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.