Arthropod –borne

infections
• ARTHROPOD BORNE DISEASES
MOSQUITO – Malaria, Filaria,
Japanese encephalitis,
Dengue, Chikungunya

HOUSEFLY – Typhoid, Cholera

SANDFLY – Kalazar
 Arthropod borne diseases

LOUSE – Pediculosis

TSETSEFLY – Sleeping sickness

ITCH MITE – Scabies

COCKROACHES
Lymphatic Filariasis
 Epidemiological determinants
• Agent:
parasite vector
wuchereria bancrofti culex
Brugia malayi Mansonia
Brugia timori Anopheles,Mansonia
Life cycle: Infected man is bitten by mosquito Mf
enters mosquitoexsheathing first, second and
third stage larvae Mosquito bites Man Infective
larvae develop into male and female worms in man
• Definite host : man
• Intermediate host : mosquito
• Micro filaria develops into an adult in six months
• Adult worm –lives in the lymphatic system of man
• Life span : 10-15 years
• MF exhibit nocturnal periodicity 10pm to 2am.
 HOST
• Age- All ages
• Sex- Endemic areas more in men
• Migration- extension of disease to other
places
• Immunity- only after years of infection
• Social factors- urbanization,
industrialization, poverty, poor sanitation,
migration
Environment:
• Climate :Temp of 22 to 28 C, 70% humidity
• Drainage: Bad drainage, cesspools,
• Town planning: Open ditches, septic tank,pits
Mode of transmission: Bite of infected mosquito
• Mosquito bite parasite deposited near the site
of puncture lymphatics
Incubation Period- 8 TO 16 Months
 Clinical features
1) Lymphatic Filariasis-
i) Asmptomatic amicrofilaraemia- No Mf & C/F, NO LAB
TESTS
ii) Asymptomatic microfilaria- Mf +ve, no C/F
iii) Stage of acute manifestations- filarial fever
Lymphangitis, Lymphadenitis, Lymphoedema,
epidemoorchitis
iv)Stage of chronic obstructive lesions-
hydrocoele,elephantiasis of legs scrotum,penis ,arms
vulva and breast,chyleuria
2) Occult Filariasis- Classical C/F –NIL, Mf-NIL,
hypersensitivity reactions to filarial Antigens- Tropical
pulmonary eosinophilia
• MF in blood : gold standard are also used
for survey methods.
• Adult worms in the biopsy specimen .
• Skin test with filariasis antigen .
• Serology .
• Indirect evidence by eosinophila.
 Management of Acute dermato-
lymphangioadenitis
1) Uncomplicated ADLA-
Analgesics
Oral Anitibiotics-8 days
Clean limb with antiseptics
Check for wounds
Give advice
Home management
Do not give antifilarial medicine
Follow up 2 days at home—if it doesnot improve,
refer pt
2) Management of severe ADLA
-Refer pt to physician
Iv antibiotics-penicillin
Give analgesic & antipyretics
Donot give antifilarial medicine
3) Hydrocele Management- survey
and refer people with scrotal swelling
to hospital for surgery
 Control Measure
National Filaria Control Programme
1) Mass Drug Administration- Endemic areas
• Tablets : DEC 6mg/kg+albendazole
• Given to all irrespective of whether they have Mf or
clinical features
• Not given to children less than 2 years, pregnant women,
seriously ill
2) Selective treatment- given to those who are Mf +ve
• DEC 6mg/kg (12doses) for 2 weeks (6 days a week)
• In endemic areas, treatment to be repeated every 2 years
3) DEC medicated salt- Given in endemic areas after
reducing prevalence by giving MDA & Selective treatment
(Eg Lakshadweep islands)
• Dose1-4 g of DEC/ Kg for 6- 9 months
 Vector control
1) Elimination of breeding places- proper sanitation & waste water disposal
systems
2) Antilarval measure-
(I) (Chemical control):
A) Mosquito larvicidal oil, now replaced by pyrethrum oil, temephos, fenthion
B) Pyrosene oil-E
C) Organophosphorous- Temephos, fenthion
(II) Removal of Pistia plant (Encourage fish and lotus culture)
(III) Environmental measures-Filling up & covering ditches, proper drainage,
maintenance of septic tanks & soakage pits
3) Anti-adult measures- pyrethrum space sprays & personal protective
measures
4) Personal prophylaxis
5) Integrated vector control- Use of all these strategies/approaches
(Elimination of breeding places, Antilarval , Anti-adult measures
and Personal prophylaxis ) in optimum combination
Malaria
 AGENT FACTORS
• Protozoal disease, caused by
infection with parasites of the genus
Plasmodium.
• Four species- P.Vivax, malariae,
ovale and falciparum.
• Vivax has the highest geographical
reach in world
• In India: 5o%Falciparum,4-8% mixed,
less than 1%Malariae and rest vivax.
 HOST FACTORS
• Age- all ages (Newborns • Population mobility-
resistant to P.Falciparum) nomads
• Sex- Males more than • Occupation- people in
females agricultural, irrigation
• Race-Sickel cell trait less Pf, works etc
Duffy –ve less Pv • Human habits- sleeping
• Pregnancy-Poor birth out doors, replastering
outcomes of walls sprayed with
• Socio Economic DDT, not using any
Development- Malaria not personal protection
seen developed countries measures
• Housing- Malaria more in ill • Immunity- people from
ventilated and ill lighted endemic areas have
houses immunity, while people
from non endemic areas
have no immunity
 ENVIRNOMENTAL FACTORS
• Season- Maximum in July to November
• Temperature- 20 to 30deg C
• Humidity- 60%
• Rainfall - increases humidity favors
mosquito breeding, too much will flush out
breeding sites
• Altitude- not above 2000 to 2500 meter
• Man made malaria- Engineering projects,
dams, roads etc
 Prevalent major epidemiological
types of Malaria in India
• Tribal Malaria-
• 50% of Pf is in tribal areas
• seen in infants, children, pregnant & lactating women
• lack of health facilities & drugs resulting in high morbidity
& mortality
• Rural Malaria-
• Irrigated arid &semiaired plains.
• Moderate to low endemicity,
• An. Culicifacies is main vector.
• Pv in lean period and Pf in periodic exacerbation.
• Health services- moderate.
• Urban Malaria-
• 15 major cities including 4 metros- 80% cases,
• Health services good,
• periurban areas- unplanned urbanization,
• low socioeconomic groups have periodical epidemics
• Malaria in project areas-
• Areas with Construction activities
• Migration of people from malaria endemic places to non
endemic places
• Eco-system disturbance, increase man- mosquito contact
• one or more vectors involved
• limited health facilities
• Border malaria-
• international 7 state borders
• Mixing of people & poor administrative control
 MODE OF TRANSMISSION
• VECTOR TRANSMISSION: Principal mode of spread
of malaria is by the bites of female anopheles

• Blood transfusion (Transfusion malaria): This is fairly

common in endemic areas. Following an attack of
malaria, a person should not donate blood for 3years

• Mother to the growing fetus (Congenital malaria):

Intrauterine transmission of infection from mother to child
is well documented. Placenta becomes heavily infested
with the parasites.

• Needle stick injury: Accidental transmission can occur

among drug addicts who share syringes and needles.
 IP
• Ip- time interval between the bite of
infective mosquito bit  first appearance
of clinical signs, not less than 10 days
• Falciparum- 12 (9-14 days)
• Vivax- 14 (8-17 days)
• Quartian- 28(18-40 days)
• Ovale-17 (16-18) days
 Clinical features
• Cold Stage- headache, chills, nausea and
vomiting. Temp-39-41deg C, Early part skin is
cold and later hot. Parasite in blood +ve, Pulse
rapid and weak, Lasts for 1 hour
• Hot stage- pt burning hot and casts off his
clothes, skin hot & dry, headache immense,
nausea decreases, pulse full &respiration rapid.
Lasts for 2 to 6 hours
• Sweating stage- fever decreases with profuse
sweating. Temp drops and skin cool & moist.
Pulse slower, pt relieved and falls asleep. Lasts
for 2-4 hours.
 Diagnosis
1) Microscopy- 2 blood smears- thin & thick
2) Serological test- Fluorescent antibody
test- has had malaria in the past
3) Rapid diagnostic test
Approaches to Malarial Control
a) Surveillance & case management
i) Case detection (active & Passive)
ii) Early diagnosis & complete treatment
Vivax- choloquine 25 mg/kg divided doses 3
days, for relapse also give primaquine
0.25mg/kg for 14 days
Faciparum- Artemisinin combination
therapy(ACT) and single dose of
primaquine 0.75mg/kg on day 2
• Pregnant women-
Falciparum- ACT in 2nd & 3rd trimester,
Qunine in 1st trimester
Vivax- Only chloroquine and no primaquine
Mixed Infection- with falciparum should be
treated as faclciparum malaria
P.Ovale- treat as P.Vivax
P.malariae- treat as P.Falciparum
iii) Sentinel surveillance
 b) Integrated vector management

i) Indoor residual spraying-DDT, Malathion,

Fenitrothion
ii) Space application- pesticides as fog or
mist,ULV
iii) Individual protection
iv) Antilarval measures- Larvicides like temephos,
paris green
v) Source reduction
vi) Insecticide treated bed nets and long lasting
insecticidal nets
C) Epidemic preparedness and early response
D) Supportive interventions-
1) Capacity building
2) BCC
3) Intersectoral collaboration
4) Monitoring & Evaluation
5) Operational research & applied field research
Dengue Syndrome
 What is dengue?
Agent:
• Four viruses (DEN-1, DEN-2, DEN-3, or DEN-4).
• All 4 types are antigenically similar , there is no cross
immunity.
• First infection goes unnoticed and the second infection
with a different/multiple strains result in immunological
catastrophe – Hemorrhagic fevermanifections

Mode of Transmission:
The viruses are transmitted to humans by the bite of an
infected mosquito.
 Transmission
Aedes aegepti
Aedes albopictus
• Also known as ASIAN
TIGER MOSQUITO or
YELLOW FEVER
MOSQUITO
• A day biting Mosquito
• Flight range of 100m
 Environmental Factors

• Temperature- 16-30 C
• Humidity- 60-80%

Breeding places of Aedes

• Containers with
longstanding water
• Vases
• Coconut husks
• Old tyres
• Broken pots
• Tree holes
All these sites require constant inspection !!
 High RISK GROUPS

• Infants
• Elderly
• Pregnancy
• Peptic ulcer
• Menustrating women
• Haemolytic disease
• Congenital heart disease
• Chronic diseases
• Patients on NSAID or steroids
 Dengue Clinical
Syndromes
• Undifferentiated fever
• Classic dengue fever
• Dengue hemorrhagic fever
• A) Febrile phase
• B)Critical phase
• C) Recovery Phase
• D) Severe dengue
 Lab diagnosis
• Virus isolation
• Viral nucleic acid detection
• Immunological response and serological
tests-HIA, CF, NT,IgM ELISA
• Rapid diagnostic test kits
 Tourniquet Test
• This slide demonstrates what a typical
positive result from a tourniquet test may
look like. This patient has more than 20
petechiae per square inch.
 Methods of Prevention
• Prevention of breeding places

• Vector control methods

• Prevention of mosquito bites

Prevention
Prevention
Simple Steps

Steps:
•Change water in vases/
bowls every other day.
•Add sand granular
insecticide* to water.
Simple Steps
•Remove water
from flower pot
plates every
other day.
Simple Steps

•Turn over all

storage
containers
Simple Steps

•Clear blockages
and put BTI insecticide
in roof gutters at
least once a month
What Else Can You Do…
Check your landscape
structures for any water
retention & mosquito
breeding regularly.
Remove these structures
if possible. Add in
prescribed amounts of
sand granular
insecticides to stagnant
water.
 How to Prevent Mosquitoes
Bites?
• Wear shoes, socks, long pants and long-
sleeved shirt
• Use mosquito repellents
• Use mosquito coils
• Use mosquito nets
 Vector Control Methods:
Chemical Control
• Larvicides may be used to kill immature
aquatic stages
• Ultra-low volume fumigation ineffective
against adult mosquitoes
• Mosquitoes may have resistance to
commercial aerosol sprays
 Vector Control Methods:
Biological and Environmental
Control
• Biological control
– Largely experimental
– Option: place fish in containers to eat larvae
• Environmental control
– Elimination of larval habitats
– Most likely method to be effective in the long
term
 Global stratergy for dengue
prevention and control 2012-2020
• Global threat requiring global response
• Multisectoral Coordination & collaboration on
IVM
• Goals:
• To reduce dengue mortality by atleast 50%by
2020
• To reduce dengue morbidity by atleast 25%by
2020
• To estimate the true burden of the disease by
2015
 CHIKUNGUNYA
• Viral disease transmitted by Aedes aegypti
mosquito – artificial collection of rain water
• CLINICAL FEATURES
• Fever, Joint pains, Joint swelling,
Conjunctivitis
• Diagnosis – Serology
• CONTROL – VECTOR CONTROL
WHO/TDR/Crump
Communicable
Disease
(Airborne
Infections)
DR VISHNU B MENON
Transmission of airborne diseases
∙ Airborne Transmission
Transmission of infection by expelled particles that are comparatively
smaller in size and thus can remain suspended in air for longer periods
of time.

∙ Droplet Transmission
…..by particles that are likely to settle to a surface quickly, typically
within 3 ft.
∙ Many of the airborne diseases are vaccine preventable
eg; Measles, rubella etc

∙ Smallpox – successfully eradicated globally.

 Common Airborne Diseases

∙ Acute Respiratory Infections

∙ Chickenpox
∙ Measles
∙ Mumps
∙ Rubella
∙ Influenza (SARS)
∙ TB
∙ Diphtheria ∙ Whooping Cough (Pertussis)
∙ COVID 19 ∙ Meningococcal Meningitis
Host factors

∙ Vaccination Status
∙ Immunity (Immunocompromised individuals)
∙ Age group
∙ Co-Morbidities
∙ Occupation (HCW)
∙ Travel
∙ Personal Habits
Agent

∙ Common cold – rhinovirus etc

∙ Chickenpox – varicella zoster
∙ Avian flu – Influenza A virus (H5N1, H6N1)
∙ Swine flu – H1N1
∙ SARS –SARS CoV
∙ Covid 19 – SARS Cov 2
∙ TB – Mycobacterium tuberculosis
Environmental Factors

∙ Particle Size – diameter of the particle

∙ Level of infectious particles
∙ Temperature – low temp are ideal for infections
∙ Relative Humidity
∙ Ventilation
Social Factors ????

∙ Overcrowding
∙ Poverty
∙ Urbanization
∙ Travel
Dynamics of
airborne diseases
transmission
Prevention and Control Measures

Strategies to prevent airborne disease transmission in

∙ Community and Households

∙ Healthcare settings
Strategies to prevent Airborne
Transmission in Community and
Households
A. General Measures

∙ Personal Hygiene
- Handwashing
- Hand drying
- Hand disinfection
- Sanitation and cleanliness
B. Specific Measures

∙ Adequate Ventilation
- Cross ventilation

- Window area – 1/5th of the floor space

- Minimum 6 air changes per hour

- measure of the air volume added to or removed from a space in one
hour, divided by the volume of the space
-Avoiding Overcrowding
-A minimum of 6m2 per person in the living area.
-Overcrowding can be calculated based on : no of persons per room & square ft
per person.
-In Hospital wards – space between two beds = 2 metres

- Immunization – MMR vaccine, Covishield etc

- Personal Protective Measures
-Cough etiquette
-Isolation
-Avoiding close contact
Strategies to prevent Airborne
disease transmission in Healthcare
settings
A. Administrative Control

∙ Training and education of healthcare staff

- Infection control measures
- SOP for different cadre of healthcare staff
- Proper handling of infectious waste

• Measures to be taken in OP
- Well ventilated rooms for patients with respiratory symptoms
- Separate room for people with respi symptoms
- Health education to patients on cough etiquette
∙ Measures taken in IP
- Separate wards for respiratory cases
- Proper disposal of sputum
- Patient Education
B. Environmental Control
∙ Patient Segregation and adequate spacing
∙ Adequate Ventilation
∙ Special focus of high risk areas – ART centres, Bronchoscopy
rooms, MDR TB wards etc.
C. Personal respiratory protection

∙ For patients and HCW

- Masks / Gloves / Face shield etc
Regulations
∙ International Health Regulations (IHR), 2005
- Public Health Emergency of International Concern (PHEIC)
- All countries must report events of international public health importance

PHEIC is declared by WHO if the situation meets two of the four criteria
1. Is the public health impact of the event serious ?
2. Is the event unusual or unexpected ?
3. Is there a significant risk of international spread ?
4. Is there a significant risk of international travel or trade restriction?
Notifiable Airborne Disease
∙ Notifiable under IHR, 2005
- Human Influenza caused by a new subtype
- SARS
- Smallpox

▪ Notifiable under Govt of India

- TB
- Human Influenza H1N1
- SARS
- Smallpox
Blueprint List of Priority Diseases
∙ Given their potential to cause a public health emergency and the absence of efficacious
medical countermeasures, there is an urgent need for accelerated research and
development for:
- Crimean-Congo haemorrhagic fever (CCHF)
- Ebola virus disease and Marburg virus disease
- Lassa fever
- MERS-CoV and SARS
- Nipah and henipaviral diseases
- Rift Valley fever (RVF)
- Zika
- Disease X
 Medical Entomology
• What is Entomology
• Science of study of Insects
• Medical Entomology ?
• Study of Insects of Medical Importance
 Sir Ronald Ross
On 20 August 1897, in Secunderabad, Ross made his landmark
discovery
• This day relenting God
Hath placed within my hand
A wondrous thing; and God
Be praised. At His command,
Seeking His secret deeds
With tears and toiling breath,
I find thy cunning seeds,
O million-murdering Death.
I know this little thing
A myriad men will save.
O Death, where is thy sting?
Thy victory, O Grave?
 What are Vectors?
A vector is any agent that carries and
transmits an infectious pathogen into
another living organism.

Most commonly known biological

vectors are arthropods.
 arthropods
• An arthropod is an invertebrate animal
having an exoskeleton (external skeleton), a
segmented body, and jointed appendages.
Arthropods are members of the phylum
Arthropoda (from Greek ἄρθρον árthron,
"joint", and πούς pous (gen. podos), i.e.
"foot" or "leg", which together mean
"jointed leg" and include the insects,
arachnids, and crustaceans.
 Vector

• Disease carrying Mechanisms from one host

to another
• Could be
• Biological (Living needles) or
• Mechanical (Living Swabs)
 Disease Transmission
• Direct Contact Man to man through physical
contact – Scabies
• Mechanical Transmission-Transmitted
mechanically by Arthropods-Diarrheal
diseases
 Biological Transmission
• 3 types
• Propagative –Pathogenic organisms only multiplies
no cyclic changes-plague, viral diseases
• Cyclo-propagative- pathogenic organisms multiplies
as well as undergoes cyclic changes-malaria
• Cyclo-developmental- Pathogens undergoes cyclical
development with no multiplication-filariasis
 Insects other impacts
• Annoyance, painful bites and blood loss
• Dermatosis
• Allergic reaction(anaphylaxis)
• Entomophobia
• Tick paralysis
• Pediculosis (lousy)
• Harara Sand fly bites in middle east
 Important Vector Borne Diseases
• Dengue fever - Vectors: Aedes aegypti (main vector) Aedes
albopictus (minor vector) threatens -50 million people are
infected by dengue annually, 25,000 die. Threatens 2.5 billion
people in more than 100 countries.
• Malaria - Vectors: Anopheles mosquitoes - 500 million
become severely ill with malaria every year and more than 1
million die.
• Leishmaniasis - Vectors: species in the genus Lutzomyia in
the New World and Phlebotomus in the Old World. Two
million people infected.
• Bubonic plague - Principal vector: Xenopsylla cheopis At least
100 flea species can transmit plague. Re-emerging major
threat several thousand human cases per year. High
pathogenicity and rapid spread.
• Sleeping sickness - Vector: Tsetse fly, not all species. Sleeping
sickness threatens millions of people in 36 countries of sub-
Saharan Africa (WHO)
• Typhus - Vectors: mites, fleas and body lice 16 million cases a
year, resulting in 600,000 deaths annually
• Wuchereria bancrofti - most common vectors: the
mosquito species: Culex, Anopheles, Mansonia,
and Aedes; affects over 120 million people.
• Yellow fever - Principal vectors: Aedes simpsoni, A.
africanus, and A. aegypti in Africa, species in
genus Haemagogus in South America, and species in
genus Sabethes in France -200,000 estimated cases
of yellow fever (with 30,000 deaths) per year.
• KFD-Vector: Ticks
• Japanese Encephalitis-Vector: Culex vishnui gr
of mosquitoes
• West Nile Fever-Vector: Culex mosquitoes
• Chikungunya-Vector: Aedes
• Zika Virus Disease-Vector: Aedes
MOSQUITO
 Anopheles
rests at an angle
 Malaria
–97 countries in the world endemic
–In 2012 there were 207 million cases
with 627000 deaths
–One child die every minute
–In 2014 India had over 81 lakhs of
malaria cases with 40,297 deaths
–2014 Kochi had 152 cases
Anopheles stephensi
breeds in

An. Culicifacies rural An. Fluvi in jungle

Malaria vector breeds streams
 FILARIAL MOSQUITOES

CULEX HUNCH BACKED MANSONIA

BANCROFTIAN FILARIASIS
Brugian filariasis
 Culex
• World wide distribution
• Around 200 eggs in raft form
• No lateral floats
• Larvae suspended from water surface at an angle
with head pointing downwards
• Siphon tube present
• No palmate hairs
• Adult hunch backed
• Wings unspotted
• Palpi short in female
Culex prefer polluted Stagnant Water
(Faulty drains)
MANSONIA BREEDING IN PISTIA
Aedes aegypti Aedes albopictus
 Aedes
• Commonly called Tiger mosquitoes because of the
bands and stripes on body and legs
• Vectors of Dengue, chikungunya and Yellow fever
• Aedes aegypti, Ae. albopictus and Ae.vittatus
• Day biting
• Breeds in clean water. Stored water and rain water
collections in receptacles
• Eggs remain viable for months in dried condition
Aedes eggs
Aedes breeding spots
Aedes breeding
 Mosquitoes

• Anopheles
• Culex
• Aedes
• Mansonia
Black Fly
 BLACK FLY
• A tiny insect- voracious biter.
• Vector of Onchocerciasis ( River blindness)
• World’s 2nd leading infectious disease.
• Caused by Onchocerca Volvulos which lives in human
body for about 15 years.
• Black Fly picks up MF while blood feeding.
• When feeds again on another host, Mf are deposited
which form nodules in the sub-cutaneous tissue and
live there until mature in to adult,
 BLACK FLY
• Needs running water to lay eggs.
• Hence, fast flowing rivers are preferred.
• Larvae attach to the substrates ..
• Adults are strong fliers.
• Normaly 100 kms flight range.
• May go upto 400 to 600 kms.
SAND FLY
 Sand fly
• An ugly tiny insect which transmits
• Leishmaniasis
• Visceral ( Kala Azar)
• Cutaneous (oriental sore)
• VL affects internal organs of the body
• Fatal if untreated
• Cutaneous- sores on the skin
• Disfigures the infected
VISCERAL LEISHMANIASIS CUTANEOUS LEISHMANIASIS
HOUSE FLY
 House Fly
• Mechanical carrier of many diseases
• Typhoid and Paratyphoid fevers
• Diarrhea, Dysentery, cholera
• Gastroenteritis
• Amoebiasis, helminthic infestations
• Poliomyelitis, conjunctivitis
• Trachoma, anthrax, yaws
• Most diseases which could be spread mechanically
 House fly
• Internal carriage
• Pathogenic organisms are retained in the gut
for some time.
• Fly vomits frequently and pathogens come out
in the form of “vomit drops”
• Similarly fly defecates very often ( fly specks)
and pathogens are expelled in the form of
droplets.
 House fly
• External Carriage
• Wet and sticky oral disc
• Brush like hairs on legs
• Tip of the legs pulvilli covered with oily
secretion
HOUSEFLY BREEDING
COCKROACH
FLEA
Blocked flea
LICE
Tse Tse Fly
HARD TICK
KFD (Monkey fever)
MITE SCABIES
GERIATRIC HEALTH
&
PALLIATIVE CARE
 • Geriatrics- Nascher in 1914
• Defined an aged person as one who is 60 years
GERIATRIC
and above.
HEALTH • Young old- 60-74
‘ADD LIFE TO Middle old- 75-84
THE YEARS’ Oldest old- >85
• 69% rural, 31% urban

2
 1. Multiple illness, multiple therapy & iatrogenic
diseases.
2. Diminished vision, hearing, mobility and activity
PROBLEMS 3. Social isolation & under-employment
4. Psychological (mental stress, loneliness,
depression)

3
 OBESITY, SMOKING,
ALCOHOL, DRUG ABUSE
PHYSICAL INACTIVITY

VISUAL IMPAIRMENT
DIABETES MELLITES,
RISK HYPERTENSION, CVD
FACTORS

ACCIDENTS- FALLS &

HEARING LOSS
TRAUMA

BREAKDOWN OF FAMILY
SUPPORT

4
 PREVENTION OF HEALTH PROBLEMS FOR THE AGED

PRIMORDIAL PRIMARY TERTIARY

PREVENTION PREVENTION SECONDARY
PREVENTION
PREVENTION
Health promotion Early detection and
and specific treatment
protection

5
 • ROLE OF NGO / INTERNATIONAL
ORGANISATIONS

• HOMES FOR
ELDERLY
ROLE OF
COMMUNITY

• ROLE OF
GOVERNMENT

6
 • Financial Security
• Taxation
KEY • Legislation
FEATURE
• Health care and nutrition security
S OF
POLICY • Shelter security
• Life security
• Syllabus inclusion of Geriatric care

7
PALLIATIVE
CARE
 • Palliative Care is the active total care of patients whose
disease is not responsive to curative treatment.
PALLIATIVE
CARE • Control of pain, of other symptoms, and of psychological,
social and spiritual problems is paramount.

• The goal is achievement of the best possible quality of

life for patients and their families.

9
 “An approach that improves the quality of life of patients and their
families facing the problems associated with life -threatening
illness, through the prevention and relief of suffering by means of
DEFINITION early identification and impeccable assessment and treatment of
pain and other problems, physical, psychosocial, and spiritual.”

-WHO

10
 Affirms life and regards dying Neither hastens nor postpones
as a normal process. death.

PALLIATIV Provides relief from pain and Integrates the psychological

E CARE other distressing symptoms and spiritual aspects of patient
care.

Offers a support system to help Offers a support system to

patients live as actively as help the family cope during
possible until the patient’s illness and in its
death. own bereavement.

11
 • The term “palliative care” is increasingly used with

regard to diseases other than cancer.

SCOPE OF PALLIATIVE CARE • Such as chronic, progressive, pulmonary disorders,

renal disease, chronic heart failure, HIV/AIDS and

progressive neurological condition.

12
 PALLIATIVE CARE PATIENT SUPPORT SERVICES

PAIN SYMPTOM
MANAGEMENT EMOTIONAL AND
MANAGEMENT SPIRITUAL
Provide pain relief Treating symptoms SUPPORT
drugs and other other than pain
Eg:- Nausea, For both patient and
forms of therapy. family
vomiting, difficulty in
breathing, Mental
disturbance.

13
14
15
 Cancer and other NCD are on
the rise.
NEED FOR ​
PALLIATIVE CARE
IN INDIA 90% of cancers presents
beyond the curative stage. ​

Less access to adequate pain

relief care.

Home based palliative care

services on demand.

16
 AROGYA KERALAM

TO APPOINT DOCTORS,
TO IDENTIFY PATIENTS IN TO EQUIP THE PHC’S TO DISTRICT COORDINATORS,
TO PROVIDE CARE AT
NEED, OFFER GUIDANCE PROVIDE CARE INCLUDING NURSES AND AUXILIARY
HOME FOR THE BED
FOR SUITABLE MEDICINES TO THE ‘SOCIO NURSES TO COORDINATE
RIDDEN AND INCURABLY
TREATMENT ECONOMICALLY' BACKWARD HOME CARE AND OTHER
ILL.
METHODOLOGIES . PATIENTS. PROGRAMS.

17
CHALLENGES FUTURE

• Lack of institutional interest in palliative • Increase the knowledge about palliative

care. care through education and training
• Limited National palliative care policy. (community and professionals).
• Delay in transfer to palliative care. • A well stated central Govt policy.
• Increase the acceptance of palliative care.

18
THANK YOU

19
Health Education
 Synonyms for Health Education

Health Communication
Information Education Communication
(IEC)
Behaviour Change Communication (BCC)
Communication for Behavioural Impact
(COMBI)
Social Marketing
 Relevance……???
Quality Patient care

Patient education
 Patient Education
A process where by patients and in some
instances their families receive information
about specific health problems,
learn the necessary competencies to deal
with the health problems,
and develop accepting attitudes toward the
problems and
the resulting changes in lifestyle.
 Target groups
In patients
Out patients
General Community
 Who ?
Interdisciplinary team

Doctors
Nurses
Patient educators
Allied health professionals
Hospital Administrators
 Content areas
Teaching patient
to administer own treatment
Self care independent living skills
Explanation of diagnosis and treatment of
health problems
Teaching short term and long term lifestyle
adjustments
 Contd…..
Preventive aspects in general
Appropriate community resources
Financial management of health problems
Orientation to hospital facilities and services
 Communication

Two way process

of exchanging or shaping
ideas, feelings & information
 The communication Process

Adopton
Sender Message Channel Receiver process

Feedback
 Stages of Adoption
• Awareness
• Interest
• Evaluation
• Trial
• Adoption Rogers Model
 GOAL

Change in desired
direction
Knowledge Attitude Practice
Cognitive Affective Psychomotor
Communication Skills
• Speaking
• Writing
• Listening
• Reading
• Reasoning
 Types of communication
• One way (Didactic method)
• Two way (Socratic method)
• Verbal
• Non verbal
• Formal & Informal
• Visual
• Telecommunication & Internet
 Barriers of Communication
• Physical
• Psychological
• Environmental
• Social
 Behaviour change is a complex process

• Individuals rarely change their behaviour

themselves
• Their behaviour is often influenced by the
views and practices of their families,
friends, communities.
 Factors influencing behaviour
1. Personal factors - Knowledge, beliefs, state of
readiness to change.
2. Social factors - friends, family, the community
including social values and social norms.
3. Environmental factors - poverty, social services,
mass media and the availability of health
services.
changing of one’s behavior requires many
supporting factors to be in place.
 HEALTH EDUCATION……
• Have a clear idea of the problems people face
• Identify high risk practices ( eg. open air
defecation, not giving colostrums etc.)
• Identify barriers to healthy behaviour
• (eg. Lack of knowledge, family influence,
cultural belief etc.
Health education should focus on
individuals, families and community
 HEALTH EDUCATION……
• what could be motivators for behaviour
change; (convince them about the benefits
of behaviour change)

• which communication media would best

reach the target group
 Health Education

“a process or activity for

inducing behavioural change”
 Health Education
Aims & Objectives
(WHO 1954&1978)

1.To encourage people to adopt and sustain

health promoting lifestyle and practices

2.To promote the proper use of health

services.
3. To arouse interest ,provide new knowledge
improve skills and change attitudes in making
rational decisions to solve their own problems

4.To stimulate individual and community self

reliance and participation to achieve health
development through individual and
community involvement at every step from
identifying problems to solving them.
 Health Education Methods

Individual Group Mass

Personal contact Lectures TV
Home visits Demonstrations Radio
Personal Letters Role play News paper
Phone call Discussion Methods Printed material
Consultation Group Discussion Direct mailing
Panel Discussion Posters
Symposium Health Museum
Workshop Exhibitions
Conferences Folk methods
Seminar Internet
Lecture
“ Carefully
prepared oral
presentation
of facts,
organized
thoughts and
ideas by a
qualified
person”.
 Demonstration

Carefully prepared presentation to show

how to perform a skill or procedure.

Procedure is carried out step by step

before the audience.
Group Discussion

group of
people
interactin
g in a face
to face
situation”.
 Group Discussion
A “ group is an aggregation of
people interacting in a face to face
situation”.
Group size : 6-12
Seating arrangement : Circle
Select a leader and a recorder
 Rules to be observed by members
• Express ideas clearly & concisely
• Listen to what others say
• Do not interrupt when others are
speaking
• Make only relevant remarks
• Accept criticism gracefully
• Help to reach conclusions
Panel Discussion
Experts
discuss
about a
topic
in front of
a large
group
Symposium
A series
of
speech
es on a
selecte
d topic
 Seminar

Meetings to have high

level academic discussion
 Role Play

• A Pedagogical tool

• Dramatizing/acting out a real life

situation

“ Stepping into other’s shoe”

 AUDIO VISUAL AIDS
AUDITORY AIDS VISUAL AIDS COMBINED AV AIDS
NON PROJECTED PROJECTED
Radio Chalk board Slide TV
Tape Recorder Leaflet, Pamphlet Film strip Cinema
Microphone Chart
Amplifier Flannel board
Flip chart
Flash card
Exhibits
Model
Specimen
Concept of Health & Disease
Click to add text

Dr. Aswathy S,
Professor
Community Medicine
 Sound body, mind, spirit, freedom from
physical disease or pain - Webster
 Sound body, mind, functions duly &
efficiently discharged – Oxford
 Ability to lead a socially and economically
productive life - WHO
WHO Definition - Health

Health is “a state of complete physical,

mental and social well being and not
merely an absence of disease or
infirmity.”
 Dimensions of Health
 Physical dimension

 Mental dimension

 Social dimension
 Dimensions of Health
 Spiritual dimension

 Emotional dimension

 Vocational dimension
Spectrum of Health
Positive Health
Better Health
Freedom from sickness

------------------------------

Unrecognized sickness
Mild sickness
Severe sickness
Death
 Determinants of Health
 Biological

 Behavioural & Socio cultural

 Environment

 Socio Economic

 Health Services
 Kerala profile( 2016)

Kerala All India

Death Rate 7.6 6.4

Birth Rate 14.3 22.1

Infant Mortality Rate 12.0 34.0

Life expectancy 73.2 (M) 77.6 (F) 67.3 (M) 69.1 (F)

Literacy Rate 90.92 74.04

Female literacy 97.7 68.4

Mean age at marriage 23.1 22.5

Per capita income Rs.1,96,842/- Rs . 1,12,432/-

 Indicators of Health
 Mortality Indicators

 Morbidity Indicators

 Disability rates – DALY

 Nutritional status indicators

 Health Care Delivery Indicators

 Indicators of Social and Mental Health

Levels of Health Care
Tertiary

Secondary

Primary
 Concept of Disease

Disease is a condition of the body or some

part or organ of the body in which it's
functions are disrupted or deranged .

(Oxford English Dictionary)

 Concept of causation
Germ theory of disease

Disease agent Man Disease

 Multi factorial Causation
.
Causative factors

Groups of Population
And their characteristics Environment, behaviour , culture
Physiological factors ecological elements
 RISK FACTORS AND RISK GROUPS

Non infectious/ Non communicable diseases:

• Agent is unidentified in many cases
• We have factors that are significantly associated
with development of disease.
• THESE ARE RISK FACTORS
• Those possessing these Risk factors
• Are (HIGH )RISK GROUPS
 WEB OF CAUSATION FOR MI
Changes in Life style Stress

Aging
Abundance of food Smoking
Lack of Phy. Ex
Emotional disturbances
Increased catecholamines
Obesity
thrombotic tendency
HTN

DM
Hyperlipidaemia

Changes -
arteries
Coronary occlusion
Coronary
atherosclerosis
Myocardial Ischaemia

MI
 NATURAL HISTORY OF
DISEASE

What is meant by
natural history of disease?
PERIOD OF PRE-PATHOGENESIS PERIOD OF PATHOGENESIS
DISEASE PROCESS Before man is involved The course of the disease in man

DEATH
Agent Host
Chronic sta te
Defect
Disa bility

Illness
Clinica l horizon Signs & symptoms
And Immunity and
Environmenta l Fa ctors Tissue and resistance
( known and unknown) physiologic changes
Bring agent and Stimulus or agent becomes
host together or established and increases
produce a disease by multiplication
RECOVERY
providing stimulus
In the
human Interaction of host Host reaction
host and stimulas
Discernible Advanced
Early pathogeneses early lesions disease Convalescence

LEVELS OF SECONDARY
PREVENTION PRIMARY PREVENTION PREVENTION TERTIARY PREVENTION

MODES OF HEALTH SPECIFIC EARLY DIAGNOSIS DISABILITY

REHABILITATION
INTERVENTION PROMOTION PROTECTION AND TREATMENT LIMITATION
 Ice berg of disease
.
What the
physician sees Symptomatic disease

Pre-symptomatic disease
What the
Physician
does not see
Concepts of disease control

Elimination

Eradication

Control
 Concepts of prevention

Primordial prevention

Primary

Secondary

Tertiary
 Modes of Intervention

•Health Promotion

•Specific protection

•Early diagnosis and treatment

•Disability limitation

•Rehabilitation
 CONCEPT OF CONTROL
• What do you mean by disease control?
• Ongoing operations to reduce :
incidence (New cases)
duration ~ risk of transmission
effects:physical & psycho-social
financial burden
• Control implies an equilibrium between Agent
Host &Environment
• implies that the disease ceases to be Public
Health problem
 HEALTH AND MONEY MATTERS

 IMPORTANT ASPECT OF OUR PROFESSION

 IMPORTANT FOR THE GIVER AND THE RECIEVER
 PATIENT AND HIS/HER PEOPLE HAVE A LOT OF
COSTS TO TAKE CARE OF – DIRECT MEDICAL,
DIRECT NON-MEDICAL,INDIRECT –MORBIDITY
AND MORTALITY, INTANGIBLE
 WE HAVE TO ANALYSE INPUT AND OUTPUT AND
DECIDE THE COST-EFFECTIVENESS / COST
BENEFIT etc OF OUR HEALTH-CARE AND DO
WHAT IS BEST FOR THE PATIENT RESPECTING
THEIR VIEWS ALSO
How are health services organized?
 3 levels

 Primary ( most important )

 Secondary

 Tertiary
 REMEMBER
 HEALTH is multi-dimensional
 WELL BEING is important

 DISEASE is multi-factorial

 PREVENTION is better than cure ;

prevention is a broader concept than
perceived by many
Thank You
MENTAL HEALTH
SHANA SHIRIN
 What is mental health?

"'It is a state of well-being in which the individual realizes his

or her own abilities, can cope with the normal stresses of life,
can work productively and fruitfully and is able to make a
contribution to his or her community"(WHO)
• Mental disorders are on the increase because of increasing stress. One in four
people in the world will be affected by mental or neurological disorders at some
point in their lives.

• Globally around 450 million people currently suffer from such conditions, placing
mental disorders among the leading causes of ill-health and disability worldwide.

• Since the problem of mentally challenged is a global problem, WHO chose the
theme "Mental Health: Stop exclusion, Dare to Care” during year 2001 to focus
worldwide attention on the issues related to mental health.
• Major mental disorders are: Depression, schizophrenia, anxiety, mental retardation
suicides, drug abuse, Alzheimer's disease and epilepsy.

• The theme of World Health Day April 2017 was “Depression-Let's talk". "For
someone living with depression, talking to a person they trust is often the first step
towards treatment and recovery.
Burden of Mental Health Disorders in India

• As per global burden of disease report mental disorders account for 13% of total
DALYs lost for years lived with disability, with depression being the leading
cause.

• Prevalence of any mental disorder in adult Indian was 10.6% while lifetime
prevalence rate was 13.7%.

• Translating to real numbers - 150 million Indians are in need of active

intervention/services.
• Common mental disorders (CMD): CMD including depression, anxiety and
substance use disorders are huge burden affecting nearly 1 0 % o f the population.

• Severe mental disorders (schizophrenia, BPAD and severe depression): Affect

nearly 0.8% of adult population. There is significant stigma, neglect and
marginalization associated with these disorders as they affect all domains of life and
require long-term rehabilitation service.

• Substance use disorders: Include harmful use of alcohol, moderate to severe

dependance use of tobacco and illicit and prescription drugs which were prevalent in
22.4% of persons.
 • The treatment is available but not
being used. Even the available
services for mental disorders are
being poorly utilized.
• Treatment Gap of mental disorder
Treatment gap ranged between 70 and 92% for
different disorders.
• For common mental disorders
treatment gap was to the extent of
85% while for severe mental
disorders treatment gap was 73.6%.
 Utilization of Mental Health Services and Social Stigma

• Nearly two-thirds of persons with known mental disorders never seek help from
health professionals and most clients utilize the services of other agencies and resort
to harmful practices and keep on visiting faith healers and delay the treatment till the
condition deteriorates which compels them to seek the treatment from established
government institutions.

• Stigma, discrimination and neglect prevents care and treatment reaching people.

• Mental health literacy needs to be built-up strongly in the community to scale up the
utilization of available mental health services and to reduce treatment gap.
 National Mental Health Programme

NMHP was launched in India in 1982 to:

• Ensure availability and accessibility of minimum mental health care

for all in foreseeable future: particularly to the most vulnerable and
underprivileged section of population.

• To encourage application of mental health knowledge in general health

care and in social development.

• To promote community participation in the mental health services

development and to stimulate efforts.
 Approaches

• Integrating mental health services with the existing primary health care set-up to increase
the access and availability of mental health services.

• To utilize existing infrastructure of health services and also to deliver minimum m ental
health services.

• To link mental health services with existing community development programme like
ICDS and education.
• To provide appropriate task oriented training to the existing health staff.

• India was one of the first countries in the world to formulate a National Mental
Health Programme (NMHP)in 1982. However, the budgetary allocation for
implementing the NMHP was made in 1996-1997.

• The District Mental Health Programme (DMHP) is the key implementation arm of
National Mental Health Programme in India. Implementation of DMHP has been
quite tardy and slow.
 District Mental Health Programme

• Based on the experience and learning from various community health initiatives, DMHP
was launched in 1996 initially in four districts and subsequently expanded to 241 districts in
the country.

• Now 517 districts are being covered to reduce the treatment gap and to improve coverage
and quality of services.

• DMHP aims at decentralized community based mental health care through the existing
Primary Health Care System. In most cases the departments of psychiatry of medical
colleges were identified to implement DMHP.

• The DMHP has been brought under the umbrella of NHM now. The District Mental Health
Programme is a model of community-based mental health services on sustainable basis.
 • Providing sustainable basic mental health
services to the community and integrate these
services with general health services.
• Early detection and treatment of patients within
the community itself.Taking pressure away
Objectives of from mental hospitals.

DHMP • Reducing stigma attached to mental illnesses

through changes in attitude and public
education.
• Treatment and rehabilitation of mentally ill
patients discharged from the mental hospital
within the community.
Activities covered by DMHP

1. Service delivery for mental health:

• Early detection and treatment: Detection of common mental health
ailments by trained physicians /health workers /community volunteers
and referring of patients to nearest PHCs/ appropriate centre.
• Commonly used drugs have been made available at the PHC level.
Simple record keeping for monthly reporting would be observed.
• The DMHP team would provide supervision and referral support to the
mental health services at the CHC/ PHC level. DMHP team will also
provide in-service training to peripheral staff.
• School Mental Health Services Life Skills Training and Counselling in
Schools: There is growing evidence of increased rate of adolescent
behavioural problems and suicides, crime, violence, sexual
permissiveness, drug abuse, academic competition and school dropouts
are on the rise among youth.
• Counselling Services in College: A significant proportion of college
students have mental disorders in the form of depression, anxiety,
somatoform disorders, adjustment disorders, personality disorders and
alcohol and drug abuse as also emotional disturbances. Under DMHP
counselling services will be provided by supporting infrastructure for
counselling center.
• Workplace Stress Management: Workshops for stress management would be
conducted at identified workplaces by DMHP team/ NGOs by using standard
manuals for formal and informal sector including farmers and women, etc

• Suicide Prevention Services: The District Counselling and Crisis Center would
aim at providing round the clock helpline support, sensitization workshops and by
counselling center at district level besides IEC activities.

• Role of NGO: Active collaboration of NGOs is imperative in all the activities of

DMHP for all the targeted interventions.
2. Training - Most Important Input

All medical officers and health supervisors of the district have been trained in
basic mental healthcare at nodal institute for 2 weeks and ANMis and AWWs for
5 days at the district level.

3. IEC/BCC activities using local/folk media and interpersonal communication

would focus on early identification of mental illness, availability of treatment
and reduction in stigma associated with mental disorders. Very few districts have
utilized funds allocated for raising community awareness
 This Act replaced the Mental Health Act of 1987.

It aims to provide for mental health care for persons with mental illness and to
protect, promote and fulfil the rights of such persons during delivery of mental
health care. Its main features are:

Integration of mental health services with regular health systems.

Mental Health
Care Act 2017 Provision of accessible, affordable and quality mentalhealth services.

Freedom to choose form of treatment and nominate a representative a person,

friend or relative.

Protection from in-humane and degrading treatment.

Not to be administered electric shock treatment(ECT) without anaesthesia and

muscle relaxant; and bans ECT in children.
 Key recommendations of WHR 2001
are:
• Integrate mental health care into primary
healthcare
• Make psychotropicmedicines available.
World Health • Givecare in the community
Report 2001 • Educate people
• Involve communities, families and
consumers
• Develop human resources
• Link with other sector
• Monitor community mental health
• Support more research.
 New Pathways New Hope: National Mental Health Policy
Of India (October 2014)
• The vision of NMHP is to promote mental health, prevent mental illness, enable
recovery from mental illness and reduce stigma and segregation and ensure socio-
economic inclusion of persons affected by mental illness by providing accessible,
affordable and quality health and social care to all persons through their lifespan within
a right-based framework.

• Objectives:
a. To provide universal access to mental health care.
b. To increase access to and utilization of comprehensive mental health services
(preventive, curative, care and support services) to persons with mental health
problem.
c. To reduce risk and incidence of suicide and attempted suicide.

d. To ensure respect for rights and protection from harm of persons with mental
health problems.

e. To reduce stigma associated with mental problems.

f. To enhance availability and equitable skilled human resources for mental health.

g. Adequate financial allocations and its progressive enhancement and improved

utilization.

h. To identify and address the social, biological and psychological determinants of

mental health problems and to provide appropriate interventions.
 Effective Governance and Accountability for Mental Health :
Develop relevant policies, programmes, laws and regulations within
relevant sectors in line with Mental Health Policy, with associated
implementation and monitoring mechanisms.
Adequate budget for implementation of evidence-based mental health
plans and actions.

Strategic Promotion of Mental Health : Redesign Anganwadi centres to cater to

Areas for the early child care developmental and emotional needs of children
Action below 6 years with priority to under 3 years of age.

Introduce mother-child session o n parenting skills in ICDS

programme. Life skill education (LSE) should be offered to school-
children and adolescents.

Train school teachers in mental health promotion.

• Prevention of Mental Illness and Reduction of Suicide and Attempted Suicide:

Address stigma, discrimination and exclusion

Enable access to treatment and to other care givingfacilities to promote early

recovery.

Implement programmes to address drug abuse and alcohol as also tobacco.

Implement suicide reduction programmes to reduce the likelihood of suicide

andattempted suicide.

Set up crisis intervention centres and helplines as part of District Mental Health
Programme.
Universal Access to Mental Health Services

Mental health services should be provided within the existing

health care system using the primary health care approach.

Comprehensive services for mental health problems should

be made universally accessible.

A continuum of such services should be available across

facility, community and family as also across lifespan.

Promote community-based programmes to support family

and caregivers
THANK YOU
National Health
Programs
Dr Sneha Georgy
MD Resident
Department of Community Medicine
 National vector Borne Disease control
Programme
 National Leprosy Eradication Programme
 National TB Elimination Programme
 National AIDS Control Programme
1)National Vector Borne Disease
Control Program
 Against 6 diseases-
1. Malaria
2. Filariasis
3. Japanese Encephalitis
4. Dengue
5. Chikungunya
6. Kala azar
Malaria

 1953- National Malaria Control Program

 2002- NVBDCP
 Every state has a VBDCD under DHFW, headed by
State Program officer
 District level- CMO or DHO
 PHC- MO and Lab services
 Incorporated into health service delivery
programs under NRHM
 Malaria control stratergies
1. Surveillance and case management
- Active and passive case detection
- Early diagnosis and complete treatment
- Sentinel surveillance
2. Integrated vector management
-IRS,ITN,LLIN, Antilarval and source reduction measures
3. Epidemic preparedness and early response
4. Supportive interventions
- Capacity building
- BCC
- Intersectoral collaboration
- Monitoring and evaluation
- Operational research / applied field research
Elimination of Lymphatic
Filariasis
 1955- National Filaria Control Program
 National Health Policy(2002)- Eliminate LF by
2015
Stratergy-
-Annual MDA of DEC and albendazole for 5 years
(80% and above)
-Home based management of lymphoedema cases
-Increasing hydrocele operations in CHCs /
medical college
-Line listing of lymphoedema and hydrocele cases
Japanese Encephalitis

 Increase Sentinel surveillance

 Early diagnosis and case management
 Integrated vector control management(fully
clothed, bed nets, malathion outdoor fogging,
outbreak response)
 Capacity building and BCC
 JE Vaccination 1 to 15 years
 Health education
Dengue Fever and Chikungunya Fever

 Surveillance- Disease / entomological

 Case management- lab diagnosis using
ELISA based NS1 testkits and treatment of
cases
 Vector control
 Outbreak response
 Capacity building
 BCC
 Intersectoral coordination
 Monitoring and supervision
Kala-Azar

 Increase case detection using rK39 test kits

 Oral treatment using Miltefosine
 Vector control
 Active case search through Kala azar fortnights
 Rs 100 incentive to ASHAs
 BCC and intersectoral convergence
National Leprosy Eradication
Programme
 Started as NLCP in 1955
 1980 :Eradication Programme
Strategy :
- Early case detection
- Short term multi-drug chemotherapy
- Health Education
- Treatment of Ulcer & deformity care
- Rehabilitation
.
 In 2002-03 Leprosy diagnosis and treatment services
are integrated into the general health care system
 Available at all PHCs and government hospitals

 Major initiatives taken:

1. More focus on new case detection
2. Treatment completion rate taken as imp indicator
3. Emphasis on Providing disability prevention and
medical rehabilitation(DPMR)
4. ASHAs involved in bringing out suspected cases:
incentives
5. Intensive IEC campaign ‘ Towards Leprosy free India’
2) National TB Elimination Programme
 In March 2018, Prime Minister Narendra Modi had announced 2025 as
the target year for ending TB.
 By the beginning 2020, India’s TB control programme (RNTCP)
renamed into National Tuberculosis Elimination Programme (NTEP).

 National TB Control Program- 1962

 RNTCP launched as a national program in 1997.
 Entire country covered under RNTCP by March 2006.
 RNTCP Phase 2- (2006 – 2011)
 Stop TB Strategy - 2006
 Programmatic Management of Drug Resistant TB (PMDT) – 2007
 'Universal Access to TB Care' for TB control in India in 2010.
 2014:END TB strategy: vision of a world with 0 death, disease and
suffering due to TB.
 VISION: TB-Free India with zero deaths, disease and poverty
due to tuberculosis
 GOAL: To achieve a rapid decline in burden of TB, morbidity
and mortality while working towards elimination of TB in
India by 2025.
OBJECTIVES:
 Find all drug sensitive TB and drug resistant TB cases with an
emphasis on reaching TB patients seeking care from private
providers, and undiagnosed TB in high-risk populations.
 Initiate and sustain all patients on appropriate anti-TB
treatment wherever they seek care, with patient friendly
systems and social support.
 Prevent the emergence of TB in susceptible populations.
 Build and strengthen enabling policies, empowered
institutions, additional human resources with enhanced
capacities and provide adequate financial resources.
Expected Outcome

 80% reduction in TB incidence (from 217/lakh

to 44 /lakh)
 90% reduction in TB mortality (32/lakh to
3/lakh)
 0% patient having catastrophic expenditure
due to TB.

 To eliminate TB means to reduce the

incidence to less than 1 person per 1 million
population.
3)National AIDS Control
Programme
 Launched in 1987
 Aim
1)Prevent further transmission
2) Decrease morbidity and mortality
associated with HIV
3) Minimize the socioeconomic impact
resulting from HIV infection
 2017:National Strategic Plan for HIV/AIDS
and STIs (2017-2024)
Components of national strategy:

 Establishment of surveillance centres

 Identification of high-risk group and their screening
 Issuing guidelines for management of cases
 Guidelines for Blood bank, blood product manufacturers, blood
donors and dialysis units
 IEC activities: mass media
 Operational research: for reduction of impact of the disease
 Control of sexually transmitted disease
 Condom programme
THANK YOU
NUTRITION AND
HEALTH
 NUTRITION
Science of food and its
relationship to health

 FOOD
 For energy
· For growth
· For protection against diseases
 Factors affecting energy requirement
1. Age
2. Sex
3. Body composition
4. Physical activity
5. Working conditions
6. Physiological state
 BASED ON FUNCTION
• Energy giving foods- CHO, proteins,
fats

• Body building foods- proteins

• Protective foods- vitamins, minerals

• Macronutrients

Nutrients required in large amounts - proteins,

fats, carbohydrates.
They are needed for energy production

• Micronutrients
Nutrients required in small amounts - vitamins,
minerals.
They are needed for protection against
diseases
 Micronutrients

• Minerals:
Bulk Ca, Mg, Na, K , P
Trace Fe, Zn, Cu, Mn, I, Se

• Vitamins:
fat-soluble A,D,E, and K
water-soluble B group and C
 CARBOHYDRATES
Starch, sugars, cellulose
Sources - wheat, rice, potato, tapioca

• Supply energy - 4kcal/gm

• Dietary fibers
– prevent constipation
– cholesterol lowering effect
– role in weight reduction
 VITAMINS
.Class of organic compounds-essential
nutrients

.Fat soluble-A,D,E,K

.Water soluble- B&C

 MINERALS
.50 chemical elements are found in human
body
.Major minerals:
Calcium,phosporous,sodium,potassium
.Trace elements: Zinc,iron,iodine,copper
.Trace containments with no known function:
Lead,mercury,barium
 FAT

• Saturated
Unsaturated - MUFA, PUFA
• Sources
–Animal fats- ghee, butter, milk, meat
–Vegetable fats- coconut, groundnut
- Invisible fats- cereals
 Proteins
Made up of aminoacids
• Functions-
– body building
– repair of body tissues
– Synthesis of enzymes, hormones
• Supply energy-4 kcal/gm
• Sources
– animal -milk,eggs,fish
– plant -pulses,cereals,nuts
 Pulses (poor man’s meat)
Rich source of proteins (20-40mg/100gm)
Less costly than meat
Examples:
Bengalgram,Greengram,Redgram,Blackgram,
Soya)
 Supplementary action of proteins

Cereal – limiting
aminoacids - lysine,
threonine
Pulses – limiting aminoacid
- methionine
 Vegetables- protective food
• 1. green leafy vegetable
Eg: cabbage, fenugreek, drumstick
• 2. roots & tubers
Eg: Potato, tapioca, yam, carrot.
• 3. other vegetables
Eg: tomatoes, brinjal, cauliflower.

RDA for fruits & veg- 400g/ day.

 Deficiency diseases
Vit A – Xerophthalmia
Vit D – Osteomalacia, Rickets
Vit K – Bleeding disorder
Vit B1 – Beriberi
Vit B 2 – Angular Stomatitis
Niacin – Pellagra
Vit C - Scurvy
Balanced diet
 Diet containing variety of foods in
right proportions
 where current needs of energy and
nutrients are fully met
 and also provides some extra
nutrients to withstand short duration
of leanness.
 Dietary goals

–Fat 15 – 30% (Saturated fats no more than 10%)

–Carbohydrate 65-80% (Excessive consumption of
refined carbohydrates to be restricted)
–Proteins 10-15%
–Salt intake <5g per day
–Restriction of alcohol
–Junk foods which supply empty calories to be
restricted
FOOD GUIDE PYRAMID
 Assessment of nutritional
status
• Clinical examination
• Anthropometry - BMI
• Biochemical examination
• Functional assessment
• Assessment of dietary intake
• Vital and health statistics
• Ecological studies
 BMI – Body Mass Index
• Underweight <18.5
• Normal 18.5 - 22.9
• Overweight 23 - 24.9
• Obese >25

BMI = Weight In Kg
(Ht. in meter) 2
 Food hygiene
 Hygiene in
production,handling,distribution,serving
 Aim - prevent food borne diseases
 Food borne diseases
 Caused by agents that enter body through food
 Eg: organisms - typhoid,hepatitisA,ascariasis
toxins - botulism,aflatoxicosis
chemicals - pesticides (DDT)
natural toxins - lathyrism (paralysing
disease) caused by
khesari dal
 Food fortification
• Nutrients are added to foods to improve
the quality of diet of a community
• eg. Iodization of salt
Fluoridation of water
Food adulteration –mixing, substitution,
concealing quality, misbranding, putting up
decomposed food for sale
FSSA - 2006
 VULNERABLE
GROUPS

Infants, children
Pregnancy
Old age
Diseased conditions - obesity,
HT, DM, Ca
• INFANT – Exclusive Breast Feeding – 6
months - followed by Weaning
 PREGNANCY

 Do not skip meals

 Increase food intake
 Drink plenty of water
 GLV in daily diet from beginning
 Seasonal fruit daily
 Small frequent meals
 Iron and folic acid tablets
 OLD AGE

• Calorie reqt. is less

• Dentition problem
• Small meals at frequent intervals
• Milk, fruits and vegetables to be included
• Fatty, fried, heavily spiced food to be
restricted
 OBESITY
 Avoid energy dense foods including biscuits/
cakes/sweets/ice-cream/chocolates/soft drinks
Avoid fat(including prepared foods like fried foods,
pizza,burger)
 Use whole grain cereal/pulses
 Use less oil for preparation
 Take a lot of vegetables and fruits
 Exercise moderately
 Ideally aim at BMI between 18.5 and 22.9
 HYPERTENSION
DASH Diet (Dietary Approaches to Stop Hypertension)

• Low salt diet < 5 gm / day

• Saturated Fat <10% of the calories

• Use fibre food – fruits, vegetables

• Restricted alcohol
 DIET IN DIABETES
MELLITUS TYPE 11
Complex carbohydrates rather than simple sugars
Use whole grain cereals/pulses

Plenty of vegetables (>400-600gms/day )

Sugar/sweets to be restricted

Frequent(small)meals rather than 3 major meals

Avoid refined flour (whole wheat atta-better)

Exercise(walk) and maintain ideal weight

Regular testing of blood sugar

Look for complications – foot ulcer, eye, renal

function
 NUTRITION AND CANCERS
• Dietary modification
– Increase dietary fibers
– Decrease intake of processed and smoked
food
– Excessive drinking-liver cancer
– Food preservatives,colours-carcinogens
– High fat intake-colon cancer, breast cancer
THANK YOU
Non-Communicable Diseases
Dr Paul T Francis

Epidemiology of Chronic Non-communicable Disease and Conditions

p 391; Park's textbook of Preventive and Social Medicine 25th Edition

Chronic disease
Are permanent/life long
Leave residual disability
Caused by non-reversible pathology
Cardiovascular
Renal, Nervous
Metabolic
Cancer
NCDs
Incidence is showing upward trend
Increase in life expectancy
Harmful lifestyle

Prinary causes of mortality

Cardiovascular diseases
Cancer
Chronic respiratory diseases
Epidemiological transition ratio
Ratio of DALYs caused by
CMNNDs(communicable, Maternal, Neonatal and Nutritional diseases) to
NCDs
Lower the ratio, higher the contribution of NCD

Risk factors for NCDs

Tobacco
Sedentary lifestyle
Alcohol
Unhealthy diet
Raised Blood pressure
Overweight and obesity
Raised cholesterol
Cancer – associated infections
Environmental risk factors
Risk factors
Age
Sex
Genetic factors
Prevention

Simple
Undo / prevent all listed above!
Strategies
Population strategy
The entire population is targetted
High risk strategy
High risk people targetted
With family history
Smokers
Sedentary lifestyle
Say above 40 years

Cardiovascular Diseases
Ischemic Heart Disease
Hypertension
Cerebrovascular disease
Congenital Heart Disease
Coronary Heart Disease
Due to the decrease in blood flow to heart through the coronary arteries
Pain
Myocardial infarction / death

Risk factors
Diabetes
Type A personality
Hormones
Hypertension
140 and above Systolic
90 and above Diastolic

Stroke
Rapidly developed clinical signs of focal disturbance of cerebral function lasting more than 24
hours or leading to death
Ischemic stroke
Hemorrhagic stroke
Control of blood pressure

Cancer
Abnormal growth of cells
Ability to invade adjacent tissues and even distant organs
Eventual death due to cancer
Common cancers
Oral cancer
Breast
Cervix, Lung
Cancer screening
Testing to detect cancer in the early asymptomatic stage

Diabetes mellitus
Type 1 - Insulin dependent DM
Type 2 – Non-insulin dependent DM
Underlying cause is defective production or action of insulin, which control blood glucose
Chronic hyperglycemia leads to Cardiovascular, Renal, Neurological and Ocular complications
Type 1 is seen in younger individuals
Type 2 is more common and seen in older people
DM
Screening is by urine examination or blood examination
Prevention
Primordial
Primary
Secondary
Tertiary
Obesity
Assessed by BMI (body mass index)
Wt in kg/ht in metre2
Underweight <18.50
Normal 18.50 – 24.99
Overweight (pre-obese) 25 – 29.99
Obese =/> 30

Visual Impairment and Blindness

Mild – worse than 6/12
Moderate – worse than 6/18
Severe – worse than 6/60
Blindness – worse than 3/60
Epidemiological factors
Age – refractory error, malnutrition in younger age group and Cataract/Glaucoma/DM in older age
group
Malnutrition -Vit A deficiency
Occupation – factory workers, cottage industry due injuries
Social class – in poor socio-economic class
Prevention
Primary – Vit A supplementation, treatment of eye infections, injuries
Secondary – treatment of cataract, glaucoma
Tertiary – corneal grafting

Accidents and Injuries

Accident – an unexpected unplanned occurrence which may involve injury
Major cause of morbidity and mortality especially in the younger age group
Types of accidents
Road traffic accidents
Speed, Drink driving, lack of PPD, Distracted driving
Domestic accidents
Drowning
Burns
Falls
Poisoning
Types of accidents
Industrial accidents
Railway accidents
Violence
Summary
NCDs form a major cause of morbidity and mortality
Principles of Primordial, Primary, Secondary and Tertiary prevention has to be applied to prevent
NCDs
 NUTRITION PROGRAMMES IN INDIA

Dr Navami S
Senior Resident
Dept of Community Medicine

3/7/2022 1
 NUTRITION PROGRAMMES IN INDIA

• Extensive poverty resulting in chronic and constant hunger is the

single main epidemic of the developing world today

• This constantly re-enacted problem results in under-nutrition

• Vulnerable groups are commonly affected

3/7/2022 2
GOI has initiated several supplementary feeding programmes on a

large scale basis

Aim:

• Overcoming specific deficiency diseases through various ministries

to combat malnutrition

• To provide additional nutrients to target groups to fill the gap

between food intake and requirement

3/7/2022 3
 NUTRITION PROGRAMMES IN INDIA

1. Vitamin A Prophylaxis Programme

2. Prophylaxis against Nutritional Anaemia

3. Iodine Deficiency Disorders Control Programme

4. Special Nutrition Programme

5. Balwadi Nutrition Programme

6. Integrated Child Development Services Programme

7. Midday Meal Programme

3/7/2022 4
PROGRAMME MINISTRY

1.Vitamin A prophylaxis programme Ministry of Health & Family Welfare

2. Prophylaxis against nutritional Ministry of Health & Family Welfare
Anemia
3. Iodine deficiency disorders control Ministry of Health & Family Welfare
programme
4. Special nutrition programme Ministry of Social Welfare
5. Balwadi nutrition programme Ministry of Social Welfare
6. ICDS Ministry of Social Welfare
7. Mid-day meal programme Ministry of Education

3/7/2022 5
 Vitamin A Prophylaxis Programme

• Components of National Programme for Control of Blindness

• 1970: Launched by Ministry Of Health & Family Welfare

AIM

To administer a single massive dose of an oily preparation of

Vitamin A containing 200,000 IU orally to all pre-school children in

the community , every 6 months through peripheral health workers

3/7/2022 6
Objectives

1) Prevention of Vitamin A deficiency

• Promoting consumption of Vitamin A rich foods

• Creating awareness about preventing Vitamin A deficiency

• Prophylactic Vitamin A as per the following dosage schedule:

9 mega doses are to be given from 9 months of age up to 5 year

3/7/2022 7
3/7/2022 8
2) Treatment of Vitamin A deficient children

• All children with Xerophthalmia are to be treated at health facilities

• Children with measles: 1 dose of Vitamin A if they have not received

it in the previous month

• Severe malnutrition to be given one additional dose

• Programme is implemented through PHCs and sub centers

3/7/2022 9
 Prophylaxis against Nutritional Anaemia

• Launched by Ministry of Health & Family Welfare during 4th five

year plan

• NIN Hyderabad: Technology of fortification of common salt was

developed at NIN, Hyderabad

• Includes distribution of IFA tablets to pregnant & young

children(1-12 years)

3/7/2022 10
 • Implemented by:

MCH Centers in urban areas

PHCs in rural areas and

ICDS projects

• Incorporation through school health

3/7/2022 11
• Surveys, indicated that nearly 145 million people were estimated

to be known, living in goiter endemic areas of the country

• As a result, a major national programme – The IDD Control

Programme was mounted in 1986, with the objective to replace

the entire edible salt by iodide salt, in a phased manner by 1992

3/7/2022 12
Iodine Deficiency Disorders Control Programme

• Conventional goiter belt of Himalayan region

Objective:

• Identification of the goiter endemic areas to supply iodized salt, in

place of common salt

• To assess the impact of goiter control measures over a period of

time

3/7/2022 13
 Special Nutrition Programme

• Launched as a central programme in 1970

• Later transferred to state sector as part of minimum needs programme

• Under the control of Ministry of Social Welfare

3/7/2022 14
Aims: Improving nutritional status of children below 6 years,

pregnant & nursing mothers

Food supplement :

300 kcal & 10-12 gms of protein per child per day

& 500 kcal & 25 gm of protein for mothers

3/7/2022 15
 Balwadi Nutrition Programme

• Launched in 1970 by Ministry Of Social Welfare

• Aims at improving nutritional status of children between 3-6 years

• Is implemented through ‘Balwadis’

•The food supplement:

300 K Cal & 10 gm of protein per child per day

3/7/2022 16
 Integrated Child Development Services Programme

• Launched in 1975 by Ministry of Social Welfare

• Aim: Improving nutritional status of children below 6 years,

pregnant & lactating mothers

• Provides supplementary nutrition, vitamin A prophylaxis & iron and

folic acid distribution

• Workers at village level who deliver the services are called anganwadi

workers
3/7/2022 17
3/7/2022 18
 Midday Meal Programme

Also Known as School lunch programme , has been in Operation

since 1961

OBJECTIVES

•To attract more children for admission to schools

• Retain them so that literacy rate can be improved

3/7/2022 19
Principles in Formulating Midday Meals For School Children

• The meal should be a supplement and not a substitute to home diet

• The meal should supply

1/3rd of total energy requirement &

1/2 of protein need

•The cost should be reasonably low it should be prepared easily at

schools

3/7/2022 20
Principles in Formulating Midday Meals For School Children

• No complicated cooking procedures should be involved

• Locally available foods should be used as far as possible

• The menu should be frequently changed to avoid monotony

• NIN Hyderabad has prepare model menus for school children

3/7/2022 21
 Recent advances

POSHAN ABHIYAAN

• The Prime Minister’s Overarching Scheme for Holistic Nourishment

or the National Nutrition Mission

• Government of India’s flagship programme to improve nutritional

outcomes for children, pregnant women and lactating mothers

3/7/2022 22
 Strategies

• Mapping of various schemes contributing towards addressing

malnutrition

• ICT based Real Time Monitoring system

• Incentivizing States/UTs for meeting the targets

• Incentivizing Anganwadi Workers (AWWs) for using IT based

tools
3/7/2022 23

• Introducing height measurement of children at Anganwadis

 Anemia Mukth Bharat

3/7/2022 24
 6 × 6 × 6 Strategy

3/7/2022 25
 MONITORING AND EVALUATION OF NUTRITION
PROGRAMMES

Randomized Controlled Trial for Evaluation of Effectiveness

Efficiency of Health Care Programmes

3/7/2022 26
 Thank You

3/7/2022 27
TRACHOMA
TETANUS
LEPROSY
STD’S
YAWS
AIDS
 Trachoma is a chronic infectious disease of the conjunctiva and cornea,
caused by Chlamydia trachomatis, but other pathogenic
microorganisms often contribute to the disease.

 Trachoma is a major preventable cause of blindness in developing

countries.

 In 41 endemic countries about 1. 9 million people suffer from visual

impairment due to trachoma.
 AGENT : The classical endemic trachoma of developing countries is caused by C. trachomatis of
immune types A, B, or C.
 RESERVOIR : Children with active disease, chronically infected -older children and adults.
 SOURCE OF INFECTION : Ocular discharges of infected persons and fomites
 COMMUNICABILITY: Trachoma is a disease of low infectivity.

 AGE: In endemic areas, children may show signs of the disease at the age of only a few months.
But typically, children from the age of two to five years are the most infected.
 SEX : Prevalence equal in younger age groups. In older age groups, females have been found to
be affected more than males.
 PRE-DISPOSING FACTORS : Direct sunlight, dust, smoke and irritants
Environmental factors Mode of transmission

 SEASON :The incidence of  This may occur by direct or indirect

active trachoma is found contact with ocular discharges of
generally high in India during infected persons or fomites
April-May and again during July-
September  It has been shown that trachoma is a
familial disease.
 QUALITY OF LIFE : Trachoma
is associated with poor quality
of life. The disease thrives in
conditions of poverty, crowding, INCUBATION PERIOD
ignorance, poor personal
5 to 12 days
hygiene
 CUSTOMS : The custom of
applying kajal or surma to the
eyes is a positive risk factor
 1.Assessment of the problem
 2. Chemotherapy: The antibiotic of choice is 1 per cent ophthalmic ointment or oily
suspension of tetracyclines.
 - Mass treatment-the application twice daily of tetracycline 1 per cent ointment to all
children, for 5 consecutive days each month or once daily for 10 days each month for
6 consecutive months, or for 60 consecutive days
 -Selective treatment-applied to individuals by case finding rather than by community-
wide coverage

 3.Surgical correction: Individuals with lid deformities (trichiasis, entropion) should be

actively sought out, so that necessary surgical procedures can be performed and
followed-up.
 Surveillance:Once control of blinding trachoma has been achieved,
provision must be made to maintain surveillance, for several years after
active inflammatory trachoma has been controlled. Since trachoma is a
familial disease, these, the whole family group should be under
surveillance.

 Health education :The mothers of young children should be the target

for health education. Measures of personal and community hygiene
should also be incorporated in programmes of health education.

 Evaluation:Lastly evaluation. Trachoma control programme must be

evaluated at frequent intervals.
The National Programme for Control of Blindness
 An acute disease induced by the exotoxin of Clostridium tetani and
clinically characterized by muscular rigidity.
 According to WHO estimates, substantial progress has been made in
the past decade in reducing neonatal incidence and deaths – a
reduction of 75.5%(2000 to 2013).
 In May 2015, India was officially certified as achieving maternal and
neonatal tetanus elimination
 AGENT : C/. tetani is a gram-positive,
anaerobic, spore-bearing organism.
 RESERVOIR OF INFECTION : The
natural habitat of the organism is soil
and dust.
 The bacilli are found in the intestine of
many herbivorous animals , e.g.,  PERIOD OF
cattle, horses, goats and sheep and COMMUNICABILITY : None.
are excreted in their faeces Not transmitted from person to
 EXOTOXIN : Tetanus bacilli produce a person.
soluble exotoxin. It has an astounding
lethal toxicity, exceeded only by
botulinum toxin.
 AGE : Commonly, tetanus is a disease of the active age (5 to 40 years).
This period predisposes to all kinds of trauma
 SEX: Although a higher incidence is found in males, females are more
exposed to the risk of tetanus, especially during delivery or abortion
 OCCUPATION : Agricultural workers are at special risk because of their
contact with soil.
 RURAL-URBAN DIFFERENCES : The incidence of tetanus is much
lower in urban than in rural areas
 IMMUNITY: No age is immune unless protected by previous
immunization
MODE OF TRANSMISSION INCUBATION PERIOD

Acquired by contamination of
wounds with tetanus spores .  The incubation period is usually
6 to 10 days
 TRAUMATIC : Trauma -is a major and important cause of tetanus.

 PUERPERAL : Tetanus follows abortion more frequently than a normal labour.

 OTOGENIC : Ear may be a rare portal of entry

 IDIOPATHIC : In these cases there is no definite history of sustaining an injury

 TETANUS NEONATORUM : In many countries, neonatal tetanus kills about 85 per

cent of those afflicted.
 1 . Active immunization  2. Passive immunization

 (i ) HUMAN TETANUS
 a. Combined vaccine - DPT HYPERIMMUNOGLOBULIN
 b. Monovalent vaccines  (ii) ATS (EQUINE)

 i) Plain or fluid (formal)

toxoid
 ii) Tetanus vaccine.
adsorbed (PTAP, APT)
Active and passive Antibiotics
immunization  Active immunization with tetanus
toxoid is the ideal method of tetanus
 Simultaneous active and prophylaxis
passive immunization is widely
 A single intramuscular injection of 1.2
carried out in non-immune mega units of a long-acting penicillin
persons. (e.g. , benzathine penicillin) will
 The patient is given 1500 units provide a sustained concentration of
the drug for 3 to 4 weeks.
of ATS or 250 units of Human lg
in one arm, and 0.5 ml of  For patients who are sensitive to
adsorbed tetanus toxoid (PTAP penicillin, a 7-day course of
erythromycin estolate 500 mg 6-hourly
or APT) into the other arm or by mouth will kill vegetative forms of
gluteal region. Cl. tetani but not spores.
 This should be followed 6
weeks later by another dose of
0.5 ml of tetanus toxoid, and a
 Neonatal tetanus is well controlled in some industrialized
countries through clean delivery practices alone.
 Leprosy (Hansen's disease) is a chronic infectious disease caused by M. leprae. It affects
mainly the peripheral nerves. It also affects the skin, muscles, eyes, bones, testes and internal
organs.
 AGENT : Leprosy is caused by M. leprae. They are acid-fast and occur
in the human host both intracellularly and extracellularly.
 SOURCE OF INFECTION: Multibacillary cases are the most important
source of infection in the community.
 PORTAL OF EXIT : It is widely accepted that the nose is a major portal
of exit. Also exit through ulcerated or broken skin of bacteriologically
positive cases of leprosy
 INFECTIVITY :an infectious patient can be rendered non-infectious by
treatment with dapsone for about 90 days or with rifampicin for 3
weeks .Local application of rifampicin (drops or spray) might destroy all
the bacilli within 8 days
 ATTACK RATES : Among household contacts of lepromatous cases, a
varying proportion - 4 .4 per cent to12 per cent.
 SEX : Both the incidence and prevalence of leprosy appear to be higher in males than
in females in most regions of the world.
 MIGRATION : Because of the movement of population from rural to urban areas,
leprosy is creating a problem in the urban areas .
 PREVALENCE POOL : The prevalence pool of leprosy in a population in general is
in a constant flux resulting from inflow and outflow.
 INACTIVATION OF DISEASE : Where leprosy treatment facilities exist, inactivation
or cure due to specific treatment is an important mode of elimination of cases from the
prevalence pool.
 IMMUNITY : It is a well-established fact that only a few persons exposed to infection
develop the disease. Subclinical infections are far more common.
 GENETIC FACTORS: evidence that human lymphocyte antigen (HLA) linked genes
influence the type of immune response that develops
Environmental factors

 (a) The presence of infectious cases in MODE OF TRANSMISSION

the environment. There is evidence that
humidity favours the survival of M.
/Leprae in the environment.
 DROPLET INFECTION : There is more
 (b) Overcrowding and lack of ventilation and more evidence that leprosy may be
within households. transmitted via aerosols containing M.
/eprae (droplet infection).

 CONTACT TRANSMISSION: Leprosy is

transmitted from person-to-person by
close contact between an infectious
INCUBATION PERIOD patient and a healthybut susceptible
person.
Leprosy has a long incubation period, an
average of 3 to 5 years or more for  OTHER ROUTES : Bacilli may also be
lepromatous cases. transmitted by insect vectors , or by
tattooing needles.
 Indian classification  Madrid classification

 Indeterminate type  Indeterminate

 Tuberculoid type  Tuberculoid: flat; raised
 Borderline type  Borderline
 Lepromatous type  Lepromatous
 Pure neuritic type
Classification for control
programme....
On the basis of information available patients could be classified in two
groups:
a)Paucibacillary leprosy
b)Multibacillary leprosy.
In 1981,WHO made this classification.
This classification is used in the field.
Diagnosis
Clinical examination..
Physical examination...
 A thorough inspection of the skin.
 Palpation of the commonly involved peripheral and cutaneous
nerve for the presence of thickening and tenderness.
 Test for loss of sensation and paralysis of muscles.
.Skin smears are useful for diagnosing multibacillary leprosy,
by methods of skin smear and nasal smear examination.

.Nasal smears or blows

.Nasal scrapings
.
Morphological &
Bacteriological index
The percentage of solid staining bacilli
in a stained smear is referred to as
morphological index.
Criteria are;
 Indicates the density of leprosy bacilli
(a) uniform staining
in smears and includes both living and
(b) parallel sides and rounded ends dead
(c) length 5 times that of width
Other methods of diagnosis are...
 Foot pad culture
 Histamine test
 Biopsy
 Immunological tests
(i) Lepromin test
Two types of positive reactions
(a)Early reaction
(b)Late reaction

(ii) LTT and LMIT

Test for humoral responses.
(i) FLA-ABS test
(ii) monoclonal antibodies
(iii) others
 Medical measures
 . Estimation of the problem  Chemoprophylaxis
 Deformities
 . Early case detection
 Rehabilitation
 . Multidrug therapy
 IX. health education
 . Surveillance
 . Immunoprophylaxis
2. Social support
3. Programme management
4. Evaluation
 The sexually transmitted
diseases (STD) are a group of
communicable diseases that are
transmitted predominantly by
sexual contact and caused by a
wide range of bacterial, viral,
protozoal and fungal agents and
ectoparasites
 The true incidence of STDs  More than 1 million ST!s are
will never be known not acquired every day.
only because of inadequate  Each year, there are estimated
reporting but because of 357 million new infections with 1
the secrecy that surrounds of 4 ST!s : chlamydia (13 1
million), gonorrhea (78 million),
them. syphilis (5.6 million) and
trichomoniasis(143 million)
Agent factors HOST FACTORS
 (a) Age : For most notifiable STDs. the highest rates
of incidence are observed in 20-24 year-olds,
followed by the 25-29 and 15-19 years age groups.

 (b) Sex : For most STDs, the overall morbidity rate

is higher for men than for women, but the morbidity
caused by infection is generally much more severe
in women. as for example, pelvic inflammatory
disease.

 (c) Marital status : The frequency of STD infection

is higher among single, divorced and separated
persons than among married couples.

 (d) Socio-economic status : Individuals from the

lowest socio-economic groups have the highest
morbidity rate.
 • SOCIAL FACTORS
 prostitution:- major factor in spread of
STD
 broken homes
 sexual disharmony
 easy money
 DEMOGRAPHIC FACTOR
–includes population  urbanization and industrialization

explosion and  emotional immaturity

marked increase in number  social disruption

of young people  international travel

 alcoholism
 GONOCOCCAL INFECTION
 SYPHILIS

 TRICHOMONIASIS
 CHLAMYDIAL INFECTION

 DONOVANOSIS
 CHANCROID
 Many different agents cause sexually transmitted diseases. However, some of these agents
give rise to similar or overlapping clinical manifestations.
 1. Initial planning
 2 .Intervention strategies
 3. Support components
 4. Monitoring and evaluation
 National STD Control Programme
ENDEMIC TREPONEMATOSIS

Endemic treponematoses (pinta, endemic

syphilis (Bejel. yaws) continue to be public
health problems in some tropical countries
 Yaws is a chronic contagious non-venereal disease caused
by T pertenue
 Geographic distribution
 The disease is found primarily in poor communities in warm,
humid and tropical forest areas of Africa. Asia, Latin America
and the Pacific.
 WHO declared India free of yaws in May 2016
  Host factors
Agent factors

 (a) AGE : Yaws is primarily a disease

 (a) AGENT : Yaws is caused by T
pertenue of childhood and adolescence.

 (b) RESERVOIR OF INFECTION :  (b} SEX : Generally, the prevalence

Man is the only known reservoir of among males is greater than among
yaws. He is an infected person. females.

 (c) COMMUNICABILITY : Variable,  (c) IMMUNITY : Man has no natural

and may extend over several years immunity. Acquired resistance
intermittently as moist lesions break
out.Treponema are usually not found develops slowly and may take months
in late lesions or years to develop fully unless
suppressed by treatment.
 Environmental factors  Mode of transmission

 (a) CLIMATE : Yaws is endemic in  (a) DlRECT CONTACT : That is, by

warm and humid regions. contact with secretions
 (b) FOMITES : Yaws may also be
transmitted by indirect contact.
 (c) VECTOR : There is some evidence
 (b) SOCIAL FACTORS : Social factors
that small flies and other insects
are even more important than feeding on the lesion may possibly
biological factors in the perpetuation of convey the infection mechanically for
yaws in the endemic areas. brief periods.
 Incubation period
 9- 90 days (average 21 days).
CLINICAL FEATURES
CONTROL
- Survey
 (a) EARLY YAWS : The primary
- Treatment
lesion or "mother yaw“ appears
at the site of inoculation after an - Resurvey and treatment
incubation period of 3 to 5 - Surveillance
weeks.
- Environment Improvement
- Renewed eradication efforts
 (b) LATE YAWS : By the end of
5 years, destructive and often - Evaluation
deforming lesions of the skin,
bone and periosteum appear.
• There were an estimated 37.7 million [30.2–45.1 million] people
living with HIV at the end of 2020, over two thirds of whom (25.4
million) are in the WHO African Region.

• In 2020, 680 000 [480 000–1.0 million] people died from HIV-related
causes and 1.5 million [1.0–2.0 million] people acquired HIV.
 Agent factors
 {a) AGENT : When the virus was first identified it was called
"lymphadenopathy-associated virus (LAV)-"human T-cell lymphotropic virus III
(HTLV-111)
 (b) RESERVOIR OF INFECTION : These are cases and carriers. Once a
person is infected, the virus remains in the body life-long.
 (c) SOURCE OF INFECTION : The virus has been found in greatest
concentration in blood, semen and CSF.

Host factors
 (a) AGE : Most cases have occurred among sexually active persons aged 20-
49 years.
 (b) SEX : In North America, Europe and Australia, about 51 per cent of cases
are homosexual or bisexual men.
 (c) HIGH-RISK GROUPS : Male homosexuals and bisexuals, heterosexual
partners
  Mode of transmission
 The causative virus is
transmitted from person-to-
 Immunology person, most frequently through
sexual activity
 The immune system disorders
associated with HIV
infection/AIDS are considered to  Blood contact
occur primarily from the gradual
depletion in a specialized group
of white blood cells  Maternal- foetal transmission
(lymphocytes) called T-helper or : mother-to child transmission
T -4 cells.

 Incubation period-a few

months to 10 years or even
more
  DIAGNOSIS OF AIDS

 CLINICAL

 Clinical manifestations
 The clinical features of HIV
infection have been classified
into four broad categories
 I. Initial infection with the virus
and development of antibodies
 II. Asymptomatic carrier state
 III. AIDS-related complex (ARC)
 IV. AIDS.
1. Prevention
2 . Antiretroviral treatment
3. Specific prophylaxis
4. Primary health care
THANK YOU