Board 1

Question Set No 4
1. Define health and mention the major determinants of it. Tell five socio-economic
indicators of health.
Health is a state of complete physical, mental and social wellbeing, and not merely the
absence of disease or infirmity.
Health is multifactorial. The factors which influence health lie both within the individual and
externally in the society in which he or she lives. Man may fall victim by disease depends on
a combination of two sets of factors-
i. Genetic factors
ii. The environmental factors to which he is exposed

Only a brief indicators of the more important determinants or variables are:

1. Biological determinants 5. Health services
2. Behavioural and socio-cultural 6. Aging of the Population
3. Environment 7. Gender
4. Socio-economic conditions 8. Other factors

 Socio-economic indicators:
i. Rate of population increase
ii. Per capita GNP
iii. Level of unemployment
iv. Dependency ratio
v. Literacy rates, especially female literacy rates
vi. Family size

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 vii. Housing: the number of persons per room
viii. Per capita “caloric” availability

2. State the epidemiological measurements. Define incidence and prevalence. Tell the
steps of RCT.
The basic tools of measurement in epidemiology are:
• Rates.
• Ratios, and
• Proportions.
INCIDENCE: “The number of NEW cases occurring in a defined population during a specified
period of time”. Incidence=
No. of new cases of specific disease during a given time period
--------------------------------------------------------------------------------------- X 1000
Population at risk during that period

PREVALENCE: It refers to all current cases (old or new) existing at a given point in time, or
over a period of time in a given population.

No. of all current cases (old&new) of specified disease existing of a given point in time.
P.R=---------------------------------------------------------------------------------------------X1000
Estimated population at the same point in time.
RANDOMIZED CONTROL TRIAL (RCT)
Basic steps (Features):
• Drawing up a protocol
• Selecting reference and experimental populations
• Randomization
• Manipulation or intervention
• Follow up
• Assessment of outcome
3. Define antigen and antibody. Tell the different types of immunoglobulins. What is
toxin and toxiod?
Antigen is protein or polysaccharide in nature which when introduced into the body is
capable of inducing an immune response leading to formation of antibodies
Antibody is immunoglobulin (Ig). Types of immunoglobulins-IgG, IgM, IgD, IgA, IgE.
Toxin is a poison of plant or animal origin, especially one produced by or derived from
microorganisms and acting as an antigen in the body. (E.g. Diphtheria toxin, Botulinum toxin)
Toxoid is a toxin of a pathogenic organism treated so as to destroy its toxicity but leave it
capable of inducing the formation of antibodies on injection. E.g. diphtheria toxoid.
4. State the causes of high birth rate in Bangladesh. Mention the criteria of a woman
as an ideal candidate for IUCD.
Factors causing high birth rate/high growth rate:
i. Universality of marriage
ii. Early marriage
iii. Early puberty
iv. Low level of literacy
v. Poor level of living

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 vi. Limited use of contraceptives
vii. Traditional ways of living
viii. Traditional customs & habit
ix. Absence family planning practice
x. Lack of entertainment
The ideal IUCD candidate:
- Who has borne at least one child
- Has no history of pelvic disease
- Has normal menstrual period
- Is willing to check IUCD tail
- Has access to follow-up and treatment of potential problems
- Is in a monogamous relationship
5. Define data. Mention the types and sources of data. What is chlorine demand?
Data is a set of values collected during any type of scientific investigation.

Type of data: a) Qualitative

 Nominal: e.g. sex
 Ordinal: e.g. educational status
b) Quantitative
 Continuous: e.g. height
 Discrete: e.g. parity
Source of data: a) Primary (Survey, Experiment etc.)
b) Secondary (Office records like birth and death registers)
c) Tertiary (Published books)
“The chlorine demand of water is the difference between the amount of chlorine added to the
water, and the amount of residual chlorine remaining at the end of a specific period of contact
(usually 1 hour), at a given temperature and pH of water.”
[Chlorine demand = The correct dose of chlorine - Free residual chlorine]
In other words, it is the amount of chlorine that is needed to destroy bacteria, and to oxidize all
the organic matter and ammoniacal substances present in water.
6. What are the common MCH problems in Bangladesh? What are the stages of
“Maternity Cycle?
MCH problems-
1. Malnutrition
2. Infection
3. Consequences of unregulated fertility/Uncontrolled reproduction
Points Malnutrition Infection Uncontrolled reproduction

1. Adverse  LBW baby  Foetal growth  Increase prevalence of

effects/  Anaemia retardation LBW babies
Health  Toxaemia of  LBW baby  Severe anaemia
hazards pregnancy (Pre-  Embryopathy  Abortion
eclampsia,  Abortion  APH
ecalmpsia)  Puerperal  High maternal
 PPH sepsis mortality
 High mortality  High perinatal

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  High morbidity mortality
 High IMR
 High under-5 death rate
2. Preventive  Direct  Immunization  Integrated family
measures  Indirect -Through EPI planning in MCH care
 Health activities
education
[LBW= Low Birth Weight, PPH= Postpartum haemorrhage, APH= Antepartum haemorrhage,
IMR=Infant Mortality Rate]
The stages of maternity cycle are-
1. Fertilization
2. Antenatal/prenatal period-
(a) Ovum: 0 to 14 days
(b) Embryo: 14 days to 9 weeks
(c) Foetus: 9th week to birth
3. Intranatal period
4. Postnatal period
5. Inter-conceptional period

7. State the dietary goal. Mention the characteristics of mid-day meal programme in
school.
DIETARY GOALS (Prudent Diet)
National Nutrition and Food Policy setting out dietary goal recommended by WHO, are as
follows—
1) Dietary fat should be limited to approximately 15% to 30% of daily energy
intake.
2) Saturated fat should contribute no more than 10% of the total energy intake,
unsaturated vegetable oils should be substituted for the remaining fat
requirement.
3) Excessive consumption of refined carbohydrate should be avoided.
4) Source rich in energy should be restricted as fat & alcohol.
5) Salt intake should not be more than 5 gm/day.
6) Protein provided 10% to 15% of daily intake.
7) Junk foods that provided more calories should be avoided.
Characteristics of mid-day meal
i. Supplementary meal but not substitute to home diet
ii. Should supply at least one-third of the total energy and half of protein
requirement
iii. Reasonable cost
iv. Easy to prepare in school
v. Locally available food
vi. Avoid monotony
8. While you are visiting your grandmother’s house in a village, by magnifying glass
you saw some insects hopping around the cattle shed. Identify the insect and give its
public health importance.
Sandfly. Sandfly causes Leishmaniasis.

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Types of Leishmaniasis
i. Visceral Leishmaniasis (VL)/ Kala-azar
ii. Cutaneous/ mucocutaneous Leishmaniasis

9. What stands for ICDDR,B? What are the health related activities of ICDDR,B?
ICDDR,B stands for ‘International Center for Diarrhoeal Disease Research, Bangladesh’.
Health related activities of ICDDR,B are-
i. Management of patients of diarrhoeal diseases
ii. Research for diarrhoeal diseases
iii. Development, production and distribution of vaccine
iv. Provide international standard laboratory diagnostic facility for people
v. Production of Rice-Based ORS
vi. Provide international standard library facility for research work
vii. Provide health related training to create skilled personnel
10. What are the types of disaster? Mention the points to be considered for Disaster
preparedness and responses.
Types of disaster:
 Natural disaster:
1. Flood
2. Drought
3. Tidal waves
4. Tornado
5. Earthquake
6. Landslide
7. Volcano
8. Tsunami
9. Hurricanes
10. Extreme heat
11. Extreme cold/cold wave
12. Wild fire
13. Excessive rain
14. Disease causing pandemic, such as pandemic influenza, bird flue, anthrax,
diarrhea, cholera, etc
 Man-made disaster:
1. Nuclear accidents
2. Leaks of toxic chemicals
3. Armed conflict/War
4. Riot
5. Famine
6. Explosion
7. Fire
8. Bioterrorism
Management of disaster/Disaster preparedness and responses:
1. Prevention and alleviation of consequences:
a. Forecasting the disaster
b. Ascertaining the risk

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 c. Evacuation of people
d. Exercise to promote community preparedness
e. Improving professional qualities of local health personnel
2. Immediate emergency care
3. Management of the aftermath:
f. Sanitation
g. Health
h. Vaccination
i. Food and nutrition
j. Mental health
4. Rehabilitation and reconstitution