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1. OCCUPATIONAL HEALTH PROBLEM
BY:- DR.SYED ZIYAD FURQAN.
MBBS, BS(MEDICAL SCIENCES),MS PUBLIC HEALTH ( GOLD MEDALIST)

2. • 1. Maternal and Child Health MATERNAL HEALTH
I. Antenatal care: Essential : (1) Early registration of all pregnancies, within first trimester (before
12th week of pregnancy). However even if a woman comes late in her pregnancy for registration,
she should be registered and care given to her according to gestational age;
(2) Minimum 4 ANC including registration. Suggested schedule for antenatal visits: 1st visit:
within 12 weeks - preferably as soon as pregnancy is suspected - for registration, history and first
antenatal checkup; 2nd visit: between 14 and 26 weeks; 3rd visit: between 28 and 34 weeks; and
4th visit: between 36 weeks and term
; (3) Associated services like general examination such as height, weight, B.P anaemia, abdominal
examination, breast examination, folic acid supplementation {in first trimester). iron and folic acid
supplementation from 12 weeks, injection tetatnus toxoid. treatment of anaemia etc., (as per the
guidelines);
(4) Recording tobacco use by all antenatal mothers
; (5) Minimum laboratory investigations like urine test for pregnancy confirmation, haemoglobin
estimation, urine for albumin and sugar and linkages with PHC for other required tests;
(6) Name based tracking of all pregnant women for assured service delivery
; (7) Identification of high risk pregnancy cases
; (8) Identification and management of danger signs during pregnancy
; (9) Malaria prophylaxis in malaria endemic zones for pregnant women as per the guidelines of
NVBDCP;
(10) Appropriate and timely referral of such identified cases which are beyond her capacity of

3. • PRIMARY HEALTH CARE IN INDIA 961 management.;
• ( 11) Counselling on diet, rest, tobacco cessation if the antenatal mother
is a smoker or tobacco user, information about dangers of exposure to
second hand smoke and minor problems during pregnancy, advice on
institutional deliveries,
• 12 pre-birth preparedness and complication readiness, danger signs,
clean and safe delivery at home if called for;
• (13) Provide information about provisions under current schemes and
programmes like Janani Suraksha Yojana;
• (14) Identify suspected RTI/STI case, provide counselling, basic
management and referral services:

4. • Counselling and referral for HIV/AIDS; an
• d (17) Name based tracking of missed and left out ANC cases.
• II. Intra-natal care: Essential: (1) Promotion of institutional deliveries;
• (2) Skilled attendance at home deliveries when called for; and
• (3) Appropriate and timely referral of high risk cases which are beyond her
capacity of management. Essential for Type B sub-centre :
• (1) Managing labour using Partograph; (2) Identification and management of
danger signs during labour; (3) Proficient in identification and basic first aid
treatment for PPH, eclampsia, sepsis and prompt referral of such cases as per
Antenatal Care and Skilled Birth Attendance at Birth or SBA Guidelines; and (4)
Minimum 24 hours of stay of mother and baby after delivery at sub-centre.

5. • The environment at the sub-centre should be clean and safe for both
mother and baby. III. Postnatal care: Essential: (1) Initiation of early
breast-feeding within one hour of birth; (2) Ensure post-natal home visits
on 0, 3, 7 and 42nd day for deliveries at home and sub-centre (both for
mother and baby); (3) Ensure 3, 7, 42nd day visit for institutional delivery
(both for mother and baby) cases; (4) In case of low birth weight baby
(less than 2500 gm), additional visits are to be made on 14, 21 and 28th
days; (5) During post-natal visit, advice regarding care of the mother, and
care and feeding of the newborn, and examination of the newborn for
signs of sickness and congenital abnormalities as per IMNCI guidelines and
appropriate referral, if needed.; (6) Counselling on diet & rest, hygiene,
contraception, essential newborn care, immunization, infant and young
child feeding, STI/RTI and HIV/AIDS. ; and (7) Name based tracking of
missed and left out PNC cases

6. • 2. Family planning and contraception (a) Education, motivation
and counselling to adopt appropriate family planning method;
(b) Provision of contraceptives such as condoms, oral pills,
emergency contraceptives and IUD insertion (wherever ANM is
trained for IUD insertion); and (c) Follow up services to the
eligible couples adopting permanent methods of tubectomy
and vasectomy (essential). 3. Counselling and appropriate
referral for safe abortion service (MTP) (essential). 4.
Adolescent health care : Education, counselling and referral
(essential). 5. Assistance to school health services (essential).
6. Water quality monitoring (essential). 7. Promotion of
sanitation including use of toilet and appropriate garbage
disposal (essential). 8. Field visits by appropriate health
workers for disease surveillance, family welfare services
including STI, RTI awareness (essential). 9. Community need
assessment (essential).

7. • 10. Curative services for minor ailments including fever, diarrhoea,
worm infestation and first-aid including firstaid for animal bite and
snake bite; appropriate and prompt referral if needed. To provide
AYUSH treatment. 11. Training of Traditional Birth Attendants and
ASHN community health volunteers (essential). 12. Co-ordinate
services of anganwadi workers, ASHA, village health and sanitation
committee etc. (essential). 13. Disease surveillance, Integrated
Disease Surveillance Project (IDSP): (1) Surveillance about any
abnormal increase in cases of diarrhoea/dysentery, fever with rigors,
fever with rash, fever with jaundice or fever with unconsciousness,
and early reporting to concerned PHC as per IDSP guidelines; (2)
Immediate reporting of any cluster/outbreak based in syndromic
surveillance; (3) High level of alertness for any unusual health event,
reporting and appropriate action; and (4) Weekly submission of
report to PHC in 'S' Form as per IDSP guideline (essential).

8. • CONTROL OF LOCAL ENDEMIC DISEASES Essential:
(1) Assisting in detection, control and reporting of
local endemic diseases such as malaria, Kala Azar,
Japanese encephalitis, Filariasis, Dengue etc.; and (2)
Assistance in control of epidemic outbreaks as per
programme guidelines.

9. • . National Health Programmes A. Communicable disease programme a.
National AIDS Control Programme : Essential: (1) Condom promotion &
distribution of condoms to the high risk group; (2) Help and guide
patients with HIV/AIDS receiving ART with focus on adherence; and
• (3) IEC activities to enhance awareness and preventive measures about
ST!s and HIV/AIDS, PPTCT services and HIV-TB coordination. Desirable:
(1) Linkage with microscopy centre for HIV-TB coordination; and (2)
HIV/ST! Counselling, screening and referral in Type B sub-centres
(screening in districts where the prevalence of HIV/AIDS is high). b.
National Vector Borne Disease Control Programme : Essential: (1)
Collection of blood slides of fever patients; (2) Rapid Diagnostic Tests
(ROT) for diagnosis of Pf malaria in high Pf endemic areas; (3)
Appropriate anti-malarial treatment; (4) Assistance for integrated vector
control activities in relation to malaria, filaria, JE, dengue, Kala-Azar etc.
as prevalent in specific areas. Prevention of breeding places of vectors
through IEC and community mobilization. Where filaria is endemic,
identification of cases of lymphoedema/elephentiasis and hydrocele and
their referrals to PHC/CHC for appropriate management.

10. • The disease specific guidelines issued by NVBDCP are to be followed; (5) Annual mass drug
administration with single dose of diethyl carbamazine (DEC) +albendazole to all eligible
population at risk of lymphatic filariasis; (6) Promotion of use of insecticidal treated nets
wherever supplied ; and (7) Record keeping and reporting as per programme guidelines. c.
National Leprosy Eradication Programme : Essential: (1) Health education to community
regarding signs and symptoms of leprosy, its complications, curability and availability of
free of cost treatment; (2) Referral of suspected cases of leprosy (person with skin patch,
nodule, thickened skin, impaired sensation in hands and feet with muscle weakness) and its
complications to PHC; and (3) Provision of subsequent doses of MDT and follow up of
persons under treatment for leprosy, maintain records and monitor for regularity and
completion of treatment. d. Revised National Tubrculosis Control Programme : Essential: (1)
Referral of suspected symptomatic cases to the PHC/ Microscopy centre; (2) Provision of
DOTS at subcentre, proper documentation and follow-up; (3) Care should be taken to
ensure compliance and completion of treatment in all cases; and (4) Adequate drinking
water should be ensured at sub-centre for taking the drugs. Desirable: Sputum collection
centers established in subcentre for collection and transport of sputum samples in rural,
tribal, hilly & difficult areas of the country where designated microscopy centres are not
available as per the RNTCP guidelines. B. Non-Communicable Disease (NCD) Programmes
These type of services are to be provided at both types of sub-centres. a. National
Programme for Control of Blindness (NPCB): Essential: (1) Detection of cases of impaired
vision in house to house surveys and their appropriate referral. The cases with decreased
vision will be noted in the blindness register; and (2) Spreading awareness regarding eye
problems, early detection of decreased vision, available treatment and health care facilities
for referral of such cases. IEC is the major activity to help identify cases of blindness and
refer suspected cataract cases. Desirable: (1) The cataract cases brought to the district
hospital by MPW/ANM/ and ASHAS; and (2) Assisting for screening of school children for
diminished vision and referral

11. • Medical termination of pregnancy using manual vacuum
aspiration technique, wherever trained personnel and
facility exists. 5. Health education for prevention and
management of RTI/STI. 6. Nutrition Services : Diagnosis
and management of malnutrition, anaemia and vitamin A
deficiency and coordination with !CDS. 7. School health
services. Essential : (1) screening of general health
assessment of anaemia/nutritional status, visual acuity,
hearing problem, dental check-up, physical disabilities,
learning disorders and behaviour problems, etc; (2) Basic
medicines to take care of common ailments; (3)
Immunization as per national schedule; (4) Micronutrient
(Vitamin A, iron and folic acid) management; deworming;
and mid day meal. Desirable : Health promoting schools. 8

12. • National health programmes. Revised National Tuberculosis
Control Programme (RNTCP) : All PHCs to function as DOTS
Centres to deliver treatment as per RNTCP treatment
guidelines through DOTS providers and treatment of common
complications of TB and side effects of drugs, record and
report on RNTCP activities as per guidelines. National Vector
Borne Disease Control Programme : (a) Diagnosis of malaria
cases, microscopic confirmation

13. • PRIMARY HEALTH CARE IN INDIA 965 and treatment; (b) Cases of suspected JE
and dengue to be provided symptomatic treatment, hospitalization and case
management as per the protocols. (c) Complete treatment to Kala-azar cases in
endemic areas as per national policy. (d) Complete treatment of microfilaria
positive cases with DEC + albendazole and participation and arrangement of Mass
Drug Administration (MDA) along with management of side reactions, if any.
Morbidity management of lymphoedema cases. National AIDS Control
Programme : (a) !EC activities to enhance awareness and preventive measures
about STls and HIV/AIDS, Prevention of Parents to Child Transmission (PPTCT)
services. (b) Organizing school health education programme. (c) Screening of
persons practicing high-risk behaviour with one rapid test to be conducted at the
PHC level and development of referral linkages with the nearest VCTC at the
district hospital level for confirmation of HIV status of those found positive at one
test stage in the high prevalence states. (d) Risk screening of antenatal mothers
with one rapid test for HIV and to establish referral linkages with CHC or district
hospital for PPTCT services in the six high HIV prevalence states of Tamil Nadu,
Andhra Pradesh, Maharashtra, Karnataka, Manipur and Nagaland.

14. • (e) Linkage with microscopy centre for HIV-TB coordination. (f) Condom promotion and
distribution of condoms to the high risk groups. (g) Help and guide patients with HIV/AIDS
receiving ART with focus on adherence. (h) Pre and post-test counselling of AIDS patients by PHC
staff in high prevalence states. National Programme for Control of Blindness : (a) Basic services :
Diagnosis and treatment of common eye diseases; (b) Refraction services; and (c) Detection of
cataract cases and referral for cataract surgery. National Leprosy Eradication Programme :
Essential: (1) Health education to community regarding leprosy; (2) Diagnosis and management of
leprosy and its complications including reactions; (3) Training of leprosy patients having ulcers for
self-care; and (4) Counselling for leprosy patients for regularity/completion of treatment and
prevention of disability. National Programme for Prevention and Control of Deafness (NPPCD) :
Essential : (1) Early detection of cases of hearing impairment and deafness and referral; (2) Basic
diagnosis and treatment services for common ear diseases like wax in ear, otomycosis, otitis
externa, ear discharge etc; and (3) IEC services for prevention, early detection of hearing
impairment/deafness. National Mental Health Programme (NMHP) : Essential : (a) Early
identification (diagnosis) and treatment of mental illness in the community; (b) Basic services:
Diagnosis and treatment of common mental disorders such as psychosis, depression, anxiety
disorders and epilepsy, and referral; and (c) IEC activities for prevention, stigma removal, early
detection of mental disorders and greater participation/role of community for primary prevention
of mental disorders. National Programme for Prevention and Control of Cancer, Diabetes, CVD
and Stroke (NPCDCS) Cancer Essential: a. IEC services for prevention of cancer and early
symptoms

15. • All the national health programmes (NHP) should be delivered through the CHCs.
Integration with the existing programmes like blindness control, Integrated Disease
Surveillance Project, is vital to provide comprehensive services. a. RNTCP : CHCs
are expected to provide diagnostic services through the microscopy centres which
are already established in the CHCs, and treatment services as per the technical
guidelines and operational guidelines for tuberculosis control. b. National Vector-
Borne Disease Control Programme: The CHCs are to provide diagnostic and
treatment facilities for routine and complicated cases of malaria, filaria, dengue,
Japanese Encephalitis and Kala-azar in the respective endemic zones. c. HIV/AIDS
Control Programme: The services to be provided at the CHC level are : Integrated
counselling and testing centre; blood storage centre; and sexually transmitted
infection clinic. Desirable : Link anti retroviral therapy centre. d. National Leprosy
Eradication Programme: The minimum services that are to be available at the CH
Cs are for diagnosis and treatment of cases and reactions of leprosy along with
advice to patient on prevention of deformity. e. National Programme for Control of
Blindness: The eye care services that should be available at the CHC are diagnosis
and treatment of common eye diseases, refraction services and surgical services
including cataract by IOL implantation at selected CHCs optionally. 1 eye surgeon is
being envisaged for every 5 lakh population. f. Under Integrated Disease
Surveillance Project, the related services include services for diagnosis for malaria,
tuberculosis, typhoid and tests for detection of faecal contamination of water and
chlorination

16. • malaria, tuberculosis, typhoid and tests for detection of faecal contamination of water
and chlorination
• level. CHC will function as peripheral surveillance unit and collate, analyze and report
information to District Surveillance Unit. In outbreak situations, appropriate action will
be initiated. g. National Programme for Prevention and Control of Deafness (NPPCD) :
(1) The early detection of cases of hearing impairment and deafness, and referral; (2)
Provision of basic diagnosis and treatment services for common ear diseases; and (3)
Awareness generation through appropriate IEC strategies and greater participation/role
of community in primary prevention and early detection of hearing impairment/
deafness. h. National Mental Health Programme (NMHP) (1) Early identification,
diagnosis and treatment of common mental disorders (anxiety, depression, psychosis,
schizophrenia, manic depressive psychosis); (2) !EC activities for prevention, removal of
stigma and early detection of mental disorders; and (3) Follow up care of detected cases
who are on treatment (essential). Desirable : With short term training the medical
officers would be trained to deliver basic mental health care using limited number of
drugs and to provide referral service.

17. • This would result in early identification and treatment of common mental illnesses
in the community. i. National Programme for Prevention and Control of Cancer,
Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) Cancer control : ( 1)
Facilities for early detection and referral of suspected cancer cases; (2) Screening
for cervical, breast & oral cancers; (3) Education about breast self examination and
oral self examination; and (4) PAP smear for cancer cervix (essential). Desirable : (
1) Basic equipment (magna visualiser, indirect laryngoscope, punch biopsy forceps)
and consumables for early detection of common cancers; (2) Public private
partnership for laboratory investigations biochemical, pathological (including
biopsy), microbiological, tumor markers, mammography etc. which are related to
cancer diagnosis; and (3) Investigations to confirm diagnosis of cancer in patients
with early warning signals through public private partnership mode. j. Diabetes,
CVD and strokes Promotion and prevention (essential) : - Health promotion : Focus
will be on healthy population. - Modify individual, group and community behaviour
through intervention like, - Promotion of healthy dietary habits. - Promotion of
physical activity. - Avoidance of tobacco and alcohol. - Stress management. -
Treatment & timely referral (complicated cases) of diabetes mellitus, hypertension,
IHD, CHF etc. - Assured investigations : Urine albumin and sugar, blood sugar,
blood lipid profile, KFT

18. • Central Government Health Scheme The
Central Government Health Scheme
(previously known as Contributory Health
Service Scheme) for the Central Government
employees was first introduced in New Delhi
in 1954 to provide comprehensive medical
care to Central Government employees. The
scheme is based on the principle of
cooperative effort by the employee and the
employer, to the mutual advantage of both.

19. • The facilities under the scheme include : (a) out-patient
care through a network of dispensaries; (bl supply of
necessary drugs; (c) laboratory and X-ray investigations (d)
domiciliary visits; (el hospitalization facilities at
Government as well as private hospitals recognized for the
purpose; (f) specialist consultation; (g) paediatric services
including immunization; (h) antenatal, natal and postnatal
services; (i) emergency treatment; (j) supply of optical and
dental aids at reasonable rate; and (kl family welfare
services

20. • MATERNAL AND CHILD WELFARE SERVICES :
There are a large number of maternity and
child welfare centres all over India, either
directly administered by or are affiliated to the
Red Cross. There is a bureau of Maternity and
Child Welfare, which provides technical advice
and financial aid to schemes for

21. "Medicine is one of the pillars of
peace"
• The Health Organization of the League of Nations (1923) After the first World War (1914-18), the
League of Nations was established to build a better world. It included a 'Health Organization' to "take
steps in matters of international concern for the prevention and control of disease". Although the
League of Nations was a failure on the political side, its Health Organization, which was established in
1923, did creditable work. Not confining itself to quarantine regulations and epidemiological
information or even larger problems of epidemic diseases, the Health Organization of the League
branched out into such matters as nutrition, housing and rural hygiene, the training of public health
workers and the standardization of certain biological preparations. The League analysed
epidemiological information received, and started the series of periodical epidemiological reports
now issued by the WHO. It also established the Far Eastern Bureau at Singapore. It laid down lines for
technical studies (including the use of expert committees) which are substantially followed by the
WHO. The WHO owes much to the work done and methods devised by the Health Organization of the
League. It may be mentioned that efforts to amalgamate the OIHP, PASB and the Health Organization
of the League of Nations proved a failure, and all the three organizations were co-existing during the
years between the two World Wars. In 1939, the League of Nations was dissolved but its Health
Organization in Geneva continued to deal as best it could with requests for information and the
publication of the Weekly Epidemiological Records was never suspended. The United Nations Relief
and Rehabilitation Administration (1943) The United Nations Relief and

22. • Rehabilitation Administration (UNRRA) was set up in 1943 with the general purpose of
organizing recovery from the effects of the Second World War. The UNRRA had a health
division to care for the health of the millions of displaced persons, to restore and help
services and to revive the machinery for international interchange of information on
epidemic diseases. UNRRA did outstanding work of preventing the spread of typhus and
other diseases, so that they never reached serious epidemic levels anywhere. Similarly,
UNRRA'S assistance to malaria control in such countries as Greece and Italy, where war
had disrupted peace-time anti-malaria services, was on an immense scale. The world
renowned campaign for the eradication of malaria from Sardinia was begun as a joint
effort of UNRRA, the Rockefeller Foundation and the Italian Government (5). At the end
of 1946, UNRRA terminated its official existence and its health activities and financial
assets were taken over by the Interim Commission on the WHO. Birth of the WHO The
WHO has its ongm in April 1945, during the conference held at San Francisco to set up
the United Nations. The representatives of Brazil and China proposed that an
international health organization should be established and that a conference to frame
its constitution should be convened. The constitution was drawn up at an international
health conference in New York in 1946. The same conference set up an '·Interim
Commission" to prepare the ground for the new organization and to carry out urgent
tasks until the WHO constitution had been accepted by the required number of UN
Member State

23. • Two major policy developments have
influenced the WHO. First, the Alma-Ala
Conference in 1978 on primary health care
which provided both WHO and UNICEF with a
common charter for health, and secondly, the
Global Strategy for Health for All by 2000, and
more recently Millennium Development Goals

24. • OTHER UNITED NATIONS AGENCIES UNICEF UNICEF (United
Nations International Children's Emergency Fund) is one of
the specialized agencies of the United Nations. It was
established in 1946 by the United Nations General
Assembly to deal with rehabilitation of children in war
ravaged countries. In 1953, when the emergency functions
were over, the General Assembly gave it a new name "U.N.
Children's Fund" but retained the initials, UNICEF. UNICEF's
regional office is in New Delhi; the region is known as the
South Central Asian Region which covers Afghanistan, Sri
Lanka, India, the Maldives, Mongolia and Nepal. UNICEF is
governed by a thirty six nation Executive Board as in 2010.
The headquarters of the UNICEF is at United Nations, New
York.

25. • UN Fund for Population Activities The United
Nations Fund for Population Activities (UNFPA)
has been providing assistance to India since
1974. In addition to funding national level
schemes, Area Projects for intensive
development of health and family welfare
infrastructure and improvement in the
availability of services in the rural areas

26. • NON-GOVERNMENTAL AND OTHER AGENCIES
Rockefeller Foundation The Rockefeller
Foundation is a philanthropic organization
chartered in 1913 and endowed by Mr. John D.
Rockefeller. Its purpose is to promote the well-
being of mankind throughout the world. In its
early years, the Foundation was active chiefly in
public health and medical education.
Subsequently, its interest was expanded to
include the advancement of life sciences, the
social sciences. the humanities and the
agricultural sciences

27. NUTRITION
TOPIC 7
• CARE OF THE PRE-SCHOOL CHILD Children
between 1-4 years of age are generally called pre-
school age children or toddlers. In the history of
health services of many developing countries,
their social and health needs were realized rather
late. Today, more than ever before, the ·pre-
school age child has become a focus for organized
medical-social welfare activities, and their death
rate is considered a significant indicator of the
social situation in a country

28. • 2. Mortality The pre-school age (1-4 years) mortality in India
is 2.3 per cent of all deaths. This high mortality which is
largely due to infection and malnutrition is characteristic of
this age group in underprivileged areas. Malnutrition was
shown to be an underlying cause in 3.4 per cent of all deaths
in young children and associated cause in no less than 46 per
cent (41). 3. Morbidity The data on the extent of morbidity of
pre-school children are scarce. Some hospital records and a
few surveys suggest that children in this age group are usually
victims of PEM accompanied by retarded growth and
development. Surveys indicate that the main morbidity
problems are malnutrition and infections. The prevalence of
severe protein-energy malnutrition

29. • CHILD HEALTH PROBLEMS The problems facing
the health worker in the developing world are
vast and are nowhere more evident than in the
field of childcare. The main health problems
encountered in the child population comprise
the following : 1. low birth weight; 2.
malnutrition; 3. infections and parasitosis; 4.
accidents and poisoning; and 5. behavioural
problems. 1. Low birth weight This has been
discussed in detail earlier.

30. Continue…
• 2. Malnutrition Malnutrition is the most widespread
condition affecting the health of children. Scarcity of
suitable foods, lack of purchasing power of the family as
well as traditional beliefs and taboos about what the baby
should eat, often lead to an insufficient balanced diet,
resulting in malnutrition. It is estimated that no less than 45
per cent of the children who died before the age of 5 years
were found to have malnutrition as underlying factor and
80 per cent of newborn

31. • 4. Growth and development The importance of the first 5
or 6 years of life of a child for its growth and development
is well known. Any adverse
• CHILD HEALTH PROBLEMS 601 influences operating on
children during this period (e.g., malnutrition and infection)
may result in severe limitations in their development. some
of which at least are irreversible. The concept of
vulnerability calls for preventive care and special actions to
meet the biological and psychological needs inherent in the
process of human growth and development (35). 5.
Accessibility While the infant may be easily reached, the
toddler is hard to reach, and it is therefore difficult to look
after his health. Special inputs are needed (e.g., day care
centres, play group centres, children's clubs) to reach the
toddler and to bring him into

32. • the orbit of health care. Operation research all over the world has demonstrated that
parents are unlikely to travel more than 5-8 kms to obtain medical care. For the toddler
who needs to be carried, the distance may be reduced even further. 6. Prevention in
childhood of health problems in adult life Results of research indicate how events in
early life (e.g. child's diet, infections) affect its health when it becomes an adult, and
how many conditions can be prevented through early action, for example, dental
diseases in adulthood. Early treatment of streptococcal infection can prevent rheumatic
heart disease. Longitudinal studies suggest that the foundations of obesity,
hypertension, cardiovascular diseases, and certain mental disorders may be laid in early
life. Some of the chronic orthopaedic ailments of the adult are probably connected with
anomalies in the development or minor uncorrected infirmities of the infant (e.g.
talipes, congenital dislocation of the hip). Many of the measures subsequently
undertaken to treat these disorders often do not fully succeed. Since young children are
"vulnerable" to social and health hazards which can retard or arrest their physical and
mental development during these critical years, they deserve special attention by the
administration, general population and the family.

33. • Malnutrition makes the child more susceptible to
infection. recovery is slower and mortality is higher.
Undernourished children do not grow to their full
potential of physical and mental abilities. Malnutrition
in infancy and childhood leads to stunted growth. It
also manifests by clinical signs of micronutrient and
vitamin deficiencies. Prevention and appropriate
treatment of diarrhoea, measles and other infections in
infancy and early childhood are important to reduce
malnutrition rates as infection and malnutrition often
make vicious cycle. Exclusive breastfeeding in first 6
months of life is very important

34. • (a) Breast-feeding Infant health is related to
breast feeding because of the nutritional
content and natural immunizing agents
contained in breast milk, at least for fully
breast-fed infants. Early weaning and bottle-
fed infants living under poor hygienic
conditions are more prone to die than the
breast-fed infants living under similar
conditions.

35. • STUNTING : Stunting is the impaired growth and development that
children experience from poor nutrition, repeated infection, and
inadequate psychosocial stimulation. Children are defined as stunted
if their height-for-age is more than two standard deviations below the
WHO Child Growth Standards median.
• WASTING: Wasting is defined as low weight-for-height.
It often indicates recent and severe weight loss,
although it can also persist for a long time.
• WEANING is when a baby moves from breast milk to
other sources of nourishment. Weaning your baby is a
process that takes patience and understanding from
both you and your child
• CLOSTRUM: is the first secretion from the
mammary glands after giving birth, rich in
antibodies.

36. • . Growth monitoring It is a low cost technology
available for reducing infant mortality. All infants
should be weighed periodically (at least once a
month) and their growth charts maintained.
These charts help to identify children at risk of
malnutrition early. Babies who do not thrive or
show growth failure are given special health care
to pull them on to the road-to-health. Thus
systematic use of growth chart will help to
promote health in children.

37. IMMUNIZATION
• Immunization is a global health and
development success story, saving
millions of lives every year. Vaccines
reduce risks of getting a disease by
working .
• Search more..?

38. ORAL REHYDRATION
• Oral rehydration therapy is a type of fluid
replacement used to prevent and treat
dehydration, especially due to diarrhea. It
involves drinking water with modest amounts
of sugar and salts, specifically sodium and
potassium. Oral rehydration therapy can also
be given by a nasogastric tube. Wikipedia
• Other names: oral rehydration solution
(ORS), oral rehydration salts (ORS), glucose-
salt solution

39. Causes of death among children under
5 year
• The leading causes of death in children
under 5 years are preterm birth
complications, birth asphyxia( lack of
oxygen) /trauma, pneumonia, diarrhoea
and malaria, all of which can be
prevented or treated with access to
affordable interventions in health and
sanitation

40. OTHER TRACE ELEMENTS
• The following indicators are useful in this regard (58) : -
prevalence of goitre; - prevalence of cretinism; - urinary
iodine excretion; - measurement of thyroid function by
determination of serum levels of thyroxine (T 4) and pituitary
thyrotropic hormone (TSH); and - prevalence of neonatal
hypothyroidism. Since the objective of goitre control
programme is to increase iodine intake, indices of urinary
excretion are particularly recommended for use in
surveillance. Neonatal hypothyroidism has been found to be a
sensitive indicator of environmental iodine deficiency. Serum
T 4 level is a more sensitive indicator of thyroid insufficiency
than T3• FLUORINE Fluorine is the most abundant element in
nature. Being so highly reactive, it is never found in its
elemental gaseous form, but only in combined form.

41. • About 96 per cent of the fluoride in the body is found in bones and teeth.
Fluorine is essential for the normal mineralization of bones and formation
of dental enamel. Sources The principal sources of fluorine available to
man are : (a) Drinking water : The major source of fluorine to man is
drinking water. In most parts of India, the fluoride content of drinking
water is about 0.5 mg/L, but in ftuorosis-endemic areas, it may be as high
as 3 to 12 mg/L (59). (b) Foods : Fluorides occur in traces in many foods,
but some foods such as sea fish,, cheese and tea are reported to be rich in
fluorides (38). Deficiency /excess Fluorine is often called a two-edged
sword. Prolonged ingestion of fluorides through drinking water in excess
of the daily requirement is associated with dental and skeletal fluorosis;
and inadequate intake with dental caries. The use of fluoride is recognized
as the most effective means available for the prevention of dental caries.
Requirements The recommended level of fluorides in drinking water in
India is accepted as 0.5 to 0.8 mg per litre (60, 61). In temperate countries
where the water intake is low, the optimum level of fluorides in drinking
water is accepted as 1 to 2 mg per litre (62). OTHER TRACE ELEMENTS

42. • Zinc Zinc is a component of more than 300 enzymes. It is active in the metabolism of glucides
and proteins, and is required for the synthesis of insulin by the pancreas and for the immunity
function. Zinc is present in small amounts in all tissues. Zinc-plasma level is about 96µg per 100
ml for healthy adults, and 89 µg per 100 ml for healthy children (63). The average adult body
contains 1.4 to 2.3 g of zinc (64). Zinc deficiency has been reported to result in growth failure
and sexual infantilism in adolescents, and in loss of taste and delayed wound healing (10).
There are also reports of low circulating zinc levels in clinical disorders such
• as liver disease, pern1c1ous anaemia, thalassaemia and myocardial infarction. Zinc deficiency
is common in children from developing countries due to lack of intake of animal food, high
dietary phytate content, inadequate food intake and increased faecal losses during diarrhoea.
Zinc supplementation in combination with oral rehydration therapy has been shown to
significantly reduce the duration and severity of acute and persistent diarrhoea and to increase
survival in a number of randomized control trials. Adequate zinc intake is essential for
maintaining the integrity of immune system. Zinc affects multiple aspects of the immune
system, from the barrier of the skin to gene regulation within lymphocytes. Severe maternal
zinc deficiency has been associated with spontaneous abortion and congenital malformations
like anencephaly. Milder forms of zinc deficiency has been associated with low birth weight,
intrauterine growth retardation and preterm delivery. Several studies have indicated that zinc
supplementation may reduce the incidence of clinical attacks of malaria in children.

43. HANDICAP AND THE COMMUNITY
• What do you call a handicapped person?
• Emphasize the individual not the disability.
Rather than using terms such as disabled
person, handicapped people, a crippled
person, use terms such
as people/persons with disabilities, a
person with a disability, or a person
with a visual impairment.
• Assignment on handicap and the community?

44. NORMAL GROWTH
GROWTH AND WEIGHT OF CHILDREN
• During the second half of the first year of life,
growth is not as rapid. Between ages 1 and 2,
a toddler will gain only about 5 pounds (2.2
kilograms). Weight gain will remain at about 5
pounds (2.2 kilograms) per year between ages
2 to 5. Between ages 2 to 10 years, a child will
grow at a steady pace

47. Thank you!