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DEPARTMENT OF COMMUNITY MEDICINE

GOVERNMENT MEDICAL COLLEGE


CHANDIGARH

MANUAL FOR PRACTICALS/FIELD VISITS

VOLUME - I

Roll No.
Name

Batch

CONTENTS
SECTION-A

VISIT TO HEALTH AGENCIES

SECTION B

MUSEUM DEMONSTRATIONS

SECTION C

MISCELLANEOUS

SECTION - A
VISIT TO HEALTH AGENCIES
Topics

DATE OF
VISIT

GRADE

PAGE

FACULTY

REMARKS

1. Anganwadi
2. Anti- Retroviral therapy
(ART) Centre
3. Central Sterilization and
Supply Department (CSSD)
4. Cold Chain Facility
5. Community Health Centre
(CHC), Manimajra
6. Directorate for the vector
borne diseases
7. District Tuberculosis
Centre (DTC)
8. Government Institute for
Mentally Retarded
Children (GIMRC)
9.

Home for the visually


challenged

10. Hospice centre


11. Incinerator
12. Integrated Counseling and
Testing Centre (ICTC)
13. Leper's Colony /
Leprosorium
14. Medical Record
Department (MRD)
15. Old age Home
16. Public Health Lab
17. Rehabilitation Centre for
Physically Challenged
18. Slaughter House
19. SOS Village
20. Sub-centre, Palsora
21. Sewage Treatment Plant
22. Verka Milk Plant
23. Water Treatment Plant
24. Others
4
OVERALL GRADING:

GRADE
A- >70%
B- 60-70%

C- 50-60%
D- <50%
I/C Academics (U.G.)

SECTION - B
MUSEUM DEMONSTRATION
S.
NO.

DATE

1.

TOPIC

GRADE

PAGE

FACULTY

REMARKS

VACCINES

NUTRITION

2.

FAMILY PLANNING

3.

DEVICES
4.

REPRODUCTIVE &
CHILD HEALTH

5.

ENTOMOLOGY

6.

INSECTICIDES

7.

DISINFACTANTS

8.

MISCELLANEOUS
OVERALL GRADING:
GRADE
A- >70%
B- 60-70%
C- 50-60%
D- <50%
I/C Academics (U.G.)
6

SECTION - C
MISCELLANEOUS
S.
NO.

DATE

1.

TOPIC

GRADE

PAGE

FACULTY

REMARKS

CASE
PRESENTATION

2.

EPIDEMIOLOGICAL
EXERCISES

3.

PROBLEM BASED
LEARNING

4.

CASE STUDY

5.

STATISTICAL
EXERCISES

6.

VIDEOS

7.

SEMINARS

8.

OTHERS
OVERALL GRADING:
GRADE
A- >70%
B- 60-70%
C- 50-60%
D- <50%
I/C Academics (U.G.)
7

LEARNING OBJECTIVE (OF PRACTICALS


/FIELD VISITS IN COMMUNITY MEDICINE)
To enable the students to learn (cognitive domain):
1.

Regarding the organizational structure, the staffing pattern, and the functioning of various health
agencies. By promoting interaction with the physically and mentally challenged, the under privileged and
the socially ostracized, the attempt is to help the students identify the specific problems and needs (i.e.
medical, social, emotional, vocational, etc) of these people and help them develop a more humane
approach towards them.

2.

About various insects of public health importance so that they are able to distinguish them, identify their
breeding habits, enumerate diseases transmitted by them, suggest suitable preventive and control measure
to be taken against them.

3.

Regarding different kinds of disinfectants and insecticides of public health importance, their method of
application, where and how to use, precautions to be taken while using them and management of cases of
toxicity, if any.

4.

Regarding vaccines under Universal Immunization Programme and newer vaccines, family planning
devices, reproductive and child health related specimens and nutritional samples so that to use this
knowledge for the promotion of health of individual and the community as well.

5.

Regarding different environmental models, their public health significance, their merits and demerits so
as to help the individual and the community to lead an eco-friendly life.

VISIT TO ANGANWADI
Address of Health Agency visited

__________________________________________________

Objective of the visit

__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________

Description of Agency (in brief)

a)

Staff

__________________________________________________
__________________________________________________

b)

Infrastructure

__________________________________________________

c)

Functioning

__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________

Utility of the department :

__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________

Skills Learnt

__________________________________________________

Problems identified (if any)

__________________________________________________

Remarks / Suggestions:

__________________________________________________
9

VISIT TO ANTI- RETEROVIRAL THERAPY (ART) CENTRE


Address of Health Agency visited

__________________________________________________

Objective of the visit

__________________________________________________
__________________________________________________

Description of Agency (in brief)

a) Staff

__________________________________________________

b) Infrastructure

__________________________________________________

c) Functioning

Utility of the place

__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________

Skills Learnt

__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________

Problems identified (if any)

__________________________________________________

Remarks / Suggestions:

__________________________________________________
__________________________________________________

10

VISIT TO HOME FOR THE BLIND


Address of Health Agency visited

__________________________________________________

Objective of the visit

__________________________________________________
__________________________________________________
_____________________________________________________
_______________________________________________

Description of Agency (in brief)

a) Staff

__________________________________________________

b) Infrastructure

__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________

Services provided

__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________

Skills Learnt

__________________________________________________

Problems identified (if any)

__________________________________________________

Remarks / Suggestions:

__________________________________________________

11

VISIT TO
Address of Health Agency visited

__________________________________________________

Objective of the visit

__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________

Description of Agency (in brief)

a) Staff

b) Observation of Functioning

__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________

Skills Learnt

__________________________________________________

Problems identified (if any)

__________________________________________________

Remarks / Suggestions:

__________________________________________________
__________________________________________________

12

VISIT TO CENTRAL STERILIZATION AND SUPPLY


DEPARTMENT (CSSD)
Address of Health Agency visited

__________________________________________________

Type of Agency

NGO / Govt. Agency

Objective of the visit

__________________________________________________
__________________________________________________
__________________________________________________

Description of Agency (in brief)

a) Staff

b) Infrastructure
c) Observation of Functioning

__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
___________________________________________________

Skills Learnt

___________________________________________________

Problems identified (if any)

___________________________________________________

Remarks / Suggestions:

___________________________________________________
___________________________________________________

13

VISIT TO COLD CHAIN FACILITY


Address of Health Agency visited

___________________________________________________

Type of Agency

NGO / Govt. Agency

Objective of the visit

___________________________________________________
___________________________________________________
___________________________________________________

Description of Agency (in brief)

a) Staff

___________________________________________________

b) Infrastructure

___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________

c) Observation of Functioning

Skills Learnt

___________________________________________________

Problems identified (if any)

___________________________________________________

Remarks / Suggestions:

___________________________________________________
___________________________________________________

14

VISIT TO COMMUNITY HEALTH CENTRE (CHC),


MANIMAJRA
Address of Health Agency visited

___________________________________________________

Type of Agency

NGO / Govt. Agency

Objective of the visit

___________________________________________________
___________________________________________________
___________________________________________________

Description of Agency (in brief)

a) Staff

b) Infrastructure

c) Observation of Functioning

___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________

Skills Learnt

___________________________________________________

Problems identified (if any)

___________________________________________________

Remarks / Suggestions:

___________________________________________________
___________________________________________________

15

VISIT TO DISTRICT TUBERCULOSIS CENTRE (DTC)


Address of Health Agency visited

___________________________________________________

Type of Agency

NGO / Govt. Agency

Objective of the visit

___________________________________________________
___________________________________________________
___________________________________________________

Description of Agency (in brief)

a) Staff

b) Infrastructure

c) Observation of Functioning

___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________

Skills Learnt

___________________________________________________

Problems identified (if any)

___________________________________________________

Remarks / Suggestions:

___________________________________________________
___________________________________________________

16

VISIT TO GOVT. INSTITUTE FOR MENTALLY RETARDED


CHILDREN, (GIMRC)
Address of Health Agency visited

___________________________________________________

Type of Agency

NGO / Govt. Agency

Objective of the visit

___________________________________________________
___________________________________________________
___________________________________________________

Description of Agency (in brief)

a) Staff

b) Infrastructure
c) Observation of Functioning

___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________

Skills Learnt

___________________________________________________

Problems identified (if any)

___________________________________________________

Remarks / Suggestions:

___________________________________________________
___________________________________________________

17

VISIT TO HOSPICE CENTRE


Address of Health Agency visited

___________________________________________________

Type of Agency

NGO / Govt. Agency

Objective of the visit

___________________________________________________
___________________________________________________
___________________________________________________

Description of Agency (in brief)

a) Staff

b) Infrastructure

c) Observation of Functioning

___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________

Skills Learnt

___________________________________________________

Problems identified (if any)

___________________________________________________

Remarks / Suggestions:

___________________________________________________
___________________________________________________

18

VISIT TO INCINERATOR
Address of Health Agency visited

___________________________________________________

Type of Agency

NGO / Govt. Agency

Objective of the visit

___________________________________________________
___________________________________________________
___________________________________________________

Description of Agency (in brief)

a) Staff

b) Infrastructure

c) Observation of Functioning

___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________

Skills Learnt

___________________________________________________

Problems identified (if any)

___________________________________________________

Remarks / Suggestions:

___________________________________________________
___________________________________________________

19

VISIT TO INTEGRATED COUNSELING AND TESTING


CENTRE (ICTC)
Address of Health Agency visited

___________________________________________________

Type of Agency

NGO / Govt. Agency

Objective of the visit

___________________________________________________
___________________________________________________
___________________________________________________

Description of Agency (in brief)

a) Staff

b) Infrastructure

c) Services provided

___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________

Skills Learnt

___________________________________________________

Problems identified (if any)

___________________________________________________

Remarks / Suggestions:

___________________________________________________
___________________________________________________

20

VISIT TO LEPERS COLONY / LEPROSORIUM


Name of Health Agency visited

___________________________________________________

Type of Agency

NGO / Govt. Agency

Objective of the visit

___________________________________________________
___________________________________________________

Description of Agency (in brief)

a) Staff

b) Infrastructure

c)

Services provided

___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________

Skills Learnt

___________________________________________________

Problems identified (if any)

___________________________________________________

Remarks / Suggestions:

___________________________________________________
___________________________________________________

21

VISIT TO DIRECTORATE FOR VECTOR BORNE


DISEASES
Address of Health Agency visited

___________________________________________________

Type of Agency

NGO / Govt. Agency

Objective of the visit

___________________________________________________
___________________________________________________
___________________________________________________

Description of Agency (in brief)

a) Staff

b) Infrastructure
c) Observation of Functioning

___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________

Skills Learnt

___________________________________________________

Problems identified (if any)

___________________________________________________

Remarks / Suggestions:

___________________________________________________
___________________________________________________

22

VISIT TO OLD AGE HOME


Address of Health Agency visited

___________________________________________________

Type of Agency

NGO / Govt. Agency

Objective of the visit

___________________________________________________
___________________________________________________
___________________________________________________

Description of Agency (in brief)

a) Staff

b) Infrastructure

c) Observation of Functioning

___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________

Skills Learnt

___________________________________________________

Problems identified (if any)

___________________________________________________

Remarks / Suggestions:

___________________________________________________
___________________________________________________

23

VISIT TO PUBLIC HEALTH LAB


Address of Health Agency visited

___________________________________________________

Type of Agency

NGO / Govt. Agency

Objective of the visit

___________________________________________________
___________________________________________________
___________________________________________________

Description of Agency (in brief)

a) Staff

b) Infrastructure

c) Observation of Functioning

___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________

Skills Learnt

___________________________________________________

Problems identified (if any)

___________________________________________________

Remarks / Suggestions:

___________________________________________________
___________________________________________________

24

VISIT TO REHABILITATION CENTRE FOR PHYSICALLY


CHALLANGED
Address of Health Agency visited

___________________________________________________

Type of Agency

NGO / Govt. Agency

Objective of the visit

___________________________________________________
___________________________________________________
___________________________________________________

Description of Agency (in brief)

a) Staff

b) Infrastructure
c) Observation of Functioning

___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________

Skills Learnt

___________________________________________________

Problems identified (if any)

___________________________________________________

Remarks / Suggestions:

___________________________________________________
___________________________________________________

25

VISIT TO SLAUGHTER HOUSE


Address of Health Agency visited

___________________________________________________

Type of Agency

NGO / Govt. Agency

Objective of the visit

___________________________________________________
___________________________________________________

Description of Agency (in brief)

a) Staff

___________________________________________________

b) Infrastructure

___________________________________________________

c) Observation of Functioning

___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________

Funding (for NGO / Private)

___________________________________________________

Services Provided:

___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________

Skills Learnt

___________________________________________________

Problem Identified (if any)

___________________________________________________

Remarks / Suggestions:

___________________________________________________
___________________________________________________

26

VISIT TO SUB- CENTRE, PALSORA


Address of Health Agency visited

___________________________________________________

Type of Agency

NGO / Govt. Agency

Objective of the visit

___________________________________________________
___________________________________________________

Description of Agency (in brief)

a) Staff

___________________________________________________

b) Infrastructure

___________________________________________________

c) Observation of Functioning

___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________

Funding (for NGO / Private)

___________________________________________________

Services Provided:

___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________

Skills Learnt

___________________________________________________

Problem Identified (if any)

___________________________________________________

Remarks / Suggestions:

___________________________________________________
___________________________________________________

27

VISIT TO SEWAGE TREATMENT PLANT


Name of Health Agency visited

___________________________________________________

Type of Agency

NGO / Govt. Agency

Objective of the visit

___________________________________________________
___________________________________________________

Description of Agency (in brief)

a) Staff

b) Functioning

Funding (for NGO / Private)

___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________

Observation / Demonstration:

_____________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________

Skills Learnt

___________________________________________________
___________________________________________________

Remarks / Suggestions:

___________________________________________________
__________________________________________________

28

VISIT TO WATER TREATMENT PLANT

Address of Health Agency visited

___________________________________________________

Type of Agency

NGO / Govt. Agency

Objective of the visit

___________________________________________________
___________________________________________________

Description of Agency (in brief)

b) Staff

___________________________________________________

b) Infrastructure

___________________________________________________

c) Observation of Functioning

___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________

Funding (for NGO / Private)

___________________________________________________

Services Provided:

___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________

Skills Learnt

___________________________________________________

Problem Identified (if any)

___________________________________________________

Remarks / Suggestions:

___________________________________________________
___________________________________________________
29

VISIT TO OTHER HEALTH AGENCIES


Name of Health Agency visited

___________________________________________________

Type of Agency

NGO / Govt. Agency

Objective of the visit

___________________________________________________
___________________________________________________

Description of Agency (in brief)

c) Staff

d) Functioning

Funding (for NGO / Private)

___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________

Observation / Demonstration:

___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________

Skills Learnt

___________________________________________________
___________________________________________________

Remarks / Suggestions:

___________________________________________________
___________________________________________________

30

VACCINES

31

BACILLUS CALMETTE GUERIN (BCG) VACCINE

CONTENTS / DILUENT

________________________________________________
________________________________________________

AGE AT WHICH IT IS GIVEN

________________________________________________

DOSE

________________________________________________

ROUTE OF ADMINISTRATION

SITE OF ADMINISTRATION

SIDE REACTIONS / COMPLICATIONS__________________________________________

__________________________________________

__________________________________________

CONTRA - INDICATIONS

________________________________________________
________________________________________________

STORAGE / COLD CHAIN

________________________________________________

PROTECTIVE EFFICACY

________________________________________________

ORAL POLIO VACCINE (OPV)

CONTENTS / DILUENT

________________________________________________
________________________________________________

AGE AT WHICH IT IS GIVEN

________________________________________________

DOSE

________________________________________________

ROUTE & SITE OF ADMINISTRATION

__________________________________________

SIDE REACTIONS / COMPLICATIONS

__________________________________________
__________________________________________

CONTRA - INDICATIONS

________________________________________________
________________________________________________

STORAGE / COLD CHAIN

PROTECTIVE EFFICACY

________________________________________________
________________________________________________
32

DPT / DT / TT VACCINE

CONTENTS / DILUENT

________________________________________________
________________________________________________

AGE AT WHICH IT IS GIVEN

________________________________________________

DOSE

________________________________________________

ROUTE & SITE OF ADMINISTRATION

__________________________________________

SIDE REACTIONS / COMPLICATIONS

__________________________________________
__________________________________________

CONTRA - INDICATIONS

________________________________________________
________________________________________________

STORAGE / COLD CHAIN

________________________________________________

PROTECTIVE EFFICACY

________________________________________________

MEASLES VACCINE

CONTENTS / DILUENT

________________________________________________
________________________________________________

AGE AT WHICH IT IS GIVEN

________________________________________________

DOSE

________________________________________________

ROUTE & SITE OF ADMINISTRATION

__________________________________________

SIDE REACTIONS / COMPLICATIONS

__________________________________________
__________________________________________

CONTRA - INDICATIONS

________________________________________________
________________________________________________

STORAGE / COLD CHAIN

________________________________________________

PROTECTIVE EFFICACY

________________________________________________

33

HEPATITIS B VACCINE

CONTENTS / DILUENT

________________________________________________
________________________________________________

AGE AT WHICH IT IS GIVEN

________________________________________________

DOSE

________________________________________________

ROUTE & SITE OF ADMINISTRATION

__________________________________________

SIDE REACTIONS / COMPLICATIONS

__________________________________________
__________________________________________

CONTRA - INDICATIONS

________________________________________________
________________________________________________

STORAGE / COLD CHAIN

________________________________________________

PROTECTIVE EFFICACY

________________________________________________

MUMPS, MEASLES, RUBELLA (MMR):

CONTENTS / DILUENT

________________________________________________
________________________________________________

AGE AT WHICH IT IS GIVEN

________________________________________________

DOSE

________________________________________________

ROUTE & SITE OF ADMINISTRATION

__________________________________________

SIDE REACTIONS / COMPLICATIONS

__________________________________________
__________________________________________

CONTRA - INDICATIONS

________________________________________________
________________________________________________

STORAGE / COLD CHAIN

________________________________________________

PROTECTIVE EFFICACY

________________________________________________

34

HAEMOPHYLLOUS INFLUENZA TYPE- B, (Hib) VACCINE

CONTENTS / DILUENT

________________________________________________
________________________________________________

AGE AT WHICH IT IS GIVEN

________________________________________________

DOSE

________________________________________________

ROUTE & SITE OF ADMINISTRATION

__________________________________________

SIDE REACTIONS / COMPLICATIONS

__________________________________________
__________________________________________

CONTRA - INDICATIONS

________________________________________________
________________________________________________

STORAGE / COLD CHAIN

________________________________________________

PROTECTIVE EFFICACY

________________________________________________

HEPATITIS A VACCINE

CONTENTS / DILUENT

________________________________________________
________________________________________________

AGE AT WHICH IT IS GIVEN

________________________________________________

DOSE

________________________________________________

ROUTE & SITE OF ADMINISTRATION

__________________________________________

SIDE REACTIONS / COMPLICATIONS

__________________________________________
__________________________________________

CONTRA - INDICATIONS

________________________________________________
________________________________________________

STORAGE / COLD CHAIN

________________________________________________

PROTECTIVE EFFICACY

________________________________________________

35

ANTI- RABIES VACCINE, (VERORAB)

CONTENTS / DILUENT

________________________________________________
________________________________________________

AGE AT WHICH IT IS GIVEN

________________________________________________

DOSE

________________________________________________

ROUTE & SITE OF ADMINISTRATION

__________________________________________

SIDE REACTIONS / COMPLICATIONS

__________________________________________
__________________________________________

CONTRA - INDICATIONS

________________________________________________
________________________________________________

STORAGE / COLD CHAIN

________________________________________________

PROTECTIVE EFFICACY

________________________________________________

OTHER VACCINES:

CONTENTS / DILUENT

________________________________________________
________________________________________________

AGE AT WHICH IT IS GIVEN

________________________________________________

DOSE

________________________________________________

ROUTE & SITE OF ADMINISTRATION

__________________________________________

SIDE REACTIONS / COMPLICATIONS

__________________________________________
__________________________________________

CONTRA - INDICATIONS

________________________________________________
________________________________________________

STORAGE / COLD CHAIN

________________________________________________

PROTECTIVE EFFICACY

________________________________________________

36

NUTRITION

37

CEREALS

NUTRITIVE VALUE PROTEINS

(per 100 gms)

FATS

(per 100 gms)

CALORIES

(K cal)

SPECIFIC MINERALS

SPECIAL FEATURES

_______________________________________________________
_______________________________________________________
_______________________________________________________

RECIPES

_______________________________________________________
_______________________________________________________

PUBLIC HEALTH IMPORTANCE

_________________________________________________
_________________________________________________

MILLETS

NUTRITIVE VALUE PROTEINS

(per 100 gms)

FATS

(per 100 gms)

CALORIES

(K cal)

SPECIFIC MINERALS

SPECIAL FEATURES

_______________________________________________________
_______________________________________________________
_______________________________________________________

RECIPES

_______________________________________________________
_______________________________________________________

PUBLIC HEALTH IMPORTANCE

_________________________________________________
_________________________________________________

38

PULSES

NUTRITIVE VALUE PROTEINS

(per 100 gms)

FATS

(per 100 gms)

CALORIES

(K cal)

SPECIFIC MINERALS

_____________________________________
_____________________________________

SPECIAL FEATURES

_____________________________________
_____________________________________

RECIPES

_____________________________________
_____________________________________

PUBLIC HEALTH IMPORTANCE

_____________________________________
_____________________________________

SOYABEAN

NUTRITIVE VALUE PROTEINS

(per 100 gms)

FATS

(per 100 gms)

CALORIES

(K cal)

SPECIFIC MINERALS

_____________________________________
_____________________________________

SPECIAL FEATURES

_____________________________________
_____________________________________
_____________________________________
_____________________________________

RECIPES

_____________________________________
_____________________________________
_____________________________________
_____________________________________

PUBLIC HEALTH IMPORTANCE

_____________________________________
_____________________________________

39

GREEN LEAFY VEGETABLES

NUTRITIVE VALUE PROTEINS

(per 100 gms)

FATS

(per 100 gms)

CALORIES

(K cal)

SPECIFIC MINERALS

_____________________________________
_____________________________________

SPECIAL FEATURES

_____________________________________
_____________________________________

RECIPES

_____________________________________
_____________________________________

PUBLIC HEALTH IMPORTANCE

_____________________________________
_____________________________________

ROOTS AND TUBERS

NUTRITIVE VALUE PROTEINS

(per 100 gms)

FATS

(per 100 gms)

CALORIES

(K cal)

SPECIFIC MINERALS

_____________________________________
_____________________________________

SPECIAL FEATURES

_____________________________________
_____________________________________

RECIPES

_____________________________________
_____________________________________

PUBLIC HEALTH IMPORTANCE

_____________________________________
_____________________________________

40

GROUNDNUT

NUTRITIVE VALUE PROTEINS

(per 100 gms)

FATS

(per 100 gms)

CALORIES

(K cal)

SPECIFIC MINERALS

_____________________________________
_____________________________________

SPECIAL FEATURES

______________________________________
______________________________________

RECIPES

_____________________________________
_____________________________________

PUBLIC HEALTH IMPORTANCE

______________________________________
______________________________________

OILS

NUTRITIVE VALUE PROTEINS

(per 100 gms)

FATS

(per 100 gms)

CALORIES

(K cal)

SPECIFIC MINERALS

_____________________________________
_____________________________________

SPECIAL FEATURES

______________________________________
_____________________________________

RECIPES

_____________________________________
_____________________________________

PUBLIC HEALTH IMPORTANCE

_____________________________________
_____________________________________

41

ORANGE

NUTRITIVE VALUE PROTEINS

(per 100 gms)

FATS

( per 100 gms)

CALORIES

(K cal)

SPECIFIC MINERALS

_____________________________________
_____________________________________

SPECIAL FEATURES

______________________________________
_____________________________________

RECIPES

_____________________________________
_____________________________________

PUBLIC HEALTH IMPORTANCE

________________________________________
________________________________________

BANANA

NUTRITIVE VALUE PROTEINS

(gms)

FATS

(gms)

CALORIES

(K cal)

SPECIFIC MINERALS

_____________________________________
_____________________________________

SPECIAL FEATURES

______________________________________
_____________________________________

RECIPES

_____________________________________
_____________________________________

PUBLIC HEALTH IMPORTANCE

________________________________________
________________________________________

42

MILK

NUTRITIVE VALUE PROTEINS

(per 100 gms)

FATS

(per 100 gms)

CALORIES

(K cal)

SPECIFIC MINERALS

_____________________________________
_____________________________________

SPECIAL FEATURES

______________________________________
_____________________________________

RECIPES

_____________________________________
_____________________________________

PUBLIC HEALTH IMPORTANCE

________________________________________
________________________________________

EGG

NUTRITIVE VALUE PROTEINS

(gms)

FATS

(gms)

CALORIES

(K cal)

SPECIFIC MINERALS

_____________________________________
_____________________________________

SPECIAL FEATURES

______________________________________
_____________________________________

RECIPES

_____________________________________
_____________________________________

PUBLIC HEALTH IMPORTANCE

________________________________________
________________________________________

43

SUGAR & JAGGERY

NUTRITIVE VALUE CALORIES


SPECIFIC MINERALS

(K cal)
_____________________________________
_____________________________________

SPECIAL FEATURES

______________________________________
_____________________________________
_____________________________________
_____________________________________

RECIPES

_____________________________________
_____________________________________
_____________________________________
_____________________________________

PUBLIC HEALTH IMPORTANCE

________________________________________
________________________________________
________________________________________

SPICE & CONDIMENTS

NUTRITIVE VALUE PROTEINS

(per 100 gms)

FATS

(per 100 gms)

CALORIES

(K cal)

SPECIFIC MINERALS

_____________________________________
_____________________________________

SPECIAL FEATURES

______________________________________
_____________________________________

RECIPES

_____________________________________
_____________________________________

PUBLIC HEALTH IMPORTANCE

________________________________________
________________________________________

44

OTHERS :
NUTRITIVE VALUE PROTEINS

(per 100 gms)

FATS

(per 100 gms)

CALORIES

(K cal)

SPECIFIC MINERALS

_____________________________________
_____________________________________

SPECIAL FEATURES

______________________________________
_____________________________________

RECIPES

_____________________________________
_____________________________________

PUBLIC HEALTH IMPORTANCE

________________________________________
________________________________________

45

FAMILY PLANNING DEVICES

(CONTRACEPTIVES)

46

CONDOMS

DESCRIPTION

_________________________________________________
_________________________________________________
_________________________________________________

TYPE

_________________________________________________
_________________________________________________

MECHANISM OF ACTION

_________________________________________________

METHOD OF USE

_________________________________________________
_________________________________________________

EFFECTIVENESS (Failure Rate)

_________________________________________________

ADVANTAGES

_________________________________________________
_________________________________________________
_________________________________________________

DISADVANTAGES

_________________________________________________
_________________________________________________

CONTRA-INDICATIONS

_________________________________________________

COPPER-T

DESCRIPTION

_________________________________________________
_________________________________________________
_________________________________________________

TYPE

_________________________________________________
_________________________________________________

MECHANISM OF ACTION

_________________________________________________

METHOD OF USE

_________________________________________________
_________________________________________________

EFFECTIVENESS (Failure Rate)

_________________________________________________

ADVANTAGES

_________________________________________________
_________________________________________________
_________________________________________________

SIDE EFFECT

_________________________________________________
_________________________________________________

CONTRA-INDICATIONS

47
_________________________________________________

ORAL CONTRACEPTIVE PILLS (HORMONAL)

DESCRIPTION

_________________________________________________
_________________________________________________
_________________________________________________

TYPE

_________________________________________________
_________________________________________________

MECHANISM OF ACTION

_________________________________________________

METHOD OF USE

_________________________________________________
_________________________________________________

EFFECTIVENESS

_________________________________________________

ADVANTAGES

_________________________________________________
_________________________________________________
_________________________________________________

SIDE EFFECT

_________________________________________________
_________________________________________________

CONTRA-INDICATIONS

_________________________________________________
_________________________________________________

ORAL CONTRACEPTIVE PILLS (NON - HORMONAL)


SAHELI

DESCRIPTION

_________________________________________________
_________________________________________________
_________________________________________________

TYPE

_________________________________________________
_________________________________________________

MECHANISM OF ACTION

_________________________________________________

METHOD OF USE

_________________________________________________
_________________________________________________

EFFECTIVENESS (Failure Rate)

_________________________________________________

48

ADVANTAGES

_________________________________________________
_________________________________________________
_________________________________________________

SIDE EFFECT

_________________________________________________
_________________________________________________

CONTRA-INDICATIONS

_________________________________________________
_________________________________________________

SPERMICIDE (TODAY)

DESCRIPTION

_________________________________________________
_________________________________________________
_________________________________________________

TYPE

_________________________________________________
_________________________________________________

MECHANISM OF ACTION

_________________________________________________

METHOD OF USE

_________________________________________________
_________________________________________________

EFFECTIVENESS (Failure Rate)

_________________________________________________

ADVANTAGES

_________________________________________________
_________________________________________________
_________________________________________________

SIDE EFFECT

_________________________________________________
_________________________________________________

CONTRA-INDICATIONS

_________________________________________________
_________________________________________________

49

EMERGENCY CONTRACEPTIVES (I- PILL)


DESCRIPTION

_________________________________________________
_________________________________________________
_________________________________________________

TYPE

_________________________________________________
_________________________________________________

MECHANISM OF ACTION

_________________________________________________

METHOD OF USE

_________________________________________________
_________________________________________________

EFFECTIVENESS (Failure Rate)

_________________________________________________

ADVANTAGES

________________________________________________
________________________________________________
________________________________________________

SIDE EFFECT

________________________________________________
________________________________________________

CONTRA-INDICATIONS

________________________________________________
_________________________________________________

OTHERS:

DESCRIPTION

_________________________________________________
_________________________________________________
_________________________________________________

TYPE

_________________________________________________
_________________________________________________

MECHANISM OF ACTION

_________________________________________________

METHOD OF USE

_________________________________________________
_________________________________________________

EFFECTIVENESS (Failure Rate)

_________________________________________________
50

ADVANTAGES

_________________________________________________
_________________________________________________
_________________________________________________

SIDE EFFECT

_________________________________________________
_________________________________________________

CONTRA-INDICATIONS

_________________________________________________
_________________________________________________

PRODUCTIVE & CHILD HEALTH


GROWTH CHART
TYPE OF GROWTH CHART

_________________________________________________________

OBJECTIVES :

________________________________________
________________________________________
________________________________________

FEATURES / COMPOSITION :

________________________________________
________________________________________

USE :

________________________________________
________________________________________
________________________________________

51

ORAL REHYDRATION SALT (ORS)


OBJECTIVES :

________________________________________
________________________________________
________________________________________

FEATURES / COMPOSITION :

________________________________________

USES :

________________________________________

METHOD OF USE:

________________________________________

DOSAGE :

________________________________________

52

IRON FOLIC ACID TABLETS


OBJECTIVES :

________________________________________

FEATURES / COMPOSITION :

_____________________________________________

________________________________________
________________________________________

USE :

________________________________________
________________________________________
________________________________________

DOSAGE :

VITAMIN - A SOLUTION
OBJECTIVES :

________________________________________
________________________________________
________________________________________

FEATURES / COMPOSITION :

________________________________________
________________________________________

USE :

________________________________________
________________________________________
________________________________________

DOSAGE :

________________________________________

53

DAI DELIVERY KIT (DDK)


OBJECTIVES :

________________________________________
________________________________________
________________________________________

FEATURES / COMPOSITION :

________________________________________
________________________________________

USE :

________________________________________

OTHERS:
OBJECTIVES :

________________________________________
________________________________________
________________________________________

FEATURES / COMPOSITION :

________________________________________
________________________________________

USE :

________________________________________
________________________________________

DOSAGE :

________________________________________

54

ENTOMOLOGY

55

*ANOPHELES
EGG ___________________

DIAGRAMS

*CULEX
EGG ___________________

___________________

___________________

___________________

___________________

LARVA___________________

LARVA___________________

___________________

___________________

___________________

___________________

PUPA ___________________

PUPA ___________________

___________________

___________________

___________________

___________________

ADULT___________________

ADULT___________________

___________________

MALE ___________________

___________________

___________________

___________________

___________________

___________________

___________________

FEMALE

_______________

DIAGRAMS

FEMALE

_______________

_______________

_______________

_______________

_______________

PUBLIC HEALTH IMPORTANCE


__________________________________________

__________________________________________

56

AEDES MOSQUITO (ADULT)

IDENTIFYING / DISTINGUISHING FEATURES

DIAGRAMS

_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________

HABIT / BREEDING SITE

_______________________________________________
_______________________________________________

PUBLIC HEALTH IMPORTANCE

_______________________________________________
_______________________________________________

CONTROL MEASURES

_______________________________________________
_______________________________________________

HOUSEFLY

IDENTIFYING / DISTINGUISHING FEATURES

_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________

HABIT / BREEDING SITE

_______________________________________________
_______________________________________________

PUBLIC HEALTH IMPORTANCE

_______________________________________________
_______________________________________________

CONTROL MEASURES

_______________________________________________
_______________________________________________
57

DIAGRAMS

LOUSE

IDENTIFYING / DISTINGUISHING FEATURES

DIAGRAMS

_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________

HABIT / BREEDING SITE

_______________________________________________
_______________________________________________

PUBLIC HEALTH IMPORTANCE

_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________

CONTROL MEASURES

_______________________________________________
_______________________________________________
_______________________________________________

RAT FLEA

IDENTIFYING / DISTINGUISHING FEATURES

_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________

HABIT / BREEDING SITE

_______________________________________________
_______________________________________________

58

DIAGRAMS

PUBLIC HEALTH IMPORTANCE

_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________

CONTROL MEASURES

_______________________________________________
_______________________________________________
_______________________________________________

TICK

IDENTIFYING / DISTINGUISHING FEATURES

_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________

HABIT / BREEDING SITE

_______________________________________________
_______________________________________________

PUBLIC HEALTH IMPORTANCE

_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________

CONTROL MEASURES

_______________________________________________
_______________________________________________
_______________________________________________
59

DIAGRAMS

ITCH MITE

IDENTIFYING / DISTINGUISHING FEATURES

_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________

HABIT / BREEDING SITE

_______________________________________________
_______________________________________________

PUBLIC HEALTH IMPORTANCE

_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________

CONTROL MEASURES

_______________________________________________
_______________________________________________
_______________________________________________

Please Draw the Diagram

60

DIAGRAMS

INSECTICIDES

61

ABATE (Temephos)

PROPERTIES

_________________________________________________________
_________________________________________________________
_________________________________________________________

ACTION

_________________________________________________________

USES & DOSE

_________________________________________________________
_________________________________________________________

PRECAUTION

_________________________________________________________
_________________________________________________________

BENZENE HEXA CHLORIDE (BHC)

PROPERTIES

________________________________________________________
_________________________________________________________
_________________________________________________________

ACTION

_________________________________________________________

USES & DOSE

_________________________________________________________
_________________________________________________________

PRECAUTION

_________________________________________________________
_________________________________________________________

62

DDT (Dichloro diphenyl trichloroethane)

PROPERTIES

_________________________________________________________
_________________________________________________________
_________________________________________________________

ACTION

_________________________________________________________

USES & DOSE

_________________________________________________________
_________________________________________________________

PRECAUTION

_________________________________________________________
_________________________________________________________

63

MALATHION

PROPERTIES

_________________________________________________________
_________________________________________________________
_________________________________________________________

ACTION

_________________________________________________________

USES & DOSE

_________________________________________________________
_________________________________________________________

PRECAUTION

_________________________________________________________
_________________________________________________________

MINERAL OIL

PROPERTIES

_________________________________________________________
_________________________________________________________
_________________________________________________________

ACTION

_________________________________________________________

USES & DOSE

_________________________________________________________
________________________________________________________

PRECAUTION

_________________________________________________________
_________________________________________________________

64

PYRETHRUM & SYNTHETIC PYRETHROIDS

PROPERTIES

_________________________________________________________
_________________________________________________________
_________________________________________________________

ACTION

_________________________________________________________

USES & DOSE

_________________________________________________________
_________________________________________________________

PRECAUTION

_________________________________________________________
_________________________________________________________

65

PARIS GREEN (Copper aceto arsenite)

PROPERTIES

_________________________________________________________
_________________________________________________________
_________________________________________________________

ACTION

_________________________________________________________

USES & DOSE

_________________________________________________________
_________________________________________________________

PRECAUTION

_________________________________________________________
_________________________________________________________

PRECAUTION

_________________________________________________________
_________________________________________________________

ZINC PHOSPHIDE (RODENTICIDE)

PROPERTIES

_________________________________________________________
_________________________________________________________
_________________________________________________________

ACTION

_________________________________________________________

USES & DOSE

_________________________________________________________
_________________________________________________________

PRECAUTION

_________________________________________________________
_________________________________________________________

66

OTHERS:

PROPERTIES

_________________________________________________________
_________________________________________________________
_________________________________________________________

ACTION

_________________________________________________________

USES & DOSE

_________________________________________________________
_________________________________________________________

PRECAUTION

_________________________________________________________
_________________________________________________________

67

DISINFECTANTS

68

ALUM

PROPERTIES

_________________________________________________________
_________________________________________________________
_________________________________________________________

ACTION

_________________________________________________________

USES & DOSE

_________________________________________________________
_________________________________________________________

PRECAUTION

_________________________________________________________
_________________________________________________________

BLEACHING POWDER (CHLORINATED LIME)

PROPERTIES

_________________________________________________________
_________________________________________________________
_________________________________________________________

ACTION

_________________________________________________________

USES & DOSE

_________________________________________________________
_________________________________________________________

PRECAUTION

_________________________________________________________
_________________________________________________________

69

CETRIMIDE

PROPERTIES

_________________________________________________________
_________________________________________________________
_________________________________________________________

ACTION

_________________________________________________________

USES & DOSE

_________________________________________________________
________________________________________________________

PRECAUTION

_________________________________________________________

70

DETTOL

PROPERTIES

_________________________________________________________
_________________________________________________________
_________________________________________________________

ACTION

_________________________________________________________

USES & DOSE

_________________________________________________________
_________________________________________________________

PRECAUTION

_________________________________________________________
_________________________________________________________

ETHYL ALCOHOL

PROPERTIES

_________________________________________________________
_________________________________________________________
_________________________________________________________

ACTION

_________________________________________________________

USES & DOSE

_________________________________________________________
_________________________________________________________

PRECAUTION

_________________________________________________________
_________________________________________________________

71

FORMALDEHYDE

PROPERTIES

_________________________________________________________
_________________________________________________________
_________________________________________________________

ACTION

_________________________________________________________

USES & DOSE

_________________________________________________________
_________________________________________________________

PRECAUTION

_________________________________________________________

72

IODINE

PROPERTIES

_________________________________________________________
_________________________________________________________
_________________________________________________________

ACTION

_________________________________________________________

USES & DOSE

_________________________________________________________
_________________________________________________________

PRECAUTION

_________________________________________________________
_________________________________________________________

PHENOL (CARBOLIC ACID)

PROPERTIES

_________________________________________________________
_________________________________________________________
_________________________________________________________

ACTION

_________________________________________________________

USES & DOSE

_________________________________________________________
_________________________________________________________

PRECAUTION

_________________________________________________________
_________________________________________________________

73

SAVLON

PROPERTIES

_________________________________________________________
_________________________________________________________
_________________________________________________________

ACTION

_________________________________________________________

USES & DOSE

_________________________________________________________
_________________________________________________________

PRECAUTION

_________________________________________________________

74

SODIUM HYPOCHLORIDE

PROPERTIES

_________________________________________________________
_________________________________________________________
_________________________________________________________

ACTION

_________________________________________________________

USES & DOSE

_________________________________________________________
_________________________________________________________

PRECAUTION

_________________________________________________________
_________________________________________________________

OTHERS :

PROPERTIES

_________________________________________________________
_________________________________________________________
_________________________________________________________

ACTION

_________________________________________________________

USES & DOSE

_________________________________________________________
_________________________________________________________

PRECAUTION

_________________________________________________________
_________________________________________________________

75

SECTION - C
MISCELLANEOUS
a)

MEDICO-SOCIAL (CLINICO-SOCIAL) CASES

b)

EPIDEMIOLOGICAL EXERCISES

c)

PROBLEM BASED LEARNING

d)

CASE STUDY

e)

BIOSTATISTICAL EXERCISES

f)

VIDEO - SHOWS i.e. ORS, MALARIA, ANAEMIA, DIET IN


PREGNANCY ETC.

g)

SEMINARS

76

CASE PRESENTATIONS
NOTE:
1. As far as possible cases should be presented from the assigned families.
2. If cases are not available in the family, then case should be taken from the RHTC or UHTC
Date ______________

Case 1: Acute respiratory infection


Name of the student presented the case: ______________________
Comprehensive diagnosis: ______________________________________
Important issues discussed:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
77

Date ______________

Case 2: Acute diarrhoeal disease


Name of the student presented the case: ______________________
Comprehensive diagnosis: ______________________________________
Important issues discussed:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
78

Date ______________

Case 3: Kochs disease (Tuberculosis)


Name of the student presented the case: ______________________
Comprehensive diagnosis: ______________________________________
Important issues discussed:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
79

Date ______________

Case 4: Antenatal case


Name of the student presented the case: ______________________
Comprehensive diagnosis: ______________________________________
Important issues discussed:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

Date ______________

Case 5: Postnatal case


Name of the student presented the case: ______________________
Comprehensive diagnosis: ______________________________________
Important issues discussed:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

68

Date ______________

Case 6: Case of Anaemia


Name of the student presented the case: ______________________
Comprehensive diagnosis: ______________________________________
Important issues discussed:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

69

______________

Date ______________

Case 7: Infant / under five case


Name of the student presented the case: ______________________
Comprehensive diagnosis: ______________________________________
Important issues discussed:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

70

Date ______________

Case 8:Protein Energy Malnutrition (PEM) Case


Name of the student presented the case: ______________________
Comprehensive diagnosis: ______________________________________
Important issues discussed:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

71

______________

Date ______________

Case 9: Geriatric case


Name of the student presented the case: ______________________
Comprehensive diagnosis: ______________________________________
Important issues discussed:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

72

Date ______________

Case 10: Febrile illness/ Malaria


Name of the student presented the case: ______________________
Comprehensive diagnosis: ______________________________________
Important issues discussed:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

73

Date ______________

Case 11: Hansens Disease (Leprosy) case


Name of the student presented the case: ______________________
Comprehensive diagnosis: ______________________________________
Important issues discussed:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

74

Date ______________

Case 12: Goiter case


Name of the student presented the case: ______________________
Comprehensive diagnosis: ______________________________________
Important issues discussed:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

75

EPIDEMIOLOGY EXERCISE - No. 1


The occurrence of cases of measles for twenty year period is given below:
Year

cases

Year

Cases

1986
1987
1988
1989
1990
1991
1992
1993

107,385
165,432
96,807
46,311
141,109
45,619
88,436
199,382

1996
1997
1998
1999
2000
2001
2002
2003

38,512
46,418
1,74,560
56,480
47,317
140,402
45,519
68,702

1994
1995

50,496
41,482

2004
2005

2,21,506
61,312

By using the above data answer the following questions.


1. Prepare the appropriate graphic presentation.
2. Are there any fluctuations in the disease occurrence? Y/N,
3. If yes, what is the periodicity?

4. What could be the reasons for such periodicity?

5. Name different disease trends.

6. What type of trend is this?

7. What is the practical utility of this data?

76

EPIDEMIOLOGY EXERCISE - No. 2


A screening test was applied on 2000 apparently healthy people. The prevalence of the disease was 10% in
the population. The results of the screening test were as follows:
Disease status
Test result
Positive
Negative
Total

Present
160
40
200

Absent
360
1440
1800

Total
520
1480
2000

1. Calculate sensitivity, specificity, positive predictive value, negative predictive value, and yield of the
screening test.

2. Calculate the positive predictive value and the negative predictive value of the test at a prevalence
of :
1%
20%
Note the changes as compared to 10% prevalence?

77

EPIDEMIOLOGY EXERCISE - No. 3

In 2006 all the school children near Vellore were examined for evidence of leprosy. The procedure
was repeated again in2007. The following were the results.
2006
a.
b.
c.
2007
a.
b.
c.
d.
e.
f.

No. of children on the rolls


No. of children examined
No. of children found to have active leprosy

52,000
48,000
150

No. of children on the rolls


No. of children examined for the first time
No. of active cases among the above
No. of children reexamined
No. of old cases among them i) Active
ii) Inactive
No. of new cases among the reexamined children

54,000
6,000
30
40,000
20
80
40

QUESTIONS :
1.
What was the prevalence of leprosy?.
a)
in 2006
b)
in 2007
2.
3.
4.

What was the incidence of leprosy during2006- 07?.


What preventive measure can be applied to arrest leprosy-transmission in this school?.
Name the states of India which are highly endemic for leprosy.

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78

EPIDEMIOLOGY EXERCISE - No. 4


A one year house to house study in Manimajra PHC area having a population of approximately 35, 000
revealed the following data with respect to tuberculosis :I.
1.
2.

DATA BEFORE THE STUDY HAD STARTED (2005)


No. of deaths showing positive reaction to tuberculin test - 1050.
No. of sputum positive persons - 140.

II.
1.

DATA AFTER THE COMPLETION OF THE STUDY (2006)


No. of new persons showing positive reaction to tuberculin test
(in addition to previous years)
=
350
No. of new sputum positive cases
=
35

2.

In the study period there were 320 deaths from all causes and 32 deaths due to T.B. in the same area.
QUESTIONS:Study the above data and calculate the following :i.
Prevalence of Infection.
ii.
Incidence of Infection.
iii.
Prevalence of Disease.
iv.
Incidence of Disease.
v.
Crude Death Rate.
vi.
Proportional Mortality rate of T.B.
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79

EPIDEMIOLOGY EXERCISE - No. 5


200 newborn children were followed up till their 2 nd birthday to study the incidence of diarrhoea. The
following table shows the distribution of the children according to the number of loose motions per day.
No. of Episodes of Loose motions /
No. of Children
day
1st Year
2nd Year
0
0
40
1
40
80
2
100
60
3
40
15
4
15
3
5
5
2
200
200
QUESTIUONS :
1.
Calculate incidence of diarrhoea:a.
During the 1st year
b.
During the 2nd year
c.
Over all during the first two years of the life.
2.
What type of study is this?.
3.
What are the levels of prevention applicable in this population List 2 measures in each level ?
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80

EPIDEMIOLOGY EXERCISE - No. 6


I.

January
February
March
April
May
June
July
August
Sept.
Oct.
Nov.
Dec.

Measles is endemic in a village as a few cases occur round the year but sometimes incidence
takes epidemic form. The monthly incidence data in the village for 10 years were presented below
since 1992. Draw a Bar Diagram.
1992
4
10
18
16
7
5
3
4
4
4
2
1

1993
2
5
4
6
3
2
1
2
2
1
2
1

1994
1
4
4
5
1
2
2
2
3
4
3
5

1995
5
12
22
18
9
6
5
5
4
2
3
1

1996
3
6
7
7
4
3
4
3
3
2
2
1

1997
1
5
5
4
2
2
2
2
2
1
2
2

1998
2
12
15
15
4
3
3
2
2
2
1
2

1999
2
5
3
3
2
1
1
2
2
2
1
1

2000
2
6
4
4
1
1
1
1
2
1
1
1

2001
2
2
2
1
1
2
1
1
2
1
1
2

2002
3
2
2
1
1
2
1
1
1
1
1
1

QUESTIONS :
1.
Examine the data to delineate the epidemic and endemic behaviour of the measles in the area
(assuming the population has not changed appreciably during the period) by studying (a) secular
trend, (b) seasonal variation (c) cyclic variation.
2.
Have you noticed any deviation in the usual incidence pattern of diseases?. If so, could you explain
reason for the phenomenon?
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81

EPIDEMIOLOGY EXERCISE - No. 7


Village A
5,150

Village B
4,400

Total birth per year

130

150

Total death per year

45

50

Total infant death

11

18

Total maternal death


Causes of Deaths.

01

02

3.
a.

Diarrohea

16

18

b.

Respiratory tract infection

15

12

c.

Tuberculosis

01

02

d.

Accidents

08

10

e.

Heart disease

04

06

f.
4.

Pregnancy and post delivery causes


Morbidity number of cases:

01

02

a.

Diarrohea

150

200

b.

Respiratory tract infection

250

300

c.

Tuberculosis

010

015

d.

Accidents

020

030

e.

Malnutrition

035

045

f.

Heart disease

010

015

g.

Eye problem

020

045

h.

Skin condition

450

650

i.
A.

Others
1,050
Study the above data and calculate the following mortality and morbidity rates.

1.
2.

Total Population (Mid Year)


Vital events :

A.

Crude Birth Rate

B.

Crude Death Rate

C.

Natural Increase(Growth Rate)

D.

Infant Mortality Rate

E.

Maternal Mortality Rate

F.

Cause Specific Death Rate

1,200

B.

Compare the rates with National figures and comment on the health status of the two villages.

C.

Draw suitable diagrams to bring out the comparative features of these two villages.

D.

What priority services you recommend for these villages based on your finding?

82

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83

EPIDEMIOLOGY EXERCISE - No. 8

1.
2.

3.
i.
j.
k.
l.
m.
n.

Total Population (Mid Year)


Vital events :
Total birth per year
Total death per year
Total infant death
Total maternal death
Causes of Deaths.
Diarrohea
Respiratory tract infection
Tuberculosis
Accidents
Heart disease
Pregnancy and post delivery causes

Village - A

Village B

5000

4000

130
45
11
01

150
50
18
02

16
15
01
08
04
01

18
12
02
10
06
02

QUESTIONS:A.

B.

Study the above data and calculate the following mortality


and morbidity rates.
A.
Crude Birth Rate
D.
Crude Death Rate
B.
Natural Increase(Growth Rate)
E.
Infant Mortality Rate
C.
Maternal Mortality Rate
F.
Cause Specific Death Rate
Compare the rates with National figures and comment on the health status of the two villages.

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84

EPIDEMIOLOGY EXERCISE - No. 9


In a village, an outbreak of cholera was reported. On investigation, following was the pattern of cases
reported :
Date
August 2
August 3
August 4
August 5
August 6
August 7
August 8
August 9
August 10
August 11

No. of Cases
03
07
10
12
15
07
05
02
02
01

No cases were reported from August 12-21.


QUESTIONS:i.
ii.

Draw an epidemic curve.


Draw the inference from the curve by answering the following questions:a).
What type of Epidemic has occurred ?.
b).
Can you estimate the incubation period of the disease?.
c).
What is the criteria to decide that the epidemic has stopped?.
d).
How will you provide chemoprophylaxis to the susceptible contacts of the victim?

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85

EPIDEMIOLOGY EXERCISE - No. 10


Ten persons of village Palsora reported to GMCH-32 with history of dog bite. How will you manage
the problem? What steps will you suggest to prevent recurrence of such cases in future?
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86

EPIDEMIOLOGY EXERCISE - No. 11


One case of Acute Flaccid Paralysis was reported at RHTC, Palsora and you are the Medical Officer
incharge there. Suggest suitable measures you will take as a doctor.
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87

Income

Score

76664 & above


3332 -

12

6655.67

10

2499 33323.67

1666

2490.67

999.6 -

1657.67

333.2 -

991.27

< 333.2

Conversion factor is determined by = CPI 4.93


100

Whereas CPI is consumer Price Index. CPI as on Feb. 2010 of Chandigarh


for inducting workers on base 2001 =100, was 169.
So, the modified family income group of kvppuswamys socio-economic
status scale was obtained by multiplying conversion factor with original
income groups.

88

PROBLEM BASED
LEARNING

89

PROBLEMS IN NUTRITION - I
1.

A North Indian vegetarian family of low socio-economic status, living at Ropar has the following
family composition. Prescribe a balanced diet for the family considering all the characteristics
given below, with appropriate and locally available foods, in pre-designed Performa as given
below:

S.No.

Name

1.
2.
3.
4.
5.

Sukhwinder
Amrit
Gurpreet
Jaswinder
Raju

Age

Sex

53
50
27
23
3

M
F
M
F
M

Occupation

Physiological Status

Agricultural Worker
Housewife
Mason
Housewife
-

Pregnancy (II Trimester)


I0 malnutrition repeated
diarrhoeal episodes

S.No.

Names

Cereals
(Specify)

Pulses
(Specify)

Leafy
Veg.

Other
Veg.

Roots & Milk Oil Sugar


Tubers (Specify)

1.
2.
3.
4.
5.
Total
Solution:
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90

PROBLEMS IN NUTRITION - 2

2.

A non-vegetarian family of upper-middle socio-economic status, living at Mohali, has the following
family composition. Prescribe a balanced diet for the family considering all the characteristics
mentioned below, with appropriate, locally available foods, in the Performa.

S.No.

Name

1.
Inderjeet
2.
Rupinder
3.
Harjeet
4
Lavanya
Solution:

Age

Sex

Occupation

Physiological Status

45
35
10
1

M
F
M
F

Manager
Clerical
School Going

Lactating

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91
PROBLEMS IN NUTRITION
-3

3.

A vegetarian family, of upper-middle class socio-economic status, living at Doiwala, has the
following family composition. Prescribe a balanced diet for the family considering all the

characteristics mentioned below, with appropriate, locally available foods, in the Performa. There is
a family history of obesity.
S.No.

Name

1.
Krishan Bhat
2.
Kaushalya
3.
Ravinder
4.
Tara
Solution:

Age

Sex

Occupation

Physiological Status

35
30
5
2

M
F
M
F

Hotel-owner
Housewife
-

(overweight) for age


(overweight) for age

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92

PROBLEM IN NUTRITION - 4
An anthropometric survey done in an under-fives clinic showed the following weights for your
children. With the following data, estimate the nutritional status and classify according to the degree of
malnutrition (if malnourished), according to classification of *Indian Academy of Paediatrics (given
below).
S.No.
1.
2.
3.
4.

Name

Age

Observed Weight

Expected Weight

11 Kgs
11 Kgs
9 Kgs
5 Kgs

12 Kgs
13.5 Kgs
11 Kgs
14 Kgs

Gopal
3 Yrs.
Krishana
4 Yrs.
Ashwath
2
Sumant
4
IAP Classification :
80% of expected weight for age

Normal

71-80% of expected weight for age

I0 Malnutrition

61-70% of expected weight for age

II0 Malnutrition

51-60% of expected weight for age

III0 Malnutrition

Below 50% of expected weight for age:

IV0 Malnutrition

Nutritional Status

Solution:
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93

PROBLEM IN NUTRITION - 5
An anthropometric survey in an Anganwadi Centre showed the following weights for your children.
With the following data, estimate the nutritional status and classify according to the degree of malnutrition
(if malnourished), according to *Gomez classification (given below).
S.No.
1.
2.
3.
4.

Name

Age

Observed Weight

Expected Weight

8 Kgs
12.8 Kgs
10 Kgs
8 Kgs

12 Kgs
13.5 Kgs
14.3 Kgs
12.9 Kgs

Surat
3 Yrs.
Samrat
4 Yrs.
Sarat
4
Prushart
3
Gomez Classification :
90% of expected weight for age

Normal

75-90% of expected weight for age

I0 Malnutrition

60-74% of expected weight for age

II0 Malnutrition

Below 60% of expected weight for age:

Nutritional Status

III0 Malnutrition

Solution:
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94

PROBLEM IN NUTRITION - 6

The following weights and heights were recorded for school children in a school health survey.
Estimate *Quetlet index (Body Mass Index) (given below) and classify the child into normal and
malnourished.
S.No.

Name

Age

Weight in Kg.

Height in Cms.

1.
2.
3.
4.

Sankar
Sruti
Sindhu
Dinkar

7 Yrs
10 Yrs
7 Yrs
8 Yrs

15
27
20
20

112
125
112
117

Quetlet Index =

Quetlet Index

Comment

Weight
---------- 2 X 100 (0.15 and 0.15 - normal, 0.15 - Malnourished)
Height

(Weight in Kgs. & Height in Cms.)


Solution:
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95

PROBLEM IN NUTRITION - 7
In a primary school of a village belonging to hilly region, in medical examination majority of
students show following characteristics: i.

Signs of mental retardation i.e. repeatedly poor school performance, subnormal intelligence.

ii.

Retarded overall physical development i.e. Dwarfism.

iii.

Various grades of swelling in the neck.

iv.

Neuromuscular weakness i.e. muscles weakness in legs, arms, trunk.


During interview with the teacher it was revealed that they consume locally available coarse salt

and mostly brassic group of vegetables i.e. cabbage, cauliflower etc.


After going through the maternal & child health records of health worker, it was found that
incidence of intra uterine death i.e. still birth, abortion was unusually high in the area.
Please offer your comments: a)

What type of health problem are you dealing with?

b)

Enumerate the control measures.

Solution:
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96

PROBLEM ON ENVIRONMENT
EXERCISE - I
A couple has shifted to a metropolitan city and is residing at the heart of city. Presently they were
staying in a town. Both husband and wife are showing symptoms of stress like annoyance, increased
arguments, lack of sleep, loss of appetite, loss of concentration etc. The average daytime noise level is
approximately 50 decibel and in the night it is 35 decibel. How can we help them?
Solution:
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97

PROBLEM ON ENVIRONMENT
EXERCISE - II
Mr. Ramesh is a trained Engineer in a heavy industry. He is exposed to 85-decibel noise level for 8
hours a day. For relaxation at home he watchs TV and enjoy pop music. For last few weeks Ramesh has to
raise the volume of TV and sound system to be able to enjoy.
What is wrong with Ramesh and how can wee help him?
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98

PROBLEM ON ENVIRONMENT
EXERCISE - III
A boy aged 14 years who is the only child in family is brought to your clinic with following
complaints: 1.
2.
3.
4.
5.

Inability to concentrate on studies (failed in Ist terminal examination), though has been a good
student
in last class.
Headache and body ache off & on and sleeplessness.
General examination did not show any abnormality except slight pallor.
The boy is not interested in eating proper meals he likes only fast food.
Family has recently been benefited financially and has acquired all the luxuries of modern timing.
What will be your approach in this case as "a community physician".

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99

PROBLEM ON ENVIRONMENT
EXERCISE - IV
In a family of north India there are four members including head of the family, Mr. Narendra, 45
yrs old, working as a clerk in a govt. office, his wife Gurpreet, 42 yrs old is working as marketing executive
in a multinational company, their son Randhir who is 20 yrs old is preparing for pre-medical entrance
exams (PMET) for last three years and daughter Sumita, 17 yrs old who has just completed 10+2.
Mrs. Gurpreet, leaves her house at 7 o'clock in the morning and returns back at about 9 o'clock at
night. The head of the family comes to you with complaints of palpitation, giddiness, off and on chest pain
and moderate level of stress.
How will you manage the above stated health problem as family physician?
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100

PROBLEM ON ENVIRONMENT
EXERCISE - V
A school health check up was conducted in a govt. primary school situated in colony no. 4,
Chandigarh and it was found out that out of 250 students, 140 were suffering from moderate level of
anaemia. History of passing worms and along with stool examination revealed that 90 students were
suffering from worm infestation.
70% of the students studying in the school belong to low socio-economic status with poor housing
condition.
You are the medical officer incharge of the area, suggest suitable measures to tackle the health
problem at individual level, family level and community level.
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101

PROBLEM ON HOSPITAL INFECTION CONTROL - I


A report is published in a Daily Newspaper that Incinerator installed in your hospital is not being
properly utilized and disposable syringes, I.V sets etc. are being recycled. On investigation you find that
the storage of hospital waste is not being done as recommended by Ministry of Environment under the
Biomedical Waste (Management & Handling) Rules-1998.
As an incharge of the team for hospital infection control, How would you act?
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102

PROBLEM ON HOSPITAL INFECTION CONTROL - II


PBL-1
A superspeciality hospital is producing waste 1.5-2.5kg/bed/day. Due to inadequate staff it is not
being segregated and disposed off by incineration properly. What are the likely health hazard from
inadequate disposal of this waste matter?
PBL-2
You have been appointed as a hospital administrator of this hospital, how will you manage this
matter?
PBL-3
By the system approach, you have come to know that the staff is not trained properly and they are
at risk of suffering all kind of disease associated with contamination by inadequate disposal of hospital
waste. Suggest corrective measures.
PBL-4
You have trained al the staff members, nurses and house keeping persons concerned with hospital
infection but they are not adhering to guidelines. How will you tackle this problem?
PBL-5
Class IV staff employees have gone on sudden strike, how will you handle the situation?
PBL-6
A hospital has good infection control system and there was no case due to inadequate sanitary
measures previously but suddenly during regular medical check up two (2) technicians from department of
Pathology are detected as HIV positive. How will you manage the situation?
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103

CASE STUDY - I
Jyoti is 10 months old. Her mother tells you that she has cough and difficult breathing since 3 days.
Although Jyoti is not eating well she is able to drink. Jyoti has a respiratory rate of 72 per minute and
axillary temperature of 39.4 deg. C. She has no chest indrawing. There is no stridor or wheeze. Her
nutritional status appears normal. Although she resents examination, she is otherwise alert.

a)

List all signs of Jyoti's illness in the space below :


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b)

What is Jyoti suffering from? Give reasons for your decision.


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c)

What laboratory investigations would you like to do ?


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d)

What treatment would you prescribe for Jyoti's illness?


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104

CASE STUDY - II
Mohan is six months old. His mother tells you that Mohan has cough and difficult breathing for the past 2
days. On examination you find his respiratory rate to be 60 per minute and chest indrawing is present.
Mohan's temperature is 39.6 deg. C. Mohan is alert, does not have stridor or wheezing. Mohan is
undernourished but is able to drink.

a.

List Mohan's signs of illness in the space below.


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b.

What is Mohan suffering from ?


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c.

In the space below write the treatment you would prescribe for Mohan.
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When you reviewed Mohan the next day you find his respiratory rate has come down to 50 per minute.
Chest indrawing is still present. He is, however, unable to drink, is excessively sleepy and difficult to wake.
a.

List additional signs which have appeared.


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b.

Would you like to revise your diagnosis at this stage, if so why?


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c.

How would you treat Mohan now?


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105

CASE STUDY - III


Taiji Bai came for her first antenatal visit during the 7 th month of pregnancy. On enquiry it was found that
Taiji was 29 years old, having had five full-term normal deliveries, and the last delivery was eighteen
months back. This time she was feeling tired for the last two months, feeling breathless and could not
perform routine household work, which she could before. She had developed swelling of the feet during
the last one month. The ANM found her pale and she asked her to get admitted. Taiji did not get admitted
because her husband did not take her as there was nobody at home to look after the children. Taiji also said
that she had five normal deliveries at home, there was no checkup that was done, and everything was fine
in the past.
Three days later, the ANM visited her- she had gone into labor and was delivered at home by an untrained
dai. After the delivery of the baby, there was severe bleeding and part of the placenta was still inside. So
the dai told her to go to hospital. Before any transportation was organized Taiji died at home.
Taiji went to visit Dr. Matwankar, a private practitioner in the village at the seventh month. Dr. Matwankar
was interviewed by the Health staff later. He said Taiji was anaemic and so the doctor prescribed iron
tablets and B complex. But her brother said he did not purchase that medicine. Dr. Matwankar also said
that after the delivery of the baby he saw that a part of the placenta inside and so advised Taijis family to
take her to the primary health centre. Due to lack of transport he said the patient died at home. He also
commented that no blood or urine test was done, nor her blood pressure examined because these facilities
were not available.
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106

CASE STUDY - IV
Chanchal, 24 years old, residing at Bhirwadi, was admitted to the District Hospital Alibaug for two months
amenorrhea (no menstruation) with fever and bleeding per vaginum. On enquiry, Chanchal had two full
term normal deliveries - both boys. She had a disturbed marital life. Her husband beat her up regularly
after being heavily drunk. Her mother in - law always supported her husband to beat her and abuse her.
Chanchal left her in law house and went to her parents with both her children. Occasionally; her husband
would visit her. She became pregnant after her husband's last visit: she asked her husband what to do.
Chanchals husband refused to let her have an abortion (MTP) with or without sterilization. Chanchals
mother -in-law wanted her to deliver six children like herself.
Chanchal and her friend, Shobha, went to an ANM for medical termination of pregnancy. The ANM gave
her the district hospital's address. Chanchal's mother took her to a local dai who conducts delivery in the
village, Maltibai (dai) introduced a stick and paste into her uterus and asked her to go home. Chanchal was
bleeding and had fever with chills two days latter. She started getting foul smelling discharge. She went to
Maltibai who told her to wait and observe the problem for a few days more. Meanwhile, Chanchal started
having high temperature, vomiting, and distension of abdomen and breathlessness. The ANM was called
after three days; and advised them to go to the district hospital.
The family went to primary health centre, and no doctor was there. They then went to the district hospital.
The Medical Officer examined the patient. Ampicillin injections were started within 48 hours. Chanchal
became more breathless, stopped passing urine and died.
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107

CASE STUDY - V
Sulochana Gajanand Patel, 17 years old has been married for eight months. Since her marriage , she did not
menstruate.
She started developing swelling of feet since four months for which was the advised to go to Primary
Health Centre for blood pressure, urine check up, etc. Sulochana contacted the ANM only after she got
swelling of the feet.
Her mother-in-law refused to take Sulochana to any institution, as she herself has delivered 10 children and
never seen a hospital. Two days later Sulochana had pain in the abdomen, difficulty in vision and was
irritable. The mother-in-law and realtives thought it was due to evil spirits, so they sent for the person
known for removing evil spirits. He arrived after two hours and performed the rituals for removing the evil
spirits from her. Suddenly the patient had fits. To stop the fit, they put lime, shoes and other items in front
of her nose. But the fits continued for sometime. They went to call ANM who asked them to transfer her to
a PHC. It was night time so they did not get transport. Next day morning, they took her in a cloth stretcher
to the primary health centre. She was found deeply unconscious, with high blood pressure and no urine
passed. There was swelling of the face and Sulochana's leg. The PHC doctor referred Sulochana to the
district hospital.
At district hospital she was treated for five days before Sulochana died.
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108

CASE STUDY - VI
Sumati, aged 31, died in King George Hospital, Luckhnow. She died after delivering a baby. She had five
children. Sumati never visited the sub-centre or primary health centre. Even though the ANM visited
Sumati's village, she never contacted the ANM.
On 30th August 1990, Sumati delivered a baby. Within 24 hours she started bleeding heavily. So Sumati's
relatives carried her to the primary health centre which was three kilometers away on cloth hammock on
their shoulders. But in the primary health centre, Dr. Yadav was not present. So the relatives carried her to
the next primary health centre where they reached at 11.00 p.m. at night. Dr. Srivastava examined Sumati
and advised them to go immediately to the district hospital as there was heavy bleeding and the primary
health centre had no blood transfusion facility. The relatives took Sumati to the District Hospital. There was
no blood available; nor were their any facilities to get the blood. So here again she was referred to
Lucknow. The relatives took her to the railway station where she delivered a dead baby. To save Sumati
they went on King George Hospital, Lucknow. Sumati died within six hours of admission.
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109

CASE STUDY - VII


Saku, 35 years old female had four full term normal deliveries. She was admitted in the primary health
centre as an emergency case due to the inability of the dai and relatives, as well as the local doctor, to
deliver her.
Saku contacted the ANM during the eighth month of this pregnancy. She was given iron folic acid tablet by
ANM and asked to come for blood and urine examination. According to ANM, Saku never felt the need in
all five deliveries so she did not go for investigation and ANC check up.
On 13 July 1991 she started labour pain at home. She was getting very strong pain but could not deliver so
the relative went and called the dai Shantabai. Shantabai came and examined her by putting finger inside
the birth canal without washing. Shantabai went and called private doctor who gave Saku an injection.
After the injection Saku's pain increased and she was screaming with pain but could not deliver the baby.
Then Shantabai told the relatives to take her to primary health centre. There was no transport available in
the village so they carried her on the shoulder to primary health centre, walking for over four hours.
When she reached PHC Saku collapsed. The doctor incharge was not available in the primary health centre
because he had gone for a meeting. The other doctor was on training leave. So the ANM, who accompanied
the 'patient, asked them to go to the doctor in the district hospital.
Relatives requested that the primary health centre vehicle be given for transportation; but it was election
time and the vehicle was not available.
Saku's condition further deteriorated and she died in the PHC without treatment. Post mortem revealed that
the child was dead lying in the abdomen and uterus had ruptured tearing urinary bladder.
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110

STATISTICAL EXERCISE- 1
1.

Test whether there is any evidence of association between jaundice among infants and taking of
contraceptive pills by mothers on the basis of a study results given below:
Mothers on Pills

Infant Jaundice +ve

Infant Jaundice -ve

Yes
No

33
14

24
45

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111

STATISTICAL EXERCISE- 2
From the following data, calculate the crude accident rates of the two factories A and B and also the
standardized (adjusted) accident rate of B taking factory A as the standard. Comment on your results.
Experience
in years
Under 5
5 15
15 25
25 and above
Total

Factory A

Factory B

No. of Workers

No. of Accidents

No. of Workers

No. of Accidents

100
1500
850
20
2500

40
150
37
108
335

1000
500
400
100
2000

300
40
24
6
370

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112

STATISTICAL EXERCISE- 3
Erythrocyte Sedimentation Rate (ESR) of 10 subjects was found :
7, 5, 7, 9, 6, 9, 7, 8, 10, 7
Calculate the Mean, Mode and Median.
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113

STATISTICAL EXERCISE- 4
A Community Health Director observes that exposure to a pesticide results in a higher rate

of

miscarriage. To test the hypothesis regarding exposure and miscarriage, he selects 40 women experiencing
a miscarriage and 160 women experiencing a normal pregnancy from the records of the hospital. The 200
subject were interviewed to determine their prior exposure to the pesticide. The results are summarized as:

Miscarriage
No Miscarriage

Exposed
30
70

Not Exposed
10
90

(i)

Name the study design and calculate the relative odds of exposure to pesticide.

(ii)

Test whether exposure to the pesticide is a risk factor for miscarriage?

Total
40
160

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114

STATISTICAL EXERCISE- 5
The Table below present data on cumulative weight loss from excessive sweating during insulin induced
hypoglycemia for 12 patients treated with propranolol and 11 control patients.

Sample Size
Sample Mean
Sample Standard Deviation

Study Group
N
=
12
__
X1
=
120 g
s1
=
10

Control Group
N
=
11
__
X2
=
70 g
s2
=
8

Using 5% level of significance, test the hypothesis that mean cumulative weight loss differs between two
groups.
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115

STATISTICAL EXERCISE- 6

An epidemiological study was conducted for the association between smoking and hypertension. A total
of 1,000 individuals were surveyed and classified as:

Smokers
Non-Smokers
Total

Hypertensive
120
30
150

Normotensive
280
570
850

Total
400
600
1000

(i)

Name the study design and calculate the prevalence rate of hypertension, if valid, from this

(ii)

Test whether smoking is a risk factor of hypertension.

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116

study.

STATISTICAL EXERCISE- 7

In a hearing survey 246 urban school children, 36 were found with conductive hearing loss and
among
350 villages school children 61 were found with conductive hearing loss. Test whether there is any
evidence that conductive hearing loss is as common among urban and rural school going children?.
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117