UNIT NO .

01
Describe the Concepts of Health and wellness as Basic Human needs (WHO definition).
Definition of Basic Concepts
HEALTH:
Definition:
According to WHO, Health is a state of complete physical, mental and social well being and ability to
function, not merely the absence of disease or infirmity.
1. It is the fundamental right of every human being. It is the state of integration of the body and mind
2. Health and illness are highly individualized perception. Meanings and descriptions of health and illness
vary among people in relation to geography and to culture.
3. Health - is the state of complete physical, mental, and social well-being, and not merely the absence of
disease or infirmity. (WHO)
4. Health is the ability to maintain the internal milieu. Illness is the result of failure to maintain the
internal environment.(Claude Bernard)
5. Health is the ability to maintain homeostasis or dynamic equilibrium.
Homeostasis is regulated by the negative feedback mechanism.(Walter Cannon)
6. Health is being well and using ones power to the fullest extent. Health is maintained through
prevention of diseases via environmental health factors.(Florence Nightingale)
7. Health is viewed in terms of the individuals ability to perform 14 components of nursing care
unaided. (Henderson)
8. Positive Health symbolizes wellness. It is value term defined by the culture or individual. (Rogers)
9. Health is a state of a process of being becoming an integrated and whole as a person.(Roy)
10. Health is a state the characterized by soundness or wholeness of developed human structures and of
bodily and mental functioning.(Orem)
11. Health-is a dynamic state in the life cycle; illness is interference in the life cycle. (King)
12. Health is an elusive, dynamic state influenced by biologic, psychologic, and social factors. Health is
reflected by the organization, interaction, interdependence and integration of the subsystems of the
behavioral system.(Johnson)
o Health is not a condition .it is an adjustment.(change)
o Health is a highly individual perception.(accepts)
o Individual health is a dedicated balance between internal, external as well as his social environment.
If one is disturbed then the other is followed.
WELLNESS
Definition:
It is defined as an evaluation of standard of living or level of living and quality of life which an individual or
groups of individual have.
Wellness is the condition in which all parts and subparts of an individual are in harmony with the whole
system. (Neuman)
ILLNESS:
Definition:
1. Illness is a state in which the equilibrium of the body and its function are disturbed.
2. It may be defined as phenomenon in which one or more natural functions of the body are so disturbed
that the affected individual cannot meet the natural requirement of everyday life.
3. Illness is failure or disturbance in the growth, development, function and adjustment of the organism as
a whole or any of its function or system (Engle)
4. It is a personal state in which the person feels unhealthy.
5. Illness is a state in which a persons physical, emotional, intellectual, social, developmental, or spiritual
functioning is diminished or impaired compared with previous experience.
6. Illness is not synonymous with disease.
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Stages of Illness
1. Symptoms Experience- experience some symptoms, person believes something is wrong
3 aspects physical, cognitive, emotional
2. Assumption of Sick Role acceptance of illness, seeks advice
Medical Care Contact
3. Seeks advice to professionals for validation of real illness, explanation of symptoms, reassurance or
predict of outcome
4. Dependent Patient Role. The person becomes a client dependent on the health professional for help.
o Accepts/rejects health professionals suggestions.
o Becomes more passive and accepting.
5. Recovery/Rehabilitation
Gives up the sick role and returns to former roles and functions.
EFFECTS OF ILLESS
Change he normal behaviour
Give up the autonomy e.g. Planning meals, practices work etc.
Financial burden.
Change in life style.
DISEASE:
Definition:
1. Disease is defined as a condition in which the body health is impaired (WEBSTER).
2. A state in which the individual is no longer in a state of equilibrium with force in his/her external and
internal environment. (Blend)
3. An alteration in body function resulting in reduction of capacities or a shortening of the normal life span.
4. Biologic agent e.g. microorganism
5. Inherited genetic defects e.g. cleft palate
6. Developmental defects e.g. imperforate anus
7. Physical agents e.g. radiation, hot and cold substances, ultraviolet rays
8. Chemical agents e.g. lead, asbestos, carbon monoxide
9. Tissue response to irritations/injury e.g. inflammation, fever
10. Faulty chemical/metabolic process e.g. inadequate insulin in diabetes
11. Emotional/physical reaction to stress e.g. fear, anxiety
Risk Factors of a Disease
1. Genetic and Physiological Factors
For example, a person with a family history of diabetes mellitus is at risk in developing the disease
later in life.
2. Age
Age increases and decreases susceptibility (risk of heart diseases increases with age for both sexes
3. Environment
. The physical environment in which a person works or lives can increase the likelihood that certain
illnesses will occur.
4. Lifestyle
. Lifestyle practices and behaviors can also have positive or negative effects on health.
Classification of Diseases
1. According to Etiologic Factors
a.Hereditary due to defect in the genes of one or other parent which is transmitted to the offspring
b. Congenital due to a defect in the development, hereditary factors, or prenatal infection
c.Metabolic due to disturbances or abnormality in the intricate processes of metabolism.
d. Deficiency results from inadequate intake or absorption of essential dietary factor.
e.Traumatic- due to injury
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f. Allergic due to abnormal response of the body to chemical and protein substances or to physical
stimuli.
g. Neoplastic due to abnormal or uncontrolled growth of cells.
h. Idiopathic Cause is unknown; self-originated; of spontaneous origin
i. Degenerative Results from the degenerative changes that occur in the tissue and organs.
j. Iatrogenic result from the treatment of the disease
2. According to Duration or Onset
a.Acute Illness An acute illness usually has a short duration and is severe. Signs and symptoms
appear abruptly, intense and often subside after a relatively short period.
b.
Chronic Illness chronic illness usually longer than 6 months, and can also affects
functioning in any dimension. The client may fluctuate between maximal functioning and serious
relapses and may be life threatening. It is characterized by remission and exacerbation.
c.Remission- periods during which the disease is controlled and symptoms are not obvious.
d.
Exacerbations The disease becomes more active given again at a future time, with
recurrence of pronounced symptoms.
e.Sub-Acute Symptoms are pronounced but more prolonged than the acute disease.
3. Disease may also be described as:
a.Organic results from changes in the normal structure, from recognizable anatomical changes in
an organ or tissue of the body.
b.
Functional no anatomical changes are observed to account from the symptoms
present, may result from abnormal response to stimuli.
c.Occupational Results from factors associated with the occupation engage in by the patient.
d.
Venereal usually acquired through sexual relation
e.Familial occurs in several individuals of the same family
f. Epidemic attacks a large number of individuals in the community at the same time. (e.g. SARS)
g.
Endemic Presents more or less continuously or recurs in a community. (e.g.
malaria, goiter)
h.
Pandemic An epidemic which is extremely widespread involving an entire country
or continent.
i. Sporadic a disease in which only occasional cases occur. (e.g. dengue, leptospirosis)
Health and illness are inverted through application of nursing process including
Assessment
Goal setting
Planning
Implementation
Evaluation
Health promotion
It is a process which is undertaken to increase level of wellness in individuals, families and
communities.

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HEALTH AND ILLNESS CONTINUUM

According to this continuum health is not a state but ability to function with different levels. Health is a
dynamic process with one end to death and other to highest level of wellness. and the individuals can place
themselves at different locations at one point at one time. Jut like different cultures have their own norms
and standard, health has its levels.
o A disease can lead towards the serious sickness and then to death.
o Awareness of health, health care and proper and accurate treatment and well social, economic, mental
and physical environment can lead to wellness.
Health
Peak

High

Good

Normal

Poor

Extreme

Critical ill

Death

OR

SIGNS

CAUSATIVE AGENT

HEALTH EDUCATION CARE & CURE

DEATH

TOTAL
WELLNESS

DISABILITY
Rx MODEL

SYMPTOMS

NO RISK
NEUTRAL POINT

AWARENESS

SELF ACTUALIZATION
WELLNESS MODEL

NURSING
ICN (INTERNATIONAL COUNCIL OF NURSES): Nursing encompasses autonomous and collaborative care
of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing
includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people.
Advocacy, promotion of a safe environment, research, participation in shaping health policy and in
patient and health systems management, and education are also key nursing roles.
Nursing is a profession in which the nurse applies skills and attitudes in the provision of comfort and
care for the health needs of people. It is a dynamic, therapeutic and educative process by which the
practitioner provides preventive, curative promotive and rehabilitative health services to individuals,
families and communities.
Nursing is a profession in which the nurse applies skills and attitudes in the provision of comfort and
care for the health needs of people. It is a dynamic, therapeutic and educative process by which the
practitioner provides preventive, curative promotive and rehabilitative health services to individuals,
families and communities.
As defined by the as written by Virginia Henderson.
The unique function of the nurse is to assist the individual, sick or well, in the performance of those
activities contributing to health, it is recovery, or to a peaceful death the client would perform unaided if
he had the necessary strength, will or knowledge.
Help the client gain independence as rapidly as possible.
Mahmood Ahmed Arain

UNIT NO. 02
DEFINITION AND BRIEF DESCRIPTION OF:
1. Community
2. Community Health.
3. Community Health Nursing.

1. Community
Definition:
Community is a large group of individual living together for a long time in a locality, having, common
interests, goats, ways of life and norms e.g. village and Mohallah.
Community is a social group determined by geographical boundaries and or common values and
interests its members know and interact with each other.
Community- derived from a Latin word comunicas which means a group of people.
a group of people with common characteristics or interests living together within a territory or
geographical boundary
place where people under usual conditions are found
Functions of Community
The basic functions of the community can be summarized in the following order.
To determine the use of space for living and other purposes.
To make the available means for production and distribution of necessary goods.
To protects and conserve the health life, resources and the property of individuals.
To educate and accumulate the new comers e.g. children and immigrants.
To transmit in formations, ideas and beliefs.
To provide opportunity for interactions between individuals, and groups.

2. COMMUNITY HEALTH
Definition:
Community health refers to the health status of the members of the community, to the problems affecting
their health, and to the totality of health care provided for the community.
The utilization of the nursing process in the different levels of clientele-individuals, families, population
groups and communities, concerned with the promotion of health, prevention of disease and disability
and rehabilitation.
Aims:
1. Health promotion
2. Disease prevention
3. Management of factors affecting health

Goal: To raise the level of citizenry by helping communities and families to cope with the
discontinuities in and threats to health in such a way as to maximize their potential for high-level
wellness.
3. COMMUNITY HEALTH NURSING
Definition:
Community Health Nursing is a synthesis of nursing practices applies to the promoting and of preserving the
health of population, it is not limited to a particular age or a diagnostic group, health promotion, health
maintenance, health education, coordination and continuity of care utilized in holistic approach to the family,
group and community.

The Emergence (Appearance) Of Community Health Nursing:

The Community health nursing started hundreds of years ago.
The early Israelites and Egyptians hired women, later called midwives, assisted at births. Noblewomen,
including the wives of emperors cared for the ill in ancient Rome. During the War, Military nursing orders
of Monks and Knights tended the sick and wounded.
During the 1600s to mid 1800s, wealthy people did not go to hospitals. They were nursed at home.

Mahmood Ahmed Arain

In 1669, Community Health Nursing got development dramatically, since the first visiting Nurses were
sponsored by St.Vincent De Pual in Paris.

In 1747 first visiting nurses in Canada were the Grey Nuns, established in Montreal.
In 1802 Nuns were visiting the poor in community for care of ills & promoting health.
In 1800 to 1850, Smallpox, Yellow Fever, Cholera, Typhoid, & Typhus were spread through
immigrants in USA, so government of USA trained some health workers to give care those
people in their homes, later on these known as Community Health Nurses/Public Health Nurses.
Community Health Nursing developed in the United States in the late nineteenth and early
twentieth centuries.
In 1859 Community Health Nursing began with William Rathone in Liverpool, England.
In 1860 Florence Nightingale Training School for Nurses established at St.Thomas Hospital in
London.
In 1866 New York Metropolitan Board of Health established.
In 1 864 Factory Act passed to control of diseases & treatment of children of persons who work
in factories.
In 1886, First Health Visiting Nurse Society began in Philadelphia, which provided home care to
community.
In 1910, a decision was made to employ a nurse for the Care of tuberculosis patients in homes.
Through subscriptions and entertainments conducted by Christ Episcopal Church, a nurse was
engaged.
After 2nd World War Community Health Nurses were visiting community on foot, in horsedrawn buggies or on bicycles.
In Pakistan, Post-Basic Diploma course of Community Health Nursing is being run by Pakistan
Institute of Medical & Health Science Islamabad, College of Nursing Lahore, College of Nursing
JPMC Karachi ,College of Nursing Jamshoro and St. James College of Nursing Karachi
Community Health Nursing is taught as a subject in all academic years of diploma in nursing,
In Government sector the community health worker training program was started in last decade
for the promotion of women health and promotion of family planning.
In private sector The Agha Khan community health service was started which provides services
only to the Agha Khan community.
MISSION OF CHN
Health Promotion
Health Protection
Health Balance
Disease prevention
Social Justice
PHILOSOPHY OF CHN
The philosophy of CHN is based on the worth and dignity of human beings.
Community health nursing believes that it works toward attaining, maintaining or regaining the high
level of wellness by preventing from diseases and treatment of diseases.
Community Health Nursing believes that every individual has a need of health learning. It believes
every one member of community has an equal right to get health care in equal.
It believes that advancement in science & technology has a big positive role in the promotion of the
health & prolonging life.
It believes that prevention from diseases & promotion of health is better than cure.
It believes that the provision of specialist nursing care must respond to the needs of people and should
follow an inter-professional and multi sectoral approach.
Health Care should be provided in such a way to improve the quality of life in that community.
Principles of Community Health Nursing:

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1. The community is the patient in CHN, the family is the unit of care and there are four levels of clientele: individual,
family, population group (those who share common characteristics, developmental stages and common exposure
to health problems e.g. children, elderly), and the community.
2. In CHN, the client is considered as an ACTIVE partner NOT PASSIVE recipient of care
3. CHN practice is affected by developments in health technology, in particular, changes in society, in general
4. The goal of CHN is achieved through multi-sectoral efforts
5. CHN is a part of health care system and the larger human services system.

PRINCIPLES OF COMMUNITY HEALTH NURSING

Community health nursing is based on recognized needs of communities, families, groups and
individuals
The community health nurse must understand fully the objectives and policies of the agency she
represents
FAMILY unit of service
Community health nursing must be available to all
The community health nurse works as a member of the health team
Utilize existing active groups in the community
Make use of available community health resources
Educative supervision
Opportunities for continuing staff education program must be provided
HEALTH TEACHING primary responsibility of the community health nurse
Accurate recording and reporting
There must be periodic evaluation

UNIT NO. 03
ROLES AND FUNCTIONS OF THE COMMUNITY HEALTH NURSE
Health Care Provider:
The Community Health Nurse provides direct care in community. A CHN conducts the deliveries in
community, Provides Geriatric Care, .Antenatal care, Postal natal care, Neonatal care, nursing
procedures, Wound dressings and Treats minor illnesses, Provides the first aid.
Health Educator:
CHN Educates individual, family and community for the principles and techniques of prevention of
communicable disease, the modes of spread of genetic and infectious diseases, about proper diet in
quantity and quality, the personal, family and community Hygiene, the handling and first aid techniques
for emergencies like, Drowning, Snake bite, Dog Bite etc and training of the Traditional Birth
Attendants for normal delivery and safe delivery in communities.
Collaborators:
CHN works with the collaboration of other health workers and works with doctors, dispensers,
vaccinators, TBAs, midwives, and LHVs etc in the community.
Counselor:
CHN (Community Health Nurse) conducts the counseling of individuals, families, in community in
some social and mental problems, and also for motivation of family planning, vaccination and for
removing the some un-healthy behaviors in folk ways.
Advocate:
CHN advocates for the patients, client through Pleading and leading for installation of facilities of health
care in suitable and required places. A CHN participates the district govt. meeting and talks to
administration for the favor folks for solution of health care, social and financial problems available in
his her constituency.
Researcher:
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 CNN works hard for searching new methods of care and application of new technology and also finds
the social and economical problems in community, which makes hindrance for care and cure and also
searches causes of illnesses. She collects the statistical data like morbidity rate, mortality rate, death rat
birth rate etc and analyzes that data. After analysis she sends the reports to higher authorities for
remedies in feedback and writes the research papers on different issues and problems n community.
Manager:
CHN has managerial role in community Organizations and manages various programs of health and
assume leadership of nursing team for supervision of nursing and other staff. She works as a manager
and leading person in the Lady Health Workers in Taluka / tehsil level on the position of supervisor.
Evaluator:
CHN evaluates the special health programs in community, effectiveness any program or drug or teaching
or vaccination in community and she evaluates the success or outcome of project or program after
implementation of any project or health program in a community.
Clinician CHN is a health care provider, taking care of the sick people at home or in the hospital.
Health Advocator speaks on behalf of the client
Supervisor - who monitors and supervises the performance of midwives
Facilitator - CHN establishes multi-sectoral linkages by referral system.
Other Specific Responsibilities of a Nurse,
Supervision and care of women during pregnancy, labor and puerperium
Performance of internal examination and delivery of babies
Suturing lacerations in the absence of a physician
Provision of first aid measures and emergency care
Recommending herbal and symptomatic medsetc.
In the care of the families:
Provision of primary health care services
Developmental/Utilization of family nursing care plan in the provision of care.
In the care of the communities:
Community organizing mobilization, community development and people empowerment.
Case finding and epidemiological investigation.
Program planning, implementation and evaluation.
Influencing executive and legislative individuals or bodies concerning health and development.
Responsibilities of COMMUNITY HEALTH NURSE
Be a part in developing an overall health plan, its implementation and evaluation for communities.
Provide quality nursing services to the three levels of clientele.
Maintain coordination/linkages with other health team members.
NGO/government agencies in the provision of public health services.
Conduct researches relevant to CHN services to improve provision of health care.
Provide opportunities for professional growth and continuing education for staff development.

Mahmood Ahmed Arain

UNIT NO. 04
ALMA ATA DECLARATION
Alma Ata is a capital city of Kazakhstan where the conference of 134 countries Govt. and 67 representatives
of NGOs held in 6 to12 September 1978. This conference was arranged by W.H.O in the implementation of
20th World Health Resolution of 1977 on provision for Primary Health Care to all people of world, that they
live socially and economically productive lives. In this conference, it was decided that up to 2000 every
Government is responsible to provide Primary Health Care to all its People and this slogan was known as
Health for All by year 2000.
Definition of Health for All (HFA/2000):
Health for ALL is defined as The attainment of a level of health that will enable every individual to lead
a socially and economically productive.
ALMA ATA DECALRATION
The International Conference on Primary Health Care, meeting in Alma-Ata this twelfth day of
September in the year Nineteen hundred and seventy-eight, expressing the need for urgent action by all
governments, all health and development workers, and the world community to protect and promote the
health of all the people of the world, hereby makes the following Declaration:
I: The Conference strongly reaffirms that health, which is a state of complete physical, mental and social
wellbeing, and not merely the absence of disease or infirmity, is a fundamental human right and that the
attainment of the highest possible level of health is a most important worldwide social goal whose
realization requires the action of many other social and economic sectors in addition to the health sector.
II :The existing gross inequality in the health status of the people particularly between developed and
developing countries as well as within countries is politically, socially and economically unacceptable and
is, therefore, of common concern to all countries.
III : Economic and social development, based on a New International Economic Order, is of basic
importance to the fullest attainment of health for all and to the reduction of the gap between the health status
of the developing and developed countries. The promotion and protection of the health of the people is
essential to sustained economic and social development and contributes to a better quality of life and to
world peace.
IV : The people have the right and duty to participate individually and collectively in the planning and
implementation of their health care.
V : Governments have a responsibility for the health of their people which can be fulfilled only by the
provision of adequate health and social measures. A main social target of governments, international
organizations and the whole world community in the coming decades should be the attainment by all
peoples of the world by the year 2000 of a level of health that will permit them to lead a socially and
economically productive life. Primary health care is the key to attaining this target as part of development in
the spirit of social justice.
VI :Primary health care is essential health care based on practical, scientifically sound and socially
acceptable methods and technology made universally accessible to individuals and families in the
community through their full participation and at a cost that the community and country can afford to
maintain at every stage of their development in the spirit of self- reliance and self -determination. It forms
an integral part both of the country's health system, of which it is the central function and main focus, and of
the overall social and economic development of the community. It is the first level of contact of individuals,
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the family and community with the national health system bringing health care as close as possible to where
people live and work, and constitutes the first element of a continuing health care process.
VII : Primary health care:
reflects and evolves from the economic conditions and sociocultural and political characteristics of the
country and its communities and is based on the application of the relevant results of social, biomedical and
health services research and public health experience;

addresses the main health problems in the community, providing promotive, preventive, curative and
rehabilitative services accordingly;

includes at least: education concerning prevailing health problems and the methods of preventing
and controlling them; promotion of food supply and proper nutrition; an adequate supply of safe water and
basic sanitation; maternal and child health care, including family planning; immunization against the major
infectious diseases; prevention and control of locally endemic diseases; appropriate treatment of common
diseases and injuries; and provision of essential drugs;
Primary health care:

involves, 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,
communications and other sectors; and demands the coordinated efforts of all those sectors;

requires and promotes maximum community and individual self-reliance and participation in the
planning, organization, operation and control of primary health care, making fullest use of local, national
and other available resources; and to this end develops through appropriate education the ability of
communities to participate;

should be sustained by integrated, functional and mutually supportive referral systems, leading to the
progressive improvement of comprehensive health care for all, and giving priority to those most in need;

Relies, at local and referral levels, on health workers, including physicians, nurses, midwives,
auxiliaries and community workers as applicable, as well as traditional practitioners as needed, suitably
trained socially and technically to work as a health team and to respond to the expressed health needs of the
community.
VIII : All governments should formulate national policies, strategies and plans of action to launch and
sustain primary health care as part of a comprehensive national health system and in coordination with other
sectors. To this end, it will be necessary to exercise political will, to mobilize the country's resources and to
use available external resources rationally.
IX: All countries should cooperate in a spirit of partnership and service to ensure primary health care for all
people since the attainment of health by people in any one country directly concerns and benefits every
other country. In this context the joint WHO/UNICEF report on primary health care constitutes a solid basis
for the further development and operation of primary health care throughout the world.
X

An acceptable level of health for all the people of the world by the year 2000 can be attained through
a fuller and better use of the world's resources, a considerable part of which is now spent on armaments and
military conflicts. A genuine policy of independence, peace, dtente and disarmament could and should
release additional resources that could well be devoted to peaceful aims and in particular to the acceleration
of social and economic development of which primary health care, as an essential part, should be allotted its
proper share.

The International Conference on Primary Health Care calls for urgent and effective national and
international action to develop and implement primary health care throughout the world and particularly in
developing countries in a spirit of technical cooperation and in keeping with a New International
Economic Order

It urges governments, WHO and UNICEF, and other international organizations, as well as
multilateral and bilateral agencies, non- governmental organizations, funding agencies, all health workers
and the whole world community to support national and international commitment to primary health care
and to channel increased technical and financial support to it, particularly in developing countries. The
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10

Conference calls on all the aforementioned to collaborate in introducing, developing and maintaining
primary health care in accordance with the spirit and content of this Declaration.

HEALH PROBLEMS IN PAKISTAN

Maternal Child Health problems
Problems in pre-natal period:
Still Birth, Low Birth Weight, Pre-mature Birth, Congenital Disorders,
Eclampsia, Ante-partum hemorrhage, Abortions, Anemia, Post partum Haemorrhage
Accidental problems
Road traffic accidents, accidental burns, terrorism
Geriatric health problems
Osteoporosis, fractures, hearing and vision problems, hypertension, diabetes mellitus
Infectious diseases
Measles, Diphtheria, Tetanus Whooping Cough, Hepatitis-B, Poliomyelitis
Tuberculosis, malaria, AIDS, swine flu, dengue fever, Influenza, Gastroenteritis
Parasitic Diseases:
Hook worm, Round worm, Thread Worm and Pin worm infestation
Mental Health problems
Psychosis, Schizophrenia, Mania, Anxiety, depression, drug abuse
Occupational health problems
Malnutrition
Obesity, Marasmus, Kwashiorkor, Anemia, Night blindness, Scurvy
Ophthalmic diseases
Safe Water Supply
School Health
Reproductive health
Cancer
Cardiovascular diseases
Chronic Obstructive Pulmonary Diseases
Renal Disease

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11

UNIT NO. 05
PRIMARY HEALTH CARE
Definition:
Primary health care is an essential health care based, on practical scientifically Sound and socially
acceptable methods and technology made universally accessible to individual and families in the community
through their full participation and at a cost that the community and country can afford to maintain at every
stage of their development in the spirit of self-reliance and self-determination.
DEFINING OF PRIMARY HEALTH CARE
Value driven: dignity, equity, solidarity and ethics
Protects and promotes health
Centered on people, but allowing self reliance
Focus is quality including cost effectiveness
Sustainable finances, allowing universal coverage and equitable access
Topic: 5.2
COMPONENTS OF P .H.C.
OR
ELEMENTS OF P.H.C.
OR
CORNER STONES OF P.H.C.
1. Health education concerning prevailing health problems and methods of preventing and controlling
them.
2. Provision of adequate food supply and proper nutrition (provision of balanced diet).
3. Adequate supplies of safe water and basic sanitation.
4. Provision Of adequate maternal and child health care, including family planning.
5. Prevention against major infectious disease through immunization.
6. Prevention and control of locally endemic disease e.g., malaria and diarrhea.
7. Appropriate treatment of common diseases and injuries.
8. Provision of adequate mental health care.
9. Provision Of essential drugs.
OR (ELEMENTS+M)
Education of prevailing Health Problems
Locally-endemic Disease Prevention and Control
Expanded Program of Immunization
Maternal and Child Health and Family Planning
Environmental Sanitation and Safe Water Supply
Nutrition and Food Supply
Treatment of Communicable & Non-communicable Diseases/Conditions
Supply and Proper use of Essential Drugs and Herbal Medicine
Mental Health Promotion
THE FUNCTIONS OF PRIMARY HEALTH CARE
1. To provide continuous and comprehensive care
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12

2.
3.
4.
5.

To refer to specialists and/or hospital services

To co-ordinate health services for the patient
To guide the patient within the network of social welfare and public health services
To provide the best possible health and social services in the light of economic considerations.

UNIT NO. 06
Topic: 6.1
BASIC PRINCIPLES OF P.H.C:
1. Accessibility of health services to all populations.
2. Maximum individual and community involvement in the planning and operation of healthcare
services.
3. Emphasis on services that are preventive and prornotive rather than curative services only.
4. Use of appropriate technology.
5. Integration of health development with total overall social and economic development.
GENERAL PRINCIPLES OF P.H.C.
All points are basically derived from definition of P. H.C. by WHO.
1. Equity (Equitable distribution)
Primary health care for all with special attention to those who need and vulnerable groups e.g., rich or
poor people, urban and rural area.
2. Affectiveess
Services must be through qualified persons and at proper time.
3. Efficiency
Services must be with favorable effects.
4. Affordability
At a reasonable cost, so that poor can also make use of these services.
5. Community participation
All people, families and communities assume responsibility in promoting their own health and welfare.
Therefore in PHC community participation is must.
6. Multi-sectoral Approach
All sectors related to health must be involved for promoting the community health and self-reliance.
These are agriculture, irrigation, education, housing, public works, communication, rural development,
cooperatives, industries, panchayats and voluntary organizations.

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UNIT NO: 7
Team: a group of people working together for a common predetermined goal.
Health Team:
The group of health professionals works in collaboration for achievement of maximum health of
individual, family and community.
It is a group of health professionals working together for achievement of health of the particular
community.
This group is known as Health Team is usually consisting on:
Medical Officer
Nurse
Lady Health Visitor / Health Technician.
Dispenser
Community Health Worker
Trained Traditional Birth Attendant
Security Guard
Sanitary Worker
PURPOSES OF A OF PRIMARY HEALTH CARE TEAM:
Working for a goal such as promotion of health, prevention of disease and disability and rehabilitation.
Identify the goal
To establish the goal according to the need of population.
To develop the plan of action.
To set the priority.
To enable all team members to contribute for achievement of the goal.
Provide health care to the individuals.
To provide health education to the people in the community.
The basic health care level starts from a Basic Health Unit where a health team consists of Medical
Officer, Nurse, Lady Health Visitor / Health Technician, Dispenser, Community Health Worker, Trained
Traditional Birth Attendant, Security Guard and Sanitary Worker. This team provides the basic health care
services of primary health care to a population of 5000 10,000.
TYPES OF TEAM:
Nuclear team (a few members at primary health care level)
Extended team (more people in this team at secondary level of health care )
Multidisciplinary team (a broad set up of services having all types of health care facilities availability)
Advantages of team work:
Reduce of over all cost by sharing offices and personal equipments.
Provide confidence among team members as team work gives opportunities to work independently or
interdependently on each other.
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 Members lead to built trust and positive relationship.

It may reflect the idea more brain / more ideas, while working in a team, exchange of ideas occur, people
share their personal experiences and knowledge with other team members so the learning opportunities are
available.
More work can be done in a short time.
Responsibilities of administration are shared by delegations of tasks to all team members.
Reasonable rest and relaxation time for all team members is available when needed.
Complete, error free and efficient records can be prepared that might be used for research purposes.
Professional persons have the time to avail opportunities o improve their skills and professional growth.
Team spirit developes and people feel themselves more self worth.
Disadvantages of team work:

Non- willing workers do not bother to work and the burden may be on the others who really want to accomplish
the task.
While working in a group he conflict may arise because of individual difference and heir ideas and if his is not
resolved properly and intelligently, it will hinder to achieve the team objectives.
One or more members may influence the others and it can suppress the abilities of other team members.
Communication problems may occur when busy individuals forget to inform other regarding messages.

PRINCIPLES OF WORKING IN A TEAM:

Roles and expectations of all team members should be clear.
Team members should remember that the team leader has strength as well as limitations, never criticize
him/ her in front of others.
Positive behaviour should be praised and negative be ignored once, unless it hinders the team work.
Always be polite while working in a team. It helps o build constructive relationship .be assertive but be
careful about any conflict developing and for is resolution.
Promote effective communication and encourage comfortable and harmless environment for the team
members.
Keep the team well informed. The success of the team work depends on his key principle.
Do not hide the mistakes and not blame the others for it. Making error is a natural human tendency it is
better to admit the mistakes to the team members because it provides the opportunity to improve it and
be careful in future.
Team leader should accept only those tasks which the team members have the ability to achieve or
fulfill.
Each team member is responsible to work but if a member is weak or has insufficient skills, the others
have the responsibility to help and observe his work and to improve his skills. Do not criticize over him
or her.
Avoid irritating and frustrating to each other while working in a team.
Achievement of a goal or accomplishment of any task must be publicized in front of all team members.
It provides a sense of job satisfaction and feeling of self worth.
RESPONSIBILITIES /ROLES OF HEALH TEAM MEMBERS
It is a group of health professionals working together for achievement of health of the particular
community and each member has specific roles and responsibilities according to job description.
Medical officer:
Makes medial diagnosis and prescribes medications to he patients.
Responsible for the coordination of work in a unit.
A guider of team members.
Plans and conducts health education sessions. Responsible for professional growth of team members.
Prepares reports and records for submission to superior authority and for further utility.
Registered nurse:
Health Care Provider: Clinician CHN is a health care provider, taking care of the sick people at
home or in the hospital. The CHN provides direct care in community as she conducts the deliveries in
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community, Provides Geriatric Care, .Antenatal care, Postal natal care, Neonatal care, nursing
procedures, Wound dressings and Treats minor illnesses, Provides the first aid.
Health Advocator speaks on behalf of the client
Supervisor - who monitors and supervises the performance of midwives.
Facilitator - CHN establishes multi-sectoral linkages by referral system.
Health Educator
Collaborators
Counselor
Advocate
Researcher
Manager
Evaluator (see UNIT NO. 2 for details)
Health technician:
Assists in client care activities e.g. growth monitoring immunization.
Lady health visitor / Midwife:
Home visiting and assessing individuals, families and community needs.
Helping in antenatal and pos natal activities and conducting normal deliveries in community. Link
between a MCH Centre and a BHU.
Referring to hose people who need further help.
Growth monitoring of children in a community.
Trained Traditional Birth Attendant:
Antenatal and postnatal care in community or hospital.
Conduct deliveries under supervision.
Community health worker:
Links between community and health care centre.
Home visiting.
Encourage good health habits and clean environment.
Identify false taboos and practices which are harmful to health of pregnant women and children.
Identify the causes of water contamination in homes and community.
Shares informations related to prenatal, natal, postnatal and neonatal care.
Identify high risk pregnant women in community and refer hem to well facilitated hospitals.
Encourage adequate nutrition for mothers and children.
Identify and refer children with different types of infections such as diarrhea, and other communicable
diseases.
Identify and refer people with communicable diseases.
Share informations with families about the causes and prevention of diarrhea and other communicable
diseases.
Security Guard:
Responsible for the safety of hospital /unit.
Controlling of people and maintain discipline.
Sanitary Worker:
Responsible to keep the unit neat and clean.
What are the main duties of a Health team?
The main duties of a health team during a disaster are:
1. First aid
2. Emergency care
3. Ambulatory care.
4. Patient referral.
5. Public education.
The following list shows the characteristics that comprise high-performance teams:
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The team has a common focus, including clear and understandable goals, plans of action,
and ways to measure success.
Roles and responsibilities are clearly defined for each team member.
Each member has clearly defined expectations of other members.
The team fully utilizes its resourcesboth internal and external.
Members value each others differences in healthy and productive ways.
Each member is able to give, receive, and elicit necessary feedback.
The team members manage their meetings in a productive way.
The team is able to reach goals by achieving the necessary results.

Reasons for poorly working by health team members.

Inadequate salary
Non-interesting work
Poor working condition
Poor security

UNIT NO: 08
HEALTH CARE SERVICES IN PAKISTAN
In Pakistan, at this time there are two main systems providing health care services to the people.
1. Government established health care system
2. Private or public sector.
In Government established health care system:
a. The institutes are developed at federal and provincial level. In federal level different teaching and special
services hospitals are established which provide tertiary level healthcare services. These hospitals are only in
major cities.
b. In provincial system the hospitals are established from a basic level to teaching hospitals. These hospitals are
spread in all over the country and provide health care services to the people. Government established health care
system provides health care services on free or very low cost to the people.
In Private or public sector established hospitals provide services to the people in mostly cities all over the country.
These range from a general clinic to a teaching hospital and provide health care services to the people on cost. Some
NGOs also have established hospitals in the country which provide special services as Mary Adelaide Health Services
for Family Planning and Leprosy Control, Latin Rehmatullah Benevolent Trust provide services for ophthalmic care.

Levels of Health Care:

There are three levels of health care:
Primary Health Care
Secondary Health Care
Tertiary Health Care.
Primary Health Care
Primary health care is an essential health care based, on practical scientifically Sound and socially
acceptable methods and technology made universally accessible to individual and families in the community
through their full participation and at a cost that the community and country can afford to maintain at every
stage of their development in the spirit of self-reliance and self-determination.
It focuses on prevention and promotion rather than cure. First Aid is also part of PHC.
All elements of primary health care are being practiced in the Level.
Patients are referred from this level to Secondary level for detection and treatment of disease.
It is provided on Dispensaries, Family Planning Centers MCH centers, and BHU & RHCS.
Secondary Health Care Level:
This focuses on early detection and treatment of diseases.
It is curative rather than preventive.
The patients are received from primary health care level.
It has special services of Physician, Gynecologist, Orthopedic Surgeon, and Pediatrician etc also.
It is provided on at Tehsil Taluka, & District / Civil Hospitals.
Tertiary Health Care Level:
It is provided in teaching hospitals, and regional hospitals.
It provides high level of care of different diseases and prevents disabilities & provides rehabilitations.
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 It has specialized units and departments Medical and surgical units, Ophthalmology, ENT, maternity,
Gynecology, Cancer, & Orthopedic departments etc.
It is equipped with latest technology, well trained staff and advanced machinery.
PRIMARY LEVEL
Health Promotion and Illness
Prevention
Provided at
Health care/BHU
Health Stations, clinics
Main Health Center
Community Hospital and
Health Center
Private
and
Semiprivate
agencies

SECONDARY LEVEL
Prevention of Complications
through Early DIAGNOSIS and
Treatment
When hospitalization is deemed
necessary.
referral is made to emergency
(now district), provincial or regional
or private hospitals.

TERTIARY LEVEL
Prevention of Disability, etc.
When highly specialized Medical care is
necessary.
referrals are made to hospitals and
medical center such as from RHC, BHU,
National Center for Mental Health, and other
govt, private hospitals at the municipal level

Basic Health Unit:

Basic Health unit is basically a primary Health Care centre, which promotes health & prevents diseases
by immunization, health education, family planning and treating minor illnesses.
It provides services to a population from 5000-10000.
The working staff in BHU is consisting of:
o Medical officer
o Health Technician
o Lady Health worker
o Dispenser
o Security Guard and
o Sanitary worker
Rural Health Center:
It provides services to a population of 50,000-100,000.
It provides primary health care services that promotes health, & prevents through immunization,
health education, family planning and treating common minor illnesses.
It provides the special services of Gynecology, & General Surgery.
Nine elements of Primary Health Care are implemented through Rural Health Center:
A Rural Health Center is integrated with 4-6 Basic Health Units. It has 10 - 25 bedded ward and it is
staffed with:
o Medical Superintendent
o Store Keeper
o Deputy Medical Superintendent
o Vaccinator
o Medical Officers male and Female
o Office Clerk
o Gynecologist & Obstetrician
o Registration Clerk
o Surgeon
o Two Drivers
o Staff Nurses
o Ward Servant
o Lady Health Visitor
o One Naib Qasid /Peon
o Dispenser
o Sanitary worker
Taluka Head Quarter Hospital:
It is consisted for the population of 10, 0000 or More.
It is a Secondary Health Care Level Hospital.
It provides more curative services rather than preventive health care.
It provides prompt diagnosis & treatment of minor & major diseases. Patients are received from
primary health care units.
It has special services of Gynecologist, Eye, Pediatrics, ENT including general surgery &
Medicine.
One Taluka Hospital is integrated with 3 -4 Rural Health Centers.
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 It has a 25 - 50 bed capacity.

District Head Quarter Hospital / Civil Hospital:
It is consisted for the population of 1600000 or more. It is a Secondary Health Care Level
Hospital. It is integrated with 4-5 Taluka Hospitals.
It provides more curative services rather than preventive health care.
It provides prompt diagnosis & treatment of minor & major diseases. Patients are received from
primary health care units. Different wards of various diseases are present in a civil /district
hospital.
It has special services of Gynecologist, Eye, Pediatrics, ENT including general surgery &
Medicine.
It has the capacity of more than 100 beds.
The training of paramedical staff and nursing is also provided in the schools affiliated with civil /
district hospitals.
Teaching Hospitals:
These are tertiary health care level hospitals.
These hospitals also provide medical nursing and paramedical staff teaching services. These
provide special care e.g. Psychiatry, ENT, EYE, Neuro orthopedic, Gynecology, Obstetrics,
Pediatrics & oncology etc.
These hospitals prevent disabilities & provide rehabilitation services.
These hospitals have more technological devices & procedures.
These hospitals are under control of Provincial Secretary of Health/provincial Government
directly.
Federal Hospitals:
These hospitals are established under control of Federal Government and mostly located in capital
city of province.
These hospitals provide tertiary health care services to the people.
Pakistan Institute of Medical Sciences Islamabad, Federal Government Services Hospital, Poly
Clinic, National Institute of Health in Islamabad and National Institute of Child Health Karachi,
Jinnah Postgraduate Medical Centre Karachi And National Institute of Cardiovascular Diseases
Karachi are the examples of Federal Government Hospitals.
Atomic Energy Medical Centres:
These centers work autonomously with the support of Pakistan Atomic Energy Medical Commission
.These centers provide the diagnostic facilities and scans of cancer patients on very low cost to the
people.

HEALTH CARE SYSTEM IN PAKISTAN

UNIVERSITY
HOSPITAL

POPULATION
COVERED

600000

DISTRICT
HOSPITAL

350000 To
400000

TEHSIL
HOSPITAL

TEHSIL
HOSPITAL

TEHSIL
HOSPITAL
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25000 TO
100000

RURAL
HEALTH
CENTER

RURAL
HEALTH
CENTER

RURAL
HEALTH
CENTER

RURAL
HEALTH
CENTER

RURAL
HEALTH
CENTER

5000 TO
10000

BASIC
HEALTH
UNIT

BASIC
HEALTH
UNIT

BASIC
HEALTH UNIT

BASIC
HEALTH
UNIT

BASIC
HEALTH
UNIT

CHW

CHW

CHW

CHW

CHW

CHW

REFERRAL SYSTEM
Teaching hospital
750-1700 beds

Specialized hospital
100-450 beds

Civil or district head

quarter hospital
250-350 beds

Major hospitals
department hospital
100-200 beds

HEAD QUARTER HOSPITAL

30-50 beds
RHC /UHC
20-30 beds
MATERNITY hospital
10-20 Beds
Basic health unit/
urban health centre
Clinics

Dispensaries

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UNIT No - 09
EPIPDEMIOLOGY
The word epidemiology is derived from three Greek words.
EIPDEMIOLOGY
________________________________________

Epi
Demos
Logos

Upon, Among
People
Study, Science
Definitions
Epidemiology
1. The study of distribution of disease or physiologic condition among human population s and the
factors affecting such distribution
2. The study of the occurrence and distribution of health conditions such as disease, death,
deformities or disabilities on human populations
3. Epidemiology is the study of distribution of diseases.
4. Epidemiology is the study of distribution and determinants of health related problems in the
population (Last 1983).
5. Epidemiology s the branch of medical science, which treats epidemics (Parkin 1873).
6. The science of the mass phenomenon of infectious diseases (Frost 1927).
7. Epidemiology may be defined as the study of the distribution, dynamic and determinants of disease
in human population.
8. the study of distribution of disease or physiologic condition among human population s and the
factors affecting such distribution
9. the study of the occurrence and distribution of health conditions such as disease, death, deformities
or disabilities on human populations
Aims of Epidemiology
1. Identify the factor of disease in human population.
2. Control and treatment of diseases.
3. To provide data essential to the planning, implementation and evaluation of services for the prevention
of diseases.
Steps in EPIDEMIOLOGICAL IVESTIGATION:
1. Establish fact of presence of epidemic
2. Establish time and space relationship of the disease
3. Relate to characteristics of the group in the community
4. Correlate all data obtained
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Role of the Nurse

Case Finding
Health Teaching
Counseling
Follow up visit
VARIOUS TERMS USED IN EPIDEMIOLOGY
INFECTLQN
The process of introducing or introduction of micro organisms into human host followed by their
multiplication within the body at the expense of hosts Called infection
EPIDEMIC
The disease, which affects large number of people within a short space of time of large number of
susceptible persons.
Epidemic disease: is an infectious disease which attacking a number of people in the same area at one
time as cholera, plague, measles etc.
Endemic
The disease which is always present in a community , but never flourishes because the number of
susceptible persons is equal to number of immune persons, e.g. enteric fever.
SPORADIC
It is a disease which affects few persons because of great number of immune persons than susceptible
persons in a community.
Pandemic
When a disease spreads to almost the whole world, e.g., influenza or AIDS.
Communicable disease
It is state of disorder in man that results from the entrance of microorganisms that are pathogenic and can
be communicated to other individuals in the community.
Non-Communicable disease
It is not transmitted from person to person. Non Communicable diseases include cardiovascular, renal,
nervous and mental conditions, musculoskeletal condition, accidents, cancer, diabetes, .obesity and
various other diseases.
Career: a person or animal that harbors specific infectious agents in the absence of clinical manifestations
and serves as potential source of infection.
Fomites: inanimate object or material in which disease producing organisms may be conveyed e.g.
patients personal possessions such as Lenin, clothes and utensils.
Virulence: the ability of on organism to cause disease.
Disinfectant: an agent that kills all growing forms of micro organisms, thus completely eliminating them
from objects used only on inanimate objects.
Sterilization: the process by which all microbes pathogenic and nonpathogenic and their spores are killed.
Vector: an animal usually an orthopode, insect tick that transfers any infectious microbe from one host to
one another.
Isolation: It is the separation during the period of communicability of infected persons or animals from
others to prevent the spread of the disease to those who are susceptible.
Quarantine: A person or an animal in kept in isolation coming from the abroad (other country) until the
symptoms of disease appear or that person or animal is declared free of any infection.
Categories of Isolation: (7 categories)
Hands must be washed after contact with the patient or potentially contaminated articles and before
taking care of another patient.
Articles contaminated with infectious materials should be appropriately discarded or bagged & labeled
before being sent for decontamination & reprocessing.

Strict Isolation to prevent highly contagious and virulent infections that may spread by both air and contact.

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o
o
o
o

Private room
Use of mask, gloves & gown for all persons entering the room.
Special ventilation requirements with the room at negative pressure to surrounding areas is
desirable

Contact Isolation

o
o

Specification:

For less highly transmissible or serious infections

Disease or conditions which are spread primarily by close or direct contact.

Respiratory Isolation diseases spread through the air

Tuberculosis IsolationEnteric Precaution
Drainage Secretion precaution
Blood & Body fluid precaution

UNIT NO.1O
THE CONCEPT OF DISEASE
When a disease attacks a large number of individuals in the community at the same time is called
epidemic disease. Occurrence of any disease always depends on three variables:
1. Agent: etiological factor.
2. Host: particular individual or group of people.
3. Environment: all that is external to the agent and host.
DISEASE TRANSMISSION IS AFFECTED BY:
Factors intrinsic to man
Factors intrinsic to the disease
Role of vectors
Factors intrinsic to the environment
The study of these factors and their dynamics in disease transmission is EPIDEMIOLOGY.
AGENT

ENIRONMENT

ENT

DISEASE
AGENT

THE EPIDEMIOLOGICAL TRIANGLE

Agent:
Any element, substance, or force whether living or non-living, the presence of which can initiate or
perpetuate a disease process
Types of agents:
Living or biological agents: includes all living organisms such as bacteria, viruses, protozoa, fungi and
helminthes.
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Physical: these are heat, cold, humidity, pressure, light, air, water, radiation, electricity etc.
Mechanical: chronic friction and other mechanical forces resulting in injuries, trauma, sprains etc.
Chemical: these may be the internal (endogenous) such as urea, glucose, bilirubin etc or external
(exogenous) such as allergic gases, insecticides, strong acids or bases.
Nutrients: different nutritional components such as minerals, vitamins, carbohydrates, proteins, fats and
water.
Characteristics of agents:
Inherent: physical features, biologic requirements, chemical make-up, viability, resistance
Those directly related to man: infectivity, pathogenicity, virulence, antigenicity.
Those related to the environment: reservoirs and sources of infection and mode of transmission.
Those directly related to man
Infectivity: ability to gain access and adapt to the human host to the extent of finding lodgment and
multiplication
Pathogenicity: measures the ability of the agent to cause a specific reaction
Virulence: severity of the reaction, usually measured in terms of fatality
Antigenicity: ability to stimulate a response
Different pathogenetic mechanisms
Direct tissue invasion
Production of a toxin
Immunologic enhancement or allergic reaction leading to damage to the host
Persistent or latent infection
Enhancement of host susceptibility to drugs of otherwise minimal toxicity
Immune suppression
Different mechanisms of transmission:
Direct transmission
Indirect transmission:

Vehicle-borne

Vector-borne:

Mechanical

Biological

Airborne: 1-5 um

Droplet nuclei

Dust
HOST
This may be a human being or an animal that come in contact with the agent.
Host factor influences the interaction with the agent and environment.
Age: Certain diseases are more common in certain age groups e.g. measles in childhood and hypertension
in old age
Sex: pregnancy related issues of women and prostatic hypertrophy in males.
Race: for example, Negro suffered more with sickle cell anemia.
Genetic factors: behavioural and blood disorders run into the next generation caused by chromosomal
factors.
Habits: living habits and dietary habits such as dietary pattern, use of tobacco, alcohol etc.
Nutrition: taking some foods more or less due to availability or unavailability or cultural restrictions may
cause some diseases such as obesity, malnutrition, diabetic mellitus and cardiac disorders.
Immunity: low immune persons can suffer with some diseases more than immune persons such as
children than the elders.
Customs: some traditions of a society can lead to specific diseases such as

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Social status: some diseases are more common in lower classes such as malnutrition, uberculosisetc.
Occupational status: some diseases are related to working environment such as respiratory problems are
more in garments industrial workers
Educational status: educated people can easily control and change their unsafe habits rather than
uneducated.
ENVIRONMENT:
It refers to the aggregate of all external conditions and influences affecting the life and development of an
organism, human (reservoir) behaviour and society.
Physical environment:
It includes water, soil, air, heat, light, radiation, noise, housing, climate, and geography etc.
Biological environment:
It includes al, living things such as (human, animal and microorganisms) in ecological system.
Ecology:
It is Science of relationship and interaction of totality of the organism to the environment.
Social environment:
Such as cultural, values, norms, customs, habits, beliefs, attitudes, religions and other psychosocial
factors.

MODES OF DISEASES TRANSMISSION:

OR
ROUTES OF ENTRANCE OF MICROORGANISMS INTO BODY.
1. INHALATION. Micro-organisms can enter into the body through nose and mouth during respiration
and they can produce infection such as upper respiratory tract infections and lower respiratory tract. As
influenza, Measles, pneumonia tuberculosis etc) .
2. INGESTION.
Micro-organisms can enter into the body through contaminated water and food so
that they can produce infection such as Diarrhea, Dysentery, Hepatitis, Poliomyelitis and Food
poisoning by staphylococcus.
3. IN - OCULATION. Pathogenic micro-organisms can enter through blood or serum into the body.
They can enter through mucous membrane into deep tissue of living organisms as by surgical wound,
through injected materials, serum, or other substance or by biting of insects and animals. e.g. Tetanus
(infection),rabies (dog), malaria (mosquito) and hepatitis e.g. Hepatitis-B and through serum / infected
blood.
4. SKIN CONTACT: Micro-organisms can enter into the body through the skin such as Herpes, simplex
virus, H Zoster virus, scabies etc.
5. SEXUAL CONTACT. Micro-organisms can enter into the body during sexual intercourse if a partner
is infected by a specific disease which can be transfer to the other partner as AIDS by semen.

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UNIT NO.11
EPIDEMIOLOGICAL APPROACH
Epidemiological approach is the observation of the determinants, frequency and
distribution of diseases. Health professionals can solve health problems by using the
epidemiological approach by asking questions related to health events in the following
approach:
Who (person)
Who is affected gender, age, race, colour.
Where (place)
The geographical area where diseases is seen more frequent or less it may be a
community, village , urban or rural area district ,province, country or continent.
When (Time)
In which season the disease appear summer, winter, autumn, spring .e.g. influenza,
gastroenteritis.
What is being done?
The health care facilities / measures those are being provided on the incidence. These are
Curative measures
Preventive measures
Promoting measures
What else could be done?
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It means that what was done at past related to that disease (habits, concepts, preventive and
curative measures) and what could be done more preventive and curative measures
regarding that disease.

UNIT NO.12
SURVEILLANCE AND NOTIFICATION OF COMMUNICABLE DISEASES
SURVEILLANCE:
Surveillance is a continual dynamic method of gathering data about the general public for the purpose of
primary prevention. (Harkness1995)
Ongoing, systemic collection, analysis and interpretation of health data, essentials to planning,
implementation and evaluation of public health practice.(CDC1988).
The continuous inspection / security of the factors that determine the occurrence and distribution of
diseases and other conditions of health related issues.
Surveillance is a process of data collection for action.
Surveillance is the collection of data about cases of target diseases and uses of the data, to improve action
to prevent these diseases.
NEEDS OF SURVEILLANCE PROCESS:
Through the Surveillance process changes in the trend or distribution of various states of health in the
population can be detected.
Identified changes increase awareness of health and disease prevention.
Timely feedback of data to those persons (Health agencies and Government department) who have needs
for planning control and prevention activities.
Data can also be used to evaluate previous actions that already taken to control and prevention of health
problems.
CHARACTERISTICS OF A SUCCESSFUL SURVEILLANCE SYSTEM
It involves health problems that are perceived to be important public health concern.
Some types of official reporting or unofficial recording of information is involved.
Successful Surveillance requires frequent sustained interaction with reporting resource including feedback
and follow up of reported cases.
The health care personals who are involved in the process understand the importance of follow up cases.
FACTORS THAT CONTRIBUTE OF SUCCESSFUL SURVEILLANCE SYSTEM
Simplicity
Timeliness
Flexibility
Ability too detect the true cases
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TYPES OF SURVEILLANCE
There are four general types of Surveillance.
Passive, active sentinel and special Surveillance
Passive Surveillance:
Health care personals use standardized report forms to submit informations about cases of communicable
diseases to health department. No action is taken unless the feedback or instructions are received by the
agency.
Active Surveillance
This is ongoing search for new cases e.g. AIDS, polio, etc.
This can be accomplished through telephone calls to health care personals or laboratories or a review of
hospital or clinical record.
Active Surveillance programmes are more complete than passive but are more expensive to maintain.
Sentinel Surveillance
Identified trends in frequently occurring conditions. A random sample of physicians office or health care
clinics are contacted and asked to report incidence of infectious diseases on regular bases.
Special Surveillance
It includes microbiological surveys and maintaining the emergence of antibiotic resistant organisms. e.g.
vibrio cholera .
Sources of Surveillance information
General population:
Morbidity data
Mortality data
Case investigation
Epidemic reports
Epidemic field investigation results
Laboratory reports population surveys
Animal and vector population survey
Biological product use report
Demographic data
Special population:
Clinics, BHU, RHC, Taluka and District hospitals
Medical records
Occurrence records
Patient or family interview
Provider office record
Workers compensation record
Employee health record personal record absentee reports
Surveillance system in Pakistan
The control of the Surveillance system is at Director General Health Services, DHO/EDHO at district
level and ADHO at Tehsil level.
These people are the responsible for the control of infectious diseases and have the authorities to take all
the steps, which are required for safe water supply, pure food and proper sewerage system checking.
If an infection occurs, they have to find out sources of infection, control of infectious diseases and make
steps to prevent its spread.
Nurses role in Surveillance
The community health and public health nurses use the process of Surveillance in two ways.
1. Surveillance data is used to identifying the need for primary prevention, interventions that are
delivered in the clients environment. e.g. well baby clinic , family planning employees health record.
2. Nurses engage in surveillance activities, as they monitor the health of individuals in thin population.
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 Identifying the individuals with health problems within family and community groups.
Planning early interventions to control and prevent illness, require constant monitoring.
Notification of Communicable Diseases
Definition
1. This is an act of intimation of the appearance of the infectious disease to the Municipal authorities to
enable them to undertake prevention and control of disease.
2. Notification means immediate intimation of occurrence of an infectious disease to the Heath Officer or
Sanitary authorities.
A list of notifiable diseases is usually available in the municipalities. Such diseases include:
Malaria.
Measles.
Poliomyelitis.
Rabies.
Diphtheria.
Cholera.
Chicken pox
Small pox.
Typhoid (Enteric Fever).

UNITNO.13
STATISTICS
In health sciences, the study of health and diseases is concerned with the statistics that tells us the
various healths needs and proper arrangement of resources for a given population.
It is a systemic approach for obtaining, organizing and analyzing numerical facts, so that scientific
conclusions can be drawn from them.
USES
o Vital statistics are the figures or rates that give us a picture of the population. e.g. births, deaths and
diseases etc.
o The application of statistical measures to vital events (births, deaths and common illnesses) that is
utilized to gauge the levels of health, illness and health services of a community.
o Identifies the totality of health problems and needs of population.
o Find various methods to meet these identified needs of people.
PURPOSES:
Essential for the assessment of health level in the community.
For further planning of health services.
Budget planning
Analyzing and evaluation of health programme
It provides the information to various health agencies which help that community on the basis of given
informations.
Comparison with other health statistics, human and non human resources.
Compression between various age groups health problems and needs.
TYPES OF STATISICS
Vial statistics
Health statistics
1. VITAL STATISTICS
These are the figures or rates that give us a picture of the population .e.g. birth, death etc.
Special branch of statistics concerned with the collection of data related to important events in the human
life .e.g. human population census, death, birth, sickness, marriages causes of deaths etc.
It is necessary for planning of various health programmes such as
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 Maternal child health

Communicable diseases control
Environmental health
It identifies health problem and makes possible to analyze the nature and current situation of such health
problem for the further planning to recover it.
Vital statistics provide the basic information of population for planning of health services in any
community and country.
ORIGIN OF VITAL STATISTICS
For a long time ago people carried out vital statistics for the purpose of taxation, to determine the
human population strength and to establish military power.
Data related to birth, death and marriages records were kept at religious institutes.
The first known census wad carried out in Sweden in 1749.
In sub-continent the first known census was carried out in 1867-72 and then repeated in1881. After
that was carried out every tenth year.
In Pakistan first census was carried out in 1951 and then in 1961, 1972, 1981and last in1998.
The responsibility to collect and keep the records is compiled in rural and urban setting.
Rural
The Headman (Number dar) of the village and chairman of union council have the authority and
responsibility to keep the records of births, deaths and human population in their area.
Urban
Town committees, municipal offices and metropolitan corporations are responsible to keep the records of
births, deaths and human population in their area.
2. HEALTH SATISTICS
These are the facts and figures which reveal the state of health of the community such as diseases,
housing, social, economic factors and environment.
USES
These all are important in measuring the health of the community
Health statistics are concerned with the following
Incidences of the diseases (morbidity)
Health status of the community
For further planning in health programmes
Evaluation of program
SOURCES OF VITAL AND HEALTH STATISTICS:
- Census
Population census involves in collection, computing and publication of demographic, economical and
social data of all persons in the community at a specific time. It includes all peoples age, sex, marital
status, birth place, religion, literacy occupation, income, education, and language and other information on
national level.
- Registration
Registration of birth, death and marriage all are called vital statistics. Data can be obtained from a
concerned office like union council, town, municipal and metropolitan offices about these facts. At present
exact figures availability is impossible due to lack of maintenance of records.
- Notification
Reports presented in the form of press release also provide the health records. These figures are presented
in the news papers, radio and TV news. These are the fastest resource of information in the world about
any health issue.
- Records

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Records of various clinics, hospitals and community health Centres can provide the facts and figures of
health statistics. These records are available in the forms of registers and also in computerized system
through different web sites of departments.
- Health surveys
Health surveys are carried out through various health agencies at different levels. At community level a
community health worker collects information through survey of homes in community about maternal and
child health problems.
HEALTH INDICATORS
o Health indicators are measurements of morbidity and mortality and vital events in a community for
only health program and planning through the census data.
TYPES
Crude Birth Rate
Crude Death Rate
Infant Mortality Rate
Morbidity Rate
Perinatal Mortality Rate
Neonatal Mortality Rate
Maternal Mortality Rate
Incidence Rate
General Fertility Rate
A. CRUDE BIRTH RATE
It is the number of live births per 1000 population during the specified period of time.
Through the crude birth rate we assess the fertility and estimate growth rate of population.
Total # of live births in a given calendar year
Estimated population of the same given year

X 1000

B. CRUDE DEATH RATE

It is the number of deaths per 1000 population during a specified period of time.

Total # of death in a given calendar year

Estimated population of the same calendar year

X 1000

C. INFANT MORTALITY RATE

It is the number of deaths less than one year of age reported in a year for every 1000 live births during the
same period.
Total # of death below 1 yr in a given calendar year
X 1000
Estimated population of the same calendar year
D. MORBIDITY RATE:
It is the number of reported cases of a given disease of every 1000 population for a particular
period of time.
Total # of cases in a given calendar year
Estimated population of the same calendar year

X 1000

E. PERINATAL MORTALITY RATE:

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It is the number of fetal deaths after 28 weeks of gestation and death of neonate under one week of age,
for every 1000 total births after 28 weeks of gestation during one year..
Late fetal deaths + death under one week of age
X 1000
Estimated population of the same calendar year
F. NEONATAL MORTALITY RATE
It is the number of deaths less than one month children of age reported in a year for every 1000 live births
during the same period.
Total # of death below 1 month in a given calendar year
X 1000
Total number of births during that year
G. MATERNAL MORTALITY RATE
It is the number of deaths reported among all maternal cases in a given calendar year.
C
Total # of death among all maternal cases in a given calendar year X 1000
Estimated population of the same calendar year
H. INCIDENCE RATE
D
It is the number of new reported cases of a given disease per 1000 population in a given year.
E
Total # of new cases in a given calendar year
X 100
Estimated population of the same calendar year

I. PREVALENCE RATE
Number of cases of a specific illness cases in a given calendar year
F
Total # of new & old cases in a given calendar year
X 100
Estimated population of the same calendar year
J. LIFE EXPECTANCY:
The average number of infants per year is expected to live generally used to refer life expectancy for that
year. The life expectation for the year 2009 means the average number of children born in the year 2009 is
expected to live.
K. GENERAL FERTILITY RATE
It is the number of live births per 1000 women between the ages 15-45 years during the specified period of
time.
Total # of live births in a given calendar year
Total number of reproductive age

X 1000

L. ATTACK RATE
Total # of person who are exposed to the disease
Estimated population of the same calendar year

X 100

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UNIT NO.14
DATA is a plural of datum which means known things.
Data: plural noun: information in words or figures about a particular subject, especially information
which is available on computer.
(Note: in scientific usage, data is used with a plural verb: the data are accurate. in everyday language,
data is often used with a singular verb: the recent data supports our case.)
Data bank: a store of information in a computer e.g. the hospital keeps a databank of information about
possible kidney donors.
Database: a structured collection of information in a computer that can be automatically retrieved and
manipulated
Data Protection Act: a parliamentary act intended to protect information about individuals that is held on
computers. It ensures that all information is stored securely and allows people to have access to their
entries.
TYPES OF DATA:
There are two types of data.
Primary data: the facts which are observed directly by researcher /observer are called primary data.
The primary data are those, which are collected afresh and for first time and thus happen to be original in
character.
Secondary data: The secondary are those which have been collected by someone else and which have
already been passed through statistical process. It may be published or unpublished and is collected from
various publications of govt., foreign market, technical & trade generals, reports by search scholars &
public records & statistics.
METHODS OF DATA COLLECTION:
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How to select a method for data collection

The method collecting primary and secondary data differ. Hence primary data are to be originally
collected while in case of secondary data the nature of data collection work is merely that of compilation.
A researcher must judiciously select the method for his or own study keeping in view the following
factors: Nature & Scope of enquiry
Availability of funds
Time factor
Precision required
Sources of data collection:
The task of data collection begins after a research problem has been defined & the research design has
been chalked out.
There are mainly two sources of data collection:a. Primary data
b. Secondary data
COLLECTION OF PRIMARY DATA:
There are several ways of collecting primary data.
They are:
1. Observation method
2. Interview method
3. Through questionnaires
4. Through schedules
1. Observation method Definition- under this method the information is sought by the way of investigators own direct
observation without asking from the respondent.
Types1. Structured observation: where observation is done, the conditions are standardized &
then the pertinent data is selected.
2. Unstructured observation: when the observations take place without the above mentioned
characteristics to be thought in advance.
Advantages- subjective bias is eliminated, information relates to the current happenings,
independent of the respondent, & best suited for those who can not give the verbal report of their
feelings.
Disadvantages- expensive method, limited information, unforeseen of certain factors, interference
with the observations, & people rarely available for direct observation
2. INTERVIEW METHOD
Definition- involves the presentation of oral verbal stimulus & reply in terms of oral verbal
responses.
Types1. personal interviews: interviewer asking questions generally in face to face contact to the other
person/s. it can be of two types further: direct or indirect personal interviews.
2. Telephone interviews: method of collecting information by contacting the respondent on
phone itself.
Advantages- more information, greater flexibility, effective control on samples, supplementary
info about the respondents personal characteristic & environment.
Disadvantages- expensive, imaginary info, restriction by cost considerations & possibilities of
bias.
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3. QUESTIONNAIRES
Definition- questionnaire consist of no. of questions printed or typed in definite order on a form or
a set of forms & is then presented to the person concerned with request for the answers.
Types1. structured: are those questionnaires in which there are definite, concrete & pre-determined
questions & is represented in the same order to all the respondents.
2. unstructured: when these characteristics are not present in the questionnaire & the exact
formulations for the question s is the responsibility of the interviewer.
Advantages- inexpensive, answers in respondents own words, convenient & less time
consuming
Disadvantages- low rate of return, control lost when once sent, inbuilt inflexibility, difficult to
know if the respondents are true representatives & is the slowest of all methods
4. SCHEDULES
Definition- the aim & objective of the investigation & the removal to the difficulties of the
respondent or the definition or concept of difficult terms is personally assisted by an enumerator
specially appointed for this purpose.
Differences between questionnaire & schedule
Schedules are relatively cheap and economical
No response is usually case in questionnaires which is not the case in schedules.
Reply is clearer in schedules than questionnaires.
Personal contact not possible in questionnaires
Risk of collecting incomplete and wrong information is relatively more in questionnaires than in
schedules.
Observation method along with schedules can be used which is not possible in case of questionnaires.
OTHER PRIMARY METHODS
Warranty cards
Distributors audits
Pantry audits
Consumer panels
Using mechanical devices
Through projective techniques
Depth interviews
Content analysis
COLLECTION OF SECONDARY DATA
Secondary data means that are already available that is they refer to the data, which have already been
collected and analyzed by someone else. When the researcher utilizes secondary data, then he has to look
into various sources from where he can obtain them. In this case he is certainly not confronted with the
problems that are usually associated with the collection of original data. Secondary data is available in two
forms:a. Published data: can be various publications of govt., foreign market, technical & trade generals,
reports by search scholars & public records & statistics.
b. Unpublished data: may be found in diaries, letters, unpublished biographies & autobiographies or
other public & private individuals & organizations.
Usually published data are available in:
Various publications of the central, state and local government
Various publications of foreign government or of international bodies and their subsidiary
organization.
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 Technical and trade journals

Books magazines and newspapers
Reports publication of various associations connected with business and industry, banks, stocks
exchanges etc
Reports prepared by various scholars universities economists etc in different field
Public records and statistics, historical documents and other sources of publish information. The
sources of unpublished data are many; they may be found in diaries, letters unpublished biographies
and autobiographies and also may be available with scholars research workers. Trade organization,
labor bureaus and other public/private organizations
Before using the secondary data the researcher must look the following characteristics:
Reliability of data
Suitability of data
Adequacy of data

PRESENTATION OF DATA
After the data has been collected, it needs to be stored and presented properly for analysis. It is
also useful as an aid to interpretation after the analysis has been carried out. The main ways of describing
data are in the form of tables, pie charts, bar charts/histograms and line graphs.
A graphical chart provides a visual display of data that is presented in a table; a table, that is
presented in text. Ideally, a chart conveys ideas about the data that is not readily apparent if they are
displayed in a table or as text.
Definition of table
A table is a set of facts and figures arranged in columns and rows.
A table provides a clear summary record of a collection of data. Tables have a number of columns and
rows, depending on the amount of data and the detail shown
Uses
A table is a very useful way of organizing numerical information.
Tables are likely to be used as a particular structured format to summarize numerical information.
They tend to be used to present data as a summary and as a starting point for discussion
DATA IN TABLE FORM:
A simple table is often all that is required to convey information from a study. Thought should be put
into the format, the number of tables and the type of values to go into the body of the table: count total and
percentages.
Malaria
Resp.Problems
Diarrhea

JAN
2
10
10

FEB
1
11
9

MAR
6
8
10

APR
7
7
16

MAY
8
5
15

JUN
22
4
20

JUL
20
9
27

AUG
26
10
25

SEP
8
9
11

OCT
7
10
9

NOV
3
23
5

DEC
4
20
7

Table: the No. of patients of various diseases in a Health Centre

Bar Charts:
Bar charts typically display the relationship between one or more categorical variables with one or
more quantitative variables represented by the length of the bars. The categorical variables are usually
defined by the categories displayed on the X-axis and, if there is more than one data series, by the legend.
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A BAR CHART SHOWS THE ANNUAL PATIENTS, RECORD

Pie charts:
Pie charts are used to represent the distribution of the categorical components of a single variable. Note
that as a general rule, multivariate comparisons provide for more meaningful analysis than do single
variable distributions and for this and other reasons pie charts should be rarely used. In this PIE CHART
shows malarial patients, month wise annual record.

A PIE CHART SHOWS MALARIAL PAIENTS, ANNUAL RECORD

__________________________

Line chart: The line chart is one of the most efficient means of displaying large amounts of data in ways
that provide for meaningful analysis. The typical time series line chart is a chart with time represented on
the X-axis and lines connecting the data points.
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LINE CHART SHOWS THE ANNUAL PAIENTS, RECORD

A LINE CHART SHOWS THE ANNUAL PAIENTS, RECORD

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A RADAR CHART SHOWS THE ANNUAL PAIENTS, RECORD

PURPOSES OF PRESENTATION OF DATA:

It helps to bring out the answer most simply, logically and quickly.
It helps to draw clear conclusion.
It helps to present data in more short and easy form for viewers and readers
It helps to present data in different forms for readers understanding.
It helps to save data easily and reachable.
It also provides comparison of different variables.

UNIT NO.15
Environmental sanitation
Environment:
All the external factors living or non-living, material or non-material which surround the man.
Environment includes not only the water, air and soil that form our environment but also social,
economical conditions under which we live.
Sanitation:
It deals with the control of all factors in the physical environment which has dangerous affects on mans
health, the control of all those factors in mans environment which exercise deleterious effects on his
physical development .health and survival. (WHO)
It is the science and practice of bringing about healthful environmental conditions through proper methods
of drainage and sewage disposal, pure water supp and hygiene of housing.
Components of Environment:
Physical environment:
Housing, food, water, air, light, excreta.
Biological environment:
A man is in contact with insects, virus, bacteria, fungi, animals, human beings.
Social environment:
Man is in contact with persons others than himself.
Psychosocial environment:
Living style at home, schools, at work places, at neighborhood etc.
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Economical environment:
Ways of living influenced by economical circumstances.
REFUSE OR WASTE:
This includes all unwanted or discarded waste material excreted from houses and streets and from
commercial, industrial and agricultural activities of man.
Domestic refuse consists of garbage, rubbish and ash.
Waste is an unwanted or undesired material or substance. It was commonly referred as rubbish, trash,
garbage or junk depending upon the type of material and the regional terminology.
Waste is directly linked to the human development, both technologically and socially. With industrial
development and innovation being directly linked to waste materials, examples are plastics and nuclear
technology.
Types of Wastes / refuse:
There are two main types of refuse.
1. Solid or dry and
2. Mixed with water /Sewage
Waste can be divided into further different types. There are many different kinds of waste, including solid,
liquid, gaseous, hazardous, radioactive, and medical also.
REFUSE OR SOLID WASTE:
Solid wastes are waste materials that contain less than 70% water
Solid wastes include:
Forest and wood processing residues;
Agricultural crop residues;
Municipal solid wastes (MSW), which is domestic refuse, commercial wastes and industrial
wastes, such as pallets, paper, cardboard and plastics.

Methods of solid waste disposal:

Solid Waste Disposal, disposal of normally solid or semisolid materials, resulting from human and animal
activities that are useless, unwanted, or hazardous. Solid wastes typically may be classified as follows:
Garbage: decomposable wastes from food
Rubbish: non decomposable wastes, either combustible (such as paper, wood, and cloth) or
noncombustible (such as metal, glass, and ceramics)
Ashes: residues of the combustion of solid fuels
Large wastes: demolition and construction debris and trees
Dead animals:
Sewage-treatment solids: material retained on sewage-treatment screens, settled solids, and biomass
sludge
Industrial wastes: such materials as chemicals, paints, and sand
Mining wastes: slag heaps and coals refuse piles
Agricultural wastes: farm animal manure and crop residues.
WASTE MANAGEMENT METHODS
Waste management methods vary widely between areas for many reasons, including type of waste
material, nearby land uses, and the area available.
LANDFILL
A waste disposal site in which each days accumulation of debris is covered by a blanket of
sediment.
trucks bring in days waste, place it in active area where it is compacted
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and at the end of the day covered by layer of sediment

Each days accumulation unit is called a cell.
Fill is capped with impervious clay to prevent infiltration and percolation of water through the fill.
Fill bottom is lined and provided with a drainage system to contain and remove any leakage or
leachate that occurs. Monitoring wells provide a final check.

Problems of Landfills
Leachate generation and groundwater contamination
Methane production
Incomplete decomposition
Settling
Dumping:
The refuse is collected and then carried upto 5 kilometers away from the residential areas to pits and
depressions. Through this the land filling and smoothening occurs. This is an economical method and
environment friendly if the refuse is free from dangerous and radioactive material.
Controlled tipping:
In this method, the refuse is dumped in the ground in a depth of 6 feet and covered with a layer of earth
dust as air may not enter into dumped refuse. The refuse is decomposed with various processes into
fertilizer and is used in cultivation of crops.
Composting:
Composting operations of solid wastes include preparing refuse and degrading organic matter by aerobic
microorganisms. Refuse is presorted, to remove materials that might have salvage value or cannot be
composted, and is ground up to improve the efficiency of the decomposition process. The refuse is placed
in long piles on the ground or deposited in mechanical systems, where it is degraded biologically to humus
with a total nitrogen, phosphorus, and potassium content of 1 to 3 percent, depending on the material
being composted. After about three weeks, the product is ready for curing, blending with additives,
bagging, and marketing.
Burning/ Incineration:
Incineration is carried out both on a small scale by individuals and on a large scale by industry.
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By this method the collected refuse or solid waste id burnt at temperature exceeding 1100C. The material
reduces to 10% of the volume of the original material and does not need much place for placing. Hospital
items are usually disposed off through this method. Modern incineration facilities are computer
controlled , fuel efficient and output gases are strictly monitored by law and output gases are filtered
Depending on the type of waste, the waste itself becomes the fuel for the incineration process and newer
plants are able to utilise the neat for co-generation of electricity or other purposes.
Recycling methods
The process of extracting resources or value from waste is generally referred to as recycling, meaning to
recover or reuse the material. There are a number of different methods by which waste material is
recycled: the raw materials may be extracted and reprocessed, or the calorific content of the waste may be
converted to electricity. New methods of recycling are being developed continuously, and are described
briefly below.
Commercial incinerators operate at temperature exceeding 1100C in the primary chamber. Incineration not
only decontaminates the waste, it completely destroys the waste and reduces it to ash with less than 10%
of the volume of the original material. It is an approved disposal method for all waste streams with the
exclusion of radioactive waste. There is an outdated stigma attached to high temperature incineration.
Modern incineration facilities are computer controlled,.

TRANSMISSION OF DISEASES:
Many diseases can spread through contamination. The germs of such disease transmit in different
channels.
Faecal-borne diseases: The diseases can transmit through the faeces of a sick person who is suffering
with a disease. The germs of many diseases excrete through faeces. In those areas where open fields are
used, the flies sit on faeces and the germs can attach to their legs from the faeces, when these flies sit on
food items, the germs are shifted to that food .These germs of disease can transmit into body through
eating such contaminated food to produce diseases. The germs of typhoid, cholera, dysentery, polio,
amoebiasis, and diarrhea and worms larva are transmitted from contaminated food and water from faeces.
If hands are not washed properly after defecation, the germs may remain attach to hands which may
transmit into the body to produce disease.
Water borne diseases:
Contaminated water is a major source of causing diseases like diarrhea, cholera, dysentery, amoebiasis
worm infestations and hepatitis etc.
Food borne diseases:
Contaminated food is a major source of causing diseases like diarrhea, cholera, dysentery, amoebiasis,
food poisoning, worm infestations and hepatitis etc.
Hands: Diseases are transmitted through contaminated hands if these are not washed before eating
something. Eating without washing hands may cause of transferring many diseases because we work with
our hands everywhere and hands are contaminated with germs.
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Soil
Many microorganisms are present in the wet soil and spores of many diseases like tetanus in the dry soil.
Some parasites as hookworms larva are also found in wet soil .when someone walks with naked feet on
soil, these larva may enter through soles into human body and cause diseases.
Flies borne diseases
Flies are the vectors which transfer the germs from one place to another. The flies sit on refuse and excreta
from where the germs are attached to their hairy legs and body and when these sit on
another place the germs transfer to that place thing.
1.
Other bacterial infections:
Infectious diseases can be transmitted by food include the following:Typhoid fever Paratyphoid fever
Shigellosis
Hemolytic streptococcal infections
Enterococci Clostridium perfringens
Brucellosis
Cholera
Dysenterys
2.
Viral Infections:
2.1
Infectious hepatitis
2.2
Others such as: poliomyelitis
3.
Parasitic infections:
- Amebiasis (amebic and bacillary)
- Tenia (Saginata and solium)
- Fish tape worm diseases from fish
- Trichinosis from pork food
- Giardiasis - Hemilipis nana
- Strangloids - Oxyuris (enterobius vermicularis)
- Ascariasis

METHODS OF DISPOSAL OF REFUSE (Sewage)

Disposal of excreta is carried out by the non-sewage (conservancy method or dry method and sanitary
latrine) and the sewage method involves water carriage of excreta through a system of drains and
ultimately disposal at sewage treatment plant.
SOLID WASTE DISPOSAL
Disposal of excreta is carried out by the non-sewage conservancy method or dry method and sanitary
latrine.
This method involves manual collection and removal of refuse to the disposal point. Initially the solid
waste is collected from the homes and streets to a collection point and then it is brought to the place
through solid waste careers where it is treated inn different methods.
In olden times in villages and small towns, the human excreta were also collected with buckets or pans.
These pans and buckets were emptied into the carts or Lorries and then excreta were carried away for
disposal outside the town.
DEFINITION OF SEWAGE
It is a liquid waste material drained from houses, farms, factories and business places.
Compositions of Sewage:
Sewage is composed mainly from water and organic material. The most serious component is pathogens that
could contaminate the environment and endanger health. In countries with damaged draining system a solid
material and sand could be present and block the system.
Hazards of Sewage:
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1.

Disease transmission: most of enteric diseases could be transmitted from one person to other through
contaminated environment such as Cholera, Typhoid, Dysentery, parasites, Polio and Hepatitis.
2.
Bad smell resulted in psychological disturbance.
3.
Sewage collection is a breading place for insects as mosquitoes and flies.
4.
Contamination of underground water by biological and chemical pollutants.
Management of Sewage:
There are two main methods for sewage disposal: Dry and Wet methods.

1.

Dry Method: This method is applied where access to public sewer system is not possible. Different types of latrines
could be used depending on the available community resources, population needs, and the type of the soil.

2.

Wet method: this method is applied when public sewer system is available. Latrines are constructed
inside the buildings with available water source that carry the sewage through closed pipe system to a
collection chamber. The collected sewage is carried in pipes to a central sewage treatment plant. In the plant
a process started by screening, grit removal, sedimentation and biological treatment. Biological treatment is
performed by these mechanisms:
a. Filtration: the sewage is filtrated by passing through sand or gravel beds.
b. Aeration (oxidation): This mechanism gives a chance of oxidation where oxygen kills anaerobic
microorganisms.
c. Disinfection: Chlorine could be used to minimize other bacterial hazards.
The properly treated sewage water could be used to irrigate specific types of trees. When safety is sure it
could be injected into underground water under precautions.
METHODS OF SEWAGE DISPOSAL:
In this system, the human or animal excreta are carried out by flush of water from the water closet into the
soil pipe leading to house drains and to sewers and then for disposing in various methods. Water from the
factories, kitchen, bathrooms and rain water also mixed within the drain.
Liquid wastes include:
sewage sludge and effluent;
animal wastes;
food processing residues; and
Industrial effluents.
Methods of disposing Liquid Wastes
THEORY
A well is drilled in a dry porous layer and
wastes are pumped in. Contamination of
groundwater is prevented by the casing and
seal around the portion of the well that
penetrates groundwater.

Practice
1. Wastes spill or leak at surface.
2. Corrosion of casing allows waste to
escape.
3. Inadequate seal permits waste to backflow
4. Fractures existing or caused by
earthquakes or the introduction of fluids,
allow wastes to escape into groundwater.

- Sea outfall the human or animal excreta are carried out by flush of water from the water closet into the
soil pipe leading to house drains and to sewers and then for disposing in the sea.
- River outfall: the human or animal excreta are carried out by flush of water from the water closet into the
soil pipe leading to house drains and to sewers and then for disposing into the river.
- Land treatment
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- Oxidation ponds
- Open drainage
- pit latrines:
- Open field: : the human or animal excreta are carried out by flush of water from the water closet into the
open fields.

1.

Pollution:
Types of water pollution:
Water pollution is classified as follows:
1. Organic wastes from domestic sewage.
2. Infectious agents contributed by domestic sewage.
3. Plant nutrients as algae.
4. Synthetic organic chemicals as pesticides, detergents etc.
5. Inorganic chemicals and minerals substances
6. Sediments that fill stream channels and reservoirs.
7. Radio - active pollution
2.
Contamination:
The most common water born diseases are Typhoid, Paratyphoid, dysenterys (amebic and
dysentery), gastro-enteritis, infective hepatitis and cholera.
Health hazards could be direct due to use of the water in drinking such as the hazards associated with
drinking contaminated water or a water polluted by chemical substances or excess of specific chemicals.
Example of the last hazards is the drinking of water with less or excess of fluorides. Less fluoride would lead
to Dental caries and excess florid leads to florosis.
Health hazards could by indirect such as swimming in water infected with Bilharzia cercaria. Some
hazards could be from the water breading places of insects such as mosquitoes. These entire hazard whether
they are direct or indirect could affect the human health and quality of life.
PEST & RODENT CONTROL
Importance:
1.
Human Health and disease
a.
Organic: Plague, malaria
b.
Psychological: fears
2.
Economic:
a.
Agriculture
b.
House: furniture cloths, Electrical
Control Measures:
A.
Preventive Measures:
1.
Good sanitation
2.
Structural measures
B.
Pesticides and Rodenticides
Sanitation:
1.
Personal hygiene and cleanliness
2.
Proper Garbage collection
3.
Proper sewage system
4.
Food storage and cover
5.
Dealing with water collections
Structure:
1.
Screening of the windows & doors
2.
Closing unnecessary opening
3.
Repair of Clarks in the walls
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4.

Rodent proof buildings

Pesticides & Rodenticides:

Before using chemicals we have to try these methods:
1.
Biological methods: as Cats.
2.
Mechanical Methods: Traps.
3.
Electrical: light.
4.
Fumigation gasses.
Then these chemical methods could be used:
Organic Phosphorus Compounds.
Chlorinated hydrocarbons.
Zinc phosphate (not used now)
Anti Coagulants
Warfarines
D.D.T. (not used)
Malathion

1. Rescue of victims
2. Provision of emergency medical care
3. Evacuation of the population (chemical and nuclear emergencies).
4. Elimination of physical dangers (e.g., fires, gas, leaks, etc.).
5. Provision of preventive and routine medical care.
6. Provision of safe water.
7. Provision of food.
8. Provision of clothing.
9. Provision of shelter.
10. Disposal of human excrement.
11. Control of vector borne diseases.
12. Disposal of human bodies.
13. Disposal of solid waste.
What are the main duties of a Health team?
The main duties of a health team during a disaster are:
6. First aid
7. Emergency care
8. Ambulatory care.
9. Patient referral.
10. Public education.

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UNIT. NO. 16
COMMUNITY WATER SUPPLY
SOURCES OF WATER

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Topic: 16.1
SAFE AND WHOLESOME WATER
Sate Water
Definition
Water that cannot harm the consumer even when ingested over prolonged periods is called safe water.
Wholesome Water
Definition
Wholesome water is that water, which is agreeable. Such water is acceptable.
Characteristics of Water
It should be:
Free from pathogenic agents.
Free from harmful substances.
Pleasant to the taste.
Usable for domestic purposes.
Topic: 16.2
USES OF WATER
Domestic Uses
Drinking.
Cooking
Washing
Bathing.
Public Uses
Public cleansing.
Fire fighting.
Maintenance of gardens and swimming pools.
Industrial Uses
Without water there cannot be any industrial development, some industries like, steel, iron and paper
industry, etc. needs water.
Agricultural Uses:
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The food and raw material needed by the world cannot be raised without water.
Topic:
16.3 WATER REQUIREMENT
Daily requirement of water is 150-200 liters per head or 35-40 gallons per head.
Daily water required by a man is 2500 m/24 hours, which is fulfilled by two sources.
o Exogenous Sources water as such drunk-ingested in solid food.
o Endogenous Sources-- water is released during the oxidation of ingested food, amount is
essential than 500 ml/24 hours.
Following are the daily-requirement for all purposes.
Domestic
For drinking
0.35 gallons
For ablution
0.65 gallons
For cooking
8.00 gallons
For washing of utensils
3.00 gallons
House laundering
3.00 gallons
For water closets
5.00 gallons
For trade and manufacturing purposes
5.00 gallons
c)
Municipal (for watering streets, public baths, fire, flushing etc.)
5.00 gallons
COMMUNITY WATER SUPPLY
Topic: 16.4
SOURCES OF WATER
A) Rain Water
It is the chief source of water. It is the aqueous vapor in the atmosphere which condenses and falls on the
surface of earth as rain, snow or hail.
a) It is distilled water (purest water in nature).
b) Clear, bright and sparkling.
c) Soft water is liable to have solvent action on metals.
it is good for washing, cooking, and dying as it is free from calcium salt.
e) Free from pathogenic agents.
0 Contains only traces of dissolved solid (0.0005%)
g) Process corrosive action on lead pipes.
Impurities of Rain Water
Dust.
Soot.
Microorganisms.
Gases Oxygen, Nitrogen, Carbon dioxide, Ammonia.
B. Surface Water
When rain water touches the surface of earth it is called surface water.
Sources of Surface Water
a) Impounding reservoirs.
b) Upland surface hill water.
c) Streams.
d) Rivers.
e) Lakes.
f) Ponds.
a) Impounding Reservoirs
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There are artificial lakes constructed usually of masonry in which large quantities of surface water are
stored after falling off the rain on the hills.
Characteristics
1. Usually furnishes a good quality of water.
2. Soft, clear and palatable.
3. Free from pathogenic agents.
b) Upland Surface Hill Water or catchments area
It is an area from where rainwater is drained into the reservoir. It is in fact a large tract of land on the hill
set apart for the collection of water.
c) Rivers and Streams
Characteristics
1. Turbid in rainy season.
2. Contains all kind of dissolved and suspended impurities.
3. High bacterial count.
4. Large quantity of carbon dioxide.
Sources of impurities
1. Surface washing.
2. Sewage and sludge water.
3. Industrial and trade wastes.
4. Agricultural drainage.
c) What is Ground Water?
When rainwater percolates into the ground pass downwards until it reaches an impervious stratum with
bars its further downward passage. This water then flows in a more or less horizontal direction. It is called
ground or underground water.
Advantages
i) Free from pathogenic agents.
ii Requires no treatment.
iii) Supply is certain even during rainy seasons.
Disadvantages
i) Salts of calcium and magnesium are present rendering the water hard.
ii Require pumping to lift the water.
iii) Large quantities of dissolved carbon dioxide.
Sources of Underground Water
i) Well
ii) Springs.
i) Well
A well is an artificial pit or hole sunk into the earth to reach the water Level.
Kinds of Well
a) Shallow well
b) Deep well
c) Artesian well
d) Tube well.
a) Shallow Well
It is a well, which taps the water from above the first impervious layer in the ground.
b) Deep Well
It is a well, which penetrates the first impervious layer in the ground and taps the water lying beneath the
imperious layer.
c) Artesian Well

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During sinking a deep well sometimes water rapidly raises in the bore and even overflows the surface.
This occurs when water rises above the level of the underground water and is held under pressure between
two imperious strata. This type of well is called artesian well.
d) Tube Well
Shallow Abyssinian) Tube Well
It consists of galvanized iron pipe 1.5 to 2.6 inches in diameter driven into the soil up to 25 feet. Being
more suitable where the level of sub water is high.
Deep(bored) tube Well
This is sunk into the ground by drilling thru. A successive substratum of gravel or rock until a suitable
supply of ground water is located being several hundred feet deep.

Definition
Chemical quality.
Bacteriologically
. Yield
Depth

Difference between Shallow and Deep Well

Shallow Well
Deep Well
Taps the water from above
Taps the water from below
the first impervious layer.
the first impervious layer.
Moderately hard water
Much hard water.
Grossly contaminated
Not contaminated
Dry in summer
Constant supply of water.
Less than 200 feet
200600 feet.

ii) Springs
It is a ground water that finds its way to the surface because of certain topographical characteristics of the
land, yield of which is low.
Kinds of springs
a) Shallow spring
b) Deep spring or main spring
c) Mineral spring
d) Thermal spring
a) Shallow Spring
It can be compared with shallow well.
b) Deep springs
They are not formed by the outcropping of the impervious stratum but they are the result of some cracks
or fissures in the soil.
c) Thermal springs
These springs are formed where volcano eruption has ceased resulting in hot water from such spring.
COMMUNITY WATER SUPPLY
Topic: 16.5
WATER-BORNE DISEASES
a) Viral Diseases
1. Poliomyelitis
2. Infective hepatitis (viral hepatitis)
3. Keratoconjunctivitis
4. Rota virus diarrhea in infants.
b) Bacterial diseases
1. Cholera,
2. Enteric fever (Typhoid).
3. Bacillary dysentery.
4. Diarrhea.
Protozoal Diseases
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1. Amoebic dysentery
Helminths
1. Ascariasis / Round worm
2. Entrobiasis
3. Draconculosis / Thread worm
4. Whip worm
5. Hydatid cyst. Fish tape worm
e) Bed Sonial
1. Trachorna.
Topic: 16.6 PURFICATION OF WATER
Purification means removal of impurities from water. In this way safe and wholesome water is obtained.
a) Purification of Water on Large Scale
Water on large scale, such as an urban water supply is purified in three main stages.
i) Storage and sedimentation.
ii Filtration
iii) Chlorination
o Storage and Sedimentation
Storage is an excellent means of purification of water. By storage solid particles e.g., mud settles down
and takes bacteria along with it.
Organic matter is oxidized by aerobic bacteria. The ultraviolet rays kill the bacteria. By storage the
bacterial count falls greatly. Ninety percent of bacteria in river water die in 5-7 days. Optimum time for
storage is 10-14 days.
2 Filtration
For large scale purification of water following methods are used.
Slow sand filtration or biological filtration
Rapid sand or mechanical filtration
Slow Sand or biological Filtration
It is generally accepted as standard method of water purification. It has following elements.
Supernatant.
A bed of graded sand.
An under-drainage system.
A system of filter control valves.
The slow sand filter consists of open tank measuring 9-12 feet in depth. There is a layer of broken stone or
brick. Above this there is a layer of gravel and then there is a layer of gravel coarse sand 6-12 inches.
Finally there is top layer of fine sand 3 feet.
Self Purification
It occurs by natural process of purification such as dilution, oxidation, sedimentation, sunlight, plant and
animal life.
Advantages of River Water
1. Rivers are natural source of water supply.
2. Volume of water fielded is enormous.
3. Undergo natural process of purification.
4. No initial expense is required to get water.
Disadvantages of River Water
River water is turbid; it is constantly polluted by surface and subsoil water drainage from manure and
cultivated lands, from the drain of neighboring villages and sewers of town, waste product of factories and
the animal bathing in the river.
d) Tanks, Ponds and Lakes
Tanks
These are large excavations in which surface water is stored.
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Characteristics
1. Recipients of contamination of all kinds.
2. Full of silt and colloidal matter.
3. Full of aquatic vegetations.
Sources of Impurities
1. Washing of clothes and cooking pots.
2. Washing of call le.
3. Bathing of public.
Steps for Obtaining Good Quality Tank Water
1. Edges should be elevated.
2. Fence should around the neck.
3. Prohibition to get into the tank directly.
4. Elevated platforms should be constructed for drawing of water.
5. Removal of weeds periodically.
Cleaning of the tank at the off dry season.

Water Treatment Methods:

The type and degree of purification is governed by the characteristics and pollution load of the raw
water, and by economic factors whatever degree of treatment is adopted, a safe supply must be the minimum
accepted. So, the most common methods of purification have been developed through the accumulation of
experience and study over many years that include certain fundamental principles as follows:
Storage in natural lakes or impounding reservoirs to obtain sedimentation.
Coagulation by chemical treatment for the removal of turbidity and color.
Sedimentation of the coagulated flock to minimize the quantity of suspended colloidal matter on the
filter beds.
Filtration through sand gravel beds to remove turbidity and many microorganisms.
Disinfection by chemical or physical agents to eliminate pathogenic bacteria.
Removal of taste and odors by aeration, chemical treatment or physical absorption to make the water
more attractive.
Hardness reduction by chemical precipitation or Base Exchange phenomenon for aesthetic reasons.
Removal of dissolved minerals by surface adsorption (contact beds) generally for aesthetic reasons.
Corrective treatment with alkali to reduce pipe corrosion for economic reasons.
Fluoridation to reduce dental caries.

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Other disinfecting agents

o ozonation
o ultraviolet radiation

Ozonation
relatively unstable gas
it is a powerful oxidising agent
it eliminates undesirable odor, taste and colour and removes all chlorine from water
ozone is a powerful virucidal agent
in seconds kills all viruses but chlorine or iodine requires minutes
more than 1000 municipal water treatment plants use ozone, oldest is in France since 1906
drawback is it decomposes after it acts
there is no residual germicidal effects
The current thinking is that ozone should be used as a pretreatment of water to destroy not only viruses
and bacteria but also organic compounds that are precursors for undesirable chloro-organic compounds
that form when chlorine is added
Ultraviolet radiation
o effective against most microorganisms including viruses
o method involves the exposure of a film of water up to 120mm thick to one or several quartz mercury
vapor arc lamps emitting ultraviolet radiation at a wavelength in the range of 200-295 nm
o Applications are limited to individual or institutional systems
o water should be free from turbidity and suspended or colloidal constituents for efficient disinfection
Advantages
o exposure time is short
o no foreign matter is introduced
o no taste and odor produced
Disadvantages
o no residual side effects
o lack of rapid field test for efficiency
o expensive apparatus
Solar water disinfection (SODIS System)9
o
o
o
o
o
o
o
o
o

Solar water disinfection is a method of treating relatively small amounts of water at the point
of use. There are three ways in which solar radiation can be used to eliminate pathogens. The first is
through heating, second through the use of natural UV radiation and third through the use of mixture
of both thermal and UV effects. None of these methods is yet widely used but laboratory experiments
and field programmes show that some systems have good potential to produce potable water.
Thermal heating from the sun can be via the solar cookers or from simply exposing blackpainted containers to the sun. In many systems temperatures can reliably reach over 55 degree Celcius
killing many pathogens. With the cookers and some of the other systems the temperature of the water
can easily exceed 65 degree Celcius, a pasteurization temperature capable of inactivating nearly all
enteric pathogens.
The use of heating and UV radiation to simultaneously disinfect water is used by a number of
different solar treatment systems. The widest known is the SODIS (Solar Disinfection) system which
is suitable for low-income countries. The only equipment required is locally available bottles to
contain the water. This technique is being tested in various parts of the world. The half of the bottle
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furthest from the sun should be painted with black paint to improve the heat gain from the absorption
of thermal radiation (Figure 4), and the bottle can be laid on a dark roof to further increase the
potential temperature rise in the water. The water requires several hours of strong sunlight to obtain the
advantageous energy between UV dosage and temperature rise
Purification of water on a small scale or Household purification of water.
Three methods are available that can be used for purification of water on an individual or
domestic scale. They can be used either singly or in combination2.
a) Boiling
This is a satisfactory method for purifying water for domestic purposes. To be effective the
water must be brought to a rolling boil for about 5 to 10 minutes. It kills all bacteria, cysts, ova and
spores and yields sterilized water. Boiling also removes the hardness of water by driving off carbon
dioxide and precipitating the calcium carbonate. The taste of water is altered but it is harmless. While
boiling is an excellent method of purifying water, it offers no residual protection against subsequent
microbial contamination2.
9 II b) Chemical disinfection- It can be done by using following chemicals(i) Bleaching powder- Bleaching powder or chlorinated lime is a white amorphous powder
with a pungent smell of chlorine. When freshly made it contains about 33% of available chlorine. But
when exposed to air and light it rapidly loses it chlorine content. Therefore it should be stored in a cool
and dark place in a closed container that is resistant to corrosion. So it is mixed with lime to retain its
strength and is called as stablized bleach. That amount of bleaching powder has to be added to the
water which can produce free residual chlorine of 0.5mg/litre at the end of one hour contact2.
(ii) Chlorine solution- Chlorine solution may be prepared from bleaching powder. If 4kg of
bleaching powder with 25 percent available chlorine is mixed with 20 litres of water, it will give a 5%
solution of chlorine. It should also be kept in a cool and dark place in a closed container2.
(iii) High test hypochlorite or perchloron- It is a calcium compound which contains 60 to
70% available chlorine. It is more stable than bleaching powder and deteriorates less on storage.
Solutions prepared from HTH are also used for water disinfection2.
(iv) Chlorine tablets- These are available under various trade names like halazone tablets in
the market. They are good for disinfecting small quantities of water but they are expensive. The
National Environmental Engineering Research Institute, Nagpur has formulated a new type of chlorine
tablet which is 15 times better than ordinary halogen tablets. A single tablet of 0.5g is sufficient to
disinfect 20 litres of water2.
(v) Iodine- It can be used for emergency disinfection of water. Two drops of 2% ethanol
solution of iodine will suffice for one litre of clean water. A contact time of 20 to 30 minutes is needed
for effective disinfection. Iodine does not react with ammonia and organic compounds to any great
extent; hence it remains in its active molecular form over a wide range of pH values. High costs and
the fact that the element is physiologically active are its major disadvantages2.
(vi) Potassium permanganate- Once it was widely used but now its no longer used to
disinfect water. Although it is a powerful oxidizing agent but it is unable to kill all the pathogenic
microorganisms. It also alters the color, taste and smell of water2.
Filtration
Water can be purified on a small scale by filtering through ceramic filters such as Pasteur
Chamberland filter, Berkefeld filter and Katadyn filter. The essential part of the filter is the
candle which is made of porcelain in the Chamberland type and of kieselgurh or infusorial earth in
the Berkefeld filter. In the Katadyn Filter, the surface of the filter is coated with a silver catalyst so that
the bacteria coming in contact with the surface are killed by the oligodynamic action of the silver ions
which are liberated into the water. Filter candles of the fine type usually kill bacteria found in drinking
water, but not the filter passing viruses. Filter candles are liable to be lodged with impurities and
bacteria. They should be cleaned with a hard brush under running water and boiled at least once a
week. Only clean water should be used with ceramic filters. But these types of filters are not suitable
for use under Indian conditions2.
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Other water purification techniques

Other popular methods for purifying water, especially for local private supplies are listed
below. In some countries, some of these methods are also used for large scale municipal supplies.
Particularly important are distillation (de-salination of seawater) and reverse osmosis.
(a) Carbon filtering 2-Charcoal, a form of carbon with a high surface area, absorbs many
compounds including some toxic compounds. Water passing through activated charcoal is common in
household water filters and fish tanks. Household filters for drinking water sometimes contain silver to
release silver ions which have an anti-bacterial effect.
(b) Distillation 2- It involves boiling the water to produce water vapour. The vapour contacts a
cool surface where it condenses as a liquid. Because the solutes are not normally vaporized, they
remain in the boiling solution. Even distillation does not completely purify water, because of
contaminants with similar boiling points and droplets of unvaporized liquid carried with the steam.
However, 99.9% pure water can be obtained by distillation. Distillation does not confer any residual
disinfectant and the distillation apparatus may be the ideal place to harbour Legionnaires' disease.
Legionnaires, disease is an infectious disease caused by bacteria belonging to the genus Legionella.
Legionellosis infection normally occurs after inhaling an aerosol (suspension of fine particles in air)
containing Legionella bacteria. Such particles could originate from any infected water source. When
mechanical action breaks the surface of the water, small water droplets are formed, which evaporate
very quickly. If these droplets contain bacteria, the bacteria cells remain suspended in the air, invisible
to the naked eye but small enough to be inhaled into the lungs.
(c) Reverse osmosis 2- Mechanical pressure is applied to an impure solution to force pure water
through a semi-permeable membrane. Reverse osmosis is theoretically the most thorough method of
large scale water purification available, although perfect semi-permeable membranes are difficult to
create. Unless membranes are well-maintained, algae and other life forms can colonize the
membranes.
(d) Ion exchange- 2 Most common ion exchange systems use a zeolite resin bed to replace
unwanted Ca2+ and Mg2+ ions with benign (soap friendly) Na+ or K+ ions. This is the common water
softener.
(e) Electrodeionization 2- Water is passed between a positive electrode and a negative
electrode. Ion selective membranes allow the positive ions to separate from the water toward the
negative electrode and the negative ions toward the positive electrode. High purity deionized water
results. The water is usually passed through a reverse osmosis unit first to remove non-ionic organic
contaminants.
Chlorination of Water:
Chlorine is added to water to kill the pathogenic bacteria. Chlorine is universally used in water
purification because it is reliable, inexpensive, and easy to administer, it has powerful oxidizing properties, its
concentration in water should be at least = 0.2 - 0.5 p.p.m. (Part per million).

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UNIT.NO. 17

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UNIT.NO. 18
Teaching:
Interaction between teacher and learner under the teachers responsibility in order to bring about
expected changes in the learners behaviour.
Teaching is a system of activities intends to produce learning.
Learning:
Learning is acquiring new knowledge,values,peferences,undesanding, and may involve
synthesizing different types of informaion.The ability to learn is possessed by humans, animals and some
macchines. Progress over time tends to follow learning cures.
Human learning may occur as part of educaion or personal developement. It may be goal-oriented
and may be aided by motiation. The study of how learning occurs is part of Neuropsychology, educational
psychology, learning theory and pedagogy.
It is a process resulting in some modifications, relatively permanent of think, feeling, doing of the
learners.
Learning involves the entire person and it can affect the persons life style, methods of handling
problems, attitude and knowledge.
Learning requires attention in the topic or matter and the ability to concentrate.
Characteristics of learning:
It produces a behavioural change in he learner.
It leads to relatively permanent hat is also gradual adaptable and selective.
It results from practice, repetition and experience.
Not directly observable.
Purposes of teaching:
It helps learners to:
Acquire, retain and be able to use the knowledge.
Understand, analyse, synthesize and evaluate, achieve skills establish habits.
Developes attitude.
Teaching approaches:
Talk to learners.
Talk with learners.
Have then to talk together. Show learners how supervise them.
Provide opportunities for practice.

Conditions to facilitate learning:

FACTORS WHICH AFFECT LEARNING
Factors, which affect patient learning, need to be assessed in order for appropriate teaching strategies to
be used.
a) Include the following factors in your assessment.
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1. Developmental considerations. Knowledge of intellectual, psychosocial, and physiologic age is

necessary before you select age-appropriate teaching methods.
2. Delayed development in any of these areas should be considered.
a. Children have limited past experiences. Adults learn more quickly than children because
they are able to build upon previous knowledge.
b. Use chronological age to assess whether the developmental stage is as would be expected.
3. Educational level. You will effectively promote learning if you are aware of the learner's
intellectual ability and avoid "talking down" to him or her or using an inappropriate teaching
strategy.
4. Past learning experiences. Attitudes toward future learning are influenced by learning experiences
in the past. Encourage the learner to express how he views education so that you can deal with his
feelings before teaching is attempted.
5. Physical condition. The patient will not be ready to learn until he is comfortable enough to pay
attention to the information you present.
6. Sensory abilities. Note any deficit in the learner's sight, hearing, and touch so that teaching is
planned appropriately.
7. Emotional health. The emotional state of the learner should be conducive to learning before
teaching is done.
a. A patient, who is moderately anxious about his/her condition, will probably be attentive to
presentation of information that will help him manage the condition.
b. If the patient is in a state of crisis with a high level of anxiety, delay teaching until the crisis
is over.
8. Social and economic stability. Being hospitalized and absent from work cause some patients
excessive stress. Help the patient deal with any social and economic problems before imposing the
additional stress of learning information or a new skill.
9. Responsibility. To learn self-care or take preventive measures against illness, a patient must have
a sense of responsibility. Encourage the patient to participate in planning the learning activities to
promote his feelings of control.
10. Self perception. Self-perception has an effect on the ability to learn. If effective learning about a
health problem is to occur, any unrealistic self-image or body image should be addressed. If
necessary, help the patient improve self-image before focusing on learning needs.
11. Attitude toward learning. Attitude toward learning is difficult to measure.
12. Talk to the patient to get an idea of how he feels about learning to improve his health. If the
patient has a negative attitude about learning, establish a relationship that will help in altering that
attitude.
13. Motivation to learn. The patient must want to learn for teaching to be effective. If the patient is
not motivated to learn the material needed to improve his health, discussing his interest and
concerns may lead to success.
14. Culture. Some cultures value education that will improve their condition, while others view
change or new practices as threatening. Do not stereotype any person because of his culture; but
recognize that each person has a unique family background with certain cultural values that may
have an effect on how teaching learning is perceived.
15. Communication skills. The basic requirement for the teaching-learning process is
communication. Assess your communication skills as well as those of the learner.
a. Assess the learner's reading skills before using printed material as a teaching aid.
b. Assess to what degree English is spoken and understood by the learner. Most hospitals
have printed and audiovisual materials available for non-English speaking patients.
PRINCIPLES FOR EFFECTIVE TEACHING-LEARNING

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These basic principles are effective guidelines when applied in situations in which the teachinglearning process is used by nurses to meet the needs of clients. Clients may be patients, family members,
or support persons.
(1) The teaching-learning process is facilitated by the existence of a helping relationship.
a) A helping relationship exist among people who provide and receive assistance in meeting a
common goal. The relationship is established as a result of communication.
b) The communication is continuous and reciprocal.
(2) The teachers must be able to communicate effectively with individuals, with small groups, and in
some instances with large groups.
(3) Knowledge of the communication process is necessary for the assessment of verbal and nonverbal
feedback.
(4) A thorough assessment of clients and the factors affecting learning helps to diagnose their learning
needs accurately.
(5) The teaching-learning process is more effective when the client is included in the planning of learner
objectives.
(6) Unless the client values these objectives, little learning is likely to occur.
(7) The implementation of a teaching plan should include varied strategies for sensory stimulation, which
apparently promote learning.
(8) Relating new learning material to clients' past life experiences is effective in helping to assimilate new
knowledge.
(9) Proposed behavioral changes must always be realistic and explored in the context of the client's
resources and everyday life-style.
(10)
Careful attention should be paid to time constraints, scheduling, and the physical
environment.
(11)
Learner objectives provide the basis for evaluating whether learning has occurred.
(12)
When learning objectives have not been met, careful reassessment provides ideas for
changing the teaching plan for subsequent implementation.
18.2 HEALTH EDUCATION
Definition:
Is a process that informs motivates and helps peoples to adopt and maintain healthy practices and lifestyle.
Health Education is to inform people or disseminate scientific knowledge about prevention of disease
and promotion of health.
Health education is defined as a process which brings about changes in the knowledge and attitude of
the people and thereby effecting change in health practices.
Purpose of health education:
The purpose of health education is to aware peoples to achieve health by their own
actions and efforts. It should aims:_
1. To help peoples to understand the health and to help them to achieve health by their own
activities and efforts.
2. To develop a sense of responsibility for improvement of their health as individual members of
families and community.
3. To educate peoples for proper use of health services in what ever form it is made available to them
by the government.
4. To provide a person with appropriate knowledge to enjoy de scent heath and also knowledge about
occurrence and spread of disease and enabling them to adopt relevant preventive measures.
5. To create them a desire to support health education programmes in their area.
6. Health education main aim is bringing about the following changes in :
a. Knowledge,
c. Behavior
b. Attitude
d. Habit
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e. Customs
PLANNING OF HEALTH EDUCATION PROGRAM
To carry out any health education program in the community, the community health nurse
need to prepare a check list of all steps to be taken by them and their team .following
steps should be considered.
Identify health problems and health needs through baseline survey.
Identify leaders in community and discuss about health education program
Approach to health education:
Health education can be carried out through.
Working with individual persons, couples and families.
Working with small groups of community members.
Mass approach and use of mass media.
METHODS OF HEALTH EDUCATION
There are two main methods used in health education.

Didactic Method

Socratic Method
DIDACTIC METHOD:
It is based on direct instruction to the individual or group. It is also called one way
method.
SOCRATIC METHOD :
Is based on interchange of knowledge among people themselves .it is also known as
two way method.
Both types of methods may be used with good communication can be more effective than
one way communication.
Didactic Method:
Based on
a) Lectures
b) Mass Media
Socratic Method:
Based on
a) Group discussions
h) Task force
b) Panel discussions
i) Brain storming
c) Seminar
j) Buzz sessions
d) Symposium
k) Case study
e) Demonstration
l) Open forum
f) Role playing
m) Skits
g) Interview
n) Field trip
Didactic Method:
Lecture:
Lecture is a general oral presentation of the subject .It is organized easily and may be
used with groups of any size.
Mass Media:
Refers to those messages conveyed through TV, radio, films etc.
SOCRATIC METHOD:
Group discussion: in which all permits to discuss all members, but it is time
consuming.
Panel discussion: in 04 to 8 persons who are qualified to talk about the topic. They
sit and discuss a given problem or topic.
Seminar: It refers to group of persons who prepared themselves on a particular topic
and speak to audience.
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 Demonstration: It refers to a presentation that shows in detail ,important technique

of health education
Role playing: it is a spontaneous acting out of a clearly defined situation.

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