NATIONAL OPEN UNIVERSITY 0F NIGERIA

University Village, Nnamdi Azikiwe Express Way, Jabi, Abuja

FACULTY OF HEALTH SCIENCES
DEPARTMENT OF PUBLIC HEALTH SCIENCE
EXAMINATION QUESTIONS 2021_2
COURSE TITLE: Introduction to Public Health and Primary Health Care(PHS801)
CREDIT UNIT: 2 Units
TOTAL SCORE: 70 Marks
TIME ALLOWED: 1½ Hours
INSTRUCTION: Answer All Questions

QUESTION 1 20 Marks
1a). What are the aims and objectives of public health? (5 marks)
1b).List five (5) roles and functions of the federal ministry of health in the
organization of health services in Nigeria. (10 marks)
1c). Mention at least five functions of local governments as health care providers. (5 marks)

ANSWER
Q1a).What are the aims and objectives of public health?(5 marks)
Answer Q1a)
i. Protection of the general public from the spread of communicable diseases.
ii. Promote physical and mental health
iii. Prevent diseases.
iv. Prevent injuries and disability.
v. Improve health outcomes and health status that can be achieved by work of all as
individually and collectively.(5 marks: 1 mark each)

Q1b). List five (5) roles and functions of the Federal Ministry of Health in the organization of
health services in Nigeria.(10 marks)
Answer Q1b)
i. Formulation of national health policies.
ii. Funds provision for manpowertraining and establishment of specialized training
and research institutions, such as colleges of medicine, teaching hospitals and
research units.
iii. Provision of funds for the ministries of health or health departments at state and
local government levels respectively, either for capital projects, training or
research.
iv. Monitoring and supervision of projects and programmes at state and local
governments levels.
v. Setting of standards of state and local government healthdepartments.
 vi. Organizing tertiary care institutions.(10 marks. 2 marks each for any 5 correct
answers).

Q1c). Mention at least five functions of local governments as health care providers (5 marks)
Answer Q1c.
i. Formulation of policies at local government level.
ii. Recruitment, training, promotion and discipline of staff.
iii. Planning and organizing of primary health care services.
iv. Liaising with state and federal governments on primary health care matters.
v. Enforcement of environmental health laws.
vi. Referral primary health care services.(5marks: 1 mark each for any correct
answer).

QUESTION 2 25 Marks
2a. Public healthfunctions are based on social justice and focus preventive
strategies.What are the strategies? (5 marks)
2b. List ten (10) essential Public health services. (10 marks)
2c.Explain the Social Learning Theory when applied to the theories
in changing health behaviour. (10 marks)

ANSWER
Q2a. Public health functions are based on social justice and focuses preventive
strategies.What are the strategies? (5 marks)

Answer Q2a
The strategies are:
i. Public health prevents epidemics and spread of diseases.
ii. Protects against environmental hazards.
iii. Prevents injuries
iv. Promotes and encourages healthy behaviors.
v. Responds to disasters and assists communities in recovery.
vi. Assures the quality and accessibility of health services.(5 marks.1 mark each for
any five correct answers)

Q2b. List ten (10) essential Public health services.(10 marks)

Answer Q2b
i. Monitor health status to identify community health problems.
ii. Diagnose and investigate health problems and health hazards in the community.
iii. Inform, educate and empower people about health issues.
iv. Mobilise community partnerships to identify and solve health problems.
v. Develop policies and plans that support individual and community health efforts.
vi. Enforcement of laws and regulations that protect health and ensure safety.
vii. Link people with needed personal health services and ensure the provision of health
care when otherwise available.
viii. Assure a competent public health and personal health care workers.
 ix. Evaluate effectiveness, accessibility and quality of personal and population based
health services.
x. Research for new insights and innovative solutions to health problems.(10 marks: 1
mark each for any correct answer) ( Total : 10 marks )

Q2c.Explain the Social Learning Theory when applied to the theories in changing health
behaviour. (10 marks)

Answer 2c
i. Social learning theory (SLT) was developed by Albert Bandura in 1977.
ii. Its evolution was originally from behaviors.
iii. Now it embraces some of the ideas of cognitivists and that is the reason the theory is
also referred to as social cognitive theory.
iv. Social learning theory focuses on the learning that takes place within the the social
context.
v. It asserts that people serve as models of human behavior and;
vi. Some others(significant others) are capable of eliciting behavioral change to certain
individuals based on his value and interpretation system.
vii. It emphasizes the importance of observing and modeling behaviors,attitudes and
emotional reactions of others.
viii. It is likely the most influential theory of learning and development.
ix. SLT is rooted in many of the basic concept of traditional learning theory .
x. The theory added a social component arguing that people can learn new information
and behaviors by watching other people and this is referred to as observational
learning or modelling.
xi. SLT is also known as vicarious or imitation learning which can be used to explain a
wide variety of behaviors in the study observation.
xii. Learning occurred as the student interact withpeers in the schools and communities.
(10 marks: 1 mark each for any correct answer)

QUESTION 3 25 Marks
3a. List five (5) roles the State government plays in primary healthcare.(5 marks)
3b. Mention the role the Federal government plays in in the organization
of primary health care. (10 marks)
3c. At the local government level health workers work as a team not
minding their professional cadre. List the roles they perform in
primary health care. (10 marks)

ANSWER
Q3a.List five (5) roles the state government plays in primary healthcare.(5 marks)
Answer
Q3a
i. Formulation of policies in line with federal government guidelines.
ii. Provision of facilities for training of PHC workers eg establishment of school of
health technology.
iii. Storage and distribution of vaccines to LGAs.
 iv. Provide guidelines for LGA regarding implementation of PHCprogrammes.
v. Promote research activities especially as regards the endemic diseases.
vi. Collaborate withnon-governmental organizations and international health agencies.(5
marks. 1 mark each for any correct answer).

Q3b. Mention the role the federal government plays in in the organization of primary health
care. (10 marks).
Answer
Q3b.
i. Formulation of national policies on primary health care.
ii. Provision of financial support to the state and local government areas for the
implementation of primary health care programmes.
iii. Provision of guidelines on how to implement policies at the state and local
government levels.
iv. Supervision and setting up standards for the training of primary health care workers
and service delivery.
v. Promote research activities.
vi. Collaborate with international health agencies such as world health organization,
unicef etc.
vii. Monitor and evaluate measures for the implementation for the implementation
ofprimary health care programmes at state and local government levels.
i. Provision of vaccines for state and local government NPI.(10 marks: 2 marks each,
for any correct answer)

Q3c. At the local government level health workers work as a team not minding their professional
cadre. List the roles they perform in primary health care (10 marks).

Answer
Q3c.
i. Management of resources to achieve maximum result.
ii. Planning and implementation of primary health care programmes.
iii. Health Education against prevailing health conditions.
iv. Record keeping and data collection for monitoring and evaluation of primary health
care programmes.
v. Liaising with other agencies whose functions are health related (i.e intersectoral
collaboration)’
vi. Training of Traditional Birth Attendants (TBA) to reduce the risks of complications
arising from poor management of cases.
 vii. Evaluation of programmes.
i. Primary health care Referral services. (10 marks. 2 marks for each 5 correct
answers).
QUESTION 4 25 Marks
4a. Identify 4 health theories and discuss any 2 in relation to changing health behaviour.
(10 marks)
4b. Enumerate three (3) problems that can be identified in any community. (3 marks)
4c. If health care coverage is as low as 30 %, it means that the community has no
access to health care facilities, describe 6 appropriate strategies for solving this
problem. (12 marks)

ANSWER

Q4a. Identify 4 health theories and discuss any 2 in relation to changing health behaviour.
(identify(4mks, 1mk each); discuss (6mks, 3mks each) =10mks)

Q4ai. Identify 4 Theories or Models That Explains Health Behavior and Health Behaviour
Change (4marks; 1mark each)
i. Health belief model (HBM)
ii. Social learning theory
iii. Transtheoritical model (stages of change)
iv. Theory of reasoned action
Q4aii. Discuss any two (2) theories (6 marks; 3 marks each)

i. Social Learning theory: The Social Learning theory was developed by Albert Bandura
in 1977. Its evolution was originally from behaviours but it has now embraced some of
the ideas of cognitivists and this is the reason the theory is also referred to as social
cognitive theory (University South Alabama 2011).
ii. Social Learning Theory (SLT) focuses on the learning that takes place within the social
context and asserts that people serve as models of human behaviour and some people
(significant others)are capable of eliciting behavioural change to certain individuals based
on his value and interpretation system.
It emphasized the importance of observing and modeling behaviours, attitudes and
emotional reactions of others.
 iii. Cherry (2008) in an overview of Bandura‟s social learning theory noted that the
theory is likely the most influential theory of learning and development.
Q4b. Enumerate three (3) problems that have bearing with health that can be
identified in any community. (3marks; 1mark each for any 3 correct points)

Problems that can be identified in any community include:

i. Direct health problems such as malaria, diarrhea, hypertension, polio, guinea worm
infestation etc
ii. Indirect health problems such as lack of portable water supply, environmental
insanitation, unhygienic housing conditions, unhealthy habits, uncontrolled vector breeding
and practices etc
iii. Health related problems such as poverty, illiteracy, ignorance, unemployment,
uncontrolled production etc
iv. Service-related problems such as poor health care facilities, untrained staff, inadequate
drug supply, inadequate monitoring and supervision

Q4c. If health care coverage is as low as 30%. It means that the community has no
access to health care facilities, identifysix (6) appropriate strategies for solving this
problem. (12marks; 2marks each for any 6 correct points)

i. Improving access: That is facilities should be closer to the community.

ii. Improving referral system (transportation, communication) should be strengthened
iii. Improving health workers skills: accelerating pre-service and in-service licensing support
and supervision
iv. Improving health system and ensuring constant availability of essential medicines, potent
vaccines in health facilities sustained supervision and referral
v. Improvements in the case management skills of health staff through provision of locally
adapted guidelines for the most common causes of death
vi. Improvements in health system required for effective management of epidemic disease
vii. Improvement in family and community practices
 1

NATIONAL OPEN UNIVERSITY 0F NIGERIA

University Village, Nnamdi Azikiwe Express Way, Jabi, Abuja

FACULTY OF HEALTH SCIENCES

DEPARTMENT OF PUBLIC HEALTH SCIENCE

COURSE TITLE: Principles of Epidemiology I (PHS803)

COURSE UNITS: 2 Units

TIME ALLOWED:1½ hours.

TOTAL MARKS: 70%

INSTRUCTION: Answer all the Questions

QUESTION 125 marks

1a. Differentiate between a Cohort Studies and Case-Control Studies (5 marks; 2.5 marks each)

b. Explain the five procedures generally used in conducting cohort study (10 marks: 2 marks
each)

ci. List5 each of advantages and disadvantages of the cohort design in general (5 marks; 0.5
mark each)

ii. Mention two major types of experimental study designs (5 marks, 2.5 marks each)

Q1a. Differentiate between a Cohort Studies and Case-Control Studies (5 marks; 2.5 marks
each)

Cohort study

 The cohort study design identifies a people exposed to a particular factor and a comparison
group that was not exposed to that factor and measures and compares the incidence of
disease in the two groups.

 A higher incidence of disease in the exposed group suggests an association between that
factor and the disease outcome.
 This study design is generally a good choice when dealing with an outbreak in a relatively
small, well-defined source population, particularly if the disease being studied was fairly
frequent. (2.5 marks)

Case-control study

 The case-control design uses a different sampling strategy in which the investigators identify
a group of individuals who had developed the disease (the cases) and a comparison of
individuals who did not have the disease of interest.

 The cases and controls are then compared with respect to the frequency of one or more past
exposures. If the cases have a substantially higher odds of exposure to a particular factor
compared to the control subjects, it suggests an association.

 This strategy is a better choice when the source population is large and ill-defined, and it is
particularly useful when the disease outcome was uncommon. Examples of two real
outbreaks will be used to illustrate these differences in sampling strategy. (2.5 marks)

Q1b. Explain the five procedures generally used in conducting cohort study (10 marks; 2
marks each)

The procedure for conducting cohort include:

1. Selection of study subjects

2. Collection of data on exposure

3. Selection of subjects for comparison

4. Follow-up

5. Analysis

Explanations

1. Selection of study subjects

 The study subjects are either selected from the general population or are made up of special
groups of people that can be readily studied and have different degrees of exposure to the
etiological factor.
 The general population is studied when the exposure to the risk factor for a health problem is
fairly frequent.
 The study subjects should reside in welldefined geographical, political and administrative
areas. A sample that is representative of the general population may be used if the
population is very large.
 The special groups are either made up of select groups or exposure groups. Selected groups
are homogenous inconstitution and may be professional groups (e.g. doctors, nurses,
 teachers, engineers, civil servants, traders, farmers), pregnant women, undergraduates, war
veterans, volunteers, etc.
 These groups are readily accessible for prolonged follow-up. Another type of special groups
are exposure groups made up of persons that have been exposed to the suspected causal
factor of a disease or health problem. If the exposure is rare, it is more economical to study
the exposure cohort.
 Readily accessible exposure cohorts are workers in industries and those in high-risk
situations like radiologists that are exposed to harmful rays. These cohorts are classified
according to the degree or duration of exposure to the suspected factor, for subsequent
analytical study.

2. Collection of Data on Exposure

 Information may be obtained directly from the cohort members themselves by means of
interviews or questionnaires.
 In some developed countries with large literate population, the questionnaires may be
mailed, thereby offering a simple and more economic study.
 Information may be available from past records, especially those that are specific in nature
and cannot be easily given by lay people. Examples are details of medical treatment, typesof
surgery performed, types and doses of radiotherapy administered, etc.
 Information may also be obtained from medical examination or special laboratory tests such
as measurements of weight, blood pressure, serum cholesterol, ECG, CAT scan, etc.
 Environmental surveys may be used to obtain information on exposure levels of the
suspected causal factor in the environment where the study subjects lived and worked. Basic
information on demographic variables are also obtained from the cohort members, as these
may have some influence on the disease under study.
3. Selection of Subjects for Comparison
 In some cohort studies, the study subjects are classified into several comparison groups
based on degrees or levels of exposure to risk factor before the disease develops, e.g.
smoking, blood pressure, serum cholesterol, etc.These are known as internal comparisons.
These groups are compared in terms of their subsequent morbidity and mortality rates.
External comparisons can be carried out with outside comparison groups that serve as the
control groups. This is necessary when information on the degree of exposure of the study
groups is not available.
 Cohort studies can be carried out between smokers and nonsmokers; radiologists and Public
Health physicians, etc. However, the study and control cohorts should be similar in
demographic and other important variables, but not the ones under study. Comparison can be
made with the general population rates in the same geographic area as the exposed people.
An example is the comparison of frequency of lung cancer among uranium miners with lung
cancer mortality in the general population where the miners resided.
 A similar study design is the comparison of frequency of cancer among asbestos workers
with the frequency in the general population in the same geographic area. Rates of disease in
the study and control subjects are considered in terms of age, sex and other variables
considered being important for the study.
 Rates in the control cohort are applied to those in the study cohort to determine the
“expected” values in the absence of exposure. The effect of the risk factor under study can
be estimated by the ratio of the “observed” and “expected” rates in the control group.
4. Follow-up
The procedures for regular follow-up visits of participants in cohort studies are as follows

 Periodic medical examination of each member of the cohort

  Review of physician and hospital records
  Routine surveillance of death records
  Mailed questionnaire, telephone calls and periodic home visits
The greatest amount of information is obtained from periodic medical examination of each
member of the cohort.

 Loss to follow-up may result from death, change of residence, migration or withdrawal of
occupation. As theses losses may introduce bias to the results, it is necessary to obtain basic
information on outcome for those who cannot be followed up in detail for the whole duration
of the study. However, it is recommended that researchers should achieve as close to a 95
percent follow-up as possible.
5. Analysis
At the end of the data collection, analysis are done to determine the incident rates among
exposed and non-exposed cohorts, and also to estimate the risk of outcome in the two groups.

Q1ci. List5 each of advantages and disadvantages of the cohort design in general (5 marks;
0.5 mark each)

Advantages

 Incidence can be directly calculated

 Direct estimation of the relative risk (RR)
 More than one outcome of the risk factor can be studied
 Dose response relationship with exposure can be studied
 Temporal association of the exposure with the outcome can be seen
 Certain biases like recall bias, interviewer’s bias are not a problem (0.5 mark for any 5
points = 2.5 marks)

Disadvantages

 The major disadvantage is the huge requirement for resources, viz. time, money and
personnel
 Unsuitable for rare diseases
 Long periods of follow up needed
 Attrition is a problem as long follow up is required
 Ethical problems are more because as evidence of the RF accumulates, it becomes the
duty of the investigator to educate those with the risk factor. Wait and watch may be
unethical
 Only one or a few risk factors can be studied. (0.5 mark for any 5 points = 2.5 marks)

Q1cii. Mention two major types of experimental study designs (5 marks; 2.5 marks
each)
 Randomized controlled trials. These involve a process of random/allocation assignment of
subjects to experimental (intervention) and control groups. Controlled before-and-
after trials are defined by pre- and post-intervention outcome assessment and a non-
random group allocation that is not under the control of the investigator (2.5 marks)
 Non-randomized or “non-experimental” trials. These do not follow strict randomization but
have sound theoretical basis for conclusions. Non-randomised trials are defined
as trials where the investigator controls allocation, which is not at random. (2.5 marks)

(Total = 25 marks)

QUESTION 225 marks

2a. Define and distinguish among:

i. Prospective cohort study

ii. Retrospective cohort study
iii. Ambidirectional cohort study (9 marks)

b. List 5 strengths and weaknesses each of retrospective and prospective cohort studies (10
marks)

c. Highlights the two ways of interpreting population attributable risk percent indicator (6
marks).

Q2a.Define and distinguish among: (9 marks; 3 marks each)

iv. Prospective cohort study

v. Retrospective cohort study
vi. Ambidirectional cohort study

i.Prospective Cohort Study?

 A prospective cohort study is one in which the disease or other outcome has not occurred at
the beginning of the investigation. It starts in the present and continues to the future.
 It is a type of cohort study whereby the researchers conceive and design the study, recruit
subjects, and collect background data on all subjects before they start developing noteworthy
outcomes.
 These subjects are then usually observed for a long period while recording interesting
observations.  
 The researcher will usually do a follow-up during this period through interviews, online
forms, questionnaires, physical examinations, tests, etc.
 The subjects may be given some things as part of the investigation, which could involve
recording the effect of these things on the subject.
 In the typical sense, investigators do have a primary focus which will inform how the study
is. For example, learning more about the causes of stomach ulcers. (3 marks)
ii. Retrospective Cohort Study

 The outcomes of the study have already occurred before the start of the investigation.
 This cohort study groups subjects based on their exposure status and compare their incidence
of disease.
 Investigators go back in time to identify a group that was initially unexposed and study the
incidence of their exposure.
 Other names for the retrospective cohort study are the historical cohort study,
prospective study in retrospect and non-concurrent prospective study.
 They can use different methods to carry out these investigations including interviewing the
cohort, consulting old newspapers & magazines, reports or journals that have talked about it
in the past, etc.
 In essence, the investigators time travel to the past to identify a cohort that fits the required
profile.

For example, we could have a retrospective cohort study whereby the investigators go back
several decades to get the records of the factory workers from a manufacturing company. These
workers could be investigated on how exposure to particular radiation from the machines
affected them over the years. (3 marks)

iii. Ambidirectional Cohort Study

 A cohort study that is ambidirectional is said to be both prospective and retrospective.

 This means that there are both prospective and retrospective phases of the study.
 In this type of study, the cohort is selected from past records and assessed during a particular
date that has passed for outcome.
 The same cohort is then followed upprospectively into future for further assessment of
outcome.
 The ambidirectional cohort study is conceptually consistent with and shares elements of both
the prospective and retrospective studies.
 It includes the advantages, disadvantages, uses, applications, etc. of both cohort studies.

For example, the development of a new treatment for a particular medical issue may require
studying the effects of this treatment on patients compared to the old one that was used in the
past. A prospective cohort study will be carried out on new patients who will use this treatment
for some time, while a retrospective cohort study will be carried out on patients who used the old
treatment. (3 marks)

Q2b. List 5 strengths and weaknesses each of retrospective and prospective cohort studies
(10 marks; 0.5 mark each)

Strengths of Prospective Cohort Studies

1. The outcomes for diseases and their prevalence are quite easier to understand and note.
2. At the same time, the study of multiple conditions can be conducted efficiently.
3. There is no scope of intervention by issues such as ethical ones
4. They can help determine risk factors for being infected with a new disease because they are
a longitudinal observation over time, (2.5 marks)
5. The collection of results is at regular time intervals, so recall error is minimized

Weaknesses of Prospective Cohort Studies

1. You may have to follow large numbers of subjects for a long time.
2. They can be very expensive and time consuming.
3. They are not good for rare diseases.
4. They are not good for diseases with a long latency.
5. Differential loss to follow up can introduce bias.(2.5 marks)

Strengths of Retrospective Cohort Studies

1. They are conducted on a smaller scale.

2. They typically require less time to complete.
3. They are generally less expensive, because resources are mainly devoted to collecting data.
4. They are better for analyzing multiple outcomes.
5. In a medical context, they can potentially address rare diseases, which would necessitate
extremely large cohorts in prospective studies.(2.5 marks)

Weaknesses of Retrospective Cohort Studies

1. As with prospective cohort studies, they are not good for very rare diseases.
2. If one uses records that were not designed for the study, the available data may be of poor
quality.
3. There is frequently an absence of data on potential confounding factors if the data was
recorded in the past.
4. It may be difficult to identify an appropriate exposed cohort and an appropriate
comparison group.
5. Differential losses to follow up can also bias retrospective cohort studies.(2.5 marks)

Q2c. Highlights the two ways of interpreting population attributable risk percent
indicator(6 marks).

1. The first is as the proportion of risk of occurrence of given disease in the population, in
the specified time interval, that is due to exposure to the specified risk factor. Thus, it
is a good way of expressing the impact of magnitude of specified risk factors. (3
marks)
2. The second way is as the proportional amount, in percentage, by which a disease in the
referent population can be reduced by controlling or eliminating exposure to the risk
factor in question. Thus, it is a good indicator of the effectiveness of prophylactic
intervention regimen, when such interventions are implemented as measures designed
to reduce exposure or susceptibility to a disease. (3 marks)
(TOTAL = 25 marks)

QUESTION 320 marks

3ai. How is demography related to population? (2 mark)

ii. What is difference between fertility and fecundity? (2 mark)

iii. Distinguish between Direct and Indirect Standardization of Rates (2 marks)

b. Define the following as it relates to fertility measures (4 marks)

i. Crude Birth Rate (CBR)

ii. Gross Reproduction Rate (GRR)

iii. Mean number of Children ever born per woman

iv. Total Fertility Rate (TFR)

ci. What are the maternal mortality indicators? (4 marks)

ii. Highlights the steps in the Investigation of a Disease Outbreak (6 marks)

Q3ai.How is demography related to population? (2 mark; 1 mark each)

 Demographics help us understand the size, status, and behavior of populations.

 Population is defined as a group of individuals of the same species living and
interbreeding within a given area.
 Broadly defined, demography is the study of the characteristics of populations. (2 marks)

Q3aii. What is difference between fertility and fecundity? (2 mark)

 Fecundity means the ability to produce live offspring, and

 Fertilitymeans the actual production of live offspring.
 Fecundity refers to the potential production, while
 Fertility to actual production, of live offspring (2 marks)

Q3aiii. Distinguish between Direct and Indirect Standardization of Rates (2 marks; 1 mark
each)

i. DIRECT STANDARDIZATION
 The age structure of the standard population is selected.
 The ASDR of each of the observed population is applied to the standard age structure to
yield expected deaths in the standard population,
 The crude death rate in the standard population at the ASDR of each of the observed
population can thus be calculated.
 The calculated crude death rate in the standard population is now called the Standardized
Death Rate (1 mark)
ii. INDIRECT STANDARIZATION

 A standard set of ASDR is selected. The crude death rate of this standardpopulation must
also be known.
 The actual total deaths in each area must be available as well as the age distribution of the
area.
 The method boils down to adjusting the crude death rate of the Standard population by a
factor.
 The factor is the ratio of the recorded number of deaths to the expected number of deaths (1
marks)

Q3b.Define the following as it relates to fertility measures (4 marks; 1 mark each)

ii. Crude Birth Rate (CBR)

ii. Gross Reproduction Rate (GRR)

iii. Mean number of Children ever born per woman

iv. Total Fertility Rate (TFR)

Crude Birth Rate (CBR): This is defined as the number of live births during the year per
1000 population of the specified area. (1 mark)

Gross Reproduction Rate (GRR): This is the total number of daughters a woman would
have or bear if she experiences a given set of Age Specific Fertility Rates throughout the
reproductive ages with no allowance for mortality over this period. Thus GRR is restricted to
female births only, yielding values that areapproximately half as large as the
TotalFertilityRate. (1 mark)

Mean number of Children ever born per woman: This is the mean number of children
ever born to a group of women of a specific age or age group. It is calculated from census or
survey data on the no. of children ever born and the distribution of women. (1 mark)

Total Fertility Rate (TFR): Total no. of children a woman would have or bear from age 15
to 49 if she were to bear children according to the present schedule of Age Specific fertility
Rates (asfrs) throughout her productive ages. (1 mark)
Q3ci. What are the maternal mortality indicators? (4 marks; 1 mark each)

Maternal mortality indicators often used to measure maternal mortality are the maternal mortality
ratio (MMRatio or MMR), maternal mortality rate (MMRate), proportion of maternal deaths
among all deaths of females of reproductive age (PM), and the lifetime risk of maternal death
(LTR).

i.The Maternal Mortality Ratio(MMR) is the number of maternal deaths per live birth. Thus, it
represents obstetric risk.

MMR = n umber of maternal death/ number of live birth X 100,000

ii. Maternal Mortality Rate (MMRate), which is the number of maternal deaths divided by the
number of women of reproductive age (usually between ages 15 to 49).

MMRate is a cause-specific death rate and represents the risk of maternal death among women
of reproductive age.

MMRate = n umber of maternal death/ number of women aged 15 to 49 X 1, 000

iii. The Proportion of Maternal (PM) is the proportion of maternal deaths among all deaths of
women of reproductive age.

PM = n umber of maternal death/ number of death among women aged 15 to 49

iv.The Lifetime Risk of Maternal Death(LTR) is the probability of a woman dying from maternal
causes over the course of her reproductive lifespan (usually 35 years). These measures can be
used with either maternal or pregnancy-related deaths. When using pregnancy-related deaths, it
is important to indicate that the measures are pregnancy-related rather than maternal.

LTR=(life table person-years lived above age 15/ life table person-years lived above age 50/
survivors to age 15) X MMRate

Q3cii. Highlights the steps in the Investigation of a Disease Outbreak (6 marks; 0.5 mark
each)

Most outbreak investigations involve the following steps:

 1. Preparation for the investigation/field work
2. Verifying the diagnosis and establishing the existence of an outbreak
3. Establishing a case definition and finding cases/epidemic
4. Conducting descriptive epidemiology to determine the personal characteristics of the
cases, changes in disease frequency over time, and differences in disease frequency based
on location.
5. Developing/formulate hypotheses about the cause or source and test hypothesis
6. Evaluating the hypotheses & refining the hypotheses and conducting additional studies if
necessary
7. Assess local response capacity
8. Implementing control and prevention measures
9. Address the resource gaps
10. Report writing
11. Communicating/disseminate the findings
12. Intensify surveillance (0.5 marks each x 12 =6 marks)

(TOTAL = 20 marks)

QUESTION 4 20 marks

4a. What is randomization? (5 marks)

bi. As a public health officer, why would you want to investigate communicable disease
outbreaks? (2 marks)

ii. Write short notes of the two types demographic sample surveys (3 marks)

c. Discuss Screening as an epidemiological tool under the following headings:

(10 marks).

Q4a. What is randomization? (5 marks)

Randomization or random allocation is the process of allocating participants into “study” and
“control” groups; to receive or not to receive an experimental preventive and therapeutic
manoeuvre or intervention or intervention. The purpose of the procedure is to eliminate “bias”
and allow for comparability. (2 marks)

Randomization performs three functions:

1) It eliminates selection bias on the part of the participants and investigators.

2) It creates groups that are comparable in all factors that influence prognosis.
3) It gives validity in the statistical treatment of data. (3 marks)
Q4bi. As a public health officer, whywould you want to investigatecommunicable disease
outbreaks? (2 marks)

 The primary reason for conducting outbreak investigations is to identify the source in order
to establish control and to institute measures that will prevent future episodes of disease.

 They are also sometimes undertaken to train new personnel or to learn more about the
disease and its mechanisms for transmission.

 Whether an outbreak investigation will be conducted may also be influenced by the severity
of the disease, the potential for spread, the availability of resources, and sometimes by
political considerations or the level of concern among the general public (2 marks)

Q4bii. Explain the two types of Demographic sample survey(3 marks)

Demographic sample surveys may be conducted in a single round or multi-rounds.

(a) Single-Round Sample Survey:

In a single round sample survey, enumerators collect information from members of the selected
households in one visit. The main disadvantage is that the error rate is relatively high especially
the non-sampling errors, non-response error and errors of under-reporting of vital events (births,
deaths, migration etc). In spite of this drawback, single round sample survey is the most widely
adopted method. This is because it is simple, flexible and easy to administer and involves
relatively low cost and time. (1.5 marks)

(b) The Multi-RoundsSurvey:

The multi-round survey, also known as follow-up survey, requires two or more visits in order to
collect data. It is designed to address some of the short-comings of the single-round survey. Lists
of persons and households compiled during the earlier visits are used in the subsequent rounds of
visits at intervals to collect data on changes which may have occurred since the previous visits.
(1.5 marks)

Q4c. Discuss Screening as an epidemiological tool (10 marks).

i. Definition
ii. Aims and importance
iii. Uses
iv. Types
v. Characteristics of a Good Screening Test
Definition of screening:

 Screening is defined as the presumptive identification of an unrecognized disease or defect

through tests, exams, or other procedures that can be applied rapidly and easily.
 Screening tests differentiate apparently healthy persons who may have a disease from those
who probably don’t have the disease.
 A screening programme must include all the core components in the screening process from
inviting the target population to accessing effective treatment for individuals diagnosed with
disease.
 Screening is a process –one that begins with invitation to participate and ends with treatment
for appropriately identified individuals. An effective screening programme should meet the
following criteria:
1. Mechanisms for systematic invitation and follow-up for individuals identified by the screening
testas having an abnormal finding (call and recall mechanisms);
2. Participation of over 70% of the target population to be screened;
3. Necessary infrastructure and resources to offer the test periodically and to adequatelydiagnose
and treat those found to have cancer or a precancerous lesion, and;
4. Robust monitoring and evaluation framework to assure quality. (2 marks)

Aims and Importance of screening:

Aims include:

 The general aim of screening is to sort out from a large group of apparently health persons
those that are likely to have the disease, or are at an increased risk of having the disease
under study.
 The persons that are “apparently abnormal” should then be brought under medical
supervision and treatment. Detection of disease before symptoms develop alters the natural
history of the disease in a favorable manner and therefore improves the chances of
preventing death and disability.
Importance:

 Screening is widely considered the bedrock of secondary prevention.

 Periodic health screening can lead to early detection and diagnosis of a disease.
 This early detection then leads to earlier treatment with a goal of decreasing mortality and
morbidity related to that disease.
 In the case of infectious diseases, screening can also break the chain of transmission and
prevent development of new cases.
 Screenings can be cost-effective if the disease is common enough and the test is accurate
enough.
 It’s also cost-effective if affordable treatments that work are accessible to those patients
whom test positive. Because we may develop diseases at many points throughout our
lifespan, many screenings are only effective if done periodically. (2 marks)

Usesof Screening: Screening is used for the following purposes:

i. Case Detection:
Screening is used for the presumptive identification of unrecognized disease, which does not
arise from a patient?s request, e.g. compulsory antenatal screening of mothers for HIV in some
health facilities. These persons are screened primarily for their health benefit. Other diseases that
can be screened for are breast cancer, cervical cancer, diabetes mellitus, pulmonary tuberculosis,
haemolytic disease of the newborn, etc.

ii. Control of Disease

This is also called “prospective screening”. In this type of screening, people are examined for the
benefit of others. Examples are screening of immigrants for the detection of diseases like
tuberculosis, syphilis and HIV, in order to protect the home population. The screening
programme leads to early diagnosis of these problems and prompt treatment, thereby limiting the
spread of infection to others and/or resultant death from the disease.

iii. Research

Screening may be used for research purposes because it aids in obtaining the basic

knowledge of the natural history of certain diseases such as cancer and hypertension. The initial
screening gives the prevalence estimate, while subsequent ones gives the incident rate. (2 marks)

Types of Screening: There are 3 types screening

Mass Screening:

 Mass screening is the screening of the whole population or a population subgroup. An

example is the screening of all adults in a community for pulmonary tuberculosis.
 This type of screening is offered to all persons in the population under study, irrespective of
the particular risks individual may have for the disease under study.
High-Risk or Selective Screening:

 This type of screening is applied selectively to the high-risk groups for the particular disease
under study.
 The screening is more effective and economical. Family members can be selectively
screened for diseases that are familialin origin e.g. hypertension, diabetesmellitus, breast
cancer, etc.
 Risk factors can also be screened for because they antedate the actual disease in question,
e.g. elevated serum cholesterol can lead to coronary heart disease.
 Preventive measures can then be applied on time before the disease develops.
Multiphasic Screening:

 Multiphasic screening means the application of two or more screening tests to a large
number of people at one time, rather than carrying out separate screening tests for single
diseases.
 The procedure may include administration of questionnaire, clinical examinations and a
variety of measurements and investigations.
 All these can beperformed rapidly with the appropriate staff and equipment.
 Most multiphasicscreening hasbeen wasteful of resources, thereby casting doubts on their
overall usefulness. (2 marks)
Characteristics of a Good Screening Test:

A good screening test must meet several important criteria.

 It needs to be simple and quick to administer.

 It should be inexpensive and safe to use.
 It also needs to be readily available, along with an accessible plan of treatment in place in
case of positive results.
 A good screen must be acceptable to the population in which it will be used.
 It must also be well researched and proven to be valid, reliable, and to have good predictive
values. (2 marks)

(TOTAL = 20 marks)

NATIONAL OPEN UNIVERSITY OF NIGERIA

FACULTY OF HEALTH SCIENCES
DEPARTMENT OF PUBLIC HEALTH
2021_1 MARKING GUIDE
Course Code:PHS 805
Course Title: Research methodology.
Credit Unit: 3
Total Score: 70
Time Allowed: 2Hours
Instruction: Attempt all questions
1) Research is systemic and scientific problem solving techniques
a) What are the importances of public health research? (5 marks)
Any relevant importance correctly explain 1 mark x 5 =5 marks

b) Discuss on quantitative versus qualitative public research method (10 marks)

Definitions of the quantitative and qualitative methods ½ mark each = 1 mark
4 features each of ‘’ ,, ,, ½ mark each x 8 = 4 marks
2 examples from ,, ,, ,, ½ mark x 4 = 2 marks
3 examples of application ,, ,, ,, ½ mark each x 6 = 3 marks
Subtotal 1 + 4 + 2 + 3 = 10 marks
Total: 5 + 10 = 15 marks
State all features clearly
2) Quite often the need for writing of research proposal arose
Explain how you are going to write an acceptable research proposal (10 marks)

Construction and Formulation of Research Topics 4 marks

Components of a Research Proposal 4 marks
Beyond Research Proposal 2 marks

Total: 4 + 4 + 2 = 10 marks

State all the components clearly

3) What makes collected data for research purpose useful is how best the data are
analyzed; discuss this in detail (20 marks)

Statistical Methods for Experimental Studies

Statistical Methods for Cohort (Prospective) Designed Studies
Statistical Methods for Case-control (Retrospective) Studies
Statistical Methods for Cross-sectional Designed Studies
5 marks for any correct explanation of the above points x 4 = 20 marks

4) How will you present you final school project for an assessment? (25 marks)
Here the accepted and current school format should serve as guide:

Preliminary pages:
Tittle page ¼ mark
Fly page ¼ mark
Dedication page ¼ mark
Certification page ¼ marks
Abstract 1 mark
Acknowledgement ½ mark
Table of contents1 marks
Subtotal: ¼ + ¼ + ¼ + ¼ + 1 + ½ + ½ + 1 = 3 ½ marks

Chapter I
Background of the study 2 marks
Statement of the problem 1 mark
Purpose and objectives of the study 1 mark
Significance of the study¼ mark
Scope of the study ¼ mark
Limitation of the study ¼ mark
Operational definition of terms used in the study¼
Subtotal: 2 + 1 + 1 +¼ + ¼ + ¼ + ¼ = 5marks

Chapter II
Introduction ¼ mark
Conceptual literature review 1 marks
Empirical literature review ½ mark
Summary ¼ mark
Subtotal; ¼ + 1 ½ + ½ + ¼ = 2 mark

Chapter III
Introduction ½ mark
Description of study area 1 mark
Study design 2 marks
Sample and sampling technique 2 marks
Instrument for data collection 1 ½ marks
Procedure for data collection ½ mark
Ethical clearance 1 mark
Procedure for data analysis ½ mark
Subtotal: ½ + 1 + 2 + 2 + 1 ½ + ½ + 1 + ½ = 9 marks

Chapter IV
Introduction ¼ mark
Presentation of data 1 ½ mark
Summary ¼ mark
Subtotal: ¼ + 1 ½ + ¼ = 2 marks

Chapter V
Summary ½ mark
Discussion 2 marks
Recommendation ½ mark
Conclusion ¼ mark
Suggestion for further research ¼ mark
Subtotal: ½ + 2 + ½ + ¼ + ¼ =3 ½ marks
Total:3 ½ + 5 + 2 + 9 + 2 + 3 ½ = 25
 Grand total: 15 + 10 + 20 + 25 = 70 marks

QUESTION 4 20 Marks
4a. List and discuss two (2) tests you are to carry out when using questionnaire to carry out
your studies. (10 marks)
4b. Explain cross-sectional study with examples (10 marks)

ANSWER

4a. List and discuss two (2) tests you are to carry out when using questionnaire to carry out
your studies. (10 marks)

The two (2) tests are:

1. Validity test
2. Reliability test (2 marks; 1 mark each)

1. VALIDITY TEST (8 marks)

Validity is commonly defined as the extent to which an outcome measure (e.g., a questionnaire)
measures what it is intended to measure.(2 marks)

TYPES OF VALIDITY TEST(6 marks; 1 mark each)

There are variousforms of validity in any measurements:

i. Face Validity:is the extent to which a test appears to measure what it is intended
to measure.
ii. Content Validity:refers to the degree to which the terms in a questionnaire cover
the relevant issues.
iii. Construct Validity:reflects the ability of a test to measure the underlying concept
of interest to the researcher.
iv. Convergent and Discriminant:validity can be used to support the construct
validity of a test. Convergent validity is demonstrated when scores on the test
being examined are highly correlated to scores on a test thought to measure similar
or related concepts.
 v. Discriminant validity is demonstrated when scores on the test being examined
are not correlated to scores on a test meant to measure a very different construct.
vi. Criterion related validity: It is the correlation of a scale with some other measure
of the trait or disorder under studies, ideally, a “gold standard” that has been used
and accepted in the field.
OR

2. RELIABILITY (8 marks)
Reliability (2 marks; 1 mark each for any correct 2 definitions given)

i. Reliability is the proportion of observed variation in scores across repeated

measurements that reflects actual variation in health levels and concerned with
error in measurements.
ii. It can also be defined technically as the degree to which random error in a test is
reduced. Reliability is characterized by a measure of the degree of consistency in
the results obtained following repeated testing.
iii. It is also concerned with error in measurement. Several synonyms have been used
for reliability; these include precision, stability, reproducibility, consistency and
predictability.

There are various methods to assess the reliability of an instrument.

Types of Reliability (6 marks; 2 marks each)

i. A.Intra-rater (or intra-observer) reliability; also known as test-retest reliability :
ii. This describes the agreement between results when the instrument is used by the same
observer on two or more occasions (under the same conditions and in the same test
population). Test-retest reliability measures stability over time in repeated
applications of the test. It can be defined as the consistency in scores obtained on an
instrument on two occasions separated by some interval of time. For example, the
one-week test-retest reliability of the new 19-item depression questionnaire will be
 determined by having the participants in the study to complete the questionnaires on
two separate occasions seven days apart. Test-retest reliability can be measured
statistically using the intra-class correlation coefficients.

B. i. Inter-rater (or inter-observer) reliability: this measures the degree of

agreement between the results when two or more observers administer the
instrument on the same subject under the same conditions. For example, the inter-
rater reliability for a blood pressure measuring instrument (sphygmomanometer)
would be determined by having two different research assistants with the same
training on blood pressure measurement use the same sphygmomanometer to
measure blood pressure of same participants.

C. i. Internal consistency reliability: Internal consistency reliability is a measure of

reliability used to evaluate the degree to which different test items that probe the
same construct produce similar results. It describes the degree of agreement, or
consistency, between different parts of a single instrument. It is mostly a statistical
procedure rather than actual measurement. Internal consistency can be determined
using Cronbach’s alpha (α).

Q4b. Explain cross-sectional study with examples (10 marks)

i. Cross sectional studies provide the opportunity to measure all the variables at one
time.
ii. It does not permit temporal relation between exposure and outcome but allows control
over study population and measurements of several associations between variables at
the same time.
iii. It has potential bias such as, poor recall and higher proportion of long survivors.
Examples of cross-sectional studies are surveys in which the distribution of a disease,
disability, pathological condition, immunological condition, nutritional status, fitness,
or intelligence, etc., is assessed.
iv. This design may also be used in health systems research to describe ‗prevalence‘by
certain characteristics – pattern of health service utilisation and compliance – or in
opinion surveys.
 v. A common cross-sectional study procedure used in family planning and in other
services is the KAP survey (survey of knowledge, attitudes and practice).

NATIONAL OPEN UNIVERSITY 0F NIGERIA

University Village, Nnamdi Azikiwe Express Way, Jabi, Abuja
FACULTY OF HEALTH SCIENCES
DEPARTMENT OF PUBLIC HEALTH SCIENCE

EXAMINATION QUESTIONS
COURSE TITLE: Environmental Health (PHS 807)
CREDIT UNIT: 2 Units
TOTAL SCORE: 70 Marks
TIME ALLOWED: 1½ Hours
INSTRUCTION: Answer All Questions

MARKING GUIDE

QUESTION 1 30 Marks
1a). In a known rural community over 90 % of the women employ firewood for
cooking and this process leads to the release of a variety of air pollutants.
Briefly describe this scenario and what the key pollutants would be. (10
marks)
1b). Exposure to air pollutants results in deleterious effects. Give an account of
the harmful effects associated with exposure to CO arising from automobile
emissions. (10marks)
(c) Briefly outline the hazards associated with chronic exposure to particulate
matter in a rice processing mill. (10 marks)

ANSWER

QUESTION 1a 10 Marks
Q1a). In a known rural community over 90 % of the women employ firewood for
cooking and this process leads to the release of a variety of air pollutants.
Briefly describe this scenario and what the key pollutants would be. (10 marks)

ANSWER
(i).Firewood is a biomass. (2marks)
(ii). It is a cooking energy source in most rural and some urban settlements. (2marks)
(iii). Combustion of firewood leads to the release of oxides of carbon, sometimes oxides of
nitrogen hydrocarbons and sulphur as well as hydrocarbons. (3marks)
(iv). The process of firewood combustion also leads to the release of soot and other particulate
Matter. (3marks)

Q1b) 10 Marks
(i). When CO is inhaled, it binds to hemoglobin(2 marks)
(ii). It has over 200 times the affinity of oxygen(2marks)
(iii). It forms carboxyhemoglobin (COHb) (2marks)
(iv). An increased level of COHb reduces the transport of oxygen to tissues(2marks)
(v). This reduces the supply of oxygen to the cells.(2marks)

Q1c) 10 Marks
Briefly outline the hazards associated with chronic exposure to particulate
matter in a rice processing mill. (10 marks)

ANSWER
(i). Particulate matter (PM) is one of the major components of air pollution. (2marks)
(ii). It can be from either natural or anthropogenic sources. (2marks)
(iii). Exposure to PM reduces the pulmonary function. (3marks)
(iv). In a rice processing mill lung disorders such as pneumoconiosis is prevalent (3marks)

QUESTION 2 20 Marks
2a). A community in South eastern Nigeria has a river as its major source of water supply.
Explain giving reasons based on certain indicators if this water source is potable or not.
(5marks)
2b). An urban water supply system requires some measure of treatment prior to distribution.
State the objectives for and key methods employed in such a water treatment plant.
(7 marks)
(c) Mention some of the diseases that are associated with contaminated water and other water
related conditions.
(8marks)

ANSWER
Q2a)5 Marks
(i).Water from a river contains a lot of impurities hence it is not potable. (1mark)
(ii). Potable water must be aesthetically, physically, chemically and microbiologically
safe and acceptable. (1mark)
(iii). The river water is likely to contain high total dissolved and total suspended
Solids. (1mark)
(iv). There are likely going to be dissolved chemicals such as anions and cations. (1mark)
(v). It is likely to contain high levels of microorganisms. (1mark)
Q2b) 7 Marks
(i).Water treatment is aimed at reducing and eradicating concentration of physical and chemical
substances particulate matter, parasites, bacteria, algae, viruses and fungi. (2marks)
(ii).The methods used include pretreatment, physical processes such as flocculation,
coagulation, sedimentation and filtration with use of slow sand filters. (2marks)
(iii).Chemical processes such as disinfection using chlorination or ozone or use of
electromagnetic radiation such as ultraviolet light. (3marks)

Q2c) 8 Marks
(i) Waterborne diseases:They include cholera, typhoid, and dysentery and are caused
bydrinking
water containing infectious viruses or bacteria which often come from human oranimal waste.
(2 marks)
(ii) Water-washed diseases:Such as skin and eye infections, are caused by lack of clean water
for
Washing. (2 marks)
(iii) Water-based diseases:Such as schistosomiasis, are spread by organisms/parasites that
develop in water
and then become human parasites. They are spread by contaminated water and by eating
insufficiently cooked aquatic animals.(2 marks)
(iv) Water-related diseases: Such as caused by mosquitoes, breed in or near water and spread
diseases, including dengue and malaria. (2 marks)

QUESTION 3 20 Marks
3a). World Health Organization is the major United Nations organ that oversees health
issues. State its five key principles related to food hygiene to help in the prevention of food
related illnesses. (5marks)
3b). What is HACCP. Outline briefly all the steps involved in HACCP that are employed in
food hygiene and safety. (8marks)
3c). Most food-borne illnesses are caused by microorganisms. Briefly describe the
characteristics of viral-based food-borne illness.
(7marks)

ANSWER

Q3a). 5 Marks
World Health Organization is the major United Nations organ that oversees health issues.
State its five key principles related to food hygiene to help in the prevention of food
related illnesses. (5 marks)

The five key principles of food hygiene, according to the World Health Organization are
 i. Prevent contaminating food with pathogens spreading from people, pets, and pests. (1
mark)
ii. Separate raw and cooked foods to prevent contaminating the cooked foods.
(1mark)
iii. Cook foods for the appropriate length of time and at the appropriate temperature to kill
pathogens.
(1mark)
iv. Store food at the proper temperature.
(1mark)
v. Do use safe water and safe raw materials (1mark)

Q3b) 8 Marks
3b). What is HACCP. Outline briefly all the steps involved in HACCP that are employed in
food hygiene and safety. (8 marks)

HACCP is a systematic approach to the identification, evaluation, and control of food safety
hazards based on the following seven principles (1 mark):

Principle 1: Conduct a hazard analysis(1mark)

Principle 2: Determine the critical control points (CCPs)(1 mark)

Principle 3: Establish critical limits(1mark)

Principle 4: Establish monitoring procedures(1mark)

Principle 5: Establish corrective actions(1mark)

Principle 6: Establish verification procedures(1mark)

Principle 7: Establish record-keeping and documentation procedures (1 mark)

Q3c) 7 Marks
3c). Most food-borne illnesses are caused by microorganisms. Briefly describe the
characteristics of viral-based food-borne illness.
(7 marks)

(i).Viral infections make up about one third of cases of food poisoning in developed countries.

(2marks) 
(ii).Foodborne viral infections usually have an incubation period of one to three days.
(2marks)

(iii).Foodborne viral pathogens include; Enterovirus, Hepatitis A (which is known to have

an incubation period of two to six days), Hepatitis E, Norovirus and Rotavirus. (3marks)

QUESTION 4 25 Marks
List and explain the five disciplines in Public health

ANSWER

The five (5) disciplines that contribute to describing environmental health problems are as follows:

A. Environmental epidemiology
B. Environmental toxicology
C. Exposure science
D. Environmental engineering
E. Environmental law(5 marks; 1 mark each)

A. Environmental Epidemiology (4 marks, 1 mark each)

i. Environmental epidemiology is concerned with the discovery of the environmental
exposures that contribute to or protect against injuries, illnesses, developmental conditions,
disabilities, and deaths; and identification of public health and health care actions to
manage the risks associated with harmful exposures.
ii. Environmental epidemiology studies external factors that affect the incidence, prevalence,
and geographic range of health conditions.

iii. Environmental epidemiology studies external factors that affect the incidence, prevalence,
and geographic range of health conditions. These factors may be naturally occurring or may
be introduced into environments where people live,work, and play.
iv. Environmental epidemiology research can inform risk assessments; development of
standards and other risk management activities and estimates of the co-benefits and co-
harms of policies designed to reduce global environment change, including policies
implemented in other sectors (e.g. food and water) that can affect human health.

B. Environmental exposures or Exposure Science (4 marks, 1 mark each for any 4 correct points)
i. can be broadly categorized into those that areproximate (i.e. directly leading health
conditions) including chemicals,physical agents and microbiological pathogens, and those
 that are distal,such as socioeconomic conditions, climate change, and other
broadscaleenvironmental changes.
ii. Proximate exposures occur through air,food, water, and skin contact.
iii. Distal exposures cause adverse healthconditions directly by altering proximate exposures,
and indirectlythrough changes in ecosystems and other support systems for humanhealth.
iv. Exposure science is the study of an organism's (usually human) contactwith chemical,
physical, biological agents or other health risk (e.g.accidents) occurring in their
environments, and advances knowledge ofthe mechanisms and dynamics of events either
causing orpreventing adverse health outcomes.
v. Exposure science studies humanexposure to environmental contaminants by both
identifying andquantifying exposures. Exposure science has the advantage of being ableto
very accurately quantify exposures to specific chemicals, but it doesnot generate any
information about health outcomes like environmentalepidemiology or toxicology.
vi. Exposure science can be used to support environmental epidemiology bybetter describing
environmental exposures that may lead to a particularhealth outcome, identify common
exposures whose health outcomesmay be better understood through a toxicology study, or
can be used in arisk assessment to determine whether current levels of exposure
mightexceed recommended levels.
vii. Exposure science plays a fundamental rolein the development and application of
epidemiology, toxicology,and risk assessment. It provides critical informationfor protecting
human and ecosystem health.
viii. Exposure science also hasthe ability to play an effective role in other fields,including
environmental regulation, urban, traffic safety and ecosystemplanning, and disaster
management; in many cases these are untappedopportunities.
ix. Exposure science links human and ecologic behavior toenvironmental processes in such a
way that the information generatedcan be used to mitigate or prevent future adverse
exposures.

C. Environmental Toxicology (4 marks, 1 mark each)

i. Environmental toxicology is a multidisciplinary field of scienceconcerned with the study of
the harmful effects of various chemical,biological and physical agents on living organisms.
Toxicology studieshow environmental exposures lead to specific health outcomes,generally
in animals, as a means to understand possible health outcomesin humans.
ii. Toxicology has the advantage of being able to conductrandomized controlled trials and
other experimental studies because theycan use animal subjects. An organism can be
exposed to toxicants atvarious stages of its life cycle. Harmful effects of such toxicants
canaffect an organism and its community by reducing its species diversityand abundance.
iii. Such changes in population dynamics affect theecosystem by reducing its productivity and
stability.There are many sources of environmental toxicity that can lead to thepresence of
toxicants in our food, water and air. These sources include organic and inorganic pollutants,
pesticides and biological agents, all ofwhich can have harmful effects on living organisms.
iv. There can be socalled point sources of pollution, for instance the drains from a
specificfactory but also non-point sources like the rubber from car tires thatcontain
numerous chemicals and heavy metals that are spread in theenvironment.

D. Environmental Engineering (4 marks, 1 mark each)

i. Environmental engineering is concerned with the application ofscientific and engineering
principles for protection of humanpopulations from the effects of adverse environmental
factors;protection of environments, both local and global, from potentiallydeleterious
effects of natural and human activities and improvement ofenvironmental quality.
ii. Environmental engineering can also be describedas a branch of applied science and
technology that addresses the issuesof energy preservation, protection of assets and control
of waste fromhuman and animal activities.
iii. Furthermore, it is concerned with findingplausible solutions in the field of public health,
such as waterbornediseases, implementing laws which promote adequate sanitation
inurban, rural and recreational areas.
iv. It involves waste watermanagement, air pollution control, recycling, waste disposal,
radiationprotection, industrial hygiene, animal agriculture, environmentalsustainability,
public health and environmental engineering law. It alsoincludes studies on the
environmental impact of proposed constructionprojects.

E. Environmental Law (4 marks, 1 mark each)

i. Environmental law includes the network of treaties, statutes, regulations,common and
customary laws addressing the effects of human activity onthe natural environment.
Information from epidemiology, toxicology,and exposure science can be combined to
conduct a risk assessment forspecific chemicals, mixtures of chemicals or other risk factors
todetermine whether an exposure poses significant risk to human health(exposure would
likely result in the development of pollution-relateddiseases.
ii. This can in turn be used to develop and implementenvironmental health policy that, for
example, regulates chemicalemissions, or imposes standards for proper sanitation. Actions
ofengineering and law can be combined to provide risk management tominimize, monitor,
and otherwise manage the impact of exposure toprotect human health to achieve the
objectives of environmental healthpolicy.
iii. Customary international law is an important source of internationalenvironmental law.
These are the norms and rules that countries followas a matter of custom and they are so
prevalent that they bind all statesin the world. Numerous legally binding
 internationalagreements encompass a wide variety of issue-areas, from terrestrial,marine
and atmospheric pollution through to wildlife and biodiversityprotection. International
environmental agreements aregenerally multilateral treaties.
iv. Protocols are subsidiary agreements builtfrom a primary treaty. They exist in many areas of
international law butare especially useful in the environmental field, where they may be
usedto regularly incorporate recent scientific knowledge. They also permitcountries to reach
agreement on a framework that would be contentiousif every detail were to be agreed upon
in advance. The most widelyknown protocol in international environmental law is the
KyotoProtocol, which followed from the United Nations FrameworkConvention on Climate
Change.

Q5 25 Marks
List and explain five disciplines in public health

ANSWER

The five (5) disciplines that contribute to describing environmental health problems are as follows:

F. Environmental epidemiology
G. Environmental toxicology
H. Exposure science
I. Environmental engineering
J. Environmental law(5 marks; 1 mark each)
F. Environmental Epidemiology (4 marks, 1 mark each)
v. Environmental epidemiology is concerned with the discovery of the environmental
exposures that contribute to or protect against injuries, illnesses, developmental conditions,
disabilities, and deaths; and identification of public health and health care actions to
manage the risks associated with harmful exposures.
vi. Environmental epidemiology studies external factors that affect the incidence, prevalence,
and geographic range of health conditions.

vii. Environmental epidemiology studies external factors that affect the incidence, prevalence,
and geographic range of health conditions. These factors may be naturally occurring or may
be introduced into environments where people live,work, and play.
viii. Environmental epidemiology research can inform risk assessments; development of
standards and other risk management activities and estimates of the co-benefits and co-
harms of policies designed to reduce global environment change, including policies
implemented in other sectors (e.g. food and water) that can affect human health.

G. Environmental exposures or Exposure Science (4 marks, 1 mark each for any 4 correct points)
x. can be broadly categorized into those that areproximate (i.e. directly leading health
conditions) including chemicals,physical agents and microbiological pathogens, and those
 that are distal,such as socioeconomic conditions, climate change, and other
broadscaleenvironmental changes.
xi. Proximate exposures occur through air,food, water, and skin contact.
xii. Distal exposures cause adverse healthconditions directly by altering proximate exposures,
and indirectlythrough changes in ecosystems and other support systems for humanhealth.
xiii. Exposure science is the study of an organism's (usually human) contactwith chemical,
physical, biological agents or other health risk (e.g.accidents) occurring in their
environments, and advances knowledge ofthe mechanisms and dynamics of events either
causing orpreventing adverse health outcomes.
xiv. Exposure science studies humanexposure to environmental contaminants by both
identifying andquantifying exposures. Exposure science has the advantage of being ableto
very accurately quantify exposures to specific chemicals, but it doesnot generate any
information about health outcomes like environmentalepidemiology or toxicology.
xv. Exposure science can be used to support environmental epidemiology bybetter describing
environmental exposures that may lead to a particularhealth outcome, identify common
exposures whose health outcomesmay be better understood through a toxicology study, or
can be used in arisk assessment to determine whether current levels of exposure
mightexceed recommended levels.
xvi. Exposure science plays a fundamental rolein the development and application of
epidemiology, toxicology,and risk assessment. It provides critical informationfor protecting
human and ecosystem health.
xvii. Exposure science also hasthe ability to play an effective role in other fields,including
environmental regulation, urban, traffic safety and ecosystemplanning, and disaster
management; in many cases these are untappedopportunities.
xviii. Exposure science links human and ecologic behavior toenvironmental processes in such a
way that the information generatedcan be used to mitigate or prevent future adverse
exposures.
H. Environmental Toxicology (4 marks, 1 mark each)
v. Environmental toxicology is a multidisciplinary field of scienceconcerned with the study of
the harmful effects of various chemical,biological and physical agents on living organisms.
Toxicology studieshow environmental exposures lead to specific health outcomes,generally
in animals, as a means to understand possible health outcomesin humans.
vi. Toxicology has the advantage of being able to conductrandomized controlled trials and
other experimental studies because theycan use animal subjects. An organism can be
exposed to toxicants atvarious stages of its life cycle. Harmful effects of such toxicants
canaffect an organism and its community by reducing its species diversityand abundance.
vii. Such changes in population dynamics affect theecosystem by reducing its productivity and
stability.There are many sources of environmental toxicity that can lead to thepresence of
toxicants in our food, water and air. These sources include organic and inorganic pollutants,
pesticides and biological agents, all ofwhich can have harmful effects on living organisms.
viii. There can be socalled point sources of pollution, for instance the drains from a
specificfactory but also non-point sources like the rubber from car tires thatcontain
numerous chemicals and heavy metals that are spread in theenvironment.
I. Environmental Engineering (4 marks, 1 mark each)
v. Environmental engineering is concerned with the application ofscientific and engineering
principles for protection of humanpopulations from the effects of adverse environmental
factors;protection of environments, both local and global, from potentiallydeleterious
effects of natural and human activities and improvement ofenvironmental quality.
vi. Environmental engineering can also be describedas a branch of applied science and
technology that addresses the issuesof energy preservation, protection of assets and control
of waste fromhuman and animal activities.
vii. Furthermore, it is concerned with findingplausible solutions in the field of public health,
such as waterbornediseases, implementing laws which promote adequate sanitation
inurban, rural and recreational areas.
viii. It involves waste watermanagement, air pollution control, recycling, waste disposal,
radiationprotection, industrial hygiene, animal agriculture, environmentalsustainability,
public health and environmental engineering law. It alsoincludes studies on the
environmental impact of proposed constructionprojects.
J. Environmental Law (4 marks, 1 mark each)
v. Environmental law includes the network of treaties, statutes, regulations,common and
customary laws addressing the effects of human activity onthe natural environment.
Information from epidemiology, toxicology,and exposure science can be combined to
conduct a risk assessment forspecific chemicals, mixtures of chemicals or other risk factors
todetermine whether an exposure poses significant risk to human health(exposure would
likely result in the development of pollution-relateddiseases.
vi. This can in turn be used to develop and implementenvironmental health policy that, for
example, regulates chemicalemissions, or imposes standards for proper sanitation. Actions
ofengineering and law can be combined to provide risk management tominimize, monitor,
and otherwise manage the impact of exposure toprotect human health to achieve the
objectives of environmental healthpolicy.
vii. Customary international law is an important source of internationalenvironmental law.
These are the norms and rules that countries followas a matter of custom and they are so
prevalent that they bind all statesin the world. Numerous legally binding
internationalagreements encompass a wide variety of issue-areas, from terrestrial,marine
and atmospheric pollution through to wildlife and biodiversityprotection. International
environmental agreements aregenerally multilateral treaties.
viii. Protocols are subsidiary agreements builtfrom a primary treaty. They exist in many areas of
international law butare especially useful in the environmental field, where they may be
usedto regularly incorporate recent scientific knowledge. They also permitcountries to reach
agreement on a framework that would be contentiousif every detail were to be agreed upon
in advance. The most widelyknown protocol in international environmental law is the
 KyotoProtocol, which followed from the United Nations FrameworkConvention on Climate
Change.

NATIONAL OPEN UNIVERSITY 0F NIGERIA

University Village, Plot 91, Cadastral Zone,
Nnamdi Azikiwe Express Way, Jabi, Abuja
PHS8092021_1Examination MG

COURSE TITLE: Social Medicine

COURSE CODE: PHS809

UNITS:2
TIME ALLOWED: 11/2HOURS
INSTRUCTION: Answer all questions (70%)

Q.1. Mr. Kabiru and Iya Bose both lived in Girbobo village. One morning the two woke up with
increase in body temperature and swollen feet. Mr Kabiru took his car and goes to the General
Hospital in the city while Iya Bose stayed back in the village contemplating what to do. Discuss the
likely factors that influenced the decision of the two.

b. Discuss why people sometimes prefer traditional or alternative medicine in Nigeria.

Answer: General when people are sick, they make a decision of seeking medical care or not, and
what type of care should they seek and where.

Taking such decisions are influenced by so many factors some of which includes.

i. Education.(1 Mark) Education is known to increase Knowledge and with knowledge right
attitudes towards health are achieved.
Education is also known to increase level of income and social status in the community as
most educated people have white collar jobs therefore increases their access to Health care.
1 mark
Education also brings about economic empowerment and better control of financial
resources within the family as well as more decision-making power, increased self-
confidence and ability to demand adequate service.
Education enables an individual or family to take informed decision on healthcare utilisation
and execute such decision without interferences.
 Educated individuals also understands the principles behind medical services and treatment
therefor have confidence in the system as such they always go for the best care available.1
mark
ii. Level of Income(1 mark) The higher the level of income of an individual the more access he
will have to health care and therefore the more he decides to go for medical care in times of
illness.
Income is an economic factor which determines financial capability to offset costs of
healthcare service. Affordability of healthcare service is the ability to pay for needed
services which obviously determine the possibility of health service utilisation. Poverty plays
a critical role in accessing health care, poor people tend to use non-formal sources of health
care because in most cases they cannot afford the standard services. In some cases they
resolve to traditional care or even not seeking treatment at all. 1 mark
The use of patent medicine stores or small clinics manned by unqualified staff is a common
practice in rural and some urban settlements.1 mark
iii. Religion and traditional beliefs.(1mark) In Africa religion and traditional beliefs are still
playing a major role in seeking of medical care. They are often considered as markers of
cultural background and values when it comes to healthcare utilisation. Some religious
groups such as the Apostolic Faith and Faith Tabernacle sect do not utilise any form of
healthcare service apart from prayers for healing.(1mark)
According to most traditional or religious beliefs, pregnant women do not attend any health
clinic for ante-natal care and delivery, they prefer to stay and take concoctions and prayer
waters.
People that usually go for orthodox medicines are sometimes considered as having no or
less faith in God and His healing powers. Similarly, there are diseases believed by the
adherents of the African Traditional Religion to be caused by supernatural powers and
therefore such disease will not respond to medical treatment.
The African traditionalists believe that such health issues can only be managed with spiritual
methods such as incantations and by appeasing the gods, particularly if the sufferer has
engaged in any culturally abominable act. ½ mark
Traditionally in the African context, certain diseases have cultural connotation and the
people believe diseases such as stroke, measles, convulsions fall outside the zone of
orthodox medical care and as such do not respond to orthodox treatment regimen,½ mark
iv. Accessibility.(1mark). Access to medical care is very important factor in making choice or
deciding to use it or not. People cannot use what is not available. Geographical locations
and Geographical accessibility involves accessible distance in a reasonable time, available
means of transportation.(1mark), affordable means of transportation and ease of
movement such as having less obstacles on the road. The further the health facility the
more difficult it is to access it and the less likely people will decide to use it..(1mark)
v. Gender.(1mark). Gender is always an important factor in Africa and Nigeria as a whole, it
determines access to Education, Job, income and therefore Health care.
Male (Men) have more access to Health care than women and among women Marital status
plays an important role in deciding to use health care, for instance a woman in marriage in
 most societies will be mindful of the choice or interest of her husband on where to access
healthcare for herself or her children.
She has to be given permission and also be financed. This is more in African societies where
a woman is expected to be under the authority of the husband.(1mark) Most women in
Africa are dependent on their husband financially as they are not financially self-sufficient or
economically stable. Young single mothers will have intrusions from natal family on where
to seek maternity care for the singular reason that her family is responsible for procuring
the required health services.
On the contrary, men can always take decision on their own as regards to health care
because they are free to go to hospitals without seeking permission and are going to pay for
the services by themselves.(1mark)

Total for question 15 marks

b. In Nigeria and Africa in General, there is general preference to traditional and alternative
medicine over the Orthodox. Some of the reasons for such include:

i) Concept of illness. The general concept of Disease in Nigeria is illness emanates from
magical or religious sources. This change the mind-set that the traditional healer will
understand their problems better and they have the confidence that the traditional healer
will correctly address their problem. 1 mark for mention 1 mark for explanation. Totalling 2
marks.
ii) Availability and accessibility. Traditional care practitioners are readily available and easily
accessible to their Patients. People have to cover some distance to reach an orthodox
medical centre however they have traditional medical practitioners all over. Another factor
is waiting time, availability and attitudes of healthcare workers. 1 mark for mention 1 mark
for explanation. Totalling 2 marks.
iii) Cost. Traditional and alternative health care system is always cheaper and in some cases
come free. While orthodox medicine is expensive because one has to pay consultation and
pay also for drugs and other medications.1 mark for mention 1 mark for explanation.
Totalling 2 marks.
iv) Familiar skills. People are very much familiar skills and methodology for the care. Skills
Procedures applied in rendering care by traditional healers are familiar to the people and
easier to handle when compared with complicated and complex methods of diagnosis and
treatment found in modern healthcare service such as in the hospitals. The recipients of
traditional healthcare services are at home with their traditional healthcare providers. 1
mark for mention 1 mark for explanation. Totalling 2 marks.
v) Simplicity. Traditional medical care is very simple and does not require test and screenings
unlike orthodox medicine where several test procedures are involved. 1 mark for mention 1
mark for explanation. Totalling 2 marks.

Total for Section B 10 marks

 Total for Question is 25 marks.

Q2. Discuss the various Conceptsof Health.

b. What are the Major Challenges facing the Health Care System in Nigeria?

Concepts of Health

i) Biomedical concept of health(1mark). In this concept health is seen as absence of disease or

any physical or mental ailment. This means that anyone who is free from disease is
considered healthy. This assertion is what the biomedical concept of health represents, and
it is based on the germ theory of disease. At the early part of the twentieth century the
germ theory, which believes disease is caused by an external organism or germ has
dominated the medical thought. (1mark).
The human body was viewed then as a machine while disease was seen as the consequence
of breakdown of the machine and the doctors were to repair the machine. Health was
narrowed and was not recognising the role of environmental, social, psychological and
cultural factors. (1mark).
The biomedical concept of health was found to be inadequate because of its inability to
address some major health problems, such as malnutrition, chronic diseases, accidents, drug
abuse, mental health disorders, environmental pollution and population explosion. This
realization came as a result of developments in medical and social sciences. (1mark).
ii) Ecological concept of health(1mark).. This concept views health as a dynamic equilibrium
between man and his environment and disease. Any shift in the equilibrium becomes a
maladjustment of the individual to his environment. (1mark).
This concept holds that an individual should in addition to having relative absence of pain
and discomfort, adapt and adjust to the environment for optimal functioning. The ecological
concept came up as a response to the gap that exists in the biomedical concept of health.
The ecological concept raises the issue of imperfect man and imperfect environment.
(1mark).
iii) Psychosocial concept of health(1mark).. The psychosocial concept of health reveals the
influence of social, psychological, cultural, economic and political factors on health. This
view that health is both a biological and social phenomenon is rooted in the developments
made in the area of social sciences. (1mark).
These psychosocial factors are very relevant in defining and measuring health because
health is a biological phenomenon as well as a social phenomenon. (1mark).
iv) Holistic concept of health(1mark).. According to this concept, health is a blend of the other
three concepts stated above. It recognises the strength of social, economic, political and
environmental influences on health. (1mark).
 It has been described as a multidimensional process involving the wellbeing of the whole
person in the context of his environment. This concept agrees with the view of the ancient,
that health is a sound mind in a sound body, in a sound family, in a sound environment. This
implies that health is affected by every facet of the society. (1mark).

Total for Question is 13 Marks

b. What are the major challenges facing the Health care system in Nigeria

Challenges of Health Care System in Nigeria.

COMMON CHALLENGES FACING HEALTHCARE SYSTEM IN NIGERIA Some of the challenges
confronting the Nigeria healthcare system include:
i) Inadequate health manpower(1mark).. Nigeria is yet to meet up with the
recommended doctor-patient ratio, nurse patient ratio and the situation is same
with other health professionals such as pharmacists, physiotherapist. The deficiency
in health manpower has been further worsen by the increasing rates of brain drain
that occurred in the recent past, when health professionals from Nigeria migrated
to the high income countries of world as a result of deplorable working condition,
poor pay(1mark).
ii) Skewed distribution of existing health manpower(1mark).Bulk of the health
professionals wants to stay and work in cities and urban areas consequently the
facilities in the rural and sub-urban areas have fewer skilled manpower.
Maldistribution of health professionals limits access to the needed healthcare
services by the affected population. Secondly there is aggregation of health care
facilities in cities while the rural areas are left without much health care facilities.
(1mark).
iii) Inadequate health facilities(1mark).. This has to do with either the quantity or
quality of available health facilities across the country. Health care facilities are
scanty In some areas of the country particularly rural areas, this reduces access and
make health care difficult to access to most people. Where the facilities exist, some
are not adequately equipped, or they lack the required manpower to deliver
services to the people. There is generally an absence of trained technical personnel
capable of repairing medical equipment and this compounds the poor maintenance
culture occasioning abandoning and dumping of broken-down equipment and
infrastructures.(1mark).
iv) Low budgetary provision and organisational resources(1mark).. Health budget are
very low and in some cases non release of funds leading to inadequate resources to
the health sector in Nigeria, as evidenced by the percentage of annual national
budget allocated to the health sector which for many years is far below what the
World Health Organisation recommended, thus resulting in the deterioration of the
healthcare infrastructure. Factors responsible for this include; poor resource base,
 corruption, insensitivity and poor organisational competence that exploit existing
potentials. (1mark).
v) High prevalence of preventable diseases(1mark).. Prevalence of preventable and
communicable and non-communicable diseases such as malaria, typhoid fever,
meningitis, HIV infection, lower respiratory tract infections, malnutrition, is still
high. This overwhelms the healthcare resources as personnel, time and materials
are unduly expended to manage the preventable conditions. Some of these
conditions emanate from ignorance, poor environmental conditions, indulging in
health risk behaviours and lack of access to preventive healthcare services. (1mark).
vi) Delay in seeking healthcare(1mark).. This has to do with the attitude of people
towards seeking medical treatment. The tendency of seeking healthcare service late
is high and this can be attributed to illness behaviour, perception of cause of illness,
poverty, inaccessibility of health facility among other social hindrances. Also,
attitude of health workers has been listed as one of the factors discouraging people
from accessing healthcare from public health facilities. (1mark).
Total for section is 12 Marks
Total for Question is 25 Marks

Q3. Discuss the meaning and brief History of Social Epidemiology.

b. What are the social and Health Importance of Epidemiology .

Social epidemiology is the branch of epidemiology concerned with how social interactions and
the combined activities of human beings that influences health and it focuses on the way social
structures, institutions and relationships influence health.2 marks

The assumption in social epidemiology is that the distribution of health and disease among
members of any society is the reflection of the distribution of advantages and disadvantages in
the society. Social epidemiology uses other social science disciplines such as economics, medical
anthropology, medical sociology, health psychology, medical geography and many domains of
epidemiology. 2 marks

BRIEF HISTORY OF SOCIAL Epidemiology

Social epidemiology usually explain the effect of social factors on the health of the individual
and that of the population. 1 mark

The earlier record of work on social epidemiology were several investigations carried out at the
beginning of the 19th century in France by Villermethat were based on the idea that social
conditions affect health. 1 mark
 The differences in mortality between the poor and the affluent was studied and he emphasized
that improved schooling and working conditions would reduce disparities in mortality between
the poor and the affluent. 1 mark

Another study was conducted in Germany In Germany by Virchow who reported the
relationship between poor social conditions and the typhus epidemic in Upper Silesia. 1 mark

He speculated that unequal access to society’s products was the main cause of unequal
distribution of diseases in the society and highlighted the central role of social conditions in
population health. 1 mark

In the middle of the 19th century, Chadwick reported that unsanitary soil, air, and water were
major causes of diseases and promoted sanitation measures to improve the health of the poor
and at the end of the 19th century germ theory of disease was developed and consequently, the
idea that social conditions affect health was overshadowed at the period. 1 mark

The early 20th century witnessed the flourishing of the idea that exposure to a single individual
risk factor including germs was the cause of disease. With the rise in infectious diseases came
the concept of “web of causation” which explained that disease is caused by exposure to
multiple risk factors. 1 mark

Modern epidemiology has developed based upon this multi-factorial model. By the 1980s,
several epidemiologists developed social epidemiology which underscores the importance of
socio-structural factors on health of an individual as well as the population. 1 mark

Total for section 12 marks

IMPORTANCE OF EPIDEMIOLOGY

Some of the benefits of epidemiology include:

i) To understand the history of the disease in a particular the community or population.

ii) To understand the pattern of a disease in a given population.
iii) To help in diagnosing the health of the community
iv) To highlight areas of strength and weaknesses of health services thereby indicating
effectiveness or otherwise.
v) To understand the experiences of the various sub groups within the population based on
different variables so as to determine common problems and susceptibility levels.
vi) To understand the best possible ways of solving identified health problems.
vii) To identify new diseases, disorders and syndromes in the community.
viii) To identify and link Social determinants of Health to causes to health problem.
I mark each totalling 8 Marks for section
Total for Question is 20 Marks

Q4. Discuss the various dimensions of health

b. Discuss the various Alternative and Complimentary Medicine available to People in Nigeria

Health is multi-dimensional, spanning beyond the three dimensions contained in the World
Health Organisation definition of health (physical, mental and social) to encompass other
elements such as spiritual, emotional, vocational and political dimensions.

i) Physical dimension. This dimension is based on biological concept of health and is

based on the assumption that the body is made up of body cells, organs and systems
and they are at optimum performance in healthy body. It is also assume at optimum
level an individual will have good appetite, bright eyes, good complexion, lustrous
hair, regular bladder and bowel movement among others. Physical health can be
measured in modern medicine using self-assessment of overall health, investigation
of symptoms of illness and associated risk factors, medication and use of medical
services. At the community level, parametres such as death rate, number of aged
people and infant mortality rate are used as indicators of a healthy community.
Mention 1 mark explanation 1 mark total 2 marks
ii) Mental dimension. Mental stability and the ability to respond appropriately to
experiences of life and not the mere absence of mental illness is considered as good
health in Mental dimension of health. Mention 1 mark explanation 1 mark total 2
marks
Exhibit sense of purpose, conforming to societal norms and values and maintaining
good and harmonious relationship with others is considered as good mental health.
Mental health refers to maintaining state of equilibrium between the individual and
the world around him. Psychological factors can engender other types of illness other
than mental illness, such as hypertension and peptic ulcer among others. Mental
health can be assessed at the community level using a mental health questionnaire.
Mention 1 mark explanation 1 mark total 2 marks
iii) Social dimension.This is a concept that emanated from the assumption that human
being is social in nature and lives as part of family and the larger society, who should
live and relate with others cordially and socially and should contribute to the
development of the family and society at large.
Social health measured wellness based on the quality of interpersonal relationship
maintained by the individual, his level of positive involvement with the community
and maintaining social network. Favourable economic conditions that allow the
individual to cope with resource demands are also taken as a good measure of
health.Mention 1 mark explanation 1 mark total 2 marks
iv) Spiritual dimension. The belief that man as a human being is a body that is occupied
by spiritual beings brought about the Spiritual dimension of health. This dimension of
health focuses on that part of the individual which strives for meaning and purpose of
life. The elements of spiritual dimension of health comprise of integrity, principles,
ethics, purpose in life and commitment to higher beingand is beyond just anatomical
 and physiological well been. It is believed that spiritual health deserves serious
consideration because it plays a great role in health and disease. Anyone who
experiences spiritual uneasiness or who is not spiritually at peace is not likely to put
up appropriate behaviour that reflects wholeness. Mention 1 mark explanation 1
mark total 2 marks
v) Emotional dimension. Emotional stability associated with mental stability are
considered to be related however now differences between the two elements (mental
and emotional) have been reported which aligns mental health to cognition and
emotional health to feelings. Mention 1 mark explanation 1 mark total 2 marks
Emotional disturbances will affect the individual’s response and adaptation to his
environment and how he relates, interact and socialised with other people around him.
Emotional dimension of health is now giving priority considering the new findings on
the influence of emotional aspect of human being on his health.
vi) Vocational dimension. This is a new dimension of health. It is believed that working
towards a goal is part of human existence and it plays an important role in health.
Work is part of human existence and plays a role in promoting physical and mental
health. Work brings about satisfaction and associated with improved physical
capacity. Achievement of goals brings about self-realization, satisfaction and self-
esteem thereby bringing about emotional and mental stability as such good health.
When a person loses his job or is not doing well in his vocational jobhe will be
emotional disturbed, mentally derailed and with loss of income thereby losing his
health.Mention 1 mark explanation 1 mark total 2 marks

Qb. Discuss the various complementary and alternative health care System.

Health care system is as old as the concept of the Disease as well. Over time, traditional
knowledge of treatment were changed to modern orthodox medical system. Despite the
development of the orthodox medicine, some traditional and complementary alternative medical
systems are still in practice. Some of these includes

i. Acupuncture: This is a medical practice that originated from China. It is based on

the believethe human body is covered with network of nervous system and sensitising
one end of nerves can trigger certain actions in the body or organs. In the treatment,
solid metallic needles are pushed into the skin with hands or electrical stimulation.
This practice sees the body as a delicate balance of two opposing but inseparable
forces referred to as Yin and Yang. It is believed that where there is no balance
between the two forces disease and illness results. Therefore the balance of the forces
is created by pushing pins into designated points in the skin. Yin is the cold, slow or
passive principle, while Yang is the hot, excited or active principle. Knowing where
to place the needle and the depth to push the needle is learned from masters.Mention
1 mark explanation 1 mark total 2 marks
ii. Massage: This is based on the principles that during every movement, muscles in the
body stores expends energy, and when the body is tired it result to sickness such as
cramps. The process involves rubbing and moving the muscles and the soft tissues of
the body using the hands and the fingers. The essence of this practice is to increase
blood and oxygen supply to the specific area of the body. The increased blood supply
causes the relaxation of the tensed muscles and nerves relieving aches, pains and
tension. Mention 1 mark explanation 1 mark total 2 marks
iii. Acupressure; This practice combines acupuncture and massage. It is often termed
acupuncture without needles. The fingers (thumb) or knuckles are used to apply
gentle but firm pressure on the designated points in the body believe that blood flow
and oxygen supply will be increased in the areas leading to relaxation. Mention 1
mark explanation 1 mark total 2 marks
iv. Osteopathy: This is a traditional method used to treat bones and their disorder. It is
mainly for orthopaedic and rheumatic disorders. It is based on the principle that
diseases are chiefly as a result of loss of structural integrity which can be restored by
manipulation. In osteopathy the dysfunctional structure is restored through physical
manipulation and hence health is restored. Record abounds for successful bone setting
by traditional bone setters and in some cases it does better than the orthodox setting
particularly where there is no open wound associated with the fracture.Mention 1
mark explanation 1 mark total 2 marks
v. Phyto-medicine: This is the use of herbs with therapeutic properties for the treatment
of diseases and other health conditions. Knowledge about use of Plants for medical
purposes has been documented over a long period of time. It is the practice of
herbalism. Preparation and use of herbal drugs and has always been with humanity.
Herbalism is traditional medical practice but in modern times botanical remedies are
explored and turned into drugs for the treatment of various illnesses.Also some
orthodox drugs were developed from Natural products of Plants origin, antimalarial
drug artemisin is derived from Artemisia plant. Mention 1 mark explanation 1
mark total 2 marks
vi. Chiro-practice: The focus of chiro-practice is to align the spine or any other part of
the body that has lost alignment causing pain to the individual. The notion is that the
relationship of the spine with the nervous system affects health and so the loss of
proper alignment of this or any part of the body is believed to cause dysfunction and
body pain. Mention 1 mark explanation 1 mark total 2 marks
vii. Aromatherapy: This practice uses the application of essential oils from plants and
other aromatic compounds to alter the mind, mood and cognitive functions for health.
In some cases aromatic plants are smoked and patients are covered with a cloth to
inhale the smoke, It is applied in situations where there is need for reduction of pain
and anxiety; need for enhancement of energy and memory; and need for relaxation.
Some school of thought is of the opinion that the aroma influences the brain through
 the olfactory system. The essential oils equally exert positive effect on the individual
producing feeling of wellbeing. Mention 1 mark explanation 1 mark total 2 marks

Total of 26 marks for the Question

Q5. Discuss the various dimensions of health.

b. Discuss the various Alternative and Complimentary Medicine available to People in Nigeria

Health is multi-dimensional, spanning beyond the three dimensions contained in the World
Health Organisation definition of health (physical, mental and social) to encompass other
elements such as spiritual, emotional, vocational and political dimensions.

vii) Physical dimension. This dimension is based on biological concept of health and is
based on the assumption that the body is made up of body cells, organs and systems
and they are at optimum performance in healthy body. It is also assume at optimum
level an individual will have good appetite, bright eyes, good complexion, lustrous
hair, regular bladder and bowel movement among others. Physical health can be
measured in modern medicine using self-assessment of overall health, investigation
of symptoms of illness and associated risk factors, medication and use of medical
services. At the community level, parametres such as death rate, number of aged
people and infant mortality rate are used as indicators of a healthy community.
Mention 1 mark explanation 1 mark total 2 marks
viii) Mental dimension. Mental stability and the ability to respond appropriately to
experiences of life and not the mere absence of mental illness is considered as good
health in Mental dimension of health. Mention 1 mark explanation 1 mark total 2
marks
Exhibit sense of purpose, conforming to societal norms and values and maintaining
good and harmonious relationship with others is considered as good mental health.
Mental health refers to maintaining state of equilibrium between the individual and
the world around him. Psychological factors can engender other types of illness other
than mental illness, such as hypertension and peptic ulcer among others. Mental
health can be assessed at the community level using a mental health questionnaire.
Mention 1 mark explanation 1 mark total 2 marks
ix) Social dimension.This is a concept that emanated from the assumption that human
being is social in nature and lives as part of family and the larger society, who should
live and relate with others cordially and socially and should contribute to the
development of the family and society at large.
Social health measured wellness based on the quality of interpersonal relationship
maintained by the individual, his level of positive involvement with the community
and maintaining social network. Favourable economic conditions that allow the
 individual to cope with resource demands are also taken as a good measure of
health.Mention 1 mark explanation 1 mark total 2 marks
x) Spiritual dimension. The belief that man as a human being is a body that is occupied
by spiritual beings brought about the Spiritual dimension of health. This dimension of
health focuses on that part of the individual which strives for meaning and purpose of
life. The elements of spiritual dimension of health comprise of integrity, principles,
ethics, purpose in life and commitment to higher beingand is beyond just anatomical
and physiological well been. It is believed that spiritual health deserves serious
consideration because it plays a great role in health and disease. Anyone who
experiences spiritual uneasiness or who is not spiritually at peace is not likely to put
up appropriate behaviour that reflects wholeness. Mention 1 mark explanation 1
mark total 2 marks
xi) Emotional dimension. Emotional stability associated with mental stability are
considered to be related however now differences between the two elements (mental
and emotional) have been reported which aligns mental health to cognition and
emotional health to feelings. Mention 1 mark explanation 1 mark total 2 marks
Emotional disturbances will affect the individual’s response and adaptation to his
environment and how he relates, interact and socialised with other people around him.
Emotional dimension of health is now giving priority considering the new findings on
the influence of emotional aspect of human being on his health.
xii) Vocational dimension. This is a new dimension of health. It is believed that working
towards a goal is part of human existence and it plays an important role in health.
Work is part of human existence and plays a role in promoting physical and mental
health. Work brings about satisfaction and associated with improved physical
capacity. Achievement of goals brings about self-realization, satisfaction and self-
esteem thereby bringing about emotional and mental stability as such good health.
When a person loses his job or is not doing well in his vocational jobhe will be
emotional disturbed, mentally derailed and with loss of income thereby losing his
health.Mention 1 mark explanation 1 mark total 2 marks

Qb. Discuss the various complementary and alternative health care System.

Health care system is as old as the concept of the Disease as well. Over time, traditional
knowledge of treatment were changed to modern orthodox medical system. Despite the
development of the orthodox medicine, some traditional and complementary alternative medical
systems are still in practice. Some of these includes

viii. Acupuncture: This is a medical practice that originated from China. It is based on
the believethe human body is covered with network of nervous system and sensitising
one end of nerves can trigger certain actions in the body or organs. In the treatment,
solid metallic needles are pushed into the skin with hands or electrical stimulation.
 This practice sees the body as a delicate balance of two opposing but inseparable
forces referred to as Yin and Yang. It is believed that where there is no balance
between the two forces disease and illness results. Therefore the balance of the forces
is created by pushing pins into designated points in the skin. Yin is the cold, slow or
passive principle, while Yang is the hot, excited or active principle. Knowing where
to place the needle and the depth to push the needle is learned from masters.Mention
1 mark explanation 1 mark total 2 marks
ix. Massage: This is based on the principles that during every movement, muscles in the
body stores expends energy, and when the body is tired it result to sickness such as
cramps. The process involves rubbing and moving the muscles and the soft tissues of
the body using the hands and the fingers. The essence of this practice is to increase
blood and oxygen supply to the specific area of the body. The increased blood supply
causes the relaxation of the tensed muscles and nerves relieving aches, pains and
tension. Mention 1 mark explanation 1 mark total 2 marks
x. Acupressure; This practice combines acupuncture and massage. It is often termed
acupuncture without needles. The fingers (thumb) or knuckles are used to apply
gentle but firm pressure on the designated points in the body believe that blood flow
and oxygen supply will be increased in the areas leading to relaxation. Mention 1
mark explanation 1 mark total 2 marks
xi. Osteopathy: This is a traditional method used to treat bones and their disorder. It is
mainly for orthopaedic and rheumatic disorders. It is based on the principle that
diseases are chiefly as a result of loss of structural integrity which can be restored by
manipulation. In osteopathy the dysfunctional structure is restored through physical
manipulation and hence health is restored. Record abounds for successful bone setting
by traditional bone setters and in some cases it does better than the orthodox setting
particularly where there is no open wound associated with the fracture.Mention 1
mark explanation 1 mark total 2 marks
xii. Phyto-medicine: This is the use of herbs with therapeutic properties for the treatment
of diseases and other health conditions. Knowledge about use of Plants for medical
purposes has been documented over a long period of time. It is the practice of
herbalism. Preparation and use of herbal drugs and has always been with humanity.
Herbalism is traditional medical practice but in modern times botanical remedies are
explored and turned into drugs for the treatment of various illnesses.Also some
orthodox drugs were developed from Natural products of Plants origin, antimalarial
drug artemisin is derived from Artemisia plant. Mention 1 mark explanation 1
mark total 2 marks
xiii. Chiro-practice: The focus of chiro-practice is to align the spine or any other part of
the body that has lost alignment causing pain to the individual. The notion is that the
relationship of the spine with the nervous system affects health and so the loss of
proper alignment of this or any part of the body is believed to cause dysfunction and
body pain. Mention 1 mark explanation 1 mark total 2 marks
 xiv. Aromatherapy: This practice uses the application of essential oils from plants and
other aromatic compounds to alter the mind, mood and cognitive functions for health.
In some cases aromatic plants are smoked and patients are covered with a cloth to
inhale the smoke, It is applied in situations where there is need for reduction of pain
and anxiety; need for enhancement of energy and memory; and need for relaxation.
Some school of thought is of the opinion that the aroma influences the brain through
the olfactory system. The essential oils equally exert positive effect on the individual
producing feeling of wellbeing. Mention 1 mark explanation 1 mark total 2 marks

NATIONAL OPEN UNIVERSITY OF NIGERIA

Plot 91, Cadastral Zone, NnamdiAzikiwe Express way, Jabi Abuja
FACULTY OF HEALTH SCIENCES
2021 EXAMINATION MG 2021_1
PROGRAMME: PRINCIPLES OF HEALTH PLANNING AND MANAGEMENT

COURSE CODE: PHS 811

CREDIT UNIT: 2 UNITS

TIME ALLOWED: 11/2 HOURS

INSTRUCTION: ANSWER ALL THE QUESTIONS.

Q1

a) Discuss the five of the project management cycle. (10 Marks)

The five project process groups are defined as:
i. Initiating/Conceptualization, before you can execute or even plan a project you have to show
that there is need for it, and it‘s going to contribute to your organizational objective which will
allow you to create feasibility study.

ii. Planning, once the project has been approved, it‘s time to create the schedule and task. Then
secure the necessary resources for the project. You will also develop a mechanism
communication and reports.

iii. Execution/implementation, once the roadmap has been created, it is time to start and begin to
assign task to team members.

iv. Monitoring and Controlling, there will be issues that arise over the course of the project, so
it‘s crucial that you are monitoring the project progress and controlling those changes.

v. Closing, the project it is not over once the deliverables have been delivered. There is still
outstanding contracts and other paperwork that need signing, distributing and achieving for use
when planning future work. Then you close the project. Each point is 0.5 mark, Discussion 1
mark and drawing of cycle 2.5 marks (10 marks)

b)Decision Analysis techniques are rational processes/systematic procedures for applying critical
thinking to information, data, and experience in order to make a balanced decision when the
choice between alternatives is unclear. List and discuss four (4) decision method/techniques (8
Marks)

Pros and Cons Analysis

Pros and Cons Analysis is a qualitative comparison method in which good things (pros) and bad
things(cons) are identified about each alternative. Lists of the pros and cons, based on the inputs
of subject matter experts, are compared one to another for each alternative. The alternative with
the strongest pros and weakest consist preferred. The decision documentation should include an
exposition, which justifies why the preferred alternative ‘s pros are more important and its cons
are less consequential than those of the other alternatives. Pros and Cons Analysis is suitable for
simple decisions with few alternatives (2 to 4) and few discriminating criteria (1 to 5) of
approximately equal value. It requires no mathematical skill and can be implemented rapidly
Kepner-Tregoe (K-T) Decision
Analysis K-T is a quantitative comparison method in which a team of experts numerically score
criteria and alternatives based on individual judgments/assessments. The size of the team needed
tends to be inversely proportional to the quality of the data available – the more intangible and
qualitative the data, the greater the number of people that should be involved. In K-T parlance
each evaluation criterion is first scored based on its relative importance to the other criteria (1 =
least; 10 = most). These scores become the criteria weights. Once the wanted objectives
(goals)have been identified, each one is weighted according to its relative importance. The most
important objective is identified and given a weight of 10. All other objectives [are] then
weighted in comparison with the first, from 10 (equally important) down to a possible 1 (not
very important). When the time comes to evaluate the alternatives, we do so by assessing them
relative to each other against all want objectives – one at a time.
Analytic Hierarchy Process (AHP)
AHP is a quantitative comparison method used to select a preferred alternative by using pair-
wise comparisons of the alternatives based on their relative performance against thecriteria. The
basis of this technique is that humans are more capable of making relative judgments than
absolute judgments. ―The Analytic Hierarchy Process is a systematic procedure for representing
the elements of any problem, hierarchically. It organizes the basic rationality by breaking down a
problem into its smaller and smaller constituent parts and then guides decision makers through a
series of pair wise comparison judgments (which are documented and can be reexamined) to
express the relative strength or intensity of impact of the elements in the hierarchy.
Multi-Attribute Utility Theory (MAUT)
MAUT is a quantitative comparison method used to combine dissimilar measures of costs, risks,
and benefits, along with individual and stake holder preferences, into high-level, aggregated
preferences. The foundation of MAUT is the use of utility functions. Utility functions transform
diverse criteria to one common, dimensionless scale (0 to1) known as the multi-attribute
―utility‖. Once utility functions are created an alternative‘s raw data (objective) or the analyst‘s
beliefs (subjective) can be converted to utility scores. As with the other methods, the criteria are
weighted according to importance. To identify the preferred alternative, multiply each
normalized alternative‘s utility score results for all of an alternative‘s criteria. The preferred
alternative will have the highest total score. Utility functions (and MAUT) are typically used,
when quantitative information is known about each alternative, which can result in firmer
estimates of the alternative performance. Utility graphs are created based on the data for each
criterion. Every decision criterion has a utility function created for it.
The MAUT evaluation method is suitable for complex decisions with multiple criteria and many
alternatives. Additional alternatives can be readily added to a MAUT analysis, provided they
have data available to determine the utility from the utility graphs. Once the utility functions
have been developed, any number of alternatives can be cored against them.

The simple multi attribute rating technique

(SMART) can be a useful variant of the MAUT method. This method utilizes simple utility
relationships. Data normalization to define the MAUT/SMART utility functions can be
performed using any convenient scale. Five, seven, and ten point scales are the most commonly
used. In a classical MAUT the full range of the scoring scale would be used even when there
may be no real difference between alternatives scores. The SMART methodology allows for use
of less of the scale range if the data does not discriminate adequately so that, for example,
alternatives which are not significantly different for a particular criterion can be scored equally.
This is particularly important when confidence in the differences in data is low. Research has
demonstrated that simplified MAUT decision analysis methods are robust and replicate decisions
made from more complex MAUT analysis with a high degree of confidence.
Cost-benefit analysis
Cost-Benefit Analysis (CBA) is ―a systematic quantitative method of assessing the desirability
of government projects or policies when it is important to take a long view of future effects and a
broad view of possible side effects‖. CBA is a good approach when the primary basis for making
decisions is the monetary cost vs. monetary benefit of the alternatives.
Custom tailored tools
Customized tools may be needed to help understand complex behavior within a system. Very
complex methods can be used to give straightforward results. Because custom-tailored tools are
not off-the-shelf, they can require significant time and resources for development. If a decision
cannot be made using the tools described previously, or the decision must be made many times
employing the same kinds of considerations, the decision-making support staff should consider
employing specialists with experience in computer modeling and decision analysis to develop a
custom-tailored.

C). According to Denhil et al, 2012, implementation of Primary Health Care (PHC) must be
guided by principles, which determine success or failure of any PHC program worldwide. List 6
(Six) principles. (3 Marks)

Each point listed 0.5 marks (3 marks)

i. Political commitment: The presence of progressive political will is central to the success of a
health system.

ii. Integration of promotive, curative, preventive and rehabilitative health care services.

iii. Equity: Everyone must have equal access to basic health care and social services without
segregation of sub groups and provision of care.

iv. Accessibility: Services must reach all people in the country in terms of geographical,
financial and functional accessibility.

v. Affordability: Level of health care must be in line with what the community and country can
manage to pay for. The inability to pay should not be a limiting factor to receiving health care.

vi. Availability: There should be adequate and appropriate services to meet particular health
needs of each community.
vii. Effectiveness: Services provided must meet the objectives for which they were intended and
should be justifiable in terms of cost.

viii. Efficiency: Results accomplished should be proportionate to resources used.

Q2a)Planning is a dynamic movement back and forth between various stages of process,
culminating in a purposeful projection of action to achieved pre-determined goals. Discuss stages
of planning process/cycle. (20 Marks)

Each point listed 0.5 mark, discussion 1.5 marks (8 marks)

The first stage in the process consists of organizing for planning, also known as planning the
planning during this stage, the planning team is assembled and prepared for the task ahead. The
detailed composition of the planning team will vary with the level at which the plan is being
formulated.
The second stage is situation analysis, the main purpose of this stage of the process is to
determine the most common health and health related problems and the population groups which
they affect, the factors which contribute to the development of the problems and so to identify
obstacles and constraints to the improvement of health care. The situation analysis requires a
definition of the common health problems in quantified terms, for example, incidence and
prevalence rates. It also requires fore-casting of situations which are likely to have direct or
indirect implications on health and health care in future.
The third stage is prioritization of health problems; this step is informed by the fact that the
resources for the implementation of our plans are presumed to be insufficient to address all the
health problems which are discovered.
Fourth is setting objectives-specification, for each priority problem, set objectives in terms of
the specific results to be achieved e.g. proportional reduction in incidence of the disease. These
will be guided by personal experience of disease control in the field, given the prevailing
conditions. It will also be guided by reported experiences of other workers in similar situations.
The objectives should be SMART- Specific, Measureable, Achievable, Realistic and Time-
bound.
Fifth, specification of technical interventions, for each desired objective, alternative technical
interventions which will be required to make the prescribed impact on the health status of the
community should be specified in terms of desired proportional increase in coverage e.g. ―to
increase coverage with potable water from 22% to 50%‖. These technical interventions consisted
of appropriate promotive, preventive, curative and rehabilitative services, which would result in
the desired changes.

Six stage, Constraints analysis and specification of strategies (identification of constraints to

implementation and alternative strategies for circumventing the constraints), For each technical
intervention specified, the major obstacles, problems, bottlenecks and constraining factors, which
were likely to impede implementation, were identified. These generally are resource and
operational deficiencies, which had been identified in the health system during the situation
analysis.
Seven stage, selection of strategies -selection of priority strategies, The strategies should be
evaluated and selected on the basis of perceived cost effectiveness, feasibility, cost-efficiency
logistical requirements, etc. Economic evaluation techniques are invaluable tools for the
effective selection and priority strategies.
Eight stage, detailed programming and resource specification, this stage involved the translation
of the interventions and strategies through the techniques of activity analysis and task analysis
into specific activities and tasks to be carried out by the health system, and other sectors and the
community i.e. identify the activities required for the execution of each strategy and clearly
specify what exactly was to be done, by whom, where it should be done, when and with what
resources.
Nine stage, output of the planning process, the exercise produced a detailed plan of work which
clearly specified the objectives to be attained, activities to be executed, standards and procedures,
who was responsible for each task, the time of execution and completion and the resource and
budgetary requirements for each direct task and support activity. Planning does not really end at
this stage. It is important, particularly at the local level that the planners should also participate in
the implementation and evaluation of the programs. The planning cycle thus continues through
implementation and evaluation, during which valuable information is collected. These are fed-
back for the improvement of the next planning cycle.

Each point discussed 2 marks (20 marks)

c)Outline four (4) characteristics of team building. (4 Marks)

i. Clear goals and a shared sense of purpose and commitment to achieving them;

ii. Members provide care to a common group of patients;

iii. Focus of members is on needs of the patient rather than on individual contributions of
members;

iv. Members develop common goals for patient outcomes and work toward those goals;

v. Effective communication with patients is a value shared by all team members;

vi. Members work together in delivering patient care;

vii. Each individual is able to contribute their own ideas toward solving a common problem;

viii. Mutual trust, respect and support among members;

ix. Appropriate roles and functions are assigned to each member, and each member understands
the roles of the other members;

x. Team possesses a mechanism for sharing information;

xi. Team has organizational structures, including regular meetings;

xii. Team possesses a mechanism to oversee the carrying out of plans, to assess outcomes, and to
make adjustments based on the results of those outcomes.
Each point listed 1 mark, discussion 1 marks (12 marks)

Q3 a)Health care management occupy several position at various level in health care
organization. Briefly describe three (3) main level. (3 Marks)

i. Strategic or top management level: Managers at the strategic or top level include Ministers and
Commissioners of Health, Directors of various departments in Health Ministries, members of the
Board of Management of Teaching Hospitals, Chief Medical Directors, Directors of Clinical
Services and Training, Directors of Administration, Chief Matrons, chief Pharmacists etc. Top
level managers take decisions concerning policy formulation, setting of organizational goals,
strategic planning, general strategies to be used, allocation of resources, corporate evaluation,
etc.

ii. Tactical, administrative or middle management level: at the tactical, administrative or middle
management level, the decisions taken are concerned with translating policies formulated at the
top and interpreting them according to local needs, defining the tactics of implementation,
structuring authority and responsibilities, coordination of activities, etc. Health managers who
occupy this position in a tertiary hospital setting would include Heads of departments,
Consultants, Matrons etc.

iii. Operational or supervisory management level: at the operational or supervisory level,

decisions are concerned with the day to day activities (processes) and services outputs, activity
scheduling, monitoring of performance, utilization of resources, inventory control etc.
Each point 1 marks (3 marks)
b) Write short note on Quality Assurance cycle. (10 Marks)

Setting Standards and Specifications

To provide consistently high-quality services, an organization must translate its programmatic
goals and objectives into operational procedures. In its widest sense, a standard is a statement of
the quality that is expected. Under the broad rubric of standards there are practice guidelines or
clinical protocols, administrative procedures or standard operating procedures, product
specifications, and performance standards.
Communicating Guidelines and Standards
Once practice guidelines, standard operating procedures, and performance standards have been
defined, it is essential that staff members communicate and promote their use. This will ensure
that each health worker, supervisor, manager, and support person understands what is expected
of him or her.
Monitoring Quality
Monitoring is the routine collection and review of data that helps to assess whether program
norms are being followed or whether outcomes are improved.
Generally, all levels of staff should be involved in designing a monitoring system so that
everyone receives all necessary information.
Identifying Problems and Selecting Opportunities for Improvement
Program managers can identify quality improvement opportunities by monitoring and evaluating
activities. With effective monitoring systems, health programs can conduct special community or
patient surveys or comprehensive assessments.
Defining the Problem
Having selected a problem, the team must define it operationally--as a gap between actual
performance and performance as prescribed by guidelines and standards.
Choosing a Team
Once a health facility staff has employed a participatory approach to selecting and defining a
problem, it should assign a small team to address the specific problem. The team will analyze the
problem, develop a quality improvement plan, and implement and evaluate the quality
improvement effort.
Analyzing and Studying the Problem to Identify the Root Cause
Achieving a meaningful and sustainable quality improvement effort depends on understanding
the problem and its root causes. Given the complexity of health service delivery, clearly
identifying root causes requires systematic, in-depth analysis.
Developing Solutions and Actions for Quality Improvement
The problem-solving team should now be ready to develop and evaluate potential solutions.
Unless the procedure in question is the sole responsibility of an individual, developing solutions
should be a team effort. It may be necessary to involve the personnel responsible for the
processes to the root cause.
Implementing and Evaluating Quality Improvement Efforts
Implementing quality improvement requires careful planning. The team must determine the
necessary resources and time frame and decide who will be responsible for implementation.
Each point listed 0.5 mark, discussion 0.5 marks (10 marks)
b)Outline and discuss six (6) stages of delegation of power based on the concept described by
Culp and Smith (1997). (12 Marks)

Stage 1: Deciding what to delegate

Delegators must decide what tasks should be delegated. To accomplish this, they must examine
the current situation within a particular work environment. For example, they must determine
who does what, and when and how tasks are to be completed. This stage enables managers who
are overloaded with other responsibilities to manage time better.
Stage 2: Selecting delegates

Delegators must identify what skills are needed for particular tasks and then decide whether
delegatees are the best people to carry them out. It is necessary to match the skills required for
the tasks with delegatees' skills.
It is also important that delegators take into account the experience and competence of the
delegatees and decide whether they need extra training before undertaking the task. Selecting the
right people can enhance the professional development of delegatees.
Stage 3: Assigning tasks
Delegators should describe the particular task in detail and offer an explanation as to why
delegatees were selected. They must also discuss the responsibilities associated with the task and
outline clearly the level of authority associated with it.
It is important at this stage to check that carrying out the delegated tasks and the responsibilities
are within the skill and experience of the delegatees. The activities involved in this stage are
important because they can promote trust between delegators and delegatees.
Stage 4: Assessing and discussing
Delegators need to include delegatees actively in the delegation process so that delegatees are
given an opportunity to assess the tasks and determine whether they are happy to undertake
them.
This may include further discussion of the skills required and the delegatees may like some time
to consider whether the tasks have well defined goals, whether they are competent to undertake
them and whether further training and education are required.
Delegatees may also want to establish how the tasks or projects affect overall workload and what
new responsibilities and levels of authority are associated with them. If theactivities at this stage
are followed through, duplication of effort and the possibility of team members working at cross
purposes can be reduced.
Stage 5: Executing the task
Delegatees should keep delegators informed of how the tasks progress, and it is important that
delegators inform other team members of the level of authority that has been assigned to
delegatees while they undertake the tasks.
Delegators must also decide on the supervision and feedback that is necessary during the
process. According to Tappen (1995), supervision and feedback can improve self-confidence of
the delegatees.
Stage 6: Completion of the task
It is essential that delegators share with the rest of the team the success or shortcomings of the
completed tasks or projects. Celebrating success can increase the delegatees' commitment and
self-esteem.
 BIOSTATISTICS AND APPLICATIONS

NATIONAL OPEN UNIVERSITY OF NIGERIA

Plot 91, Cadastral Zone, Nnamdi Azikiwe Expressway, University Village, Jabi-Abuja

NOVEMBER 2020_1 EXAMINATION

COURSE TITLE: PUBLIC HEALTH BIOSTATISTICS APPLICATION

COURSE CODE: PHS813 UNIT:3
INSTRUCION: ANSWER ALL TIME:2 HOURS

Question 1 20MARKS

Suppose a sample consists of birth weights (in grams) of all live born infants born
at a private hospital in a city, during a 1week period. This sample is shown as
follow:

3265 ,3323, 2581, 2759, 3260 ,3649, 2841, 3248, 3245, 3200 ,3609 ,3314,
3484 ,3031, 2838, 3101, 4146 2069 ,3541, 2834.

Calculate Sample Mean 10 Marks

Answer; Sample mean = (3265 + 3260 + . . . + 2834)/20

= 633338/20 = 3166.9g 10 Marks

Calculate the Harmonic mean for the following data 2, 5, 3, 6, 7. 5 Marks

Answer

XH = 5/ (1/2 + 1/5 + 1/3 + 1/6 + 1/7) = 5/ (0.5 + 0.2 + 0.33 + 0.167+ 0.143) = 3.73

Calculate the median of these numbers 4, 6, 7, 8, 10, 12.

Answer = The Median = 7+8/2 = 7.5 5 Marks

Total = 20 marks.

Question 2

Find the probability of getting:

(i) 2 heads (4Marks) (ii) 1 head (3 Marks) (iii) no head (3Marks) if a coin is tossed
twice. TOTAL = 10 Marks)

Answer

P (getting of a head) = ½ (2Marks)

(i) P (getting two heads) = P (1st is head) P (2nd is head) = ½ x ½ = ¼ (2Marks)

(ii) P (getting 1 head) = P (1stis head and 2nd is tail) or P (1st

is tail and 2nd is head) =P (H T) + P (T H) = ½ x ½ + ½ + ½ = ¼ + ¼ = ½ (3Marks)

(iii) P (getting no head) = P(1st is tail and 2nd is tail) = ½ x ½ = ¼ (3Marks)

Total = 10 Marks
Question 3

1 Differentiate between a population and a sample (12 Marks)

2. Explain the concept of sampling distribution (8 Marks)

Total = (20 Marks)

ANSWER

 A population is the aggregate number of subjects or respondents or

experimental units under consideration. 1/2 Mark
 This implies that a population should contain every member of a group of
interest, being studied.1/2 Mark
 Example could include the following: all children aged between five and ten
with corona virus living in Lagos; 1/2 Mark
 All women in Nigeria who had their first children at the age of 15;1/2 Mark
 All women in reproductive age in Ogun State for instance. 1/2 Mark
 A numerical characteristic or quantity or property of the population that we
wish to know about is called a population parameter.1/2 Mark
 Let a population consists all HIV patients between the ages of 20 and 60 in
Nigeria; with interest to study their weights.1/2 Mark
 Population parameter in this case could be the average weights of the
patients. 1/2 Mark
 So, population average or mean (μ) is a parameter.1/2 Mark
 Other examples of population parameters are the population variance
(σ2),1/2 Mark
 population standard deviation (σ),1/2 Mark
 population proportion (P), e.t.c. 1/2 Mark
 A parameter of a population is usually unknown.1/2 Mark
 The target of scientific investigation is usually the population, with some
characteristics of interest.1/2 Mark
 Sometimes, the population does not exist, like in prospective studies, or1/2
Mark
 Could be so large that obtaining measurements of all the members on the
characteristics of interest is impossible.1/2 Mark
  This means that obtaining value for the parameters is not possible. 1/2
Mark
 When situation like this arise, a sample from the population is studied
instead of the entire population.1/2 Mark
 Another way to deal with this problem is to conduct a clinical trial, if it is
health related and if necessary.1/2 Mark

Any correct six points = 6 marks

While Sample

 A sample is the part of a population that we actually study 1/2 Mark

 A numerical characteristic or quantity or property of a sample that we wish
to know about is called a sample statistic, or simply statistic. 1/2 Mark
 Example of sample statistics are sample average (X), sample variance (S2),
sample standard deviation (S) and sample proportion (p).1/2 Mark
 For instance, we might decide to select 50 HIV patients in the age range of
20 to 60 and measure their weights. 1/2 Mark
 Suppose the average weight of the 50 patients is, say, 58kg.1/2 Mark
 The sample size is 50 and the value of the sample statistic (average weight
in this example) is 58kg.1/2 Mark
 A numerical for the process of statistical inference to be valid we must
ensure that we take a representative sample of our population.1/2 Mark
 This implies that the characteristics of a sample we take, as much as
possible, match the characteristics of the population we are sampling
from.1/2 Mark
 Two simple and effective methods of doing this are making sure the sample
size is large enough and making sure it is randomly selected.1/2 Mark
 A large sample size includes more members of the population and is more
likely to be representative of a population than a small one. 1/2 Mark
 For studying the average weight of HIV patients between 20 to 60 years of
age in Nigeria, a sample of size1,000,000 HIV patients is more likely to be a
representative sample for the population average than a sample of size 10,
because the average weight of 1,000,000 patients would be likely close to
the population average than that of 10 patients.1/2 Mark
  Depending on the population size, a sample size greater than 30 is taken as
large sample. 1/2 Mark
 A random sample is a sample which gives every member of the population
an equal chance of being selected into the sample.1/2 Mark
 A random sample has the advantage of eliminating bias. Besides, most
statistical procedures are based on the idea of random sampling.1/2 Mark
 Descriptive Statistics involve the use of techniques and measures to
present, explore and summarize sample data. 1/2 Mark
 Sample statistics are summary measures. 1/2 Mark
 The main features of a sample and further details of random sampling
techniques would have been discussed in earlier modules and well
documented in most elementary statistics textbooks.1/2 Mark
Any correct six points = 6 marks

Total =12 POINTS

SAMPLING DISTRIBUTION OF A SAMPLE STATISTIC

 It is also important to state here that a sample statistic or an estimator is a

random variable (refer to early chapters of this material for notes on
random variables).1Mark
 This means that repeated samples of same size can be drawn
independently from the same population and values of the statistic of
interest computed for each sample drawn.1Mark
 This process would produce a set of values for the statistics.1Mark
 Therefore, like any random variable, a statistic (an estimator) has a
distribution, referred to as sampling distribution, with mean and
variance.1Mark
 Therefore, a sampling distribution of a statistic is defined as the distribution
of the values of the statistic over all possible repeated samples of same size
drawn from a specific population in consideration.1Mark
 A very important property of a statistic is unbiasedness and this can be
accessed through its sampling distribution. Bias is the difference between
the true value of a parameter and the expected value of the statistic
(estimator) used in estimating it.1Mark
  As an illustration: Let a population consist of 2, 3, 5, 7, 9. Then the
population mean, say μ = (2+3+5+7+9)/5 = 26/5 = 5.2. (Accept any other
correct arithmethecal example)1Mark
 Recall that μ is the parameter. /Suppose that random samples each of size
3 are to be selected from this population, and their sample means (sample
statistic) be computed. 1 Mark
(Accept any other correct arithmethecal example)
Any correct eight points x1 = 8 Marks
TOTAL = 20 POINTS

4.a) Define the following terms:

I. Prevalence 3Marks

ii. Incidence 3Marks

iii. Screen Test 3 Marks

iv.Clinical Trial 3Marks

v. Epidemiological Studies 3 Marks

b) Describe the three main types of bias errors in epidemiological studies.

5 Marks

Total 20 Marks

ANSWERS

1 Prevalence

 Prevalence is a measure of disease that allows us to determine a person's

likelihood of having a disease.1Mark

 Therefore, the number of prevalent cases is the total number of cases of

disease existing in a population.1Mark
 A prevalence rate is the total number of cases of a disease existing in a
population divided by the total population.1Mark

 So, if a measurement of 37cancer is taken in a population of 40,000 people

and 1,200 were recently diagnosed with cancer and 3,500 are living with
cancer, then the prevalence of cancer is 0.118. 1Mark

 (or 11,750 per 100,000 persons) Prevalence gives a figure for a factor
(disease, injury, health status e.t.c) at a single point in time (point
prevalence) or time period (period prevalence).1Mark

 Period prevalence provides the better measure of the factor since it

includes all cases between two dates, whereas point prevalence only
counts cases on a particular date.1Mark

 It is a measure of disease that allows us to determine a person's likelihood

of having a disease. 1Mark

 It is most meaningfully reported as the number of cases as a fraction of the

total population at risk and can be further categorized according to
different subsets of the population. An example of prevalence:1Mark

 A recent Scottish study showed that the prevalence of obesity in a group of

children aged from 3 to 4 years was 12.8% at the time. 1Mark
(Accept any other correct arithmethecal example)
Any3x1 = 3 marks

II Incidence:

 Incidence is often confused with prevalence.1Mark

 The easy way to remember the difference is that prevalence is the

proportion of cases in the population at a given time rather than rate of
occurrence of new cases. 1Mark

 Thus, incidence conveys information about the risk of contracting the

disease, whereas prevalence indicates how widespread the disease is.
1Mark

 -Incidence is a measure of disease that allows us to determine a person's

probability of being diagnosed with a disease during a given period of
time.1Mark

 -Therefore, incidence is the number of newly diagnosed cases of a disease.

An incidence rate is the number of new cases of a disease divided by the
number of persons at risk for the disease.1Mark

 If, over the course of one year, five women are diagnosed with breast
cancer, out of a total female study population of 200 (who do not have
breast cancer at the beginning of the study period), then we would say the
 incidence of breast cancer in this population was 0.025. (or 2,500 per
100,000 women years of study).1Mark
 (Accept any other correct arithmethecal example)
 -Mortality is another term for death. 1Mark

 -A mortality rate is the number of deaths due to a disease divided by the

total population. 1Mark

 -If there are 25 lung cancer deaths in one year in a population of 30,000,
then the mortality rate for that population is 83 per 100,000 1Mark

 (Accept any other correct arithmethecal example)

Any 3 x 1 = 3 marks

Screening Test

 A simple test performed on a large number of people.1Mark

 To identify those who have or are likely to develop a specified
disease.1Mark
 A preliminary / abridged test intended to eliminate the less probable
members of an experimentalseries.1 Mark
Any three points x 1 = 3 Marks
CLINICAL TRIAL AND EPIDEMIOLOGY

 A Clinical trial is a medical experiment on human subjects, particularly in a

clinic setup, such as to find efficacy and safety of a new therapeutic or
diagnostic regimen. 1/2 Mark
 clinical trial actually is an experiment testing medical treatments on human
subjects. 1/2 Mark
 The clinical investigator controls factors that contribute to variability and
bias such as the selection of subjects, application of the treatment,
evaluation of outcome, and methods of analysis. 1/2 Mark
 The distinction of a clinical trial from other types of medical studies is the
experimental nature of the trial and its occurrence in humans.1/2 Mark
 We defined a clinical trial as a prospective study that compares the effects
and value of intervention(s) against a control in human beings.1/2 Mark
 Note that a clinical trial is prospective, rather than retrospective. 1/2 Mark
 A clinical trial must employ one or more intervention techniques.1/2 Mark
 These may be single or combinations of diagnostic, preventive, or
therapeutic drugs, biologics, devices, regimens, procedures, or educational
approaches.1/2 Mark
 Intervention techniques should be applied to participants in a standard
fashion in an effort to change some outcome. 1/2 Mark
 Follow up of people over a period of time without active intervention may
measure the natural history of a disease process, but it does not constitute
a clinical trial. 1/2 Mark
 Without active intervention the study is observational because no
experiment is being performed. The term “clinical trial” is preferred over
1/2 Mark
 “clinical experiment” because the latter may connote disrespect for the
value of human life

Any 6 points x ½ = 3 marks

While Epidemiology is the study of factors that affect distribution and

determinants of disease or a health condition in a human population.1/2 Mark
Epidemiology is the study of diseases in populations of humans or other animals,

specifically, how, when and where they occur. 1/2 Mark

Epidemiologists attempt to determine what factors are associated with diseases

(risk factors), and what factors may protect people or animals against disease
(protective factors). 1/2 Mark

Epidemiology studies are conducted using human populations to evaluate

whether there is a correlation or causal relationship between exposure to a
substance and adverse health effects. 1/2 Mark

These studies differ from clinical investigations in that individuals have already
been administered the drug during medical treatment or have been exposed
to it in the workplace or environment. 1/2 Mark

Epidemiological studies measure the risk of illness or death in an exposed

population compared to that risk in an identical, unexposed population (for
example, a population of the same age, sex, race and social status as the
exposed population). 1/2 Mark

Standard and quantitative measures are used to determine if epidemiological

data are meaningful. This can be achieved using some common statistical
measures. 1/2 Mark

Any six points x1/2 = 3 marks

b) Describe the three main types of bias errors in epidemiological studies5Marks

ANSWER to b)

i)Selection bias: This occurs when the study group is not representative of the
population from which it came. 1 mark
ii)Information bias: This occurs when study subjects are misclassified as to disease
or exposure status. 2Mark

Recall bias occurs when individuals are asked to remember exposures or

conditions that existed years before. 1Mark

iii)Confounding factor: which occur when the study and control populations differ
with respect to factors which might influence the occurrence of the
disease1Mark

For example, smoking might be a confounding factor and should be considered

when designing studies. 1Mark

Often, however, epidemiology provides sufficient evidence to take appropriate

control and prevention measures. 1mark

Any 5 x1 = 5 Marks.

Q5. a). What is Chi Square Goodness of Fit? (5 marks)

Answer:
i. It is used to test whether a given set of data come from a specialized
distribution. (1 mark)
ii. The test is a test of agreement between the observed frequencies
and the expected frequencies. (1 mark)
iii. It makes use of Chi square ( X 2) distribution. (1 mark)
iv. The degree of freedom is usually (k-1) as there is only one row or one
column with k distinct groups. (1 mark)

b). A manager of a hospital supply store which has Five (5) branches
believed that the amount of revenue generated from each branch are the
same. A survey was then carried out to see whether this claim is valid at 5
 percent level of significance and the following results were obtained. (15
marks)

Branch A B C D E
Revenue 380 450 430 390 350
generated(₦)

Solution:
The null hypothesis is,
H0: The distribution of revenue is normal (the same) (1 mark)
H1: The distribution of revenue is not normal (has changed) (1 mark)
The assumption is that if revenue generation has not changed, then the
branches are expected to record equal revenue.
The total revenue generated divided by the number of branches:
₦ 2000
=₦ 400(1 mark) is expected from each branch.
5

1
Table = (10 marks) i.e., 2 mark for each bolded item

Branch Observed Expected ∑¿ ¿

Revenue (O) Revenue (E)
A 380 400 1.0
B 450 400 6.25
C 430 400 2.25
D 390 400 0.25
E 350 400 6.25
2000 16.0
X cal=∑¿ ¿(1 mark)
2

2
X tab = X k−1 ( 0.05 )=X 5−1(0.05)= X 4(0.05) = 9.49
2 2 2

Since the calculated statistic is greater than the critical value, there is enough
evidence to reject H0. Therefore, we conclude that the revenue generation
pattern has changed or the revenue generated from the branches are not
normally distributed.(1 mark)

NATIONAL OPEN UNIVERSITY OF NIGERIA

FACULTY OF HEALTH SCIENCES
DEPARTMENT OF PUBLIC HEALTH
2021_1 EXAM MG
Course Code:PHS 815
Course Title: Health Care Financing.
Credit Unit: 2
Total Score: 70
Time Allowed: 2Hours
Instruction: Attempt all questions
1. Allocation of resources for health care services requires skillful planning processes so as to
ensure equity in services to various socioeconomic groups in the society. In the light of this:
a. Describe 5 roles of healthcare financing in Nigeria (10mks)
Financing health care services encompasses the following: personal payments at the time of
service delivery, financing through health insurance (prepayment) by the employer and
employee at the workplace as well as general taxations supplemented by private organizations
and non-governmental organizations (NGOs). Health financing comprises 2 main functions:
resource mobilization mechanism (raising money for health) and financial management
(efficient management of resources raised)
Government’s funding is very necessary especially to take care of the services that health
insurance plans cannot effectively cover, particularly in the cases of non-communicable
diseases that could degenerate to disability. This funding is also important in the control of
epidemics as well of in the cost-effective interventions like immunizations which are for the
good of the public.
b. Enumerate 5 health care financing strategies in Nigeria (1mk each = 5mks)

 General tax revenues,

 Social insurance,
 Voluntary insurance,
 Charitable donations (also referred to as financial aid), and
 Individual out-of-pocket expenses.

c. Explain how any 2 of the strategies above influence health care for all citizens in
Nigeria (5mks each = 10mks)

 General tax revenues: The tax revenues that are generated in less developed countries
including Nigeria are smaller and are spread over other important public goods thereby
making other public health efforts including education, infrastructure, and economic
development of a low priority. That is why the tax base and consistency required
fordeveloping, administrating, and sustaining public health efforts are often excluded
from financing public health activities with general tax revenues.
 When this revenue is used to pay for public health activities, the taxes are considered
direct, indirect, or excise taxes.
Direct taxes are paid by individuals to governments and this tax cannot be avoided by
either behavioral or consumption decisions. By virtue of citizenship or ownership of any
property, individuals are expected to pay direct taxes.
Indirect taxes are taxes paid when transactions occur within a government’s purview.
Indirect taxes are considered as taxes on consumption.
Excise taxes which are much more specific, are taxes placed on the production or sale of
certain goods or services that can be used by governments to change the population’s
 consumption behavior by increasing the cost of a particular good or service. For example,
an excise tax placed on cigarettes will increases the price of cigarettes on consumers
thereby, help to generate additional tax revenue.
 Social insurance system provides minimum level of economic protection for citizens in
the form of giving them comprehensive system of health care like retirement, long-term
care, and unemployment insurance that are financed jointly by employers and employees.
Social health insurance plays an important role in the public health system by advancing
disease prevention, health promotion, resource and capital planning, as well as the
participation and management of disease registries which are according to WHO,
components of the essential health operations.
 Voluntary insurance occurs when employers and/or individuals choose to purchase
insurance from private firms so as to mitigate the potential loss of income associated with
illness or the costs of health care consumption. In some countries, voluntary insurance
systems are used to finance the health needs of the population instead of the social
insurance systems. In such countries, voluntary insurance covers about two-thirds of the
health needs of non-elderly working population, but the percentage to be enjoyed varies
and tends to decrease during periods of poor economic growth. Therefore, both social and
voluntary insurance financing mechanisms concentrate more on the delivery of acute
health care services than the essential operations of public health services.
 Charitable donations, financial aid, and the work of non-profit organizations in the
development and financing of public health cannot be understated because all countries,
regardless of their wealth, history, and where they are in the market maximization or
minimization spectrum, rely to some extent on charity and non-profit organizations.

2. Health care financing is visible and central on the global health stage, especially, for
countries wishing to achieve universal health coverage (UHC) so as to improve their
health status in the face of declining donor funds.
a. Explain 4 range of services requiring funding for all population in Nigeria
(2.5mks each = 10mks)
The range of services requiring funding for all population groups includes:
  Institutional care – teaching hospitals, general hospitals, mental and other special
hospitals, long-term nursing care, residential care, Pharmaceuticals and vaccines,

 Ambulatory care – primary care, family practice, pediatric, prenatal, and medical
specialist; medical, diagnostic, and treatment;

 Ambulatory and day hospital clinics; surgical, medical, geriatric, dialysis, mental,
oncological, drug and alcohol treatment,

 Elderly support service centers,

 Categorical programs – immunization, maternal and child health, family planning,

mental health, STIs, HIV, tuberculosis preventions, screening for birth defects,
cancer, diabetes, hypertension,

 Dental health,

 Community health activities – healthy communities, health promotion in the

community for risk groups; smoking restriction, promotion of physical fitness and
healthy diet; environmental and occupational health; nutrition and food safety, safe
water supplies, special groups,

 Research

 Professional education and training

b. Examine the challenge faced by governments in macroeconomic financing to reduce the

burden of out-of-pocket (OOP) healthcare payments for people (5mks)
 Out-of-Pocket Payments are payments made for health care services at the point of service.
The charges levied for health care services are termed as user fees but the scope of the user
fees is quite adjustable and can include combination of drug costs, medical costs, entrance
fees, and consultation fees.
 Out-of-pocket payments account for the highest proportion of health expenditure in Nigeria.
Out-of-pocket expenditure as a proportion of the total health expenditure (THE) averaged at
64.5% from 1998 to 2002 and later increased to 74% of THE showing that households bear
the highest burden of health expenditure in Nigeria
  One of the challenges faced by governments is to reduce the burden of out-of-pocket (OOP)
healthcare payments for their people by providing subsidies and extending prepaid
programs. OOP payment is the weakest and most unfair payment approach for health care.
 From the perspective of protection against risk, this approach is considered to be the worst
possible form of healthcare financing. OOP payments can negatively affect access to health
services, expose households to catastrophic health expenditure (CHE) and also slow the
progress of universal healthcare coverage.
 Direct out-of-pocket payments will further limit or exclude those who are unable to pay for
the services or those who place greater emphasis on other priorities. As a result, direct out-
of-pocket payments for healthcare services can constitute a barrier in obtaining services that
can improve health. This is why some researchers view out-of-pocket payment that exceeds
20% of the total health expenditures as a substantial barrier.
c. Explain 5 implications of out-of-pocket health expenditure in health care service
(2mls each = 10mks)
 OOP payments can affect access to and utilization of health care services. It limits the
progress toward universal healthcare coverage.
 OOP and high medical fees will make members of the households to face catastrophic
healthexpenditure (CHE) when the household’s OOP payment exceeds the capacity to pay
then the household will experience CHE. Then CHE becomes the major challenge for the
households, especially those in low- and middle-income countries like Nigeria.
 CHE will affect the health of all the household members, and can result to a cycle of poverty
in health. This is why poorer households are often forced to borrow money, sell assets or
property, reduce consumption of food or resort to making savings to pay for their health care
expenses, thereby, causing them extreme poverty.
 Millions of people around the world suffer from financial hardship as a result of OOP
healthcare payments. According to WHO report, about 44 million households and more than
150 million individuals all over the world encounter CHE every year.
 The increasing costs of health care and the challenge of achieving equity in the financial
contribution to health systems globally have raised concerns in communities on how to
finance health care systems.
3. The economic consequences of decisions some countries make in resource allocation
arethe major issues that determine health care economics. However, there are several laws
that guide the resource allocation of a nation.
a. Discuss 2 laws of resource allocation and the implications to revitalization of the
primary health care systems in Nigeria (4mks each = 8mks)
 Sutton’s law: Willy Sutton specialized in bank robbery. He robbed banks in such a way
that fascinated journalists and an interview was organized to find out the reasons he had
for robbing only banks. When he was asked,” why do you only specialize in bank
robbery?” In his reply, he said “Well, that’s where the money is”. His expression during
the interview is currently used by health planners to show that health care services will
emphasize the aspects that are better financed. This law translates the idea that if more
funds are available for treatment services than preventive care services, that prevention of
diseases will be relatively underfunded. That will mean that treatment services will
receive greater emphasis than prevention.
 Capone’s law: Al Capone was a well-known gangster who with his colleagues planned
the division of Chicago. In their plan, he arrogated the southern part of Chicago to
himself while his colleagues took the northern side. The law explains that resources are
allocated according to mutual interests. This expression in the health context means that
planning in health care service will reflect the interests of providers and not that of the
general public. The law further explains that the concept of macroeconomics planning
serves the interest of the general public at the expense of that of the individual patient.
 Bunker’s law: The law believes that the more there are surgeons in a health care system,
the more the health care system will generate surgeries. This means that the greater the
number of surgeons employed in a health care system, the more the number of surgeries
they will perform and the less the number of referrals they will make to other health care
professionals The law explains that the regimented health care functions of professionals
and gatekeeper in a health care system will limit referrals and self-referral to other
specialists in professional organizations and governments. These monopolies in functions
the law explains limit health care financing, training opportunities and licensing for some
specialists.
  Roemer’s law: This law believes that hospital beds, once built and insured, that the beds
must be filled to capacity. The law explains that hospital bed supply and occupancy are
usually reduced with the introduction of out of pocket and diagnosis-related group (DRG)
methods of payment. The law believes that encouraging incentives that will enhance both
increase in the hospital bed supply and utilization of services, are crucial determinants of
the efficiency and effectiveness of health care financing and planning in the health
industry.
b. Identify 4 factors that influence demand for Health Care Services (1mk each = 4mks)

 Illness behavior which is itself influenced by age, gender, education, and socioeconomic
class
 Knowledge of services
 Influences from the media.
 The supply of services, which is itself influenced by the use of guidelines, and evidence
of clinical and cost-effectiveness.

c. Explain the influence of health on development of Nigerian citizens (8mks)

Basically, as countries develop economically, the structure of economic and social
organizations changes.
 The country’s industrial sector will grow at the expense of the agricultural sector both in
employment and in value added.
 The service sector will increase as a share of the economy. With the population becoming
more urbanized, the traditional social structures will be less important, and the
distribution of income will change.
 The effects of these changes in the social structure on health outcomes will be ambiguous
because when the nature of health problems changes, the effect on the overall health
status of the population will be difficult to ascertain.
 Changing from agriculture in the rural area to engage in industrial production in the urban
area will reduce the incidence of most infectious diseases that are common in rural areas
like schistosomiasis,
 Such a decrease in incidence may be associated with an increase in diseases related
topollution, including lung cancer.
tion scores and to continue to be relevant.

4. QUESTION 4 20marks

(3a) Depict team building in public health 10marks

NOTE:1mark for any correctly mentioned and described point

(i) People in the workplace talk about team building , but only few of them have the
understanding and the experience of teamwork, and

(ii) How to maintain effective team for the sustainability of health care services.
Belonging to a team will enable a worker to understand

(iii) Objectives of the organization and work towards the realization of the objectives, a
team-oriented environment, workers contribute to the overall success of the organization

(iv) No matter the specific job function and the department a team member belongs, the
individual is unified with other staff members to accomplish the overall objectives of
the organization.

(v) To have an effective teamwork, a leader should communicate clearly the expected
performance ,outcomes for the team members so as to enable team members understand
why the team was created.

(vi) The leader should make the work of the team to receive sufficient emphasis in the
areas of the effective management of time and money

(vii) Discussion and attention given to team members to make them committed in
accomplishing the expected outcomes.

(viii) This will make the team to have enough freedom and empowerment necessary to
accomplish the aim of forming the team.

(ix) Team members understand the stages of the team development

(x) Answers to questions will show the extent to which the team members are innovative
and collaborative.

(3b) Explain how fragmentation contributes to efficiency in public health 10marks

NOTE:1mark for any correctly mentioned and explained point

FIRST
 (i) There are higher administrative costs in having multiple pooling/purchasing agencies
rather than one, result in raised system-wide costs.

(ii) Multiple funds will imply multiple information systems linked to each pool/purchaser
that can

(iii) Give rise to more administrative staff and more spending at the level of providers.

(iv) The administrative costs are greater when there are different service providers that are
associated with each financing arrangement.

(v) Duplication of functions is the major driver of inefficiency in the entire health
system.

SECOND

(vi) Fragmentation can enhance efficiency by weakening the potential gains of using
purchasing as

(vii) Instrument of influencing provider behavior in countries where

(viii) Multiple purchasers use different payment methods and

(ix) Rates to pay the same providers in an uncoordinated way.

This will encourage the providers to alter the costs between patients that are covered by different
schemes , reduce the system’s impact on purchasing reforms.

NATIONAL OPEN UNIVERSITY 0F NIGERIA

University Village, Nnamdi Azikiwe Express Way, Jabi, Abuja 1
FACULTY OF HEALTH SCIENCES
DEPARTMENT OF PUBLIC HEALTH SCIENCE
EXAMINATION QUESTIONS 2020_2
COURSE TITLE: Occupational Health and Safety (PHS817)
CREDIT UNIT: 3 Units
TOTAL SCORE: 70 Marks
TIME ALLOWED: 2 Hours
INSTRUCTION: Answer All Questions

MARKING GUIDE
QUESTION 115 marks
1a. What are occupational diseases (5marks)
1b. Mention and describe four occupational diseases(10marks)

ANSWER
Q1a).

(i) occupational disease” is any disease contracted primarily as a result of an

exposure to risk factors arising from work activity.
(ii) Work-related diseases” have multiple causes,
(iii) where factors in the work environment may play a role, together with other risk
factors, in the development of such diseases.
(iv) that results from exposure to physicalChemical or biological agent
(v) Theextent that the health of the Worker is impaired

1b)
Pneumoconiosis
(i) disabling pulmonary fibrosis that results fromthe inhalation of various
inorganic dust
(ii) such as silica, asbestos,coal, talc, china clay, silicosis and asbestosis:

Dermatitis
(i) Allergic and irritant dermatitis (also known as ‘contact dermatitis’) is the
most important cause of occupational skin diseases
(ii) Contact dermatitis is caused by a wide array of physical, biological or
chemical agents.

Musculoskeletal disorders
(iii) Are pre prevalent in most workplaces, even in office settings.
(iv) Indeed, office workers may be at risk of repetitive strain injuries  
Hearing loss
(v) workers who had higher occupational noise exposures than the general
population.
Workers in the mining, construction and manufacturing industries need
better hearing conservation
Cancer
 (vi) Occupational cancers occur when workers are in contact with
carcinogenic substances in their workplace.
(vii) Certain substances are associated with different cancers, and certain
carcinogens can be especially prevalent in certain industries.
Stress and mental health disorders
(viii) Multiple sources state that mental health disorders can also be
considered as occupational diseases in certain contexts.
(ix)
(x) Post traumatic stress disorder (PTSD) is most commonly cited.
Infectious diseases.
(xi) workers run the risk of contracting infectious diseases such as hepatitis
B and C, tuberculosis
(xii) The human immunodeficiency virus (HIV).
(xiii) TB is also a risk for workers in social services or correctional
facilities as they are in constant contact with high-risk populations.

QUESTION 2 25 marks
2a Itemize the factors responsible for deindustrialization (5 marks)
2b. Describe fully any three types of Personal Protective Equipment designed to
protect workers from workplace hazards (20marks)

2a. Itemize the factors responsible for deindustrialization (1 mark for each)
1. Development of replacement technology
2. Loss of competitive advantage
3. Increase in the service sector at the expense of manufacturing industries
4. Development of an information-based economy
5. Upgrading of the quality of the product being manufactured

2b. Describe fully any three types of Personal Protective Equipment designed to protect workers
from workplace hazards (6.7marks each for any three)
1. Eye and Face Protection
To protect from hazards that pose dangers to the eyes and face. Employees are required to have
appropriate eye or face protection if they are exposed to eye or face hazards from flying
particles, molten metal, liquid chemicals, acids or caustic liquids, chemical gases or vapours,
potentially infected material or potentially harmful light radiation. These include;
a. Safety Spectacles
b. Goggles
c. Welding shields
d. Face shield
e. laser Safety goggles

2. Head Protection
Wearing a safety helmet or hard hat is one of the easiest way to protect an employee’s head from
injury. Hard hats/ bump hats can protect employees from impact and penetration hazards as well
as from electrical shock and burn hazards. Employers must ensure that their employees wear
head protection if any of the following apply:
a. Objects might fall from above and strike them on the head
b. They might bump their heads against fixed objects, such as exposed pipes or beams; or
c. There is a possibility of accidental head contact with electrical hazards.

Head protection that is either too large or too small is inappropriate for use, even if it meets all
other requirements.

3. Foot and Leg Protection

Employees who face possible foot or leg injuries from falling or rolling objects or from crushing
or penetrating materials should wear protective footwear. Also, employees whose work involves
exposure to hot substances or corrosive or poisonous materials must have protective gear to
cover exposed body parts, including legs and feet. If an employee’s feet may be exposed to
electrical hazards, non-conductive footwear should be worn. On the other hand, workplace
exposure to static electricity may necessitate the use of conductive footwear.
Examples include;
a. Leggings
b. Metatarsal guard
c. Toe Guard
d. combination of foot and shin guard
e. Safety Shoes

4.Hand and Arm Protection

Potential hazards include skin absorption of harmful substances, chemical or thermal burns,
electrical dangers, bruises, abrasions, cuts, punctures, fractures and amputations. Protective
equipment includes gloves, finger guards and arm coverings or elbow-length gloves. There are
many types of gloves available to protect against a wide variety of hazards and the nature of the
hazard and the operation involved will affect the selection of gloves
Factors influencing the selection of protective gloves include;

a. Type of chemicals handled.

b. Nature of contact (total immersion, splash, etc.).
c. Duration of contact.
d. Area requiring protection (hand only, forearm, arm).
e. Grip requirements (dry, wet, oily).
f. Thermal protection.
g. Size and comfort
h. Abrasion/resistance requirements.

5. Body Protection
Employees who face possible bodily injury of any kind that cannot be eliminated through
engineering, work practice or administrative controls, must wear appropriate body protection
while performing their jobs. In addition to cuts and radiation, the following are examples of
workplace hazards that could cause bodily injury:
a. Temperature extremes
b. Hot splashes from molten metals and other hot liquids
c. Potential impacts from tools, machinery and materials
d. Hazardous chemicals.

Types of body Protection include;

a. Overalls, aprons and coveralls (protection against hazardous substances)
b. Laboratory coats
c. Surgical gowns
d. Clothing for cold, heat and bad weather
e. Clothing to protect against machinery, e.g. chainsaws
f. High visibility clothing (e.g. jackets, vests)
g. Harnesses
h. Back supports
i. Life jackets
j. full body suits.

QUESTION 3 20 marks
3a Define the following;
i. Health care provider (2marks)
ii Risk (2marks)
iii. Occupational accident (2marks)
iv. Hazard (2 marks)
v Internal responsibility system (4 marks)

3b. Explain the four basic steps in risk assessment process (8 marks)
ANSWER
3ai).Health care provider- Any person delivering care to a client/patient/resident. This includes,
but is not limited to, the following: emergency service workers, physicians, dentists, nurses,
respiratory therapists and other health professionals, personal support workers, clinical
instructors, students and home health care workers. In somenon-acute settings, volunteers might
provide care settings, volunteers might provide care and would be included as health care
providers. (2 marks)

3aii). Risk- The likelihood of harm (in defined circumstances) (2 marks)

3aiii). Occupational accident- Accident occurring at the workplace which may cause
damage to machinery, tools or people. (2 marks)

3aiv). Hazard -Any existing or potential condition in the workplace which, by itself or by
interacting with other variables, can result in death, injury, property damage or loss. Simply,
hazard is a potential source of harm. An occupational hazard is a thing or situation with the
potential to harm a Worker. A safety hazard causes accidents that physically injure Workers. A
health hazard results in the development of disease. (2 marks)

3av).Internal responsibility system-system in which every individual is responsible and

accountable for health and safety, including Employers, Supervisors and Workers (4 marks)

Q3b. Explain the four basic steps in risk assessment process(2 marks each) = 8marks

a. Hazard identification —Defining the hazard and nature of the harm; for example, identifying
a chemical contaminant, such as lead or carbon tetrachloride, and documenting its toxic effects
on human beings.

b. Exposure assessment—Determining the concentration of a contaminating agent in the

environment and estimating its rate of intake in target organisms; for example, finding the
concentration of aflatoxin (a fungal toxin) in peanut butter and determining the dose an
‘‘average’’ person would receive.

c. Dose–response assessment— Quantifying the adverse effects arising from exposure to a

hazardous agent based on the degree of exposure. This assessment is usually expressed
mathematically as a plot showing a response (i.e., mortality) in living organisms to increasing
doses of the agent.

d. Risk characterisation—Estimating the potential impact of a hazard based on the severity of

its effects and the amount of exposure.
QUESTION 4 10marks
4a. List five potential health hazards (5 marks)
4b. Explain the relationshipbetween work and health (5marks)
ANSWER

Q4a. List five potential health hazards.(1 mark for each)

i. Air contaminants
ii. Chemical Hazards
iii. Biological Hazards
iv. Physical Hazards
v. Ergonomic Hazards

Q4b.
(i) Relationship between work and health,
(ii) The worker must be strong
(iii) Free of illness
(iv) Or disease for him or her
(v) To continue in his or her work place

Explain three occupation diseases(four marks each for any three) = 5 marks

ANSWER
4bi). Pulmonary Dust Diseases 4 marks
If the work place is dusty, dust will inevitably be inhaled. Dust particles below five microns in
diameter are called respirable since they have the chance to penetrate to the alveoli. The
respiratory tract has certain defence mechanisms against the dust but when the environment is
very dusty a significant amount of dusts can be retained in the lungs.

4bii). Occupational Infections4 marks

Human diseases caused by work-associated exposure microbial agents, e.g. bacteria, viruses,
rickettsia, fungi and parasites (helminthes, protozoa), are called occupational infections. An
infection is described as occupational when some aspects of the work involves contact with a
biologically active organism. Exposure occurs among health care workers in fever hospitals,
laboratories and general hospitals; among veterinarians and agricultural workers in animal
husbandry and dairy farms and pet shops; and among sewerage workers, wool sorters and
workers in the leather industry.

4biii). Occupational/Pulmonary Tuberculosis4 marks

Health care workers in tuberculosis treatment centres, in laboratories and in veterinary clinics are
particularly affected. The disease is caused by Mycobacterium tuberculosis (Koch’s bacillus) and
is transmitted occupationally by droplet infection, contact with infected material from humans
(sputum) or animals. The organism can survive in dust and away from direct sunlight for many
days and enters the body through the respiratory tract or abraded skin where it causes a skin
ulcer. The disease usually affects the lungs but can also affect the gastrointestinal tracts, bones,
kidneys, meninges, pleural and peritoneum. Pulmonary tuberculosis is manifested by coughing,
expectoration, haemoptysis, loss of weight, loss of appetite, night sweats and night fever. It can
be diagnosed by chest X-ray and bacteriological examination of the sputum.

4biv).Viral Hepatitis B and C4 marks

Health care workers who are likely to come into contact with the blood and body fluids of
infected persons are at great risk of infection. An acute onset of hepatitis is the exception; more
often there are vague general symptoms or none at all and the infection is discovered on routine
serological examination. The disease may pass into chronic active hepatitis: liver cirrhosis,
hepatic failure and liver carcinoma.

4bv).Occupational Dermatoses4 marks

Occupational dermatoses are the most common occupational diseases and are almost always
preventable by a combination of environmental, personal and medical measures.The skin can be
affected by many factors:
i. repeated many irritations may cause callosities and thickening of the skin
ii. various kinds of radiation
iii. tuberculosis and anthrax
iv. chemicals can cause irritation and sensitization

Types of occupational dermatosis:

i. acute contact eczema due to irritation and sensitisation
ii. chronic contact eczema due to irritation and sensitisation
iii. chloracne (lubricating and cutting oils, tar and chlorinated naphthalenes)
iv. photosensitization (chemicals, drugs and plants)
v. hypopigmentation and hyperpigmentation (dyes, heavy metals and chlorinated hydrocarbons)
vi. keratoses (ionizing radiation, ultraviolet radiation)
vii. Benign tumours and epitheliomas (UV, ionizing radiation, tar, soot, arsenic)
viii. ulcers (trauma, burns).

f. Occupational Cancer
The cause of cancer is still not completely understood. It has been observed however, through
epidemiological studies that cancer of certain organs has been associated with certain exposures.
Occupational cancer is not different from other types of cancers in terms of presentation or
histopathologic forms. A positive history of exposure to a carcinogenic agent can be obtained in
occupational cancer.

g. Reproductive Effects
Occupational exposure to certain chemicals or physical factors (like ionizing radiation) has been
found to have certain effects on reproductive functions:
i. dysfunction in males (sterility or defective spermatozoa) and females (anovulation,
implantation defects in the uterus).
ii. Increased in incidence of miscarriage, stillbirth and neonatal death.
iii. Induction of structural and functional defects in new-born babies.
iv. Induction of defects during the early postnatal developmental stage.

Chemicals which may have been associated with reproductive effects include: alcohols,
anaesthetic gases, cadmium, carbon disulphide, lead, manganese, polyvinyl chloride.

QUESTION 5 25 marks
5a. Give account of Hollands approach to the types of work environment 7.5marks

5b. Depict workplace environments as physical and non - physical?10 marks

5c. Write a short note on interaction between work and health(7.5 marks)

Holland’s approach to the types of work environment looked at the nature of the work done. He
identified six different environments:
1. Realistic
2. Social
3. Enterprising
4. Artistic
5. Investigative
6. Conventional

In realistic environments, work is more hands on, while investigative environments place a
high priority on thinking and theoreticaldiscussions. Enterprising environments involve more
self-initiative tostart and innovate projects. Conventional work environments use setprotocols
and routines, such as data basing customer information, while artistic environments promote
creativity and the production of worksof art. Social work environments involve a high degree
of interaction,as seen in customer service and teaching.

5b. Describe workplace environments as physical and non - physical? (5 marks for physical
and 5 marks for non-physical)

Workplace environment factor can be classified into two (2) broad categories namely:
1. The Physical Environment Factor
2. The Non-Physical Environment Factor
These two interacts together to determine the efficiency of workers at a given occupational
setting.

The physical environment factors are physical conditions in the workplace (e.g., noise, heat
stress) that expend the three resources of human energy (i.e., physical, mental, and emotional).
Also, the chemical (e.g., dust, fumes), biological (e.g., bacteria, viruses), and radiological (e.g.,
X-rays) factors are part of the physical environment conditions that drain all three resources of
energy.

The non-physical or social environment loads are demands imposed upon the worker due to
work situations and conditions that require interaction with others in the organisation (e.g., social
conflict with the supervisor or co-workers). The organisational loads are demands in the work
environment defined by how work is organised and structured (e.g., working night shift or long
hours). The technical workplaceenvironment conditions deal with the adequacy of equipment,
tools, skills, knowledge, and supervision required to alter materials or information in some
specified or anticipated way to achieve a desired end result. The social, organisational, and
technical environment conditions primarily influence the emotional energy exertion.

5c Short note on interaction between work and health 7.5marks

(i) If there is no good health, definitely there will be no work
(ii) Occupational diseases are adverse health conditions in
(iii) The human being,the occurrence or
(iv) Severity of which is related to exposure
(v) To factors
(vi) the job
(vii) The work environment.

NATIONAL OPEN UNIVERSITY 0F NIGERIA

University Village, Nnamdi Azikiwe Express Way, Jabi, Abuja
FACULTY OF HEALTH SCIENCES
DEPARTMENT OF PUBLIC HEALTH SCIENCE
EXAMINATION MG 2021-1
COURSE TITLE: Health Promotion and Education and Its Advances (PHS 819)
CREDIT UNIT: 2 Units
TOTAL SCORE: 70 Marks
TIME ALLOWED: 1½ Hours
INSTRUCTION: Answer All Questions

QUESTION 1 25 marks
1a. List and discuss the priorities for Health promotion in the 21st Century as outlined by the
World Health Organization (WHO). 20marks

1b. Under the Trans Theorical model of behavior change, list the five stages of behavior change
5marks
1a.
1. Promote social responsibility for health
(i) Decision-makers must be firmly committed to social responsibility.
(ii) Public and private sectors should promote health by pursuing policies
(iii) Avoid harming the health of individuals, protect the environment and ensure sustainable use
of resources . (3 marks)

2. Increase investment for health development

(i) In many countries, current investment in health is inadequate and often ineffective.
(ii) Increasing investment for health development requires a truly multi-sectoral approach
(iii) Greater investment for health and reorientation of existing investmentsamong countries, has
the potential to achieve significant advances in human development, health and quality of life.
(3 marks)

3. Consolidate and expand partnerships for health

(i) Health promotion requires partnerships for health and social development between the
different sectors at all levels of governance and society.
(ii) Existing partnerships need to be strengthened and the potential for new partnerships must be
explored.
(iii) Partnerships offer mutual benefit for health through the sharing of expertise, skills and
resources. . (3 marks)
4. Increase community capacity and empower the individual
(i) Health promotion is carried out by and with people, not on or to people.
(ii) It improves both the ability of individuals to take action, and the capacity of groups,
organizations or communities influence the determinants of health.
(iii) Improving the capacity of communities for health promotion requires practical education,
leadership training, and access to resources.
(3 marks)

5. Secure an infrastructure for health promotion

(i) To secure an infrastructure for health promotion, new mechanisms for funding it locally,
nationally, globally must be found.
(ii) Incentives should be developed to influence the actions of governments, nongovernmental
organizations, educational institutions
(iii) The private sector to make sure that resource mobilization for health promotion is
maximized. (iv) Training in and practice of local leadership skills should be encouraged in order
to support health promotion activities. (4 marks)

6. Call for action

(i) The participants in the Jakarta Conference are committed to sharing the key messages of the
Jakarta Declaration with their governments, institutions and communities.
(ii) In order to speed progress towards global health promotion, the participants endorse the
formation of a global health promotion alliance.
(iii) The goal is to advance the priorities for action in health promotion set out in this
Declaration. raising awareness of the changing determinants of health.
(iv) The participants call on WHO to take the lead in building such a global health promotion
alliance and enabling its Member States to implement the outcomes of the Conference. (4
marks)

1b.
i. Pre-contemplation: this describes individuals who are not even considering changing
behaviour or are consciously intending not to change
ii. Contemplation: the stage at which a person considers making a change to a specific
behaviour
iii. Determination, or preparation: the stage at which a person makes a serious commitment to
change
iv. Action: the stage at which behaviour change is initiated
v. Maintenance: sustaining the change, and achievement of predictable health gains. Relapse
may also be the fifth stage

QUESTION 225 marks

2a. List at least five domains in Health Promotion 5marks

2b. Discuss the three commonly used theories and models in Health Promotion 15 marks

2c. Write a short note on the communication-behaviour change model 5marks

2a. 5Marks
iPreventive services ii. Preventive health education

iii. Preventive health protection iv. Health education for preventive health protection

v. Positive health education vi. Positive health protection

vii. Health education aimed at positive health protection (5marks)

2b. 15marks

A. The Health Belief Model:

(i) This is one of the longest established theoretical models designed to explain health
behaviour by understanding people‟s beliefs about health.
(ii) It was originally articulated to explain why individuals participate in health screening
and immunization programmes ,has been developed for application to other types of
health behaviour.
(iii) The model predicts that individuals will take action to protect or promote health

(iv) They perceive themselves to be susceptible to a condition or problem, believe it will

have potentially serious consequence, believe a course of action is available which will reduce
their susceptibility.

(v) The health belief model has been found to be most useful when applied to behaviours for
which it was originally developed, particularly prevention strategies . (5marks)

B.The Stages of Change (Trans-theoretical) Model

(i) This model was developed to describe and explain the different stages in behaviour change

(ii)The model is based on the premise that behaviour change is a process, not an event, and that
individuals have different levels of motivation or readiness to change.

(iii) Pre-contemplation describes individuals who are not even considering changing behaviour
or are consciously intending not to change

(iv) The model has been used in workplace programmes to promote regular physical activity,
which traditionally have met with limited success.

(v) The intervention produced promising short-term results by supporting many participants to
move on through the different stages of change towards more regular activity. (5marks)

C. Social Cognitive Theory:

(i) This is one of the most widely applied theories in health promotion because and addresses
both the underlying determinants of health behaviour and the methods of promoting change.

(ii) The theory was built on an understanding of the interaction that occurs between an individual
and their environment.

(iii) Social cognitive theory indicates that the relationship between people and their environment
is more subtle and complex.

(iv) They are then likely to modify their behaviour. In this case, the non-smokers have influenced
the smoker‟s perception of the environment through social influence.

(v) This understanding emphasizes the importance of understanding personal beliefs and
motivations underlying different behaviour, and the need to emphasize short-term and tangible
benefits. (5 marks)

2c.Write a short note on the communication-behaviour change model 5marks

(i) Effective health promotion strategies are best developed by engaging

individuals and communities in the issue to be addressed.
(ii) It involves understanding the beliefs and knowledge that people have about a
problem and their skills in addressing it, as well.
(iii) Clear communication between health promotion practitioners and those
whom they are trying to influence is essential.
(iv) The communication-behaviour change model involves source, message,
channel
(v) Receiver, destination.
QUESTION 320marks
3a. Describe the five communication inputs as described by McGuire.10 marks

1. Source:
(i) The person, group or organization from whom a message is perceived to have
come.
(ii) The source can influence the credibility, clarity and relevance of a message.
(iii) The same message delivered from a government source
(iv) A celebrity or from a non-governmental organization will have different
credibility
(v) Relevance to different target audiences
2. Message:
(i) What is said and how it is said.
(ii) The content and form of a message can influence audience response.
(iii) The use of fear or humour to communicate the same message may provoke
different responses from different target audiences.
(iv) Practical considerations such as the length of the message
(v) Form of language and tone of voice also need to be considered.
3. Channel:
(i) The medium through which a message is delivered.
(ii) Mass media include television, radio and print media as well as techni
(iii) More recently, information technology has opened up a range of new media
for use in communicating health messages in high-income countries.
(iv) Issues to be considered in selecting a channel for communication
(v) Differences in the complexity of message which can be communicated
through different media.
4. Receiver:
(i) The intended target audience.
(ii) Recognizing differences in audience segments
(iii) Their media preferences are important in matching the right message to the
right channel from the right source.
(iv) Social and demographic variables such as gender, age, ethnicity, income
and location, as well as current attitudes
(v) Behaviours, and media use can all be considered as a part of this element.
5. Destination:
(i) The desired outcome to the communication.
(ii)The communication-behaviour change model also provides a twelve-step
sequence of events, representing outputs from a communication
(iii)This model illustrates that for a communication strategy to be effective, the
message has to be carefully designed and delivered through an appropriate channel
(iv)The population has to be exposed to the message, pay attention to it and
understand it.
 (v)These inputs and outputs can be put together as a matrix to illustrate the need to
change the input mix depending on the targeted output.

3b. Write a short note on the four-stage model for organizational change in health promotion.
10marks
Four Stages of the Model

NOTE: 21/2marks for each stage

Stage 1
(i) bDescribed as awareness raising
(ii) This stage is intended to stimulate interest and support for organizational
change at a senior level
(iii) Clarifying health problems in the organizational environment, and identifying
potential solutions.
(iv) These senior administrators are likelyto be the most influential in decisions to
adopt new policies and programmes in an organization.
(v) They are convinced of the importance of a problem and the need for a solution
involving their organization, then the strategy moves to the next stage.
Stage 2
(i) Described as adoption and involves planning for and adoption of a policy,
programme or other innovation that addresses the problem identified in Stage
(ii) Ddentification of resources necessary for implementation.
(iii) In larger organizations, this stage will often involve a different level in the
management structure who are more closely associated with the day-to-day
running of an organization.
(iv) This could involve school principals and senior teachers responsible for school
curricula and organization.
(v) This element of adaptation is often essential to the adoption of change in
organizations
Stage 3
(i) As implementation and is concerned with technical aspects of programme
delivery.
(ii) The provision of training and material support needed for the introduction of
change.
(iii) This phase may involve training and the provision of resource support to foster
the successful introduction of a programme.
(iv) This capacity building is essential for the successful introduction and
maintenance of change in organizations.
(v) Many policy initiatives fail at this point because too little attention is given to
the detail of the implementation process
Stage 4

(i) As institutionalization
(ii) Concerned with the long-term maintenance of an innovation
(iii) It has been successfully introduced.
(iv) Senioradministrators again become the leading players.
(v) Establishing systems for monitoring and quality control, including continued
investment in resources and training.

4. QUESTION 4 25marks

(1a) Discuss the history of health promotion. 15 marks

NOTE: INTRODUCTION = 1mark; Any correctly mentioned and explained point = 1

mark

Introduction:
(i) Key turning point in the history

(ii) Now referred to as health promotion was the publication in Canada, in 1974, of the
Lalonde Report,

OTHER POINTS1mark for any correctly mentioned and explained point

(i) A New Perspective on the Health of Canadians.

(ii) The report, released by the then Minister for Health, Marc Lalonde

(iii) Widely acknowledged as a pioneering statement by a national government.

(iv) It explicitly recognized that health was created by the complex interrelationships
between biology, environment, lifestyle and the system of health care.

(v) Though not greeted with universal praise at the time

(vi) Giving prominence to the role of lifestyle and the environment in an analysis of
public health, the Lalonde

(vii) Report opened the door to a significant debate in Canada

(viii) Elsewhere about the role of government in improving health through its policy
decisions the limitations of personal healthcare.
(ix) Although the Lalonde Report is recognized today for its influence on health policy
development,
 (x) The time it generated little change in Canada as Lavada Pinder succinctly put it

(xi) There were no announcements, no new resources, and no implementation plan‟.

(xii) Until a Health Promotion Directorate was established in the Canadian Federal
Department of Health in 1978
(xiii) Under the gifted leadership of Ron Draper, that the ideas put forward in the Lalonde
(xiv) Report began to be considered more systematically

(b) Briefly write on ‘’Surgeon General’s Report on Health Promotion and Disease
Prevention 10marks

NOTE: 1 mark for any correctly mentioned point

(i) Healthy People was published in the United States of America

(ii) This provided an overview of the progress in public health in the country
(iii) Reviewed contemporary, preventable threats to health.

(iv) It drew heavily on the growing scientific base of information on health promotion

(v) Disease prevention being developed through the National Institutes for Health .

(vi) Identified priority areas in which further gains could be expected over the following
decade

(vii) Mid-term review of progress in the United States of America showed that the
objectives for the nation had helped establish a national health agenda.

(viii) This was achieved by identifying specific health priorities, facilitating organized
responses and supporting progress towards enhanced levels of health.

(ix) Though the review found that almost half the objectives had been met,

(x) It also highlighted the need for further actions to achieve a reduction in some of the
major inequalities in health status
 NATIONAL OPEN UNIVERSITY 0F NIGERIA
University Village, Nnamdi Azikiwe Express Way, Jabi, Abuja
FACULTY OF HEALTH SCIENCES
DEPARTMENT OF PUBLIC HEALTH SCIENCE
EXAMINATION QUESTIONS 2021_1

COURSE TITLE: School Health (PHS821)

CREDIT UNIT: 2 Units
TOTAL SCORE: 70 Marks
TIME ALLOWED: 1½ Hours
INSTRUCTION: Answer All Questions

MARKING GUIDE

QUESTION 1 25 Marks
The school setting provides unique platform to foster good health for school members
as well as for community members.
1a. Briefly describe the concept of School health program (7 marks)
1b. Explain five (5) links between health and education which serves as
rationale for School health programme as proposed by the Education for
All Framework (2000) (10 marks)
1c. Identify the components of a comprehensive School health programme. (8 marks)

ANSWER

The school setting provides unique platform to foster good health for school members as well as
for community members.
Q1a. Briefly describe the concept of school health program. (7 marks; 1 mark each)

i. School health programme refers to the coordinated, preplanned and formal efforts and
activities aimed at protecting, promoting and maintaining the health status of learners and
workers in the school.
ii. Moronkola (2012) defined the School health programme as an educational and health
programme targeted at meeting the health needs of learners and staff at present and at the
 same time, laying good foundation for their future health status with the support of the
home, community and government.
iii. The conceptualization of school health programme according to the scholar transcends
present health needs but also aims at ensuring good health status on a progressive note.
iv. Beyond mere meeting of health needs, school health programme targets ensuring
optimum health for every member of the school community.
v. The utmost aim is academic excellence among learners and career advancement for the
workers.
vi. In its conceptualization of school health programme, the Federal Republic of Nigeria
(FRN, 2006), views the aim of school health programme beyond individual to national
development.
vii. It is also seen as a strategic tool to realizing national and international health, education
and developmental objectives.

Q1b. Explain five (5) links between health and education which serves as rationale for
School health programme as proposed by the Education for All Framework (2000). (10
marks; 2marks each for any 5 correct points mentioned)

i. School-based nutrition and health interventions can improve academic

performance.
ii. Students‟ health and nutrition status improves their enrolment, retention, and
reduce absenteeism.
iii.Education benefits health.
iv. Education can reduce social and gender inequities.
v. Health promotion for teachers‟ benefits their health, morale, and quality of
instruction.
vi. Health promotion and disease prevention programs are cost-effective.
vii. Treating youngsters in school can reduce disease in the community
Q1c. Identify the components of a comprehensive School health programme.(8marks; 1
mark each)

i. Physical Education
ii. Health Services
iii. Nutrition Services
iv. Counselling, Psychological and Social Service
v. Health Education
vi. Healthy School Environment
vii. Family/Community Involvement
viii. Health Promotion for Staff

QUESTION 2 25 Marks

Nigerian National School Health Policy is thus aimed at realizing the objectives of Education for
All (EFA) and Health for All (HFA) using the school health programme
Q2a.Briefly describe the objectives of the Nigerian National School Health Policy (7mks)

i. The Nigerian National School Health Policy is thus aimed at realizing the objectives
of Education for All (EFA) and Health for All (HFA) using the School health
programme as a tool through organized and coordinated roles of
ii. various cognate agencies of government including Education, Health, Environment,
Agriculture, Water Resources, Information and Orientation, among others. (2 marks;
1 mark each)

The Objectives of the National School Health Policy (5 marks; 1 mark each)
The objectives of the National School Health Policy are to:
i. Provide the necessary framework for the mobilization of support for the implementation
of the school health programme.
ii. Set up the machinery for the coordination of community efforts with those of government
and non-governmental organizations towards the promotion of child friendly school
environments.
iii. Guide the provision of professional services in the implementation of the school health
programme
iv. Promote the teaching of skill-based health education
v. Facilitate effective monitoring and evaluation of the school health programme
vi. Set up modalities for the sustainability of the school health programme

Q2b. Briefly discuss four (4) initiatives for realizing objectives of School health
programme in Nigeria (10 Marks; 2 marks each)

ANSWER
Brief discussion
1. Global School Health Initiative:WHO in collaboration with other international agencies
(UNESCO, UNICEF) introduced the Global School Health Initiative (GSHI) IN 1995.The
essence of the initiative was to mobilize and strengthen school health promotion activities at all
levels with a view to improving the health of learners and other members of the school
community
2. The Health Promoting School Initiative: (HPSI) originates from the GSHI and focuses on
mobilising, strengthening and complimenting the School Health Programme. UNICEF (2013)
identified two parameters for judging a health promoting school – healthy school environment
and education on health and hygiene issues
3. Life skills according to the WHO are abilities for adaptive and positive behaviour that enable
individuals to deal effectively with the demands and challenges of everyday life. They are a
group of psychosocial competencies and interpersonal skills that help people make informed
decisions, solve problems, think critically and creatively, communicate effectively, build healthy
relationships, empathise with others, and cope with and manage their lives in a healthy and
productive manner.
4. Home-Grown School Feeding and Health Programme (HGSF & HP):This initiative was
designed by the Nigerian government with active partnership from national, regional and
international development partners like the National Economic Empowerment and Development
Strategy (NEEDS), New Partnership for African Development (NEPAD), United Nation
Children‟s Fund (UNICEF) among others. The initiative is targeted at attracting and keeping
out-of-school children in school by meeting the nutritional and health needs of school children
basically through the provision of nutritional meals at school.
5. Skill-Based Health Education Initiative Health Education is widely acclaimed as an
effective tool to improving and promoting health and well-being. The importance of Health
Education cannot be overemphasized as it plays significant role in preventing disease,
prolonging life and protecting health. In a century characterized by explosion of knowledge as
well as emerging challenges, skill-based Health Education has evolved as a responsive tool to
surmounting the myriads of health challenges in this century

Q2c. Briefly discuss 4 personnel for School health programme administration in Nigeria.
(8marks; 2marks each for any 4 correct points)

1.School Administrator The school health teacher’s major role is in the area of skill-based
health education. He/she is saddled with the responsibility of teaching health and playing major
roles in health curriculum issues. The school health teacher also plays collaborative roles in other
components of the school health programme aside taking the lead in skill-based health education
2. School Health Programme DirectorThe school health programme director is responsible for
the day-to-day running of the school health programme. This director could be a medical doctor
or nurse with educational background or a professional health educator. The major task of the
director is to supervise and or coordinate the activities of the school health programme. He/she is
expected to domesticate national school health policy to the peculiarities of the school and direct
as well as supervise its implementation relying on the authority and approval of the school
administrator.
3. The School Health Teacher The school health teacher’s major role is in the area of skill-
based health education. He/she is saddled with the responsibility of teaching health and playing
major roles in health curriculum issues. The school health teacher also plays collaborative roles
in other components of the school health programme aside taking the lead in skill-based health
education.
4. School Medical Director The school medical doctor is at the Centre of the school’s curative
aspect of the school health services. The school medical director also ensures and supervises
medical examination for school community members is carried out to detect asymptomatic
illnesses and to ensure proper diagnosis for better treatment of diseases. Unfortunately, only few
schools engage school medical doctors in Nigeria.
5. School Nurse The school nurse assists the school medical doctor in carrying out his/her
duties. Aside this, the school nurse plays significant roles in keeping health records, appraising
health status of school community members, preventing and controlling communicable diseases,
serving as resource person in health teaching as well as making input in formulating or
domesticating school health policy.
6. Physical Educator The major role of the physical educator is to plan and direct fitness
programmes for school community members. Obesity and overweight are becoming major
public health problems and physical fitness has been reported to play protective role against
weight problems

QUESTION 3 20 Marks
Health Education is an effective strategy towards empowering young people to
developing positive health behaviour.

Q3a. State 5 objectives of skill-based Health Education in Nigeria (5 marks; 1mark each)

The objectives of skill - based health education are to:

i. Provide functional knowledge on health issues to learners
ii. Develop life skill-based learning experience to influence the development of
desirable health habits and discourage unhealthy practices.
iii. Stimulate health consciousness in learners to assume responsibilities for their
own health
iv. Instill positive health attitudes required to stimulate positive health behaviours
in learners
v. Stimulate imaginative, creative and innovative thinking abilities in learners
using participatory approach as a tool
Q3b. Mention five (5) learning principles in skill-based Health Education (5marks; 1
mark each for any 5 correct points)

Learning Principles in Skill-Based Health Education

i. Teachers' knowledge of the subject matter is essential to the implementation of

important teaching tasks
ii. Active involvement of the learner enhances learning
iii. Interaction between teachers and students is the most important factor in student
motivation and involvement
iv. Students benefit from taking responsibility for their learning
v. There are many routes to learning, teachers must make use of all possible routes to
enhance learning
vi. Realization of learning objectives is intricately tied to learners‟ and teachers‟
expectations
vii. Learning is enhanced in an atmosphere of cooperation
viii. Use of appropriate aids and materials enhance learning

Q3c. Discuss five (5) factors necessary for effective teaching of skill-based Health
Education. (10marks; 2 marks each for any 5 correct points discussed)
i. Highly competent teacher
ii. Highly motivated learners
iii. Use of participatory approaches
iv. Use of relevant teaching aids
v. Citing examples that are real and meaningful to learners
vi. Making learning as practicable as possible beyond abstract conceptualizations
vii. Supportive learning environment
viii. Discuss assessment procedures for skill-based Health Education