance concepts as applied in communicable diseases

4. Name the communicable diseases within your community.

5. Explain the preventive measure of communicable diseases.

 6.Describe the measures of diseases in a population.

CHAPTER SEVEN

IMMUNIZATION:
Objectives:

At the end of the chapter,the student should be able to:

1.Learn the different types of vaccines.

2.Define immunization.

3.Name the specific vacinnes that are available.

4.Understand the immunization schedule in Kenya.

5.Understand the different vaccines required when travelling to East Africa.

7.0 Introduction:

Immunization is the process whereby a person is made immune or resistant to an infectious disease, typically by
the administration of a vaccine. Vaccines stimulate the body’s own immune system to protect the person against
subsequent infection or disease.

Immunization is a proven tool for controlling and eliminating life-threatening infectious diseases and is
estimated to avert over 2 million deaths each year. It is one of the most cost-effective health investments, with
proven strategies that make it accessible to even the most hard-to-reach and vulnerable populations. It has
clearly defined target groups; it can be delivered effectively through outreach activities; and vaccination does
not require any major lifestyle change.

7.1 Types of Vaccines

Vaccines are of two general types:

1. In live attenuated vaccines, the organism in the vaccine is alive but unable to infect a person with a
normal immune system. Patients with impaired immunity-such as those with immune deficiencies, on
chemotherapy for cancer, or with AIDS-and pregnant women must not be given live vaccines. Examples
of live attenuated vaccines are measles, mumps, rubella, and oral polio.
2. Inactivated or killed vaccines contain dead, but intact, organisms, so the immune system can still
recognize them. Most vaccines are inactivated.
Vaccines are usually given at multiple intervals because the immune system needs several reminders to “boost”
immunity. Specific vaccines are available for the following infections:

Diphtheria

Disease: Diphtheria is a bacterial illness acquired through inhalation of infected particles. It causes a severe sore
throat and possibly heart and nerve damage. The bacteria live in the airways of healthy or recovering humans.
Vaccine: DTP
Interval: 2-, 4-, 6-, and 15 months and 5 years of age.

Pertussis

Disease: A bacterial illness acquired through inhalation of the infected particles. It causes severe, life-
threatening coughing spells (whooping cough), and possibly seizures and brain damage. The bacteria usually
live in the airways of adults with no or minimal cough.
Vaccine: DTP
Interval: 2-, 4-, 6-, and 15 months and 5 years of age.

Tetanus

Disease: Tetanus is a bacterial infection acquired through dirty wound infection. Tetanus causes severe and
painful muscle contractions. The bacteria are abundant in the soil.
Vaccine: DTP
Interval: 2-, 4-, 6-, and 15 months, 5 years of age. The vaccine must be repeated every 10 years.

Polio

Disease: Polio is a viral infection involving the mouth and throat, and later the blood and spinal cord.
Approximately 10% of the infected people develop spinal cord infection, causing muscle paralysis, usually one-
sided.
Vaccine: OPV (oral=live) and Injected (inactivated); inactivated vaccine is given to children with
immunodeficiencies.
Interval: 2-, 4-, 6-, and 18 months and 5 years of age.

Measles

Disease: Measles is a viral infection acquired through breathing infected particles. It causes rash, croupy cough,
pneumonia, diarrhea, and possibly brain infection and bleeding.
Vaccine: MMR
Interval: 15 months and 12 years.

Mumps

Disease: Mumps is a viral infection acquired through breathing infected particles. It causes painful swelling of
the Parotid gland, testes, and pancreas gland.
Vaccine: MMR
Interval: 15 months and 12 years.

Rubella (German Measles)

Disease: Rubella is a viral infection acquired through inhalation of infected particles. It causes rash, fevers, and
enlarged lymph nodes. If a pregnant woman becomes infected, the fetus could be severely and permanently
damaged.
Vaccine: MMR
Interval: 15 months and 12 years.

Haemophilis influenza type b (Hib)

Disease: Haemophilis influenza type b is a bacterial infection acquired through inhalation of infected particles
or through contact with infected objects. It causes life-threatening conditions such as meningitis (infection of
the lining of the brain), throat swelling, and joint infection.
Vaccine: Hib
Interval: 2-, 4-, 6-, and 15 months

Influenza Virus

Disease: Influenza is a viral infection of the upper- and lower respiratory tract. It can be fatal in people with
heart, lung, and other chronic diseases.
Vaccine: Flu shot; recommended for patients with heart and lung disease and residents of nursing homes and
long-term care facilities.
Interval: yearly

Pneumococcal pneumonia

Disease: Pneumococcal pneumonia is a bacterial illness causing pneumonia.

Vaccine: Pneumococcal vaccine; recommended for people with heart, lung, or other chronic illnesses.
Interval: Every ten years.

Also available, based on specific circumstances, are vaccines for the following:

Varicella-Zoster (Chickenpox): Varicella-Zoster is a viral infection acquired through inhalation of infected

particles. It causes painful blistering and later crusty rash and fevers. Rare complications include infections of
the brain, joints, and kidneys and/or hemorrhaging. Vaccination is recommended for children with
immunodeficiencies, but it is safe and frequently given to healthy children.

Hepatitis B: Hepatitis B is a viral infection of the liver. It is acquired through exposure to blood (such as in a
transfusion), through sexual intercourse, and from a mother to her fetus. Vaccination is recommended in high-
risk patients, especially the health care providers.

Cholera: Cholera is a bacterial infection of the small intestine. It causes severe watery diarrhea and dehydration
that could lead to death. The vaccine is recommended for travelers to Africa, Middle East, and the Far East.

Plague: Plague is a bacterial infection carried by rodents. It causes fever, skin sores, enlarged lymph nodes, and
if not treated, death. Humans are accidentally infected by fleas that feed off the infected rodents. The vaccine is
recommended for people traveling to or working in areas where plague is prevalent.

Typhoid fever: Typhoid is a bacterial infection caused by Salmonella. It causes diarrhea, fevers, and if left
untreated, death. The vaccine is recommended for travelers to Africa, South America, the Middle East, and the
Far East.
Rabies: Rabies is a viral infection acquired through the bite of an infected mammal. It causes fevers, headaches,
restlessness, seizures, coma, and death. Immunization is passive by injection of anti-Rabies antibodies.

Lyme Disease: Lyme Disease is a bacterial infection acquired through the bite of a tick that feeds on deer. It
causes rash, fever, and, left untreated, possible neurological or heart damage. Vaccination is recommended to
those who live in areas where deer population is large and in contact with the human population.

The following vaccines may be recommended when one is travelling to East Africa.

 Hepatitis A or immune globulin (IG). Transmission of hepatitis A virus can occur through direct person-
to-person contact; through exposure to contaminated water, ice, or shellfish harvested in contaminated
water; or from fruits, vegetables, or other foods that are eaten uncooked and that were contaminated
during harvesting or subsequent handling.
 Hepatitis B, especially if you might be exposed to blood or body fluids (for example, health-care
workers), have sexual contact with the local population, or be exposed through medical treatment.
Hepatitis B vaccine is now recommended for all infants and for children ages 11–12 years who did not
receive the series as infants.
 Meningococcal (meningitis) if you plan to visit countries in this region that experience epidemics of
meningococcal disease during December through June.
 Rabies, pre-exposure vaccination, if you might have extensive unprotected outdoor exposure in rural
areas, such as might occur during camping, hiking, or bicycling, or engaging in certain occupational
activities.
 Typhoid vaccine. Typhoid fever can be contracted through contaminated drinking water or food, or by
eating food or drinking beverages that have been handled by a person who is infected. Large outbreaks
are most often related to fecal contamination of water supplies or foods sold by street vendors
 As needed, booster doses for tetanus-diphtheria, measles, and a one-time dose of polio vaccine for
adults.

7.2 summary of immunisation schedule in Kenya:

Vaccine Age of administration

BCG At birth

OPV At birth,6wk,10wk,14wk

DPT-Hep B-Hib 6wk,10wk,14wk

Measles 9months

Yellow fever 9months(Baringo,Keiyo,Koibatek,Marakwet)

TT Given in pregnancy under the 5TT schedule.

Vitamin A 6m,12m,18m,24m,30m,36m,42m,48m.Also
given to mothers wothin six weeks after
 delivery.

Revision questions

1.Describe the different types of vaccines.

2.Define immunization.

3.State four vaccines available in Kenya.

4.Describe the immunization schedule in Kenya.

CHAPTER EIGHT

MANAGEMENT OF COMMON ACCIDENTS AT HOME

OBJECTIVES

At the end of this chapter,the student should be able to:

1.Understand the common hazards that can occur at home and within the community.

2.Describe the different first aid procedures for common injuries at home and within the community.

3.Describe the steps that can be taken to prevent their occurance

Introduction:
Accidents happen every day and result in thousands of people suffering personal injury every year. An accident injury can
occur on the roads and footpaths, at work, in public places, at home, at school, during medical treatment and in many
other situations but whatever the location, if the accident was caused wholly or partly by someone else, a right to
compensation is likely to exist.

In many cases the accident and consequent injury is through no fault of the injured person but is caused by someone else.

Burns

A burn is a type of injury to the skin caused by heat, electricity, chemicals, light, radiationor friction. Most burns only
affect the skin (epidermal tissue and dermis).

Classification of burns

Burns are classified based upon their depth.

A first degree burn is superficial and causes local inflammation of the skin. Sunburns often are categorized as first
degree burns. The inflammation is characterized by pain, redness, and a mild amount of swelling. The skin may be very
tender to touch.

Second degree burns are deeper and in addition to the pain, redness and inflammation, there is also blistering of the skin.

Third degree burns are deeper still, involving all layers of the skin, in effect killing that area of skin. Because the nerves
and blood vessels are damaged, third degree burns appear white and leathery and tend to be relatively painless.

First aid for burns

For major burns(second and third degree burns)

1. Remove the victim from the burning area, remembering not to put the rescuer in danger.

2. Remove any burning material from the patient.

3. Call 911 or activate the emergency response system in your area if needed.
4. Once the victim is in a safe place, keep them warm and still. Try to wrap the injured areas in a clean sheet if
available. DO NOT use cold water on the victim; this may drop the body temperature and cause hypothermia.

Burns of the face, hands, and feet should always be considered a significant injury (although this may exclude sunburn.

For minor burns (first degree burns or second degree burns involving a small area of the body)

 Gently clean the wound with lukewarm water.

 Though butter has been used as a home remedy, it should NOT be used on any burn.
 Rings, bracelets, and other potentially constricting articles should be removed (edema, or swelling from
inflammation may occur and the item may cut into the skin).
 The burn may be dressed with a topical antibiotic ointment like Bacitracin or Neosporin.
 If there is concern that the burn is deeper and may be second or third degree in nature, medical care should be
accessed.
 Tetanus immunization should be updated if needed.

For electrical burns

Victims of electrical burns should always seek medical care.

For chemical burns

1. Identify the chemical that was involved.

2. Contact the emergency services in your area or your local hospital's Emergency Department.
3. Victims with chemical burns to their eyes should always seek emergency care.

Fractures

A fracture is the medical term for a broken bone. Fractures are common; the average person has two during a lifetime.
They occur when the physical force exerted on the bone is stronger than the bone itself. Your risk of fracture depends, in
part, on your age. Broken bones are very common in childhood, though children's fractures are generally less complicated
than fractures in adults. As you age, your bones become more brittle and you are more likely to suffer fractures from falls
that would not occur when you were young.

There are many types of fractures, but the main categories are displaced, non-displaced, open, and closed. Displaced and
non-displaced fractures refer to the way the bone breaks. In a displaced fracture, the bone snaps into two or more parts; if
the bone is in many pieces, it is considered comminuted. In a non-displaced fracture, the bone cracks either part or all of
the way through, but does move and maintains its proper alignment.

A closed fracture is when the bone breaks but there is no puncture or open wound in the skin. An open fracture is one in
which the bone breaks through the skin; it may then recede back into the wound and not be visible through the skin. This
is an important difference from a closed fracture because with an open fracture there is a risk of a deep bone infection.

The severity of a fracture depends upon its location and the damage done to the bone and tissue near it. Serious fractures
can have dangerous complications if not treated promptly; possible complications include damage to blood vessels or
nerves and infection of the bone (osteomyelitis) or surrounding tissue. Recuperation time varies depending on the age and
health of the patient and the type of fracture. A minor fracture in a child may heal within a few weeks; a serious fracture in
an older person may take months to heal.

Symptoms of a fracture

- Very intense pain increasing on movement of affected area.

- Bruising may or may not be there
-Swelling
-Injured area looks abnormal as compared to opposite side
-Difficulty in moving the injured area.
- Shock

-Unconsciousness may temporarily be there.

First aid for fractures

What to do:

1. Immobilise the affected area.

2. Keep the patient still and support the injured area.
3. For arm fractures a sling can be made to support and immobilise the affected area, which can be hung around the
neck using triangular bandage or cloth.
4. Splints (any long firm object) can be used for support and
immobilisation,but usually splinting to another part of the body is best.
5. In case of leg fractures the patient's both legs can be tied together.
Open fractures - control the bleeding with sterile dressing and pressure if required.

Do not:

1. Give massage to affected area

2. Try to straighten the broken limb
3. Move the patient without support
4. Ask the patient to move on his own
5. Move the joints above and below the fracture.

Poisoning

Poisoning is the harmful effect that occurs when a toxic substance is swallowed, is inhaled, or comes in contact with the
skin, eyes, or mucous membranes, such as those of the mouth or nose.

 Possible poisonous substances include prescription and over-the-counter drugs, illicit drugs, gases, chemicals,
vitamins, and food.
 Some poisons cause no damage, whereas others can cause severe damage or death.
  The diagnosis is based on symptoms, on information gleaned from the poisoned person and bystanders, and
sometimes on blood and urine tests.
 Medications should always be kept in original child-proof containers and kept out of the reach of children.
 Treatment consists of supporting the person, preventing additional absorption of the poison, and sometimes
increasing elimination of the poison.

First aid

1. People exposed to a toxic gas should be removed from the source quickly, preferably out into fresh air, but rescue
attempts should be done by professionals.

2. In chemical spills, all contaminated clothing, including socks and shoes, and jewelry should be removed immediately.
The skin should be thoroughly washed with soap and water. If the eyes have been exposed, they should be thoroughly
flushed with water or saline. Rescuers must be careful to avoid contaminating themselves.

3. Containers of the poisons and all drugs that might have been possibly taken by the poisoned person (including
nonprescription products) should be saved and given to the doctor or rescue personnel.

4.Incase its an eye poisoning flush the child’s eye by holding the eyelid open and pouring a steady stream of room
temperature water into the inner corner.

Snake bites:

Snake bites can be deadly if not treated quickly. Children are at higher risk for death or serious complications due to snake
bites because of their smaller body size.The right antivenom can save a person's life. Getting to an emergency room as
quickly as possible is very important. If properly treated, many snake bites will not have serious effects.

Symptoms depend on the type of snake, but may include:

 Bleeding from wound

 Blurred vision
 Burning of the skin
 Convulsions
 Diarrhea
 Dizziness
 Excessive sweating
 Fainting
 Fang marks in the skin
 Fever
 Increased thirst
 Loss of muscle coordination
 Nausea and vomiting
 Numbness and tingling
 Rapid pulse
 Tissue death
 Severe pain
 Skin discoloration
 Swelling at the site of the bite

First aid treatment

1. Keep the person calm, reassuring them that bites can be effectively treated in an emergency room. Restrict movement,
and keep the affected area below heart level to reduce the flow of venom.

2. If you have a pump suction device (such as that made by Sawyer), follow the manufacturer's directions.

3. Remove any rings or constricting items because the affected area may swell. Create a loose splint to help restrict
movement of the area.

4. If the area of the bite begins to swell and change color, the snake was probably poisonous.

5. Monitor the person'svital signs -- temperature, pulse, rate of breathing, and blood pressure -- if possible. If there are
signs of shock (such as paleness), lay the person flat, raise the feet about a foot, and cover the person with a blanket.

6. Get medical help right away.

7. Bring in the dead snake only if this can be done safely. Do not waste time hunting for the snake, and do not risk another
bite if it is not easy to kill the snake. Be careful of the head when transporting it -- a snake can actually bite for up to an
hour after it's dead (from a reflex).

Do not
 Allow the person to become over-exerted. If necessary, carry the person to safety.
 Apply a tourniquet.
 Apply cold compresses to a snake bite.
 Cut into a snake bite with a knife or razor.
 Try to suck out the venom by mouth.
 Give the person stimulants or pain medications pain medications unless a doctor tells you to do so.
 Give the person anything by mouth.
 Raise the site of the bite above the level of the person's heart.

Electric shock:

An electric shock occurs when a person comes into contact with an electrical energy source. Electrical energy flows
through a portion of the body causing a shock. Exposure to electrical energy may result in no injury at all or may result in
devastating damage or death. Burns are the most common injury from electric shock.

Symptoms

A person who has suffered an electric shock may have very little external evidence of injury or may have obvious severe
burns. The person could even be in cardiac arrest.

 Burns are usually most severe at the points of contact with the electrical source and the ground. The hands, heels,
and head are common points of contact.

 In addition to burns, other injuries are possible if the person has been thrown clear of the electrical source by
forceful muscular contraction. Consideration should be given to the possibility of a spine injury. The person may
have internal injuries especially if he or she is experiencing any shortness of breath, chest pain, or abdominal pain.
 Pain in a hand or foot or a deformity of a part of the body may indicate a possible broken bone resulting from the
electric shock.
 In children, the typical electrical mouth burn from biting an electric cord appears as a burn on the lip. The area has
a red or dark, charred appearance.

First aid

Brief low-voltage shocks that do not result in any symptoms or burns of the skin do not require care. For any high-voltage
shock, or for any shock resulting in burns, seek care at a hospital's emergency department. A doctor should evaluate
electric cord burns to the mouth of a child. Treatment depends on the severity of the burns or the nature of other injuries
found.

Burns are treated according to severity.

o Minor burns may be treated with topical antibiotic ointment and dressings.

o More severe burns may require surgery to clean the wounds or even skin grafting.
o Severe burns on the arms, legs, or hands may require surgery to remove damaged muscle or even
amputation.

Drowning:

First aid

1.Don't assume it's too late to save a child's life - even if she's unresponsive, continue performing CPR and do not stop
until medical professionals take over.

. Tilt the head back with one hand, and lift her chin with the other to open the airway of the child.. Put your ear to the
child's mouth and nose, and look, listen and feel for signs that she is breathing.

2. If the child doesn't seem to be breathing

A Infants under age 1: Place your mouth over infant's nose and lips and give two breaths, each lasting about 1 1/2
seconds. Look for the chest to rise and fall.

B Children 1 and older: Pinch child's nose and seal your lips over her mouth. Give two slow, full breaths (1 1/2 to 2
seconds each). Wait for the chest to rise and fall before giving the second breath.

3. If the chest rises, check for a pulse (see number 4).

If the chest doesn't rise, try again. Retilt the head, lift the child's chin, and repeat the breaths.

4. Check for a pulse: Put two fingers on your child's neck to the side of the Adam's apple (for infants, feel inside the arm
between the elbow and shoulder). Wait five seconds. If there is a pulse, give one breath every three seconds. Check for a
pulse every minute, and continue rescue breathing until the child is breathing on her own or help arrives.

5. If you can't find a pulse then .....

A Infants under age 1: Imagine a line between the child's nipples, and place two fingers just below its centerpoint. Apply
five half-inch chest compressions in about three seconds. After five compressions, seal your lips over your child's mouth
and nose and give one breath.

B Children 1 and older: Use the heel of your hand (both hands for a teenager or adult) to apply five quick one-inch chest
compressions to the middle of the breastbone (just above where the ribs come together) in about three seconds. After five
compressions, pinch your child's nose, seal your lips over his mouth, and give one full breath.

All ages: continue the cycle of five chest compressions followed by a breath for one minute, then check for a pulse.
Repeat cycle until you find a pulse or help arrives and takes over.

Note: These instructions are not a substitute for CPR training, which all parents and caretakers should have.
Choking

Cause:

Accidental swallowing of foreign body, strangulation, covering of head by blankets, accidental suffocation by pillow
while baby sleeps in a prone position, near-drowning etc.

Prevention:

 Choose toys appropriate to the age of children. Avoid toys with detachable small parts.
 Ensure small objects are kept out of reach of children.
 Pull cords on curtains and blinds should be kept short and out of reach of children.
 Strings and plastic bags should be kept out of reach of children.
 Foldable furniture should be properly placed and locked. Instruct children not to play with them.
 Instruct children not to play while eating.
 Never let children use milk bottle by themselves without adult’s supervision.
 Never use pillow for baby under one year of age. Do not use large and heavy blanket. Never let the blanket cover
the face of children during sleep.
 Avoid sleeping with baby on the same bed.
 Never leave children alone in a bath tub or basin filled with water.
 Bucket filled with water must be covered and keep children away from it.

First Aid:

1. Do not panic. Remove the cause from the patient.

2. Call for help immediately.
3. Perform CPR if necessary.