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Catalogue of community medicine spotters

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Writing materials for community medicine practicals and clinical postings.

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Catalogue of community medicine spotters

  1. 1. Velammal Medical College Hospital & Research Institute Department of Community Medicine CATALOGUE) Velammal Village, Madurai-Tuticorin Ring Road, Anuppanadi, Madurai-625009
  2. 2. Department of Community Medicine, Velammal Medical College Hospital & Research Institute Table of Contents Part 1 Title Page Number Disinfection 1 Savlon 2 Bleaching Powder 3 Malathion 4 Abate 5 BHC 6 Fenthion 7 Mosquito Repellents 8 Rodenticides 9 Analytical Balance 10 Lactometer 11 Fat Extraction Apparatus 12 Micro Cellular Rubber Footwear 13 Harpenden Calipers 14 Free Sanitary Napkin Scheme, Tamil Nadu 15 Chicken Pox (Varicella) 16 Measles (Rubeola- Red Spots) 17 Mumps 18 Multi Drug Therapy-Leprosy 19 Anti- TB Drugs 20 Condom 21 Combined Pills-Oral Pills 22 Copper-T 23 Vasectomy 24 Tubectomy 25-26 Vitamin A Solution 27 MMR Vaccine 28 Pentavalent Vaccine 29 JE (SA 14-14-2) Vaccine 30 Vi Polysaccharide Typhoid Vaccine 31 RABIES VACCINE 32 VACCINE CARRIER 33 Tetanus Toxoid 34 Bacille Calmette Guerin (BCG) Vaccine 35 Oral Polio Vaccine (OPV) 36 Diphtheria-Pertussis-Tetanus (DPT Vaccine) 37
  3. 3. Department of Community Medicine, Velammal Medical College Hospital & Research Institute Table of Contents Title Page Number Measles Vaccine 38 Tuberculin Syringe (Omega Microstat Syringe) 39 Oral Rehydration Salt (ORS) 40 Mother Linked Child Health Card 41 Iron and Folic Acid Tablets 42 Fruits 43 Fruits Rich in Vitamin A 44 Fruits Rich in Vitamin C 45 Green Leafy Vegetables 46 Fats and Oils 47 Carbohydrates – Sugars 48 Weaning Foods / Complementary Feeding 49 Hyderabad Mix 50 Par-Boiled Rice 51 Food Weighing Scale 52 Modification of Foods 53 Five Whites 54 Food Preservatives 55 Complementary Food 56 Rice (Arisi) 57 Wheat (Godumai) 58 Maize (Makka Cholam) 59 Ragi (Kezhvaragu, Keppai) Finger Millet 60 Bajra (Barli Arisi / Kambu) Pearl Millet 61 Jowar (Cholam) 62 Pulses (Legumes) 63 Soya Bean 64 Nuts and Oil Seeds 65 Ground Nut (Kadalai) 66 Mustard Seeds (Kadugu) 67 Milk 68 Salt (Iodized) 69 Egg 70 Balanced Diet 71-72 Occupational Safety and Health 73-74
  4. 4. 1 DISINFECTION • Disinfection- It is the process of killing of infectious agents outside the body by direct exposure to chemical or physical agents. It is the process of elimination of most pathogenic micro organisms (excluding bacterial spores) on inanimate objects. • Disinfectants are substances which destroys harmful microbes (not usually spores) with the object of preventing transmission of disease. • Different disinfectants have different target ranges, not all disinfectants can kill all micro organisms. Disinfectants are suitable for application to inanimate objects. Disinfectants in low solution act as antiseptics. • Antiseptics: Substance which destroys or inhibits the growth of micro organism. Antiseptics are suitable for application to living tissues. Antisepsis is the use of chemicals (antiseptics) to make skin or mucus membranes devoid of pathogenic micro organisms. • Deodorant-These are substances which suppress or neutralize bad odours. eg. lime and bleaching powder. • Detergent: Surface cleaning agent which acts by lowering surface tension .eg. Soap • Sterilization: Process of destroying all life including spores. • Decontamination: Process of removal of contaminating pathogenic microorganisms from the articles by a process of sterilization or disinfection. It is the use of physical or chemical means to remove, inactivate, or destroy living organisms on a surface so that the organisms are no longer infectious. • Sanitization: Process of chemical or mechanical cleansing, applicable in public health systems. Usually used by the food industry. It reduces microbes on eating utensils to safe, acceptable levels for public health. • Asepsis is the employment of techniques (such as usage of gloves, air filters, UV rays etc) to achieve microbe – free environment.
  5. 5. 2 SAVLON • The active ingredients in savlon are cetrimide and chlorhexidine gluconate. Uses • Plastic appliances like lippies loop may be disinfected by keeping them in normal strength savlon for 20 minutes. • Clinical thermometers may be best disinfected in savlon 1 in 6 in spirit in 3 minutes. • It is commonly used for treatment of mild scarring, some mild burns, cuts and bruises as well as skin healing treatment for spots (i.e. pimples). Toxicity • Idiosyncratic skin reactions may occur. • Savlon antiseptic should not be applied repeatedly to the skin and wet dressings should not be left in contact as sensitivity may occur. • Ototoxicity has been reported after direct instillation into the middle ear. • Hypochlorite bleaches may cause brown stains to develop in fabrics which have previously been in contact with savlon antiseptic.
  6. 6. 3 BLEACHING POWDER • It is also known as chlorinated lime and was first produced in 1799 by Charles Tennant in Glasgow, Scotland. • Bleaching powder is a white powder that is usually a mixture of calcium chloride hypochlorite; calcium hypochlorite, and calcium chloride. • It can be prepared by reacting calcium hydroxide or slaked lime, Ca(OH)2, with chlorine gas, CI 2. • A good sample of bleaching powder contains about 33 % of available chlorine. Uses • It is widely used in public health practice in India as a disinfectant of water, feces and urine and as a deodorant. • It kills most of the organisms when used in the strength of 1 to 3 % • A 5% solution (3 to 4 rounded tablespoon to 1 litre of water) is suitable for disinfection of feces and urine allowing a period of one hour for disinfection. Drawbacks • Chief drawback of bleaching powder is that it is unstable compound and loses its chlorine content on storage. • Its action is rapid but brief.
  7. 7. 4 MALATHION • Malathion is an organophosphate parasympathomimetic which binds irreversibly to cholinesterase. • It is widely used as a pesticide in agriculture, public recreation areas, and in public health pest control programs such as mosquito eradication. • It is used in indoor residual spraying under National Vector Borne Disease Control Programme for the control of malaria where vector has shown resistance to DDT. • The endophilic malaria vectors that rest inside the houses after taking a blood meal are killed when they come in contact with the insecticide and thus transmission is prevented. • It is sprayed at a dose of 2 kg in 10 litres of water for 500m2and has a residual effect for 6-8 weeks. • It is the least toxic of all organophosphorus compounds. • Low volume spray of malathion is used for killing adult mosquitoes to prevent or interrupt dengue-hemorrhagic fever and mosquito-borne encephalitis epidemics. • Malathion in low doses (0.5% preparations) is used in treatment of scabies and pediculosis.
  8. 8. 5 ABATE • Abate (temephos) is an organic phosphate insecticide effective against the larvae of certain aquatic insects. • It is a brown viscous liquid and is soluble in petroleum solvents. It is safe, without any odor or color, have residual effect with low mammalian toxicity and do not pose any health hazard. • In many parts of the world Abate has been approved for use in drinking water supplies for the control of mosquitoes and dracunculiasis (guinea worm disease). • It should be used at strength of 2.5 cc in 10L and the dosage is 20 cc per square meter weekly. • Because of low toxicity, it has been extensively used in India for the control of A. stephensi in wells and in domestic water containers with good results at a dosage not greater than 1ppm. • Abate plays an important role in control of Aedes mosquitoes as they breed only in clean water and household containers. • Abate is less effective against adult mosquitoes. • Abate is not labeled for use in areas which contain fish. Abate biodegrades rapidly and normally persists in the environment for only a few days.
  9. 9. 6 BHC • Benzene hexachloride was first synthesized by Michael Faraday in 1825. • It is an organochlorine chemical, also known as gamma- hexachlorocyclohexane, (γ-HCH) or Lindane. • Properties: o White or chocolate colored powder with a musty smell o Irritating to the eyes, nose and skin. o Slightly volatile o More insecticidal than DDT, although its insecticidal action is not prolonged as that of DDT • Action: Lindane is a neurotoxin that interferes with GABA neurotransmitter function. It kills insects by direct contact, but its insecticidal action is of a shorter duration, upto 3 months.Kills insects by its vapor effect also. • Application: As a residual spray BHC was applied in a dose of 25- 50 mg per square feet. • Due to its toxicity BHC is banned for agricultural or vector control use in India. Lindane is now only used for treatment of scabies and lice.
  10. 10. 7 FENTHION • Fenthion is an organothiophosphate insecticide. • Like most other organophosphates, its mode of action is via cholinesterase inhibition. Due to its relatively low toxicity towards humans and mammals, fenthion is listed as moderately toxic compound. • Fenthion is a contact and stomach insecticide used against many sucking, biting pests. It is particularly effective against fruit flies, leaf hoppers, cereal bugs, stem borers, mosquitoes, animal parasites, mites, aphids, codling moths, and weaver birds. • It has been widely used in sugar cane, rice, field corn, beets, pome and stone fruit, citrus fruits, pistachio, cotton, olives, coffee, cocoa, vegetables, and vines. • Common form of fenthion exposure is occupation related, and occurs through dermal contact or inhalation of dust and sprays. Another likely means of contamination is through ingestion of food, especially, if it has been applied quite recently with fenthion. • Acute poisoning of fenthion results in miosis, headache, nausea/vomiting, dizziness, muscle weakness, drowsiness, lethargy, agitation, or anxiety. In extremely severe cases, coma, respiratory arrest, seizures, loss of reflexes, and flaccid paralysis.
  11. 11. 8 MOSQUITO REPELLENTS • A mosquito repellent is a substance put on skin, clothing, or other surfaces which discourages mosquitoes from landing or crawling on that surface. • They repel the mosquitoes by their smell and protect the individuals from mosquito bites. They are available in various forms such as coils, liquidizer, gel, lotion, cream etc. • Mosquito repellants may be natural or synthetic. Neem oil, citronella oil and oil of lemon eucalyptus are some of the natural repellants. In general natural repellents are less effective than synthetic. • Repellents that contain DEET (N, N-diethyl-m-toluamide), permethrin, 3-[Nbutyl-N-acetyl]-aminopropionicacid or picaridin are the most effective synthetic mosquito repellents. • Permethrin products are intended for use on items such as clothing, shoes, bed nets and camping gear and should not be applied to skin. • Other repellents which are less effective are dimethyl phthalate, dimethylcarbamate, indalone, ethyl hexanediol, etc. • Repellants are usually effective only for a short period of 8-10 hours except permethrin which is effective for 1 to 3 weeks.
  12. 12. 9 RODENTICIDES • Two main types are available-single dose (acute) and multiple- dose (cumulative). • The former are lethal to rat after a single feeding, while the latter require multiple feedings over a period of 3 days. • Commonly used rodenticides in India are Barium carbonate and Zinc phosphide. • Barium carbonate is a white tasteless powder and is very cheap. It is mixed with wheat or rice flour in the ratio of 1 part to 4 parts of flour, which is moistened with water and made into small round marbles. Poisoned baits are placed near the rat burrows and secluded places. On eating the pills, the rats are killed in 2-24 hours. • Zinc Phosphide: When moist, the chemical slowly gives off phosphine whose garlic odor is repellent to man and domestic animals, but seems to have no adverse effect on rats. It is used in the ratio of 1 part to 10 parts of wheat or rice flour and mixed with few drops of edible oil in water to render it more attractive to rats. Rats are killed in about 3 hours.
  13. 13. 10 ANALYTICAL BALANCE • An analytical balance is a class of balance designed to measure small mass in the sub-milligram range. • An analytical balance is so sensitive that it can detect the mass of a single grain of a chemical substance. • The measuring pan of an analytical balance (0.1 mg or better) is inside a transparent enclosure with doors so that dust does not collect and so any air currents in the room do not affect the balance's operation. This enclosure is often called a draft shield. • Also, the sample must be at room temperature to prevent natural convection from forming air currents inside the enclosure from causing an error in reading. • Electronic analytical scales measure the force needed to counter the mass being measured rather than using actual masses. • As such they must have calibration adjustments made to compensate for gravitational differences. • They use an electromagnet to generate a force to counter the sample being measured and output the result by measuring the force needed to achieve balance.
  14. 14. 11 LACTOMETER • Lactometers are used for rapid determination of specific gravity. • The method is based on law of floatation which states that when a solid is immersed in a liquid. It is subject to upward thurst equal to the weight of the liquid displaced by the body and acting in upward direction. • A lactometer (or galactometer) is a hydrometer used to test milk. The specific gravity of milk does not give conclusive indication of its composition since milk contains a variety of substances that are either heavier or lighter than water. • The instrument is graduated into a hundred parts. Procedure • Adjust the temperature of milk sample at 50-80 0 F. • Fill the clean, dry glass jar about 2/3 rd volume of it with milk; pour the milk down along the sides of the jar to avoid the incorporation of air. • Lower the lactometer gently in the milk making sure that the lactometer floats freely without touching the sides of the jar. • Add milk to brim of the jar. • Read the lactometer reading at the top of the meniscus within one minute. • Record the temperature of milk.
  15. 15. 12 FAT EXTRACTION APPARATUS • It is a piece of laboratory apparatus originally designed for the extraction of a lipid from a solid material. • Typically, an extraction is used when the desired compound has a limited solubility in a solvent, and the impurity is insoluble in that solvent. • This method is applicable to the determination of fat in food like meat, milk, poultry, and processed meat products etc. at desirable levels. • Fat determination is one of the key analyses used for food labelling and quality control. • The sample is placed in an extraction chamber and solvent is heated to reflux. The extraction chamber is emptied when the set level is reached, with the solvent flowing to the heated beaker. During each cycle, a portion of the non-volatile compound (fat) dissolves in the solvent. At the end of the extraction, the desired compound is concentrated in the beaker. • Importance of analysis include: • Accurate food labeling • Verify standard of identify • Ensure manufacturing specification • Nutritional formulation
  16. 16. 13 MICRO CELLULAR RUBBER FOOTWEAR • Footwear is an important factor in the prevention of plantar ulcers among leprosy patients. • Protective footwear must be worn by all patients with sensory loss in their soles throughout their life time. • People with leprosy, lymphatic fialariasis (LF), diabetes mellitus and other circulatory diseases are 20 times more likely to have foot problems than the general public. • Micro-cellular rubber (MCR) foot-wear has been used widely over the past several years for the anaesthetic feet of leprosy. • MCR is made out of natural rubber with chemical blowing agent and sulphur. • MCR cushioned insoles tend to distribute walking pressure more widely over the sole thereby minimising the risk of wounds on pressure points. • Lepra India has been producing high-quality protective footwear for people with leprosy since past 20 years. • Each patient undergoes a Bio-Mechanical assessment following which footwear are made with 10 mm Micro Cellular Rubber (MCR) with podiatry appliances as required. • Although MCR has got good shock absorbing and moulding qualities, many tend to reject the foot-wear because of the stigma of the disease which it carries.
  17. 17. 14 HARPENDEN CALIPERS • The Harpenden skin fold Caliper is the de facto standard body fat assessment device. • It had been used in numerous clinical studies over the last 25 years for obesity and body composition analysis. • The Harpenden skin fold Caliper is engineered to extremely precise standards and calibrated to traceable standards. • Recent enhancements to the caliper include an increased jaw opening to facilitate measurement up to 80mm. • This makes them suitable for both the measurement of skin folds and the girth measurement of small joints such as the condyle processes at the ankle, wrist, knee and elbow. TECHNIQUE • The skinfold should be firmly grasped by the thumb and index finger, using the pads at the tip of the thumb and finger. Gently pull the skinfold away from the body. • The Caliper should be placed perpendicular to the fold, on the site marked, dial up, at approximately 1 cm below the finger and thumb. While maintaining the grasp of the skinfold, allow the Caliper to be released so that full tension is placed on the skinfold. • The dial should be read to the nearest 0.50 mm, 1 to 2 seconds after the grip has been fully released.
  18. 18. 15 FREE SANITARY NAPKIN SCHEME, TAMIL NADU • In India, menstruation and menstrual practices are clouded by taboos and socio-cultural restrictions for women as well as adolescent girls. • Limited access to safe sanitary products and facilities is believed to be one of the reasons for constrained school attendance, high dropout rates and ill health due to infection. • In a bid to better the health of adolescent girls, and ensure reproductive health of women, the Government of Tamil Nadu has launched a ‘napkin revolution’ all over the state. • Over 41 lakh adolescent girls in the 10-19 age group in rural areas, 7 lakh new mothers and over 700 women prisoners stand to benefit from the free sanitary napkin scheme, described as a first-of-its-kind initiative in India. • Free sanitary napkins will be distributed to rural girls, new mothers and girls studying in government schools. • Government hospitals, primary health centers, village sub centers, anganwadis, rural nurses and Integrated Child Development Scheme centers have been asked to distribute the napkins.
  19. 19. 16 CHICKEN POX (VARICELLA) Agent: This is a highly infectious disease caused by V-Z (Varicella –Zoster) virus. Host: Children < 10years of age are vulnerable and one attack confers lifelong immunity. Mode of transmission: It is transmitted from person to person through droplet infection. Most persons are infected by face to face contact and the portal of entry is respiratory tract. Communicable period is 1-2 days before and 4-5 days after the appearance of rash. Clinical features: The disease is characterized by rashes which appears first on the trunk and then comes on the face, arms and legs. Rashes advances quickly through the stages of macule, papule, vesicle and scab. Usually the first to attract attention are the vesicles filled with clear fluid and looking like dew drops on the skin. Another characteristic feature of the rash is Pleomorphism. Prevention and control: Disease control can be achieved by isolation of patients. VZIG (Varicella Zoster immunoglobulin) administered within 72 hours of exposure can prevent the development of disease. Live attenuated varicella vaccine is available which can be given to children in age group 12-18 months who have not had chicken pox.
  20. 20. 17 MEASLES (RUBEOLA- RED SPOTS) Agent: Measles is an acute, highly infectious disease caused by a RNA paramyxovirus. Host: Children between 6 months to 3 years of age are most commonly affected. Mode of transmission: Transmitted directly from person to person by droplet infection. Communicable period is from 4 days before and 5 days after the onset of rash. Clinical features: Characterized by fever and catarrhal symptoms of the upper respiratory tract (coryza, cough) followed by a typical rash. Typical dusky- red, macular / macula-popular rash begins behind the ears and spreads below. A day or two before the appearance of rash table salt like crystals appears on the buccal mucosa opposite to first and second lower molars. They are small, bluish white spots on a red base and are called Koplik’s spots. Complications: Most common complications of measles are diarrhea, pneumonia and otitis media. Some serious neurological manifestations such as convulsions, encephalitis and sub acute sclerosing pan encephalitis can also occur. Prevention and control: Live attenuated measles vaccination at 9 months of age and second dose at 15 months is given under universal immunization programme (UIP) in India.
  21. 21. 18 MUMPS Agent: Mumps is an acute, infectious disease caused by Myxovirus parotiditis- RNA virus of the myxovirus family. Host: Commonly affects children in the age group 5-9 years. Mode of transmission: The disease is transmitted by droplet infection from 4 -6 days before and one week after the appearance of symptoms. Clinical features: It is characterized by non – suppurative enlargement and tenderness of one or both the parotid glands. Complications: Some of the common complications of mumps include orchitis, oophortis, pancreatitis, meningo-encephalitis, thyroiditis, neuritis, hepatitis and myocarditis. Rare complications include nerve deafness, polyarthritis, hydrocephalus, encephalitis, cerebellar ataxia, facial palsy and transverse myelitis. Prevention and control: Live attenuated mumps vaccine is available as a single vaccine or as a combination vaccine (for Mumps, Measles and Rubella).
  22. 22. 19 MULTI DRUG THERAPY-LEPROSY • National Leprosy Eradication Programme is following the WHO recommended multi drug therapy for leprosy treatment. • The standard regimen for Multibacillary (MB) leprosy is Rifampicin-600 mg once a month, Dapsone-100 mg daily, Clofazimine-300 mg once a month and 50 mg daily for 12 months. • The standard regimen for Paucibacillary (PB) leprosy is Rifampicin-600 mg once a month, Dapsone-100 mg daily for six months. • Adverse effects of rifampicin include anorexia, nausea, vomiting and abdominal pain. Orange colored urine is a common side effect of rifampicin which should be explained to the patient. • Adverse effects of dapsone include hepatitis, agranulocytosis, peripheral neuropathy, hemolytic anemia and lepra reaction. • Adverse effects of clofazimine are darkish red coloration of skin, mucous membranes, urine and sweat. • The relapse rate is very low (0.1% per year for PB and 0.06% per year for MB on the average). • In addition, the low frequency of side-effects has made it highly acceptable to patients in a variety of settings.
  23. 23. 20 ANTI- TB DRUGS • Under Revised National Tuberculosis Control Programme “DOTS” strategy (Directly Observed Treatment Short course) is followed for treatment of tuberculosis. • The most important drugs used in the treatment of TB are Isoniazid (H), Rifampicin (R), Pyrazinamide (Z), Streptomycin (S) and Ethambutol (E). • Drugs are supplied in Patient - Wise Boxes (PWB) containing the full course of treatment and packaged in blister packs. Categories of TB patients and standardized regimen Category Type of patient Regimen Duration Category-I Red Box New sputum positive New sputum negative New extra- pulmonary Other new cases 2H3R3Z3E3 / 4H3R3 6 months Category-II Blue Box Sputum positive relapse Sputum positive failure Sputum positive treatment after default 2H3R3Z3E3S3/ 1H3R3Z3E3 / 5H3R3E3 8 months
  24. 24. 21 CONDOM Condoms are physical barrier contraceptive devices and available in lubricated form. They may also be coated with spermicidal jelly which is usually nonoxynol-9. It is better known as NIRODH in India and provided free of cost by the Government of India through hospitals, PHCs and sub-centers. Mechanism of action: Condoms prevent sperm from meeting the ovum thereby preventing fertilization. The average shelf life is 5 years from date of manufacture and they should be stored in cool and dry place. Failure rate: The total “slippage” and “breakage” rate is 4% to 9%. The average failure rate is 12% to 14%, but if correctly used, it may be as low as 3%. Concurrent use of spermicidal jelly will further reduce the failure rate. Advantages: Condoms are easily available, cheap and easy to use and they have no side effects. Condoms are very good choice as temporary method, especially for couples in who use of OCPs and IUDs is not indicated among the female partner. According to NFHS 3, 5.3% of eligible couples are using condoms. Disadvantages: They may slip off or tear and some couples may complaint they interferes with sexual sensation.
  25. 25. 22 COMBINED PILLS-ORAL PILLS OCPs are one of the highly effective temporary contraceptive methods with a low failure rate of <1%. They are hormonal pills containing synthetic estrogen and progestogen. They should be taken orally for 21 consecutive days beginning on the 5th day of menstrual cycle. Mechanism of action: Hormones present in the pills affect ovulation, makes endometrium unfavorable for implantation and alters cervical mucus thickness which prevents sperm entry. Under the National Family Welfare Programme they are produced in two names: Mala-D and Mala-N. Both of the brands contain Levonorgestrol 0.15 mg and Ethinyl estradiol 0.03 mg. While Mala-N is provided free of cost, Mala- D is available at subsidized rates in our country. According to NFHS 3, 3% of eligible couples are using it. Advantages: Low failure rate, easy administration, protection against fibrocystic disease, fibroadenoma of the breast, ovarian cyst, iron deficiency anemia, PID, ectopic pregnancy and ovarian cancer are the main advantages. Disadvantages: They may cause breast tenderness, venous thrombosis, cervical cancer, hepatocellular adenoma, weight gain and headache. Contraindicated in women with Ca breast, liver diseases, history of thromboembolism, abnormal uterine bleeding.
  26. 26. 23 COPPER-T Copper-T is a second generation Intra Uterine Contraceptive Device (IUCD). It is a T shaped device with copper wire around it and a pair of threads which comes out of cervical os, into vaginal canal after the Copper-T has been inserted. Mechanism of action: They act by inducing mild inflammatory changes and foreign body reaction in the endometrium, prevent sperm from fertilizing the ovum, and even if fertilization occurs, make the uterine environment inhospitable for the implantation. Copper T 380 A is currently provided under the National Family Welfare programme. It contains copper and silver. The copper has an exposed area of 380sq mm and hence the name Cu-T 380 A. It can be left in situ for ten years. NFHS- 3 had estimated that 1.8% of married women are using IUCD. Advantages: IUCDs are suitable for breastfeeding women, not user dependent, inexpensive and do not interfere with intercourse. Disadvantages: Includes requirement of trained person for insertion, bleeding, expulsion, pain, infections, perforation and ectopic pregnancy. Contraindications: Absolute contraindications are PID, suspected pregnancy, undiagnosed vaginal bleeding, Ca cervix or uterus, previous ectopic pregnancy. Relative contraindications are anemia, menorrhagia, purulent cervical discharge, distorted uterine cavity, unmotivated persons.
  27. 27. 24 VASECTOMY Procedure: It is the permanent method of family planning for males. In the conventional procedure, an incision is given on the scrotal skin and a piece of vas deferens 1 to 1. 5 cm long is removed. In the more recent technique of “No Scalpel Vasectomy” a puncture is made in scrotal skin using a reverse scissor and a hole of approx half a cm is created through which vas is ligated after removing a piece 1 cm long. The ends are ligated and folded back on themselves and sutured into position, so that the ends face away from each other which will reduce re-canalization. Mechanism of action: Sperm production and hormone output are unaffected by the procedure. Sperms are destroyed intra- luminally by phagocytosis which occurs in normal male genital tracts, but the rate of destruction is greatly increased after vasectomy. It must be emphasized on the acceptor that it will take 3 months for him to become completely sterile. Overall failure rate of vasectomy is 1 to 2 per 1000 person years. The reason for failure is spontaneous re-canalization of the vas. NFHS 3 showed 1% of couples are adapting this method. Advantages: Vasectomy is a very simple, cheap and effective procedure which can be performed by trained MBBS doctors. Disadvantages: The main disadvantage is the difficulty in convincing males to accept the procedure.
  28. 28. 25 TUBECTOMY Tubectomy is the terminal method of family planning for females. Female sterilization can be done as an interval procedure, postpartum or at the time of abortion. As per NFHS-3, 37.3% of married women in India are using this method. Two procedures have become most common, namely laparoscopy and mini laparotomy. Laparoscopy: This is a technique of female sterilization through abdominal approach with a specialized instrument called “laparoscope”. The abdomen is inflated with gas (carbon dioxide, nitrous oxide or air) and the instrument is introduced into the abdominal cavity to visualize the tubes. Once the tubes are accessible, the Falope rings (or clips) are applied to occlude the tubes. This operation should be undertaken only in those centers where specialist obstetrician- gynecologists are available. The short operating time, shorter stay in hospital and a small scare are some of the attractive features of this operation. Patient selection: Laparoscopy is not advisable for postpartum patients for 6 weeks following delivery; however, it can be done as a concurrent procedure to MTP. Hemoglobin per cent should not be less than 8. There should be no associated medical disorders such as heart disease, respiratory disease, diabetes and hypertension. It is
  29. 29. 26 recommended that the patient be kept in hospital for a minimum of 48 hours after the operation. The cases are required to be followed-up by health workers (F) LHVs in their respective areas once between 7-10 days after the operation, and once again between 12 and 18 months after the operation. Complications: Although complications are uncommon, when they do occur they may be of a serious nature requiring experienced surgical intervention. Puncture of large blood vessels and other potential complications have been reported as major hazards of laparoscopy. Mini-laparotomy: This is a modification of abdominal tubectomy. It is a much simpler procedure requiring a smaller abdominal incision of only 2.5 to 3 cm conducted under local anesthesia. The minilap/pomeroy technique is considered a revolutionary procedure for female sterilization. It is also found to be a suitable procedure at the primary health centre level and in mass campaigns. It has the advantage over other methods with regard to safety, efficiency and ease in dealing with complications. Minilap operation is suitable for postpartum tubal sterilization.
  30. 30. 27 VITAMIN A SOLUTION • Vitamin A (VA) is an essential nutrient needed in small amounts for the normal functioning of the visual system, growth and development, maintenance of epithelial cellular integrity, immune function and reproduction. • Vitamin A deficiency (VAD) has been recognized as a major controllable public-health and nutritional problem in India. An estimated 5.7% children are suffering from eye signs of VAD. Severe deficiency of VA is known to produce corneal xerophthalmia, keratomalacia and blindness in children. • The National Prophylaxis Program against Nutritional Blindness due to vitamin A deficiency (NPPNB due to VAD) was started in 1970 with the specific aim of preventing nutritional blindness due to keratomalacia. • Vitamin A solution should be administered using only the spoon/dispenser provided with each bottle. The half mark in the spoon indicates 100,000 IU and a level full spoon contains 200,000 IU of Vitamin A. • 100000 IU at 9 months with measles immunization, 200000 IU at 16-18 months, with DPT booster and 200000 IU every 6 months, up to the age of 5 years. • Nearly all of the early stages of xerophthalmia can be reversed by administration of a massive dose (200000 IU) orally on two successive days.
  31. 31. 28 MMR VACCINE • This is a trivalent attenuated live virus vaccine containing- Measles (Edmonston-Zagreb strain), Mumps ((L-Zagreb strain) and Rubella (Wistar-RA27/3 strain). • It is a lyophilized vaccine and should be reconstituted with the solvent provided before administration. It is administered subcutaneously and the dose is 0.5 ml. • MMR vaccine has been successfully used by many developed countries in a two dose schedule in preschool children to eliminate measles, mumps and rubella from their population. • Although MMR vaccine is not a part of the national immunization schedule of India, the Indian Academy of Pediatrics (IAP) recommends to offer MMR vaccine to all parents who can afford it as two dose schedule, one at 15-18 months and second at school entry (4-6 yr of age). • Adverse reactions following immunization are rarely serious. Mild adverse reactions such as fever, malaise, rashes etc., can occur. Since this is a live vaccine it is contraindicated in pregnant women.
  32. 32. 29 PENTAVALENT VACCINE • Pentavalent vaccine is a conjugate vaccine which combines antigens against five infections: Diphtheria, Tetanus, Pertussis, Hepatitis B and Haemophilus influenza type b. • The recommended age group for vaccination in India is from 6 weeks to less than1year of age. • The vaccine is administered at 6 weeks, 10 weeks and 14 weeks. Each dose is 0.5 ml and given by intra muscular injection in antero-lateral aspect of the mid-thigh. • Pentavalent vaccine is a freeze sensitive vaccine, and should be stored and transported at 2-8°C in ice lined refrigerators and vaccine carriers with conditioned ice pack. • The pentavalent vaccine has already been introduced in Tamil Nadu and Kerala states of India in December 2011. • Adverse events include redness, swelling and pain at the site of injection in as many as 25% of those who have been vaccinated. • Contraindications: Persons with moderate or severe acute illness and history of severe allergic reactions.
  33. 33. 30 JE (SA 14-14-2) VACCINE • Cell-culture derived, live attenuated vaccine based on the SA 14- 14-2 strain of the Japanese encephalitis virus. The vaccine is manufactured in China and imported to India. • The SA 14-14-2 vaccine strain was obtained from its wild-type SA 14 parent by serial passages in cell cultures (primary hamster kidney cells) and in animals with successive plaque purifications (in primary chick embryo cells). • The vaccine was first licensed in 1988 and had become an integral part of UIP in 11 endemic districts in UP, Assam, West Bengal and Karnataka. • It is given at 16-24 months along with DPT/OPV booster. Dose is 0.5 ml and administered subcutaneously on left upper arm. • Several studies have demonstrated an excellent immune response after a single dose of SA 14-14-2 vaccine, with neutralizing antibody responses produced in 85%-100% of non-immune children. • Contraindications: Anaphylaxis to a prior dose, severe hypersensitivity reaction to any vaccine component, immuno- suppression or having the signs and symptoms of AIDS , pregnancy, acute infectious disease, renal, hepatic or cardiac disease, active tuberculosis, otitis media and epilepsy. • Precautions: In a child with fever, vaccination should be postponed until fever settles.
  34. 34. 31 Vi POLYSACCHARIDE TYPHOID VACCINE • This is a sub unit vaccine composed of purified Vi capsular polysaccharide from the Ty2 Salmonella typhi strain. • It elicits a T-cell independent IgG response that is not boosted by additional doses. • Vaccine is administered subcutaneously or intramuscularly and the protection is induced about 7 days after the injection. • Vaccine is indicated for active immunization for the prevention of typhoid fever caused by S typhi and is approved for use in persons two years of age or older; revaccination is recommended every 3 years. • The vaccine is stable for 6 months at 37◦ C and for two years at 22◦ C. The recommended storage temperature is 2-8◦ C. • No serious adverse effects are associated with Vi polysaccharide vaccination. • There are no contraindications to the use of this vaccine other than previous history of severe hypersensitivity reaction to vaccine components.
  35. 35. 32 RABIES VACCINE Vaccines 1. Cell Culture Vaccines • Human Diploid Cell Vaccine (HDCV) • Purified Chick Embryo Cell Vaccine (PCEC) • Purified Vero Cell Rabies Vaccine (PVRV) 2. Purified Duck Embryo Vaccine: INTRA-MUSCULAR (IM) REGIMEN Essen Schedule: This is a five dose intramuscular regimen. The course for post-exposure prophylaxis should consist of intramuscular administration of five injections on days 0, 3, 7, 14 and 28. The sixth injection (D90) should be considered as optional and should be given to those individuals who are immunologically deficient, or at the extremes of age and on steroid therapy. Day 0 indicates date of first injection. Injections should be given over the deltoid region. INTRA-DERMAL (ID) REGIMEN Updated Thai Red Cross Schedule (2-2-2-0-2). This involves injection of 0.1ml of reconstituted vaccine per ID site and on two such ID sites per visit (one on each deltoid area, an inch above the insertion of deltoid muscle) on days 0, 3, 7 and 28. The day 0 is the day of first dose administration of IDRV and may not be the day of rabies exposure/animal bite.
  36. 36. 33 VACCINE CARRIER • Vaccine carriers are part of ‘cold chain’ which is a system of storage and transport of vaccines at lower temperature from the manufacturer to the vaccination site. • Vaccine carriers are insulated containers that, when lined with ice packs, keep vaccines and diluents cold during transportation. • They are smaller than cold boxes and are easier to carry when walking. They are used for transporting vaccines from health facilities with refrigeration to outreach sessions where refrigeration and ice are not available. • They are typically carried by a single health worker travelling on foot or by other means, where the combined journey time and immunization activity ranges from a few hours to a whole day. • The vaccine storage capacity of vaccine carriers are between 0.1 and 5.0 litres. • Vaccine carriers are used at Primary Health Centre to carry small quantities of vaccine (16-20 vials) for the outreach sessions. • Before the vaccines are placed inside, 4 fully frozen packs are used for lining the sides. Vaccines are kept in cartons or polythene bags. • Vials of DPT, DT, TT and diluents should not be placed in direct contact with frozen packs. Carriers should be closed tightly.
  37. 37. 34 TETANUS TOXOID • It is a sterile, whitish turbid, uniform suspension of tetanus toxoid adsorbed on aluminium phosphate and suspended in isotonic sodium chloride solution. Each dose of 0.5 ml human dose contains: • Tetanus Toxoid ≥ 5 Lf • Adsorbed on Aluminium Phosphate (AlPO4) ≤ 1.25 mg • Thiomersal = 0.01 % as preservative • Primary immunization includes two doses (each 0.5 ml) injected into the arm at intervals of 1-2 months. Booster doses includes, first booster- 1 year after the primary immunization and second booster- 5 years after the first booster. • It is stored between 4-10ºC and should not allow to freeze. • In pregnant women, 2 doses of TT must be given between 16-36 weeks of pregnancy with an interval of 1-2 months between the 2 doses. In case of subsequent pregnancy within five years one booster dose is enough. This gives protection for both the mother and new born against tetanus. • Adverse reactions: Mild local reactions consisting of pain, erythema, tenderness and indurations at the injection site are common. Vaccine is contraindicated in children with high fever, or other evidence of acute illness.
  38. 38. 35 BACILLE CALMETTE GUERIN (BCG) VACCINE • This is a live bacterial vaccine derived from an attenuated bovine strain of tubercle bacilli (Danish 1331 strain). • Single dose of strength 0.1mg in 0.05 ml is administered to all newborns who are delivered at institutions under the National Immunization Schedule. • If this is not given then vaccine is administered in strength of 0.1 mg in 0.1 ml at 6 weeks of age. • Vaccine is given as intra-dermal injection just above the insertion of the deltoid muscle in the left arm and normal saline is used as diluent. • Two to three weeks after vaccination, a papule develops at the site of administration. The papule increases in size up to 4 to 8 mm and breaks into a shallow ulcer after five weeks. The ulcer heals leaving behind a tiny, round, permanent scar after 6 to 12 weeks. • Different studies had showed that the range of protection offered by BCG vaccine varies between 0 to 80% in different parts of the world. If the vaccine is given subcutaneously, it may cause suppurative lymphadenitis. Other complications include osteitis and disseminated BCG diseases.
  39. 39. 36 ORAL POLIO VACCINE (OPV) • The live oral polio vaccine (OPV) is a trivalent vaccine containing suspensions of types 1, 2 and 3 attenuated poliomyelitis viruses (Sabin strains) prepared in monkey kidney cells. The vaccine comes in vials of 20 doses. • Each dose contains not less than virus concentration per dose 106.0 CCID50 of type 1, 105.0 CCID50 of type 2 and 105.8 CCID50 of type 3. MgCl2 1M is used as a stabilizer and phenol red as indicator. During formulation of OPV trace amounts of antibiotics: Kanamycin and Neomycin sulphate are added. • Two drops are delivered directly into the mouth of vaccinee from the multidose vial by dropper or dispenser. Primary immunization consists of 3 doses at 6 weeks, 10 weeks and 14 weeks of age with booster dose at 16-24 months. (Institutional deliveries an additional dose is given at the time of birth). • Vaccine should be stored at -20◦ C and the vials are provided with ‘Vaccine Vial Monitor’ (VVM) which changes color according to increase in temperature. OPV produces both humoral and intestinal immunity and can be used during epidemics. It is cheaper, easy to manufacture and administer compared to inactivated polio vaccine. • Occurrence of cases due to vaccine derived polio virus (VDPV) is the major disadvantage of this vaccine. In 1994 the Indian Government launched the Pulse Polio Campaign to eliminate polio and stopped transmission of polio with its last reported case in 2011.
  40. 40. 37 DIPHTHERIA-PERTUSSIS-TETANUS (DPT VACCINE) • This is an inactivated and combined vaccine which protects against three diseases namely Diphtheria, Pertussis and Tetanus. • Two types are available - Plain and Adsorbed. Aluminum phosphate or hydroxide is the usual adsorbent. • Each dose contains o Diptheria toxoid : 20-30 Lf o Tetanus toxoid: 5-25 Lf o Pertussis : ≥ 4.0 IU o Aluminium : ≤1.25 mg o Thiomersal : 0.01% • Primary immunization consists of 3 doses at 6, 10 and 14 weeks of age. A booster dose is given at 16-24 months of age. • Route of administration is intramuscular injection with a dose of 0.5 ml given in lateral aspect of thigh. • DPT vaccine should be stored in refrigerator at 4-8◦ C and should not be allowed to freeze. • Contraindications for DPT vaccination are seriously ill children, severe reactions after previous dose like screaming episodes, temperature >40o C, convulsions and anaphylaxis. Fever, mild local reactions are common adverse effects while encephalitis and Reye’s syndrome are rare but serious adverse effects.
  41. 41. 38 MEASLES VACCINE • Measles Vaccine is a freeze-dried preparation containing live attenuated measles virus (Edmonston Zagreb Strain) propagated on Human Diploid Cells (HDC). Each dose of 0.5 ml contains not less than 1000 CCID50 of Measles virus on reconstitution with the diluent (Sterile Water for Injections) provided. • The reconstituted vaccine is given subcutaneously during 9 months of age. Second dose of measles vaccine is given between 15 to 18 months of age. The vaccine should be stored in the freezer compartment of the refrigerator (diluents must be stored at 4-8ºC). The reconstituted vaccine should be kept in ice and used within one hour. • Even a single dose of measles vaccine gives 95% protection. • Adverse effect includes fever or rash, or both, generally appear between the 5th and the 12th day after vaccination. • Toxic shock syndrome (TSS) can occur if the measles vaccine gets contaminated. The vaccine should not be used after four hours of opening the vial. TSS is totally preventable and if occurs it reflects poor quality of immunization services. • It is particularly important to immunize children suffering from malnutrition. Low-grade fever, mild respiratory infections or diarrhoea, and other minor illness should not be considered as contraindications to immunization.
  42. 42. 39 TUBERCULIN SYRINGE (OMEGA MICROSTAT SYRINGE) • It is used to administer BCG Vaccine. • The tuberculin syringe is fitted with a 1 cm steel 26 gauge intradermal needle and has markings from 0.1 ml to 1.0 ml. • The injection is given intradermally just above the insertion of the deltoid muscle. • If it is injected too high or too forward or backward, the adjacent lymph nodes may become involved and tender. • Dose to be injected is 0.05ml for neonates and 0.1 ml for infants after the age of 1 month. • A satisfactory injection should produce a wheal of 5 mm in diameter. • The vaccine must not be contaminated with an antiseptic or detergent. • If alcohol is used to swab the skin, it must be allowed to evaporate before the vaccine is given.
  43. 43. 40 ORAL REHYDRATION SALT (ORS) • ORS prevents and treats dehydration from diarrhea irrespective of cause or age group affected. • It is a balanced mixture of glucose and electrolytes for treating and preventing dehydration, potassium depletion and base deficit due to diarrhea. India was the first country to launch the reduced osmolarity ORS solution which is as safe and effective as the original in preventing and treating diarrheal dehydration and also reduced stool output or offers additional clinical benefit or both. • Packets of oral re - hydration mixture are freely available. The contents of the packet are dissolved in 1 litre of drinking water and the prepared solution should be used within 24 hours. It should not be boiled or sterilized otherwise. • There is no restriction in quantity of ORS to be given and the affected child can take as much as possible. COMPOSITION OF REDUCED OSMOLARITY ORS Contents Grams/liter Sodium chloride 2.6 Glucose, anhydrous 13.5 Potassium chloride 1.5 Trisodium citrate, dehydrate 2.9 Total weight 20.5
  44. 44. 41 MOTHER LINKED CHILD HEALTH CARD • This comprehensive multipurpose card is a joint initiative of ICDS and NRHM. • It provides information to the parents on various types of services delivered through ICDS and NRHM, which the families can access and utilize for growth and development of their children and health of the mothers. • The card contains a unique identification number which is linked to the Mother Child Tracking software under NRHM. • The card also contains the code of the AWC, along with detailed information about the AWC and the worker. • Other important details present in the card are ante natal visits, mode of delivery, person who conducted delivery, whether the colostrum was given or not, immunization details, Iron and Vitamin A supplementation, growth chart up to 3 years for boys / girls. • It also contains advice on – nutrition, oral rehydration therapy, seeking timely health care for Acute Respiratory Infection (ARI) and other illness.
  45. 45. 42 IRON AND FOLIC ACID TABLETS • It is estimated that 41.8% of pregnant women worldwide are anemic and half of this anemia burden is assumed to be due to iron deficiency. • According to NFHS-3 around 56% of pregnant women and 79% of children <3 years are anemic in India. • Pregnant women require additional iron and folic acid to meet their own nutritional needs as well as those of the developing fetus while children need iron and folic acid for their normal growth and development. • Deficiencies in iron and folic acid during pregnancy can negatively impact the health of the mother, her pregnancy, as well as fetal development.. • WHO recommends daily oral iron and folic acid supplementation as part of the antenatal care. • IFA tablets given to pregnant women in India contain 100mg elemental iron and 0.5mg folic acid. • Normal pregnant women should take 100 IFA tablets during their second trimester while anemic mothers should take double the dose. • Children between 6 months to 60 months should be given 20mg elemental iron and 100 mcg folic acid per day per child.
  46. 46. 43 FRUITS • Fruits are protective and extremely nutritious food because of minerals, vitamins and digestible fibers. • They act as a mild laxative in constipation. • Being eaten raw and fresh, the minerals, vitamins and phytochemicals present in them, do not have to suffer the humiliation of “mutilation” through heat and fire. • Fruits can be classified into citrus, non-citrus and dried fruits. Public health importance • Eating a wide variety of fruits is recommended as a preventive measure against various free radical mediated diseases (coronary heart disease, cancer, inflammatory bowel disease etc.) • Approximately 1.7 million (2.8%) of deaths worldwide are attributable to low fruit and vegetable consumption. • Low fruit and vegetable intake is among the top 10 selected risk factors for global mortality. • Worldwide, insufficient intake of fruit and vegetables is estimated to cause around; 14% of gastrointestinal cancer deaths, 11% of ischaemic heart disease deaths and 9% of stroke deaths. • The recommended intake is a minimum of 400 g of fruits and vegetables per day for the prevention of chronic diseases such as heart diseases, cancer, diabetes and obesity.
  47. 47. 44 FRUITS RICH IN VITAMIN A • Papaya and mango are rich in carotene. • Yellow peaches are a good source of carotene. • Dried apricots and prunes are rich in vitamin A. • If a sufficient amount of mango is eaten in the season it will provide adequate store of vitamin A in liver. • Vitamin A is essential for many physiological processes, including maintaining the integrity and function of all surface tissues (epithelia), and it is essential for vision • One of the main consequences of VAD is an increased risk of severe infection. Ocular manifestation includes keratomalacia. • Vitamin A can also be fortified in sugar, salt and vanaspati. • It is important that all sources of vitamin A are not overcooked, as this can reduce the vitamin A content. • Ultraviolet light can also reduce the vitamin A content of food, so drying of fruits such as mangos should not be done in direct sunlight. Recommended daily allowances • 600 mg of retinol for adult, during pregnancy and lactation 800 and 950 respectively. • For infants 350 mg , for children 1-6 years is 600 mg.
  48. 48. 45 FRUITS RICH IN VITAMIN C Source • Guava, Amla, Orange, Lemon, Mosambi, Malta etc. are rich in ascorbic acid. Papaya and mango are moderately rich in vitamin C. • One medium sized orange provides enough juice to meet the daily requirement of ascorbic acid of an adult. • Long-term storage of fruits can cost a significant amount of vitamin C. Deficiency diseases Scurvy: Signs include bleeding gums, sub cutaneous bruising, bleeding into skin / joints, delayed wound healing, anemia and weakness. Public health importance of vitamin C • Ascorbic acid helps in oxidation process metabolism of the metal ions and plays a vital role in maintaining vascular integrity through prostacyclin. • It also reduces oxidation of low density lipoproteins and prevents deposition of atheromatous plaque. It protect against free radical damage. Vitamin C can increase the absorption of iron (especially the iron found in plant foods) and may help lower the risk of dietary iron deficiency. The recommended daily intake for vitamin C is 40mg per day.
  49. 49. 46 GREEN LEAFY VEGETABLES Description • Vegetables, especially green leafy and coloured vegetables are termed as the protective foods. • These are significant source vitamins A, C, E and K as well as several B vitamins. They are rich sources of minerals such as calcium, magnesium, iron and potassium. • They are rich in fiber, extremely low in fat and carbohydrates and provide an excellent source of protein. Their caloric value is very low (25-50kcal/100gm). The darker the green leaves, the greater their nutritive value. • Because of their high magnesium content and low glycemic index, green leafy vegetables are also valuable for persons with type 2 diabetes. • Studies have repeatedly shown that people with higher vegetable intake have: lower risks of stroke, type 2 diabetes, high blood pressure, Alzheimer's disease and heart disease, Lower risks of certain types of cancer, eye diseases and digestive problems and higher antioxidant levels. • The recommended daily intake of green leafy vegetables is about 40 gm for an adult.
  50. 50. 47 FATS AND OILS • Fats are solids at 200 c. They are called ‘oils’ if they are liquid at that temperature. They are concentrated sources of energy. • One gm of fat yields 9 Kcal of energy. They serve as a medium for cooking as their boiling point is very high. • Fats and oils could be of either plant or animal origin. Butter and ghee are fats of animal origin. • Dalda or Vanaspati are fully or partially hydrogenated vegetable oils sold in India as a lower cost substitute for ghee. • Vegetable oils such as mustard, ground nut, gingelly, coconut, sunflower and safflower are widely used for cooking purposes. • Those of vegetable origins are rich in polyunsaturated fatty acids except coconut and palm oils. Public health importance • Vitamin A and D fortification can be done in hydrogenated oil. • Hydrogenated oils have mainly saturated fatty acids and are poor in essential fatty acids. • Saturated fats increase blood cholesterol. Monounsaturated and polyunsaturated fats tend to lower blood cholesterol. Trans fats are potentially harmful and are used to make baked products, pies, cakes, biscuits and buns. Omega-6 and omega-3 fats can benefit your health.
  51. 51. 48 CARBOHYDRATES – SUGARS Functions • The chief function is to provide energy to the body so that it can carry out day to day work and maintain body temperature. It is the cheapest source of energy, 1 g of carbohydrate provides 4 Kcal of energy. • They are required for complete oxidation of fat. • Glucose is the only form of energy used by central nervous system. • The sugar lactose helps in absorption of the minerals – calcium and phosphorus. • Dietary fibers help in preventing constipation and also help in lowering cholesterol level. • The simplest way to consume healthier carbohydrates is to choose unprocessed whole grains, cereals, and starchy vegetables, fresh fruit, dried beans and peas, and skim milk or low sugar soy/rice milk. Source • Sugarcane, jiggery, sago, honey, dried fruits, cereals, millets, pulses, roots and tubers. Daily requirement • The recommended intake of carbohydrate in balanced diet is between 50-80% of total energy intake.
  52. 52. 49 WEANING FOODS / COMPLEMENTARY FEEDING Definition • Weaning is the introduction of supplementary foods to augment energy and nutrient intake of the infant. Description • Weaning is usually started at 6 months of life. The infant can be fed family foods, provided that consistency and energy content are appropriate. • Foods should vary and balanced mixtures containing cereals, tubercles, foods of animal and vegetable origin, and fat should be offered. • New foods should be gradually introduced, one at a time, every three to seven days. On average, infants need to be exposed to a new food eight to 10 times until they accept it well. • The small amount of complementary foods initially offered should be gradually increased with age. • Proper maternal practices regarding the management, preparation, administration and storage of complementary foods may reduce their contamination and thereby diarrhea among infants. • Benefits: It helps to reduce the risk of micronutrient deficiency and malnutrition and prevents growth faltering.
  53. 53. 50 HYDERABAD MIX Description • This was prepared by National Institute of Nutrition (NIN), Hyderabad Contents of Hyderabad protein 1. Whole wheat (40g) 2. Roasted bengal gram (16g) 3. Groundnut (10g) 4. Jaggery (20g) • 86g of mixture provides 330Kcal and 11g of protein. Uses • Food supplements are required for those children who show obvious clinical signs of nutritional deficiency. • Hyderabad Mix is an energy dense supplement, used for malnourished children. • Domiciliary / home management of PEM (Protein Energy Malnutrition). • The incidence of malnutrition among pre-school children can be considerably reduced with such preparations which are much cheaper than proprietary and processed foods.
  54. 54. 51 PAR-BOILED RICE Description • Partial cooking of rice in steam is an ancient Indian technique of preserving the nutritive quality of rice. Procedure • In this process paddy is soaked in hot water (60-700 C) for 4 hours, which swells the grain. • This is followed by draining the water and steaming the paddy for 10 minutes which is then dried and later home pounded or milled. Importance • During the steaming process a greater part of vitamins and minerals, present in the outer aleurone layer of the rice grains are driven into inner endosperm. • This process preserves the nutrients of brawn layer especially vitamin B1 (Thiamine). It also improves the keeping quality and makes grain insect resistant. • Parboiled rice has double the fiber than cooked white rice. It has a low glycemic score of 38, compared with a high 89 for white rice. One cup of cooked parboiled rice supplies 23% RDA of niacin, 19% RDA of vitamin- B6, 4% RDA of fiber and 2 to 3% RDA of calcium, iron, magnesium and potassium.
  55. 55. 52 FOOD WEIGHING SCALE • Various methods are used for diet survey. • They are food balance sheet method, inventory method, weighment method, 24 hr Recall method (Questionnaire method), Dietary score method, Food Frequency Questionnaire method, Duplicate sample (chemical analysis) method. • Weighment method involves an individual or an investigator weighing each and every item of food and drink prior to consumption. • A detailed description of the food and its weight is recorded in a specially designed booklet. Usually a space is left to record any leftovers so that the precise weight of food eaten can be calculated. • Weighed records can be kept for 3,4,5 or 7 days. The 7 day weighed record has often been taken as the gold standard. • Strengths: Widely used method, Precision of portion sizes • Weaknesses: High respondent burden, Mis-reporting, Expensive, Food composition data limited.
  56. 56. 53 MODIFICATION OF FOODS • Food modifications are done to produce various food varieties and increase the palatability of food. • Some foods are modified for improving the keeping quality and insect resistant. • Example:-parboiling of rice, aval (poha) puffed rice and maida. • Parboiling is a partial cooking of rice in steam in order to preserve the nutritive quality of rice. • Flattened rice (also called poha) is a dehusked rice which is flattened into flat light dry flakes. This easily digestible form of raw rice and is normally used to prepare snacks or light and easy fast food in a variety of Indian cuisine styles. • Puffed rice or Mudhi is a type of puffed grain made from rice, commonly used in breakfast cereal or snack foods, and served as a popular street food in India. It is usually made by heating rice kernels under high pressure in the presence of steam, though the method of manufacture varies widely. • Maida is finely milled refined and bleached wheat flour, closely resembling cake flour. Maida flour is used extensively in making Indian fast food, bakery products such as pastries and bread.
  57. 57. 54 FIVE WHITES • These include sugar, salt, margaraine, maida, milk products. • These five whites are to be used restrictedly. • It is a double edged sword. When consumed in less quantities, it leads to hypoglycemia, hypotension etc. But, when used in excess quantities with routine diet, it may lead to non-communicable diseases like diabetes, hypertension, and hyper cholesterolemia. • A healthy diet helps protect against malnutrition in all its forms, as well as noncommunicable diseases (NCDs), including diabetes, heart disease, stroke and cancer. • Energy intake (calories) should be in balance with energy expenditure. • Limiting intake of free sugars to less than 10% of total energy intake is part of a healthy diet. A further reduction to less than 5% of total energy intake is suggested for additional health benefits. • Keeping salt intake to less than 5 g per day helps prevent hypertension and reduces the risk of heart disease and stroke in the adult population. • WHO Member States have agreed to reduce the global population’s intake of salt by 30% and halt the rise in diabetes and obesity in adults and adolescents as well as in childhood overweight by 2025.
  58. 58. 55 FOOD PRESERVATIVES Definition • Preservative “means a substance which when added to food, is capable of inhibiting, retarding or arresting the process of fermentation, acidification or other decomposition of food”. • Types of preservatives & uses • Preservatives could either be natural (Class I) or synthetic (Class II). Salt, sugar, vinegar or acetic acid, honey, edible vegetable oils are some of the Class I preservatives. Addition of Class I preservatives in any food is not restricted, unless otherwise provided in the rules. • Benzoic acid, sulphurous acid (including salts), nitrates or nitrites of sodium or potassium, sorbic acid including its salts, propionates of calcium or sodium, lactic acid, and acid calcium phosphate etc are some of the Class II preservatives. Use of more than one Class II preservative prohibited. • Food Safety and Standards Authority of India (FSSAI) had laid down the rules and regulations for the maximum amount of preservative usage in foods. • Preservatives are used to increase the keeping quality of food and to preserve its nutritional characteristics. • It also preserves the appearance, color and texture of food.
  59. 59. 56 COMPLEMENTARY FOOD • This is issued by Tamil Nadu Government at Balwadis / Anganwadis at free of cost. • Ingredients:- 100 mg of mix contains the following; o Wheat/Maize/Bajra-52g o Sprouted Ragiflour – 5g, o Bengal gram flour-12g, o Jaggery -30g, o Vitamins and Minerals – 1g. • The nutrient value of 100g of the mix is 8.5 gms of protein, 250mcg of vit A, 325mcg of Vit B1, 25mg of Vit C, 280mg of calcium, 625mcg of VitB2, folic acid 93.1mcg, Iron 30mg, Niacin 4mg and provided 350Kcal of energy. Importance of complementary food • The purpose is to prevent malnutrition and other micronutrient deficiency disorders. • It prevents faltering of growth and promotes growth and development of children. • The incidence of malnutrition among pre-school children can be considerably reduced with such preparations which are much cheaper than proprietary and processed foods.
  60. 60. 57 RICE (Arisi) Description • Rice belongs to food group of cereals. It is staple food for more than half of the world population. Rice is high in energy (345Kcal / 100g). The protein content is moderate, 6-9g %. • Rice is also fairly rich in thiamine, riboflavin and niacin. It is a poor source of Vit A, D and C. It is poor in Calcium and Iron as well. The limiting amino acid is lysine even though its content is higher in rice as compared to other cereals. • Milling and polishing cause the greatest nutritional loss. The nutritive loss because of milling, polishing, and other processing and cooking practices can be prevented by taking suitable and timely measures like parboiling. • Rice kernels do not contain vitamin A, so people who obtain most of their calories from rice are at risk of vitamin A deficiency. • German and Swiss researchers have genetically engineered rice to produce beta-carotene, the precursor to vitamin A, in the rice kernel. The beta-carotene turns the processed (white) rice a "gold" color, hence the name golden rice. • Also studies showed that replacing about two servings a week of white rice with the same amount of brown rice would lower diabetes risk 16%.
  61. 61. 58 Wheat (Godumai) Description • Wheat is the most widely consumed cereal in North India. • The calorie content of wheat is almost as that of rice i.e about 346 Kcal / 100g. • The protein content is higher than that of rice i.e 9-16g%. The quality of protein is however poor as it is deficient in the essential amino acids lysine and threonine. • The whole grain wheat flour is richer source of Vitamin B than refined white flour. Wheat per 100 g contains about 1.9 g of total fat, 68 g of carbohydrate, 12.2 g of dietary fiber, and 3.6 mg of iron. Much of the carbohydrate fraction of wheat is starch. Uses • It is used to make flour, maida for bread, dalia and suji to make various savouries. Disadvantages • Hard milling, extraction and discarding the bran caused loss of fibre, vitamins and proteins. • Under improper storage conditions, Aspergilus-fungus grows which produces Aflatoxins – hepatotoxic. Coeliac (also written as celiac) disease is a condition that is caused by an adverse immune system reaction to gliadin, a gluten protein found in wheat.
  62. 62. 59 MAIZE (Makka cholam) Description • Maize is the staple diet in many parts of Africa and Central Asia. • In most parts of India and many other parts of the world it is commonly eaten only as corn. • It is energy yielding cereal with 342 Kcal /100g. • Yellow variety of maize contains significant amount of carotenoid pigments. • The protein per 100gm of maize is approximately 11.1gm. • Maize is fairly rich in fat, 3.6 %. • It is a good source (10-19% of the Daily Value) of the B vitamins, thiamin, niacin, pantothenic acid (B5) and folate. • In moderate amounts, they also supply dietary fiber and the essential minerals, magnesium and phosphorus. Disadvantages • The quality of protein is poorer as it is deficient in tryptophan and lysine. • It also contains excess leucine which interferes with conversion of tryptophan to niacin. • Thus maize eaters may face the deficiency of niacin and a higher risk of pellagra.
  63. 63. 60 RAGI (Kezhvaragu, Keppai) Finger Millet Description • Ragi is a popular millet in Andhra and Karnataka. It is an important weaning food. It is the cheapest among millets. • The nutritive value is as follows:- o Provides 344 Kcal / 100g o Carbohydrate 72g/100g o Protein 7.3g/100g o Fat 1.3g/100g o Calcium 344mg/100g • Ragi is rich in calcium. Ragi flour is cooked and eaten as porridge. • A special amino acid, Tryptophan present in Ragi helps in curbing appetite. Ragi is the richest source of calcium among plant foods. Calcium along with vitamin D helps to strengthen bones. • Regular consumption of finger millet is known to reduce the risk of diabetes mellitus and gastrointestinal tract disorders and these properties are attributed to its high polyphenol and dietary fiber content. • Ragi is an excellent plant source of natural Iron. It also helps in lowering high cholesterol levels.
  64. 64. 61 BAJRA (Barli Arisi / Kambu) Pearl Millet Description • Bajra forms the staple food of large sections of North India. • The nutritive value per 100 gm is • Energry(kcals) 361 • Protein(gm) 12 • Fat(gm) 5 • Mineral(gm) 2 • Fibre(gm) 1 • Carbohydrates(gm) 67 • Calcium(mg) 42 • Phosphorous(mg) 296 • Iron(mg) 8 • It is deficient in lysine and Threonine. Public health importance • The iron content of Bajra is the highest among all cereals 8mg/100gm. • Bajra contains significant amount of B group vitamins and minerals such as calcium and iron. • It is used in Rajasthan, Gujarat and some parts of Maharashtra as porridge. It is also used to make flour for chappatis.
  65. 65. 62 JOWAR (Cholam) • Jowar is also known as kaffir corn or milo. • It is a major crop grown in India next to wheat and rice. • The protein content is approximately 10.4g for 100gms. • Like other cereals it is deficient in amino acids lysine and threonine. Nutritive value per 100 gms • Energry(kcals) 349 • Protein(gm) 10 • Fat(gm) 2 • Mineral(gm) 2 • Fibre(gm) 2 • Carbohydrates(gm) 73 • Calcium(mg) 25 • Phosphorous(mg) 222 • Iron(mg) 4 Disadvantages • In some species the leucine content might be higher that interferes with the conversion of tryptophan to niacin. Thus sole consumption of jowar could be pellagrogenic. • This disorder is of often seen in the Telengana and Marathwada regions were jowar is predominantly consumed.
  66. 66. 63 PULSES (Legumes) Description • Pulses comprise a variety of grams. Most commonly eaten are bengal gram (kadala paruppu), red gram( tuvar paruppu), Green gram (pasi paruppu), Black gram ( ulundha paruppu), Horse gram (Kollu), Peas (pattani) and soya bean. • Pulses contain 20-25% of proteins (Soya bean approximately 43.2gm/100gms) which is double that found in wheat and three times found in rice. They provide energy of 315- 432 Kcal / 100g. Public health importance • Pulses provide protein, complex carbohydrates, and several vitamins and minerals. Like other plant-based foods, they contain no cholesterol and little fat or sodium. • Pulses also provide iron, magnesium, phosphorus, zinc and other minerals, which play a variety of roles in maintaining good health. • Pulses are rich in lysine, minerals and B group vitamins such as riboflavin and thiamine. In dry state pulses do not contain vit C. Germinated pulse however contains higher concentration of vitamins especially vit C and B vitamins. • Pulses contain more proteins than eggs, fish or flesh food but in regard to quality pulse proteins are inferior to animal proteins.
  67. 67. 64 SOYA BEAN Description • Soyabean is the richest among pulses. The limiting amino acid is methionine. Composition o Protein (40g %) o Fat (20%) o Minerals (4%) o Iron (10mg / 100mg) Uses • Milk prepared from soya bean termed as “soy milk” is a variety of vegetable milk. • Soya bean can be cooked and eaten as dhal. • Soya bean is low in fat with no cholesterol. It contains essential heart friendly omega-3 fats and is an excellent source of fiber. • Is a good source of enriched Calcium and Vitamin B12. Is a complete protein, containing all the amino acids essential to human nutrition. It provides important minerals such as calcium, magnesium, iron and selenium. • It is rich in probiotics in the form of fermented soy products, such as miso, tempeh, and soy yogurt. • It contains isoflavones which are beneficial in reducing risk of various cancers, heart disease and osteoporosis.
  68. 68. 65 NUTS AND OIL SEEDS • Nuts are seeds or fruits consisting of an edible fat containing kernel and surrounded by a hard or a brittle shell. Nuts have rich flavour and have a great commercial importance. • Nuts and oil seeds include Ground nut (pea nut), Cashew nut, Coconut, Walnut, Almond , Pistachios, Mustard seeds, Sesame seeds and Sunflower seeds. • They contain a good amount of fat and good quality protein in a relatively small bulk. • Nuts are good source of vitamins of the B group. They contribute minerals such as calcium, phosphorus and iron. Pistachio is the richest containing 14mg of iron per 100g. • Most of the vegetable oils are rich in essential fatty acids. • After oil extraction the residue is formulated into acceptable foods. Example: groundnut flour is used in multipurpose food, balahar and balanced malt food. Disadvantages • Due partly to their high fat content and partly to their high cellulose contents nuts are not easily digestible. • Pea nuts should be thoroughly dried and properly stored to avoid the growth of Aspergillus flavus which produces Aflatoxin.
  69. 69. 66 GROUND NUT (Kadalai) • Ground nut contains 40% fat, 27% Protein and nicotinic acid – 14mg%. Composition 100g of groundnut contains - 567 Kcal - 90mg of calcium - 2.5mg of Iron • It is a good source of Thiamine (B1) and Riboflavin (B2). • Groundnuts resemble other pulse in general nutritive value, except that they are rich in fat. The whole seed contains about 40% fat, twice the amount in Soyabean. • The chief product is the oil, which can be used either as cooking oil or for making margarine and soap. The secondary product is the residue or cake left after the expression of the oil. It is also purified and used in supplementary mix. • The major proteins of groundnut are arachin and conarachine which is lacking in lysine and methionine. Public health importance • Aspergillus poisoning is common if stored improperly. This fungus infests groundnuts and produce aflatoxins of which B1 and G1 are the most potent hepatotoxins. • Ensure proper storage after drying, moisture content should be kept below 10 %.
  70. 70. 67 MUSTARD SEEDS (Kadugu) Description • It is widely used in North India as cooking oil. • Mustard seeds are very rich in phyto-nutrients, minerals, vitamins and anti-oxidants. • Phytonutrient compounds are protective against gastrointestinal cancer whereas selenium has been shown to help reduce the severity of asthma, decrease some of the symptoms of rheumatoid arthritis, and help prevent cancer. • Mustard seeds are an excellent source of essential B-complex vitamins such as folates, niacin, thiamin, riboflavin, pyridoxine (vitaminB-6), pantothenic acid. • Contamination / Adulteration with argemone oil may result in Epidemic dropsy due to sanginarine, a toxic alkaloid present in Argemone oil, • Epidemic dropsy is of public health importance Preventive measures • Strict enforcement of prevention of food adulteration act. Detection tests 1. Nitric acid test 2. Paper chromatography test.
  71. 71. 68 MILK • Milk is a fine blend of all nutrients essential for growth and development of young ones. Good source of proteins, fats, sugars, vitamins and minerals. Content Buffalo Cow Goat Fat (g) 6.5 4.1 4.5 Protein (g) 4.3 3.2 3.3 Lactose(g) 5.1 4.4 4.6 Calcium (mg) 210 120 170 Iron (mg) 0.2 0.2 0.3 Vitamin C (mg) 1 2 1 Minerals (mg) 0.8 0.8 0.8 Water (g) 81.0 87 86.8 Energy (kcal) 117 67 72 • 100g of human milk contains 65kcal whereas cow’s milk contain 67Kcal. Casein is the chief protein which occurs as calcium caseinogen. It also contains lactalbumin and lactglobulin. It is rich in Tryprophase and sulphur containing amino acids like cystine. Public health importance • Rich in oleic acid and linoliec acid • Rich in retinol,vit D, Rich in calcium , poor in iron, Poor in vit C • Toned milk – 1part water, 1 part natural milk, 1/8 part of skim milk powder. Toned milk has the composition nearly equivalent to cow’s milk.
  72. 72. 69 SALT (IODIZED) Introduction • Recommended daily intake is 5g per day. In India maximum it could be 15 gms since it is a tropical country. • Iodine is an essential micronutrient required for synthesis of thyroid hormones, which is essential for normal growth and development and well being of all humans. • Recommended daily intake of iodine among adults is 150µg / day Reasons for iodisation • Iodine deficiency disorders are a major public health problem in India. • In children it causes sluggishness to impaired mental function. • In pregnancy it results in spontaneous abortion, still births and infant deaths. • Iodine is fortified with salt to prevent iodine deficiency disorder. • Recommended levels of iodine in iodized salt are 30ppm at production level and 15ppm at consumer level. • Under the National Iodine Deficiency Disorders control programme, the Government of India has adopted a strategy to iodisation of all edible salt in the country which is a long term and sustainable preventive solution to eliminate iodine deficiency disorders.
  73. 73. 70 EGG • Animal food containing all nutrients except carbohydrate and vit C. • About 12% is made up of shell, 58% of egg white and 30 per cent of egg yolk. • An egg weighing 60gms contains 6g of protein, 6g fat, 30mg calcium and 1.5g iron and supplies about 70 kcal of energy. • Except for vitamin C , egg contains all the fat soluble and water soluble vitamins • Important minerals such as calcium, phosphorus, iron, zinc and other trace elements are present in egg. • Egg proteins have all the nine essential amino acids needed by the body in right proportion. • Net protein utilization (NPU) for egg is 100. • Boiled egg is superior to raw egg because boiling destroys ‘avidin’ which prevents the body from obtaining B complex vitamins. • Cholesterol content of egg yolk (250mg/egg) has posed a risk of coronary heart disease (CHD). • Limiting egg consumption may have some health benefits, at least in geographic areas where egg consumption makes a relatively large contribution to total dietary cholesterol intake.
  74. 74. 71 BALANCED DIET Definition:- • A balanced diet is defined as one which contains a variety of foods in such quantities and proportions that the need for energy, amino acids, vitamins, minerals, fats, carbohydrate and other nutrients is adequately met for maintaining health, vitality and general well-being and also makes a small provision for extra nutrients to withstand short duration of leanness. • A balanced diet has become an accepted means to safeguard a population from nutritional deficiencies. Principles to be followed:- • First and foremost, the daily requirement of protein should be met. This amounts to 10-15% of the daily energy intake. • Next is the fat requirement, which should be limited to 15- 30% of the daily energy intake. • Carbohydrates rich in natural fibre should constitute the remaining food energy. The requirements of micronutrients should be met.
  75. 75. 72 BALANCED DIET Food Item (gms) Adult Man Sedentary Moderate Worker Heavy Worker Cereals 460 520 670 Pulses 40 50 60 Leafy Vegetables 40 40 40 Other Vegetables 60 70 80 Roots And Tubers 50 60 80 Milk 150 200 250 Oil And Fat 40 45 65 Sugar Or Jiggery 30 35 55 Food Item Adult Woman Sedentary Moderate Worker Heavy Worker Cereals 410 440 575 Pulses 40 45 50 Leafy Vegetables 100 100 50 Other Vegetables 40 40 100 Roots And Tubers 50 50 60 Milk 100 150 200 Oil And Fat 20 25 40 Sugar Or Jiggery 20 20 40 Food Item Children Boys Girls 1-3 Years 4-6 Years 10-12 Years Cereals 175 270 420 Pulses 35 35 45 Leafy Vegetables 40 50 50 Other Vegetables 20 30 50 Roots And Tubers 10 20 30 Milk 300 250 250 Oil And Fat 15 25 40 Sugar Or Jaggery 30 40 45
  76. 76. 73 OCCUPATIONAL SAFETY AND HEALTH • Occupational safety and health (OSH) is an area concerned with protecting the safety, health and welfare of people engaged in work or employment. • The goals of occupational safety and health programs include fostering a safe and healthy work environment. • OSH may also protect co-workers, family members, employers, customers, and many others who might be affected by the workplace environment. • Occupational safety and health can be important for moral, legal, and financial reasons. • All organizations have a duty of care to ensure that employees and any other person who may be affected by the companies undertaking remain safe at all times. • Moral obligations would involve the protection of employee's lives and health. • Legal reasons for OSH practices relate to the preventative, punitive and compensatory effects of laws that protect worker's safety and health. • OSH can also reduce employee injury and illness related costs, including medical care, sick leave and disability benefit costs.
  77. 77. 74 Measures for prevention of occupational hazards
  78. 78. Department of Community Medicine, Velammal Medical College Hospital & Research Institute Table of Contents Part 2 Title Page Number Chloroscope 1 Barometer 2 Dry & Wet Bulb Thermometer 3 Dug Well Latrine 4 Bore Hole Latrine 5 Trench Latrine 6 Shallow Trench Latrines 7 Rapid Sand Filter 8 Berkefeld Filter 9 Sanitary Well 10 Step Well 11 Septic Tank 12 Horrock’s Apparatus 13 Activated Sludge Process 14 Hardness Of Water 15 Insanitary Well 16 Incinerator 17 Slow Sand/Biological Filters 18 Soakage Pit 19 Biogas Plant 20 House Drainage System 21 Still For Distilled Water 22 Autoclave 23 Incubator 24 Anopheles – Mouth Parts 25 Female Adult Anopheles Mosquito 26 Culex – Mouth Parts 27 Female Adult Culex Mosquito 28
  79. 79. Department of Community Medicine, Velammal Medical College Hospital & Research Institute Table of Contents Title Page Number Aedes – Mouth Parts 29 Female Adult Aedes Mosquito 30 Anopheles Larva 31 Culex Larva 32 Aedes Larva 33 Larva of Mosquito 34 Pupa of Mosquito 35 Adult House Fly 36 Larva of House Fly (Maggots) 37 Sandfly 38 Head Lice 39 Rat Flea 40 Hard Tick 41 Soft Tick 42 Itch Mite 43 Cyclops 44 Normal Distribution 45 Pie Chart 46 Histogram 47 Line Graph 48 Bar Chart 49 Composite Bar Chart 50 Multiple Bar Chart 51 Pictogram 52 Frequency and Frequency Tables 53 Scatter Plot 54
  80. 80. 1 CHLOROSCOPE Definition • Chloroscope is a simple, compact, portable and easy to operate comparator apparatus to estimate the residual chlorine in water. Components • The standard kit consists of a plastic box, removable top lid, two glass test tubes - one for the untreated water and the other for treated water, one special dropper and ortho-toluidine reagent. • The front of the plastic box on the left side has a column of 5 standard filter discs of varied colour density to compare the colour developed in the treated water after adding reagent on the right side. • The rear side is provided with a translucent sheet to allow uniform diffused light for the comfort of the viewer. • The inside of the plastic box contains built-in convenient test tube holders. Interpretation • If chlorine is present in the water a yellow colour will develop after adding the reagent. • The amount of chlorine present can be determined by matching the shade of yellow colour against the standard colour discs. • The recommended level of free residual chlorine in drinking water is generally stated to be 0.5 mg/L.
  81. 81. 2 BAROMETER Definition • A barometer is a scientific instrument used to measure atmospheric pressure. It can measure the pressure exerted by the atmosphere by using water, air, or mercury. Types • Based on the materials used to measure pressure they can be classified into Water-based barometers, Mercury barometers, Vacuum pump oil barometer and Aneroid barometers. Uses • A barometer is commonly used for weather prediction, as high air pressure in a region indicates fair weather while low pressure indicates that storms are more likely. • Typically if the barometer is falling, deteriorating weather or some form of precipitation is indicated, however if the barometer is rising, it is likely there will be fair weather or no precipitation. • When used in combination with wind observations, reasonably accurate short-term forecasts can be made. • Simultaneous barometric readings from across a network of weather stations allow maps of air pressure to be produced.
  82. 82. 3 DRY & WET BULB THERMOMETER Definition • It is a combination of dry and wet bulb thermometers used to measure of moisture content in the atmosphere, also known as humidity of the air. The wet bulb thermometer is covered with a damp cloth dipped in water. Procedure • To use a hygrometer: fill the water bottle and screw it on to the instrument hang the hygrometer (by the loop at the top) on a wall or a tree, for instance, for at least five to 10 minutes before taking the measurements. The instrument should not be in direct sunlight. • The difference in temperature between the dry bulb and wet bulb is used to calculate the relative humidity of the air. • To work out the level of humidity: • Record the dry bulb temperature (e.g. 15 degrees) • Record the wet bulb temperature (e.g. 10 degrees) • Calculate the wet bulb depression (e.g. 15 – 10 = 5 degrees) • From the chart on the face of the hygrometer, read down from the wet bulb depression (5) and across from the dry bulb temperature (15) to where both meet. This will give you the relative humidity as a percentage (in this case it will be 49%). A relative humidity of 100 per cent is when the air has as much water vapour as it can hold at a particular temperature.
  83. 83. 4 DUG WELL LATRINE Introduction • It is also known as Pit Latrine. It was first introduced in Singur, west Bengal. Dimensions • The dimensions are as follows: a circular pit of 75cm diameter and 3 to 3.5 meter deep is dug into ground,covered by a slab. • If the soil is loose, at least the top 1m of the pit should be lined to prevent collapse. • A squat or drop-hole is provided in the slab which allows excreta to fall directly into the pit. • Firmly supported on all sides and raised above the surrounding ground level to prevent surface water entering the pit. • The superstructure can be made from materials available locally. Advantages • The advantages are of dug well latrine are that it is easy to construct and no special equipment like auger is required. It has a longer life than bore hole latrine as it lasts for about 5 years for a family of 4 to 5 persons. • No water needed for operation, when the pit is filled up, a new pit is constructed. • The action of the dug well latrine is the same as in the borehole latrine, i.e., anaerobic digestion.
  84. 84. 5 BORE HOLE LATRINE Introduction • The borehole latrine is the forerunner of the non-service type of latrines in this country. It was first introduced by the Rockefeller foundation during 1930's in campaigns of hookworm control. Borehole latrines are most appropriate in situations where a large number of latrines must be constructed rapidly, and where pits are difficult to excavate, either because of ground conditions or the lack of a labour force. Dimensions • The dimensions are as follows: A circular hole 30-40 cm in diameter up to depth of 4-8 meters is dug up using a special equipment known as auger. At least the top 0.5m should be lined. Advantages • Its advantages are that there is no need for the services of a sweeper for daily removal of night soil. The pit is dark and unsuitable for fly breeding. It lasts for (a family of) 5 people for 2 years. Disadvantages • Lifespan is short; sides are liable to be fouled, causing odour and attracting flies; and there is a high likelihood of blockages. • It can be used for only for family purpose and it cannot be used as a public convenience because of its small capacity. • Drilling equipment is required. • There is a greater risk of groundwater pollution due to greater depth than pit latrines; this option should only be considered in extreme conditions when pit excavation is not possible.
  85. 85. 6 TRENCH LATRINE Types • There are two types of trench latrine. One is shallow trench and the other is deep trench. Deep Trench Latrines • Maximum length of trench is 6m, providing six cubicles, 0.8-1 m wide, 3.75 m long and 2-2.75m deep. It can be used by 100 people for few months. Advantages • It is cheap and quick to construct. • No water is needed for operation. • It is easily understood by the community. Constraints • Unsuitable where water-table is high, soil is too unstable to dig or ground is very rocky; • Often odour problems; Cleaning and maintenance of communal trench latrines are often poorly done by users. Improvisation of Deep Trench Latrine • It may be carried out by placing the seats fitted with modified water closets, 1.5m in front of the long edge of the trench. • The seats are fitted with a water seal (bend pipe) which is connected to a pipe leading into the trench. • Small quantity of water (2.5 to 3 liters) is sufficient to flush the seats after each use. The excreta is flushed through sewage pipes into the trench.
  86. 86. 7 SHALLOW TRENCH LATRINES Dimensions • It is around 20-30 cm (about a foot) wide and 15-30 cm (about ½ -1 foot) deep. • The trench field can be divided into strips 1.5m wide with access paths. • Dug in parallel with an interval of at least 60 cm in between two trenches. • The issue of privacy is also important. Plastic sheeting, bamboo-mat etc. can be used to make ‘walls’. Instructions for use • The earth removed should be neatly piled at its head end which could be used to cover the excreta by each user, and subsequently to fill the trench. • The trench is used by squatting astride it, with a foot on either side and not both feet on the same side. • After defecation the excreta must be covered by earth with a scoop Advantages • It is rapid to implement. • Faeces can be covered easily with soil. Constraints • Limited privacy, short life and requirement of considerable space are some of the constraints. • Fly breeding occurs if excreta is not covered with earth.
  87. 87. 8 RAPID SAND FILTER Definition • It is method of large-scale water purification. Types • There are two types of rapid sand filter. One is gravity type (Paterson’s filter) and the other is pressure type (Candy’s filter). .Components • Filter tank or filter box • Filter sand or mixed-media • Gravel support bed • Under drain system • Wash water troughs • Filter bed agitators Steps of purification • Steps involved in purification of water are coagulation, rapid mixing, flocculation, sedimentation and filtration. • Filter cleaning is done by reversing the flow of water through the sand bed, which is called “back- washing”. Advantages • The advantages of rapid sand filter are: It can deal with raw water directly and no preliminary storage needed. • The filter bed occupies less space. • The filtration is rapid 40-50 times that of a slow sand filter. • The washing of filter is easy and there is more flexibility in operation.
  88. 88. 9 BERKEFELD FILTER Definition • It is a method of small-scale water purification at the household. It was invented in Germany in 1891, and by 1922 was being marketed in the United Kingdom by the Berkefeld Filter Co. The Berkefeld is a good bacterial water filter used in microbiological laboratories, in homes and out in the field. Design and mode of action • The filter housing consists of two metal or plastic cylinders sitting one on top of the other. The upper one has a lid and can be filled with impure water. In the bottom of the upper cylinder are one or more holes fitted with porcelain filter columns. The water is forced through the filters by gravity, and then trickles down to the lower cylinder where it is stored and tapped off as required. Uses and maintenance • The Berkefeld is a cheap, portable and efficient bacterial filter in general, though it does not remove viruses like Hepatitis A and some bacteria such as mycoplasma. Filter candles are liable to be logged with impurities and bacteriae. The candle should be cleaned by scrubbing with a hard brush under running water and boiled at least once a week. Disadvantage • Its main disadvantage is that only clean water should be used with filters.
  89. 89. 10 SANITARY WELL Definition • A well that is built according to proper regulations is called sanitary well. Location • At a higher elevation than surroundings. • Should be >50 feet away from source of water contamination. • Within reach of 100 meters from most of population Lining • With bricks or stores set in cement upto a depth of 20 feet. Parapet wall • Up to a height of 28 inch above the ground. Platform • Cement concrete platform round the well extending at least 3 feet in all direction with having gentle slope outwards. Drain • Pucca drain to carry off spilled wastes to a public drain. Covering • A cement concrete cover should close top of the well. Hand Pump • For lifting water in sanitary manner. • There should be efficient maintenance services and arrangements for immediate repair. Quality • Physical, chemical & bacteriological quality of water should be checked regularly.
  90. 90. 11 STEP WELL Definition • Step wells were common a few years ago. They can still be seen in certain rural areas. They are huge excavations in the ground and provide water to an entire village or a group of villages. They are most common in western India. Components • Steps are constructed into these wells to enable people to descend into the well to fetch water or quench their thirst. • Step wells usually consist of two parts: a vertical shaft from which water is drawn and the surrounding inclined subterranean passageways, chambers and steps which provide access to the well. • The galleries and chambers surrounding these wells were often carved profusely with elaborate detail and became cool, quiet retreats during the hot summers Disadvantage • There is considerable personal contact between the user and the water. There is great potential for contamination with human excreta and other domestic and animal waste. • Guinea worm disease was quite common in areas where step wells were in use. • Presently, due to the efforts of the government step wells have been uncommon and guinea worm disease has been eradicated in India.
  91. 91. 12 SEPTIC TANK Definition • The septic tank is a watertight box, usually made of concrete, with an inlet and outlet pipe. Wastewater flows from the home to the septic tank through the sewer pipe. The septic tank treats the wastewater naturally by holding it in the tank long enough for solids and liquids to separate. Dimensions • The capacity of a septic tank will depend upon the number of users. A capacity of 20-30 gallons per person is recommended for household septic tanks. The depth of a septic tank is from 1.5 to 2 m. The liquid depth is only 1.2 m. Some are double chambered and some single chambered. Functioning • The solid part of sewage settles down in the tank to form “sludge”, while the lighter solids (fat and grease) rise to the surface to form “Scum”. • The solids are attacked by anaerobic bacteria and broken into simpler chemical compounds (Anaerobic digestion). • The liquid that passes out of the outlet pipe is called as “Effluent”. • Aerobic oxidation of effluent takes place outside the septic tank, in the subsoil. • So anaerobic and aerobic oxidation complete the purification of sewage.
  92. 92. 13 HORROCK’S APPARATUS • This water testing apparatus is designed to find out the dose of bleaching powder required for disinfection of water. Components • It consists of 6 white cups (200 ml each), 1 black cup with a circular mark on inside, 2 metal spoons (holds 2g), seven glass-stirring rods, 1 special pipette, two droppers, starch iodide indicator solution and instruction folder. Procedure • Take 1 level spoonful (2g) of bleaching powder in the black cup and make a thin paste with little water. Add more water up to the circular mark with vigorous stirring. This is the stock solution. • Fill the 6 white cups with water to be tested, up to about a cm below the brim. With the special pipette, add 1 drop of stock solution to 1st cup, 2 drops to 2nd cup and so on. Stir the water in each cup using a separate rod. • Wait for half an hour for the action of chlorine. Add 3 drops of starch iodide indicator to each of white cups and stir again. Interpretation • A blue color indicates the presence of free residual chlorine. Note which cup shows blue color, supposing if 3rd cup shows distinct blue color, then 3 level spoonfuls or 6 grams of bleaching powder would be required to disinfect 455 liters of water.
  93. 93. 14 ACTIVATED SLUDGE PROCESS • The activated sludge process is a process for treating sewage and industrial wastewaters using air and a biological floc composed of bacteria and protozoa. Components 1. Wastewater aeration in the presence of a microbial suspension, 2. Solid-liquid separation following aeration, 3. Discharge of clarified effluent, 4. Wasting of excess biomass, and 5. Return of remaining biomass to the aeration tank. Action • The proportion of activated sludge to the incoming effluent is of the order of 20-30%. • The mixture is subjected to aeration in the aeration chamber for 6-8 hours. • The aeration is accomplished either by mechanical agitation or diffuse aeration. • During the process of aeration, the organic matter of the sewage gets oxidized into carbon dioxide, nitrates and water with the help of aerobic bacteria in the activated sludge. Advantages • Activated sludge plants occupy less space, require skilled operations and are best suited for larger cities.
  94. 94. 15 HARDNESS OF WATER Definitions • It defined as the soap destroying power of water. It is related to water taste. Causes • Hardness is mainly caused because of four dissolved compounds, calcium bicarbonate, magnesium bicarbonate, calcium sulphate and magnesium sulphate. Types • Hardness is classified as carbonate and non-carbonate types. • Carbonate hardness (temporary) is due to presence of Ca and Mg bicarbonates. • Non-carbonate hardness (permanent) is due to Ca and Mg sulphates, chlorides and nitrates. Hardness is expressed in terms of mEq/L. Standards for hardness of drinking water • Drinking water should be moderately hard. • Softening of water is recommended when the hardness exceeds 3 mEq/L. • Common methods for water softening are permutit process and reverse osmosis. • The taste threshold for the calcium ion is in the range of 100- 300 mg/litre. In some instances consumers tolerate water hardness in excess of 500 mg/litre.