Professional Documents
Culture Documents
Arthropod Borne Infections - MHA (12 Files Merged)
Arthropod Borne Infections - MHA (12 Files Merged)
infections
• ARTHROPOD BORNE DISEASES
MOSQUITO – Malaria, Filaria,
Japanese encephalitis,
Dengue, Chikungunya
SANDFLY – Kalazar
Arthropod borne diseases
LOUSE – Pediculosis
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 mosquitoexsheathing 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
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%
• 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
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
•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
∙ Vaccination Status
∙ Immunity (Immunocompromised individuals)
∙ Age group
∙ Co-Morbidities
∙ Occupation (HCW)
∙ Travel
∙ Personal Habits
Agent
∙ Overcrowding
∙ Poverty
∙ Urbanization
∙ Travel
Dynamics of
airborne diseases
transmission
Prevention and Control Measures
∙ 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
• 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
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
• 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
BREAKDOWN OF FAMILY
SUPPORT
4
PREVENTION OF HEALTH PROBLEMS FOR THE AGED
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.
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.
11
• The term “palliative care” is increasingly used with
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.
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
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
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
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
• A Pedagogical tool
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
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
Environment
Socio Economic
Health Services
Kerala profile( 2016)
Life expectancy 73.2 (M) 77.6 (F) 67.3 (M) 69.1 (F)
Morbidity Indicators
Secondary
Primary
Concept of Disease
Groups of Population
And their characteristics Environment, behaviour , culture
Physiological factors ecological elements
RISK FACTORS AND RISK GROUPS
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
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
•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
Secondary
Tertiary
REMEMBER
HEALTH is multi-dimensional
WELL BEING is important
DISEASE is multi-factorial
• 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%.
• 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
• 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.
• 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.
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.
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:
Mental Health
Care Act 2017 Provision of accessible, affordable and quality mentalhealth services.
• 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.
f. To enhance availability and equitable skilled human resources for mental health.
Set up crisis intervention centres and helplines as part of District Mental Health
Programme.
Universal Access to Mental Health Services
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
• 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
• Dietary fibers
– prevent constipation
– cholesterol lowering effect
– role in weight reduction
VITAMINS
.Class of organic compounds-essential
nutrients
.Fat soluble-A,D,E,K
• 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.
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
• Restricted alcohol
DIET IN DIABETES
MELLITUS TYPE 11
Complex carbohydrates rather than simple sugars
Use whole grain cereals/pulses
Sugar/sweets to be restricted
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
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
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
Dr Navami S
Senior Resident
Dept of Community Medicine
3/7/2022 1
NUTRITION PROGRAMMES IN INDIA
3/7/2022 2
GOI has initiated several supplementary feeding programmes on a
Aim:
to combat malnutrition
3/7/2022 5
Vitamin A Prophylaxis Programme
AIM
3/7/2022 6
Objectives
3/7/2022 7
3/7/2022 8
2) Treatment of Vitamin A deficient children
year plan
children(1-12 years)
3/7/2022 10
• Implemented by:
ICDS projects
3/7/2022 11
• Surveys, indicated that nearly 145 million people were estimated
Objective:
3/7/2022 13
Special Nutrition Programme
3/7/2022 14
Aims: Improving nutritional status of children below 6 years,
Food supplement :
300 kcal & 10-12 gms of protein per child per day
3/7/2022 15
Balwadi Nutrition Programme
3/7/2022 16
Integrated Child Development Services Programme
• Workers at village level who deliver the services are called anganwadi
workers
3/7/2022 17
3/7/2022 18
Midday Meal Programme
since 1961
OBJECTIVES
3/7/2022 19
Principles in Formulating Midday Meals For School Children
schools
3/7/2022 20
Principles in Formulating Midday Meals For School Children
3/7/2022 21
Recent advances
POSHAN ABHIYAAN
3/7/2022 22
Strategies
malnutrition
tools
3/7/2022 23
3/7/2022 24
6 × 6 × 6 Strategy
3/7/2022 25
MONITORING AND EVALUATION OF NUTRITION
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.
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
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.
(i ) HUMAN TETANUS
a. Combined vaccine - DPT HYPERIMMUNOGLOBULIN
b. Monovalent vaccines (ii) ATS (EQUINE)
.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
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
• 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.
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