community health nursing notes year one general nursing in pakistan .doc

UNIT NO . 01

Describe the Concepts of Health and wellness as Basic Human needs (WHO definition). Definition of Basic ConceptsHEALTH:Definition:According to WHO, Health is a state of complete physical, mental and social well being and ability to function, not merely the absence of disease or infirmity.1. It is the fundamental right of every human being. It is the state of integration of the body and mind2. Health and illness are highly individualized perception. Meanings and descriptions of health and illness

vary among people in relation to geography and to culture.3. Health - is the state of complete physical, mental, and social well-being, and not merely the absence of

disease or infirmity. (WHO) 4. Health – is the ability to maintain the internal milieu. Illness is the result of failure to maintain the

internal environment.(Claude Bernard) 5. Health – is the ability to maintain homeostasis or dynamic equilibrium.

Homeostasis is regulated by the negative feedback mechanism.(Walter Cannon) 6. Health – is being well and using one’s power to the fullest extent. Health is maintained through

prevention of diseases via environmental health factors.(Florence Nightingale) 7. Health – is viewed in terms of the individual’s ability to perform 14 components of nursing care

unaided. (Henderson)8. Positive Health – symbolizes wellness. It is value term defined by the culture or individual. (Rogers) 9. Health – is a state of a process of being becoming an integrated and whole as a person.(Roy) 10. Health – is a state the characterized by soundness or wholeness of developed human structures and of

bodily and mental functioning.(Orem) 11. Health-is a dynamic state in the life cycle; illness is interference in the life cycle. (King) 12. Health – is an elusive, dynamic state influenced by biologic, psychologic, and social factors. Health is

reflected by the organization, interaction, interdependence and integration of the subsystems of the behavioral system.(Johnson)o Health is not a condition .it is an adjustment.(change)o Health is a highly individual perception.(accepts)o Individual health is a dedicated balance between internal, external as well as his social environment.

If one is disturbed then the other is followed. WELLNESSDefinition:It is defined as an evaluation of standard of living or level of living and quality of life which an individual or groups of individual have.Wellness – is the condition in which all parts and subparts of an individual are in harmony with the whole system. (Neuman)

ILLNESS:Definition:1. Illness is a state in which the equilibrium of the body and its function are disturbed.2. It may be defined as phenomenon in which one or more natural functions of the body are so disturbed

that the affected individual cannot meet the natural requirement of everyday life.3. Illness is failure or disturbance in the growth, development, function and adjustment of the organism as

a whole or any of its function or system (Engle)4. It is a personal state in which the person feels unhealthy.5. Illness is a state in which a person’s physical, emotional, intellectual, social, developmental, or spiritual

functioning is diminished or impaired compared with previous experience. 6. Illness is not synonymous with disease.

Mahmood Ahmed Arain 1

Stages of Illness1. Symptoms Experience- experience some symptoms, person believes something is wrong

3 aspects –physical, cognitive, emotional2. Assumption of Sick Role – acceptance of illness, seeks advice

Medical Care Contact 3. Seeks advice to professionals for validation of real illness, explanation of symptoms, reassurance or

predict of outcome4. Dependent Patient Role. The person becomes a client dependent on the health professional for help.

o Accepts/rejects health professional’s suggestions. o Becomes more passive and accepting.

5. Recovery/RehabilitationGives up the sick role and returns to former roles and functions.EFFECTS OF ILLESS• Change he normal behaviour• Give up the autonomy e.g. Planning meals, practices work etc.• Financial burden.• Change in life style. DISEASE:Definition:1. Disease is defined as a condition in which the body health is impaired (WEBSTER).2. A state in which the individual is no longer in a state of equilibrium with force in his/her external and

internal environment. (Blend)3. An alteration in body function resulting in reduction of capacities or a shortening of the normal life span.4. Biologic agent – e.g. microorganism 5. Inherited genetic defects – e.g. cleft palate6. Developmental defects – e.g. imperforate anus 7. Physical agents – e.g. radiation, hot and cold substances, ultraviolet rays 8. Chemical agents – e.g. lead, asbestos, carbon monoxide 9. Tissue response to irritations/injury – e.g. inflammation, fever 10. Faulty chemical/metabolic process – e.g. inadequate insulin in diabetes11. Emotional/physical reaction to stress – e.g. fear, anxiety Risk Factors of a Disease

1. Genetic and Physiological Factors For example, a person with a family history of diabetes mellitus is at risk in developing the disease later in life.

2. Age Age increases and decreases susceptibility (risk of heart diseases increases with age for both sexes

3. Environment . The physical environment in which a person works or lives can increase the likelihood that certain illnesses will occur.

4. Lifestyle . Lifestyle practices and behaviors can also have positive or negative effects on health. Classification of Diseases

1. According to Etiologic Factors a.Hereditary – due to defect in the genes of one or other parent which is transmitted to the offspring b. Congenital – due to a defect in the development, hereditary factors, or prenatal infection c.Metabolic – due to disturbances or abnormality in the intricate processes of metabolism. d. Deficiency – results from inadequate intake or absorption of essential dietary factor. e.Traumatic- due to injury


f. Allergic – due to abnormal response of the body to chemical and protein substances or to physical stimuli.

g. Neoplastic – due to abnormal or uncontrolled growth of cells. h. Idiopathic –Cause is unknown; self-originated; of spontaneous origin i. Degenerative –Results from the degenerative changes that occur in the tissue and organs. j. Iatrogenic – result from the treatment of the disease

2. According to Duration or Onset a.Acute Illness – An acute illness usually has a short duration and is severe. Signs and symptoms

appear abruptly, intense and often subside after a relatively short period. b. Chronic Illness – chronic illness usually longer than 6 months, and can also affects

functioning in any dimension. The client may fluctuate between maximal functioning and serious relapses and may be life threatening. It is characterized by remission and exacerbation.

c.Remission- periods during which the disease is controlled and symptoms are not obvious. d. Exacerbations – The disease becomes more active given again at a future time, with

recurrence of pronounced symptoms. e.Sub-Acute – Symptoms are pronounced but more prolonged than the acute disease.

3. Disease may also be described as: a.Organic – results from changes in the normal structure, from recognizable anatomical changes in

an organ or tissue of the body. b. Functional – no anatomical changes are observed to account from the symptoms

present, may result from abnormal response to stimuli. c.Occupational – Results from factors associated with the occupation engage in by the patient. d. Venereal – usually acquired through sexual relation e.Familial – occurs in several individuals of the same family f. Epidemic – attacks a large number of individuals in the community at the same time. (e.g. SARS) g. Endemic – Presents more or less continuously or recurs in a community. (e.g.

malaria, goiter) h. Pandemic –An epidemic which is extremely widespread involving an entire country

or continent. i. Sporadic – a disease in which only occasional cases occur. (e.g. dengue, leptospirosis)

Health and illness are inverted through application of nursing process including • Assessment • Goal setting• Planning• Implementation• Evaluation

Health promotionIt is a process which is undertaken to increase level of wellness in individuals, families and communities.


Health

Peak High Good Normal Poor Extreme Critical ill Death

HEALTH AND ILLNESS CONTINUUMAccording to this continuum health is not a state but ability to function with different levels. Health is a dynamic process with one end to death and other to highest level of wellness. and the individuals can place themselves at different locations at one point at one time. Jut like different cultures have their own norms and standard, health has its levels. o A disease can lead towards the serious sickness and then to death.o Awareness of health, health care and proper and accurate treatment and well social, economic, mental

and physical environment can lead to wellness.

OR

NURSING • ICN (INTERNATIONAL COUNCIL OF NURSES): Nursing encompasses autonomous and collaborative care

of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles.

• Nursing is a profession in which the nurse applies skills and attitudes in the provision of comfort and care for the health needs of people. It is a dynamic, therapeutic and educative process by which the practitioner provides preventive, curative promotive and rehabilitative health services to individuals, families and communities.

• Nursing is a profession in which the nurse applies skills and attitudes in the provision of comfort and care for the health needs of people. It is a dynamic, therapeutic and educative process by which the practitioner provides preventive, curative promotive and rehabilitative health services to individuals, families and communities.

As defined by the as written by Virginia Henderson. • The unique function of the nurse is to assist the individual, sick or well, in the performance of those

activities contributing to health, it is recovery, or to a peaceful death the client would perform unaided if he had the necessary strength, will or knowledge.

• Help the client gain independence as rapidly as possible.

Mahmood Ahmed Arain

SIGNS CAUSATIVE AGENT HEALTH EDUCATION CARE & CURE

DISABILITY SYMPTOMS NO RISK AWARENESS SELF ACTUALIZATION

Rx MODEL NEUTRAL POINT WELLNESS MODEL

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DEATH TOTAL WELLNESS

UNIT NO. 02DEFINITION AND BRIEF DESCRIPTION OF:

1. Community2. Community Health.3. Community Health Nursing.

1. CommunityDefinition: Community is a large group of individual living together for a long time in a locality, having, common

interests, goats, ways of life and norms e.g. village and Mohallah. Community is a social group determined by geographical boundaries and or common values and

interests its members know and interact with each other.Community- derived from a Latin word “comunicas” which means a group of people.• a group of people with common characteristics or interests living together within a territory or

geographical boundary• place where people under usual conditions are found

Functions of CommunityThe basic functions of the community can be summarized in the following order.• To determine the use of space for living and other purposes.• To make the available means for production and distribution of necessary goods.• To protects and conserve the health life, resources and the property of individuals.• To educate and accumulate the new comers e.g. children and immigrants.• To transmit in formations, ideas and beliefs.• To provide opportunity for interactions between individuals, and groups.

2. COMMUNITY HEALTHDefinition:• Community health refers to the health status of the members of the community, to the problems

affecting their health, and to the totality of health care provided for the community.• The utilization of the nursing process in the different levels of clientele-individuals, families, population

groups and communities, concerned with the promotion of health, prevention of disease and disability and rehabilitation.Aims:

1. Health promotion2. Disease prevention3. Management of factors affecting health

Goal: “To raise the level of citizenry by helping communities and families to cope with the discontinuities in and threats to health in such a way as to maximize their potential for high-level wellness”.

3. COMMUNITY HEALTH NURSINGDefinition:

Community Health Nursing is a synthesis of nursing practices applies to the promoting and of preserving the health of population, it is not limited to a particular age or a diagnostic group, health promotion, health maintenance, health education, coordination and continuity of care utilized in holistic approach to the family, group and community.The Emergence (Appearance) Of Community Health Nursing:The Community health nursing started hundreds of years ago. The early Israelites and Egyptians hired women, later called midwives, assisted at births. Noblewomen,

including the wives of emperors cared for the ill in ancient Rome. During the War, Military nursing orders of Monks and Knights tended the sick and wounded.

During the 1600s to mid 1800s, wealthy people did not go to hospitals. They were nursed at home. In 1669, Community Health Nursing got development dramatically, since the first visiting Nurses were

sponsored by St.Vincent De Pàual in Paris.


In 1747 first visiting nurses in Canada were the Grey Nuns, established in Montreal. In 1802 Nuns were visiting the poor in community for care of ills & promoting health. In 1800 to 1850, Smallpox, Yellow Fever, Cholera, Typhoid, & Typhus were spread through

immigrants in USA, so government of USA trained some health workers to give care those people in their homes, later on these known as Community Health Nurses/Public Health Nurses.

Community Health Nursing developed in the United States in the late nineteenth and early twentieth centuries.

In 1859 Community Health Nursing began with William Rathone in Liverpool, England. In 1860 Florence Nightingale Training School for Nurses established at St.Thomas Hospital in

London. In 1866 New York Metropolitan Board of Health established. In 1 864 Factory Act passed to control of diseases & treatment of children of persons who work

in factories. In 1886, First Health Visiting Nurse Society began in Philadelphia, which provided home care to

community. In 1910, a decision was made to employ a nurse for the Care of tuberculosis patients in homes.

Through subscriptions and entertainments conducted by Christ Episcopal Church, a nurse was engaged.

After 2nd World War Community Health Nurses were visiting community on foot, in horse-drawn buggies or on bicycles.

In Pakistan, Post-Basic Diploma course of Community Health Nursing is being run by Pakistan Institute of Medical & Health Science Islamabad, College of Nursing Lahore, College of Nursing JPMC Karachi ,College of Nursing Jamshoro and St. James College of Nursing Karachi

Community Health Nursing is taught as a subject in all academic years of diploma in nursing, In Government sector the community health worker training program was started in last decade

for the promotion of women health and promotion of family planning. In private sector The Agha Khan community health service was started which provides services

only to the Agha Khan community.MISSION OF CHN• Health Promotion• Health Protection• Health Balance• Disease prevention• Social JusticePHILOSOPHY OF CHN • The philosophy of CHN is based on the worth and dignity of human beings.• Community health nursing believes that it works toward attaining, maintaining or regaining the high

level of wellness by preventing from diseases and treatment of diseases. • Community Health Nursing believes that every individual has a need of health learning. It believes

every one member of community has an equal right to get health care in equal.• It believes that advancement in science & technology has a big positive role in the promotion of the

health & prolonging life.• It believes that prevention from diseases & promotion of health is better than cure.• It believes that the provision of specialist nursing care must respond to the needs of people and should

follow an inter-professional and multi sectoral approach.• Health Care should be provided in such a way to improve the quality of life in that community.Principles of Community Health Nursing:1. The community is the patient in CHN, the family is the unit of care and there are four levels of clientele: individual,

family, population group (those who share common characteristics, developmental stages and common exposure to health problems – e.g. children, elderly), and the community.

2. In CHN, the client is considered as an ACTIVE partner NOT PASSIVE recipient of care


3. CHN practice is affected by developments in health technology, in particular, changes in society, in general4. The goal of CHN is achieved through multi-sectoral efforts5. CHN is a part of health care system and the larger human services system. PRINCIPLES OF COMMUNITY HEALTH NURSING

Community health nursing is based on recognized needs of communities, families, groups and individuals

The community health nurse must understand fully the objectives and policies of the agency she represents FAMILY – unit of service Community health nursing must be available to all The community health nurse works as a member of the health team Utilize existing active groups in the community Make use of available community health resources Educative supervision Opportunities for continuing staff education program must be provided HEALTH TEACHING – primary responsibility of the community health nurse Accurate recording and reporting There must be periodic evaluation

UNIT NO. 03ROLES AND FUNCTIONS OF THE COMMUNITY HEALTH NURSE

Health Care Provider:The Community Health Nurse provides direct care in community. A CHN conducts the deliveries in community, Provides Geriatric Care, .Antenatal care, Postal natal care, Neonatal care, nursing procedures, Wound dressings and Treats minor illnesses, Provides the first aid.Health Educator: CHN Educates individual, family and community for the principles and techniques of prevention of communicable disease, the modes of spread of genetic and infectious diseases, about proper diet in quantity and quality, the personal, family and community Hygiene, the handling and first aid techniques for emergencies like, Drowning, Snake bite, Dog Bite etc and training of the Traditional Birth Attendants for normal delivery and safe delivery in communities.Collaborators:CHN works with the collaboration of other health workers and works with doctors, dispensers, vaccinators, TBAs, midwives, and LHVs etc in the community.Counselor:CHN (Community Health Nurse) conducts the counseling of individuals, families, in community in some social and mental problems, and also for motivation of family planning, vaccination and for removing the some un-healthy behaviors in folk ways.Advocate:CHN advocates for the patients, client through Pleading and leading for installation of facilities of health care in suitable and required places. A CHN participates the district govt. meeting and talks to administration for the favor folks for solution of health care, social and financial problems available in his her constituency.Researcher:• CNN works hard for searching new methods of care and application of new technology and also finds the social and economical problems in community, which makes hindrance for care and cure and also searches causes of illnesses. She collects the statistical data like morbidity rate, mortality rate, death rat birth rate etc and analyzes that data. After analysis she sends the reports to higher authorities for remedies in feedback and writes the research papers on different issues and problems n community.Manager:


CHN has managerial role in community Organizations and manages various programs of health and assume leadership of nursing team for supervision of nursing and other staff. She works as a manager and leading person in the Lady Health Workers in Taluka / tehsil level on the position of supervisor.Evaluator:CHN evaluates the special health programs in community, effectiveness any program or drug or teaching or vaccination in community and she evaluates the success or outcome of project or program after implementation of any project or health program in a community.Clinician – CHN is a health care provider, taking care of the sick people at home or in the hospital.Health Advocator – speaks on behalf of the clientSupervisor - who monitors and supervises the performance of midwivesFacilitator - CHN establishes multi-sectoral linkages by referral system.

Other Specific Responsibilities of a Nurse,• Supervision and care of women during pregnancy, labor and puerperium• Performance of internal examination and delivery of babies• Suturing lacerations in the absence of a physician• Provision of first aid measures and emergency care• Recommending herbal and symptomatic meds…etc.In the care of the families:• Provision of primary health care services• Developmental/Utilization of family nursing care plan in the provision of care.In the care of the communities:• Community organizing mobilization, community development and people empowerment.• Case finding and epidemiological investigation.• Program planning, implementation and evaluation.• Influencing executive and legislative individuals or bodies concerning health and development.Responsibilities of COMMUNITY HEALTH NURSE • Be a part in developing an overall health plan, its implementation and evaluation for communities.• Provide quality nursing services to the three levels of clientele.• Maintain coordination/linkages with other health team members.• NGO/government agencies in the provision of public health services.• Conduct researches relevant to CHN services to improve provision of health care.• Provide opportunities for professional growth and continuing education for staff development.


UNIT NO. 04ALMA ATA DECLARATIONAlma Ata is a capital city of Kazakhstan where the conference of 134 countries Govt. and 67 representatives of NGOs held in 6 to12 September 1978. This conference was arranged by W.H.O in the implementation of 20th World Health Resolution of 1977 on provision for Primary Health Care to all people of world, that they live socially and economically productive lives. In this conference, it was decided that up to 2000 every Government is responsible to provide Primary Health Care to all its People and this slogan was known as “Health for All by year 2000”.Definition of Health for All (HFA/2000):“Health for ALL” is defined as “The attainment of a level of health that will enable every individual to lead a socially and economically productive.ALMA ATA DECALRATION

The International Conference on Primary Health Care, meeting in Alma-Ata this twelfth day of September in the year Nineteen hundred and seventy-eight, expressing the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all the people of the world, hereby makes the following Declaration:I: The Conference strongly reaffirms that health, which is a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity, is a fundamental human right and that the attainment of the highest possible level of health is a most important worldwide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector.II :The existing gross inequality in the health status of the people particularly between developed and developing countries as well as within countries is politically, socially and economically unacceptable and is, therefore, of common concern to all countries.III : Economic and social development, based on a New International Economic Order, is of basic importance to the fullest attainment of health for all and to the reduction of the gap between the health status of the developing and developed countries. The promotion and protection of the health of the people is essential to sustained economic and social development and contributes to a better quality of life and to world peace.IV : The people have the right and duty to participate individually and collectively in the planning and implementation of their health care.V : Governments have a responsibility for the health of their people which can be fulfilled only by the provision of adequate health and social measures. A main social target of governments, international organizations and the whole world community in the coming decades should be the attainment by all peoples of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life. Primary health care is the key to attaining this target as part of development in the spirit of social justice.VI :Primary health care is essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self- reliance and self -determination. It forms an integral part both of the country's health system, of which it is the central function and main focus, and of the overall social and economic development of the community. It is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process. VII : Primary health care:reflects and evolves from the economic conditions and sociocultural and political characteristics of the country and its communities and is based on the application of the relevant results of social, biomedical and health services research and public health experience; Mahmood Ahmed Arain 9

addresses the main health problems in the community, providing promotive, preventive, curative and rehabilitative services accordingly; includes at least: education concerning prevailing health problems and the methods of preventing and controlling them; promotion of food supply and proper nutrition; an adequate supply of safe water and basic sanitation; maternal and child health care, including family planning; immunization against the major infectious diseases; prevention and control of locally endemic diseases; appropriate treatment of common diseases and injuries; and provision of essential drugs;Primary health care: involves, in addition to the health sector, all related sectors and aspects of national and community development, in particular agriculture, animal husbandry, food, industry, education, housing, public works, communications and other sectors; and demands the coordinated efforts of all those sectors; requires and promotes maximum community and individual self-reliance and participation in the planning, organization, operation and control of primary health care, making fullest use of local, national and other available resources; and to this end develops through appropriate education the ability of communities to participate; should be sustained by integrated, functional and mutually supportive referral systems, leading to the progressive improvement of comprehensive health care for all, and giving priority to those most in need; Relies, at local and referral levels, on health workers, including physicians, nurses, midwives, auxiliaries and community workers as applicable, as well as traditional practitioners as needed, suitably trained socially and technically to work as a health team and to respond to the expressed health needs of the community.VIII : All governments should formulate national policies, strategies and plans of action to launch and sustain primary health care as part of a comprehensive national health system and in coordination with other sectors. To this end, it will be necessary to exercise political will, to mobilize the country's resources and to use available external resources rationally.IX: All countries should cooperate in a spirit of partnership and service to ensure primary health care for all people since the attainment of health by people in any one country directly concerns and benefits every other country. In this context the joint WHO/UNICEF report on primary health care constitutes a solid basis for the further development and operation of primary health care throughout the world.X

• An acceptable level of health for all the people of the world by the year 2000 can be attained through a fuller and better use of the world's resources, a considerable part of which is now spent on armaments and military conflicts. A genuine policy of independence, peace, détente and disarmament could and should release additional resources that could well be devoted to peaceful aims and in particular to the acceleration of social and economic development of which primary health care, as an essential part, should be allotted its proper share. The International Conference on Primary Health Care calls for urgent and effective national and international action to develop and implement primary health care throughout the world and particularly in developing countries in a spirit of technical cooperation and in keeping with a New International Economic Order

• It urges governments, WHO and UNICEF, and other international organizations, as well as multilateral and bilateral agencies, non- governmental organizations, funding agencies, all health workers and the whole world community to support national and international commitment to primary health care and to channel increased technical and financial support to it, particularly in developing countries. The Conference calls on all the aforementioned to collaborate in introducing, developing and maintaining primary health care in accordance with the spirit and content of this Declaration.


HEALH PROBLEMS IN PAKISTAN


Maternal Child Health problems Problems in pre-natal period:Still Birth, Low Birth Weight, Pre-mature Birth, Congenital Disorders,Eclampsia, Ante-partum hemorrhage, Abortions, Anemia, Post partum HaemorrhageAccidental problems Road traffic accidents, accidental burns, terrorismGeriatric health problemsOsteoporosis, fractures, hearing and vision problems, hypertension, diabetes mellitusInfectious diseasesMeasles, Diphtheria, Tetanus Whooping Cough, Hepatitis-B, PoliomyelitisTuberculosis, malaria, AIDS, swine flu, dengue fever, Influenza, GastroenteritisParasitic Diseases:Hook worm, Round worm, Thread Worm and Pin worm infestationMental Health problems Psychosis, Schizophrenia, Mania, Anxiety, depression, drug abuseOccupational health problemsMalnutrition Obesity, Marasmus, Kwashiorkor, Anemia, Night blindness, ScurvyOphthalmic diseasesSafe Water SupplySchool Health Reproductive health Cancer Cardiovascular diseasesChronic Obstructive Pulmonary Diseases Renal Disease

Mahmood Ahmed Arain

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UNIT NO. 05PRIMARY HEALTH CAREDefinition:Primary health care is an essential health care based, on practical scientifically Sound and socially acceptable methods and technology made universally accessible to individual and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination.DEFINING OF PRIMARY HEALTH CARE

• Value driven: dignity, equity, solidarity and ethics• Protects and promotes health• Centered on people, but allowing self reliance• Focus is quality including cost effectiveness• Sustainable finances, allowing universal coverage and equitable access

Topic: 5.2COMPONENTS OF P .H.C.ORELEMENTS OF P.H.C.ORCORNER STONES OF P.H.C.

1. Health education concerning prevailing health problems and methods of preventing and controlling them.

2. Provision of adequate food supply and proper nutrition (provision of balanced diet).3. Adequate supplies of safe water and basic sanitation.4. Provision Of adequate maternal and child health care, including family planning.5. Prevention against major infectious disease through immunization.6. Prevention and control of locally endemic disease e.g., malaria and diarrhea.7. Appropriate treatment of common diseases and injuries.


8. Provision of adequate mental health care.9. Provision Of essential drugs.OR (ELEMENTS+M)Education of prevailing Health ProblemsLocally-endemic Disease Prevention and ControlExpanded Program of ImmunizationMaternal and Child Health and Family PlanningEnvironmental Sanitation and Safe Water SupplyNutrition and Food SupplyTreatment of Communicable & Non-communicable Diseases/ConditionsSupply and Proper use of Essential Drugs and Herbal MedicineMental Health PromotionTHE FUNCTIONS OF PRIMARY HEALTH CARE1. To provide continuous and comprehensive care2. To refer to specialists and/or hospital services3. To co-ordinate health services for the patient4. To guide the patient within the network of social welfare and public health services5. To provide the best possible health and social services in the light of economic considerations.

UNIT NO. 06Topic: 6.1BASIC PRINCIPLES OF P.H.C:

1. Accessibility of health services to all populations.2. Maximum individual and community involvement in the planning and operation of healthcare

services.3. Emphasis on services that are preventive and prornotive rather than curative services only.4. Use of appropriate technology.5. Integration of health development with total overall social and economic development.

GENERAL PRINCIPLES OF P.H.C.All points are basically derived from definition of P. H.C. by WHO.1. Equity (Equitable distribution)

Primary health care for all with special attention to those who need and vulnerable groups e.g., rich or poor people, urban and rural area.

2. AffectiveessServices must be through qualified persons and at proper time.

3. EfficiencyServices must be with favorable effects.

4. AffordabilityAt a reasonable cost, so that poor can also make use of these services.

5. Community participationAll people, families and communities assume responsibility in promoting their own health and welfare. Therefore in PHC community participation is must.

6. Multi-sectoral ApproachAll sectors related to health must be involved for promoting the community health and self-reliance. These are agriculture, irrigation, education, housing, public works, communication, rural development, cooperatives, industries, panchayats and voluntary organizations.


UNIT NO: 7Team: a group of people working together for a common predetermined goal.Health Team: • The group of health professionals works in collaboration for achievement of maximum health of

individual, family and community. • It is a group of health professionals working together for achievement of health of the particular

community.This group is known as ‘Health Team is usually consisting on:

• Medical Officer• Nurse• Lady Health Visitor / Health Technician.• Dispenser• Community Health Worker• Trained Traditional Birth Attendant• Security Guard• Sanitary WorkerPURPOSES OF A OF PRIMARY HEALTH CARE TEAM:

• Working for a goal such as promotion of health, prevention of disease and disability and rehabilitation.• Identify the goal• To establish the goal according to the need of population.• To develop the plan of action.• To set the priority.• To enable all team members to contribute for achievement of the goal.• Provide health care to the individuals.• To provide health education to the people in the community.


The basic health care level starts from a Basic Health Unit where a health team consists of Medical Officer, Nurse, Lady Health Visitor / Health Technician, Dispenser, Community Health Worker, Trained Traditional Birth Attendant, Security Guard and Sanitary Worker. This team provides the basic health care services of primary health care to a population of 5000 – 10,000.

TYPES OF TEAM:• Nuclear team (a few members at primary health care level)• Extended team (more people in this team at secondary level of health care )• Multidisciplinary team (a broad set up of services having all types of health care facilities availability)

Advantages of team work:• Reduce of over all cost by sharing offices and personal equipments.• Provide confidence among team members as team work gives opportunities to work independently or interdependently on each other.• Members lead to built trust and positive relationship.• It may reflect the idea more brain / more ideas, while working in a team, exchange of ideas occur, people share their personal experiences and knowledge with other team members so the learning opportunities are available.• More work can be done in a short time. • Responsibilities of administration are shared by delegations of tasks to all team members.• Reasonable rest and relaxation time for all team members is available when needed.• Complete, error free and efficient records can be prepared that might be used for research purposes.• Professional persons have the time to avail opportunities o improve their skills and professional growth.• Team spirit developes and people feel themselves more self worth.Disadvantages of team work:• Non- willing workers do not bother to work and the burden may be on the others who really want to accomplish

the task.• While working in a group he conflict may arise because of individual difference and heir ideas and if his is not

resolved properly and intelligently, it will hinder to achieve the team objectives.• One or more members may influence the others and it can suppress the abilities of other team members.• Communication problems may occur when busy individuals forget to inform other regarding messages.PRINCIPLES OF WORKING IN A TEAM:• Roles and expectations of all team members should be clear.• Team members should remember that the team leader has strength as well as limitations, never criticize

him/ her in front of others.• Positive behaviour should be praised and negative be ignored once, unless it hinders the team work.• Always be polite while working in a team. It helps o build constructive relationship .be assertive but be

careful about any conflict developing and for is resolution.• Promote effective communication and encourage comfortable and harmless environment for the team

members.• Keep the team well informed. The success of the team work depends on his key principle.• Do not hide the mistakes and not blame the others for it. Making error is a natural human tendency it is

better to admit the mistakes to the team members because it provides the opportunity to improve it and be careful in future.

• Team leader should accept only those tasks which the team members have the ability to achieve or fulfill.

• Each team member is responsible to work but if a member is weak or has insufficient skills, the others have the responsibility to help and observe his work and to improve his skills. Do not criticize over him or her.

• Avoid irritating and frustrating to each other while working in a team.


• Achievement of a goal or accomplishment of any task must be publicized in front of all team members. It provides a sense of job satisfaction and feeling of self worth.

RESPONSIBILITIES /ROLES OF HEALH TEAM MEMBERS It is a group of health professionals working together for achievement of health of the particular community and each member has specific roles and responsibilities according to job description.Medical officer: • Makes medial diagnosis and prescribes medications to he patients.• Responsible for the coordination of work in a unit.• A guider of team members.• Plans and conducts health education sessions. Responsible for professional growth of team members.• Prepares reports and records for submission to superior authority and for further utility. Registered nurse:• Health Care Provider: Clinician – CHN is a health care provider, taking care of the sick people at

home or in the hospital. The CHN provides direct care in community as she conducts the deliveries in community, Provides Geriatric Care, .Antenatal care, Postal natal care, Neonatal care, nursing procedures, Wound dressings and Treats minor illnesses, Provides the first aid.

• Health Advocator – speaks on behalf of the client• Supervisor - who monitors and supervises the performance of midwives.• Facilitator - CHN establishes multi-sectoral linkages by referral system.• Health Educator• Collaborators• Counselor• Advocate• Researcher• Manager• Evaluator (see UNIT NO. 2 for details)Health technician:• Assists in client care activities e.g. growth monitoring immunization.Lady health visitor / Midwife:• Home visiting and assessing individuals, families and community needs.• Helping in antenatal and pos natal activities and conducting normal deliveries in community. Link

between a MCH Centre and a BHU.• Referring to hose people who need further help.• Growth monitoring of children in a community. Trained Traditional Birth Attendant:• Antenatal and postnatal care in community or hospital.• Conduct deliveries under supervision.Community health worker:• Links between community and health care centre. • Home visiting.• Encourage good health habits and clean environment.• Identify false taboos and practices which are harmful to health of pregnant women and children.• Identify the causes of water contamination in homes and community.• Shares informations related to prenatal, natal, postnatal and neonatal care.• Identify high risk pregnant women in community and refer hem to well facilitated hospitals.• Encourage adequate nutrition for mothers and children.• Identify and refer children with different types of infections such as diarrhea, and other communicable

diseases.• Identify and refer people with communicable diseases.• Share informations with families about the causes and prevention of diarrhea and other communicable

diseases. Mahmood Ahmed Arain 17

Security Guard:• Responsible for the safety of hospital /unit.• Controlling of people and maintain discipline.Sanitary Worker:• Responsible to keep the unit neat and clean. What are the main duties of a Health team?The main duties of a health team during a disaster are:

1. First aid2. Emergency care3. Ambulatory care.4. Patient referral.5. Public education.

The following list shows the characteristics that comprise high-performance teams:• The team has a common focus, including clear and understandable goals, plans of action,

and ways to measure success.• Roles and responsibilities are clearly defined for each team member.• Each member has clearly defined expectations of other members.• The team fully utilizes its resources—both internal and external.• Members value each other’s differences in healthy and productive ways.• Each member is able to give, receive, and elicit necessary feedback.• The team members manage their meetings in a productive way.• The team is able to reach goals by achieving the necessary results.Reasons for poorly working by health team members.• Inadequate salary• Non-interesting work• Poor working condition • Poor security

UNIT NO: 08HEALTH CARE SERVICES IN PAKISTAN In Pakistan, at this time there are two main systems providing health care services to the people. 1. Government established health care system2. Private or public sector.In Government established health care system:

a. The institutes are developed at federal and provincial level. In federal level different teaching and special services hospitals are established which provide tertiary level healthcare services. These hospitals are only in major cities.

b. In provincial system the hospitals are established from a basic level to teaching hospitals. These hospitals are spread in all over the country and provide health care services to the people. Government established health care system provides health care services on free or very low cost to the people.

In Private or public sector established hospitals provide services to the people in mostly cities all over the country. These range from a general clinic to a teaching hospital and provide health care services to the people on cost. Some NGOs also have established hospitals in the country which provide special services as Mary Adelaide Health Services for Family Planning and Leprosy Control, Latin Rehmatullah Benevolent Trust provide services for ophthalmic care. Levels of Health Care:

There are three levels of health care:• Primary Health Care• Secondary Health Care• Tertiary Health Care.

Primary Health CarePrimary health care is an essential health care based, on practical scientifically Sound and socially acceptable methods and technology made universally accessible to individual and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination.


• It focuses on prevention and promotion rather than cure. First Aid is also part of PHC.• All elements of primary health care are being practiced in the Level.• Patients are referred from this level to Secondary level for detection and treatment of disease.• It is provided on Dispensaries, Family Planning Centers MCH centers, and BHU & RHCS.Secondary Health Care Level:• This focuses on early detection and treatment of diseases.• It is curative rather than preventive.• The patients are received from primary health care level.• It has special services of Physician, Gynecologist, Orthopedic Surgeon, and Pediatrician etc also. • It is provided on at Tehsil Taluka, & District / Civil Hospitals.Tertiary Health Care Level:• It is provided in teaching hospitals, and regional hospitals.• It provides high level of care of different diseases and prevents disabilities & provides rehabilitations.• It has specialized units and departments Medical and surgical units, Ophthalmology, ENT, maternity,

Gynecology, Cancer, & Orthopedic departments etc. • It is equipped with latest technology, well trained staff and advanced machinery.

PRIMARY LEVELHealth Promotion and Illness Prevention

SECONDARY LEVELPrevention of Complications through Early DIAGNOSIS and Treatment

TERTIARY LEVELPrevention of Disability, etc.

Provided at –• Health care/BHU• Health Stations, clinics• Main Health Center• Community Hospital and

Health Center• Private and Semiprivate

agencies

When hospitalization is deemed necessary. ►referral is made to emergency (now district), provincial or regional or private hospitals.

When highly specialized Medical care is necessary.► referrals are made to hospitals and medical center such as from RHC, BHU, National Center for Mental Health, and other govt, private hospitals at the municipal level

Basic Health Unit:• Basic Health unit is basically a primary Health Care centre, which promotes health & prevents diseases

by immunization, health education, family planning and treating minor illnesses.• It provides services to a population from 5000-10000. • The working staff in BHU is consisting of:

o Medical officero Health Techniciano Lady Health workero Dispensero Security Guard and o Sanitary worker

Rural Health Center:• It provides services to a population of 50,000-100,000.• It provides primary health care services that promotes health, & prevents through immunization,

health education, family planning and treating common minor illnesses.• It provides the special services of Gynecology, & General Surgery.• Nine elements of Primary Health Care are implemented through Rural Health Center:• A Rural Health Center is integrated with 4-6 Basic Health Units. It has 10 - 25 bedded ward and it is

staffed with:o Medical Superintendento Deputy Medical Superintendento Medical Officers male and Femaleo Gynecologist & Obstetrician

o Surgeono Staff Nurseso Lady Health Visitoro Dispenser


o Store Keepero Vaccinatoro Office Clerko Registration Clerk

o Two Driverso Ward Servanto One Naib Qasid /Peono Sanitary worker


Taluka Head Quarter Hospital:• It is consisted for the population of 10, 0000 or More.• It is a Secondary Health Care Level Hospital.• It provides more curative services rather than preventive health care. • It provides prompt diagnosis & treatment of minor & major diseases. Patients are received from

primary health care units.• It has special services of Gynecologist, Eye, Pediatrics, ENT including general surgery &

Medicine. • One Taluka Hospital is integrated with 3 -4 Rural Health Centers.• It has a 25 - 50 bed capacity.

District Head Quarter Hospital / Civil Hospital:• It is consisted for the population of 1600000 or more. It is a Secondary Health Care Level

Hospital. It is integrated with 4-5 Taluka Hospitals.• It provides more curative services rather than preventive health care. • It provides prompt diagnosis & treatment of minor & major diseases. Patients are received from

primary health care units. Different wards of various diseases are present in a civil /district hospital.

• It has special services of Gynecologist, Eye, Pediatrics, ENT including general surgery & Medicine.

• It has the capacity of more than 100 beds.• The training of paramedical staff and nursing is also provided in the schools affiliated with civil /

district hospitals.

Teaching Hospitals: • These are tertiary health care level hospitals. • These hospitals also provide medical nursing and paramedical staff teaching services. These

provide special care e.g. Psychiatry, ENT, EYE, Neuro orthopedic, Gynecology, Obstetrics, Pediatrics & oncology etc.

• These hospitals prevent disabilities & provide rehabilitation services.• These hospitals have more technological devices & procedures.• These hospitals are under control of Provincial Secretary of Health/provincial Government

directly.Federal Hospitals:

• These hospitals are established under control of Federal Government and mostly located in capital city of province.

• These hospitals provide tertiary health care services to the people.• Pakistan Institute of Medical Sciences Islamabad, Federal Government Services Hospital, Poly

Clinic, National Institute of Health in Islamabad and National Institute of Child Health Karachi, Jinnah Postgraduate Medical Centre Karachi And National Institute of Cardiovascular Diseases Karachi are the examples of Federal Government Hospitals.

Atomic Energy Medical Centres:• These centers work autonomously with the support of Pakistan Atomic Energy Medical Commission

.These centers provide the diagnostic facilities and scans of cancer patients on very low cost to the people.

HEALTH CARE SYSTEM IN PAKISTAN

POPULATION COVERED

UNIVERSITY HOSPITAL

600000 DISTRICT HOSPITAL

↓350000 To

400000TEHSIL

HOSPITAL TEHSIL

HOSPITALTEHSIL

HOSPITAL

25000 TO

100000RURAL

HEALTH CENTER

RURAL HEALTH CENTER

RURAL HEALTH CENTER

RURAL HEALTH CENTER

RURAL HEALTH CENTER

5000 TO

10000BASIC

HEALTH UNIT

BASIC HEALTH

UNIT

BASIC HEALTH

UNIT

BASIC HEALTH

UNIT

BASIC HEALTH

UNIT

CHW CHW CHW CHW CHW CHW

REFERRAL SYSTEM

Teaching hospital750-1700 beds

Specialized hospital100-450 beds

Civil or district head quarter hospital

250-350 beds

Major hospitals department hospital

100-200 beds

HEAD QUARTER HOSPITAL30-50 beds

RHC /UHC20-30 beds

MATERNITY hospital10-20 Beds

Basic health unit/ urban health centre

Clinics Dispensaries

UNIT No - 09EPIPDEMIOLOGYThe word epidemiology is derived from three Greek words. EIPDEMIOLOGY ____________________↓____________________ ↓ ↓ ↓ Epi Demos Logos ↓ ↓ ↓ Upon, Among People Study, ScienceDefinitionsEpidemiology

1. The study of distribution of disease or physiologic condition among human population s and the factors affecting such distribution

2. The study of the occurrence and distribution of health conditions such as disease, death, deformities or disabilities on human populations

3. Epidemiology is the study of distribution of diseases.4. Epidemiology is the study of distribution and determinants of health related problems in the

population (Last 1983).5. Epidemiology s the branch of medical science, which treats epidemics (Parkin 1873).6. The science of the mass phenomenon of infectious diseases (Frost 1927).7. Epidemiology may be defined as the study of the distribution, dynamic and determinants of disease

in human population.8. the study of distribution of disease or physiologic condition among human population s and the

factors affecting such distribution

9. the study of the occurrence and distribution of health conditions such as disease, death, deformities or disabilities on human populations

Aims of Epidemiology1. Identify the factor of disease in human population.2. Control and treatment of diseases.3. To provide data essential to the planning, implementation and evaluation of services for the prevention

of diseases.Steps in EPIDEMIOLOGICAL IVESTIGATION:

1. Establish fact of presence of epidemic2. Establish time and space relationship of the disease3. Relate to characteristics of the group in the community4. Correlate all data obtained

Role of the Nurse• Case Finding• Health Teaching• Counseling• Follow up visit

VARIOUS TERMS USED IN EPIDEMIOLOGYINFECTLQNThe process of introducing or introduction of micro –organisms into human host followed by their multiplication within the body at the expense of hosts Called infectionEPIDEMICThe disease, which affects large number of people within a short space of time of large number of susceptible persons.Epidemic disease: is an infectious disease which attacking a number of people in the same area at one time as cholera, plague, measles etc.

EndemicThe disease which is always present in a community , but never flourishes because the number of susceptible persons is equal to number of immune persons, e.g. enteric fever.SPORADIC It is a disease which affects few persons because of great number of immune persons than susceptible persons in a community.PandemicWhen a disease spreads to almost the whole world, e.g., influenza or AIDS.Communicable diseaseIt is state of disorder in man that results from the entrance of microorganisms that are pathogenic and can be communicated to other individuals in the community.Non-Communicable diseaseIt is not transmitted from person to person. Non Communicable diseases include cardiovascular, renal, nervous and mental conditions, musculoskeletal condition, accidents, cancer, diabetes, .obesity and various other diseases.Career: a person or animal that harbors specific infectious agents in the absence of clinical manifestations and serves as potential source of infection.Fomites: inanimate object or material in which disease producing organisms may be conveyed e.g. patient’s personal possessions such as Lenin, clothes and utensils.Virulence: the ability of on organism to cause disease.Disinfectant: an agent that kills all growing forms of micro organisms, thus completely eliminating them from objects used only on inanimate objects.Sterilization: the process by which all microbes pathogenic and nonpathogenic and their spores are killed.

Vector: an animal usually an orthopode, insect tick that transfers any infectious microbe from one host to one another.Isolation: It is the separation during the period of communicability of infected persons or animals from others to prevent the spread of the disease to those who are susceptible. Quarantine: A person or an animal in kept in isolation coming from the abroad (other country) until the symptoms of disease appear or that person or animal is declared free of any infection. Categories of Isolation: (7 categories)

• Hands must be washed after contact with the patient or potentially contaminated articles and before taking care of another patient.

• Articles contaminated with infectious materials should be appropriately discarded or bagged & labeled before being sent for decontamination & reprocessing.

• Strict Isolation – to prevent highly contagious and virulent infections that may spread by both air and contact.

o Specification:

o Private room

o Use of mask, gloves & gown for all persons entering the room.

o Special ventilation requirements with the room at negative pressure to surrounding areas is desirable

• Contact Isolation –

o For less highly transmissible or serious infections

o Disease or conditions which are spread primarily by close or direct contact.

• Respiratory Isolation – diseases spread through the air

• Tuberculosis Isolation-

• Enteric Precaution

• Drainage Secretion precaution

• Blood & Body fluid precaution

UNIT NO.1OTHE CONCEPT OF DISEASE When a disease attacks a large number of individuals in the community at the same time is called epidemic disease. Occurrence of any disease always depends on three variables:

1. Agent: etiological factor.2. Host: particular individual or group of people.3. Environment: all that is external to the agent and host.

DISEASE TRANSMISSION IS AFFECTED BY:• Factors intrinsic to man• Factors intrinsic to the disease• Role of vectors• Factors intrinsic to the environment

The study of these factors and their dynamics in disease transmission is EPIDEMIOLOGY.

Agent: Any element, substance, or force whether living or non-living, the presence of which can initiate or perpetuate a disease processTypes of agents:Living or biological agents: includes all living organisms such as bacteria, viruses, protozoa, fungi and helminthes.Physical: these are heat, cold, humidity, pressure, light, air, water, radiation, electricity etc. Mechanical: chronic friction and other mechanical forces resulting in injuries, trauma, sprains etc. Chemical: these may be the internal (endogenous) such as urea, glucose, bilirubin etc or external (exogenous) such as allergic gases, insecticides, strong acids or bases. Nutrients: different nutritional components such as minerals, vitamins, carbohydrates, proteins, fats and water.Characteristics of agents:Inherent: physical features, biologic requirements, chemical make-up, viability, resistanceThose directly related to man: infectivity, pathogenicity, virulence, antigenicity.Those related to the environment: reservoirs and sources of infection and mode of transmission.Those directly related to manInfectivity: ability to gain access and adapt to the human host to the extent of finding lodgment and multiplicationPathogenicity: measures the ability of the agent to cause a specific reactionVirulence: severity of the reaction, usually measured in terms of fatalityAntigenicity: ability to stimulate a response

Different pathogenetic mechanisms• Direct tissue invasion• Production of a toxin• Immunologic enhancement or allergic reaction leading to damage to the host• Persistent or latent infection• Enhancement of host susceptibility to drugs of otherwise minimal toxicity• Immune suppressionDifferent mechanisms of transmission:• Direct transmission• Indirect transmission:

– Vehicle-borne– Vector-borne: – Mechanical– Biological

ENIRONMENT ENT

AGENT

DISEASEAGENT

THE EPIDEMIOLOGICAL TRIANGLE

– Airborne: 1-5 um– Droplet nuclei– Dust

HOSTThis may be a human being or an animal that come in contact with the agent.Host factor influences the interaction with the agent and environment.Age: Certain diseases are more common in certain age groups e.g. measles in childhood and hypertension in old age Sex: pregnancy related issues of women and prostatic hypertrophy in males. Race: for example, Negro suffered more with sickle cell anemia.Genetic factors: behavioural and blood disorders run into the next generation caused by chromosomal factors. Habits: living habits and dietary habits such as dietary pattern, use of tobacco, alcohol etc. Nutrition: taking some foods more or less due to availability or unavailability or cultural restrictions may cause some diseases such as obesity, malnutrition, diabetic mellitus and cardiac disorders. Immunity: low immune persons can suffer with some diseases more than immune persons such as children than the elders.Customs: some traditions of a society can lead to specific diseases such as Social status: some diseases are more common in lower classes such as malnutrition, uberculosisetc. Occupational status: some diseases are related to working environment such as respiratory problems are more in garments industrial workers Educational status: educated people can easily control and change their unsafe habits rather than uneducated.ENVIRONMENT: It refers to the aggregate of all external conditions and influences affecting the life and development of an organism, human (reservoir) behaviour and society.Physical environment:It includes water, soil, air, heat, light, radiation, noise, housing, climate, and geography etc.Biological environment:It includes al, living things such as (human, animal and microorganisms) in ecological system.Ecology: It is Science of relationship and interaction of totality of the organism to the environment.Social environment:Such as cultural, values, norms, customs, habits, beliefs, attitudes, religions and other psychosocial factors.

MODES OF DISEASES TRANSMISSION: ORROUTES OF ENTRANCE OF MICROORGANISMS INTO BODY.

1. INHALATION. Micro-organisms can enter into the body through nose and mouth during respiration and they can produce infection such as upper respiratory tract infections and lower respiratory tract. As influenza, Measles, pneumonia tuberculosis etc) .

2. INGESTION. Micro-organisms can enter into the body through contaminated water and food so that they can produce infection such as Diarrhea, Dysentery, Hepatitis, Poliomyelitis and Food poisoning by staphylococcus.

3. IN - OCULATION. Pathogenic micro-organisms can enter through blood or serum into the body. They can enter through mucous membrane into deep tissue of living organisms as by surgical wound, through injected materials, serum, or other substance or by biting of insects and animals. e.g. Tetanus (infection),rabies (dog), malaria (mosquito) and hepatitis e.g. Hepatitis-B and through serum / infected blood.

4. SKIN CONTACT: Micro-organisms can enter into the body through the skin such as Herpes, simplex virus, H Zoster virus, scabies etc.

5. SEXUAL CONTACT. Micro-organisms can enter into the body during sexual intercourse if a partner is infected by a specific disease which can be transfer to the other partner as AIDS by semen.

UNIT NO.11

EPIDEMIOLOGICAL APPROACHEpidemiological approach is the observation of the determinants, frequency and distribution of diseases. Health professionals can solve health problems by using the epidemiological approach by asking questions related to health events in the following approach:

Who (person)

Who is affected gender, age, race, colour.

Where (place)The geographical area where diseases is seen more frequent or less it may be a community, village , urban or rural area district ,province, country or continent.

When (Time)In which season the disease appear summer, winter, autumn, spring .e.g. influenza, gastroenteritis.

What is being done? The health care facilities / measures those are being provided on the incidence. These are• Curative measures• Preventive measures • Promoting measures

What else could be done?It means that what was done at past related to that disease (habits, concepts, preventive and curative measures) and what could be done more preventive and curative measures regarding that disease.

UNIT NO.12

SURVEILLANCE AND NOTIFICATION OF COMMUNICABLE DISEASESSURVEILLANCE: Surveillance is a continual dynamic method of gathering data about the general public for the purpose of primary prevention. (Harkness1995)Ongoing, systemic collection, analysis and interpretation of health data, essentials to planning, implementation and evaluation of public health practice.(CDC1988).The continuous inspection / security of the factors that determine the occurrence and distribution of diseases and other conditions of health related issues. Surveillance is a process of data collection for action.Surveillance is the collection of data about cases of target diseases and uses of the data, to improve action to prevent these diseases.NEEDS OF SURVEILLANCE PROCESS:

Through the Surveillance process changes in the trend or distribution of various states of health in the population can be detected. Identified changes increase awareness of health and disease prevention. Timely feedback of data to those persons (Health agencies and Government department) who have needs for planning control and prevention activities. Data can also be used to evaluate previous actions that already taken to control and prevention of health problems.CHARACTERISTICS OF A SUCCESSFUL SURVEILLANCE SYSTEMIt involves health problems that are perceived to be important public health concern.Some types of official reporting or unofficial recording of information is involved.Successful Surveillance requires frequent sustained interaction with reporting resource including feedback and follow up of reported cases.The health care personals who are involved in the process understand the importance of follow up cases.FACTORS THAT CONTRIBUTE OF SUCCESSFUL SURVEILLANCE SYSTEM• Simplicity• Timeliness • Flexibility • Ability too detect the true cases TYPES OF SURVEILLANCE There are four general types of Surveillance.Passive, active sentinel and special Surveillance Passive Surveillance:Health care personals use standardized report forms to submit informations about cases of communicable diseases to health department. No action is taken unless the feedback or instructions are received by the agency.Active SurveillanceThis is ongoing search for new cases e.g. AIDS, polio, etc.This can be accomplished through telephone calls to health care personals or laboratories or a review of hospital or clinical record.Active Surveillance programmes are more complete than passive but are more expensive to maintain. Sentinel SurveillanceIdentified trends in frequently occurring conditions. A random sample of physicians’ office or health care clinics are contacted and asked to report incidence of infectious diseases on regular bases. Special Surveillance It includes microbiological surveys and maintaining the emergence of antibiotic resistant organisms. e.g. vibrio cholera .

Sources of Surveillance information General population:• Morbidity data• Mortality data• Case investigation • Epidemic reports• Epidemic field investigation results• Laboratory reports population surveys • Animal and vector population survey • Biological product use report • Demographic data Special population:

• Clinics, BHU, RHC, Taluka and District hospitals • Medical records • Occurrence records • Patient or family interview• Provider office record • Workers compensation record • Employee health record personal record absentee reportsSurveillance system in PakistanThe control of the Surveillance system is at Director General Health Services, DHO/EDHO at district level and ADHO at Tehsil level. These people are the responsible for the control of infectious diseases and have the authorities to take all the steps, which are required for safe water supply, pure food and proper sewerage system checking. If an infection occurs, they have to find out sources of infection, control of infectious diseases and make steps to prevent its spread.Nurses role in SurveillanceThe community health and public health nurses use the process of Surveillance in two ways.1. Surveillance data is used to identifying the need for primary prevention, interventions that are

delivered in the client’s environment. e.g. well baby clinic , family planning employees health record.2. Nurses engage in surveillance activities, as they monitor the health of individuals in thin population.

• Identifying the individuals with health problems within family and community groups.• Planning early interventions to control and prevent illness, require constant monitoring.

Notification of Communicable DiseasesDefinition1. This is an act of intimation of the appearance of the infectious disease to the Municipal authorities to

enable them to undertake prevention and control of disease.2. Notification means immediate intimation of occurrence of an infectious disease to the Heath Officer or

Sanitary authorities. A list of notifiable diseases is usually available in the municipalities. Such diseases include: Malaria. Measles. Poliomyelitis. Rabies. Diphtheria. Cholera. Chicken pox Small pox. Typhoid (Enteric Fever).

UNITNO.13

STATISTICSIn health sciences, the study of health and diseases is concerned with the statistics that tells us the

various healths needs and proper arrangement of resources for a given population.It is a systemic approach for obtaining, organizing and analyzing numerical facts, so that scientific conclusions can be drawn from them. USESo Vital statistics are the figures or rates that give us a picture of the population. e.g. births, deaths and

diseases etc.o The application of statistical measures to vital events (births, deaths and common illnesses) that is

utilized to gauge the levels of health, illness and health services of a community.

o Identifies the totality of health problems and needs of population.o Find various methods to meet these identified needs of people.PURPOSES:• Essential for the assessment of health level in the community.• For further planning of health services.• Budget planning• Analyzing and evaluation of health programme• It provides the information to various health agencies which help that community on the basis of given

informations.• Comparison with other health statistics, human and non human resources.• Compression between various age groups health problems and needs. TYPES OF STATISICS• Vial statistics• Health statistics 1. VITAL STATISTICSThese are the figures or rates that give us a picture of the population .e.g. birth, death etc.Special branch of statistics concerned with the collection of data related to important events in the human life .e.g. human population census, death, birth, sickness, marriages causes of deaths etc.It is necessary for planning of various health programmes such as • Maternal child health • Communicable diseases control• Environmental health It identifies health problem and makes possible to analyze the nature and current situation of such health problem for the further planning to recover it.Vital statistics provide the basic information of population for planning of health services in any community and country.ORIGIN OF VITAL STATISTICS • For a long time ago people carried out vital statistics for the purpose of taxation, to determine the

human population strength and to establish military power. • Data related to birth, death and marriages records were kept at religious institutes.• The first known census wad carried out in Sweden in 1749.• In sub-continent the first known census was carried out in 1867-72 and then repeated in1881. After

that was carried out every tenth year.• In Pakistan first census was carried out in 1951 and then in 1961, 1972, 1981and last in1998.The responsibility to collect and keep the records is compiled in rural and urban setting.RuralThe Headman (Number dar) of the village and chairman of union council have the authority and responsibility to keep the records of births, deaths and human population in their area.

UrbanTown committees, municipal offices and metropolitan corporations are responsible to keep the records of births, deaths and human population in their area.2. HEALTH SATISTICS These are the facts and figures which reveal the state of health of the community such as diseases, housing, social, economic factors and environment.USES• These all are important in measuring the health of the community• Health statistics are concerned with the following• Incidences of the diseases (morbidity)

• Health status of the community• For further planning in health programmes • Evaluation of programSOURCES OF VITAL AND HEALTH STATISTICS:- Census Population census involves in collection, computing and publication of demographic, economical and social data of all persons in the community at a specific time. It includes all people’s age, sex, marital status, birth place, religion, literacy occupation, income, education, and language and other information on national level. - RegistrationRegistration of birth, death and marriage all are called vital statistics. Data can be obtained from a concerned office like union council, town, municipal and metropolitan offices about these facts. At present exact figures availability is impossible due to lack of maintenance of records. - NotificationReports presented in the form of press release also provide the health records. These figures are presented in the news papers, radio and TV news. These are the fastest resource of information in the world about any health issue. - Records Records of various clinics, hospitals and community health Centres can provide the facts and figures of health statistics. These records are available in the forms of registers and also in computerized system through different web sites of departments.- Health surveysHealth surveys are carried out through various health agencies at different levels. At community level a community health worker collects information through survey of homes in community about maternal and child health problems.

HEALTH INDICATORSo Health indicators are measurements of morbidity and mortality and vital events in a community for

only health program and planning through the census data. TYPES• Crude Birth Rate • Crude Death Rate • Infant Mortality Rate• Morbidity Rate • Perinatal Mortality Rate• Neonatal Mortality Rate• Maternal Mortality Rate• Incidence Rate • General Fertility Rate

A. CRUDE BIRTH RATEIt is the number of live births per 1000 population during the specified period of time.Through the crude birth rate we assess the fertility and estimate growth rate of population.

Total # of live births in a given calendar year X 1000 Estimated population of the same given year

B. CRUDE DEATH RATEIt is the number of deaths per 1000 population during a specified period of time.

•

Total # of death in a given calendar year X 1000 Estimated population of the same calendar year

C. INFANT MORTALITY RATEIt is the number of deaths less than one year of age reported in a year for every 1000 live births during the same period.

Total # of death below 1 yr in a given calendar year X 1000 Estimated population of the same calendar yearD. MORBIDITY RATE:

It is the number of reported cases of a given disease of every 1000 population for a particular period of time.

Total # of cases in a given calendar year X 1000 Estimated population of the same calendar year

E. PERINATAL MORTALITY RATE:It is the number of fetal deaths after 28 weeks of gestation and death of neonate under one week of age, for every 1000 total births after 28 weeks of gestation during one year..

Late fetal deaths + death under one week of age X 1000 Estimated population of the same calendar year

F. NEONATAL MORTALITY RATEIt is the number of deaths less than one month children of age reported in a year for every 1000 live births during the same period.

Total # of death below 1 month in a given calendar year X 1000 Total number of births during that year

G. MATERNAL MORTALITY RATEIt is the number of deaths reported among all maternal cases in a given calendar year.

Total # of death among all maternal cases in a given calendar year X 1000 Estimated population of the same calendar year

H. INCIDENCE RATE It is the number of new reported cases of a given disease per 1000 population in a given year.

Total # of new cases in a given calendar year X 100 Estimated population of the same calendar year

I. PREVALENCE RATENumber of cases of a specific illness cases in a given calendar year

Total # of new & old cases in a given calendar year X 100 Estimated population of the same calendar year

J. LIFE EXPECTANCY:The average number of infants per year is expected to live generally used to refer life expectancy for that year. The life expectation for the year 2009 means the average number of children born in the year 2009 is expected to live.

K. GENERAL FERTILITY RATEIt is the number of live births per 1000 women between the ages 15-45 years during the specified period of time.

Total # of live births in a given calendar year X 1000 Total number of reproductive age

L. ATTACK RATE

Total # of person who are exposed to the disease X 100 Estimated population of the same calendar year

UNIT NO.14

DATA is a plural of datum which means “known things”. Data: plural noun: information in words or figures about a particular subject, especially information which is available on computer.(Note: in scientific usage, data is used with a plural verb: the data are accurate. in everyday language, data is often used with a singular verb: the recent data supports our case.)Data bank: a store of information in a computer e.g. the hospital keeps a databank of information about possible kidney donors.

Database: a structured collection of information in a computer that can be automatically retrieved and manipulatedData Protection Act: a parliamentary act intended to protect information about individuals that is held on computers. It ensures that all information is stored securely and allows people to have access to their entries.

TYPES OF DATA:There are two types of data.Primary data: the facts which are observed directly by researcher /observer are called primary data. The primary data are those, which are collected afresh and for first time and thus happen to be original in character.Secondary data: The secondary are those which have been collected by someone else and which have already been passed through statistical process. It may be published or unpublished and is collected from various publications of govt., foreign market, technical & trade generals, reports by search scholars & public records & statistics.

METHODS OF DATA COLLECTION:

How to select a method for data collection The method collecting primary and secondary data differ. Hence primary data are to be originally collected while in case of secondary data the nature of data collection work is merely that of compilation. A researcher must judiciously select the method for his or own study keeping in view the following factors:-• Nature & Scope of enquiry• Availability of funds• Time factor• Precision requiredSources of data collection:The task of data collection begins after a research problem has been defined & the research design has been chalked out.There are mainly two sources of data collection:-

a. Primary datab. Secondary data

COLLECTION OF PRIMARY DATA:There are several ways of collecting primary data.They are:

1. Observation method 2. Interview method 3. Through questionnaires 4. Through schedules

1. Observation method-

• Definition- under this method the information is sought by the way of investigators own direct observation without asking from the respondent.

• Types- 1. Structured observation : where observation is done, the conditions are standardized &

then the pertinent data is selected.2. Unstructured observation : when the observations take place without the above mentioned

characteristics to be thought in advance.

• Advantages - subjective bias is eliminated, information relates to the current happenings, independent of the respondent, & best suited for those who can not give the verbal report of their feelings.

• Disadvantages - expensive method, limited information, unforeseen of certain factors, interference with the observations, & people rarely available for direct observation

2. INTERVIEW METHOD

• Definition - involves the presentation of oral verbal stimulus & reply in terms of oral verbal responses.

• Types -1. personal interviews : interviewer asking questions generally in face to face contact to the other

person/s. it can be of two types further: direct or indirect personal interviews.2. Telephone interviews : method of collecting information by contacting the respondent on

phone itself.

• Advantages - more information, greater flexibility, effective control on samples, supplementary info about the respondents’ personal characteristic & environment.

• Disadvantages - expensive, imaginary info, restriction by cost considerations & possibilities of bias.

3. QUESTIONNAIRES

• Definition - questionnaire consist of no. of questions printed or typed in definite order on a form or a set of forms & is then presented to the person concerned with request for the answers.

• Types- 1. structured : are those questionnaires in which there are definite, concrete & pre-determined

questions & is represented in the same order to all the respondents.2. unstructured : when these characteristics are not present in the questionnaire & the exact

formulations for the question s is the responsibility of the interviewer.• Advantages - inexpensive, answers in respondents own words, convenient & less time

consuming• Disadvantages - low rate of return, control lost when once sent, inbuilt inflexibility, difficult to

know if the respondents are true representatives & is the slowest of all methods4. SCHEDULES

• Definition- the aim & objective of the investigation & the removal to the difficulties of the respondent or the definition or concept of difficult terms is personally assisted by an enumerator specially appointed for this purpose.

Differences between questionnaire & schedule• Schedules are relatively cheap and economical• No response is usually case in questionnaires which is not the case in schedules.• Reply is clearer in schedules than questionnaires.• Personal contact not possible in questionnaires • Risk of collecting incomplete and wrong information is relatively more in questionnaires than in

schedules.• Observation method along with schedules can be used which is not possible in case of questionnaires.OTHER PRIMARY METHODS• Warranty cards • Distributors audits

• Pantry audits• Consumer panels • Using mechanical devices• Through projective techniques• Depth interviews • Content analysisCOLLECTION OF SECONDARY DATASecondary data means that are already available that is they refer to the data, which have already been collected and analyzed by someone else. When the researcher utilizes secondary data, then he has to look into various sources from where he can obtain them. In this case he is certainly not confronted with the problems that are usually associated with the collection of original data. Secondary data is available in two forms:-

a. Published data : can be various publications of govt., foreign market, technical & trade generals, reports by search scholars & public records & statistics.

b. Unpublished data: may be found in diaries, letters, unpublished biographies & autobiographies or other public & private individuals & organizations.

Usually published data are available in:• Various publications of the central, state and local government• Various publications of foreign government or of international bodies and their subsidiary

organization.• Technical and trade journals• Books magazines and newspapers• Reports publication of various associations connected with business and industry, banks, stocks

exchanges etc• Reports prepared by various scholars’ universities economists etc in different field• Public records and statistics, historical documents and other sources of publish information. The

sources of unpublished data are many; they may be found in diaries, letters unpublished biographies and autobiographies and also may be available with scholar’s research workers. Trade organization, labor bureaus and other public/private organizations

Before using the secondary data the researcher must look the following characteristics:• Reliability of data• Suitability of data• Adequacy of data

PRESENTATION OF DATAAfter the data has been collected, it needs to be stored and presented properly for analysis. It is

also useful as an aid to interpretation after the analysis has been carried out. The main ways of describing data are in the form of tables, pie charts, bar charts/histograms and line graphs.

A graphical chart provides a visual display of data that is presented in a table; a table, that is presented in text. Ideally, a chart conveys ideas about the data that is not readily apparent if they are displayed in a table or as text. Definition of table

A table is a set of facts and figures arranged in columns and rows. A table provides a clear summary record of a collection of data. Tables have a number of columns and

rows, depending on the amount of data and the detail shownUses A table is a very useful way of organizing numerical information. Tables are likely to be used as a particular structured format to summarize numerical information.

They tend to be used to present data as a summary and as a starting point for discussionDATA IN TABLE FORM:

A simple table is often all that is required to convey information from a study. Thought should be put into the format, the number of tables and the type of values to go into the body of the table: count total and percentages.

JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DECMalaria 2 1 6 7 8 22 20 26 8 7 3 4Resp.Problems 10 11 8 7 5 4 9 10 9 10 23 20Diarrhea 10 9 10 16 15 20 27 25 11 9 5 7

Table: the No. of patients of various diseases in a Health CentreBar Charts:

Bar charts typically display the relationship between one or more categorical variables with one or more quantitative variables represented by the length of the bars. The categorical variables are usually defined by the categories displayed on the X-axis and, if there is more than one data series, by the legend.

NO. OF PATIENTS OF VARIOUS DISEASES

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MALARIA RESP. PROBLEMS Diarrhea

JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC

QQQQQQQQQQQQQQQQQQQQQQQQQQQ

A BAR CHART SHOWS THE ANNUAL PATIENTS, RECORD

Pie charts:Pie charts are used to represent the distribution of the categorical components of a single variable. Note that as a general rule, multivariate comparisons provide for more meaningful analysis than do single variable distributions and for this and other reasons pie charts should be rarely used. In this PIE CHART shows malarial patients, month wise annual record.

NO. OF PATIENTS OF MALARIA PER MONTH IN A YEAR

1 2 3 4 5 6 7 8 9 10 11 12


A PIE CHART SHOWS MALARIAL PAIENTS, ANNUAL RECORD__________________________

Line chart: The line chart is one of the most efficient means of displaying large amounts of data in ways that provide for meaningful analysis. The typical time series line chart is a chart with time represented on the X-axis and lines connecting the data points.

NO. OF PATIENTS OF VARIOUS DISEASES

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LINE CHART SHOWS THE ANNUAL PAIENTS, RECORD

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A LINE CHART SHOWS THE ANNUAL PAIENTS, RECORD

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A RADAR CHART SHOWS THE ANNUAL PAIENTS, RECORDPURPOSES OF PRESENTATION OF DATA:

It helps to bring out the answer most simply, logically and quickly. It helps to draw clear conclusion. It helps to present data in more short and easy form for viewers and readers It helps to present data in different forms for readers understanding. It helps to save data easily and reachable. It also provides comparison of different variables.

UNIT NO.15Environmental sanitation

Environment:All the external factors living or non-living, material or non-material which surround the man.Environment includes not only the water, air and soil that form our environment but also social, economical conditions under which we live.Sanitation:It deals with the control of all factors in the physical environment which has dangerous affects on man’s health, the control of all those factors in man’s environment which exercise deleterious effects on his physical development .health and survival. (WHO) It is the science and practice of bringing about healthful environmental conditions through proper methods of drainage and sewage disposal, pure water supp and hygiene of housing. Components of Environment:Physical environment:• Housing, food, water, air, light, excreta.Biological environment:• A man is in contact with insects, virus, bacteria, fungi, animals, human beings. Social environment:• Man is in contact with persons others than himself.Psychosocial environment:• Living style at home, schools, at work places, at neighborhood etc.Economical environment:• Ways of living influenced by economical circumstances.

REFUSE OR WASTE:

This includes all unwanted or discarded waste material excreted from houses and streets and from commercial, industrial and agricultural activities of man.Domestic refuse consists of garbage, rubbish and ash. Waste is an unwanted or undesired material or substance. It was commonly referred as rubbish, trash, garbage or junk depending upon the type of material and the regional terminology. Waste is directly linked to the human development, both technologically and socially. With industrial development and innovation being directly linked to waste materials, examples are plastics and nuclear technology. Types of Wastes / refuse: There are two main types of refuse.

1. Solid or dry and2. Mixed with water /Sewage

Waste can be divided into further different types. There are many different kinds of waste, including solid, liquid, gaseous, hazardous, radioactive, and medical also. REFUSE OR SOLID WASTE:Solid wastes are waste materials that contain less than 70% water “Solid” wastes include:

• Forest and wood processing residues; Agricultural crop residues;

• Municipal solid wastes (MSW), which is domestic refuse, commercial wastes and industrial wastes, such as pallets, paper, cardboard and plastics.

Methods of solid waste disposal: Solid Waste Disposal, disposal of normally solid or semisolid materials, resulting from human and animal activities that are useless, unwanted, or hazardous. Solid wastes typically may be classified as follows:Garbage: decomposable wastes from foodRubbish: non decomposable wastes, either combustible (such as paper, wood, and cloth) or noncombustible (such as metal, glass, and ceramics)Ashes: residues of the combustion of solid fuelsLarge wastes: demolition and construction debris and treesDead animals:Sewage-treatment solids: material retained on sewage-treatment screens, settled solids, and biomass sludgeIndustrial wastes: such materials as chemicals, paints, and sandMining wastes: slag heaps and coals refuse pilesAgricultural wastes: farm animal manure and crop residues.WASTE MANAGEMENT METHODSWaste management methods vary widely between areas for many reasons, including type of waste material, nearby land uses, and the area available.LANDFILL

• A waste disposal site in which each day’s accumulation of debris is covered by a blanket of sediment.

• trucks bring in days waste, place it in active area where it is compacted• and at the end of the day covered by layer of sediment• Each day’s accumulation unit is called a cell.• Fill is capped with impervious clay to prevent infiltration and percolation of water through the fill.

Fill bottom is lined and provided with a drainage system to contain and remove any leakage or leachate that occurs. Monitoring wells provide a final check.

Problems of Landfills• Leachate generation and groundwater contamination• Methane production• Incomplete decomposition

• Settling

Dumping:The refuse is collected and then carried upto 5 kilometers away from the residential areas to pits and depressions. Through this the land filling and smoothening occurs. This is an economical method and environment friendly if the refuse is free from dangerous and radioactive material.Controlled tipping:In this method, the refuse is dumped in the ground in a depth of 6 feet and covered with a layer of earth dust as air may not enter into dumped refuse. The refuse is decomposed with various processes into fertilizer and is used in cultivation of crops.Composting:Composting operations of solid wastes include preparing refuse and degrading organic matter by aerobic microorganisms. Refuse is presorted, to remove materials that might have salvage value or cannot be composted, and is ground up to improve the efficiency of the decomposition process. The refuse is placed in long piles on the ground or deposited in mechanical systems, where it is degraded biologically to humus with a total nitrogen, phosphorus, and potassium content of 1 to 3 percent, depending on the material being composted. After about three weeks, the product is ready for curing, blending with additives, bagging, and marketing.

Burning/ Incineration:

Incineration is carried out both on a small scale by individuals and on a large scale by industry.By this method the collected refuse or solid waste id burnt at temperature exceeding 1100C. The material reduces to 10% of the volume of the original material and does not need much place for placing. Hospital items are usually disposed off through this method. Modern incineration facilities are computer controlled , fuel efficient and output gases are strictly monitored by law and output gases are filtered Depending on the type of waste, the waste itself becomes the fuel for the incineration process and newer plants are able to utilise the neat for co-generation of electricity or other purposes.

Recycling methods The process of extracting resources or value from waste is generally referred to as recycling, meaning to recover or reuse the material. There are a number of different methods by which waste material is recycled: the raw materials may be extracted and reprocessed, or the calorific content of the waste may be converted to electricity. New methods of recycling are being developed continuously, and are described briefly below. Commercial incinerators operate at temperature exceeding 1100C in the primary chamber. Incineration not only decontaminates the waste, it completely destroys the waste and reduces it to ash with less than 10% of the volume of the original material. It is an approved disposal method for all waste streams with the exclusion of radioactive waste. There is an outdated stigma attached to high temperature incineration. Modern incineration facilities are computer controlled,.

TRANSMISSION OF DISEASES:Many diseases can spread through contamination. The germs of such disease transmit in different channels. Faecal-borne diseases: The diseases can transmit through the faeces of a sick person who is suffering with a disease. The germs of many diseases excrete through faeces. In those areas where open fields are used, the flies sit on faeces and the germs can attach to their legs from the faeces, when these flies sit on food items, the germs are shifted to that food .These germs of disease can transmit into body through eating such contaminated food to produce diseases. The germs of typhoid, cholera, dysentery, polio, amoebiasis, and diarrhea and worms larva are transmitted from contaminated food and water from faeces. If hands are not washed properly after defecation, the germs may remain attach to hands which may transmit into the body to produce disease. Water borne diseases: Contaminated water is a major source of causing diseases like diarrhea, cholera, dysentery, amoebiasis worm infestations and hepatitis etc.Food borne diseases:Contaminated food is a major source of causing diseases like diarrhea, cholera, dysentery, amoebiasis, food poisoning, worm infestations and hepatitis etc.

Hands: Diseases are transmitted through contaminated hands if these are not washed before eating something. Eating without washing hands may cause of transferring many diseases because we work with our hands everywhere and hands are contaminated with germs. Soil Many microorganisms are present in the wet soil and spores of many diseases like tetanus in the dry soil. Some parasites as hookworms’ larva are also found in wet soil .when someone walks with naked feet on soil, these larva may enter through soles into human body and cause diseases.Flies borne diseasesFlies are the vectors which transfer the germs from one place to another. The flies sit on refuse and excreta

from where the germs are attached to their hairy legs and body and when these sit on another place the germs transfer to that place thing.

1. Other bacterial infections:Infectious diseases can be transmitted by food include the following:-- Typhoid fever - Paratyphoid fever- Shigellosis - Hemolytic streptococcal infections- Enterococci - Clostridium perfringens- Brucellosis - Cholera- Dysentery’s

2. Viral Infections:2.1 Infectious hepatitis2.2 Others such as: poliomyelitis

3. Parasitic infections:- Amebiasis (amebic and bacillary)- Tenia (Saginata and solium)- Fish tape worm diseases from fish- Trichinosis from pork food- Giardiasis - Hemilipis nana- Strangloids - Oxyuris (enterobius vermicularis)- Ascariasis

METHODS OF DISPOSAL OF REFUSE (Sewage) Disposal of excreta is carried out by the non-sewage (conservancy method or dry method and sanitary latrine) and the sewage method involves water carriage of excreta through a system of drains and ultimately disposal at sewage treatment plant.SOLID WASTE DISPOSALDisposal of excreta is carried out by the non-sewage conservancy method or dry method and sanitary latrine.This method involves manual collection and removal of refuse to the disposal point. Initially the solid waste is collected from the homes and streets to a collection point and then it is brought to the place through solid waste careers where it is treated inn different methods.In olden times in villages and small towns, the human excreta were also collected with buckets or pans. These pans and buckets were emptied into the carts or Lorries and then excreta were carried away for disposal outside the town. DEFINITION OF SEWAGEIt is a liquid waste material drained from houses, farms, factories and business places. Compositions of Sewage:Sewage is composed mainly from water and organic material. The most serious component is pathogens that could contaminate the environment and endanger health. In countries with damaged draining system a solid material and sand could be present and block the system.Hazards of Sewage:

1. Disease transmission: most of enteric diseases could be transmitted from one person to other through contaminated environment such as Cholera, Typhoid, Dysentery, parasites, Polio and Hepatitis.

2. Bad smell resulted in psychological disturbance.3. Sewage collection is a breading place for insects as mosquitoes and flies.4. Contamination of underground water by biological and chemical pollutants.

Management of Sewage:There are two main methods for sewage disposal: Dry and Wet methods.

1. Dry Method: This method is applied where access to public sewer system is not possible. Different types of latrines could be used depending on the available community resources, population needs, and the type of the soil.

2. Wet method: this method is applied when public sewer system is available. Latrines are constructed inside the buildings with available water source that carry the sewage through closed pipe system to a collection chamber. The collected sewage is carried in pipes to a central sewage treatment plant. In the plant a process started by screening, grit removal, sedimentation and biological treatment. Biological treatment is performed by these mechanisms:

a. Filtration: the sewage is filtrated by passing through sand or gravel beds.b. Aeration (oxidation): This mechanism gives a chance of oxidation where oxygen kills anaerobic

microorganisms. c. Disinfection: Chlorine could be used to minimize other bacterial hazards.

The properly treated sewage water could be used to irrigate specific types of trees. When safety is sure it could be injected into underground water under precautions.

METHODS OF SEWAGE DISPOSAL:In this system, the human or animal excreta are carried out by flush of water from the water closet into the soil pipe leading to house drains and to sewers and then for disposing in various methods. Water from the

factories, kitchen, bathrooms and rain water also mixed within the drain. “Liquid” wastes include:

• sewage sludge and effluent; • animal wastes; • food processing residues; and • Industrial effluents.

Methods of disposing Liquid WastesTHEORY A well is drilled in a dry porous layer and wastes are pumped in. Contamination of groundwater is prevented by the casing and seal around the portion of the well that penetrates groundwater.

Practice1. Wastes spill or leak at surface.2. Corrosion of casing allows waste to escape.3. Inadequate seal permits waste to back-flow4. Fractures existing or caused by earthquakes or the introduction of fluids, allow wastes to escape into groundwater.

- Sea outfall the human or animal excreta are carried out by flush of water from the water closet into the soil pipe leading to house drains and to sewers and then for disposing in the sea.

- River outfall: the human or animal excreta are carried out by flush of water from the water closet into the soil pipe leading to house drains and to sewers and then for disposing into the river. - Land treatment- Oxidation ponds- Open drainage- pit latrines:- Open field: : the human or animal excreta are carried out by flush of water from the water closet into the open fields.

1. Pollution:Types of water pollution:Water pollution is classified as follows:

1. Organic wastes from domestic sewage.2. Infectious agents contributed by domestic sewage.3. Plant nutrients as algae.4. Synthetic organic chemicals as pesticides, detergents … etc.5. Inorganic chemicals and minerals substances6. Sediments that fill stream channels and reservoirs.7. Radio - active pollution

2. Contamination: The most common water born diseases are Typhoid, Paratyphoid, dysentery’s (amebic and

dysentery), gastro-enteritis, infective hepatitis and cholera.Health hazards could be direct due to use of the water in drinking such as the hazards associated with

drinking contaminated water or a water polluted by chemical substances or excess of specific chemicals. Example of the last hazards is the drinking of water with less or excess of fluorides. Less fluoride would lead to Dental caries and excess florid leads to florosis.

Health hazards could by indirect such as swimming in water infected with Bilharzia cercaria. Some hazards could be from the water breading places of insects such as mosquitoes. These entire hazard whether they are direct or indirect could affect the human health and quality of life.PEST & RODENT CONTROLImportance:1. Human Health and disease

a. Organic: Plague, malariab. Psychological: fears

2. Economic:a. Agricultureb. House: furniture cloths, Electrical

Control Measures:A. Preventive Measures:

1. Good sanitation2. Structural measures

B. Pesticides and RodenticidesSanitation:1. Personal hygiene and cleanliness2. Proper Garbage collection3. Proper sewage system4. Food storage and cover5. Dealing with water collectionsStructure:1. Screening of the windows & doors2. Closing unnecessary opening3. Repair of Clark’s in the walls4. Rodent proof buildingsPesticides & Rodenticides:Before using chemicals we have to try these methods:1. Biological methods: as Cats.2. Mechanical Methods: Traps.3. Electrical: light.4. Fumigation gasses.Then these chemical methods could be used:

Organic Phosphorus Compounds.Chlorinated hydrocarbons.Zinc phosphate (not used now)Anti CoagulantsWarfarinesD.D.T. (not used)Malathion

.

1. Rescue of victims

2. Provision of emergency medical care3. Evacuation of the population (chemical and nuclear emergencies).4. Elimination of physical dangers (e.g., fires, gas, leaks, etc.).5. Provision of preventive and routine medical care.6. Provision of safe water.7. Provision of food.8. Provision of clothing.9. Provision of shelter.10. Disposal of human excrement.11. Control of vector borne diseases.12. Disposal of human bodies.13. Disposal of solid waste.

What are the main duties of a Health team?The main duties of a health team during a disaster are:

6. First aid7. Emergency care8. Ambulatory care.9. Patient referral.10. Public education.

UNIT. NO. 16COMMUNITY WATER SUPPLY

SOURCES OF WATER

Topic: 16.1SAFE AND WHOLESOME WATERSate WaterDefinitionWater that cannot harm the consumer even when ingested over prolonged periods is called safe water.Wholesome WaterDefinitionWholesome water is that water, which is agreeable. Such water is acceptable.Characteristics of WaterIt should be:

Free from pathogenic agents. Free from harmful substances. Pleasant to the taste. Usable for domestic purposes.

Topic: 16.2USES OF WATERDomestic Uses

Drinking. Cooking Washing

Bathing.Public Uses

Public cleansing. Fire fighting. Maintenance of gardens and swimming pools.

Industrial UsesWithout water there cannot be any industrial development, some industries like, steel, iron and paper industry, etc. needs water.Agricultural Uses:The food and raw material needed by the world cannot be raised without water.

Topic:16.3 WATER REQUIREMENT Daily requirement of water is 150-200 liters per head or 35-40 gallons per head. Daily water required by a man is 2500 m/24 hours, which is fulfilled by two sources.

o Exogenous Sources — water as such drunk-ingested in solid food.o Endogenous Sources-- water is released during the oxidation of ingested food, amount is

essential than 500 ml/24 hours.Following are the daily-requirement for all purposes.Domestic

For drinking 0.35 gallonsFor ablution 0.65 gallonsFor cooking 8.00 gallonsFor washing of utensils 3.00 gallonsHouse laundering 3.00 gallons For water closets 5.00 gallons

For trade and manufacturing purposes 5.00 gallonsc) Municipal (for watering streets, public baths, fire, flushing etc.) 5.00 gallons

COMMUNITY WATER SUPPLYTopic: 16.4SOURCES OF WATERA) Rain WaterIt is the chief source of water. It is the aqueous vapor in the atmosphere which condenses and falls on the surface of earth as rain, snow or hail.a) It is distilled water (purest water in nature).b) Clear, bright and sparkling.c) Soft water is liable to have solvent action on metals.it is good for washing, cooking, and dying as it is free from calcium salt.e) Free from pathogenic agents.0 Contains only traces of dissolved solid (0.0005%)g) Process corrosive action on lead pipes.Impurities of Rain Water• Dust.• Soot.• Microorganisms.• Gases — Oxygen, Nitrogen, Carbon dioxide, Ammonia.

B. Surface WaterWhen rain water touches the surface of earth it is called surface water.Sources of Surface Watera) Impounding reservoirs.b) Upland surface hill water.c) Streams.d) Rivers.e) Lakes.f) Ponds.a) Impounding ReservoirsThere are artificial lakes constructed usually of masonry in which large quantities of surface water are stored after falling off the rain on the hills.Characteristics

1. Usually furnishes a good quality of water.2. Soft, clear and palatable.3. Free from pathogenic agents.

b) Upland Surface Hill Water or catchment’s areaIt is an area from where rainwater is drained into the reservoir. It is in fact a large tract of land on the hill set apart for the collection of water.c) Rivers and Streams Characteristics

1. Turbid in rainy season.2. Contains all kind of dissolved and suspended impurities.3. High bacterial count.4. Large quantity of carbon dioxide.

Sources of impurities1. Surface washing.2. Sewage and sludge water.3. Industrial and trade wastes.4. Agricultural drainage.

c) What is Ground Water?When rainwater percolates into the ground pass downwards until it reaches an impervious stratum with bars its further downward passage. This water then flows in a more or less horizontal direction. It is called ground or underground water.Advantagesi) Free from pathogenic agents.ii Requires no treatment.iii) Supply is certain even during rainy seasons. Disadvantagesi) Salts of calcium and magnesium are present rendering the water hard.ii Require pumping to lift the water.iii) Large quantities of dissolved carbon dioxide.Sources of Underground Wateri) Wellii) Springs.i) WellA well is an artificial pit or hole sunk into the earth to reach the water Level.Kinds of Wella) Shallow wellb) Deep well

c) Artesian welld) Tube well.a) Shallow WellIt is a well, which taps the water from above the first impervious layer in the ground.b) Deep WellIt is a well, which penetrates the first impervious layer in the ground and taps the water lying beneath the imperious layer.c) Artesian WellDuring sinking a deep well sometimes water rapidly raises in the bore and even overflows the surface. This occurs when water rises above the level of the underground water and is held under pressure between two imperious strata. This type of well is called artesian well.d) Tube Well• Shallow Abyssinian) Tube WellIt consists of galvanized iron pipe 1.5 to 2.6 inches in diameter driven into the soil up to 25 feet. Being more suitable where the level of sub water is high.Deep(bored) tube WellThis is sunk into the ground by drilling thru. A successive substratum of gravel or rock until a suitable supply of ground water is located being several hundred feet deep.

Difference between Shallow and Deep WellShallow Well Deep Well

Definition Taps the water from above the first impervious layer.

Taps the water from below the first impervious layer.

Chemical quality. Moderately hard water Much hard water.Bacteriologically Grossly contaminated Not contaminated . Yield Dry in summer Constant supply of water.Depth Less than 200 feet 200—600 feet.

ii) SpringsIt is a ground water that finds its way to the surface because of certain topographical characteristics of the land, yield of which is low.Kinds of springsa) Shallow springb) Deep spring or main springc) Mineral springd) Thermal springa) Shallow SpringIt can be compared with shallow well.b) Deep springs -They are not formed by the outcropping of the impervious stratum but they are the result of some cracks or fissures in the soil.c) Thermal springsThese springs are formed where volcano eruption has ceased resulting in hot water from such spring.

COMMUNITY WATER SUPPLYTopic: 16.5WATER-BORNE DISEASESa) Viral Diseases

1. Poliomyelitis

2. Infective hepatitis (viral hepatitis)3. Keratoconjunctivitis4. Rota virus diarrhea in infants.

b) Bacterial diseases1. Cholera,2. Enteric fever (Typhoid).3. Bacillary dysentery.4. Diarrhea.

Protozoal Diseases1. Amoebic dysentery

Helminths1. Ascariasis / Round worm2. Entrobiasis3. Draconculosis / Thread worm4. Whip worm5. Hydatid cyst. Fish tape worm

e) Bed Sonial1. Trachorna.

Topic: 16.6 PURFICATION OF WATERPurification means removal of impurities from water. In this way safe and wholesome water is obtained.a) Purification of Water on Large ScaleWater on large scale, such as an urban water supply is purified in three main stages.i) Storage and sedimentation.ii Filtrationiii) Chlorinationo Storage and SedimentationStorage is an excellent means of purification of water. By storage solid particles e.g., mud settles down and takes bacteria along with it.Organic matter is oxidized by aerobic bacteria. The ultraviolet rays kill the bacteria. By storage the bacterial count falls greatly. Ninety percent of bacteria in river water die in 5-7 days. Optimum time for storage is 10-14 days.2 FiltrationFor large scale purification of water following methods are used.• Slow sand filtration or biological filtration• Rapid sand or mechanical filtrationSlow Sand or biological FiltrationIt is generally accepted as standard method of water purification. It has following elements.• Supernatant.• A bed of graded sand.• An under-drainage system.• A system of filter control valves.The slow sand filter consists of open tank measuring 9-12 feet in depth. There is a layer of broken stone or brick. Above this there is a layer of gravel and then there is a layer of gravel coarse sand 6-12 inches. Finally there is top layer of fine sand 3 feet.Self Purification It occurs by natural process of purification such as dilution, oxidation, sedimentation, sunlight, plant and animal life.Advantages of River Water

1. Rivers are natural source of water supply.2. Volume of water fielded is enormous.

3. Undergo natural process of purification.4. No initial expense is required to get water.

Disadvantages of River WaterRiver water is turbid; it is constantly polluted by surface and subsoil water drainage from manure and cultivated lands, from the drain of neighboring villages and sewers of town, waste product of factories and the animal bathing in the river.d) Tanks, Ponds and Lakes TanksThese are large excavations in which surface water is stored.Characteristics

1. Recipients of contamination of all kinds.2. Full of silt and colloidal matter.3. Full of aquatic vegetations.

Sources of Impurities1. Washing of clothes and cooking pots.2. Washing of call le.3. Bathing of public.

Steps for Obtaining Good Quality Tank Water1. Edges should be elevated.2. Fence should around the neck.3. Prohibition to get into the tank directly.4. Elevated platforms should be constructed for drawing of water.5. Removal of weeds periodically.

Cleaning of the tank at the off dry season.

Water Treatment Methods:The type and degree of purification is governed by the characteristics and pollution load of the raw

water, and by economic factors whatever degree of treatment is adopted, a safe supply must be the minimum accepted. So, the most common methods of purification have been developed through the accumulation of experience and study over many years that include certain fundamental principles as follows:- Storage in natural lakes or impounding reservoirs to obtain sedimentation.- Coagulation by chemical treatment for the removal of turbidity and color.- Sedimentation of the coagulated flock to minimize the quantity of suspended colloidal matter on the

filter beds.- Filtration through sand gravel beds to remove turbidity and many microorganisms.- Disinfection by chemical or physical agents to eliminate pathogenic bacteria.- Removal of taste and odors by aeration, chemical treatment or physical absorption to make the water

more attractive.- Hardness reduction by chemical precipitation or Base Exchange phenomenon for aesthetic reasons.- Removal of dissolved minerals by surface adsorption (contact beds) generally for aesthetic reasons.- Corrective treatment with alkali to reduce pipe corrosion for economic reasons.- Fluoridation to reduce dental caries.

Other disinfecting agentso ozonationo ultraviolet radiation

Ozonationo relatively unstable gaso it is a powerful oxidising agento it eliminates undesirable odor, taste and colour and removes all chlorine from watero ozone is a powerful virucidal agento in seconds kills all viruses but chlorine or iodine requires minuteso more than 1000 municipal water treatment plants use ozone, oldest is in France since 1906o drawback is it decomposes after it actso there is no residual germicidal effectso The current thinking is that ozone should be used as a pretreatment of water to destroy not only viruses

and bacteria but also organic compounds that are precursors for undesirable chloro-organic compounds that form when chlorine is added

Ultraviolet radiationo effective against most microorganisms including viruseso method involves the exposure of a film of water up to 120mm thick to one or several quartz mercury

vapor arc lamps emitting ultraviolet radiation at a wavelength in the range of 200-295 nmo Applications are limited to individual or institutional systemso water should be free from turbidity and suspended or colloidal constituents for efficient disinfectionAdvantages o exposure time is shorto no foreign matter is introducedo no taste and odor producedDisadvantageso no residual side effectso lack of rapid field test for efficiencyo expensive apparatus Solar water disinfection (SODIS System)9

Solar water disinfection is a method of treating relatively small amounts of water at the point of use. There are three ways in which solar radiation can be used to eliminate pathogens. The first is through heating, second through the use of natural UV radiation and third through the use of mixture

of both thermal and UV effects. None of these methods is yet widely used but laboratory experiments and field programmes show that some systems have good potential to produce potable water. Thermal heating from the sun can be via the solar cookers or from simply exposing black-painted containers to the sun. In many systems temperatures can reliably reach over 55 degree Celcius killing many pathogens. With the cookers and some of the other systems the temperature of the water can easily exceed 65 degree Celcius, a pasteurization temperature capable of inactivating nearly all enteric pathogens. The use of heating and UV radiation to simultaneously disinfect water is used by a number of different solar treatment systems. The widest known is the SODIS (Solar Disinfection) system which is suitable for low-income countries. The only equipment required is locally available bottles to contain the water. This technique is being tested in various parts of the world. The half of the bottle furthest from the sun should be painted with black paint to improve the heat gain from the absorption of thermal radiation (Figure 4), and the bottle can be laid on a dark roof to further increase the potential temperature rise in the water. The water requires several hours of strong sunlight to obtain the advantageous energy between UV dosage and temperature rise

Purification of water on a small scale or Household purification of water. Three methods are available that can be used for purification of water on an individual or domestic scale. They can be used either singly or in combination2.a) Boiling

This is a satisfactory method for purifying water for domestic purposes. To be effective the water must be brought to a ‘rolling boil’ for about 5 to 10 minutes. It kills all bacteria, cysts, ova and spores and yields sterilized water. Boiling also removes the hardness of water by driving off carbon dioxide and precipitating the calcium carbonate. The taste of water is altered but it is harmless. While boiling is an excellent method of purifying water, it offers no ‘residual protection’ against subsequent microbial contamination2.

9 II b) Chemical disinfection- It can be done by using following chemicals- (i) Bleaching powder- Bleaching powder or chlorinated lime is a white amorphous powder with a pungent smell of chlorine. When freshly made it contains about 33% of available chlorine. But when exposed to air and light it rapidly loses it chlorine content. Therefore it should be stored in a cool and dark place in a closed container that is resistant to corrosion. So it is mixed with lime to retain its strength and is called as ‘stablized bleach’. That amount of bleaching powder has to be added to the water which can produce ‘free’ residual chlorine of 0.5mg/litre at the end of one hour contact2. (ii) Chlorine solution- Chlorine solution may be prepared from bleaching powder. If 4kg of bleaching powder with 25 percent available chlorine is mixed with 20 litres of water, it will give a 5% solution of chlorine. It should also be kept in a cool and dark place in a closed container2. (iii) High test hypochlorite or perchloron- It is a calcium compound which contains 60 to 70% available chlorine. It is more stable than bleaching powder and deteriorates less on storage. Solutions prepared from HTH are also used for water disinfection2. (iv) Chlorine tablets- These are available under various trade names like ‘halazone’ tablets in the market. They are good for disinfecting small quantities of water but they are expensive. The National Environmental Engineering Research Institute, Nagpur has formulated a new type of chlorine tablet which is 15 times better than ordinary halogen tablets. A single tablet of 0.5g is sufficient to disinfect 20 litres of water2. (v) Iodine- It can be used for emergency disinfection of water. Two drops of 2% ethanol solution of iodine will suffice for one litre of clean water. A contact time of 20 to 30 minutes is needed for effective disinfection. Iodine does not react with ammonia and organic compounds to any great extent; hence it remains in its active molecular form over a wide range of pH values. High costs and the fact that the element is physiologically active are its major disadvantages2.

(vi) Potassium permanganate- Once it was widely used but now its no longer used to disinfect water. Although it is a powerful oxidizing agent but it is unable to kill all the pathogenic microorganisms. It also alters the color, taste and smell of water2.

Filtration Water can be purified on a small scale by filtering through ceramic filters such as Pasteur ‘Chamberland filter’, ‘Berkefeld’ filter and ‘Katadyn’ filter. The essential part of the filter is the ‘candle’ which is made of porcelain in the Chamberland type and of kieselgurh or infusorial earth in the Berkefeld filter. In the Katadyn Filter, the surface of the filter is coated with a silver catalyst so that the bacteria coming in contact with the surface are killed by the oligodynamic action of the silver ions which are liberated into the water. Filter candles of the fine type usually kill bacteria found in drinking water, but not the filter passing viruses. Filter candles are liable to be lodged with impurities and bacteria. They should be cleaned with a hard brush under running water and boiled at least once a week. Only clean water should be used with ceramic filters. But these types of filters are not suitable for use under Indian conditions2.

Other water purification techniques Other popular methods for purifying water, especially for local private supplies are listed below. In some countries, some of these methods are also used for large scale municipal supplies. Particularly important are distillation (de-salination of seawater) and reverse osmosis. (a) Carbon filtering2-Charcoal, a form of carbon with a high surface area, absorbs many compounds including some toxic compounds. Water passing through activated charcoal is common in household water filters and fish tanks. Household filters for drinking water sometimes contain silver to release silver ions which have an anti-bacterial effect. (b) Distillation2- It involves boiling the water to produce water vapour. The vapour contacts a cool surface where it condenses as a liquid. Because the solutes are not normally vaporized, they remain in the boiling solution. Even distillation does not completely purify water, because of contaminants with similar boiling points and droplets of unvaporized liquid carried with the steam. However, 99.9% pure water can be obtained by distillation. Distillation does not confer any residual disinfectant and the distillation apparatus may be the ideal place to harbour Legionnaires' disease. Legionnaires, disease is an infectious disease caused by bacteria belonging to the genus Legionella. Legionellosis infection normally occurs after inhaling an aerosol (suspension of fine particles in air) containing Legionella bacteria. Such particles could originate from any infected water source. When mechanical action breaks the surface of the water, small water droplets are formed, which evaporate very quickly. If these droplets contain bacteria, the bacteria cells remain suspended in the air, invisible to the naked eye but small enough to be inhaled into the lungs. (c) Reverse osmosis2- Mechanical pressure is applied to an impure solution to force pure water through a semi-permeable membrane. Reverse osmosis is theoretically the most thorough method of large scale water purification available, although perfect semi-permeable membranes are difficult to create. Unless membranes are well-maintained, algae and other life forms can colonize the membranes. (d) Ion exchange-2 Most common ion exchange systems use a zeolite resin bed to replace unwanted Ca2+ and Mg2+ ions with benign (soap friendly) Na+ or K+ ions. This is the common water softener. (e) Electrodeionization2- Water is passed between a positive electrode and a negative electrode. Ion selective membranes allow the positive ions to separate from the water toward the negative electrode and the negative ions toward the positive electrode. High purity deionized water results. The water is usually passed through a reverse osmosis unit first to remove non-ionic organic contaminants.

Chlorination of Water:Chlorine is added to water to kill the pathogenic bacteria. Chlorine is universally used in water

purification because it is reliable, inexpensive, and easy to administer, it has powerful oxidizing properties, its concentration in water should be at least = 0.2 - 0.5 p.p.m. (Part per million).

UNIT.NO. 17

UNIT.NO. 18

Teaching:• Interaction between teacher and learner under the teacher’s responsibility in order to bring about

expected changes in the learner’s behaviour.• Teaching is a system of activities intends to produce learning. Learning:

Learning is acquiring new knowledge,values,peferences,undesanding, and may involve synthesizing different types of informaion.The ability to learn is possessed by humans, animals and some macchines. Progress over time tends to follow learning cures.

Human learning may occur as part of educaion or personal developement. It may be goal-oriented and may be aided by motiation. The study of how learning occurs is part of Neuropsychology, educational psychology, learning theory and pedagogy.

• It is a process resulting in some modifications, relatively permanent of think, feeling, doing of the learners.

• Learning involves the entire person and it can affect the person’s life style, methods of handling problems, attitude and knowledge.

• Learning requires attention in the topic or matter and the ability to concentrate.Characteristics of learning:• It produces a behavioural change in he learner. • It leads to relatively permanent hat is also gradual adaptable and selective.• It results from practice, repetition and experience.

• Not directly observable.Purposes of teaching:It helps learners to:• Acquire, retain and be able to use the knowledge.• Understand, analyse, synthesize and evaluate, achieve skills establish habits.• Developes attitude.Teaching approaches:• Talk to learners. • Talk with learners.• Have then to talk together. Show learners how supervise them.• Provide opportunities for practice.

Conditions to facilitate learning: FACTORS WHICH AFFECT LEARNING Factors, which affect patient learning, need to be assessed in order for appropriate teaching strategies to be used.

a) Include the following factors in your assessment. 1. Developmental considerations. Knowledge of intellectual, psychosocial, and physiologic age is

necessary before you select age-appropriate teaching methods. 2. Delayed development in any of these areas should be considered.

a. Children have limited past experiences. Adults learn more quickly than children because they are able to build upon previous knowledge.

b. Use chronological age to assess whether the developmental stage is as would be expected. 3. Educational level. You will effectively promote learning if you are aware of the learner's

intellectual ability and avoid "talking down" to him or her or using an inappropriate teaching strategy.

4. Past learning experiences. Attitudes toward future learning are influenced by learning experiences in the past. Encourage the learner to express how he views education so that you can deal with his feelings before teaching is attempted.

5. Physical condition. The patient will not be ready to learn until he is comfortable enough to pay attention to the information you present.

6. Sensory abilities. Note any deficit in the learner's sight, hearing, and touch so that teaching is planned appropriately.

7. Emotional health. The emotional state of the learner should be conducive to learning before teaching is done.

a. A patient, who is moderately anxious about his/her condition, will probably be attentive to presentation of information that will help him manage the condition.

b. If the patient is in a state of crisis with a high level of anxiety, delay teaching until the crisis is over.

8. Social and economic stability. Being hospitalized and absent from work cause some patients excessive stress. Help the patient deal with any social and economic problems before imposing the additional stress of learning information or a new skill.

9. Responsibility. To learn self-care or take preventive measures against illness, a patient must have a sense of responsibility. Encourage the patient to participate in planning the learning activities to promote his feelings of control.

10. Self perception. Self-perception has an effect on the ability to learn. If effective learning about a health problem is to occur, any unrealistic self-image or body image should be addressed. If necessary, help the patient improve self-image before focusing on learning needs.

11. Attitude toward learning. Attitude toward learning is difficult to measure.

12. Talk to the patient to get an idea of how he feels about learning to improve his health. If the patient has a negative attitude about learning, establish a relationship that will help in altering that attitude.

13. Motivation to learn. The patient must want to learn for teaching to be effective. If the patient is not motivated to learn the material needed to improve his health, discussing his interest and concerns may lead to success.

14. Culture. Some cultures value education that will improve their condition, while others view change or new practices as threatening. Do not stereotype any person because of his culture; but recognize that each person has a unique family background with certain cultural values that may have an effect on how teaching learning is perceived.

15. Communication skills. The basic requirement for the teaching-learning process is communication. Assess your communication skills as well as those of the learner.

a. Assess the learner's reading skills before using printed material as a teaching aid. b. Assess to what degree English is spoken and understood by the learner. Most hospitals

have printed and audiovisual materials available for non-English speaking patients.

PRINCIPLES FOR EFFECTIVE TEACHING-LEARNING

These basic principles are effective guidelines when applied in situations in which the teaching-learning process is used by nurses to meet the needs of clients. Clients may be patients, family members, or support persons. (1) The teaching-learning process is facilitated by the existence of a helping relationship.

a) A helping relationship exist among people who provide and receive assistance in meeting a common goal. The relationship is established as a result of communication.

b) The communication is continuous and reciprocal. (2) The teachers must be able to communicate effectively with individuals, with small groups, and in

some instances with large groups. (3) Knowledge of the communication process is necessary for the assessment of verbal and nonverbal

feedback. (4) A thorough assessment of clients and the factors affecting learning helps to diagnose their learning

needs accurately. (5) The teaching-learning process is more effective when the client is included in the planning of learner

objectives. (6) Unless the client values these objectives, little learning is likely to occur. (7) The implementation of a teaching plan should include varied strategies for sensory stimulation, which

apparently promote learning.(8) Relating new learning material to clients' past life experiences is effective in helping to assimilate new

knowledge. (9) Proposed behavioral changes must always be realistic and explored in the context of the client's

resources and everyday life-style. (10) Careful attention should be paid to time constraints, scheduling, and the physical

environment. (11) Learner objectives provide the basis for evaluating whether learning has occurred. (12) When learning objectives have not been met, careful reassessment provides ideas for

changing the teaching plan for subsequent implementation.

18.2 HEALTH EDUCATION Definition:• Is a process that informs motivates and helps peoples to adopt and maintain healthy practices and life-

style.

• Health Education is to inform people or disseminate scientific knowledge about prevention of disease and promotion of health.

• Health education is defined as a process which brings about changes in the knowledge and attitude of the people and thereby effecting change in health practices.

Purpose of health education: The purpose of health education is to aware peoples to achieve health by their own

actions and efforts. It should aims:_1. To help peoples to understand the health and to help them to achieve health by their own

activities and efforts.2. To develop a sense of responsibility for improvement of their health as individual members of

families and community.3. To educate peoples for proper use of health services in what ever form it is made available to them

by the government.4. To provide a person with appropriate knowledge to enjoy de scent heath and also knowledge about

occurrence and spread of disease and enabling them to adopt relevant preventive measures.5. To create them a desire to support health education programmes in their area. 6. Health education main aim is bringing about the following changes in :

a. Knowledge,b. Attitudec. Behavior

d. Habite. Customs

PLANNING OF HEALTH EDUCATION PROGRAM To carry out any health education program in the community, the community health nurse need to prepare a check list of all steps to be taken by them and their team .following steps should be considered.• Identify health problems and health needs through baseline survey.• Identify leaders in community and discuss about health education program Approach to health education:Health education can be carried out through.• Working with individual persons, couples and families.• Working with small groups of community members.• Mass approach and use of mass media. METHODS OF HEALTH EDUCATION There are two main methods used in health education.• Didactic Method

• Socratic MethodDIDACTIC METHOD: It is based on direct instruction to the individual or group. It is also called one way method. SOCRATIC METHOD : Is based on interchange of knowledge among people themselves .it is also known as two way method. Both types of methods may be used with good communication can be more effective than one way communication.Didactic Method: Based on a) Lectures b) Mass MediaSocratic Method: Based on

a) Group discussions b) Panel discussions c) Seminar d) Symposium e) Demonstration f) Role playing g) Interview

h) Task force i) Brain storming j) Buzz sessions k) Case study l) Open forum m) Skits n) Field trip

Didactic Method: Lecture: Lecture is a general oral presentation of the subject .It is organized easily and may be used with groups of any size. Mass Media: Refers to those messages conveyed through TV, radio, films etc.

SOCRATIC METHOD:• Group discussion : in which all permits to discuss all members, but it is time

consuming.• Panel discussion : in 04 to 8 persons who are qualified to talk about the topic. They

sit and discuss a given problem or topic.• Seminar: It refers to group of persons who prepared themselves on a particular topic

and speak to audience.• Demonstration : It refers to a presentation that shows in detail ,important technique

of health education • Role playing: it is a spontaneous acting out of a clearly defined situation.

community health nursing notes year one general nursing in pakistan .doc

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