See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/310424963

Public Health and Community Medicine

Book · March 2016

CITATIONS READS
30 75,751

4 authors, including:

Muhammad Irfanullah Siddiqui Muhammad Anas Ansari

Umm Al-Qura University University of Texas at Arlington
99 PUBLICATIONS 730 CITATIONS 8 PUBLICATIONS 31 CITATIONS

SEE PROFILE SEE PROFILE

All content following this page was uploaded by Muhammad Irfanullah Siddiqui on 16 November 2016.

The user has requested enhancement of the downloaded file.

Public Health and
Community Medicine

Editor
Muhammad Irfanullah Siddiqui
MBBS (Dow), MPH, MCPS, M Phil (BMU), FCPS,
Former Dean, Faculty of Health Sciences, Baqai Medical University.
Former Vice Principal, Bahria University Medical and Dental College
Former Chairman, Hamdard College of Medicine & Dentistry, Hamdard University
Currently Professor at Umm Al-Qura University, Makkah Mukarramah, KSA

Associate Editors
Shahida Rasheed S.N. Bazmi Inam
MBBS , MPH, MCPS, FCPS, MBBS, MPH (USA), FCPS
Professor, Chairperson, Department of Former Professor & Chairman,
Community Health Sciences, Department of Community Health Sciences,
Ziauddin University, Karachi Ziauddin University, Karachi
Professor, Department of
Iftikhar Ahmed Khan Community Medicine,
B.Sc., MBBS, DPH Qaseem University, KSA
Professor & Chairman, Department of
Community Health Sciences, Prof. Lubna Baig
Gandhara University Medical College, Dean, APPNA Institute of Public Health
Peshawar. Jinnah Sindh Medical University,
Former, Professor & Head, Karachi.
Department of Community Medicine,
Khyber Medical College, Peshawar Mahmuda Mubasher
Professor & Head, Department of
Ghulam Qadir Malik Community Medicine,
MBBS(Pb.), MD, DCH, DPH Lahore Medical College, Lahore.
Professor & Chairman, Department of
Community Medicine, Farida Habib Khan
Frontier Medical College, Abbottabad. FCPS, MPH, MCPS, DCH, MBBS
Former, Professor & Chairman, Professor & Head,
Department of Community Medicine, Department of Community Medicine,
Nishtar Medical College, Multan. College of Medicine
Princess Nourah Bint Abdul Rahman University,
Inayat H. Thaver Riyadh, (KSA)
MBBS, MSc. MCH (London), Kingdom of Saudi Arabia
MCPS, FCPS, Ph.D (London)
Consultant, British High Commission, Kashif Shafique
Islamabad. MBBS (Dow), MPH (Glasgow), PhD (Glasgow)
Former Consultant, Honorary Senior Clinical Lecturer
United Nations Fund for Population Activity. (University of Glasgow)
Former Dean Faculty of Health Sciences, Associate Professor & Vice Dean,
Baqai Medical University. School of Public Health,
Dow University of Health Sciences,
Karachi, Pakistan.
Public Health and Community Medicine
© All rights reserved. This book, or any part thereof, may not be used or reproduced in any manner
without written permission from the author and publisher. The rights of manuscript are reserved
with the author, whereas the rights of layout design, type setting and other technical aspects are
reserved with the publisher, Time Publisher, Medical Division.

ISBN: 978-969-8261-56-6
Public Health and Community Medicine

First Edition 1979

Second Edition 1984
Third Edition 1993
Fourth Edition 1997
Fifth Edition 2000
Sixth Edition 2003
Seventh Edition 2006
Eight Edition 2016

Like in medicine, knowledge in public health is also constantly changing. As new information
becomes available, changes in procedures, treatment, preventive measures and the use of epi-
demiology and statistics becomes necessary. The editors/contributors and the publisher have,
as far as it is possible, taken care to ensure that the information given in the text is accurate
and up to date. However, readers are strongly requested to confirm that the information given
complies with standards of practice and latest legislation.

Published in Pakistan by
TIME PUBLISHER, Medical Division, Urdu Bazar, Hashmi Trust Building,
Karachi, Pakistan. Tel.: 92-21-2625539 Email: timepublisher@gmail.com

Price Rs. 1095.00

US$ 50.00
Foreword
(Public Health and Community Medicine)

It is a great honour and pleasure for me to write a Foreword for the 8th edition of “Public
Health and Community Medicine” a legendary book on the subject.
The first edition of the book was the brainchild of Late Prof. Mohammad Ilyas (1915-2007),
legendary pioneer, who dedicated and devoted his life in the field of Public Health Educa-
tion in Pakistan
Ever since its first edition in 1979, seven editions of the book have already been pub-
lished.
For more than 3 decades the book continues to enjoy the reputation of being not only the
most popular manual on the subject, but also a great source of learning and reference for
Undergraduates, Postgraduates, teachers and public health scientists in the country and
abroad.
The new edition has taken a while longer than expected, almost a decade, due to the sad
demise of Prof. Mohammed Ilyas and subsequently Dr. Hansotia who took over the initial
responsibility to provide guidance for the 8th edition.
Public Health is a dynamic field and several changes have taken place in this arena in the
last decade.
The current edition of the book has taken into consideration and incorporated all changes
taking place in the field, regionally and globally.
This credit goes to Prof. Muhammad Irfanullah Siddiqui who has taken the responsibility of
providing very able leadership to the 8th edition of the book
It has been a great pleasure for me to be part of humble contributor in the current edition.
I have no doubt in my mind that the new 8th edition of the book will be much more popular than
its predecessor among all students, teachers and scientists in the field of Public Health.

Dr. Abdul Gaffar Billoo

Sitara-e-Imtiaz
Professor Emeritus,
Department of Paediatrics & Child Health,
Aga Khan University, Karachi.
 Dedication
This book is dedicated to the revered memories of:
Dr. K. S. Shah
Founder Dean,
Institute of Hygiene and
Preventive Medicine &
Public Health, Lahore.
Head, Department of
Communicty Medicine,
Fatima Jinnah College,
Lahore.
Dr. Mehar F. Honsotia
Associate Professor,
Head of Department,
Community Medicine (DMC)
Registrar, Dow University of
Health Sciences, Karachi.
Ghulam Qadir Malik
Professor, Chairman,
Department of Community
Medicine,
Nishtar Medical College,
Multan.
Professor, Chairman,
Frontier Medical College,
Abbottabad.
All those contributors who have left us.
Dr. Mohammad Iliyas
Principal, Sindh Medical College (SMC)
Dean, Faculty of Health Sciences,
Baqai Medical University,
Karachi
Iftikhar Ahmed Khan
Professor, Head,
Department of
Community Medicine,
Khyber Medical College,
Peshawar.
Professor & Head,
Department of
Community Health Sciences,
Gandhara University Medical
College, Peshawar.
Dr. M. A. Ansari
Professor,
Head, Department of
Community Mecicine,
Dow Medical College (DMC)
Karachi.
Dr. Shahida Rasheed
Professor, Chairperson,
Department of Health Sciences,
Ziauddin University,
Karachi.
N. A. Jafery
Professor of Pathology,
Jinnah Post Graduate
Medical Centre,
Karachi.
Vice Chancellor & Advisor,
Ziauddin Medical University,
Karachi.
 Sponsors to 8th Edition

The preparation of this edition has been sponsored by the following leading personalities,
who have been teachers in professional institutions for several decades. They are:-
● N.A. Jaferey
Advisor, Ziauddin Medical University,
Karachi.

● Gaffar Billo
Professor & Head, Department of Pediatrics,
Aga Khan University, Karachi.

● Shahida Rasheed
Professor and Head,
Department of Community Medicine,
Ziauddin University, Karachi

● Syed Aley Hasan Zaidi

Chairman,
Department of Pathology & Vice Dean,
Postgraduate Medical Institute,
Baqai Medical University,
Karachi.

● Inayat H. Thaver
Professor & Former Dean,
Baqai Medical University, Karachi.

● Lubna Baig
Professor & Dean APNA Institute of Public Health,
Jinnah Sindh Medical University, Karachi.

● Zubair Ahmed
Professor & Chairman, Department of Community Medicine,
Baqai Medical College, Karachi.

● Meher F. Hansotia
Former Registrar,
Dow University of Health Sciences,
Karachi.

● Ata Muhammad Chandio

Dean, Benazir Medical University,
Nawabshah.
About the Former
Editor-in-Chief

After six years of service in the Health Department of Mysore State, now known as Karnataka
in South India, Dr. Iliyas migrated to Pakistan in November, 1947. While residing in India,
he was trained in Public Health at the All India Institute of Hygiene & Public Health, as well
as, the Institute of Tropical Medicine at Calcutta.
On arrival in Pakistan his employer happened to be, his distinguished Professor of Public
Health Administration in Calcutta. After a period of two years of his service as a Quarantine
Officer at the Karachi Airport, Dr. Iliyas was deputed for MPH training at Harvard University,
and on completion of this course of training, he gained experience in various sectors of
Public Health in Pakistan.
It was during the martial law period of Gen. Ayub, that, he was invited to set the Ministry
of Health in order, since it was facing problems of maladministration, nepotism and fa-
vouritism, and, bureaucracy was not cooperating according to the expectation of the new
government.
Earlier he was also designated to a concurrent post of Professor of Hygiene (at Dow Medical
College) as, it was known at that time. Holding this post, his method of teaching followed an
integrated approach, conducted open book and MCQ examinations, not known in Pakistan
at that time. In mid-fifties the functions now included in Primary Health Care were organized
at a Basic Health Unit at Bizerta Lines. A Preventive Paediatric Unit was established at the
JPMC with himself, a Resident Medical Officer of Paediatric Section Dr. Ms. Tahira Akbani
and a Medico-social worker Ms. Khan became the staff members for teaching as well as
health services, which inter alia covered immunization, health counselling, treatment of ail-
ments and counselling on health promotion. Both the Basic Health Unit and the preventive
paediatric units became teaching and demonstration centers for Dow Medical College which
was the only college in Karachi at that time.
WHO experts who visited Pakistan during that period paid rich tributes to his efforts and
later sent a written communication offering him an assignment without even his application.
The ministry however, did not spare him for this post.
During the Ayub’s Martial Law regime, a proposal came up for the establishment of the
College of Physicians and Surgeons and he was assigned the task of its first Secretary in
addition to his teaching and administration. After four years of spade work under the guid-
ance of General Burki, the Minister of Health, the college came into existence and attained
the status of world renowned institution producing thousands of postgraduates in Medical
Sciences, of international standing.
During the year 1963, the Government of Pakistan deputed him to the World Health Organization, EMRO, as a Public
Health Administrator in Saudi Arabia, where he worked for four years and transferred to Western Pacific Region from
where he retired during mid-seventy five. While in Korea, he succeeded in the establishment of a National Teacher
Training Centre - the first center in the world at the national level, the components of this center were three, - A train-
ing unit, a research center and a production unit.
During his eight years’ service in Korea, he became the recipient of several awards for meritorious services, the most
distinguished one being the Civil Order of Merit, - The Favourite Flower of Korea by the President of that country.
On his retirement from WHO, he was offered assignments from several countries, but he preferred to spend his
remaining years of life in his home country.
During 1977, he commenced working as an honorary professor of Community Medicine at Sindh Medical College
where he became the Principal of that college. During his tenure of office at that college the President of the time
sanctioned a gracious grant of nearly one and a half crore rupees for the college in appreciation of his honorary
service as Principal without his asking. After a period of seven years, he relinquished this charge and joined Baqai
Medical College in the private sector with support from Professor Zaki Hassan, Founder Principal of that college, he
was able to establish a network of PHC centers catering for health, income-generation and community education.
Professor Baqai and his wife, Professor Mrs. Zahida Baqai, have earned the distinction of being pioneers in imple-
menting the inter-sectoral approach of primary health care as defined at the Alma Ata Conference of 1978 with a
focus on poverty alleviation and primary education besides health care. During his assignment at that college, which
became a medical university, he commenced a training course of MPH which other institutions have subsequently
followed. He is no more with us physically but his work has made him immortal

Muhammed Usman Dawood Gaba

Publisher
Preface to the 7th Edition

I do not intend to write a long preface. I merely wish to invite the attention of the young genera-
tion to the emerging problems that pose a challenge to Public Health at the community level.
These have been presented in this edition as well as in the 6th.
Particular attention is drawn to the section on Disaster Control and Management written by
Ghulam Qadir Malik of Nishter Medical College, Multan. Had the attention of the policy makers
been drawn to its recommendation, pre-disaster management would have been in existence,
which would have minimized the effects of devastation and crippling subsequent to the earth-
quake of 8th October 2005, in Azad Kashmir and Northern Areas. Likewise the Nuclear arms
race in developing countries, if not prevented will face a calamity that may be far more severe
than that of Hiroshima and Nagasaki bombing.
When I was a student at Harvard School of Public Health, teachings of atomic energy com-
menced in the year 1950 and we were shown the Giegy Mullar Counter and other devices for
radiation detection and diagrammatically shown the devastation, a large city will face, when
an attack is made by an atomic bomb. This diagram is still in my mind and I have reproduced
it in the chapter on Nuclear Medicine by R.A. Khan.
The health personnel should also be prepared for possible relief work in the event of future
natural disasters that may threaten human, animal and plant life due to climate changes,
floods, earthquakes, scarcity of water, reduction in food sources due to crops failure beside
environmental degradation, as a result of man’s interference in the natural ecosystem.
The new dimensions added in this edition are Suicide, Obesity and Effective Treatment of
Malaria. The last component has been reproduced with the kind permissions of W.H.O. from
W.H.O. bulletin, January 2006.
Dr. Mehtab Karim & Dr. A. Ghaffar Billo of Aga Khan Medical College, who have international
fame have, through painstaking efforts updated the sections on Demography and Integrated
Management of Childhood Illnesses respectively. Dr. Muhammad Irfanullah Siddiqui has revised
the section on Health Information & Biostatistics and given a new dimension to its presentation
making it understandable to all categories of Health Professions.
Finally I find no words to thank for continued efforts of Mr. Muhammad Usman the publisher
and his team namely Mr. Abbas Ali Khan and Professor Abdul Mobin Khan.
Finally the painstaking efforts made by Registrar and In-charge Department of Community
Medicine at Dow University of Health Sciences Dr. Meher F. Hansotia for cross checking omis-
sions and adding new information, year after year is praiseworthy. I am of considered opinion
that he richly deserves an academic award.
A humble servant devoted to the cause of Community Medicine and a prayer for an up
gradation of its low profile in Pakistan.

Muhammad Iliyas
Editor-in-Chief
Karachi, August 2006
 A word for Prof. Ilyas

I feel all that pain, while writing these lines, which is associated with loss of your most precious
things. Prof Iliyas, who was one of the pioneer of this book, was a fatherly figure to me. During
my ten years at Baqai University, I have learned a lot from him, first as a student, and then as
colleague in the capacity of lecturer, Assistant professor and Associate professor. However
I had most of the learning when I was promoted as Associate Dean. I do not have words, to
write anything, for such a legendary figure and of course, there are no words to describe his
great personality. I could never imagine, when I was taking him to Prof. Zakiuddin Oonwala,
for a consultation on May 17, 2007, that he would be no more with us next day.
He had a very kind personality and was always positive towards community issues. He had
developed a model of integrated primary health care centers as a practical example of imple-
menting the PHC strategies to achieve the health for all. I have found no such model in any
other part of Pakistan and it was so successful and popular that I was invited by Oxford Brooks
University, England in 2003 to deliver a lecture to the faculty and post graduate students on
this PHC model, while serving as Dean Faculty, after the retirement of Prof. Iliyas.
It was a hot day of June 2003, when I entered the office of Lt. General (retd.) Syed Azhar
Ahmed, then Vice Chancellor of Baqai Medical University, to discuss some issues related to
faculty and was surprised to know that VC has written a letter to Prof Iliyas requesting him,
to inherit the responsibility of editing of community medicine book to me. I disagreed with
him because I was of the opinion that this is such a huge task that I would not be able to do
it, but he insisted that in the current scenario of public health you are the person, who have
experience, motivation and commitment to do it. Later on at a meeting at his residence,
Prof. Iliyas, gave me the reference of General Azhar’s letter and told me that he had already
decided to share the responsibility of editing with me along with Dr. Mehr Hansotia even
before the request of Lt. General (retd) Syed Azhar Ahmed.
Dr. Mohamad Iilyas, served Dow Medical College, Karachi as Professor of Community
Medicine from 1952 to 1963. He served at many important positions including the first
Secretary of College of Physician and Surgeons Pakistan from 29th April 1963 to 31st
January 1964. He died in Karachi at the age of 92. He also served the Ministry of Health
Government of Pakistan, as Senior Medical Officer. He joined World Health Organization
in 1964 as Advisor Health, Manpower Development and Community Medicine and served
WHO for over eight years. Upon his return, he joined Sindh Medical College as Professor of
Community Medicine in 1977 and Principal of the College in 1980. He served Sindh Medical
College till 1984. Upon his retirement, he joined Baqai Institute of Health Sciences, (which
later became Baqai Medical University) as Principal in 1990. He served Baqai Medical Uni-
versity as Professor and First Dean of Community Medicine. He initiated a program leading
to Masters in Public Health in 1992. This program played a key role in development of public
health personalities in the country. Most of the graduates of this institute are now serving at
key position in administration, planning and research division of Ministry of Health, Pakistan
as well as heads of the department of community medicine in medical schools in Pakistan
and abroad. Almost all of the senior faculty in community medicine departments of Pakistan
are his student.
Born in 1915 at Mysore, India, he did his MBBS from Mysore Medical College and DPH from
Calcutta, India. He did his MPH from Harvard University, USA. He was awarded FCPS by
the College of Physicians and Surgeons in 1987. He was also decorated with a Civil Award
by the President of Korea. He breathed his last on 18th May, 2007 in Karachi.
The best way to pay tribute to the greatest personalities is to keep their work alive. In this
regard a meeting was held at the residence of Prof. Naeem Jaffery, Ex Vice Chancellor,
Ziauddin University to complete, Prof. Iliyas’s, unfinished work for eighth edition. The member
included were; Dr. Inayat Thaver, Dr. Shahida, Dr. Mehar Hansotia and Dr. Muhammad
Irfanullah Siddiqui. Later on some more eminent personalities joined the arena, who had
commitment with Prof Iliyas and his work, including Prof. A. Gaffar Billo, Prof. Aley H Zaidi,
Prof. Lubna Baig, Prof. Rafiq Soomro, Prof. Farida Habib, Prof. Asifa Ghazi, Prof. Iqbal
Akhtar, Prof. Farhat Jafry, Prof. Ata Mohammad Chandio, Dr. Ali Yawar and Dr. Kashif
Shafique, and by their full effort, this edition is now in your hand. Unfortunately Dr. Mehar,
who was a very active member of the team and right hand of Prof Iliyas, left us in 2011 and
much of the work, he had done for the current edition, was lost.
Rest of the team, along with new members, kept on working for the current edition and, with
the grace of Allah SWT, were able to fulfill the promise made to Prof. Iliyas. We hope that this
much awaited edition will serve as great tribute to his services.

Muhammad Irfanullah Siddiqui

March, 2016.
 Acknowledgement

The editor wishes to acknowledge with thanks the assistance of Dr. Gaffar Billo, Dr. Aley Hasan Zaidi,
Dr. Shahida Rasheed, Dr. Ghulam Qadir Malik, Dr. Rafique Somroo and Dr. Zubair for their devoted
and untiring efforts in all the editions.
Thanks to Dr. Shahida Rasheed and Dr. Kashif Shafique for reviewing and proof reading of all the
composed chapters of this edition.
I will be failing in my duty if I do not mention Dr. Mehr Hansotia (late), Dr. Farida Habib, and Dr. Asifa,
Dr. Muhammad Saddique for the addition of some good and innovative material to the current edition.
I am thankful to Dr. Inayat H. Thaver and Dr. Lubna Baig for their kind support in this edition as well
as in all previous editions.
In the end I wish to extend my gratitude to Professor Naeem Jaferey of Ziauddin University to take full
interest in publication of eighth edition of this book of historical importance.
Preface to the 8th Edition

Overlooking the practice of recording the prefaces of all previous edition, we have ventured
to present my thoughts on the eighth edition, Knowledge is expanding at a much higher rate
than world had ever witnessed. To meet this need a book should be updated at least once
in two years. Unfortunately this edition of the book took more than nine years to get itself
updated because of many factors beyond the control of editors. We intend not to write a
long preface, but an explanation of the need for meeting the health challenges of the current
century, which the young generation, the future health providers, may face. After they have
read it, we would invite them to take the material to those, who work for the communities who
have been deprived of basic health services, not to speak of sophisticated diagnostic and
treatment technologies, limited only to those whose financial resources are in abundance. If
they find that we have helped them even the least bit in understanding the urgency needed
for the access for health for all, - a goal enunciated at Alma Ata Conference in 1978, and, ap-
preciating the efforts, both us and those who have spared their time for this work, we would
claim that our humble attempt is justified.
We (Dr. IH Thaver, Dr. Mehar Hansothia, Dr. Shahida Rasheed and Dr. Muhammad
Irfanullah Siddiqui) under the patronage of Dr. Naeem Jafery, began to work for the revision
and updating the information of the various sections, in the second half of 2008. Several meet-
ings were held to discuss the improvement for the current edition. We decided to restructure
the chapters sequences, addition of current public health issues as well as adding of objectives
in the beginning of each chapter, so that, every student should know, what learning outcome
is expected from him/her after each chapter. It was further decided to improve the index and
add some more key words in order to ease the finding of a topic. It was also decided to remove
redundant material and avoid duplication and contradicting information.
The whole team, worked very hard day after day. Had it not been for their association we
would not have succeeded in our efforts for the 8th edition of this book. Later Dr. Gaffar Billo,
Dr. Lubna Baig, Dr. Aley Hasan Zaidi, Dr. Rafique Soomro, Dr. Farida Habib Khan,
Dr. Kashif Shafique and Dr. Asifa joined hand to take the task to the end.
Research is the stepping stone for development and goes a long way for progress.
Dr. Shahida Rasheed has updated her chapter by adding, not only, the current modern tools
of measurement and addressed issues of validity in research but described both quantitative
and qualitative research as a mixed approach, in a logical sequence. Of all the health chal-
lenges of the current century the most serious one that health providers may have to face is
one due to nuclear arms race. The devastation caused by nuclear bombing of Hiroshima and
Nagasaki in Japan is before us. The chapter on Nuclear Medicine contains a brief descrip-
tion of this catastrophe presented by survivors who travelled from one country to another
depicting photographic pictures of the devastation and the problems hospitals had to face.
The main chapter on Nuclear Medicine has been written by Dr. R. A. Khan. Some topics
which were more relevant to biostatistics were transferred from epidemiology to biostatistics
and vice versa.
The chapter on helpful methods of Anthropology had a wide applause, and is of practical use by scientists in Pakistan. we
owe our thanks to Prof. Denis Mull and his lady who presented her anthropological (Tradition) findings for staff and post
graduate students in Islamabad some years ago. Chapter on health information narrates the concepts of biostatistics in a
story like fashion and links all the topic in a logical and coherent way. Chapter on Demography was revised by Dr. Rukhsana
Majeed and Dr. Farida to include the current demographic data of public health importance. A new chapter on health policy
was added by Dr. Sabeena Jalal to sensitize the health care provider about the current health policy and its implication on
health. Section of social science includes chapter on biomedical ethics, which was updated to meet the needs of undergradu-
ate students and received great appreciation by the reader when made available at Researchgate.
More scientists were invited to write on emerging health issues. A chapter by Ali Yawar Alam on public health problem solv-
ing paradigm is a good addition for understanding public health priorities and factors affecting it. Moreover monitoring and
evaluation of public health program is also a good addition to the current edition.
A new chapter of introduction by Dr. Farida Habib Khan has been added, she had summarized the section of definition and
added qualities of seven star doctors and millennium development goals. Some old chapters like air and ventilation, light
and lighting, housing, climate and environmental hazards have been merged as environmental factors in health. Chapter
on nutrition has been revised by “Nida Javed and” Dr. Kashif Shafique. Chapter of community dental health has
been updated by Dr. Abdul Haleem. Chapter of integrated management of childhood illness has been given a
new shape by Prof. A. Gaffar Billo. Chapter on cancer control has been rewritten by Dr. Kashif Shafique, under the
guidance of Prof. Naeem Jafrey. Prof. Asifa Ghazi has given new vision to the reproductive health section. She has
made the task of students fairly easy by adding plates and photographs and added Islamic perspective in reproductive
health issues. Prof. Aley Hassan Zaidi has revised all his chapters and updated the information. He has added a new
chapter on mycology.
“Importance of surveillance has been emphasized by Anand Joshi in his newly added chapter on surveillance.
Nosheen Zehra and Shahida Rasheed have revised the chapter on health management and information sys-
tem to add relevant examples to make it more practical. Dr Akhtar Ali has completely reshaped the chapter of
Military hygiene to add new knowledge regarding common disease and factors. Dr. Meher has strengthened the
concepts of leadership by adding evaluation of leadership. Chapters on school health services has been revised
by Dr. Farah Ahmed to delete redundant material and added new material like role of private sector relevant in
Pakistani context. Dr. Amin has revised his chapter on community mental health to add some more objectives in
the changing world context. Dr. Iqbal Akhtar has updated his chapters on sports medicine and travel medicine
by adding psychological issues related to injury in athletes and ergogenic aids, doping and its legal aspects. The
chapter on travel medicine is one of the most updated chapters of this edition and includes, not only recent data
but addresses the issues of Hajj and travel kit. Preventive cardiology written by Dr. Javed Usman in the current
edition has been added as separate chapter and addresses the issues of hypertension in children as well as re-
vised version of hypertension classification and cost effective preventive cardiology. Dr. Zahir Shah has updated
the section of occupational lung disorders to include the much needed details of silicosis, coal worker’s pneumo-
coniosis and asbestosis. Prof. A. G. Billo has given a new look to the chapter of communicable diseases written
by various authors by updating the information in the light of current world scenario. He has deleted the redundant
material and added the information about the emerging diseases and their control. Dr. Ejaz Vohra and Dr. Kashif
Shafique have completely revised the chapter on non-communicable diseases to include the concept of metabolic
syndrome especially with reference to Pakistan. They not only, highlighted the risk factors for non-communicable
disease but focused on diabetes mellitus as one of the major killer in the developing countries.”
The untiring efforts of the publisher Mr. Muhammad Usman and his team namely Abbas Ali Khan Khattak and
Mr. Muhammad Faisal, Professor Abdul Mobin Khan is highly commendable. Though we have taken care of updating the
information but the knowledge is expanding at a very rapid rate. You are requested to point out the deficiency in the current
issue so that it may be rectified in the next issue.
A humble servant of Community Health Science

Muhammad Irfanullah Siddiqui

Editor in Chief,
Professor, Faculty of Medicine,
Umm Al-Qura University (KSA), Makkah Mukarramah,
Saudi Arabia.
 L’envol

I praise and glorify Allah who has enabled me to complete the work which was inherited to me by
Prof Iliyas. I have systematically and unceasingly laboured for the 8th edition of community medicine.
I had not imagined human jealousy should pursue one who seeks no monetary gain and pretend
to be an authority on the subject. I have been consoled by many near and distant readers who
have appreciated my efforts. I thank them all, and feel that they and I are fellow riders on steed of
research in a field that is unlimited in scope compared to the traditional belief in Pakistan on com-
munity medicine of any importance, such relationship is dearer in any joint enterprise.
No less important is the untiring efforts of the publisher Mr. Usman, who has time and again brought
the manuscript to me and Dr. Kashif Shafique for reviewing and proof reading of the various chap-
ters and now ready to bring about the current edition for which a complete computerized index has
been appended.
And so I pray, gentle reader that providence may guide thee to become a seven star doctor / dentist
/ nurse or a health provider and I wish thee to pray for me to continue my efforts in meeting the
challenges of community health in the 21st century.

Muhammad Irfanullah Siddiqui

Karachi,
March 2016
 Contributors

1. Aamir Omair 9. Ali Yawar Alam 18. Denis Mull

MBBS, MPH, MBA MBBS(K.E), MS epidemiology ( U.K), M.D., M.P.H,
Coordinator Research Unit, MPH (Johns Hopkins, USA), CPHQ (USA) Professor of Family Medicine,
Medical Education Director Project Management Office, University of California, IRVINE.
King Saud bin Abdulaziz University for Strategy Management Department, Recepient of 19 Grants Distinguished
Health Sciences, Riyadh, Saudi Arabia Ministry of Health, Saudi Arabia. Consultant and Visiting Professor of
Numerous Institution and Editor and
2. Abdul Gaffar Billoo 10. Amin A. Gadit eminent Writer of Several books and
Sitara-e-Imtiaz MBBS(Dow), MRCPsych(London), journals.
Professor Emeritus, FRCP(Ireland), PH.D(England),
Department of Paediatrics & Child Health, BCPsych(London), D.P.M.(Ireland), 19. Farah Ahmad
Aga Khan University, Karachi D.C.P.(Ireland), MCPS(Pak), Assistant Professor
Professor of Psychiatry, Department of Community Health Sciences
3. Abdul Haleem Memorial University of Newfoundland, Ziauddin University,
PhD (University of the Punjab), Canada Karachi.
M.Sc. (London), B.D.S.(BZU)
Assistant Professor, 11. Arjumand Faisal 20. Farah Muhammad Asad Mansuri
Department of Community Dentistry & Oral MBBS (Karachi), MCPS, FCPS MBBS, MCPS, FCPS
Epidemiology, Professor Dept of Community & Family
12. Asif Aslam
Qassim University, Saudi Arabia Medicine
MBBS, MPH (Harvard)
Taibah University
UNICEF Programme Officer, Karachi
4. Abdul Sattar Tabani Al Medinah Munawara
M.B., D.C.H., D.C.P., 13. Asifa Ghazi Saudi Arabia
MFSEM(IRL) ASSOMICGP, ACOEM MBBS, FCPS(Gynae/Obs)
Specialist Registrar, Occupational Medicine, Professor gynae/obs at 21. Farida Habib Khan
Royal College of Physicians, Dow medical college & Civil Hospital FCPS, MPH, MCPS, DCH, MBBS
Ireland. Karachi, Professor & Head,
Dow University of Health Sciences, Karachi Department of Community Medicine,
5. Afroze Ramzan College of Medicine
MBBS, FCPS, Associate Professor, 14. Assad Ali Abro Princess Nourah Bint Abdul Rahman
Institute of Child Health, Karachi. MBBS University,
Formerly Provincial Operations Officer, Riyadh, (KSA)
6. Ahmed Nazir Chowdhry Sindh. World Health Organization. Kingdom of Saudi Arabia
MBBS, M.A. (Harvard), Ph.D., Dip. Stat.,
Professor of Epidemiology and Vital and 15. Aziz Ahmed Siddiqi 22. Fauzia Imtiaz
Health Statistics, Dean Institute of Hygiene M.Sc., Formerly Director, KANUPP BSc, MBBS, MSc, LLB, M.Phil,
and Public Health College, Institute of Nuclear Power Engineering, FCP(Path), PhD
Govt. of Punjab (Retd.) Karachi Professor of Biochemistry,
Dow Medical College,
7. Akhter Qureshi 16. Bilqees Mujib Dow University of Health Sciences,
MBBS (Pb.), DPH(Pb.), FRSH (London), Ph.D (Karachi), Karachi
MAPHA (USA), Professor of Parasitology.
Advisor to the Ministry of Health, Baqai Medical University. Karachi 23. Gulam Murtaza
Consultant World Bank. MBBS, Director, Emergency Department,
17. Burney M. I. Govt. Hospital,
8. Ali Faisal Saleem MBBS, M.C. PATH. (London) Alkhobar,
MBBS, FCPS, MSc (Clinical Research), FCPS, FRC Path (London), Saudi Arabia.
Fellowship in Paediatric Infectious Disease Specialist in Pathology Hilal-i-Imtiaz,
Director Paediatric Residency Program, Shousha Award (WHO), 24. Hashim Ali Kazmi
Assistant Professor Global 500-Award for Environment (UNEP), B.Sc. (Pb.), MBBS, DPH, M. Phil.,
Department of Paediatrics & Child Health Fellow Pakistan Academy of Science, Professor of Pathology,
Aga Khan University, Member WHO Technical Committies, Baqai Medical College,
Karachi. USAAID Consultant, Karachi Formerly Professor at Sindh & Dow
Formerly Director National Institute of Medical College,
Health, Islamabad. Karachi.
 35. Lubna Baig 47. Muhammad Irfanullah Siddiqui
25. Ijaz H. Aqeel Dean APPNA Institute of Public Health FCPS, M Phil, MPH, MCPS, MBBS
BDS(Pb), FDS(Edin), RCS(Edin), Jinnah Sindh Medical University Prof, Faculty of Medicine,
FCPS(Pak) Karachi Umm Al-Qura University
Former Dean,
26. Inayat H. Thaver 36. M. Riazul Haque Mohyuddin Brig. Faculty of Health Management,
Phd (UK), MCH (London) MBBS, DPH (Pb.), M.Sc (Med. Admn.), Baqai Medical University
Chief Executive, QUA,
Mustashaar Social Development Advisors Associate Professor, 48. Muhammad Saddique Arain
and Head of Department (Public Health) Department of Community Medicine, MBBS, FRCS(Edin)
School of Public Health, Army Medical College, Head of department of Surgery,
Al-Shifa Trust Hospital, Rawalpindi Baqai Medical University,
Islamabad Karachi
37. Mahmuda Mubasher
27. Iqbal Akhtar Khan Professor & Former Head of the 49. Naureen Mushtaq
MBBS, DTM (USA), FACTM (Australia), Department of Community Medicine, MBBS, MCPS, FCPS,
Ph.D. Lahore Medical College, Lahore Fellowship in Paediatric Oncology/
Independent Scholar Hematology
Lahore (Pakistan) 38. Malik Gulam Qadir Assistant Professor
MBBS, M.D., DPH (Pb.), DCH, Professor Department of Paediatrics & Child Health
28. Ismat Majid and Head, Aga Khan University,
MBBS, FCPS, DCH, DRCOG, Dept. of Community Medicine, Karachi.
Physician and Associate Professor Frontier Medical College, Abbottabad
Department of School of Pediatrics, 50. Nida Jawed MSc. RDN.
Jinnah Postgraduate Medical Centre, 39. Meher F. Hansotia Consultant Dietitian
Karachi (Retd), MBBS, MCPS, DTM & H (London) Senior Lecturer Nutritional Sciences &
Professor, Former Registrar, BS-Nutrition Coordinator
Baqai Institute of Health Sciences (Rtd.) Dow University of Health Sciences, Karachi. School of Public Health,
Associate Professor & Incharge, Dow University of Health Sciences
29. Jafery N. A. Department of Community Medicine, Vice President,
MBBS, FCPS (Pak), Dow Medical College, Karachi. Pakistan Nutrition & Dietetic Society
Diplomate of American Board of Pathology, Provincial
Professor of Pathology, Co-ordinator Sindh Community Oriented 51. Nighat Nisar
Jinnah Postgraduate Medical Centre, Medical Education Professor Community Medicine
Karachi (Retd), Dow Medical College
Co-Director, 40. Mehtab Karim Dow University of Health Sciences
National Teacher Training Centre, Ph.D., Karachi, Pakistan
College of Physicians & Surgeons, Karachi, Professor CHS and Head of
Vice Chancellor, Department of Reproductive Health, 52. Sabeena Jalal
Ziauddin Medical University, Aga Khan University Medical College MBBS, MSc (Harvard),
Karachi. PhD (Karachi University)
41. Memon Mohamed Saleh Assistant Professor
30. Jawaid Usman
MBBS, M. Phil. Principal, Community Health Sciences, Bahria
MBBS, MD,MCPS, MPH(Australia)
Isra Medical College, Hyderabad, Sindh. University Medical and Dental College
MRCGP (Int)
Karachi.
Professor and Chairman
42. Mir Liaqat Ali Fulbright Scholar, Grand Challenges
Department of Family Medicine
Environment Consultant, Fellow of the Grantee
Ziauddin University
American Board of Environment.
31. Jill Randell 53. Pathan Abdullah Jan
Nutrition Advisor to Government of Pakistan 43. Mir Zahida Sultana MBBS, TDD, DTM & H (Eng.), DTCD
& USAID. MBBS (Pb.), DPH, MPH, Professor & Head, (Wales), MRID (Japan), FCCP (America)
Department of Community Medicine,
32. K. Zaki Hassan King Edward Medical College, Lahore. 54. Paul Campbell Erwin
MBBS, FRCP, FCPS, (Retd.), MD. MPH.
DEAN, Jinnah Medical College, Consultant Child Survival Project GOP/
Karachi. USAID, Islamabad. 55. Pfau Ruth
M.D. Honorary Consultant to President of
33. Kashif Shafique 44. Mohamed Afzal Pakistan and Director,
MBBS (Dow), MPH (Glasgow), MBBS, MPH (Karachi), Marie Adelaide Centre, Karachi.
PhD (Glasgow) Associate Professor,
Honorary Senior Clinical Lecturer Sir Syed Medical College for Girls, 56. Qureshi Fayyaz Ahmed
(University of Glasgow) Karachi. MBBS, DPH (Pb.)
Associate Professor & Vice Dean Professor of Community Medicine,
School of Public Health 45. Mohamed Ahmed Khan King Edward Medical College, Lahore.
Dow University of Health Sciences MD (USA), St. George University,
Karachi, Pakistan. New York. 57. R.A. Khan
MBBS, MS (Radiation)
34. Kehkeshan Mufti 46. Mohamed Iliyas University of Rochester, New York
MBBS, MPH, MCPS (Fam Med), B.Sc., MBBS (Mysore), DPH (Cal.), Professor of Nuclear Radiation,
Professor & Head, MPH (Harvard), FCPS, Ziauddin Medical University, Karachi
Department of Community Medicine, Former Dean, Faculty of Health Sciences, Formerly Director,
Layari Medical College, Shaheed Banazir Baqai Medical University, Atomic Energy Medical Centre,
Bhutto University, Karachi. Jinnah Postgraduate Medical Centre
Karachi Karachi.
58. Rafiq Ahmed Soomro
HOD Community Medicine
Liaquat National Medical College and
Hospital Karachi
and Ex-dean LUMHS Jamshoro.
59. Rana Ahsanul Haq
M.Sc., Ph.D (Pb.), M.S. Columbia,
Professor of Nutrition Institute of Hygiene
and Preventive Medicine, Lahore (Retd.).
60. S. N. Bazmi Inam
MBBS, MCPS, MPH (Harvard), FCPS
Professor, Department of Family and
Community Medicine,
Qassim University, KSA.
61. Sadiqa Jafery
MBBS, FRCOG, FCPS
Professor of Gynaecology and obstetrics,
Ziauddin Medical University, Karachi
62. Salahuddin Naseem
MBBS (Pb.), Diplomat of the American
Board of Internal Medicine,
Consultant Physician, Liaquat National
Hospital and
Honorary Consultant Physician, Aga Khan
University Hospital, Karachi.
63. Sameen Siddiqi
MBBS., M.Sc (London), Asst. Professor,
Academy of Health Sciences, Islamabad.
64. Saqib Shahab
MBBS, MRCP, MPH,
Environments Health & Occupational
Medicine,
Health Services Academy,
Ministry of Health, Islamabad.
65. Shah K.S.
MBBS (Pb), D.Sc. (Joh Hopkins),
DPH (EdinO), DTM (Liverpool),
Former Dean Institute of Hygiene and
Preventive Medicine,
Emeritus Professor of Bacteriology and
Head of the Department of Community
Medicine, Fatima Jinnah Medical College
for Women, Lahore.
66. Shah Mohamed Zahir
MBBS (Pesh.), DOH, MPH (Sydney),
Professor and Head, Department of
Community Medicine,
Khyber Medical College, Peshawar.
View publication stats
67. Shaheena Manzoor
MBBS, MSc (London), FCPS,
Former Principal, Fatima Jinnah Medical
College, Lahore.
68. Shahida Rasheed
MBBS, MPH, MCPS, FCPS
Chairperson
Community Health Sciences
Ziauddin Medical College, Karachi.
69. Shaukat Raza
MBBS, FRCP, Professor of Paeds.,
King Edward Medical College, Lahore.
70. Sheikh Tanveer Ahmed
MBBS, MPH
Coordinator, Provincia Child Survival
Training Unit, Department of Pediatrics,
Civil Hospital, Karachi.
71. Shoukat Malik
M.B.B.S., R.M.P. (Pak)
FCPS.,
Nishtar Medical College,
Multan.
72. Sohail Karim Hashmi
MBBS, DPH,
EX Secretary, Pakistan Medical & Dental
Council, Islamabad.
73. Syed Aley Hasan Zaidi
BSc, MBBS, MA (IR), M.Phil, FCPS,
FRCP (Edin) PhD
Life Fellow Royal Society Medicine
(London)
Former Chairman Dept. of Pathology
Ex-Principal, Sindh Medical College &
Hamdard College of Medicine & Dentistry
Ex-Dean Faculty of Medicine,
University of Karachi
& Faculty of Medicine & Health Science
Hamdard University, Karachi.
Chairman,
Department of Pathology & Vice Dean,
Postgraduate Medical Institute,
Baqai Medical University,
Karachi.
74. Syed Azam Sher
MBBS ( DOW ), M.Sc ( Env Sciences )
Specialist and Coordinator Public Health
Department of Infectious Diseases and
Vector Control Unit
AlQassim Regional Health Directorate
Buraida City, Saudi Arabia
75. Syed Mehmood Hasan
MBBS, M.Phil (Path), FCP (Path),
PhD.
Chairman, Department of Pathology
Jinnah Sindh Medical University
Karachi
76. Syed Muhammad Hasan
MBBS, MRCP (Dublin)
Assistant Professor Medicine
77. Syeda Nosheen Zehra
Assistant professor
Department of Community Health Sciences,
Ziauddin University,
Karachi
78. Talat J. H. Rizvi
MBBS (Pb), MPH (USA)
Former Research Director, PMRC,
Jinnah Postgraduate Medical Center,
Karachi
79. Unaiza Niaz
MD,DPM,FRCPsych
Honorary Member The World Psychiatric
Association,
International Distinguish Fellow,
American Psychiatric Association,
Advisory Council Member,
Women’s Mental Health, WPA,
Advisory Board Member,
International association of
Women’s Mental Health,
Vice President Eastern Mediterranean
Region, & Board Member WFMH,
80. Zahid Naeem
MBBS, FCPS
Professor Department of Family and
Community Medicine,
Qassim University
KSA