1.

Explain the most cost-effective epidemiological study design to

investigate the association between smokeless tobacco use and oral cavity
cancer. Justify your choice and outline the key steps involved in
conducting such a study.

Answer 1

Study Design: Case Control Study.

Justification:

1.​ Cost-Effectiveness: It is "relatively easy to carry out, rapid and inexpensive (compared
with cohort studies)."
2.​ Suitability: It is "particularly suitable to investigate rare diseases or diseases about which
little is known." Oral cancer takes a long time to develop, making case control ideal as it
proceeds from effect to cause.
3.​ Efficiency: It requires comparatively few subjects.

Key Steps Involved:

1.​ Selection of Cases and Controls:

○​ Selection of Cases: Definition of a case (Diagnostic criteria, Eligibility criteria).
Sources of cases (Hospitals or General population).
○​ Selection of Controls: Must be free from the disease under study (oral cancer).
Sources: Hospitals, Relatives, Neighbourhoods, or General population.
2.​ Matching:
○​ Process by which we select controls in such a way that they are similar to cases
with regard to certain pertinent selected variables (e.g., age, sex) which are
known to influence the outcome of disease and which, if not adequately matched
for comparability, could distort or confound the results.
3.​ Measurement of Exposure:
○​ Information about exposure (smokeless tobacco use) should be obtained in
precisely the same manner both for cases and controls (e.g., by interviews,
questionnaires).
4.​ Analysis and Interpretation:
○​ (a) Exposure rates among cases and controls to suspected factor.
 ○​ (b) Estimation of disease risk associated with exposure (Odds ratio).

2. You need to select 20 students from a class of 100 (20 male and 80
female) student for a survey. Name the most appropriate sampling
method and describe the steps to implement it in this setting.

●​ Answer:
○​ Sampling Method: Stratified Random Sampling.
○​ Justification: The population is heterogeneous (males and females are not in equal
proportions). To ensure that the sample represents the population structure (20%
male, 80% female) accurately, the population should be divided into strata based on
sex.
○​ Steps to Implement:
1.​ Identify Strata: Divide the total population (100 students) into two strata:
Males (20 students) and Females (80 students).
2.​ Determine Sample Proportion: You need 20 students total.
■​ Calculation: (20 / 100) x 20 = 4 Males.
■​ Calculation: (80 / 100) x 20 = 16 Females.
3.​ Random Selection:
■​ Assign a unique number to every male (1-20) and every female
(1-80).
■​ Use a table of random numbers or simple random sampling
technique to select 4 males from the male stratum.
■​ Use a table of random numbers to select 16 females from the female
stratum.
4.​ Combine: Combine the selected individuals to form the final sample of 20
students.
○​ Reference: Park’s Textbook of Preventive and Social Medicine, 27th Edition,
Chapter 21, Page 978 (Stratified random sample).
3. MMR is comparatively high in Bangladesh compared to developed
countries. Explain how EOC could reduce this MMR in Bangladesh?

●​ Answer:
○​ Explanation: Essential Obstetric Care (EOC) is crucial because complications
associated with pregnancy are not always predictable.
○​ How EOC reduces MMR:
■​ Early Registration: Ensures pregnancy is tracked within 12-16 weeks.
■​ Antenatal Check-ups: Minimum three check-ups to monitor progress and
detect risks/complications early for referral.
■​ Safe Delivery: Ensuring delivery at home or institution is safe.
■​ Postnatal Check-ups: To monitor recovery and detect complications.
○​ Emergency Obstetric Care (EmOC): This is a specific intervention for maternal
morbidity and mortality. It strengthens First Referral Units (FRUs) to provide:
■​ Surgical interventions (e.g., Caesarean section).
■​ New-born care.
■​ Blood storage facility.
■​ Emergency care for sick children.
○​ Reference: Park’s Textbook of Preventive and Social Medicine, 27th Edition,
Chapter 7, Page 518-520 (RCH Phase I and II interventions).

4. District X (population 300,000) recorded 6,000 live births and 3,000

deaths last year. (a) Calculate the CBR and CDR. (b) Using only these
rates, infer the likely demographic transition stage and state planning
implication for health services.

●​ Answer:
○​ (a) Calculations:
■​ Crude Birth Rate (CBR): (Total Live Births / Mid-year Population) x 1000
■​ (6,000 / 300,000) x 1000 = 20 per 1000 mid-year population.
■​ Crude Death Rate (CDR): (Total Deaths / Mid-year Population) x 1000
■​ (3,000 / 300,000) x 1000 = 10 per 1000 mid-year population.
○​ (b) Inference:
■​ Demographic Stage: A birth rate of 20 and a death rate of 10 indicates the
Third Stage (Late Expanding) of the demographic cycle. In this stage, the
 death rate declines further, and the birth rate tends to fall, but the population
continues to grow because births exceed deaths.
■​ Planning Implications: Since the population is still growing (Natural
increase = 20 - 10 = 10 per 1000, or 1% growth), health services must plan
for:
■​ Continued Family Planning services to further reduce CBR.
■​ Maternal and Child Health services to handle the birth load.
■​ Geriatric care planning as life expectancy increases due to falling
CDR.
○​ Reference: Park’s Textbook of Preventive and Social Medicine, 27th Edition,
Chapter 8, Page 554 (Demographic Cycle), Page 563 (Birth Rate), Page 565 (Death
Rate).

5. A 30-year-old woman with two children (youngest 8 months old,

breastfeeding) seeks contraception. Which contraceptive methods
would you recommend and why?

●​ Answer:
○​ Recommended Method: Intra-uterine Device (IUD) (specifically Copper T).
■​ Reason: It is an effective spacing method, independent of coitus,
inexpensive, has a high continuation rate, and does not interfere with
lactation.
○​ Alternative Method: Progestogen-only pill (POP/Mini-pill) or Injectables (DMPA).
■​ Reason: Evidence suggests progestogens alone have little or no effect on
lactation (unlike combined oral pills which suppress lactation).
○​ Methods to Avoid: Combined Oral Contraceptive Pills.
■​ Reason: They contain oestrogen which suppresses lactation.
○​ Reference: Park’s Textbook of Preventive and Social Medicine, 27th Edition,
Chapter 9, Page 617 (Family Planning/Lactation) and Chapter 8, Page 573, 607.
6. What is standard deviation? In a study, body weight measurements
are normally distributed with a mean of 60 kg and a standard
deviation of 5 kg. What percentage of participants have body weight
between 50 kg and 70 kg?

7. A country (population 300,000) recorded 3,000 live births and 6,000

deaths last year. (a) Calculate the CBR and CDR. (b) Using only these
rates, infer the likely demographic transition stage and state planning
implication for health services.

●​ Answer: Note: The numbers in this question seem inverted compared to typical
demographic trends (Deaths > Births), but calculating based on provided figures:
○​ (a) Calculations:
■​ CBR: (3,000 / 300,000) x 1000 = 10 per 1000.
■​ CDR: (6,000 / 300,000) x 1000 = 20 per 1000.
○​ (b) Inference:
 ■​ Stage: This scenario (Death rate > Birth rate) represents a Declining
Population. This corresponds to the Fifth Stage (Declining) of the
demographic cycle where the birth rate is lower than the death rate.
■​ Planning: Focus on geriatric care, social security for the aged, and perhaps
pronatalist policies if the decline is a concern for the labor force.
○​ Reference: Park’s Textbook of Preventive and Social Medicine, 27th Edition,
Chapter 8, Page 554.

8. The height of 50 students is reported as 155.0 ± 2.5 cm. Identify the

statistics reported. Interpret what each number implies. Assuming
normality, state the approximate proportion expected between 150 cm
and 160 cm.
9. A country (population 300,000) recorded 3,000 live births and 3,000
deaths last year. (a) Calculate the CBR and CDR. (b) Using only these
rates, infer the likely demographic transition stage and state planning
implication for health services.
●​ Answer:
○​ (a) Calculations:
■​ CBR: (3,000 / 300,000) x 1000 = 10 per 1000.
■​ CDR: (3,000 / 300,000) x 1000 = 10 per 1000.
○​ (b) Inference:
■​ Stage: Birth rate equals Death rate. This represents the Fourth Stage (Low
Stationary). The population becomes stationary (Zero population growth).
■​ Planning: Maintenance of health services, focus on quality of life, and
monitoring of aging population.
○​ Reference: Park’s Textbook of Preventive and Social Medicine, 27th Edition,
Chapter 8, Page 554.

10. An intern working consecutive night shifts averages 4–5 hours of

sleep per 24 hours... (a) Define learning. (b) Which conditions
influence learning? Which conditions influencing learning are
impaired in this case?

●​ Answer:
○​ (a) Definition of Learning: Learning is any relative permanent change in behaviour
that occurs as a result of practice or experience. It means acquiring something
new—new knowledge, new techniques, new skills, new fears and new experiences.
○​ (b) Conditions influencing learning:
1.​ Intelligence.
2.​ Age.
3.​ Learning situation (Physical facilities).
4.​ Motivation.
5.​ Mental health (Worries, anxieties, and fears interfere with learning).
 ○​ Impaired Conditions: The intern is suffering from Mental health issues (anxiety,
headaches) and likely physiological fatigue due to lack of sleep, which interferes with
learning/memory.
○​ Reference: Park’s Textbook of Preventive and Social Medicine, 27th Edition,
Chapter 12, Page 791-792.

11. You are assigned for planning a comprehensive program against

diabetes mellitus in a community. Propose two measure for each level
of prevention.

1. Primary Prevention:

●​ Population Strategy: Maintenance of normal body weight through adoption of healthy

nutritional habits (adequate protein, high dietary fibre, avoidance of sweet foods) and
physical exercise.
●​ High-Risk Strategy: Targeted advice to high-risk groups (e.g., obese, those with family
history) to correct sedentary lifestyle and over-nutrition.

2. Secondary Prevention:

●​ Treatment/Control: Maintenance of blood glucose levels as close within the normal limits as
is practicable and maintenance of ideal body weight through diet, oral antidiabetic drugs, or
insulin.
●​ Self-care: The patient should take major responsibility for his own care, e.g., adherence to
diet and drug regimens, urine examination, and abstinence from alcohol.

3. Tertiary Prevention:

●​ Specialized Clinics: Establishment of Diabetic clinics to provide diagnostic and

management skills of a high order.
●​ Prevention of Complications: Basic clinical and epidemiological research to prevent
disability (blindness, kidney failure, gangrene, etc.).

Reference: Park's Textbook of Preventive and Social Medicine, 27th Ed, Pages 450-451, Chapter 6.
12. Suppose you are part of a vaccination team facing resistance from
parents regarding the new enteric fever vaccine for children aged
5–15 years. Using the stages of the motivation cycle, explain how you
would help convert this hesitancy into positive action.

Motivation includes the stages of interest, evaluation, and decision-making.

○​ Application:
1.​ Interest: Create awareness and spark interest by explaining the benefits of
the vaccine simply and clearly.
2.​ Evaluation: Help parents weigh the pros and cons (addressing fears vs.
disease protection). Provide scientific facts to help them evaluate the
information.
3.​ Decision-making: Encourage them to make a favourable decision. Use
interpersonal communication to support this decision.
4.​ Action: Facilitate the actual vaccination (make it accessible).
○​ Reference: Park’s Textbook of Preventive and Social Medicine, 27th Edition,
Chapter 22, Page 988.

13. A newly married women want to adopt a contraceptive method.

Which options would you suggest for her? Mention one key
advantage and one main disadvantage each.

●​ Answer:
○​ Oral Contraceptive Pills (Combined):
■​ Advantage: Almost 100% effective; allows spacing; independent of coitus.
■​ Disadvantage: Requires daily motivation/adherence; side effects like nausea
or weight gain; cardiovascular risks in susceptible individuals.
○​ Condoms:
■​ Advantage: Safe, inexpensive, no side effects, protects against STDs.
■​ Disadvantage: May slip/tear; interferes with sex sensation; requires
motivation for every act.
○​ Reference: Park’s Textbook of Preventive and Social Medicine, 27th Edition,
Chapter 8, Page 569 (Condom), 574 (Pills).
14. In a community where parents are reluctant to vaccinate their
children with the new enteric fever vaccine, discuss how each stage
of the adoption of new ideas can be applied to promote vaccine
acceptance.

Answer: (Based on the Adoption Model):

○​ Awareness: Create general information about the vaccine and the disease it
prevents.
○​ Interest: Parents seek more detailed information. Provide details on safety and
efficacy.
○​ Evaluation: Parents weigh the social, psychological, and health aspects. They may
consult others. Use peer groups to influence opinion.
○​ Decision-making: Parents decide whether to accept or reject. Interpersonal
communication is vital here.
○​ Action (Adoption): The parent takes the child for vaccination.
○​ Reference: Park’s Textbook of Preventive and Social Medicine, 27th Edition,
Chapter 22, Page 988 (Fig 2).

15. A couple prefers a non-hormonal, reversible, long-term

contraceptive method. Which method would you suggest, and what
are its advantages and disadvantages?

●​ Answer:
○​ Method: Intra-uterine Device (Copper T / Cu-T 380A).
○​ Advantages:
■​ Effective life of at least 10 years (Cu-T 380A).
■​ No systemic metabolic side-effects associated with hormonal pills.
■​ Highest continuation rate; single act of motivation.
■​ Inexpensive and reversible.
○​ Disadvantages:
■​ Bleeding (increased menstrual blood loss).
■​ Pain (low backache/cramps).
 ■​ Pelvic infection (PID).
■​ Expulsion.
○​ Reference: Park’s Textbook of Preventive and Social Medicine, 27th Edition,
Chapter 8, Page 571-573.

16. Parents are hesitant to vaccinate their children (5–15 years)

against enteric fever in a newly introduced national vaccination
program in Bangladesh. As a public health officer, how would you
apply the stages of the motivation cycle to encourage parents to
participate in the program?

Answer: (See Answer 12 - Motivation Cycle is identical).

○​ Reference: Park’s Textbook of Preventive and Social Medicine, 27th Edition,

Chapter 22, Page 988.

17. A medical student averages 4–5 hours of sleep per 24 hours,

reports recurrent headaches and anxiety, and perform poor in items.
(a) Define learning. (b) Which conditions influence learning? Which
conditions influencing learning are impaired in this student?

Answer: (See Answer 10 - Identical Question).

○​ Reference: Park’s Textbook of Preventive and Social Medicine, 27th Edition,

Chapter 12, Page 791-792.
 18. You need to select 20 students from a class of 100 (50 male
and 50 female) student for a survey. Name the most appropriate
sampling method and describe the steps to implement it in this
setting .

●​ Answer:
○​ Method: Simple Random Sampling (since the gender distribution is equal [50/50],
stratification is less critical than in Q2, though Stratified Random Sampling is still
valid and precise. Simple Random Sampling is sufficient here).
○​ Steps:
1.​ Assign a number to each of the 100 students (Sampling frame).
2.​ Use a table of random numbers to select 20 numbers.
3.​ The students corresponding to these numbers form the sample.
○​ Reference: Park’s Textbook of Preventive and Social Medicine, 27th Edition,
Chapter 21, Page 978.

19. You need to select 20 students from a class of 100 (50 male and 50
female)...

●​ Answer: Refer to Answer 18.

20. A couple prefers a non-hormonal, reversible, long-term

contraceptive method...

●​ Answer: Refer to Answer 15 (IUD/Copper T).

 21. Dague is endemic in Bangladesh. What is IVM? What source
reduction measures could be employed to control this disease
in a community setting.

●​ Answer:
○​ IVM (Integrated Vector Management): This involves vector control by the
appropriate biological, chemical, and environmental interventions of proven efficacy,
separately or in combination, as appropriate to the area.
○​ Source Reduction Measures (Environmental Management):
■​ Environmental management for source reduction involves preventing
mosquito breeding in domestic and peridomestic areas.
■​ Elimination of breeding places by covering overhead tanks, cisterns, and
water coolers.
■​ Removing artificial collections of water in discarded tins, broken bottles,
flower pots, coconut shells, and old tyres.
■​ Implementation of civic bye-laws.
○​ Reference: Park’s Textbook of Preventive and Social Medicine, 27th Edition,
Chapter 7, Page 473 (Urban Malaria/Vector Control) and Page 481 (Dengue).
●​

22. You need to select 20 students from a class of 100...

●​ Answer: Refer to Answer 18.

23. Describe how you would investigate an outbreak of cholera in a

community?

The investigation of a cholera epidemic follows standard epidemiological steps:

1.​ Verification of Diagnosis:

○​ It is important to have confirmation of the outbreak as quickly as possible.
○​ Identify V. cholerae O1 in the stools of the patient. Once proved, it is not necessary
to culture stools of all cases.
2.​ Confirmation of the existence of an epidemic:
 ○​ Compare disease frequencies with previous years. Often, the existence of a cholera
epidemic is obvious needing no such comparison.
3.​ Defining the population at-risk:
○​ Obtain a map of the area and count the population.
4.​ Rapid search for all cases:
○​ Medical survey to identify all cases (mild, moderate, severe).
5.​ Data Analysis:
○​ Time: Construct an epidemic curve.
○​ Place: Prepare a spot map.
○​ Person: Analyze by age, sex, and occupation.
6.​ Formulation of Hypothesis:
○​ Explain the epidemic in terms of possible source (e.g., water source), causative
agent, and mode of spread.
7.​ Testing of Hypothesis:
○​ Compare attack rates in those exposed and not exposed.
8.​ Evaluation of Ecological Factors:
○​ Investigate sanitary status of water, food, and environmental conditions.
9.​ Further Investigation:
○​ Examination of suspected water, food, or faeces samples.
10.​Writing the Report:
○​ Document findings and recommendations.

24. MMR is comparatively high in Bangladesh... Explain how EOC

could reduce this MMR...

●​ Answer: Refer to Answer 3.

25. District X (population 300,000) recorded 6,000 live births and 3,000
deaths...

●​ Answer: Refer to Answer 4.

26. Explain the most cost-effective epidemiological study design...

●​ Response: Refer to ans 1

27. Suppose you are part of a vaccination team facing resistance...

●​ Answer: Refer to Answer 12.

28. A 20-year-old after her first delivery seeks contraception. Which

contraceptive methods would you recommend and why?

●​ Answer:
○​ Recommendation: Spacing Methods.
○​ Specific Options:
1.​ IUD (Copper T): Ideal for spacing (3-5 years or more). Does not interfere
with lactation.
2.​ Progestogen-only pill (Mini-pill): If breastfeeding, as it does not suppress
lactation.
3.​ Barrier Methods (Condoms): No side effects, safe.
○​ Methods to Avoid immediately: Combined Oral Contraceptive Pills (if
breastfeeding < 6 months).
○​ Reference: Park’s Textbook of Preventive and Social Medicine, 27th Edition,
Chapter 8 (Family Planning) & Chapter 9 (Preventive Medicine in Obstetrics -
Postnatal Care).

29. What is standard deviation? In a study, body weight

measurements are normally distributed with a mean of 60 kg and a
standard deviation of 5 kg. What percentage of participants have body
weight between 50 kg and 70 kg?

●​ Answer: Refer to Answer 6. (Answer is 95%).

30. Design a cohort study to evaluate the risk of coronary artery disease
among obese? How will you calcualte relative risk in this study?

Design:

1.​ Selection of Study Subjects: Select a defined population (e.g., a specific community or
professional group) free from Coronary Artery Disease (CAD).
2.​ Obtaining Data on Exposure: Classify the subjects into two groups based on Body
Mass Index (BMI):
○​ Exposed Group: Obese (BMI ≥ 30).
○​ Non-Exposed Group: Non-obese (BMI < 25).
3.​ Follow-up: Follow both groups over a period of time (e.g., 10 years) under identical
conditions.
4.​ Assessment of Outcome: Determine the frequency (incidence) of CAD in both groups.​

31. A traveler arrives from a country with ongoing Ebola transmission

but has no symptoms. What public health action should be taken?
Justify your answer based on epidemiological principles.
●​ Answer:
○​ Action: Surveillance (or Medical Surveillance).
○​ Justification: According to International Health Regulations (IHR) and
epidemiological principles, quarantine is restricted to specific diseases (like yellow
fever). For diseases like Ebola, or generally for travelers from infected areas who are
symptom-free, they are placed under surveillance.
 ○​ Procedure: They are permitted to proceed to their destination but must report to the
local health authority. They are medically examined if necessary. This allows freedom
of movement while ensuring monitoring during the incubation period.
○​ Reference: Park’s Textbook of Preventive and Social Medicine, 27th Edition,
Chapter 25, Page 1027 (International Health/IHR) and Chapter 3
(Quarantine/Surveillance concepts). Note: While the definition is in Ch 3, the
application to international travelers is Ch 25.

32. How would you apply the holistic concept of health in designing a
community health program for urban slums?
Application of Holistic Concept:​
The holistic model is a synthesis of the biomedical, ecological, and psychosocial concepts. It
recognizes that "health implies a sound mind, in a sound body, in a sound family, in a sound
environment."

Design Steps for Urban Slums:

1.​ Multidimensional Approach: The program should not focus only on treating diseases
(Biomedical) but must address the social, economic, political, and environmental
influences on health.
2.​ Intersectoral Coordination: Involve sectors other than health, such as:
○​ Agriculture/Food: To ensure food security/nutrition.
○​ Public Works: For sanitation, housing, and water supply.
○​ Education: For health literacy.
3.​ Promotion and Protection: The emphasis should be on the promotion and protection
of health rather than just curing sickness.

33. You want to test whether a school-based health education program

improves handwashing behavior among students. Which epidemiological
design would be most appropriate? Outline briefly how you would conduct
this study.
Answer 33

Study Design: Field Trial.

Outline of Conduct:

1.​ Select Subjects: Select healthy students from schools (since field trials involve
healthy people).
2.​ Randomization: Randomly assign schools or classes into two groups:
○​ Study Group: Receives the health education program.
○​ Control Group: Does not receive the specific program.
3.​ Intervention: Implement the health education program in the study group.
4.​ Follow-up: Observe both groups over a defined period.
5.​ Assessment: Measure the handwashing behavior (outcome) in both groups and
compare the results to determine efficacy.

34. Do you fulfil the social dimension of health? Justify your answer.
Justification based on definition:​
One fulfills the social dimension of health if they possess:

1.​ Social Skills: The possession of social skills.

2.​ Social Functioning: Proper social functioning.
3.​ Social Adjustment: The ability to see oneself as a member of a larger society.

Social well-being implies "harmony and integration within the individual, between each individual and
other members of society and between individuals and the world in which they live." It is defined as
the "quantity and quality of an individual's interpersonal ties and the extent of involvement with the
community.
35. You have collected the heights (in centimeters) of 50 medical
students. What is the most appropriate chart to present this
continuous data? Is it appropriate to use a bar chart for this purpose?
Justify your answer.

●​ Answer:
○​ Appropriate Chart: Histogram or Frequency Polygon.
○​ Bar Chart Appropriateness: No, it is not appropriate to use a bar chart.
○​ Justification:
■​ Height is continuous data (quantitative variable).
■​ Bar charts are used for discrete (discontinuous) data or qualitative data
where the items are distinct entities.
■​ Histograms are used for continuous data (frequency distribution) where the
class intervals are continuous and the area of the block represents the
frequency.
○​ Reference: Park’s Textbook of Preventive and Social Medicine, 27th Edition,
Chapter 21, Page 973.

36. During a community health camp, blood pressure is checked for all
adults. Those found hypertensive are referred to hospital for confirmation.
Identify the activity being performed. How does it differ from diagnosis?

Activity: Screening (Specifically Mass Screening).​

Definition: "The search for unrecognized disease or defect by means of rapidly applied tests,
examinations or other procedures in apparently healthy individuals."

Difference from Diagnosis:

1.​ Subjects: Screening is done on apparently healthy individuals; Diagnosis is done on those
with indications or sick.
2.​ Purpose: Screening is to sort out those likely to have the disease; Diagnosis is to confirm or
refute the disease.
3.​ Accuracy: Screening tests are less accurate; Diagnostic tests are more accurate.
4.​ Finality: Screening is not a basis for treatment; Diagnosis is used as a basis for
treatment.
37. You have measured the height (in cm) and weight (in kg) of 50
children. What type of variables are these? Which graph would be
most appropriate to show the relationship between height and weight,
and why?

●​ Answer:
○​ Type of Variables: Continuous variables (Quantitative).
○​ Appropriate Graph: Scatter Diagram.
○​ Reason: Scatter diagrams are used to show the relationship (correlation) between
two variables (e.g., height and weight). If the dots cluster around a straight line, it
shows evidence of a relationship.
○​ Reference: Park’s Textbook of Preventive and Social Medicine, 27th Edition,
Chapter 21, Page 974.

38. Elaborate and state the primary roles of: (a) WHO, (b) UNICEF, (c)
icddr,b in supporting Bangladesh’s health system.

●​ Note: The book describes these agencies generally or in the context of India/Global. I will
provide the general roles defined in the book.
●​ Answer:
○​ (a) WHO (World Health Organization):
■​ Directing and coordinating authority on international health work.
■​ Prevention and control of specific diseases (communicable and
non-communicable).
■​ Development of comprehensive health services.
■​ Family Health (MCH, nutrition, health education).
■​ Environmental Health.
■​ Health Statistics and Biomedical Research.
○​ (b) UNICEF:
■​ Child health (production of vaccines, sera).
■​ Child nutrition (supplementary feeding, applied nutrition programs).
■​ Family and child welfare (day-care, youth agencies).
 ■​ Education (formal and non-formal).
■​ Water and Sanitation (GOBI campaign strategy).
○​ (c) icddr,b:

○​ Provides free, high-quality diarrhoeal disease treatment through its Dhaka

Hospital.​

○​ Conducts research on major national health issues (diarrhoea, dengue, cholera,

malnutrition).​

○​ Develops low-cost, practical health solutions such as ORS and zinc therapy.​

○​ Strengthens the health workforce through training and capacity building.​

○​ Supports the government with evidence for policy-making and outbreak response.

39. A researcher observes two groups of people — smokers and

non-smokers — and compares their incidence of lung cancer over time.
Identify the type of study. Is this observational or experimental? Justify
your answer.

Type of Study: Cohort Study (Prospective Study).

Category: Observational Study.

Justification:​
It is Observational because the investigator measures but does not intervene. They allow
nature to take its own course. The researcher did not assign the subjects to smoke or not
smoke; the subjects self-selected their exposure status, and the researcher simply observed
the outcome over time.
40. Explain the most cost-effective epidemiological study design...

●​ Response: Refer to ans 1.

41. A couple with two children (ages 8 and 6) want to limit their family size... What permanent
family planning methods are available for men and women? What counseling points should
be discussed before performing sterilization

●​ Answer:
○​ Permanent Methods:
1.​ Men: Vasectomy (Conventional or No Scalpel Vasectomy - NSV).
2.​ Women: Tubectomy (Laparoscopic or Minilap).
○​ Counseling Points (Guidelines for sterilization):
1.​ The operation is for all practical purposes irreversible.
2.​ The consent of the spouse has been obtained without coercion.
3.​ The couple must have 2 living children at the time of operation (age of
youngest child is usually considered).
4.​ For men: The patient is not sterile immediately after operation; at least 30
ejaculations are necessary before seminal examination is negative.
Contraceptives must be used until aspermia is established.
5.​ Complications (though rare) like spontaneous recanalization or operative
complications.
○​ Reference: Park’s Textbook of Preventive and Social Medicine, 27th Edition,
Chapter 8, Page 583-584.

42. A survey is conducted among 500 university students... Identify the study design...

●​ Response: Cross-sectional study. Covered in Chapter 3. Refer to Part 1.

43. A mother brings her newborn to the clinic for a postnatal check-up. The child was born
full term, but the mother is concerned about the baby’s feeding habits. How would you
address her concerns about exclusive breastfeeding and ensure the baby is getting adequate
nutrition?
 ●​ Answer:
○​ Exclusive Breastfeeding Advice:
■​ Breast milk is safe, clean, hygienic, cheap, and available at the correct
temperature.
■​ It meets all nutritional requirements for the first few months.
■​ It contains antimicrobial factors (IgA, lactoferrin) protecting against infections.
■​ No other food is required until 6 months.
○​ Ensuring Adequate Nutrition/Feeding:
■​ Initiate breastfeeding within an hour of birth.
■​ Feed the baby on demand (whenever the baby wants), not by the clock.
■​ Avoid feeding bottles.
■​ Colostrum (first milk) is highly nutritious and must be given.
○​ Reference: Park’s Textbook of Preventive and Social Medicine, 27th Edition,
Chapter 9, Page 606 (Breast-feeding) and Chapter 11, Page 743.

44. During a survey in a rural area, it was found that for every one diagnosed case of
hypertension, three undiagnosed cases existed... Which epidemiological concept does this
illustrate?

●​ Response: Iceberg Phenomenon. Covered in Chapter 2. Refer to Part 1.

45. A pregnant woman from a low-income background has not attended antenatal care and
arrives at 30 weeks of pregnancy complaining of abdominal pain and fever. What danger
signs of pregnancy should you consider in this case, and what immediate actions would you
take?

●​ Answer:
○​ Danger Signs (Warning Signals) to Consider:
■​ Bleeding or discharge per vagina (Antepartum haemorrhage).
■​ Fever (Infection/Sepsis).
■​ Severe headache/blurring of vision (Pre-eclampsia).
■​ Swelling of feet (Oedema).
■​ Fits (Eclampsia).
■​ Abdominal pain (Premature labour, abruptio placentae).
■​ Decreased/absent foetal movements.
○​ Immediate Actions:
 ■​ Report/Refer immediately to the nearest Primary Health Centre (PHC),
Community Health Centre (CHC), or First Referral Unit (FRU).
■​ Assessment for high-risk factors (anaemia, toxaemias).
■​ Start treatment for infection if confirmed.
○​ Reference: Park’s Textbook of Preventive and Social Medicine, 27th Edition,
Chapter 9, Page 603 (Warning signs), 600 (History/Physical Exam).

46. ‘A’ is a university student living Dhaka. He started smoking cigarettes when he was 18,
smoked by his seniors. Justify-‘tobacco use is a behavioral cause of disease’ using the
cognition-attitude-practice framework.

●​ Answer:
○​ Cognition (Knowledge): 'A' likely lacks full awareness or conviction about the
long-term hazards of smoking (lung cancer, CVD). Or, he perceives smoking as a
symbol of "adult" behaviour or status due to peer pressure.
○​ Attitude: He may have developed a positive attitude towards smoking due to social
environment (seniors smoking), viewing it as acceptable or necessary for social
integration.
○​ Practice (Behaviour): This attitude led to the practice of smoking. This behaviour
exposes him to carcinogens and toxins.
○​ Justification: Health behaviour is determined by knowledge (cognition),
beliefs/values (attitude), and influence of peers. Tobacco use is a voluntary risk
behaviour influenced by these social and psychological factors, leading to disease.
Changing this requires altering the knowledge and attitude to change the practice.
○​ Reference: Park’s Textbook of Preventive and Social Medicine, 27th Edition,
Chapter 22, Page 985-987 (Health Education and Behaviour), Chapter 12, Page 789
(Health Behaviour).

47. You need to select 20 students from a class of 100...

●​ Answer: Refer to Answer 18.

48. You are evaluating the effectiveness of a new malaria vaccine...

●​ Response: Experimental Epidemiology. Covered in Chapter 3. Refer to Part 1.

49. In a community where parents are reluctant to vaccinate their children... discuss how
each stage of the adoption of new ideas can be applied...

●​ Answer: Refer to Answer 14.

50. There has been an incident of food poisoning in your hostel...

●​ Response: Investigation of epidemic / Case control. Covered in Chapter 3. Refer to Part 1.

51. A pregnant woman comes to your clinic for her first antenatal visit. She is 24 years old,
with no previous pregnancies, and reports no significant medical history. What initial steps
would you take to ensure a comprehensive antenatal assessment? What essential
investigations would you recommend?

●​ Answer:
○​ Initial Steps (First Visit):
1.​ History Taking: Confirm pregnancy, record date of Last Menstrual Period
(LMP), calculate Expected Date of Delivery (EDD), record family history and
any current symptoms.
2.​ Physical Examination:
■​ Check for pallor (anaemia).
■​ Measure blood pressure (rule out hypertension).
■​ Check weight (baseline).
■​ Check for oedema.
■​ Breast examination.
3.​ Abdominal Examination: Fundal height (if applicable based on gestation).
○​ Essential Investigations:
1.​ Urine: For albumin and sugar.
2.​ Blood: Haemoglobin estimation (for anaemia).
3.​ Blood Grouping: Including Rh factor.
4.​ Serology: VDRL/RPR (Syphilis) and HIV screening.
5.​ Others: Blood sugar (Gestational diabetes), HBsAg (Hepatitis B), Malaria (if
endemic).
 ○​ Reference: Park’s Textbook of Preventive and Social Medicine, 27th Edition,
Chapter 9, Page 600-601.

52. A 26 year old woman delivered her second baby at the upazila health complex two days
ago. What should be the schedule for postnatal visits according to national guideline? Why is
it important to discuss family planning during postnatal visits and which methods are
suitable for her at this stage?

●​ Answer:
○​ Schedule of Postnatal Visits (Home Visits):
■​ Institutional Delivery: Six visits - Days 3, 7, 14, 21, 28, and 42.
■​ (Note: Park mentions 3-6 visits in general MCH care, but under HBNC/ASHA
guidelines in India, the schedule is specific. For general postnatal care, visits
are recommended at least once a month for the first 6 months).
○​ Importance of Family Planning: The mother is psychologically more receptive to
advice at this time. Women who have recently delivered are of proven fertility and at
risk of becoming pregnant again rapidly.
○​ Suitable Methods (Postpartum):
■​ Postpartum Sterilization (Tubectomy): Usually recommended on the 2nd
day after delivery (if family is complete).
■​ IUD (Postpartum IUCD): Can be inserted immediately or within 48 hours.
■​ Progestogen-only methods: If not sterilized.
■​ Barrier methods.
■​ Avoid Combined Oral Pills during lactation.
○​ Reference: Park’s Textbook of Preventive and Social Medicine, 27th Edition,
Chapter 9, Page 606 (Postnatal Care/Family Planning) and Chapter 7, Page 527
(HBNC schedule).

53. You have collected the heights (in centimeters) of 50 medical students. What is the most
appropriate chart...

●​ Answer: Refer to Answer 35.

54. Explain the meaning of sustainable development and discuss how SDG-3 contributes to
achieving it through specific two maternal and neonatal health related target.

●​ Answer:
○​ Meaning: Sustainable development is "development that meets the needs of the
present without compromising the ability of future generations to meet their own
needs."
○​ SDG-3 (Ensure healthy lives and promote well-being for all at all ages):
○​ Two Maternal/Neonatal Targets (Target 3.1 & 3.2):
1.​ Maternal Mortality: By 2030, reduce the global maternal mortality ratio to
less than 70 per 100,000 live births.
2.​ Neonatal Mortality: By 2030, end preventable deaths of newborns... aiming
to reduce neonatal mortality to at least as low as 12 per 1,000 live births.
○​ Contribution: Improving maternal and neonatal health reduces mortality,
strengthens the workforce of the future, reduces poverty associated with ill health,
and promotes social equity, which are pillars of sustainable development.
○​ Reference: Park’s Textbook of Preventive and Social Medicine, 27th Edition,
Chapter 14, Page 824-825 (Table 1).

55. A 6-month-old infant is exclusively breastfed, but the mother is now considering
introducing solid foods. What guidelines would you provide for complementary feeding to
ensure the infant’s optimal growth and nutrition?

●​ Answer:
○​ Timing: Introduce complementary foods at 6 months while continuing breastfeeding
up to 2 years or beyond.
○​ Guidelines:
1.​ Supplementary Foods: Start with soft cooked rice, suji, dhal, and
vegetables.
2.​ Nutritional Value: Foods should be rich in protein and other nutrients.
3.​ Consistency: Soft-cooked and mashed.
4.​ Frequency: Introduce gradually, increasing amount and frequency.
5.​ Hygiene: Prepare hygienically to avoid diarrhoea (weaning diarrhoea).
6.​ Low Cost: Use locally available foods consumed by the family (Home-made
weaning foods).
○​ Reference: Park’s Textbook of Preventive and Social Medicine, 27th Edition,
Chapter 11, Page 745 (Weaning) & Chapter 9, Page 617 (National Guidelines).
56. A breastfeeding mother expresses concerns about the possible health risks of using
formula milk for her infant. List the advantages of breastfeeding over bottle feeding, and
explain why breastfeeding is recommended, particularly in the first six months of life.

●​ Answer:
○​ Advantages of Breastfeeding:
1.​ Safe and Hygienic: Clean, correct temperature, no preparation needed.
2.​ Nutritional: Fully meets nutritional requirements for the first few months;
easily digested.
3.​ Anti-infective: Contains IgA, lactoferrin, macrophages protecting against
diarrhoea and respiratory infections.
4.​ Bonding: Promotes close mother-child relationship.
5.​ Growth: Protects against obesity and malnutrition.
6.​ Maternal Benefits: Helps uterine involution, protects against breast/ovarian
cancer, acts as a contraceptive (lactational amenorrhea).
○​ Risks of Bottle Feeding: High risk of contamination leading to diarrhoea and
malnutrition; nutritional inadequacy if over-diluted; cost.
○​ Recommendation: Exclusive breastfeeding for the first 6 months is recommended
because breast milk provides all necessary nutrients and immunity during this
vulnerable period, significantly reducing infant mortality.
○​ Reference: Park’s Textbook of Preventive and Social Medicine, 27th Edition,
Chapter 9, Page 615; Chapter 11, Page 743.

57. A traveler arrives from a country with ongoing Ebola transmission...

●​ Answer: Refer to Answer 31.

58. A couple prefers a non-hormonal, reversible, long-term contraceptive method...

●​ Answer: Refer to Answer 15.

59. In a town of 2000 households, a researcher divides the household into three groups
based on income (low, middle, high). Then, from each group, 50 households are selected
randomly. What sampling method is used here? Why this method more precise than simple
random sampling in this context? What are the potential challenges in applying this method?

●​ Answer:
○​ Method: Stratified Random Sampling.
○​ Precision: It is more precise because it ensures that all subgroups (strata) of the
population (income groups) are adequately represented in the sample. In simple
random sampling, a specific group (e.g., high income) might be missed or
underrepresented by chance.
○​ Challenges:
1.​ Requires accurate knowledge of the income status of every household
beforehand to create the sampling frame for each stratum.
2.​ More complex to organize than simple random sampling.
○​ Reference: Park’s Textbook of Preventive and Social Medicine, 27th Edition,
Chapter 21, Page 978.

60. A pregnant woman comes to your clinic for her first antenatal visit...

●​ Answer: Refer to Answer 51.

61. A researcher conducts a study among 500 adults in urban area to determine the
prevalence of hypertension...

●​ Response: Cross-sectional Study. Covered in Chapter 3. Refer to Part 1.

62. You are given the age-sex pyramid of a village, which shows a very large number of
children aged below 15 years, and a small number of elderly people. What does this type of
population pyramid indicate about the stage of demographic cycle? What challenges can
arise in the future due to a high proportion of children?

●​ Answer:
○​ Indication: A broad base and tapering top indicates a "Young" population with
high birth rates and relatively high death rates (or rapidly declining death rates but
sustained high birth rates). This corresponds to the Second Stage (Early
 Expanding) or early Third Stage (Late Expanding) of the demographic cycle
(typical of developing countries).
○​ Challenges:
1.​ High Dependency Ratio: Large number of dependents to support.
2.​ Population Momentum: Large number of people entering reproductive age
in the future, leading to continued population growth.
3.​ Demand on Services: Increased need for schools, MCH services, and job
creation in the future.
○​ Reference: Park’s Textbook of Preventive and Social Medicine, 27th Edition,
Chapter 8, Page 557-558.
●​

63. A researcher suspected a relationship between tobacco smoking and lung cancer...

●​ Response: Case-Control Study. Covered in Chapter 3. Refer to Part 1.

64. In a community survey, it was found that 35% of married women of reproductive age
wanted to delay their next pregnancy but were not using any method of contraception. Define
the term ‘unmet need of family planning’. What strategies can MCH services use to reduce
unmet need?

●​ Answer:
○​ Definition: Unmet need for family planning refers to women who are sexually active
and would prefer to avoid becoming pregnant (either limiting or spacing), but
nevertheless are not using any method of contraception.
○​ Strategies to Reduce Unmet Need:
1.​ Education: Address lack of information and fears about side effects.
2.​ Access: Improve convenience and satisfactory services (make
contraceptives available/affordable).
3.​ Choice: Offer a wide basket of contraceptive choices.
4.​ Counselling: Overcome opposition from husband/relatives.
5.​ Integration: Integrate FP services with MCH/RCH services.
○​ Reference: Park’s Textbook of Preventive and Social Medicine, 27th Edition,
Chapter 8, Page 585.
65. A community health worker reports an increased number of LBW infants in a particular
village. What socio-economic, dietary, and health-related factors could be contributing to this
situation, and what strategies would you suggest to address the issue at a community level?

●​ Answer:
○​ Contributing Factors:
1.​ Maternal Malnutrition: Inadequate dietary intake (food gap), anaemia.
2.​ Health: Infections (malaria, UTI), hypertension/toxemia, smoking/tobacco
use.
3.​ Socio-economic: Poverty, illiteracy, heavy physical work during pregnancy.
4.​ Demographic: Low maternal age (<18), high parity, close birth spacing.

Strategies (Direct Intervention):

5.​ Food Supplementation: Provide supplementary nutrition to pregnant

women (e.g., ICDS).
6.​ Anaemia Control: Iron and Folic Acid distribution.
7.​ Antenatal Care: Early registration and regular check-ups to detect risk
factors.
8.​ Control of Infections: Treatment of malaria, worms.
○​ Strategies (Indirect): Family planning (spacing), sanitation improvement, and health
education.
○​ Reference: Park’s Textbook of Preventive and Social Medicine, 27th Edition,
Chapter 11, Page 753-754.

66. A mother brings her newborn to the clinic for a postnatal check-up...

●​ Answer: Refer to Answer 43.

67. A public health researcher wants to investigate whether daily consumption of sugary
drinks...

●​ Response: Cross-sectional Study. Covered in Chapter 3. Refer to Part 1.

68. Define screening. Differentiate between screening and diagnosis...

 ●​ Response: Screening. Covered in Chapter 4. Refer to Part 1.

69. A 35 year old woman with 2 children wants to start oral contraceptive pill. She has
irregular menstrual cycles and mild hypertension. Would you advice her to use combined
OCP? Justify your answer and suggest a safer alternative with benefits if not.

●​ Answer:
○​ Advice: No, Combined OCP is not advisable.
○​ Justification:
■​ Hypertension: Mild hypertension is a relative contraindication (special
problem requiring medical surveillance) for Combined OCPs because
oestrogen can elevate blood pressure and increase the risk of cardiovascular
complications (stroke/MI).
■​ Age: Being 35 years old adds to the cardiovascular risk profile if combined
with other factors like hypertension.
○​ Safer Alternative: Intra-uterine Device (IUD) or Progestogen-only pill (POP) or
Condoms.
■​ IUD is highly effective, non-hormonal (Copper T), and does not affect blood
pressure.
○​ Reference: Park’s Textbook of Preventive and Social Medicine, 27th Edition,
Chapter 8, Page 576-577 (Risks/Contraindications of Oral Pills).

70. A researcher wants to study the satisfaction level of patients attending the OPD of a
general hospital. He selects every 10th patient entering the OPD from 8am-12pm. What type
of sampling method is applied here? What are the possible biases in this method? How could
randomization improve this design?

●​ Answer:
○​ Method: Systematic Random Sampling.
○​ Biases: If there is a periodic or cyclic pattern in the arrival of patients that coincides
with the sampling interval (e.g., patients from a specific bus arriving every 10th slot),
the sample may not be representative.
○​ Improvement: Use Simple Random Sampling where every patient has an equal
and independent chance of being selected, regardless of arrival order.
○​ Reference: Park’s Textbook of Preventive and Social Medicine, 27th Edition,
Chapter 21, Page 978.
71. MMR is comparatively high in Bangladesh...

●​ Answer: Refer to Answer 3.

72. What are the host factors responsible for disease causation...

●​ Response: Host Factors. Covered in Chapter 3. Refer to Part 1.

73. A 26-year-old woman, who recently gave birth, is planning her next pregnancy. She has a
history of gestational diabetes in her previous pregnancy. What advice would you give her
regarding antenatal care for her next pregnancy, and what high-risk factors should be closely
monitored?

●​ Answer:
○​ Advice:
1.​ Early Registration: Register pregnancy as soon as possible.
2.​ Regular Screening: Screen for diabetes early in pregnancy (as she is high
risk) and repeat at 24-28 weeks if initial screen is negative.
3.​ Diet/Exercise: Counsel on healthy diet and weight management.
○​
○​ High-Risk Factors to Monitor:
1.​ Blood Sugar: Recurrence of Gestational Diabetes (GDM) or overt Diabetes.
2.​ Blood Pressure: Risk of pre-eclampsia.
3.​ Foetal Growth: Macrosomia (big baby) or growth retardation.
4.​ Congenital Anomalies.
○​ Reference: Park’s Textbook of Preventive and Social Medicine, 27th Edition,
Chapter 9, Page 603 (Gestational Diabetes), 604.

74. A 60 year old diabetic patient first visits a community clinic for routine blood sugar
checks. The community clinic refers him to district hospital when complication arises.
Eventually he is admitted to a medical college hospital for specialized kidney treatment. Map
each stage of her care to the correct level of health care. How could referral systems improve
patient outcomes in such cases?
 ●​ Answer:
○​ Mapping:
■​ Community Clinic: Primary Care Level (First level of contact, basic care).
■​ District Hospital: Secondary Care Level (Intermediate level, more complex
problems).
■​ Medical College Hospital: Tertiary Care Level
(Specialized/Super-specialist care).
○​ Referral System Improvement: A sound two-way referral system ensures:
■​ Continuity of Care: Better tracking of the patient's history.
■​ Efficiency: Patients are treated at the appropriate level, preventing
overcrowding at tertiary centres with simple cases.
■​ Feedback: Specialists return patients to primary care with instructions for
follow-up, ensuring long-term management.
○​ Reference: Park’s Textbook of Preventive and Social Medicine, 27th Edition,
Chapter 10, Page 692-693.

75. A mother brings her newborn to the clinic for a postnatal check-up...

●​ Answer: Refer to Answer 43.

76. In a community survey, it was fund thar 35% of married women...

●​ Answer: Refer to Answer 64.

77. You are working in a region with a recent outbreak of dengue. What immediate actions
would you take to control the spread of the disease?

●​ Answer:
○​ Vector Control:
1.​ Anti-larval: Source reduction (eliminate breeding sites like containers, tyres),
use of larvicides (Abate/Temephos) in potable water, larvivorous fish.
2.​ Anti-adult: Thermal fogging (space spray) with Malathion/Pyrethrum to kill
infected adult mosquitoes during outbreaks.
○​ Personal Protection: Use of mosquito nets, repellents, covering body.
 ○​ Surveillance: Early detection of cases, isolation (under bed nets) to prevent
mosquito infection.
○​ Health Education: Community awareness about breeding sites.
○​ Reference: Park’s Textbook of Preventive and Social Medicine, 27th Edition,
Chapter 7, Page 481 (Dengue Control) and Chapter 15, Page 898 (Mosquito
control).

78. A researcher observes two groups of people...

●​ Response: Cohort Study. Covered in Chapter 3. Refer to Part 1.

79. An urban area experiences a sudden rise in dengue cases during the monsoon. Identify
the probable vector responsible for this outbreak? Suggest preventive measures at
household and community level?

●​ Answer:
○​ Vector: Aedes aegypti (and Aedes albopictus).
○​ Preventive Measures:
■​ Household Level:
■​ Empty and clean water containers (flower pots, coolers, buckets)
weekly.
■​ Cover water storage tanks.
■​ Use mosquito nets and repellents.
■​ Wear protective clothing.
■​ Community Level:
■​ Solid waste management to remove potential breeding sites (tyres,
cups, bottles).
■​ Anti-larval measures (chemical/biological).
■​ Fogging during outbreaks.
■​ Health education campaigns.
○​ Reference: Park’s Textbook of Preventive and Social Medicine, 27th Edition,
Chapter 15, Page 897 (Aedes Habits) and Chapter 7, Page 481.

80. A team gives half the school children vitamin A capsules...

 ●​ Response: RCT/Experimental Study. Covered in Chapter 3. Refer to Part 1.

81. A 35-year old multiparous women with a history of unexplained vaginal bleeding
requested to have an IUCD for contraception. Is IUCD suitable for this woman or not and
why? What are the contraindications of IUCD insertion?

●​ Answer:
○​ Suitability: No, IUCD is not suitable.
○​ Reason: Unexplained vaginal bleeding is an Absolute Contraindication for IUD
insertion because the IUD can exacerbate bleeding or mask an underlying condition
(like cancer).
○​ Contraindications of IUD:
■​ Absolute: Suspected pregnancy, Pelvic Inflammatory Disease (PID), Vaginal
bleeding of undiagnosed aetiology, Cancer of cervix/uterus/adnexa, Previous
ectopic pregnancy.
■​ Relative: Anaemia, menorrhagia, history of PID, distorted uterine cavity.
○​ Reference: Park’s Textbook of Preventive and Social Medicine, 27th Edition,
Chapter 8, Page 572.

82. During an outbreak of gastroenteritis, an investigator studies food history...

●​ Response: Case-Control Study. Covered in Chapter 3. Refer to Part 1.

83. A 30-year-old woman with two children...

●​ Answer: Refer to Answer 5.

84. You are given the age-sex pyramid of a village...

●​ Answer: Refer to Answer 62.

85. Parents are hesitant to vaccinate their children...

 ●​ Answer: Refer to Answer 12 (Motivation Cycle).

86. During a survey in a rural area, it was found that for every one diagnosed case of
hypertension...

●​ Response: Iceberg Phenomenon. Covered in Chapter 2. Refer to Part 1.

87. MMR is comparatively high in Bangladesh...

●​ Answer: Refer to Answer 3.

88. A public health researcher wants to study the effect of smoking on the development of
COPD...

●​ Response: Cohort Study. Covered in Chapter 3. Refer to Part 1.

89. A rural health clinic reports that many women experience complications during
pregnancy due to short intervals between pregnancies. How can family planning contribute
to reducing maternal mortality in this community? What types of family planning methods
would be most effective for spacing pregnancies safety?

●​ Answer:
○​ Contribution to Reducing Maternal Mortality:
1.​ Prevents unwanted pregnancies and abortions (which are often unsafe).
2.​ Limits the number of births (risk increases with parity > 4).
3.​ Regulates intervals (short intervals increase risk of anaemia, haemorrhage,
and maternal depletion).
4.​ Protects against high-risk pregnancies (too young, too old).
5.​ Estimate: Family planning alone could reduce maternal deaths by 25%.
○​ Effective Spacing Methods:
1.​ IUD (Copper T): Highly effective, long-term (3-10 years), reversible.
2.​ Oral Contraceptive Pills: Effective if taken daily.
3.​ Condoms: Safe, no side effects, also protect against STIs.
4.​ Injectables (DMPA): Effective for 3 months per shot.
 ○​ Reference: Park’s Textbook of Preventive and Social Medicine, 27th Edition,
Chapter 8, Page 566-567 (Health aspects of family planning) & 569.

90. Suppose you are part of a vaccination team facing resistance...

●​ Answer: Refer to Answer 12.

91. What do you mean by iceberg phenomenon of disease?

●​ Response: Iceberg Phenomenon. Covered in Chapter 2. Refer to Part 1.

92. Mention the measures of dispersion. In a study measuring the blood pressure of 50
patients, the mean, median and mode SBP are 130, 125, and 120 mmHg, respectively. Which
measure of central tendency would you use to report the central value of blood pressure in
this study, and why?

●​ Answer:
○​ Measures of Dispersion:
■​ Range.
■​ Mean Deviation.
■​ Standard Deviation.
○​ Choice of Central Tendency:
■​ The Mean (130), Median (125), and Mode (120) are different, suggesting the
data is skewed (not a perfect normal distribution where
Mean=Median=Mode).
■​ However, usually, the Arithmetic Mean is the most useful and widely used
statistic for biological data (like BP) as it includes all values.
■​ Note: If the data is highly skewed (e.g., by outliers), the Median is better.
Without information on outliers, the Mean is generally the standard for
reporting BP in medical studies, but if the difference (130 vs 120) suggests
significant skewness, Median might be safer to describe the "typical" patient.
Park states: "The arithmetic mean is by far the most useful of the statistical
averages."
○​ Reference: Park’s Textbook of Preventive and Social Medicine, 27th Edition,
Chapter 21, Page 976 (Dispersion), 975 (Mean).
93. Despite availability of vaccines, a rural community has a low uptake of childhood
vaccines. What would be the key barriers to effective health communication in this case. If
you were to design a health education campaign, which channels /methods would be most
effective and why?

●​ Answer:
○​ Barriers:
■​ Cultural: Beliefs, customs, religion (e.g., vaccine causes infertility rumors).
■​ Psychological: Fear of side effects, lack of interest.
■​ Environmental: Illiteracy, language difficulties.
■​ Physiological: Difficulty in understanding.
○​ Effective Channels/Methods:
■​ Interpersonal Communication: (Face-to-face with health workers/ASHAs).
Most effective for overcoming resistance and motivating the undecided.
■​ Group Discussion: Allows peer interaction and decision making.
■​ Folk Media: (Songs, drama). Culturally appropriate and appealing to rural
audiences.
■​ Opinion Leaders: Involving village heads/religious leaders to legitimize the
message.
○​ Reference: Park’s Textbook of Preventive and Social Medicine, 27th Edition,
Chapter 22, Page 984 (Barriers), 983 (Channels/Methods).

94. During the COVID-19 pandemic, a confirmed positive patient was admitted to a hospital
ward, while his family members were asked to stay at home for 14 days under supervision...

●​ Response: Isolation/Quarantine. Covered in Chapter 3. Refer to Part 1.

95. A 20-year-old after her first delivery seeks contraception...

●​ Answer: Refer to Answer 28.

96. Despite availability of vaccines, a rural community has a low uptake...

 ●​ Answer: Refer to Answer 93.

97. How would you apply the holistic concept of health in designing a community health
program for urban slums?

●​ Answer:
○​ Concept: While "Holistic Concept" is defined in Chapter 2, applying it involves
integrating various sectors.
○​ Application (based on Health Care of Community/Urban Health):
■​ Biomedical: Provide medical care (immunization, treatment).
■​ Social/Environmental: Improve water supply, sanitation, housing, and
garbage disposal (Slum improvement).
■​ Economic: Vocational training or livelihood support (poverty reduction).
■​ Educational: Health education on hygiene and nutrition.
■​ Political: Involving local municipal governance (Urban Local Bodies) in
decision making.
■​ Integration: Addressing all dimensions (physical, mental, social) rather than
just treating disease.
○​ Reference: Park’s Textbook of Preventive and Social Medicine, 27th Edition,
Chapter 10, Page 512 (National Urban Health Mission covers these aspects).

100. What are the characteristics of normal distribution curve? If the data follows a normal
distribution with a mean of 60 and a standard deviation of 5, what is the range of values that
would contain approximately 95% of the data points?

●​ Answer:
○​ Characteristics of Normal Curve:
■​ Smooth, bell-shaped.
■​ Perfectly symmetrical.
■​ Mean, Median, and Mode coincide at the center (are equal).
■​ Total area under the curve is 1.
○​ Range for 95%:
■​ 95% of values lie between Mean ± 2 Standard Deviations.
■​ Mean = 60. SD = 5. 2SD = 10.
■​ Lower limit: 60 - 10 = 50.
■​ Upper limit: 60 + 10 = 70.
 ■​ Range: 50 to 70.
○​ Reference: Park’s Textbook of Preventive and Social Medicine, 27th Edition,
Chapter 21, Page 977

103. What is standard deviation? In a health study, blood pressure readings are normally
distributed with a mean of 120 mmHg and a standard deviation of 15 mmHg. What percentage
of participants have blood pressure between 105 mmHg and 135 mmHg?
109. Design a cohort study to evaluate the risk of coronary artery disease among obese?

●​ Response: Cohort Study. Covered in Chapter 3. Refer to Part 1.

111. Describe how you would investigate an outbreak of cholera in a community?

●​ Response: Outbreak Investigation. Covered in Chapter 3. Refer to Part 1.

From PART ONE

61. A researcher conducts a study among 500 adults in urban area to determine the
prevalence of hypertension and its association with obesity. What type of study design is
used here? what are the advantages of this study? What kind of bias can occur here?

Answer 61

Study Design: Cross-sectional Study (Prevalence Study).

Advantages:

1.​ Provides information about the prevalence of disease.

2.​ Relatively easy and inexpensive to conduct.
 3.​ Can identify associations between variables (hypothesis formulation).

Bias:

1.​ Selection Bias: The sample may not be representative of the population.
2.​ Recall Bias: If questionnaires are used.
3.​ Measurement Bias: Errors in BP measurement or weight/height.​
(Note: Park generally discusses biases more heavily in Case-Control sections, but Selection
and Measurement bias apply here).

Reference: Park's Textbook of Preventive and Social Medicine, 27th Ed, Pages 77-78, Chapter 3.

63. A researcher suspected a relationship between tobacco smoking and

lung cancer in a sudden increase of lung cancer in a city. He selected 150
patients with lung cancer(cases) and 150 patients without lung
cancer(control). What type of study design is used here? What are the
advantages of using this design for this disease? List two possible biases
that may affect this study?

Answer 63

Study Design: Case Control Study.

Advantages:

1.​ Particularly suitable to investigate rare diseases or diseases about which little is known.
2.​ Relatively easy to carry out and inexpensive.
3.​ Requires comparatively few subjects.
4.​ No risk to subjects.

Possible Biases:

1.​ Memory or Recall Bias: Cases may recall past habits (smoking) differently than controls.
2.​ Selection Bias: Cases and controls may not be representative of the general population.
3.​ Interviewer's Bias: Prior knowledge of the hypothesis may influence how questions are
asked.
Reference: Park's Textbook of Preventive and Social Medicine, 27th Ed, Pages 79 and 81-82,
Chapter 3.

67. A public health researcher wants to investigate whether daily

consumption of sugary drinks is associated with obesity in teenagers in a
city. Which type of study design would be most appropriate if the
researcher wants a snapshot of the current prevalence. What are the
strengths and limitations of this design in this context?

Answer 67

Study Design: Cross-sectional Study (Prevalence Study).

Strengths:

1.​ Provides a snapshot of the health status (obesity and drink consumption) at one point in
time.
2.​ Calculates prevalence rates.
3.​ Quick and economical.

Limitations:

1.​ No Time Sequence: Cannot determine if sugary drinks caused obesity or if obese teenagers
drink them more (Temporal association issues).
2.​ Not for Causality: Tells about distribution, not aetiology/causation.

Reference: Park's Textbook of Preventive and Social Medicine, 27th Ed, Page 77, Chapter 3.

68. Define screening. Differentiate between screening and diagnosis. What

is the purpose of screening in public health?

Answer 68
Definition:​
Screening is "the search for unrecognized disease or defect by means of rapidly applied tests,
examinations or other procedures in apparently healthy individuals."

Differentiation (Screening vs Diagnosis):

1.​ Subjects: Screening = Apparently healthy; Diagnosis = Sick/Symptomatic.

2.​ Test: Screening = Less accurate; Diagnosis = More accurate.
3.​ Result: Screening = Not final; Diagnosis = Final/Basis for treatment.
4.​ Initiative: Screening = Investigator; Diagnosis = Patient.

Purpose in Public Health:​

To sort out from a large group of apparently healthy persons those likely to have the disease or at
increased risk, to bring those who are "apparently abnormal" under medical supervision and
treatment.

Reference: Park's Textbook of Preventive and Social Medicine, 27th Ed, Pages 151-152, Chapter 4.

72. What are the host factors responsible for disease causation? A measles
outbreak occurs in a partially vaccinated community. What host factors
may explain why some vaccinated children still became ill?

Answer 72

Host Factors Responsible for Disease Causation:

1.​ Demographic: Age, Sex, Ethnicity.

2.​ Biological: Genetic factors, Blood groups, Enzymes, Immunological factors.
3.​ Social & Economic: Socio-economic status, Education, Occupation.
4.​ Lifestyle: Nutrition, Habits, Personality.

Why Vaccinated Children Became Ill (Measles):

1.​ Primary Vaccine Failure: The child failed to seroconvert (develop immunity) after
vaccination. This can happen due to the presence of maternal antibodies (if vaccinated too
early, <9 months), poor nutrition, or immune status.
 2.​ Malnutrition: Measles tends to be very severe in the malnourished child; malnutrition may
affect the immune response (Cell-mediated immunity).
3.​ Immunity Status: Waning immunity or failure to mount an adequate response.

Reference: Park's Textbook of Preventive and Social Medicine, 27th Ed, Page 43, Chapter 2 & Page
165, Chapter 5.

77. You are working in a region with a recent outbreak of dengue. What
immediate actions would you take to control the spread of the disease?

Answer 77

Immediate Actions (Control Measures):

1.​ Mosquito Control:

○​ Anti-Adult: Targeted residual spraying and space spraying/fogging to rapidly reduce
the adult mosquito population.
○​ Anti-Larval: Source reduction (removing breeding sites like artificial containers), use
of larvicides (e.g., temephos), and biological control.
2.​ Personal Protection:
○​ Use of repellents, protective clothing (full sleeves), and window screens.
○​ Use of insecticide-treated bed nets (though Aedes bites during the day).
3.​ Surveillance:
○​ Early determination of dengue virus infection during the outbreak.
○​ Notification of cases.
4.​ Health Education:
○​ Community involvement to keep water storage containers free of mosquitoes and
eliminate breeding places.

Reference: Park's Textbook of Preventive and Social Medicine, 27th Ed, Pages 298-299, Chapter 5.

78. A researcher observes two groups of people — smokers and

non-smokers — and compares their incidence of lung cancer over time.
Identify the type of study. Is this observational or experimental? Justify
your answer.

Answer 78

Type of Study: Cohort Study (Prospective Study).

Category: Observational Study.

Justification:​
It is Observational because the investigator measures but does not intervene. They allow nature
to take its own course. The researcher did not assign the subjects to smoke or not smoke; the
subjects self-selected their exposure status, and the researcher simply observed the outcome over
time.

Reference: Park's Textbook of Preventive and Social Medicine, 27th Ed, Page 70 & 83, Chapter 3.

79. An urban area experiences a sudden rise in dengue cases during the
monsoon. Identify the probable vector responsible for this outbreak?
Suggest preventive measures at household and community level?

Answer 79

Probable Vector: Aedes aegypti.​

(It is a highly domesticated, urban vector that breeds in artificial containers and population fluctuates
with rainfall).

Preventive Measures:

●​ Household Level:
1.​ Source Reduction: Cover stored water containers; empty coolers, flower vases, and
buckets; dispose of discarded tins/tyres.
2.​ Personal Protection: Wear full-sleeve clothes, use mosquito repellents/coils/mats,
and use bed nets (for infants/day sleepers).
●​ Community Level:
1.​ Anti-Larval: Application of larvicides (e.g., Temephos) in water bodies. Biological
control (fish).
 2.​ Anti-Adult: Space spraying/fogging during outbreaks.
3.​ Health Education: Social mobilization to keep the environment clean and eliminate
breeding sites.
4.​ Dry Day: Observance of weekly dry day.

Reference: Park's Textbook of Preventive and Social Medicine, 27th Ed, Pages 290 and 298-299,
Chapter 5.

80. A team gives half the school children vitamin A capsules and keeps the
other half as control to study its effect on night blindness. Identify the type
of study. Why is this not observational? What precautions are needed to
ensure validity?

Answer 80

Type of Study: Community Trial (Community Intervention Study) or Field Trial (depending on if
randomized by individual or school). Generally, if schools are assigned, it's a Community Trial.

Why Not Observational:​

It is not observational because the investigator actively intervenes or manipulates the conditions
(giving Vitamin A) rather than allowing nature to take its own course.

Precautions for Validity:

1.​ Randomization: Random allocation of children/schools to study and control groups to

ensure comparability.
2.​ Control Group: Must be similar to the experimental group.
3.​ Blinding: Use of placebo and blinding (Single/Double) to reduce subject and observer bias.
4.​ Protocol: Strict adherence to a protocol.

Reference: Park's Textbook of Preventive and Social Medicine, 27th Ed, Pages 70, 88-89, Chapter
3.

82. During an outbreak of gastroenteritis, an investigator studies food

history of affected and unaffected persons to identify the cause. Which
epidemiological method is used? Is it observational or experimental? What
is the justification for choosing this design?

Answer 82

Method: Case Control Study.​

(Comparing food history of "affected" [Cases] vs "unaffected" [Controls]).

Type: Observational Study.

Justification:

1.​ Retrospective Nature: The disease has already occurred, and the investigator is looking
backward (retrospectively) from effect (gastroenteritis) to cause (food).
2.​ Efficiency: It is rapid, inexpensive, and easy to carry out during an outbreak investigation to
quickly identify the source.
3.​ Comparison: It uses a control group to support or refute the inference.

Reference: Park's Textbook of Preventive and Social Medicine, 27th Ed, Page 79, Chapter 3.

86. Same as Question 44.

88. A public health researcher wants to study the effect of smoking on the
development of COPD. She follows 1000 smokers and 1000 non-smokers
over 10 years. What type of analytical study is being conducted? What are
the advantages and limitations of this study?

Answer 88

Type of Study: Prospective Cohort Study.

Advantages:

1.​ Incidence: Incidence can be calculated.

 2.​ Multiple Outcomes: Several possible outcomes related to exposure can be studied
simultaneously.
3.​ Direct Estimate of Risk: Provides a direct estimate of Relative Risk.
4.​ Bias Reduction: Dose-response ratios can be calculated, and certain biases (like recall
bias) are minimized.

Limitations (Disadvantages):

1.​ Time and Cost: It takes a long time to complete and is expensive.
2.​ Attrition: Loss of follow-up is inevitable/possible.
3.​ Sample Size: Involves a large number of people.
4.​ Behaviour Change: The study itself may alter people's behaviour.

Reference: Park's Textbook of Preventive and Social Medicine, 27th Ed, Page 87, Chapter 3.

91. What do you mean by iceberg phenomenon of disease? Provide two

examples of diseases where the iceberg phenomenon is particularly
relevant. Explain the implications of this concept for planning health
services.

Answer 91

Meaning:​
Disease in a community may be compared with an iceberg.

●​ Floating Tip: Represents what the physician sees in the community (clinical cases).
●​ Submerged Portion: Represents the hidden mass of disease (latent, inapparent,
presymptomatic, undiagnosed cases and carriers).
●​ Waterline: Represents the demarcation between apparent and inapparent disease.

Examples:

1.​ Hypertension
2.​ Diabetes
3.​ (Others: Anaemia, Malnutrition, Mental illness)

Implications for Planning Health Services:

 ●​ The hidden part of the iceberg constitutes an important, undiagnosed reservoir of infection or
disease.
●​ Clinicians/Planners usually see only the tip; relying only on hospital data gives a false
impression of the disease load.
●​ Active case detection (Screening) and surveillance are required to assess the true burden
and allocate resources effectively for control.

Reference: Park's Textbook of Preventive and Social Medicine, 27th Ed, Page 46, Chapter 2.

94. During the COVID-19 pandemic, a confirmed positive patient was

admitted to a hospital ward, while his family members were asked to stay at
home for 14 days under supervision. Identify the public health measures
applied to the patient and to the family members. Explain the purpose of
each measure.

Answer 94

Measure applied to Patient: Isolation.

●​ Purpose: To prevent the transfer of infection from the reservoir (patient) to possible
susceptible hosts. It stops the spread of the virus to the community.

Measure applied to Family Members: Quarantine.

●​ Purpose: To limit the freedom of movement of well persons exposed to communicable

disease for a period not longer than the longest usual incubation period (14 days for
COVID-19). This prevents effective contact with those not so exposed, in case the family
members become infectious during the incubation period.

Reference: Park's Textbook of Preventive and Social Medicine, 27th Ed, Page 133
(Isolation/Quarantine definitions) & Page 192 (COVID specific), Chapter 5.

109. Same as Question 30.

111. Same as Question 23.