🌍 COMMUNITY MEDICINE — 16 17 Aug 2024
1 ⃣ Levels of Prevention
Level Definition Example
Primordial Prevent development of risk factors Health education, promoting
healthy diet/lifestyle in children
Primary Prevent disease before occurrence Vaccination, reducing salt intake,
exercise programs
Secondary Detect disease early and treat Screening for diabetes,
hypertension, breast or cervical cancer
Tertiary Limit complications in established disease Rehabilitation after
stroke, diabetic foot care
💡 Exam tip:
If question says “screening” → secondary,
“campaign or health education” → primary,
“rehabilitation” → tertiary.
---
2 ⃣ Epidemiology — Definitions & Concepts
1
Incidence:
→ Number of new cases in a population over a period of time.
Useful to study risk or causation.
Prevalence:
→ All existing cases at a given time.
Useful to study burden of disease.
Case Fatality Rate (CFR):
→ Proportion of deaths among diagnosed cases.
Attack Rate:
→ Used during outbreaks (no. of new cases ÷ exposed population).
---
3 ⃣ Screening Programs
Definition: Early detection of disease among apparently healthy people.
Examples:
Pap smear → cervical cancer.
Mammography → breast cancer.
2
Fasting glucose → diabetes.
BP check → hypertension.
Types of Screening:
Type Description
Mass Entire population (e.g., newborn screening for hypothyroidism)
Selective High-risk groups only
Multiphasic Multiple tests at once (CBC + urine + ECG)
Opportunistic During routine visit (check BP, glucose)
Good Screening Test Criteria:
Simple, cheap, acceptable, sensitive, specific.
---
4 ⃣ Surveillance
Definition: Continuous systematic collection, analysis, and interpretation of
health data for planning and action.
3
Types:
Active: Health workers search for cases.
Passive: Routine reports from health facilities.
Sentinel: Selected sites used to monitor trends (e.g., influenza centers).
Purpose:
Early outbreak detection, monitoring control programs, evaluate
interventions.
---
5 ⃣ Epidemiologic Study Designs
Study Type Direction Example Use
Descriptive None Case report, survey Describe distribution
Analytical – Case-Control Retrospective Compare exposure in cases vs
controls Rare diseases
Analytical – Cohort Prospective Follow exposed vs non-exposed Risk factors
Experimental (RCT) Interventional New drug/vaccine trials Causality
4
Mnemonic: “Case-control = Rare diseases, Cohort = Rare exposures.”
---
6 ⃣ Measures of Association
Relative Risk (RR):
= Incidence in exposed / incidence in non-exposed.
Used in cohort studies.
Odds Ratio (OR):
= Odds of exposure in cases / controls.
Used in case-control studies.
Interpretation:
RR or OR = 1 → no association; >1 → positive association; <1 → protective
factor.
---
7 ⃣ Outbreak Investigation Steps
5
1. Verify diagnosis.
2. Confirm existence of outbreak.
3. Define cases and collect data.
4. Analyze data (time, place, person).
5. Formulate hypothesis.
6. Implement control measures.
7. Report findings.
Epidemic curve:
Helps identify type of outbreak (common source vs propagated).
6
---
8 ⃣ Immunization & Vaccines
Types of Immunity:
Active: Body produces antibodies (infection or vaccine).
Passive: Preformed antibodies (maternal or immunoglobulin).
Live vaccines: MMR, OPV, BCG, Yellow fever.
Killed vaccines: IPV, Hepatitis B, Rabies.
Cold Chain: 2–8°C for vaccine preservation (Refrigerator, Ice-lined).
Contraindications for live vaccines: Immunodeficiency, pregnancy (except
smallpox).
---
9 ⃣ Maternal & Child Health (MCH)
Antenatal Care:
7
Minimum 4 visits recommended.
Early booking (<12 weeks).
Iron + folic acid supplementation.
Tetanus toxoid vaccination.
Indicators of MCH:
MMR (Maternal Mortality Ratio).
IMR (Infant Mortality Rate).
Under-5 mortality.
Crude Birth/Death Rates.
---
🔟 Family Planning & Fertility
Goal: Control fertility, improve maternal & child health.
8
Methods:
Temporary: Condoms, pills, IUCD, injectables.
Permanent: Tubectomy, vasectomy.
Determinants of Low Fertility:
Female education, delayed marriage, use of contraception, urbanization.
Natural Methods: Rhythm, lactational amenorrhea (LAM effective ≤6 months
if exclusive breastfeeding).
---
11 ⃣ Nutrition & Deficiency Disorders
Nutrient Deficiency Manifestation
Vitamin A Xerophthalmia Night blindness
Vitamin D Deficiency Rickets, osteomalacia
Iron Anemia Pallor, fatigue
9
Iodine Goiter Hypothyroidism, cretinism
Prevention:
Food fortification (iodized salt), supplementation programs, dietary
education.
---
12 ⃣ Water-Borne & Vector-Borne Diseases
Water-borne: Cholera, typhoid, hepatitis A, dysentery.
→ Prevention: Safe water, chlorination, sanitation, hygiene.
Vector-borne: Malaria, dengue, filariasis.
→ Prevention: Insecticide-treated nets, environmental control,
chemoprophylaxis.
Dengue vector: Aedes aegypti (day-biting, clean water).
---
13 ⃣ Health Education & Communication
Aims:
10
Increase knowledge, change behavior, promote health.
Principles:
Interest, motivation, participation, comprehension, feedback.
Methods:
Individual: Counseling, home visit.
Group: Lectures, discussions.
Mass: Media, posters, campaigns.
Stages of Behavior Change: Knowledge → Attitude → Practice (KAP model).
---
14 ⃣ Occupational Health
Common Hazards:
Physical (noise, heat, radiation).
Chemical (toxins, gases).
11
Biological (infections).
Ergonomic (posture).
Psychological (stress, fatigue).
Common Diseases:
Silicosis (stone cutting).
Byssinosis (cotton).
Noise-induced deafness.
Occupational dermatitis.
Prevention: Personal protection, ventilation, periodic medical check-up.
---
15 ⃣ Health Indicators
12
Indicator Formula / Meaning
IMR Infant deaths <1 year ÷ live births × 1000
MMR Maternal deaths ÷ live births × 100,000
CBR Live births ÷ population × 1000
CDR Deaths ÷ population × 1000
Life expectancy Average years a newborn is expected to live
Most sensitive indicator of community health: Infant Mortality Rate.
---
16 ⃣ Environmental & Sanitation Topics
Safe Water:
40–20 liters/person/day minimum.
Residual chlorine 0.5 mg/L at point of use.
Coliform count = 0/100 mL (drinking water).
Waste Disposal:
13
Sanitary landfill (solid waste).
Sewage treatment (liquid waste).
Incineration (infectious hospital waste).
Vector control: Drainage, insecticides, larvicides, biological control (fish).
---
17 ⃣ Epidemiologic Transition
Definition: Shift from communicable → non-communicable diseases as
societies develop.
Stages:
1. Pestilence & famine (infectious).
2. Receding pandemics.
14
3. Degenerative & man-made diseases.
4. Lifestyle diseases (CVD, cancer).
🏥 6. Community Medicine 2025
🔹 Outbreak Investigation
Outbreak starts with 1 confirmed case.
Use mapping and survey to confirm spread.
---
🔹 Epidemiology
Incidence: New cases only.
Prevalence: All existing cases (old + new).
Case control study: Used for rare diseases.
15
---
🔹 Public Health
PHC (Primary Health Care): Focus on health education + early treatment.
Vaccination: Best method to prevent communicable diseases.
Environmental sanitation: Prevents water-borne diseases.
Infant mortality in developing countries: Mainly due to infections and
malnutrition.
16