Alldiebedie - Commhealth - Essay N Viva PDF

QUOFI NYARKO-PONG JAN 2012
COMMUNITY HEALTH/PUBLIC HEALTH
1. METHODS OF REFUSE DISPOSAL

 Controlled tipping
 Sanitary landfill
 Composting
 Disposal at sea
 Incineration
 Burning
 Disadvantages of crude dumping
 Harbor rodents
 Attract flies
 Bad odor
 Pollute surface/ underground water
 May cause fire outbreaks
2. Methods of health education

 Mass media papers, radios, TV
 Small group discussion
 Drama
 Role plays
 Demonstration
 Film shows
 Disadvantages of mass media
 Need for ability to read or watch TV
 Must be able to buy newspaper
 Information may be misunderstood
 Audience cannot ask questions
3. Social factors affecting fertility in Ghana

 Polygamy  competition
 Need for children to work on farms
 Need for specific sex  usually male
 Value of children in societyprestige
 Child survival increased birth to replace dead ones
 Remarrying of widows
 Ignorance of the consequences of high fertility and births
 Religion may prevent use of FP
4. Objectives of school health education

 To make school children value health as a desirable asset
ALL DIE BE DIE SERIES

 To teach children what they can do as individuals to promote and maintain health
 To promote proper use of health services and sanitary facilities in children
 To prepare the children to be able to carry out these activities
5. Principles of health education

 People stay healthy or become ill often as a result of their own action or behavior
 Successful past experiences enhance the adoption of behavior
 People learn by watching, seeing and doing
 Desire in people to change behavior can be created
 People’s perception can be modified to bring about change
 Social factors such as group approach can influence the adoption of behavior change
6. Double blind study

 An experimental epidemiological study in which neither the experimenter nor the subjects
know the identity of what is being given as a way of eliminating bias
7. Factors influencing size and selection of cohort study

 Size
o Resources
o Ethical issues
o Attrition rate
o Incidence of disease
o Number of variables under study
 Selection
o Prediction of incidence
o Availability of volunteers
o Accessibility of volunteers to study
o Logistics
8. Rodent control at port

 Rat population at port should be very negligible
 Sodium fluoroacetate was used but it’s now abandoned due to its high toxicity
 Rat stop is now used together with other traps to catch rats
 Rat guards must be present in ships, they are on the ropes and prevents rats from crossing
either way
 Inspected ships are to some extent de-ratified for a fee. If de-rating certificate has expired
and the ship is loaded in such a way that no proper inspection can be done, the old one is
extended for a month.
 A de-rating certificate is issued when the ship has been completely rid of rats by gas/
fumigation.

9. The Bamako Initiative

 Adopted by African Ministers of Health in 1987 at Bamako, Mali
 It is a joint WHO/UNICEF strategy being used to achieve the PHC particularly for women and
children in rural communities
 It aims to
o Alleviate the constraints of the public health and to establish a self-sustaining
essential drug scheme at the district level through the creation of the community
revolving fund. It involves drug purchasing and other community projects
o It guarantees the provision of essential drugs to ensure efficient functioning of the
health facilities
 In Ghana, the Bamako initiative is being implemented through the primary health care
essential drug list and the regional door-to-door distribution of drugs to the districts.
10. Methods of food preservation

 Salting
 Pricking
 Drying
 Smoking
 Refrigeration
 Canning
11. Public health importance of rats

 Host fleas and mites which are vectors of plague and marine typhoid respectively both
internationally notifiable diseases as well as Salmonella and Rickettsial disease
 Dropping may contaminate food causing food poisoning
 Urine may transmit leptospirosis
 Bite may cause rat bite fever
 May transmit trichinosis
12. Isolation and quarantine

 Isolation: Separation of infected person(s) from non infected persons for the period of
communicability of the disease
 It is indicated for diseases with high infectivity and mortality and without contaminated
reservoirs
 Quarantine: limitation of freedom of movement of apparently well person who has been
exposed to an infectious disease for the duration of the maximum incubation period of the
disease with the view to prevent transmission
 Presently quarantinable diseases include: yellow fever, plague, typhus, relapsing fever
13. Concept of safe motherhood
 Adopted at the Nairobi Conference in 1987 organized by the WHO and consists of the
following:

o Adequate food for female from infancy to adolescence

o Family planning should be made universally available
o ANC for all pregnant women
o Postnatal care after delivery
o All deliveries must be supervised
o Easy access to facilities in times of emergency with a good referral system
o Adequate PHC
14. Factors to cause rapid decline of fertility in Ghana

 Family planning
 Family life education
 Female education
 Abolition of customs that favor high fertility eg. Early marriage
 Health education to discourage polygamy
 Political commitment to population control
15. Procedures of meat inspection:

 Rest and watering or animals
 Examination of live animals to exclude signs of disease- veterinary officer
 Slaughtering, skinning/burning and dissection
 Examination of internal offal: lung, liver, heart, lymph nodes, spleen, to exclude disease
 Slaughter houses should be fly-proof and the floor must be clean
 There should be periodic medical examination of slaughter house workers
 There should be a sterilizer and isolation room
16. Factors in communicable disease process

 Infective agent
 Source of infection
 Portal of exit
 Mode of transmission
 Portal of entry
 Susceptible host
17. The cold chain

 A system of people and equipment that ensures that vaccines are potent from the time of
manufacture to the time it is used
 How it can be broken:
o Central stores staff may not know the correct ways vaccines are stored
o Vehicle carrying vaccines may break down
o Frequent power cut
o Bad personal attitude towards work

o Improper storage
o Problem of recycling
o Lack of some equipment such as vaccine carrier, cold box, thermometer and
icepacks
o Non adherence to instructions
18. Carrier:
 An infected individual who does not have apparent clinical disease but is a potential source
of infection to others
 Types:
o Incubatory/Precocious: measles, hepatitis, chicken pox. They shortly develop
disease
o Convalescent: have already had the disease. Hepatitis, typhoid fever
o Symptomless carrier: never show disease. Polio, CSM, hepatitis B.
o Chronic carriers: typhoid, hepatitis
19. Components of disease surveillance

 Surveillance is the exercise of continuous scrutiny and watchfulness over the distribution
and spread of a disease and related factors with sufficient accuracy and completeness to
provide basis for control
 Components (3):
o Systemic collection of data
o Collation and evaluation of data
o Prompt dissemination of results to those who need to know for action to be taken
o Diseases under WHO surveillance: yellow fever. Plague, AIDS
20. Diseases with skin or mucous membrane as portal of entry:

 Life cycle
o Skin: onchocerciasis, schistosomiasis, malaria, hookworm, scabies, yaws, loiasis
o Mucous membrane: gonorrhea, syphilis, AIDS, Hepatitis
21. Common complaints with IUCD use:

 Offensive vaginal discharge
 Abdominal cramps
 Excessive menstruation
 Spotting
22. Leaders in community

 Assemblyman
 Priest (offerings, harvests to raise funds)
 Chief – mobilization of the people and levies

 Village development committee chairman

 Head teacher/ master of village school
 Successful business man
23. Malnutrition- causes and prevention:

 Causes
o Inadequate food supplies due to wars, drought, floods and Earthquakes
o Limited purchasing power due to poverty, economic recession
o Poor health knowledge and practices: poor weaning practices, ignorance of proper
nutrition; diseases such as measles, diarrhea
o Certain cultural practices and beliefs
o Lack of specific nutrients in food grown in area eg. Iodine
 Prevention
o Food made available and affordable through grants and loans to boost agriculture
o Revival of economy
o Creation of employment opportunities
o Improving status of women
o Accessible and affordable health care
o Health education on how to improve upon nutritional value of food
o Promoting breast feeding
o Improve weaning practices
o Immunization against measles
24. EPI
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The EPI is a WHO program which assists health authorities to design, implement and
evaluate immunization program, training their health personnel, acquire vaccines and
other essential supplies.
 It is a global strategy with this aim of reducing morbidity and mortality of children by
providing immunization against the childhood killer diseases: TB, Diphtheria, Polio,
Pertussis and Tetanus; and reduce the incidence of the disease by 80%
 In Ghana, yellow fever and CSM have been added, and the target population is children
under 2 years. The schedule is as follows:
o At birth: BCG (0.05ml intradermal), Polio 0(OPV 0)
o 6 weeks: Hib HepB DPT1 (0.5ml sc/im), Polio 1 (OPV1)
o 10 weeks: Hib HepB DPT2, Polio 2 (OPV2)
o 14weeks: Hib HepB DPT3, polio 3 (OPV3)
o 9 months: measles (0.5ml, sc), yellow fever
o Pregnant women: tetanus toxoid
25. Maternal depletion syndrome
 MDS results from having too many children, too closely spaced and too early

 Such women go into pregnancy with nutritional deficits which becomes worse at the
end of the pregnancy
 Such women are overworked, prematurely aged, malnourished, anaemic and prone to
infections
26. Occupational hazard in welding
 Arc eye
 Cataract
 Skin burns
 Retinitis
 Foreign body in eyes
 Electric shock
 Flash burn
27. Health implication of rural-urban migration

 Creation of slum
 Overcrowding
 Poor refuse/sewage disposal
 Spread of communicable diseases
 Overstretch of health facilities
 Unemployment- malnourished
 Social vices: prostitution, substance abuse, alcoholism, teenage pregnancy
 Reduced food production in rural areas
 Breakdown of extended family system
28. Causes of perinatal deaths in Ghana

 (Death from 28weeks of pregnancy to 1st week after birth; perinatal mortality rate
reflects the level of antenatal and obstetric care in a community)
 Causes:
o Prematurity
o LBW
o PIH
o Obstructed labor
o Congenital deformities
o Asphyxia
o Birth injuries
o Cord accidents
o APH
29. Deficiencies of vital events registration in Ghana

 (Vital events refer to the continuous registration of events such as births, deaths,
marriage and divorce. They serve as one of the traditional sources of data to central
government and health services)
 Deficiencies include:
o Large proportions of births and deaths occur in rural communities where
registration centers do not exist
o Ignorance of importance of vital events registration leading to reluctance to
register
o Many marriages are contracted on traditional custom, which are not registered
o Huge costs and long waiting times in divorce proceedings make many marriages
to be dissolved out of court.
o Lack of legislation to enforce vital event registration
o Traditional events which are against report of some vital events eg. Death
before one week
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 Measures to be implemented:
o Birth certificate needed for school, passport
o Death certificate for burial
o Training of TBAs to record births
30. Point source epidemic

 Outbreak of disease due to exposure of a group of people to a common noxious agent
 If the exposure is brief and simultaneous, all the resultant cases develop within one
period after the incubation period of the disease.
31. Advantages and Disadvantages of prospective and retrospective studies

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 (A prospective study is an analytical study in which a group of persons exposed to a
suspected etiological agent (factor) are matched with controls that have not been
similarly exposed. All the subjects are free of the disease under study and are selected
on the basis of exposure and non-exposure)
 Advantages:
o Gives incidence rates as well as relative risks
o Can yield additional information and by products, attributable risk, person years
of risk
o Cause and effect
 Disadvantages:
o Bias
o Expensive
 Large amount of subjects required
 Long follow up
 High attrition rate
 Criteria and methods of diagnosis may change overtime
 (Retrospective study compares cases of disease with persons who do not have the
disease (control) with regard to the presence of some factor in their past experience.
The controls are selected by matching to resemble the cases in all respect except for the
presence of the disease under study
 Advantages:
o Relatively cheap
o Smaller number of subjects
o Relatively quick results
o Suitable for rare diseases
 Disadvantages:
o Incomplete information
o Biased recall
o Difficulty in selection of control
o Gives only relative risk
32. Implication of rapid population growth

 Individual:
o Repeated pregnancy – MDS
o Inability of parent to feed, clothe and shelter children

o Reduced parental supervision – increased school dropouts

 Society:
o Increased social vices (stealing, prostitution, teenage pregnancy, substance
abuse)
o Overcrowding
o Poor environmental sanitation
o Use of resources to provide hospitals, schools, jobs at the expense of
development projects
33. Epidemiology of yaws in Ghana

 Yaws is a water washed disease caused by Treponema pertenue, a spirochete
 It is endemic in Ghana and has an incubation period of 1-3 weeks
 Man is the source of infection, and the source of infection is the moist skin lesions in the
early phase of the disease
 Transmission is by direct person to person contact
 The disease is common in children below 15 years and occurs predominantly in rural
communities where standard of living and personal hygiene are low
34. Measures of spread, location, p-value, sensitivity, relative risk and odds ratio:
 Measures of location: mean, mode, median
 Measures of dispersion: range, standard deviation, variance, percentile
 Characteristics of Gaussian curve: unimodal; bell shaped; mode, mean and median
coincide; depends on mean and standard deviation; area under the curve is unity
 P-value: probability of observing a value as extreme as or more extreme than the actual
value observed if the null hypothesis is true ie. The probability that a given event could
have occurred by chance. An association is considered statistically significant if the p-
value is less than 0.05
 Sensitivity of a test is the ability of a test to identify individuals with the condition ie.{
(true positives)/ (True positives +false negatives) }
 Relative risk = Incidence rate in exposed
Incidence rate in non-exposed
It measures the number of times more an exposed person is likely to develop the
disease as compared to the non-exposed
 Odds ratio is an approximation of the relative risk.
35. Nosocomial infections: factors

 Infections acquired in a hospital
 Host and environmental factors play a part in the development of nosocomial infections
 Host:
o Patients with DM, lymphoma, uremia, burns have a reduced immunity and are
liable to opportunistic infections

o Sick persons exposed to many reservoirs of infections (ie. Hospital staff who are
carriers, patients shedding bacterial from wound)
o Widespread use of antibiotics leading to the spread of resistant organisms
o Invasive procedures such as IV therapy, venepuncture
o The hands and noses of infected health workers serve as portals of exit
o Mode of transmission is by direct contact or airborne
o Reservoirs of water in humidified………… can support the presence of
microorganisms
o Organisms include: staphylococci, streptococci, pseudomonas, serratia
organisms
36. Components of school health

 Clinical:
o Treatment of minor ailments and injuries
o Dental care
o School hygiene inspection
o Physical inspection
o Growth monitoring
o Immunization
 Environmental health/sanitation
 Nutrition/school food program
 Health education
37. Health and social problems of a refugee camp

 Health
o Poor environmental sanitation
o Poor health care facilities
o Overcrowding
o Poor housing
o Inadequate safe water
o STDs
o Malnutrition
 Social
o Theft
o Rape
o Prostitution
o Substance abuse
o Adolescent pregnancy
38. Determinants of health

 (Health is a complete physical, mental and social wellbeing of an individual and not
merely the absence of disease or infirmity)
 Determinants include:
o Hereditary factors
o Environmental factors
 Biological (all living things)
 Social (culture, beliefs)
 Physical (climate, altitude, water)
o Behavior- personal decisions made and effects on choice- lifestyle, sexual
practice, smoking, alcoholism
o Health care system
o Nutrition
o Occupation
o Demography (both a tool and a determinant)
39. Evaluation and supervision

 Evaluation is a systematic way of learning from experience and using the lessons learnt
to improve current activities and promote better planning in the future. It involves
critical analysis of the planning and implementation in health programs
 Significance:
o To improve programs
o To guide resource allocation in current and future programs
o To take decision to continue or stop program
 Supervision is a process in which designated individuals or a group of individuals oversee
the work of others in order to improve on performance. It involves
o Training
o Guidance
o Demonstration
o Checking
o Individual counseling
o (It is not a fault finding process but it is a method of measuring one’s objective
performance according to objectives; individuals who perform well could be
praised to boost the morale of others)
40. Permissive abortion for juveniles

 This may be done in the following situations:
o Pregnancy following rape or incest
o No regular source of income
o Medical disease complicating pregnancy
o Mentally unstable juveniles

41. Arrangements for the orphaned newborn:

 Wet mother to breastfeed the child
 Orphanage
 Adoption
o Adv:
 Can get proper parental care
o Disadv:
 Long, bureaucratic process
 Hospital care
 SOS village
 Orphanage
o Adv:
 physical and emotional need taking care of
o Disadv:
 No breast milk
 No maternal bonding
42. Slow and Rapid sand filtration:

 Both are used in the purification of water. Rapid sand filtration may be used as a pre-
treatment to reduce the load on the proceeding slow sand filter
 SLOW  RAPID
 Size 0.15 – 0.35mm  0.4 – 1.2mm
 Used for high turbid water  For low turbid water
 Slow filtration rate  High filtration rate
 Water stays on filter bed for a very long time  Water stays on filter bed for a short time
 Not used for water under pressure  Can be used for water under pressure
 Removes both pathogens and suspended  Removes only iron, manganese, and suspended
matter matter
 Cleaned by scrapping the top layer  Cleaned by directing high rate air/water back
through filter bed
43. Training and functions of public and community health nurses

 PHN- training
o Entry requirement is a staff nurse midwife
o Train in public health training school at Korle-bu for 1year
 PHN- functions

o Supervision of auxiliary staff

o Maternal and child care (ANC, delivery, immunization)
o Home visiting
o Data collection and report writing
 CHN – training
o Entry requirement of MSLC, O’level, or SSS/WASCE certificate
o Training at one of these four (4) schools: Tamale, Ho, Akim Oda or Winneba for
three (3) years (two (2) years nursing care and one (1) year public health)
 CHN – functions
o Assist the PHN in her duties
o Follow-up of patients
o Health education
o Detection of case in homes
o Immunization
o Growth monitoring
44. Growth spurt, Catch-up growth

 Growth spurt: a sudden increase in the rate of growth in an individual
o It occurs in phases ( 3 phases)
 Infancy: increase in weight, height and head circumference
 Pre-puberty year: increase in height and weight
 Puberty: increase in height, weight, and secondary sexual characteristics
 Catch up growth: During a period of illness or starvation or in low birth weight (LBW)
babies, the rate of growth is slow but after the offending factor is removed, the child
grows more rapidly than usual and catches up towards his original growth curve. This
occurs provided extra food is given.
45. Functions of the district MOH

 Carry out community diagnosis
 Undertake epidemiological survey or research
 Manage a disease control program
 Evaluate a health program
 Investigate epidemics
 Set up and improve surveillance system
 Train staff
 Supervise
 Provide clinical skills
 Mobilize the people
 Write memos
 Write speech for DCE on health issues
 Write annual report

46. Methods for summarizing data

 Descriptive
 Numerical –mean, mode, median, range, standard deviation, variance
 Tabular
 Graphical –histogram, bar chart, pie chart
47. Sampling methods: Multistage, Stratified

 Multistage : this is a form of cluster sampling done in stages. It is obtained from
sampling bigger units, and for the random sampling, the subunits within the bigger units
eg. Few region district from the selected region village from districtheads of
households in village
 Stratified sampling is a form of sampling in which a heterogeneous population is divided
into homogenous units from which a sample can be picked by balloting, simple random
sampling or systematic sampling
48. Herd immunity

 The term is used to express the immunity of a group or community
 It is the resistance of a group to invasion and spread of an infection and is based on the
immunity of the members of the group
 If herd immunity is low, introduction of an infection causes an epidemic
49. Case fatality rate:

 Number of deaths from disease X 1000
Number of cases of disease
 It is frequently used to measure the severity of a disease and the probability of death
among diagnosed cases
50. Center for Health Information Management (CHIM)

 CHIM was established in 1967 as medical records and documentation unit
 Its functions include:
o To provide statistics on morbidity and mortality
o To provide statistics on physical resources, manpower and health facility
utilization
o Provide statistics for management of health services
o To act as a consultancy to provide data for research work
o To provide data for planning and evaluation of health services
 Problems encountered include
o Poor returns from private clinics
o Late returns from regions
o Lack of adequate funding

o Lack of staff
o Inadequate equipment
o
51. Fertility, Fecundity, Nuptiality
 Fertility: the reproductive performance of couples in a population and measure of the
frequency of childbearing amongst the population
 Fecundity: the physiological ability to reproduce. The role of birth in population change
and human reproduction
52. Legal adoption of children in Ghana

 The adoption act was enacted in 1962. It puts the Department of Social Welfare in
charge of handling legal adoption of children.
 Any person who wants to adopt applies to the department stating the age and sex of
the child desired as well as the facilities that will be available to the child
 The following may adopt:
o Any couple
o A single woman
o Age > 25 years
o 21 years older than child
 A single man cannot adopt
 A social worker is sent to the applicants house to review the facilities
 If satisfied with the facilities, the adopted child is sent to the home to live for a trivial
period of 3 months
 During this period the social worker visits regularly to check compatibility
 If satisfied, a report is filed and the legal documents are signed at the High Court
granting the applicant custody over the child
53. Portals of exit of disease

 Respiratory tract: Leprosy, Measles, Meningitis, pulmonary TB, Influenza, Pneumonia,
chicken pox
 GIT: Hookworm, Strongyloides, Ascariasis, intestinal Schisto., Polio, Cholera, Typhoid
 Skin/mucous membrane: Guinea worm, Leprosy, Scabies, Yaws, HIV, Syphilis, Gonorrhea
54. Epidemic, Endemic, Pandemic

 Epidemic: occurrence of a disease in a community in excess of a normal expectancy with
regard to the geographical area, season, and population
 Endemic: habitual presence of a disease or infective agent in a geographical area
o Holoendemic: affects children ,with adults less affected
o Hyperendemic: affects all age groups equally
 Pandemic: occurrence of disease in excess of normal expectancy throughout a country,
continent or the world

55. Zoonosis
 Infectious disease of vertebrate animals which are transmissible to man under natural
conditions eg.
o Bovine TB –cows
o Rabies –dogs, bats, foxes
o Yellow fever – monkey
o Brucellosis- goats, pigs
o Anthrax- cattle, sheep
o Leptospirosis- rodents
o Trypanosomiasis- wildlife
56. Epidemiology of yellow fever

 Yellow fever is an acute infectious disease caused by a flavivirus, the yellow fever virus
 Incubation period of 3-6 days (Intrinsic)
 It is endemic in Africa and South America, with the endemic zone in Africa lying between
latitudes 10°S and 15°N (10 degrees south and 15 degrees north)
 Epidemics occur from time to time with one occurring in Ghana in 1986/87 and 1993 in
Jirapa-Lawra area
 There are two (2) epidemiological forms
o Urban type: Man-mosquito-Man; vector is Aedes aegypti
o Jungle type: Monkey-mosquito-Monkey; vector is Aedes africanus
 These are linked by Aedes simpsoni when it bites man coming into the forest, leading to
the transmission of the disease.
 There is an extrinsic incubation period of 9-12 days in the A. aegypti; once a mosquito is
infected, it remains infected for life.
 Immunity: recovery from yellow fever is followed by lasting immunity. Transient passive
immunity in infants born to immune mothers may persist up to 6 months.
 Control:
o Interruption of pathway of transmission; nursing patients in a mosquito proof
compartment for at least the final 5 days of the disease
o Control of mosquitoes
o Protection of susceptible host- vaccine, booster every 10 years
57. Aedes index

 Proportion of house with breeding sites for A. aegypti in a well defined area
 Index < 1% YF is not of PH importance
 Index > 5% eminent outbreak of YF
58. TB in Ghana
 TB is a major health problem in Ghana

 An annual number of over 32,000 new cases occur with 15,000 deaths
 More than 100000 people are infected yearly with a total of 5% of the population
affected
 The upsurge of TB is attributed to the spread of HIV/AIDS and the emergence of
resistant strains
 The source of infection is the patient with open pulmonary TB, and transmission is by
inhalation of airborne droplets through coughing, sneezing and spitting
 TB control in Ghana aims at early diagnosis and cure of patients using the DOTS strategy.
Ghana’s targets are
o 55% case finding (WHO- 70%) and
o A cure rate of 85%
Case finding is a passive one through patients presenting at health institutions, with
signs and symptoms suggestive of TB.
 In addition, all children are to be given the BCG immunization at birth as part of the EPI
59. Biting habits and control of the black fly, Simulium damnosum
 Habits
o It is the female simulium which bites
o It bites on the trunks and legs during the day
o Biting is most intense during the rainy season
o It has a flight range of 300km
 Control
o Treatment of rivers in endemic areas to kill larvae with biodegradable abate
o Light winged aircrafts are used
60. Life cycles of onchocerca volvulus and wuchereria bancrofti

 Onchocerca:
o adults are found in the subcutaneous tissue. Microfilaria (Mf) are found in the
lymphatic vessels of the cutaneous tissue and tissue of the eye.
o Adult female is ovoviviparous and produces Mf which are picked by the
simulium when it feeds on an infected man.
o The Mf leave the guts of the fly into the thoracic muscle to develop into
infective larva in two (2) weeks
o The then infected vector introduces infective larva into man when it bites. The
larvae matures into adult forms
o The adult worms live for 10 – 15 years while the Mf live for 2½ years.
 Wucheraria bancrofti:
o Adults live in the lymphatic vessels while the Mf are in the peripheral blood.
o Adult females are viviparous and produces Mf which appear in bloodstream
between 10pm and 2am, and 12noon and 8pm

o When mosquitoes bite an infected man, it picks the Mf which escape from their
sheath, penetrate the gut wall and enter the thoracic muscles of the mosquito
where they develop into infective larva in 2 weeks
o When the infected mosquito bites man it injects the infected larvae into the
bloodstream which later gets into the lymphatics
61. Community organization

 Bringing together a number of individuals or groups who work to promote the health of
a community
 The aim is to bridge the gap between available health facilities in the urban and rural
areas
62. Components of a district profile

 Name of district
 Geography
o Boundaries/ location
o Layout
o Vegetation
o Climate
 Population
o Size
o Distribution
o Composition
o Growth rate
 Culture
o Ethic group
o Religion
o Taboos
 Economic activities
 Main occupation
 Educational facilities
 Transport and communication
 Utility services
o Electricity
o Water
 Environmental sanitation
o Refuse and excreta disposal
 Health facilities and manpower distribution
 Local administration
 Cause of morbidity and mortality

63. The WHO

 It is the global body involved in health regulation and is under the UN
 It was founded on 7th April 1947 and has 3 functional bodies
o The secretariat workers at WHO
o World Health AssemblyHealth Ministers of member states
o Executive Boarddirecting authority headed by Director General
 It now has 193 member states and has the following functions:
o Responsible for setting standards as reference for member states
o Provide technical cooperation in health matters of member states
o Global research center for health information through health bulletins and
publications to member states
o Capacity building for health in the form of training and technology transfer
o Resource mobilization for health, both globally and regionally
o Coordination and support of special programs – fertility control, tropical disease
research, AIDS program
 There are six (6) regions, each with a director
 Achievements
o Eradication of small pox
o Oncho control program in West Africa
o Yaws control program
o PHC strategy
64. Sources and protection of rural water
 Sources: wells, rivers, springs, ponds, streams, rainfall
 Protection of wells
o Site at least 30m uphill from source of pollution
o Watertight lining 3m from surface
o Parapet 1m high from ground
o Drainage gutter around parapet to drain waste water away
o Watertight cover
o Bucket anchored to well
65. Training and function of health inspectors

 Entry requirement: O’level, SSS
 Training at School of Hygiene (Korle-bu for 3 years)
 Qualifies after taking the RSA Diploma examination
 Functions:
o Basic sanitary duties
o Meat and food inspection
o Port health duties
o Building inspection
o Vector control

66. Diseases producing ulcer

 Buruli ulcer
 Guinea worm
 Diabetes
 Neurotropic
 Leprosy
 Syphilitic ulcer
 BURULI ULCER
o Caused by M. ulcerans and is a necrotizing ulcer of the skin and subcutaneous
tissues
o Reservoir and mode of transmission of infection is uncertain
o The incubation period is 4 – 10 weeks
o Infection has been recognized in the Ashanti, Greater Accra. Eastern and Brong-
Ahafo regions of Ghana
o The peak season is between September to November
o It is common in children but among adults it is common in females
 Control
o Wide surgical excision of all involved tissues followed by skin grafting
o Rifampicin
o BCG immunization is also giving promising results
67. Levels of disease prevention

 Primary prevention
o It is the prevention of disease by altering susceptibility or reducing exposure to
a susceptible host
o Measures may be:
 General health promotion: good nutrition, environmental sanitation
 Specific: immunization
 Secondary prevention
o Early detection and prompt treatment of diseases to possibly cure the diseases
at the earliest stage of the disease to prevent complications and limit disability
o Early treatment of persons with infectious disease may protect others from
getting the infection (primary prevention) eg. Screening measure such as PAP
smear for ca cervix, blood sugar for DM
 Tertiary prevention
o Alleviation of disability resulting from disease through rehabilitation. This is in
attempt to restore a disabled person to useful, satisfying and self-sufficient role
in society. The major aim is the maximum utilization of the individual’s
residential capacities

o Modern rehabilitation includes medical, vocational and psychosocial

components, calling for a team work
68. Goal and Objective
 A goal is what is to be achieved whiles the objective is the means/ activity or necessary
short term plan, needed to achieve the goal
69. Child survival and developmental revolution

 Child survival and developmental revolution emerged as a result of the high morbidity
and mortality of children in the developing countries from vaccine preventable diseases,
diarrheal diseases and malnutrition
 The aim of the revolution is to improve the survival and development of children in
developing countries
 UNICEF has been the advocate of the revolution and the strategies in use are: (GOBIFFF)
o Growth monitoring
o Oral rehydration therapy
o Breastfeeding
o Immunization
o Food supplementation
o Family planning
o Female education
 In Ghana, mothers are additionally taught malaria prevention. These activities take
place at the CWC
70. Natural history of disease
 Many diseases especially the chronic ones pass through various stages constituting their
natural history
 These stages include: Susceptibility, Pre-symptomatic disease, Clinical disease, and
Disability
 In the stage of Susceptibility, the disease has not occurred but the ground works has
been laid by the presence of factors which favor the occurrence of the disease. There is
however no interaction between the factors to produce pathologic changes
 In the Pre-symptomatic stage, interaction of the factors begins to produce pathologic
changes but overt disease has not yet resulted. The changes are below the level of
clinical horizon
 In the stage of Clinical disease, sufficient anatomical or physiological changes has
occurred to produce recognizable signs and symptoms of the disease
 Severe diseases have residual defects termed disability limitation of a person’s
activities including his psychological role as a parent, etc. The emphasis is on loss of
function and not structural defect.
71. Examples of diseases caused by various agents

 Biological: Salmonella typhoid fever

 Physical: Silica Silicosis

 Chemical: Lead Lead poisoning
 Nutrient deficiency: Vitamin ANight blindness; ProteinKwashiorkor
72. Demographic Transition Theory (DTT)

 The DTT is the most widely accepted theory which explains population change with time
 It states that a population’s fertility and mortality will decline from high to low levels as
a result of economic and social development, but the decline in mortality precedes the
decline in fertility resulting in a rapid population growth during the transition period.
 Four (4) stages have been identified:
o Stage 1: Agricultural society, children needed for farm work and inheritance. No
adoption of modern family planning methods ie. Increased birth rate. But there
are diseases and famine ie. Increased death rate. Therefore a stable population
results
o Stage 2: Advances in sanitation, improved availability and quality of food, water
and shelterincreased life expectancy
 No change in birth rate or increased birth rate from improved
conditions of life ie. increased births +decreased deathshigh
population growth eg. Most developing countries
o Stage 3: urbanization, migration to urban areas, break in traditional patterns,
compared living quarters, women work outside home, increased acceptance of
family planning methods
 Decreased birth rate + decreasing death rate slow growth eg. Japan
o Stage 4:
 Decreased birth rate +decreased death very slow growth
73. UNICEF
 United Nations Children Emergency Fund (UN children’s fund) was established after the
2nd World War. It is not an official UN agency but affiliates to it with its own constitution
and executive board.
 It is financed by voluntary contributions from governments, private foundations and
public donations
 It is concerned with the wellbeing of children and has been committed to improving the
survival of children in developing countries
 It aims to mobilize all groups in societies to be concerned about improving the survival
of children through the widespread dissemination of technologies that can save
children’s lives and improve their wellbeing
 Its programs include GOBIFFF, water and sanitation, malaria control, AIDS control
74. Factors affecting breastfeeding in Ghana

 Educational level of mother

 Occupation of mother and her income

 Cultural practices and values
 Presence/absence of infant formulae
 Mother’s role in society
75. Traditional customs and food habits related to malnutrition

 Discarding colostrums because it is believed to be unclean and cause diarrhea
 Pregnant women not allowed to eat eggs and snails because the child will steal or drool
saliva
 Children with diarrhea not breastfed
 Men given most of family meat prepared, leaving little for mother and child
 Beans not eaten b’cos it gives offensive stools
 Tilapia not eaten b’cos it is believed to cause leprosy
76. Control of an epidemic:

 Define epidemic is the disease clearly in excess of normal expectation regarding area,
season, population and previous incidence?
 Confirm the epidemic
o Review reported cases
o Make clinical diagnosis
o Take sample for confirmation
o Using the diagnostic criteria, differentiate and classify non cases, possible cases,
probable cases and confirmed cases
 Describe the epidemic
o Who is affectedage, sex, occupation, residence
o When is it occurringthe epidemic incidence curve to define point source and
propagated epidemic
o Where is it occurring
 Conduct case control analysis
o Although the descriptive epidemiology provides sufficient information for
immediate control measures to be taken, further analysis may be necessary
using a case control study
 Environmental assessment
o Sample of suspected food or water for detection of toxic substances, fecal
contaminant, etc
o Breeding sites
 Control the epidemic
o Attack source
 Treat cases and carriers
 Isolate cases
 Surveillance of suspects

 Control of animal reservoirs

 Notification of cases
o Interrupt transmission
 Improve environmental and personal hygiene
 Vector control
 Restrict population movement
o Protect susceptible hosts
 Better nutrition
 Personal protection
 Immunization
 Chemoprophylaxis
 Notification
o Report to others involved in healthcare delivery: MOH, RDOH, community
leaders, local government
77. Strategies for implementation of PHC in districts

 Training and using community members as health workers
 Involve community in planning and implementation of health programs
 Inter-sectorial co-ordination particularly between agriculture, education, housing,
sanitation, and water supply.
 Collaboration between governmental and non-governmental agencies, traditional and
private practitioners
 Decentralization of the MOH and strengthening of DHMT and district health system
78. Recognition of certain diseases during meat inspection

 Tuberculosis
o Enlarged lymph nodes
o Caseation with cavitation
o Miliary change
 Taenia solium
o Encysted bladder like larval forms whitish in color with an opalescent
transparency
 Anthrax
o Dark hemorrhagic spleen
o Malignant pustule in skin at different stages of development
o Rapid putrefaction
 Brucellosis
o Enlarged lymph nodes without caseation
o Splenomegaly
79. Storage of vaccines

Freezer (-8°C to -25°C) Fridge (2°C to 8°C)
BCG DPT
Polio TT
Measles CSM
Yellow fever Anti-rabies
Anti-snake
Anti-tetanus
80. Important dates:

 World health day -----7th April
 World population day-----11th July
 World food day-----16th October
 World aged day-----1st October
 World TB day-----24th March
 World AIDS day-----1st December
 World No Tobacco day-----31st May
 National AIDS day-----1st April
 National children’s day-----31st August
 National Diabetes week----- July
 National oral health week----- July
o Family planning-----May
 Leprosy day----- Last Sunday of January (31st January)
 World breastfeeding week-----1st – 7th August
 Malaria awareness month-----March
 World rural (women’s) day-----15th October
 World literacy day-----17th October
81. Important names

 Selwyn Clarkepublic health
 Louis Pasteurgerm theory
 Henry DonantRed cross
 W.T SaundersMFU
 George SaundersTrypanosomiasis, smallpox, yaws
 Edward JennerImmunization against smallpox
 Doll and HillAssociation between cigarette and lung cancer
 Ronald RossMalaria
 James LindVitamin C

 Edwin ChadwickSanitation policy in Great Britain

 Hupley NoguchiYellow fever, T. pallidum
82. Themes of World Health Days

YEAR THEME
1990 A wounded Planet
1991 Should disaster strike, be prepared
1992 Heartbeat, the rhythm of health
1993 Handle life with care, prevent

violence and negligence
1994 Oral health for a healthy life
1995 Global Polio Eradication
1996 Healthy Cities for a Better Life
1997 Emergency Infectious Diseases –

global alert, global response
1998 Safe Motherhood
1999 Active Aging Makes The Difference
2000 Safe Blood Starts with Me
2001 Mental Health: Stop Exclusion, Dare

to Care
2002 Move for Health
2003 Shape the Future of Life: Healthy

Environments for children
2004 Road safety
2005 Make every mother and child count
2006 Working together for health
2007 International health security (Invest

in health, build a safer future)

2008 Protecting health from (the adverse

effects of) climate change
2009 Save lives, Make hospitals Safe in

Emergencies
2010 Urbanization and Health
83. The World Bank

 The World Bank is an NGO affiliated to the WHO
 It is involved in lending funds for development, and assists the health aspect of
development projects such as creation of man-made lakes and large scale irrigation
schemes
 Its programs involving the health sector includes
o Strengthening of management systems
o Health policy formulations
o Development of peripheral health care system
o Training health sector staff
o Establishing strategies for health sector financing
o It is also involved in specific programs such as maternal mortality, malaria,
nutrition and non-communicable chronic diseases
o In Ghana, the World Bank is involved in the structural adjustment program,
rehabilitation of major hospitals, provision of vehicles to hospitals and
programs, provision of corn mill to support weaning food project
84. The TBA box
 Contents
o Cord ligature in spirit
o Soap in container
o 2 bowls of swabs (used and unused)
o Towel
o Brush
o Sterile (boiled) water for cleaning baby’s eyes
o Cotton wool
o Packet of new blades
o Mercurochrome
o ‘Dettol’
o Mcintosh
o Record books (ANC, deliveries)
o Referral cards (Red – emergency, Green – others, Blue – FP)
o ORS
o Contraceptives ( condoms, conceptrol)

85. Accidents in childhood

 Burns from fire, scalds from boiling water or oil
 Cuts
 Fallswounds, fractures from running or climbing
 Poisoning from ingestion of kerosene, petrol, pills, insecticide, rat poison
 Drowning in rivers, lakes, ponds and wells
 RTA
86. Census
 Population census is the total process of collecting, compiling, and publishing
demographic, economic and social data pertaining at a specific time to all person in a
country or defined area
 Uses:
o Satisfactory method of recording the size, distribution and other characteristics
of the population
o Source of primary data for planning, and administration (resource allocation,
parliamentary seats)
o Provides data for projection of future population
o Provides a frame from which samples can be taken
 Limitations
o Only a limited number of questions can be asked
o Can only be carried out at intervals of 10 years because of the high cost involved
o These intervals are too long to satisfy the data requirement especially of
developing countries whose populations are growing and changing fast
o The time needed for processing an entire census is too long to satisfy urgent
requirement for information
 Process
o A population census is a vast undertaking and therefore careful advanced
planning, adequate provision of resources and proper training of enumerators
are needed
o Publicity to educate the population on the exercise
o Census right
 Count
o De factocounting anybody physically present at the time of census
o De jurecounting of normal residence of an area. Normal resident is defined by
the census office; usually 3 months is required
o It is a more suitable count for administrative and planning purposes
87. Water associated diseases

 Water-borne diseases

o Agent of disease carried by water; cholera, typhoid

 Water-based diseases
o Agent as part of its lifecycle in water; schisto., guinea worm
 Water-related diseases
o Developmental stages of the vector require water but the adult does not; yellow
fever, oncho
 Water-washed diseases
o Trachoma, scabies, yaws
88. The social environment

 It is one (1) of the three (3) environments affecting the development of disease
 It is defined in terms of the overall economic and political organization of a society and
of the institution by which individuals are integrated into society at various stages of
their life
 This affects the:
o Technical level of medical care
o System by which medical care is delivered
o Extent of support for medical care
o Level of enforcement of laws controlling health related problems
o Level of acceptance of new health ideas due to the custom, beliefs and cultural
practices against which new health ideas may run contrary
89. The Ghana Medical and dental council (GMDC)

 The GMDC started as the Ghana Medical and Dental Board in 1959 but was converted to
a council in 1974
 It is composed of:
o Selected members by profession
o 6 registered medical practitioners
o 2 registered dental practitioners
o 6 appointed members
o 2 ex-officio members
 The executive officers include a chairman, treasurer and a registrar
 The aim of the council is to protect the general public and the medical and dental
practitioner
 It performs the following functions:
o Prescribe standards of professional conduct
o Responsible for keeping a register of newly qualified doctors
o Uphold and enforce high standard of action by its disciplinary powers
o Ensures good quality training of doctors and dentists in Ghana
90. Importance of pre-testing a questionnaire

 To improve upon the questionnaire

 To test reliability of the questionnaire
 To find out the request rate
 To ascertain the time period needed to administer the questionnaire
 To test the validity of the questionnaire
 To check on the analysis of the questionnaire
91. Primary Health Care (PHC)

 4 tenets
o Health is a fundamental human right
o Health is made or broken where people live and work
o Health is a tool as well as a product of socio-economic development
o Local people are the best agents for their health development
 Elements
o Safe water and sanitation
o Food and nutrition
o Health education
o Immunization
o MCH and FP
o Control of endemic diseases
o Availability of essential drugs
o Treatment of minor illness and injuries
o Mental health
o Dental health
 Success depends on: (Pillars of PHC)
o Political will
o Appropriate technology
o Community participation
o Inter-sectoral collaboration
92. The TBA

 The TBA is a person, usually a woman who has acquired the skills of delivering pregnant
women by working with other TBAs and from their own experiences
 In Ghana and other developing communities , TBAs have been trained and incorporated
into the health services at the community level (level A)
 They belong to the community where they practice and have gained the confidence of
the people
 The training program aims to:
o Improve the technique
o Recognize at risk pregnancies and difficult labor and refer promptly
o To know their limitation

 They are supplied with kits which includes hygienic dressing and basic requirements
93. Parameters used in evaluating the health hazards in a food factory

 Heat emanating from factory machines
 Level of noise
 Nature of floor of the factory
 Regularity of medical examination of factory workers
 Rates of accidents in factory
94. Problems of the aged

 Neglect
 Malnutrition
 Lack of medical care
 Lack of financial resources
 Chronic diseases
 Lack of recreational facilities
 Loneliness
 Solution:
o Free medical care for the aged
o Education of the general public on the need to support their old parents
o Creation of centers where the aged can go and interact with their counterparts
o The pension scheme should be strengthened and expanded to include the
informal sector
o Old people homes for those who do not have families and for the treatment and
rehabilitation of those suffering from chronic diseases and malnutrition
o Involvement of NGOs
95. The Cash and Carry system

 The scheme was introduced by MOH to reinforce user charge collection procedure and
to ensure a more efficient use of financial resources in health institutions
 Under the scheme funds are accumulated to serve as a revolving fund for the
replacement of drugs and other consumables
 It aims at improving the supply of drugs and quality of care
 Problems
o Inability of some patients to pay
o Procurement of low quality drugs
96. Merits and Demerits of Child labor

 Merits
o Money from labor can supplement family income
o Child may acquire vocational skills

o Child may be kept busy from social vices such as drug abuse
o Child may earn money to be able to continue education
 Demerits
o Increase school drop out
o Substance abuse for energy to work
o Lack of respect for parents
97. Null Hypothesis, Statistical significance, Degrees of freedom

 Null hypothesisThis states that samples being compared in an experiment/study/test
are similar and that any difference observed is due to chance and not any factor
 Statistical significancethis is the conclusion that the difference in samples is not due
to chance but other factors leading to the rejection of the null hypothesis.
 Degrees of freedomthe number of variables in a distribution that can be freely
assigned values when the sum of the values is fixed. The degrees of freedom is:
o (rows-1)(columns-1) in the chi-squared distribution, and
o (n1+n2-2) if n1+n2 <30; or assumed to be (n1+n2) if this sum is >30
98. Tools used in demography

 Countabsolute number of population or demographic event in a specified area and
time
 Ratemeasure of frequency of a demographic event in relation to a unit population
over a specified period
 Proportionrelation of one population subgroup to the entire population
 Ratiothe relation of one subgroup of a population to another subgroup in the same
population
 Constantan unchanging arbitrary number eg. 100, 1000, 100,000
99. Occupation with noise as a hazard

 Mining - gold
 Quarry
 Combustion engine mechanics
 Jet engine mechanics
 Textile industries
 Breweries
 Sawmills
100. Septic tank

 Type of body waste disposal usually used on household basis, but may be used
communally
 It is a water tight tank designed to slow down the amount of raw sewage so that the
solid part separates, settles and is broken down by liquefaction and bacterial action

 The septic tank does not purify the sewage, eliminate odor or destroy the matter. The
tank simply conditions the sewage so that it can be disposed of in a sub-surface leaching
system (soak away)
 It should have a liquid volume of not less than 2200L and a detention time of not less
than 12hours
101. Biological oxygen demand

 This is the amount of oxygen expressed in mg/L required for bacterial oxidation of
organic matter
 The BOD is a standard test measure of oxygen taken up in 5 days in water at a
temperature of 20° C
 It is the basic means of determining water contamination
 It is the most important measure of water quality control and sewage treatment
102. Visual aids in health education

 Anything that help people learn through seeing
 They are used to capture the attention of the audience to reinforce health information
 There is the need for interaction and explanation
 Adv:
o Easy to use
o Facilitates comparison between object and ideas
o Allows individuals to see things that cannot be seen
o Provides basis for discussion
o Attracts interest
 Factors to consider in using visual aids include
o Size of the audience
o Type of audience
o Educational level of audience
o The message to be passed on
o Resources available
103. Primary or Formal group

 The primary group comprises of serious minded people derived from the different
localities in the community
 It is concerned with identifying problems in the community and finding solutions to
them
 They set standards for other members of the community to emulate
 Membership is voluntary
104. Crude and standardized death rates

 Crude death rate is a summary rated on the actual number of deaths in a community

 Standardized rates are fictitious summary rates in which the effect of different
composition (age, sex rate) of the population has been removed to permit unbiased
comparison to be made between two populations
 Two methods are used
o Direct method – where the age specific rates of the study population are
applied to a standard population, an arbitrary chosen population. The
standardized rate is then calculate as:
Total number of expected deaths in standard population
Number of standard population
o Indirect method – where the age specific death rate of the standard population
is applied to the study population to obtain the expected deaths in the
population. A standardized mortality ratio is calculated as:
Total observed deaths
Total expected deaths
105. Issues associated with boreholes in rural communities

 Decreased incidence of guinea worm and schistosomiasis
 Some communities are not using it b’cos the water does not taste nice, and is also
difficult to lather (hard)
 Difficulties in maintaining boreholes despite the training of two members of the
community to maintain them
 Requirement of energy to pump water making children and women unable to use.
106. The family tribunal

 It is a tribunal set up to deal with acts of parental irresponsibilities towards the
maintenance of their children
 When a parent refuses to maintain a child, he/she in turn sends him to the tribunal
 The case is tried and the parent instructed to pay regular maintenance which is decided
by the tribunal for feeding, schooling, hospital fees, etc
 In some cases, the tribunal orders the parent’s salary to be decided at source
107. Measures of maintaining food hygiene

 Prohibition of the use of human manure as fertilizer for the cultivation of vegetables
 Regular medical examination of food handlers
 Protection of food from flies
 Sale of food in sanitary environment
 Meat inspection
 Good personal hygiene of food sellers
108. The Ghana Social Marketing Foundation (GSMF)

 Started in 1986 with assistance from USAID

 It is involved in the distribution of contraceptive products, notably panther condoms
and the normest contraceptive pills
 It advertises the use of contraceptive methods, offers health education and councils
clients
 It subsidizes the price of contraceptives to make them affordable to as many clients as
possible
109. Health education methods to improve infant feeding

 Demonstration
 Role play
 Discussion
 Drama
 Film show
 Home visit
110. Factors affecting utilization of urban health services

 Health knowledge of the people in the community
 Beliefs and values
 Physical accessibility
 Financial accessibility
 Quality of care given
 Attitude of health personnel
 Presence of alternative health services
111. Contribution of health education to any public health program

 Creation of awareness and increase in health knowledge
 Motivation of people leading to behavior change
 Involvement of people in program
 Utilization of the services offered by the program
 Generation of thoughts and discussion which may help to bridge the gap between
knowledge and practices
112. Health hazards in occupation

 Farming
o Snake bites
o Infections
o Accidents
o Chemical poisoning
o Byssinosis (“Brown lung disease”/ “Monday fever”)
o Low back pain

 Welding
o Arc eye
o Skin burn
o Flash burn
o Electric shock
o Foreign bodies in eye
o Cataract
 Fishing industry
o Drowning
o Accidents
o Schistosomiasis
o Fire burns (smokers)
113. Planned Parenthood Association of Ghana (PPAG)

 A nonprofit making voluntary organization established in 1967 with the aim of
o Assisting national efforts in improving the quality of life of the population
o Promoting the physical and mental health of families especially women and
children
o Offering advice and guidance on problems of sub-fertility and infertility
 Membership is open to all persons 10 years and above
 It is a full member of the International Planned Parenthood Federation
 They provide FP information, education and services in the country to supplement the
government FP programs
 They are involved in health education in schools
114. The DHMT (DISTRIC HEALTH MANAEMENT TEAM)

 Composition
o DMOH
o SMO in charge of district hospital
o District PHN
o District nutrition officer
o District disease control officer
o District health inspector
 Functions
o To plan the district health program
o Supervise the sub-district and monitor their progress
o To offer technical advice to the sub-districts
o To provide in-service training for sub-district staff
o Coordinate with other sectors important in healthagriculture, education,
water and sewage corporation, communications

115. Weaning
 It is the introduction of food other than breast milk to the child
 It is important because breast milk alone is inadequate for optimal growth of the child
after 4 months
 The time to start weaning is 4 – 6 months
 The weaning period is critical because the child is introduced to food which may be
contaminated or inadequate in quality and/or quantity
 Many infants develop diarrhea and/or lose weight during this period
 Factors affecting weaning
o Mother
 Education
 Beliefs
 Occupation
 Income
 Role in society
 Time spent with child
o Food
 Types
 Availability
o Influence by other people
 Mother-in-law
 Mother
 husband

END OF CLERKSHIP VIVA
DEPARTMENT OF COMMUNITY HEALTH
 What is sampling?
o The method of selecting a representative group of a population as the basis of a survey.

 What are the scales of measurement and describe them?
o Nominal scale – refers to a scale of measurement in which objects in a variable are
assigned name or labels, there is no inherent order. Mode is possible but not mean or
median. Standard deviation does not exist. E.g. sex, blood group (A, AB, O and B)
o Ordinal scale – in which objects in the variable are assigned labels or numbers such that
there is an inherent order and can be ranked, however intervals between them is
meaningless. E.g. good, better, best, the rank of a horse race etc. MODE and MEDIAN
but not mean. QUARTILES and PERCENTILES can be obtained but not standard deviation
o Interval Scale – in which objects in the variable are assigned numbers with features of
ordinal scale and equal differences between measurements connote equivalent
intervals and the zero point is arbitrary. E.g date, temperature. MODE, MEDIAN AND
MEAN, SD possible
o Ratio Scale – in which objects in the variable are assigned numbers with features on
interval however a definite zero point. E.g. mass, length etc. all measures of central
tendency and variation are possible.
 Discuss natural history of disease
o Stage of Susceptibility – there is exposure to the risk factors of the disease however,
pathological process heralding the commencement of the disease haven’t began. E.g.
smoking, obesity
o Stage of Pre-Symptomatic Disease – pathological process of disease is initiated due to
adequate exposure to the risk factors. However changes are subtle to produce
symptoms. E.g. artherosclerosis
o Stage of Clinical Disease – in which pathological process results in significant disruption
in anatomical and physiological function hence signs and symptoms of disease is
recongnizable. E.g. heart attacks or hypertension.
o Stage of Disability - there has been a residucal defect either anatomically or
functionally after the disease has ran its course. It may result in death. E.g. blindness in
oncho, paralysis in stroke. Rehabilitation is required.
 Discuss the levels of disease prevention

o Primary Prevention – interventions to prevention the acquisition of the disease. (alter
the susceptibility of the host and reduce exposure).E.g. health promotion,
chemoprophylaxis, immunizations
o Secondary Prevention – interventions to detect the disease at an early stage and treat
appropriately to prevent disability and compliaitons. E.g. management of hypertension

o Tertiary Prevention – interventions to rehabilitate and alleveiate disability resulting

from disease.
 What is cysticercosis
o Infection due to the larval stage of Taenia solium. It is due to ingestion of contaminated
food or water containing the ova of T. solium. Larvae from the ova penetrate the gut
wall and encyst in the subcutaneous tissues, muscles and brain.
 What is ratio, proportion, doubling time, balancing equation, urbanization, metropolitan area?
o Ratio – relation of one population sub-group to another population sub-group. E.g. sex
ratio, dependency ration
o Proportion - type of ratio in which the numerator is included in the denominator. E.g.
proportion of males in a population.
o Doubling Time – the time it takes for a given population to replace itself completely or
double its size given the current population growth rate. = 70 / popn growth rate
o Balancing Equation - Popn Change = Natural increase + Net Migration
o Urbanization - denotes redistribution of populations from rural to urban settlements.
o Metropolitan area?
 What is sewerage?
o A method of liquid and human excreta waste disposal in which all drainage systems are
connected by a network of pipes or sewers to a treatment plant.
 Give the various methods of sanitary sewerage disposal
o Pit latrines
o KVIP
o WC
 Give the properties of a Gaussian curve
o Bell shaped
o Mean, mode and median coincide
o Area under the curve is 1
o Symmetrical
o Mean + 1SD = 68%
o Mean + 2SD = 95%
o Mean + 3SD = 99.7%
 What is the difference between a Gaussian curve and a normal curve? – the same
 What is sample survey?
 What are the types of sampling?
 Sampling frame and sampling fraction?
o Sampling frame – the entire list of all sampling members or units in the population from
which the sample is to be taken.
o Sampling fraction – sample size/popn size
 Describe systematic random sampling
o
 Components of school health
o Clinical
 Medical inspection
 Dental care
 Immunization

 Treatment of minor illness

 Growth monitoring
o School Environment and Food Hygiene
o Health Education
o Nutrition
 What is epidemiology
 What is demography
 Types of epidemiology
 What is a zoonotic disease? Give 6 examples
 What is food poisoning? What are the types?
 What is cyclical change?
 What species of schistosomiasis do you know of? What is the life cycle?
 What is the life cycle of yellow fever?
 As the DDHS, what will you do in a suspected cholera outbreak?
 Spell epidemiology. Why the need for epidemiology? What are the epidemiological tools?
 Who are your heroes in community health? Who is Garland PJ Grant? Who was John Snow?
 What are the measures of central tendency? Define each one.
 What is the public health importance of festivals?
 What is the plasmodium cycle?
 You went to Akosombo where there were a lot of goitre cases. What accounts for this and what
should be done?
 As DDHS, you want to give health education on iodated salt. Which groups of people will you call
and how will you go about the health education?
 A lot of RTAs are found among the ages of 18-24 years. It has been advocated that issuing
driving licences to these age groups should be stopped. Do you agree?
 What is the public health significance of buruli ulcer?
 As the DMOH, three successive cases of diarrhoea come to your consulting room. What will you
suspect and what will you do?
 What is sabin? What will you do if you suspect a case of polio? What strategies are being put in
place in Ghana to eradicate polio?
 How will you manage a case of cholera? Give the history of cholera in Ghana.
 Do you think the Ankaful rotation for medical students is necessary? Give the cardinal signs of
leprosy. How will you do a laboratory test for leprosy?
 CARDINAL SIGNS
o Anaesthetic skin patch or macule
o Enlarged or tender peripheral nerve with sign of peripheral nerve damage
o Presence of AFB on Slit Skin Smear
 LABORATORY TESTING FOR LEPROSY IS THE SSS

o Skin specimen is taken from the 2 ear lobes, the eyebrow, the elbow, the knee and
buttocks for a new patient but for follow up cases an ear lobe, eyebrow, knee, elbow
are taken.
o Rub these sites with methylated spirit.
o Pinch the area for about 1 minute to inflict numbness and to render the area bloodless.
o Using a sterile scapel blade, an incision is made into the skin and the smear of tissue is
taken using the scapel blade.
o After each slit skin smear performed, smears are made on the slide at 6 locations on the
slide.
o Heat the slide on which tissue is smeared to fix it
o Add carbol fuschin dye, heat until vapour and wait for 15 minutes.
o Add sulphuric acid (1% HCl in 70% alcohol), wash off the sulphuric acid
o Add 1% methylene blue. Wait for 5 mins.
o The slide is then viewed under the microscope.
 What is fertility, fecundity, total fertility, crude birth rate? What are the figures for Ghana?
o Fertility – refers to the actual reproductive performance of males, females or couples in

a population.
o Fecundity – refers to the physiological capacity to participate in reproduction.
o Total Fertility – refers to the number of children a woman will have if she were to
conform to ASFR of the population. – 4
o Crude Birth Rate – = total births/mid year population * 1000 = 30.5 per 1000.
 What is the core of community health?

o
 What is an epidemic? In your district, what attempts are made to prevent an epidemic?
o Epidemic is the occurrence of a disease in excess of normal expectation in terms of the
existing prevalence.
o At my district the following is done to curb epidemic
 EPI – immunization of children
 Environmental sanitation controls like
 Meat inspection
 Food hygiene measures
 BOTH liquid and solid waste disposal
 Provision of potable water
 Proper human excreta disposal
 Surveillance by Disease control officer to pick up epidemic prone disease.
 What is surveillance? Have you heard about the integrated approach to surveillance of disease?
What is it?

o Surveillance is the continual scrutiny of all aspects of occurrence and spread of disease
that are pertinent to the control of the disease.
o
 I am the manager of SIC. Convince me that occupational health is of benefit since it will cost my
company money to establish it.
o In the short term is expensive but in the long term is cost effective. – in that it reduces
litigation and compensation cost
o It is the legal right of every employee
o A healthy and happy worker translates into productivity and profitability of the
company. – i.e. improves morale and motivation of staff, reduces absenteeism.
o It will enhance the corporate image of the company
o Better employee – industrial relation
 What are the causes of RTA in your hometown?
 What are the differences between tuberculoid leprosy and lepromatous leprosy? What organs
can leprosy affect? What measures will prevent further eye damage to the eye in a leprosy
patient with eye involvement?
o Difference between tuberculoid and lepromatous leprosy

 Tuberculoid – cell immunity is intact, lepromatous – cell immunity is
compromised
 Tuberculoid – early nerve involvement, lepromatous – late nerve involvement
 Tuberculoid – lesions have defined borders, lepromatous – lesions have ill
defined borders
 Tuberculoid – nil or zero BI, lepromatous – BI is 5 – 6
 Tuberculoid – surface is dry and rough, lepromatous – surface of lesion is
smooth and shiny
 Tuberculoid – mucous membranes not affected, lepromatous – affects mucous
membranes.
o Leprosy affects: the eyes, the nose, the peripheral nervous system, skin
o Management of eye complications in leprosy
 Eye complications – lagothalmous, corneal anaesthesia
 Encourage patient to attempt blinking regularly – for instance every
time you see a tree, blink – this enables lubrication of the cornea
 Regular inspection of the eye for foreign bodies – every night
 Irrigation of the eyes with water 2x dly
 Advice patients on the signs of eye infections – red eye
 Wearing of protective glasses
 During sleep ask the patient to cover the eye with a piece of cloth if
lagothalmous.

 What is a communicable disease? What communicable diseases can one get through water?
o Communicable disease is a disease that is transmissible from an infected person to a
susceptible host either directly or indirectly.
o Communicable diseases via water:
 Cholera
 Typhoid fever
 Schistosomiasis
 Dracunculiasis
 Give the life cycles of the following and their symptoms: guinea worm and schistosomiasis.
o read
 Leprosy: definition, mode of transmission, classification, care of the eyes and differential
diagnosis
o Leprosy is defined as a mild chronic infectious disease of man affecting the skin and
peripheral nerves caused by Mycobacteria leprae.
o Mode of transmission
 By air-borne droplets (100 million bacilli from nasal secretions in those with MB)
 Indirectly – tattoo needles, insects(not significant)
o Ridley – Joplin classification
 TT – epitheloid cells and lymphocytes predominate
 BT
 BB
 BL
 LL – macrophages predominate
o Madrid Classification
 T
 B
 L
o WHO classification
 PB
 MB
 Difference between maternal mortality rate and maternal mortality ratio.

o Maternal mortality rate = maternal deaths/WIFA * 1000
o Maternal mortality ratio = maternal deaths/ Live Births * 100,000
 Maternal death is the death of a woman during pregnancy or 40 days after the
termination of the pregnancy irrespective of the site of the pregnancy due to
complications relating to or aggravated by the pregnancy, or due to its
management (omission or commission) but not due to incidental and accidental
causes.
 Common causes of maternal mortality.
o Medical causes
 Haemorrhage (APH, PPH)
 Eclampsia
 Abortion complications – septic abortion
 anaemia

o Social-Cultural causes – 3 delays

 Delay in taking decisions to seek help
 Delay in transportation to the nearest health centre
 Delay at the health facilities and staff attitudes
 Low level of female education and empowerment
 Malnutrition
 FGM
o Infrastructural causes
 Poor road and transportation networks
 Lack of health facilities with essential obstetric care facilities – poor geographic
accessibility
 Lack of ambulance services
 What is the importance of knowing the following rates with regards to the socio-economic
development of a country: infant mortality rate, under five mortality rate and maternal
mortality rate?
o Infant mortality rate
 Unmet health needs
 Nutritional status – breast feeding and complimentary feeding
 Female education
 Availability of health services and preventive services
 Socio-economic status
o Under 5 mortality rate
 Level of immunization
 Availability of food and good nutrition
 ORS usage
 Clean water availability
 Safety of children’s environment
o Maternal mortality rate
 Health facilities and services available
 Infrastructure – roads
 Female education and empowerment
 Level of nutrition of mothers
 What is food poisoning?

o Food poisoning is simply food borne bacterial gastroenteritis manifesting mainly as
diarrhoea, vomiting with or without abdominal cramps. May result in dehydration.
3 types – infective (presence of organism producing gastro), toxin (ingested food
contain toxin of bacteria) and intermediate (organism produces the toxin in the body
i.e. the bowel causing gastro)
 Which organisms are responsible and what is their mode of transmission?

o Salmonella typhi – ingestion of infected food, contaminated hands
o Cholera – contaminated water, contaminated food, formites

o Staphylococcus aureus – contaminated food with toxin

o Clostridium perfringens –
 Give the life cycles of ascaris, ancylostoma and strongyloides.

Read.
 What is a vector? Talk about vectors in disease transmission giving the scientific names of the
vectors.
o A vector is an arthropod responsible for transmission of an infective agent from an
infected host to a susceptible host either directly or indirectly. The vector may be
mechanical or biological. Mechanical vector is just a carrier of the infective agent from
infected host to susceptible host e.g. housefly and cholera or typhoid. Biological vector –
the infective agent multiplies an goes through its stages of development in the vector
e.g. mosquito and plasmodium, shistosome and Bulinus sp.
o Female Anopheles mosquito, Bulinus sp, Cyclops and guinea worm, yellow fever and
Aedes aegypti
 Talk about the roll-back malaria strategy. Has it been successful so far?
 What is the life cycle of the malaria parasite?

Read
 Talk about water treatment. What is residual chlorine? What is its importance?
o Water Treatment
 Collection
 Aeration
 Flocculation – using alum (aluminium hydroxide)
 Clarification and sedimentation
 Filtration
 Chlorination
o Residual chlorine – refers to leftover of chlorine levels that is aimed at keeping water
bacteria free during its distribution from the production point.
o During the distribution of water from the treatment plant, the water travel several
distance through pipes, however the sterility of these pipe channels cannot be
ascertained. Also, break in pipes allows contamination with soil and several bacteria.
Hence residual chlorine is important to kill of germs contaminating distributed water
peripheral from the treatment point. In cholera outbreaks, the residual chlorine is
increased as a measure of control.

 What diseases result from water contamination?

o Cholera
o Typhoid fever
o Gastroenteritis from coliforms e.g. E. coli
o Amoebiasis – Entamoeba histolytica
o Giardiasis – Giardia lamblia - steatorrhoea
o
 As the DDHS, what measures would you take when there is an outbreak of cholera?
o Isolation and treatment of suspected case
o Case confirmation and notification
o Investigate for the source, disinfect the source and home of case
o Treatment of contact with doxycycline or tetracycline
o Inform the community of an outbreak
o Educate community on personal hygiene practice, eating of hot food, boiling water
before drinking, environmental cleanliness
o Surveillance and prompt treatment and isolation of affected cases.
o Notify environmental division so they ensure environmental hygiene.
o Increase residual chlorine content of water
 What are the modes of transmission of HIV? What advice would you give to the youth?
o Mode of transmission – sexual, blood transfusion, sharing of contaminated needles,
sharp objects with an infected individual.
o Abstenance, Barrier Methods like condoms
Dr. Nimo
 When were the millennium development goals launched? Mention any 4 of them. Do you think
the millennium development goals will be achieved? Give reasons.
o MDGs were launched in 2000
o MDG – 1 : TO ELIMINATE EXTREME POVERTY AND HUNGER
o MDG – 2 : TO ACHIEVE UNIVERSAL BASIC EDUCATION
o MDG – 3 : PROMOTE GENDER EQUALITY AND FEMALE EMPOWERMENT
o MDG – 4 : TO REDUCE CHILD MORTALITY
o MDG – 5 : TO IMPROVE MATERNAL HEALTH
o MDG – 6 : TO COMBAT MALARIA, HIV/AIDS AND OTHER DISEASES
o MDG – 7 : TO ENSURE ENIRONMENTAL SUSTAINABILITY
o MDG – 8 : TO DEVELOP A GLOBAL PARTNERSHIP FOR DEVELOPMENT
 Define DOTS. How is it carried out?

o DOTS – Direct Observed Therapy Shortcourse, the treatment regime for TB worldwide
propounded by the WHO in 1993.
o TB treatment under the DOTS regime has 2 phases i.e. intensive phase and continuation
phase. With intensive phase – drugs are given under supervision on admission in the

hospital by a health worker. For the continuation phase, the patient is referred to a
DOTS centre close to the vicinity where he/she can each day go for the medication.
However this is changing with the institution of CB-DOTS and Enabler’s package.
 Why is TB control difficult? How is TB diagnosed? Which of the TB drugs is not used in HIV/AIDS
patients? Which will you replace it with?
o Why TB control is difficult:
 The surgence of HIV/AIDS pandemic
 Compliance due to long duration of treatment
 Low Case detection rate i.e. of sputum smear positive patient who are
reservoirs of the disease in the human population.
o Thiacetazone – due to risk of severe toxicity in HIV patients
o Other drug considerations in HIV/TB treatment
 Rifampicin – is a hepatic drug inducer hence decreases plasma levels of PIs and
NNRI e.g. efavirenz. Hence to bypass this, the dose of efavirenz is increased
from 600mg to 800mg per dose
 Streptomycin – is used with caution since it is give by IM and there is the risk of
needle stick injury hence the HRZE is advised.
 What is CSM? What is classification of CSM?

o CSM is acute inflammation of the coverings of the brain due to infection with bacterial
organism of public health importance is Neisseria meningitides.
 What are the control and preventive measures?

o Control measures are interventions instituted to bring the prevalence of a disease to a
target that is manageable creating the platform for the initiation of further interventions
to drive the prevalence to a point where it assumes little or no public health
importance. Preventive measures are considered a subset of control measures.
o Preventive measures are interventions put in place to prevent individuals acquiring a
disease.
 What are the 3 main clinical features of HIV?

o Persistent generalized lymphadenopathy
o Persistent intermittent fever
o Unexplained weight loss
 What is leprosy? What are the different types? What are the characteristics of lepromatous
leprosy?
 What is buruli ulcer? What is the cause of contractures in buruli ulcer? What are the types of
mycobacterium?

o Buruli ulcer is a necrotizing ulcerative disease involving the skin and subcutaneous
tissues caused by Mycobacteria ulcerans. The reservoir and mode of transmission is not
known. Highest incidence is from 5 to 14 years. The earliest lesion is a small nodule.
o Cause of contractures in buruli ulcer is the healing of ulcers by scarification across the
joints.
o Control of Buruli ulcer
 Early detection and treatment of case (first line treatment since 2004 –
rifampicin and streptomycin for 8 weeks, second line – wide surgical excision
and antibiotics)
 BCG immunization
 Health education on the earliest lesion detection and early presentation.
 Health system strengthening – to equip doctors with basic plastic surgery
procedures and wound care
 Research.
o Other mycobacteria types are
 Mycobacteria tuberculosis
 Mycobacteria leprae
 Mycobacteria bovis
 What method of contraception will you prefer? Give reasons.
 What are the complications of the IUD? What advice will you give a woman who uses the IUD?
o PAINS; P – Abdominal Pains, A – abnormal bleeding i.e. spotting, menorrhagia and
changing in the menstrual cycle, I – Infections, N – nasty vaginal discharge, S – string
may be missing i.e. device may fall out.
o She should immediately report to the clinic if she’s experiencing offensive discharge
o She should expect spotting and heavy periods
o She should from time to time during her bath check for the string of the IUD.
 What factors are responsible for vitamin A deficiency in northern Ghana?
o Poverty burden is high, mothers don’t have enough to supplement childrens diet with
Vit A containing fruits like pawpaw, mango, green leafy vegetables etc.
o Low female education level
Prof. Ashitey
 How will you explain community health to anyone?

 What is health status? What are the indicators of health status?
 What is maternal mortality? How will you compare the rate for Ghana with that of the advanced
countries?
 What are the causes of maternal mortality? What steps will you take as the DMOH to prevent
these?
o Interventions to reduce maternal mortality
 Prepregnancy i.e. focus on WIFA

 Education on nutrition
 Family planning + male involvement
 Female empowerment and education
 Pregnant women
 Scale up outreach antenatal services and also encourage those close to
health centres and hospitals to patronize the antenatal care. Where
they will receive Fe, SP and TT.
 Education of pregnant women on the warning signs of pregnancy.
 Training and supervision of TBAs to supervise deliveries in the
community and refer promptly cases beyond them
 Liase with the transport and communication department to improve
such facilities in the district, this will eliminate delay 2
 Ensure the existence of essential obstetric care facilities at the nearest
referral point.
 Postabortion care
 Postnatal women
 Encourage regular postnatal clinic visit where she’ll be monitored for
anaemia, restoration of prepregnancy physiology and puerperal sepsis.
 What is demography? What are ‘demos’ and ‘graphy’? List demographic indices.
 What is natural increase? What are the components of population change? What are the types
of migration?
 The prevalence of HIV/AIDS has decreased. What was the previous prevalence and what is it
now? Do you think based on this new prevalence, we are on track? What are the components of
prevalence?
 What district did you go to? Did you meet the DDHS? Who are the members of the DHMT? Did
you meet all of them whilst at the district? Is health care being addressed at the district?
o Members of the DHMT
 DDHS
 DMOH
 DPHN
 DDCO
 DEO
 What is CHPS?
o CHPS is Community based Health Planning and Services a concept adopted by the GHS
and MOH to serve as the means of achieveing the PHC system and a means of making
basic health care services available to the peripheral communities. It was adopted as a
matter of policy and the first phase of implementation took off in btn 1998 – 2000 after
it was piloted in the Kasena Nankana district of the upper west.
o The regions were demarcated into CHPS zones each consisting of 10 – 15 communities.
Each CHPS zone is to have a CHPS compound through which primary health services
would be delivered.
o It thrives on community mobilization, participation and the pooling of local resources as
well as volunteerism.

 What are the aspects of community health?

o Epidemiology
o Demography
o Occupational health
o Biostatistics
o Health management
o Reproductive and child health
o Health psychology and sociology
o Health education and promotion
o Social welfare
 What is management? What is the management cycle? As DDHS, how would you use the
implementation phase to reduce the incidence of schisto?
o Refers to the creation and maintenance of an internal environment in an organization
for individuals to work together in groups to perform efficiently and effectively towards
the attainment of the goals of the organization.
o Management cycle – PIE
o Principles of Schisto control
 Mass chemoprohylaxis with Praziquantal
 Health education
 Vector control
 Provision of potable water and toilet facilities
 The first 2 activities would be assigned to the public health unit to be
undertaken by community health nurses supervised by a public health nurse.
Where they go from endemic townships to give praziquantel to school going
aged children and give health education
 Vector control – assigned to the disease control unit supervised by the district
disease control officer
 Provision of potable water and toilet facilities – collaboration with department
in the district who oversee water issues in the district as well with the ministry
of water, works and housing.
 Communication with each of the groups assigned task is key to harmonizing and
monitoring efforts of each of these departments.
Dr. Amoo + Mr. Avle
 What is epidemiology? What are the methods?

o Epidemiology is the study of the distribution of diseases and injuries in a population and
the factors that influence the distribution.
o Methods include
 Descriptive epidemiology
 Analytical epidemiology
 Experimental epidemiology
 What is incidence rate?
o = no of new cases in a year/mid year popn at risk * 1000
 What is case fatality rate? Name a disease with 100% case fatality rate.

o = no of death in cases / no of cases * 100

 What is sampling? What are the various types of sampling?
 What is sex ratio?
Dr. Asante
 Which is more important, the rights of the HIV positive patient or those of the non HIV patient?
What are the features of HIV/AIDS? What do you do when you suspect someone has HIV?
 What is screening? What are criteria the screening tests? Is it ethical to screen HIV patients
when there is no cure?
o Screening is defined as the presumptive identification of unrecognized disease or defect
in a population by the rapid application of tests, examinations and procedures to sort
out those who have the disease from those who do not.
o Criteria for screening test
 The disease
 Must be a serious disease
 The natural history must be known
 Preclinical stage must be long
 High prevalence of preclinical stage
 The screening
 Test should be sensitive and specific
 Test should be quick and cheap
 Safe and acceptable
 Reliable
 Diagnosis
 There should adequate facilities for confirmatory diagnosis of the
disease
 Treatment
 Effective, safe and acceptable treatment should be available
o Types of screening
 Mass screening
 Multiphasic or multiple screening
 Case finding / Opportunistic screening e.g. antenatal screening
 Targeted screening
 Would you advise your sister to exclusively breastfeed? Do you think it is right to give 3 months
maternity leave and ask mothers to exclusively breastfeed? What are the components of breast
milk? What is the percentage of water?
Prof. Osei
 What is a sample? What methods are there for taking a representative sample? Explain how
they are carried out.
 What is the difference between secular trends and cyclical trends. Give examples of diseases
which follow these trends.

 What are point source epidemics and propagated epidemics?

 What are the measures of central tendency and measures of spread? Define each one.
 What are the features of a normal distribution curve?
 What is family planning? Who is eligible for family planning? What are the different methods
you know of and which one would you advise for a lactating mother?
MY COMMUNITY HEALTH VIVA
 What is the public health importance of RTAs

 What are the sources of information on RTAs in Ghana
 If you were to give a health talk to trotro drivers on RTAs what would you say?
 What are the types of enumeration in a census
 What is the disadvantage of Defacto method of enumeration
 What is sampling
 What are the sampling methods
 How is nutrition assessment carried out in a child
 Describe mid upper arm circumference
 Do you know shyker coding
 What are carriers
 What are the duties of port health officials
 What are quarantinable disease
 Name some quarantinable diseases you know
 Describe the flags in port health
 What are the types of plague
 What is an impairment – give examples
 What is a disability – give examples
 What is a handicap – give examples
 What is incidence rate
 What is prevalence rate
 What is the difference between a ratio and a rate
 Name two intestinal worms that cause anaemia
 Which of the two is worse
 How does one acquire the infection and give the life cycle
 After how long do viable eggs in the soil hatch to produce larvae and what are the
conditions suitable for eggs to hatch into the larvae.
 What is cutaneous larval migrans.
OTHER PEOPLE
 What is a longtitudinal study

 What is the difference between a longitudinal study and prospective study
 What is community mobilization
 What is degrees of freedom and how is it calculated


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Alldiebedie - Commhealth - Essay N Viva PDF

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QUOFI NYARKO-PONG JAN 2012

COMMUNITY HEALTH/PUBLIC HEALTH

1. METHODS OF REFUSE DISPOSAL

2. Methods of health education

3. Social factors affecting fertility in Ghana

4. Objectives of school health education

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5. Principles of health education

6. Double blind study

7. Factors influencing size and selection of cohort study

8. Rodent control at port

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9. The Bamako Initiative

10. Methods of food preservation

11. Public health importance of rats

12. Isolation and quarantine

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o Adequate food for female from infancy to adolescence

14. Factors to cause rapid decline of fertility in Ghana

15. Procedures of meat inspection:

16. Factors in communicable disease process

17. The cold chain

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19. Components of disease surveillance

20. Diseases with skin or mucous membrane as portal of entry:

21. Common complaints with IUCD use:

22. Leaders in community

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 Village development committee chairman

23. Malnutrition- causes and prevention:

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27. Health implication of rural-urban migration

28. Causes of perinatal deaths in Ghana

29. Deficiencies of vital events registration in Ghana

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30. Point source epidemic

31. Advantages and Disadvantages of prospective and retrospective studies

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32. Implication of rapid population growth

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o Reduced parental supervision – increased school dropouts

33. Epidemiology of yaws in Ghana

35. Nosocomial infections: factors

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36. Components of school health

37. Health and social problems of a refugee camp

38. Determinants of health

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39. Evaluation and supervision

40. Permissive abortion for juveniles

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41. Arrangements for the orphaned newborn:

42. Slow and Rapid sand filtration:

 Size 0.15 – 0.35mm  0.4 – 1.2mm

 Used for high turbid water  For low turbid water

 Slow filtration rate  High filtration rate

43. Training and functions of public and community health nurses

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o Supervision of auxiliary staff

44. Growth spurt, Catch-up growth

45. Functions of the district MOH

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46. Methods for summarizing data