COMMERCIAL SEX WORKERS

DEFINITION  Female , male and transgender adults and young people who receive money or goods
in exchange for sexual services ,either regularly or occasionally are called commercial sex workers.

TYPES  Street prostitutes  Bar dancers  Call girls  Escort girls  Road side brothel  Child
prostitutes

HEALTH ISSUES RELATED TO COMMERCIAL SEX WORK  Stigmatization and marginalization . 

Limited access to health and social services .  Increased incidence of sexually transmitted diseases
such as HIV/AIDS . Lack of health promotion programs and funds for improving health of sex workers.

FACTORS INFLUENCING INCREASED HIV PREVALENCE IN COMMERCIAL SEX WORKERS  Significant

legal and institutional discrimination shown on sex workers (male and female) put them in great
struggle to meet their own health and well being needs.  Health service providers do not want to
provide services to sex workers  Law enforcement officials like police most often violate the human
rights of sex workers.  Lack of programs and fundings .

MEASURES TO PROMOTE HEALTH AMONG COMMERCIAL SEX WORKERS  Health education and
information about HIV and sexual health that reaches sex workers, clients and the broader
population.  Access to appropriate medical services , condoms and other prevention tools . 
Policies and laws that reduce sex workers ‘ marginalization and vulnerability to exploitation should be
implemented.

 Social , legal and psychological support should be provided to sex workers. NEW WHO GUIDELINES
1. Prevent discrimination of sex workers . 2. Improve access to health services for sex workers. 3.
Interventions to empower sex workers. 4. Correct and consistent condom use .

SUMMARY  Abortion of female foetus after undergoing a sex determination test is known as female
foeticide .  Dowry system ,preference for a male child, low status of women ,etc become the
reasons for female foeticide . Consequences of which are skewed sex ratio ,female trafficking, rape &
women exploitation.  Many laws are now been enacted to stop female foeticide .  Commercial sex
workers are females , males , trans genders who receive money in exchange of sexual services .HIV
infection is more prevalent in them due to indulging in such work. Measures are now been taken to
improve their sexual health and self esteem.

REFERENCES  BOOK  INTERNET

BIBLIOGRAPHY  Manivannan D Shyamala ; “ Textbook of Community Health Nursing -2” ; Page no.
182-195.  Kumar K.K. Gulani ; “ Textbook of Community Health Nursing (principles &practices)” ;
Page no. 450-59  www.wikipedia.com  www.slideshare.net  www.med.nic.in
PRESENTED BY: Miss. Suchita G. 4th year BSc nursing Community health nursing- ll SJGCOHSCONG,
Karnataka

FOOD ADULTERATION

INTRODUCTION Food adulteration is defined as the addition of some unacceptable things to the
food materials, which ruin the quality of the food for consumption. Despite various measures taken
by the government, spreading awareness about the hazards of food adulteration, it is a prevalent
practice in many countries. Various methods of food adulteration are deployed by the food
industries using various chemical and synthetic substances.

DEFINITION Food adulteration can be defined as “The addition or subtraction of any substances to
or from food, so that the natural composition and quality of food substances is affected. OR
“Adulteration is defined as the process by which the quality of the product is reduced through
addition of baser substance or a removal of a vital element.”

ADULTERANTS • The material that is employed for the purpose of adulteration and the substances
that lower the quality of food, when added to it are called adulterants.

FOOD IS CONSIDERED ADULTERATED IF: A substance that degrades the quality of food or turns it
hazardous is added to it. Cheaper or low quality substance are used as a substitute for whole or a
few ingredients. A constituents of food is partly or wholly taken out, reducing the quality of food.
It’s made presentable with harmful substances or its colour is changed to make it look better.
Anything that depreciates the quality of food is added to or abstracted from it.

Adulterants added to specific food items Milk Fat, starch, water, removal of cream Ice-cream
Cellulose, starch, non permitted colors Coffee powder Date husk, tamarind husk Lentils (Dals) Coalter
dyes, khesari Turmeric powder Lead chromate powder Cereals Mud, grits, soapstone bits

Chilli powder Saw dust, brick powder Ghee Vegetable/plant oils, animal body fat Edible oils Mineral
oils, argemone oils Honey Liquid glucose, invert sugars, high fructose corn syrups Fruits Calcium
carbide, copper sulfate, wax, oxytocin sachharin Fish Formaline

WHY IS FOOD ADULTERATION DONE? Practised as a part of the business strategy. An imitation of
some other food substances. Lack of knowledge of proper food consumption. To increase the
quality of food production and sales. Increased food demand for a rapidly growing population. To
make maximum profit from food items by fewer investments. The inefficiency of government
initiatives to control it.

TYPES OF FOODADULTERATION Intentional adulteration Incidental adulteration Natural adulteration

Metallic adulteration Packaging hazardous Economic adulteration

CONSEQUENCES OF FOOD ADULTERATION Consumer has to pay more money for food of lower
quality and quantity. It can be harmful to health and may lead to death. Prolonged consumption of
such food increases the toxicity in the body. Some adulterated food may affect internal organs
directly leading to heart, kidney, liver and many more organ disorders and failure.

PREVENTION  Checking whether the food samples in the outlets are periodically inspected by the
food inspectors.  Maintenance of the cleanliness of the premises with no infestations.  Checking
the date of manufacture, date of expiry, source of the product, etc.  Checking the inactness of the
package.  Educate the community about the adulteration and cleanliness.  Purchasing ingredients
in a reputed shop.
FOOD STANDARDS Codex Alimentarius International organization for standardization (ISO) AGMARK
Standards Bureau of Indian standards (BIS) Food Safety and Standards Act, 2006 Food safety and
standard authority of India (FSSAI)

1. Codex Alimentarius The Codex Alimentarius Is A Collection Of Internationally Recognized

Standards, Codes Of Practice, Guidelines, And Other Recommendations Published By The Food And
Agriculture Organization Relating To Food, Food Production, Food Labelling, And Food Safety.
Originally Published: 1981 The food standards in India are based on the standards of the codex
Alimentarius.

2. International Organization for Standardization (ISO) ISO is an independent, non-governmental,

International organization that develops standards to ensure the, safety and efficiency of products.
Founded on 23 February 1947 Headquarter- Geneva, Switzerland. E.g. ISO 22000: International
standards on food safety management system.

ISO 22000 ISO 22000 is a certifiable standard that sets out the overall requirements for a food
safety management system. It defines the steps an organization must take to demonstrate its ability
to control food safety hazards and ensure that food is safe for human consumption. ISO published
its revised food safety standard, ISO 22000:2018, on June19, 2018. The previous version was ISO
22000:2005.

3. AGMARK Standards AGMARK’s Expansion Is Agricultural Marketing. Effective since: 1937, 1986
(amended) AGMARK Is A Quality Certification Mark Provided By The Government Of India. Product
category: Agricultural products This Certification Confirms The Quality Control And Hygienic
Condition Of The Food. Certifying agency: Directorate Of Marketing And Inspection

4. Bureau Of Indian Standards National standardization activity started in India in 1947 with the
establishment of the Indian standards institution (ISI). The ISI is an initialism of Indian standards
institution, the name of the national standards body until 1 January 1987, when it was renamed to
the bureau of Indian standards. The bureau of Indian standards act was passed by the parliament in
1986 and BIS came into being on 1 April 1987. A new Bureau of Indian standards (BIS) Act 2016
which was notified on 22nd March 2016, has been brought into force with effect from 12th October
2017. The act establishes the bureau of Indian standards (BIS) as the national standards body of
India.

BIS is the National Standard Body of India for the harmonious development of the activities of
standardization, marking and quality certification of goods. The ISI mark is a standards-compliance
mark for industrial products in India since 1955. The mark certifies that a product conforms to an
Indian standard (IS) developed by the Bureau of Indian Standards (BIS), the national standards body
of India.

5. Food Safety And Standards Act, 2006 The Indian parliament has passed the food safety and
standards act, in year 2006 that overrides all other food related laws: 1.Prevention Of Food
Adulteration Act, 1954 2.Fruit Products Order, 1955 3.Meat Food Products Order, 1973 4.Vegetables
Oil Products (Control) Order, 1947 5.Edible Oils Packaging (Regulation) Order, 1988 6.Milk And Milk
Products Order, 1992

1. Prevention Of Food Adulteration (PFA) Act, 1954 To protect the consumer’s health the
government of India promulgated the prevention of food adulteration act in the 1954 year. The act
prohibits the manufacture , sale and sale and distribution not only adulterated food but also food
contaminated with toxicant or misbranded food. It was amended in 1964, 1976, 1986.

OBJECTIVES To provide pure and wholesome food to the consumer  to protect them from
fraudulent and deceptive trade purchase To prevent the sale of standard foods. To protect the
interest of the consumer by eliminating fraudulent practice.

Administrative Bodies Central committee for food standards Public analyst Food inspector Central
food laboratory

ADULTERATION An article of food shall be deemed to be adulterated : If the article sold by vendor
does not meet the nature , substance or quality demanded by the purchaser. If presence of any
other substance which affects the substance or its quality. If any constituent of the article has been
wholly or in part extracted to affect the quality of thereof. If the article under unsanitary condition
become injurious to health. If the article wholly or in part of any putrefied, decomposed substance
unfit for human consumption. If the article is obtained from a diseased animal.

CONT …… If the article contains poisonous substance which renders it injurious to health. If the
container of the article composed deleterious substance which renders its contents injurious to
health. If any colouring matter other than that prescribed present in the article. If the article
contains any prohibited preservatives or permitted preservatives in excess. If the quality and purity
of the article falls below the prescribed limits. If the quality and purity of the article falls below the
prescribed standard which render its injurious to health.

PENALTIES Minimum 6 months imprisonment with a fine of Rs 1000/- If adulteration leads to
death or critical harm, punishment will be life imprisonment with fire of Rs 5000/- From 1986
amendment, consumers and NGOs are empowered to take samples of food for examination.
Central committee for food standards frames and revises the rules under PFA act. Any food not
conforming to the standards is labelled as adulterated.

2. Fruit Products Order, 1955  The Fruit Products Order 1955, promulgated under Section 3 of the
Essential Commodities Act - 1955, with an objective to manufacture fruit & vegetable products
maintaining sanitary and hygienic conditions in the premises and quality standards laid down in the
Order. The standards have been in force since 1955 by the law of Fruit Products Order, after which
the mark is named, but the mark itself got a mandatory status only after the Food Safety and
Standards Act of 2006. A FPO license is, in fact, necessary to start a fruit processing industry in
India. The agency that develops standards for this purpose and that which issues the mark is the
Ministry of food processing Industries of the Government of India.

• The FPO mark is a certification mark mandatory on all processed fruit products sold in India such
as packaged fruit beverages, fruit-jams, squashes, pickles, dehydrated fruit products, and fruit
extracts, following the Food Safety and Standards Act of 2006.

3. Meat Food Products Order (MFPO), 1973 •. In 1973, Government of India promulgated an Order
to enforce strict quality control on the productio0n and processing of meat food products under
Essential Commodities Act 1955. The main objective is to regulate production and sale of meat food
products through licensing of manufacturers, enforce sanitary and hygienic conditions prescribed for
production of wholesome meat food products, exercise strict quality control at all stages of
production of meat food products, fish products including chilled poultry etc. No person could carry
on business as a manufacturer except under and in accordance with the terms and conditions of
license granted to him this order.
4. Vegetable Oil Products (Regulation) Order, 1998 The earlier two orders: Vegetable oil products
(control) Order, 1947 and Vegetable Oil Products (Standards of Quality) Order, 1975 have been
replaced by a single Order called “Vegetable Oil Products (Regulation) Order, 1998 for proper
regulation of manufacture, distribution and sale of vegetable oil products. The Vegetable oil
products industry is regulated by this order through the Directorate of Vanaspati, Vegetable Oils and
fats, Department of Food, Public Distribution, Ministry of consumer Affairs, and food and public
distribution.

5. Edible Oils Packaging (Regulation) Order, 1998 In order to ensure availability of safe and quality
edible oils in packed at pre-determined prices to the consumers, the central govt. promulgated on 17
September, 1998, an edible oils packaging (Regulation) Order, 1998 under the Essential commodities
Act, 1955 to make packaging of edible oils, sold in retail, compulsory unless specifically exempted by
the concerned state Govt. Edible oils including edible mustard oil will be allowed to be sold only in
packed form from 15 th December 1998. Only oils which conform to the standards of quality as
specified in the prevention of food adulteration act and rules made there under will be allowed to be
packed.

6. Milk And Milk Products Order, 1992 The Government of India had promulgated the Milk and
Milk Product Order (MMPO) 1992 on 9/6/1992 under the provisions of Essential Commodities Act,
1955 consequent to de-licensing of Dairy sector in 1991. As per the provision of this order, any
person/ dairy plant handling more than 10,000 litres per day of milk or 500 MT of milk solids per
annum needs to be registered with the Registering Authority appointed by central Government.
The objective of the order is to maintain and increase the supply of liquid milk of desired quality in
the interest of the general public and also for regulating the production , processing and distribution
of milk and milk products.

6.Food Safety And Standards Authority Of India (FSSAI) The FSSAI has been established under food
safety and standards act, 2006 which consolidates various acts and orders that have until now
handled food related issues. Functions Formulating the regulations to set norms and procedures in
relation to article of food. Formulating policies, procedure sand guidelines to assess and provide
accreditation for food businesses. Laying down procedures and guidelines for accreditation of
laboratories. Supports central and state governments to formulate the policies and rules in relation
to food safety and nutrition.

Data collection regarding food consumption, incidence and prevalence of biological risk and
contaminants in food and foods products, early identification of up coming risks and introduction of
rapid alert system. Creating an information network with public, consumer and local administrative
bodies to provide fast information about food safety and related issues. Provide training programs
for persons who are involved or intend to get involved in food business. Assist with the
development of international technical standards of food, sanitary and sanitary standards . To
provide general awareness about food safety and food standards.
Substance abuse  INTRODUCTION substance use refer to condition arising from the abuse of
alcohol, psychoactive drugs and other chemicals such as volatile solvents. SUBSTANCE SUBSTANCE is
used in reference to any drugs, medication or toxic that shares the potential for abuse.

ADDICTION Addiction is a physiologic and psychologic dependence on alcohol or other drugs of

abuse. ABUSE It refer to maladaptive pattern of substance use that impairs health in a broad sense.

DEPENDENCE  It refer to certain physiological and psychological phenomena induced by the

repeated taking of a substance. TOLERANCE It is state in which after repeated administration, a drug
produce decreased effect, or increasing doses are required to produce the same effect.

DEFINITION OF SUBSTANCE ABUSE  ACCORDING TO R SREEVANI  ‘’Maladaptive recurring use of a

substance accompanied by repeated detrimental effect as a result of continued use’’  ACCORDING
TO DSIM 2000  Substance abuse is define as excessive maladaptive pattern use of any substance like
alcohol, drugs.

TYPES OF SUBTANCE ABUSE Alcohol dependence. Opioids. Cannabies. Sedative and hypnotics.
Cocaine. Caffeine and other stimulants. Hallucinogen. Volatile solvant. Anaesthetics.

ALCOHOL DEPENDENCE SYNDROME  Alcoholism refers to the use of alcoholic beverages to the
point of causing damage to the individual, society or both.  According to this report, around 30% of
total population of India consumed alcohol in the year 2010.

OPIOID USE DISORDER The commonly abused opioids (narcotics) in our country are heroin (brown
sugar) and synthetic preparation like pethidine. The drugs that are injected through needle are
heroin.

CANNABIS USE DISORDER Cannabis is derived from the plant cannabissative, which grows in the wild
all around the world. It is used in various form such as o Bhang o Ganja

COCAINE USE DISORDER Common street name is ‘crack’ it can be administered orally, intranasally by
smoking or prenterally. BARBITURATES These are sedatives and are used for the sedation of
aggevated patients to relief pain.

VOLATILE SOLVENTS These are central nervous system depressants, c ether, common used solvents
are spirit, petrol, chloroform, ether, nitrous oxide, thinner and cleaning fluids. They may cause initial
euphoria and is followed by confusion, disorientation, ataxia, delusion and hallucinations. High
concentration may cause convulsion, coma and death.

INCIDENCE RATE Women who use any kind of tobacco (6.8%) Men who use any kind of
tobacco(44.5%) Women who consume alcohol(1.2%) Men who consume alcohol(29.2)

CAUSES OF SUBSTANCE ABUSE A. BIOLOGICAL FACTOR B. PSYCHOLOGICAL FACTOR C. SOCIAL

FACTOR

BIOLOGICAL FACTOR i. GENETIC FACTOR= Family history of substance use disorder. ii. BIOCHEMICAL
FACTOR= for example role of dopamine and non epinephrine have been implicated in cocaine,
ethanol and opioids dependence

B. PSYCHOLOGICAL FACTOR i. Sense of inferiority. ii. Poor impulse control. iii. Low self esteem. iv.
Desire of escape from reality. v. Pleasure seeking. vi. Sexual immaturity.

C. SOCIAL FACTOR i. Religious reasons. ii. Peer pressure. iii. Urbanization. iv. Unemployment. v. Over
crowding. vi. Poor social support.
MODE OF TRANSMISSION Cannabis is used in several ways. Orally as a, milk based drink called
thandai in commonly use in north india b, Sweet. Smoking as a ,in cigratte b, clay pipes c, water pipes
.

CLINICAL FEATURE i. Alcohol- Malaise. Dyspepsia. Depression. Increase incidence of infection. Deniar
of problem. Anger.

 OPIOID- Apathy. Bradycardia. Hypotension. Subnormal temperature. Insomnia. AMPHETAMINE-

Cardiac failure. panic. insomnia. paranoid hallunatory syndrome.

 COCAINE- pupillary dilatation. trachycardia. sweating. nausea. hypertension. anorexia. seizure.

 COCAINE- pupillary dilatation. trachycardia. sweating. nausea. hypertension. anorexia. seizure.

ALLUCINOGHEN- derealization. illusion. automatic hyperactivity. impairement of judgement.

depersonalization. marked anxiety.

TREATMENT MEDICAL MANAGEMENT DELIRIUM TREMENS TREATING SEIZURE. TREATMENT OF

OPIOIDS. MAINTENANCDETOXIFIXCATION TREATING E OF THERAPY.

PREVENTION OF SUBSTANCE ABUSE PRIMARY PREVENTION. SECONDARY PREVENTION. TERTIARY

PREVENTION.

COMPLICATION A. CARDIOPULMONARY COMPLICARTION arrythmias cardiomyopathy. pneumonia.

Increase risk of tuberculosis. B. GASTROINTESTINAL COMPLICATION chronic diarrhea. esophagitis.
gastric ulcer.

C. HEPATIC COMPLICATION alcoholic hepatitis. cirrosis of liver. fatty liver. D. PSYCHIATRIC

COMPLICATION Depression. Suicide. Multiple substance abuse.