PSM DEFINITIONS

MAN AND MEDICINE

TOWARDS HEALTH FOR ALL

1) PREVENTIVE MEDICINE
Preventive medicine is applied to ‘healthy people,
customarily by action affecting large number of population. Its
primary objective is prevention of disease and promotion of health.

2)SOCIAL MEDICINE
Social medicine is the study of men as a social
being in his total environment. Its focus is on the health of the
community as a whole.

3)FAMILY MEDICINE
A field of medicine which is neither disease nor
organ oriented. It is family oriented medicine or health care centred
on the family as the unit- from first contact to the ongoing care of
chronic problem.

4)COMMUNITY MEDICINE
It is successor of what was previously
known as public health, community health, preventive and social
medicine. All these have common ground i.e., prevention of disease
and promotion of health.

CONCEPT OF HEALTH AND DISEASE

1)HEALTH
Health is a state of complete physical, mental and social
well being and not merely an absence of disease or infirmity and the
ability to lead a “socially and economically productive life”.

2)POSITIVE HEALTH
The state of positive health implies the notion of
“perfect functioning “ of the body and mind. It conceptualizes health
biologically – as a state in which every cell and every organ is functioning at
optimum capacity and in perfect harmony with the rest of the body.
Psychologically – as a state in which the individual feels a sense of perfect well
being and of mastery over this environment. Socially – as a state in which the
individual’s capacities for participation in the social system are
optimal.

3)STANDARD OF LIVING
By WHO- income and occupation,
standard of housing, sanitation and nutrition, the level of provision of
health, education, recreational and other services may all be used
individually as measures of social-economic status, and collectively as
an index of the standard of living.

4)QUALITY OF LIFE-
By WHO- the condition of life resulting from
the combination of the effects of the complete range of factors such
as those determining health, happiness, education, social and
intellectual attainment, freedom of action, justice and freedom of
expression. The product of the interplay between social, health,
economic and environmental conditions which affect human and
social development

5)PRIMARY HEALTH CARE-

Essential health care based on practical,
scientifically sound and socially acceptable methods and accessible
to individual and families in the community through their full
participation and at a cost that the community and the country can
afford to maintain at every stage of their development in the spirit of
self determination.

6)DISEASE ELIMINATION –
The term “Elimination” is used to describe
interruption of transmission of disease.
7)DISEASE ERADICATION –
Means to “tear out of roots”. Eradication of disease implies
termination of all transmission of infection by termination of the infectious
agent.

8)Surveillance
Continuous analysis, interpretation, and feedback of
systematically collected data, generally using methods
distinguished by their practicality, uniformity, and
rapidity rather than by accuracy or completeness. By
observing trends in time, place, and persons, changes
can be observed or anticipated and appropriate action,
including investigative or control measures, can be
taken. Sources of data may relate directly to disease or
to factors influencing disease. Thus they may include
mortality and morbidity reports based on death
certificates, hospital records, general practice sentinels,
or notifications; laboratory diagnosis; outbreak reports;
vaccine uptake and side effects; sickness absence
records; changes in disease agents, vectors, or
reservoirs; serological surveillance through serum
banks. The latter can also be seen as an example of
biological monitoring

9)Sentinel surveillance
No routine notification system can identify all cases of
infection or disease. A method for identifying the
missing cases and thereby supplementing the notified
cases is required. This is known as "sentinel
surveillance."
10)Primary prevention
Primary prevention can be defined as "action taken
prior to the onset of disease, which removes the
possibility that a disease will ever occur''. It signifies
intervention in the pre-pathogenesis phase of a disease
or health problem (e.g., low birth weight) or other
departure from health

11)Secondary prevention
Secondary prevention can be defined as "action which
halts the progress of a disease at its incipient stage and
prevents complications". The specific interventions are
early diagnosis (e.g., screening tests, case finding
programmes) and adequate treatment. By early
diagnosis and adequate treatment, secondary
prevention attempts to arrest the disease process;
restore health by seeking out unrecognized disease and
treating it before irreversible pathological changes
have taken place; and reverse communicability of
infectious diseases.

12)Health protection
The term "health protection" which is quite often used,
is not synonymous with specific protection. Health
protection is defined as "The provision of conditions for
normal mental and physical functioning of the human
being individually and in the group. It includes the
promotion of health, the prevention of sickness and
curative and restorative medicine in all its aspects".
13)Impairment :
An impairment is defined as "any loss or abnormality of
psychological, physiological or anatomical structure or
function". e.g., loss of foot, defective vision or mental
retardation. An impairment may be visible or invisible,
temporary or permanent, progressive or regressive.
Further, one impairment may lead to the development
of "secondary" impairments as in the case of leprosy
where damage to nerves (primary impairment) may
lead to plantar ulcers (secondary impairment) .

14)Disability :
Because of an impairment, the affected person may be
unable to carry out certain activities considered normal
for his age, sex, etc. This inability to carry out certain
activities is termed "disability". A disability has been
defined as ''any restriction or lack of ability to perform
an activity in the manner or within the range
considered normal for a human being".

15)Handicap :
As a result of disability, the person experiences certain
disadvantages in life and is not able to discharge the
obligations required of him and play the role expected
of him in the society. This is termed "handicap~, and is
defined as "a disadvantage for a given individual,
resulting from an impairment or a disability, that limits
or prevents the fulfilment of a role that is normal
(depending on age, sex, and social and cultural factors)
for that individual"

16)Disability prevention
Another concept is "disability prevention". It relates to
all the levels of prevention: (a ) reducing the
occurrence of impairment, viz. immunization against
polio (primary prevention): (b) disability limitation by
appropriate treatment (secondary prevention); and. (c)
preventing the transition of disability into handicap
(tertiary prevention)

17)Rehabilitation
Rehabilitation has been defined as "the combined and
coordinated use of medical, social, educational and
vocational measures for training and retraining the
individual to the highest possible level of functional
ability". It includes all measures aimed at reducing the
impact of disabling and handicapping conditions and at
enabling the disabled and handicapped to achieve
social integration. Social integration has been defined
as the active participation of disabled and handicapped
people in the mainstream of community life.

18)Hygiene
"the science of health and embraces all factors
which contribute to healthful living".

19)Public health
 "the science and art of preventing disease,
prolonging life, and promoting health and efficiency
through organized community efforts for the sanitation
of the environment, the control of communicable
infections, the education of the individual in personal
hygiene, the organization of medical and nursing
services for early diagnosis and preventive treatment of
disease, and the development of socio-machinery to
ensure for every individual a standard of living adequate
for the maintenance of health, so organizing these
benefits as to enable every citizen to realize his birth
right of health and longevity"

20)Health for All

"the organized application of local, state,
national and international resources to achieve "Health
for All", i.e., attainment by all people of the world by the
year 2000 of a level of health that will permit them to
lead a socially and economically productive life".

PRINCIPLES OF EPIDEMIOLOGY AND EPIDEMIOLOGIC

METHODS

1)Epidemiology
 "The study of the occurrence and distribution of
health- related events, states, and processes in
specified populations, including the study of the
determinants influencing such processes, and the
application of this knowledge to control relevant health
problems."

2)Crude death rate

The simplest measure of mortality is the 'crude
death rate' . It is defined as "the number of deaths
(from all causes) per 1000 estimated mid-year
population in one year, in a given place". It measures
the rate at which deaths are occurring from various
causes in a given population, during a specified period.

3)INCIDENCE
Incidence rate is defined as "the
number of NEW cases occurring in a defined
population during a specified period of time"

4)PREVALENCE
The term "disease prevalence" refers
specifically to all current cases (old and new) existing
at a given point in time, or over a period of time in a
given population. A broader definition of prevalence is
as follows: "the total number of all individuals who have
an attribute or disease at a particular time (or during a
particular period) divided by the population at risk of
having the attribute or disease at this point in time or
midway through the period (2)"

5)Association
Association may be defined as the
concurrence of two variables more often than would be
expected by chance. In other words, events are said to
be associated when they occur more frequently
together than one would expect by chance. Association
does not necessarily imply a causal relationship.

6)EPIDEMIC
The occurrence in a community or region of
cases of an illness, specific health- related behaviour,
or other health-related events clearly in excess of
normal expectancy.

7)ENDEMIC
It refers to the constant presence of a
disease or infectious agent within a given
geographic area or population group, without
importation from outside; may also refer to the
"usual" or expected frequency of the disease
within such area or population group. For
instance, common cold is endemic because
somebody always has one. e.g., hepatitis A, typhoid
fever).
8) HYPERENDEMIC
The term "hyperendemic" expresses that the disease is
constantly present at a high incidence and/or prevalence rate
and affects all age groups equally; . and the term
"holoendemic" a high level of infection beginning early in life
and affecting most of the child population, leading to a state of
equilibrium such that the adult population shows evidence of
the disease much less commonly than do the children, as in the
case of malaria

9)SPORADIC
The word sporadic means scattered about. The cases
occur irregularly, haphazardly from time to time, and
generally infrequently. The cases are so few and
separated widely in space and time that they show little
or no connection with each other nor a recognizable
common source of infection, e.g., tetanus, herpes-
zoster and meningococcal meningitis. A sporadic
disease may be the starting point of an epidemic when
conditions are favourable for its spread. Many zoonotic
diseases are characterised by sporadic transmission to
man.

10)PANDEMIC
An epidemic occurring over a very wide area, crossing
international boundaries, and usually affecting a large
number of people. Only some pandemics cause severe
disease in some individuals or at a population level.
Characteristics of an infectious agent influencing the
causation of a pandemic include : the agent must be
able to infect humans, to cause disease in humans and
to spread easily from human to human. Examples are
influenza pandemics and cholera pandemics.

11)ERADICATION
Termination of all transmission of infection by
extermination of the infectious agent through
surveillance and containment. Eradication is an
absolute process, an "all or none" phenomenon,
restricted to termination of an infection from the whole
world. It implies that disease will no longer occur in a
population. To-date, only one disease has been
eradicated, that is smallpox.

12)ELIMINATION
Elimination is sometimes used to describe
"eradication" of disease (e.g., measles) from a large
geographic region or political jurisdiction. In the state of
our present knowledge, diseases which are amenable
to eradication are measles, diphtheria, polio and guinea
worm

13)CASE
A case is defined as "a person in the population or
study group identified as having the particular disease,
health disorder or condition under investigation". A
variety of criteria (e.g., clinical, biochemical, laboratory
registries and notifications, abstracts of clinical records,
surveys of the general population, population screening
and reporting of defects etc.) may be used to identify
cases. Broadly, the presence of infection in a host may
be clinical, subclinical or latent. These variations in the
manifestations of disease are referred to as "spectrum
of disease" or "gradient of infection"

In epidemiological terminology, the term primary case

refers to the first case of a communicable disease
introduced into the population unit being studied. The
term index case refers to the first case to come to the
attention of the investigator; it is not always the
primary case. Secondary cases are those developing
from contact with primary case. A suspect case is an
individual (or a group of individuals) who has all of the
signs and symptoms of a disease or condition, yet has
not been diagnosed as having the disease or had the
cause of the symptoms connected to the suspected
pathogen.

14)Generation time
Another concept in infectious disease epidemiology is
"generation time". It is defined as "the interval of time
between receipt of infection by a host and maximal
infectivity of that host"

In general, generation time is roughly equal to the

incubation period. However, these two terms are not
the same. The time of maximum communicability may
precede or follow the incubation period. For example, in
mumps, communicability appears to reach its height
about 48 hours before the onset of swelling of the
salivary glands

15)Communicable period
The communicable period is defined as "the time
during which an infectious agent may be transferred
directly or indirectly from an infected person to another
person, from an infected animal to man, or from an
infected person to an animal, including arthropods".

16)Secondary attack rate

Secondary attack rate (SAR) is defined as "the number
of exposed persons developing the disease within the
range of the incubation period, following exposure to
the primary case"

17)QUARANTINE

Quarantine has been defined as “the limitation of

freedom of movement of such well persons or domestic animals
exposed to communicable disease for a period of time
not longer than the longest usual incubation period of
the disease, in such manner as to prevent effective
contact with those not so exposed”.

18)ISOLATION
Isolation is the oldest communicable disease control
measure. It is defined as "separation, for the period of
communicability of infected persons or animals from
others in such places and under such conditions, as to
prevent or limit the direct or indirect transmission of
the infectious agent from those infected to those who
are susceptible, or who may spread the agent to others "

19)Point prevalence
Point prevalence of a disease is defined as the number
of all current cases (old and new) of a disease at one
point of time, in relation to a defined population. The
"point" in point prevalence, may for all practical
purposes consist of a day, several days, or even a few
weeks, depending upon the time it takes to examine
the population sample

20)Period prevalence
A less commonly used measure of prevalence is period
prevalence. It measures the frequency of all current
cases (old and new) existing during a defined period of
time (e.g., annual prevalence) expressed in relation to
a defined population. It includes cases arising before
but extending into or through to the year as well as
those cases arising during the year
21)Disinfectant:

Usually a chemical agent (but sometimes a physical agent) that

destroys disease causing pathogens or other harmful microorganisms
but might not kill bacterial spores. It refers to substances applied to
inanimate objects.

22)Disinfection :

Thermal or chemical destruction of pathogen and other types of

microorganisms. Disinfection is less lethal than sterilization because it
destroys most recognized pathogenic microorganisms but not
necessarily all microbial forms (e.g., bacterial spores)

23)Sterilization:

Validated process used to render a product free of all forms of viable

microorganisms including bacterial spores. Sterilizer is the apparatus
used to sterilize medical devices, equipment or supplies by direct
exposure to the sterilizing agent.

24)Antiseptic:

Substance that prevents or arrests the growth or action of micro-

organisms by inhibiting their activity or by destroying them. The term
is used especially for preparations applied topically to living tissue

25)Asepsis:

Prevention of contact with micro-organism.

26)Sanitizer

Agent that reduces the number of bacterial contaminants to safe

levels as judged by public health requirements. Commonly used with
substances applied to inanimate objects.

27)Sterile:

State of being free from all living micro- organisms.

28)Germicide:
Agent that destroys micro-organisms, especially pathogenic
organisms.

29)Detergent

Surface cleaning agent that makes no antimicrobial claims on the

label. They comprise a hydrophilic component and a lipophilic
component. It acts by lowering surface tension e.g., soap which
removes bacteria along with dirt.

30)Cleaning:

Removal, usually with detergent and water or enzyme cleaner and

water, of adherent visible soil, blood, protein substances, micro-
organisms and other debris from the surfaces, crevices, serrations,
joints, and lumens of instruments, devices and equipment by a
manual or mechanical process that prepares the items for safe
handling and/or further decontamination.

31)Deodorant :

Deodorant is a substance which suppresses or neutralizes bad odors,

e.g., lime and bleaching powder

32)Emporiatrics :
Emporiatrics is the term coined to describe the science of the health
of travelers.

SCREENING FOR DISEASES

1)Intra-observer variation:If a single observer takes two

measurements (e.g., blood pressure, chest expansion) in the same
subject, at the same time and each time, he obtained a different
result, this is termed as intra-observer or within-observer variation.

2)Inter-observer variation:
This is variation between different observers on the same subject or
material, also known as between-observer variation.

3)Validity (accuracy):
The term validity refers to what extent the test accurately measures
which it purports to measure. In other words, validity expresses the
ability of a test to separate or distinguish those who have the disease
from those who do not. For example, glycosuria is a useful screening
test for diabetes, but a more valid or accurate test is the glucose
tolerance test.
4)Sensitivity :
The term sensitivity was introduced by Yerushalmy (17) in 1940s as a
statistical index of diagnostic accuracy. It has been defined as the
ability of a test to identify correctly all those who have the disease,
that is "true-positive".

5)Specificity:
It is defined as the ability of a test to identify correctly those who do
not have the disease, that is, "true-negatives".

6)False-negatives: The term "false-negative" means that patients

who actually have the disease are told that they do not have the
disease. It amounts to giving them a "false reassurance."

7)False positives: The term "false-positive" means that patients

who do not have the disease are told that they have the disease. In
this case, normal healthy people may be subjected to further
diagnostic tests, at some inconvenience, discomfort, anxiety and
expense- until their freedom from disease is established.

8)Yield: "Yield" is the amount of previously unrecognized disease

that is diagnosed as a result of the screening effort.

EPIDEMIOLOGY OF COMMUNICABLE DISEASE

1)Antigenic shift & Antigenic Drift

When there is a sudden complete or major change, it is called a shift,

and when the antigenic change is gradual over a period, it is called a
drift.
2)Suspected case:

A suspected case of influenza A (H,N₁) 2009 is defined as a person

with acute febrile respiratory illness (fever > 38°C) with onset (a)
within 7 days of close contact with a person who is a confirmed case
of influenza A (HN) 2009 virus infection, or; (b) within 7 days of travel
to areas where there are one or more confirmed cases, or (c) resides
in a community where there are one or more confirmed influenza A
(H,N,) 2009 cases.

3)Confirmed case:
A confirmed case of pandemic influenza
A (H1N1) 2009 virus infection is defined as a person with an
acute febrile respiratory illness with laboratory confirmed
influenza A (H1N1) 2009 virus infection at WHO approved
laboratory
COVID - 19

TB Rx Outcomes for TB patients ( excluding patient

treated for RR-TB or MDR-TB)

- Incidence is defined as the number of new and recurrent (relapse) episodes of TB (all
forms) occurring in a given year.
- Recurrent episodes are defined as a new episode of TB in people who have had TB in
the past and for whom there was bacteriological confirmation of cure and/or
documentation that treatment was completed.
- Prevalence is defined as the number of TB cases (all forms) at a given point in time. It i
the best available practical index to estimate the case load in a community.
- Mortality from TB is defined as the number of deaths caused by TB in HIV-negative
people, according to the latest revision of the International Classification of Diseases
(ICD-10).
- Cured (outcome) - A pulmonary TB patient with bacteriologically confirmed TB at the
beginning of treatment who was smear or culture-negative in the last month of treatmen
and on at least one previous occasion.
- Treatment completed - A TB patient who completed treatment without evidence of failur
BUT with no record to show that sputum smear or culture results in the last month of
treatment and on at least one previous occasion were negative, either because tests
were not done or because results are unavailable.
- Treatment failed - A TB patient whose sputum smear or culture is positive at month 5 or
later during treatment.
4) Lost to follow-up
- A TB patient who did not start treatment or whose treatment was
interrupted for 2 consecutive months or more.

5)Not evaluated
A TB patient for whom no treatment outcome is assigned. This
includes cases "transferred out" to another treatment unit as well as
cases for whom the treatment outcome is unknown to the reporting
unit.

6)Treatment success : The sum of cured and treatment completed.

7)Cohort
A group of patients in whom TB has been diagnosed, and who
were registered for treatment during a specified time period ( eg. the
cohort of new smear - positive cases registered in the calendar year
2011) .

TB Outcomes for RR-TB/MDR/XDR-TB patients

treated using second- line treatments

8)Cured
Treatment completed as recommended by the national
policy without evidence of failure AND three or more
consecutive cultures taken at least 30 days apart are negative
after the intensive phase.

9)Treatment completed
Treatment completed as recommended by the national
policy without evidence of failure BUT no record that three or
more consecutive cultures taken at least 30 days apart are
negative after the intensive phase.

10)Treatment failed - Treatment terminated or need for

permanent regimen change of at least two anti-TB drugs
because of: lack of conversion by the end of the intensive
phase," or bacteriological reversion in the continuation phase
after conversion to negative, or evidence of additional acquired
resistance to fluoroquinolone or second-line injectable drugs, or
adverse drug reactions (ADRs).

11)Died - A patient who dies for any reason during the course
of treatment.

12)Lost to follow-up - A patient whose treatment was

interrupted for 2 consecutive months or more.

13)Malaria control: Reducing the malaria disease

burden to a level at which it is no longer a public health
problem.

14)Malaria elimination: The interruption of local

mosquito- borne malaria transmission; reduction to
'zero' of the incidence of infection caused by human
malaria parasites in a defined geographical area as a
result of deliberate efforts; continued measures to
prevent re-establishment of transmission are required.
Certification of malaria elimination can be granted by
WHO after it has been proven beyond reasonable doubt
that the chain of local human malaria transmission by
Anopheles mosquitoes has been fully interrupted in an
entire country for at least 3 consecutive years.

15)Malaria eradication: Permanent reduction to

'zero' of the worldwide incidence of infection caused by
a specific agent; applies to a particular malaria parasite
species. Intervention measures are no longer needed
once eradication has been achieved.
16)Aedes aegypti index:
This is a house index and is defined as "the percentage of houses and
their premises, in a limited well-defined area, showing actual
breeding of Aedes aegypti larvae .

17)Arthropod borne viruses:

They are defined as viruses "which are maintained in nature
principally, or to an important extent through biological transmission
between susceptible vertebrate hosts by haematophagous
arthropods, they multiply in the tissues of arthropods, and are
passed on to new vertebrates by the bites of arthropod after a period
of extrinsic incubation .

18)Virulence of an organism:
It is related to its ability to produce exotoxin, endotoxin fraction and
many other antigens and toxins.

19)Total flea index:

It is the average number of fleas of all species per rat.

20)Cheopis index:
It is the average number of cheopis per rat. It is a specific flea index.
It is a more significant index than the total flea index. If this index is
more than one, it is regarded as indicative of potential explosiveness
of the situation, should a plague outbreak occur .

21)Specific percentage of fleas:

It is the percentage of different species of fleas that are found on
rats.

22)Burrow index:
It is the average number of free-living fleas per species per rodent
burrow.
23)Wild plague:
Wild plague is defined as "plague existing in nature, independent of
human populations and their activities. The disease spreads among
wild rodents by wild rodent fleas.

24)Domestic plague:
Is defined as "plague that is intimately associated with man and
rodents living with and has a definite potential for producing
epidemics.

25)Natural foci:
It is defined as "a strictly delimited area where ecological conditions
ensure the persistence of the aetiological agent for considerable
periods of time, and where epizootics and periods of quiescence
alternate, without introduction of infection from outside.

26)Bacterial index:
It is the only objective way of monitoring the benefit of treatment.
The Bacteriological (or Bacterial) Index indicates the density of bacilli
in smears and includes both living (solid-staining) and dead

27)Case definition of Kala azar:

A case of kala-azar is defined as a person from an endemic area with
fever of more than 2 weeks duration and with splenomegaly, who is
confirmed by an RDT ( Rapid diagnostic test) or a biopsy.

28) Treatment outcome definitions of Kala azar

a. Cure: a patient is considered clinically cured if he/she has

completed full treatment and there are no signs and symptoms of
kala-azar.
b. Non response: Signs and symptoms persist or recur despite
satisfactory treatment for more than two weeks.
c. Relapse
any reappearance of kala-azar signs and symptoms within a period of
six months after the end of treatment.

e. Final cure:
An initially cured patient who is symptom-free at six months after the
end of treatment.

29)Case definition of PKDL(post Kala azar dermal leishmaniasis)

a. Probable PKDL: a patient from kala-azar endemic area with

multiple hypopigmented macules, papules or nodules, who is
RDT positive.

b. Confirmed PKDL: a patient from kala-azar endemic area with

multiple hypopigmented macules, papules, plaques or nodules,
who is parasite positive in slit- skin smear (SSS) or biopsy.

30)Treatment outcome in PKDL

a. Initial cure: Clinical improvement at the end of treatment -

defined as a considerable reduction in the number and size of
skin lesions.

b. Final cure: Clinical cure 12 months after the end of treatment -

defined as a complete resolution of macules,papules,
plaques,nodules.
 31)Case of leprosy:
A "case" of leprosy is a person showing clinical signs of leprosy
with or without bacteriological confirmation of the diagnosis,
and who has not yet completed a full course of treatment with
MDT. This definition is for estimating the prevalence of leprosy.

Paucibacillary leprosy: A person having 1-5 skin lesions and/or

only one nerve involvement.

Multibacillary leprosy: A person having 6 or more skin lesions

and/or more than one nerve involvement.

32)Adequate treatment: Adequate treatment implies the completion

of a regimen of multidrug therapy within a reasonably short period of
time: (a) for paucibacillary cases, adequate treatment implies that
the patient has received 6 monthly doses of combined therapy within
9 months. (b) for multibacillary cases, adequate treatment implies
that the patient has received 12 monthly doses of combined therapy
within 18 months.

33)Regular treatment:
A patient may be considered to have had regular treatment if
he or she has received MDT for at least two-thirds of the
months in any interval of time. For example, regular treatment
for 12 months, implies that the patient has had at least 8 full
months of combined therapy during that 12-month period.

34)Newly diagnosed case: A person who has been diagnosed

as a leprosy case, and who has not taken MDT in the past.

35)Defaulter case: A defaulter is a leprosy patient on MDT, who

has not collected treatment for 12 consecutive months. Any
patient who has been categorized as a defaulter should be
removed from the register.

36)Relapsed case: A patient whose therapy was terminated,

having successfully completed an adequate course of multidrug
therapy, but who subsequently develops new signs and
symptoms of the disease, either during the surveillance period
or thereafter, is considered to have "relapsed" .

37)Leprareaction : During the course of leprosy,

immunologically mediated episodes of acute or subacute
inflammation known as reactions may occur. Because
peripheral nerve trunks are often involved, unless reactions
promptly are and adequately treated, such episodes can result
in permanent deformities.

Lepra reactions are usually diagnosed by clinical examination

only. Inflammatory changes in skin lesions or appearance of
new lesions, patches or nodules with acute onset, draw the
attention of patient to report. Some cases develop signs of
nerve damage without changes in skin lesions.
 38)Disability: A disability is defined as lack of ability to perform an
activity. A deformity is a visible consequence of an impairment
inside the body.

39)Rehabilitation
The WHO Expert Committee on Leprosy in its Second Report (43)
defined rehabilitation as
"The physical and mental restoration, as far as possible, of all
treated patients to normal activity, so that they may be able to
resume their place in the home, society and industry".

Rehabilitation is, therefore, an integral part of leprosy control. It

must begin as soon as the disease is diagnosed. The cheapest and
surest rehabilitation is to prevent physical deformities and social
and vocational disruption by early diagnosis and adequate
treatment. The measures that are taken in this direction are
known as "preventive rehabilitation". The approach to
rehabilitation should, therefore, begin with preventing
rehabilitation. We should never allow rehabilitation to take place
and afterwards take up the uphill task of rehabilitation.

40)Community-based rehabilitation defined by WHO and major

NGOs is as follows:
"Community-based rehabilitation is a strategy within general
community development for the rehabilitation, equalization of
opportunities and social inclusion of all people with disabilities.
Community-based rehabilitation is implemented through the
combined efforts of the people with disabilities themselves, their
milieus, organizations and communities, and the relevant
governmental and non-governmental health, education,
vocational, social and other services".

41)Definitions for Indicators and formula to be used for their

calculation are indicated below:
 Annual new case detection rate (ANCDR)
Definition: It is the rate at which new cases (never treated before)
are detected in a defined geographical area (block, district) in a
year (April-March).

42)SEXUALLY TRANSMITTED DISEASES

The sexually transmitted diseases (STD) are a group of
communicable diseases that are transmitted predominantly by
sexual contact and caused by a wide range of bacterial, viral,
protozoal and fungal agents and ectoparasites.

 YAWS
Yaws is a chronic contagious non-venereal disease caused by T.
pertenue, usually beginning in early childhood. It resembles
syphilis in its clinical course and is characterized by a primary skin
lesion (mother yaw) followed by a generalized eruption and a late
stage of destructive lesions of the skin and bone. Yaws is also
known as pian, bubas or framboesia.

 AIDS, the acquired immuno-deficiency syndrome (sometimes

called "slim disease")
is a fatal illness caused by a retrovirus known as the human
immuno-deficiency virus (HIV) which breaks down the body's
immune system, leaving the victim vulnerable to a host of life-
threatening opportunistic infections, neurological disorders, or
unusual malignancies (1). Among the special features of HIV
infection are that once infected, it is probable that a person will
be infected for life. Strictly speaking, the term AIDS refers only to
the last stage of the HIV infection. AIDS can be called our modern
pandemic, affecting both industrialized and developing countries.
 AIDS-RELATED COMPLEX
A person with ARC has illnesses caused by damage to the immune
system, but without the opportunistic infections and cancers
associated with AIDS, they may exhibit one or more of the
following clinical signs; unexplained diarrhea lasting longer than a
month, fatigue, malaise, loss of more than 10 per cent body
weight, fever, night sweats, or other milder opportunistic
infections such as oral thrush, generalized lymphadenopathy or
enlarged spleen. Patients from high-risk groups who have two or
more of these manifestations (typically including generalised
lymphadenopathy), and who have a decreased number of T-
helper lymphocytes are considered to have AIDS-related complex.
Some patients with AIDS-related complex, subsequently develop
AIDS .

WHO case definition for AIDS surveillance

For the purposes of AIDS surveillance an adult or adolescent t > 12
years of age) is considered to have AIDS if at least 2 of the following
major signs are present in combination with at least 1 of the minor
signs listed below, and if these signs are not known to be due to a
condition unrelated to HIV infection (20).
43)Emerging diseases

Emerging infectious diseases are those whose incidence in

humans has increased during the last two decades or which
threaten to increase in the near future. The term also refers to
newly-appearing infectious diseases, or diseases that are
spreading to new geographical areas cholera in South America and
yellow fever in Kenya." such as

The diseases in question involve all the major modes of

transmission - they are spread either from person to person, by
insects or animals, or through contaminated water or food. The
most dramatic example of a new disease is COVID-19 in the year
2019. The ongoing COVID-19 pandemic has changed the world.
 The Commission on Chronic Illness in USA has defined "chronic
diseases" as "comprising all impairments or deviations from
normal, which Re-emerging diseases
The term re-emerging diseases refers to the diseases which were
previously easily controlled by chemotherapy and antibiotics, but
now they have developed antimicrobial resistance and are often
appearing in epidemic form.

44)Definition of nosocomial infections

Nosocomial infections, also called "hospital-acquired infections",

are infections acquired during hospital care which are not present
or incubating at admission. Infections occurring more than 48
hours after admission are usually considered nosocomial.
Definitions to identify nosocomial infections have been developed
for specific infection sites (e.g. urinary, pulmonary)
Nosocomial infections may also be considered either endemic or
epidemic. Endemic infections are most common. Epidemic
infections occur during outbreaks, defined as an unusual increase
above the baseline of a specific infection or infecting organism.

 Chronic diseases and conditions have been variously defined. An

EURO symposium in 1957 gave the following definition :
"An impairment of bodily structure and/or function that
necessitates a modification of the patient's normal life and has
persisted over an extended period of time".

have one or more of the following characteristics:

a. are permanent
b. leave residual disability
c. are caused by non-reversible pathological alteration
d. require special training of the patient for rehabilitation e.
may be expected to require a long period of supervision,
observation or care.
 In short, there is no international definition of what duration
should be considered long-term, although many consider that
chronic conditions are generally those, that have had a
duration of at least 3 months. A practical definition should be
established which will suit the particular conditions of the
community.

 Non-communicable diseases (NCDs) include cardiovascular, renal,

nervous and mental diseases, Musculo- skeletal conditions such as
arthritis and allied diseases, chronic non-specific respiratory
diseases (e.g., chronic bronchitis, emphysema, asthma),
permanent results of accidents, senility, blindness, cancer,
diabetes, obesity and various other metabolic and degenerative
diseases and chronic results of communicable diseases. Disorders
of unknown cause and progressive course are often labelled
"degenerative".

45)PHYSICAL ACTIVITY by WHO:

WHO defines physical activity as any bodily movement
produced by skeletal muscles that requires energy expenditure.
Physical activity refers to all movement including during leisure time,
for transport to get to and from places, or as part of a person's work.
Both moderate and vigorous-intensity physical activity improve
health.
 EPIDEMIOLOGY OF NON COMMUNICABLE DISEASE

46) CORONARY HEART DISEASE

Coronary heart disease (syn: ischaemic heart disease)has been
defined as "impairment of heart function due to inadequate blood
flow to the heart compared to its needs, caused by obstructive
changes in the coronary circulation to the heart".

47) STROKE
WHO defined stroke as rapidly developed clinical signs of focal
disturbance of cerebral function; lasting more than 24 hours or
leading. to death, with no apparent cause other than vascular origin"

48)CANCER
Cancer may be regarded as a group of diseases characterized by an (i)
abnormal growth of cells (ii) ability to invade adjacent tissues and
even distant organs, and (iii) the eventual death of the affected
patient if the tumour has progressed beyond that stage when it can
be successfully removed. Cancer can occur at any site or tissue of the
body and may involve any type of cells.

49)RHEUMATIC HEART DISEASE

Rheumatic fever (RF) and rheumatic heart disease (RHD) cannot be
separated from an epidemiological point of view. Rheumatic fever is
a febrile disease affecting connective tissues particularly in the heart
and joints initiated by infection of the throat by group A ẞ haemolytic
streptococci. Although RF is not a communicable disease, it results
from a communicable disease (streptococcal pharyngitis). Rheumatic
fever often leads to RHD which is a crippling disease. The
consequences of RHD include: continuing damage to the heart;
increasing disabilities; repeated hospitalization, and premature death
usually by the age of 35 years or even earlier. RHD is one of the most
readily preventable chronic disease.

50)DIABETES MELLITUS
The term diabetes describes a group of metabolic disorders
characterized and identified by the presence of hyperglycaemia in
the absence of treatment. The heterogeneous aetio-pathology
includes defects in insulin secretion, insulin action, or both, and
disturbances of carbohydrate, fat and protein metabolism.

51)OBESITY
Obesity may be defined as an abnormal growth of the adipose tissue
due to an enlargement of fat cell size (hypertrophic obesity) or an
increase in fat cell number (hyperplastic obesity) or a combination of
both. Obesity is often expressed in terms of body mass index(BMI).

Overweight is usually due to obesity but can arise from other causes
such as abnormal muscle development or fluid retention.

52) BLINDNESS
"visual acuity of less than 3/60 (Snellen) or its equivalent.

53) VISUAL IMPAIRMENT

A)Distance vision impairment:
a)Mild
Presenting visual acuity worse than 6/12
b)Moderate
Presenting visual acuity worse than 6/18
c)Severe
Presenting visual acuity worse than 6/60
d)Blindness
Presenting visual acuity worse than 3/60

B)Near vision impairment:

Presenting near vision acuity worse than N6 or M0.8 at 40 cm with

existing correction.

54) ORAL HEALTH WHO

 "a state of being free from chronic mouth and facial pain, oral and
throat cancer, oral infection and sores, periodontal (gum) disease,

tooth decay, tooth loss, and other diseases and disorders that limit
an individual's capacity in biting, chewing, smiling, speaking, and
psychosocial wellbeing".

55)ACCIDENT :
- Unpremeditated event resulting in recognizable damage. ( WHO
)
- An unexpected unplanned occurrence which may involve injury.
( Park)
56)DROWNING :
- It is the process of accidental respiratory impairment from
submersion/immersion in liquid.

HEALTH PROGRAMMES IN INDIA

57)Reproductive and child health - reproductive and child health

approach has been defined as “people have the ability to reproduce
and regulate their fertility, woman are able to go through pregnancy
and child birth safely, the outcome of pregnancies is successful in
terms of maternal and infant survival and well-being, and couples are
able to have sexual relations, free of fear of pregnancy and of
contracting disease ".
58)Newborn care corner (NBCC)- NBCC is a space within the delivery
room in any health facility where immediate care is provided to all
newborns at birth. This is MANDATORY for all health facilities where
deliveries are conducted.

59)Newborn stabilization Unit (NBSU)- NBSU is a facility within or in

close proximity of the maternity ward where sick and low birth
weight newborns can be cared for during short periods.

60)Special newborn care unit (SNCU)- SNCU is a neonatal unit in the

vicinity of the labor room which is to provide special care (all care
except assisted ventilation and major surgery ) for sick newborns.

DEMOGRAPHY AND FAMILY PLANNING

61)Life expectancy
Life expectancy - or expectation of life - at a given age
is the average number of years which a person of that
age may expect to live, according to the mortality
pattern prevalent in that country.

62)FERTILITY
By fertility is meant the actual bearing of children.
Some demographers prefer to use the word natality in
place of fertility. A woman's reproductive period is
roughly from 15 to 45 years - a period of 30 years.

63)Birth Rate
Birth rate is the simplest indicator of fertility and is
defined as "the number of live births per 1000
estimated mid-year population, in a given year".
64)General Fertility Rate (GFR)
It is the "number of live births per 1000 women in the
reproductive age-group (15-44 or 49 years) in a given
year"

65)General Marital Fertility Rate (GMFR)

It is the "number of live births per 1000 married women
in the reproductive age group (15-44 or 49) in a given
year"

66)Age-specific Fertility Rate (ASFR)

A more precise measure of fertility is age-specific
fertility rate, defined as the "number of live births in a
year to 1000 women in any specified age-group".

67)Age-specific Marital Fertility Rate (ASMFR) : It

is the number of live births in a year to 1000 married
women in any specified age group.

68)Total Fertility Rate (TFR)

Total fertility rate represents the average number of
children a woman would have if she were to pass
through her reproductive years bearing children at the
same rates as the women now in each age group.

69)Total Marital Fertility Rate (MFR)

Average number of children that would be born to a
married woman if she experiences the current fertility
pattern throughout her reproductive span.

70)Gross Reproduction Rate (GRR)

Average number of girls that would be born to a woman
if she experiences the current fertility pattern
throughout her reproductive span (15-44 or 49 years),
assuming no mortality.

71)Net Reproduction Rate (NRR)

Net Reproduction Rate (NRR) is defined as the number
of daughters a new-born girl will bear during her
lifetime assuming fixed age-specific fertility and
mortality rates.

72)Child-woman Ratio
It is the number of children 0-4 years of age per 1000
women of child-bearing age, usually defined as 15-44
or 49 years of age.

73)Pregnancy Rate
It is the ratio of number of pregnancies in a year to
married women in the ages 15-44 (or 49) years. The
"number of pregnancies" includes all pregnancies,
whether these had terminated as live births, stillbirths
or abortions or had not yet terminated.

74)Abortion Rate
The annual number of all types of abortions, usually per
1000 women of child-bearing age (usually defined as
age 15-44)

75)Abortion Ratio
This is calculated by dividing the number of abortions
performed during a particular time period by the
number of live births over the same period

76)Marriage Rate
It is the number of marriages in the year per 1000
population

77)FAMILY PLANNING

There are several definitions of family planning. An

Expert Committee (1971) of the WHO defined family
planning as "a way of thinking and living that is
adopted voluntarily, upon the basis of knowledge,
attitudes and responsible decisions by individuals and
couples, in order to promote the health and welfare of
the family group and thus contribute effectively to the
social development of a country" .
Another Expert Committee defined and described
family planning as follows: Family planning refers to
practices that help individuals or couples to attain
certain objectives :
• to avoid unwanted births;
• to bring about wanted births;
• to regulate the intervals between pregnancies;
• to control the time at which births occur in
relation to the ages of the parent; and
• to determine the number of children in the
family.
78)Eligible couples
An "eligible couple" refers to a currently married couple
wherein the wife is in the reproductive age, which is
generally assumed to lie between the ages of 15 and
45.

79)Target couples
the term target couple was applied to couples who
have had 2-3 living children, and family planning was
largely directed to such couples.
The definition of a target couple has been gradually
enlarged to include families with one child or even
newly married couples with a view to develop
acceptance of the idea of family planning from the
earliest possible stage.
In effect, the term target couple has lost its original
meaning.
The term eligible couple is now more widely used and
has come to stay.

80)Couple protection rate (CPR)

Couple protection rate (CPR) is an indicator of the
prevalence of contraceptive practice in the community.
It is defined as the per cent of eligible couples
effectively protected against childbirth by one or the
other approved methods of family planning, viz.
sterilization, IUD, condom or oral pills.

81)CONTRACEPTIVE METHODS
(Fertility Regulating Methods)

Contraceptive methods are, by definition, preventive

methods to help women avoid unwanted pregnancies.
They include all temporary and permanent measures to
prevent pregnancy resulting from coitus.

82) ABORTION
Abortion is theoretically defined as termination of
pregnancy before the foetus becomes viable (capable
of living independently). This has been fixed
administratively at 28 weeks, when the foetus weighs
approximately 1000 g.

83) Pearl index

Pearl index is defined as the number of "failures per
100 woman-years of exposure (HWY)."

84) EVALUATION OF FAMILY PLANNING

Evaluation is defined as a "process of making

judgements about selected objectives and events by
comparing them with specified value standards for the
purpose of deciding alternative course of action".

PREVENTIVE MEDICINE IN
OBSTETRICS,PAEDIATRICS&GERIATRICS

85)Maternal and child health:

Promotive, preventive, curative and rehabilitative health care for
mothers and children.

86)Antenatal care:
The care provided by skilled health care professionals to pregnant
women and pregnant adolescent girls in order to ensure the best
health conditions for both mother and baby during pregnancy.

87)Domiciliary midwifery service:

Mothers with normal obstetrics history may be advised to have their
own homes, provided the home conditions are satisfactory. In such
cases, the delivery may be conducted by the Health Worker Female
or trained Dai. This is known as “domiciliary midwifery service.”

88)Rooming in:
Keeping the baby’s crib by the side of mother’s bed is called
“rooming-in.”

89)Postnatal care:
Care of mother (and the newborn) after delivery is known as
postnatal care.

90)Torches Infection:
Congenital infections caused by toxoplasmosis, rubella,
human(alpha) herpes virus 1 or 2, human (beta) herpes virus, and
syphilis, is known as torches infection.

91)Preterm babies:
Preterm is defined as babies born alive before 37 weeks of pregnancy
are completed (less than 259 days).

92)Term babies:
Term is defined as babies born from 37 completed weeks to less than
42 completed weeks (259 to 293 days) of gestation.
93)Post term babies:
Post term is defined as babies born at 42 completed weeks or any
time thereafter (294 days and over) of gestation.
94)Small-for-date (SFD) babies:
Also known as small for gestational age. They weigh less than 10th
percentile for gestational age.

95)Kangaroo mother care:

Includes skin-to-skin positioning of a baby on mother’s chest; adequate
nutrition through breast feeding; ambulatory care as a result of early discharge
from hospital; and support for the mother for the mother and her family in
caring for the baby.

96)Growth and development:

Growth is increase in the physical size of the body and development is increase
in skills and functions. Growth and development include physical, intellectual,
emotional and social aspect.

97)Growth chart:
It is a visible display of the child’s physical growth and development.

98)National policy for children:

“It shall be the policy of the state to provide adequate services to children, both
before and after birth and through the period of growth, to ensure their full
physical, mental and social development. The state shall progressively increase
the scope of such services so that, within a reasonable time, all children in the
country enjoy optimum conditions for their balanced growth.”

99)Maternal death:
It is defined as the death of a women while pregnant or within 42 days of
termination of pregnancy, irrespective of the duration and site of pregnancy
from any cause related to or aggravated by the pregnancy or its management
but not from unintentional or incidental causes.

100)Direct obstetric death (direct maternal death):

Those resulting from obstetric complications of pregnant state (pregnancy,
labour and puerperium), from interventions, omissions, incorrect treatment, or
from a chain of events resulting from any of the above.

101)Indirect obstetric deaths (Indirect maternal deaths):

Those resulting from previous existing disease or disease that
developed during pregnancy and which was aggravated by
physiological effects of pregnancy.

102)Late maternal death:

It is “the death of women from direct or indirect obstetric causes,
after more than 42 days but less than one year after termination of
pregnancy.”

103)Maternal mortality ratio (MMR):

Is defined as the number of maternal deaths during a given time
period per 100,000 live births during the same time period.

104)Maternal mortality rate (MMRate):

Is defined and calculated as the number of maternal deaths divided
by person-years lived by women of reproductive age in a population.
The MMRate captures both the risk of maternal death per pregnancy
or per birth (whether live birth or stillbirth), and the level of fertility
in the population.

105)FOETAL DEATH:
Foetal death is death prior to the complete expulsion or extraction
from its mother of a product of conception, irrespective of the
duration of pregnancy; the death is indicated by the fact that after
such separation the foetus does not breathe or show any other
evidence of life, such as beating of the heart, pulsation of the
umbilical cord, or definite movement of voluntary muscles.

106)STILLBIRTH RATE:
"Death of a foetus weighing 1000 g (this is equivalent to 28 weeks of
gestation) or more" occurring during one year in every 1000 total
births (live births plus stillbirths).

107)PERINATAL MORTALITY RATE:

 Late foetal deaths (28 weeks gestation and more)
+ early neonatal death (first week) in one year.
PMR=----------------------------------------------------------------X1000
Live births + late foetal deaths
(28 weeks gestation and more) in the same year.

108)NEONATAL MORTALITY RATE:

The neonatal mortality rate is tabulated as:
Number of deaths of children under
28 days of age in a year
=---------------------------------------------------------------X1000
Total live births in the same year

109)POST-NEONATAL MORTALITY RATE:

Number of deaths of children between 28 days and one year of
the age in a given year to the total number of live births in the same
year; expressed as rate per 1000.

110)INFANT MORTALITY RATE: Number of deaths of children less

than one year of age in a year to the number of live births in the
same year; expresses as rate per 1000 live births

111)1-4 YEAR MORTALITY RATE (CHILD DEATH RATE): Number of

deaths of children aged 1-4 years during a year to total no. of
children aged 1-4 years at middle of the year.

112)CHILD MORTALITY RATE: Number of deaths of children less than

5 years of age in a given year to number of live births in the same
year.

1000 – under 5 mortality rate

113)CHILD SURVIVAL RATE: 10
114)CONGENITAL MALFORMATIONS: Those diseases that are
substantially determined before or during birth and which are in
principle recognizable in early life.

115)HANDICAP: Reduction in a person’s capacity to fulfil a social role

as a consequence of an impairment, inadequate training for the role,
or other circumstances.

116)IMPAIRMENT: Any loss or abnormality of psychological,

physiological, or anatomical structure or function. Impairment is
disturbances at the level of organ and include defects, loss of limb,
organ or other body structure and defects or loss of mental function

117)DISABILITY: Any restriction or lack of ability to perform an

activity in a manner or within the range considered normal for a
human being.

118)SOCIALLY HANDICAPPED CHILD: Child whose opportunities for a

healthy personality development and full unfolding of potentials are
hampered by certain elements in his social environment such as
parental inadequacy, environmental deprivation and emotional
disturbances.

119)JUVENILE DELIQUENCY: The children act, 1960 in India defines

delinquent as “a child who has committed an offence”.
(Juvenile: a boy who has not attained the age of 18 years)

120)BATTERED BABY SYNDROME: a clinical condition in young

children, usually under 3 years of age who have received non-
accidental wholly inexcusable violence or injury on one or more
occasions, including minimal as well as severe fatal trauma, for what
is often the most trivial provocation, by the hand of an adult in a
position of trust, generally apparent, guardian or foster parent. In
addition to physical injury, there may be deprivation of nutrition, care
and affection in circumstances which indicate that such deprivation is
not accidental”.

121)CHILD ABUSE: WHO defines child abuse and child maltreatment

as “all forms of physical and/ or emotional ill-treatment, sexual
abuse, neglect, or negligent treatment or commercial or other
exploitation resulting in actual, or potential harm to the child’s
health, survival, development or dignity in context of relationship of
responsibility, trust or power”.

122)ADOLESCENCE: Term Adolescence has been defined as including

those aged between 10 and 19

123)YOUTH: Age group between 15 and 24

124)YOUNG PEOPLE: Age group between 10 and 24

HEALTH CARE OF THE COMMUNITY

Health care– a multitude of services provided to individuals or

communities by agents of the health services or professions for the
purpose of promoting ,maintaining , monitoring or restoring health

• Medical care- to those personal services that are provided

directly by physicians or rendered as the result of physician’s
instruction.

• Primary care level- first level of contact of individuals, the family

and community with the national health system, where primary
health care is provided.

• Comprehensive health care- by Bhore committee –

• a. provide adequate preventive, curative and promotive health
services

• b. be as close to the beneficiaries as possible

• c. has the widest cooperation between the people ,the service

and the profession

• d. is available to all irrespective of their ability to pay

• e. look after specifically the vulnerable and weaker sections of the

community

• f. create and maintain a healthy environment both in homes as

well as working place
Basic health services- is understood to be a network of coordinated,
peripheral and intermediate health units capable of performing
effectively a selected group of functions essential to the health of an
area and assuring the availability of competent professional and
auxillary personnel to perform these functions

• Health for all- attainment of a level of health that will enable

every individual to lead a socially and economically productive
life.

• Community participation- meaningful involvement of the

community in the planning , implementation and maintenance of
health services besides maximum reliance on local resources such
as manpower, money and materials.

• Intersectoral coordination- 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, communication and
other sector.
• Health manpower- includes both professional and auxillary
health personnel who are needed to provide the health care

NUTRITION AND HEALTH

• Nutrition- as the science of food and its relationship to health .

• Macronutrients- these are proteins, fats and carbohydrates
which are often called “proximate principles” because they form
the main bulk of food.

• Micronutrients- these are vitamins and minerals, that are

required in small amounts which may vary from a fraction of a
milligram to several grams.

• Proteins- are complex organic nitrogenous compounds.

• Essential amino acids- those amino acids that body cannot

synthesize them in amounts corresponding to its needs, and
therefore , they must be obtained from dietary proteins.
Dietary fibre- is the remnants of the edible part of plants and
analogous carbohydrates that are resistant to digestion and
absorption in the human small intestine with complete or partial
fermentation in the human large intestine

• Vitamin A- both a pre-formed vitamin , retinol and a pro-vitamin ,

beta carotene , some of which is converted to retinol in the
intestinal mucosa.
• Vitamin E- a group of closely related and naturally occurring fat
soluble compounds, the tocopherols.
• Vitamin B12- is complex organo-metallic compound with a cobalt
atom.
Trace elements- these are elements required by the body in
quantities of less than a few milligrams per day

Recommended dietary allowance (RDA) -The average daily dietary

nutrient intake level sufficient to meet the nutrient requirement of
nearly all healthy individuals in a particular life stage & gender group.

Estimated average requirement (EAR) - The average daily nutrient

intake level estimated to meet the requirement of half of the healthy
individuals in a particular life stage & gender group

Physical activity ratio(PAR). - It is expressed as the ratio of the energy

cost of an individual activity per minute to the cost of the basal
metabolic rate per minute

Protein Energy ratio. - Energy from protein *100

Total energy in diet

Balanced Diet - It is defined as one which contains a variety of foods

in such quantities and proportions that the need for energy, amino
acids, vitamins, minerals, fats, carbohydrates & other nutrients is
adequately met for maintaining health, vitality, & general well being

Under weight child- child has a weight for age Z score that is at least
2standard deviation (-2SD) below the median
Stunted child- child has a height for age Z score that is atleast 2
standard deviation (-2SD) below the median
Wasted child - child has weight for height Z score that is atleast
2standard deviation (-2SD) below the median
Severe Acute Malnutrition (SAM)- It is defined by 1)very low weight
for height/ length (Z score below -3SD of the median)
2) a mid upper arm circumference <115mm
Or 3)by presence of nutritional oedema

Malnutrition- It is a pathological state resulting from a relative or

absolute deficiency or excess of one or more essential nutrients

Food safety/Food hygiene- Defined as all conditions & measures

that are necessary during the production, processing, storage,
distribution,& preparation of food to ensure that it is safe, sound,
wholesome & fit for human consumption

Pasteurization of milk- It is defined as the heating of milk to such

temperatures & for such periods of time as are required to destroy
any pathogens that may be present while causing minimal changes in
the composition, flavour & nutritative value

MEDICINE AND SOCIAL SCIENCES

Social science -The term "social sciences" refers to a composite of

several disciplines. These disciplines are anthropology, economic,
political science, psychology, sociology etc.

1) The term 'social sciences' is applied to those disciplines which

are committed to the scientific examination of human
behaviour. These are economics, political science, sociology,
social psychology and social anthropology.
 2) The term 'behavioural sciences' is applied to the last three, i.e.,
sociology, social psychology and social anthropology, because
they deal directly with human behaviour.

3) political science is concerned with the study of the system of

laws and institutions which constitute government of whole
societies

4) SOCIAL PSYCHOLOGY
This is branch of psychology. It is concerned with the
psychology of individuals living in human society or groups. The
emphasis is on understanding the basis of perception, thought,
opinion, attitudes, general motivation and learning in
individuals and how these vary in human societies and groups.
In other words, it deals with the effect of social environment on
persons, their attitudes and motivations

6) ANTHROPOLOGY
The word 'anthropology' is derived from the root words,
anthropos meaning man and logos meaning science. It is the
study of the physical, social and cultural history of man.
7) The study of human evolution, racial differences, inheritance of
bodily traits, growth and decay of the human organism is called
physical anthropology.

8)The study of the development and various types of social life is

called social anthropology.

9)The study of the total way of life of contemporary primitive man,

his ways of thinking, feeling and action is called cultural
anthropology.
10). Medical anthropology, deals with the cultural component in the
ecology of health and disease

11). society is a vast network of relationships and compulsions that

propel, direct and constrain man's individual efforts. The character of
society is dynamic; it changes over time and place.

12)The definition accepted by WHO Expert Committee is

"A community is a social group determined by geographical

boundaries and/or common values and interests".

13)SOCIAL STRUCTURE
Social structure refers to the pattern of inter-relations between
persons.

14)SOCIAL INSTITUTIONS
A social institution is an organized complex pattern of behaviour in
which a number of persons participate in order to further group
interest.

15). Socialism -It is a system of production and distribution based on

social ownership for raising the living standard of the working class,
as opposed to capitalism which is based on private ownership of the
means of production and aims at maximum private profit at the
expense of the working class.

16)SOCIALIZATION
"It is the process by which an individual gradually acquires culture
and becomes a member of a social group. Children going to school is
an instance of socialization.

17) culture - it is widely held, that culture stands for the customs,
beliefs, laws, religion and moral precepts, arts and other capabilities
and skills acquired by man as a member of the society.
18)STANDARD OF LIVING
The term "standard of living" refers to the usual scale of our
expenditure, the goods we consume and the services we enjoy. It
includes food, dress, house, amusements and in short the mode of
living.

18)SOCIAL PATHOLOGY
The term "social pathology" is given a restricted interpretation linking
it to poverty, crime, delinquency and vagrancy. In the modern
context, the term is also used to describe the relation between
disease and social conditions

19)CASE STUDY
Case study is a method of exploring and analysing the life of a social
unit be that unit a person, a family, an institution, culture group, or
even an entire community.

20)COMMUNICATION The term "communication" refers to a social

process the flow of information, the circulation of knowledge and
ideas, and the propagation of thoughts.

21)PSYCHOLOGY : Psychology is defined as "the study of human

behaviour - of how people behave and why they behave in just the
way they do".

22)Health behaviour
Health behaviour refers to those activities people undertake to avoid
disease and to detect asymptomatic infections through appropriate
screening tests.
23)MOTIVATION
It is an inner force which drives an individual to a certain action. It
also determines human behaviour. Motivation may be positive
negative.

24) . An attitude has been defined as relatively enduring organization

of beliefs around an object, subject or concept which pre-disposes
one to respond in some preferential manner.

25)OPINIONS AND BELIEFS

Opinions are views held by people on a point of dispute. They are
based on evidence available at the time. Opinions by definition are
temporary, provisional. They can be looked on as beliefs for the time
being. Beliefs, on the other hand are permanent, stable, almost
unchanging. These are usually derived from our parents, grand-
parents, and other people we respect. We accept beliefs, without
trying to prove that they are true.

26)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.
27)HABITS
Habit is an accustomed way of doing things, example in the field of
health is washing one's hands before handling food. It is usual way of
action or an act performed without thinking. Habits are said to have
3 characteristics: (a) they are acquired through repetition (b) they are
automatic, and (c) they can be performed only under similar
circumstances. Habits accumulated through generations emerge as
customs;
28)PERSONALITY
The term "personality" is a key word in psychology. It implies certain
physical and mental traits which are characteristic of a given
individual.

29)INTELLIGENCE
Intelligence is an important aspect of personality. It has not been
satisfactorily defined as yet. The widely accepted definition is that it
is the ability to see meaningful relationships between things. It
includes perceiving, knowing, reasoning and remembering.
Psychologists believe that intelligence results from an interplay
between hereditary and environmental factors.

30)Intelligence Quotient
This is an improvement over the concept of mental age. It is obtained
by dividing the mental age by chronological age, and multiplying by
100.

IQ =Mental age /Chronological age × 100

31)SOCIAL PSYCHOLOGY
Social psychology is an important branch of psychology. It is defined
as the science of behaviour of the individual in society. That is, it
studies the behaviour of the individual in group, crowd, mob,
audience and other social situations. It also studies the attitudes of
the individuals towards cultural and social values.

32) SOCIOLOGY
Sociology is the science of society. It deals with the study of
relationship between human beings, it also deals directly with the
study of human behaviour. Whereas the unit of study of psychology
is the individual, the unit of study of sociology is the group. Sociology
studies man in the context of society and as a part of it

33) Medical sociology is a specialization within the field of sociology.

Its main interest is in the study of health, health behaviour and
medical institutions.

34)The Crowd: When a group of people come together temporarily,

for a short period, motivated by a common interest or curiosity (e.g.,
to witness a football match), it is known as a crowd. The crowd lacks
internal organization and leadership. When the interest is over, the
crowd disperses.

35) The Mob: The mob is essentially a crowd, but has a leader who
forces the members into action. There may be a symbol in the shape
of a flag or slogan. The mob is more emotional than a crowd. Like the
crowd, it is unstable and without internal organization. When the
purpose of the mob is achieved, the group disperses.

36) The Herd: This is also a crowd with a leader. Here the members of
the group have to follow the orders of the leader without question,
e.g., the tourist group under a guide.

37)The Band: It is the most elementary community of a few families

living together. Here the group has organized itself and follows a
pattern of life e.g., gypsies in India.
38)The Village: The village is a small collection of people
permanently settled down in a locality with their homes and cultural
equipment. From time immemorial, the village has constituted a
basic unit in India. According to the 2011 census, there were
6,40,867 villages in India. The average population of a village is
estimated to be 550.. .

39)The Towns and Cities: From a sociological point of view, a city or

town may be defined as a relatively large, dense and permanent
settlement of socially heterogeneous individuals.
39) Socio-economic status has been defined as the position that an
individual or family occupies with reference to the prevailing average
standards of cultural and material possessions, income, and
participation in group activity of the community.

40) OPERATIONAL RESEARCH

The term 'operational research' was coined during the World War II
in connection with the best use of a new invention, the radar. Since
the war, the term has spread rapidly in Britain and America and it has
come to mean today more than the study of the use of new
inventions - the study of the whole systems of services rendered in
industry, administration, education and health services.

SUSTAINABLE DEVELOPMENT GOALS

41)Gross National Income (GNI) Formerly known as GNP or Gross
National Product. It is gross income generated from within the
country as also net income received from abroad. It is expressed
either "at current prices" i.e., at prices prevailing during the period to
which the figure refers, or "at constant prices"; i.e., at prices
prevailing during a fixed base period in the past, irrespective of the
period to which the figures refers.

42)PER CAPITA INCOME

An index of the standard of living of the people is "per capita
income".

43)Gross Domestic Product (GDP)

GDP is gross income generated within a country, i.e., it excludes net
income received from abroad.
44)Net National Product (NNP)
It is the GNP minus the capital we consume (e.g., equipment,
machinery, etc.,) in the production process. In other words, NNP is
the market value of all final goods and services after providing for
depreciation.

45)Net Domestic Product (NDP)

It is the gross domestic product minus the value of depreciation on
fixed assets.

46)GDP at Market Price

It is GDP at factor cost plus indirect taxes minus subsidies.

47)NNP at Market Price

It is NNP at factor cost plus indirect taxes minus subsidies.

48)GNP at Market Price

It is GNP at factor cost plus indirect taxes minus subsidies.

49)Purchasing Power Parity (PPP)

It is defined as the number of units of a country's currency required
to buy the same amount of goods and services in the domestic
market as one dollar would buy in the USA.

50)Gross domestic savings

It is excess of current income over current expenditure.

51). Hunger: distress related to lack of food.

52). Malnutrition: an abnormal physiological condition, typically due

to eating the wrong amount and/or kinds of foods; encompasses
undernutrition and overnutrition.

53,). Undernutrition: deficiencies in energy, protein, and/or

micronutrients.
54) Micronutrient deficiency (also known as hidden hunger): a form
of undernutrition that occurs when intake or absorption of vitamins
and minerals is too low to sustain good health and development in
children and normal physical and mental function in adults. Causes
include poor diet, disease, or increased icronutrient needs not met
during pregnancy and lactation.

55).undernourishment -chronic calorie deficiency, with consumption

of less than 1,800 kilocalories a day, the minimum most people need
to live a healthy, productive life

56) Overnutrition: excess intake of energy or micronutrients.

57) Hidden hunger (micronutrient deficiency) is a form of

undernutrition that occurs when intake and absorption of vitamins
and minerals (such as zinc, iodine, and iron) are too low to sustain
good health and development

58) SOCIAL SECURITY

Social security is defined as "security that society furnishes through
appropriate organization, against certain risks to which its members
are exposed". The risks which social security covers in most countries
are sickness, invalidity, maternity, old age and death. Social security
also includes social insurance and social assistance.
 ENVIRONMENT AND HEALTH

1)Sanitation definition by National Sanitation Foundation of USA:-

'Sanitation is a way of life. It is quality of living that is expressed in
clean home, clean farm, clean business, clean neighborhood and the
clean community. Being a way of life it must come from within the
people; it is nourished by knowledge and grows as an obligation and
an ideal in human relations.'

2)Environmental sanitation define by WHO :-

The control of all those factors in man's physical environment which
exercise or may exercise a deleterious effect on his physical
development, health and survival ".

3)Safe and Wholesome Water defined as

Water that is
a)free from pathogenic agents
b)free from harmful chemical substances;
c) usable for domestic purposes.

4) Shallow wells:- Shallow wells taps subsoil water i.e. the water from
above the first impervious layer in ground.

5)Deep wells :-A deep well is one which taps water from the water
bearing stratum below the first impervious layer in ground .

6)Sanitary Well:- A Sanitary well is one which is properly located,well-

constructed and protected against contamination with a view to yield
a supply of safe water.

7) Breaking point:-
The point at which the chlorine demand of water is met is called the
break point.

8) Tolerable daily intake( TDI):-

The TDI is estimate of the amount of a substance in food or drinking
water, expressed on a body weight basis (mg/kg of body weight), that
can be ingested daily over a lifetime without appreciable health risk.

9)No-observed-adverse-effect level (NOAEL):- The NOAEL is defined

as the highest dose or concentration of a chemical in single study,
found by experiment or observation, that causes no detectable
adverse health effect.

10) Lowest -observed-adverse-effect level(LOAEL):- LOAEL is lowest

observed dose or concentration of a substance at which there is a
detectable adverse health effect.

11) Hardness of water may be defined as the soap destroying power

of water.

12) Comfort zone may be defined as the range of effective

temperature( ETs) over which the majority of adult feel comfortable.

13)Noise is defined as "wrong sound, in wrong place, at the wrong

time."
1) HEAT STROKE : This is attributed to failure of the heat
regulating mechanism. It is characterized by very high body
temperature which may rise to 110OF (43.3 0C) and profound
disturbances including delirium, convulsions and partial or
complete loss Of consciousness. The Skin is dry and hot.
Classically, sweating is absent, but many victims of clear-cut
heat stroke perspire profusely.

2) HEAT HYPERPYREXIA : This is attributed to impaired functioning

of the heat-regulating mechanism but without characteristic
features of heat stroke. It is arbitrarily defined as a temperature
above 106OF It may proceed to heat stroke.

3) HEAT EXHAUSTION : Unlike heat stroke, heat exhaustion is not

because of failure of thermo-regulation. It is a milder illness
than heat stroke and is caused primarily by the imbalance or
inadequate replacement Of water and salts lost in perspiration
due to thermal stress. Heat exhaustion typically occurs after
several days of high temperature. Body temperature may be
normal or moderately elevated, but it is uncommon to exceed
1020F (38.90C)

4) HEAT CRAMPS : Heat cramps occur in persons who are doing

heavy muscular work in high temperature and humidity There
are painful and spasmodic contractions Of the skeletal muscles.
The cause of heat cramps is loss of sodium and chlorides in the
blood.
 HEAT SYNCOPE: In its milder form, the person standing in the sun
becomes pale, his blood pressure fails and he collapses suddenly.
There is practically no rise in body. The condition results from pooling
of blood in lower limbs due to dilatation of blood vessels, with the
result that the amount of blood returning to the heart is reduced,
which in turn is responsible for lowering of blood pressure and lack
of blood supply to the brain.

1) ABSOLUTE HUMIDITY is the weight of water vapour in a unit

volume of air. It is expressed as grammes per kilogram or
grammes per cubic meter of air.

2) RELATIVE HUMIDITY: Relative humidity is the most common

way of describing atmospheric moisture. It does not indicate
the actual amount of water vapor in the air, instead, it tells us
how close the air is to being saturated. The relative humidity
(RH) is the ratio of the amount of water vapor actually in the air
to the maximum amount of water vapor required for saturation
at that particular temperature (and pressure). It is the ratio of
the air’s water vapour content to its capacity.
3) PRECIPITATION -The term precipitation is the collective term
used for rain, snow, hail, dew and frost — that is, all forms of
water precipitated from the atmosphere. It is measured by
raingauges. The rain-gauge prescribed by the Government of
India for use at rainfall measuring stations in India is known as
the “Symon’s Rain-gauge”.

1)
 Overcrowding – Overcrowding refers to the situation in which
more people are living within a single dwelling than there is space
for, so that movement is restricted. privacy secluded, hygiene
impossible. Rest and sleep difficult In general the risks as regards
physical health are clear enough — infectious diseases spread
rapidly under conditions of overcrowding heart is reduced, which
in turn is responsible for lowering of blood pressure and lack of
blood supply to the brain.

HOSPITAL WASTE MANAGEMENT

1) Dumping -Refuse is dumped in low lying areas partly as a method

of reclamation of land but mainly as an easy method of disposal of
dry refuse. As a result of bacterial action, refuse decreases
considerably in volume and is converted gradually into humus.

2)Controlled tipping- Controlled tipping or sanitary landfill is the

most satisfactory method of refuse disposal where suitable land is
available, It differs from ordinary dumping in that the material is
placed in a trench or other prepared area, adequately compacted,
and covered with earth at the end of the working day

3)Composting- Composting is a method Of Combined disposal Of

refuse and nightsoil or sludge. It is a process of nature whereby
organic matter breaks down under bacterial action resulting in the
formation of relatively stable humus-like material, called the compost
which has considerable manurial value for the soil. The principal by-
products are carbon dioxide, water and heat.

4)Bio-medical waste”- means any waste, which is generated during

the diagnosis, treatment or immunization Of human beings or
animals, or in research activities pertaining thereto or in the
production or testing of biologicals.
5)Incineration - Incineration is a high temperature dry oxidation
process, that reduces organic and combustible waste to inorganic
incombustible matter and results in a very significant reduction of
waste-volume and weight. The process is usually selected to treat
wastes that cannot be recycled, reused or disposed off in a land fill
site,

6)Controlled tipping- Controlled tipping or sanitary landfill is the

most satisfactory method of refuse disposal where suitable land is
available, It differs from ordinary dumping in that the material is
placed in a trench or other prepared area, adequately compacted,
and covered with earth at the end of the working day

7)Composting- Composting is a method Of Combined disposal Of

refuse and nightsoil or sludge. It is a process of nature whereby
organic matter breaks down under bacterial action resulting in the
formation of relatively stable humus-like material, called the
compost which has considerable manurial value for the soil. The
principal by-products are carbon dioxide, water and heat.

8)Bio-medical waste”- means any waste, which is generated

during the diagnosis, treatment or immunization Of human beings
or animals, or in research activities pertaining thereto or in the
production or testing of biologicals.

9)Incineration - Incineration is a high temperature dry oxidation

process, that reduces organic and combustible waste to inorganic
incombustible matter and results in a very significant reduction of
waste-volume and weight. The process is usually selected to treat
 wastes that cannot be recycled, reused or disposed off in a land fill
site,

HEALTH INFORMATION SYSTEM

A health information system is defined as: "a mechanism for the

collection, processing, analysis and transmission of information
required for organizing and operating health services, and also for
research and training"

1. A census is defined by the United Nations as "the total process

of collecting, compiling and publishing demographic, economic
and social data pertaining at a specified time or times, to all
persons in a country or delimited territory" .

2. The United Nations defines a vital events registration system as

including "legal registration, statistical recording and reporting
of the occurrence of, and the collection, compilation,
presentation, analysis and distribution of statistics pertaining to
vital events, i.e., live births, deaths, foetal deaths, marriages,
divorces, adoptions, legitimations, recognitions, annulments
and legal separations".

3. Lay reporting is defined as the collection of information, its

use, and its transmission to other levels of the health system by
non-professional health workers.

4. The term record linkage is used to describe the process of

bringing together records relating to one individual (or to one
family), the records originating in different times or places.
5. The range is by far the simplest measure of dispersion. It is
defined as the difference between the highest and lowest
figures in a given sample.

6. The word "average" implies a value in the distribution, around

which the other values are distributed. It gives a mental picture
of the central value.

7. The standard deviation is the most frequently used measure of

deviation. In simple terms, it is defined as "Root - Means -
Square - Deviation." It is denoted by the Greek letter sigma σ or
by the initials S.D.

8. Communication can be regarded as a two-way process of

exchanging or shaping ideas, feelings and information. Broadly
it refers "to the countless ways that humans have of keeping in
touch with one another" .

Persuasion is the art of winning friends and influencing people.

 a) Health education is the translation of what is known
about health, into desirable individual and community
behaviour process. patterns by means of an educational

b) The definition adopted by John M Last is "The process by

which individuals and groups of people learn to behave in
a manner conducive to the promotion, maintenance or
restoration of health

c) Any combination of learning opportunities and teaching

activities designed to facilitate voluntary adaptations of
behaviour that are conducive to health

d) The definition adopted by the National Conference on

Preventive Medicine in USA is "Health education is a
process that informs, motivates and helps people to adopt
and maintain healthy practices and lifestyles, advocates
environmental changes as needed to facilitate this goal
and conducts professional training and research to the
same end

e) Health education is the part of health care that is

concerned with promoting healthy behaviour

12. Alma-Ata Declaration

The dynamic definition of health education is now as follows:
"a process aimed at encouraging people to want to be healthy, to
know how to stay healthy, to do what they can individually and
collectively to maintain health, and to seek help when needed
9. National Health Planning has been defined as "the orderly
process of defining community health problems, identifying
unmet needs and surveying the resources to meet them,
establishing priority goals that are realistic and feasible and
projecting administrative action to accomplish the purpose of
the proposed programme