7.2.1. Fertility and fertility related statistics. Fertility – Fertility means the actualbearing of children. 15 to 45 years isthe reproductive period of a woman.
In India Information on fertility indicatesthat an average women gives birth to an average of about 3 children if her marriedlife is not interrupted. Fertility depends on several factors. Eg. Lower age atmarriage, low level of literacy, poor level of living limited use ofcontraceptives and traditional ways of life. 2.9% is the total fertility rateof India for the year 2006.
7.2.2. Family planning In 1971 WHO Expert Committee defined and described family planning as”Family planning refers to practices that help individuals and couples toattain certain objectives such as · avoidunwanted pregnancies· bringabout wanted births· regulatethe intervals between pregnancies· controlthe type of which births occur in relation to the ages of the parent and · determinethe number of children in the family.Family planning has been recognized as a basic humanright by the United Nations in 1908.In 1977, the Govt. of India redesignated theNational Family planning Programme as the National Family Welfare Programme. Itis to promote the family planning through the total welfare of the family.
The term family welfare is much broader than familyplanning. The concept of welfare is basically related to quality of life whichfocuses on the following aspects, as they are all essential factors associatedwith the concept of welfare.· Education· Nutrition· Health· Employment· Women’s Welfare And Rights· Shelter· Safe Drinking Water 7.2.3.
Population policyPopulation policy in general refers to policiesintended to decrease the birth rate or growth rate. Statement of goals,objectives and targets are inherent in population policy. 2.4. National demographic goals The National Socio – Demographic Goals to beachieved by the year 2010 are as follows 1.Address the unmet needs for basic reproductive and child health services. 2.Make School education up to the age 14 free and compulsory and reduce the drop outs at primary and secondary schoollevels to below 20 percent for both boys and girls.
3.Reduce infant mortality rate to below 30% for 1000 live births. 4.Achieve Universal Immunization of children against all vaccine preventable diseases.
5.Reduce Maternal Mortality ratio to below 100 per 100000 live births. 6.Promote delayed marriage for girls, not earlier than age 18 and preferablyafter 20 years of age. 7.Achieve 80 per cent of institutiondeliveries and 100 per cent deliveries by trained persons.
8.Achieve universal access to information/counselling and services for fertility regulation and contraception. 9.Achieve 100 per cent registration of births, deaths, marriage and pregnancy. 10.Contain the spread of AIDS and promote greater integration between the management of reproductive tractinfections and sexually transmitted infections and National Aids Control Organization.
11.Prevent and control Communicable diseases. 12.Integrate Indian System of Medicine (ISM) in the provision of reproductive and child health services and in reachingout to households. 13.Promote the small family norm. 14.Bring about convergence in implementation of related social sector programmes so that family welfare becomes apeople centred programme.
7.3.Epidemiology7.3.1. Conceptof disease.The term disease means without ease.Man’s concept ofdisease has evolved down from Supernatural theory of disease Germ theory of disease Modern multi-factorialtheory of disease Definition – A physiological/psychologicaldysfunction.
A condition in which body health is impaired, a departure fromstate if health.Illness – A subjective state of the person whofeels aware of not being well.Sickness – A state of dysfunction.Concept ofCausation – Up to the timeof Louis Pasteur, various concepts of disease were in vogue. Germ theory ofdisease gained momentum in 19th century.
The emphasis had shifted fromempirical causes such bad air to microbes as the sole cause of disease. Epidemiologicaltriad – The germ theory ofdisease describes disease causation has the basic factors of agent, host andenvironment. Interaction of these three factors are needed to initiate thedisease in man. The epidemiological triadnot only determines the onset of disease by also the distribution of disease incommunity. Agent factors: In the chain of disease transmission is a diseaseagent is the first link. “Agent” is defined as a substance, living ornon-living, or a force, tangible or intangible, the excess presence or relativelack of which may initiate the disease process. Hostfactors – Some host factors that influence susceptibility todisease are: Sex, Race, Age, Occupation, Nutrition, Heredity, Marital status and SocioeconomicstatusEnvironmentfactors – All that which isexternal to man is the environment broadly speaking. The concept of environmentis complex.
The external environmentor the Macro-environment issaid to be responsible for millions of preventable diseases.Micro-environment is the Domestic environment in which man lives. External environment – “All that is external to theindividual human host, living and non-living, and with which he is in constantinteraction”. The environmenthas three components – physical,biological, and psychosocial environment.
Iceberg of disease – A concept closely related to the spectrumof disease is the concept of the iceberg phenomenon of disease. According tothis concept, disease in a community maybe compared with an iceberg. Iceberg of Disease7.3.
2.Epidemiological triad.Definition 1.
Epidemiology is concerned with the patterns ofdisease occurrence in human populations and of the factors that influence thesepatterns. 2. Epidemiology isthe study and analysis of the distribution and determinants of health and disease conditions in defined populations.
The causative factors of disease may be classifiedas Agent, Host,and Environment – These factors are known as epidemiological triad. Even thoughthese factors are present, disease process will not occur unless there is aninteraction. Diseases cannot occur in the absence of any one of these threefactors. 7.3.4. Conceptsof control and prevention .Concepts ofPrevention – In modern day the concept of prevention has becomebroad – based.
It is customary to define prevention in terms of 4 levels. Levels of Prevention: 1. Primordial prevention 2.Primary prevention 3.Secondary prevention 4.Tertiary prevention PrimordialPrevention – Prevention ofemergence or development of risk factors in population groups in which theyhave not yet appeared.
e.g. Lifestylediseases.Intervention: Health education.PrimaryPrevention – Action taken prior to the onset of disease, which removes the possibilitythat a disease will occur. Intervention inthe pre?pathogenesisphase- Elimination or modification of risk factors. e.g.
Communicable diseases and Non CommunicableDiseases. Approaches forprimary prevention: – Adequatenutrition, provision of water and supply, facilities for the safe disposal ofhuman excreta and other human wastes and periodic health screening. SecondaryPrevention – Actions which halts the progress of a disease at itsincipient stage and prevents complications. Intervention inearly pathogenesis phase – Earlydiagnosis and adequate treatment. mTertiary Prevention – All measures available to reduce or limitimpairments and disabilities, minimize suffering caused by existing departuresfrom good health and to promote the patient’s adjustment to irremediableconditions. Intervention in late pathogenesis phases – prevention of complication and disability limitation.
Modes ofintervention: 1. Healthpromotion -Environmentalmodifications Nutritionalinterventions Life style andbehavioural changes2. Specificprotection -Immunizatione.g. Vaccine preventable diseases, Specificnutrient e.g. Iron, protection against injuries (helmet, seat belt) Chemoprophylaxise.
g. against Malaria. Control ofconsumer product quality and safety of foods, drugs, cosmetics etc. 3. Earlydiagnosis and treatment – Thedetection of disturbances of homoeostatic and compensatory mechanism whilebiochemical, morphological and functional changes are still reversible. Important in reducing high morbidity andmortality.
4. Disabilitylimitation 5. Rehabilitation- The combined andcoordinated use of medical, social, educational and vocational measures fortraining and retraining the individual to the highest possible level offunctional ability. Medicalrehabilitation Vocationalrehabilitation Socialrehabilitation PsychologicalrehabilitationHealtheducation Concept ofControlThe term “disease control” aims to reduceIncidenceof diseaseDistribution ofdisease Effects ofinfectionFinancialburden to the communityControl activities may focus on primary preventionor secondary prevention. Tertiary control is less relevant to control efforts.Controlling sources of infection1. Supply of safe drinking water 2. Safe disposal of human excreta and animal excreta 3.
Control vectors of diseases.4. Animals – vaccinate dogs against rabies andeliminate street dogs.5. Rodent control measures-trapping and killing6. Hospital waste management7. Disinfections8. Legislation- Epidemic disease control act.
9. Observe international health regulations7.3.5.principlesof epidemiology(components, measurements, prevalence and incidence)7.3.6Epidemiologic methods : Descriptive,analytical and Experimental studies.Epidemiological studies can be classified asobservational and experimental studies.
1. Observationalstudies a. Descriptive studies – A simple description of the health statusof a community. Based on routinely available data or data obtainedin special surveys. b. Analytical studies i.
Ecological or co relational ii.Cross sectional or Prevalence iii.Case – control or Case reference iv.Cohort or Follow up2.
Experimental studies a. Randomized control trial b.Field trials c.Community trialsAnalyticalStudies – Analyzingrelationships between health status and other variables.
TYPES 1. Case-control studies. (Casereference studies) 2.Cohort studies. (Follow-up studies) Cohort Studies – Cohort is group ofpeople with similar characteristics also called follow-up or incidence studies.Whole cohort is followed up to see the effect of exposure.
Study design of acohort study.Types of CohortStudies 1. Prospective cohort studies. (Currents cohortstudy) 2.Retrospective cohort studies. (Historical cohort study) 3.Combination of retrospective and prospective cohort studies.EXPERIMENTALEPIDEMIOLOGYInterventional or experimental study involvesattempting to change a variable in subjects under study.
This could mean theelimination of a dietary factor thought to cause allergy, or testing a newtreatment on a selected group of patients. The effects of an intervention aremeasured by comparing the outcome in the experimental group with that in acontrol group. Types of Experimental Studies 1. Randomized Control Trials. 2. Field Trials & Community Trials.
7.3.7.Uses of epidemiology 1. Search of cause/causes of disease/diseases.
2. Helps to describe the health status of populationor groups.3. Helps to discover and bridge gaps in naturalhistory of diseases.4. Helps in controlling the diseases. Break theweakest link in chain of transmission of communicable diseases and reducing noncommunicable diseases.
5. Helps in planning of health programs on evidencebasis and setting up of health priorities.6. Helps to evaluate health programs and interventions.7.
Helps to determine the chances or probability ofoccurrence of disease/ deaths and disability8. Helps in better management of health services andhospital services.9. Helps to set-up cut-off levels between normal andabnormal population andestablish trigger levels for action or intervention.7.4. Communityhealth – Community healthrefers to the health status of the members of the community, to the problemsaffecting their health, and to thetotality of health care provided for the community.Community health implies integration of curative,preventive and promotional health services.
The focus in community diagnosis is onidentification of community health problems. A community is a whole entity thatfunctions because of the interdependence of its parts or subsystems.CommunityDiagnosis – The diagnosis ofthe individual is based on signs and symptoms. When this is applied to acommunity it is known as “community diagnosis.
Community diagnosis generally refers to theidentification and quantification of health problems in a community as a wholein terms of mortality and morbidity rates and ratios, and identification oftheir correlates for the purpose of defining those at risk or those in need ofhealth care. For diagnosis of community health problems, we haveto studya. age and sex composition of the population.b.
vital statistical rates such as the death rate, infant mortalityrate. c.incidence and prevalence of important diseases in the community.CommunityTreatment – which consistsof eight elements of Primary Health Careto achieve the goal of Health For All. 1.Education of the people about the prevailing health problems and the methods of preventing andcontrolling 2.Promotion of food supply and adequate nutrition 3.Adequate supply of safe water and basic sanitation 4.
Mother and Child Health care and family planning 5.Immunization against the vaccine preventable diseases 6.Prevention and control of locally prevailing diseases 7.Proper treatment of diseases and injuries 8.Provision of essential drugsCommunicable Non-communicable DiseasesCommunicable disease is one that is spread from one person toanother through a variety of ways. Eg.
contact with blood and bodily fluids; breathing in an airborne virus; or bybeing bitten by an insect.Reporting of cases of communicable disease is important· Planningand evaluation of disease prevention and control programs,· Appropriatemedical therapy, · Detectionof common-source outbreaks. Some examples of the reportable communicable diseases include HepatitisA, B & C, influenza, measles, and salmonella and other food borneillnesses.How these diseases spreaddepends on the specific disease or infectious agent. Some ways in whichcommunicable diseases spread are by:1.
Physical contact with aninfected person, such as through touch (staphylococcus), sexual intercourse (HIV), fecal/oral transmission (hepatitis A), or droplets (influenza, TB)2. Contact with a contaminatedsurface or object (Norwalk virus), food (salmonella, E. coli), blood (HIV, hepatitisB), or water (cholera)3. Bites from insects or animalscapable of transmitting the disease (mosquito: malaria and yellow fever; flea:plague); and4. Travel through the air, suchas tuberculosis or measles..
Non-communicable diseases (NCDs), also known as chronic diseases, tend to be of longduration and are the result of a combination of genetic, physiological,environmental and behaviors factors. Non-infectious are non-communicable diseases and caused by a variety ofreasons. Reasons for the non-infectious diseaseare· genetics· nutritionaldeficiency· age· sexof the individual Examples include cancer, diabetes, hypertension, cardiovascular diseases (like heart attacksand stroke),chronic respiratory diseases (such as chronic obstructive pulmonarydisease and asthma) and diabetes. National andinternational health7.5.1.Nationalhealth programmes in India Since India became free, several measures have beenundertaken to improve the health status of the people. Prominent among thesemeasures are the National Health Programmes which have been launched by theCentral Government for the control/eradication of the communicable diseases,improvement of environmental sanitation, raising the standard of nutrition,control of population and improving rural health.
Various Internationalagencies have been providing technical and material assistance in theimplementation of these programmes. 1. National AIDSControl Program was launchedin India in the year 1987. The aim of the programme is to prevent furthertransmission of HIV, to decrease morbidity and mortality associated with HIVinfection and to minimize the socio economic impact resulting from HIVinfection.
2. NationalVector borne Disease Control programme – Govt. India provides technical support,insecticides, larvicides and insecticide treated bed nets for treatment ofmalaria, filaria and kala-azar.3. NationalTuberculosis Control programme hasbeen in operation since 1962. 4, NationalCancer Control Program – Withthe objective of prevention and earlydiagnosis and treatment, the national cancer control programme was launched in1975 – 76.5. NationalMental Health Programme – TheMental Health programme was launched during 1992 with a view to ensureavailability of Mental Health Services for all, especially the community atrisk and under privileged section of the population.
6. National FamilyWelfare Program (NFWP) – 100%Centrally sponsored. Family Welfare Dept was created in 3rd Fifth Five YearPlan. Family Planning was integrated with MCH services.
Other healthprogrammes are:- National Diarrheal Disease Control Program National FilariaControl ProgramNational Family Welfare ProgramNational Iodine Deficiency Disorders Control ProgramNational Leprosy Eradication Program National Malaria Eradication Program National Program for Control of Blindness &Visual ImpairmentNational Reproductive and Child Health ProgramNational Program for surveillance Program for Communicablediseases National Tuberculosis Control Program Minor ProgramsNational Mental Health Program National Japanese Encephalitis control ProgramNational Diabetes Control Program — NationalKala-azar Control ProgramNational Water Supply and Sanitation Program 7.5.2. International health(who and other unitednations agencies) 1. World Health Organization (WHO)was established shortly after World War II asa multilateral health organization to unite countries in the common goals oftackling disease and achieving better health globally.
2. World Bank – As a leadinginstitution for investments in health and development, the World Bank plays a critical role in shaping global healthpolicy. The World Bank strives to alleviate poverty by providing loans,credits, and grants to poor counties to implement various developmentprojects in areas such as education, healthcare, agriculture, environmental andnatural resource management, infrastructure, and other relevant projects.3. UNICEF established in 1946 with headquarter at New York.
South east Asia region covers India. FUNCTION UNICEF- works in closecollaboration with WHO & other UN agencies on Child nutrition & healthFamily & child welfare Education.4. UNDP UnitedNations Development Programme- Established in 1966.
OBJECTIVES To help poorer nations develop their human & natural resources morefully. It coversevery social & economic sector-agriculture, industry, education, science,health & manpower.5. FAO It was formed in 1945. AIMS· Tohelp nation wise living standard.
· Toimprove nutrition o the people of all countries. · Toincrease the efficacy of farming, forestry & fisheries. · Tobetter the condition of rural people & widen opportunities of all peoplefor productive work.
The Food andAgriculture Organization(FAO) wasformed in the year 1945 with headquarters in Rome. It was United Nationsorganization specialized agency created to look after several areas of worldco-operation.TheInternational Labour Organization (ILO) is a United Nations agency dealing with labourissues, particularly international labour standards and decent work for all. 5.The United States Agency for International Development (USAID) is the UnitedStates federal government agency primarily responsible for administeringcivilian foreign aid.
INTERNATIONALRED CROSS The red cross is anon-political and non-official international humanitarian organization.Role of Redcross: 1)It was largely confined to the victims of the war – first aid in case of war like situations 2)MCH services 3)Disastermanagement and has designed emergen