PSM
1. Epidemiological study designs
Case control Cohort Cross sectional Ecological
Retrospective Prospective Snapshot of population Correlational
(Effect → Cause) (Cause/RF → Effect) (Survey) (Compare populations)
Measures : Incidence Prevalence Correlation of variables
Odds ratio (OR) RR, AR, PAR
Unit : Individual Individual Individual Population
Recall bias Attrition bias Ecological fallacy
Study of choice : Temporal association
Rare diseases Natural H/O disease
2. Levels of prevention
Riskfactor Disease Complications Disability/ Death
Primordial No No No No HEALTH PROMOTION /
prevention HEALTH EDUCATION
Primary Yes NO NO NO HEALTH PROMOTION AND
prevention SPECIFIC PROTECTION
Secondary YES YES NO NO EARLY DIAGNOSIS AND
prevention TREATMENT
Tertiary YES YES YES NO DISABILITY LIMITATION AND
prevention REHABILITATION
3. Demographic Cycle
Stage Birth rate Death rate Demographic gap Countries
1 (High stationary) High High Few-very underdeveloped
- countries
2 (Early expanding) High Declining Increase Most of developing/
(maximum) Underdeveloping countries
3 (Late expanding) Declining Declining slowly Starts India, China
declining
4 (Low stationary) Low/slow Low/slow Low stable/ Most of developed countries
declining declining declining
5 (Declining) Less than Death Low stable Negative BR< DR
rate Japan, Greece, Norway
4. Parameters used in HDI , PQLI , Kuppusamy scale.
PQLI : Physical quality of life index (RANGE: 0-100)
• Literacy rate
• IMR (infant mortality rate )
• Life expectancy at 1 year.
HDI : Human developmental index (RANGE: 0-1)
• Literacy rate
• Living Standards- Gross National Income per capita
• Life expectancy at birth.
Kuppuswamy Scale;
- Education of head of family,
- Occupation of head of the family
- Income per month from all sources
This scale classifies the study populations into Upper, middle, and low SES with a score of 3-29
DALY (Disability adjusted life years) : YLL (Years lost to life) + YLD (Years lived with disability).
• Most important measure for burden of disease
QALY (Quality adjusted life years) : Most important measure of effectiveness of an intervention. Gain in
quality life years with an intervention
Sullivans index; disability free life expectancy
5. MMR, IMR, U5MR, SMR, CDR Formulas and its use
MM Ratio: No. of Maternal Deaths/ Live Births X 100000
MM Rate: No. of Maternal Mortality deaths / women inReproductive age group (15-49 yrs) X 100000
Indicators for Preventive Pediatrics
Infant Mortality rate= No of infant deaths during the year / No of live births during the same year X 1000
(0-1 years)
Neonatal Mortality rate = No of infant deaths age < 29 days during the year / No of live births during the
same year X 1000
Child Death Rate = No. of deaths of children 1-4 yrs of ageduring the year / Mid-year population b/w 1-4 yrs
age X 1000
Under 5 mortality rate = No. of deaths of children 0-5 yrs of age during year / No. of love births during same
year X 1000
Perinatal Mortality rate= Late fetal death (beyond 28 weeks) + early neonatal death / No of live births during
the same yearX 1000
Crude death rate= No. of deaths in year / Mid-year Population × 1000
Case fatality rate= No. of deaths from a particular disease / Total cases of same disease × 100
6. Instruments for measuring Qualities of Air
Kata thermometer- Cooling power of Air Globe thermometer Sling Psychrometer
Low air velocity measurement Radiant Heat Humidity of the air
Velocity/Movement- Anemometer.
7. RDA of Vitamins, Iodine , Iron , FA and Calorie requirement in pregnant and lactating females
Energy Requirements
19-39 years and BMI 18.5-22.9 Man - 65 kg Kcal /d Woman- 55kg Kcal /d
Sedentary 2100 1700
Moderate 2700 2100
Heavy 3500 2700
Preg - 350+, Lactation - 600+520 Kcal /d
Infants; 550 kcal/d - 0-6mths
670 kcal/d 6-12 mths
8. Food adulterants and toxins
Neurolathyrism Beta Oxalyl Adulterated Khesri Dal Vit C, steeping, and parboiling
Amino Alanine
(BOAA)
Endemic ascites (Severe Pyrrolizidine Adulterated Millets Sieving
liver toxicity)
Epidemic dropsy sanguinarine Adulterated De-weeding
Mustard oil
Aflatoxicosis Aflatoxin Stored grains Low humidity and
(Ground nuts) improving ventilation
Ergotism Ergot alkaloid Rye, sorghum, Floating plant in 20%
bhajra salt solution
9. Vectors classification (Mosquito , Flea, Louse and Tics)
Anopheles Culex Aedes Mansonia
Sophisticated Nuisance Tiger
Disease Malaria JE, Lymphatic Dengue, Rift Valley Lymphatic filariasis
filariasis Fever, yellow fever,
chikungunya , Zika
Water Clean, stagnant Dirty, polluted Artificial, stored Aquatic Plants
Single, boat shaped Cluster, in rafts Single, cigar shaped Cluster, star shaped
Special Sits at 45° to the Hunch back Stripes on legs Long legs,
features surface of skin appearance Hunch back big body.
Black spots on margin appearance
of wings
Soft Tick-Q fever, Relapsing fever
Hard Tick-KFD(India), Indian tick typhus, Babesiosis,
Tick encephalitis and tick hemorrhagic fever, Tularemia
Louse Transmitted diseases
- Epidemic Typhus
- Relapsing fever
- Trench fever
- Pediculosis
Reduvid Bug- Trypanosomiasis Sand Fly (Phlebotomous sp.) Rat Flea (xenopsylla cheoposis
(Chagas disease) Kala Azar, Oriental Sore , Oraya Fever Bubonic plague, Endemic typhus
10. Pillars of Primary health and Referral system
Principles of primary health care
1. Equitable distribution
2. Community Participation
3. Intersectoral coordination
4. Appropriate technology
Level Population norms Manpower
District hospital For a district Specialized doctors, No of beds
specialized Minimum : 100
labs, blood banks (Recommended :
1/1000)
CHC 1/80,000 : HTF Specialized doctors, OT Beds :
1/1,20,000 : Plains tech, Rural CHC :30-50
2.5 lakh :Non -metro . Lab tech U-CHC :50-100
5 lakh :Metro
PHC 1/20,000 : HTF Medical officer, HA, ANM, Types
1/30,000 : Plains pharmacist, lab tech A :< 20deliveries /m
50000 :Urban B :>20 deliveries /m
No of beds
A : 4-6
B : 8-10
Subcenter 1/3000 : HTF MPW male No of beds
1/5000 : Plains MPW female A : 0-1
B : 2-3
Type - A No delivery
Type-B Delivery +nt
Medical college & Hospital – No Population Limits
11. International Health (Logos , Head quarters , GOBI FFF, SIDA , DANIDA)
Geneva New York -: GOBIFFF, BFHI Blindness Program of India TB control
GOBI-FFF Campaign
1. Growth Monitoring
2. ORS
3. Breastfeeding
4. Immnunization
5. Female Education
6. Family Planning
7. Food Supplementation
12. Types of vaccines , Open vial policy , Lapsed Immunization and Side effects
Live Vaccines BCG , Varicella , Measles, mumps , Rubella , Influenza , Influenza, Rotavirus, JE , Polio and
Typhoid oral (Ty21)
Killed Vaccines ; Td /Tdap,Killed Influenza
Conjugate Vaccine ; PCV, MCV
The vaccine can be kept in a health center for 28 days with temperature Maintenance
Open vial policy does not apply to : Measles/Rubella vaccine , BCG and Covid 19.
AEFI (Adverse effects following Immunization)- 30 mins observation
–– Paralysis - OPV
–– Anaphylactic Shock - Hep B
–– Persistent crying - Pertussis
–– HHE - Pertussis
–– TSS - Measles
–– Intussusception - RVV
–– GBS - Killed Influenza vaccine
–– Thrombocytopenia - MMR & Hep B
Delayed Immunization
Given upto 1 year -BCG, Rotavirus Vaccine, Pentavalent, fIPV, PCV and Hepatitis B vaccine alone can also
Given upto 5 years- OPV , MR vaccine and VitA drops
given upto 7 years- DPT
Given upto 15 years- JE
13. Health communication methods
Sociogram Focused Group Discussion Panel Discussion (4-8 experts)
Demonstration
Cancer Prognosis →SPIKES Technique
GATHER Approach Cafeteria → Contraceptive counselling
Flannel Graph → Sequential pasting of photograph on piece of cloth
14. STI/RTI kits
Grey – Discharge- Urethral, Cervical, Anorectal
Green - Vaginal Discharge
White - Genito ulcerative disease (GUD)(nonherpetic)
Blue - Same as white, only for those allergic to penicillin
Red - GUD (Herpetic)
Yellow - Lower abd. Pain
Black - Inguinal bubo
15. Triage - Based on likelihood of survival and done at site of disaster .
Red :Highest Priority→ Immediate resuscitation, Limb/life saving surgery in 0-6 hrs
Yellow :High Priority → Possible resuscitation, Limb/life saving surgery in 6-24 h
Green :Low Priority→Other minor injuries (Ambulatory)
Black : Least Priority → Dead or moribund
16. Bio-Medical Waste Management
Yellow - Treatment options: Incineration/Plasma pyrolysis/Deep burial
Red- Treatment options:Autoclaving/Microwaving/ Hydroclaving
Blue - Treatment options: Autoclaving and Microwaving
White- Treatment options: Land fills/ Sharp pits
17. Graphs in Bio statistics
Histogram Frequency polygon Frequency curve
Bar diagram Line diagram (trend of events) OGIVE-cumulative frequency Diagram
Scatter Diagram Pie chart Stem and Leaf Plot Funnel Plot
Box and Wisker Plot Forrest Plot
18. Calculation of SD with mean
B/L symmetrical Bell-shaped
Mean ± 1 SD covers = 68%
Mean ± 2 SD covers = 95.45%Q
Mean ±3 SD covers = 99.7%
Mean > Median > Mode Mean = Median = Mode Mean < Median < Mode
19. National Programs (NTEB, NACO, NLEP ,JSSK ,RBSK )
NTEP (National TB Elimination Program)
Eliminate by the year 2025→ Reduce incidence by 80%, Reduce mortality by 90%
Dx Tests
I. Sputum Smear Microscopy
II. CultureL JM (Lowenstein-Jensen) and ALC (Automated Liquid Culture)
IV. Molecular Assays – CBNAAT, LPA ( LINE PROBE ASSAY)Q
ICT enabled Surveillance System
NLEP- National Leprosy Elimination Program
UNIFORM MDT→ 3 Drug regimen for all patients: Dapsone /Rifampicin / Clofazimine
Paucibacillary (PBL) • Skin Lesions - 1-5 • Nerve - 0-1 Multibacillary (MBL); Skin Lesions - > 5, Nerve - ≥ 1
Drugs - Dapson + Rifampicin Drugs - Dapsone + Rifampicin + Clofazimine
Duration - 6 months, F/U - 2 years Duration - 12 Months, F/u - 5 Years
NPCBVI National Program for Control of Blindness & Visual Impairment .
WHO : Blindness <3/60 better eye BPCQ (Bestpossible correction)
SVSP (School Vision Screening Program)
Done by class teacher 1/150 students→ Visual Acuity <6/9, referred to PMOA (PHC)
JSSK (JANANI SHISHU SURAKSHA KARYAKRAM)
Maternal - Free transport, Dx, drugs, delivery, blood transfusion, surgery(if
required) & diet (VD - 3 days, CS - 7 days)
Newborn - Free Dx, drugs, blood transfusion, NBCC , NBSU , SNCU F-IMNCI,HBN
NSSK NAVJAT SHISHU SURKSHA KARYKRAM
Training Programme On Newborn Care and Resuscitation for all Health care personel.
HBNC (Home Based Newborn Care)
• Post-natal ASHA worker visits to newborn homes
• Institutional Delivery - 6 (D 3-7-14-21-28-42)
• Home Delivery - 7 (D 1-3-7-14-21-28-42)
RBSK RASHTRIYA BAL SWASTHYA KARYAKRAM; Children(0-18yrs)
–– Diseases, Deficiencies, Defect and Developmental Delays & Disability
RKSK RASHTRYA KISHOR SWASTHYA KARYAKRAM- Adolescents (10-19yr)
20. Drugs regimens for TB, Leprosy , HIV and Malaria
Drug resistant TB (DRTB)
Mono drug resistance A TB patient, who is resistant to one first line anti – TB drug only
Poly resistance Resistant to >1 first line anti – TB drugs other than INH & Rifampicin
Multi Drug Resistance Resistance to both INH and Rifampicin with or without resistance to other
(MDR) first line anti TB drugs
Extensively Drug MDR/RR TB and resistance to any
Resistance (XDR) fluroquinolones and resistance to second line injectables ( Kanamycin, Amikacin
or capreomycin)
DOTS REGIMENS
1. Category 1 & 2 New patient & Previously Treated- 2 HRZE + 4 HRE in 6 months
2. In pregnancy- 2 HRE + 7 HR in 9 months
Management of HIV :
Adults Child > 6 years & Neonates/child < 6 years /> 20 kgs
Tenofovir (TDF) Pregnancy Zidovudine (or) Abacavir
S/E : Nephrotoxic Zidovudine (AZT) Lamivudine (3TC)
Lamivudine (3TC) S/E : Anemia Lopinavir/ritonavir(LPV/r)
Dolutegravir (or) (or) Raltegravir (RAL)
(DTG) Abacavir (ABC)
Lamivudine (3TC)
Dolutegravir (DTG)
‘
HIV prophylaxis :
Post exposure prophylaxis : Tenofovir, Lamivudine & Dolutegravir x 4 weeks OD.
Alternatively : Tenofovir, Lamivudine X OD & LPV /r x BD
Prevention of mother to child transmission (MTCT) :
DOC to prevent MTCT : Nevirapine.
21. ASHA Worker, AWW , MPW roles in their community
ASHA- Accredited Social Health Activist @ Village (Bridge b/w ANM and Subcentre)
25-45 year Female married / Divorced
P. Norm : 2/1000 , 1/1000 : Minimum
Education : 10th pass
Training (AWW + ANM) : 23 days at PHC
Roles; Create awareness on health and social issues, Counsel women on RCH., Depot holder for ORS, antibiotics,
IFA tablets, FP methods
MPW(Multi-purpose Worker) Subcente
P. Norm: 1/5000
Education: 12th pass
Training : 12 months
VHG- Village Health Guide
P. Norm : 1/1000
Education : 6th pass
Training : 3 months
TBA Traditional Birth Attendant (Trained Dai)
P. Norm : 1/1000
Training : 1 month
AWW- Anganwadi Worker Under ICDS @ AW center
P. Norm : 1/400-800
Education : mini; 10th pass
Training : 4 months
Roles
• Clean AWC, clean drinking water.
• Availability of facility for ANC, immunizations.
• Growth monitoring of children, pregnant females.
• Records of growth & development.
22. Anemia Mukth Bharat Dosage and color coding
AMB - Anemia Mukt Bharat- Reduce prevalence of anemia by 3%.
6x6x6→6 Beneficiaries, 6 Interventions and 6 Institutional Mechanisms
Biweekly, 1 ml Iron and Folic Acid syrup 20 mg elemental Iron + 100 mcg of Folic
6 – 59 months of age
Acid.
o Weekly, 1 Iron and Folic Acid tablet 45 mg elemental Iron + 400 mcg Folic Acid,
5- 10 years children
sugar-coated, pink color
o Weekly, 1 Iron and Folic Acid tablet Each tablet containing 60 mg elemental iron
School going adolescent girls
+ 500 mcg Folic Acid, sugar-coated, blue color
and boys, 10-19 years of
age
o Weekly, 1 Iron and Folic Acid tablet
Women of reproductive age
o 60 mg elemental Iron + 500 mcg Folic Acid, sugar-coated, red color
(non-pregnant, non-
o
lactating) 20-49 years
o Daily, 1 Iron and Folic Acid tablet starting from the fourth month of pregnancy
Pregnant women and
(that is from the second trimester), continued throughout pregnancy (minimum
lactating mothers (0-6 180 days during pregnancy) and to be continued for 180 days, post-partum
months child) o Each tablet containing 60 mg elemental Iron + 500 mcg Folic Acid, sugar-coated,
red color
23. Rabies Immunization
Prophylaxis Visits Doses Route
Re-exposure 2 (0,3) 2 0.1 ml ID/ 0.5 ml IM
Bite within 3 months -No need
Pre-exposure 3 (0,7,21/28) 3 0.1 ml ID/ 0.5 ml IM
Updated Thai regimen 4 (0, 3, 7 & 28) 8 (2-2-2-0-2) 0.1 ml ID
Essen regimen 5( 0, 3, 7, 14 & 28) 5 0.5 ml IM
Categories of contact with suspect rabid animal Post-exposure prophylaxis measures
Category I None
Touching of feeding animals
Licks of intact skin
Category II 1. Immediate vaccination and
Nibbling of uncovered skin 2. Local treatment of wound
Minor scratches or abrasions without bleeding
Category III 1. Immediate vaccination
Single or multiple transdermal bites or scratches 2. Administration of rabies immunoglobulin
Licks on broken skin 3. Local treatment of the wound
Contamination of mucous membrane with saliva
from licks Contacts with bats
Human Rabies Immunoglobin (HRIG) - 20 IU/kg and Equine Rabies Immunoglobin (ERIG)- 40 IU/kg
24. Tetanus Immunization
Category Description Clean wound (<6 hrs) Unclean wound(>6 hrs)
A Completely immunized within 5 years - -
B Completely immunized within 5 -10 TT 1 dose TT 1 dose
years
C Completely immunized > 10 years TT 1 dose TT 1 dose +Tetanus Ig
D Unknow or never Immunized TT 2 doses TT 2 doses +Tetanus Ig
Extra Edge;
Tests;
Qualitative Date →
Quantitative data→
Factories Act
Max work hrs → 48hr/ week
Max work hrs(with overtime) → 60hr/ week
minimum space/ person in factory 500 cu feet
ESIC- Ministry –union ministry of labour
1Medical benefit -OP & IP services
2. Sickness benefit -@ 70% of salary ✗ 91 days
3. Extended sickness benefit -@ 80% of salary ✗ 2 yrs for 34 days
4. Enhanced sickness benefit-100% of salary Tubecto my ✗ 14 days and Vasectomy ✗ 7 days
Disease →Impairment→ Disability→ Handicap
Antenatal Visits →Recommended - 13-14Q
Minimum Antenatal Visits ≥ 4 (RCH)
Single Exposure Point Source Epidemic Multiple Exposure Point Source Epidemic
Sudden rise and Sudden fall in no. of cases within single incubation period.
Data;
IMR (Infant Mortality Rate) - 28 infant deaths/ 1000 live births
NNMR (Neonatal Mortality Rate) – 20 deaths/ 1000 LB
U5MR (Under 5 Mortality Rate) - 32 deaths/1000 LB
MMR (Maternal Mortality Rate) - 97 maternal deaths/100000 live births
PNMR (Perinatal Mortality Rate) - 18 death/1000 LB
Sex Ratiob- SR = (No. Of females/ No. Of Males) x 1000 →943 (F)/1000(M)
National program for prevention and control of Diabetes, Cardio-
vascular Diseases and Stroke (NPCDCS)
Health promotion, Opportunistic screening, referral, diagnosis and
management of none communicable diseases
National Iodine Deficiency disorder control Programme (NIDDCP)
1992
Salt Iodinisation- 30 ppm at production level
15 ppm at consumer level
Pradhan Mantri Surakshit Matritva Abhiyaan (SUMAN)
Free antenatal care check-ups on 9th of every month by MOHFW,
GOI
Integrated Disease Surveillance
S form- Symptoms ( HW),
P form- Presumptive ( MO) and
L form- Lab confirmation (Lab. Staff )
Unnati Jyoti by Affordable LEDs for All (UJALA)
Pradhan Mantri Ujjwala Yojana (PMUY)
Free LPG connections to BPL families and gas cylinders at subsidized
rates
By Ministry of Petroleum and Natural Gas, GOI
UJJAWALA YojanaA Comprehensive scheme for prevention of
trafficking and Rescue, Rehabilitation and Reintegration of Victims of
Trafficking and Commercial Sexual Exploitation
Mission Indradhanush
It Includes 100% coverage for 11 vaccine preventable Diseases by
2020 through catch up campaigns.
TB, POLIO, Diphtheria, Pertussis, Tetanus, Hepatitis B, Measles,
Rota virus, MR, IPV, JE
PMJAY : Pradhan Mantri Jan Arogya Yojana
• 5 petals : Indicate 5 lakh Rs given to 10 crore families.
PMMVY : Pradhan Mantri Matru Vandana Yojana
• Under Ministry of women and child development.
• Cash incentive of 5000 Rs : 3 installments
RKSK : Rashtriya Kishore Swaasthya Karyakram
• Both girls and boys of age grp 10-19 years.
• Saathiya approach → Peer to peer or friend to
friend approach
. POSHAN : Pradhan Mantri Overarching Scheme for Holistic
Nourishment
• Under Ministry of Women and child development.
NLEP : National Leprosy Eradication Programme :
Mx paucibacillary: 3 Drugs x 6 months
Mx multibacillary : 3 Drugs x 12 months
Chemoprophylaxis : Single dose Rifampicin
LaQshya : Labor room Quality
Improvement Initiative :• Improving quality of labor room.
• Sterile equipments & standard devices for delivery of the newborn.
Food Safety and Standards Authority of India
FSSAI is responsible for protecting and promoting public health
through the regulation and supervision of food safety.
AGMARK
AGMARK is a certification mark employed on agricultural products in
India, assuring that they conform to a set of standards.
