2. Statistics:
• A science of collection of numerical data and fact, the
techniques of analyzing and drawing conclusion from such
data
Indicators
• Variables that help to measure changes in a health situation
directly or indirectly and to assess the extent to which the
objective and targets of program are achieved (WHO)
• Measurements that reflects a given situation
3. Variables:
• An empirical property that can take on two or more
values. If property can change value or kind, that is
regarded as a variable
Health indicators
• Indicator applicable to health or health related
situations.
• These are summary measures that capture relevant
information on different attributes and dimensions
health status and performance of health system
4. CHARACTERISTIC OF HEALTH INDICATOR
• Valid
Measures what it is supposed to measure
• Reliable
Same result is obtained when measured by different people
• Sensitive
Sensitive to changes according to situation
• Specific
Reflect changes only in the concerned situation
5. Feasible
• Have ability to obtain data needed
Relevant
• Contribute to understanding of the phenomenon of interest
• Provides information that is appropriate and useful for
guiding policies and programs as well as for decision
making
7. CRUDE BIRTH RATE
• Also called natality.
• The number of live births per 1000 estimated mid-year
population, in a year.
• 22.4/1000 (NDHS,2016)
8. GENERAL FERTILITY RATE
• The number of live births per 1000 women in the reproductive
age group (15 to 49 years) in a given year.
• 88/1000 (NDHS 2016)
10. TOTAL FERTILITY RATE
• The average number of children a women would have if she
were to pass through her reproductive years bearing children
at the same rates as the women in each age group.
• 2.3/1000 (ndhs 2016)
12. CRUDE DEATH RATE
• The number of death per 1000 population per year in a
certain geographical area.
• 7/1000 (Nepal population report)
13. • The ratio of death under 1 year of age in a given year to the
total number of live births.
• 32/1000 (ndhs 2016)
Infant Mortality Rate
14. PERINATAL MORTALITY RATE
• Includes both late fetal and early neonatal deaths (28th week
of gestation to the 7th day after birth) weighting over 1000
gm at birth, expressed as a ratio per 1000 live births
weighting over 1000 gm at birth.
• 13/1000 (ndhs 2016)
15. NEONATAL MORTALITY RATE
• The ratio of neonatal deaths in a given year to the total number
of live births in the same year expressed as:
• 21/1000 (ndhs 2016)
16. STILLBIRTH RATE
• Death of a fetus weighting 1000 gm or more occurring
during a year in every 1000 total births (live births plus
still births).
17. MATERNAL MORTALITY RATE
• The death of a women while pregnant or within 41 days of
termination of pregnancy but not from accidental or
incidental causes.
• 170/100000 (ndhs 2016)
18. INCIDENCE RATE
• The number of new cases occurring in a defined population
during a period of time.
1000
19. • E.g. If there 250 new cases of an illness in a population of
50000 in a year, the incidence rate would be:
= 250*1000/50000
= 5 per 1000
20. PREVALENCE RATE
Refers specifically to all current cases (old and new)
existing at a given point in time or over a period of time in
a given population.
Point prevalence
Period prevalence
23. Life expectancy
• The statistical measure of the average time a person is
expected to live. According to the world health organization
(WHO), the global life expectancy as of 2016 was 72.0
years, 74.2 for females and 69.8 years for men.
• In 2020, life expectancy for Nepal was 71.1 years.
24. USES OF HEALTH STATISTICS
• Measurement of status of health of the country
• Comparison of health status of one country with the
another
• Assessment of the health care needs
• Research
• Planning and implement the health care services
• Evaluation of the health care services
25. SOURCES OF HEALTH STATISTICS
• Census
The enumeration of the total population of the country at a given
movement of time.
1st census in Nepal was undertaken in 1911.
26. • Registration of vital events
The recording of vital events like birth, death, marriage,
divorce and migration in VDC office, ward office,
metropolitan, sub-metropolitan.
Nepal government reinforced the law to register vital events
since 1962
27. • Notification
The recording and reporting system of commonly occurring disease in
concerned authority is known as notification of diseases
The primary purpose of notification is for effective prevention and control of
the diseases in the community
It vary from country to country and also within a country between urban and
rural areas
ARI in hilly region
Malaria in terai
Diarrhoea in rural area
At international level, the notifiable diseases of WHO are cholera, plague,
AIDS, yellow fever etc
28. • Records
Records of the hospital, school, medical clinic give some information
about diseases. These are recorded as the primary source of information
about disease prevalence in the community
• Health survey
Information is collected from a sample of the population, which is
representative of the whole and from which conclusion are drawn by the
use of scientific method
First health sample survey of Nepal was conducted in 1956.
30. 30 /
Immunity:
• The resistance exhibited by the host towards infection caused
by micro organisms and their products(toxins).
● Based on the property of self and non self recognition.
● Immune response is the reaction of the body against any foreign
antigen.
● The special cells that take part in immunity are
B cells (B lymphocytes)
T cells (T lymphocytes)
31. 31 /
Antigen
–Any harmful or foreign substances such as a germ or toxin
which gets into the body will cause the lymphocytes to make
antibodies against it.
–Substance which stimulates the formation of antibody.
Antibody
–It is protein called immunoglobulin which is produced by
lymphocyte and plasma cell.
32. 32 /
Vaccine
● A preparation used to stimulate the body’s immune response
against diseases. Vaccines are usually administered through
needle injections, but some can be administered by mouth or
sprayed into the nose.
Vaccination:
• The act of introducing a vaccine into the body to produce
protection from a specific disease.
Immunization:
A process by which a person becomes protected against a
disease through vaccination.
33. 33 /
CLASSIFICATION OF IMMUNOGLOBULINS
● Immunoglobulins or the antibodies involved in immunity
are the special proteins.
● There are 5 different types of immunoglobulins. They are
–IgG
–IgM
–IgA
–IgD
–IgE
34. 34 /
IgG
–Major immunoglobulin
–Only antibody that can cross placenta and provide innate
power to the baby.
–Represents nearly 75% of antibodies
IgM
–Produced in first exposure to antigen
–Primary immune response
–Its presence may be indicative of recent infection
35. 35 /
IgA
–Found in body secretions (milk, tear, saliva).
–It produces primary defense mechanism at the mucus
membranes against local infection.
IgD
–Present in lymphocyte’s cell surface.
–Its function has not yet been determined
IgE
–It plays role in allergic and parasitic infection
37. 37 /
1. Innate immunity
–Host’s first line of defense.
–Is largely non-specific, responding to a broad range of microbes
Present by nature or acquired during the growth by the virtue of its
• Species
• Racial
• Individual Exposure:
38. Innate immunity is acquired by:
Present by nature or acquired during the growth by the virtue of its
• Species: Certain species are already immunity against certain
diseases. E.g. dogs, rat, and mice against TB; hen against tetanus
• Racial: Immunity possessed by the genetic makeup. E.g. blacks
do not suffer yellow fever
• Individual Exposure: Exposure do not cause infection to all.
Among those exposed and infected some may develop severe
symptoms while other may not. The differences are due to
individual peculiarities.
39. 39 /
2. Acquired immunity
● Immunity to a particular disease that is not innate but has
been acquired during life.
● Developed after exposure to a suitable agent.
● Acquired by exposure to an infection or by vaccination
(active immunity) or by the transfer of antibody or
lymphocytes from an immune donor.
40. 40 /
Active Immunity:
Individual develops immunity when exposed to antigen
• Natural active immunity
• acquired when a person gets diseases such as measles,
chickenpox;
• sometimes acquired by sub clinical infections, e.g. poliomyelitis
• Artificial active immunity
• is achieved through administration of vaccines containing disease
causing microorganisms, their toxoids or combination of both
41. Passive Immunity:
Immunity acquired when antibody produced in one body is
administered to another person
• Natural passive immunity: Antibodies are passed through
from mother to baby via placenta. These are short acting
and protects against diseases for few month. E.g. tetanus,
measles, chickenpox etc.
42. • Artificial passive immunity:
• The serum containing specific antibodies give
immunity when injected into the suspected animals
• Short acting and is of value in treatment in injuries
and diseases such as tetanus, diphtheria etc.
• This type of immunity is commonly used for
curative and prophylactic purpose
43. Types of vaccine
1. Live attenuated vaccine
2. Dead or killed vaccine Inactivated
3. Toxoid
4. Cellular fractions
5. Combination
43 /
44. 44 /
Live Attenuated vaccine :
• Prepared from weakened form of virus
• Passed into laboratory for tissue culture
• More potent than killed vaccine because:
• Live organism multiplies in the host and results in large
antigenic dose
• Immune response similar to natural infection
• Possess major and minor antigenic components
45. 45 /
Live Attenuated vaccine:
• Viral
• Measles
• Mumps
• Rubella
• Small pox
• Japanese encephalitis
• Bacterial
• Oral typhoid
• BCG
• Hib
46. Dead or killed vaccine
• Act as antigen
• Organisms are killed by heat or chemical
• When injected, stimulate active immunity
• Generally safe
• Less effective then live vaccine
• Double or triple dose as well as booster dose needed to
increase efficiencies
• Usually administered subcutaneous or intramuscular
47. Dead or killed vaccine
• Bacterial:
• Pertutis
• Typhoid
• Cholera
• Plague
• Viral
• Hepatitis A
• Polio (Salk)
• Rabies
•Fractional:
• Hepatitis B
• Influenza
• Diptheria
• Tetanus
48. TOXOID
• Toxins produced from certain organism are detoxicated and
used
• Highly effective and usually safe
• Tetanus
• Diptheria
50. COMBINATION
• More than one kind of immunizing agent included
• The aim of combined forms of vaccine is to simplify
administration, reduce cost and minimize the number of
contacts with the health center
51. • Differentiate between active and passive immunity.
• Develop immunization schedule according to nip of nepal.
• What is cold chain and what is the importance of cold
chain?
52. COLD CHAIN
• The system of transporting and storing vaccines within the
temperature range of 35°F (2°C) to 45°F (8°C). It begins when
vaccine is manufactured to the place of administration.
Cold Chain Process
• Manufacturer
• Distributor
• Vaccine Depots
• Provider Office
• Client
53. KEY ELEMENTS OF THE COLD CHAIN
• Personnel: to manage vaccine storage and distribution
(vaccine and cold-chain handler at each cold-chain point)
• Equipment: to store and transport vaccine and monitor
temperature
• Procedures: to ensure correct utilization of equipment and
ensure vaccines are stored and transported safely.
54. IMPORTANCE OF COLD-CHAIN
• Vaccines are sensitive biological cold sensitive vaccines
experience an immediate loss of potency following freezing
• Vaccines exposed to temperatures above the recommended
temperature range experience some loss of potency with
each episode of exposure
• Repetitive exposure to heat episodes results in a cumulative
loss of potency that is not reversible
55. CONT’D…
• Ensure maximum benefit from immunization
• Assurance in potent product and vaccine program
• Compliance with manufacturer that is any vaccine that has
not been stored at a temperature of 2-8o as per its licensing
conditions is no longer a licensed product.
56. Q) National Immunization Program was initiated by Nepal
Government in 2034 BS as
•Expanded Program on Immunization
•Integrated Management of Childhood Illness
•Primary Health Care Program
•Eradication Program
58. National immunization program
• Initiated by Nepal Government in 2034 BS as Extended Program
on Immunization
• Certified as having achieved control of rubella and congenital
rubella syndrome in August 2018
• Rota virus was lunched in routine immunization on 18th Ashad
2077
• Human papilloma virus and typhoid conjugated vaccine are
planned for introduction in Nepal (15 and 16th of Baisakh 2079)
• Nepal targeted to eliminate measles and control rubella and
congenital rubella syndrome by 2030
• Nepal is 1st country with immunization act in South East
Asia(2072) 26th Jan 2016
• Concept of full immunization was initiated in 2069/70.
59. Question
Which of the following vaccine comes in dark glass container?
a) Measles
b) Typhoid
c) BCG
d) both Measles and BCG
60. Answer : d) (Both Measles and BCG)
Reason:
Because these vaccines are sensitive to light and can
loss its potency when exposed to light.
(Reference: Park’s textbook of preventive and social medicine 24th edition)
61.
62. Family planning services in nepal
Started in early 1959 with establishment of family planning
association
Since 1968 Government of Nepal is providing FP services
with establishment of Nepal Family Planning and Maternal
Child health project
Family planning association of Nepal became member of
IPPF in 1959
FP was recognized as a basic human right the UMN in 1867
Included in national plan in 1966
63. • According to WHO (1971), FP is “ a way of thinking and living
that is adopted voluntarily, upon the basis of knowledge,
attitudes and responsible decisions by individuals and couples,
in order to promote the health and welfare of the family group
and thus contribute effectively to the social development of the
country.
It is conscious effort of couples to regulate the number and
spacing of births through artificial and /or natural methods of
contraception.
Definition of FP
64. To avoid unwanted births
To bring about wanted births
To regulate the interval between pregnancy
To control the time at which births occur in relation to the
ages of the parents
Purpose of FP
65. To determine the numbers of children in the family
To provide treatment in case of infertility in the couple
To improve health status of mothers children and family
To decrease the maternal and child mortality and morbidity
rate
66. Physical health of both mother, babies and others
Economic: less expenses and more saving
Social: decrease unemployment and crimes
Educational : easy to provide education for children
Others: life style/standard of living, food/ nutrition, etc
Benefits of FP
67. Among women’s health
Reduces maternal mortality
Reduces morbidity of women of child bearing age
Improves nutritional status, weight change,
Hemoglobin level etc.
Prevents complication of pregnancy and abortion
Occurs through
• Avoidance of unwanted pregnancy
• Limiting number of births and proper spacing
• Timing of the births, (1st and last in relation to age of
the mother)
Impact of FP
68. Reduces fetus mortality
Reduces abnormal development
Occurs via
• Motivating couples to avoid unwanted pregnancies that may result to
genetic abnormalities.
• Low birth weight infants resulting from premature birth or
inadequate fetus nutrition , is less likely to grow well and more likely
to fall ill, and four times more likely to die in the first year of life
than normal weight babies.
Among fetus’s health
69. Reduces neonatal, infant and pre-school mortality through birth
spacing of at least 2 to 3 years
Improves health of the infant at birth as child is likely to secure
is full share of love and care including the nutrition he needs
when the family size is small.
Decreases a child’s vulnerability as children living in small
families are less vulnerable for infections disease such as
gastro-enteritis, respiratory and skin infections than those with
large families
Among infant and child health’s health
70. Proper spacing and
limitation of births
Advice on sterility
Education for parenthood
Sex education
Screening for pathological
conditions related to the
reproductive system
SCOPE OF FP
Genetic counselling
Premarital consultation and
examination
Carrying out pregnancy tests
Marriage counselling
Services for unmarried
mothers
71. Population explosion
Excessive growth rate
Social and economical reason
Health risk
Modern contraceptive prevalence rate in Nepal is 43%
(NDHS, 2016)
Why is FP needed in context of nepal?
72. • Contraceptive methods is a preventive methods to help women
avoid unwanted pregnancies.
• Contraception is also called birth control, that prevents
pregnancy by interfering with the normal process of ovulation,
fertilization, and implantation
• It is deliberate prevention of conception or impregnation by any
variety of drugs, techniques, or devices; birth control.
Methods of FP
73. 1. Safe
2. Effective
3. Acceptable
4. Easy to use
5. Long-lasting
6. Inexpensive
7. Require less or no
medical cares
8. Independent to coitus
Ideal contraceptive should be:
74.
75. Short acting
• Condom
• Oral Contraceptive Pills
• Injectable hormones
• Spermicides
• Mechanical method
Long acting reversible
•Intrauterine contraceptive
device
•Mechanical and chemical
combination
•Norplant
Traditional (Behavioural)
• Coitus interrupt
• Safe period
• Basal body method
• Lactation Amenorrhea
method
Temporary
FP
method
76. Short Acting
Methods
Types MOA Effectiveness
Condom -Male condom
-Female Condom
Works as barrier 95%
-Diaphragm
-Cervical cap
Inhibiting the entrance of the
sperm into the vagina.
Oral
Contraceptive
Pills
-Combined oral
contraceptive
-Progesterone only
Estrogen suppresses ovulation,
progesterone decreases the
permeability of the cervical mucus
to limit the sperm’s access to the
ova
99.9%
Injectable
hormones
-Depo-Provera Medroxyprogesterone inhibits
ovulation and causes changes in
the endometrium and the cervical
mucus
Almost
100%
Spermicides Spermicides,
vaginal gels and
creams, and
glycerin films
Affects sperms ability to move
and fertilize ova.
Less
effective
method
77.
78.
79. CONDOM
• Stop sperm from entering the vagina.
• Protects against sexually transmissible
infections (STIs) and from unintended
pregnancy
• 95% effective
80. Hormonal method
● Include the Pill and the Depo provera injection.
● There are two types of pill:
– Combined oral contraceptive pill
– Progestogen-only contraceptive pill
● Take one pill each day.
● 99% effective at preventing pregnancy.
81. ● The depo provera injection
– Every three months. If you get your injections on time,
– More than 99% effective.
• Consists of medroxyprogesterone, a progesterone
• Given once every 12 weeks intramuscularly.
• Inhibits ovulation and causes changes in the endometrium
and the cervical mucus.
82. Chemical barriers
• spermicides, vaginal gels and creams, and glycerin films
• Causes the death of sperms before they can enter the cervix and
also lower the ph level of the vagina so it will not become
conducive for the sperm.
• cannot prevent sexually transmitted infections
• can be bought without any prescription.
• Fail rate of chemical barriers is 80%.
83. Diaphragm
• Inhibiting the entrance of the sperm into the vagina.
• Circular, rubber disk that fits the cervix and should be placed
before coitus.
• Should be fitted only by the physician, and should remain in
place for 6 hours after coitus.
• Can be left in place for not more than 24 hours to avoid
inflammation or irritation.
84. Natural Methods MOA
Coitus interrupt Removal of penis prior to ejaculation
Safe period (Rhythm)
(Calendar method)
Refraining from coitus during the days that the woman is
fertile.
3 or 4 days before and 3 or 4 days after ovulation, the
woman is likely to conceive.
Basal body temperature BBT falls at 0.5⁰F before the day of ovulation and during
ovulation, it rises to a full degree because of progesterone
and maintains its level throughout the menstrual cycle,
Lactation Amenorrhea
method
Woman is able to suppress ovulation through irregular
secretion of GNRH which disrupts follicular development
Cervical mucosa method If cervical mucus is copious and watery and a day a she
must avoid coitus during these days.
85. Cervical cap
• Barrier method that is made of soft
rubber and fitted on the rim of the
cervix.
• Shaped like a thimble with a thin rim,
and could stay in place for not more
than 48 hours
86. EC
Copper bearing intrauterine device and ECPs
• Copper bearing intrauterine device prevents fertilization by causing a
chemical change in sperm and egg before they meet
• Stops or delays the release of an egg from your ovaries until the sperm
aren't active in your body any more. Prevents the sperm from fertilizing an
egg by changing the way the sperm moves in your body.
• ECP should be taken as early as possible within 120 hours
• ECP with ulipristal acetate (UPA) are more effective when taken
between 72 to 120 hours after unprotected sex.
• IUCD should be inserted within 120 hours of unprotected sex.
87. Family planning counselling
• A process of communication, where the counsellor gives
accurate and complete information to the client/clients and
assists them to make informed and voluntary decision about
their fertility and contraceptive options
88. • A face to face, unbiased or objective, two way
communications between service provider and client.
• Provides complete information to help client come to a
decision based on their reproductive needs, values and
reproductive goals
89. Principles of FP counselling
• Focus on individual needs of the client
• Voluntary choice of client’s fertility behavior
• Empowerment
• Confidentiality
• Consent
90. Benefits of FP counselling
• Increased acceptance
• Appropriate method of choice
• Effective use of method
• Longer continuation
• Counter rumors and misconception
