Community Medicine (SPM) – Last Moment Revision

patientsDr Amir Khalid  BHMS,MD(Hom)
Calicut. Kerala

Health : Health is state of complete physical and mental well being not merely an absence of disease or infirmity.
Sullivan’s index: This index (expectation of life free of disability) is computed by subtracting from the life expectancy the probable duration of bed disability and inability to perform major activities.

Determinants of health

  • Heredity
  • Environment
  • Life-style
  • Socioeconomic
  • Health and family welfare
  • Other factors like health related systems ( eg: food and agriculture, education, industry, social welfare, rural development )

Indicators of health


  1. Valid
  2. Reliable
  3. Sensitive
  4. Specific

Indicators may be classified as

1.  Mortality indicators

  1. Crude death rate: The  number of deaths per 1000 population per year in given community
  2. Expectation of life: Life expectancy at birth is “the average number of years that will be lived by those born alive into a population if the current-age specific mortality persists.
  3. Infant mortality rate: Ratio of deaths under 1 year of age in a given year to the total number of live births in the same year.
  4. Child mortality rate: Number of deaths at ages 1-4 years in a given year per 1000 children in that age group at the mid point of the year concerned.
  5. Under-5 proportionate mortality rate: Proportion of total deaths occurring in the under 5 age group.
  6. Maternal (puerperal) mortality rate:
  7. Disease specific mortality
  8. Proportional mortality rateMorbidity indicators

They are

  1. Incidence and prevalence
  2. Notification rates
  3. Attendance rates at out patient departments, health centres, etc
  4. Admission readmission and discharge rates
  5. Duration of stay in hospital
  6. Spells of sickness of absence from work or school

2. Disability rates

a) Event type indicators

(i)  Number of days of restricted activity

(ii) Bed disability days

(iii)  Work loss days (or school loss days) with in a special period

b)  Person type indicators

(i)  Limitation of mobility

(ii) Limitation of activity

3. Nutritional status indicators

  1. Anthropometric measurements of pre school children
  2. Heights (and some weights) of school children at school entry
  3. Prevalence of low birth weight (less than 2.5 kg)

4. Health care delivery indicators

  • Doctor population ratio
  • Doctor-nurse ratio
  • Population-bed ratio
  • Population per health/subcentre
  • Population per traditional birth attendant

5. Utilization rates

6. Indicators of social mental health

7. Environmental indicators

8. Socio-economic indicators

9.  Health policy indicators

10. Indicators of quality of life

11. Other indicators   


1.    National Anti-Malaria Programme

  • National Malaria Control Programme (NMCP) was launched in India in April 1953. it was in operation for 5 years( 1953-58).
  • National Malaria Eradication Progamme (NMEP) launched in 1958.
  • New approach to malaria control was approved by WHO in 1978, ie. Implementation of malaria control in the context of the primary health care strategy.
  • An Enhanced Malaria Control Project with world bank support launched on 30th September 1997.
  • In 1999, the government of India decided to drop the term “National Malaria Eradication Progamme” and renamed it “National anti-malaria programme”

2.    National Filaria Control Programme

National Filaria Control Programme (NFCP) has been in operation since 1955.

3.    Kala-Azar Control Programme

Centrally sponsored programme was lunched in

4.    Japanese Encephalitis Control

5.    Dengue Fever Control  

 QUESTION : In demographic cycle stage/stages in which population remains stationary

a) first               b) fourth            c) both a & b                  d) none


The actual bearing of children

Reproductive period of women 15-45 years-a period of 30 years

Factors affecting fertility 

  1. Age at marriage
  2. Duration of married life
  3. Spacing of children
  4. Education
  5. Economic status
  6. Caste and religion
  7. Nutrition
  8. Family planning

9. Other factors like place of women in the society, value of children in the society, widow remarriage, breast feeding, customs and believes, industrialization and urbanization, better health conditions, housing, opportunities fro women and local community involvement.

Fertility related statistics

Number of live birth in the year X1000

  1. Birth rate        Estimated mid-year population
  2. General fertility rate
  3. General marital fertility rate
  4. Age specific fertility rate
  5. Age specific marital fertility rate
  6. Total fertility rate
  7. Total marital fertility rate
  8. Net reproduction rate
  9. Child women ratio
  10. Pregnancy rate
  11. Abortion rate
  12. Abortion ratio
  13. Marriage rate 


    The ‘milestones’ given here are approximations and to assess any individual child, all types of growth development and behaviour must be taken into account


Medical Causes Social Factors
  Obstetric causes:
 Toxaemias of pregnancy Age at child birth
 Haemorrhage Parity
 Infection Too close pregnancies
 Obstructed labour Family size


            Neonatal mortality         Post-neonatal mortality
                        (0-4 weeks)                (1-12 months)
l. Low birth weight 1. Diarrhoeal diseases
2. Birth injury and difficult labour 2. Acute respiratory infections
3. Congenital anomalies 3. Other communicable diseases
4. Haemolytic diseases of newborn 4. Malnutrition
5. Conditions of placenta and cord 5. Congenital anomalies
6. Diarrhoeal diseases 6. Accidents
7. Acute respiratory infections
8. Tetanus


           Developing countries        Developed countries
Diarrhoeal diseases Accidents
Respiratory infections Congenital anomalies
Malnutrition Malignant neoplasms
Infectious diseases Influenza
(e.g., measles, whooping cough) Pneumonia
Other febrile diseases
Accidents and injuries


     Fat intake Essential fatty acids
      g/day      Energy % (energy per cent)
Adults : Man & Woman     20*   9 3
Pregnant woman     30 12.5 4.5
Lactating mother     45 17.5 5.7
Older children     22   9 3
Young children     25 15 3
  • About half of this will come from invisible fat present in the foods.   


                 Food materials            Common adulterants
Cereals such as wheat, rice Mud, grits, soapstone bits.
Dals Coaltar dyes, khesari dal
Haldi (Turmeric) powder Lead chromate powder
Dhania powder Starch, cow dung or horse dung powder
Black pepper Dried seeds of papaya,
Chilli powder Saw dust, brick powder
Tea dust/leaves Blackgram husk, tamarind seeds powder,
saw dust, used tea dust
Coffee powder Date husk, tamarind husk, Chicory,
Asafoetida (Hing) Sand, grit, resins, gums
Mustard seeds Seeds of prickly poppy-Argemone
Edible oils Mineral oils, argemone oil,
Butter Starch, animal fat.
Ice -cream Cellulose, starch, non-permitted colours,
Sweetmeats Non-permitted colours.
Fresh green peas in packing Green dye
Milk Extraction of fat, addition of starch and water
Ghee Vanaspati


  • Vitamin A prophylaxis programme
  • Prophylaxis against nutritional anaemia
  • Iodine deficiency disorders control programme
  • Special nutrition programme
  • Balwadi nutrition programme
  • ICDS programme
  • Midday meal programme


Foodstuffs g/day/child
Cereals and millets 75
Pulses 30
Oils and fats   8
Leafy vegetables 30
Non-leafy vegetables 30


      Noxious Agents             Sources                  Adverse effects
Oxides of Nitrogen Automobile exhaust, gas stoves and heaters, wood-burning stoves, kerosene space heaters Respiratory tract irritation, bronchial hyperactivity, impaired lung defences, bronchialitis obliterans
Hydrocarbons Automobile   exhaust, cigarette smoke Lung cancer


There is no internationally accepted definition for the term “occupational disease” However, occupational diseases are usually defined as diseases arising out of or in the course of employment. For convenience, they may be grouped as under:

I. Diseases due to physical agents:

(1) Heat      Heat hyperpyrexia, heat exhaustion, heat syncope, heat cramps,burns and local effects such as prickly heat.

(2) Cold      Trench foot, frostbite, chilblains

(3) Light     Occupational cataract, miner’s nystagmus

(4) Pressure  Caisson   disease,   air   embolism,   blast (explosion)

(5) Noise        Occupational deafness

(6) Radiation     Cancer,   leukaemia,   aplastic   anaemia, pancytopenia

(7) Mechanical factors       Injuries, accidents.

(8) Electricity     Burns

II. Diseases due to chemical agents:

(1)Gases: C02, CO, HCN, CS2, NH3, N2, H2S, HCI, SO2 – these cause gas poisoning.

(2)Dusts (Pneumoconiosis) :
(i)   Inorganic Dusts :

(a) Coal dust       Ahthracosis

(b) Silica       ..     Silicosis

(c) Asbestos       Asbestosis, cancer lung

(d) Iron       ..      iderosis
(ii)   Organic (vegetable) Dusts :

(a) Cane fibre      Bagassosis

(b) Cotton dust     Byssinosis

(c) Tobacco           Tobacossis

(d) Hay or grain dust   ..    Farmers’lung

(3) Metals and their compounds:

Toxic hazards from lead, mercury, cadmium, manganese, beryllium, arsenic, chromium etc.

(4) Chemicals   : Acids, alkalies, pesticides

(5) Solvents     : Carbon bisulphide, benzene, trichloroethylene, chloroform, etc.

III. Diseases due to biological agents:

Brucellosis, leptospirosis, anthrax, actinomycosis, hydatidosis, psittacosis, tetanus, encephalitis, fungal infections, etc.

IV. Occupational cancers:

Cancer of skin, lungs, bladder

V..Occupational dermatosis:

Dermatitis, eczema

VI..Diseases of psychological origin:

Industrial neurosis, hypertension, peptic ulcer, etc.

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