COMMUNITY HEALTH

Module-1

 Community health implies, in a broad sense, integration of curative, preventive and promotive
health services. The traditional and important responsibilities of public health are now included in the
concept of community health.

 ‘Community health refers to the health status of the members of the community, to the
problems affecting their health, and to the totality of health care provided to the community’ .
Concept of health
“Health is a state of complete physical, mental and social well-being and not merely an absence of
disease or infirmity.”-WHO (1948)
New Philosophy Of Health
 Health is a fundamental human right
 Health is the essence of productive life, and not the result of ever increasing expenditure on
medical care
 Health is an integral part of development
 Health is central to the concept to the concept of quality of life
 Health involves individuals, state and international responsibility.
 Health and its maintenance is a major social investment
 Health is worldwide social goal

Changing concepts of health

1. Biomedical concept
2. Ecological concept
3. Psychosocial concept
4. Holistic concept

DISEASE
 Webster defines disease “ as a condition in which body health is impaired, a departure from a
state of health, an alteration of the human body interrupting the performance of vital functions”.
 “Condition of the body or some part or organ of the body in which its functions are disrupted
or deranged”- Oxford English Dictionary
Acute disease
• Sudden and rapid onset
• Symptoms disappear quickly
E.g. influenza
Chronic disease
• Long term
• Symptoms lasting months or years
E.g. Tuberculosis

Categories of disease
 Physical disease
Results from permanent or temporary damage to the body.
 Infectious disease
Organism that cause disease inside the human body are called pathogens
Diseases are said to be infectious or communicable if pathogens can be passed from one person to
another
Disease, Illness and Sickness
The term disease literally means without ease, the opposite of ease-when something is wrong with
bodily function. Disease is a physiological/psychological dysfunction defined professionally.
• Illness refers to the individual’s perceptions and behaviour in response to being ill. Illness is a
subjective state of the person who feels aware of not being well.
• Sickness refers to a state of social dysfunction.(from disease or illness).
• A role that the individual assumes when ill (sickness role)

CONCEPT OF WELL BEING

• Objective components: standard living, Level of living
• Subjective component: Quality of life
• Standard of living: Refers of expenditure, Goods we consume service we enjoy.
• Definition : Income and occupation, standards of housing, sanitation, nutrition, level of
provision of health, educational, recreational and other services may all be used individually as
measures of socio – economic status & collectively as an index called Standard of Living (WHO)
• Level of Living: Parallel term for standard of living.
• Nine components: Health, Food consumption, Education, Occupation & Working conditions,
Housing, Social security, Clothing, Recreation. Leisure & Human rights
• Quality of Life : “ the condition of life resulting from the combination of the effects of the
complete range of factors such as those determining health, happiness, education, social and
intellectual attainments, freedom of action justice and freedom of expression
• Physical Quality of Life Index(PQLI) : Three factors viz. infant mortality, life expectancy at
age one, and literacy.
• PQLI: does not measure economic growth, measure social, economic &political policies
• Human development index: include 3 factors
• Longevity (life expectancy at birth); knowledge(adult literacy rate and mean years of
schooling); and income
Positive Health
• Perfect functioning’ of the body and mind
• Biologically – as a state in which every cell and every organ is functioning at optimum
capacity and in perfect harmony with rest of the body
• Psychologically- as a state in which the individual feels a sense of perfect well-being and of
mastery over his environment
• Socially- as a state in which the individual’s capacities for participation in social system are
optimal.
Determinants of Health
Health is multifactorial. The factors which influence health lie both within the individual and
externally in the society in which he or she lives.
• Genetic factors & environmental factors
• These factors interact and these interactions may be health-promoting or deleterious.

1. Biological determinants
2. Behavioural & socio-cultural conditions
3. Environment
4. Health services
5. Ageing of population
6. Gender
7. Other factors

Spectrum of health
• The spectrum concept of health emphasizes that the health of an individual is not static; is a
dynamic phenomenon & a process of continuous change, subject to frequent subtle variations.
• In some people, however, the disease process may never progress to clinically apparent illness.
• In others, the disease process may result in illness that ranges from mild to severe or fatal.
This range is called the spectrum of disease.
• Ultimately, the disease process ends either in recovery, disability or death.

community health
The WHO defines community health as the environmental, social, and economic resources to sustain
emotional and physical well-being among people in ways that advance their aspirations and satisfy
their needs in their unique environment.
It is a branch of public health that focuses on people and their role as determinants of their own and
other people’s health. This is in contrast to environmental health, which focuses on the physical
environment and its impact on people’s health.
 It is a major field of study within the medical and clinical sciences that focuses on the maintenance,
protection, and improvement of the health status of population groups and communities.
Medical interventions that occur in communities can be classified in three categories: each focuses on
a different level and approach toward the community or population group:
Primary health care. Primary health care programs aim to reduce risk factors and increase health
promotion and prevention.
Secondary health care. Secondary health care, also called "hospital care," is where acute care is
administered in a hospital setting.
Tertiary health care. Tertiary health care refers to highly specialized care usually involving disease or
disability management.

Community Health Components

Health care workers working in urban areas identify how the populations are impacted by factors
related to social and economic status; like poverty, nutrition, water source, war, crime, and transport
services. They also decide how the health and education services of the community relate to the lives
of people and what changes are needed. Vital components of community health include:

• Identification of significant public health issues, such as social and environmental influences
impacting healthy living, within the same geographic region.

• Developing an intervention strategy to resolve urban infrastructure shortages, such as setting up

community health centers, mobile clinics, and services for outreach.

• In order to promote life changes, inform people about the importance of medical treatment and safe
lifestyles.

• Ensuring the availability of essential medical services like screenings, therapy, and counseling.
• In case emergencies cost reduction of expensive treatments and hospitalizations.
• Advocating to state and federal officials for better treatment for at-risk communities.
• Works alongside other neighborhood groups to discuss the emotional, physical, cultural, and
social features of the city, including housing, nutrition, and transportation.

Importance of Community Health

Large population residing in rural areas does not have access to proper care and treatments in the hour
of their need. Elderly people, pregnant women, neonatals, persons with chronic illness residing in a
distant location from a hospital are always at high risk. Community health system is a big hope here.

• Addressing disparities in access to health care

Rural and small cities where per capita income is less, unavailability of hospitals and shortage of
doctors occur, healthcare inequalities may be extremely pronounced. Such populations are at high risk
of exposure to extreme poverty, drug abuse, and several other risks to human health and life. If a
regional health system that takes into account the particular features of the community is set in order
to meet unmet needs, the general level of service of the community can be dramatically increased.
• Minimizing costs to health care
 Social health is an important part in health policy reforms aimed at lowering public spending on
healthcare. Public health services work within a model of patient-centered treatment, including
patients in decisions regarding care. This model helps physicians to direct patients away from
expensive visits to the emergency department to discourage relapses.

• Establishing public health centers and programs

In public health efforts such as the war against the drug crisis and the halting of the HIV epidemic and
the ongoing Covid19 pandemic, community health services have become vital tools. The holistic
model of health treatment helps physicians to manage and avoid a variety of disorders simultaneously.

Right to health

According to the World Health Organization (WHO), health is a state of complete physical, mental
and social well being and not merely the absence of disease. The Constitution of India does not
expressly recognize Right to Health as a fundamental right under Part III of the Constitution
(Fundamental Rights).
The right to the highest attainable standard of health” implies a clear set of legal obligations on states
to ensure appropriate conditions for the enjoyment of health for all people without discrimination.

The right to health is one of a set of internationally agreed human rights standards, and is inseparable
or ‘indivisible’ from these other rights. This means achieving the right to health is both central to, and
dependent upon, the realisation of other human rights, to food, housing, work, education, information,
and participation.

The right to health, as with other rights, includes both freedoms and entitlements:

• Freedoms include the right to control one’s health and body (for example, sexual and reproductive
rights) and to be free from interference (for example, free from torture and non-consensual medical
treatment and experimentation).
• Entitlements include the right to a system of health protection that gives everyone an equal
opportunity to enjoy the highest attainable level of health.

Focus on disadvantaged populations

Disadvantage and marginalization serve to exclude certain populations in societies from enjoying good
health. Three of the world’s most fatal communicable diseases – malaria, HIV/AIDS and tuberculosis
– disproportionately affect the world’s poorest populations, and in many cases are compounded and
exacerbated by other inequalities and inequities including gender, age, sexual orientation or gender
identity and migration status. Conversely the burden of non-communicable diseases
– often perceived as affecting high-income countries – is increasing disproportionately among lower-
income countries and populations, and is largely associated with lifestyle and behaviour factors as well
as environmental determinants, such as safe housing, water and sanitation that are inextricably linked
to human rights.
A focus on disadvantage also reveals evidence of those who are exposed to greater rates of ill-health
and face significant obstacles to accessing quality and affordable healthcare, including indigenous
populations. While data collection systems are often ill-equipped to capture data on these groups,
reports show that these populations have higher mortality and morbidity rates, due to
noncommunicable diseases such as cancer, cardiovascular diseases, and chronic respiratory disease.
These populations may also be the subject of laws and policies that further compound their
marginalization and make it harder for them to access healthcare prevention, treatment, rehabilitation
and care services

Violations of human rights in health

Violations or lack of attention to human rights can have serious health consequences. Overt or implicit
discrimination in the delivery of health services – both within the health workforce and between health
workers and service users – acts as a powerful barrier to health services, and contributes to poor
quality care.

Mental ill-health often leads to a denial of dignity and autonomy, including forced treatment or
institutionalization, and disregard of individual legal capacity to make decisions. Paradoxically, mental
health is still given inadequate attention in public health, in spite of the high levels of violence,
poverty and social exclusion that contribute to worse mental and physical health outcomes for people
with mental health disorders.

Violations of human rights not only contribute to and exacerbate poor health, but for many, including
people with disabilities, indigenous populations, women living with HIV, sex workers, people who use
drugs, transgender and intersex people, the health care setting presents a risk of heightened exposure
to human rights abuses – including coercive or forced treatment and procedures.

Disease prevention
Disease prevention, understood as specific, population-based and individual-based interventions for
primary and secondary (early detection) prevention, aiming to minimize the burden of diseases and
associated risk factors.
Primary prevention refers to actions aimed at avoiding the manifestation of a disease (this may include
actions to improve health through changing the impact of social and economic determinants on health;
the provision of information on behavioral and medical health risks, alongside consultation and
measures to decrease them at the personal and community level; nutritional and food supplementation;
oral and dental hygiene education; and clinical preventive services such as immunization and
vaccination of children, adults and the elderly, as well as vaccination or post-exposure prophylaxis for
people exposed to a communicable disease). Secondary prevention deals with early detection when
this improves the chances for positive health outcomes (this comprises activities such as evidence-
based screening programs for early detection of diseases or for prevention of congenital
malformations; and preventive drug therapies of proven effectiveness when administered at an early
stage of the disease). It should be noted that while primary prevention activities may be implemented
independently of capacity-building in other health care services, this is not the case for secondary
prevention. Screening and early detection is of limited value (and may even be detrimental to the
 patient) if abnormalities cannot be promptly corrected or treated through services from other parts of
the health care system. Moreover, a good system of primary health care with a registered population
facilitates the optimal organization and delivery of accessible population based screening programs
and should be vigorously promoted.

Health promotion

Health promotion is the process of empowering people to increase control over their health and its
determinants through health literacy efforts and multisectoral action to increase healthy behaviors.
This process includes activities for the community-atlarge or for populations at increased risk of
negative health outcomes. Health promotion usually addresses behavioral risk factors such as tobacco
use, obesity, diet and physical inactivity, as well as the areas of mental health, injury prevention, drug
abuse control, alcohol control, health behavior related to HIV, and sexual health.

Disease prevention and health promotion share many goals, and there is considerable overlap between
functions. On a conceptual level, it is useful to characterize disease prevention services as those
primarily concentrated within the health care sector, and health promotion services as those that
depend on intersectoral actions and/or are concerned with the social determinants of health.

Scope of the function Disease prevention

Primary prevention services and activities include:

• Vaccination and post-exposure prophylaxis of children, adults and the elderly;

• Provision of information on behavioural and medical health risks, and measures to reduce risks at the
individual and population levels;

• Inclusion of disease prevention programmes at primary and specialized health care levels, such as
access to preventive services (ex. Counselling); and

• Nutritional and food supplementation; and

• Dental hygiene education and oral health services.

• Secondary prevention includes activities such as:

• Population-based screening programmes for early detection of diseases;

• Provision of maternal and child health programmes, including screening and prevention of congenital
malformations; and

• Provision of chemo-prophylactic agents to control risk factors (e.g., hypertension)

Iceberg phenomenon of disease

Iceberg phenomenon of disease gives a picture of the spectrum of diseases in a community. The
visible part of the iceberg denotes the clinically apparent cases of disease in the community. The part
of the iceberg below the water level denoted the latent, subclinical, undiagnosed and carrier states in
the community, which forms the major part. The hidden part is especially important in disease like
hypertension, diabetes and malnutrition.

Some diseases exhibiting iceberg phenomenon:

 Diabetes

 Hypertension

 Malnutrition

 Polio

 Leprosy

A common situation in clinical practice, where only a small proportion of cases of important diseases,
the tip of the iceberg, are seen at an early stage in the natural history when intervention can achieve
prevention, cure, or relief of symptoms.

The iceberg phenomenon describe a situation in which a large percentage of a problem is subclinical,
unreported or otherwise hidden from view.

Uses of Iceberg Concept

• For detection of sub-clinical and in-apparent cases

• Treatment of in-apparent cases

• Control of disease with more number of sub-clinical cases

• To have a detailed knowledge regarding natural history of disease

cultural factors in health and diseases

The influence of culture on health is vast. It affects perceptions of health, illness and death, beliefs
about causes of disease, approaches to health promotion, how illness and pain are experienced and
expressed, where patients seek help, and the types of treatment patients prefer. These include
initiation, birth and death rites; arranged marriages, female genital mutilation, circumcision and
various iterations of cleansing rituals associated with the body and mind. The major elements of
culture are material culture, language, aesthetics, education, religion, attitudes and values and social
organisation. Encompasses the set of beliefs, moral values, traditions, language, and laws (or rules of
behavior) held in common by a nation, a community, or other defined group of people.
Cause of disease

• All people, whether rural or urban, have their own beliefs and practices concerning health and
disease

• Not all customs and beliefs are bad. Some are based on centauries of trial and error and have
positive values, while others may be useless or positively harmful

1. Concept of aetiology and cure

• The causes of disease, as understood by the majority of rural people, fall into two groups: (a)
supernatural and (b) physical.

a) Supernatural causes

 Wrath of god and goddesses

 Breach of taboo

 Past sins

 Evil eye

Spirit or ghost intrusion

b) Physical causes

 The effects of weather

 Water

 Impure blood

[Link] sanitation

 Disposal human excreta

 Disposal of wastes

 Water supply

 Housing

[Link] and child health

 Good

 Bad
 Unimportant

 uncertain

[Link] hygiene

• Oral hygiene

• Bathing

• Shaving

• Smoking

• Sleep

• Wearing shoes

• Circumcision

[Link] habits

[Link] and marriage

MULTIPLE CAUSES OF DISEASE

Infectious diseases can be caused by:

• Bacteria. These one-cell organisms are responsible for illnesses such as strep throat, urinary
tract infections and tuberculosis.

• Viruses. Even smaller than bacteria, viruses cause a multitude of diseases ranging from the
common cold to AIDS.

• Fungi. Many skin diseases, such as ringworm and athlete's foot, are caused by fungi. Other
types of fungi can infect your lungs or nervous system.

• Parasites. Malaria is caused by a tiny parasite that is transmitted by a mosquito bite. Other
parasites may be transmitted to humans from animal feces.

Direct contact

An easy way to catch most infectious diseases is by coming in contact with a person or an animal with
the infection. Infectious diseases can be spread through direct contact such as:
• Person to person. Infectious diseases commonly spread through the direct transfer of bacteria,
viruses or other germs from one person to another. This can happen when an individual with the
bacterium or virus touches, kisses, or coughs or sneezes on someone who isn't infected.

These germs can also spread through the exchange of body fluids from sexual contact. The person
who passes the germ may have no symptoms of the disease, but may simply be a carrier.

• Animal to person. Being bitten or scratched by an infected animal — even a pet — can make
you sick and, in extreme circumstances, can be fatal. Handling animal waste can be hazardous, too.
For example, you can get a toxoplasmosis infection by scooping your cat's litter box.

• Mother to unborn child. A pregnant woman may pass germs that cause infectious diseases to
her unborn baby. Some germs can pass through the placenta or through breast milk. Germs in the
vagina can also be transmitted to the baby during birth.

Indirect contact

Disease-causing organisms also can be passed by indirect contact. Many germs can linger on an
inanimate object, such as a tabletop, doorknob or faucet handle.

When you touch a doorknob handled by someone ill with the flu or a cold, for example, you can pick
up the germs he or she left behind. If you then touch your eyes, mouth or nose before washing your
hands, you may become infected.

Insect bites

Some germs rely on insect carriers — such as mosquitoes, fleas, lice or ticks — to move from host to
host. These carriers are known as vectors. Mosquitoes can carry the malaria parasite or West Nile
virus. Deer ticks may carry the bacterium that causes Lyme disease.

Food contamination

Disease-causing germs can also infect you through contaminated food and water. This mechanism of
transmission allows germs to be spread to many people through a single source. Escherichia coli (E.
coli), for example, is a bacterium present in or on certain foods — such as undercooked hamburger or
unpasteurized fruit juice.

Bio-psychosocial aspects of Health and illness

The biopsychosocial model, first developed by cardiologist Dr. George Engel, is today widely
accepted by the mental health professions. This model suggests that biological, psychological and
social factors are all interlinked and important with regard to promoting health or causing disease.
Considers the functional aspect of health an Illness, which includes the course of life’s processes in a
human organism and biological, psychological, and social manifestations of a human being, to be the
most significant aspect. Health is defined as a functional optimum of all of life’s processes and
manifestations. The basic signs of health, particularly the psychological and social ones, are discussed
with respect to a human being. The biopsychosocial model views health and illness as the product of
biological characteristics (genes), behavioral factors (lifestyle, stress, health beliefs), and social
conditions (cultural influences, family relationships, social support).

Biological Influences on Health

Biological influences on health include an individual’s genetic makeup and history of physical trauma
or infection. Many disorders have an inherited genetic vulnerability. The greatest single risk factor for
developing schizophrenia, for example is having a first-degree relative with the disease (risk is 6.5%);
more than 40% of monozygotic twins of those with schizophrenia are also affected. If one parent is
affected the risk is about 13%; if both are affected the risk is nearly 50%. It is clear that genetics have
an important role in the development of schizophrenia, but equally clear is that there must be other
factors at play. Certain non-biological (i.e., environmental) factors influence the expression of the
disorder in those with a pre-existing genetic risk.

Psychological Influences on Health

The psychological component of the biopsychosocial model seeks to find a psychological foundation
for a particular symptom or array of symptoms (e.g., impulsivity, irritability, overwhelming sadness,
etc.). Individuals with a genetic vulnerability may be more likely to display negative thinking that puts
them at risk for depression; alternatively, psychological factors may exacerbate a biological
predisposition by putting a genetically vulnerable person at risk for other risk behaviors. For example,
depression on its own may not cause liver problems, but a person with depression may be more likely
to abuse alcohol, and, therefore, develop liver damage. Increased risk-taking leads to an increased
likelihood of disease.

Social Influences on Health

Social factors include socioeconomic status, culture, technology, and religion. For instance, losing
one’s job or ending a romantic relationship may place one at risk of stress and illness. Such life events
may predispose an individual to developing depression, which may, in turn, contribute to physical
health problems. The impact of social factors is widely recognized in mental disorders like anorexia
nervosa (a disorder characterized by excessive and purposeful weight loss despite evidence of low
body weight). The fashion industry and the media promote an unhealthy standard of beauty that
emphasizes thinness over health. This exerts social pressure to attain this “ideal” body image despite
the obvious health risks.

Cultural Factors

Also included in the social domain are cultural factors. For instance, differences in the circumstances,
expectations, and belief systems of different cultural groups contribute to different prevalence rates
and symptom expression of disorders. For example, anorexia is less common in non-western cultures
because they put less emphasis on thinness in women
 Health promotion must address all three factors, as a growing body of empirical literature suggests that
it is the combination of health status, perceptions of health, and sociocultural barriers to accessing
health care that influence the likelihood of a patient engaging in health-promoting behaviors, like
taking medication, proper diet or nutrition, and engaging in physical activity.

Health Education

Health education is an essential tool of community health. It has been defined as a process which
effects changes in the health practices of people and in the knowledge and attitudes related to such
changes. Health education teaches about physical, mental, emotional and social health. It motivates
students to improve and maintain their health, prevent disease, and reduce risky behaviors. It also
focuses on emotional, mental and social health too. Educating students on the importance of health
builds their motivation.

Health education is important to improve health status of the communities. Health education raises
students’ knowledge about physical, mental, emotional and social health. It motivates youth to
improve and maintain their health, prevent diseases, and avoid unhealthy behaviors.

Aims of health education

The WHO has formulated the aims of health education as follows

• To ensure that health is valued as an asset in the community;

• To equip the people with skills, knowledge and attitudes-to enable them solve their health
problems by their own actions & efforts; and

• To promote the development and proper use of health services

Objectives of health education

• To provide the public with information to create awareness and dispel misconceptions, doubts and
ignorance

• Help people achieve health by their own actions and efforts

• To induce people to make use of the health services available in the community.

Areas of health education

• Human biology

• Nutrition

• Hygiene

• MCH and family planning

• Prevention of communicable diseases

• Prevention of accidents

• Use of health services

• Mental health

Principles of health education

• Interest

• Participation

• Comprehension

• Communication

• Motivation

• Learning by doing

• Good human relations

Practice of health education

• Individual
• Group
• General public

Individual health education

Doctors and nurses, who are in direct contact with patients and their relatives have opportunities for
much individual health education.

Group health education

The groups are many–mothers, school children, patients, industrial workers-to whom we can direct
health teaching. The choice of subject in group health teaching is very important; it must relate to the
interest of the group.

EDUCATION OF THE GENERAL PUBLIC

For the education of the general public we employ “mass media of communication”-

• Posters

• Health magazines

• Press
• Films

• Radio& TV

• Health exhibitions

• Health museums

HEALTH PLANNING IN INDIA

Health and health care development has not Been A priority of the Indian state.

• Low level of investment and allocation of Resources to the health sector

• Unregulated private health sector

The Central government has shaped health Policy and planning in India. Through the Council of
Health and Family Welfare And various Committee recommendations At the state government level
there is no Evidence of any policy initiatives in the health Sector.

Planning is an important skill for Health Extension Practitioners because it is a key management
function for all healthworkers and health managers. Planning is the process of determining in advance
what should be accomplished – when, by whom, how and at what cost. Regardless of whether it is
planning long-term programme priorities or a two-hour meeting, the planning aspect of management
will be a major contributor to your success. Stated simply: ‘If you don’t know where you are going,
then you won’t know whether you have arrived!’.

Types of planning

There are two types of planning commonly used in the health sector: strategic planning and
operational planning

Strategic planning is the process of determining what the health sector should be achieving in the
future and how it will carry out the actions necessary to bring about those achievements

Operational planning refers to the action plans that guide your day-to-day work. Without a strategic
plan you don’t know where you are going or why you are going there.

Establishing health planning in India is a key to improving the health of the Indian Population. The
Ministry of Health and Family Welfare has been facilitating Health needs in India by establishing
various schemes and organizations.

The Government is conscious of the need for dynamic Indian health planning and management.
Innovative healthcare and development programs are the need of the hour. For this, major
organizations like the National AIDS Control organization have been established by the Health
Ministry. The areas to focus on in Health Planning have been laid down by the Ministry’s National
Health Policy. Some of them are mentioned below:
• Increasing Healthcare programs: To be implemented in various socio-economic settings of different
States of India.

• Increasing Public Health infrastructure: More hospitals, Outdoor medical facilities, Medical
equipments.

• Efficient doctors and nurses: To ensure minimum standards of Patient care.

• Family Medicine: Establishing more personnel for family healthcare.

• Low cost drugs and vaccines: Keeping in view of the possible globalization induced high costs.

• Mental health: Need for increase in hospitals and professionals.

• Health research: Medical innovation and specialization is needed.

• Disease control: More database needs to be collected in this regard in order treat and prevent diseases.

• Women’s health: Adequate access to public healthcare facilities is a necessity which in turn will
improve family health as well

List of National Health Programs organized by the health ministry are National Vector Borne Disease
Control Program (NVBDCP) , National Iodine Deficiency Disorders Control Program, National
Leprosy Eradication Program, National Program for Control of Blindness, National Filaria Control
Program, National Program for Prevention and Control of Deafness, National Cancer Control
Program, National Aids Control Program,

Universal Immunization Program (RTI ACT, 2005), Revised National TB Control Program, and
National Mental Health [Link] more endeavors for health planning in India are Medical
Health Division, Hospital Services Consultancy Corporation, SC/ST facilities, Central Government
Health Schemes, Prevention of food adulteration, establishment of food and drug testing laboratories,
L.R.S. Institute of Tuberculosis and Respiratory Diseases, National Rural Health Mission, etc.

Health for all and primary health care

The Health for All campaign is directed toward the maintenance of primary health care within an
established national health care system. It encourages planned action in the health care system and
promotes coordination and integration of health care with other sectors. The social objective of Health
for All is based on the implementation of primary health care. This was defined at Alma Ata: "primary
health care is essential health care based on practical techniques, scientifically valuable and socially
acceptable, and rendered universally acceptable to all individuals and families..." The essence of
primary health care is fundamental care necessary to promote and protect the physical, mental, and
social health of man.

ATTRIBUTES OF PRIMARY HEALTH CARE

• Essential health care • Universally accessible

• Acceptable • Community based
• First point of contact • Affordability • Adaptability
• Appropriateness • Community participation
• Continuity • Comprehensiveness • Coordination

PRINCIPLES OF PRIMARY HEALTH CARE

 Equitable distribution
 Community participation
 Intersectoral coordination
 Appropriate technology

(1) EQUITABLE DISTRIBUTION

• Inequity in the availability of health services - major concern

• Supply of health care resources- more towards affluent areas
• Julian Tudor Hart - “Inverse Care Law” Availability of good medical care tends to vary
inversely with the need for it in the population served.
• Ensures that individuals with more compromised health conditions will receive more health services
• Commitment to health equity focuses not only on ensuring program inputs but also reducing
differences in health outcomes.
• Access to health care - horizontal equity & vertical equity
• Horizontal equity - “equal access for equal needs” 
 equal resources
 equal access to health care
 equal utilization of health services
 equal health

(2)COMMUNITY PARTICIPATION

• Involvement of the individuals, families and community

• Determines both collective needs and priorities
• Important role in formulating a health problem, make informed choices ,objectives with community
priorities
• Universal coverage cannot be achieved without the involvement of the local community

Advantages of community participation:

• Increases program acceptance and leadership

• Ensures that the program meets the local needs
• Cost of implementing the program may be reduced by using the local resources
• Uses local/ familiar organizations and hence problem solving is efficient
• Commitments to the decision is facilitated
• Key to the sustainability

(3)INTERSECTORAL CO-ORDINATION

• “Primary care involves in addition to the health sector, all related sectors and aspects of national and
community development”
• Includes sustainable participation that combine inter- organizational cooperative working alliances
• Possibly, but not necessarily, in collaboration with the health sector

Difficulties facing intersectoral co-ordination:

 • Create conflicts of interest and disequilibrium
• Power struggles
• Agencies must be able to compromise and impose change on the normal working patterns
• Cultural changes may occur within organisations
• Co-ordination may turn out to be more expensive in terms of time, money and manpower.

APPROPRIATE TECHNOLOGY

• “Technology that is scientifically sound, adaptable to local needs and acceptable to those who apply
it and those for whom it is used and is maintained by the people themselves in keeping with the
principle of self reliance with the resources the country and the community can afford”
• Designed to meet specific health needs
• Criteria for choosing which needs should be addressed - include magnitude of the population
affected, the degree of morbidity or mortality caused by the health condition
• Lack of solutions that are effective, safe, acceptable, affordable, accessible, and sustainable

An appropriate technology should be: (WHO-1989)

• Scientifically valid
• Adapted to local needs
• Acceptable to users and recipients
• Maintainable with local resources

COMMUNITY HEALTH TEAMS

According to the ACA, a community health team is “an interdisciplinary, interprofessional team of
health care providers” and “may include medical specialists, nurses, pharmacists, nutritionists,
dieticians, social workers, behavioral and mental health providers (substance use disorder prevention
and treatment providers), doctors of chiropractic, licensed complementary and alternative medicine
practitioners, and physicians’ assistants. community health teams have various requirements to follow.
They need to provide support services to primary care providers by establishing collaborative
contractual agreements. They support the patient-centered medical home model, which includes
personal physicians, or primary care providers; whole-person orientation; coordinated and integrated
care; evidence-based medicine for safe and high-quality care; use of health information technology;
ongoing quality improvements; expanded access to care; and payment system that values ideas of
patientcentered care.
They are to work with local primary care providers and existing state and communitybased resources
in coordinating disease prevention, management of chronic diseases, and transition between health
care providers and case management. The goal of community health teams is to develop and
implement care models that integrate clinical and community health promotion and preventive
services for patients. Priority is given to patients with chronic diseases. The program design should
incorporate health care providers, patients and caregivers.
Another significant role of community health teams is to provide necessary support for local primary
care providers. The teams assist providers in coordinating and providing access to high-quality health
care, preventive and health promotion services, appropriate specialty care, inpatient services and
pharmacist-delivered medication management services. They also support providers in providing
quality-driven, cost-effective and culturallycompetent patient- and family-centered care; coordinating
appropriate complementary and alternative medicine services; incorporating effective treatment
planning strategies; monitoring health outcomes and use of resources; sharing information and
treatment decisions; avoiding duplication of care; and providing local continuum of care services such
as access to coordinated care. The community health teams also aid in collecting and reporting data for
evaluation of improvements on patient outcomes. Such data may include patient experience in care
and areas for improvement. The collaboration between community health teams and primary care
providers also aims at developing a coordinated system of early detection of children at risk for
developmental or behavioral problems through the use of health information technology and
information lines to provide prompt referral.
Community health teams are integral to providing support for transitions in care and for 24-hour care
management. They provide onsite visits at hospital, nursing home or other institution settings, and aid
in developing discharge and medication plans to ensure that post-discharge care plans include
medication management. As appropriate, plans should also consist of referrals for mental and
behavioral health services and for transitional health care needs from adolescence to adulthood.
Overall, the community health teams may serve as a liaison to community prevention and treatment
programs. They also take part in implementing and maintaining health information technology with
certified electronic health records technology. The health information technology facilitates
coordination between the community health teams and affiliated primary care practice. The ACA also
presents requirements for primary care providers, in collaboration with community health teams, to
provide the teams with a care plan for each patient and access to health records and meet with the
teams on a regular basis to maintain well-integrated care.
Functions of community health team
 care coordination;
 health coaching;
 social support
 health assessment;
 resource linking;
 case management;
 medication management;
 remote care;
 follow-up;
 administration;
 health education;

MAJOR HEALTH PROGRAMMES IN INDIA

• A health program is a set of actions developed by a Government with the aim of improving the health
conditions of the [Link] the authorities promote prevention campaigns and to ensure democratic and
mass access to medical centres. The health programme is an instrument to operationalize health policy through
the planning, execution and evaluation of [Link] are several types of health programs. For example,
following the geographical field of application, a health program can be national, regional or municipal.
Programs may also aim the satisfaction of the needs of a specific field of health.

Health system strengthening programs

• Ayushman Bharat Yojana.
• Pradhan Mantri Swasthya Suraksha Yojana (PMSSY)
• LaQshya' programme (Labour Room Quality Improvement Initiative)
• National Health Mission.
• National Digital Health Mission (NDHM)
Ayushman Bharat Yojana
• AYUSHMAN BHARAT YOJANA also known as the Pradhan Mantri Jan Aroya Yojana (PMJAY), is
a scheme that aims to help economically vulnerable Indians who are in need of healthcare facilities.
• Prime Minister Narendra Modi rolled out this health insurance scheme on 23 September 2018 to cover
about 50 crore citizen in India.
• This covers a majority of diagnostics, medicines, pre-hospitalization costs, and medical treatment
expenses.
• PMJAY Scheme makes quality healthcare accessible to the poorest of poor families in India.
• Hence, the benefits offered by this health plan are massive.
 FEATURES OF PMJAY
• Health cover of Rs 5 lakhs
• Priority to girl child, women and senior citizens
• Pre – existing diseases covered
• Access to paperless and cashless health care
• Supporting and coordination by the Aroyga Mitra
• Benefits available across India
• Families listed in SECC are covered
 The Benefits of PMJAY Scheme
• It handles all the uncovered hospital expenses with ease.
• It provides a cashless facility to its beneficiaries.
• It covers the transport allowances of the beneficiary during the pre-hospitalization and post-
hospitalization period.
• It covers the day-care expenses within the insurance package.
• It also covers the pre-existing ailments of the beneficiary, which are included under the PMJAY plan.
• It makes provisions for the follow-up treatments to ensure the complete recovery of the patient.
PRADHAN MANTRI SWASTHYA SURAKSHA YOJANA (PMSSY)
• The Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) was announced in 2003 with the objectives
of correcting regional imbalances in the availability of affordable/ reliable tertiary healthcare services and also
to augment facilities for quality medical education in the country.
• The scheme was approved in March 2006.
• The main aim is to make tertiary healthcare services available in different parts of the country
 FEATURES OF PMSSY
• To develop patterns of teaching in undergraduate and postgraduate medical education in all its branches
so as to demonstrate a high standard of medical education to all medical colleges and other allied institutions in
India.
• To attain self-sufficiency in postgraduate medical education.
• Provide for undergraduate and postgraduate teaching in the science of modern medicine and other allied
sciences, including physical and biological sciences
LAQSHYA PROGRAMME [LABOUR ROOM QUALITY IMPROVEMENT INITIATIVE]
• Recently, the Union Ministry of Health and Family Welfare has launched “LaQshya” (Labour room
Quality Improvement Initiative) to improve the quality of care in the labour room and maternity operation
theatres in public health facilities.
 GOALS
• Reduce maternal and new born morbidity and mortality
• Improve quality of care during delivery and immediate post-partum period
• Enhance satisfaction of beneficiaries, positive birthing experience and provide Respectful Maternity
Care (RMC) to all pregnant women attending public health facilities.
 OBJECTIVES
• To reduce maternal and new born mortality and morbidity due to APH, PPH, retained placenta,
preterm, preeclampsia and eclampsia, obstructed labour, puerperal sepsis , new born asphyxia, and sepsis etc
• To improve quality of care during the delivery and immediate post- partum care, stabilization of
complications and ensure timely referrals, and enable an effective two – way follow – up system
• To enhance satisfaction of beneficiaries visiting the health facilities and provide respectful maternity
care (RMC) to all pregnant women attending the public health facility.
NATIONAL HEALTH MISSION
• National health mission (NHM) was launched by the government of India in 2013 subsuming the
national rural health mission and national urban health mission. It was further extended in March 2018 to
continue till March 2020.
• The main programmatic components include health system strengthening in rural and urban areas for
reproductive- maternal – neonatal – child – and adolescent health (RMNCH+A) and non-communicable
diseases.
• The Goal of the Mission is to improve the availability of and access to quality health care by people,
especially for those residing in rural areas, the poor, women and children.
• Reduction in Infant Mortality Rate (IMR) and Maternal Mortality
• Ratio (MMR)
• Universal access to public health services such as Women’s health, child health, water, sanitation &
hygiene, immunization, and Nutrition.
• Prevention and control of communicable and non-communicable diseases, including locally endemic
diseases
• Access to integrated comprehensive primary healthcare
• Population stabilization, gender and demographic balance
• Revitalize local health traditions and mainstream AYUSH
• Promotion of healthy life styles

NATIONAL DIGITAL HEALTH MISSION (NDHM)

• The National Digital Health Mission (NDHM) aims to develop the backbone necessary to support the
integrated digital health infrastructure of the country.
• The ministry of health and family welfare government of India has formulated the national digital
health mission (NDHM) with the aim to provide the necessary support for integration of digital health in
infrastructure in the country.
• Its vision is to create a national digital health ecosystem that supports universal health coverage in an
efficient.
• This visionary initiative stemming from the national health policy 2017 intends to digitize healthcare in
India.
• Interoperable standards based digital systems and ensures the security, confidentiality and privacy of
health-related personal information.
 DIGITAL SYSTEMS
• Health ID - It is important to standardize the process of identification of an individual across healthcare
providers. Health ID will be used to uniquely identify persons.
• Digi-Doctor - It is a comprehensive repository of all doctors practicing or teaching modern/ traditional
systems of medicine Enrolling on Dig-Doctor is completely voluntary and enables doctors to get connected to
India s digital health ecosystem.
• Health Facility Registry (HER) - It is a comprehensive repository of health facilities of the country
across different systems of medicine
• Personal Health Records (PHR) - PHR IS an electronic record of health-related information of an
individual that conforms to nationally recognized interoperability standards
• Electronic Medical Records - EMR IS a digital version of a patient's treatment history from a single
facility. The clinical information can further be shared with other healthcare facilities after the patient provides
consent.
National Health Mission (NHM)
The National Health Mission (NHM) seeks to provide universal access to equitable, affordable and quality
health care which is accountable, at the same time responsive, to the needs of the people, reduction of child and
maternal deaths as well as population stabilization, gender and demographic [Link] NHM essentially
focuses on strengthening primary health care across the country. The emphasis is on strengthening health
facilities and services up to the district level in urban and rural areas. The key approaches of NHM include
augmentation of human resources, strengthening health infrastructure, flexible financing, decentralized planning
through village health sanitation and nutrition committees and setting up of Rogi Kalyan Samitis, Medical
Mobile Units to provide health service delivery especially in un-served and underserved areas, One of the areas
of focus of NHM is facility based delivery system. In this direction the NHM seeks to strengthen infrastructure,
equipment, human resources, drugs and supplies, quality assurance systems and service provisioning. To
provide out reach of health care delivery the NHM supports Mobile medical units (MMUs) for rural and remote
areas. Each unit has- one doctor, one nurse, one radiologist, one lab attendant, one pharmacist and a helper and
driver. There is provision of medicines in the unit. The NHM also provides for Patient Transport Service
(National Ambulance Service (NAS)- 108 which is predominantly an emergency response system (ERS),
primarily designed to attend to patients of critical care, trauma and accident victims etc. NHM encompasses two
Sub-Missions, National Rural Health Mission (NRHM) and National Urban Health Mission (NUHM).
1,National Rural Health Mission (NRHM) 2005-2012
National Rural Health Mission is the name of a flagship programme launched by Ministry of Health and
Family Welfare in 2005 to provide universal health care through a well functioning health system throughout
the country with special focus on eighteen states which have unsatisfactory health indicators and/or weak public
health infrastructure. The NRHM aims to provide accessible, affordable, equitable and qualitative health care to
rural population by rejuvenating the health delivery system. It provides support to the states for strengthening of
the health care system in rural areas by making provisions for physical infrastructure, human resources,
equipment, emergency transport, drugs, diagnostics and other support. It covers all programmes in the health
sector except HIV/AIDS, Mental Health and cancer.
The Mission adopts a synergistic approach by relating health to determinants of good
health viz. nutrition, sanitation, hygiene and safe drinking water. The core strategies of the Mission for
achieving its objectives are enhancing the capacity of the Panchayati Raj Institutions (PRI) to own, control and
manage public health services; involvement of female health activist to promote access to improved healthcare
at household level; strengthening of existing primary health care through better staffing; provision of untied
fund to all the health facilities; preparation of health plans at various levels (viz. village, distri The goals of the
NRHM
(i) Reduction in Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR).
(ii) Universal access to integrated comprehensive public health services.
(iii) Child health, water, sanitation and hygiene.
(iv) Prevention and control of communicable and non-communicable diseases, including locally endemic
diseases.
(iv) population stabilization, gender and demographic balance
(v) revitalize local health traditions and main-stream Ayurvedic, Yoga, Unani, Siddha and Homeopathy
Systems of Health (AYUSH)
vii) promotion of healthy life styles
ct); and decentralization of planning to district level etc.
Major Initiatives under NRHM
 ASHA (Accredited Social Health Activist ) :- In order to provide effective healthcare to the rural
population, the National Rural Health Mission (NRHM) by government of India proposed introduction of
female health workers village level. These workers are called Accredited Social Health Activists (ASHA) and
their role is to act at an interface between the community and the government healthcare services. More
specifically, she is responsible for promoting universal immunisation, referral and escort services for
reproductive and child healthcare and other health care delivery [Link] present there are over 9 Lakh
ASHAs. The ASHA scheme is presently in place in 33 states (except Goa, Chandigarh & Puducherry).ASHA Is
the first port of call in the community especially for marginalised sections of the population with focus on
women and children.
 The village health sanitation and nutrition committee(VHSNC) :-The village health sanitation and
nutrition committee is an important tool of community empowerment and participation at the grassroots level to
address issues of environmental and social [Link] SNC membership includes Panchayati raj
representatives, Asha and other frontline workers and also representatives of the marginalised communities.
 Janani suraksha yojana(JSY) :- janani suraksha yojana aims to reduce maternal mortality among
pregnant women by encouraging them to deliver in government health facilities. under the scheme, cash
assistance is provided to eligible pregnant women for giving birth in a government health facility. Since the
inception of in narottam 8.55 crore women have benefited under this scheme.
 Janani shishu suraksha karyakram(JSSK) :- Janani shishu suraksha karyakram launched on 1st
June,2011 ,entitles all pregnant women delivering in public health institutions to absolutely free and no expense
delivery, including Caesarean [Link] marks a shift to an entitlement based approach. The free entitlements
include free drugs and consumables, free diagnostics, free diet during stay in the health institutions, free
provision of blood, free transport from home to health institution, between health institutions in case of referrals
and drop back home and exemption from all kinds of user charges. Similar entitlements are available for all
Sick infants (up to 1 year of age) accessing public health institutions. All States and union territories are
implementing this scheme.
 Facility based newborn care :- A continnum of newborn care has been established with the launch of
home based and facility based newborn care components ensuring that every newborn receives essential care
right from the time of birth and first 48 hours at the health facility and then at home during the first 42 days of
life. Newborn Care Corners(NBCCs) are established at delivery points to provide essential newborn care at
birth ,while Special Newborn Care Units(SNCUs)at District Hospital or medical colleges and Newborn
Stabilization Units(NBSUs) at FRUs provide care for sick newborns.
 National ambulance services(NAS) :- As on date, 31 states/UTs have the facility where people can dial
108 or 102 telephone number for calling an ambulance. Dial 108 is predominantly an emergency response
system, primarily designed to attend to patients of critical care, trauma and accident victims etc. Dial 102
services essentially consist of basic patient transport aimed at the needs of pregnant women and children
through other categories are also taking benefits and are not excluded. JSSK entitlements [Link] transport from
home to facility, inter facility transfer in case of referral and drop back for mother and children are the key
focus of 102 service. This service can be accessed through a toll free call to a call centre.
 Kilkari :- Kilkari is an interactive voice response(IVR) based mobile service that delivers time-sensitive
audio messages (voice call) about pregnancy and child health directly to the mobile phones of pregnant women,
mothers of young children and their families. The service covers the critical time period where the most
maternal or infant death occur from the 4th month of pregnancy until the child is one year old. Families which
subscribe to the service receive one pre-recorded system generated call per week. Each call will be 2 minutes in
length and serve as reminders for what the family should be doing that depending on woman stage of pregnancy
or the child’s age. Kilkari services will be available to states in regional dialect too.
2, National Urban Health Mission(NUHM)
National Urban Health Mission (NUHM) under the NHM strives to improve the health status of the urban
poor particularly the slum dwellers and other disadvantaged sections by facilitating equitable access to quality
health care. The Framework for Implementation of NUHM has been approved by the Cabinet on May 1, 2013.
Ineffective outreach and weak referral system also limits the access of urban poor to health care services. Rates
of under-nutrition, anemia, and incidence of vector borne diseases, TB, and other respiratory infections are
significantly higher than among other urban population groups. Slum populations face greater health hazards
due to overcrowding, poor sanitation, lack of access to safe drinking water and environmental pollution. Under
NUHM, the most vulnerable including construction site workers, homeless persons, street children, victims of
communal violence, invisible habitations such as lime and brick kiln workers would be accorded focused
attention and health care through strategies appropriate to the local situation.
Major initiatives under NUHM
 Service Delivery infrastructure :- NUHM envisages setting up of service delivery infrastructure which
is largely absent in cities or towns to specially address the healthcare needs of urban poor and provides
• Urban Primary Health centre(U-PHC) :- New U-PHCs are established as per gap analysis, as per norm
of one U-PHC for approximately 50,000 urban populations. The new U-PHCs are preferably located within or
near a slum for providing preventive, promotive and OPD(consultation), basic lab diagnosis, drug or
contraceptive dispensing services, apart from counselling for all communicable and non communicable
diseases.
• Urban community health centre (U-CHC) and Referral hospitals :- 30-50 bedded U-CHCs are
established for providing inpatient care. U-CHCs are setup in cities with a population of above 5 lakhs.
 Community process
• Mahila Arogya Samiti(MAS) :- Mahila Arogya Samiti (MAS) is a community based federal group of
around 50 to 100 households, depending upon the size and concentration of the slum population. They are
responsible for health and hygiene, behaviour change promotion and facilitating community risk pooling
mechanism in their coverage area. Mahila Arogya Samiti in urban areas especially at slum level is envisaged as
a broader framework of community mobilization enabling the people both individual/group for planning,
execution, monitoring & evaluation of activities on a sustained basis to help improve their health and
development needs.
SCHOOL HEALTH PROGRAMME
DEFINITION OF SCHOOL HEALTH
“school health refers to a state of complete physical, mental, social, and spiritual well-being and not merely the
absence of disease or infirmity among pupils, teachers and other personnel” K.K. Gilani
Definition of School Health Programme
W.H.O. states that “An effective school health programme can be one of the most cost-effective investments a
nation can make to simultaneously improve education and health.”
The School Health Program is defined as “the school measures that contribute to the preservation and
enhancement of the health of children and school personnel, as well as health services healthful living and
health education”.
Historical background:
The beginning of school health services in India dates back to 1909, when for the first-time medical
examination of school children was carried out in Baroda city. The Bhore committee 1946, reported that school
health services were practically non-existent in India, and where they existed, they were in under-developed
state. In 1953, the secondary education committee emphasized the need for medical examination of pupils and
school feeding programmes .in 1960, the govt. of India constituted a school health committee to assess the
standards of health and nutrition of school children. The committee submitted report in 1961, which include
very useful recommendations. during the five-year plans, many state governments have provided for school
health, and school feeding programmes. In spite of these efforts to improve school health, it must be stated that
in India, as in other developing countries, the school health services provided are hardly more than a token
service because of shortage of recourses and insufficient facilities
Objectives of school health services: -
1. The promotion of positive health
2. The prevention of diseases
3. Early diagnosis, treatment and follow-up of defects
4. Awakening health consciousness in children
5. The provision of healthful environment
COMPONENTS OF SCHOOL HEALTH PROGRAMME
Health service provision:
• Screening, health care and referral:
• Screening of general health, assessment of Anaemia/Nutritional status, visual acuity, hearing problems, dental
check up, common skin conditions, heart defects, physical disabilities, learning disorders, behaviour problems.
• Basic medicine kit to be provided to take care of common ailments prevalent among young school going
children.
• Referral Cards for priority services at District / Sub-District hospitals.
• Immunization:
• As per national schedule
• Fixed day activity
• Coupled with education about the issue
• Micronutrient (Vitamin A & Iron Folic Acid) management:
• Weekly supervised distribution of Iron-Folate tablets coupled with education about the issue
• Vitamin-A as per national schedule.
• De-worming
• As per national guidelines
• Biannually supervised schedule
• Prior IEC with intimation to families to bring siblings to school on the fixed day
• Siblings of students also to be covered
• Health Promoting Schools
• Counselling services, Promotion of mental well-being.
• Regular practice of Yoga, Physical education, health education
• Peer leaders as health educators
• Adolescent health education
• Linkages with the out of school children
• Health clubs, Health cabinets, Health jamborees
• First Aid room/corners or clinics.
• Capacity building of teachers and involved health personnel
• Monitoring & Evaluation
• Mid Day Meal
The Mid-day Meal Scheme is a school meal programme of the Government of India designed to improve the
nutritional status of school-age children nationwide. The objectives of the scheme are: Improve the
effectiveness of primary education by improving the nutritional status of children thereby reducing
malnutrition.
CONCEPT OF SCHOOL HEALTH PROGRAMME
The school Health Programme is applied across the country. It is the only community-based program which
specifically targets on nutrition and health of school aged children. It is focused to improve health outcomes,
reduce risk of communicable and non-communicable diseases and improve the health and wellness of millions
of children
The scheme of a comprehensive School Health Programme, conceived in the 1940’s, comprised the following
major parts viz. medical care, hygienic school environment and nutritious midday meal and health and physical
education. These major parts are important for the wholesome development of the child and hence need to be
included as a part of the curriculum.
Schools are in the best position to promote health by providing the latest scientific information, forming and
motivating health attitudes, and habits and by providing opportunity for the establishment of desirable patterns
of healthy behavior. School Health Programme empowers the stake holders, teachers, parents and children. It
deals with comprehensive school health problem and it creates awareness, health promotion, school health care,
child health care, assessment and evaluation of child health. The School Health Programme covers not only the
students but also the teachers and other school personnel. It will check student’s fitness level, eye check-up,
dental checkup, physical pain checkup, Psychological check- ups and put records in electronic medical records
for health analysis and diet [Link] Health Programme underlines developing healthy habits among
the school going children. School Health Programme is concerned with the schools and the children in the
schools. It focuses on the holistic health, nutrition of these children. This plays a major role in school.
ORGANIZATION OF SCHOOL HEALTH PROGRAMME
There is no stable pattern of school health administration in India as well as in other countries. Health of the
school child is the main responsibility of the parents, teacher, stakeholders, health administrators and the
community. The school health committee set up by the government of India in 1960 recommended that it
should be an integral part of the general hearth services.
Features of Organizing School Health Programme
• In each school, a health council and health committee should be constituted.
• Health committee should provide leadership and guidance to the health education programme in the school,
which will assist the welfare of community.
• The members of this council should include the head of the school, the school medical advisor, health
coordinator, various teachers, students and parents’ representatives like school management committee
members.
• Every school should have a counselor, trained teacher of first aid, nutritionist or a dentist.
• Medical advisor/doctor should be full time or part time in the school because students need medical care and
emergency care anytime.
• Health coordinator is most important and responsible person for well implementation of school health
programme in school. He/she may be head of the department, Principal and physical educationist.

ASPECTS OF SCHOOL HEALTH PROGRAMME

The school health programme has three aspects

School Health Services

School health services are the powerful means of developing a good community for future generation as it plays
an important role is development of children. It is an important aspect of school health programme. A school
health committee was formed to analyze the standard of health and nutrition among the school children and
their improvement.
Features of School Health Services
The task of School Health Services is manifold and varies according to local priorities. Some features of School
Health Services are as follows:
• Health appraisal of school children and school personnel consists of periodic medical examination and
observation of the children by the class teacher or a medical expert.
• Remedial measures and follow up includes not only the initial medical check- ups but also the regular follow
ups and appropriate treatment.
• Prevention of communicable diseases comprises of recording all immunization reports and maintaining these
reports as part of school health record.
• Nutritional services require all the nutrients in proper proportion and adequate for the maintenance of the
optimum health. Mid-day school meal is an essential part of program in order to raise the nutrition level of
children in schools.
• First-aid and emergency care are a big responsibility on the shoulders of teachers who are trained to provide
students basic emergency care in the situation of accidents leading to minor or serious injuries and medical
emergencies such as fainting, gastroenteritis all etc. Also, a fully equipped first-aid post should be provided in
every school as per the regulation St. John Ambulance Association of India.
• Mental health of the child affects her/his physical health and the learning process. Therefore, there is a great
need for vocational counselors in schools for regulating the children into career aspects, drug addiction, mal-
adjustment and juvenile delinquency.
• Dental health comprises of dental caries and periodontal disease which are the two most common dental
diseases in India. Although, the school health programs have a provision for dental examination still the
children suffer from various dental diseases.
• Health education acts as the most important element of School Health Programme. It aims to bring necessary
changes in health knowledge, in attitudes and in practice of the students.
• The education of children with special needs CWSN targets to assist them and their family to realize their
maximum potential so as to lead a normal life and become productive and self-supporting member of the
society.
• School health record means proper maintenance and use of health records. It should contain all
i. Identifying data, name, date of birth, parents name, address etc.
ii. Past health history.
iii. Record of findings of physical examination, screening test and records of service provided.
This record will also be useful in analyzing and evaluating school health programmes.

School Health Environment

This is an important aspect of school health programme and it is also called school hygiene. Healthful school
living includes a school building, site, and equipment amongst which a child grows and develops. Each school
should also serve as best sanitation for every child. So, it requires best emotional, social and personal health for
students.
Features of Healthful School Living
Healthful school living has the aim of optimum efficiency of school hygiene which can be achieved in school
environment. Some features of healthful school living are as follows:
• Adequate sanitation, safe drinking water and nutrition education
• Proper execution of mid-day meal programme.
• Location of school should normally be centrally situated with proper approach roads at a fair distance from
market place.
• Class room and furniture should suit the age group of students.
• Periodical health examination of children.
• Separate toilets for girls and boys.
• Privacy and safety for girl
• Keeping school free of violence and any other distraction.
• No corporal punishments
• Regular practice of yoga, physical education and health education.
• First aid room or first aid kit should be maintained
• In India, central and state governments committed to ensure inclusive access to wash facility, school toilet,
safe drinking water, sanitation and hygiene in the school under the one aspect of mission “SWACHH BHARAT
ABHIYAN” which has great impact on school healthful condition
Health Education
Health education is the most important part of the school health programme. It consists of teaching numerous
types of health information including safety education, personal hygiene, environmental health and family life.
The goal of health education should be to bring about beneficial changes in health knowledge, in mind-set, in
practice; and not only that but to teach children a set of rules of hygiene also.
Features of Health Education
Some features of Health Education are as follows:
• Health related knowledge can be obtained by studying health education, while considering a variety of topics.
• Maintenance of school health record. These records are very helpful in monitoring and evaluating school
health programme and it provides linkage between the school, the home and, the community.
• Provides curative services which include regular dental checkup and rapid treatment wherever possible and
referral for a special problem.
• A foundation of support to every child and adolescent.
• Well-implemented health education has been shown to improve the school achievement.
• Active student involvement, every school child is a health worker.
• Daily morning inspection of each child in order to know the sign of illness.

There are a variety of models that have been used to describe the components of a school health program. Three
of the most common models are summarized below.
♦ The Three-Component Model. Originating in the early 1900s and evolving through the 1980s, the three-
component model is considered the traditionalmodel of a school health program, consisting of the following
basic components:
(1) health education, (2) health services, and (3) a healthful environment.
♦ The Eight-Component Model. In the 1980s, the three-component model was expanded into an eight-
component model—traditionally referred to as “comprehensive school health program”—consisting of the
following components: (1) health education; (2) health services; (3) healthy school environment; (4) physical
education; (5) nutrition services; (6) health promotion for school staff; (7) counseling, psychological, and social
services; and (8) parent and community involvement.
♦ Full-Service Schools. In recent years, additional models, definitions, and descriptions have emerged that build
on previous models, including the full- service school model. In addition to quality education, a full-service
school model involves a one-stop, seamless institution, where the school is the center for providing a wide
range of health, mental health, social, and/or family services.

The Three-Component Model

Traditional Model. Originating in the early 1900s and evolving through the 1980s, the three-component model
is considered to be the traditional model of a school health program. According to this model, a school health
program consists of the following three basic components.
1. Health Instruction - Accomplished through a comprehensive health education curriculum that focuses on
increasing student understanding of health principles and modifying health-related risk behaviors.
2. Health Services - Focuses on prevention and early identification and redemption of student health problems.
3. Healthful School Environment - Concerned with the physical and psychosocial setting and such issues as
safety, nutrition, food services, and a positive learning atmosphere

The Eight-Component Model

CDC Model. The Centers for Disease Control and Prevention (CDC) eight-component model of a
comprehensive school health program consists of the following interactive components.
1. Health Education
2. Physical Education
3. Health Services
4. Nutrition Services
5. Health Promotion for Staff
6. Counseling, Psychological, and Social Services
7. Healthful School Environment
8. Parent and Community Involvement

Key Features of a Comprehensive School Health Program

[Link] Education
♦ Designed to motivate and assist students to maintain and improve their health, prevent disease, and reduce
health-related risk behaviors.
♦ Allows students to develop and demonstrate increasingly sophisticated health-related knowledge, attitudes,
skills, and practices.
♦ Includes a variety of topics, such as personal health, family health, community health, consumer health,
environmental health, sexuality education, mental and emotional health, injury prevention and safety, nutrition,
prevention and control of disease, and substance use and abuse.
♦ Qualified, trained teachers provide health education.
[Link] Education
♦ Promotes each student’s optimum physical, mental, emotional, and social development through a variety of
planned physical activities.
♦ Promotes activities and sports that all students enjoy and can pursue throughout their lives.
♦ Includes such activities as basic movement skills; physical fitness; rhythms and dance; games; team, dual, and
individual sports; tumbling and gymnastics; and aquatics.
♦ Qualified, trained teachers teach physical activity.
[Link] Services
♦ Designed to ensure access or referral to primary health care services or both.
♦ Fosters appropriate use of primary health care services.
♦ Prevents and controls communicable disease and other health problems.
♦ Provides emergency care for illness or injury.
♦ Promotes and provides optimum sanitary conditions for a safe school facility and school environment.
♦ Provides educational and counseling opportunities for promoting and maintaining individual, family, and
community health.
♦ Qualified professionals (such as physicians, nurses, dentists, health educators, and other allied health
personnel) provide these services.

[Link] Services
♦ Reflects the U.S. Dietary Guidelines for Americans and other criteria to achieve nutrition integrity.
♦ Offers students a learning laboratory for classroom nutrition and health education.
♦ Serves as a resource for linkages with nutrition-related community services.
♦ Qualified child nutrition professionals provide these services.
[Link] Promotion for Staff
♦ Encourages school staff to pursue a healthy lifestyle that contributes to their improved health status, improved
morale, and a greater personal commitment to the school’s overall comprehensive health program.
♦ Personal commitment often transfers into greater commitment to the health of students and creates positive
role modeling.
♦ Improves staff productivity.
♦ Decreases staff absenteeism.
♦ Reduces health insurance costs.
[Link] and Psychological/Social Services
Services provided to improve students’ mental, emotional, and social health.
♦ Includes individual and group assessments, interventions, and referrals.
♦ Organizational assessment and consultation skills of counselors and psychologists contribute not only to the
health of students but also to the health of the school environment.
♦ Professionals (such as certified school counselors, psychologists, and social workers) provide these services.
[Link] School Environment
♦ Factors that influence the physical environment include the school building and the area surrounding it, any
biological or chemical agents that are detrimental to health, and such physical conditions as temperature, noise,
and lighting. And also Psychological environment includes the physical, emotional, and social conditions that
affect the well-being of students and staff.
[Link]/Community Involvement
An integrated school, parent, and community approach for enhancing the health and well-being of students.
♦ Builds support for school health program efforts through school health advisory councils, coalitions, and
broadly-based constituencies for school health.
♦ Schools should actively solicit parent involvement and engage community resources
 MODULE 2

COMMUNICABLE DISEASES

What is a communicable disease?

A communicable disease is one that is spread from one person to another through a variety of
ways that include: contact with blood and bodily fluids; breathing in an airborne virus; or by being
bitten by an insect.

“Communicable disease” means an illness caused by an infectious agent or its toxins that occurs
through the direct or indirect transmission of the infectious agent or its products from an infected
individual or via an animal, vector or the inanimate environment to a susceptible animal or human
host.

How do these communicable diseases spread?

How these diseases spread depends on the specific disease or infectious agent. Some ways in
which communicable diseases spread are by:

1. physical contact with an infected person, such as through touch (staphylococcus), sexual
intercourse (gonorrhea, HIV), fecal/oral transmission (hepatitis A), or droplets (influenza, TB)

2. contact with a contaminated surface or object (Norwalk virus), food (salmonella, E. coli),
blood (HIV, hepatitis B), or water (cholera);

3. bites from insects or animals capable of transmitting the disease (mosquito: malaria and
yellow fever; flea: plague); and

4. Travel through the air, such as tuberculosis or measles.

Tuberculosis

Tuberculosis (TB) is caused by a bacterium called Mycobacterium tuberculosis. The bacteria

usually attack the lungs, but TB bacteria can attack any part of the body such as the kidney, spine,
and brain. Not everyone infected with TB bacteria becomes sick. As a result, two TB-related
conditions exist: latent TB infection (LTBI) and TB disease. If not treated properly, TB disease
can be fatal.

Latent TB Infection
TB bacteria can live in the body without making you sick. This is called latent TB infection. In
most people who breathe in TB bacteria and become infected, the body is able to fight the bacteria
to stop them from growing. People with latent TB infection:

• Have no symptoms

• Don’t feel sick

• Can’t spread TB bacteria to others

• Usually have a positive TB skin test reaction or positive TB blood test

• May develop TB disease if they do not receive treatment for latent TB infection

Many people who have latent TB infection never develop TB disease. In these people, the TB
bacteria remain inactive for a lifetime without causing disease. But in other people, especially
people who have a weak immune system, the bacteria become active, multiply, and cause TB
disease.

TB Disease

TB bacteria become active if the immune system can’t stop them from growing. When TB
bacteria are active (multiplying in your body), this is called TB disease. People with TB disease
are sick. They may also be able to spread the bacteria to people they spend time with every day.

Many people who have latent TB infection never develop TB disease. Some people develop TB
disease soon after becoming infected (within weeks) before their immune system can fight the TB
bacteria. Other people may get sick years later when their immune system becomes weak for
another reason.

For people whose immune systems are weak, especially those with HIV infection, the risk of
developing TB disease is much higher than for people with normal immune systems.

There is a difference between being infected with TB bacteria and having active tuberculosis
disease.

The stages of TB are:

Exposure. This happens when a person has been in contact with, or exposed to, another person
who has TB. The exposed person will have a negative skin test, a normal chest X-ray, and no
signs or symptoms of the disease.

Latent TB infection. This happens when a person has TB bacteria in their body but no symptoms
of the disease. The infected person's immune system walls off the TB organisms. And the TB
stays inactive throughout life in most people who are infected. This person would have a positive
skin or blood test for TB but a normal chest X-ray or one that only shows past scarring from the
disease. They would have no signs of active infection in other parts of the body.

TB disease. This person has signs and symptoms of an active TB infection. The person could have
a positive or negative skin or blood test for TB and a positive chest X-ray, biopsy, or other finding
showing an active infection.

How TB Spreads

TB bacteria are spread through the air from one person to another. The TB bacteria are put into the
air when a person with TB disease of the lungs or throat coughs, speaks, or sings. People nearby
may breathe in these bacteria and become infected.

TB is NOT spread by

• shaking someone’s hand

• sharing food or drink

• touching bed linens or toilet seats

• sharing toothbrushes

• kissing

When a person breathes in TB bacteria, the bacteria can settle in the lungs and begin to grow.
From there, they can move through the blood to other parts of the body, such as the kidney, spine,
and brain. TB disease in the lungs or throat can be infectious. This means that the bacteria can be
spread to other people. TB in other parts of the body, such as the kidney or spine, is usually not
infectious. People with TB disease are most likely to spread it to people they spend time with
every day. This includes family members, friends, and coworkers or schoolmates.

Signs & Symptoms

Symptoms of TB disease depend on where in the body the TB bacteria are growing. TB bacteria
usually grow in the lungs (pulmonary TB). TB disease in the lungs may cause symptoms such as

• a bad cough that lasts 3 weeks or longer

• pain in the chest

• coughing up blood or sputum (phlegm from deep inside the lungs)

Other symptoms of TB disease are

• weakness or fatigue

• weight loss

• no appetite

• chills

• fever

• sweating at night

People who have latent TB infection do not feel sick, do not have any symptoms, and cannot
spread TB to others.

TB Risk Factors

Some people develop TB disease soon after becoming infected (within weeks) before their
immune system can fight the TB bacteria. Other people may get sick years later, when their
immune system becomes weak for another reason.

Overall, about 5 to 10% of infected persons who do not receive treatment for latent TB infection
will develop TB disease at some time in their lives. For persons whose immune systems are weak,
especially those with HIV infection, the risk of developing TB disease is much higher than for
persons with normal immune systems.

Generally, persons at high risk for developing TB disease fall into two categories:

• Persons who have been recently infected with TB bacteria

• Persons with medical conditions that weaken the immune system

Persons who have been Recently Infected with TB Bacteria

This includes:

• Close contacts of a person with infectious TB disease

• Persons who have immigrated from areas of the world with high rates of TB

• Children less than 5 years of age who have a positive TB test

• Groups with high rates of TB transmission, such as homeless persons, injection drug users,
and persons with HIV infection
• Persons who work or reside with people who are at high risk for TB in facilities or
institutions such as hospitals, homeless shelters, correctional facilities, nursing homes, and
residential homes for those with HIV

Persons with Medical Conditions that Weaken the Immune System

Babies and young children often have weak immune systems. Other people can have weak
immune systems, too, especially people with any of these conditions:

• HIV infection (the virus that causes AIDS)

• Substance abuse

• Silicosis

• Diabetes mellitus

• Severe kidney disease

• Low body weight

• Organ transplants

• Head and neck cancer

• Medical treatments such as corticosteroids or organ transplant

• Specialized treatment for rheumatoid arthritis or Crohn’s disease

Testing

There are two kinds of tests that are used to detect TB bacteria in the body: the TB skin test (TST)
and TB blood tests. A positive TB skin test or TB blood test only tells that a person has been
infected with TB bacteria. It does not tell whether the person has latent TB infection (LTBI) or has
progressed to TB disease. Other tests, such as a chest x-ray and a sample of sputum, are needed to
see whether the person has TB disease.

Diagnosis

If a person is found to be infected with TB bacteria, other tests are needed to see if the person has
latent TB infection or TB disease.

Treatment for TB
When TB bacteria become active (multiplying in the body) and the immune system can’t stop the
bacteria from growing, this is called TB disease. TB disease will make a person sick. People with
TB disease may spread the bacteria to people with whom they spend many hours.

It is very important that people who have TB disease are treated, finish the medicine, and take the
drugs exactly as prescribed. If they stop taking the drugs too soon, they can become sick again; if
they do not take the drugs correctly, the TB bacteria that are still alive may become resistant to
those drugs. TB that is resistant to drugs is harder and more expensive to treat.

TB disease can be treated by taking several drugs for 6 to 9 months. There are 10 drugs currently
approved by the U.S. Food and Drug Administration (FDA) for treating TB. Of the approved
drugs, the first-line anti-TB agents that form the core of treatment regimens are:

isoniazid (INH)

rifampin (RIF)

ethambutol (EMB)

pyrazinamide (PZA)

How is TB treated?

Treatment may vary depending on if you have latent or active TB. Treatment may include:

Short-term hospital stay.

For latent TB. Often a 3- to 9-month course of 1 or 2 antibiotics will be given to kill off the TB
organisms in the body. The most common antibiotics prescribed are isoniazid, rifapentine, and
rifampin. Your healthcare provider can review the treatment options. They may recommend one
as the best option for you, taking into account many factors.

For active TB. Your healthcare provider may prescribe 2 to 4 or more antibiotics in combination
for 6 to 9 months or longer. Examples include isoniazid, rifampin, pyrazinamide, and ethambutol.
People often begin to improve within a few weeks of starting treatment. After several weeks of
treatment with the correct medicines, the person is often no longer contagious. But medicine must
be finished for the greatest chance of cure, as prescribed by a healthcare provider.

What are possible complications of TB?

If TB of the lung is not treated early or if treatment isn’t followed, long-lasting (permanent) lung
damage can result. TB can also cause infection of the bones, spine, brain and spinal cord, lymph
glands, and other parts of the body. It can damage those areas and cause short-term (temporary) or
permanent symptoms from the damage. Uncontrolled TB can lead to death. And TB remains one
of the leading infectious causes of death worldwide.

What can I do to prevent TB?

If you will be spending time with anyone with active TB, wear a strongly filtering face mask. And
try not to stay in a small enclosed space with poor ventilation. People who work in situations
where there is a high risk for contact with people infected with TB should be tested for TB on a
routine basis. This includes healthcare and shelter workers. In countries outside the U.S. where TB
is more common, a childhood vaccine is often given. But it's not clear how well it works.

Drug resistance TB

Tuberculosis (TB) is a disease caused by bacteria that are spread from person to person through
the air. TB usually affects the lungs, but it can also affect other parts of the body, such as the
brain, the kidneys, or the spine. In most cases, TB is treatable and curable; however, people with
TB can die if they do not get proper treatment. Sometimes drug-resistant TB occurs when bacteria
become resistant to the drugs used to treat TB. This means that the drug can no longer kill the TB
bacteria.

Drug-resistant TB (DR TB) is spread the same way that drug-susceptible TB is spread. TB is
spread through the air from one person to another. The TB bacteria are put into the air when a
person with TB disease of the lungs or throat coughs, sneezes, speaks, or sings. People nearby
may breathe in these bacteria and become infected.

HIV \ AIDS

HIV causes AIDS and interferes with the body's ability to fight infections. Also called: human
immunodeficiency virus, acquired immunodeficiency syndrome.

The virus can be transmitted through contact with infected blood, semen or vaginal fluids. Within
a few weeks of HIV infection, flu-like symptoms such as fever, sore throat and fatigue can occur.
Then the disease is usually asymptomatic until it progresses to AIDS. AIDS symptoms include
weight loss, fever or night sweats, fatigue and recurrent infections. No cure exists for AIDS, but
strict adherence to antiretroviral regimens (ARVs) can dramatically slow the disease's progress as
well as prevent secondary infections and complications.

Signs and symptoms

The symptoms of HIV vary depending on the stage of infection. Though people living with HIV
tend to be most infectious in the first few months after being infected, many are unaware of their
status until the later stages. In the first few weeks after initial infection people may experience no
symptoms or an influenza-like illness including fever, headache, rash or sore throat.

As the infection progressively weakens the immune system, they can develop other signs and
symptoms, such as swollen lymph nodes, weight loss, fever, diarrhoea and cough. Without
treatment, they could also develop severe illnesses such as tuberculosis (TB), cryptococcal
meningitis, severe bacterial infections, and cancers such as lymphomas and Kaposi's sarcoma.

Transmission

HIV can be transmitted via the exchange of a variety of body fluids from infected people, such as
blood, breast milk, semen and vaginal secretions. HIV can also be transmitted from a mother to
her child during pregnancy and delivery. Individuals cannot become infected through ordinary
day-to-day contact such as kissing, hugging, shaking hands, or sharing personal objects, food or
water.

It is important to note that people with HIV who are taking ART (Antiretroviral therapy (ART):
Treatment that suppresses or stops a retrovirus. One of the retrovirus is the human
immunodeficiency virus (HIV) that causes AIDS) .and are virally suppressed do not transmit HIV
to their sexual partners. Early access to ART and support to remain on treatment is therefore
critical not only to improve the health of people with HIV but also to prevent HIV transmission.

Prevention

Individuals can reduce the risk of HIV infection by limiting exposure to risk factors. Key
approaches for HIV prevention, which are often used in combination, include:

 male and female condom use;

 testing and counselling for HIV and STIs;

 testing and counselling for linkages to tuberculosis (TB) care;

 voluntary medical male circumcision (VMMC);

 use of antiretroviral drugs (ARVs) for prevention;

 harm reduction for people who inject and use drugs; and

 elimination of mother-to-child transmission of HIV.

Treatment
No cure exists for AIDS, but strict adherence to antiretroviral regimens (ARVs) can dramatically
slow the disease's progress as well as prevent secondary infections and complications.

HIV disease can be managed by treatment regimens composed of a combination of three or more
antiretroviral (ARV) drugs. Current antiretroviral therapy (ART) does not cure HIV infection but
highly suppresses viral replication within a person's body and allows an individual's immune
system recovery to strengthen and regain the capacity to fight off opportunistic infections and
some cancers.

Diagnosis

HIV can be diagnosed through blood or saliva testing. Available tests include:

 Antigen/antibody tests. These tests usually involve drawing blood from a vein. Antigens
are substances on the HIV virus itself and are usually detectable — a positive test — in the blood
within a few weeks after exposure to HIV.

Antibodies are produced by your immune system when it's exposed to HIV. It can take weeks to
months for antibodies to become detectable. The combination antigen/antibody tests can take two
to six weeks after exposure to become positive.

 Antibody tests. These tests look for antibodies to HIV in blood or saliva. Most
rapid HIV tests, including self-tests done at home, are antibody tests. Antibody tests can take three
to 12 weeks after you're exposed to become positive.

 Nucleic acid tests (NATs). These tests look for the actual virus in your blood (viral load).
They also involve blood drawn from a vein. If you might have been exposed to HIV within the
past few weeks, your doctor may recommend NAT. NAT will be the first test to become positive
after exposure to HIV.

Causes

HIV is caused by a virus. It can spread through sexual contact or blood, or from mother to child
during pregnancy, childbirth or breast-feeding etc.

Tests to stage disease and treatment

If you've been diagnosed with HIV, it's important to find a specialist trained in diagnosing and
treating HIV to help you:

 Determine whether you need additional testing

 Determine which HIV antiretroviral therapy (ART) will be best for you

 Monitor your progress and work with you to manage your health

If you receive a diagnosis of HIV/AIDS, several tests can help your doctor determine the stage of
your disease and the best treatment, including:

 CD4 T cell count. CD4 T cells are white blood cells that are specifically targeted and
destroyed by HIV. Even if you have no symptoms, HIV infection progresses to AIDS when your
CD4 T cell count dips below 200.

 Viral load (HIV RNA). This test measures the amount of virus in your blood. After
starting HIV treatment the goal is to have an undetectable viral load. This significantly reduces
your chances of opportunistic infection and other HIV-related complications.

 Drug resistance. Some strains of HIV are resistant to medications. This test helps your
doctor determine if your specific form of the virus has resistance and guides treatment decisions.

Tests to stage disease and treatment

If you've been diagnosed with HIV, it's important to find a specialist trained in diagnosing and
treating HIV to help you:

 Determine whether you need additional testing

 Determine which HIV antiretroviral therapy (ART) will be best for you

 Monitor your progress and work with you to manage your health

If you receive a diagnosis of HIV/AIDS, several tests can help your doctor determine the stage of
your disease and the best treatment, including:

 CD4 T cell count. CD4 T cells are white blood cells that are specifically targeted and
destroyed by HIV. Even if you have no symptoms, HIV infection progresses to AIDS when your
CD4 T cell count dips below 200.
 Viral load (HIV RNA). This test measures the amount of virus in your blood. After
starting HIV treatment the goal is to have an undetectable viral load. This significantly reduces
your chances of opportunistic infection and other HIV-related complications.

 Drug resistance. Some strains of HIV are resistant to medications. This test helps your
doctor determine if your specific form of the virus has resistance and guides treatment decisions.

The Mission Initiated by Government of Kerala for AIDS

The Kerala State AIDS Control Society (KSACS), plays a pivotal role in the state's strategy in
combating the HIV/AIDS epidemic. The Kerala State AIDS Control Society (KSACS), plays a
pivotal role in the state’s strategy in combating the HIV/AIDS epidemic. It is an autonomous
society registered under the Charitable Societies Act, with its members drawn from all key
government departments to ensure greater flexibility and more effective programme management.
Its work is supervised by a Governing body, chaired by the Chief Secretary of the state, and which
includes as members Secretaries of various government departments like Health, Social Welfare,
Finance, Education, and Project Director of KSACS, Director of Health Services, Director of
Medical Education, State Drugs Controller and Inspector General of Police (Law & Order).

KSACS was formed to implement the National AIDS Control Programme (NACP) in the state. It
works under the National AIDS Control Organisation (NACO) which is a part of the Ministry of
Health and Family Welfare of the Government of India. The National AIDS Control Programme
is fully funded by the Government of India and by international donors such as the World Bank,
the Global Fund for AIDS, TB and Malaria, DFID (Department for International Development,
UK) and USAID (the US Agency for International development) and others.

National Programme for HIV / AIDS

The National AIDS Control Programme (NACP), launched in 1992, is being implemented as a
comprehensive programme for prevention and control of HIV/AIDS in India.

NACP I was implemented with an objective of slowing down the spread of HIV infections so as
to reduce morbidity, mortality and impact of AIDS in the country. National AIDS Control Board
(NACB) was constituted and an autonomous National AIDS Control Organization (NACO) was
set up to implement the project. The first phase focused on awareness generation, setting up
surveillance system for monitoring HIV epidemic, measures to ensure access to safe blood and
preventive services for high risk group populations.

The Mission Initiated by Government of Kerala for AIDS

The Kerala State AIDS Control Society (KSACS), plays a pivotal role in the state's strategy in
combating the HIV/AIDS epidemic. The Kerala State AIDS Control Society (KSACS), plays a
pivotal role in the state’s strategy in combating the HIV/AIDS epidemic. It is an autonomous
society registered under the Charitable Societies Act, with its members drawn from all key
government departments to ensure greater flexibility and more effective programme management.
Its work is supervised by a Governing body, chaired by the Chief Secretary of the state, and which
includes as members Secretaries of various government departments like Health, Social Welfare,
Finance, Education, and Project Director of KSACS, Director of Health Services, Director of
Medical Education, State Drugs Controller and Inspector General of Police (Law & Order).

KSACS was formed to implement the National AIDS Control Programme (NACP) in the state. It
works under the National AIDS Control Organisation (NACO) which is a part of the Ministry of
Health and Family Welfare of the Government of India. The National AIDS Control Programme
is fully funded by the Government of India and by international donors such as the World Bank,
the Global Fund for AIDS, TB and Malaria, DFID (Department for International Development,
UK) and USAID (the US Agency for International development) and others.

National Programme for HIV / AIDS

The National AIDS Control Programme (NACP), launched in 1992, is being implemented as a
comprehensive programme for prevention and control of HIV/AIDS in India.

NACP I was implemented with an objective of slowing down the spread of HIV infections so as
to reduce morbidity, mortality and impact of AIDS in the country. National AIDS Control Board
(NACB) was constituted and an autonomous National AIDS Control Organization (NACO) was
set up to implement the project. The first phase focused on awareness generation, setting up
surveillance system for monitoring HIV epidemic, measures to ensure access to safe blood and
preventive services for high risk group populations.

COVID 19

Meaning

Coronaviruses are a family of viruses that can cause respiratory illness in humans. They get their
name, “corona,” from the many crown-like spikes on the surface of the virus. Severe acute
respiratory syndrome (SARS), Middle East respiratory syndrome (MERS) and the common cold
are examples of coronaviruses that cause illness in humans.
Origin of the “COVID-19” abbreviation
On December 31, 2019, a strange new pneumonia of unknown cause was reported to the Chinese
WHO Country Office. A cluster of these cases originally appeared in Wuhan, a city in the Hubei
Province of China. These infections were found to be caused by a new coronavirus which was
given the name “2019 novel coronavirus” (2019-nCoV).

It was later renamed “severe acute respiratory syndrome coronavirus 2,” or SARS-CoV2 by
the International Committee on Taxonomy of Viruses on February 11, 2020. It was named SARS-
CoV2 because the virus is a genetic cousin of the coronavirus which caused the SARS outbreak in
2002 (SARS-CoV). The unofficial name for the virus is “the COVID-19 virus.”

Causes

 Infection with the new coronavirus (severe acute respiratory syndrome coronavirus 2, or
SARS-CoV-2) causes coronavirus disease 2019 (COVID-19).

 The virus that causes COVID-19 spreads easily among people, and more continues to be
discovered over time about how it spreads. Data has shown that it spreads mainly from person to
person among those in close contact (within about 6 feet, or 2 meters). The virus spreads by
respiratory droplets released when someone with the virus coughs, sneezes, breathes, sings or
talks. These droplets can be inhaled or land in the mouth, nose or eyes of a person nearby.

 In some situations, the COVID-19 virus can spread by a person being exposed to small
droplets or aerosols that stay in the air for several minutes or hours — called airborne
transmission. It's not yet known how common it is for the virus to spread this way.

 It can also spread if a person touches a surface or object with the virus on it and then
touches his or her mouth, nose or eyes, but the risk is low.

 Some reinfections of the virus that causes COVID-19 have happened, but these have been
uncommon.

Symptoms of COVID-19

Signs and symptoms of coronavirus disease 2019 (COVID-19) may appear two to 14 days after
exposure. This time after exposure and before having symptoms is called the incubation period.
Common signs and symptoms can include:
 Fever
 Cough
 Tiredness
Early symptoms of COVID-19 may include a loss of taste or smell.
Other symptoms can include:

 Shortness of breath or difficulty breathing

 Muscle aches
 Chills
 Sore throat
 Runny nose
 Headache
 Chest pain
 Pink eye (conjunctivitis)
 Nausea
 Vomiting
 Diarrhea
 Rash
People who are older have a higher risk of serious illness from COVID-19, and the risk increases
with age.
People who have existing medical conditions also may have a higher risk of serious illness.
Certain medical conditions that may increase the risk of serious illness from COVID-19 include:

 Serious heart diseases, such as heart failure, coronary artery disease or cardiomyopathy
 Cancer
 Chronic obstructive pulmonary disease (COPD)
 Type 1 or type 2 diabetes
 Overweight, obesity or severe obesity
 High blood pressure
 Smoking
 Chronic kidney disease
 Sickle cell disease or thalassemia
 Weakened immune system from solid organ transplants
 Pregnancy
 Asthma
 Chronic lung diseases such as cystic fibrosis or pulmonary fibrosis
 Liver disease
 Dementia
 Weakened immune system from bone marrow transplant, HIV or some medications
 Down syndrome
 Brain and nervous system conditions
 Substance use disorders

Incubation Period of the COVID-19 Virus

The incubation period is the time between the person’s first exposure to the virus and the onset of
the first symptoms of the associated disease.

The incubation period for COVID-19 is thought to be between 4 and 14 days, with a median time
of five days. However, some studies have reported people experiencing symptoms up to 11.5 days
after exposure to SARS-CoV-2.

This is the reason why world governments have imposed the rule of isolation for 14-days for a
suspect COVID patient.

How is coronavirus diagnosed?

COVID-19 is diagnosed with a laboratory test. Your healthcare provider may collect a sample of
your saliva or swab your nose or throat to send for testing.

Complications

Although most people with COVID-19 have mild to moderate symptoms, the disease can cause
severe medical complications and lead to death in some people. Older adults or people with
existing medical conditions are at greater risk of becoming seriously ill with COVID-19.

Complications can include:

 Pneumonia and trouble breathing

 Organ failure in several organs
 Heart problems
 A severe lung condition that causes a low amount of oxygen to go through your
bloodstream to your organs (acute respiratory distress syndrome)
 Blood clots
 Acute kidney injury
 Additional viral and bacterial infection
Mode of Transmission

Droplet transmission: Droplet transmission occurs when a person is in in close contact (within 1
m) with someone who has respiratory symptoms (e.g., coughing or sneezing) and is therefore at
risk of having his/her mucosae (mouth and nose) or conjunctiva (eyes) exposed to potentially
infective respiratory droplets. Coughing and sneezing cause increased expulsion of droplets from
the oral cavity and respiratory tract. In COVID-19 patients these droplets contain a virus that if
inhaled or ingested or landing on the mucous membranes will cause disease in people.
Transmission may also occur through fomites in the immediate environment around the infected
person.
Airborne transmission: Airborne transmission is different from droplet transmission as it refers
to the presence of microbes within droplet nuclei, which are generally considered to be particles
<5μm in diameter, can remain in the air for long periods of time and be transmitted to others over
distances greater than 1 m. The virus can also exist within dust particles. As long as air-borne
particles are resistant to drying, they can be breathed into people’s respiratory tracts and
cause infections.
Fortunately, there have been only a limited number of diseases that are airborne, including:
 Tuberculosis
 Chickenpox
 Measles

Mother to child: As of July 2020, there have been no cases of transmission from mother to
baby during pregnancy. Studies have not found any viable virus in breast milk. The WHO
recommends that mothers with suspected or confirmed COVID-19 should be encouraged to
initiate or continue to breastfeed

Direct Contact Transmission: it may occur through direct contact with virus-contaminated
objects or surfaces and infecting people through the mouth, nose, or eyes. Healthcare providers
attending COVID-19 patients are especially at risk of being infected via this mode of disease
transmission, one reason there are numerous nosocomial infections. In direct contact transmission,
the fomites are suspected to be the main source of infectious particles. The transmission of
COVID-19 can be minimized by frequent washing of hands with an alcohol-based hand rub or
soap and water and avoiding touching eyes, nose, and mouth with contaminated hands.

Epidemiological Factors

Epidemiological triad

 The interrelationship of the 3 components: agent, environment, and host.

 The interrupting factors characterized into 3 scenarios: community, hospital, and

AGMPs. AGMP indicates aerosol-generating medical procedure

“Interrupting factors” (IFs) between any 2components can be categorized as agent–host IFs
(decreasing the host’s susceptibility or diminishing the virus’ virulence), agent–environment IFs
(eliminating or decreasing the viral burden in droplets and surfaces), and environment–host IFs
(decreasing the opportunity for active virus to infect new hosts).

Agent-host IFS: In community While a COVID-19 vaccine and/antiviral treatment is the most
effective agent–host IFs, they are still being developed.

Environment–host IFs: Environment-host IFs in the community include shelter-in-place policies

and social distancing.

Similarly, hospitals have implemented interim cancellations of elective surgical cases, restricted
hospital visitors, and encouraged personal protective equipment (PPE) use.

In both settings, frequent hand washing or disinfection, avoidance of physical contact, and
restraint from touching one’s face have been vital to controlling the spread of COVID-19.

For AGMPs, such as intubation, video laryngoscopy, PPE (including N95 respirators, powered air
purifying respirators [PAPRs], face shields, gowns, and gloves)

Agent–environment IFs: Agent-environment in the community include the self-quarantine of

infected individuals, respiratory hygiene, and mask wearing by infected individuals, and
restriction of travel from areas with widespread on-going transmission.

In hospitals, airborne infection isolation rooms (AIIRs or negative pressure rooms) and dedicated
hospital wards with devoted COVID health care teams limit transmission to the rest of the
hospital.

Social factors
 The most people observed self-quarantine at homes; however, it developed empathy and
intimacy among family members at a larger scale.

 These social factors caused psychological problems and violence by creating differences
among people as well as verbal and physical disputes.

 Besides, staying at home for a long time may lead to depression, lethargy, and exacerbation
of previous illnesses like hypertension, stress, and anxiety.

 The other social factor refers to the lack of adequate consumption of antiseptics at home,
which leads to other problems, such as damage to the respiratory system.

Prevention

Protect yourself and others around you by knowing the facts and taking appropriate precautions.
Follow advice provided by your local health authority. To prevent the spread of COVID-19:

 Clean your hands often. Use soap and water, or an alcohol-based hand rub.

 Maintain a safe distance from anyone who is coughing or sneezing.

 Wear a mask when physical distancing is not possible.

 Avoid touching your eyes, nose and mouth.

 Maintain social distancing (approximately 2 meters) from individuals with respiratory
symptoms.
 If you have a fever, cough and difficulty breathing seek medical care.
 Cover your nose and mouth with your bent elbow or a tissue when you cough or sneeze.

 Stay home if you feel unwell.

 Masks can help prevent the spread of the virus from the person wearing the mask to others.

 Take vaccination dose to prevent covid-19 and reduce immunity power.

NIPAH AND BLACK FUNGUS

NIPAH

Nipah virus infection

Nipah virus infection is a zoonotic illness that is transmitted to people from animals, and can also
be transmitted through contaminated food or directly from person-to-person. In infected people, it
causes a range of illnesses from asymptomatic (subclinical) infection to acute respiratory illness
and fatal encephalitis. It infects a wide range of animals and causes severe disease and death in
people.

Nipah Virus (NiV) is a viral infection caused by the Henipavirus genus belonging to
the Paramyxovidae family. It is a zoonosis ,ie, an animal disease that can spread to humans –
transmitted by infected fruit bats (Pteropus). Bats can transmit the virus through infected air
droplets, saliva, and excrement. Animals can become infected by eating food contaminated by bats
and can transmit the virus to other animals, including humans. Human cases have occurred after
contact with respiratory secretions and tissues from NiV-infected pigs. Transmission can also
occur by drinking raw date palm sap contaminated with infected bat excretions.

Person to person transmission of NiV occurs when coming into contact with the blood and bodily
secretions of infected persons without proper infection control gear (masks, gloves, and gowns) or
coming in direct contact with unsterilized medical instruments, infected blood products and
organs.

Agent Factors
Natural host: Fruit Bats.
Fruit bats of the family Pteropodidae – particularly species belonging to the Pteropus genus – are
the natural hosts for Nipah virus. Nipah virus can be transmitted to humans from animals (such as
bats or pigs), or contaminated foods and can also be transmitted directly from human to human.
Past Outbreaks
Nipah virus (NiV) was first discovered in 1999 following an outbreak of disease in pigs and
people in Malaysia and Singapore. This outbreak resulted in nearly 300 human cases and more
than 100 deaths, and caused substantial economic impact as more than 1 million pigs were killed
to help control the outbreak.

While there have been no other known outbreaks of NiV in Malaysia and Singapore since 1999,
outbreaks have been recorded almost annually in some parts of Asia since then—primarily in
Bangladesh (2001) and India. The virus has been shown to spread from person-to-person in these
outbreaks, raising concerns about the potential for NiV to cause a global pandemic.

NiV is a member of the family Paramyxoviridae, genus Henipavirus. It is a zoonotic virus,

meaning that it initially spreads between animals and people. The animal host reservoir for NiV is
the fruit bat (genus Pteropus), also known as the flying fox. Given that NiV is genetically related
to Hendra virus, another henipavirus known to be carried by bats, bat species were quickly singled
out for investigation and flying foxes were subsequently identified as the reservoir.

Infected fruit bats can spread the disease to people or other animals, such as pigs. People can
become infected if they have close contact with an infected animal or its body fluids (such as
saliva or urine) this initial spread from an animal to a person is known as a spillover event. Once it
spreads to people, person-to-person spread of NiV can also [Link] symptoms of NiV infection
range from mild to severe, with death occurring in 40%- 70% of those infected in documented
outbreaks between 1998 and 2018.

Incubation Period
The incubation period (time from initial exposure to virus to when symptoms begin) for NiV
usually varies from about 4 to 14 days . There have been a few cases with much longer incubation
periods, as long as 45 days has been reported.

Mode of Transmission
Nipah virus (NiV) can spread to people from:

 Direct contact with infected animals, such as bats or pigs, or their body fluids (such as
blood, urine or saliva)
 Consuming food products that have been contaminated by body fluids of infected animals
(such as palm sap or fruit contaminated by an infected bat)
 Close contact with a person infected with NiV or their body fluids (including nasal or
respiratory droplets, urine, or blood)
 In the first known NiV outbreak, people were probably infected through close contact with
infected pigs. The NiV strain identified in that outbreak appeared to have been transmitted initially
from bats to pigs, with subsequent spread within pig populations. Then people who worked
closely with infected pigs began falling ill. No person-to-person transmission was reported in that
outbreak.
 However, person-to-person spread of NiV is regularly reported in Bangladesh and India.
This is most commonly seen in the families and caregivers of NiV-infected patients, and in
healthcare settings. Transmission also occurs from exposure to food products that have been
contaminated by infected animals, including consumption of raw date palm sap or fruit that has
been contaminated with saliva or urine from infected bats. Some cases of NiV infection have also
been reported among people who climb trees where bats often roost.
Signs and symptoms.
Infection with Nipah virus (NiV) can cause mild to severe disease, including swelling of the brain
(encephalitis) and potentially death.

In some cases, the infection is asymptomatic – persons do not exhibit symptoms. Symptoms
typically appear in 4-14 days following exposure to the virus. The illness initially presents as 3-14
days of fever and headache, and often includes signs of respiratory illness, such as cough, sore
throat, and difficulty breathing. A phase of brain swelling (encephalitis) may follow, where
symptoms can include drowsiness, disorientation, and mental confusion, which can rapidly
progress to coma within 24-48 hours.

Symptoms may initially include one or several of the following:

 Fever
 Headache
 Cough
 Sore throat
 Difficulty breathing
 Vomiting

Severe symptoms may follow, such as:

 Disorientation, drowsiness, or confusion

 Seizures
 Coma
 Brain swelling (encephalitis)

Death may occur in 40-75% of cases. Long-term side effects in survivors of Nipah virus infection
have been noted, including persistent convulsions and personality changes. Infections that lead to
symptoms and sometimes death much later after exposure have also been reported months and
even years after exposure. In approximately 20% of patients that recover, neurological symptoms
can persist such as seizures or changed personality. Currently, supportive care of symptoms is the
only way to treat the infection.

What are risk factors for a Nipah virus infection?

The risk factors for this infection include having close contact with infected animals such as pigs,
bats, and/or humans infected with the virus. In addition, consumption of raw date palm sap is a
significant risk factor since bat excrement often contaminates this substance. Persons working in
healthcare settings are also at greater risk, especially if working in unhygienic conditions and
adequate protective equipment is not available.

Diagnosis
Initial signs and symptoms of Nipah virus infection are nonspecific, and the diagnosis is often not
suspected at the time of presentation. Nipah virus infection can be diagnosed with clinical history
during the acute and convalescent phase of the disease.

Nipah virus (NiV) infection can be diagnosed during illness or after recovery. Different tests are
available to diagnose NiV infection. The main tests used are :

 During early stages of the illness, laboratory testing can be conducted using Real Time
Polymerase Chain Reaction (RT-PCR) from throat and nasal swabs, cerebrospinal fluid, urine,
and blood.

 Later in the course of illness and after recovery, testing for antibodies is conducted using
an Enzyme-Linked Immunosorbent Assay (ELISA).

Early diagnosis of NiV infection can be challenging due to the non-specific early symptoms of the
illness. However, early detection and diagnosis are critical to increase chances of survival among
infected individuals, to prevent transmission to other people, and to manage outbreak response
efforts. NiV should be considered for people with symptoms consistent with NiV infection who
have been in areas where Nipah is more common, such as Bangladesh or India—particularly if
they have a known exposure.

Treatment

There are currently no drugs or vaccines specific for Nipah virus infection although WHO has
identified Nipah as a priority disease for the WHO Research and Development
Blueprint. Intensive supportive care is recommended to treat severe respiratory and neurologic
complications. Treatment is limited to supportive care, including rest, hydration, and treatment of
symptoms as they occur.

Prevention
In areas where Nipah virus (NiV) outbreaks have occurred (Bangladesh, Malaysia, India, and
Singapore), people should:

 Practice handwashing regularly with soap and water.

 Avoid contact with sick bats or pigs ,do not touch or handle dead animals.
 Avoid areas where bats are known to roost.
 Avoid consumption of raw date palm sap.
 Avoid consumption of fruits that may be contaminated by bats.
 Avoid contact with the blood or body fluids of any person known to be infected with NiV.

Because NiV can be spread from person-to-person, standard infection control practices and proper
barrier nursing techniques are important in preventing hospital-acquired infections (nosocomial
transmission) in settings where a patient has confirmed or suspected NiV infection. Those who
care for patients with suspected or confirmed NiV cases should wear protective gowns, gloves,
masks, as well as a face shield.

In addition to steps that individuals can take to lower their risk for NiV infection, it will be critical
for scientists, researchers, and communities at risk to continue learning about NiV to prevent
future outbreaks. Broader prevention efforts include:

 Increasing surveillance of animals and people in areas where NiV is known to exist.
 Increasing research on the ecology of fruit bats to understand where they live and how they
spread the virus to other animals and people.
 Evaluation of novel technologies or methods to minimize spread of the virus within bat
populations.
 Improving tools to detect the virus early in communities.
 Reinforcing protocols for healthcare settings on standard infection control practices to
prevent person-to-person spread.

BLACK FUNGUS

A rare disease

According to the Centers for Disease Control and Prevention (CDC) , “Mucormycosis is caused
by a group of molds called mucormycetes, which are found in soil and organic matter, like
compost piles”. The infection typically affects people with health problems (like COVID-19) or
those who take medicines that can lower the immune system’s ability to fight infection. It
commonly affects the sinuses or lungs after the fungal spores are inhaled from the air.

“Mucormycosis is a fungal infection that tends to infect people who have suppressed immune
systems, such as people with severe diabetes,” Dr. Eric Cioe-Peña, director of global health at
Northwell Health in New York, told Healthline. “Once it infects you, it’s very morbid and has a
high mortality.” Depending on what part of the body is affected, mucormycosis can be fatal in up
to 96%.

What is Black fungus infection (mucormycosis)?

 Black fungus, also known as Mucormycosis, is a rare but dangerous infection. Black
fungus is caused by getting into contact with fungus spores in the environment. It can also form in
the skin after the fungus enters through a cut, scrape, burn, or another type of skin trauma.

 Fungi live in the environment, particularly in soil and decaying organic matter such as
leaves, compost piles, rotten wood, and so on. This fungal infection is caused by a type of mould
known as 'mucromycetes’. It should be noted that this rare fungal infection affects persons who
have health issues or who use drugs that weaken the body's ability to fight the infections.

Types of mucormycosis

 Rhinocerebral (sinus and brain) mucormycosis is an infection in the sinuses that can
spread to the brain. This form of mucormycosis is most common in people with uncontrolled
diabetes and in people who have had a kidney transplant.
 Pulmonary (lung) mucormycosis is the most common type of mucormycosis in people
with cancer and in people who have had an organ transplant or a stem cell transplant.
 Gastrointestinal mucormycosis is more common among young children than adults,
especially premature and low birth weight infants less than 1 month of age, who have had
antibiotics, surgery, or medications that lower the body’s ability to fight germs and sickness.
 Cutaneous (skin) mucormycosis: occurs after the fungi enter the body through a break in
the skin (for example, after surgery, a burn, or other type of skin trauma). This is the most
common form of mucormycosis among people who do not have weakened immune systems.
 Disseminated mucormycosis occurs when the infection spreads through the bloodstream to
affect another part of the body. The infection most commonly affects the brain, but also can affect
other organs such as the spleen, heart, and skin.

Incubation period

The symptoms of mucormycosis or black fungus usually appear two-three days after a person has
recovered from the Covid-19 infection. In some cases, the infection appears during recovery.
From the sinus, the infection takes about two-four days to invade the eyes.. In the next 24 hours,
the black fungus can travel up to the brain.
Black Fungus Causes:

 Mucormycetes are a type of mould that causes fungal infections. These moulds can be
found everywhere in the environment, including soil, air, and food. They enter the body via the
nose, mouth, or eyes and can have an impact on the brain if it is not treated on time. According to
medical experts, the main cause of black fungus (mucormycosis) is steroid misuse during COVID
treatment.

 Black fungus (mucormycosis) primarily affects people who have health problems or who
take medications that reduce the body's ability to fight germs and illness. The person's immunity is
low after covid treatment, which makes them vulnerable to black fungus infection. People with
diabetes and COVID-19 patients are at greater risk of developing an infection.

Symptoms of Mucormycosis
The symptoms of mucormycosis depend on where in the body the fungus is growing. Contact your
healthcare provider if you have symptoms that you think are related to mucormycosis.

Symptoms of rhinocerebral (sinus and brain) mucormycosis include:

 Headache & fever

 Nasal or sinus congestion
 Black lesions on nasal bridge or upper inside of mouth that quickly become more severe

Symptoms of pulmonary (lung) mucormycosis include:

 Fever
 Cough
 Chest pain
 Shortness of breath

Cutaneous (skin) mucormycosis can look like blisters or ulcers, and the infected area may turn
black. Other symptoms include pain, warmth, excessive redness, or swelling around a wound.

Symptoms of gastrointestinal mucormycosis include:

 Abdominal pain
 Nausea and vomiting
 Gastrointestinal bleeding
Disseminated mucormycosis typically occurs in people who are already sick from other medical
conditions, so it can be difficult to know which symptoms are related to mucormycosis. Patients
with disseminated infection in the brain can develop mental status changes or coma.

Other Black Fungus Symptoms:

The symptoms of black fungus will vary depending on where the fungus is growing in your
body. They may include the following:

 Fever
 Cough
 Chest pain
 Shortness of breath
 Swelling on one side of your face
 Headache
 Sinus congestion
 Black lesions on the top of the nose or the inside of the mouth
 Belly pain
 Nausea and vomiting
 Gastrointestinal bleeding
 Blood in your stool
 Diarrhea
If your skin is infected, the affected area may appear blistered, red, or swollen. It may turn black,
feel warm, or be painful. Through your blood, the infection can also spread to other parts of your
body. This is referred to as disseminated black fungus (mucormycosis). When this occurs, the
fungus can attack organs such as your spleen and heart. In severe cases, you may experience
mental changes or fall into a coma. It can even be fatal.

Black Fungus Risks:

Mucormycosis is rare, but it’s more common among people who have health problems or take
medicines that lower the body’s ability to fight germs and sickness. Certain groups of people are
more likely to get mucormycosis. Patients who get COVID treatment within six weeks are more
likely to develop black fungus. People who fall into the following categories are more likely to
develop black fungus:
 Uncontrolled diabetes, diabetic ketoacidosis, and diabetics taking steroids Patients taking
immunosuppressants or receiving anticancer treatment, as well as those suffering from a chronic
debilitating illness.

 Cases of COVID-19 Severity

 Patients on oxygen who required nasal prongs, a mask, or a ventilatory support

 Cancer

 Organ transplant
 Stem cell transplant
 Neutropenia (low number of white blood cells)
 Long-term corticosteroid use
 Injection drug use
 Too much iron in the body (iron overload or hemochromatosis)
 Skin injury due to surgery, burns, or wounds
 Prematurity and low birth weight (for neonatal gastrointestinal mucormycosis

Mode Of Transmission

The fungi that cause mucormycosis live in the environment. Mucormycetes, the group of fungi
that cause mucormycosis, are present throughout the environment, particularly in soil and in
association with decaying organic matter, such as leaves, compost piles, and animal dung. They
are more common in soil than in air, and in summer and fall than in winter or spring. Most people
come in contact with microscopic fungal spores every day, so it’s probably impossible to
completely avoid coming in contact with mucormycetes. These fungi aren’t harmful to most
people. However, for people who have weakened immune systems, breathing in mucormycete
spores can cause an infection in the lungs or sinuses which can spread to other parts of the body.

So how does someone get mucormycosis? People get mucormycosis through contact with fungal
spores in the environment. For example, the lung or sinus forms of the infection can occur after
someone inhales the spores from the air. A skin infection can occur after the fungus enters the skin
through a scrape, burn, or other type of skin injury.

How Black fungus effects COVID patients?

Mucormycosis is a rare but serious fungal infection. While the cases of this infection were
relatively less, the Covid-19 outbreak has given a boost to the spread of this infection. It is
commonly known as black fungus, the infection is now detected among Covid-19 patients across
India. With a significant increase in fungal infection cases, the government has mandated that all
states have to report suspected and confirmed cases of mucormycosis to the Integrated Disease
Surveillance Programme (IDSP).

Now let’s take a look at what this infection is and why it is caused more frequently among
Covid-19 patients. The infection is rare, but once a person is infected, the fungus manifests in the
skin or can affect the brain or lungs, many cases of this infection have been reported in Covid-19
patients.

Why is it occurring in COVID-19 patients?

 Mucormycosis can occur after COVID-19 infection, whether during the hospital stay or a few
weeks after discharge.

 The COVID-19 generates a sudden change in the interior environment of the host for the
fungus, and the medical treatment administered unknowingly promotes fungal development.
COVID-19 causes harm to the airway mucosa and blood vessels. It also causes a rise in serum
iron, which is required for the fungus to grow. Although antifungals such as Voriconazole prevent
Aspergillosis, Mucor survives and grows due to a lack of resistance. Long-term ventilation
decreases immunity, and there is conjecture that the humidifier water that is delivered along with
the oxygen transfers the fungus.

What are the warning signs of black fungus disease that need immediate medical attention?

 Nasal blockage

 Abnormal black discharge , bleeding from nose

 Eyes pain, swollen eyes, double vision, redness around eyes, paralysis of eyelid
muscles.

 Facial pain, numbness and tingling sensation.

 Difficulty in opening mouth or chewing.

Diagnosis
Healthcare providers consider your medical history, symptoms, physical examinations, and
laboratory tests when diagnosing mucormycosis. Healthcare providers who suspect that you have
mucormycosis in your lungs or sinuses might collect a sample of fluid from your respiratory
system to send to a laboratory. Your healthcare provider may perform a tissue biopsy, in which a
small sample of affected tissue is analyzed in a laboratory for evidence of mucormycosis under a
microscope or in a fungal culture. You may also need imaging tests such as a CT scan of your
lungs, sinuses, or other parts of your body, depending on the location of the suspected infection.

Black Fungus Treatment:

Mucormycosis treatment must be fast and aggressive. Most patients will need surgical and
medical treatment. Most infectious disease experts say that without aggressive surgical
debridement of the infected area, the patient is likely to die. Medicines play an important role.
Two main aims are sought simultaneously: antifungal drugs to slow or stop the fungal spread and
drugs to treat debilitating underlying diseases. Amphotericin B (initially intravenous) is the usual
drug of choice for antifungal therapy. Posaconazole or isavuconazole can treat mucormycosis.
Patients may even require an intravenous antifungal procedure lasting 4 -6 weeks. Patients with
underlying diseases like diabetes need to be in optimal control of their diabetes.

Patients normally on steroids or taking deferoxamine (Desferal; used to remove excess iron from
the body) are likely to have these drugs stopped because they can increase the survival of fungi in
the body. Patients may need additional surgeries and usually need antifungal treatment for an
extended period (weeks to months) depending on the severity of the disease.

Mucormycosis is a serious infection and needs to be treated with prescription antifungal medicine,
usually amphotericin B, posaconazole, or isavuconazole. These medicines are given through a
vein (amphotericin B, posaconazole, isavuconazole) or by mouth (posaconazole, isavuconazole).
Other medicines, including fluconazole, voriconazole, and echinocandins, do not work against
fungi that cause mucormycosis. Often, mucormycosis requires surgery to cut away the infected
tissue.

Black Fungus Preventions:

Preventive measures to be followed:

 Protect yourself from the environment

 Antifungal medication.

 Humidifier cleaning and replacement (for those using Oxygen Concentrators)

 The humidifier bottle should be sterilized with normal saline and refilled on a regular basis.

 Masks should be disinfected regularly, and they should not be used for weeks.

 Those who use steroids should also monitor their blood sugar levels.

 During the COVID-19 therapy, mortified oxygen should be utilized

 Practicing good hygiene and maintaining the cleanliness of their surroundings

 Brushing and gargling daily is extremely beneficial.

 If you have recovered from COVID, it is critical to wear masks to prevent the infection from
entering the body.

 Diabetics patients must keep their diabetes under control and monitor their blood glucose
levels

 These must be monitored, especially after infection with Covid-19. Steroid use is to be
reduced, and immunomodulating drugs are to be discontinued

Be aware of this, even after covid, don't take it easy. If you're diabetic, keep your sugar under
control, if you have any of the symptoms mentioned, Get Yourself Tested the doctor can write
CTPNS or MRI of PNS, this can be detected early, and treatment can be effective.

LIFESTYLE DISEASES, CARDIOVASCULAR DISEASES,

HYPERTENSION

LIFE STYLE DISEASES / NCD

 Medical Definition

Life style disease: A disease associated with the way a person or group of people lives. Lifestyle
diseases include atherosclerosis, heart disease, and stroke; obesity and type 2 diabetes; and diseases
associated with smoking and alcohol and drug abuse. Regular physical activity helps prevent obesity,
heart disease, hypertension, diabetes, colon cancer, and premature mortality.

 Life style diseases

Some diseases do not get spread from one person to another through touch, air, food, water and
sexual contacts. These diseases may develop in a person due to faulty eating and living habits e.g.
obesity, diabetes and hypertension. These disease are called life style diseases.

A lifestyle is a pattern of living that we follow- how we work, what and when we eat, how
and when we sleep, how much physical activity we do and whether we smoke or consume alcohol.
Lifestyle diseases include diseases which occur based on regular habits of people. The onset of these
lifestyle diseases is insidious, they take years to develop, and once encountered do not lend themselves
easily to cure (John H, G. 2010). Such diseases are known as chronic diseases which are a major issue
in this modern society. These are non-communicable diseases and are the major cause of death all over
the world. Chronic diseases are now the major cause of death worldwide. Diseases such as cancer,
diabetes, heart disease, migraine and stroke are the main cause of deaths in the world, representing
around 60% of all the deaths. Lifestyle factors are responsible for chronic illnesses because of many
health related factors such as smoking habit, improper time management which leads to sleep
deprivation and by following a hectic schedule. Some chronic diseases are hereditary; it is not the case
all the time that lifestyle factors are responsible for it. Although they play a major role in occurrence
of these diseases.

Characteristics of NCDs

 Complex etiology (causes): Non communicable diseases are driven by seemingly unrelated
causes such as rapid unplanned urbanization, globalization of unhealthy lifestyles and population
ageing. Apparent causes such as raised blood pressure, increased blood glucose, elevated blood lipids
and obesity may be representations of deep lying lifestyle habits.5

 Multiple risk factors: There are a number of risk factors that lead to the onset and development
of NCDs. The various types of risks can be divided into three primary risk sets: modifiable behavioral
risk factors, non-modifiable risk factors and metabolic risk factors, many of which are common for a
number of diseases.

 Long latency period: The latency period of NCDs is generally long, often stretching from
many years to several decades.

 Non-contagious origin (non-communicable): NCDs are not communicated from one person to
another, so it is a given that these diseases develop in a person from non-contagious origins.

 Prolonged course of illness: NCDs are chronic in nature and thus the course of illness if often
prolonged and takes years before a patient may be forced to opt for medical care or intervention.

 Functional impairment or disability: NCDs usually give rise to circumstances that make it
difficult for the patients to lead a normal life. Patients with chronic NCDs may not be able to take part
in regular physical activity, go to the office or eat normally.

Causes of life style diseases

 Dehydration: Dehydration of the muscles and tendons is a primary cause of muscle fatigue, strain,
tendonitis, and other disorders of the musculoskeletal system.
 Malnutrition: The lack of living foods in our diet along with the overconsumption of dead foods
causes chronic disease.

 Inflammation: It is a primary cause of most life style related disorders, including heart disease and
musculoskeletal disorders.

 Fatigue: Lack of sleep is associated with numerous, serious medical illnesses including: high blood
pressure, heart disease, stroke, obesity and mental impairment.

 Poor physical fitness : It’s widely recognized that there’s a direct correlation between poor levels of
physical fitness and increased risk of chronic diseases.

 Poor health habits: Smoking, alcohol, drug use/abuse, sugar, fast food, soft drinks, chocolate, artificial
sweeteners, worry, and stress have a negative impact on your health.

CARDIO VASCULAR DISEASES

The cardiovascular, or circulatory, system supplies the body with blood. It consists of the heart, arteries, veins,
and capillaries. The cardiovascular system is made up of the heart and blood vessels. Cardiovascular disease
(CVD) is defined as any serious, abnormal condition of the heart or blood vessels(arteries, veins).
Cardiovascular disease includes coronary heart disease (CHD), stroke, peripheral vascular disease, congenital
heart disease, endocarditic, and many other conditions. Many cardiovascular diseases are preventable.

 TYPES

There are many different types of CVD. Four of the main types are described below.

Coronary heart disease

Coronary heart disease occurs when the flow of oxygen-rich blood to the heart muscle is blocked or
reduced. This puts an increased strain on the heart, and can lead to:

 Angina – chest pain caused by restricted blood flow to the heart muscle

 Heart attacks – where the blood flow to the heart muscle is suddenly blocked

 Heart failure – where the heart is unable to pump blood around the body properly.
Strokes and TIAs

A stroke is where the blood supply to part of the brain is cut off, which can cause brain damage and
possibly death. A transient ischemic attack (also called a TIA or "mini-stroke") is similar, but the
blood flow to the brain is only temporarily disrupted. The main symptoms of a stroke or TIA can be
remembered with the word FAST, which stands for:
 Face – the face may have drooped on one side, the person may be unable to smile, or their
mouth or eye may have dropped.

 Arms – the person may not be able to lift both arms and keep them there because of arm
weakness or numbness in one arm.

 Speech – their speech may be slurred or garbled, or they may not be able to talk at all.

 Time – it's time to dial 999 immediately if you see any of these signs or symptoms.
Peripheral arterial disease

Peripheral arterial disease occurs when there's a blockage in the arteries to the limbs, usually the legs.
This can cause:

 Dull or cramping leg pain, which is worse when walking and gets better with rest

 Hair loss on the legs and feet

 Numbness or weakness in the legs

 Persistent ulcers (open sores) on the feet and legs

Aortic disease
Aortic diseases are a group of conditions affecting the aorta. This is the largest blood vessel in the
body, which carries blood from the heart to the rest of the body. One of most common aortic diseases
is an aortic aneurysm, where the aorta becomes weakened and bulges outwards. This doesn't usually
have any symptoms, but there's a chance it could burst and cause life-threatening bleeding.

 SYMPTOMS

Symptoms will vary depending on the specific condition. Some conditions, such as type 2
diabetes or hypertension, may initially cause no symptoms at all. However, typical symptoms of an
underlying cardiovascular issue include:

 Pain or pressure in the chest, which may indicate angina

 Pain or discomfort in the arms, left shoulder, elbows, jaw, or back
 Shortness of breath
 Nausea and fatigue
 Lightheadedness or dizziness
 Cold sweats
Although these are the most common ones, CVD can cause symptoms anywhere in the body.

 LIFESTYLE TIPS

People can take the following steps to prevent some of the conditions within CVD:

 Manage body weight

 Get regular exercise
 Follow a heart-healthy diet
 Quit smoking

 TREATMENT

The treatment option that is best for a person will depend on their specific type of CVD. However,
some options include:

 Medication, such as to reduce low density lipoprotein cholesterol, improve blood flow, or
regulate heart rhythm.
 Surgery, such as coronary artery bypass grafting or valve repair or replacement surgery
 Cardiac rehabilitation, including exercise prescriptions and lifestyle counseling

Treatment aims to:

 Relieve symptoms
 Reduce the risk of the condition or disease recurring or getting worse
 Prevent complications, such as hospital admission, heart failure, stroke, heart attack, or death

Depending on the condition, a healthcare provider may also seek to stabilize heart rhythms, reduce
blockages, and relax the arteries to enable a better flow of blood.

RISK FACTORS

 Age – CVD is most common in people over 50 and your risk of developing it increases as you
get older

 Gender – men are more likely to develop CVD at an earlier age than women

 Diet – an unhealthy diet can lead to high cholesterol and high blood pressure

 Alcohol – excessive alcohol consumption can also increase your cholesterol and blood pressure
levels, and contribute to weight gain
 High blood pressure, or hypertension
 Atherosclerosis or blockages in the arteries

 Smoking

 Poor sleep hygiene

 High blood cholesterol, or hyper lipidemia

 Diabetes

 Physical inactivity

 Obesity

 Sleep apnea

 Excessive alcohol consumption

 Stress

 Air pollution

 Chronic obstructive pulmonary disorder or other forms of reduced lung function

CAUSES

Many types of CVD occur as a complication of atherosclerosis. Damage to the circulatory system can also
result from diabetes and other health conditions, such as a virus, an inflammatory process such as myocarditis ,
or a structural problem present from birth (congenital heart disease). CVD often results from high blood
pressure, which produces no symptoms. It is therefore vital that people undergo regular screening for high
blood pressure.

PREVENTION

Many types of CVD are preventable. It is vital to address risk factors by taking the following steps:

 Reducing the use of alcohol and tobacco

 Eating fresh fruit and vegetables

 Reducing salt, sugar, and saturated fat intake

 Avoiding a sedentary lifestyle, particularly for children

Adopting damaging lifestyle habits, such as eating a high sugar diet and not getting much physical
activity, may not lead to CVD while a person is still young, as the effects of the condition are
cumulative. However, continued exposure to these risk factors can contribute to the development of
CVD later in life.

HYPERTENSION

Hypertension is another name for high blood pressure. It can lead to severe health complications and increase
the risk of heart disease, stroke, and sometimes death. Blood pressure is the force that a person’s blood exerts
against the walls of their blood vessels. This pressure depends on the resistance of the blood vessels and how
hard the heart has to work.

Hypertension is a primary risk factor for cardiovascular disease, including stroke, heart attack, heart failure,
and aneurysm. Keeping blood pressure under control is vital for preserving health and reducing the risk of these
dangerous conditions.

TYPES

There are two main types of high blood pressure: primary and secondary high blood pressure.

 Primary, or essential, high blood pressure is the most common type of high blood pressure.
For most people who get this kind of blood pressure, it develops over time as you get older.
 Secondary high blood pressure is caused by another medical condition or use of certain
medicines. It usually gets better after you treat that condition or stop taking the medicines that are
causing it.

SYMPTOMS

Hypertension is called a "silent killer". Most people with hypertension are unaware of the problem because it
may have no warning signs or symptoms. For this reason, it is essential that blood pressure is measured
regularly. When symptoms do occur, they can include early morning headaches, nosebleeds, irregular heart
rhythms, vision changes, and buzzing in the ears. Severe hypertension can cause fatigue, nausea, vomiting,
confusion, anxiety, chest pain, and muscle tremors.

The only way to detect hypertension is to have a health professional measure blood pressure. Having blood
pressure measured is quick and painless. Although individuals can measure their own blood pressure using
automated devices, an evaluation by a health professional is important for assessment of risk and associated
conditions.

TREATMENT
If elevated blood pressure levels are accompanied by diabetes, kidney disease, or cardiovascular disease, your
doctor may suggest blood pressure medication as well lifestyle changes. If elevated levels are your only
condition, lifestyle changes can help prevent blood pressure from rising. The following are lifestyle changes
that may help lower blood pressure:

 Losing weight if overweight or obese

 Eating a healthy, low-salt diet
 Exercise regularly
 Limit alcohol consumption
 Quit smoking

RISK FACTORS

Modifiable risk factors include unhealthy diets (excessive salt consumption, a diet high in saturated fat and
trans fats, low intake of fruits and vegetables), physical inactivity, consumption of tobacco and alcohol, and
being overweight or obese. Non-modifiable risk factors include a family history of hypertension, age over 65
years and co-existing diseases such as diabetes or kidney disease.

 CAUSES

Food, medicine, lifestyle, age, and genetics can cause high blood pressure. Your doctor can help you
find out what might be causing yours. Common factors that can lead to high blood pressure include:

 A diet high in salt, fat, and/or cholesterol.

 Chronic conditions such as kidney and hormone problems, diabetes, and high cholesterol.
 Family history, especially if your parents or other close relatives have high blood pressure.
 Lack of physical activity.
 Older age (the older you are, the more likely you are to have high blood pressure).
 Being overweight or obese.
 Race (non-Hispanic black people are more likely to have high blood pressure than people of
other races).
 Some birth control medicines and other medicines.
 Stress.
 Tobacco use or drinking too much alcohol.

PREVENTION

Reducing hypertension prevents heart attack, stroke, and kidney damage, as well as other health
problems.

 Reducing salt intake (to less than 5g daily).

 Eating more fruit and vegetables.
 Being physically active on a regular basis.
 Avoiding use of tobacco.
 Reducing alcohol consumption.
 Limiting the intake of foods high in saturated fats.

OBESITY AND DIABETICS

OBESITY
Obesity is a complex disease involving an excessive amount of body fat.
It is a medical problem that increases your risk of other diseases and health problems, such as heart
disease, diabetes, high blood pressure and certain cancers.
There are many reasons why some people have difficulty avoiding obesity.
Usually, obesity results from a combination of inherited factors, combined with the environment and
personal diet and exercise choices.
The good news is that even modest weight loss can improve or prevent the health problems associated
with obesity.

Symptoms
Obesity is diagnosed when your body mass index (BMI) is 25 or higher.
To determine your body mass index, divide your weight in pounds by your height in inches squared
and multiply by 703. Or divide your weight in kilograms by your height in meters squared.

BMI Weight status

 Below 18.5-Underweight
 18.5-24.9-Normal
 25.0-29.9-Overweight
 30.0 and higher Obesity

Causes
Although there are genetic, behavioral, metabolic and hormonal influences on body weight, obesity
occurs when you take in more calories than you burn through exercise and normal daily activities.
Your body stores these excess calories as fat. Most Americans' diets are too high in calories—often
from fast food and high-calorie beverages. People with obesity might eat more calories before feeling
full, feel hungry sooner, or eat more due to stress or anxiety.
Risk factors
Family inheritance and influences
Lifestyle choices
Social and economic issues
Age
Other factors

Complications
• Heart disease and strokes
• Type 1 and 2 diabetes
• Certain cancers
• Digestive problems
• Gynecological and sexual problems
• Sleep apnea
• Osteoarthritis
• Severe COVID-19 symptoms
Other weight-related issues that may affect your quality of life include:
 Depression
 Disability
 Sexual problems
 Shame and guilt
 Social isolation
 Lower work achievement
Prevention
 Exercise regularly
 Follow a healthy-eating plan
 Know and avoid the food traps that cause you to eat
 Monitor your weight regularly
 Be consistent
DIABETICS
Diabetes is a disease that occurs when your blood glucose, also called blood sugar, is too high. Blood
glucose is your main source of energy and comes from the food you eat. Insulin, a hormone made by
the pancreas, helps glucose from food get into your cells to be used for energy.

8 Signs You Could Have Diabetes

Going to the bathroom more than usual.
Feeling very thirsty all the time.
Having itchy skin.
Having an increased appetite.
Feeling tired or drowsy.
Experiencing blurred vision.
Feeling pain or numbness in feet or legs.
Cuts and scrapes taking longer to heal.
There are a few different types of diabetes:
 Type 1 diabetes
 Type 2 diabetes
 Prediabetes
 Gestational diabetes

General symptoms
o increased hunger
o increased thirst
o weight loss
o frequent urination
o blurry vision
o extreme fatigue
o Symptoms in men
o Symptoms in women
Complications of diabetics
heart disease, heart attack, and stroke
• neuropathy
• nephropathy
• hearing loss
• skin conditions such as bacterial and fungal infections
• depression
• dementia

PREVENTION
Lose extra weight.
Be more physically active. There are many benefits to regular physical activity.
Eat healthy plant foods. Plants provide vitamins, minerals and carbohydrates in your diet.
Eat healthy fats.
Skip fad diets and make healthier choices.

CANCER

The Definition of Cancer

Cancer is a disease in which some of the body’s cells grow uncontrollably and spread to other parts of
the body. Cancer can start almost anywhere in the human body, which is made up of trillions of cells.
Normally, human cells grow and multiply (through a process called cell division) to form new cells as
the body needs them. When cells grow old or become damaged, they die, and new cells take their
place.

Sometimes this orderly process breaks down, and abnormal or damaged cells grow and multiply when
they shouldn’t. These cells may form tumors, which are lumps of tissue. Tumors can be cancerous or
not cancerous (benign).
Cancerous tumors spread into, or invade, nearby tissues and can travel to distant places in the body to
form new tumors (a process called metastasis). Cancerous tumors may also be
called malignant tumors. Many cancers form solid tumors, but cancers of the blood, such
as leukemias, generally do not.

Benign tumors do not spread into, or invade, nearby tissues. When removed, benign tumors usually
don’t grow back, whereas cancerous tumors sometimes do. Benign tumors can sometimes be quite
large, however. Some can cause serious symptoms or be life threatening, such as benign tumors in the
brain.

Diagnosing cancer

Often, a diagnosis begins when a person visits a doctor about an unusual symptom. The doctor will
talk with the person about his or her medical history and symptoms. Then the doctor will do various
tests to find out the cause of these symptoms.

But many people with cancer have no symptoms. For these people, cancer is diagnosed during a
medical test for another issue or [Link] a doctor finds cancer after a screening test in an
otherwise healthy person. Examples of screening tests include colonoscopy, mammography, and a Pap
test. A person may need more tests to confirm or disprove the result of the screening test.

For most cancers, a biopsy is the only way to make a definite diagnosis. A biopsy is the removal of a
small amount of tissue for further study. Learn more about making a diagnosis after a biopsy.
Treatments of Cancer

Cancer treatment is the use of surgery, radiation, medications and other therapies to cure a cancer,
shrink a cancer or stop the progression of a cancer. Many cancer treatments exist. Depending on your
particular situation, you may receive one treatment or you may receive a combination of treatments.

The goal of cancer treatment is to achieve a cure for the cancer, allowing to live a normal life span.
This may or may not be possible, depending on the specific situation. If a cure isn't possible, the
treatments may be used to shrink the cancer or slow the growth of the cancer to allow you to live
symptom free for as long as possible.

Cancer treatments may be used as:

Primary treatment:

 The goal of a primary treatment is to completely remove the cancer from your body or kill all
the cancer cells.
 Any cancer treatment can be used as a primary treatment, but the most common primary cancer
treatment for the most common types of cancer is surgery. If your cancer is particularly sensitive to
radiation therapy or chemotherapy, you may receive one of those therapies as your primary treatment.
Adjuvant treatment:

 The goal of adjuvant therapy is to kill any cancer cells that may remain after primary treatment
in order to reduce the chance that the cancer will recur.
 Any cancer treatment can be used as an adjuvant therapy. Common adjuvant therapies include
chemotherapy, radiation therapy and hormone therapy.
 Neoadjuvant therapy is similar, but treatments are used before the primary treatment in order to
make the primary treatment easier or more effective.
Palliative treatment:

 Palliative treatments may help relieve side effects of treatment or signs and symptoms caused
by cancer itself. Surgery, radiation, chemotherapy and hormone therapy can all be used to relieve
symptoms. Other medications may relieve symptoms such as pain and shortness of breath.
 Palliative treatment can be used at the same time as other treatments intended to cure your
cancer.
Surgery: The goal of surgery is to remove the cancer or as much of the cancer as possible.

Chemotherapy: Chemotherapy uses drugs to kill cancer cells.

 Radiation therapy: Radiation therapy uses high-powered energy beams, such as X-rays or
protons, to kill cancer cells. Radiation treatment can come from a machine outside your body (external
beam radiation), or it can be placed inside your body (brachytherapy).

Bone marrow transplant: Your bone marrow is the material inside your bones that makes
blood cells from blood stem cells. A bone marrow transplant, also knowns as a stem cell transplant,
can use your own bone marrow stem cells or those from a donor.

A bone marrow transplant allows your doctor to use higher doses of chemotherapy to treat your
cancer. It may also be used to replace diseased bone marrow.

Immunotherapy: Immunotherapy, also known as biological therapy, uses your body's immune
system to fight cancer. Cancer can survive unchecked in your body because your immune system
doesn't recognize it as an intruder. Immunotherapy can help your immune system "see" the cancer and
attack it.

Hormone therapy: Some types of cancer are fueled by your body's hormones. Examples
include breast cancer and prostate cancer. Removing those hormones from the body or blocking their
effects may cause the cancer cells to stop growing.

Targeted drug therapy: Targeted drug treatment focuses on specific abnormalities within
cancer cells that allow them to survive.

Cryoablation: This treatment kills cancer cells with cold. During cryoablation, a thin,
wandlike needle (cryoprobe) is inserted through your skin and directly into the cancerous tumor. A gas
is pumped into the cryoprobe in order to freeze the tissue. Then the tissue is allowed to thaw. The
freezing and thawing process is repeated several times during the same treatment session in order to
kill the cancer cells.

Radiofrequency ablation: This treatment uses electrical energy to heat cancer cells, causing
them to die. During radiofrequency ablation, a doctor guides a thin needle through the skin or through
an incision and into the cancer tissue. High-frequency energy passes through the needle and causes the
surrounding tissue to heat up, killing the nearby cells.

Clinical trials: Clinical trials are studies to investigate new ways of treating cancer. Thousands
of cancer clinical trials are underway.

Other treatments may be available to you, depending on your type of cancer.

Types of cancer
Doctors divide cancer into types based on where it begins. Four main types of cancer are:

 Carcinomas:
A carcinoma begins in the skin or the tissue that covers the surface of internal organs and glands.
Carcinomas usually form solid tumors. They are the most common type of cancer. Examples of
carcinomas include prostate cancer, breast cancer, lung cancer, and colorectal cancer.

 Sarcomas:

A sarcoma begins in the tissues that support and connect the body. A sarcoma can develop in fat,
muscles, nerves, tendons, joints, blood vessels, lymph vessels, cartilage, or bone.


 Leukemias:
Leukemia is a cancer of the blood. Leukemia begins when healthy blood cells change and grow
uncontrollably. The 4 main types of leukemia are acute lymphocytic leukemia, chronic lymphocytic
leukemia, acute myeloid leukemia, and chronic myeloid leukemia.
 Lymphomas:
Lymphoma is a cancer that begins in the lymphatic system. The lymphatic system is a network of
vessels and glands that help fight infection. There are 2 main types of lymphomas: Hodgkin
lymphoma and non-Hodgkin lymphoma.

How cancer spreads

As a cancerous tumor grows, the bloodstream or lymphatic system
may carry cancer cells to other parts of the body. During this process, the cancer cells grow and may
develop into new tumors. This is known as metastasis.

One of the first places a cancer often spreads is to the lymph nodes. Lymph nodes are tiny,
bean-shaped organs that help fight infection. They are located in clusters in different parts of the body,
such as the neck, groin area, and under the [Link] may also spread through the bloodstream to
distant parts of the body. These parts may include the bones, liver, lungs, or brain. Even if the cancer
spreads, it is still named for the area where it began. For example, if breast cancer spreads to the lungs,
it is called metastatic breast cancer, not lung cancer.

ACCIDENT AND INJURIES, IMMUNIZATION

ACCIDENT

An accident is an unintentionally-caused event. In most cases, the term is used specifically in

reference to unintentionally-caused negative events.
Accidents can be caused by human (behavioural) factors, such as:
• Unsafe conduct

• Inattention

• Negligence

• Improper training

• Inexperience

• Drowsiness, fatigue, or illness

As well as by environmental and workplace design factors, such as:

• Unsafe working conditions

• Unsafe workplace design

• Substandard safety controls

• Inclement weather

When an accident occurs, it is important to investigate the events that lead up to the accident in
order to fully understand its cause. This form of investigation is referred to as a rootcause analysis,
and is a critical part of accident prevention—uncovering an accident’s root causes enables an
employer to address those causes so that they cannot occur again.

DEFINITION
An unfortunate event resulting from carelessness, unawareness, ignorance, or a combination of
causes

An unexpected bodily event of medical importance especially when injurious a cerebrovascular

accident

An unexpected happening causing loss or injury which is not due to any fault or misconduct on
the part of the person injured but for which legal relief may be sought

TYPES OF ACCIDENTS
• Road traffic accidents

• Domestic accidents

• Industrial accidents
• Railway accidents

• Violence

• Road traffic accidents

Road traffic injuries cause considerable economic losses to individuals, their families, and to
nations as a whole. These losses arise from the cost of treatment as well as lost productivity for
those killed or disabled by their injuries, and for family members who need to take time off work
or school to care for the injured. Road traffic crashes cost most countries 3% of their gross
domestic product.

Who is at risk?

Socioeconomic status
More than 90% of road traffic deaths occur in low- and middle-income countries. Road traffic
injury death rates are highest in the African region. Even within high-income countries, people
from lower socioeconomic backgrounds are more likely to be involved in road traffic crashes.

Age
Road traffic injuries are the leading cause of death for children and young adults aged 5-29 years.
Sex
From a young age, males are more likely to be involved in road traffic crashes than females.

Risk factors The Safe System approach: accommodating human error

The Safe System approach to road safety aims to ensure a safe transport system for all road users.
Such an approach takes into account people’s vulnerability to serious injuries in road traffic
crashes and recognizes that the system should be designed to be forgiving of human error. The
cornerstones of this approach are safe roads and roadsides, safe speeds, safe vehicles, and safe
road users, all of which must be addressed in order to eliminate fatal crashes and reduce serious
injuries.

Speeding
• An increase in average speed is directly related both to the likelihood of a crash occurring
and to the severity of the consequences of the crash. For example, every 1% increase in mean
speed produces a 4% increase in the fatal crash risk and a 3% increase in the serious crash risk.

• The death risk for pedestrians hit by car fronts rises rapidly (4.5 times from 50 km/h to 65
km/h).
• In car-to-car side impacts the fatality risk for car occupants is 85% at 65 km/h.

Driving under the influence of alcohol and other psychoactive substances

• Driving under the influence of alcohol and any psychoactive substance or drug increases
the risk of a crash that results in death or serious injuries.
• In the case of drug-driving, the risk of incurring a road traffic crash is increased to differing
degrees depending on the psychoactive drug used. For example, the risk of a fatal crash occurring
among those who have used amphetamines is about 5 times the risk of someone who hasn't.

Non-use of motorcycle helmets, seat-belts, and child restraints

• Correct helmet use can lead to a 42% reduction in the risk of fatal injuries and a 69%
reduction in the risk of head injuries.
• Wearing a seat-belt reduces the risk of death among drivers and front seat occupants by 45
- 50%, and the risk of death and serious injuries among rear seat occupants by 25%.

• The use of child restraints can lead to a 60% reduction in deaths.

Distracted driving
There are many types of distractions that can lead to impaired driving. The distraction caused by
mobile phones is a growing concern for road safety.

• Drivers using mobile phones are approximately 4 times more likely to be involved in a
crash than drivers not using a mobile phone. Using a phone while driving slows reaction times
(notably braking reaction time, but also reaction to traffic signals), and makes it difficult to keep in
the correct lane, and to keep the correct following distances.

• Hands-free phones are not much safer than hand-held phone sets, and texting considerably
increases the risk of a crash.

Unsafe road infrastructure

The design of roads can have a considerable impact on their safety. Ideally, roads should be
designed keeping in mind the safety of all road users. This would mean making sure that there are
adequate facilities for pedestrians, cyclists, and motorcyclists. Measures such as footpaths, cycling
lanes, safe crossing points, and other traffic calming measures can be critical to reducing the risk
of injury among these road users.
Unsafe vehicles
Safe vehicles play a critical role in averting crashes and reducing the likelihood of serious injury.
There are a number of UN regulations on vehicle safety that, if applied to countries’
manufacturing and production standards, would potentially save many lives. These include
requiring vehicle manufacturers to meet front and side impact regulations, to include electronic
stability control (to prevent over-steering) and to ensure airbags and seat-belts are fitted in all
vehicles. Without these basic standards the risk of traffic injuries – both to those in the vehicle and
those out of it – is considerably increased.

Inadequate post-crash care

Delays in detecting and providing care for those involved in a road traffic crash increase the
severity of injuries. Care of injuries after a crash has occurred is extremely time-sensitive: delays
of minutes can make the difference between life and death. Improving post-crash care requires
ensuring access to timely prehospital care, and improving the quality of both prehospital and
hospital care, such as through specialist training programmes.

What can be done to address road traffic injuries

Road traffic injuries can be prevented. Governments need to take action to address road safety in a
holistic manner. This requires involvement from multiple sectors such as transport, police, health,
education, and actions that address the safety of roads, vehicles, and road users.

Effective interventions include designing safer infrastructure and incorporating road safety
features into land-use and transport planning, improving the safety features of vehicles, improving
post-crash care for victims of road crashes, setting and enforcing laws relating to key risks, and
raising public awareness.

• Domestic accidents
An accident is an unexpected, unplanned occurrence which may involves injury . And those
accidents which takes place in the home or in its immediate surroundings, which are not connected
with traffic vehicles and sports.

Common Domestic Accidents are-

-Drowning

-Burns

-Falls
 -Poisoning

-Animal bites

• Industrial accidents
An industrial accident is any accident that happens to a person in the course of their work that
results in an [Link] accident is a unplanned and un-controlled event happened results in injury.

Definition
“Industrial accidents - is an occurrence in an industrial premises causing physical injury to an
employee which make him unfit to resume his duties in the next 48 hours” • - FACTORIES ACT-
1948

Causes
-Unsafe Condition

They are work related causes.

Technical factors such as defective plants, equipments, tools, buildings

They are also associated with work-related factors: Nature of jobs, Nature of machinery and
Equipments, Poor physical conditions, Psychological climate, Work schedules.

-Unsafe Acts

Results in lack of knowledge or skills on the part of employees

Operating without Authority

Failing to secure the equipment

Carelessness

Sped processing

Unsafe procedures

Unsafe equipments Improper lifting

Other Causes

Happening due to unsafe situations, climate conditions and variations:

Bad working condition

Rough & slippery floors

Behavior of superiors Addiction to alcohol & drugs

• Railway accidents
The Indian railways is the world’s largest railway system under a single management; with about
63,000 km route network that operates over 11,000 trains every day. There have been many
railway accidents which could be considered as disasters.

While every case is unique, the most common causes of train accidents include:

• Negligence

• Human error

• Reckless pedestrians and drivers

• Mechanical failure

• Speedy trains

• Defective tracks

• Derailments

• Unprotected railroad crossings

• Stalled cars on the track

• Suicides

1. Negligence

Railroad accidents due to negligence can be blamed on different groups. Some may be the fault of
the railway company itself, whereas others are because a conductor or railroad employee was
negligent. Some accidents are even caused by the neglect of a government agency. an equipment
manufacturer can be a reason why the accident happened.

A common factor that contributes to this problem is the decades old, outdated technology still
frequently used for railways and trains today. Better technology is available to improve railway
safety, but adopting these features is often put on hold because it involves a hefty investment.

2. Human Error
If the conductor is inexperienced, train accidents can easily happen. Human error has always been
one of the most common reasons for any accident. From poor judgment to vision issues to
impaired reactions, these factors can (and do) contribute to train disasters.

3. Reckless Pedestrians & Drivers

Train accidents aren’t always the fault of the train operator or company. Sometimes, a reckless or
distracted pedestrian can cause a collision by standing on or crossing the tracks at the wrong time.
In other, the driver of a car, truck, motorcycle or other motor vehicle can cause an accident by
leaving their vehicle parked on a train track or trying to beat the train across a crossing.

4. Mechanical Failure
The train operator, railway employees and the company itself can do everything within their
ability to follow all the required safety procedures, but a train accident can still happen.
Mechanical failure and defective parts are more rare than other common causes of train collisions,
but they do occasionally happen.

5. Speedy Trains
Time and again, car accident data proves that driving recklessly fast can lead to serious injuries
and deaths. Trains are no exception. Many train accidents in recent years showed that the faster
the train, the worse the consequences become in the event of a crash and the higher likelihood of
derailment.

6. Defective Tracks
Obstruction is a common issue with the tracks and can cause train derailment.

, in some cases, a conductor fails to see these obstacles at all or in time to stop a collision.

7. Derailments
A derailment is when a train runs off its rail, either because of a collision with another object, a
conductor error, mechanical track failure, broken rails, or defective wheels. A derailment doesn’t
necessarily mean the train leaves the tracks – some may be minor. However, a serious derailment
can be catastrophic if it occurs while the train is moving at a high rate of speed.

8. Unprotected railroad crossings

Accidents at unprotected railroad crossings are most often caused by:
• Poor visibility

• Driver distraction

• Driver inebriation/intoxication

• Driver trying to race the train

• Malfunctioning signals

• Obstacles that block a driver’s view

• Conductor failing to sound an alarm

9. Stalled cars on the track

Cars rarely get stuck on railroad grade crossings. It can also cause the death or accident

10. Suicides
Sadly, some people choose to take their own lives by standing on the tracks or jumping in front of
a train.

• Violence
Violence, an act of physical force that causes or is intended to cause harm. The damage inflicted
by violence may be physical, psychological, or both. Violence may be distinguished from
aggression, a more general type of hostile behaviour that may be physical, verbal, or passive in
nature.

Violence is a relatively common type of human behaviour that occurs throughout the world.
People of any age may be violent, although older adolescents and young adults are most likely to
engage in violent behaviour. Violence has a number of negative effects on those who witness or
experience it, and children are especially susceptible to its harm. Fortunately, various programs
have been successful at preventing and reducing violence.

Types of violence
Violence can be categorized in a number of ways. Violent crimes are typically divided into four
main categories, based on the nature of the behaviour:

Homicide : the killing of one human being by another, sometimes for legally justifiable
reasons.
Assault : physically attacking another person with the intent to cause harm.

Robbery : forcibly taking something from another person.

Rape : forcible sexual intercourse with another person.

Other forms of violence overlap with these categories, such as Child sexual abuse : engaging in
sexual acts with a child.

Domestic violence : violent behaviour between relatives, usually spouses.

INJURIES

A Wound or Injury is defined as termination of the natural continuity of any of the tissues of the
living body. Any physical damage to the body caused by violence or accident or fracture can be
called Injury.

Injuries are a leading cause of death and disability

• Injury death rates are much higher in low- and middle- income countries

• Emergency care is effective at limiting the impact of injuries and at improving outcomes

• Emergency care is a great integrated investment, improving outcomes of a range of health

conditions
• Well-organized emergency care systems will help to achieve many of the Sustainable
Development Goal.

DEFINITION
Legally, as per sec. 44 IPC; injury is defined as any harm caused illegally to a person i.e. to his
body, mind, reputation or property. Under section 44 IPC.

TYPES OF INJURY

Brain injury
In general, a "brain injury" refers to a physical trauma to the head or brain. These traumas may
involve bumping, shaking, or penetration by an object. One of the most common brain injuries is a
concussion, which involves a blow to the head or other shaking of the brain. While most people
associate concussions with their milder forms, a concussion can involve permanent brain injury.
Closed head injuries are those involving few or no external signs of injuries. Some brain injuries
have an internal cause. For example, the brain needs oxygen to continue to function, and oxygen
deprivation, either partial or total, can result in serious brain injuries This type of damage can be
the result of a swimming accident, a birth injury, or medical malpractice. Traumatic brain injury is
one of the most common severe types of brain injuries. Signs of a traumatic brain injury include
an inability to concentrate, blurred vision, a persistent headache, fatigue, dizziness, cognitive
losses, and nausea. Often the person will lose consciousness, but at times a severe injury can
happen even though the person remained conscious.

Broken/Fractured Bones
A fracture is a break, usually in a bone. If the broken bone punctures the skin, it is called an open
or compound fracture. Fractures commonly happen because of car accidents, falls, or sports
injuries. Other causes are low bone density and osteoporosis, which cause weakening of the bones.
Overuse can cause stress fractures, which are very small cracks in the bone.
Symptoms of a fracture are

• Intense pain

• Deformity - the limb looks out of place

• Swelling

• Problems moving a limb

Catastrophic Injury
Generally, catastrophic injuries are those injuries that permanently prevent an individual from
performing work and enjoying life the way he or she would have before the accident. Often, they
involve permanent disabilities or have very long-term effects. Some common catastrophic injuries
are spinal cord injuries, severe burns, accidental amputations, brain injury, and paralysis.

The most common causes of catastrophic injuries are motor vehicle accidents, construction site
falls, medical malpractice, and intentional acts of violence. Catastrophic injuries can require
follow-up care and surgeries over many years.

Drowning
Drowning is a form of asphyxia. It is caused by the aspiration of fluid into an airway, usually
caused when the nose and mouth are submerged in water for a sufficient period of time. Initially,
when someone falls into the water, he or she will sink due to the force of the fall and gravity.
The victim may rise to the surface afterward because of the body’s natural buoyancy. However, he
or she may inhale water. While the person can hold his or her breath for varying periods, CO2 will
rise and stimulate the respiratory system so that he or she inhales again. This in turn produces
coughing, pushes air out of the lungs, and disturbs the rhythm of breathing. The drowning victim
may sink again.

Consciousness is usually lost within a three-minute [Link], the brain is losing [Link]
some cases, an accident victim drowns but survives and suffers from serious brain injuries, spinal
cord injuries, neck damage, or nerve damage.

Brain damage from drowning can happen very quickly,

Burn Injury
Burn injuries are very complex and can affect all the major organ systems. A well-known cause of
burns is accidental fires. Other sources of burns include scalding liquids or steam, contact with
something hot, contact with chemicals, electrocution, and radiation.

There are two types of burns from fires: flash burns and burns from flames. Those who suffer
burns from flames or electrical burns often need hospitalisation, whereas a flash burn victim
usually can be treated as an outpatient.

There are three degrees of severity when dealing with burns: first, second, and third degree.

First-degree burns affect only the top layer of skin. They should be submerged in cool water or
covered with cool compresses—not water that is too hot or too cold—until the pain stops, and
then they should be protected with a sterile nonstick bandage.

Second-degree burns affect the top layer of skin and the layer beneath it. As with firstdegree
burns, the affected area should be submerged in cool water or covered in cool compresses. The
area should be loosely covered with a sterile bandage. and a doctor should be seen to assess the
severity of the burns and prescribe pain medications, antibiotics, or a tetanus shot.

Third-degree burns are very serious, and emergency help should be called. While waiting, the
affected area of skin should be loosely covered with a sterile bandage or a clean sheet. The burn
should not be soaked in water, and the main goal is to stop the injury victim from going into
shock. Shock can be avoided by lying the injury victim flat, covering him or her with a blanket,
and elevating the feet about a foot above heart level when it is possible. It is possible for second-
and third-degree burns to leave very serious scars or even disfigurement.
Electrocution
Electrocution happens when someone is exposed to high voltage electricity and shocked, and it
can cause injuries that result in death. Toddlers and adolescents are the age groups most likely to
suffer electrocution. The severity of the injuries depends on the amount of voltage, how long the
victim encountered a current, the pathway of the electricity through the body, and the type of
current and circuit. Smaller currents, which can cause heart damage,. However, large currents can
cause permanent damage to cells and result in serious burns.

Some injuries arising out of electrocution include internal organ damage, cardiac arrest, brain or
nerve damage, headaches, changes in temperament or personality, loss of vision, memory loss,
neuropathy, loss of cognition, permanent heart muscle damage, unconsciousness, burns,
respiratory failure, and seizures. The organs most likely to be damaged are in the cardiovascular,
respiratory, and central nervous systems.

Some long-term complications from electrocution to the central nervous system include damage to
peripheral nerves, delayed spinal cord injuries, or psychiatric issues such as depression.

Amputation
Amputation occurs when any limb or piece of the body is severed, either in an accident or in a
planned surgery. An amputation can be partial or total. Losing a limb entirely can have more
consequences. People who suffer an amputation or require surgical amputation due to other
personal injuries may need medical care for the rest of their lives. So They may not be able to
work in their current jobs and have to change careers. They may experience significant limb pain
as well as debilitating psychological distress. A person who suffers an amputation often has to
adjust to a whole new life and relearn basis skills, such as eating, using the bathroom, and
walking.

There are two types of amputation: unintentional amputation arising out of a trauma to one or
more limbs and intentional surgical amputation. Unintentional amputations can be the result of car
accidents, work accidents, or malfunctioning, defective machines. Intentional amputations are
usually scheduled procedures to remove a limb due to, diabetes, bone infection, or another serious
condition. They can also be the result of medical malpractice when a doctor does not provide
appropriate treatment for a condition before amputation is necessary, the doctor amputates the
wrong limb, or there is insufficient medical evidence to support an amputation ordered by a
doctor.

Paralysis
Paralysis is an injury in which the victim loses muscle function in part or the entirety of his or her
body. Initially, it can be very frightening to the person suffering from it. It can be partial or
complete, and it may occur on one side of the body or both. In some cases, the paralysis is
temporary, while in others it is a permanent disability. One of the most common causes of
paralysis is trauma to the spine. Spinal cord injuries can be the result of blunt force that bruises or
crushes the cord. However, it also can be damaged when oxygen is cut off or when it is
penetrated. Damage can be mediated by neurotransmitters coming from damaged cells or an
inflammatory immune response.

In some cases, paralysis is temporary. Physical traumas, such as a heavy blow, diabetic
neuropathy, strokes, or pinched nerves, can cause temporary paralysis. However, any temporary
paralysis should be evaluated by a doctor who can determine whether it is likely to turn into a
permanent injury.

Scarring and Disfigurement

Suffering an injury causes immediate, physical damage that can be devastating, but many people
don’t think beyond the initial recovery to a traumatic injury. Many victims of injuries are left with
permanent imperfections – scars or other disfigurements – that not only serve as a physical
reminder to that trauma, but might also add emotional harm to their plight as well.
Scars are what remain after the skin has been wounded.

Soft Tissue Injuries

Not every type of injury is visible like a broken bone or life-threatening like brain trauma. Some
types of injuries involve damage to the muscles, ligaments, and tendons of the body, causing
substantial pain to a victim. These are known as soft tissue injuries, and they can form the basis of
a personal injury claim if they resulted from an accident. Soft tissue injuries also may result from
repetitive motions on the job that overuse a body part, and injured employees may be able to seek
workers’ compensation benefits in these cases.

Vision and Hearing Loss

While a person’s vision and hearing usually decline naturally with age, a sudden traumatic event
can cause loss of vision, hearing, or both.

For example, a car accident can cause a traumatic head injury that disrupts the optic nerve or
breaks bones around the eye. someone who slips and falls may suffer a skull fracture or a damage
eardrum. Another situation in which vision loss may occur is when someone uses chemicals at
work to which their eyes are exposed. Workplace activities involving explosions or loud noises
may cause permanent damage to hearing as well.

PTSD and Other Psychological Conditions

Many types of physical injuries are easy to prove. If you break your leg in a slip and fall, or if you
suffer burns in a car crash, it would be hard to deny that these injuries occurred. The situation can
become more complicated if a victim suffers from PTSD (post-traumatic stress disorder) or other
psychological conditions following a traumatic event like an accident. In these cases, the harm is
not visible, and some insurers or juries may be skeptical about it without strong evidence
supporting the condition.

IMMUNIZATION

Immunization: A process by which a person becomes protected against a disease through

vaccination. This term is often used interchangeably with vaccination or inoculation.

Immunization is the process of giving a vaccine to a person to protect them against disease. The
term vaccine refers to the material used for immunization, while vaccination refers to the act of
giving a vaccine to a person.

Immunity (protection) by immunization is similar to the immunity a person would get from
disease, but instead of getting the disease you get a vaccine. This is what makes vaccines such
powerful medicine.

Immunizations prepare the immune system to ward off a disease. To immunize against viral
diseases, the virus used in the vaccine has been weakened or killed.

Examples: tetanus, diphtheria, mumps, measles, pertussis (whooping cough), meningitis, and
polio.

IMPORTANCE OF IMMUNIZATION

Immunization saves lives. It protects you, your family and your community. Immunization helps
protect future generations by eradicating diseases.
Many infectious diseases are rare or eradicated now as a result of immunization programs, but
new infectious diseases are appearing around the world.

Immunity is the body’s way of preventing disease. Children are born with an immune system
composed of cells, glands, organs, and fluids located throughout the body.

HOW DOES IT WORKS?

Immunization protects against infectious disease. Vaccines work by stimulating the body's defense
mechanisms to provide protection against infection.

Vaccines can sometimes produce a stronger, longer-lasting protective response compared to

immunity from a natural infection. Vaccines use dead or severely weakened viruses to trick our
bodies into thinking we have already had the disease.

When you get a vaccine, your immune system responds to these weakened 'invaders' and creates
antibodies to protect you against future infection.

The Immune response is a natural mechanism activated by the human body when it detects the
presence of an infectious agent. Among our immune system’s most important features is its ability
to distinguish cells and molecules that belong to the body from those that don’t.

Its role is to stop a pathogenic agent (a virus, bacteria, or parasite, etc.) from spreading inside our
bodies. Once an infectious agent is recognized, the immune system responds to the invasion by
producing antibodies and competent cells in adequate quantities, targeting specifically the
infection or the disease.

MAJOR VACCINE PREVENTABLE DISEASES

POLIO

 Polio is a crippling and potentially deadly infectious disease that is caused by poliovirus.
The virus spreads from person to person and can invade an infected person’s brain and spinal
cord, causing paralysis.
 Polio was eliminated with vaccination, and continued use of polio vaccine has kept these
countries polio-free. But still a threat in some other countries. Making sure that infants and
children are vaccinated is the best way to prevent polio from returning. Make sure your baby is
protected with the polio vaccine.
 OPV stands for Oral Polio Vaccine. It protects children from poliomyelitis.
 When to give- OPV is given at birth called zero dose and three doses are given at 6, 10 and
14 weeks. A booster dose is given at 16-24 months of age.
 Route and site - OPV is given orally in the form of two drops.
 fIPV stands for Fractional Inactivated Poliomyelitis Vaccine. It is used to boost the
protection against poliomyelitis.
 When to give- Two fractional doses of IPV are given intradermally at 6 and 14 weeks of
age.
 Route and site- It is given as intradermal injection at right upper arm.
2. Tetanus and diphtheria

• Tetanus causes painful muscle stiffness and lock jaw and can be fatal. Parents used to warn
kids about tetanus every time we scratched, scraped, poked, or sliced ourselves on something
metal.
• Nowadays. Tetanus and adult diphtheria (Td) vaccine TT vaccine has been replaced with
Td vaccine in UIP to limit the waning immunity against diphtheria in older age groups.
• When to give: Td vaccine is administered to adolescents at 10 and 16 years of age and to
pregnant women.
• Pregnant women- Td-1 is given early in pregnancy as first dose and 4 weeks after Td1,
second dose of Td as Td-2 is given. Td- Booster is given, if pregnant woman has received 2 TT/Td
doses in a pregnancy within the last 3 years.
• Route and site: Td is given as intramuscular upper arm.
3. BCG

• About-BCG stands for Bacillus Calmette-Guerin vaccine. It is given to infants to protect

them from tubercular meningitis and disseminated TB.
• When to give - BCG vaccine is given at birth or as early as possible till 1year of
• Route and site- BCG is given as intradermal injection in left upper arm.
4. Pentavalent Vaccine

• About-Pentavalent vaccine is a combined vaccine to protect children from five diseases

Diphtheria, Tetanus, Pertussis, Haemophiles influenza type b infection and Hepatitis B.
• When to give - Three doses are given at 6, 10 and 14 weeks of age (can be given till one
year of age).
• Route and site-Pentavalent vaccine is given intramuscularly on anterolateral side of mid-
thigh
5. Hepatitis B

• Hepatitis B is a vaccine-preventable liver infection caused by the hepatitis B virus (HBV).

Hepatitis B is spread when blood, semen, or other body fluids from a person infected with the
virus enters the body of someone who is not infected.
• It’s especially dangerous for babies, since the hepatitis B virus can spread from an infected
mother to child during birth.
• About nine out of every 10 infants who contract it from their mothers become chronically
infected, which is why babies should get the first dose of the hepatitis B vaccine shortly after
birth.
• All pregnant women should be tested and all babies should be vaccinated. Hepatitis B
vaccine protects from Hepatitis B virus infection.
• When to give: Hepatitis B vaccine is given at birth or as early as possible within 24 hours.
Subsequently 3 doses are given at 6, 10 and 14 weeks in combination with DPT and Hib in the
form of pentavalent vaccine.
• Route and site- Intramuscular injection is given at anterolateral side of mid-thigh.

6. Rotavirus

• Rotavirus is a very contagious virus that causes diarrhea. Before the development of the
vaccine children had been infected.
• This virus cause inflammation in the stomach and [Link] cause vomiting, belly pain,
fever, and dehydration in infants, young children, and some adults.
• RVV stands for Rotavirus vaccine. It gives protection to infants and children against
rotavirus diarrhea. It is given in select states. When to give - Three doses of vaccine are given at 6,
10, 14 weeks of age (can be given at one year of age).
• Route and site-5 drops of liquid vaccine or 2.5 ml
(lyophilized vaccine) are given orally.

7. PCV

• PCV stands for Pneumococcal Conjugate Vaccine. It protects infants and young children
against disease caused Streptococcus pneumoniae. by the bacterium.
• When to give - The vaccine is given as two primary doses at 6 & 14 weeks of age followed
by a booster dose at 9-12 months of age.
• Route and site- PCV is given as intramuscular (IM) injection in antero-lateral side of mid-
thigh.
• It should be noted that pentavalent vaccine and PCV are given as two separate injections
into opposite thighs.
8. Measles

• Measles is very contagious, and it can be serious, especially for young children. Because
measles is common in parts of the world, unvaccinated people can get measles. Anyone who is not
protected against measles is at risk.
• Measles vaccine is used to protect children from measles. In few states Measles and
Rubella, a combined vaccine is given to protect from Measles and Rubella infection. Rubella is
spread by coughing and sneezing.
• It is especially dangerous for a pregnant woman and her developing baby.
• When to give-First dose of Measles or MR vaccine is given at 9 completed
months to12 months (vaccine can be given up to 5 years if not given at 9 12

months age) and second dose is given at 16-24 months.

• Route and site: Measles Vaccine is given as subcutaneous injection in right

upper arm.

9. JE vaccine

• JE stands for Japanese encephalitis is a virus spread by bite of infected mosquitoes. It’s a
common disease in rural and agricultural areas vaccine. It gives protection against Japanese
Encephalitis disease. JE vaccine is given in select districts endemic for JE after the campaign.
• When to give- JE vaccine is given in two doses first dose is given at 9 completed months-
12 months of age and second dose at 16-24 months of age.
• Route and site- Live attenuated vaccine is given as subcutaneous injection in left upper arm
and killed vaccine is given as intramuscular injection in anterolateral aspect of mid- thigh.
10. DPT booster

• DPT is a combined vaccine; it protects children from Diphtheria, Tetanus and Pertussis.
• When to give -DPT vaccine is given at 16-24 months of age is called as DPT first booster
and DPT 2nd booster is given at 5-6 years of age.
• Route and site- DPT first booster is given as intramuscular injection in antero-lateral side
of mid-thigh in left leg. DPT second booster is given as intramuscular injection in left upper arm.
IS COVID IS AN VACCINE PERVENTABLE DISEASES??

• If someone is unlucky to get Covid after having been vaccinated and you can still, in some
cases, get Covid after you get vaccinated, even though your chances seem to be lower, it is likely
you will experience a much milder disease.
• But still Once you receive your first shot, your body begins producing antibodies to the
coronavirus. These antibodies help your immune system fight the virus if you happen to be
exposed, so it reduces your chance of getting the disease
• COVID-19 is spreading in your community, stay safe by taking some simple precautions,
such as physical distancing, wearing a mask, keeping rooms well ventilated, avoiding crowds,
cleaning your hands, and coughing into a bent elbow or tissue. Check local advice where you live
and work. Do it all.

IMPAIRMENT, DISABILITY, HANDICAP, TYPES OF IMPAIRMENT,

CAUSES AND CONSEQUENCES OF DISABILITY, NEEDS AND PROBLEMS
OF PERSONS WITH DISABILITIES

 IMPAIRMENT, DISABILITY AND HANDICAP

The terms disability, impairment, and handicap have been used synonymously within the education,
counseling, and health literature. Although, each of these three terminologies can be used when
discussing disabling conditions, they convey three different meanings. To promote the appropriate use
of these terms the World Health Organization (WHO) provided the following definitions in their
International Classification of Impairment, Disability, and Handicap (1980):

 Impairment – any loss or abnormality of psychological, physiological or anatomical structure

or function.

 Disability – any restriction or lack of ability to perform an activity in the manner or within the
range considered normal for a human being.

 Handicap – the result when an individual with impairment cannot fulfill a normal life role.

Based on these definitions, it should be understood a handicap is not a characteristic of a person, rather
a description of the relationship between the person and the environment. Consider the following. A
person who is born blind (the impairment) is unable to read printed material, which is how most
information is widely disseminated (the disability). If this person is prevented from attending school or
applying for a job because of this impairment and disability, this is a handicap. This person may be
able to perform the daily activity (reading) using some type of assistive technology to overcome this
handicap.

DIFFERENCE BETWEEN IMPAIRMENT, DISABILITY AND HANDICAP

There is a difference between disability, handicap and impairment: ‘Impairment’ is concerned with the
abnormalities of body structure and appearance or of organ and system functioning, resulting from any
cause. One can use ‘impairment’ in conjunction with speech, hearing, sight and mobility or with other
form of loss or abnormality. A person may also be “impaired” either by a correctable one (such as
cerebral palsy).

‘Disability’ is the functional consequence of impairment, in terms of altered functional performance

and activity by the individual. People may be disabled by physical, intellectual or sensory impairment,
medical conditions or mental illness. Such impairments, conditions or illnesses may be permanent or
transitory in nature. A permanent physical, sensory or intellectual impairment substantially limits one
or more of a person’s major life activities, including reading, writing and other aspects of education;
holding a job, and managing various essential functions of life such as dressing, bathing and eating.

‘Handicap’ relates to the disadvantages experienced in society by the individual, as a result of his or
her disability. It is basically society and the physical environment what makes people handicapped.
Not all impairments result in disabilities. One may also be disabled but not handicapped.

 TYPES OF IMPAIRMENT

Impairments can be permanent, temporary, or situational. They can also be invisible.

1. Vision impairments:

 A person who is blind has a permanent vision impairment.

 A person with an eye injury has a temporary vision impairment.

 A person in a bright environment has a situational vision impairment.

2. Hearing impairments:

 A person who is deaf has a permanent hearing impairment.

 A person with an ear infection has a temporary hearing impairment.

 A person in a noisy room has a situational hearing impairment.

3. Mobility impairments:
 A person who is paralyzed has a permanent mobility impairment.

 A person with a broken arm has a temporary mobility impairment.

 A person carrying a large box has a situational mobility impairment.

4. Cognitive impairments:

 A person diagnosed as having dyslexia has a permanent cognitive impairment.

 A person with a concussion has a temporary cognitive impairment.

 A distracted driver has a situational cognitive impairment.

5. Speech impairments:

 A person with apraxia of speech has a permanent speech impairment.

 A person with laryngitis has a temporary speech impairment.

 A person with a heavy accent has a situational speech impairment.

CAUSES AND CONSEQUENCES OF DISABILITY

CAUSES:

[Link] and malnutrition:

Poverty is one of the biggest causes of disability. Poor people are most vulnerable to disability because
they are forced to live and work in unsafe environments with poor sanitation, crowded living
conditions, and with little access to education, clean water or enough good food.

This makes diseases such as tuberculosis, polio and the severe disabilities they cause much more
common because diseases get passed from one person to another more easily. Many babies who are
born in poor families may be born with disabilities or may die in infancy. This may be because the
mother did not get enough to eat when she was a girl.

2. War:

In today’s wars, more civilians than soldiers are killed or disabled and most of them are women and
children. Explosions cause people to become deaf, blind and lose their limbs, as well as causing other
injuries. Their mental health is also badly affected with violence. The destruction of homes, schools,
health centers and means of livelihood that results from conflicts and wars leads to increased
disability, poverty and disease. Land mines, cluster bombs, bullets and chemicals used in wars cause
more disabilities in the world today than anything else.

3. Nuclear Accidents:

Many people have suffered after being exposed to massive amounts of radiation. This happened after
accidents in nuclear power plants at Three Mile Island in the USA in 1979 and at Chernobyl in the
Ukraine in 1986. And it also happened when the USA dropped nuclear bombs on Japan in 1945. These
incidents caused widespread destruction and death from exposure to radiation. The people who
survived these accidents and bombing attacks have suffered mainly from cancers either tumors in
various parts of the body, especially in the thyroid gland or leukemia (cancer of blood), all of which
bring an early death. In communities where these nuclear incidents happened, there has also been an
increase in the number of children born with learning difficulties, such as Down Syndrome.

4. Poor Access to Health Care:

Good health care can prevent many disabilities. Difficult labor and birth can cause a baby to born with
a disability such as cerebral palsy. Trained birth attendants who can identify risks and handle
emergencies can prevent babies from being born with many disabilities.

Immunization can also prevent many disabilities. But many times vaccines are not available, or
people who are poor or live far from cities cannot afford them, or there are not enough for everyone.

[Link]:

Some illnesses a pregnant woman may get can cause physical or learning problems when her baby is
born. Illnesses that can cause birth defects include German measles (rubella), which is a cause of
deafness in newborn babies. There is a vaccine that gives protection against rubella, but a woman who
gets an immunization of the rubella should not get pregnant for one month afterward.

Syphilis, herpes and HIV can also be passed from a mother to her baby and can cause birth defects. So
women need to be tested and treated for sexually transmitted infections to protect the baby developing
in the womb.

[Link] and Injections:

When used correctly, certain injected medicines, like some vaccinations, are important to protect
health and prevent disability. However, there is a worldwide epidemic of unnecessary injections.

Each year these injections sicken, kill, or disable millions of persons, especially children. Giving
injections with an unclean needle or syringe is a common cause of infection and can pass the germs
that cause serious diseases such as HIV/AIDS or hepatitis. Unclean injections are also a common
cause of injection that can lead to paralysis or spinal cord injury or death. Also, some injected
medicines can cause dangerous allergic reactions, poisoning, and deafness to a baby in the mother’s
womb.

[Link] Work Conditions:

Women who work long hours without enough rest are likely to have accidents. Women who work in
factories, mines or on agricultural plantations can be exposed to dangerous machinery, tools or
chemicals. Accidents, overwork and exposure to chemicals can all cause disability.

A growing number of women have also been permanently injured due to violence at work. Supervisors
sometimes use violence and threats to try and make women work harder and faster. Sometimes the
authorities bring in the military or police to stop women from striking or protesting unsafe working
conditions.

8. Accidents:

Many women and children get disabling injuries at home by burns from cooking fires, falls, road
accidents, and breathing or drinking toxic chemicals. Workplace accidents, especially in less regulated
sectors such as construction, agriculture, mining and smaller businesses, are a common source of
disability.

9. Poisons and Pesticides:

Poisons such as lead found in paints, pesticides such as rat poison, and other chemicals can cause
disabilities in people and cause birth defects in babies growing in the womb. Smoking or chewing
tobacco, breathing smoke, and drinking alcohol during pregnancy can also harm a child before she is
born.

Workers often use chemicals on the job or in the fields without being taught how to use them safely, or
without even knowing if they are dangerous. Accidents in factories can release poisons into the air,
water, or ground, causing terrible health problems, including permanent disabilities.

10. Inherited Disabilities:

Some disabilities are known to be inherited, such as Spinal Muscular Atrophy and Muscular Ditrophy
(diseases of the muscles and nerves). Women who already have one or more children with an inherited
disability are more likely to give birth to another child with the same problem.

Other disabilities can result when close blood relatives (such as brothers and sisters, first cousins or
parents and children) have children together. Children born to mothers 40 years of age or older are
more likely to have Down syndrome. However, most disabilities are not inherited. In most cases, the
parents of a baby born with a disability did nothing to cause the disability. They should never be
blamed.
CONSEQUENCES:

People with disabilities face multi-dimensional marginalization in rural India, where impairment is
largely an outcome of poverty and the lack of basic health services. Government policy is inadequate.
The people concerned are agents of their own interests.

[Link] Work in Agriculture:

In most societies, official data shows that, while Persons with Disabilities PWDs do not participate in
work to the same extent as able bodied persons do, most are engaged in a range of paid and unpaid
work. In agriculture dominated economies, moreover, only those with very severe disabilities and the
very old do not work. The problem is that PWDs work is not socially recognized and does not lead to
full social integration. All too often, PWDs are excluded from education, and end up in low-skill jobs
that do not allow them to escape poverty.

In rural India, PWDs are mostly wage laborers at the lowest rung of farm employment. According to
Action Aid Study, all wage laborers get very little money, and find only seasonal jobs. Due to
impairment, PWDs tend to be the last to be hired, the first to be fired and the worst paid. The bottom
line is that seasonal wage labor does not offer PWDs any real prospects. Accordingly, many of them
engage in other kinds of work. Such activities, however, are petty jobs at very low pay. Most women
with disabilities, moreover, engage in domestic work that remains unrecognized.

[Link] about Self-employment:

The standard approach to including PWDs in social and economic life is to teach them skills in
various crafts and trades in the hope that they will start their own businesses and earn a living. There is
no guarantee that skills lead to gainful self-employment, since entrepreneurship requires more than
some trades competences. Entrepreneurs must understand markets and be able to identify business
opportunities.

They must not only produce things, but market them too. They must make plans to expand, and as
such plans succeed, managing the supply chain becomes ever more demanding. Only very few persons
have an aptitude for enterprise, and even they typically need some assistance to succeed.
Unsurprisingly, most PWDs are unable to set up viable micro businesses to escape poverty and
improve standing in society.

[Link] Achieving Environment:

India has several programs that are meant to alleviate poverty. Typically, they are also meant to take
disabilities into account. Despite various provisions, policy makers are not doing a great job of
protecting and promoting the livelihood rights of the PWDs. The PWD Act of 1995 neither empowers
any authority to enforce provisions, nor does it define any system of accountability.

As a result, government bureaucracies are not under pressure to create mechanisms for inclusion. The
National Handicapped Finance and Development Corporation NHFDC is an example. It was set up in
1997 to promote PWDs, but by December 2008, it had supported a mere 36,000 people, and half of its
funds remained unspent.

NEEDS AND PROBLEMS OF PERSONS WITH DISABILITIES

NEEDS:

Disabled people have agreed 12 basic requirements to ensure equality for all within our society.

1. Full access to the environment (towns, countryside & buildings)

2. An accessible transport system

3. Technical aids and equipment

4. Accessible/adapted housing

5. Personal assistance and support

6. Inclusive education and training

7. An adequate income

8. Equal opportunities for employment

9. Appropriate and accessible information

[Link] (towards self-advocacy)

[Link]

[Link] and accessible health care

PROBLEMS:

[Link] Barriers:

Attitudinal barriers are the most basic and contribute to other barriers. For example, some people may
not be aware that difficulties in getting to or into a place can limit a person with a disability from
participating in everyday life and common daily activities. Examples of attitudinal barriers include:
 Stereotyping: People sometimes stereotype those with disabilities, assuming their quality of
life is poor or that they are unhealthy because of their impairments.

 Stigma, prejudice, and discrimination: Within society, these attitudes may come from people’s
ideas related to disability-People may see disability as a personal tragedy, as something that needs to
be cured or prevented, as a punishment for wrongdoing, or as an indication of the lack of ability to
behave as expected in society.

[Link] Barriers:

Communication barriers are experienced by people who have disabilities that affect hearing, speaking,
reading, writing, and or understanding, and who use different ways to communicate than people who
do not have these disabilities. Examples of communication barriers include:

 Written health promotion messages with barriers that prevent people with vision impairments
from receiving the message. These include:

 Use of small print or no large-print versions of material, and

 No Braille or versions for people who use screen readers.

 Auditory health messages may be inaccessible to people with hearing impairments, including

 Videos that do not include captioning, and

 Oral communications without accompanying manual interpretation (such as, American Sign
Language).

 The use of technical language, long sentences, and words with many syllables may be
significant barriers to understanding for people with cognitive impairments.

[Link] Barriers:

Physical barriers are structural obstacles in natural or manmade environments that prevent or block
mobility (moving around in the environment) or access. Examples of physical barriers include:

 Steps and curbs that block a person with mobility impairment from entering a building or using
a sidewalk;

 Mammography equipment that requires a woman with mobility impairment to stand; and

 Absence of a weight scale that accommodates wheelchairs or others who have difficulty
stepping up.

[Link] Barriers:
Policy barriers are frequently related to a lack of awareness or enforcement of existing laws and
regulations external icons that require programs and activities be accessible to people with disabilities.
Examples of policy barriers include:

 Denying qualified individuals with disabilities the opportunity to participate in or benefit from
federally funded programs, services, or other benefits;

 Denying individuals with disabilities access to programs, services, benefits, or opportunities to

participate as a result of physical barriers; and

 Denying reasonable accommodations to qualified individuals with disabilities, so they can

perform the essential functions of the job for which they have applied or have been hired to perform.

[Link] Barriers:

Programmatic barriers limit the effective delivery of a public health or healthcare program for people
with different types of impairments. Examples of programmatic barriers include:

 Inconvenient scheduling;

 Lack of accessible equipment (such as mammography screening equipment);

 Insufficient time set aside for medical examination and procedures;

 Little or no communication with patients or participants; and

 Provider’s attitudes, knowledge, and understanding of people with disabilities.

[Link] Barriers:

Social barriers are related to the conditions in which people are born, grow, live, learn, work and age
or social determinants of health that can contribute to decreased functioning among people with
disabilities. Here are examples of social barriers:

 People with disabilities are far less likely to be employed. In 2017, 35.5% of people with
disabilities, ages 18 to 64 years, were employed, while 76.5% of people without disabilities were
employed, about double that of people with disabilities.

 Adults age 18 years and older with disabilities are less likely to have completed high school
compared to their peers without disabilities (22.3% compared to 10.1%).

 People with disabilities are more likely to have less income than compared to people without
disabilities (22.3% compare to 7.3%).

 Children with disabilities are almost four times more likely to experience violence than
children without disabilities.
[Link] barriers:

Transportation barriers are due to a lack of adequate transportation that interferes with a person’s
ability to be independent and to function in society. Examples of transportation barriers include:

 Lack of access to accessible or convenient transportation for people who are not able to drive
because of vision or cognitive impairments, and

 Public transportation may be unavailable or at inconvenient distances or locations.

CONCLUSION

The terms impairment, disability and handicap are often used interchangeably, but have distinct
meanings that help to describe the physical and social impact on an individual. According to the WHO
International Classification of Impairment, Disabilities and Handicap, impairment relates to bodily
functions, disability to activities, and handicap to social roles. The three are distinct but interrelated.
Impairment is the loss or abnormality of a body function that can be anatomical, physiological or
psychological, e.g. a missing limb or diagnosed mental disorder.

A disability is an inability or restricted ability to perform an activity within the normal human range,
e.g. being unable to walk. A handicap is a disadvantage resulting from impairment or disability that
limits the social role of an individual, e.g. being unable to work somewhere due to limited access.
Impairment is any loss or abnormality of psychological, physiological or anatomical structure or
function.

Disability is any restriction or lack (resulting from an impairment) of ability to perform an activity in
the manner or within the range considered normal for a human being. Handicap is a disadvantage for a
given individual that limits or prevents the fulfillment of a role that is normal.

REHABILITATION – DEFINITION, PRICIPLES AND TYPES

Definition – Rehabilitation
 Rehabilitation is defined as “a set of interventions designed to optimize functioning and
reduce disability in individuals with health conditions in interaction with their environment.
(WHO)
 Rehabilitation is " an attempt to provide the best possible community role which will
enable the patient to achieve the maximum range of activity, interest and of which he is capable".
Maxwell Jones [1952]
 Medical Definition of Rehabilitation: The process of helping a person who has suffered an
illness or injury restore lost skills and so regain maximum self-sufficiency.
Objectives Of Rehabilitation

 To restore the physical, social and psychological potential to a level, so that he can
independently function and carry on an independent life.
 To prevent disability and return to normalcy.
 To maximize level of restoration through different interventions.
Training in vocational methods to suit working with residual disability and earn a lively and
independently

Principles of Rehabilitation

 Rehabilitation should begin during the initial contact with the patient.
 Increasing independence would be the first step in rehabilitation process.
 Primary focus is on improvement of capabilities and competence of patients with
psychiatric problems.
 Maximum use must be made of residual capacities.
 Patient’s active participant is very essential.
 Skill development, therapeutic environment are fundamental interventions for a successful
rehabilitation process.
 Every patient has a right to the rehabilitation services.

Types of rehabilitation

Medical rehabilitation
Medical rehabilitation is the process targeted to promote and facilitate the recovery from physical
damage, psychological and mental disorders, and clinical disease. Physical medicine and
rehabilitation is a medical specialty that helps people regain body functions they lost due to
medical conditions or injury.
❖ Medical Rehabilitation: help a person better in all his daily physical and mental activities.
Related to increasing the potential capabilities and correction of deformities, restoration of
functions. Rehabilitation can help many body functions, including bowel and bladder problems,
chewing and swallowing, problems thinking or reasoning, movement or mobility, speech, and
language
❖ Persons with disabilities often suffer from the following physical problems:
● Motor weakness/paralysis
● Spasticity
● Sensory Loss
● Pressure sores
● Deformities and Contractures
● Loss of limb or part
● Urinary and fecal incontinence/ retention
● Pain.
There may also be hearing, speech, visual, mental retardation or higher function problems
either in isolation or combination of them.

❖ Due to the above physical problems, there are subsequent functional limitation in the
performance of activities of daily living (ADL). For example:

● Transferring from one place to another

● Mobility, ambulation and transportation
● Self-care activities like toileting, bathing, grooming etc.
● Social and leisure activities
● Work place activities.

❖ For the physical restoration and achieving maximum function and independence,
Rehabilitation interventions are called for. These interventions are:-

1. Appropriate exercise therapy for maintaining the range of motion of the joints, regaining
or improving the muscle power in the weak muscles and strengthening of normal muscles.
2. Restoring the function of the affected extremity by appropriate training, including gait
training.
3. Provision of external appliance, splint or caliper if required.
4. Relief of pain by means of physical modalities like heat, cold, electricity etc.
5. Bladder1 bowel training to achieve continence.
6. Training in the activities of daily living in order to restore the various lost functions like
transfers, self-care etc. It may require the use of self-help devices, if indicated.
7. Education of the patient to maintain the physical status so achieved preventing any
complications.
8. Artificial limbs (prostheses); splints1 calipers (orthoses), walking aids like crutches, sticks,canes,
walker or wheel chair may be prescribed depending upon the physical status of the patient. These are
to be fabricated or made available to him and patient trained in their
use.

Psychosocial Rehabilitation
People with mental illnesses and other psychiatric concerns often need help in different aspects of
their lives including work, living, social, and learning environments. One approach that can help
people manage symptoms and improve functioning is known as psychosocial rehabilitation (PSR).
PSR is a treatment approach designed to help improve the lives of people with disabilities. The
goal of psychosocial rehabilitation is to teach emotional, cognitive, and social skills that help those
diagnosed with mental illness live and work in their communities as independently as possible.

Core goals of Psycho social rehabilitation

Hopeful: People may be left feeling demoralized as a result of their condition; rehabilitation
focuses on helping clients feel hopeful about the future.
Empowered: Each individual needs to feel that they are able to set their own goals and have the
power and autonomy to pursue those aims.
Skilled: Rehabilitation aims to teach people skills to help them manage their condition and live
the life they want to live. This includes living skills, work skills, social skills, and others.
Supported: Mental health professionals should offer support and help clients build relationships
and social connections in their community.

Key principles of psychosocial rehabilitation

● All people have potential that can be developed.

● People have a right to self-determination.

● The emphasis is on the individual's strengths rather than their symptoms.

● Each person's needs are different.

● Professional services should be committed and take place in as normalized an environment as

possible.

● There is a focus on a social model of care (as opposed to a medical model).

● It is centered on the present rather than fixated on the past.

Vocational rehabilitation
The term vocational rehabilitation means that part of the continuous and co-ordinated process of
rehabilitation which involves the provision of those vocational services, e. g. vocational guidance,
vocational training and selective placement, designed to enable a disabled person to secure and
retain suitable employment.
Vocational rehabilitation services should be made available to all disabled persons, whatever the
origin and nature of their disability and whatever their age, provided they can be prepared for, and
have reasonable prospects of securing and retaining, suitable employment.

Importance of vocational rehabilitation

Vocational rehabilitation provides an opportunity for an individual to become self sustaining and
so gain self respect and independence.
vocational rehabilitation programs is to aid the disabled in receiving training for new occupations,
locating jobs, retaining jobs, and building permanent careers.

Educational rehabilitation
Education is a key component in the rehabilitation.
The effective implementation of value based education is necessary for juveniles at school
level,where juveniles’ crimes are increasing day by day.
VBE (value based education) provides a positive focus for redirecting juveniles’ inappropriate
behaviors. It helps to create a collaborative and cohesive school community which finds juveniles’
problems and tries to solve them effectively. It enhances quality teaching, seeks for greater care of
students, makes students more tolerant, cooperative and responsible towards their goal and makes
the student-teacher relationship trustworthy.
The engagement of co-curricular activities with the values and community based programme
develop the ability of freedom of self-expression, self-confidence and universal brotherhood
among juveniles

Rehabilitation is one of the core health strategies of the World Health Organization, along with
promotion, prevention, treatment, and palliative care. Rehabilitation is an essential service offered
across all levels of the health care system. Rehabilitation is without doubt a crucial aspect of
health that is aimed at enhancing functionality and independence.
REHABILITATION – SOCIAL WORKER AS A MEMBER OF THE
MULTIDISIPLINARY REHABILITATION TEAM, REHABILITATION
COUNSELLING

MULTIDISCIPLINARY REHABILITATION

A multidisciplinary team approach for care and service is the basis of rehabilitation treatment.
Multidisciplinary is when many different disciplines work together toward a common goal. A
physiatrist usually directs the team. Other specialists also play important roles in the treatment and
education process. individual goal for the patient and in general there is little. overlap between the
team members. However, the term “multidisciplinary team” is also used to. describe a team
consisting of many different professions. working in the field of rehabilitation medicine.
Multidisciplinary teams (MDTs) are the mechanism for organizing and coordinating health and
care services to meet the needs of individuals with complex care needs. The teams bring together
the expertise and skills of different professionals to assess, plan and manage care jointly.
multidisciplinary approach involves drawing appropriately from multiple. disciplines to explore
problems outside of normal boundaries and reach solutions. based on a new understanding of
complex situations.

GOALS OF MULTIDISCIPLINARY REHABILITATION

The primary goal of a healthcare team is to provide

 quality patient care

 however we must recognize what feeds into the goals that determine a team actions.
 Maintain a professional and mutually satisfying relationship with patients.
 inform patients of their oral health care needs and treatment options.
 demonstrate a commitment to continually enhance our knowledge
 skill and judgment

SIGNIFICANCE OF MULTIDISCIPLINARY REHABILITATION TEAM

Multidisciplinary teams convey many benefits to both the patients and the health professionals
working on the team. These include improved health outcomes and enhanced satisfaction for
clients, and the more efficient use of resources and enhanced job satisfaction for team members.
Multidisciplinary and multiagency working involves appropriately utilizing knowledge, skills and
best practice from multiple disciplines and across service provider boundaries to redefine, re-
scope and reframe health and social care delivery issues, and to reach solutions based on an
improved collective understanding.

ROLE OF SOCIAL WORKER IN MULTIDISCIPLINARY TEAM

 Teamwork is one of the most fundamental factors in rehabilitation medicine.

 Different professionals, assessment and evaluations are brought together to obtain a holistic
view of the patients problems.

 This allows realistic rehabilitation measurements to be taken and realistic objectives to be

set in order to obtain the best possible outcome.

 “The term refers to activities that involve the efforts of individuals from a number of
disciplines. These efforts are disciplinary- oriented and although they may impinge upon clients or
activities dealt with by other disciplines. They approach them primarily through each discipline
relating to its own activities”.

 Professionals in the multidisciplinary model usually work independently to accomplish

discipline specific goals. Sharing information and making decisions based on that information
these team members regarding care planning.

MEMBERS OF REHABILITATION TEAM

 Patient and family

 Nurses: registered nurses and licensed particular nurses
 Advance practice nurses: clinical nurse specialist and nurse practioners.
 Psychiatrists: doctor of physical medicine and rehabilitation
 Therapist: physical and occupational therapist, speech- language pathologists, Recreational
therapists and respiratory therapist.
 Psychologist
 Case managers
 Social workers
 Dieticians
 Chaplains

REHABILITATION COUNSELING

Rehabilitation counseling is a process that is designed to assist people with disabilities in

accomplishing their goals and in achieving independence and full participation in all aspects of
community life. Rehabilitation counseling is also a recognized counseling profession, with a long
history and established professional credentialing procedures. It is variously conceptualized as a
specialty within counseling, as a specialty within rehabilitation, and as a separate profession.

As is true with other professions and specialties, a variety of definitions of rehabilitation

counseling have been advanced by individual scholars and practitioners and by professional
organizations. An official definition of rehabilitation counseling is provided by the Commission
on Rehabilitation Counselor Certification (CRCC), the national credentialing body for
rehabilitation counselors, in their “scope of practice statement”:

The historical roots of rehabilitation counseling date back to the early 1900s. During World War I,
many military personnel returned home with disabilities, and rehabilitation programs were
established to assist them in returning to productive civilian roles. The Soldier Rehabilitation Act
(Public Law 65-178) was enacted in 1918. Simultaneously, efforts were under way in several
different states to assist workers who had been injured in industrial accidents in returning to work,
the roots of contemporary worker’s compensation programs. Finally, the Smith-Fess Act of 1920
(Public Law 66-236) established a vocational rehabilitation program for civilians with disabilities.
All of these initiatives evolved into the extensive network of government, private-nonprofit, and
private-for-profit agencies and programs to assist people with disabilities. Rehabilitation
counseling plays a central role within these agencies and programs, providing assessment,
counseling, and coordination of rehabilitation services.

GOALS OF REHABILITATION COUNSELING

The ultimate aim of rehabilitation is to provide the individual with opportunities for full and
effective participation and inclusion in society, including studying, working and access to all
services on the same basis as other citizens. The primary goal of rehabilitation counseling is to
assist individuals with disabilities gain or regain their independence through employment or some
form of meaningful activity.
REHABILITATION COUNSELING CAREERS

Careers in the profession

In the United States, many rehabilitation counselors work in a variety of arenas. The predominant
placement of rehabilitation counselors are state rehabilitation programs as Vocational Counselors,
social service agencies as Administrators, and at the collegiate level as Disability
Counselors/Specialists

State rehabilitation programs

The predominant need for rehabilitation counselors is within federal/state funded vocational
rehabilitation programs. While the Veterans Benefits Administration has its own vocational
rehabilitation program, the rest of Federal/State Vocational Rehabilitation Programs are funded
and regulated by the Rehabilitation Services Administration (RSA), a division of the U.S
Department of Education. Although policies vary from state to state, rehabilitation counselors who
work in the federal/state systems typically must hold a master's degree in rehabilitation
counseling, special education or a related field, and are required to be certified or be eligible to sit
for the certification examination. People accepting employment in the federal/state Vocational
Rehabilitation programs do so with the agreement they will meet these qualifications by a
specified date to maintain employment.

Social service agencies and the corporate sector

Rehabilitation Counselors can work in the non-profit/corporate sector in various ways. Though the
majority start as counselors, specializing in career counseling, most rehabilitation counselors that
work in the non-profit arena rise to the administration level, either in supervising staff or directing
programs for people with disabilities. Others supervise staff that work in case management
programs that serve people with disabilities. Some rehabilitation counselors work with
Independent Living Centers, doing community engagement, advocacy, outside referrals, and
social service provision for people with disabilities. Entrepreneurial rehabilitation counselors also
work as consultants, establishing their own private service agencies. Counselors in working with
corporations focus on community relations or corporate service, serving as liaisons between
companies and charities or service programs.

College disability counselors and specialists

By law all community colleges, colleges and universities are required to make reasonable
accommodations for students with disabilities. To satisfy this requirement most collegial settings
have a Disability Resources Center, a Special Needs Coordinator or a similar office. Staff are
responsible for coordinating services that may include but are not limited to: advocacy/liaison,
computer access, counseling (academic, personal, vocational), equipment loan,
information/referral services, in-service awareness programs, notetakers, on campus orientation
and mobility training for visually impaired students, priority registration assistance, readers,
scribes, shuttle (on-campus), sign language interpreters, test proctoring/testing accommodations,
and tutors.

Forensic rehabilitation counselors

Forensic rehabilitation counselors can work as consultants, serving as witnesses and advocates in
the legal profession. Forensic rehab counselors serve as legal advisors with specialized
information on disability in the areas of higher education access, Social Security, marital
dissolution, personal injury, and Worker's Compensation.
 MODULE 3

ENVIRONMENTAL HEALTH

INTRODUCTION

The environment can directly and indirectly impact on our health and wellbeing.

Environmental health examines the interaction between the environment and our

health The health of the environment is connected to the health of people.

Environmental health professionals are working to better understand the environment

and its connections to human health. refers to aspects of human health (including

quality of life) that are determined by physical, chemical, biological, social and

psychosocial factors in the environment. Environment broadly includes everything

external to ourselves, including the physical, natural, social and behavioral

environments. Health is a state of complete physical, mental and social wellbeing, and

is not merely the absence of disease or illness. We need safe, healthy and supportive

environments for good health. The environment in which we live is a major

determinant of our health and wellbeing. We depend on the environment for energy

and the materials needed to sustain life, such as:

 clean air,

 Safe drinking water

 nutritious food

 Safe places to live.

Many aspects of our environment – both built and natural environment – can impact

on our health. It’s important that we interpret health issues in the wider context of our

environment and where we live.

CONTENT

Environmental health is the branch of public health that: focuses on the relationships

between people and their environment; promotes human health and well-being; and

fosters healthy and safe communities. Environmental health is a key part of any

comprehensive public health system. Environmental health include ; air pollution ,

water pollution , poor housing ,climate change ,health hazards of accumulated solid

waste , environmental sanitation, food sanitation .The health of the environment is

connected to the health of people. Environmental health professionals are working to

better understand the environment and its connections to human health.

AIR POLLUTION

Air pollution occurs when gases, dust particles, fumes (or smoke) or odor are

introduced into the atmosphere in a way that makes it harmful to humans, animals and

plant. Air pollution threatens the health of humans and other living beings in our planet.

It creates smog and acid rain, causes cancer and respiratory diseases, reduces the

ozone layer atmosphere and contributes to global warming. In this industrial age, air
pollution cannot be eliminated completely, but steps can be taken to reduce it. The

government has developed, and continues to develop, guidelines for air quality and

ordinances to restrict emissions in an effort to control air pollution. On an individual

level, we can reduce our contribution to the pollution problem by carpooling using

public transportation. Additionally, buying energy-efficient light bulbs and appliances

or otherwise reducing our electricity use will reduce the pollutants released in the

production of electricity, which creates the majority of industrial air pollution

Causes: Factors Responsible for Air Pollution

Air pollution can result from both human and natural actions. Natural events that

pollute the air include forest fires, volcanic eruptions, wind erosion, pollen dispersal,

evaporation of organic compounds and natural radioactivity. Sources of air

pollution refer to the various locations, activities or factors which are responsible

for the releasing of pollutants into the atmosphere.

Man-made sources mostly related to burning different kinds of fuel; "Stationary

Sources" include smoke stacks of power plants, manufacturing facilities (factories) and

waste incinerators, as well as furnaces and other types of fuel-burning heating devices.

In developing and poor countries, traditional biomass burning is the major source of air

pollutants; traditional biomass includes wood, crop waste and dung.

• "Mobile Sources" include motor vehicles, marine vessels, aircraft and the effect

of sound etc.
 Chemicals, dust and controlled burn practices in agriculture and forestry

management. Controlled or prescribed burning is a technique sometimes used in

forest management, farming, prairie restoration or greenhouse gas abatement.

Natural source

 Dust from natural sources, usually large areas of land with few or no vegetation.

 Methane, emitted by the digestion of food by animals, for example cattle.

 Radon gas from radioactive decay within the Earth's crust. Radon is a colorless,

odorless, naturally occurring, radioactive noble gas that is formed from the decay of

radium

 Smoke and carbon monoxide from wildfires

 Vegetation, in some regions, emits environmentally significant amounts of VOCs

on warmer days. Consequences: Effects of Air Pollution

Health Effects

Air pollution is a significant risk factor for multiple health conditions including

respiratory infections, heart disease, and lung cancer, according to the WHO. The

health effects caused by air pollution may include difficulty in breathing, wheezing,

coughing, asthma and aggravation of existing respiratory and cardiac conditions.

These effects can result in increased medication use, increased doctor or emergency

room visits, more hospital admissions and premature death. The human health effects

of poor air quality are far reaching, but principally affect the body's respiratory system

and the cardiovascular system. Individual reactions to air pollutants depend on the type

of pollutant person is exposed to, the degree of exposure, the individual's health status

and genetics. Around the world, children living in cities with high exposure to air
pollutants are at increased risk of developing asthma, pneumonia and other lower

respiratory infections. Because children are outdoors more and have higher minute

ventilation they are more susceptible to the dangers of air pollution. Risks of low

initial birth weight are also heightened in such cities.

Government (or community) level prevention

 Governments throughout the world have already taken action against air pollution

by introducing green energy. Some governments are investing in wind energy and

solar energy, as well as other renewable energy, to minimize burning of fossil fuels,

which cause heavy air pollution.

 Governments are also forcing companies to be more responsible with their

manufacturing activities, so that even though they still cause pollution, they are

a lot controlled.

 Companies are also building more energy efficient cars, which pollute less than

before.

WATER POLLUTION

water pollution (or aquatic pollution) is the contamination of water bodies, usually as

a result of human activities. Water bodies include for example lakes, rivers, oceans,

aquifers and groundwater. Water pollution results. When contaminants are introduced

into the natural environment. For example, releasing inadequately treated wastewater

into natural water bodies can lead to degradation of aquatic ecosystems. In turn, this can
lead to public health problems for people living downstream. They may use the same

polluted river water for drinking or bathing or irrigation. Water pollution is the leading

worldwide cause of death and disease, e.g. due to water-borne diseases. Water pollution

can be classified as surface water or groundwater pollution. Marine pollution and

nutrient pollution are subsets of water pollution. Sources of water pollution are either

point sources or non-point sources. Point sources have one identifiable cause of the

pollution, such as a storm drain or a wastewater treatment. Plant. Non-point sources are

more diffuse, such as pollution is the result of the cumulative effect over time. All

plants and organisms living in or being exposed to polluted water bodies can be

impacted. The effects can damage individual species and impact the natural biological

communities they are part of.

 Effects of water pollution: Polluted water has effects on both human and aquatic

life; Deteriorating water quality is damaging the environment, health conditions and the

global economy. The president of the World Bank, David Malpass, warns of the

economic impact: "Deteriorating water quality is stalling economic growth and

exacerbating poverty in many countries". The explanation is that, when biological

oxygen demand — the indicator that measures the organic pollution found in water —

exceeds a certain threshold, the growth in the Gross Domestic Product (GDP) of the

regions within the associated water basins falls by a third. In addition, here are some of

the other consequences:

 Chemicals in water that affect human health: Some of the chemicals

affecting human health are the presence of heavy metals such as Fluoride, Arsenic,

Lead, Cadmium, Mercury, petrochemicals, chlorinated solvents, pesticides and

nitrates. Fluoride in water is essential for protection against dental carries and
weakening of the bones. ect of water pollution on human health. Arsenic is a very

toxic chemical that reaches the water naturally or from wastewater of tanneries,

ceramic industry, chemical factories and from insecticides such as lead arsenate,

effluents from fertilizers factories and from fumes coming out from burning of coal

and petroleum. Arsenic is highly dangerous for human health causing respiratory

cancer, arsenic skin lesion from contaminated drinking water in some districts of West

Bengal. Long exposure leads to bladder and lungs cancer. Lead is contaminated in the

drinking water source from pipes, fitting, solder, household plumbing systems. In the

human beings, it affects the blood, central nervous system and the kidneys. Child and

pregnant women are mostly prone to lead exposure. Mercury is used in industries

such as smelters, manufactures of batteries, thermometers, pesticides, fungicides

[Link] of water pollution on plants The following are the effects of water pollution

on plants:

 Effects of acid deposition: Many of the gases from acid, aerosols and other

acidic substances released into the atmosphere from industrial or domestic sources of

combustion from fossil fuels finally fall down to ground and reach the water bodies

along with run-off rainwater from polluted soil surfaces thereby causing acidification of

water bodies by lowering its pH . In many countries chemical substances like sulphates,

nitrates and chloride have been reported to make water bodies such as lakes, river and

ponds acidic.

 effects of organic matter deposition: Organic matter from dead and decaying

materials of plants and animals is deposited directly from sewage discharges and

washed along with rainwater into water bodies causing increase in decomposers /
microbes such as aerobic and anaerobic bacteria. Rapid decomposition of organic

matter increase nutrient availability in water favouring the luxuriant growth of

planktonic green and blue-green algal bloom. In addition many of the macrophytes

like Salvinia, Azolla, Eicchhornia etc. grow rapidly causing reduced penetration of

light into deeper layer of water body with gradual decline of the submerged flora . This

condition results in reducing the dissolved Oxygen and increase in the biological

oxygen demand (B.O.D).

 Effects of agricultural chemicals: Chemicals from fertilizers, pesticides,

insecticides, herbicides etc. applied to crops in excess are washed away with rainwater

as runoff, then enter into soil and finally arrive at the water bodies. Chemicals from

fertilizers result in eutrophication by enrichments of nutrients. Ammonium from

fertilizers is acidic in nature causing acidification of water. Similarly pesticides,

herbicides and insecticides also cause change in pH of the water bodies. Most common

effect of these substances is the reduction in photosynthetic rate. Some may uncouple

oxidative phosphorylation or inhibit nitrate reductase enzyme. The uptake and

bioaccumulation capacities of these substances are great in macrophytic plants due to

their low solubility in water.

Control of Water Pollution

The key challenges to better management of the water quality in India comprise of

temporal and spatial variation of rainfall, uneven geographic distribution of surface

water resources, persistent droughts, overuse of ground water and contamination,

drainage and salinisation and water quality problems due to treated, partially treated

and untreated wastewater from urban settlements, industrial establishments and runoff

from irrigation sector besides poor management of municipal solid waste and animal

dung in rural areas (CPCB Report, 2013).Some of the control measures are given below:

1-The Ganga Action Plan and the National River Action Plan are being implemented for

addressing the task of trapping, diversion and treatment of municipal wastewater.

2-In most parts of the country, waste water from domestic sources is hardly treated, due to

inadequate sanitation facilities. This waste water, containing highly organic pollutant load, finds its

way into surface and groundwater courses near the vicinity of human habitation from where further

water is drawn for use. Considerable investments should be done to install the treatment systems.

3-With rapid industrialization and urbanization, the water requirement for energy and industrial use

is estimated to rise to about 18 per cent (191 bcm) of the total requirements in 2025 (CPCB Report,

2013). Poor environmental management systems, especially in industries such as thermal power

stations, chemicals, metals and minerals, leather processing and sugar mills, have led to discharge of

highly toxic and organic wastewater. This has resulted in pollution of the surface and groundwater

sources from which water is also drawn for irrigation and domestic purpose. The enforcement of

regulations regarding discharge of industrial wastewater and limits to extraction of groundwater

needs to be considerably strengthened, while more incentives are required for promoting waste water

reuse and recycling.

3-For the agricultural sector, water and electricity for irrigation are subsidized for political reasons.

This leads to wasteful flood irrigation rather than adoption of more optimal practices such as

sprinkler and drip irrigation. Optimized irrigation, cropping patterns and farming practices should

be encouragde for judicious use of water.

4-The water quality management in India is accomplished under the provision of Water

(Prevention and Control of Pollution) Act, 1974 that was amended in 1988. The basic objective of

this Act is to maintain and restore the wholesomeness of national aquatic resources by prevention

and control of pollution. The Water (Prevention and Control of Pollution) Cess Act was enacted in

1977, to provide for the levy and collection of a cess on water consumed by persons operating and

carrying on certain types of industrial activities.

5-The Central Pollution Control Board (CPCB) has established a network of monitoring stations on

aquatic resources across the country. The water quality monitoring and its management are governed

at state/union territory level in India. The network covers 28 states and 6 Union Territories (CPCB

Report, 2013). Water quality monitoring is therefore an imperative prerequisite in order to assess the

extent of maintenance and restoration of water bodies.

POOR HOUSING

Good-quality housing is a key element for ensuring a healthy village. Poor housing can lead to many

health problems, and is associated with infectious diseases (such as tuberculosis), stress and

depression. Everyone should therefore have access to good-quality housing and a pleasant home

environment that makes them happy and content. Problems associated with poor housing.
Cramped and crowded conditions give rise to poor hygiene by providing places for vermin to breed

and transmit diseases via fleas, ticks and other vectors. Poor household hygiene leads to food and

water contamination within the home Poor indoor air quality leads to respiratory problems and

inadequate lighting leads to Eyesight problems. Stress is higher for individuals living in poor housing

and poverty

Government schemes and programme for poor housing

Housing programmes in the First and the Second Five-Year Plans

(1951- 1961)

1. Subsidised Housing Scheme for Industrial Workers and the Economically Weaker Sections.

The first major housing programme launched in 1952, it involved disbursements of loans to

industrial employers or cooperative societies of industrial workers to cover a sizeable proportion

(75 or 90 percent, respectively, with a 25 percent subsidy component) of the project costs of

housing to be provided on a rental basis for a completed or an open development plot. The

target beneficiaries were the industrial workers employed in mines and factories in the private

sector with monthly incomes of less than INR 500. Workers could obtain non-refundable

loans from their provident funds to finance the remaining construction of houses.

2. The Low Income Housing Scheme of 1954. It provided loans of up to 80 percent of the

construction cost of a dwelling unit (subject to a cap of INR 8,000) to individuals whose

incomes did not exceed INR 6,000 per annum. Loans under the scheme were also made accessible

to non-profit organisations, educational institutions, and hospitals, to create rental or hire-purchase

housing stock for their low-income employees.

3. Slums Clearance and Improvement programme of 1956. This programme was designed

to clear and rehabilitate slum dwellers into government created housing stock at nominal rents.

The recipients were provided either a bare minimal structure or an open development plot around

the size of 1000 -1200 square feet with a toilet facility. The remaining construction was to be
undertaken by prospective beneficiaries, with the use of limited building materials that were

provided to them by the government on the basis of specific guidelines

Housing programmes in the 1970s and ‘80s

The Environmental Improvement of Urban Slums (EIUS). The programme was launched in 1972,

motivated by the realisation that the notion of housing for the poor cannot remain confined

to shelter alone and must accommodate concerns about basic amenities, location and tenure.

The scheme focused on slum upgrade through the provision of services such as paving of

streets, water supply, sewerage, and toilet facilities.[16]

4. The Urban Basic Services (UBS) Scheme. Launched in 1986, this programme

extended the provision of physical infrastructure to that of social services such as learning

opportunities for women, vocational training, pre-school programmes for children, and setting

up of community organisations. The scheme placed particular emphasis on women and children

in urban slums.[

Housing schemes in the 1990s

5. The Nehru Rozgar Yojana (NRY). This was an employment programme consisting

of the Scheme of Housing and Shelter Upgradation (SHASHU). The NRY comprised three

employment related schemes: one that involved financial assistance to set up micro-enterprises;

the second consisted of providing training for self- employment; and the third provided urban

wage employment to the urban unemployed poor. Although the NRY scheme tried to integrate

efforts to tackle employment and housing, it was not based on the assessment of the level of

income required to support a basic minimum standard of housing. Nor did the scheme take into

consideration the need to generate employment opportunities which generated enough income to

access a loan or live in a rental space.[

6. the National Slum Development Programme (NSDP). To financially consolidate an

integrated approach to tackle the multiple dimensions of poverty, this programme was
launched in 1997 by combining the housing component of NRY and the Prime Minister’s

Integrated Urban Poverty Eradication Programme. The programme emphasised on the provision of

not only essential amenities involved in the upgrade of shelter but also social services such as

skills enhancement

Housing schemes in the 21st century

1. The Jawaharlal Nehru National Urban Renewal Mission (JNNURM). Launched in December

2005, the JNNURM aims at a reform-driven, planned developmental transformation of India’s

urban areas. The Mission acknowledges the responsibility entrusted upon cities to act as the

primary agent, engine and catalyst in the process of sustainable growth and development.

Accordingly, it aspires to create “economically productive, efficient, equitable and responsive

cities.”

2. Pradhan Mantri Awas Yojana. Launched by the Narendra Modi government in 2015,

it aspires to eliminate urban housing shortage in India by the year 2022. This Yojana is being

executed through four verticals:

CLIMATE CHANGE

 The primary cause of climate change is the burning of fossil fuels, such as oil and coal,

which emits greenhouse gases into the atmosphere—primarily carbon dioxide. Other human

activities, such as agriculture and deforestation, also contribute to the proliferation of greenhouse

gases that cause climate change.

 Climate change affects the social and environmental determinants of health – clean

air, safe drinking water, sufficient food and secure shelter.

What is the impact of climate change on health?

Although global warming may bring some localized benefits, such as fewer winter deaths in

temperate climates and increased food production in certain areas, the overall health effects of a

changing climate are overwhelmingly negative. Climate change affects many of the the social

and environmental determinants of health – clean air, safe drinking water, sufficient food and
secure shelter.

Extreme heat

Extreme high air temperatures contribute directly to deaths from cardiovascular and respiratory

disease, particularly among elderly people. High temperatures also raise the levels of ozone and other

pollutants in the air that exacerbate cardiovascular and respiratory disease. Pollen and other

aeroallergen levels are also higher in extreme heat. These can trigger asthma, which affects around

300 million people. Ongoing temperature increases are expected to aggravate this burden.

Natural disasters and variable rainfall patterns

Globally, the number of reported weather-related natural [Link] sea levels and increasingly

extreme weather events will destroy homes, medical facilities and other essential services. More than

half of the world's population lives within 60 km of the sea. People may be forced to move, which in

turn heightens the risk of a range of health effects, from mental disorders to communicable diseases.

Creasingly variable rainfall patterns are likely to affect the supply of fresh water. A lack of safe water

can compromise hygiene and increase the risk of diarrheal disease, which kills over 500 000 children

aged under 5 years, every year. In extreme cases, water scarcity leads to drought and famine. By the

late 21st century, climate change is likely to increase the frequency and intensity of drought at

regional and global scale.

Floods and extreme precipitation are also increasing in frequency and intensity.

(1) Floods contaminate freshwater supplies, heighten the risk of water-borne diseases, and create

breeding grounds for disease-carrying insects such as mosquitoes. They also cause drowning and

physical injuries, damage homes and disrupt the supply of medical and health services. Rising

temperatures and variable precipitation are likely to decrease the production of staple foods in many

of the poorest regions. This will increase the prevalence of malnutrition and under nutrition, which
currently cause 3.1 million deaths every year.

WHO response

 In 2015, tartnerships: to coordinate with partner agencies within the UN system, and

ensure that health is properly represented in the climate change agenda.

 Awareness raising: to provide and disseminate information on the threats that climate

change presents to human health, and opportunities to promote health while cutting

carbon emissions.

 Science and evidence: to coordinate reviews of the scientific evidence on the links

between climate change and health, and develop a global research agenda.

 Support for implementation of the public health response to climate change: to

assist countries in building capacity to reduce health vulnerability to climate change, and

promote health while reducing carbon emissions.

HEALTH HAZARDS OF ACCUMULATED SOILD WASTE

Modernization and progress has had its share of disadvantages and one of the main aspects of

concern is the pollution it is causing to the earth – be it land, air, and water. With increase in the

global population and the rising demand for food and other essentials, there has been a rise in the

amount of waste being generated daily by each household. Waste that is not properly managed,

especially excreta and other liquid and solid waste from households and the community, are a serious

health hazard and lead to the spread of infectious diseases. Unattended waste lying around attracts

flies, rats, and other creatures that in turn spread disease. Normally it is the wet waste that

decomposes and releases a bad odour. This leads to unhygienic conditions and thereby to a rise in the

health problems.

Impacts of solid waste on health;

The group at risk from the unscientific disposal of solid waste include – the population in areas
where there is no proper waste disposal method, especially the pre-school children; waste workers;

and workers in facilities producing toxic and infectious material. Other high-risk group include

population living close to a waste dump and those, whose water supply has become contaminated

either due to waste dumping or leakage from landfill sites. Uncollected solid waste also increases

risk of injury, and infection. exposure to hazardous waste can affect human health, children being

more vulnerable to these pollutants. In fact, direct exposure can lead to diseases through chemical

exposure as the release of chemical waste into the environment leads to chemical poisoning. Many

studies have been carried out in various parts of the world to establish a connection between health

and hazardous waste. Waste from agriculture and industries can also cause serious health risks.

Other than this, co-disposal of industrial hazardous waste with municipal waste can expose people

to chemical and radioactive hazards. Uncollected solid waste can also obstruct storm water runoff,

resulting in the forming of stagnant water bodies that become the breeding ground of disease. Waste

dumped near a water source also causes contamination of the water body or the ground water

source. Direct dumping of untreated waste in rivers, seas, and lakes results in the accumulation of

toxic substances in the food chain through the plants and animals that feed on it.

Disposal of hospital and other medical waste requires special attention since this can create major

health hazards. This waste generated from the hospitals, health care centres, medical laboratories,

and research centres such as discarded syringe needles, bandages, swabs, plasters, and other types of

infectious waste are often disposed with the regular non-infectious waste.

Waste treatment and disposal sites can also create health hazards for the neighbourhood.

Improperly operated incineration plants cause air pollution and improperly managed and designed

landfills attract all types of insects and rodents that spread disease. Ideally these sites should be

located at a safe distance from all human settlement. Landfill sites should be well lined and walled

to ensure that there is no leakage into the nearby ground water sources

GOVERNMENT SCHEMES AND SERVICES FOR PREVENTION OF SOLID WASTE;

SWACHH BHARAT MISSION MUNICIPAL SOLID WASTE MANAGEMENT Manual:

The management of municipal solid waste in India has surfaced or continued to be a severe problem

not only because of environmental and aesthetic concerns but also because of the enormous quantities

generated every day. Even though only 31% of Indian population resides in urban areas, this

population of 377 million (Census of India, 2011) generates a gigantic 1,43,449 metric tonnes per day

of municipal solid waste, as per the Central Pollution Control Board (CPCB), 2014-15 and these

figures increase every day with an increase in population. To further add to the problem, the total

number of towns (statutory and census) in the country have also increased from 5,161 in 2001 to 7,936

in 2011, thus increasing the number of municipal waste generation by 2,775 within a decade.

The management of municipal solid waste is one of the main functions of all Urban Local

Bodies (ULBs) in the country. All ULBs are required to meticulously plan, implement and monitor all

systems of urban service delivery especially that of municipal solid waste. With limited financial

resources, technical capacities and land availability, urban local bodies are constantly striving to meet

this challenge.

With the launch of the flagship programme by the Government of India, Swachh Bharat

Mission in 2014 that aims to provide basic infrastructural and service delivery with respect to

sanitation facilities to every family, including toilets and adopting the scientific methods to collect,

process and disposal of municipal solid waste. The mission focuses on quality and sustainability of

the service provision as well as emphasising on the commitment on every stakeholder to bring about

a visible change in society. This manual on Municipal Solid Waste Management provides guidance

to urban local bodies on the planning, design, implementation and monitoring of municipal solid

waste management systems. Issues of environmental and financial sustainability of these systems are

a critical consideration.

Suchitwa Mission

The Total Sanitation Campaign (TSC) in the state was coordinated and monitored by the Kerala

Total Sanitation and Health Mission (KTSHM) and their activities were confined to the rural

Panchayat. The Clean Kerala Mission (CKM) was enabling the urban and rural local bodies in
establishing solid waste management systems. In order to avoid duplication of efforts and tackle the

existing and emerging challenges in various sanitation aspects for an overall health and

environmental outcome, it was felt necessary to have a professional institution. Accordingly, the

above Missions were integrated as Suchitwa Mission, which started functioning since April 2008.

This institutional reform has enabled the up scaling of initiatives envisaged in the Malinya Mukta

Keralam Action Plan. The Mission is taking steps to strengthen its technical capabilities in various

aspects of sanitation.

ENVIORNMENTAL SANITATION

Environmental sanitation is a major public health issue in India. Environmental sanitation

envisages promotion of health of the community by providing clean environment and breaking the
cycle of disease. It depends on various factors that include hygiene status of the people, types of
resources available, innovative and appropriate technologies according to the requirement of the
community, socioeconomic development of the country, cultural factors related to environmental
sanitation, political commitment, capacity building of the concerned sectors, social factors including
behavioural pattern of the community, legislative measures adopted, and others.

Poor sanitation can sometimes be the initial domino that starts a cascading wave of other
problems. In the case of India, poor sanitation and open defecation have allowed for an
overwhelmingly unhygienic environment and a variety of widespread health problems.

Combining an unhygienic environment with a high population density creates a breeding

ground for preventable disease epidemics. Two common hygiene-related diseases, typhoid and
diarrhea, prevent their victims from absorbing necessary nutrients which leads to malnutrition.

Need of Sanitation for Healthy Environment

For good health, it is necessary that you keep yourself clean and even the environment
(disposal of human wastes) hygienic. If you don’t take care of your environment, you would indirectly
pollute the surrounding, thereby leading to serious health problems like diarrhoea, cholera and many
others. There are many things that you can do in order to prevent such problems and these are like
using clean and safe toilets, keep the water sources clean, place the garbage far away from the
residential areas/garbage bins, wear clean clothes and drink 100% pure and safe water.

Sanitation would cover few things that include:

 Safe collection, proper treatment, and disposal of feces and urine
  Proper management and recycling of solid wastes

 Properly managing and disposal of household wastewater

 Treatment and disposal of sewage effluents

 Proper collection and management of industrial wastes

 Efficiently managing the hazardous wastes

India’s Total Sanitation Campaign(TSC) in 1999, the Indian government introduced the Total
Sanitation Campaign (TSC) to accelerate sanitation coverage throughout the country, particularly
in rural areas. It focused on information and education to generate public demand for sanitation
facilities, particularly in schools. The TSC made some progress, but it suffered from its relatively low
priority and its ineffective deployment of resources. It was renamed Nirmal Bharat Abhiyan in 2012
and relaunched as Swachh Bharat Abhiyan in 2014.

The initiative he Total Sanitation Campaign (TSC) in India was introduced by the GoI in 1999 as
a restructure of the CSRP. It was implemented by the Ministry of Rural Development and the central
government to "improve the general quality of life in rural areas [and] accelerate sanitation coverage
in rural areas through access to toilets to all by 2012"

The programme also recognised the importance of local leadership, and integrated rewards to
encourage participation. “Recognising the role of elected local representatives (Gram Panchayats
[GPs]) to promote sanitation through collective community action, the GoI instituted an award, called
Nirmal Gram Puraskar (NGP) in October 2003. The NGP awards are given to districts, blocks, and
GPs that have achieved 100 percent sanitation coverage of individual households, 100 percent school
sanitation coverage, are free from OD, and conduct clean environment maintenance.

TSC projects were scaled significantly in the first decade, and by 2012 the programme was
operational in 572 rural districts, with additional districts planned to be added in subsequent years.

Some initiatives for promoting environmental sanitation in India

 Ministry of Urban Development, Govt. of India has drafted National Urban Sanitation Policy
(NUSP). The vision for Urban Sanitation in India is, “All Indian cities and towns become totally
sanitized, healthy and liveable and ensure and sustain good public health and environmental
outcomes for all their citizens with a special focus on hygienic and affordable sanitation facilities
for the urban poor and women”.
1. Policy focuses on important sanitation issues such as poor awareness, social, and occupational
aspects of sanitation, lack of an integrated city-wide approach.
 2. To rapidly promote sanitation in urban areas of the country (as provided for in the NUSP and
Goals 2008), and to recognize excellent performance in this area, the Government of India
intends to institute an annual award scheme for cities.
 “National School Sanitation Initiative” started with the mission to achieve 100% sanitation,
Ministry of Urban Development, Ministry of Human Resource Development, Central Board for
Secondary Education, and GTZ.
1. More than 100 schools affiliated to CBSE across India are a part of this programme. The
initiative supports the goals laid in the NUSP 2008 by focusing on proper sanitation and
hygiene, its disposal, and waste segregation in order to achieve an Open Defecation Free Life
for all the citizens. The schools and students are the “Agents of Change and Transformation”
for a countrywide initiative on sanitation through awareness generation and behavioural
change..
 Total Sanitation Campaign, in June 2003, Ministry of Rural Development, Govt. of India initiated
an incentive scheme for fully sanitized and open defecation free Gram Panchayats (GPs), Blocks,
and Districts called the ‘Nirmal Gram Puraskar’ (NGP). First NGPs were distributed in 2005. NGP
seeks to recognize Panchayat Raj Institution and other institutions who have contributed
significantly toward ensuring full sanitation coverage in their areas of operation.[7] These are an
extremely important initiative undertaken by Govt. of India to address environmental sanitation.

FOOD SANITATION

Food sanitation is the practice of following certain rules and procedures to prevent the
contamination of food, keeping it safe to eat. Many jurisdictions around the world have specific food
sanitation laws, along with lists of regulations created by public health agencies. The practice of food
sanitation is recommended at every step of the supply chain within the food industry, from workers in
crop fields to waiters at restaurants. The term "food sanitation" typically refers to rules and procedures
within the food industry, whether during production, packaging, transporting or serving. At the
consumer level, such as in a home kitchen, practices designed to ensure that food is uncontaminated
and safe to eat are often referred to using the term "food hygiene."
Poor food hygiene practice will lead to those consuming the food to become severely ill, most
likely with food poisoning. Food poisoning can normally be treated at home, treating symptoms such
as vomiting and diarrhoea.

Gastroenteritis can be caused by the norovirus and bacterial food poisoning, which results in
serious vomiting and diarrhoea. When there are large groups of people together, gastroenteritis can
spread easily and cause mass illness.
 Therefore, poor food hygiene practices do not just affect those who consume food – food
poisoning can also be passed on to those who come into contact with sick people, making it a serious
health issue.

Many individuals suffer from allergies or intolerances to certain foods. Reactions can range in
severity from mild nausea and rashes, to extreme life-threatening attacks such as anaphylactic shock.
Reactions to food allergies and intolerances will often lead to long-term hospitalisation and can result
in death.

Poor food hygiene increases your risk of cross-contamination in the kitchen, which is a
common way an individual might suffer from an allergic reaction. Having a good level of food
hygiene training will ensure all of your staff are aware of the severity of food allergies and
intolerances and that everyone takes the appropriate measures to avoid cross-contamination .

 In the wake of the food crises of the early 1970s and the resulting World Food Conference of
1974, a group of innovators realized that food security depends not only on crop production, but
also on the policies that affect food systems, from farm to table. The International Food Policy
Research Institute (IFPRI) was founded in 1975 and for the past four decades has worked to
provide solid research and evidence for policy options to partners in donor and re
 Agriculture is the largest livelihood provider in India—especially in the rural areas—and plays a
critical role in alleviating poverty and undernutrition. The Indian government’s Twelfth Five-Year
Plan (2012–2017) aims to accelerate the growth of agricultural production and includes food
security as a high-priority research area of national relevance. cipient countries.
 India has begun to implement its 2013 National Food Security Act, which calls for providing
highly subsidized food grains to two-thirds of the country’s population. By the end of 2014, five of
India’s 29 states were fully implementing the Act and six other states were partially implementing
it.

National and International Health Funding Organizations

WHO: World Health Organisation
• WHO is the directing and coordinating authority for health within the United Nations system.
It is responsible for providing leadership on global health matters, shaping the health research
agenda, setting norms and standards, articulating evidence-based policy options, providing
technical support to countries and monitoring and assessing health trends.

• In the 21st century, health is a shared responsibility, involving equitable access to essential
care and collective defense against transnational threats

• The role of WHO in public health

 • WHO fulfils its objectives through its core functions:

• providing leadership on matters critical to health and engaging in partnerships where joint
action is needed;

• shaping the research agenda and stimulating the generation, translation and dissemination of
valuable knowledge;

• setting norms and standards and promoting and monitoring their implementation;

• articulating ethical and evidence-based policy options;

• providing technical support, catalysing change, and building sustainable institutional capacity;
and

• Monitoring the health situation and assessing health trends.

• These core functions are set out in the 11th General Programme of Work, which provides the
framework for organization-wide programme of work, budget, resources and results. Entitled
“Engaging for health”, it covers the 10-year period from 2006 to 2015.

WHO: World Health Organisation

• WHO is the directing and coordinating authority for health within the United Nations

system. It is responsible for providing leadership on global health matters, shaping the health

research agenda, setting norms and standards, articulating evidence-based policy options,

providing technical support to countries and monitoring and assessing health trends.

• In the 21st century, health is a shared responsibility, involving equitable access to essential

care and collective defense against transnational threats

The role of WHO in public health

• WHO fulfils its objectives through its core functions:

• providing leadership on matters critical to health and engaging in partnerships where joint

action is needed;

• shaping the research agenda and stimulating the generation, translation and dissemination of

valuable knowledge;

• setting norms and standards and promoting and monitoring their implementation;

• articulating ethical and evidence-based policy options;

• providing technical support, catalysing change, and building sustainable institutional

capacity; and
• monitoring the health situation and assessing health trends.

• These core functions are set out in the 11th General Programme of Work, which provides the

framework for organization-wide programme of work, budget, resources and results. Entitled

“Engaging for health”, it covers the 10-year period from 2006 to 2015.

United Nations Development Programme (UNDP)

• By decision of its Executive Board, UNDP has a goal of ensuring that 60 per cent of core

resources are allocated to LDCs.

• Core resources are voluntary contributions by Member States, distributed to programme

countries based on the so-called Target for Resource Assignment from the Core (TRAC)

system. According to this system, every programme country receives a certain minimum

amount of guaranteed funding from the core budget, called TRAC 1. This amount is

determined by a distribution methodology established by the Executive Board of the UNDP

and takes into account a country’s gross national product per person and its population size.

WHAT IS UNICEF?

• UNICEF is the world’s farthest-reaching humanitarian organization for children. Across 190

countries and territories, and in the world’s toughest places, we work day in and day out to

help children survive. To defend their rights. To keep them protected, healthy and educated.

To give them a fair chance to fulfil their potential.

UNICEF’S MISSION

• Our mission is to mobilize and empower Canadians to invest in the positive transformation

of every child’s future.

• UNICEF stands for every child, everywhere. We are guided by the 1989 Convention on

the Rights of the Child, advocating for the protection of children’s rights, helping to meet

their basic needs, and giving them a fair chance to reach their full potential.

• Undaunted by war, disaster, disease or distance, UNICEF staff work day in and day out to

reach the world’s most disadvantaged children with healthcare and vaccines, nutrition, clean

water and sanitation, protection, quality education, emergency relief and more.
• UNICEF is on the ground before, during and long after humanitarian emergencies, leading

international response in water and sanitation, nutrition, education and child protection. Our

global supply chain and local presence mean we can rapidly send help, even before it’s

needed.

• As part of the UN family, our ability to work neutrally with governments, the private sector

and civil society generates results for children on a scale that is unparalleled. UNICEF even

has the influence to pause hostilities in conflict zones – ceasefires known as ‘Days of

Tranquility’ – so that children can receive medical care.

• Donor support helps reach 45% of the world’s children under age 5 with vaccines, and create
long-term solutions that address maternal, newborn, child and adolescent health; child

marriage; girls’ access to education; HIV prevention; ending violence against children; child

trafficking and exploitation.

UNEP: United Nations Environment Programme

• The United Nations Environment Programme (UNEP) is the leading environmental authority

in the United Nations system. UNEP uses its expertise to strengthen environmental standards

and practices while helping implement environmental obligations at the country, regional

and global levels. UNEP’s mission is to provide leadership and encourage partnership in

caring for the environment by inspiring, informing, and enabling nations and peoples to

improve their quality of life without compromising that of future generations.

• SIX AREAS OF CONCENTRATION

• UNEP re-organized its work programme into six strategic areas as part of its move to results-

based management. The selection of six areas of concentration was guided by scientific

evidence, the UNEP mandate and priorities emerging from global and regional forums.

• CLIMATE CHANGE UNEP strengthens the ability of countries to integrate climate change

responses by providing leadership in adaptation, mitigation, technology and finance. UNEP

is focusing on facilitating the transition to low-carbon societies, improving the understanding

of climate science, facilitating the development of renewable energy and raising public
 awareness.

• 2. POST-CONFLICT AND DISASTER MANAGEMENT UNEP conducts environmental

assessments in crisis-affected countries and provides guidance for implementing legislative

and institutional frameworks for improved environmental management. Activities

undertaken by UNEP’s Post-Conflict & Disaster Management Branch (PCDMB) include

post-conflict environmental assessment in Afghanistan, Côte d’Ivoire, Lebanon, Nigeria and

Sudan.

• 3. ECOSYSTEM MANAGEMENT Facilitates management and restoration of ecosystems in

a manner consistent with sustainable development, and promotes use of ecosystem services.

Examples include the Global Programme of Action (GPA) for the Protection of the Marine

Environment from Land-Based Activities.

• 4. ENVIRONMENTAL GOVERNANCE UNEP supports governments in establishing,

implementing and strengthening the necessary processes, institutions, laws, policies and

programs to achieve sustainable development at the country, regional and global levels, and

mainstreaming environment in development planning.

• 5. HARMFUL SUBSTANCES UNEP strives to minimise the impact of harmful substances

and hazardous waste on the environment and human beings. UNEP has launched

negotiations for a global agreement on mercury, and implements projects on mercury and the

Strategic Approach to International Chemicals Management (SAICM) to reduce risks to

human health and the environment.

• 6. RESOURCE EFFICIENCY/SUSTAINABLE CONSUMPTION AND PRODUCTION

UNEP focuses on regional and global efforts to ensure natural resources are produced,

processed and consumed in a more environmentally friendly way. For example, the

Marrakesh Process is a global strategy to support the elaboration of a 10-Year Framework of

Programs on sustainable consumption and production.

What is UNFPA's goal?

• The goal of UNFPA is ensure reproductive rights for all. To accomplish this,
 UNFPA works to ensure that all people, especially women and young people,

are able to access high-quality sexual and reproductive health services,

including voluntary family planning, so that they can make informed and

voluntary choices about their sexual and reproductive lives.

What does UNFPA stand for?

• The United Nations Fund for Population Activities was established as a trust fund in 1967

and began operations in 1969. In 1987, it was officially renamed the United Nations

Population Fund, reflecting its lead role in the United Nations system in the area of

population. The original abbreviation, UNFPA, was retained.

• UNFPA’s full name, the United Nations Population Fund, is the working title used in all

languages. To explain our work to a general audience, the organization can be described as

the United Nations reproductive health and rights agency. Official UN documents use the

full, written-out name.

Who funds and governs UNFPA?

• UNFPA is entirely supported by voluntary contributions of donor governments,

intergovernmental organizations, the private sector, and foundations and individuals, not by

the United Nations regular budget. Our latest annual report provides a complete list of

donors and contributions.

• UNFPA is a subsidiary organ of the UN General Assembly. It reports to the UNDP/UNFPA

Executive Board of 36 UN Member States on administrative, financial and programme

matters and receives overall policy guidance from the UN Economic and Social Council

(ECOSOC). The Executive Board is composed of 36 members: eight from Africa, seven

from Asia and the Pacific, four from Eastern Europe, five from Latin America and the

Caribbean, and 12 from Western Europe and other developed countries.

DFID
• The Department for International Development has closed. It’s been replaced by the Foreign,

Commonwealth & Development Office (FCDO) The Department for International Development

(DFID) leads the UK’s work to end extreme poverty. DFID is tackling the global challenges of time

including poverty and disease, mass migration, insecurity and conflict. DFID's work is building a

safer, healthier, more prosperous world for people in developing countries and in the UK too. The

Department for International Development (DFID) was set up in 1997. DFID employs around 2,700

staff who work in the offices in London, East Kilbride. and globally.

Honoring the UK’s international commitments and taking action to achieve the United Nations’

Global Goals

• Making British aid more effective by improving transparency, openness and value for money

• Targeting British international development policy on economic growth and wealth creation

• Improving the coherence and performance of British international development policy in

fragile and conflict-affected countries

• Improving the lives of girls and women through better education and a greater choice on

family planning

• Preventing violence against girls and women in the developing world

• Helping to prevent climate change and encouraging adaptation and low-carbon growth in

developing countries.

PRIORITIES

• Strengthening global peace, security and governance

• Strengthening resilience and response to crisis

• Promoting global prosperity

• Tackling extreme poverty and helping the world’s most vulnerable

• Delivering value for money.

FAO
The Food and Agriculture Organization (FAO) is a specialized agency of the UN established in 1945
with the headquarters in Rome. The objectives FAO are
 To help nations to improve the living standard of citizens.
  To improve the nutritional status in all countries
 To increase the output of agriculture, fisheries and forestry.
 To improve the status of rural population.
The FAO has organized a World Freedom from Hunger Campaign (FFHC) in [Link] main
objective of campaign is to combat malnutrition and disseminate information and education.
The Joint experts committees of WHO and FAO form the basis of mainly collaborative activities such
as nutrition surveys, training programmes, symposiums, researches etc. FAO acts as a neutral forum
where all nations meet as equals to negotiate agreements and debate policy. FAO is also a source of
knowledge and information, and helps developing countries and countries in transition modernize and
improve agriculture, forestry and fisheries practices, ensuring good nutrition and food security for all.

 UNESCO
The United Nations Educational, Scientific and Cultural Organization is a specialized agency of the
UN established on 16th November 1945 and its headquarters is in Paris.
The Objectives of UNESCO is to contribute to peace and security by promoting international
collaboration through education, science and culture in order to further universal respect for justice,
the rule of law and human rights along with fundamental freedoms proclaimed in UN character.
UNESCO pursues its objective through five major programmes: education, social and human science,
culture communication and information.
UNESCO’s Activities
• Education: UNESCO supports research in Comparative education; and provides expertise and
fosters partnerships to strengthen national educational leadership and the capacity of countries to offer
quality education for all.
• UNESCO also issues public statements to educate the public:
• Designating projects and places of cultural and scientific significance.
• Encouraging the "free flow of ideas by images and words“
• Promoting events.
• Founding and funding projects

 ROTARY INTERNATIONAL
Rotary Foundation (India) supports selected programs and projects of The Rotary Foundation of
Rotary International. Rotary Foundation (India) (“RFI”) is a society registered under the Societies
Registration Act of 1860 on 22nd February 1988. The Rotary Foundation of Rotary International is to
enable Rotarians to advance world understanding, goodwill, and peace through the improvement of
health, the support of education, and the alleviation of poverty.
Activities
Disease results in misery, pain, and poverty for millions of people worldwide. Rotary lead efforts both
large and small i.e. Temporary clinics, blood donation centers, and training facilities in underserved
communities struggling with outbreaks and health care access and design and build infrastructure that
allows doctors, patients, and governments to work together.
 They combat diseases like malaria, HIV/AIDS, Alzheimer’s, multiple sclerosis, diabetes, and polio.
Prevention is important, which is why we also focus on health education and bringing people routine
hearing, vision, and dental care

 USAID
The United States Agency for the international Development was formerly known as TCM or the U.S.
It is a technical co-operative mission. A United States government agency. It Provides economic and
humanitarian assistance and is established in November 3, 1961.
OBJECTIVES
• Promoting economic growth
• Advancing democracy
• Delivering humanitarian assistance to victims of famine and other population wide emergencies
• Protecting public health and supporting family planning • Protecting environment
Under USAID, India has received assistance in the following projects:
 Activities
Control of eradication of malaria and filaria;
National water supply and sanitation programme;
Assistance of nursing training;
Development of primary health centers health education and medical educations and related
institution.
Presently USAID also helping in agriculture and family planning programmes.
 MODULE: 4
COMMUNITY HEALTH ASPECTS OF NUTRITIONS
CLASSIFICATION OF FOOD
Food can be classified in accordance to their chemical property, to their function,
to their essentiality, to their concentration and to their nutritive value.

a) According to the chemical nature

 Carbohydrates
 Vitamins
 Proteins
 Dietary fibre
 Fats
 Water
Minerals
b) According to their function in the body
Energy giving foods:
The carbohydrates, fats and the protein are considered as calorie nutrients, so that
the body can perform the necessary functions. Rice, chapatti, bread, potato, sugar,
oil, butter and ghee are examples of energy giving foods.

Body building foods:

Foods such as proteins, fats and carbohydrates are also called as body-building
food. They are the nutrients that form body tissues. Fish, meat, chicken, eggs,
pulses, nuts and milk are some body building foods.
Protective foods:
Vitamins and minerals are the nutrients that function to regulate body processes.
They protect us from various diseases. Fruits and vegetables are some examples.
Therefore we must eat these regularly.

c) According to chemical properties

Organic: Nutrients that contain the element of carbon are called as organic
nutrients.
Inorganic: Nutrients that do not contain carbon element are called as inorganic
nutrients.
The organic nutrients include carbohydrates, lipids, proteins and vitamins. Water
and minerals are inorganic.
d) According to its mass depending on the quantity necessary for cells and
organisms are classified as
Macronutrients: Macronutrients are required in large quantities daily. Proteins,
carbohydrates and fats are macronutrients. They are the basis of any diet.
Micronutrients: Micronutrients are needed in small quantities (usually in amounts
less than milligrams). These nutrients are involved in regulating metabolism and
energy processes. They are vitamins and minerals.
e) According to its origin
Depending upon the origin of food it has been classified as animal food sources
and plant food sources.
f) According to its nutritive value
 Cereals and millets
 Pulses
 Nuts and oil seeds
 Vegetables
 Green leafy vegetables
 Non-leafy vegetables
 Roots and tubers
 Fruits
 Milk and milk products
 Animal foods—meat, fish, liver, egg etc
 Carbohydrate foods
 Condiments and spices
INTRODUCTION TO NUTRITION
 Nutrition is essential for growth and development, health and wellbeing.
Eating a healthy diet contributes to preventing future illness and improving quality
and length of life. Your nutritional status is the state of your health as determined
by what you eat. Nutrition is defined as the science of foods, nutrients and other
substances they contain; and of their actions within the body including ingestion,
digestion, absorption, metabolism and excretion. There are several ways of
assessing nutritional status, including anthropometric (i.e. physical body
measurement), food intake and biochemical measurement.
Your body mass index (BMI) is a good indicator of your nutritional status.
BMI = ___weight (kg) __
Height x height (m2)
BMI calculations will overestimate the amount of body fat for:
Body builders; some high performance athletes; pregnant women.
BMI calculations will underestimate the amount of body fat for:
The elderly; People with a physical disability who are unable to walk and may
have muscle wasting.

The Importance of Good Nutrition

Most people know good nutrition and physical activity can help maintain a healthy
weight. But the benefits of good nutrition go beyond weight. Good nutrition can
help:
 Reduce the risk of some diseases, including heart disease, diabetes,
stroke, some cancers, and osteoporosis
 Reduce high blood pressure
 Lower high cholesterol
 Improve your well-being
 Improve your ability to fight off illness
 Improve your ability to recover from illness or injury
  Increase your energy level
MACRO AND MICRONUTRIENTS

The nutrients your body needs to promote growth and development and regulate
bodily processes can be divided into two groups: macronutrients and
micronutrients. Macronutrients are the nutrients your body needs in larger
amounts, namely carbohydrates, protein, and fat. These provide your body with
energy, or calories. Micronutrients are the nutrients your body needs in smaller
amounts, which are commonly referred to as vitamins and minerals.

CARBOHYDRATE
 Carbohydrates are the sugars, starches and fibers found in fruits, grains, and
vegetables. They’re the most important source of quick energy in your diet
because they’re easily broken down into glucose, which the muscles and
brain use to function.
 While carbs are found in healthy foods like vegetables, they’re also found in
unhealthy foods like cakes and doughnuts, which has given them a bad
reputation in various diets.
 The important distinction to make in this instance is between simple and
complex carbohydrates.
 The difference between the two is the chemical structure which affects how
quickly the sugar is absorbed by the body.
  Simple carbs, or ‘bad’ carbs, generally release sugar faster because they are
made with processed and refined sugar and don’t contain any vitamins,
minerals, or fibers.
 Complex, or ‘good carbs’, are processed more slowly and are filled with
various nutrients.
PROTEINS

Proteins are made up of amino acids and function as hormones, enzymes, and an
antibody in the immune system. They make up parts of bodily structures like
connective tissues, skin, hair, and muscle fibres. Unlike carbs, proteins don’t serve
as a direct source of energy, but work like building blocks for other structures in
the body. The nutritional value of a protein is measured by the quantity of essential
amino acids that it contains, which varies depending on the food source.

FATS

 The distinction between saturated and unsaturated fats is important because

your body only needs the latter. Unsaturated fats regulate metabolism,
maintain the elasticity of cell membranes, improve blood flow, and promote
cell growth and regeneration.
 Fats are also important in delivering fat-soluble vitamins A, D, E and K into
the body.
 While your body doesn’t necessarily need saturated fats, they do provide
your body with cholesterol, which plays an important role in hormone
 production. Your body does produce its own cholesterol, but a small amount
introduced through your diet can help build cell membranes, produce
hormones like estrogen and testosterone, help your metabolism work,
produce vitamin D, and produce bile acids which help digest fat and absorb
nutrients. However, a diet rich in cholesterol can increase the risk of heart
disease.
 Fats should make up between 30–35 per cent of your daily caloric intake,
with a maximum of 10 per cent of that being saturated fats.
  Like macronutrients, your body doesn’t produce micronutrients in the
quantities that it needs, so eating a diet rich in vitamins and minerals is
essential for a healthy body.
 Vitamins are organic and can be broken down by elements such as heat, air,
or acid – which means they can denature when cooked or exposed to air,
making it slightly more difficult to ensure you’re getting them in your diet.
 Minerals on the other hand are inorganic and aren’t broken down in this
way. This means that your body absorbs the minerals in the soil and water
your food has come from.
VITAMINS

 One of the main functions of vitamins is to help release the energy found in
the food that you eat
 Vitamins help build protein and help your cells multiply
 They make collagen, which helps heal wounds, support blood vessel walls,
and promote healthy bones and teeth
 Vitamins keep your eyes, skin, lungs, digestive tract and nervous system in
good condition
 They build your bones, protect your vision, and interact with each other to
help your body absorb the vitamins it needs to
 They protect you against diseases
MINERALS

 Minerals maintain the correct balance of water in your body

 They promote healthy bones and stabilize the protein structures that you get
from the protein you eat, including those that make up your hair, skin, and
nails
 They get the oxygen moving around your body
 Minerals assist in your ability to taste and smell
 ASSESSMENT AND MANAGEMENT OF MALNUTRITION

Malnutrition is defined as a state in which a deficiency, excess or imbalance of

energy. Protein and other nutrients causes adverse effects on body form, function
and clinical outcome. Malnutrition refers to getting too little or too much of certain
nutrients.

TYPES OF MALNUTRITION

 Under nutrition: This type of malnutrition results from not getting enough
protein, Calories or micronutrients. It leads to low weight-for-height
(wasting), height-forage (stunting) and weight-for-age (underweight).

 Over nutrition: Overconsumption of certain nutrients, such as protein,

calories or Fat, can also lead to malnutrition. This usually results in
overweight or obesity.

People who are undernourished often have deficiencies in vitamins and minerals,
especially iron, zinc, vitamin A and iodine. However, micronutrient deficiencies
can also occur with over nutrition. It’s possible to be overweight or obese from
excessive calorie consumption but not get enough vitamins and minerals at the
same time. That’s because foods that contribute to over nutrition, such as fried and
sugary foods, tend.

SIGNS AND SYMPTOMS

The signs and symptoms of malnutrition depend on the type. Being able to
recognize the effects of malnutrition can help people and healthcare providers
identify and treat issues related to under- or over nutrition.

Under nutrition

Under nutrition typically results from not getting enough nutrients in your diet.

This can cause :

 Weight llos
 Loss of fat and muscle mass
 Hollow cheeks and sunken eyes
 A swollen stomach
 Dry hair and skin
 Delayed wound healing
 Fatigue
 Difficulty concentrating
 Irritability
 Depression and anxiety
People with under nutrition may have one or several of these symptoms. Some
types under nutrition have signature effects. Under nutrition can also result in
micronutrient deficiencies.
DEFICIENCIES AND THEIR SYMPTOMS

 Vitamin A: Dry eyes, night blindness, increased risk of infection.

 Zinc: Loss of appetite, stunted growth, delayed healing of wounds, hair loss,
diarrhea.
 Iron: Impaired brain function, issues with regulating body temperature,
stomach
 Problems.
 Iodine: Enlarged thyroid glands (goiters), decreased production of thyroid
hormone,
 Growth and development issues.
Since undernutrition leads to serious physical issues and health problems, it can
increase your risk of death.

Overnutrition: The main signs of overnutrition are overweight and obesity,

but it can also lead to nutrient

DEFICIENCIES.

Research shows that people who are overweight or obese are more likely to have
inadequate intakes and low blood levels of certain vitamins and minerals compared
to Those who are at a normal weight.

ASSESSING MALNUTRITION

Symptoms of malnutrition are assessed by healthcare providers when they screen

for the Condition. Tools that are used to identify malnutrition include weight loss
and body mass index (BMI) charts, blood tests for micronutrient status and
physical exams. If person have a history of weight loss and other symptoms
associated with undernutrition, doctor may order additional tests to identify
micronutrient deficiencies. Identifying nutrient deficiencies that result from
overnutrition, on the other hand, can be more difficult. If person is overweight or
obese and eat mostly processed and fast foods, they may not get enough vitamins
or minerals. To find out if they have nutrients deficiencies, consider discussing
their dietary habits with doctor. Malnutrition can lead to the development of
diseases and chronic health conditions. Long-term effects of undernutrition include
a higher risk of obesity, heart disease and diabetes. Researchers suspect that
childhood under nutrition causes changes in metabolism that may lead to a higher
likelihood of developing chronic diseases later in life.

Over nutrition can also contribute to the development of certain health issues.
Specifically, overweight or obese children have a higher chance of heart disease
and type 2 diabetes .Since the long-term effects of malnutrition can increase your
risk of certain diseases, preventing and treating malnutrition may help reduce the
prevalence of chronic health conditions.

COMMON CAUSES OF MALNUTRITION

 Malnutrition is a worldwide problem that can result from environmental,

economic and medical [Link] causes of malnutrition include:
 Food insecurity or a lack of access to sufficient and affordable food
 Food insecurity in both developing and developed nations to malnutrition.
• Digestive problems and issues with nutrient absorption: Conditions
that cause Malabsorption, such as Crohn’s disease, celiac disease and
bacterial overgrowth in the
 Intestines, can cause excessive alcohol consumption: Heavy alcohol use can
lead to inadequate intake of Protein, calories and micronutrients .
 Mental health disorders: Depression and other mental health conditions can
increase Malnutrition risk. One study found that the prevalence of
malnutrition was 4% higher In people with depression compared to healthy
individuals .
 Inability to obtain and prepare foods: Studies have identified being frail,
having
  Poor mobility and lacking muscle strength as risk factors for malnutrition.
These
 Issues impair food preparation skills.
Populations at Risk Malnutrition affects people in all parts of the world, but
some populations are at a higher Risk. Populations that are prone to malnutrition
include:

o People living in developing countries or areas with limited access to

Food: Undernutrition and micronutrient deficiencies are especially
common in SubSaharan Africa and Southern Asia .

o Individuals with increased nutrient needs, especially children and

pregnant or breastfeeding women: In some developing countries, 24–
31% of pregnant and breastfeeding mothers are malnourished .

o People that live in poverty or have low incomes: Low socioeconomic

status is associated with malnutrition.

o Older adults, particularly those who live alone or have disabilities:

Research shows that up to 22% of older adults are malnourished and
over 45% are at risk of malnutrition.

o People with issues that affect nutrient absorption: People with Crohn’s
disease or Ulcerative colitis may be up to four times more likely to
have malnutrition than those without these conditions.

MANAGEMENT

Preventing and treating malnutrition involves addressing the underlying causes.

Government agencies, independent organizations and schools can play a role in

preventing malnutrition. Research suggests that some of the most effective ways to
prevent malnutrition include providing iron, zinc and iodine pills, food
supplements and nutrition education to populations at risk of undernutrition. In
addition, interventions that encourage healthy food choices and physical activity
for children and adults at risk of overnutrition may help prevent overweight and
[Link] also help prevent malnutrition by eating a diet with a variety of foods
that include enough carbs, proteins, fats, vitamins, minerals and [Link]
malnutrition, on the other hand, often involves more individualized approaches. If
suspect that you or someone you know is undernourished, talk to a doctor as soon
as possible. A healthcare provider can assess the signs and symptoms of
undernutrition and recommend interventions, such as working with a dietitian to
develop a feeding schedule that may include supplements.

NUTRITIONAL REHABILITATION

Nutritional Rehabilitation is practical training to mothers of children with

malnutrition in Selecting, preparing food from locally available cheap sources and
feeding them back to health. Malnutrition has a detrimental impact on health,
physical development, brain development, and intellect especially during
pregnancy and the first two years of life. The consequences of malnutrition are
higher child mortality and morbidity; lower cognitive development, hence lower
returns from investments in education; and lower productivity leading to a higher
burden to the health system. As calculated in a recent World Bank report,
malnutrition accounts for an economic loss of about 3 percent of Gross Domestic
product in developing countries

TYPES OF NUTRITIONAL REHABILITATION

o Hospital based Nutritional Rehabilitation

 o Centre based Nutritional Rehabilitation

 Day Nutritional Rehabilitation centre

 Residential Nutritional Rehabilitation centre

o Community based Nutritional Rehabilitation

 Criteria for transfer to Rehabilitation phase

o Eating well

o Mental state has improved: smiles, responds to stimuli, interested in

surroundings

o Sits, crawls, stands or walks (depending on age)

o Normal temperature (36.5 – 37.5 degree C)

o No vomiting or diarrhea

o No edema

o Gaining weight: >5 g/kg of body wt per day for 3 successive days

 Dietary Management Diet should be:

 From locally available staple foods

o Inexpensive

o Easily digestible

o Consisting of minimum of 100 ml milk per day

o Of cereal & pulse combination – 5:1 ratio

o Evenly distributed throughout the day

 o Increase quantity of food which the child is already used to

o Increase number of feedings

o Increase calorie by adding oil

Hospital based Nutritional Rehabilitation

During rehabilitation phase – rapid catch-up growth in weight needs to be

attained facilitates early discharge & prevents secondary infections. Caloric intake
of 170-220 Kcal/kg/day required for rapid catch up growth Rapid catch up growth
is more than 10 g/kg/day and Poor catch up growth is less than 5 g/kg/day vitamin
A and minerals to be supplemented is Hospital based nutritional rehabilitation of
severely undernourished children using energy dense local foods. Results mean
gain 5 g/kg/day. Only 12% had rapid catch-up growth. Higher morbidity score was
associated with lower rate of weight gain.

Centre based Nutritional Rehabilitation

Type A – Day Nutritional Rehabilitation centre for milder forms of protein

energy Malnutrition in 6 to 8 hours / day, 6 days / week ,3 daily meals It help
mothers prepare the Meals and Preference given to food stuffs and utensils –
familiar to the mothers & available in local market and Not more than 30 children

Type B – Residential Nutritional Rehabilitation centre for severe malnutrition

after treated in a hospital for complications Usually attached to a hospital .Children
with mothers live in the institution and Mothers help to prepare the meals &
receive suitable instruction on child feeding – Educators of community .Proper
education and training to mothers can Prevent relapses & prevent other children in
same family from getting affected.

Community based Nutritional Rehabilitation (CBNR)

 Community based system of managing children who are developing PEM
with Goal: to Restore to near normal the nutritional status of the undernourished
child and to have a Sustained improved physical & mental growth, performance of
the child , siblings & other Children in the household.

NUTRITIONAL SUPPLEMENTS, BALANCED DIET

Community nutrition is the process of helping individuals and groups develop

healthy eating habits in order to promote wellness and prevent disease. The goal of
community nutrition is to educate individuals and groups so that they adopt healthy
eating habits. Community nutrition programs attempt to change attitudes so that a
diet rich in fruit, vegetables, and whole grains is more appealing than diet high in
fats and sugars. While sweet, high fat foods may be an occasional treat, community
nutrition emphasizes a lifetime of routine healthy eating.

Dietary supplements are products aimed at improving the health status and
wellness of an individual, which can be taken during meal or at specific intervals to
supplement the individual daily diet. Supplements are required when there is an
imbalance in nutrient or absence of a particular nutrient.

A diet that contains adequate amounts of all the necessary nutrients required for
healthy growth and activity is the balanced diet. A balanced diet contains sufficient
amounts of fiber and the various nutrients to ensure good health. Food should also
provide the appropriate amount of energy and adequate amounts of water.

Community Nutrition Programmes is to improve overall nutritional status , To

improve overall nutritional status of vulnerable group, To overcome specific
nutritional deficiencies among mothers and children , To help to achieve better
nutrition through indirect schemes.

NUTRITIONAL SUPPLEMENTS

Nutritional supplements include vitamins, minerals, herbs, meal supplements,

sports nutrition products, natural food supplements, and other related products used
to boost the nutritional content of the diet. Nutritional supplements are used for
many purposes. They can be added to the diet to boost overall health and energy;
to provide immune system support and reduce the risks of illness and age-related
conditions; to improve performance in athletic and mental activities; and to support
the healing process during illness and disease. However, most of these products are
treated as food and not regulated as drugs are.

Vitamins

Vitamins are micronutrients, or substances that the body uses in small amounts, as
compared to macronutrients, which are the proteins, fats, and carbohydrates that
make up all food. Vitamins are present in food, but adequate quantities of vitamins
may be reduced when food is overcooked, processed, or improperly stored. For
instance, processing whole wheat grain into white flour reduces the contents of
vitamins B and E, fiber, and minerals, including zinc and iron. The body requires
vitamins to support its basic biochemical functions, and deficiencies over time can
lead to illness and disease.

Vitamins are either water-soluble or fat-soluble. Water-soluble vitamins dissolve in

water and pass through the body quickly, meaning that the body needs them on a
regular basis. Water-soluble vitamins include the B-complex vitamins and vitamin
C. Fat-soluble vitamins are stored in the body's fatty tissue, meaning that they
remain in the body longer. Fat-soluble vitamins include vitamins A, D, E, and K.
Vitamins can be natural or synthetic. Natural vitamins are extracted from food
sources, while synthetic vitamins are formulated in laboratory processes.

Minerals

Minerals are micronutrients and are essential for the proper functioning of the
body. Cells in the body require minerals as part of their basic make-up and
chemical balance, and minerals are present in all foods. Minerals can either be bulk
minerals, used by the body in larger quantities, or trace minerals, used by the body
in minute or trace amounts. Bulk minerals include sodium, potassium, calcium,
magnesium, and phosphorus. Trace minerals include iron, zinc, selenium, iodine,
chromium, copper, manganese, and others. Some studies have shown that the
amount of minerals, particularly trace minerals, may be decreasing in foods due to
mineral depletion of the soil caused by unsustainable farming practices and soil
erosion. Supplemental minerals are available in chelated form, in which they are
bonded to proteins in order to improve their absorption by the body.

Herbs

Herbal supplements are added to the diet for both nutritional and medicinal
purposes. Herbs have been used for centuries in many traditional medicine
systems, and as sources of phytochemicals, or substances found in plants that have
notable effects in the body. Chinese medicine and Ayurvedic medicine from India,
two of the world's oldest healing systems, use hundreds of herbal medications.
Naturopathy and homeopathy, two other systems of natural healing, also rely on
herbal preparations as their main sources of medication.

Herbs can supplement the diet to aid in overall health or to stimulate healing for
specific conditions. For instance, ginseng is used as a general tonic to increase
overall health and vitality, while echinacea is a popular herb used to stimulate the
body's resistance to colds and infections. Herbs come in many forms. They can be
purchased as capsules and tablets, as well as in tinctures, teas, syrups, and
ointments.

Meal supplements

Meal supplements are used to replace or fortify meals. They may be designed for
people with special needs, or for people with illnesses that may affect digestion
capabilities and nutritional requirements. Meal supplements may contain specific
blends of macronutrients, or proteins, carbohydrates, fats, and fiber. Some meal
supplements consist of raw, unprocessed foods, or vegetarian or vegan options, or
high protein and low fat composition. Meal supplements are available to support
some popular diet programs. Meal supplements are often fortified with vitamins,
minerals, herbs, and nutrient-dense foods.

Other nutritional supplements

Other nutritional supplements include nutrient-dense food products. Examples of

these are brewer's yeast, spirulina (sea algea), bee pollen and royal jelly, fish oil
and essential fatty acid supplements, colostrum (a specialty dairy product),
psyllium seed husks (a source of fiber), wheat germ, wheatgrass, and medicinal
mushrooms such as the shiitake and reishi varieties.

Specialty products may offer particular health benefits or are targeted for specific
conditions. These products may consist of whole foods or may be isolated
compounds from natural or synthetic sources. Examples include antioxidants,
probiotics (supplements containing friendly bacteria for the digestive tract),
digestive enzymes etc.)
BALANCED DIET

A balanced diet is a diet that contains differing kinds of foods in certain quantities
and proportions so that the requirement for calories, proteins, minerals, vitamins
and alternative nutrients is adequate and a small provision is reserved for
additional nutrients to endure the short length of leanness.

A balanced diet means getting the right types and amounts of foods and drinks to
supply nutrition and energy for maintaining body cells, tissues, and organs, and for
supporting normal growth. A well-balanced diet provides important vitamins,
minerals, and nutrients to keep the body and mind strong and healthy. Eating well
can also help ward off numerous diseases and health complications, as well as help
maintain a healthy body weight, provide energy, allow better sleep, and improve
brain function. A diet with balance provides the body with the proper proportions
of carbohydrates, fats, proteins, vitamins, minerals, and liquids. It is important to
not eliminate any essential macronutrient, such as fats or carbohydrates, but be
conscious of portion control. development.

Importance of a Balanced Diet

The following are the importance of a balanced diet :

• Balanced Diet leads to a good physical and a good mental health.

• It helps in proper growth of the body.

• It increases the capacity to work

• Balanced diet increases the ability to fight or resist diseases.

Components of a balanced diet

Some components of a balanced diet are as follows:

Fats

Some part of our energy requirement is fulfilled by fats. Fats can be found in fatty
foods such as butter, ghee, oil, cheese, etc.

Proteins

We need proteins for growth purposes and to repair the wear and tear of the body.
Protein also helps in building muscle. It is found in dairy products, sprouts, meat,
eggs, chicken, etc

Carbohydrates

We need the energy to process and it is fulfilled by carbohydrates. Carbs provide

us energy. Carbohydrates can be found in rice, wheat, chapati, bread, etc. Cereals
are our staple food.

Minerals and Vitamins

Vitamins, Minerals, and Fibre improve the body’s resistance to disease. We mainly
obtain it from vegetables and fruits. Deficiency diseases like Anemia, Goitre, etc.
can be caused due to lack of mineral in the body. minerals- calcium, phosphorus,
sodium, pottasium, magnesium, iron, zinc

CALCIUM

o Helps in proper bone formation

o Cells signalling, blood clot formation, muscle contraction.

o Sources – dairy products, Green leafy vegetables, beans, Fish. Lack of

calcium in diet leads to Osteoporesis, frequent fractures, Muscle cramps, obesity.

IRON AND FOLIC ACID

o Most important for proper haemoglobin levels in our body.

o Its deficiency causes anemia.

o Sources of iron : red meat, Egg yolk, beans and legumes, Dried fruits, fruits,
ragi, bajra, Jowar, jagrey, sprouted and Fermented food products .

SODIUM

o A mineral that regulates body fluid volume, concentration and acid-base

o sources: table salt (sodium chloride), foods processed with table salt, milk,
milk products, eggs and seafoods.

COMMUNITY NUTRITIONAL PROGRAMMES

 The main aim of community nutritional programmes is to improve nutritional
status in targeted groups and overcome specific diseases to combat malnutrition.

1. Vitamin A prophylaxis programme.

2. Prophylaxis against nutritional anaemia

3. Control of iodine deficiency disorders

4. Special nutrition programme

5. Balwadi nutrition programme

6. ICDS programme

7. Mid-day meal programme

8. Mid-day meal scheme

1) VITAMIN-APROPHYLAXIS PROGRAMME

o The programme was Initiated in 1970

o Beneficiary: age group 6months - 5year.
o Objective: Prevent blindness due to VAD .
o Implemented by: PHC and subcenter.
o A single massive dose of Vitamin-A2 lac IU (retinol palmitate 110mg) orally
every 6 months above 1 year.
o Role of Vitamin-A in health :- Prevent respiratory infection, Maintain GIT
epithelium integrity, Immunity , Prevent Nutritional blindness
2) PROPHYLAXIS AGAINST NUTRITIONAL ANAEMIA

o Initiated in 1970
o Centrally sponsored programme
o Over 50%pregnant woman suffer from anemia
 o Causes LBW and perinatal mortality, maternal death
o Objectives: Assess prevalence, Give treatment, Give prophylaxis,
Monitoring, Education
o Beneficiaries: – Children aged 1 to 5years, Pregnant and nursing
mother Implemented by: PHC and sub centers
3) IODINE DEFICIENCY DISORDER CONTROL PROGRAMME

o National goiter control programme in1962

o IDD Control Programme

o Replace the entire edible salt by iodide salt

o Fortification of salt with iodine

4) SPECIAL NUTRITIONAL PROGRAMME

o Started in 1970 in urban slums, tribal areas and backward rural areas

o Main aim of the is to improve nutritional status in – children <6years

– pregnant and lactating women

o Gradually it was being merged into ICDS

5) APPLIED NUTRITIONAL PROGRAMME

 This project was started in Orissa on1963

 Later extended to TamilNadu and UtterPradesh

 In 1973 extended to all states in INDIA

Objectives:

 Promoting production and of protective food such vegetables and fruits

 Ensure their consumption by pregnant & lactating women and children.

 Major components

 Nutritional Services

 Health services

 Communication

 Monitoring and evaluation

 Later converted into ICDS

6) BALWADI NUTRITION PROGRAMME

 This was started in 1970 by the department of social welfare

 Beneficiary: – Preschool children 3-6 years of age

Activities

 300 kcal and 10 g protein

 Preschool education

7) INTEGRATED CHILD DEVELOPMENT SERVICES (ICDS) SCHEME

 Launched on 2nd October 1975.

 One of the world’s largest and most unique programmes for early
childhood development .

 India’s response to the challenge of

 Providing pre-school education on one hand and

 Breaking the vicious cycle of malnutrition, morbidity, reduced

learning capacity and mortality, on the other foremost symbol
of India’s commitment to her children.
Objectives of ICDS

 Improve the nutritional and health status of children in the age-group 0-

6years .

 Foundation for proper psychological, physical and social development of

the child.

 Reduce the incidence of mortality, morbidity, malnutrition and school

dropout.

 Co-ordination of departments to promote child development .

 Nutrition and health education to the mother.

Beneficiaries of ICDS

 Pregnant women
 Nursing Mothers
 Children less than 3 years
 Children between 3-6years
 Adolescent girls( 11-18years)
Package of services:

1. Supplementary nutrition.
2. Immunization
3. Health check-up
4. Referral services
5. Pre-school non-formal education
6. Nutrition & health education
8) MID DAY MEAL PROGRAMME
 o School Lunch Programme

Objectives

 Improve school attendance

 Improve child nutrition

Principles

o Supplement, not substitute to home diet

o 1/3rd of energy and ½of protein requirement/day
o low cost, easily prepared at schools
o locally available food, change menu frequently
9) MID-DAY MEAL SCHEME

National Programme of Nutritional Support to Primary Education

Objectives:

 Universalization of primary education by increasing enrollment (class1 to 5).

 Improve nutritional status of children (class1-5)
Nutritional supplements are any dietary supplement that is intended to
provide nutrients that may otherwise not be consumed in sufficient quantities; for
example, vitamins, minerals, proteins, amino acids or other nutritional substances.
Products are usually ingested in capsule, tablet or liquid form. A balanced diet
comprises vital nutrients like carbohydrates, fats, vitamins, minerals, proteins, and
fibre. Sufficient and nutritious food that ensures good health is included in a
balanced diet. A healthy and balanced diet helps to reduce the risk of diseases and
improves overall health. Community Nutrition Programmes is to improve overall
nutritional status and to improve overall nutritional status vulnerable group, To
overcome specific nutritional deficiencies among mothers and children
deficiencies among mothers and children , To help to achieve better nutrition
through indirect schemes.

APPROACHES TO NUTRITION EDUCATION

Community nutrition has been defined as the group of activities linked to

Applied Nutrition within the context of Public Health, whose main goal is to tailor
individual and population food patterns according to updated scientific knowledge,
in a certain region with a final aim of health promotion.

APPROACHES

For the past 20 years there has been intense debate on the strategies, objectives
and methods of nutrition education (Andrien, 1994). Conventional education
methods consisted mainly of talks given at health centres. Today this approach is
considered largely ineffective unless it is fully integrated into a broader nutrition
education strategy. The conventional method has largely given way to approaches
based on modern communication sciences.

Conventional approach

A review of nutrition education programmes in developing countries (Cerqueira,

1990) concluded that many nutrition education efforts implemented during the
1970s and early 1980s brought few changes in nutrition-related behaviour or
nutritional status. Programme failure can be attributed largely to the ineffective
communication methods used and the inappropriate content of the messages, which
often ignored the specific cultural context of the community.

Most nutrition education activities have been implemented within the health sector,
especially in primary health care. Conventional strategies for education focused on
face-to-face contact with the patient, using didactic methods of education and one-
way transfer of information. Nutrition messages were considered as treatment, like
medicine, for curing a nutrition problem. Within this context nutritional science,
rather than the concerns of the participants, dictated the content of nutrition
education. Common examples of this approach are telling mothers to eat more
green vegetables or to breastfeed their children and teaching the three food groups
in health clinics

Current approaches

More recent experiences, in contrast with the conventional approach, show that
nutrition education is concerned not only with imparting knowledge, but also with
finding ways to work with individuals or groups in the community in a systematic
manner that will stimulate their participation in and commitment to the learning
process. Nutrition education undertaken in this spirit is interactive, encourages an
exchange of information between the educator and the community and empowers
people to make appropriate choices using both scientific and local knowledge.
Moreover, it leads to the adoption of improved behaviour and contributes to lasting
effects and changes.

Social marketing approach. Social marketing is defined as the promotion of

socially responsible products, behaviour and ideas. It is based on strategies to
change human behaviour through the application of commercial marketing
principles. Consumer research is used to identify the cultural norms, aspirations
and needs of the target group, and then specific messages are designed to promote
changes in attitudes and behaviour believed to be socially beneficial to the
individual or the target community. Social marketing has contributed substantially
towards the development of modern communication approaches in the past 20
years.

Community-based approach

Evidence from different countries shows that combining interpersonal programmes

at community level with the support of the mass media is the most effective way to
educate people. It is increasingly recognized that unless people are offered the
opportunity to participate actively in seeking solutions for their nutritional
problems, the long-term impact of an intervention will be marginal.

Nutrition education in schools

Schools provide a special medium for nutrition education and for

intervention to improve children's health and nutritional status. The basic aim is to
help children acquire nutrition knowledge and to develop and encourage desirable
eating habits and food choices. Children can also help change the eating habits of
their families by demanding desirable food, and when they themselves become
parents in the future, they can impart good dietary habits to their children.
Therefore, a common maxim about how to bring about a real change in dietary
habits is "Go to school".

Available evidence on the effectiveness of nutrition education programmes

in schools shows that nutrition knowledge is most effective if there is a supportive
environment and if nutrition education is linked with practical food- and nutrition-
related activities (Lytle and Achterberg, 1995). Lunch, feeding, gardening and
health programmes in schools offer special opportunities for practical teaching in
nutrition. Student participation in school gardening, menu planning, food selection
(ideally from locally grown and processed foods) and food preparation offers
pupils first-hand experience in learning nourishing and hygienic dietary practices.
The classroom can thus serve as a "laboratory" where proper eating habits can be
demonstrated and reinforced in practice. Another important way to build a
supportive environment for nutrition education in schools is to involve the parents.
The Child to Child Programme, for example, is based on the concept of
children as social educators and as effective intermediaries for messages directed at
their parents. However, in this programme it is important to engage the parents and
other family members in the activities and the learning experience as much as
possible. For example, parents can become involved in food production, especially
in school gardening.

FOOD ADULTERATION AND FOOD BORNE DISEASE

Food Adulteration refers to the process by which the quality or the nature of
a given food is reduced through addition of adulterants or removal of vital substance.
It is the foreign and usually inferior chemical substance present in food that cause
harm or is unwanted in the food. Basically, during food adulteration, small quantity
of non-nutritious substances are added intentionally to improve the appearance,
texture or storage properties of the food. Food adulteration is quite common in the
developing countries.
Food borne disease: A disease caused by consuming contaminated food or
drink. Myriad microbes and toxic substances can contaminate foods. There are more
than 250 known food borne diseases. The majority are infectious and are caused by
bacteria, viruses, and parasites. Most food borne diseases are infections caused by a
variety of bacteria, viruses, and parasites. Other diseases are poisonings caused by
harmful toxins or chemicals that have contaminated food.

FOOD ADULTERATION
Food adulteration is the act of intentionally debasing the quality of food offered for
sale either by the admixture or substitution of inferior substances or by the removal of
some valuable ingredient.

FOOD IS ADULTERATED IF:

The food sold does not meet the nature of the substance or quality as per the demand
of consumer.

 The food contains inferior or cheaper substance

 The food has been prepared, packed or kept under unclean conditions leading to
contamination.
 Food contains substances that depreciates or injuriously affects the health.
 If the food’s original nature is substituted wholly or partially by abstracting a
portion of vital substance from food.
 If it is an imitation of some other food substance.

TYPES OF FOOD ADULTERATION:

1. Intentional adulteration: The adulterants are added as a deliberate act with

intention to increase profit. E.G. sand, marble chips, stones, chalk powder, etc.
2. Incidental Adulteration: Adulterants are found in food due to negligence,
ignorance or lack of proper facilities. E.G. Packaging hazards like larvae of
insects, droppings, pesticide residues, etc.
3. Metallic adulteration: When the metallic substances are added intentionally or
accidentally. Eg: arsenic, pesticides, lead from water, mercury from effluents,
tins from cans, etc.

METHODS OF FOOD ADULTERATION:

1. Mixing: Mixing of clay, stones, pebbles, sand, marble chips, etc.

2. Substitution: Cheaper and inferior substances being replaced wholly or partially
with good ones.
3. Concealing quality: Trying to hide the food standard. E.G. adding captions of
qualitative food to low quality for selling.
4. Decomposed food: Mainly in fruits and vegetables. The decomposed ones are
mixed with good ones
5. Misbranding/ False labels: Includes duplicate food stuffs, changing of
manufacture and expiry dates.
 6. Addition of toxicants: adding non-edible substances like argemone in mustard
oil, low quality preservatives, colouring agents, etc.

HEALTH HAZARDS OF FOOD ADULTERATION:

Some health hazards associated with specific food adulteration incudes;

 Mineral oil if added to edible oil and fats can cause cancers.
 Lead chromate when added to turmeric powder and spices can cause anaemia,
paralysis, brain damage and abortions.
 Lead added to water, natural and processed food can lead to lead poisoning, foot
drop, insomnia, constipation, anaemia, and mental retardation.
 Cobalt added to water and liquors and can cause cardiac damage also copper,
tin, and zinc can cause colic, vomiting and diarrhoea.
 Mercury in mercury fungicide treated grains, or mercury-contaminated fish can
cause brain damage, paralysis, and death.
 Non-permitted colour or permitted food colour like metal yellow, beyond the
safe limit in coloured food can cause allergies, hyperactivity, liver damage,
infertility, anaemia, cancer and birth defects.

FOOD BORNE DISEASE

Food borne diseases are acute illnesses caused by harmful bacteria or toxins
that usually develop within hours of consuming contaminated or poisonous food.
Sometimes the symptoms can be mild and will disappear within a few hours but, on
some occasions, the results can be life-threatening.
SYMPTOMS
Common symptoms of food borne illness are diarrhea and/or vomiting, typically
lasting 1 to 7 days. Other symptoms might include abdominal cramps, nausea, fever,
joint/back aches, and fatigue. What some people call the “stomach flu” may actually
be a food borne illness caused by a pathogen (i.e., virus, bacteria, or parasite) in
contaminated food or drink. The incubation period (the time between exposure to the
pathogen and onset of symptoms) can range from several hours to 1 week.

TYPES OF FOOD BORNE DISEASE

The most common food borne infections are caused by three bacteria --
Campylobacter, Salmonella, and E. coli O157:H7 -- and by a group of viruses called
calicivirus, better known as Norwalk-like virus:

1. Campylobacter -- Campylobacter is the most common bacterial cause of

diarrheal illness in the world. The bacteria live in the intestines of healthy
birds, and most raw poultry meat has Campylobacter on it. Eating undercooked
chicken, or other food that has been contaminated with juices dripping from
raw chicken is the most frequent source of this infection. Aside from diarrhea,
common symptoms include causes fever, diarrhea, and abdominal cramps.
2. Salmonella -- Salmonella is widespread in the intestines of birds, reptiles and
mammals. People can acquire the bacteria via a variety of different foods of
animal origin. The illness it causes is called salmonellosis and typically
includes fever, diarrhea and abdominal cramps. In persons with poor
underlying health or weakened immune systems, Salmonella can invade the
bloodstream and cause life-threatening infections.
3. E. coli O157:H7 -- E. coli O157:H7 has a reservoir in cattle and other similar
animals. Illness typically follows consumption of food or water that has been
contaminated with microscopic amounts of cow feces. The illness it causes is
often a severe and bloody diarrhea and painful abdominal cramps, without
much fever. But in 3 to 5% of cases, a life-threatening complication called
the hemolytic uremic syndrome (HUS) can occur several weeks after the initial
symptoms, resulting in anemia, profuse bleeding, and kidney failure.

 Calcivirus (Norwalk-like virus) -- Calicivirus (Norwalk-like virus) is an

extremely common cause of foodborne illness (though it is rarely
diagnosed, because the laboratory test is not widely available). It causes an
acute gastrointestinal illness, usually with more vomiting than diarrhea,
that resolves within two days. Unlike many foodborne pathogens that have
animal reservoirs, it is believed that Norwalk-like viruses spread primarily
from one infected person to another. Infected kitchen workers can
contaminate a salad or sandwich as they prepare it, if they have the virus
on their hands. Infected fishermen have contaminated oysters as they
harvested them.

MODULE 5
 MEDICAL TERMINATION OF PREGNANCY
ACT, 1971

• The medical termination of pregnancy act, 1971 is a legislation to legalise

termination of certain pregnancies by registered medical practitioners.
General Law is that no pregnancy shall be terminated, save for the exception
in the Indian Penal Code. By the enactment, the termination of pregnancy by
a registered medical practitioner in the interest of mother’s health and life is
permitted where- The length of pregnancy does not exceed 12 weeks. If it
exceeds 12 weeks, but not 20 weeks, then two medical practitioners shall
opinion in good faith that the continuation of pregnancy would involve
serious risk of life or grave injury to the physical & mental health of
pregnant women. There is a substantial risk of the child being born with
serious physical and mental abnormalities so as to be handicapped in life.

When the pregnancy is caused by rape or as a

result of failure of contraceptive used by any married women or by
her husband, such unwanted pregnancy may constitute grave injury
to mental health of the pregnant women. Pregnancy of a minor girl,
or who is a lunatic cannot be terminated without the written consent
of the parent or legal guardian; Pregnancy of woman who has
attained majority can be terminated only on the written consent of
woman. Husband's consent is not necessary. Termination can be
performed only in hospitals, established or maintained by the
Government, or places for the time being approved by the
Government for the purpose of act;

If the person conducting the termination of pregnancy is not a

registered medical practitioner, he is liable to punished under the
relevant provisions of IPC.
 Medical Termination Of Pregnancy (Amendment) Bill 2020

The proposed amendments introduce the

following provisions: For termination of pregnancy up to 20 weeks
of gestation the opinion of one registered medical practitioner will be
required, and for termination of pregnancy of 20-24 weeks of
gestation opinion of two registered medical practitioners will be
required. Extending the upper gestation limit from 20 to 24 weeks
for special categories of women which includes vulnerable women
including survivors of rape, victims of incest and other vulnerable
women (like differently abled women, minors) etc.

Upper gestation limit not to apply in cases

of substantial foetal abnormalities diagnosed by Medical Board.
The composition, functions and other details of Medical Board
to be prescribed subsequently in Rules under the Act. Name and
other particulars of a woman whose pregnancy has been
terminated shall not be revealed except to a person authorized in
any law for the time being in force.

PCPNDT ACT,1994


Pre-Conception & Pre-Natal

 Diagnostic Techniques Act, 1994

 An Act to provide for the prohibition of sex selection, before or after
conception, and for regulation of prenatal diagnostic techniques for the
purposes of detecting genetic abnormalities or metabolic disorders or
chromosomal abnormalities or certain congenital malformations or sex-
linked disorders and for the prevention of their misuse for sex determination
leading to female foeticide; and, for matters connected there with or
incidental there to.
  pre-natal diagnostic procedures” : means all gynaecological or
obstetrical or medical procedures

such as ultrasonography, foetoscopy, taking or removing samples of amniotic

fluid, chorionic villi, blood or any other tissue or fluid of a man, or of a woman for
being sent to a Genetic Laboratory or Genetic Clinic for conducting any type of
analysis or pre-natal diagnostic tests for selection of sex before or after conception;

 To detect :
❖Genetic disorders
❖Metabolic disorders
❖Chromosomal abnormalities
❖Congenital anomalies
❖Haemoglobinopathies
❖Sex-linked disease

Sex selection includes:

❖ Procedure

❖Technique
❖Test
❖Administration
❖Prescription
Provision for the purpose of ensuring or increasing the probability that an
embryo will be of a particular sex,

Regulation of GCC, Laboratories & Clinics

 No Genetic Counselling Centre, Laboratory or Clinic

Unless registered:

1. Can conduct associate or help in conducting activities relating to pre-natal

diagnostic techniques.
Can employ or take services of any person(honory or payment) who does
not possess qualifications.

No medical geneticist, gynaecologist, paediatrician, registered medical

practitioner or any other person shall conduct or cause to be conducted or aid in
conducting by himself or through any other person, any pre-natal diagnostic
techniques at a place other than a place registered under this Act.
Does the law allow the conduct of PNDT

Conduct of pre-natal diagnostic techniques is allowed only for the detection of:

❖ Chromosomal abnormalities

❖Genetic metabolic diseases

❖Haemoglobinopathies

❖ Sex-linked genetic diseases

Inborn-anomalies

No pre-natal diagnostic techniques shall be used or conducted unless the person

qualified to do so is satisfied for reasons to be recorded in writing that any of
the following conditions are fulfilled, namely:—

(i) age of the pregnant woman is above thirty-five years;

(ii)the pregnant woman has undergone of two or more spontaneous
abortions or
foetal loss;

iii) the pregnant woman had been exposed to potentially teratogenic

agents such as drugs, radiation, infection or chemicals;

(iv) the pregnant woman or her spouse has a family history of

mental retardation or physical deformities such as, spasticity or
any other genetic disease;
(v) any other condition as may be specified by the Central Supervisory
Board;
ABOUT THE MENTAL HEALTH CARE BILL

The Mental Healthcare Bill, 2016, aims to provide provide for mental healthcare
and services for persons with mental illness and ensure these persons have the right
to live a life with dignity by not being discriminated against or harassed.

Definition

The Bill defines “mental illness” as a substantial disorder of thinking, mood,

perception, orientation or memory that grossly impairs judgment, behaviour,
capacity to recognise reality or ability to meet the ordinary demands of life, mental
conditions associated with the abuse of alcohol and drugs, but does not include
mental retardation which is a condition of arrested or incomplete development of
mind of a person, specially characterised by subnormality of intelligence.
Mental illness shall be determined in accordance with such nationally or
internationally accepted medical standards.

Rights of persons with mental illness

The Bill ensures every person shall have a right to access mental health care and
treatment from mental health services run or funded by the appropriate
government. The Bill also assures free treatment for such persons if they are
homeless or belong to Below Poverty Line, even if they do not possess a BPL
[Link] person with mental illness shall have a right to live with dignity and
there shall be no discrimination on any basis including gender, sex, sexual
orientation, religion, culture, caste, social or political beliefs, class or disability.

A person with mental illness shall have the right to confidentiality in respect of his
mental health, mental healthcare, treatment and physical healthcare.

The photograph or any other information pertaining to the person cannot be

released to the media without the consent of the person with mental illness.

Advance Directive

A person with mental illness shall have the right to make an advance directive that
states how he/she wants to be treated for the illness and who his/her nominated
representative shall be. The advance directive should be certified by a medical
practitioner or registered with the Mental Health Board.

If a mental health professional/ relative/care-giver does not wish to follow the

directive while treating the person, he can make an application to the Mental
Health Board to review/alter/cancel the advance directive.

Mental Health Authority

The Bill empowers the government to set-up Central Mental Health Authority at
national-level and State Mental Health Authority in every State. Every mental
health institute and mental health practitioners including clinical psychologists,
mental health nurses and psychiatric social workers will have to be registered with
this Authority.

These bodies will (a) register, supervise and maintain a register of all mental health
establishments,(b) develop quality and service provision norms for such
establishments, (c) maintain a register of mental health professionals, (d) train law
enforcement officials and mental health professionals on the provisions of the Act,

(e) receive complaints about deficiencies in provision of services,

and (f) advise the government on matters relating to mental health.
A Mental Health Review Board will be constituted to protect the rights of persons
with mental illness and manage advance directives .

Mental Health treatment

The Bill also specifies the process and procedure to be followed for admission,
treatment and discharge of mentally-ill individuals.A medical practitioner or a
mental health professional shall not be held liable for any unforeseen consequences
on following a valid advance directive.

A person with mental illness shall not be subjected to electro-convulsive therapy

without the use of muscle relaxants and anaesthesia. Also, electro-convulsive
therapy will not be performed for minors.

Sterilisation will not be performed on such persons.

They shall not be chained in any manner or form whatsoever under any
circumstances.

A person with mental illness shall not be subjected to seclusion or solitary

confinement. Physical restraint may only be used, if necessary.

Suicide is decriminalised

A person who attempts suicide shall be presumed to be suffering from mental

illness at that time and will not be punished under the Indian Penal Code. The
government shall have a duty to provide care, treatment and rehabilitation to a
person, having severe stress and who attempted to commit suicide, to reduce the
risk of recurrence of attempt to commit suicide.
 REVISIONS MADE FROM THE MENTAL HEALTH ACT 1987

1. The Mental Healthcare Act 2017 aims at decriminalising the Attempt to Commit
Suicide by seeking to ensure that the individuals who have attempted suicide are
offered opportunities for rehabilitation from the government as opposed to being
tried or punished for the attempt.
2. The Act seeks to fulfill India's international obligation pursuant to the Convention
on Rights of Persons with Disabilities and its Optional Protocol.
3. It looks to empower persons suffering from mental illness, thus marking a
departure from the Mental Health Act 1987. The 2017 Act recognises the agency
of people with mental illness, allowing them to make decisions
 regarding their health, given that they have the appropriate knowledge to do
so.

4. The Act aims to safeguard the rights of the people with mental illness, along
with access to healthcare and treatment without discrimination from the
government. Additionally, insurers are now bound to make provisions for
medical insurance for the treatment of mental illness on the same basis as is
available for the treatment of physical ailments.
5. The Mental Health Care Act 2017 includes provisions for the registration of
mental health related institutions and for the regulation of the sector. These
measures include the necessity of setting up mental health establishments
across the country to ensure that no person with mental illness will have to
travel far for treatment, as well as the creation of a mental health review
board which will act as a regulatory body.
6. The Act has restricted the usage of Electro convulsive therapy (ECT) to be
used only in cases of emergency, and along with
muscle relaxants and anesthesia. Further, ECT has additionally been
prohibited to be used as viable therapy for minors.

7. The responsibilities of other agencies such as the police with respect to

people with mental illness has been outlined in the 2017 Act.
8. The Mental Health Care Act 2017 has additionally vouched to tackle stigma
of mental illness, and has outlined some measures on how to achieve the
same.

MENTAL HEALTH ACT 2017

On March 27, 2017, Lok Sabha in a unanimous decision passed the Mental
Healthcare Act 2017 which was passed in Rajya Sabha on August 2016 and got its
approval from Honorable President of India on April 2017. The new act defines
“mental illness” as a substantial disorder of thinking, mood, perception,
orientation, or memory that grossly impairs judgment or ability to meet the
ordinary demands of life, mental conditions associated with the abuse of alcohol
and drugs.”This act rescinds/revoked the existing Mental Healthcare Act 1987
which had been widely criticized for not recognizing the rights of a mentally ill
person and paving the way for isolating such dangerous [Link] act has
overturned 309 Indian Penal Code which criminalizes attempted suicide by
mentally ill person. Another highlight of this Act is to protect the rights of a person
with mental illness, and thereby facilitating his/her access to treatment and by an
advance directive; how he/she wants to be treated for his/her illness.

The various provisions under the Mental Healthcare Bill are as follows.
Rights of persons with mental illnesss

Every person will have the right to access mental healthcare services. Such
services should be of good quality, convenient, affordable, and accessible. This act
further seeks to protect such persons from inhuman treatment, to gain access to
free legal services and their medical records, and have the right to complain in the
event of deficiencies in provisions

Advance Directive: This empowers a mentally ill person to have the right to make
an advance directive toward the way she/he wants to be treated for the requisite
illness and who her/his nominated representative shall be. This directive has to be
vetted by a medical practitioner.

Mental Health Establishments: The government has to set up the Central Mental
Health Authority at national level and State Mental Health Authority in every state.
All mental health practitioners (clinical psychologists, mental health nurses, and
psychiatric social workers) and every mental health institute will have to be
registered with this authority. These bodies will (a) register, supervise, and
maintain a register of all mental health establishments; (b) develop quality and
service provision norms for such establishments; (c) maintain a register of mental
health professionals; (d) train law enforcement officials and mental health
professionals on the provisions of the act; (e) receive complaints about deficiencies
in provision of services; and (f) advise the government on matters relating to
mental health.

Admission of persons with mental illness

The act also outlines the procedure and process for admission, treatment, and
subsequent discharge of mentally ill persons.

Decriminalizing suicide and prohibiting electroconvulsive therapy

It decriminalizes suicide attempt by a mentally ill person. It also imposes on the

government a duty to rehabilitate such person to ensure that there is no recurrence
of attempt to suicide. A person with mental illness shall not be subjected to
electroconvulsive therapy (ECT) therapy without the use of muscle relaxants and
anesthesia. Furthermore, ECT therapy will not be performed for minors.

Responsibility of certain other agencies

A police officer in charge of a police station shall report to the Magistrate if he has
reason to believe that a mentally ill person is being ill-treated or neglected. The bill
also imposes a duty on the police officer in the charge of a police station to take
under protection any wandering person; such person will be subject to examination
by a medical officer and based on such examination will be either admitted to a
mental health establishment or be taken to her residence or to an establishment for
homeless persons.

Financial punishment

The punishment for violating of provisions under this Act will be imprisonment up
to 6 months or Rs. 10,000 one or both. Repeat offenders can face up to 2 years in
jail or a fine of Rs. 50,000–5 lakhs or both

LIST OF CHAPTERS

The Mental Health Care Act 2017 is split into 16 chapters which are further
elaborated as below.

Chapter I

● It comprises the definitions & terms that are asserted in the Act.
● Mental Illness gets a brand new & elaborative definition.
● It involves post-graduate Ayush doctors as Mental Health Professionals.

Chapter II

● This chapter covers mental illness and the capacity to make mental health
care and treatment decisions without any prejudice.
 ● How mental health should be determined.
● Capacity to make mental health care and treatment decisions.

Chapter III

● This chapter deals with the Advance directives.

● Manner of making Advance Directives & maintaining it & its power, review
& liability allocated to it.

Chapter IV
 ● It lies down the guidelines of determining a nominated representative.
● Appointment & Revocation of NR & his Duties.

Chapter V

It consists of Various Rights that are conferred to a mentally ill person.

● Section 18 – Right to access mental healthcare.

● Section 19 – Right to community living.
● Section 20 – Right to protection from cruel, inhuman and degrading
treatment.
● Section 21 – Right to equality and non-discrimination.
● Section 22 – Right to information.
● Section 23 – Right to confidentiality.
● Section 24 – Restriction on the release of information in respect of
Right to access medical records.
● Section 25 – Right to personal contacts and communication.
● Section 26 – Right to legal aid.

Chapter VI

● It gives direction to the government to execute the programme.

● It also promotes mental health & preventive programs.
Chapter VII

● Gives provisions for creating the Central Mental Health Authority.

● Includes Establishment, Composition & Duties of CMHA.

Chapter VIII

● Gives provisions of creating the State Mental Health Authority.

● Cover Establishment, Composition & Duties of SMHA.
Chapter IX

● It comprises finance, accounts and audit.

● Accounts, Audits & Annual Reports by Central & State Authority.

Chapter X

● This includes Mental Health Care establishments.

Chapter XI

● Development of Mental Health Review Boards.

● Registration, Audit, Inspection & Inquiry of mental health.

Chapter XII

● Admission, treatment and discharge of mentally ill.

Chapter XIII

● This Chapter guarantees guidelines in terms of Duties of police officers

concerning a mentally ill person.

Chapter XIV

● It restricts unauthorized duty and medication.

Chapter XV
 ● It deals with penalty and punishment.

Chapter XVI

● This chapter talks about the Power of the Central Government to issue
regulations.
MAJOR PROVISIONS

1) New definition of mental illness

Earlier, Mental illness was defined as any mental disorder and seldom as mental
retardation but the new act provides a broader definition which is stated below:

2) Various rights for persons with mental illness

● Every person has a right to obtain mental health care and its
treatment from mental health services run or financed by the
appropriate government.
● Right to live with dignity is provided for every person with mental
illness.
● No discrimination of any basis including gender, sex, religion,
culture, sexual orientation, caste, social, class, disability and
political beliefs should be done against mentally ill people.
● Rights of confidentiality as for mental health, treatment, mental
health care, and physical health care to mentally ill people.
● Forbid the usage of the release of a photograph or any such matter
related to a mentally ill person in the media without the
acquiescence of the person.
● Right of picking the person who would be answerable for making
decisions with the view to the treatment, his admission into a
hospital, etc.
● Persons with mental illness will also have the right to protection
from barbaric and demeaning treatment.
● Free treatment is provided for the person with mental illness if they
are homeless & fall in Below Poverty Line, even if they don’t own
a BPL card.
 3) Advance directive

A person with mental illness shall have the right to make an advance directive that
states how he/she wants to be treated for the illness and who his/her nominated
representative shall be. The advance directive should be certified by a medical
practitioner or registered with the Mental Health Board.
4) Mental health authority

The Bill provides power to the government to set-up the Central Mental Health
Authority at national-level and State Mental Health Authority in each State.

Every mental health practitioner and mental health institute including nurses,
clinical psychologists, also psychiatric social workers will be compelled to be
registered with this Authority.

These bodies command to:

1. register, supervise and manage a register of mental health

professionals & establishments,
2. generate quality and service provision norms for such establishments,
3. train law enforcement administrators and mental health experts on the
outlines of the Act,
4. receive complaints about deficiencies in the provision of services, and
5. advise the government upon matters representing mental health.

5) Mental health treatment

The Bill also specifies the process and procedure to be followed for admission,
treatment and discharge of mentally-ill individuals.
A medical practitioner or a mental health professional shall not be held liable for
any unforeseen outcomes on following a valid advance directive.

6) Decriminalization of suicide

As provided in Section 115;

1. Notwithstanding anything contained in section 309 of the Indian penel code

any person who attempts to commit suicide shall be presumed,
 unless proved otherwise, to have severe stress and shall not be tried and
punished under the said code.

2. The Appropriate Government shall have a duty to provide care, treatment

and rehabilitation to a person, having severe stress and who attempted to
commit suicide, to reduce the risk of recurrence of attempt to commit
suicide”.

This is a milestone judgement which annulled Section 309 IPC which stated that
‘Any person attempting to perform suicide shall be punished with simple
imprisonment which may prolong to one year.

7) Abolishment the barbarous treatments

● It also affirms that a person with mental illness shall not be subjected to
electroconvulsive therapy (ECT) therapy without the application of
muscle relaxants and anaesthesia.
● Electro-convulsive therapy for minors is prohibited.
● Chaining in any manner or method whatsoever is banned.

CONCLUSION

The new Mental Healthcare Act 2017 is supposed to change the fundamental
approach on mental health issues including a sensible patient-centric health care,
instead of a criminal-centric one, in India, the second most populous country and
one of the fastest economies in the world. The guidelines need to be reviewed on
aspects such as primary prevention, reintegration, and rehabilitation because
without such strengthening, its implementation would be incomplete and the issue
of former mental health patients will continue to exist. Hence, being optimistic
about the bill, there is a need to wait and watch for its implementation.
 PUBLIC HEALTH ACT

For improvement and protection of public health, an adequate health system is

required, but with any system, public health laws are absolutely essential for
proper and effective regulation of health system. The scope of public health is not
limited to one area, but it is very extensive. Hence, public health laws are also wide
based. In every aspects of community health, public health laws are important.
Therefore , to solve public health problems, effective laws are utmost essential.
The Public Health Act of 1848 was to help improve sewers, provide clean drinking
water, and give every town a medical officer. It established the general board of
health as well as local boards of health.

The 1848 Public Health Act was an important step in the improvement of the
nation's health and helped increase government and social consciousness about
hygiene and living conditions.

Meaning of public health

“Public Health” means assuring the conditions in which the population can be
healthy. This includes population-based or individual efforts primarily aimed at the
prevention of injury, disease, disability or premature mortality, or the promotion of
health in the community, such as assessing the health needs and status of the
community through public health surveillance and epidemiological research,
developing public health policy, and responding to public health needs and
emergencies;

What is public health act

The 1848 public health act was the very first law on public health to be passed in
the United Kingdom. It established a Central Board of health whose job it was to
improve sanitation and living standards in towns and populous areas in England
and wales. Public health is concerned with diseases prevention and control at the
population level, through organized efforts and informed choices of society,
organizations, public and private communities and individuals. However, the role
of government is crucial for addressing these challenges and achieving health
equity.

The public health act was an important step in the improvement of the nation’s
health and helped increase government and social consciousness about hygiene and
living conditions.
Objectives of public health act

➢ To protect and promote public health

➢ Control the risk to public health

➢ Promote the control of infectious diseases
➢ Prevent the spread of infectious diseases
➢ Recognizes the role of local governments in protecting public health

Characteristics of public health laws

➢ Government- Public health activities are the primary responsibility of

government.
➢ Population- Public health focus on the health of populations.

➢ Relationship- Public health contemplates the relationship between the state

and the population.
➢ Services- Public health deals with the provision of public health services.

➢ Coercion- Public health possesses the power to coerce the individual for the
protection of the community.

Effectiveness of public health laws

 By simply making public health laws health problems cannot be solved. To make
the health laws effective, the support of following factors are important:

➢ Useful health system for proper solving.

➢ Proper economic policies

➢ Community participation.
➢ Constitutional support.
➢ Strong political will to implement health laws.
➢ Proper resources.

Importance of PH laws
➢ Proper regulation and management of health services

➢ Strengthening the nation’s health infrastructure

➢ Following the international health laws
➢ Identification of government’s limitation on the area of health
➢ Making necessary financial provision for health
➢ Proper utilization of national resources
➢ Protecting the environmental health
➢ Protecting citizen from drug addiction, alcoholism etc.
➢ Protection of consumers health services
➢ Protection from environmental pollution and other health risks
➢ Following the codes of ethics in health and medical services, education, training and
research.

CONCLUSION

Public Health Act was the first step on the road to improved public health. Public health is
concerned with disease prevention and control at the population level, through organized efforts
and informed choices of society, organizations, public and private communities and individuals.
However, the role of government is crucial for addressing these challenges and achieving health
equity