NEWS

Community Medicine

Community medicine plays a major role in preventive measures of diseases and health hazards in society.

Objectives

The aim of teaching by the department is directed towards the achievement of the goal of “Health for All”. Towards this end, by the completion of his training, the M.B.B.S. student should be :

  1. Aware of the physical, social, psychological, economic and environmental aspects of health and disease.
  2. Able to apply clinical skills to recognise and manage common health problems, including their physical, emotional and social aspects, at the individual and family levels and deal with medical emergencies at the community level.
  3. Able to define and manage the health problems of the community he/she serves. To achieve this, he/she shall learn to :
  4. Organise elementary epidemiological studies to assess the health problems in the area. For this, he should be able to design a study, collect data, analyse it with statistical tests, make a report and be able to participate in a health information system.
  5. Prioritise the most important problems and help formulate a plan of action to manage them under National Health Programme guidelines including population control and family welfare programme. He should be able to assess and allocate resources, and implement and evaluate the programmes.
  6. Demonstrate knowledge of principles of organising prevention and control of communicable and non-communicable diseases.
  7. Organise health care services for special groups like mothers, infants, under-five children and school children.
  8. Organise health care in case of calamities.
  9. Able to work as an effective member of the health team.
  10. Able to coordinate with and supervise other members of the health team and maintain liaison with other agencies.
  11. Able to plan and implement health education programmes. Able to perform administrative functions of health centres.
  12. Able to promote community participation, especially in areas of disease control, health education and implementation of national programmes.
  13. ware of the national priorities and the goals to be achieved to implement primary health care.

Course Contents

  1. Concepts in Health
  1. Definition of health; appreciation of health as a relative concept; determinants of health.
  2. Characteristics of agent, host and environmental factors in health and disease and the multifactorial aetiology of disease.
  3. Various levels of prevention with appropriate examples.
  4. Indices used in the measurement of health.
  5. The health situation in India: demography, mortality and morbidity profile and the existing facilities in health services.
  6. Difficulties in the measurement of health.
  1. EPIDEMIOLOGY
  1. Use of basic epidemiological tools to make a community diagnosis of the health situation in order to formulate appropriate intervention measures.
  2. Epidemiology: definition, concept and role in health and disease.
  3. Definition of the terms used in describing disease, transmission and control.
  4. Natural history of disease and its application in planning intervention.
  5. Modes of transmission and measures for prevention and control of the communicable and non-communicable disease.
  6. Principal sources of epidemiological data.
  7. Definition, calculation and interpretation of the measures of frequency of diseases and mortality.
  8. Common sampling techniques, simple statistical methods for the analysis, interpretation and presentation of data, frequency distribution, measures of central tendency, and measures of variability.
  9. Need and uses of screening tests.
  10. Accuracy and clinical value of diagnostic and screening tests (sensitivity, specificity, predictive values).
  11. Planning, collecting, analysing and interpreting data to reach a community diagnosis. Planning an intervention programme with community participation based on the community diagnosis.
  12. Epidemiology of communicable and non-communicable diseases of public health importance and their control.
  13. Epidemiological basis of national health programmes.
  14. Awareness of programmes for control of non-communicable diseases.
    1. Planning and investigation of an epidemic of a communicable disease in a community setting.
    2. Institution of control measures and evaluation of the effectiveness of these measures.
  2. Various types of epidemiological study designs.
  3. Application of computers in epidemiology.

III. BIOSTATISTICS

  1. The scope and uses of biostatistics.
    • Collection, classification and presentation of statistical data.
    1.  
  2. Analysis and interpretation of data.
  1. Obtaining information, computing indices (rates and ratios) and making comparisons.
  2. Apply statistical methods in designing studies.
      1. Choosing appropriate controls.
      2. Applying the test of significance.
      3. Use of statistical tables.
  1. ENTOMOLOGY
  1. Role of vectors in the causation of diseases.
  2. Steps of management of a case of insecticide toxicity.
  3. Identifying features of and mode of transmission of vector-borne diseases.
  4. Methods of vector control with advantages and limitations of each.
  5. Mode of action, dose and application cycle of community-used insecticides.
  1. ENVIRONMENTAL SANITATION
    1. Concept of safe and wholesome water.
    2. Requirement of sanitary sources of water.
    3. Methods of purification of water with stress on chlorination of water-large scale and small scale purification.
  2. Physical, and chemical standards; tests for assessing the quality of water.
  3. Disposal of solid waste and liquid waste both in the context of urban and rural conditions in the country.
  4. Problems in the disposal of solid waste and liquid waste both in the context of urban and rural conditions in the country.
  5. Concepts of safe disposal of human and animal excreta.
  6. Sources, health hazards and control of environmental pollution.
  7. Influence of physical factors – like heat, humidity, cold, radiation and noise -on the health of the individual and community.
  8. Standards of housing and the effect of poor housing on health.
  1. NUTRITION
  1. Common sources of various nutrients and special nutritional requirements according to age, sex, activity, and physiological condition.
  2. Nutritional assessment of individuals, families and the community by selecting and using appropriate methods such as anthropometry, clinical, dietary, and laboratory techniques.
  3. Compare recommended allowances of individuals and families with actual intake.
  4. Plan and recommend a suitable diet for the individuals and families bearing in mind the local availability of foods, economic status etc.
  5. Common nutritional disorders: Protein-energy malnutrition, Vit.A.def., anaemia, iodine deficiency disease, fluorosis, food toxins diseases and their control and management.
  6. National programmes in nutrition.

VII. GENETICS AND COMMUNITY HEALTH

  1. Basic principles of genetics.
  2. Chromosomal disorders.
  3. Genetic predisposition in common disorders.
  4. Advances in molecular genetics.
  5. Preventive and social measures – Eugenics & Euthenics, genetic counselling.
  6. Early diagnosis, treatment and rehabilitation.

VIII. SOCIOLOGY AND COMMUNITY HEALTH

  1. Conduction of a clinical – social evaluation of the individual in relation to social, economic and cultural aspects; educational and residential background; attitude to health, disease and to health services; the individual’s family and community.
  2. Assessment of barriers to good health, recovery from sickness and leading a socially and economically productive life.
  3. Development of a good doctor-patient relationship.
  4. Identification of social factors related to health and disease in the context of urban and rural societies.
  5. Impact of urbanisation on health and disease.
  1. HEALTH EDUCATION
  1. Effective communication with individuals, family and community using tools and techniques of information, education and communication.
    1. Barriers to effective communication.
    2. Principles, methods and evaluation of health education.
    3. Methods of health education-their advantages and disadvantages.
    4.  Selection and use of appropriate media (simple audio-visual aids) for effective health education.
  1. Use of opportunities for health education of the individual, family and community.
  2. EPIDEMIOLOGY OF SPECIFIC DISEASES

The specific objectives of selected communicable diseases of public health importance for which National Disease Control / Eradication Programmes have been formulated are described here. For other diseases, the individual teacher would formulate the objectives while drawing the lesson plans. The idea of formulating objectives for a few diseases is to highlight their importance and emphasise certain learning outcomes.

Poliomyelitis, Infective hepatitis, ARI, Tuberculosis, Leprosy, Malaria, filariasis, Kala Azar, STDs & AIDS, Diarrhoeal diseases, Hypertension, coronary heart disease, Blindness, Mental Health.

  1. The extent of the problem, epidemiology and natural history of the disease.
  2. Relative public health importance of a particular disease in a given area.
  3. Influence of social, cultural and ecological factors on the epidemiology of the disease.
  4. Control of communicable and non-communicable diseases.
    1. Diagnosing and treating a case and in doing so demonstrating skills in :
  2. Clinical methods,
  3. Use of essential laboratory techniques,
  4. Selection of appropriate treatment regimes,
  5. Follow-up of cases.
    1. Principles of planning, implementing and evaluating control measures for the diseases at the community level bearing in mind the relative importance of the disease.
  2. Institution of programmes for the education of individuals and communities.
  3. Investigating a disease epidemic.
  4. Principles of measures to control a disease epidemic.
  5. Level of awareness of causation and prevention of disease amongst individuals and communities.
  6. Control of communicable and non-communicable diseases by diagnosing and treating a case and in doing so demonstrating skills in:
  7. Instituting measures, wherever necessary, for preventing disabilities/deformities.
  8.  Rehabilitation of the patient.
  9. Training of health workers in
  10. Disease surveillance,
  11. Control and treatment,
  12. Health education.
  13. 11. Managerial skills in the areas of
  14. supervision,
  15. collection and compilation of data
  16. maintenance of records,
  17. transmission of data.
  1. DEMOGRAPHY & FAMILY PLANNING
  1. Definition of demography and family welfare programme.
  2. Stages of the demographic cycle and their impact on the population.
  3. Definition, calculation and interpretation of demographic indices like birth rate, death rate, growth rate, and fertility rates.
  4. Reasons for rapid population growth in India.
  5. Need for population control measures and the National Population Policy.
  6. Different family planning methods and their advantages and shortcomings. Recent advances in contraception.
  7. Motivating a couple to select the appropriate family planning method.
  8. Medical Termination of Pregnancy Act.
  9. Guidance for MTP and infertility services.
  10. National Family Welfare Programme.

XII. MATERNAL AND CHILD HEALTH (MCH)

  1. Need for specialised services for these groups.
  2. The magnitude of morbidity and mortality in these groups in a given area.
  3. Local customs and practices during pregnancy, childbirth and lactation.
  4. Concepts of ‘high risk’ and ‘MCH Package’, Child Survival and Safe Motherhood, Integrated Child Development Scheme and other existing regional programmes.
  5. Under- 5: Morbidity, mortality, high risk and care.
  6. Monitoring of growth and development and use of Road to Health Chart.
  7. Organisation, implementation and evaluation of programmes for mothers and children as per National Programme guidelines; supervising health personnel; maintaining records; performing a nutritional assessment; promoting breastfeeding.

XIII. SCHOOL HEALTH

  1. Objectives of the School Health Programme.
  2. Activities of the Programme like:
  1. Carrying out periodic medical examinations of the children and the teachers.
  2. Immunisation of the children in the school.
  3. Health education.
  4. Mid-day meals.
  1. Participation of the teachers in the school health programme including maintenance of records; defining healthful practices; early detection of abnormalities.

XIV. COMMUNITY GERIATRICS

  1. Common diseases of the elderly.
  2. Prevention of degenerative diseases – the role of exercise, nutrition, lifestyle, etc.
  3. Osteoporosis and arthroses – effects of immobility – prevention of contractures and bed sores.
  4. Economic and psychosocial needs of the aged.
  5. Care of elderly in organised and unorganised sectors.
  6. Role of Health Visitor and Social Worker.
  7. Social problems in the elderly – Joint family; Day care centre and Day Hospital; home for the aged -Caregiver.
  1. URBAN HEALTH
  2. Common health problems ( Medical, Social, Environmental, Economic, Psychological) of urban dwellers.
  3. The organisation of health services for slum dwellers.
  4. Organization of health services in urban areas.

XVI. MENTAL HEALTH

  1. Importance of Mental Health.
  2. Types of mental illness and causes.
  3. Preventive aspects.
  4. Mental Health Services.
  5. Alcoholism, drug dependence – Epidemiological factors and prevention.

XVII. HEALTH PLANNING AND MANAGEMENT

  1. Explain the terms: public health, public health administration, regionalisation, comprehensive medical care, delivery of health care, planning, management, and evaluation.
  2. Salient features of the National Health Policy: provision of medical care; (b) primary health care and Health for All; (c) health manpower development; (d) planned development of health care facilities; (e) encouragement of indigenous systems of medicine; (f) recommendations of Health committees.
  3. Process of health care delivery in India :
  4. the health systems and health infrastructure at the centre, state and district levels;
  5. the inter-relationship between the community development block and primary health centre;
  6. the organisation, functions and staffing pattern of community health centres, primary health centres and sub-centre;
  7. the job descriptions of health supervisor (male and female), health workers, village health guide, Anganwadi workers, traditional birth attendants;
  8. the activities of the health team at the primary health centre.
  9. Management techniques: define and explain principles of management; explain the three broad functions of management (planning, implementation and evaluation) and how they relate to each other.
  10. Appreciate the need for International Health Regulations and Disease surveillance.
  11. Constitutional provisions for health in India: Enumerate the three major divisions of responsibilities and functions (concerning health) of the union and the state governments.
  12. Appreciate the role of national and international voluntary agencies in health care delivery.
  13. Explain the terms: cost-effectiveness, and cost-benefit.

XVIII. OCCUPATIONAL HEALTH

Relate the history of symptoms with the specific occupation including agriculture.

  1.  
    • Employees State Insurance Scheme.
    • Identification of the physical, chemical and biological hazards to which workers are exposed while working in a specific occupational environment.
    • Diagnostic criteria of various occupational diseases.
    • Preventive measures against these diseases include accident prevention.
    • Various legislations in relation to occupational health.

Skills

  1. Communication

The student should be able to communicate effectively with family members at home; patients at clinics or at homes; individuals, family or a group for health education; peers at scientific forums.

  1. Team activity

Work as a member of the health team in planning and carrying out fieldwork like school health.

  1. Environmental sanitation

Collect water samples for microbiological evaluation; chlorination of water; estimate the chlorine demand of water; estimate the residual chlorine of water; insecticides; their proper storage and use in the control of vectors.

  1. Communicable and Non – communicable diseases
  • Eliciting clinico-social history and examining the patient for diagnosis and treatment.
  • Collection of appropriate material for microbiological, pathological or biochemical tests.
  • Fixing, staining and examining smears -peripheral blood smear for malaria and filariasis, sputum for AFB; slit skin smears for leprosy; Hb estimation; urine and stool examination.
  • Assessing the severity and/or classifying dehydration in diarrhoea upper respiratory tract infection, dog bite, leprosy.
  • Adequate and appropriate treatment and follow-up of leprosy, malaria, filariasis rabies, upper respiratory tract infections, diarrhoea and dehydration
  • Advice on the prevention and prophylaxis of common diseases like vaccine-preventable diseases, tetanus, malaria, filariasis, rabies, cholera, typhoid, and intestinal parasites.
  • Use of proper screening methods in early diagnosis of common diseases.\
  • Take necessary steps in / disease outbreak/epidemics / natural disasters -Investigation of epidemics, food poisoning; notification; organising medical care following disasters.
  1. Mental and Child Health
  • Antenatal – examination of the mother; application of the risk approach in antenatal care.
  • Intranatal -conducting a normal delivery; early recognition of danger in intranatal period; referral of cases requiring special care.
  • Postnatal – assessment of the mother and new born advice on appropriate family planning method; promotion of breast feeding; advice on weaning.
  • Assessment of growth and development of the child use of the ‘road to health ‘ card; recording important anthropometric assessments of the child; giving immunisation to the child; identifying high-risk infants.
  1. Statistics
  • Make a proper sample.
  • Apply appropriate tests of significance to make correct inferences.
  • Simple analysis and presentation of data.
  1. Nutrition
  • Conducting a diet survey.
  • Community survey and clinical diagnosis of nutritional deficiencies; vitamin A deficiency, iodine deficiency, malnutrition.
  • Making recommendations regarding diet,
  1. Occupational Health
  • Inspection of work sites.
  • The recommendation in improving work sites.
  • Medical examination of workers
  1. Health care of the community
  • Ensuring community participation in health care.
  • Arranging intersectoral coordination where necessary.
  • Working in liaison with other agencies involved in health care in various National Health Programmes.
  1. Health Management
  • Be an effective team leader.
  • Guide and train workers
  • Supervised workers and programmes.
  1. Family Planning: Advice on appropriate methods.
  2. Managerial: Organise antenatal and under-five clinics.

Teaching & Learning Methods

  • Structured interactive sessions,
  • Small group discussion,
  • Focused group discussion (FGD),
  • Participatory learning appraisal (PLA),
  • Family and community visits,
  • Institutional visits,
  • Practical including demonstrations,
  • Problem-based exercises,
  • Video clips,
  • Written case scenario,
  • Self-learning tools,
  • Interactive learning and
  • e-modules