WHAT YOU OUGHT TO KNOW ON ENVIRONMENTAL HEALTH SERVICES

TABLE OF CONTENTS
1.0 INTRODUCTION.. …………………………………………3
1.1 Definition of environmental health services………………3
1.2 Objectives of environmental sanitation……………………3
1.3.Components of environmental sanitation………………….4
1.4 Responsibilities of Ministry of environmental……………..5


2.0 PROBLEMS IN PLANNING AND MANAGING ENVIRONMENTAL
HEALTH SERVICES: OSUN STATE EXPERIENCE …………6

3.0 RESULTANT IMPACT ON PEOPLES WELFARE……………….


4.0 CONCLUSION………………………………………………………..10


INTRODUCTION

Environmental health sanitation is defined as the principles and practice of effecting healthful and hygienic conditions in the environment to promote public health and welfare, improve quality of life, reduce poverty and ensure a sustainable environment.1, The Objective of environmental sanitation is to:
• Create and maintain conditions in the environment that will promote health and prevent diseases. The key to achieve this is through public awareness and education at all levels as a cornerstone of broad prevention efforts.
• Establish a common understanding of up-to-date approaches to hygiene promotion and environmental sanitation and to take stock of the best practices.
• Raising awareness on the importance of water supply and sanitation project with hygiene and sanitation promotion for a sustained behavior change.

.The essential components of Environmental sanitation include:
• Solid Waste management:
• Medical Waste management:
• Excreta and sewage management
• Food sanitation
• Sanitary inspection of premises
• Market and abattoir sanitation
• Adequate potable water supply
• School sanitation
• Pest and vector control
• Management of urban drainage
• Control of rear and stray animals
• Disposal of the dead (man and animals)
• Weed and vegetation control
• Hygiene education and promotion

Ministry of Environment at the State is expected to perform the following responsibilities:
• Provide technical assistance and logistic support to LGA in the implementation of the National Environmental Policy and Guidelines
• Encourage and support private sector participation on Environmental sanitation service delivery, through legislation and provision of financial instruments.
• Support the implementation of National Environmental sanitation action plan
• Adopt the master plan of solid waste management and implementation at the state level
• Ensure implementation of master plan on biomedical waste.
• Ensure and coordinate storage, regular collection, transportation and disposal of solid waste in the urban areas.
• Ensure proper siting of final disposal sites for management.
• Ensure adequate management of the sewerage system.
• Ensure compliance with environmental sanitation standards
• Coordinate the National Environmental Sanitation exercises and provide health education to the public and enlightment campaigns.

Problem of Planning and Managing environmental services: Osun state experience:
(1) The Committee constituted to look into the different environmental health services provision in the state and local government level are not properly constituted. Most of the specified stakeholders as earlier mentioned are not part of the committee constituted at Osun state level.
(2) Lack of reliable data on the demographic, socio-economic characteristics of the community members in the urban and rural areas of the state.
(3) Inadequate resources in terms of materials, fund and human resources at the state and local government levels.
(4) Unhealthy socio-cultural practices, poor environmental sanitation education and awareness e.t.c.
(5) Poor and inconsistent political and administrative will and commitment to environmental services provision in the state.
(6) Lack of competent and committed programmers and programme implementers.
(7) Continuing injustice in environmental services delivery especially at national level in sectoral allocation of resources.
(8) Continuing widen gap between what is said and what is done. There have been so many unfulfilled political promises and lack of political commitment to the goal of the environmental health services.
(9) Lack of proper monitoring and evaluation using appropriate indicators
(10).Lack of proper organization structure and management system which is expected
to support and encourage the participations of other sectors.

The problems are claimed to be precipitated by a wide range of factors that are crucial in fashioning out a successful implementation of environmental health services
(1) Political commitment to achieving the goals of conducting an environmental health services to ensure consistency and continuity of the programmes is usually very weak and unpredictable. Policy of the rulling party on environmental health in terms of commitment and strategies to be adopted has been generally non-specific, unclear and unrealistic.
(2) Low financial viability at the state and local government level because they depend on fund accruing from the Federal account. When this is not coming development projects comes a standstill no matter how urgent the need to execute them
(3) Politics in the mobilization, allocation and use of facilities/resources and services.
(4) Disregard for the rule of law and form of indiscipline.

REPRODUCTION AND FAMILY HEALTH PART EIGHT (END)

Disease Transmission
(1) Mechanical transmission:
In mechanical transmission infection, the responsible parasites undergo no morphological changes. Many bacterial, protozoal, helminthic and viral infections are thusmechaically transmitted to human host through the agency of a wide variety of insects. Thus the housefly (with its equal liking for human excretions, e.g. feaces, sputum, nasal secretions, pus and urine and human food supplies) may take up germs or parasite ova and convey directly either on its feet, or in its feaces and vomit to the human host.
(2) Cyclical Transmission of Disease
The term cyclical transmission implies on intermediate period during to the parasite is developing, but since it as not yet become inspective it cannot be successfully transmitted by the vector. Mosquitoes, black flies, chrysops, Glassine, Phlebotomies are able to develop specific parasites within their gut to infective stages and infect man during next meal.
(3) Myasis
This refers to invasion of tissues by maggots. The blow files (mango flies) are of medical importance because their larvae, known as maggot, invade the skin, mucous membrane or conjunctive causing secondary infection. The lava obtains the oxygen through small air pore known as spiracles.
After about one week or more, the larva leaves their host and pupates in the ground to continue their development.
INSECT CONTROL MECHANISM.
(1) Environmental control
Examples of environmental manipulations are: elimination of breeding places (source reduction); filling and drainage operation; carefully planned water management; provision of piped water supply; proper disposal of refuse and other waste; cleanliness in and around houses, house netting.
(2) Chemical control
It involves the use of repellants such citronella applied on skin, the application of oil to water is one of the oldest known mosquito control measures. The oil most widely used are diesel oil, fuel oil, kerosene, and various fractions of crude oil. Special oils (e.g mosquito larvicidal oil) are also available. A wide range of insecticides belonging to the organ chlorine, organ phosphorous and carbonate groups of compounds are available for vector control. It must be mentioned that vector control by insecticides alone is no longer fully effective because of insect coupled with danger of environmental pollution, it is now considered essential to replace gradually the highly persistent compounds such as DDT with compounds which are readily ‘’biogradable’’ and less toxic to man and animal such as methoxychlor abate and Durban, paints containing insecticides.
(3) Biological control
To minimize environment pollution with toxic chemical, great emphasis is now being placed on biological control. The use of carnivorous fish especially Gambusia is well known in mosquito control. Fungi of the genus coelomomyces are also known to be pathogenic to mosquito. But the fear exists that the introduction of biological agents for the control of arthropods may pose a direct hazard to the health of man himself.
Insect as pest control mechanism.
Various types of biological control methods have had some success fish such as guppies, which breed rapidly and eat mosquito larvae, may be valuable especially in water tanks and other enclosed water collections. Two bacteria is which produce toxins and kill larvae which eat them are Bacillus thuringiensis and Bacillus spherical. The toxin paralyses its germinate and the resulting bacilli infect the insect and kill it.
- Frogs which eat mosquito
(4) Genetic control
Much progress has taken place in recent years in the theoretical and applied aspects of genetic control of arthropods.
The WHO/ ICMR Research unit at New Delhi has contributed massively to the techniques of genetic control of mosquito.
Techniques such as sterile male techniques, chromosomal translocations have been found to be effective in small field trials
(5) Newer methods:
These are:-
(a) Insect growth regulators and
(b) Chemosterilants
Life cycle of anopheles mosquito
Night 1: feeding
The female anopheles has to forage (feed) and take blood meal.
If she fails to forage that night, she rest during the day and forages again the next night.
Day 2: Rest
During the day, anopheles mosquito rest in cool shaded humid places. A fed anopheles begins to digest the blood and her eggs starts to develop:
Night 2: Rest, half gravid: The insect rest, blood digestion and egg production continues, she may leave the house or change her rest side.
Day 3: Rest, gravid
Still in a cool shaded humid place, egg production is completed and the female is fully gravid.
Dusk 3: The gravid female flies to a suitable water collection and lays 50 – 150eggs. She will then forage for another blood meal to start the cycle again.
Larvae: The eggs hatch in 2-3days into the larvae form.
The larvae or wrigglers feed by filtering algae and other materials from the water. In favorable conditions, they grow rapidly passing there3 moults (shedding of its outer covering 3 times)
Pupa: After the 3rd moult, the larvae feed and grow then become a mobile pupa. There is no feeding at this stage.
The pupa breathes there 2 air trumpet while development of the adult proceeds internally.
Emergence: After 2-3days, the adult emerges: the pupa splits and the soft adult climbs out. It needs to dry and harden for sometime before it can fly.
Fertilization: Matting is the 1st activity of the young adult anopheles.
This takes place usually at twilight. After copulation, a mating plug is formed in the female’s genital passages probably from a secretion deposited by the male at the final act of copulation.
The female copulates once only string sperms for all subsequent egg production.
From egg to a new adult formation takes between 7-21days depending on the temperature.
Adult lives for 1month if condition is favorable
Development of plasmodium in mosquito takes 8- 10days.
International Health (cooperation)
International health (cooperation) is any health action which involves person, community and or institution in two or more countries
Origin (rationale or motives)
(1) Fear and suspicion
(2) Compassion
(3) Mutual benefits
Primordial interest in until health has its origin in the early ventures of until trade and travel and it predates the recent global events that only recently turn the world into a global village.
The original stimulates towards the early interest towards until health was that of fear and suspicion rather than international cooperation. Individual country were afraid of the spread of epidermis dx from foreign lands their region and thus tried to formulate health actions to prevent such dx transmission.
e.g. in the 14th century, a procedure called quarantine was introduced in Italy Europe to protect the importation of plague thus the health action formulated was to detain the sheep and the travelers suspected for harboring infection for a 40days orquaranta period during which time it was hoped that any dormant dx in any of the person will have manifested or be seen or otherwise die out for no dx to enter the country. Thus a quarantine practice is the origin of international health work with countries adopting difference measures and practices.
(2) Compassion – Apart from fear and suspicion, compassion for other also helps to stimulate international health actions in the past. Here medical missions, religions and humanitarian agencies, NGOS and private voluntary organizations respond to health crises not only in their community or countries but also in distant lands.
Finally in more recent times, international health cooperation is been fueled by the realization of mutual benefits obtainable by all cooperating countries.
Developments (History) of international health cooperation.
International health cooperation become necessary because through the practice of quarantine become widespread among countries, its objective of preventing international spread of communicable dx failed because of lack of scientific knowledge regarding the causation and mode of spread of dxes. It thus became necessary that international agreement and cooperation on quarantine matters be made to control communicable dxes. So, international conferences were held and organizations set up for discussion, agreement and cooperation on all matters of international health.
(1) The first international sanitary conference (1851)
These are the origin of international health cooperation. This was held in Paris attended by mainly European nation of states – Great Britain, Austria, France, Spain, Greece, Russian, Portugal and four sovereign states (Sardinia, the two sicilies, the Papal States and Tuscango)
These states join to form Italy. The objective was to introduce some order and uniformity into quarantine measures.
This conference lasted for 6monthw but there were no lasting results which had 137 articles but unfortunately only 3 of the countries ratify these codes. The countries are France, Sardinia and Portugal.
In 1865, Sardinia and Portugal withdrew again leaving only France between 1851 and 1902, other international conference followed held in rapid succession (about 10 conferences)
(2) International sanitary conference of 1892. In this conference, a convention concerning cholera was made/ adopted
(3) ISC (1897): Convention dealing with preventive measures against plague was adopted.
(4) International or pan American Bureau 1902.
This was the next important milestone in international health work. It was held in the Americans and 10ly intended alone. In 1924, they had the American sanitary code.
1947 – Reorganized and renamed PASO (pan America sanitary organization)
1947 – All agreed among themselves that PASO will be their WHO regional office for all the Americas.
1958 – Changed the name from PASO to PAHO (Pan America health organization) which had it’s headquarter in Washington BC.
PASB was the world’s first international health agency.
(5) Office international D’ Hygiene Publique (OIHP) 1907.
Decision was taken in 1903 I.S.C to have a permanent international health bureau established. So the Paris office was established in 1907 with a permanent secretariat and a permanent committee of senior public health of member govt.
Objectives.
Empower to disseminate information on communicable dxes and to supervise international quarantine measures.
Initially only European countries were involved but late with cooperation growing between PASB and OIHB, 60 other countries joined the OIHB giving the office an international xter.
OIHB existed until 1950 by which time WHO has fully taken over its responsibility
(6) The health organization of the league of Nations (1923)
After the 1st world war (1914 – 1918), the league nation was established in 1919 to help build a better world. It also included ‘a health organization to take steps in matters of international concern for the prevention and control of dx. It was established in 1923.
The health organization diversity into other matters such as nutrition, housing, rural hygiene, training of public health workers and the standardization of certain biological preparations.
The health organization also analyzed epidemiological information received from member nations and started the series of epidemiological report which the WHO also adopted.
They also laid down lines for technical studies including the use of expert committees also sustained by the WHO.
So the WHO as it stands and works today owes a lot to the found initiative and foresighted efforts to amalgamate PASB, OIHB and the health organization of League of Nation failed and all them co-existed between the years of the 2 world wars.
In 1939, the political League of Nations was dissolved but its health organization continued its work. The health organization of the League of Nations headquarter was in Gen3va.
(7) I.S.C 1926 – The international convention was revised to include provisions against typhus
(8) I.S.C 1935 – Convention for aerial navigation came into force4.
(9)Last I.S.C Paris 1938 – Sanitaria, maritime et Quarantine at Alexandria, Egypt which became a regional office of WHO for Easter Mediterranean region.
(10) United nations relief and rehabitation administration another international health programme began in 1943
Set up 1943 with the general purpose of organizing recovery from the effect of the 2nd world war. UNRRA had a health division to care for the health of the millions of displaced persons, to restore and help services and to revive the machinery for international interchange of information on epidemic dxes.
UNRRA worked to prevent the spread of typhus and other dxes so that there were no epidemics anywhere. It equally assisted in the control of other dxes e.g. malaria in Greece and Italy.
The world’s renowned campaign for the eradication of malaria was indeed begun as a joint effort of UNRAA, the Rockefeller foundation and the Italian govt.
By the end of 1947 UNRRA terminated its official activities and its health programmes and financial assets were taken over by the interim commission of the WHO.
The Birth of the WHO
(1) United nations conference on international organization April 1945 held in san Francisco USA. This conference unanimously approves the proposal made by the representatives of china and Brazil that a new autonomous, international organization be established and that a conference to frame the constitution should be convened.
(2) International health conference in New York 1946 – This conference approved the constitution of the proposal international health organization. This international health conference was attended by 51 nations. The constitution was drawn up by a technical preparatory committee. This same conference set up an interim commission of the WHO to prepare the ground for the new organization and to carry out urgent task until the WHO constitution had been accepted by the required no of UN member states.
In 1947, the interim commission has part of its effort helped to organize assistance to Egypt to combat cholera.
(3) The WHO constitution came into force on 7th April 1948 and this day is thus celebrated as the UN world health day. This happened following the required ratification of the WHO constitution by member nations when the 26th of the 61 member states who signed the constitution ratified its signature. Thus marking the establishment of the WHO as a specialized agency of the United Nations.
Later, the 1st world health was held in Geneva with delegations from 53 countries. Thus the formation of WHO represents the culmination of efforts to establish a single world wide intergovernmental health agency.
WHO
Definition: - This is a specialized nonpolitical health agency of the united nations with headquarter in Geneva
In 1946, the constitution was drafted by the technical preparation committee under the chairmanship of Mr. Rene Sand and was approved in the same 1946 by an international health conference of 51 nations in New york city of USA.
The constitutions come into force on 7th April 1948 which is celebrated every year as the world’s health day.
A world health day’s theme is chosen every year to focus attention on a specific aspect of public health.
Objectives of WHO.
(1) Attainment of all people of the highest level of health and this is set out in the preamble of its constitution.
(2) Current objective is the attainment of all people of the world by the year 2000 AD of a level of health that will permit them to lead a socially and economically productive life also known as the health for all by the year 2000 AD.
Membership of WHO.
- open to sill countries but with some difference e.g. Switzerland is a member of WHO but is not a member of united nation.
In 1948, they were 56 members
In 1996, 190 full members and 2 associate members
Now, 191 members.
All these members are entitled to aide’s services that the organization can provide.
Functions of WHO.
(1) WHO is the directing and coordinating authority on all international health work?
Specific responsibilities.
Establishing and promoting international standards in the difference fields of health.
These fields are:
(1) Prevention and control of specific dxes.
(2) Development of comprehensive health services
(3) Family health
(4) Environmental health
(5) Health statistics
(6) Biomedical research
(7) Health literature and information
(8) Cooperation with other oragnization.
Structure of WHO.
Consists of 3 principal organs.
(a) World health assembly
(b) The executive board
(c) Sectariat.
WHO is the supreme governing body of the WHO. The meet in every month of May in Geneva.
The executive board is made up representative members of member states who are technically qualified in health matters. Recently, there are 31 of them.
The sectariat is needed by a director General in Geneva and they provide support (technical and managerial support) for the national health programmes of the individual member states. There are also 5 assistance D.G in the Geneva office.
Regional offices.
In order to meet special health needs of difference areas or regions, WHO has regional headquarter or office.
African regional office – Harare Zimbabwe
East Mediterranean regional office – Cairo (Egypt)
Western pacific regional office – manila (Philippines)
The American regional office – Washington DC (USA).
Europe regional office – Copenhagen (Denmark)
South East Asia regional office – new- Delhi (India)
The Africa regional office was formally in Congo AFRO was temporarily evacuated from Congo to Harare.
Other united Nation organization Agencies.
(1) UNICEF – united nation children fund
(2) UNDP – united nation development program
(3) UNFPA – united nation fund for population activities
(4) FAO – food and Agricultural organization
(5) ILO – international organization
(6) World Bank.
MEDICAL STATISTICS
The concept of a 2x2 table:
A 2 x2 table is the table that consists of 2 columns (vertical) representing the presence or absence of a dxc and 2 rows (horizontal) that represent a tue or ve test result.
These tables may also be employed in risk factor studies.
The ffg 2 x2 table is a tool for the evaluation of standardized screening test which predict the presence or absence of dx.
Pr Abs
+ A B A+B
- C D C+D
Test


A representing true tves, B rep false tves, C rep false ves and D rep true – ves.
Validity is the extent to which a test measures what it was designed to measure.
Accuracy is the ability of a test to produce a true value for the measurement and true classification for the values under study.
Validity has 2 components.
(1) Sensitivity- Defined as the ability to correctly identify individual who have a specific dx or condition.
(2) Specificity is defined as the ability to correctly identify individual.
Who do not have a specific dx or condition?
Although the validity of a diagnostic test can be determined by sensitivity and specificity, 3 other measure are important.
(3) False true rate: defines as the proportion of false true B among non dxed B + D subjects.
(4) False – ve rate is defined as the proportion of false – ve C among dxed A+C subjects.
(5) The accuracy of a test is defined as the proportion of true results i.e. true tve A, + true – ve D among all test results
Sensitivity = A specificity = B
A + C B + D


False tve rate = B false – ve rate = C
B + D A + C

Accuracy = A + D
A +B+C +D.
The predictive value of a screening test measures the true presence or absence of a dx.
Predictive values has 2 components
(6) Positive productive value – This is the proportion of true tves among all tves. A/ A+B
(7) Negative predictive value is the proportion of true –ve among all –ves D/ C+D
E.g. an investigator evaluated 100px suffering from major depression as confirmed by the attending pscyatrics, the results were as follows


Clinical depression.
Pres Abs
+ 12 18
- 28 42
Test
Evaluate all the 7 indices.
In a prospective study of the relationship between oral contraceptive use and the subsequent risk of developing endometrial cancer, a cohort. Of 1000 women were followed for 5years. The results were as follows.
Endometrial cancer.
Pr Abs
+ 245 75
- 50 630
Oral contraceptive.
(1) What was the incident rate (absolute risk) of endom? Cancer among women who used oral contraception.
(2) Asses fully the association between oral contraception and the presentation of endometrial cancer.
Sampling in health survey
A health is a planned study or investigation to obtain primary or additional information on the health of the people in the community. This is usually done on ad-hoc basis and it is another major source of health data.
The first step in the conduct of a health survey is a good definition of the health problem followed by a definition of the population. Once the objectives are well spelled out, one basic problem in the implementation process is the decision as to whether all individual.
In a defined population should be studies or some selected units’ init and if the decision is to study selected unit, how best to do this.
It is therefore imp define the concept of the world population in its statistical sense.
Procedures.
(1) Identify the problem
(2) Identify target population e.g. under 5
(3) Objectives of the study
(4) Study design e.g. case sense, cross sectional/ prevalence study, case control.
Population
This is the totality of all available units in a defined area falls within the scope of statistical investigator i.e. the totality of units that are of interest to the researcher. The unit may be individual, households, families, schools, the community, villages, insects etc.
In survey terminology, the aggregate of all the units about whom information is required is called target population and the results of the study will apply to those population. But the population from which is the data are actually collected is the survey or study population. more often than not practical problems makes it difficult for the investigator to cover all individual in the target population in particular when the target population is large and well dispersed and shortage of personally, money and time makes it difficult to have a complete coverage.
Sample
This is part of a population selected for study such that we may be able to infer the xtics of a population from those of the sample.
Sampling approach
(1) Total population- in this case, every individual in the defined population is included and studied.
Advantages:
(a) The estimate is accurate and without error since no unit is left out
(b) There is no need to worry about selection procedure
(c) There are no feelings of discrimination created in the population
Disadvantages
(a) It is expensive
(b) takes time to complete
(c) Demands a lot of personella
(d) It may not be feasible
(e) It may be less accurate
(2) Sample approach, - Here, a sample is selected from the population and studies. It has its own merits and Demerits.
Merits
(a) Less expensive
(b) Quick results guaranteed
(c) Demands on personella is less
(d) Possibility of obtaining more accurate data because of the small no of units involved
(e) Allows studies to take place at all situations.
Demerits
(a) Some units or people are left unstudied. Estimates obtained from the sample is likely to be different from that would have been obtained if the total population have been studies. This discrepancy is called sampling error and it is always present.
(b) It is sometimes difficult to select a good sample i.e. a representative sample.
(c) Sampling may create a feeling of discrimination in the population called bias
(d) In certain situation, information may be legally required from every person in the population (census)
(e) For rare events, sample sizes have to be large.
Principles of sampling
In most surveys, we are constrained to study a sample of the population therefore it is important to consider the various sampling methods that guarantee the assumptions underlying certain statistical methods employed in the analysis of the data collected.
In the selection procedure, 2 principles are often considered.
(1) Avoidance of bias
(2) Achievement of maximum precision for a given outlay of resources.
The ffg definitions are required in order to satisfies the conditions and select a good sample from the population.
(1)Sample size – No of units in the sample
(2) Sampling fraction – This is the proportion of the total population that is constituted by the sample. If the total population is 5000 units and the sample size is 200, sampling fraction = 200/500 = 1/25.
(3) Sampling frame – This is the list containing all the units in the population.
It may be a register, a map or a telephone directory or the records in the 10 health centre. To select a probability sample, there must be a proper sampling frame.
(4) Sampling units- This is the smallest unit involved in the selection procedure. In the survey of the use of contraceptive in a community, each selected household may be sampling unit. In some cases, it may be a woman of 15yrs and above. However the sampling unit should be well defined.
(5) Unit of Enquiry – this is the unit about which information is required.
The sampling unit may be a household and the units of enquiry the female of that household say in the survey of the use of oral contraceptives in a community.
(6) Sampling error – This is an index for measuring the precision of the estimate obtained from a sample. A clear measure of how well a sample estimate is near to the population parameter.
The price paid for not studying the entire population. High precision implies small sampling error while low precision implies large sampling error.
(7) Good or representative sample:
This reflects properly some identified xtics of the population and an unrepresentative sample is based; the case where volunteers or those easily seen or haphazard sample are selected to draw reliable conclusions from the result of our sample, it is always recommended to pick a probability sample.
Non probability sample method.
(1) Quota sample
(2) Convenience sample
(3) Purposive sample
(4) Haphazard sample
(5) Volunteer sample
Each units in the population is given the same Ghana of been selected.
In general, when we select a sample, the selection must be scientific i.e. every unit in the population must posses a known chance of been selected.
A scientific sample is called a probability sample and efforts are made to ensure the selection of prob. Sample to allow the calculate of the precision of the estimates of the population parameter.
Types of probability sample.
(1) Simple random sampling – this is a sampling procedure in which each unit in the population has the same chance of being selected. However the population must be finite and a sampling frame must exist. Each unit must have an assigned no in the sampling frame. Without a proper sampling frame, it is impossible to take a simple random sample.
Selection procedure -3 ways:
(i) Lottery method
(ii) Table of random number
(iii) Computer facilities to generate sample by simple random sampling technique.
Advantage of simple random sampling
(1) It is an equitable method of selection
(2) The precision of the estimate is the highest of all methods of pro sample
Disadvantages
(1) The construction of the frame may be very laborious and expensive
(2) The same does not ensure that subgrps of interest will be adequately represented
(3) Advantage of the xture of the population is not utilized.
(2) Stratified Random sampling – Population is divided into homogenous strata according to some relevant xtics of the population and a simple random sample is selected from each stratum. The sample size may be divided in proportion to the population size in each stratum. This is called a proportional allocation. E.g. To select 200units from a population of 6000 units of which 2000units are females and 4000units male. The no chosen in each sex stratum will be 67 and 133 respectively. If there is a proportional allocation of the sample members in the strata.
Female = 2000/6000 x 200
Advantages.
(1) Increase in representative ness of the sample
(2) Provision of reasonably accurate estimates for subgrps of interest
(3) Increase in precision of estimates
(4) Most useful in heterogeneous population
Disadvantages
(1) Labour in preparation of the frame is still substantial
(3) Systematic random sampling – This is sometimes called quasi random units are selected in any one sample occupying related position to each order in the sampling frame and the 1st unit to be selected is selected at random and thereafter every kth unit is selected given that the sampling fraction is 1/k.
E.g. suppose a sample of 50px is required from the register 1000px available in the record section of the teaching hospital. The sample fraction here be 50/1000 = 1/20.
The 1st member in the proposed sample is selected randomly between 1 and 20; therefore, every 20th member is subsequently selected as sample members.
Advantages
(1) It is easy to select
(2) In some situations, the preparation of a frame is unnecessary
(3) The sample is spread evenly over the entire population
Useful in situation where arrival at a service point is at random and every arrival at known interval is selected.
Disadvantages
(1)Precision of the estimates is not easy to measure
(2) Where population unit has a periodic type of variation and interval between successive selected units happens to coincide with a particular xtics, the systematic sample will be based error of periodicity.

End

REPRODUCTION AND FAMILY HEALTH PART SEVEN (7)

Another e.g. is the schistosomiasis.
Principles of control of vectors
(A) Environmental Engineering: - study the habitat and know breeding site of vectors clearing the bush and stagnant water of breeding site of anopheles mosquito.
- prevent vector from breeding
(B) Eliminate the vector at its earliest stages in life point by using (1) chemicals e.g. eliminating the larva form of molluse.
For Dranculus medlensis – eliminate Cyclops by using abate (a larvicide’s)
The adult vectors can be eliminated by using chemicals also e.g. DDT,
The quick knock down chemicals e.g. pyrethrum used to treat insecticide nets. They are short acting but act very quickly.
The chemicals could be in form of:
Spray, powder, fog, emulsion
Advantage – No side and non toxic to humans.
The long acting chemicals called the residual type. If you spray it now, it will have a residual to will kill any inserts that comes later.
This could be toxic to humans.
E.g. DDT, organochloride, organophosphorus and the carbamates.
(C) Biological method can also be used to eliminate early and adult vector for plague. So cats are used to prey on the rats.
- use of larvivirous fish to eat the larvae form of the vector
- Bacillus thurigiensis predates on
(D) Genetic method can eliminate the adult stage
Release a huge population of sterilized male into the environ to complete with no sterilize type. Those that can procreate (no sterilize type) will not feed well, not able to reproduce and the no will start decreasing. The pop of the normal type will therefore the sterized type prey on them.
(E) Personal protection
Screen the door, window – Insecticide treated net and chemicals are used. Ensure body is covered when sleeping.
Use of insert repellants on the body to repel the mosquito.
HEALTH EDUCATION
This is any set of learning experiences to encourage voluntary changes in human behaviour that will result in improved health status. It is a process of influencing, changing or reinforcing health behavior. It is the totality of educational efforts aimed at helping motivating and / or encouraging people to desire to be healthy knows how to stay healthy, do what they can to maintain health, seek helps as and when needed.
Objectives of H/E
(1) To make health a valuable asset
(2) To help people achieve, promote, maintain and protect their health thrl their own efforts i.e. self help and self reliance.
(3) To promote development and proper use of health services
Role of H/E
(1) Promotion of good health practices e.g. sanitation, breast feeding good hygiene etc.
(2) Recognition of early symptoms of dx and promotion of early referral.
(3) Promotion of use of prevention services e.g. immunization, screening antenatal clinic etc.
(4) Promoting the correct use of medication
(5) Promotion of community support for primary health care
Targets of H/E
(1) Individuals
(2) Families
(3) Communities
(4) Political leaders / policy makers
(5) Administrators.
Principles and methods of H/E.
H/E is an essential component of any program to improve the health of a community. The first step in planning any H/E is to decide what the key problems are and what advice should be given. Attempts to introduce new practices may fail if they are incompatible with local beliefs and practices. Any proposal for a behavioral change should:
(1) Be simple to put into practice with exiting knowledge and skill in the community.
(2) Should fit in with existing lifestyle and culture and not conflict with local beliefs
(3) Meet a felt need of the community
(4) Be seen by the people to convene real benefits in the short time and not only distant future.
To achieve success, H/E programmes need to be flexible and modify their advice to fit in with people’s circumstances e.g. education about nutrition should be based on foods available locally
Examples of methods of H/E.
(1) Individual approach – This include personal contact, home visitor, personal letters etc.
(2) Group approach – this include:
(a) Lecture is to carefully prepare oral presentation of facts, organized thoughts and ideas by a qualified person. The use of flip charts and flannel graphs may be important
(b) Demonstrations – carefully prepared presentation to show how to perform a skill or procedure
(c) Role playing or social Drama – the information is communicated drama is to act by members of the group.
(d) Focus group discussion – 6 to 12 members are seated in a circle face to face to participate in a discussion. The educator himself moderates the discussion.
(e) Workshop – series of meetings that involve active participation by the members.
(f) Symposium – series of speeches on selected aspects of a particular topic
(g) Panel discussion – A panel of 4- 8 people is formed to discuss about a particular topic.
Mass approach – This is directed towards a large no of people.
Materials needed include: Television, radio, internets, newspapers posters, direct mailing, bill boards etc.
Barriers of communication
(1) Physiological: - this includes difficulties in hearing, talking etc.
(2) Psychological it may include emotional disturbances
(3) Environmental e.g. noise, poor visibility
(4) Cultural – include illiteracy, beliefs, customs, religion, attitude etc.
Harmful Traditional and cultural practices
Introduction – Definition of culture and Tradition
Effects – Beneficial, Harmful
- Violence against
Prevention / control.
Definition 2: culture – style of living, custom and belief, dressing and language, food habit. Culture is dynamic (changes from time to time caused by industrialization, globalization and urbanization).
Tradition is transfer of culture from one generation to another culture varies from region to region, community to community and society to society
Effects
Beneficial effects on health
(1) Breast feeding beneficial to matter because it serves as a phenomeiunm of family planning. Serves as a link between matter and baby.
(2) Backing
(3) Male circumcision with sterile instruments because it reduces incidence of HIV. Because if the skin covering penis cap is intake during sexual intercourse, it can be brushed and transmission of infection.
(4) Maintenance of female virginity before marriage
(5) Pregnant women are not allowed to work under the sun.
(6) Extended family system because of moral and financial support from them.
Harmful effects This is detrimental to the physical, social and mental wellbeing of the individual. Female and children are more prone to these harmful effects than the males.
Violence against women
The gender based violence act that results or likely to result in physical, sexual or psychological harm to women.
Types of violence
(1) Female genital mutilation
(2) Male preference:
(3) Societal approval of male infidelity
(4) Early marriage
(5) Practices during Labour, marriage and pureperum
(6) Nutritional taboos
(7) Wife hospitality
(8) Widowhood rites
Female genital mutilation
Definition 2: cutting of part or the whole female genital organ
Types: clitoridectomy; Excision; Infibulations; Gishiri cut.
Clitoridectomy is removal of prepuce of clitoris
Excision – clitoris is removed with labia minora
Infibulations – involves removal of clitoris, labia minora and major
The surface is stitched together leaving opening for urination and menstruation.
Gishiri cut – common among the Hausa. Incision is made in the female genital part. The incision can be done anterioly or posteriorly. When the incision is made anterriorly, it damages the bladder giving vesicovaginal fistula. If the incision is made posteriorly, it damages the rectum giving rectovaginal fistula.
Prevalence
Chtoridectomy and Excision is common in western part of Nigeria.
Infibulation is common in Eastern part of Nigeria
Gishiri cut is common in the Northern part of Nigeria.
Why do we perform these types of female genital mutilation?
- Prevention of promiscuity
- Preservation of virginity
- Religious reasons because Islam belief clutoridectomy is a form of cleanness
- Social acceptability
- Identify and
When are these processes done?
- During pregnancy and labour
- At puberty stage
Where and how it is done.
The operators are the TBAS, local barbers, olounla.
Instruments: special knifes, glass, stones
Done in a septic environment under no anesthesia
Time / Duration depend on the skill of the operators.
Compensation can be I kind or cash before or after the operation.
Consequences of these procedures.
Immediate: Bleeding, pain (intolerable), fracture due to baby struggling with the operator, shock
Intermediate consequence: Delayed wound healing, keloid formation cyst formation, dysmenorrhoea, absence.
Late consequences: Infertility, prolong and obstructed labour
Resicovaginal and rectovaginal fistula, recurrent urinary tract infection.
Complications:
Mental Effects:
Anxiety, frigidity, depression-on, lack of organism etc.
Psychoses, neuroses.
Wife hospitality: Their wives are used to entertain visitor consequences: mental effects, unwanted pregnancies and incidence of HIV and veneral dxs. Common among the TIVS and Benue state.
Male preference
The parents prefer male child because they carry on the family name.
Societal approval of male infidelity
Male having many girl friends is approved by the society consequences: STI, HIV, Early marriage (marriage below 12- 13 years
Early marriage:
Set up a marriage at age of 12 or 13 because of honour and bride price.
Consequences: Teenage pregnancy, prey induced hypertension, anemia and malaria in prey, Ecclampsia, prolonged and obstructed labour, vesicovaginal and retrovaginal fisturm
Nutritional taboo
Individual is denied of food rich in vitamin, protein and other mineral. Pregnant women and children are the most susceptible. Kids are not given meat resulting in kwashiorkor.
Pregnant women are not allowed to eat snail (so baby will not be salivating)
Practices
Abdominal massage
Incision during labour done by the TBAS
Cutting umbilical cord with septic instrument with ending up in neonatal tetanus
Domestic violence again women – verbal violence, physical abuse in form of slap ending with bruises, sexual abuse..
Prevention and control:
- Mutidisciplancy approach where health workers, police, religious leaders, policymakers, NGO community leaders, journalists are involved.
-The first thing to be done is research; (i) situation analysis (how many individual are abused, bringing out those affected, reasons beliefs and customs under such act, (ii) clinical and rehabilitation research.
- Raise awareness and break the silence using special languages and terminologies.
- Advocacy: - creating awareness and support from community leaders, opinion leaders, religion leaders and organizations
- Empower women: Improve asses to education, improve their skill asses to employment, asses to money
- Involvement of NGOS, some are involved in eradication of such practices WOTCLEF: women trafficking child labour eradication foundation by Titi Abubakar.
- Training the TBAS to become carpenters, driver etc. so as to earn their income from other means.
- Community involvement in eradication of the practices by spreading the news the media, giving health talk etc.
Q – Which of these pratises enhances transmission of HIV.

Insects of public Health Importance
Beneficial effects of inserts
(1) Pest control – praying mantis feed on anvil
(2) Pollination e.g.
(3) Honey bees produce honey which is a sweetner and an antibiotic
(4) They constitute natural manure when they die and their bodies’ decomposer
(5) Of cultural value. E.g. Butterfly is the symbol of the God they are serving (in the ancient Ephesians)
(6) They serve as food e.g. the termites
(7) Assist in soil eration e.g. burrowing beetles
(8) In aviation industries, assist in flying studies
(9) Are of great great ornamental values.
Classification of insects:
Insert belong to the family arthropod.
(1) Diptera (True flies) with head, thorax and abdomen with 2pairs of wings on the thorax e.g. (a) mosquito will transmits malaria, filariasis and some viral dx.
Mosquito < anopheles e.g. female anopheles mosquito Culex e.g. the culex and the acdes. (b) Black fillies (simulium spp) transmit onchocerciasis and the parasite transmitted is onchocerca volvulus. The infective agent is the onchocerca larva or the filarial. (c) Glossina spp (tsetse fly) transmits trypanosomiasis (African type) the parasites are Trypanaroma gmbiense and T. rhodiensilence. (d) Chooser’s (horseflies, dear files) transmitted of Loaisis (calabar swelling) parasite is Loa Loa. (e) Sandfly (phlebotomus) cause Leishmaniasis (f) Muscaspp (House fly) transmit many parasite and amoebic dxes, brucellosis, salmonellosis, Hepatitis A and viral dxes (g) Blow files e.g. mango flies (bees found on mango plantation). Do not have the parasite inside of them but transmit dx by a mechanism called Myiasis. (2) Bugs Bed bugs (cimex bugs) Reduvid bug (kissing bug) Bedbugs do not transmit dxes. Their only problem is that their bite is very painful and there could be dermatitis. Reduviid bug (kissing or assassin bugs) – cause South American type of trypanosomiasis called chages dx. Survives on crevices of abandoned building (open walls). The insets feed at night – exhibit norctunal type of periodicity As the insect is feeding, it is also defeacating and the feaces contain the parasite called Trypanosome cruzi. By reflex you rub the feaces on your face and the parasite penetrate the body which will result in a swelling called chagoma which will disappear into the blood stream in some few minutes. Lice (pediculus) Human louse (pediculus humanus). There are 3 main species. (i) Pediculus captis on the head (ii) Pediculus corporis on the body They are transmittere of 3 main dxes (1) Typhus fever caused by rickettsia (2) Trench fever (3) Relapsing fever The insect allow survival of rickettsia. The lice lives on the body and excrete on the body when an infected feaces come in contact with a traumatized skin, the rickettsia penetrate the body anol enter during the blood stream where it either cause typhus or trench fever depending on the type of ricjettsia that penetrated the body - Rickettsia prowerzekis causes typhus fever - Rickettsia Quintana cause Trench fever Relapsing fever is caused by Borealis recurrent which is a spirochete. The spirochete survive also on the body and excrete on the body when the infected feaces come in contact with a braided skin, the parasite penetrate the body and enter the blood stream causing relapsing fever. Factors assisting insects in dxes transmission (1) Anatomy of the body of adult insects is divided into head, thorax and abdomen (a) Head: head of mosquitoes and tsetse files bear the mouth part to generally posses’ highly specialized blood sucking appendage. The sensory system e.g. of housefly is much developed that is able to locate any dead body and to sense predators. (b) Thorax: the thorax (true files) bears wings which allow for possible escape during predation, cyst and ova of parasite accidental attachment thus aiding mechanical transmission of dxes. The 3 parts of legs of houseflies are provided with glandular hairs which exudes substances that keep the legs constantly wet and sticky which the result that particles readily adhere to them so that a fly visiting feaces and subsequently setting on fresh food may act as a direct conveyer of feacal material from human exercetement to substances intended for human consumption. (c) Abdomen: The internal anatomy of certain insects e.g. anopheles mosquitoes and tsetse files are suitable for developing parasites into infective stages e.g. sporozoites (infective stage of plasmodium), bankrofti larva and trypomastigate (infective stage of trypanosome) (2) Habitat: (3) (temperature, rainfall, relative humidity) Habitat plays a major role in survival of adult insects and larva and to a greater extent the type of dx associated with a particular region. Mosquitoes (e.g. are vectors of many dxes eg malaria filariasis, viral dxes) survive in tropical regions thereby eliminating dx associated in cold region. Most eggs and larva of insects thrive in swampy, dampy cold environment. In warmer weather, mosquitoes are more active. Hotter temperature even reach inside the mosquito gut and intensify the reproduction rate of dx causing parasite (plasmodium or wuchereria) thereby increasing the like hood that a single bite will cause infection. (3) Feeding habit Mosquitoes, tsetse fly, black files and other blood feeders introduce germs during blood meals. Although Musca domestica is non blood sucking pathogenic organism are easily transmitted because the feeding habit of fly involves regurgitation of its crop content and defeacation while feeding. The bite of pediculus humanus, simuluium files are usually very painful and cause discomfort, skin irritations and dermatitis periodicity (period when insect feeds) is also contributory to successful dx transfer. Mosquitoes and reduviid bugs show nocturnal periodicity and are able to carry out their deadly act when human subject is as sleep. (4) Nature of food: It is well noted that while male insects feed on plant juice (nectar), female insects with mouth parts feed on blood. Female mosquitoes suck blood because of protein derived for reproduction of egg.

REPRODUCTION AND FAMILY HEALTH PART SIX (6)

Prevention of RTA
- Education
- Engineering – better cars
- Enforcement - law
PHC – Demography
Definition: Demography is defined as the scientific study of xtics of human’s population in terms of xture, distribution, growth and development.
- Xture means the distribution of persons present in the pop by sex and age
- Distribution refers to the spread of the pop by certain xtics such as geographical spread.
- Growth refers to changes in pop size i.e. no of person in the pop.
Sources of demographic data:
(1) Census
(2) Vital registration system
(3) Migration records
(4) Special demographic survey
Census is defined as the total head count in a defined geographic region
Uses of census
(1) Planning health services
(2) Determine the dominator of health indices like infant mortality
Types of census
- Defector: Actual pop found on census day. It includes temporary residents and people in transit.
May be bloated up if the area has high migration rate.
¬- Dejure census counts only permanent residents or arbitral resident’s population.
other uses of census
(3) Planning for health and other national goals (millennium dev goals)
(4) Budget ring allocation
(5) Denominator for calculation of vital rates
(6) Monitoring and evaluation of health programme
Demographic processes.
These are events in the pop that determine the size, composition distribution. These are fertility, mortality, marriage, migration and social mobility
Demographic transition is the movement of a country from one stage of demographic cycle to another.
(1) High stationary – High rates, and death rate no pop growth
(2) Early expanding (2nd stage) – Death rates are declining while birth rates remains unchanged. Therefore pop grows.
(3) Late expanding – Death rates decline while birth rates falls pop grows
(4) Low stationary – Low birth rates with low death rates pop does not grow.
(5) Birth rate is lower than death rate. Pop size reduces.
Countries in Sweden and Finland are in stage 5.
Nigeria and other Africa countries are between 2nd and 3rd stage.
Growth rate in Nig is 2.9%
Demographic processes
Fertility – This is the actual bearing of children. It is also called natality
Determinants of fertility
(i) Age at marriage
(ii) Duration of marriage life
(iii) Spacing of children – minimum of 2 years
(iv) Level of education
(v) Religion
(vi) Nutrition
(vii) Contraceptive prevalence
(viii) Economic status
(ix) Social factors.
Population xture
This is a pictorial representation of population in histogram of age and sex. This is called population pyramid.
Horizontal histograms are used. One column reflect male and the other, the female sex, age is represented on the vertical axis.
Interval of the age is 5year interval
There are 3 types of population pyramid
(1) Expansible
(2) Constrictive
(3) Restrictive
The type of population pyramid gives an indication of the ffg:
(1) Level of technological development of the country
(2) Predominant economy
(3) Birth rate
(4) Death rate
(5) Dependency ratio
(6) Sex ratio
(7) Pattern of predominant dx.
Expansile population pyramid
Has a broad base is shows high rate. It tappers to the top – high death rate. It has high death rate and high infant mortality rate. It occurs in developing countries in agrarian economy and it has low life expectancy.
High dependency ratio, low use of contraception, communicable dx predominance.
E.g. of countries are Nigeria, Kenya, Ghana etc.





Triangular pyramid.

Constrictive population pyramid.






Have broad base, broad top; narrow in the middle famine, war and dx e.g. HIV ravaging countries.
Have high dependency ratio, high birth rate, and high death.
E.g. Democratic Republic of Congo, Kenya, somalla, Uganda.
Restrictive population pyramid.



Also called rectan0gular pyramid.


This occurs in developed countries. They have low birth and death rates. The histogram bars are of almost equal size.
Non communicable dx are most common.
E.g. Hungary, Poland, Britain, America.
Dependency ratio = <15 + >65
15 – 65
Sex ratio = M: F
At birth 104: 100
Difference between demographic transition and epidemiological transition
Distinguish between crude rates and specific rates
Distinguish between mortality rates and morbidity rates
Distinguish between De jure and Defacto census.
EPIDEMIOLOGY OF NONCOMMUNICABLE DX (N.C.DX).
NCDX – Impairmt of bodily fxd or xture that necessitates a modification of px normal life and persist over an extended period of time.
Characteristic
(1) Permanence
(2) Residual disability
(3) Non reversible
(4) Requires long period of observation or care.
Requires training of px for rehabilitation.
E.g.: of NCDX.
(1) Trauma - RTA
(2) Neoplasm – cancer
(3) Nutritional deficiency – obesity, xerophtalmia
(4) Genetic or congenital problems – sickle cell, lip, hairy pinna
(5) Metabolic conditions
(6) CVS problems – MI, coronary heart dx
(7) Renal dx – End stage renal failure, chronic nephro
(8) Neurological – stroke
(9) Mental illness
(10) Musculoskeletal disorders – arthritis
(11) Respiratory disorders – Asthma
(12) Endocrine – Diabetes mellitus
Epidemiological patterns of dx.
(1) Traditional patterns – occurs in: developing countries
Developing countries: - There is high crude birth rate, clued DR.
Fertility rates, low life expectancy; high maternal mortality communicable dx predominates.
(2) Transitional pattern: Includes declining crude birth rate, declining crude death rates, fertility rates. Rising life expectancy falling maternal mortality, double dx burden (both NCDx and CDX)
(3) Developed countries pattern:
Low birth rates, low maternal mortality rate, high life expectancy NCDX predominates.
Some NCDX tends to be associate with communicable dx:
(1) Rheumatic heart dx: - caused by sour throat with hemolytic strept.
(2) Cancer of the cervix – HPV,
(3) kaposi sarcoma- HIV
(4) Burkitt lymphoma-HIV,malaria
(5) Primary liver cell carcinoma –HBV
(6) Glomerulonephritis caused by streptococci, skin infection.
(7) Malaria nephropathy
(8) Diabetes mellitus by viral pancreatitis
(9) Cardiomyopathy – Diphtheria, whooping cough
(10) Peptic ulcer dx – helicobacter pyloric
Epidemiological Transition
Traditional pattern of dx in the developing countries are beginning to change. There is a shift from communicable to NCDX. Mixed pattern of dx is therefore noticed in many developing countries.
Reasons for epidemiological transition
(1) Demographical transition:
Declining births, declining mortality and therefore longer life expect racy
(2) Changes in ecology
(3) Changes in lifestyle – nutrition (minerals and mr Biggs) multiple sexual partners
(4) Industrialization and urbanization
NCDX or No communicable conditions of public health importance
(1) Breast cancer.
(2) Cancer of cervic, lung cancer, prostate cancer
Hypertension, diabetes, Rheumatic heart dx
Coronary heart dx (MI)
Stroke mental illness, RTA.
Epidemiology and control of dxes transmitted their respiratory tract.
Dx transmitted the respiratory tracks are air borne dxes
The infective agents old are viruses, bacteria, rickettsia, fungal.
E.g. of viruses
(1) Measles caused by measles virus
(2) Mumps – mump virus
(3) Rubella – Rubella virus
(4) Chicken pox – Vericella zoster virus
(5) Influenza – Influenza virus
Bacteria
(1) Tuberculosis – Microbacterium tuberculosis
(2) Diphtheria – Corynebacteria diphtheriae
(3) meningitis – Neisseria meninigitidis
(4) Pneumonia – Staphylococcus, streptococcus
(5) Pneumonic plague – yersinia pestis
(6) Pertusis – Bordetella pertussis

Rickettsial
(1) Q fever – coxiella burnetti
Fungal
Histoplasmosis – histoplasmosis Duboisi
Reservoir of most of these infections is man.
But rat is the animal reservoir of plague.
Some of these dxes have carrier stage: e.g. in meningitis
A carrier is a person who has not showed the clinical manifestation of the infection / dx
Route of transmission
(1) Droplet
(2) Droplet Nuclei
(3) Dust
Droplets are large particles that usually escape when the pt coughs, sneezes or talk violently e.g. TB PX may contain food debris and micro-organism enveloped in saliva or secretions of upper respirator tract.
Droplet neclei are fragmented droplets and air carries the neclei from one person to another.
Host factors
These are factors in the host that prevent transmission of infection e.g. coughing reflex, sneezing reflex, mucociliary action in the respiratory tract, host immunity: e.g.
An attack of measles confers long life immunity
An attack of plague confers partial immunity
An attack of influenza virus does not confer any immunity of the changes in the strains of the influenza virus.
General method of control of our borne dx.
(1) Elimination of reservior of infection
- treat man reservoir
- destroy the animal reservoir if the animal is a nuisance
- vaccinate the animal reservoir that is useful to you
- Eliminate dust
(2) Interrupting transmission route
- H/E – don’t cough / sneeze any how in public
- Avoid overcrowding: - ideally a TB PX should not go to market
- Good housing and good ventilation
(3) Host susceptibility
- Chemoprophylaxis e.g. INH used to prevent TB
- Immunization
Meascles
Occurrence worldwide
Organism meascles virus
Reservoir man
Transmission Airborne – Droplet
Droplet nuclei
Dust
Special epid. Common in malnourished
Children.
Special epidemiology of measles.
- Maternal protection in 1st 6month of life X 6/12
- Common in malnourished children especially PEM.
Symptons of measles:
Fever, rashes at the 4th day of fever, Xtics koplict spot opposite the 2nd lower molar, complications of pneumonia; conjunctivitis, oral trush, gastroenteritis, measles encephalitis
Incubation period of measles – 10 days x 10/7
Lab Diagnosis – more of a clinical diagnosis, culture the virus and serological techniques / immunological techniques.
Heamagglutination tests.
Control of measles
- Isolation of the child
Address the issue of malnutrition: H/E
- General method of control (elimination, interrupted and host susceptibility)
- Treat the complications
If you suspect the child of measles infection within 48hrs, give measles immunoglobulin, it will prevent progression of the measles from the sub clinical stage to the clinical measles

Meningitis

Occurrence – worldwide
Meningitis belt -: 50 to 150 north of the equator.
Organism- Neisseria meningitides
Reservoir- Man
Transmission- Airborne: Droplet nuclei, dust.
Special Epidemiology
- Rainfall of meningitis belt is of the order of 300 -1200mm
- High waves Epidermis comes in waves usually it starts at end of dry season and disappear when the rain starts/ at onset of rain symptoms
Fever, neck stiffness and positive kerning signs on clinical examination.
Complication: kernicterus, severe jaundice, intercerebral hemorrhage
Incubation period – 3 to 4 days
Lab diagnosis – Nasopharygeal and throat swarb
- CNS specimen and analysis it / CNS analysis
Control – General
- Treat Px with chloramphenicol and penicillin, cephalosporins.
- Treat all contact with the Px within the incubation period
- During meningitis outbreak, do mass vaccination of
Everybody.
TB
Occurrence – worldwide
Organism – microbacterium tuberculosis
Reservoir – man, cattle
Transmission – Airborne : Droplet, droplet nuclei, dusts.
Special Epidemiology
200million cases worldwide, 8million new infection every year and 3million deaths every year. No 1 killer in the world, followed by hepatitis. HIV/ AIDS is no 3.
Without treatment, 50% of TB Px will die, 25% will go into complication and 25% will resolve.
Symptoms
Cough of 3weeks and above; night sweat, low grade fever, coughing blood (heamoptysis), progressive weight loss
Incubation period – 4 to 6 weeks
Lab diagnosis – sputum microcopy using ziebi neelsen method culture of sputum using lowenzing gensing medium
Control – General method
Primary – H/E: warn against bad housing,
- BCG immunization
Treatment of TB
Treat for 18 months.
Secondary – treatment and contact tracing in the last 4 – 6weeks
Territory – management of complications.
Directly observed treatment short course DOTS
DOTS is the latest strategy in the control and mgt of TB
DOTS work every where in the world including Nigeria
There are 5 elements of DOTS.
(1) Diagnosis – History taken, cough of 2months, loss of weight e.t.c.
Hx exam and investigation using sputum microscope (Z.N staining).
Train all health workers to recognize cases of TB and diagnosis it.
(2) Prompt px mgt: - Direct observation for intake of drug for at least the first 2months (initiation period)
(3) Political will to ensure that the drugs are available.
The drugs are INH, pyracinamide, rifampicine, and ethambutol
Thiatezatone (contraindicated in HIV PX)
(4)Monitoring and Evaluation
At the end of imitation period, repeat sputum microscope is should be negative and continue the continuation stage/ phase
If the PX is still true at the end of imitation stage, increase initiation to 3months and reduce continuation stage to 5months.
At the end of 5/12, repeat sputum microscope and at 8/12, repeat it.
(5) Global dynamic movement: stipulates that everybody should contribute its own quota to TB management.
In case of treatment rejection, DOTS is started all over again and streptomycin is included in the treatment (tx rejection – At the end of the 8 months, the px is still true).
Uses of Tuberculin test – check text for details
- For clinical diagnosis
- Identifying susceptible gaps
- Epidemiological surveys
Dr Olowu
Community power xture and comm. Processes and their implementation for the success or failure of health programmes.
Power is always the centre of attraction and seat of authority and in all areas of man’s endavour these is the quite struggles for power. Power can be recognized in terms of money property, influence or clout
Age still plays a role through less pronounced in the present day value system. However some measure of humouring is accorded the old people in the community and the remnance* of the African value system still makes them relevant and they still respected.
In the comm., there is hierarchy and the ‘Bale’ or ‘Oba’ is still the paramount person whose opinion cannot be down played. The implication of thus setups for the success or failure of health programmes is grave / vital. Any successful process must enjoy the support of the comm. Leader and the powerful people in the community.
For a program to be acceptable and embraced, it must be well packaged and sold to the powerful people both by virtue of been the Oba/ Bale or the rich and influential in the community.
If it is a program that can be accorded colorful launching these people must be present at the ceremony and if it involves getting them to publicly endorse or partake in the programme this will go a long way to inform the people that the program is highly recommended and should be supported.
Once the support of these people perceived and acceptable to the power point of the society, approve openly that the program is good, it is most likely the program will succeed.
Failure of a program is almost certain if these people are against or along the line misunderstanding crops up and the program happens to be a good tool to fight among them, and then there will be a problem.
Common vectors and their control.
Vectors are arthropods of medical importance. They are arthropod or organisms or animal is carry and transit an infection directly or indirectly from an infection animal to a human or from an infection human to another human. They live close to man and act as carries of diseases.
E.g.: They are broadly classified into:
Class insecta, class crutaceans and class arachnida.
The mollusca are also vectors. (The snails)
- Insects: female anopheles mosquito (malaria), yellow fever, dengue fever
- Arachnida: human fleas (plague)
- Crustacians: Cyclops (Guinea worm)
Mechamechanism of Transmission
- Direct contact (like in house fly) either with food, sore or any open ulcer.
- Mechanical transmission e.g. housefly has hairy body to carries the agent. When the fly comes in contact with food, it shakes its body and drops the agent
- Biological transmission e.g. mosquito. The agent developed inside the vector without the vector, the agent cannot become infective.

REPRODUCTION AND FAMILY HEALTH PART FIVE (5)

Type of researches.
(1) Basic researches- new knowledge & technology are generated to deal with major unresolved problems .it provide information require it for planning healthcare and monitoring trends or among other thing e.g
(a) Identifying the factor that influence a certain behavior
(b) Comparing treatment regimen among other thing
(2) Applied research –Identification of priority problem and evaluation of policies & programmes that will deliver the greatest benefit using optimally the available resources .
(3) Clinical Hospital research
(4) Experimental / Laboratory research
(5) Epidemiological research
(6) Health system research
Designs of Research / studies.
(1) Observational study design
(2) Experimental study design
Observational: Descriptive and Analytical.
There are three main type of study designs
Descriptive studies- Describe the patterns of health problem especially in relation to person, place and time
e.g case record –Reporting a case you have never seen before in a journal.
Case series –reporting more than one case
Cross section e.g side view – looking at a number / set of people in a class.
Descriptive researches- study the frequency amount and distribution by person .place & time of dx or events within a population. It include case report, case series reports & cross sectional researches.
Advantages
(1) It generates information quickly hence useful when result are needed urgently and when resources for study are limited.
Disadvantages
It cannot determine the pattern of manifestation or long term trends of the health issue in focus.
Case reports – Are usually report of unusual dx or association. It is expected to generate information for further investigation.
Case series report – Aggregate of case reports
Advantages of case report studies.
(1) It generate research issues
(2) It sensitizes physicians to differential diagnosis and alternative management techniques.
(A) Cross sectional study – measurement are done as single observation and set out to describe a situation e.g the distribution of an event in a population in relation to age ,set and other specific characteristic .
Disadvantages – difficult to ascertain temporal relationship since both exposure dx are measured at the same times.
Ecological correlation study – Anther eg of descriptive study
(B) Analytical studies –can be a retrospective study or the control
The subject of interest is individual in the population but in contrast to descriptive research that looks at the entire population, but inference is not to individual but to the population from w they are selected.
The objective of analytic research is not to formulate but to test hypothesis and to investigate causal factors.
Analytical studies are stronger than cross sectional studies in establishing association.
(c) Case control study – case &control – test hypothesis on association between suspect anthological factors and the occurrence of the dx. It is a retrospective research. It compares the frequency of exposure ti the suspected etiological factor between person with the dx (cases) and those without the dc control
Advantages of case control researches
(1) A short study time and it is particular useful for study of drug include illnesses.
(2) It is relatively inexpensive
(3) It is suitable for study of rare dx.
(4) There is no risk to the subject
(5) Allow to studies of several different anthological factors .
(6) It requires comparatively few subjects.
(7) In case control researches, risk factors can be identified so that rational
Preventive & control programmes can be established.
(8) Ethical problem are minimal.
(9) There is no risk of athriction – subject will not disappear.
(10) It is relatively easy to carry out.
Disadvantages.
1. It might be difficult to select an appropriate control group.
2. There is problem of bias because we are relying on memory of past records and the accuracy may be uncertain and the validity of these might be impossible.
3. We cannot distinguish between causes and associated factors.
Cohort studies – Exposure & non exposure
4. Cohort is a group of indiv. Who share a common experience within a defined time period. A cohort study is a prospective study in to the investigator compares the occurrence of dx in a group of indiv who are exposed to the suspected risk factor to another group of indiv who are not exposed.
The info. Obtained on the incidence of dx or outcome in each study group is analysed to obtain a relative risk. If the incident of dx is higher in exposed than in unexposed group, there is an evidence of association.
Types of cohort studies
i Prospective cohort study – The outcome has not occurred a the time the investigation begins. Exposure & non exposure are ascertained at present. These study groups are followed for several years and the outcome is measured.
Eg long term effects of exposure to uranium in miners to assess subsequent development of lung cancer.
- study of oral contraceptives and health the Royal college of general practitioners.
ii Retropective cohort study –is one in w outcome has occurred by the start of investigation. Here, exposure is ascertained from objective record of the past, and the outcome is ascertained at present
iii Combination of prospective and retrospective cohort studies – Here exposure is ascertained from objectives records of the part e.g. pple exposed to ionizing radiam from atomic bomb, then we follow up and measure outcomes in the future.

Advantages of cohort studies
i There is lack of bias – bcos there is objectives records.
ii It is a method of calculating the incidence of a dx.
iii The absolute risk can be calculated directly.
iv It permits observation of many outcomes.
v There is temporal (cause-effect) relationship btw wt they were exposed to and the outcome.
vi Since exposure is not assigned, ethical concerns are minimal.

Disadvantages
i It is not cost effective / costly.
ii It will take a long time and thee will be they will disappear athrition of the subject.
iii Suitable for common dx.
iv Changes in status of subjects wt respect to the factor exposure been studied.
v There might be changes overtime in diagnostic criteria.
Ethical issues in research
This is a system of moral principles and rules of conduct guiding researches to protect against possible abuses.
In 1947, the ist international code of ethics for research involving human subjects was established. This code lay down the stds for carrying out human exptam. Revised in 1975 and 1983.
1. In carrying out a study, do not use the pt name, initials or hospital no
2. Do not use any identifying info. Published in written description.
3. Do not unpro imfringe on pt privacy without informed consent.
4. photography should not be published without written informed
5. animal exptam must proceed human exptam.
c. experimental / Intervention studies
The is similar in approach to cohort studies but the conditions in is the studies are carried out are under the direct control of the coordinator, as a result, informed consent must be obtained.
Aims of exptal studies.
1. To provide scientific proof of etiologic is may permit the modification or control of those dx.
2. To provide a method for measuring the effectiveness and efficiency of health services for the prevention, control and treatment of dx to improve the health of the community.
Exptal epidemiology has advantages & disadvantage of cohort studies Addition disadvantage are cost, ethics and feaslbilities.
Types
1. Randomized control – After obtaining informed consent, decision is taken on is subject to be exposed to or deprived of the facture by randomization. Randomization is a statistical procedure by to participants are allocated into group usually called study and control group to receive or not to receive an exptal preventive or therapeutic procedure.
Quasi exptal studies – A study is a true expt only if decisions about exposure & nonexposure to the factor under investigation are made by the investigator. This control is not always possible for the investigation i.e the control of decision about exposure & nonexposure is not totally in the control of the investigator, so the investigator can perform the quasi expt in with observation are made by and after intervention are made to are not under the investigator control.
In quasi expt, allocation into the study and control group is without randomization.
Eg of expt studies.
- Clinical trials – Trying drugs on people
- Field trials – using vaccines eg finding effects of oral polio vacc. On children community interventions eg fluorination of their water and the outcome or prevention of dental caries or not.
- How to select subject into small grps / subject selection.
- Look for inclusion and exclusion criteria.
- Inclusion- pple in the study must be a cohort i.e have similar xteristics.
- Selection of controls- should be similar in all respect to the study grp except exposure to the factors.
- Exclusion- pple that are pregnant etc


RESEARCH
Title – must be concise but accurate it must show the subject of study, research design and the location and use. Must not be more than 20 – 22 words. Time must be included.
Abstract / summary – This part is the most widely publicized, published and most read. It is best written towards the end of the research but not at the last minute because it will probably need several drafts/ rewrite. It should be a distillation of the thesis, a concise description of the problems addressed, the method of solving it/ them the result and conclusions. Abstracts do not use. Contain references and it should be fully representatives of the study done i.e. contain all the components of the study done.
Declaration: - Declaration that the study is done by you put your name and sign.
Acknowledgement: - Appreciations of all the contributors.
Introduction: - must give insight to the problems identified for the research and must give a general overview of the present knowledge of the subject or topic. Background info is given here as to the magnitude of the problems, talk about who is affected and a justification for the study.
It should contain a statement of the possible benefits that may be derived from the results that emanate from the study. It must also contain the aims and objectives of the study.
Usually the general aims and objectives talks about the overall goal of the dissertative and the specific objectives break down this goal into simple achievable stages.
Literature review – chapter 2.
It provides an idea of what information already exist about the chosen topic so as to avoid unnecessary duplication. It affords the research the opportunity to learn about what other researchers inner field have done about the problem thereby enabling the statement of the problem as initially conceived to be refined when necessary.
It enables the researchers to familiarize himself what the methods use by others and what type of results they obtained.
Literature review must contain the ffg:
Standard definitions, classification, local perspectives, global prospective, policy statements.
Sources of literature review:
Formal literatures, journals, textbooks, reports of expert’s committee conference proceedings, electronic literature like the interest, unpublished works.
Materials and methodology – chapter 3
In methodology, we want to give enough information to enable others to repeat the study and be in a position to compare the result with yours.
It describes the exptal techniques used, it reports what you’ve done on several difference problems, it should be possible for a competent researcher to reproduce exactly what has been done by following the description because there is a good change that another researcher may want to do the same expect.
Important things methodology must contain
- Study area / location
- Demography xtics – age, sex, religion
- State sample size
- You must be honest to provide information about drop-outs, non compliance
- talk about sampling method used
- talk about data collection techniques and tools e.g. questionnaires, observations or interviews.
Results of study – chapter 4
There you state the result as you observe it. It is a presentation of what was report findings, give tables and figures.
Tables and figure must be complete by themselves and should be comprehensive enough
No discussion or conclusion should be included in the result.
Discussion – chapter 5
This is the main section that the ability of the author in logical thinking. You don’t have to repeat results but you compare them what respect to existing literature
Discuss the result obtained in a summarized pattern.
Conclusion and recommendation – chapter 6
From the results, you draw the conclusion. It emanates from results then recommend for further studies.
References
There are 2 major types
Vancouver and Harvard
Vancouver referencing – names are cited and are arranged and numbered in the order into they occurred in the text. It includes name, title, journal, year journal was published and page where the referent was gotten.
Harvard referencing – drawing up a list of authors with their names in alphabetical order and numbering the list as such includes: name, date, title, journal volume, and page.
Waste management: - Refuse and sewage Disposal.
Solid wastes are made up of gabbage (food waste), rubbish paper, plastic, wood, metal, glass etc), demolition product, sewage treatment residues, dead animals e.t.c. it constitute health hazard if not well managed because:
(1) It decomposes and favours fly breeding
(2) It attracts rodent
(3) The pathogens in it can be transmitted into food directly or indirect
(4) It can cause water and soil pollution
(5) It has unsiclic appearance and bad odours
Sources of refuse
(1)Street refuse is includes leaves, papers, straws some animal droppings etc.
(2) Market refuse – putrid vegetables, animal matters etc.
(3) Industrial refuse
4) Domestic refuse from home – refuse gabbage.
Refuse might is carried out in 3 stages to include:
(1) Storage (2) collection (3) final disposal.
Storage – Galvanized steel dustbin with close fitting cover a suitable receptacle for storing refuse. The capacity will depend upon the number of user and the frequency of collection.
Paper sack is a recent invocation in western countries.
Public bins are used for a larger number of people.
Collection / transportation – This can be done from house to house to avoid refuse been dispersed along the street.
Collection from public bins is also possible.
Refuse should be transported in enclosed vans
There is a wide varieties of refuse collection vehicles of difference shapes and sizes
Final disposal – The choice of a particular method is governed by local factors such as costs and availability of land and Labour.
Principal methods include:
(1) Open dumping – This is not a sanitary method of refuse disposal but it is easy and not expensive. It can be used to reclaim land for cultivation since it gradually converts to humus.
(2) Controlled tipping or sanitary land fill – This is very useful where suitable land is available. The refuse is placed in a trench or other prepared area adequately compacted and covered with earth at the end of each working day.
Chemical, bacteriological and physical changes occur in the buried refuse.
(3) Incineration – This is by burning. It is the method of choice where suitable land is not available. Hospital waste is to particularly dangerous is best disposal off by incineration.
(4) Composting – This is a method of combined disposal of refuse and night feaces soil or sludge (remnant from sewage treatment). It is a process of nature whereby organic matter break down under bacteria action resulting in the formation of relatively stable humus – like material called the compost is has considerable manure value for the soil. Composting should be done far away from city limits.
(5) Burial – is suitable for small camp and the refuse in it is covered with soil on daily basis.
Sewage treatment
Sewage is waste water from a community containing solid and liquid excreta, waste derived from houses, factories and industries. Silage is waste water without excreta (night soil).
The aim of sewage treatment is to stabilize the organic matter so that it can be disposal off safely. It is also to convert the sewages water into an effluent of an acceptable purity which can be safely disposal into land or sea.
Biochemical oxygen Demand (BOD) – This tests the organic content of the sewage. It is the amount of O2 consumed by the sewage within specified no of days and at specified temperature (usually 5 days and 20oc)
Modern sewage treatments.
(1) Primary treatment – This involves:
(a) Screening where metal screens intercept large floating objects such as wood, masses of gabbage, dead animals etc.
(b) Grit chamber – is a long narrow chamber their with the sewage passes to allow settlement of heavier solids.
(c) Primary sedimentation – sewage flows very slowly in the 1o sedimentation tank to allow for sedimentation of suspended matter under the influence of gravity.
2) Secondary treatment
Effluent from 1o sedimentation tank is subjected to:
(a) Aerobic oxidation – This is biological treatment with the use of trickling fulter which is made of a bed of stones, a complex biological growth consisting of algae, fungi protozoa etc. is formed. (Zooleal layer) in the fulter which oxidizes the organic matter in the effluent.
(b) 2o sedimentation – This is carried out in the 2o sedimentation tank for about 2- 3hrs. The sludge is carried aerated sludge.

EPIDERMIOLOGY This is the study of the frequency distribution and determinants of health related events or states in a defined population and the application of the study to the control of health problem
Road traffic accidents: - A non communicable dx.
Non communicable dx are conditions that cause impairment of bodily xture and fxn and necessitates the modification of the person’s normal life.
It usually exists over an extended period of time.
In communicable dx, we talk about triad of agent, host and environment.
In non communicable dx, we talk about risk factors which are attribute or exposure that is significantly associated with the development of a dx.
It could also be determinants that can be modified by intervention thereby reducing the possibility of occurrence of dx or other specified outcomes. Some risk factors can be modified, others can not be modified. Examples of non- modifiable risk factors includes
Age, sex, ethnicity / race and genetic makeup etc.
Modifiable ones are the risk behaviors, smoking, drinking, poverty promiscuity etc.
An accident is an unexpected unplanned occuence it may involved injury. It can also be defined as an unpremeditated events resulting in a recognizable damage.
- An occurrence in a sequence of events to user produces untended injury, death or property damage.
RTA are the causes of the highest injury mortality rate.
They are more in the developed than in developing countries, likewise in the urban than in the rural areas.
Commoner in males than in female; commoner in the young and very old. Commoner in singles, divorce, separated than in those that are married.
Commoner in the night than the day.
Risk factors – Alcohol consumption, use of marijuana or in the host.
- In the young and the old – Risk behavior.
- The old have slow reflexes and poor sight.
- Vehicular problems – Old be bad tyres, old rickety cars, bad breaks, poor light or glare. Absence of wipers,
- Environments – steep roads, winding roads, slippery surfaces pot holes, sharp bends, narrow roads and bridges and poor road signs
Control of RTA
Prevention:
- Primordial: prevention of emergence or dev of risk factors in pop graphs in to they have not yet appeared.
- Primary: (1) health promotion: (i) H/E (don’t drink / smoke and drive, obey road traffic signs), (ii) environmental modification – roads, better road signs, (iii) Lifestyle / behavioral changes (iv) H/E proper.
- Specific protection: use of salt belts, helmets
- Secondary: early diagnosis and treatment
Hospitals that will take care of RTA victims, hospital should treat before asking for police report. Provision of ambulances.
- Tertiary: Disability imitation – Do physiotherapy
- Rehabilitation – provision of crutches, wheel chairs etc.
- Legislation –To prevent and punish culprits
- Surveillance – Watching over and see if there are more accident occurring so as to take preventive actions against them.

REPRODUCTION AND FAMILY HEALTH PART FOUR (4)

PUBILC HEALTH LAWS.
Public – Anything that has to do with generality of the population.
Health – a complete state of physical, social & mental well being (Geneva 1948) and not just the absence of dx and infirmiter.
Law- Rules & Regulation guiding the conduct of pple in a communication.
Public health law-rules & regulation enacted to promote the advancement of health of individuals or groups.
PHL. May differ from one region of the country to another.
It covers all aspect of public health this are:
1. Registration of vital events.
2. Registration of school/institution or health professionals.
3. It covers food and drugs, sales and administration.
4. Health
5. Housing.
6. Occupational health
7. Dx notification
8. Vaccination
9. Others.
Why do we need PH laws.
1. To curb the excesses of people.
2. To give legal backing to the med officer of health (MOH).
MOH: This is a med doctor with a postgraduate qualification in PH. He operates at the Local Government level.
Fxn of MOH:
1. He advices Local Government Chairman on health matters.
2. He carries basic clinical work because he is a doctor i.e. treat pt.
3. He gives record of all health event in the local government.
4. He responds to preventive measures such as investigation of epidemic
5. Abatement of nuisance.
NUISANCE.
A nuisance is any action or premises that occur in such a way that it is dangerous or inimical to health.
Upon citing a nuisance, the MOH issues an abatement notice.
Content of Notice
In the notice he will tell you:
1. Your Offence.
2. He want you to do and give you a
3. Time frame.
In case of default or nonresponse to the abatement notice, he apply to the court of law …. Issue an 1. Abatement order ….. has the same content as the abatement notice.
In case of default, the court then issue a 2. Prohibition order is more effective. Further default leads to a 3. closing order.
Registration of vital events (like birth, death, divorce etc). all vital events must be registered with the MOH. MOH is the national population commission at the L.G. level. NPC. Decree 2 of 1989.
Local Government make bye law; Acts and law are made by state and Federal Government, Decree is made by a Federal Military Government.
Birth & Dealth compulsory registration Decree 9 of 1979 backs MOH at the Local Government level.
Registrations of school / Institution / Health personnel.
So as to discoverage quacks. UCH Act cap 450 of 1980,(National postgraduate medical college of Nig) NPMCN Act cap 266 of 1980 backs establishment of institutions.
Foods/Drug sales and Administration.
It is the duty of MOH to inspect any / every food or drug and to confiscate every bad drug or food.
NAFDAC DECREE 15 OF 1993.
Food & Drug Act cap 150 of 1980. Olorunda Local Government bye law of 1959 – Bakery and wine taping law.
Environmental Health.
FEPA – fed. Environment protection agency FEPA Act 08 of 1988.
EIA – Environmental impact assessment. Eg. Assessment of the impact of your proposed industry on the environment.
Housing.
Plan of proposed house building should be sent to the MOH for approval or to the town planner. The rooms must be adequate
Occupation Health.
 Workman’s compensation ordinance of 1941 was changed to workman’s compensation decree of 1987 state that unless the employer of labor.
 Factory Decree of 1987 has done everything humanly possible to protect the employee in the working environment, no blame or responsibility should be placed on the employer.
Disease Notification.
All dx. Must be notified to the MOH who will notify the state – fed. Govt. – world health.
Vaccination.
If you refuse to vaccinate your children, you will be fined.
Others: Road safety- use seat belt. Antitobacco law prohibit to bacco smoking in public. Slaughtering of animals should be with dignity.
Problems facing the enactment of PH in Nigeria.
1. Court – not enough & attend to civil & crimal matter facility is not adequate (biro, pencil and computers).
2. Local Government council: This is a Local Government that refuse to employ competent MOH.
3. A long time for enactment of PH law.
4. Unavailability of PH laboratories.
5. Workman’s compensation board is not established.
6. Problem of leadership indiscipline and politics.
Relevance of computer education in medical practice parts of computer – UCPU, VDU, (monitor), mouse, keyboard peripheral are printer and speaker.
Types of device.
Input device – mouse, keyboard. (storage device – Hard disk, output device).
Processing: input storage output
Types of Software
1. Word processing software – Microsoft world.
2. Graphic software – Corel draw
3. Presentation software - power point
4. Statistical package software – statistical package for social.
5. Communication Software – Internet explorer.
6. Epidemiological Software – Epi-info.
Relevance
1. Administrative fx2.
 Hospital resources – keeping record of hospital recourses (man, material, money)
 Patient record
 Health management information system.
2. Clinical
 Computer aided diagnosis: helps in diagnosis.
 Computer aided therapy – eg. Video assisted thoracic surgery, helps in treatment of patient.
 Tele medicine (Television Medicine).
3. Rehabilitation eg. Silicon chips in hearing aids, computer aided wheal chairs.
4. In research: In case of literature review.
5. Teaching: medical students, consultants.
Problems facing use of computers.
1. Affordability (due to the cost).
2. Availability.
3. Technical know how.
4. power failure (PHCN).
5. Computer viruses.
6. Spare parts are not available.
Prospects: very high.
1. Nigeria have a growing IT industry.
2. Many industries now assembles computer locally.
3. Federal Government have reduced subside on imported computer.
4. Federal Government have the plan to upgrade computer facilities in higher institution.
5. More computer literate consultant, registrar and so on.
PUBLIC HEALTH NUTRITION
Nutrition refers to the science of food and its relationship to health it emphasize the role of nutrient in body gwt, development and maintenance. Nutrition is a fundamental aspect of human life, health and development from the earliest stage of development in utero, at birth, childhood & even till old age.
Nutrients are organic or inorganic complexes that are obtained from food this are needed for government, repair and other bodly FXD. They cause a deficiency state when they are lacking and can be used to cure a deficiency state.
Balanced diet – a meal that contains all the nutrients in adequate qty & proportion to maintain health and provides reserves for short period of leanness.
Food security (food * Nutrition security). Household food security refers to a situation where the households have enough to satisfy hunger for the year round. National food security – when pple in the country have enough food to satisfy their hunger all the year round.
Classification of food.
1. Based on chemical composition – CHO, Pr, fat, vit, minerals.
2. Based on body fixation eg.-energy giving foods (like CHO).
- Body building food – protein.
- Protective food – vit and fruit.
3. Based on nutrient volume- macronutrient & micronutrient.
Macronutrient – CHO, protein, fats – form the major bulk of food needed in large amt. on daily basis have to be broken down be use.
Micronutrient – required in small quantity, for body fixation. Does not need much change before it can be used by body eg. Vit & minerals.
FOOD CONTENT.
This includes:
1. Nutrient
2. Dietary fibers eg. Hemicelluloses, Lichens, cellulose
3. Anti-nutrients eg. Phytates, oxalates, thiamine’s.
4. Naturally occurring toxins eg. Cyanogens, heamagglutinins and trypsin inhibitors.
5. Contaminants includes residues of agric chemicals, insecticides
6. Food additives, eg. Magi, ginger, locust beans, WHO recommends that energy supply in food should include CHO protein, fat (CHO = 50 – 65%, protein 15 -20%, fat = 20 -30%).
Minerals include iron used for formation of Hb, brain development and fixation and bust immunity.
Sources of iron – meat, poultry, liver & fish – Animal sources.
Plant sources – nut, green leafy vegetable & legumes
Iodine: essential for synthesis of TH, government and development.
Sources – sea foods, milk, meat, vegetables, cereals, water.
Nutritional problems of PH importance.
1. protein energy malnutrition (multi nutrient under nutrition)
2. Vit A deficiency
3. Iodine deficiency
4. Nutritional anaemias
5. Obesity
Protein – energy malnutrition PEM: this term refers to wide range of nutritional deferent with or without protein deferent commonly occurring in developing countries of Asia, Africa and Latin America. More than 1 billion pple suffer from one form of undernutrition or the other in Nig, unicef in 2003 quoted that 29% of children under 5 were underweight, 39% were stuned. Undernutrition is a sig cause of morbidity and mortality.
Classification of PEM.
Classe Body weight % of student Edema Deficit
Kwashikor 80-60% + +
Maramic – kw <60% + ++ Marasmus <60% - ++ Nutritional Dwarfing <60% - min Under weight 80 – 60% - + Features of PEM (1) Failure to Thrive, anorexia or hunger, apathy, irritability, fretful, diarinoea, skin changes (Flaky paint dermatosis), edema and Hair changes. Iron DEFICFENCE Commonest cause of nutritional anaemia other causes of nut. Anaemia include folate and vit B12 def. Common among children and women of child 15-45/49yr bearing age especially in developing countries. Severe form manifest as iron def include (1)hypochromic microcytic anaemia.(2)loss of skin pigmentation (3)papillary tongue atrophy (4)angular stomatitis (5) koilonychias Causes of iron def anemia. Menstrual loss, physiological demand of pregnant location, insufficient intake, presence of anti-nutrients like phytate and oxalate malabsorption, infections like malaria and hookworm IODINE DEFICIENCY Common among people who live in mountainous areas where water and soil are deficient in iodine. Goitrogens e.g. thiocynate can interfere with iodine utilization by thyroid gland. Iodine deficiency disorders; IDD- result from iodine def. this includes (1) Goiter (2) Hypothyroidism (3) Retarded mental and physical develop and less severe cases can lead to coordination defects in normal children co genital iodine definition syndrome include neurological cretinism VITAMIN A DEFICIENCY Result from inadequate intake common among rice eating people of Asia, Africa, and Latin America. Xerophtalmia refers to all ocular manifestations of vitamin A deficiency it comprises of night blindness, conjuctival xerosis, Bitot’s spot, cornea xeroses cornea ulceration and keratomalacia Management – vit A supplementation NID’S – national immunization days – children <6mth are not deficient >6mth, give 100,000 IV of vit A or 4drop of Red cap or Blue cap
>1yr – 60/12 5yrs, give 200,000 IU or 8drops of Red cap contain 8drop blue cap – 4day
Those children that come down with measles with signs of vit A def give 200,000 IU for 2day orally
Vitamin D Deficiency
Result from inadequate exposure to sunlight Ricket & ostcomalacia hypoplasia of enamel of the teeth are all consequences.
Assesment of nutritional status
(1) Anthropometric measurement eg weight /age height for age (stunting).
(2) Clinical examination: Fluffy hair, flaky skin,
(3) Lab / brioche assessmt eg H1 level, serum albumin for pritein serum ferritin for iron.
(4) Dietary recall – what did you eat yesterday night 24hr dietary recall, 72hrs dietary recall, 1/52 recall.
(5) Assessing dietary intake by cooking.
(6) Vital statistics include infant mortality rate, under 5 mortality rates, low birth Wight rate.
List nutritional def in PH & describe the
IMPLEMENTATION MACHINERY FOR PRIMARY HEALTH CARE (PHC)
At the fed gout level, there is national PHC dev agency NPHCDA established in 1993. It’s fx2 is to sustain the PHC.
2. It maintain PHC links btw SG and LG
3. provide logistics and health service research for PHC.
Nig is divided into 4 zones (A, B, C, D) wt zonal coordinators.
State govt – SG.
There is the state PHC coordinator.
LG level –PHC implementation steps are:
1. Community diagnosis:-This is a system of diagnosing the health problems of a community. In comm diagnosis, the thing you do is :
-Community entry: 1st go to the Oba of the comm to comm to gain his approval.
He then informs his chiefs etc
- After carrying out or research, you come out with the comm diagnosis
eg in ilie, the health problems are schistosomiasis, malaria, Gastroententis, Hypertension e.t.c
2. Situation Analysis – Ask question why this pple come down wt malaria schistosomiasis etc. May be lows of poor water etc. schist boos there is a nearby river
- Take inventory of existing health facilities: eg how many health centres doctors, beds, nurses, facilities for admission do they have.
3. Map of the Local Government and the community.
Divide LG into districts and assign health team into each district
4. Carry out PHC numbering of house and household, - Give no to each houses in the street eg houses no 1, 2, 3, etc.
5. Placement of home based cards. There are 2 types.
i. Chuld health cards and
ii. Adult health crads > 18yrs.
Eg in house 1, if there are 10 children, you place 10 child health card and if there are 5 adults, you place 5 adult cards in the house.
- There is health facilities based cards and community based cards.
Comm. based cards: The village health worker to is a member of the comm. who volunteered that he will treat anybody that fall sick in the comm..
XHCS 1. He is a volunteer health worker.
2. He must be 30yrs and above.
3. He must have received training from the LG.
4. He lives within the community and a member of the comm.
5. he is married and should have his own means of livelihood
The community health log book is kept with the VHW who records every sickness within the comm.
6. Community Mobilization –
District Village Health facility / centre
- form committee village dev. Health facility dev.
Dev. Committee.
- Tell the committee their fxn.
Put important pple in the committee eg the oba, pastor, chief, oluwo etc.
Their role is moralization of the comm. member to go to the health facilities whenever they fall sick.
7. Upgrade facilities at the health centre.
- Resources at health centre: Beds, Drugs, Form / Cards, workers are adequate There are cadres of workers – Doctor, VHW, comm. health offices, (CHO), CHEW TBA (traditional birth attendant); VHW & TBA are parts of the comm. Train them, and provide the facilities for them to operate.

STRATEGIES
1. comm. Participation. Comm. participate comm. comm.
Mobilization organization
2. Integration
3. Intersectoral collaboration
4. Referral system
5 Essential Drug Program
6 Good managerial Capability
Project with comm. participation has the ffg Advantages.
i. Less costly
ii. Utilization
iii. Sense of responsibility
Integration – This means that diff health services going on in the same health facility/centrs at the same time. Eg performing immunization, ANC and family planning on the same day.
Intersectional collaboration – eg in case of diarmoe, get to the root of the problem i.e due to poor sanitary, facilities, bad water, bad personal hygiene or secondary to poor housing – this needs ministry of work/housing.
All these ministries will have to come together and work so as to eradicate the cause of the diarrhea.
* PHC is the 1st level of contact for the pt. and to secondary health centre is the 1st level of referral.
30 HC eg (LTH) – The general hospital refer the pt to the LTH.
Essential Drug Program.
When requesting for drug from the LG, request drugs that is needed by the comm.
Essential drugs: are drugs that address health problem of atleast 90% of the comm.
Problems facing Implementation of PHC in Nig.
1. Poor management
2. Community participation – Involves 8 Steps.
3. Poor Utilization of health facilities 20 to poor coom. Participation
4. Poor referral system
5. Poor Linkage between the 3 tiers of government (FG, SG, LG)
6. Reverie area has problem – difficultly in crossing the river
PHC: - Community Organization
Comm. Participation (Principle of comm. participation & Ownership)
PHC is seen as the strategy to achieving health for all, after yrs of accepting this global initiative in Nigeria, PHC has remained largely the responsibility of the government,. No satisfactory achievert has been made in Nig because of limitation of resources available to PHC and low level of comm. ownership & participation is seen as cornerstone of PHC.
Some of the ways that comm. ownership & participation can enhanced include:
1. comm. organisation
2. comm. inactivation
3. Utilization of comm. resources.
4. Provision of services using voluntary village health workers VVHW and traditional birth attendants TBA.
5. Active collaboration of comm. with health care providers.
Experience from projects in he time past show that after record an initial success or demonstration of effects, these projects did no long service ½ter the pulling out of their sponsors and two reason has been accrue to this.
1. On terminating the external funds, the recipient country, comm. lacks the capacity and the resources to sustain the project on a permanent basis.
2. Even when host comm. has potential to sustain, they are not usu. involved in the design & implementation of these projects consequently, there will not be sense of commitment or ownership on the part of the comm.
Comm. involvmt in health is a process by to partnership is established between the government & the local comm. in the planning implementation & Utilization of health activities in order to benefit the comm. from increase self reliance & social control over the infrastructure and techniques of PHC.
CIH is widely acknowledged to be essential to the dev of health services particularly in the developing countries.
It is often made easy where comm. organisations are in place.
Ways of enhancing comm. ownership & participation include.
1. Comm. organisation – This is aimed at achieving self sufficiency in the running of comm. affairs and enabling each comm. to under-stand & appreciate its uniqueness in terms of culture, group pride as well as dignity associated with dx control.
It has been found that success in getting a comm. involved in the dev and operation of PHC and its component program depends 101y on the comm. leaders and the extent to is their views are harmonized.
The organisation are diff groups within the comm. with diff interests is needs to be harmonized.

Fxnal comm. organisation could foster comm. resources in various ways for adequate health promotion & health education.
Comm. sense of responsibility & self reliance can be generated the IEC (info, education & communication) so that outside resource colud be depended upon only in case of emergencies
Various models of comm. organisation have been used successfully in the study of organisation.
These models depend on the situation and circumstances that prevail in the community:-
1. Comm. Action – This is used by disadvantaged group to catch the attention of the group to their problems. eg poverty alleviation program in Nig.
2. Financial contribution
3. Self help effort to provide amenities to government could not finance.
4. Self help effort to supplement a service is the government could not fully finance.
5. Activities to foster utilization of existing 10 health care services eg organising rallies to mobilise
6. Materials contributions by endive & interested groups for the provision of additional health facilities.
7. Collective commitmt of the comm. to the enforcemt of regulations cooperation between traditional & modern health providers.
Comm. motivation – can be enhanced their involuemt in every stage of PHC. Suggestion of comm. leaders might not be technically needed but may be the key to foster successful program
Usually there is lack of sense of ownership and participation when the comm. is not fully participating.
It may be the key to appropriate & local adaptation that is required for a health program.
Motivation could be enhanced if comm. is involved in health policy formulation.
Motivation could be enhance their involvement in every stage of PHC.
Ownership based on insolvent in PHC
Ownership based on involvement in PHC management alone is not sustainable but when there is utilization of common resources ,this resources include land labour, manpower, materials, money such as ventilated iproved pit (VIP), wells, waste disposal sites.
Benefits of utilization of common resources includes: better maintenance. Enhances security of the facility and foster utilization of the resources
3. Provision of services using WHW and TBAS.
- common should be involved in their selection
- Training and retraining is very essential. These personnel can be on disease PHC health involve .System as well as dx surveillance. They are also useful in disseminate of information. Give feedback to the comin is enhance common participation.
They can render home based care; eg care of pple living wt HIV/AIDS
Might of children wt malnutrition, rehabutato of pt with mental ht problem care of the elderly.
VVHW and TBAs can be agents of change in the comm. Educate them so that they could educate the comm. and bring ability to change.
They can be utilized in mgt of simple ailments within the comm .
They can prescribe drugs for simple ailments.
5. Active collaboration of comm wt health care providers.
Most ht care provides are not fully integrated into the comm in to they work and they themselves as provider of health care.
Integrated can be achieved the ffg
(i) Providing accommodation for the health care provides.
(ii) Comm can participate by sponsoring training of VHW and
Those dt are sponsored come back to the comm to serve.
(iii) A strategy can be deviced whereby comm. representative, can be involved in day to day mgt of health facilities at a capacity that is appropriate to the comm. This involvement may be inform of regular monitoring of the drug revolving scheme particularly where comm fund is part of the seat fund for the scheme.
A major pt here is that there is need for practical orientation & reorientation of health centre staffs to cultivate comm. interests and participation in health.
The health personelles need to attend comm meetings, maintings outreach work within the comm, and they should supervise the VVHW & TBAS and make regular home visits.
6. Comm. Health Education
The is a major way of enhancing comm participation in PHC. Health education should not be limited to health facilities alone, there should be periodic HE activities provided outside the health facility. This will enhance comm involvemt in public health activities. Health education outreach should be held at acceptable venues to foster better attendance & participation. It can serves as comm mobilization for various PH program. Comm leaders should be involved to create opportunities for program advocacy.
Advantages of comm Ownership & Participation
1. It is a cost effective way of extending a health care system to the geographical & social periphery of a country.
2. On understanding their health status objectively, the comm member may be moved to practice series preventive measures or to use them.
3. When the comm invest labour, money, material & time into health promoting activities, they will be more committed to the use and maintenance of the facilities.
4. Comm health workers if chosen by the come themselves have the people’s confidence.
5. It enhances the success of comm based & comm supported PHC.
6. it enhances sustainability of public health programs.
7. It takes cognizance of loco-cultural factors.
8. It will result in higher coverage of health services, effectiveness, efficiency, equity and self reliance.
History of health services Administration and the health team.
History of health service adm. In Nig is closely unked to the hist to the British outlook in the young colony. A nig health services adm was fashioned along the British system. Health adm began as an organisation to provide health care to soldiers and explorers. However it was operated side by side with traditional health care system. Is was in place by the British officer care into Nig.
Later the basic sources of health services are; government on & private. What we know as the modern health services nationaside can be traced to the successive national dev. Plans.
However, the point must be made that as soon as the country obtain independence, the outlook of health services adm. Changed to wards providing health care to all corners of the country.
The local government segment is the most peripheral & is community based and there can be designated the 10 level of the system.
The intermediate level is the responsibility of the states while the central or tertiary level is the domcun of the fed govt.
The health team
The team is made up of i. Doctor ii. Nurses, iii. Pharmacist, iv. Lab technologist / Lab scientist, v. Radiologist.
There must be cordial & civilized relatrship among the health team. All members must be good team players.
The doctor is the head. But is a kind of headship is should be put to positive use. A doctor must not lord it over other member of the group.
Doctor Doctor Relationship must be good and warm.
Much as it is not ideal, you may not like some pple but learn to tolerate, accommodate, work in good & polished atmosphere.
Tone of speaking must not should conceit or pride, uncouth behavior is unbecoming of any member of the health team.
It must be born in mind that no single tree can make a forest and we are all partners in the provision of health.
No matter the background of a doctor, once he/she has successfully gone their medical training, he/she must be able to manifest a civilized, cultured outlook.
The health team is an impute factor in the provision of good health care and every effort should be made to make sure it works in harmony.
Health planning process
There are 8 stages of health planning
1. Planning & developing planning competence
Planning should reflect the policy of the political power xture,
General public & professioners.
2. Statemts of policy and broad goals
Planning policies are politically determined.
3. Data collections serves as the bedrock of planning eg to determine health needs, utilization of facilities, infant mortality and cause as a means to determining how to modify MCH programs.
- Data essential for planning: Demographic:
No of pple & distributions, progressions etc.
4. Priority statemt – Nucleus of health planning is setting priorities Judgemt, wisdom & ability to bring together all relevant details are the ingredients needed in setting priorities.
5. Plan outline with statemts of major alternative proposal
The outline should include:
i. A dear definition of the technical aspects of the program
ii. The organisation framework required
iii. Personally and facilities needed
iv. Cost in comprehensible financial term.
v. Approx benefits to be expected relative to priority of concern.
6. Development of detailed plan with targets & standards:
Target should be set short term & long term, goals should be specified Targets & standards should be realistic and reasonable / achievable.
7. Implementation as part of planning process.
Implementation should be seen as part of planning. The planning should be part of the implementation. This will make him more realistic and will avoid ambiguity in the plan.
8. Evaluation:
Pla n Implementation Evaluation should be seen as a cycle.
1. The major purpose of planning is geared towards exploration of possitlities of how optimum use can be made of umited resources to meat priority needs
2. Also planning is a dynamic pr0 and in realty, many activities should be carried out concurrently so as to provide mutually supportive flow back & forth between various stages of the pr0 depending on peculiar local conditions and requiremts.
3. Flexibility is highly desirable esp at the start when adaptation a more necessary & more freq.
4. Planning should be best handled by a group or committee so as to proactive varied outlooks & thereby reduce the possibilities of indiv. Prejudice.

RESEARCH METHODS I & II
DESIGNS OF STUDIES.
A research is an investigation undertaken in order to discover new facts or get additional information. In health sciences, research is defined as a systemic collection, analysis interpretation of data to discover new facts, get additional information answer a certain question or solved a problem.
Methodology – It is the science of undertaking an investigate in other to discover a new fact. It is the systematic procedure carrying out researches.
Researches should be done to break new ground or to confirm or disprove ideals. I t could also be done to make new moves.