HEALTH EXTENSION ACTIVITIES
Item
- Title
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HEALTH
EXTENSION
ACTIVITIES - extracted text
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Module - 404
HEALTH
EXTENSION
ACTIVITIES
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The Foundation for Research in Community Health
3 & 4, Trimiti B Apts., 85, Anand Park, Aundh, Pune - 411007
Tel: (020) 25887020, Fax: (020) 25881308
Email: frchpune@giaspn01.vsnl.net.in
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HEALTH EXTENSION ACTIVITIES
INDEX
Part - 1
i.
The Concept of Health
01 - 05
2.
Health, Poverty and Gender Discrimination
06 - 09
3.
Health and Development
10 - 13
4.
People and Concepts about Health
14 - 16
5.
Disease
17 - 23
6.
The Philosophy of Different Treatment Systems
24 - 28
The Role of Health Worker
29 - 32
Part - 2
8.
Anaemia
33 - 38
9.
Blood and Anaemia
39 - 43
10.
' Nutrition
44 - 47
Malnutrition: Social Aspect
48 - 51
Care, Nutrition and Women's Health
52 - 55
Pregnancy
56 - 61
Percentage of vitamins in food ? (To be translated)
62 - 63
Part - 3
(This part is given here for additional information and not compulsory
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for examination)
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1.
Introduction
64 - 70
2.
Description
71 - 80
3
Observation and Classification
81 - 89
4.
Analysis
90 - 97
5.
Conclusions and Planning
98 - 104
6.
Planning
105 - 109
Appendix
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11.0 - 133
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Lesson 1
The Concept of Health
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Aims
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On reading this lesson you will understand
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There are many concepts about health/illness.
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Concepts are changeable i.e. they can be changed.
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The discussion methodJ can be used to know people's concepts.
Knowledge
You will know about
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The definition of health.
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The ideas of people.
Skill
You will learn
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How should information be collected from people?
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How can information be used in the programmes?
Perspective
You will understand
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Thoughts are based
on previous experience,
New experiences can mould thinking.
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Introduction
This lesson will show you that people have different concepts about health or illness.
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They are formed by experience, time, society and so on. But they have the potential to
change. We have made an effort to narrate the concepts of some people how to make
efforts to understand them.
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The main duties of Ayushi, the health-worker of Haripur is to encourage
people for vaccination and family planning. However, people approach
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her mostly for treatment of illnesses. At first she faced a lot of problems.
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The information gained during training, brings a change in one’s concepts,
but these don't match the traditional beliefs of the village. It is a challenging
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task to carry forward the new learning in spite of the conventional ideas
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of the people. This requires testing of one’s ©He thoughts and relating
them to real life.
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It is unscientific to discuss a herbal medicine simply because it was
not referred to during training. One should try out traditional remedies
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if they have proved effective in the past generations. However, it is equally
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wrong to accept certain beliefs simply because of convention e.g. leprosy as a consequence
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of sin which has been disproved by science.
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While it is easy to convert our own thoughts,
is difficult to transform social concepts,
lead to strange reactions What responses do you expect?
Accusing falsehood directly can I
We have the alternative of first finding out the cause of a misconception like Ayushi
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did. She had experienced that some people asked for medicine for the smallest of illnesses
while others refused to see a doctor even in case of a serious illness. Her mother pointed
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out that people ask for medicine only when they perceive an illness. In other words, if the
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problem of small pox is interpreted as the curse of a goddess, people will try to appease
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made Ayushi realise that people’s perceptions need to
be tested.
Ayushi called a meeting of the women of the village.
These included the school teacher and the (lady)
Sarpanch too. Both of them had suffered from a growth
in their breasts. They had undergone treatment and
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surgery. Now they were leading normal lives with their
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families. Ayushi asked the women whether they considered these two individuals healthy
or unhealthy. The discussion brought out their understanding of the terms in different ways.
They debated whether “wanting to stay in bed” is a sign of illness or laziness; whether
looking well built meant healthy or being able to^Kone’s work was important.
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In rural Maharashtra a person is considered a patient if he is ill for about 2
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weeks and if the illness is considered serious. Otherwise he is just "ill."
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They considered an individual healthy if he had a good appetite, energy to work and
a good nights sleep. Then the women tried to describe the symptoms a “patient” as one
who fell ill often, didn t get children. Others disagreed about relating reproduction with help.
Some felt it was related to past sins etc.
FRCH conducted a survey in a small village. The villagers believed that being
unemployed signified disease because one cannot get a meal unless one works
and without food one cannot be healthy They have sold their agricultural land
to industries and now feel that they cannot get food without a job.
This clarifies that people’s ideas are affected with time, spread of scientific
awareness, conflicts in life and social as well as financial problems.
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The conversations of the women revealed that people who were dissatisfied in life suffered
mental problems. This condition was interpreted as illness by society. Thus every social
belief or practice could not be acceptable.
Here are some symptoms of health or “well-being"
Physical
1.
Good appetite
2.
Energy to work
3. Normal sleep
4. Not falling ill frequently
Mental symptoms of well-being include
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1.
Feeling satisfied
2.
Being calm
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3. Able to concentrate on work
4. Not harassing others
5. Not tolerating injustice
6. Respecting others
Symptoms of Emotional well-being include
1. Maintaining good interrelationships
2.
Having friends
3.
Self-confidence
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4. Self-respect
WHO has defined health as not just absence of disease or handicap but also presence
of physical, mental and social well-being.
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Ayushi concluded the discussion about symptoms of health and illness hinting that they
would discuss the causes of illness in the following meeting.
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Self Examination
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1.
Find out from people, their concepts about health
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3.
Find out people’s definitions of illness and patients
What are the implications of having a son to a pregnant woman in your village.
4.
How will you describe blind-faith? Give examples.
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Exercises
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Choose the correct alternatives
1. Why should a health worker understand people’s beliefs?
1. To modify misconceptions
2. To make them understand one’s thoughts.
3. To provide health services
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4. To obtain people’s help achieve health/to use their experiences /to utilise their
knowledge.
2.
The meaning of health is
1. Not falling ill
2. Not being handicapped
3. Not needing medicine
4 Being physically, mentally, financially and spiritually well
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3.
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Physical symptoms of health are
1. Not falling ill frequently
2. Having appetite / good sleep
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Feeling energetic to work
4. All the above
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4.
The symptoms of mental health are
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1. Having energy to work
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2. Having friends
3. Concentrating on work
4. All the above
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Answers
Alternatives - 1-4, 2-4, 3-1, 4-2
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Lesson 2
Health, Poverty and Gender Discrimination
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Poverty and Health are related to each other.
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Gender is related to health.
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Aims
On reading this lesson you will understand
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Poverty and Health are closely inter-related.
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Poverty doesn’t just mean not having money but is also connected to some other factors.
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Our health can suffer even by absence of information
Knowledge
You will know about
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Skill
You will learn
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Understanding the thought process of villagers.
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Identifying the problems of the village.
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Perspective
You will understand
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It is wrong to make judgements without knowing the cause.
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Introduction
Ayushi started to discuss the causes of illness. She introduced the conditions leading
to the death of a 2 year old girl Surekha. She had a cough and cold. Since she was a
‘girl’ (not a boy) her unemployed but drunkard father refused to allow spending on her treatment.
Moreover, taking her to a doctor or health worker would mean losing a day’s wages without
certainty about getting medicines or meeting the concerned person. Thus, even though a
health worker like Ayushi could have saved the daughter of a poor family, it didn’t actually
happen.
Ayushi extracted the following reasons of the child’s death from the women of the village:
1.
Not getting medicines on time
2.
Lack of organisation in government hospitals
3.
Higher charges of private doctors.
4.
Unavailability of transport for the patient
5.
Bad roads
6.
Neglect as a girl-child
7.
A working woman’s inability to spend
8.
No power of decision-making
9.
Lack of awareness about early stages of disease, illiteracy
10. Drinking and wife wife-bashing habits of penniless husbands.
11. Ignorance about saving.
Ayushi then added her comments about Indian conditions among children. Absence of
pure drinking water causes diarrhoea among children. Some tribal children die of malnutrition
simultaneously there are people who spend lakh’s of RUPEES on a single party. Is such
a society healthy?
While majority of the population lives in villages, rural folk do not get sufficient water,
health services and jobs. However all the facilities are abundant in cities Social health is
connected to developments. Next time they would discuss a well-developed area of the
country.
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Self Examination
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1. Make a monthly list of the no. of patients suffering from different diseases.
This will show you the likely months of prevalence of each disease
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2. Find out the periods of high frequency of cough and cold
3. What will you advise these patients?
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4. Study the map of your village to locate areas with greater requirement of services.
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5. List the people who will be helpful in gathering the above information.
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What needs to be done?
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• Control of villagers over staff and medicines of the government hospitals
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• Training local villagers for primary health care
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• Spread of Education
• Facilities like roads and transport in villages
• Efforts to maintain unity within the villages
• Improvement in conditions of women
• Financial independence, spending capacity of all.
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Exercises
Choose the correct alternatives
1.
What should we do to ensure health for all members of our society?
1. Have big hospitals
2. Have medical colleges everywhere
3. Good education for all
4. Efforts to raise social, financial, cultural levels of all
2.
What is the cause of illness?
1. Infection
2. Mai nutrition
3. Gender Bias
4. All the above
3. What is necessary for village-level health?
1. Staff Medicinal control by villagers iin government hospitals
2. Health Training for some villagers
3. Efforts to improve social and financial levels of women
4. All the above
4.
Health can be achieved by
1. Treatment of disease
2. Prevention of illness
3. Combined efforts to solve causation problems
4. Free health service for all
Answers
Alternatives - 1-3, 2-4, 3-4, 1-3
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Lesson 3
Health and Development
Aims
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On reading this lesson you will understand
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Explaining the scope of development.
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Efforts to determine the direction of development.
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The interrelationship of development with health
Knowledge
You will know about
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The meaning of development.
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The link between development and health.
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Skill
You will learn
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To know what people consider as development.
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Perspective
You will understand
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Respect for health.
Keep in mind people of all classes while making development plans.
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Introduction
Ayushi spoke at the meeting of the women of the saving group, about a so-called “well-
developed” area.
Renuka was a hard-working house-wife in a village. She also milked the cows and
buffaloes along with house keeping. Her husband delivered it to the customer while she
worked in the fields. She returned home to cook for the family even when tired.
Some people came to the village to acquire land for the big new industry. The villagers
were tempted by the high price offered. When worried about their occupation as farmers,
they were assured of jobs in the factory. The farm-workers were worried about themselves
but women like Renuka thought it was not for them to “think”. Since they didn’t have a male
child, her husband thought they didn’t need to “preserve” their farms. She didn’t interfere
with his decision to sell the fertile land.
All the agricultural land in the village was sold for “development". A big factory was
constructed in its place and a sparking colony in the near by area. Educated city-dwellers
came to live there. It was complete with security, trees and all signs of development.
On the contrary, the original vi’lage was reduced to poverty. The man and young boys made
merry with the cash-price received. But hardly anyone got jobs. The women like Renuka
were forced to work as maids in the nearby new colony. The factory waste contaminated
the river. Construction workers from other states built temporary shelters which soon developed
into a slum area full of plastic bags, stagnant water and devoid of facilities even for the
children.
Except for a handful of villagers no one else benefited by the coming of the factory.
Remaining land became barren. There was no money to feed the families, so animal breeding
was out of question. They had no facility in any ration shop. The factory had spread smoke
all around. The senior citizen were dying of pollution. The girls had to married off while
yet at school. The story is not imaginary. Renuka father-in-law actually developed chronic
cough due to smoke. Her mother-in-law lost her eye-sight and later she too lost her life.
The following points need to be considered
Social
1.
Evaluation of social regulations, ethics and creation of new regulations.
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Follow social rules beneficial to all.
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Understand and try to ch mge discrimination based on sex, financial , caste differences.
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Political
1.
Regular meetings of Gramsabha.
2.
Having many organisations in the village.
3.
Participation of women and backward tribes.
Economic
1. Be sufficiently able to fulfil basic needs.
2. Have security for future.
3. Availability of employment for all villagers.
4. Refuse to go to any limit for excess of wealth
5.
Reducing Alcoholism
6.
Abolish malnutrition
7.
Ban female infanticide
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8. Support for ill-treated women victims.
9. Eradication of corruption.
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Cultural
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1.
Respect women, elders and children.
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2.
Respect health.
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Environment
1. Potable water for all.
2. Sewage facilities in every village.
3.
4.
Social afforestation in villages.
5.
Proper pastures and grazing areas.
33% rural areas to be under forestation.
Think about the following points -
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Self-examination
1. Why do you think Renuka’s mother-in-law died?
2. What will you describe as development?
is or should be the role/responsibility in such examples?
3. What according to you
4. How should development be clarified?
5. What should be the responsibility of the factory?
rehabilitation of the displaced recently in India?
6. Which movement stressed the r------------
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Exercises
Fill in the blanks
(Smoke form the factory, Political Development)
1.
Renuka’s father-in-law died due to
2.
Holding the Gramsabha regularly is a part of
Match the following
1. Social development
1. Respect for elders
2. Economic development
2. Participation of women in Politics
3. Environmental development
3. Eradication caste discrimination
4. Political development
4. Availability of Employment for all
5. Cultural development
5. Potable drinking water for all
Describe in your words your interpretation of development
Answers
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Blanks
- 1-1, 2-2
Match
- 1-3, 2-4, 3-5, 4-2, 5-1
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Lesson 4
People and Concepts about Health
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Aims
On reading this lesson you will understand
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What may be the causes behind the reasons for illness.
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Which measures do people take for different diseases.
People belief’s about health are related not just with illness but also with all the problems
in their lives
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Knowledge
You will know about
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People’s concepts about well-being are not linked to illness alone.
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People have/use different remedies for each disease.
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Skill
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You will learn
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To know about people’s concepts.
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To understand the factors leading to peoples illness.
Perspective
You will understand
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Why there are so many reasons for people’s ill-health.
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Introduction
Ayushi had to discuss the causative factors of people’s ill-health. She asked the women
to explain how they tackled a patient. Some of them resorted to prayers and magic when
they related the illness to family problems. They tried rituals and pilgrimages. Only if they
didn’t see any improvement they went to the doctors after buying home-remedies and traditional
medicines.
This is what they gathered from their conversation -
1. The traditional medicines for some diseases are correct.
2. Just as we believe in allopathy though it has no cure for certain diseases, there is no
harm in believing in God.
It is easier to understand the behaviour of people if we understand the concept behind
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their life-style.
4. Superstition for some may be culture for others.
5. When we expect people to change, we have to provide the related facilities e.g. - sufficient
water to practice cleanliness.
Since the concept of well-being goes beyond the disease to all aspects of life, treatments
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will also be different for the diseases.
This lesson teaches us that people have knowledge (They are not ignorant). Diseases
like cough and cold can be cured by themselves. Yet doctors prescribe medicines. Just
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as we don’t consider this unscientific we cannot criticize villagers. They have used conventional
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remedies successfully.
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So you should ask people about their traditional medicines. Find out their beliefs about
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each disease and when they prefer to consult a doctor.
Summary
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The concept of health keeps getting modified with social and economic changes. You
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must gather information about it so that you can know which aspects about their ideas
need to be changed.
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There are different angles to health and disease.
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Health is related to financial, social and cultural aspects.
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Concepts can be modified.
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Self-examination
1.
Explain how this chapter has modified your beliefs.
2.
List the beliefs of 5 women from your village.
3.
Explain the factors which obstructed your discussion with the women and how you
overcome the difficulties.
4.
What further information do you need in this connection?
5.
List the home-remedies discussed with people.
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Exercises
1. Concept of health keeps changing with these alternations
1. Social
2.
2. Economic
3. Cultu'al 4. All the above
A health worker should discuss the beliefs of the people in order to
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1. Understand their health-related superstitions.
2. Change the misconceptions
3. To achieve good health when combined with their experience
4. All the above.
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The health-worker should be aware of folk-medicines
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1. Since some diseases are linked to blind-faith.
2. Some diseases get cured with home-remedies.
3. Treatments may have some problems.
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4. All the above.
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4. Take care of the following when enlightening people about health
1. Their concepts/tradition.
2. The political/social/geographic conditions of the area
3. Conventional/home-remedies
4. All the above
Answers
Alternate
- 1-4, 2-3, 3-2, 4-4
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Lesson 5
Disease
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Aims
On reading this lesson you will understand
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Which diseases are infectious and which non-infectious
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How epidemics spread.
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On which factors does health depend
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Knowledge
You will know about
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The role of a health-worker
Skill
You will learn
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Understand the difference between infections and other diseases.
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Perspective
You will understand
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Know superstitions among people and try to remove them.
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Introduction
Diseases - Illness means malfunction in the normal systems of the body. There are 2
types of illnesses -
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2. Infectious
Non-lnfectious
Non-lnfectious diseases are as follows
1. Changes caused in the body with age e.g. 'Vaaf (Gas).
2.
Deficiency -related e.g. diet deficient in vitamin A leads to night-blindness, anaemia etc.
3.
Abnormality since birth - e.g. cleft lip.
4.
Caused by external factors e.g. -allergy.
5.
Mental Imbalance.
6.
Unnatural growth of tissues e.g. tumour, cancer.
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Infectious Diseases
They may be caused by germs, they can spread from a pa'ient to another person
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Epidemics
When the some kind of illness spreads at the same time among many people in an
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area, it is called an epidemic.
Nature has a lot of organisms and germs. While we can see many like plants, birds
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there are microbes which are so small that they can't be seen by the naked eye. 1 hese
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microscopic organisms are viewed through the microscope. They occur everywhere - in
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air, water, trees, our bodies and even grow on food.
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They are of 4 types -
1. Virus
2. Bacteria
3. Saprophytes
Germs may be harmful or beneficial
bacteria
4. Parasites
Some of them prepare vitamins is our body-
convert milk to curds.
Germs cause illness like colds, coughs, TB and malaria. Even if they are all around,
people with good resistance don't get the disease because their W.B.C. can destroy them.
But weaker people lose to them falling prey to diseases and sometimes even to death.
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We can prevent the spread of diseases by a careful diet, cleanliness around us and vaccination.
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How do diseases spread?
1. By contact with contaminated food etc. as in typhoid
2. Direct contact with the belongings/bed-clothes or touching a patient e.g. cough, cold,
TB.
3.
Entry of parasites in our body- e.g. mosquito-bite may cause malaria.
4.
Bites by animals e.g. Rabies from infected dogs
The following chart shows that factors affecting health with information of them in the
form of a tree.
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Banyan Tree of Diseases
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The Banyan Tree of Diseases shows that (good and bad) depends on social factors
as follows -
1.
Life style
A good income, nutritive diet, a house to protect from cold/heat/rain, facilities for education,
public sanitation, sewage arrangement for flowing water, provision of latrines, timely and
suitable treatment together with some rest and mental health contribute to good health. 2.
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Drinking water
Insufficient water supplies prevents cleanliness, low levels of ground water are caused
by water flowing away or too much use by cash-crops. Impure water causes , diseases
like Polio, gastro, jaundice, typhoid less water means lack of bodily cleanliness causing
skin diseases.
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Tree of Health
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3.
Flowing water
Water around the house may contain germs that cause skin diseases. It also breeds
mosquitoes causing malaria. The garbage mixes with it and pollutes the atmosphere. It creates
bad odour and flies carry the infections into the house. Thus the surroundings should be
kept clean and soak-pits should be used.
4.
Latrine
Often rural population or slum dwellers pass stools in the open due to lack of toilet
facilities. This causes many diseases to spread.
5.
Health Services
We all must have information about how and where treatment for illness can be obtained.
6.
Health Worker Scheme
This was started in 1977, keeping villages in mind. A local villagers is t'ained about
health and simple treatments. The Government provides the medicines. Such bare-foot doctors
are common in China.
Our rights regarding health
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1. Health service is given treating a patient as a human-being.
2. There should be no discrimination based
3.
on financial state while treating a patient,
The patient must be informed about the disease and the treatment.
4. The patient must have the facility to complain if these rules
are not being followed, so
that he can get justice.
5. The most important thing is that everyone must get health related services (not just
treatment).
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Health for by 2000
The poor countries like India, Pakistan and Bangla Desh suffer from bad health. In 1977
a world meeting was held to discuss how the people can be free of some diseases. These
were the main points1.
Provide primary health care to all.
2.
Reduce malnutrition by providing a sufficient quantity of good food.
3. Arrange to provide clean drinking water to all.
4. All children be immunised against 6 diseases - diphtheria, whooping coilgh, tetanus,
polio, TB, measles.
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The government had accepted the above objectives for the year 2000.
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But what is the reality today?
We must remember that we have some responsibilities to reach the goal.
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Exercises
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1. Falling ill means.
1. Body becomes weak
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2. Getting infected
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3. Getting Fever
4. Disorder of normal functioning of body system
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An epidemic is
1. Spreading of disease
2. Many simultaneous patients
3. Many people get the same disease
4. The same disease afflicts many people together in one area.
3.
Itching or rash due to allergy is a disease that is
1. Infectious
2. Non-infectious
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3. Epidemic
4. Viral infection
4. A barefoot doctor in the Health Care Scheme is
1. A doctor serving in a village.
2. A government doctor in a village.
3. A doctor moving bare-foot in a village.
4. A health worker from the village, working with the people.
5. Our health-related rights include
1. Getting good food/water
2. Getting government health services
3. Providing treatment and preventive health services to all.
4. Immunisation of children.
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23
Fill in the blanks
(Environmental cleanliness) (Health for all by 2000) (Microscope) (Resistance of the body)
(B) (1977)
1.
can save from infection by germs.
2.
The Health Care scheme was made in
3.
The World meeting of 1977 decided to aim for
4.
5. A
is a preventive measure for spread of diseases,
is used to observe microbes.
(
(
Match the pairs
1. Contaminated Food
1. Non-lnfectious Disease
2. Cancer
2. Microscope
3. Mai nutrition
3. Mosquito
4. Malaria
4. Cause of disease
5. Germs
5. Typhoid
Answers
Alternatives - 1-4, 2-3, 3-2, 4-4, 5-3
Blanks - 1-4, 2-5, 3-2, 4-1, 5-3
Correct Pairs - 1-5, 2-1, 3-4, 4-3, 5-2
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Lesson 6
The Philosophy of Different Treatment Systems
(
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Aims
On reading this lesson you will understand
•
(
r
The principles underlying treatment systems
Knowledge
You will know about
•
The fundamentals of each system (‘pathy’) of treatment.
I
Skill
You will learn
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•
Respect all treatment methods.
•
The pathy (method) is a medium, not objective, if it cures a patient, it is suitable
for him.
•
Respect for and cautious use of tradition.
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25
Introduction
Treating a patient and caring for him is natural to all human beings, whichever place
or time-period.
The nomadic man used natural things for treatment. As man progressed agriculturally,
he began to use particular plants for particular complaints.
Even animals consume a particular, grass when they suffer from motions. But man has
moved away from such natural inspiration.
Naturopathy
This is based on the belief that the body is the source of disease. So the same elements
should be used to cure it. Since illness considered a slow-process, the treatment is also
slow.
(
Therefore the 5 elements air, water, sky, earth and fire are used with the help of yoga,
diet and isolated treatments.
Ayurveda
(
This also believes organisms consist of the basic 5 elements. There has been detailed
(
analysis of diet and conduct related to the 3 doshas - kafa, vaat, and pitta. They have
to be balanced by using elements opposing them.
(
Some people have all the three doshas in the same quantities while others have one
(
of them in excess. The ‘Prakirtidosh’ or ‘Tridosh’ can be recognised as follows -
(
1. Vaatdosh - Excess of this keeps a person slim and active but has a variable appetite.
Such a person doesn’t gain weight and keeps falling ill. Vaat dosh makes a person prone
(
to constipation prefer warmth and suffers in the cold. His skin is dry and stiff. His veins
are clearly visible.
2.
(
Pitta dosh - Symptoms of excess of ‘pitta’ are - intolerant to heat, softer skin, good
appetite hot-tempered, good excretory system.
3. Kafa dosh - Those with kafa dosh are quiet, low poor appetite but good stamina, sleep
well and love exercise.
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Some people have two ‘doshas’ together
Homeopathy
It was developed by Dr. Hanneman about 200 years ago. He felt quinine was not suitable
for malarial and tried it on himself when he was normal. He found it produces the same
%
symptoms as the disease even with changed quantities. Thus he concluded that substances
having the same properties can be used for treatment. Thus homeopathic medicine, consist
f
of different materials.
%
Allopathy
In this method diseases may be divided into infectious and non-infectious.
f
Non-infectious diseases may be caused by disorder in some part of the body like-heart
attack, cataract, cancer etc.
4
♦
They may be caused by external factor e.g. - poison due to snake bite, cough due
to smoking or ulcer caused by excessive drinking.
(
(
Diseases of deficiency like malnutrition leading to anaemia etc.
Problems since birth like birth marks or mental epileptic fit or conclusion, deformity.
Some diseases may be mental. Some things are harmful like anxiety, superstition or
uncontrolled phobia. Infectious diseases spread when attacked by germs.
Reiki, Acupressure and acupuncture
They are based on the faith in fiow of energy in the body. When obstructed, it causes
disease and has to be stimulated.
Self Examination
Which systems of treatment are available in your village?
Why do people go to witch doctors?
What do self-curing diseases indicate?
Write the symptoms when the patients should be sent to the primary health,centre
or allopathic doctor.
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27
(
Exercises
(
1. According to Naturopathy for good health are must
<
(
1. Be a vegetarian
(
2. Follow suitable timings for diet and conduct
(
3. Practice Yoga/pranayama
(
4. Use exercise/yoga/fasting/simple diet/water therapy.
2. Ayurveda is the science of
1. Human disease
2. Veda
3. Man’s living and disease.
4. Diet and conduct
3.
Infectious Disease means
1. Person to person
t
2. Many people at time
3. Disease among adults
4. Children’s frequent illness
4.
(
Non-infectious diseases are -
1. One Patient shows infection
2. Not contagions
3. Similar symptoms among many patients
4. One person has symptoms of many diseases
i
5.
These medicines don’t benefit
non-infectious diseases
1. Anti bacterial
(
2. Anti viral
3. Anti parasitic
4. Homeopathic
6.
The mam thing in Reiki, acupressure, acupuncture
1. Stimulating flow of energy
2. Focussing of flow of energy
3. Balancing the energy flowing
4. Controlling the energy flowing
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7.
Reiki, Acupressure, Acupuncture believe disease
is caused by
1. Obstruction in flow of energy
2. Increase of flow of energy
3. Obstruction in flow of electric impulses
p
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4. Obstruction in fluids of tissues
Fill in the blanks
(Homeopathy), (Man’s body is the source of disease), (Earth, Fire, water, wind, sky), (Natural)
(Dr. Hanneman) (Kafa, Vaat, Pitta)
1.
Naturopathy believes that
2.
Treatment and caring for patients is a
human inspiration.
4
4
4
3. Ayurveda believes that our body consists of Panchamahabhootas
4.
The imbalance of tridosh-----------------------c!luses disease in hu ~
5. —------------------- started Homeopathy.
6. Different substances having similar properties can be used as medicine for treatment
(
«
according to
4
Match the pairs
(
<
1. Cleft lip
2. Uncontrolled phobia
3. Non infectious disease
4. ‘Vaat Dosh’
5. ‘Kafa Dosh’
6. Reduce excretory problems
<
1. Mental Disease
<
2. Non-infectious disease
3. Clearly, visible, “Neela” (veins)
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4. Bacteria
ik
5. ‘Pitta-Dosh’
(
6. Poor Eater/Fond of physical exercise
(
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Answers
(
Alternatives 1-4, 2-3, 3-1, 4-2 , 5-1, 6-2, 7-1
(
Blanks - 1-2, 2-4, 3-3, 4-6, 5-5, 6-1
(
Pairs - 1-2, 2-1, 3-4, 4-3, 5-6, 6-5
(
(
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29
!
Lesson 7
The Role of Health Worker
Aims
On reading this lesson you will understand
<■
It IS necessary to imbibe the mind-set, life-style and psychology of the villagers in order to
work as a Health Worker in a village.
t
f
•
How to help others while continuing our own work.
•
Realise the meaning of culture.
Knowledge
You will know about
•
The role of a health worker.
Skill
You will learn
•
Working in coordination with people.
Perspective
You will understand
•
The implication of ‘culture’.
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30
Introduction
A new health worker called Madhuri came to Sunderpur. She had heard that Ayushi
worked in her neighbouring village and decided to consult her to decide how to start working.
Actually Ayushi had to complete her records the same day, but decided to share her
experiences with Madhuri as she worked.
A health worker called Mahadu was once bitten by a
snake. Ayushi had rushed to give him the anti snake
venom-injection (ASV). But instead he preferred to the
treated by a traditional healer in the temple. He recovered
in a couple of days. Ayushi pointed out that it meant
he was bitten by a non-poisonous snake otherwise he
would have died without ASV Injection. He reasoned that
hardly anyone ever died of snake-bite in that region, in
spite of several people being bitten. He attributed this
to merit and sin. He felt he was bitten because his wife
had worked during menstruation (against convention) but
was saved because he wasn’t a sinner.
Madhuri criticized the man for his ignorance. But Ayushi reminded her not to dismiss
I
his knowledge gained by his experience as a farmer. Statistically he knew people there
I
didn t die of snake-bite but being illiterate his reasoning was not scientific. But this didn’t
I
mean he was not intelligent. He could draw conclusions but he could not reject convention.
I
This concern for culture was preserved by Ayushi and whenever she gave the ASV injection
<
to a villager, she urged him to visit the temple. This endeared her to the villagers and they
I
agreed to take her treatment while they continued their cultural practices.
In the olden days people attributed all illnesses to sins and curses. They took patients
to temples or places of worship. Often they felt better. Modern medical science also tell
us that some diseases get cured without treatment, like viral infections. So there is no harm
C:
in such patients visiting the temple.
Madhuri was apprehensive about whether the villagers would ever change. Ayushi reminded
her that she herself was literate, worked and dressed differently from her own mother. Thus
generations were always changing, only change is a slow process. Some rebels always
oppose what is wrong in tradition e.g. Savitri Phule and Mahatma Phule. Though education
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was denied to women by convention, they decided to start it. No doubt they had to struggle
a lot. Contact with British culture helped them in this respect. Now educating women is
acceptable to society.
Thus neither should we consider tradition as totally infallible, nor should we reject it as
a whole. We keep learning through experience. Ayushi summarised some of the customs
favourable to our lives as follows -
•
Cleaning the teeth early morning is a standard practice. Use of neem is beneficial to
us.
Bathing before visiting the temple is important for cleanliness.
•
Joint families give support to all members, thus they rarely suffer mental illness.
•
Also senior citizens and children are cared for.
People giving traditional medicines do not charge money because they consider it a
sacred duty.
•
Every festival has a recommended diet which is beneficial for health e.g. Sesame and
jaggery provide warmth in winter.
Madhuri wondered how the above facts would concern her own work. Ayushi clarified
that she could mention these practices to the village women. She could include them while
encouraging them to talk about their health problems. This would bring the health worker
closer to the people. Involving them in trying out treatments would become easier if she
showed that she accepted the above conventions. Ayushi cited the example of how once
(
she once requested a witch doctor to help her when people refused to discontinue defecating
near the drinking water in spite of repeated efforts. The man spoke to the villagers and
they agreed. Thus she had used his authority to bring about a change from wrong practices.
This helped to prevent Gastroenteritis during the rains.
Finally she mentioned how she had learnt not get cross with the villagers. Once she
discovered that a little boy had night blindness. She scolded his mother for not bringing
him for treatment. The rustic woman retorted that she did not consider it an illness at all,
moreover she had no time to meet her. Ayushi realised that they first need to he made
aware about good and bad health. Only then could they be treated for perceived ailments.
Thus Madhuri realised the importance of getting to know what the people around her thought,
what they didn't know, and how they lived. This would help a health worker to identify problems,
familiarising them at the same time. Soon they would accept her suggestions.
[321
Self Examination
1. Explain how the chapter has changed your perspective.
2. Collect information about superstitions related to different diseases in your area.
3. What would you do in case of an epidemic? Whose help will you take?
4. What will you do to prevent contamination of water in your place?
in your place?
5. Discuss with people what they think about health.
Exercises
1. A health worker in a village should
1. Move about in the village.
2. Give information to peoole
3. Only tell people what you think
I
I
4. Understand people and work in coordination with them
(
2.
People take long to change because
(
1. People have blind faith
2. There is pride about forefathers.
<
3. People are stubborn
3.
4. Cultural practices have a deep impact upon people.
(
If you wish to change superstitions related
(
to disease,
1. Provide scientific information to people
2. Pressurise people
3. C
■
Understand
their experiences and give them time to accept changes
(
4. Educate people
(
(
Fill in the blanks
(
(Malnutrition) (A)
(
causes night blindness
(
2' ---------------- may cause swelling on the bodies of children
(
1.
Deficiency of vitamin
(
Answers
(
Alternatives 1-2, 2-4, 3-3
Blanks - 1-2, 2-1
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33
Lesson 8
Anaemia
Aims
On reading this lesson
you will understand
Getting information about the illness called Anaemia.
nowing the causes, symptoms and treatment of Anaemia.
•
FindTHh16
methods of testing the constituents of blood
the age-wise amounts of consti(uents in „orma| as
as
This chapter win develop y„ur kno„ledge. ski||s and perspective as fo||oms _
Knowledge
You will know about
•
What anaemia is
•
Which substances
•
are necessary to develop constituents of blood
and
Know the symptoms of anaemia thoseuy can be recognised
Skills
You will learn
•
Testing blood contents
•
How anaemic patients are treated
Perspective
You will understand
(
•
Zatana"'e ro°' T"
00 SUCh ’ 'aC9e scale
OW anaemia can be overcome through diet
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34
Anaemia can be defined as a reduction is the oxygen carrying capacity of blood. Since
it is very common in India, people get so used to it that the condition is not perceived
as a disease. This occurs more among women, particularly rural, but even children below
5 years and 20% men suffer from anaemia. It is aggravated by poverty.
Blood contains two kind of cells 1. Red blood cells (RBC) 2. White blood cells (WBC)
RBC contain haemoglobin which gives its own red colour to blood. The RBC are created
e
e-
in bone marrow and remain in the blood for about 3 months after which they are destroyed
in the spleen. There protein, iron etc are separated from them to make new RBC. While
e
unwanted material is given out through urine, making it yellow. This colour is noticed during
jaundice.
e
In anaemic condition, total amount of haemoglobin is reduced. In one kind of anaemia it
is reduced in all the cells while in the other kind, the no. of RBC is reduced.
€
Blood components in 100 ml gram
_________ Age
For Normal Health
6 months - 6 years
About 11
Less than 11
6 years - 14 years
About 12
Less than 12
Above 15 (male)
14 to 16.5
11 to 14.5
11 to 13
Less than 13
Above 15 (female)
Pregnant women
€
€
€
Less than 12
<
Less than 11
Causes of Anaemia
a.
€
In Anaemic Condition
Deficiency of Substances needed to produce blood
- Iron, protein and vitamin
B are all necessary for production of blood. If the diet doesn’t provide any of these sufficiently,
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there is reduction in the blood count. Malnutrition is the main cause of anaemia.
Iron - It occurs in green vegetables, whole grains, meat (especially liver). Using iron utensils
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while cooking also provides a lot of iron. If we take care of these two factors, you get
sufficient iron except when there is constant bleeding as in menstruation or due to hook
worms. Repeated deliveries may deplete iron. Thus children and women are more likely
Men need 30 mg while women need 60 to 100 mg. Though this is not difficult, in reality
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very little of the consumed iron can be obtained by the body. Thus to get 1 or 2 mg you
(
need to consume 30 to 60 mg.
f
to become anaemic. Women especially during pregnancy require greater quantities of iron.
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Protein
&
Vitamin B
Folic Acid is the main
constituent in vitamin B and occurs in green leaves.
Low count of blood cells
P“ “
oonZLpeXXZsXeT
to TB or typhoid can also Zo
can-kr>
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be etseXa'3 “X
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“"S 96,3
L0"9-tem
anaerma due to greater obstruction of blood ce'ls Cancer
“ * ^-disease cause anae™ Z
cause of anaemia has to be diagnosed before treatment.
(
Symptoms and diagnosis
infeXXXdTZ"
Z’ SymP,OmS
°Sl0W
f 9readeve
' '°pmenl of anaemia goes
h"9
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unnoticed Actually iron h
women come for o
time the count Is below 8 Th''
bacterial infecli
“’ey
SenSalions of llredTOSS “ n"®"
'““"S brM'hteSS “ be“me pa,e- b>'whKb
US symp,oms carl b8 seen m case of acute anaemia-continuous
h
o.xzz1::':z::of red cotour aro“ * -*———
Blood test
A blood sample is collected from the finger or vein in one of the many different ways -
wfihT'mven 'red sh TTh
counts
•
3 S-
°" WhiCh
bl00d ls “"Wed
h'S °nly Shows absence/presence of anaemia and not the
A drop of blood r
>s put in a blue saturated solution.
there is anaemia.
dr°P
It settles down if normal. If it floats,
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36
Treatment
It is important to take preventive measures among women and children. The ferrous
pills have been distributed for many years for this purpose. However, they must be urged
to consume them and be informed about health.
The treatment depends on the amount of haemoglobin. If it is only 2 or 3 gm, the patient
(
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needs to be a given fresh blood. If not possible, they should be given inferon or jectofur
(
injection under obstruction because it may cause a reaction. For others, doses of 100 gm,
(
iron can be given orally everyday. 33.3 mg is sufficient as a preventive measure. It takes
(
6 to 8 weeks to normalise the blood count. However, pressure of other diseases should
(
also be checked. A proper diet must be recommended, along with use of iron utensils.
(
In case of non vegeta'ians too, a mere one kg of meat for a family of 5 to 6 per week
(
is not enough.
(
(
Information about iron tablets
(
The government distributes 60 mg iron with folic acid from the vitamin B group be taken
for 3 months. Children are to be given liquid form by weight-5 ml per kilo as a prevention.
J
For anaemia the dosage is to be doubled. It causes dark stools and may cause burning
or constipation. It may be taken on an empty stomach but people may not find it suitable.
t
Some details about anaemia
(
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1. 40% women and 20% men have anaemia
2.
Women need 3 times more iron than men. Breastfed children also need it.
3. Anaemia has a range of cause from chronic dysentery to malnutrition.
4. Always remember that anaemia may be the cause behind fatigue, body-ache and related
symptoms like feeling unenthusiastic etc.
5. Anaemia has to be found out because patients rarely complain about it.
6. Anaemia lowers body resistance, increasing the risk of bacterial infections thereby.
7.
Preventive iron tablets must be taken for at least 3 months.
8. Iron injections may cause reactions
9. Jaggery, green vegetables and iron utensils provide sufficient iron.
10. The government has a programme for anaemia which is cheap and easy.
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Self Examination
1. Which diet is recommended to correct the deficiency ot iron, vitamin B and
2. Why do more women suffer from anaemia?
3. Why should pregnant women prevent anaemia?
4. Is there any way to eradicate anaemia from rural areas?
Exercises
Fill in the blanks
9m)' (less btood> <12°
fred). (iron, protein, vitamin B)
(Anaemia), (11-14.5 gm), (Iron
. .
i 60 gm/folic acid), (6-8 weeks)
t
1.
Anaemia means
f
2.
Haemoglobin is
3.
RBC are produced in the
4.
RBC exist for about
5.
The amount of haemoglobin
6.
Women have
7.
You need
8.
The primary indications
in colour.
among men is
of haemoglobin,
fof production of blood.
°f ~;-------------- -- are Pa,e> lifeless skin, fatigue and panting,
The blood becomes normal after taking iron orally for
weeks.
10. The iron tablets given through the government programme include
9.
and
Choose the correct alternatives
1. Colourlessness around
eyes and nails as well as a light flabby tongue in a person
suffering fatigue are the symptoms of 1- Anaemia
2. Malnutrition
3. Jaundice
4. All the above
2.
The causes of Anaemia can be
1. Long-term bacterial infection
2. Cancer
3. Worms
4. All the above
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3. The treatment for anaemia depends upon
1. The amount of haemoglobin
2. Amount of blood
3. WBC count
4. Diet
4.
If there is only 2 to 3 gm of haemoglobin
1. Fresh blood should be given
2. Iron injection is given
3. More iron is given through diet
4. All the above
5. Anaemia occurs among
women
1. 40%
2. 20%
3. 30%
4. 50%
6.
To prevent Anaemia
1. Take iron tablets
2. Give blood
3. Take an iron injection
4. Use iron-rich food and iron utensils
f
Match the pairs
1. Ferrous
1. Folic Acid
2. Vitamin B
2. Iron tablets
3. ‘Saholi’ method
3. Haemoglobin test
4. Pregnant women
4. 12 gm haemoglobin
5. People from 6-14 years
5. 11-13 gm haemoglobin
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Answers
Blanks
-
Alternatives Pairs -
i
1-3, 2-5, 3-1, 4-4, 5-2, 6-8, 7-6, 8-7, 9-10, 10-9
1-1, 2-4, 3-1, 4-1, 5-2, 6-1, 7-4
1-2, 2-1, 3-3 4-5, 5-4.
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Lesson 9
Blood and Anaemia
Aims
On reading this lesson you will understand
•
Understanding structure of blood.
Realising the functions of blood components.
Knowledge
You will know about
•
The parts of blood
•
The causes of Anaemia
Skills
•
How to diagnose anaemia
•
The main causes of Anaemia
i*
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40
Blood
It consists of 2 parts (a) Blood cells (b) Plasma
Their components are a. Blood cells - Red blood corpuscles b. White blood corpuscles c. platelets or thrombocytes
b. Plasma
1. 90-92% water
2. 8-10% solids namely
i. Proteins albumen, globulin, fibrinogen 70%
ii. Metals like sodium, calcium, potassium, magnesium, phosphorous 0.9%
iii. Protein less - Urea, uric acid, jothin, hypojothin, other nitrogenous compounds and
‘vasa?’ cholesterol, glucose, phosfolipid
3. Breath - Oxygen and carbon dioxide
4.
Internal fluids antigen, enzyme
Blood Cells
The capacity of blood cells to carry oxygen from the lungs to the arteries depends on
the haemoglobin. 1 c.c. of blood contains 45 lakh blood cells among women and 50 lakh
among men. Their number increases while doing exercises, climbing, during hot weather
or dehydration.
There cells collect in the spleen. When there is less air pressure as at heights they
go into the blood. One-eleventh of our weight is blood. A 70 kg man has about 6 litres
of blood.
The haemoglobin blood group is a combination of haem and globin. Perfayrin can combine
with any mineral. In blood it combined with haem and gives iron.
Haemoglobin (protein) consists of haem which is iron + blood. Only when haem combines
with iron can it get oxygenated which is red. As it distributes oxygen and absorbs CO2
it gets deoxygenated (bluish-black)
Blood is produced in the bone marrow of skill bones, back-bone and long bones-. Its
4 stages are megaloblast, erythroblast, normoblast and reticulocyte. Where there is less
air, there is stimulation to produce more blood cells. When their term expires they are destroyed
and an equal quantity is created. It is normal to have 15% haemoglobin and reduced quantity
suggests anaemia and is observed by the lack of redness. These symptoms can be tested
to know the exact quantity.
In case of less haemoglobin, sufficient oxygen is not obtained when exerting even slightly
and a person has to breathe strongly to fulfil the need. Besides iron content in haemoglobin,
!
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>
BE
reduction in the stock of iron in the body can show sub-clinical symptoms like lack of appetite,
cracked corners of lips, stiffness of limbs at night and difficulty in swallowing. There are
5 reasons for deficiency of haemoglobin in blood. The most important is less iron, or less
of colour porphyrin less haem. During blood test, the reduction in size of blood cell can
be seen-microcytic, and hypo chromic anaemia can be observed where the reduced
haemoglobin can be noticed so protein must accompanyo iron in the diet. Deficiency of
vitamins, specially 'C and ‘B’ complex can also lead to anaemia. This happens when anti
anaemic factors are reduced in the liver. This illness can be cured by giving vitamins.
The factors contributing to the anaemic conditions are wrong diet, harmful medicines, pollution,
urinary disorders which damage the marrow in turn affecting production of new cells (or
destroying them). This condition can also reduce haemoglobin. So can menstruation, bleeding due to ulcers or accidents etc.
There are 4 blood groups - 0, A, B, AB, 85% people have RH factor (Rhesus) and
only 15% don’t, giving 2 sub-group - RH+ve and RH-ve.
White Blood Cell
There are 6,000 to 10,000 WBC or leucocytes in Icc of blood. They are of 2 kinds.
Agronulocytes and granulocytes
a. Agranulocytes - the cytoplasm doesn't contain granules nor parts in the nucleus. These
may be small or big, lymphocytes or monocytes.
b.
Granulocytes - The cytoplasm contains granules and nucleus sections. They are of 3
kinds - eosinophil basophil and neutrophils.
WBC combat bacteria. They may change their shapes or locations to attack them even
outside the blood vessels. If a swelling around a wound is observed through the microscope,
15 to 20 bacteria can be seem in a single WBC. The no. of WBC can also be found
out by the blood test. During fever they may rise above 8,000 though there is no external
symptom. If they start multiplying excessively in their primary stage itself, it can be fatal
leucomia or cancer. Some painkillers like analgin can lead to destruction of WBC causing
agranulocytosis. During pneumonia or typhoid WBC get reduced causing a condition called leucopania.
Platelets
Their protoplasm is Glanular 1 cc of blood contains 2 lakh 50 thousand platelets. They
contiol blood flow after injury by clothing.
Self Assessment
1. Note how important it is to know the structure of blood.
2. Think about treatment for anaemia by finding out its causes.
42
Exercises
e!
e
1. Haemoglobin consists of
1. Iron Protein
2. Iron Plasma
•
3. Iron Platelet
e
4. Iron Fat.
2.
e
e
c
e
e
What is the life of a blood cell?
1. 100
2. 110
3. 150
4. 125 (Days)
c.
3. The meaning of leukaemia is
€
1. Increased strength of blood cells
e
e
2. Growth in Ist-stage of WBC.
3. Decreased count of WBC.
4. Rise in frequency of WBC
c
c
c
4. Agranulocytosis means
1. Destruction of WBC
2. Growth of WBC
3. Creation of WBC
<
4. Reduction of WBC
5.
Leucopoenia is the condition of
c
1. No production of WBC
<
2. Growth of WBC
3. Destruction of WBC
(
4. Reduction of WBC
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Fill in the blanks
1. Blood cells, plasma
1.
2. 5,6 litres, 3. Haemoglobin,
and
4. Haemoglobin, 5. Blood cells
t
(
constitute blood.
2. Carrying O2 from lungs to arteries is the function of
3. The capacity to carry O2 depends on ----- --------------
ft
4. Blood is red due to u•
5. The body contains
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blood.
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43
Match the pairs
1- Pure blood
2. Impure blood
3. WBC
4. RBC
&
5. Platelets
6. Lekopania
1. CO.2
2. Oxygenated blood
3. Haemoglobin
4. Protection against infection
5. Reduced WBC
6. Control of bleeding
Answers
Alternatives - 1-1. 2-2, 3-2, 4-1, 5-4
Blanks ' 1-L 2-5, 3-3, 4-4, 5-2
Pairs - 1-2, 2-1 3-4, 4-3 5-6, 6-5
k
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44
Nutrition
J
Aims
On reading this lesson you will understand
Knowing about balanced diet
Knowledge
i
You will know about
(
<
•
•
The dietary constituents < '
obtained from food.
Understanding the function
'■I of constituents
Knowing the changes
caused by deficiency of constituents.
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Skills
<
You will learn
To identify the symptoms
Food
C
f
and indications of deficiencies
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Perspective
You will understand
B.a,anCed d'et dOesn,t
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expensive food.
AU the food constituents
-------- 3 are nefcessary for health.
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45
There are 5 different constituents of food
1. Carbohydrates
2. Protein
3. Fat 4. Vitamin and Minerals
5. Water
Deficiency of the constituents causes these changes - weakness, mental strain lack
of development among children, weight loss, skin changes.
I
Carbohydrates
They give instant energy to work but need other constituents to store it They occur in
<
grains (hke nee, wheat, ragi, corn, potatoes, sugar (also honey and jaggery), milk and fruits.
i
Proteins (Body building food)
quanto iXT’ S,rOn9 rCleS and d9velopm“'
They are found
high
q
m fish, eggs, soya-beans, milk and its products. On a smaller scale they also
occur m green vegetables and 'daf (split-peas)
V
Fats
Our body stores energy in the form of fat which is used when necessary. It is obtained
from butter and cooking oil
I or. a higher scale but also from groundnuts, soyabean, coconut
and milk in medium amounts.
Vitamin and Minerals (Protective Food)
They help the smooth fu„clioning of the body aW fer hea|thy b|ood
Types of Vitamins
C,
Vitamin A - necessary for healthy eyes. May cause night-blindness in case of deficiency,
Sources - yellow fruits and vegetables like papaya, carrot, cod liver oil.
Vitamin B - This group is necessary for various f_.._..„
functions of the body. Deficiency causes
1. inflammation of mouth, 2. Dermatitis 3. Indigestion
i 4. Weakness 5. Aching limbs.
Vitamin C - Present in sour fruit
f ' like guava, citrus group, tomatoes,
green leafy vegetables,
maximum in 'Amla' Deficiency causes
_3 scurvy, blue patches on skin with bleeding below
the skin.
Vitamin D - Obtained from sunlight. Necessary for strong bones and teeth.
Vitamin E - For healthy skin.
4
Vitamin K - For blood clotting
46
an/cX:eai;:“^;xr'cateium’iron and phospte“- 4'*
ManToT °' 9ra'nS "ke
Wheal' bai'a' al°n9 "lh SUitebte Quantities Zl XgetaX"
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47
Exercise
Choose the correct alternatives
1.
Balanced diet implies
1. Protein rich diet
2. Good and nutritive
3. All constituents in right proportions
4. All the above
Fill in the blanks
1. A,
2. K,
3. carbohydrate, 4. vitamin, minerals
1. Night blindness is caused by deficiency of vitamin
2. Vitamin
is needed for clotting
3.
is called Energy Giving Food Constituent
4.
ar,d
are called Protective Foods.
Match the pairs
1. Protein
1. Scurvy
2. Carbohydrates
2. Energy storing
3. Vitamin B
3. Ragi/Rice
4. Vitamin C
4. Dermatitis
5. Fat
5. Development of Muscles and Brain
Answers
Alternative 1-3
Blanks - 1-1, 2-2, 3-3, 4-4
Match - 1-5, 2-3, 3-4, 4-1, 5-2
i*
48
Lesson 10
Malnutrition: Social Aspect
Aims
On reading this lesson
•
you will understand
Get details about the cycle of undernourishment .
out the proportions of food constituents for women of different age groups.
Knowledge
You will know about
•
Causes of Malnutrition
specially in case of women.
Skills
You will learn
•
Make „ome„ realise the seriousness about ma,nutrition by maki„g
Perspective
You will understand
How our conventions are responsible for malnutrition of women
ow our political and economic activities have adversely affected women’s health
s
Food is a valuable necessity for human beings 40% of our population is below the poverty
line. The adverse effects of undernourishment are common in areas of deprivation of even
one meal a day. It is greater in case of women who are discriminated against while feeding,
right since birth.
The girl-child is top fed early. Less of mother s milk implies receiving less of resistance
power. Also girls and women have to often eat the left-overs when the ‘males’ have finished
their meal. Yet, they have to contribute to house-keeping, fetching water, baby -sitting. Absence
of sufficient food and play hinders their proper growth and development They are prone
to obstructed labour.
Pregnant women are prevented from some essential nutrients by superstitions e.g. milk
may fasten a foetus to the uterus, that papaya or jack-fruit may cause abortion etc. Further,
giving birth to a girl often leads to criticism. Once again she is expected to go through
pregnancy deliveries take their toll on her health.
Another harmful convention is fasting for almost 75 days a year for some reason or
the other. Widows are even deprived of certain foods.
MALNUTRITION CYCLE
NUTRITIVE AND MORE FOOD FOR MEN
I
SEX DISCRIMINATION
SUBSTANDARD
IN BREAST FEEDING
FOR WOMEN AND GIRLS
INFANTS UNDERWEIGHT
v
UNDERNOURISHED MOTHERS
AND PREGNANT WOMEN
t____
FOOD
The political and economic policies too have far-reaching harmful effects on women’s
health. A liberated economy has made food costlier making women its victim. Additionally,
preference for cash crops reduces shortage of food grains. This will deprive women of
nutritive diets.
(
50
AGE WISE THE RIGHT PROPORTION OF FOOD INGREDIENTS FOR WOMEN
AGE IN
YRS.
WEIGHT
KG
11 to 18
19 to 22
46
55
46
44
800
800
1200
800
18
23 to 50
55
44
44
800
30
20
800
800
+ 200
+ 400
800
10
+ 400
+ 400
18
50 to 55
Pregnant
Nursing
READY VITAMIN A CALCIUM
GMS
UG
MG
PROTEIN
(
IRON MG
18
(Ref: Corin Robinson - Nutrition and Diet Therapy)
Why should men have meals before?
A person requires about 2200 calories energy. Though we have sufficient grains in the
country, the distribution is not uniform. The rich can buy greater quantities while the poor
cannot even buy the bare minimum 40% population gets only about 1,750 calories. Since
the women eat last - only ' ,45G calories are left for them.
(Source : State of India's Health Voluntary Association of India, 1992)
Self Examination
1. Understand the undernourishment cycle well.
2. Think about solutions to break this circle.
3. do you think women have the capacity to change age-old traditions?
I
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Exercise
1. The cause of malnutrition among women is
1. Deficiency of diet
2. Excessive Exertion
3. Poverty
4. Discriminatory customs
2.
How should women break the malnutrition cycle?
1. Pregnant women should be given a nutritive diet
2. Women and girls should be given a nutritive diet.
3. Improvement of women’s status socially, financially, politically
4. Women should have meals before men.
3.
What is the effect of undernourishment during the growing age of girls?
1. Malnutrition
2. Possibility obstructed labour
3. Lack of physical development
4. Infectious Diseases
4.
What is the cause of malnutrition?
1. Unequal distribution and liberalised economy
2. Deficiency of constituents of food
3. Rising prices of grains
4. Shortage of Grain produce
5.
t
What affects women’s health adversely ?
1. Accepting liberal economic policy by government
2. Growth of tendency to plant cash crops.
(
3. Reducing cash crops
4. All the above.
(
Answers
Alternatives - 1-2, 2-3, 3-2, 4-1, 5-1
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09144
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I
Care, Nutrition and Women’s Health
I
I
Aims
On reading this lesson you will understand
t
•
The causes of dietary deficiencies
•
The effects of malnutrition
i
Why it is necessary for women to remain health.
4
t
in women.
t
Knowledge
You will know about
i
i
The reason for ill-health of women.
i
Which diseases are caused by lack of care and nutrition.
i
Skills
t
You will learn
I
f
•
How malnutrition has become
i
a part of women’s living.
Perspective
You will understand
How necessary it is for' women to realise that
<
nutrition is one’s right.
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A nutritive diet is required for good health. Most diseases in the world are caused by
malnutrition combined with infections. Not only is insufficient intake of calories responsible
c
(
but also deficiency of fine nutrients like Iodine, Vitamin A, and Iron. A protein rich diet is
expensive and the poor, who are used to a poor diet, don't consider themselves under-
nourished as they do spend their earning on food.
(
(
Anaemia related to deficiency of Iron affects women in their growth- 88% of pregnant
(
women in India, 40% in Africa, China and South America and only 15% in Western countries
<
suffer from this. Deficiency of iodine prevents development of the brain and is the greatest
I
cause of mental retardation but this can be controlled. It also is the cause of cretinism and
defects of birth.
(
Measles and Diarrhoea are aggravated by deficiency of Vitamin A along with the night
blindness. So are reproductive infections which lead to pelvic swelling, and chronic back
ache and finally even infertility which may result in rejection by families. More girls than
boys suffer this deficiency.
7 he above diseases form only 3.4% of total illnesses. Other deficiencies include insufficient
calcium obstructing bone development, resulting in osteoporosis in old age. 45 crore women
and 40 crore men are underdeveloped due to malnutrition.
r541
There are 3 causes of anaemia and malnutrition. The first is the presence of parasites
in the intestines. They destroy appetite but can be controlled by treatment. The second is
malaria to which undernourished people prone. The third is ignorance which prevents women
from consuming sufficient quantities of nutritive food. This is particularly true of Vitamin A
which can be obtained without spending much as such vegetables are easy to grow.
Misconceptions also contribute to discrimination against women’s nutrition. Several Asian
and African communities believe (wrongly) that a nutritive diet in the first 3 months of pregnancy
gets transferred to the umbilical cord, not the foetus. According to them nutrition given in
the next trimester may make the baby so heavy that labour will be difficult. Thus the expecting
mother is deprived of sufficient food. Comparatively she is better of in her parental home,
where physical exertion is reduced as she is allowed to rest with the support of her parents
and siblings. An under developed woman gives birth with a smaller cervix, often causes
infant mortality.
Poverty discourages the poor from consuming leafy vegetables. Therefore they need
to be subsidised, in order to prevent malnutrition. Women need to be made aware of essential
nutrients so that they can make changes in their life-style. If they can improve their nutrition,
they will be healthier, in turn their families and this will enable improving their financial condition.
A healthy girl becomes a healthy women. She can have a beneficial effect on the health
of the whole family since senior women control important decisions, in society. Thus girls
and women needed to be educated about health. Mere aid from foreign organisations or
non Government Organisations (NGOs) is only for emergencies and has short-term returns.
I
(
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I
55
Exercises
Fill in the blanks
1. Vitamin A, 2. Worms, 3. Malaria, Ignorance, 4. South East Asia, 5. Iodine, 6. Calcium
I
7. Reproductive, Cervix)
1. The main cause of blindness in children is
*
2. Vitamin A deficiency in women may cause infection in
x
and swelling in
the
*
3. Osteoporosis is caused by lack of sufficient
4.
and
are the causes of malnutrition and
Anaemia.
5. Deficiency of
causes cretinism and mental retardation
Correct Alternatives
1. Adverse effects of malnutrition of women’s health can be reduced by
1. Giving nutritive diet
2. Giving iron tablets
3. Educating women about rights and financial improvement
4. All the above
2.
The poor and the women suffer malnutrition because of
1. Deficient diet
2. Lack of education
3. Weak financial condition
4. All the above
Answers
Blanks - 1-1, 2-6, 3-5, 4-2, 5-4, 6-3
Alternatives - 1-3, 2-4
i*
56
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Pregnancy
eI
* !
Aims
On reading this lesson you will understand .
.
Find out about the complete diet of the pregnant women
•
.
.
Know the signs of danger during pregnancy.
Know the complaints and their treatment during pregnancy.
Know the amounts of Iron and Calcium required by Pregnant women.
.
Gather other useful suggestions for pregnant women.
f5
e!
t I
€
f
Knowledge
You will know about
•
The need for a sufficient diet among pregnant women.
e
The nature of the balanced diet for pregnant women.
•I
e t
e
Skills
l
You will learn
.
•
The signs of danger during pregnancy.
What is the treatment for typical complaints during pregna, y
•
and calcium to be given to pregnant women.
The amounts of iron u.._ --
(
(
(
(
Perspective
You will understand
(
It is to educate a pregnant woman about a balance diet
(
How necessary it is for pregnant woman to be treated properly by their families.
(
How necessary
(.
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Diet
g
■
The following requirements
r
should be fulfilled by the diet
of a pregnant woman.
(
a. Sufficient for the nutrition of the growing foetus.
(
b. Suitable to maintain the health of the mother.
c. Enough to provide energy for bodily capacities and labour
(
d. Suitable to prepare for breast-feeding.
(
A pregnant woman needs calories
Protein
Fat
<
Carbohydrates
This
m the following proportions
80 gms x 4
=
320 calories
90 gms x 9
=
810 calories
320 gms x 4
= 1280 calories
amount can be obtained from the
balanced diet given below
The food items
/
Amount per day
1.
Grains (white, rice, jowar, corn)
2. Dal
3. Green leafy vegetables
4. Other vegetables
t
5.
350 gm (3 bowls)
60 gm (450 mg or meat)
125 gm ( 1 bunch)
75 gm (1 bowl)
Roots or tubers
50 gm (3/4 bowl)
6. Fruits (seasonal)
7. Milk
30 gm (1 fruit)
325 gm (3 cups)
8.
(2 cups for non-veg)
Fat/Oil
30 gm (3 table spoon)
35 gm for meat eaters
9.
I
Sugar
10. Meat/fish
40 gms (8 teaspoons)
I
11- Egg
30 gms (optional)
egg (optional)
Signs of Danger during Pregnancy
The women must be sent to a big hospital in case of these
a. Vaginal bleeding
b. Swelling on the limbs
c. Past abdominal pains
d. Acute giddiness
There may be other small
complaints which, though not cntical, do cause stress and
58
suffering to the pregnant women, as follows -
i
Morning Sickness
May occur during 4th to 14th weeks in the mornings, due to internal changes or glucose
digestion.
Treatment
Avoid fried/spicy food. Drink a cup of milk with sugar before going to bed.
Burning Sensation in the chest
May occur due entry of gastric juices into the food pipe. The head should be kept on
i
a higher pillow while sleeping. Rest same as above.
i
Itching of abdominal skin
Should be followed by light massage using calonune lotion.
Safe mother hood can be achieved by a 4-fold approach a balanced nutritive diet, avoiding
over exertion, regular check-up and no medicine to be taken without recommendation by
the doctor.
How much iron and calcium should be given during pregnancy
Pregnant and nursing mothers need increased amounts or iron and calcium which can
be fulfilled by an increased nutritive balanced diet. But ordinary expecting mothers from
poor sections need to be given oral supplements of both for the blood and bones of the
growing foetus. It is a government practise to give 100 ferrous tablets during pregnancy
and upto 6 months later. But this amount should be doubled during the last trimester of
pregnancy and 6 months after delivery. Here are the scientific details about the need of
iron element in 280 days.
For the blood of the baby
For the development
400 mg
150 mg
For the mother increasing blood
and bleeding during delivery
Mother’s daily need of 1 mg
Total
200 mg
280 mg
1030 mg
Normally men need 1 mg per day to compensate for iron lost through sweat and urine.
Women need double during menstruation, but since this is absent during pregnancy, 1 mg
is sufficient per day.
>
[59
Iron needed to treat Anaemia
Most Indian women are deficient in Haemoglobin. Doe to absence of sufficient iron in
the diet, this persists during menslruation leading to anaemia 60% women have less than
10 mg of iron.
This has to be fulfilled by the formula = Deficiency of Haemoglobin (per 100 mg) x weight
(about 50 kg) x 3
(
In other words, 150 mg iron is necessary to raise haemoglobin by 1 gm. Similarly, more
<
(
= 4 x 50 x 3 = 600 mg.
iron is needed to substitute the depletion of iron in the liver which is used up during deficiency
This can be found out as follows -
<
t.
Total Requirement of iron
Requirement during pregnancy
+
Requirement to increase Haemoglobin
+
Requirement to restore the stock of Iron
1030 mg
600 mg
500 mg
2130 mg
As seen above, the body gets just about 1 mg through diet per day i.e. 280 mg in
the entire period. The difference i.e. 1850 mg needs to be given through tablets. One ferrous
tablet of 200 mg contains 60 mg iron or which 10 % is absorbed among normal people,
but 15% capacity during anaemia. Thus 9 mg will be absorbed per tablet. To achieve 1850
mg, the need is 1850 = 205 gm of iron through tablets. Therefore 180 tablets are necessary.
The wholesale price is only 5 paise per tablet. So the increased cost will be high. Also
giving more tablets to the women doesn’t need extra activity.
The aim should be to reach more pregnant women. To start with, the women may be
given only 1/2 a tablet per day to minimise side effects like constipation and inflammation.
Once the intestines get used to the tablets, the dose can be increased.
The haemoglobin increases after one week of starting iron tablets. But till then, other
problems of deficiency get corrected i.e. appetite is increased, body-ache and fatigue gets
reduced and there is a feeling of freshness. The health workers have found that this beneficial
experience of pregnant women along with their health education given to them makes them
take the iron tablets in spite of some problems. If taken on an empty stomach, absorption
in better.
60
Giving of tablets to other women
€
Besides pregnant women, other anaemic women should also be given the tablets. If
they show decreased symptoms of anaemia within 15 days, continue the tablets for 3 months.
There should be no calculations about saving the expenses because this tablets are very
cheap and useful. The traditional male-biased view of giving care to a woman only so that
€
€
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C
she may not die during delivery must be replaced by a practical view of keeping women
healthy throughout their lives.
Other suggestions
e
Money should not be wasted on fashionable tonics and attractive liquids and capsules
because they cannot be more effective.
€
If a women with very low haemoglobin visits the doctor in the last stage of pregnancy,
an iron must not be recommended. It is too painful, requires a special technique and may
ft
t
ft
cause allergic reactions, even a dark patch. An injection cannot increase the rate of producing
new RBC.
Only women who cannot bear oral tablets, nor get enough iron through a good diet
and iron utensils may be given an injection (Use of iron utensils and including lemon/tamarind
c
with dal and leafy vegetables, increased steadily can cure anaemia)
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Self examination
1.
How will you collect information about the balanced diet required during pregnancy
to rural women?
(
2.
How will you explain the requirement of iron and calcium tablets to them?
(
€
(
(
(
(
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61
Exercises
Fill in the blanks
1- 2,
2. 280,
3. 1030,
4. 2130,
5. one,
1. Generally pregnancy includes
6. hundred
days.
2. An anaemic pregnant woman needs
T
3. A pregnant woman requires
4.
mg jron
mg jron
In the government mother-child-care programme,
tablets of ferrous are given
to a pregnant woman.
5. A woman needs
6.
mg iron during menstruation.
Haemoglobin takes
------ week to increase after an injection.
Choose the correct alternatives
£
1.
£
Giving an anaemic
pregnant woman vitamins and iron during delivery shows
1. The attitude of care forwards pregnant women
2. Efforts for a safe delivery
3. Male chauvinistic society.
£
4. Avoiding maternal mortality during delivery.
2.
The following formula can give safe motherhood
1. Balanced Nutritive Diet
2. Avoiding excessive exertion
3. Use of medicine as recommended by doctors
4. Regular launch
(
5. All the above
Answers
Blanks - 1-2, 2-4, 3-3, 4-6, 5-1, 6-5
Alternatives - 1-3, 2-5
i1
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62
13. Table of (2 pages) Percentage of vitamins in
food ?
To be translated
Page - 1
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63
Percentage of vitamins
Page - 2
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64
1
introduction
Aims
On reading this lesson
you will understand
•
Which three factors lead to disease.
•
What is the role of the health worker i
in Epidemiology?
Knowledge
You will know about
What is the science of P. H.?
What are the features of disease?
Skill
You will learn
•
Make a list of functions
•
Comparison
on priority basis.
Perspective
You will understand
•
The duty of a health worker i
is not only to treat diseases but also prevent them and
maintain public health.
•
"I he health worker’s role is
i‘
of great importance in
preventing disease.
1651
This chapter will tell you about P. H. In this module you will read about solving the problems
faced by health workers while working at the village level.
Ayushi is a health worker in Haripur. Like other
villages, here too, people excrete near the river bank
due to absence of a latrine. The village drinking water
is drawn from a well close to the river. Naturally it
gets contaminated by the open faces during rains.
One day Ayushi received 10 to 12 patients of
T
diarrhoea in the morning itself. She almost ran out
of her stock of medicines. She asked them to take
oral rehydration. But when more patients came, she
sent them back. She decided to get her new stock
from the primary health centre after the rain stopped.
In the meanwhile, two children lost their lives.
This tragic news reached the P.H.C. The whole
team came to Haripur and scolded Ayushi.
(
Explain what was Ayushi’s mistake according to you
(
(
(
It is the responsibility of the health worker to maintain public health
Why do we need health?
We need health to become financially independent and to play our social role
well.
Most health workers spend all their time and energy on treating diseases. They forget
their duty to take steps that ensure prevention of disease. To do this, a health worker must
---------- , skills and information.
The first requirement is to know the circumstances of public health in the village and
the effect of the health worker’s work on it.
The techniques of public health have the following uses for a health worker •
To find out the problems.
•
To know the cause of the problem.
•
To know where the problem lies.
•
To identify possible measures /treatment.
•
To know which task should get priority.
•
To make plans
•
To evaluate the measures taken and judge them.
The definition of Public Health is the study of incidents/situation related to the
population of a given region, their scope and causes as well as using this information
to control health related problems.
To put it simply what are the diseasas, their scope, causes and how to prevent them.
The following are some answers given when asked about Ayushi’s mistake.
1. Ayushi didn’t think about the safety of the drinking water of the village.
2.
She didn’t inform the people about the public hazard resulting from the habit of
defecating in the open near the source of water.
3.
She didn’t inform the R H. C. that there were many complaints of diarrhoea and
vomiting which was the possibility of an epidemic.
Compare your thoughts with the above reasons. It is a skill to compare and learn.
Apart from hereditary diseases, there are 3 conditions
one needs to know about disease-
1.
The patient (affecting factor) - age, sex, financial
heredity, mental state, resistance etc.
2.
w
cf /
/
and social conditions, life-style,
Affected
person
Agent
The cause of disease (internal factors) - germs,
chemical, substances, physical matter.
3.
Environment (inclusive factors) - geographical
condition, political state, cleanliness, poverty.
Environment
67
The Environment influences both-the aggrieved persons as well as causative factors,
creating an imbalance.
In the above example the affected persons were the patients of the village (though others
had also used the same water), the germs from the faces were the cause when mixed
with the drinking water and the environment was unhealthy enough to allow the waste products
to mix with drinking water supply of the village.
This technique is not used just for infectious diseases. Look at a different example.
Ramlal is a government clerk. He loves spicy and non-vegetarian food which
he needs at every meal. He smokes about 15 cigarettes per day for the last
15 years. He has been suffering from heart trouble for some years.
Ramlal is the patient, fatty food and cigarettes are the causes and the environment consists
of a relaxed life-style.
(
This technique can be used to analyse different problems in the village for e.g. - a
(
drunkard husband beating his wife is the cause, the women the subject, or the environment
is both alcohol and a patriarchal society.
In a huge country like India, you hear about disparate situations - people die of
undernourishment in destitute areas while there is a bumper crop in the country. In this case-
I
Subject
: The dead victims
Cause
: Unequal distribution system
Circumstances
: Politics and consumerism / luxurious life-style.
The cause alone is not responsible for ill-health. In Ayushi’s village some people didn’t
fall ill. Out of the patients, the children died but the adults recovered. This is because every
person’s resistance is different.
Also environment plays an important role. Had there been a latrine, the epidemic would
not have spread in the village.
What can a health worker do to prevent epidemics
During the Epidemic
Care to prevent and measures to treat
I
(
t
i
68
Decide the priority of the listed tasks.
During the epidemic, the health worker should
2.
Treat the patient
Inform people that drinking water should be boiled.
3.
Explain about O.R.S.
4.
Warn people about serious symptoms.
5.
6.
7.
Inform the RH.C.
8.
Keep a record of the patient.
1.
€
Collect a sample of the water.
e
Put T.C.L. powder in the water.
e
Realise that rising no. of patients suggest an epidemic
Preventive Measures
1.
2.
3.
4.
Treat patients if any.
Take care of public health and encourage people to take measures.
<
Put T.C.L. regularly in the water.
Inform people about home remedies for purifying water.
C
I
5.
Instruct people about soak-pits.
Inform people about hazards if contamination of drinking water.
Inform people about cleanliness of hands- washing with soap after toilet and before
6.
7.
<
meals.
8.
9.
Give the information in the Gram Sabha.
Inform the P.H.C. about contamination of water.
<
10. Analyser the cases of different patients.
11. Estimate the proportion of disease seasonally
4
12. Bring an extra stock of medicines during rains.
(
Visit the PHC and gather information about the epidemics in the last 5 years. Report
it with the following points.
I
I
• What was the problem?
• What was its scope?
i
• Where was the problem?
• When did it happen?
i
i‘
i
*
f
Fsgi
f
Find out what measures were taken by the P.H.C.
f
Reflect about the following points -
(
c
•
What was done to scale down the problem and what effect did it have?
•
What was done to prevent such occurrences in future?
•
Discuss the type of resources needed to prevent the problems
•
What sort of difficulties were faced while solving the problem and how were they sorted
out?
t
(
Summary
(
(
The study of public health shows us how to go to the root of various social, financial,
political and cultural reasons of disease and help in giving suitable solutions wherever possible.
Self Examination
<
1. Write the three conditions leading to illness.
2. Define Epidemiology.
3. Write how Epidemiology will halp you.
4. Find out the subject, cause and circumstance in the following examples.
• Plantation of paddy is on. Many people have got malaria
• Seven year old Raju goes to school. He had cough and cold. Later his
school friend Shankar also get the same illness.
5. Compare your list of Ayushi’s task with the given one. Point out any new idea/
view.
6. Compare Ayushi’s mistakes as listed by you with what is given.
7. Describe an epidemic in your P.H.C.. Write what the staff did for it.
Your responsibility as a health worker is this
1. Find out the main causes of disease in your village.
2. Find out the causes which can be controlled collectively.
3. Think about the measures for control.
*
70
Exercises
>
1.
A health worker should be aware of public health.
1. To treat disease.
2. To give health services.
>
3. To evaluate causes and health services.
4. To raise the level of public health and treatment of disease.
2.
e
e
e
The science of public health means 1. Study of disease
2. Study of causes of disease
3.
3. Study of scale/cause/prevention/control of disease
e
4. The study of disease and health.
&
We need health
1. To avoid falling ill
c
2. To be financially independent and discharge social role well
3. To have good personal health
4. All the above.
•
4.
The study of public health will result in
e
c
1. Discovering the causes of disease
2. Identifying the disease
3. Knowing which treatment is to be given
€
4. Help for prevention
C
c
Fill in the blanks
1. Raju, 2. Virus,
<
3. Getting drenched, 4. Subject, 5. Epidemic
1.
c
, cause and surroundings are the conditions of disease.
2. More patients than usual visiting the health worker is a sign of.
3. Seven year old Raju caught a cold by getting drenched in the rain. In this case
is the subject,
the cause and
is the environment.
•
c
c
<
c
Answers
Alternatives 1-4, 2-3, 3-2, 4-4
Blanks - 1-2, 2-3, 3-1
€
<
c
c
c
(
c
c
c
71
VI'-
Lesson 2
Description
Aims
On reading this lesson you will understand
«
How should available information be analysed.
•
To know how records are to be maintained.
o
Understand the time for sending notification and ask for help.
Knowledge
You will know about
•
The meaning of epidemic
•
The importance of information.
Skill
You will learn
•
To keep records properly
•
How and whom to send information.
Perspective
You will understand
<
•
(
I
Maintaining records is an instrument of learning and helpful for planning solutions. It is
not used for fault-finding or spying on health workers.
•
The role of the health worker is a key factor in prevention of disease among people.
(
I'
►
>
72
Introduction
>
If Ayushi had got records of Haripur, she would have expected the greater no. of patients
from past experience and she could have solved the problem. When should a disease be
declared an epidemic?
e
When there are more than expected no. of patients suffering, from the same disease
in a given geographical area in a given period, it is an epidemic.
a
a
Q
It is necessary to understand how population is inter related with disease e.g. -
e
Rampur
Haripur
Population
100
1000
Patients
3
30
Per cent
3
€
30
x 100 = 3%
100
------ x100 = 3%
1000
The scope is the same in both villages. Thus the no. of patients is related to the total
population of the place in comparison.
Ayushi’s village has 3 wells of which one belongs to the Dalit section of 200 people.
fl
fl
€
C
fl
«
10 of these suffered from diarrhoea and vomiting.
c
What is the percentage of Dalit patients?
I
Your answer should be 5%.
(
We can compare percentages in 3 ways.
1. Percentage
2. Ratio
3. Proportion
(
(
The formula is the same
(.
x
-x 10n
y
x
x
y
(
10n
(
x and y are two being compared x is divided by y. 10n is a constant and may have
the value 1, 10, 1000, 100, 000 etc.
L
(
(.
■J
73
10° = 1
101 = 10
102 =
10x 10
103 =
10x 10 x 10 = 1,000
104 =
10x 10 x 10 x 10 =10,000
105 =
10x 10 x 10 x 10 x 10 = 10,000
100
Ratio
We use our sense of ratio to estimate the proportion of different things in one day to
day activities. Like we use more potatoes when we cook for more people, accordingly
increasing the quantity of green chillies, onions. Mathematically expressed as potatoes: Onions,
e
Potatoes: Green chillies.
If we use 1 onion per 6 potatoes, how many onions are needed for 24 potatoes?
6 potatoes
1 onion
:
24 potatoes?
24
= 4,
4x1=4
Ans. 4 onions
6
Similarly if 4 potatoes
: 2 green chillies
24 potatoes ?
s
24
= 4,
4x2 = 8 green chillies
6
This example of calculating ratio helps us to make estimates on different scales. Generally
Ayushi gets 30 patients for fever. This month she had 15 for respiratory diseases.
What is their ratio ?
30 : 15
1 : ?
15
1
x
30
1 =
2
Thus there were half the no. of patients with respiratory diseases as compared to those
of fever Since the population strength keeps changing, such calculations help us to get
a clear idea for comparison e.g. figures for Sunderpur.
74
Year
Fever
Respiratory disorder
Total Patients
1996
1997
1998
1999
2000
30
15
14_________
_________ 16
45
42
48
75
90
___ 28
___ 32
___ 30
30
________ 45________
60
~
How will you analyse this example?
From 1996 to 1998, patients with respiratory disorders were half of patients with fever.
But in 1999 they rose to 1.5 times that of fever patients. Then in 2000 the patients for
V
respiratory disorders doubled those of fever.
I
The health worker and the doctor discussed this increase in respiratory disorder with
(
the villages. They found out that chemical pesticides had resulted in this spurt of patients.
(
In ratio x and y are two different measures. On a given day, Ayushi had 45 patients of
(
which 30 were women and 15 men. What is the comparison?
(
(
30
Ratio = -—
x
(
2
<
15
c
Thus the no. of women patients was double that of men.
(
f.
The ratios of patients keep changing with time
■
Proportion : Two friends started a business. Sunita invested Rs. 5,000 and Rekha Rs.
(
10,000. They had a profit of Rs. 1200 that year. How should it be divided? Total amount
<
invested = 10,000 + 5,000 = 15,000
(
5000
1
Sunita's share
-------
15000
3
(
1200
= 400 (profit)
3
(
Share
(■
This technique can be used to find out the proportion of medicines required according
(
to the no. of patients, if half of the total patients are for fever, 1/2 the quantity of medicines
(
ordered for fever should also be half.
I
(
Rate
This is calculated like percentage, only adding ‘Time’ to it. e.g. - calculate the rate for
Ramu
(
(
(
c
5
FtsI
Year
1996
1997
1998
Wheat
Sold
Cultivation
Cost
(In Rs.)
Amount
Received
Profit
100
600
800
200
100
700
100
900
730
975
Rate
200 xl00=l
600
j
—33.33%
200 xl00^2
700
7
=28.5%
200
225
225
x 100 = 30 = 30%
750
1999
100
800
1025
225
225 x 100 -225 =28%
800
8
2000
100
850
1100
250
250 xlOO<25 =29.4%
850
85
In the above example, numerically Ramu got more money in the fifth year but when we
calculate the rate,
we find that the greatest profit was in the first year.
The birth rate of India is rising every year but some people say it is steady. Let us
survey the figures.
Year
Population
1996
10,000
1997
10,200
Birth
Percentage
200
200
Birth Rate
(
(
<
x 100
2%
x 100
2%
x
100
2%
100
2%
10,200
1998
10,404
204
204
10,404
1999
10,606
208
208
10,606
2000
10,808
212
212
x
10,808
I
[76]
The above table clarifies that the no. of births is rising but the rate of births is steady.
The time period is required to calculate the rate (Note that this example is imaginary and
the death figures have not been considered)
<
If we get the figures of child mortality, we can evaluate our preventive measures for
(
re
it. Thus it is necessary to maintain, record. Every year we can make a comparative judge
ment.
.
Even you find it difficult to calculate the examples given in this chapter it doesn’t matter.
The statistical records are maintained at the block level. But you must understand how to
use the calculated figures to draw conclusions. Here are some formulae to understand the
scope of a disease.
1.
Incidence (Rate of illness)
c
c
c
r
r
c
r
r
f
New patients of a disease during a given period
x 100
r
No. of patients likely to get the disease.
?
2.
Prevalence Rate (Rate of Actual Patients)
e
r
Patients afflicted with a disease (new and old)
Population
f
t
Death Rate
4
x 100
3.
No. of deaths in a year
<
x 1000
Population the middle of the year
<
4.
Rate of child mortality
(
(
Death of children less than 1 year of age in the year
(
x 1000
No. of births in that year
5.
Maternal Mortality Rate
No. of deaths of expecting mothers within 42 days of delivery
x 1,00,000
i
No. of children born that year and living
i
t
77
6.
Birth Rate
Children born in a year and alive
------x 1000
The population at the middle of the year
Required numbers can be obtained only if the figures have been entered properly. This
recorded information needs to be analysed from time to time to draw conclusions which
f
explain the expected figures. These should interpreted in the light of 'average'. When you
i
t
f
a ask a health worker
-------- theJ no' of dai|y Patients and he replies “some day 10, sometimes
i
2 to 4 and at times none at all”,, this cannot give you any idea. So you need the average.
(
(
(
(
(
(
(
(
Look at the figures for one month here Date
Patients
Date
Patients
Date
Patients
1
2
3
4
5
6
7
8
9
10
3
0
0
2
2
1
3
0
1
2
11
12
13
14
15
16
17
18
19
20
0
0
4
2
1
3
0
0
0
21
22
23
24
25
26
27
28
29
30
2
2
0
1
0
0
1
3
2
1
14
+
11
+
12
4
Totally, 37 patients were recorded in April since there
are 30 days in the month, the
average can be calculated as follows -
37 patients in 30 days
.
for 1 day -
37 x 1
= 1.2
30
(
That means 1 or
< 2" patients per day. The table shows that some days there
So the minimum no. is 'O' while the maximum is '4'. If a
the maximum no. some day, it is a hint that she must
were none,
health worker registers more than
enquire about the problem.
The health worker knows which disease Is common in a given season e.g. - cough
and cold during -winter but fever during summer.
i
rTsi
Some diseases occur in particular age groups, e.g. measles among children but heart trouble
I
after 40 years of age.
The following information must be noted Patient’s name and address
Age
Date of Treatment
Symptoms
(
(
I
This can be obtained from the patient but how will the disease be diagnosed?
(
WHO has prepared a key in which you can check the symptoms to match your entry.
(
Possible diseases are listed in front of groups of symptoms. Refer to page 170 of Lay
(
reporting of Health Information, 1978 WHO, Geneva Publication.
This key will also give you estimated figures. Although numbers at your village level care
(
very small compared to the figures used to calculate rates, you need the skill to calculate
rates. You should also be able to
<
*
1. Know how to keep records, who to send them and when.
2. Know what is to be done in case of change in proportion of disease.
3.
*
If you find any symptoms / group of signs difficult or new, know whom to send the report
4
and when. (Also in case of epidemic)
4
Every month, the following descriptions must be sent to ANM -
4
4
Births, deaths, patients, diseases, list of children for immunization, pregnant women,
under-nourished children, beneficiaries of family planning, report of tested sample of water.
4
Two copies must be made. The signature must be taken at the sub-centre, with date.
Refer to page----- for the'maintenance of record. After every 10 years, the record should
be handed over to the primary health centre or destroyed. Ask the PHC or the Gram Panchayat
to buy new register or prepare one with the help of the local school teacher who will un
4
derstand the need and supply extra sheets of paper to use.
(
(
Summary
The records should reflect the truth. Don’t avoid recording the death of a child, even
if it is sad. Also, write the actual no. of children immunized, even though the no. may be
less. 7 he records help to understand likely problems, not to find out your mistakes.
(
(
(
(
(
Even if you make a mistake, you should help to set it right. The aim is solving the
problems of the village. This can be done if you respect yourself for being faithful to yourself.
(
(.
(
(
>
i
79
Self-Examination
r
Find
1
out the average biscuits eaten by each child
Ramu
4
Shyam
5
Neela
2
Radha
3
Bunty
10
5
Surekha
2
a.
f
Ayushi received 5 patients of diarrhoea, 15 for fever 25 with cough and
50 having other diseases. Calculate the rates for diarrhoea, fever and cough.
i
b.
Find out the proportion of cough, fever and diarrhoea
Calculate the ratio of cough and fever.
/
Your responsibility as a health worker is
(
c
<
1. Maintain records and collected information in proper way.
2. Send them to right person at the given time.
t
<
i
I
K
k
K
V
V
V
V
Si.
r
[80
Exercises
1.
Epidemic means
1. Some people falling ill with the same disease.
2. Different diseases for many people during one period.
3. Many people falling ill with the same disease.
4. Getting more patients for one disease than expected figures of a given population
in a given geographical area.
2. A health
worker must keep records so that
1. To complete his/her work
2. To complete the health register properly
3. To make health services useful for evaluation
4. All the above.
Fill in the blanks
1. Deaths in one year
Average population in the middle of the year.
2. Getting new patients of a particular disease in a given period
No. of people likely to get the disease.
3. Total no. of births in a year, still alive.
The population in the middle of the year
4. (Analysis)
5. 1
1. The formula for disease is
2. The formula for death rate is
3. The formula for birth rate is
should be done of recorded information.
5. If health worker had 48 patients in April, the average is
Answers
Alternatives 1-4, 2-3,
Blanks 1-2, 2,-1, 3-3, 4-5, 5-5
___ I
1
C
(
(
81
(
(
3. Observation and Classification
(
Aims
(
On reading this lesson you will understand
•
The importance of observation.
•
The significance of analysis.
•
Which questions should be asked before asking
I
questions.
Knowledge
You will know about
(
(
(
•
The meaning and significance of P.H.
(
•
The importance of P.H. at the village level.
The role of a rural health worker with reference to P.H.
Skill
t
You will learn
•
Analysing
•
Observation
•
Drawing maps
I
Perspective
You will understand
•
Environment is an important aspect of disease.
Discussing with villages will generate greater solutions and cooperation.
i
*
Any one can imbibe new information and knowledge.
f82
Introduction
C
We think that seniors should direct our work. But those affected by the work can best
hint at the direction of work. For e.g. - if Kerala has a lower than normal birth rate, local
people should be consulted to find out the problem. Only than can the direction of work
be decided.
Health workers in villages have to work on their own.
They shape their services according to what is acceptable
to villagers. In such isolated working conditions, knowledge
of the science of RH. is useful. Ayushi had heard about
it. Now a voluntary organization had called her to attend
a training programme it. She was as apprehensive about
its connection with her work as the other participants.
€
C
In the workshop they were first given the definition
of the science of Public Health and then the 3 conditions
leading to it namely subject, cause and environment.
e
Many types we are not affected by disease only due
€
to hereditary or the effect of environment. The health
€
€
€
€
€
C.
worker tries to identify the disease that afflicts his/her village most, studying time period
the section of the village with greater effect. If possible causes are considered, they can
be tested in a laboratory e.g. - the knowledge that germs spread diarrhoea can be identified
by a pathologist. But at the village level, what is more urgent is the purification of water
and prevention of future contamination.
Dr. John Snow, the father of the science of RH. had declared before the microscope
that cholera spreads due to water. He had prevented further spread of the epidemic by
disabling the use of the hand-pump of a particular well which was the centre of a group
of people suffering most from the disease.
His science can be used by health workers to analyse the area around them. When
are services least available to the people? How can it be corrected? Ayushi listened to
examples of how to use the science.
€
€
e
€
€
C
€
€
t
i*
€
(
(
€
C
C
83]
Primary Stage
The Health Worker
Improvement in
and the village
Health of village
A
Disease / Problem
Solutions
Arrive at conclusion
Discuss the Result
through techniques of P.H.
with people
Secondary Stage
f
Notice sent
to Primary Health Centre
Give help
when necessary
(
(
(
In a place called Parinche near Pune, there were many patients with diarrhoea. The
(
health worker explained to people that defecating near the river contaminated nearby wells
(
during rains. She suggested that the well wall be made better to prevent this. The Gram
■
Panchayat at didn’t bother, but the youth club got the well-repaired, soon the no. of patients
decreased. The P.H.C. was informed, which helped in treating the patients. Thus the health
(
<
(
i
worker was able to prevent a large no. of people from disease. Thus it is not necessary
that only serious diseases need to be tackled, but the scope of a disease is equally important.
After this incident, the health worker got the water regularly checked. She discussed its
results with villagers and they could take measures whenever necessary.
A health worker in a tribal area noticed that the skirts of the women were very stiff
m some areas. When asked about it, they revealed that they suffered from white discharge.
She discussed the problem with the doctor and they were treated successfully. This shows
(
the important role that a health worker can play for the betterment of the health of the people.
I
84
A Rajasthani health worker found that lack of cleanliness during menstruation can create
health problems. Due to shortage of water, the women were using pouches of sand to soak
the bleeding. This caused breaking of the skin leading to infection. Though she couldn't
immediately solve their problem. She could identify the cause. Then there is the case of
particular mid-wife, whose deliveries always led to problems. She was advised retraining
and her skill was improved.
A health worker called Sashikala Tai would run a play group for villagers’ children through
€
which she tried to raise their health awareness. The group included the children of some
migrant workers. She noticed they were under nourished and had spots in their eyes. She
arranged for them it get Vitamin A doses through the A.N.M. She also asked the other
T
€
children to get half a bhakari and some vegetable to feed them.
Why didn’t s she order the food from one family?
To give children a sense of social responsibility and to get a variety of vegetables and
therefore complete nutrition. Getting just half a bhakan was not a burden and could be
continued. She also held a meeting of the migrant people in which a doctor of the P.H.C.
checked the children and gave information about their nutrition and care.
C
c
c
(
The discussion with the people revealed that they were underpaid by the supervisor.
f
The health worker herself enquired at the Jehsildar’s office and got information about the
4
correct rates for them.
<
How did she achieve this? By introspection -
Where is the illness? Who is most affected by it? What are the likely causes?
<
(
The wish for treatment of malnutrition led her to long-term solutions through analysis of the
situation.
<
During the training Ayushi also learnt useful techniques to analyse the truth
1.
Map
The settlement, road, river, canals, drinking water sources like wells, hand pumps, soak
(
(
pits, latrines, marshes, bunds and residence of health staff should all be shown in the map.
This will help a health worker like Ayushi as below -
(
(
® In locating incidents affecting health and possible causes
(
• Knowing where to get emergency medical and
(
• Figuring out silent epidemics for prevention and treatment
(
I
t
o
(
(
(-
85
2.
Information about population
(
If this is classified into lists of infants, children under 5, women in the productive age
etc. sensitive groups
. > can be identified easily and indicate possible periods of help.
(
(
3.
(
(
Information about the village Details of financial conditions, available resources and different schemes can be used
given on page 54 to
(
• Ensure that help reaches the Backward
d
• And
i
people
diagnose the problems and treat them correctly.
4. Diary
If unusual happenings are recorded along with difficulties and problems faced the health
workers can help her to diagnose causes of diseases and help solve problems.
(
5. Graphs of Time and Diseases
A weekly list of both notmal illnesses and important diseases nelp in calodlations This
helps m inter relating the time period (month) with disease which can answer why
(
occur at particular periods and how they get cured.
6.
(
/
Family Card
The information in this is helpful to identify families that need greater help. As explained
(
on page
every family's financial condition can be known through it.
Thus health workers like Ayushi learnt the following during the workshop on Public Health
•
Observation is necessary.
It is necessary to understand the interrelation of affecting factors with diseases (e g
contamination of drinking water)
•
Conclusions can be drawn.
•
Others help may be necessary for better understanding
•
Find a solution for the problem
•
See whether the measures taken are suitable.
and take measures.
i‘
[~86
Summary
• Introduction
about the village
and Environment
• Details about
people-life style
customs
• Health problems
of the village
The health worker knows the
The health worker asks himself
• Has the problem changed the environment?
or did the environment change before the problem?
• Which people got the disease?
(Age / Sex / Class ........)
• Is the disease evenly spread or only in particular areas?
• Is the disease related to season or to particular tasks or related to good
Is it connected to life style?
Health worker must observe
I
• What are the symptoms? Are they serious?
• Are they unknown? What is the scope of the disease?
The health worker must to this
• Discuss with people and find out what they can do
• Think about she herself can do as a health worker
• Decide what help is necessary
• Inform the PHO about disease
The health worker must participate in deciding solutions
• He/She should observe the solution properly
• Observe the effect of the measures taken
The health worker must, after the problem is solved
• Collect more information about the subject.
• Understand it and take it to the people
• If it is related to a period, plan to give information about the disease
before that period the following year
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87
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Self Examination
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1.
How is a health worker benefited by studying Public Health?
2.
Observe your village and find out the problems.
3.
Do the villagers use traditional medicine for any disease? Why?
4.
If suraj and his wife are farm labourers with undernourished little children, what
(
(
should the health worker do?
(
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(
Your responsibility as a health worker is
(
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1. Observe your village and find out the problems.
(
2. Analyse the problem regularly.
3. Find out after analysis whether any change has taken place in the problem.
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88
Exercises
1. Observations leads to
1. Know what the problem is
2. Know the cause of the problem
3. Know possible solutions
4. All the above
2. A health worker makes map at his region for
1.
Getting geographical information about the area of work
e iI
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r
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©
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Getting information about facilities available there
2.
3. To keep a record
4. To take measures against emergencies or events affecting health
€■
5. All the above.
The health worker is benefited by details about population
3.
1. To understand the strength of the population
2. The no. of men and women
3. To locate affected groups for easier help
4. All the above.
4. The health worker must write a diary
1. To understand experiences / problems
€
<■
C
€
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C
2. To find out details and methods of did
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c
3. To keep records
4. All the above
5. What should the health worker do while working?
<
1. Have information about the population
e
2. Make a map at the village
3. Write his diary
with the villagers for improvement
4. Provide services in coordination
$
Fill in the blanks
1. Circumstances that bring the subject and causes together, 2?. one in whose body the
the capacity to created illness, 4. the list of diseases
disease grows, 3. those who have t
i
and scope, 5. Public Health
<
1. The cause means
in the disease conditions.
2.
The subject of disease means _,i--------- -------------------
3.
Environment as a factor constituting disease means
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| 89 |
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4. The study of
is useful to evaluate the methods of Health Services and
improve them.
9-
5. The graph of time and disease gives information
4
6.
about
The health worker should observe the following
1. Symptoms of disease
2. Serious symptoms
3. Scope of the disease
4. Unknown symptoms
5. All the above
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7.
What should the health worker, do after the problem is solved
(
1. Collect more information
(
2. Give the information to the people
X
3. Plan about the disease the following year
(
Answers
t
Alternatives 1-1, 2-4, 3-3, 4-2, 5-4, 6-5, 7-4
Blanks 1-3, 2-2, 3-1, 4-5, 5-4
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90~]
4. Analysis
&
4*
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Aims
<!•
On reading this lesson you will understand
<
<
•
Which kinds of information is to be collected and classified.
•
How a graph is made.
•
Which six questions should be asked to find out solution to any problem.
Knowledge
You will know about
•
Which people are more needy?
•
The importance of classification and its method.
•
The method of analysis.
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c
€
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€
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Skill
<
You will learn
€
•
Making a graph
•
Making a map
•
Writing a diary
•
Classifying information
•
Analysing
Perspective
You will understand
•
It is our duty to help the needy.
•
Questioning oneself leads to self-improvement
•
Education should be used in day to day living.
a.
•
Analysis helps us to upgrade our own work.
$
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Introduction
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it. She met the Anganwadl worker and the ANM when she X The"9 ZT
t
available with them to make Family Cards (Ret Pane
> Th,
d 'nformatlon
different age-greups etc. to her. She divided them Jc'oLg^Zx Z’
(
(
Age
(
Female
Male
Total
Percentage
(
0-1 year
(
10
20
20
-- x 100
1000
2
30
30
30
----- x 100 =
1000
3
40
110
110
----- x 100 =
1000
11
240
530
530
------ x 100 =
1000
53
130
230
230
----- x 100 =
1000
23
40
80
80
--- x 100 =
1000
8
490
1000
10
- (
-1
1-4 years
r
10
(
■
5-14 years
15-44 years
45-64 years
70
290
100
—
above 65
70
550
stat
f°U"d Ol" 'he
Type of family
Poor
(
Medium
Rich
them according to their financia,
f°r “Ch
Upper caste
2%
20%
78%
r
100
Backward caste
30%
60%
10%
Scheduled Caste/Tribe
68%
30%
2%
92
This table made her realise that
1. Upper castes have more land and have less of poor.
2. The observation of poor homes revealed malnutrition
3. It identified the needy groups.
(This table can also be obtained from a Gram Sevak) Then she made a map with the
-help of the school-children and made copies of it.
The poor homes were shown in red, green for homes with young children and pink indicated
pregnant women. This would show who needed more attention.
She made separate forms for children and expecting mothers to maintain records of
regular tests (See page — and------). She marked the dates fro TB vaccination and visits
of pregnant women on the calendar. The days of giving TB medicines were also indicated.
Information about the village
With the help of the Gramsevak, she collected the details about land, crops, government
schemes for different groups etc.
Report of Illness
Ayushi noted the list of ordinary symptoms in a register against each month, by applying
the WHO Key (Ref page------ ).
Eg-
January
February
March
December
1. Cough/cold
3
2
1
4
2. Watery Motions
2
1
6
3. Shivering and Fever
1
1
3
0
This information started'her advance estimates about what is likely to happen about
diseases in different months. Epidemics will now be handled with preparedness and even
prevented.
Diary
She begin making such entries -
16/12/2000
Ramuchacha had guests. One of those children and fever a running nose. Gave him
paracetamol
20-12-2000
The child has developed a rash. May be chicken pox.
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Gave information to neighbouring families. Sent message to PHC. This diary proved
useful in identifying causes of disease.
(
After some days Ayushi began passing the details of the disease, no. of patients, its
(
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causes and treatment etc. to the village. Then she started displaying the information in black
on the walls near the Panchayat. Consequently, the villagers started participating in
precautionary measures. They felt greater respect towards her. Any visiting government servants
would also come to get information from her.
(
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Ayushi too started getting satisfaction and pleasure from her activities. She attributed
her success to the following 6 friends -
•
What is it? (the problem)
•
When is it? (the problem)
•
Why is it? (the problem)
•
To whom is it (the problem
•
Where is it? (the problem)
•
Which measures (are needed to solve the problem)
f
In this way, the study of Epidemiology will be helpful to all of us.
(Picture 1)
Ayushi recorded the numbers every month. But as they
accumulated, they became difficult to interpret. So she learnt to
(
draw graphs from the school teacher. One look at a graph conveys
(
the implication.
Y
4 -3--
1. Line graph -
2-
(
1
0 --
To show the period of illness she drew a horizontal line on
------ r
a graph-paper ‘X’. Then she drew a vertical line ‘Y’, dividing it
—X
into parts writing the 10 times table upward from O as seen in
picture 1.
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(Picture 2)
From the record she marked a point against each month
Y
(written on X-axis) at the height of the number. In another graph,
she marked the types of disease for each month which showed
her which diseases spread more in which
month.
50-40-
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SO-20-■
/
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1
o
o
3—i—i—+—x
Jan Feb Mar Apr /ay
-2
EK]
2. Bar graph
She showed the age-group of X-axis. Dividing the
(Picture 3)
population, she reflected the matching no. of people for
Y
each group on Y axis.
530
5CO--
O
Q_
O
CL
350- -
230
2CO--
150--
3. Pie chart
110
00
100- -
This was used to
show the
scope
of
20
0 Tl
33
Fl
1 5-44
4S64
GfT -X
(age-group)
diseases. She counted
■he no. of diseases. Then
she counted the no. of
people affected by each
disease. Then she calculated the percentage for each
as follows.
1.
No. of patients with fever
x 100 = 3 / 100 x 100 = 3%
Total No. of patients
2.
No. of patients with inflamed respiratory tract
x 100 = 25 / 100 x 100 = 25%
Total No. of.patients
3.
No. of patients with diarrhoea
x 100 = 15 / 100 x 100 = 15%
Total no. of patients
4.
Patients with pain
x 100 = 40 / 100 x 100 = 40%
Total No. of Patients
5.
Other Patients
x 100 = 17 / 100 x 100 = 17%
Total Patients
[~95~
To make a pie-chart, the percentage has to be transformed into circle showing angles
- e.g.
3%
x
360°
10.8°
100
Then she converted the other numbers
She drew a circle with a compass, and divided according to the percentages, drawing
lines from the centre. Each part was coloured differently and the name of the disease
was written.
A look at the chart shows clearly which disease has spread more.
Pie Chart
Other
Fever
Diarrhoea
J
1
f
Respiratory
Tract
Infection
Pain
i
Summary
I
You need information to find out what the problem is. It should be classified to find
out the causes. They should be compared and solutions must be planned often numbers
have to be converted into graphs to facilitate understanding.
[96]
Self - Examination
1. How many patients did you have per disease last month? Calculate the percent
age.
*
2. Draw a map of your village and locate the most needed services.
€
3. Get the figures of the following from the PHC of your area - child mortality, maternal
mortality. Explain possible causes and send a plan of solutions.
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4. List the people to contact in order to gather information about problems.
5. 70 children per 1000 children born alive die in
our country. Arrange the figures
of states in order, showing the first five better states.
«
e
Child Mortality Rate in India - 71
63
Assam
76
Bihar
71
Gujarat
62
Harayana
Himachal Pradesh 63
Kerala
12
Tamil Nadu
68
53
94
96
53
Punjab
47
85
51
Uttar Pradesh
85
West Bengal
55
Karnataka
Madhya Pradesh
Orissa
6.
t
Andhra Pradesh
Maharashtra
Rajasthan
e
c
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7
c
c
T
r
Look at the pie chart below and identify the people who use health service more.
4%
e
Primary' Health Centre
7
I
T
41%
t
Private
Doctor
55%
c
Health Worker
c
c
<
1.
2.
Your responsibility as a health worker
c
Use different methods to carry/ the information to the people e.g. graph, numbers
€
etc.
<
Show the analysis regularly to the people.
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97
Exercises
1.
What does analysis achieve?
1. Education
2. Help in solutions
3. Help in self-improvement
4. All the above
2.
Analysis about the village will lead to
1. Easier helping of the needy
(
2. Knowing the causes of disease
t
3. Simplified, planning of work.
(
4. All the above
3.
The information should be
1. Classified
2. Analysed
3. Used to draw conclusions
4. All the above
Fill in the blanks
1. Pie chart, 2. Calculating the percentage of illness, 3. Age Group and Population, 4.Line
1
2.
i
A
------------------- graph should be made to draw
A bar graph is used to show
a graph of disease and Time.
3' A-------------- graph is drawn to show the scope/scale of disease.
4'------------------- is necessary while drawing a pie-chart.
/
Answers
Alternatives 1-4, 2-1, 3-4
Blanks - 1-4, 2-3, 3-1, 4-2
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98
5. Conclusions and Planning
Aims
On reading this lesson you will understand
•
•
The procedure of drawing conclusions.
The technique of planning.
Knowledge
You will know about
•
•
Drawing conclusions from statistical numbers.
Perfecting one’s work.
Skill
You will learn
•
Planning
•
Collecting funds at the village level.
Perspective
You will understand
1
•
Planned work is easier to do.
•
Maintaining health and preventing disease is an important and respectable duty.
•
Work cannot be evaluated in terms of money.
99
Introduction
Some statistics have been given at the beginning of this chapter to know how to find
out the problem
Child Mortality
India has a high mortality rate of children less than 1 year of age. There are 71 deaths
per 1000 successful births. The main cause is preventive births or underweight children
getting respiratory infections due to feeling cold.
If the following members show that 20% people are dying of cough, some measures
have to be taken.
Some Facts
Main causes of death in India
<
1.
Old age
24.7%
2.
Cough
20.3%
3.
Diseases of circulatory system
10.1%
4.
Causes of particular diseases among children
9.8%
5.
Fever
7.9%
6.
Accident and Injury
6.5%
7.
Digestive Disorders
6.5%
8.
Nervous System Illness
4.6%
9.
Conception and Delivery
0.8%
10. Diseases of other systems
8.8%
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(Source Registrar General of India 1990-1992)
Of the given figures, some are at the national level while some are from smaller sections
of population. These will give you an idea of the picture of disease in the population.
Children below 5 get cough/cold 4 to 5 times a year and loose motions 3 to 5 times.
1. There are average 20 TB patients per 1000 people.
2. 2 or 3 out of 1000 people have leprosy3. 50% women in India suffer from Anaerr ia
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4. Among 100 people, at least 6 people are ill at any given time i
i.e. per 100 people,
60 would be ill (Rate of illness 6%)
5.
The experience in Gadchiroli shows that 92 out of 100
women suffer from some
reproductive/gynaecological illness.
6.
Here are the results of a study by FRCH.
The rate of illness in 3 to 4% when a population of about 5,000 was surveyed.
January
February
March
April
May
June
July
August
September
October
November
December
Respiratory Disorder
Pain
Fever
Injury
Motion
Others
Total
14
12
12
9
14
22
12
14
19
14
30
24
20
19
43
23
41
40
47
40
41
45
37
22
23
34
17
27
14
17
22
9
10
17
14
13
9
8
4
8
11
8
11
8
4
12
13
14
6
24
24
18
8
18
16
15
16
11
17
24
16
13
19
14
16
8
5
13
9
8
____
100
93
137
90
127
109
118
111
97
102
116
116
42
15
These figures will help you in the beginning. Consider how you will make plans according
to the
i.e population of your village.
1. Make a list of your responsibilities v/hich have to be completed once every month like
vaccination, sending reports, meeting the ANM or members of Health Committee, Gram
Panchayat, talking to the women's group etc.
2.
To make a list of duties Tor the week - Like taking TB patients and new-born babies
for check-up, checking patients twice a week, giving information to school children,
awareness programme about a topic for villagers etc.
3.
Daily activities like observing people, environment, giving medicines, testing the water
etc.
I
It is important to maintain yearly records of information about the village, population details
etc. This helps in planning. Divide a sheet into 12 parts, writing tasks for each month.
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101
January
February
Give
information
about Give details about TB
of
Irespiratory
diseases
system,
measles,
leprosy.
Drawing a map. Organizing a
programme for women.
_________ March
Information about
and village.
__________ May_______ _____________ June__________ ______
July
Organise a programme ofjAwareness programme about Same as June
school children, cleaning wells. ORS.
Prevention
and
Give
information
about Treatment of Malaria,
cleanliness of water and ORS
April
population Consolidate
and
analyse
previous year's details. Send to
PHC & Gram Panchayat. Give
information about Jaundice,
purification of water and Heat
stroke.
August
Programme
tor
for
women,
information about influenza,
chicken pox, home remedies for
cough, cold.
_______ September_______
October________
November _________________ December________
Awareness programme about Women's
programme Discussioni
with
traditional Organising a programme for
women's problems like white Information about Nutrition, healers of the village.
Give school children. Present a
discharge / menstruation and Panchayat
Raj.
Gram details about loose motions.
report about the health of the
suffering caused by it
Panchayat and IHealth to
village in the previous year
Villagers
You can use the <above
'
example made by Ayushi for her village to plan according to
like conditions/situation in
..i your village. You can made a monthly plan too.
09144
102
Adapt the following chart for one month to plan to suit your village.
January
1. List last months 2
births,
deaths
and
record
of
patients
(Carbon copies) Send
copy to ANM send water
sample to laboratory for
test.
3. Meeting for women
4
5. Observe
village
7
8. Warn about vaccination. 9
Inform pregnant women about
clinic visit. Visit TB patients
and new-born babies.
cleanliness
10. Help in the clinic of 11
ANM
of 6. Awareness about one topic
talk to villagers
12. Give information to school
children awareness regarding
health messages.
13
14. Visit TB patients and new- 15
born babies (below 1 month)
16. Participate in the 17. Organise a women's 18
DHC meeting
meeting
19. Give information to 20
21. Advise people
villagers using different
special problems
mediums like street-play.
22. Visit TB patients and 23
new born babies.
with
24.
Awareness
among
villages through black-board
display.
25. Give information in 26. Programme with children, 27. Arrange a meeting with
school. Conduct a study Cleaning the village with them, women
in health for children.
28
29. Participate in PHC meeting 30/31. Call PHC doctor for
visit to village (may check first
pregnancy)
• Planning for next month
* Prepare Records
Just as you plan for a month, you should also plan for each day. This includes - writing
the diary, giving medicines, test of water etc.
>-
3
103
Even if you don't have statistical figures you
may note thus -
• 2 children of Dashrath undernourished
t
f
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Soak-pit required near Sunderakaki’s house.
•
Need to check measurement of TCS by Ramuchacha
•
Sita chachi's cough persisting. Must be sent to doctor.
he'P y°U
expei" ‘° add y°Ur™S
PriOri,ise
task-
your
Some problems take longer to solve. You may meet others and discuss them e g people
should get a shelter to stay in.
9' P P
foodThe f m'"1 W°rker 9068 beyond ,hese di“tes *° ask herself whether all are getting
food, potable water, it not. why? How should our ieaders be guided for this? etc
ThouT “’ere ar<3 3 l0t
in yOUr plan 10 “mPfete Yddf ■>»" »ork
laSkS' teeP 3 day
loo Ask me pX5,
* others
also offer vn
. k3 w e her !I 'A can pay you. As people develop fajlh in you, they will
also offer you grams etc. You may collect some funds 1-
For treatment of patients
2.
For health related programmes for children and women.
g you will not paid for every task, you will earn the love and respect of the villagers.
Summary
PlanXL" Cl0Se'y ?'ed 10 Plan"in9 beCaUSe *hey te"
good qualt
y°U
a"d
,0 d°
to be done
W0'l‘- ThUS y°Ur
°f
Self Examination
Plan for the year, name the obstacles.
Send monthly plans, write the difficulties.
Write a diary of a week, not the problems
•
Make a list of the problems in your village.
Your responsibility as a health worker in this
1.
priority01 the Pr°blemS °f thS Vi,'a9e °n analysis and write them on the basis of
2.
Make plans to solve the problems
(
3. JWdarty evaluate the effect ot your sotutton. ff necessary, make change.
104
Exercises
Give correct alternatives
1. A health worker needs planning
1. To complete the work
2. To give priority to some tasks
3. To make a list of tasks
4. To get a direction
Fill in the blanks
1. Conclusion/Planning, 2.Facts and Planning
1. A health worker can give quality service with
2.
and
and
help to solve village problems
Answers
Alternatives 1-2
Blanks - 1-2, 2-1
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§
1105
6 Planning
Aims
On reading this lesson you will understand
•
You will be able to give the words and concepts used by the Foundation.
(
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Knowledge
<
You will know about
•
The meaning of words related to the Research of the Foundation.
Skill
You will learn
•
Application of the principles of the Foundation.
Perspective
You will understand
•
We should the enthusiastic/eager about new information because getting the latest
knowledge enhances one’s self-respect and self-confidence.
I'
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[106
Introduction
There is a possibility of your becoming a { ' ' "
part of the schedule of some organisation
during your work. For any scheme you require familiarity
/ with the following terms -
Survey
A process of collecting particular information
Sample
Since gathering details about the entire population is both costly and
time consuming a small representative part of the population is surveyed.
This is called ‘sample’ .
• Questionnaire
A group of questions prepared to get detailed information about some problem.
• Interview
Asking a person a particular set of questions (related to the objective) face to face.
• Focused group discussion
Discussing a particular subject with
in a project, you will find that it is
a group of 8 to 10 people. When you are working
descriptive or analytic or experimental
Descriptive
When the features are given in details i.e. Describing a population at length in order
to find out problem / cause or solution
Analytic
To break up the causes, getting to the bottom
Experimental
When new medicines or techniques are used to make observations, analysis and draw
conclusions.
Summary
1
One should always keep in touch with the latest information, without hesitating to
when one doesn't know. One should be confident that one can keep learning. I
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[wtI
Self Examination
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e i!ASfk ^hCt07 W°rker °f the P'H C' ab0Ut a project with which they were associated
Collect all the mformation about the project and write a description of it.
(
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Your responsibility as a health worker is this -
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1.
To make efforts to gain new knowledge
2.
It is necessary to develop one's knowledge and skills regularly because techniques
and information related to health are progressing day by day.
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1108|
I
Now you know
What are the main principles and policies of Epidemiology?
1. The following factors are necessary for a disease to grow (a). Subject (b) Cause
(c) Environment
Environment doesn’t just mean the natural surroundings but also the social and financial
atmosphere which affects the possibility of disease. The disease can be controlled even
*
if one of these can be regulated.
2.
The information gathering must be done honestly.
3.
The facts should be classified and analysed after they are collected, (e.g. age-wise,
*
according to economic level, sex-wise, time etc.)
4. Conclusions should be drawn from the analysed facts by asking 6 questions about 1.
the meaning of the problem 2. the person afflicted 3. the time (month/period) of the
problem 4. the location / area of occurrence 5. the cause of the problem. 6. the possible
solution to it.
5. This science is comparative. It considers the conditions before and after measures are
taken against each other. The comparison may be between two are more villages, states
or even countries.
How should records be kept
There are many descriptions with a health worker. A copy of the information about the
village and its map should be put up on the wall of the Gram Panchayat. One copy be
kept in one’s own bag, and another sent to the ANM. The remaining copy should be stored
in a trunk.
All copies to be made in pencil so that change can lie easily included when necessary.
Maps to be made on tracing paper since they can be copied easily.
Make different registers for details about families like -
•
Record of patients
•
Record of mothers
•
Baby/children cards
•
Record of deaths
(
Each register should be wrapped in a plastic bag to prevent humidity and rodents. Place
(
some neem leaves in the box to keep out insects. Individual records should be made in
(
ink since they will not change, but family information may be written in pencil.
t
(
109
Exercises
Fill in the blanks
1. Interview, 2. Survey, 3. Collecting information about a small representation of the population
1.
The process of collecting particular information is called
2. A sample means
3. Asking a person questions related to an objectives face to face is called an
Match the pairs
1. Descr ptive
2. Analytic
1. Analysing different causes
2. Describe in detail
3. Experimental
3. Focussed group discussion
4. Focussed group discussion
4. Experimental
Choose the correct alternatives
1. A health worker must add to his knowledge
4
1. To increase information
2. For planning
3. For self development
4. Health related techniques are improving day be day
t
Answers
(
Blanks - 1-2, 2-3, 3-1
Pairs - 1-2, 2-1, 3-4, 4-3
Alternatives - 1-4
r
mo
Appendix
I
(
(
I
(
I'
(
(
(
(
(
>
&
t
t
iTi]
Points to be noted before drawing a map
T
voTf16 th® direCtlOn by observin9 the sun-rise for the east with west opposite it. When
f
you face the east, the south will be your right and North to you left
Make a key to list the signs used in the map.
•
Start the map from the bus Stan, of the village. In Its absence, start from the mala temple
’
(
theZand m " “'h"1" S,a"d/temp'e
the"
there and then show even the smaller roads.
(
After the road, draw the rivers and canals flowing through the village.
«
(
•
(
main roads starting from
Show the social organisations and other temples of the village.
When all the roads and canals are shown, the village will be divided into smaller parts
(
Mark wells, tube wells, common taps, water-tank and pipe lines in the map (The lay
out of the p.pehne wHI be available with the Gram Panchayat. Count the houses between
(
e smaller parts and indicate the numbers exactly as they are, on the map).
1
•
Show flowing waste-water
•
Show stagnant dirty water.
•
Show the location of the garbage
•
Indicate the latrine of the village.
•
Indicate the places used by the villagers for defecation
•
Show the locations of the soak-pits.
1
dump.
Show the public land (common property) of the village.
•
Indicate the homes and centres of health workers.
•
Show the agricultural land.
Key
Temple
3
fi
Church
Hand pump
o
Masjid
Walled well
~ — Main Roads
Water Tank
Sub-roads
k
(
Open well
Health Centre
L+f?
w
112
River/Lake /
*
Trees
i zmn
Gram Panchayat
Z------
Post office
j LLLm
[TIXEJ
Library
e
e
e
Dairy
North
Cooperative Society
e
e
Buildings / Houses
Bus stand
Health Worker’s Home
e
Shops
€
/ [
n
p.i.c.
PIC
Marsh
£
Public Telephone
Fertile land
T
Gymnasium
Dust Bin
¥¥¥
o
Drinking water pipe
I IT I
####-
Gutter
€
C
Square
e
c.
c
c
e
e
c
<
Railway* line, bridge, Chaupal
*
Water tap,
Public tap,
f
c
c
(
Fort,
(
(
I
Public place,
<
Board
<
(
(.
('
f
(
(
113
(
f
f
Ifl
(
(
u
(
II
(
(
(
(
(
@p
(P @
(
(
(
(
(
(
(
(
\\\
\\\
(
\v
(
(
(
(
(
(
i
i
vq
\
S®:-. -
9
114
Information about village
Name of village
Name of sub-centre
Distance from your village :
PHO
Distance from your village :
©
Date of commencement of baseline
c
Date of closing of base line
e
©
Total no. of houses
€
Population (Age and Sex wise)
No.
Age-Group
Women
Unmarried
1.
Less than 1 year of age
2.
1-4 years
3.
5-8 years
4.
9-14 years
5.
15-44 years
6.
45-64 years
7.
65 and above
Men
Total
Married
€
£
C
e
c
€
4
€
t
(
Practising Private Doctors / Oza etc. :
No.
Name
Method of Treatment
Address
C
€
(
1.
(
2.
C
3.
(
4.
€
C
(
(
c
c
c
*
I
115
No.
Name
Midwife
Trained / Untrained
Address
Groups working in the village (e.g. women’s Forum, Saving Group, Youth club, Cooperative Society
c
etc.)
(
(
No.
(
1.
(
2.
Name of Group
Address
(
f
Facilities available in the village :
(
(
Aanganwadi
Primary School
(
Baalwadi
Middle School
(
Sub centre
Post Office
Bus Service :
Panchayat Office
Frequency :
t
Environment
(
(
1.
2.
3.
4.
5.
6.
7.
8.
9.
(
Total no. of wells
Total no. of hand-pumps
Lakes
Water tanks
Total no. of taps
Total Dry Pits
Kitchen garden
Gutters (with Stagnant water)
Canal (Temporary)
10. Marsh
Infectious Diseases
Total no. of patients
*
TB
Leprosy
Others (Give Names)
)
r
(
(
Signature
This record should be made every year. The map too should be attached to it
every year.
f
ms]
Family Card
%
Name of Main Member
Relation with
Main Member
>•
Age
Sex
Education
£
Occupation
%
Type of Home
(Temporary Permanent)
Source of Drinking water
G
(According to Season)
e
t
Water Purification
c
Jan. - March
April - June
Tap/Well/Tanker/Hand-pump
t
House/Grampanchayat
e
c.
TapA/Vell/Tanker/Hand-pump
<
July-September
Tap/Well/Tanker/Hand-pump
c<
October-September
Tap/Well/Tanker/Hand-pump
H
Latrine
Yes/No
Within/without
€
€
€
Animal Housing
Yes/No
Internal/external
(
C
<
(
c
<
(
c
c
c
c
>
9
f-
—
F
[7l7
Information about Domestic Animals
Animals
Number
Animals
Goats
.r
Number
Chicken
Cows
Oxen/Bullock
Buffaloes
Sheep
J
(
(
(
(
Fuel used (per week)
Firewood/Gobar gas/kerosene
Financial condition :
Lower class:
Middle class:
Higher class:
(
How many members of your family have migrated
Any other occupation?
Landed
for work?
Yes / No
Property
Irrigated land
(
Non-lrrigated land
(
Birth
(
Sr. No.:
Date of birth
Sex :
Male / Feamle
Death
Sr. No.:
Name
Date
Fiis]
Record of Patient
Paper No.
House No.
Date of onset of Illness
e
Village/ Wadi.
Name of Tai
•
Name of Patient
Age
1. Less than 7 days
2.
3. 28 days to 1 year
4. 1 year to 4 years
5. 5-14 years
6. 15 to 44 years
7. 45 to 64 years
8. 65 and above
Addition :
e
e
e
Occupation
1. Tobacco
7 to 27 days
2. Cigarette
t
4
3. Gutka
Amount
Sex
<
€
1. Female
1. Married
2. Unmarried
3. Widow
4. Separated
2. Male
1. Married
2. Unmarried
3. Widower
4. Separated
Indications
Analysis by Tai
(
Which kind of medicine did the patient demand?
2. Homeopathy
c
c
4
4
C
Expenses (For Medicines from Tai) Rs.
1. Allopathy
€
3. Ayurvedic
c
€
Treatment:
C
Advice :
(
if cured
In how many days
If not cured
Cured for some time
c
Normal check-up
* Not known
(
* Could not be contacted
c
* Others
(
C
C'
»
..
Card for Mothers
119
L General lnfOi
Nation
1- Card No.
2- Date of
Name
registration
4- House No.
Age
(
(
II. History Of Conception
(
and Delivery
(
1. Menstruation
(
^egular
2- Total
(
3- Total
(
(
,rregular
inceptions
(
Deliveries
4- Abortion I
(
Miscarriage
Total living children
6. implications
FQmale
during
Previous
Yes
/ ro„cep(jon
No
ifai's of problem
7- Date
8- Used
°f iast deliVery
family Planning devices
9. Which
are
No
10 Did you have
Yes
No
which
Male
1
<
[120]
I
III. Present Conception
1. Date of Last Menstrual Period
<
2. Probable date of delivery
3. Do have any problem at present Yes.
I
Which
No
4. Check-up (normal)
Eyes
Date
Yellow
Light
Normal
4
4
<
C
€
<
Oral Health
Swelling on legs
Throat
<
i
<
<
Urine sugar
Height
Blood Pressure
Weight
Haemoglobin
€ <
€
Urine Albumin
<
e
(
(
5.
<
Tetanus Toxide - Date
<
6.
1. Tablet
Iron and Folic Acid
<
Date
C
(Total Tablets and date)
(
2. Tablet
t
Date
(
3. Tablet
(
Date
(
7.
Advice for delivery in the PHC
Yes
No
(
(
If yes give reasons/indications
(
i*
Date
(
i
(
c
c
>
FI2T]
Check-up of belly
Date
Height of Uterus
Condition of Foetus
Heart Beats
Complications
Advice
(
(
Advice
V
Diet
Serious indications
0-3 months
Vaginal bleeding/vomiting
(
(
4 - 6 months
Bleeding, stomach-ache
vaginal bleeding with head-ache,
difficulty to see, swelling
I
6-9 months
Movement of foetus, excessively,
stomach-ache, green vaginal flow
with head-ache, difficult to see,
swelling
(
(
Delivery
3
1. Date
2. Delivery
What were the indications
3. Place of birth
Time
__ Name of Mid-wife
Normal
Complicated
of complication?
Home
Hospital
4. Sent patient to PHC/Hospital during delivery
Date
I
Time
PHC
Rest
n~22
<
Reasons
Post Delivery Care (Two Visits )
Date
Date
Date
Normal Check-up
Temperature'
Eyes
Pulse
f
Date
e
f
f
f
Blood pressure
Haemoglobin
Breasts
e
Height of uterus
e
e
c
Reasons
Advice
Care of breasts
€
f
I
Nutrition
<
Information about Family Planning
(
To abstain from intercourse for 42 days.
c
Rest
(
Information about the baby
Child Card No.
Date of birth
Dead / Alive
Weight
Colour
Sex
Heart Beat
(
Breathing
(
(
(
(
Movement
(
(
(
(
C
(
V
(.
(
(
C
(
4
4
1123]
Information about the child : Fill 6 years of age
Card No.
Name of village
House No.
Name
Mother’s name
Father’s name
Date of Birth
Weight at birth
Height at birth
Time of birth
Waist
Immunization
Date
1
2
3
4
5
6
BCG
DPT I
DPT II
DPT III
DPT Booster
Any other
(Name)
7 Measles
Date
Polio I
Polio II
Polio III
Polio Booster
Report of Visit
After 3 days in the 1st Week
Date
1. Condition of card
2. The child is drinking milk
3.
2-28 days
Every week
Drinks milk
Any problem
1 month - 1 year
: At least once a month
i*
1
124
Sr. No.
Check-up
1
General Health
(
2
Weight
<
3
Height
<
4.
Nutrition : Breast feeding,
Bottled feeding, other diet
<
5.
<
Development : Holding the hand,
Lifting the head, sitting up, crawling,
standing, walking
4
<
<
<
€
Illness :
Date
C
€
C
Indications :
Treatment :
Code No.
e
Advice :
t.
c
€
(
Signature :
C
(
(
(
Instructions for filling up Cards
<
1.
The card of every child born in the village must be filled.
2.
While giving a code no., write the serial numbers of the children
the year e.g. 1. 2001
(
(
born in that year and then
(
2. 2001 etc.
C
3.
Even if the child was not treated by you, write the indications after
4.
Attach extra paper if needed, to describe illness
(
5.
Give a code no. according to the key of illnesses.
(
enquiry about illness.
(
(
(
(
(
(
c
*
125
<
Record of Death
<
c
Card No.
1.
Name of village
4.
House No.
5.
Name of deceased
2. Tehsil
3. District
<
(
(
(
(
.(
(
6. Age
(
(
7.
Sex
8.
Name of Mother/father/wife/husband
9.
Death
(
(
Date
(
Day
(
(
<
10. Place of death
Month
home/public place/PHC/Hospital
(
11. Complaints or symptoms at the time of death
12. Any illness before death ?
Code No.
Name / Indications of disease
13. Name of informer
Relationship with deceased
14. Signature of health worker and name
Date
Year
126
?t
List of Groups of Symptoms for common people
Code
Main symptom / other indications
Possible
Diagnosis
No.
I
01 Fever with rash on the skin/body
1
10
10
which disappears after some days
11
Chicken Pox
13
11
Fever, skin and eyes yellow white stools, painlInfectious
in the joints
Jaundice
F®Ver
but symptoms different from~
above
19
13
k
V
19
L
c
Code
No.
20
21
Main symptom / other indications
Possible
Diagnosis
__________ 02 Feverand nervous problems
Fever, inability to mov^^Tp^alyseTpiir
Encephylitis
in muscles
4
4
2
20
<
^®^®F~^^W^o^TTove7Acute headache pain
in joints
Dengue
4
21
4
22
swelling
23
Fever and paralysis
24
Fever, stiff throat/neck, vomiting, redness of
skin, rash
Plague
22
4
Polio
23
Meningitis
24
<
<
29
Code
No.
30
Feverwithothef symptoms and in recognizable
nervous disorder
Main symptom / other indications
t
(
Possible
Diagnosis
38
39
(
f
-------------------------- Q3 Other types of Fever
normalising and increasing again with fever and too
weak to move
31
*
29
External symptoms lab,
test, malarial parasites Malaria
found in blood
3
(
30
(
(
(
31
(
Fever with other symptoms
38
(
39
(
(
(
(
(
(
f
e
J
?
t
i.
127
Code
Main symptom / other indications
No.
40
_________________ 04 Patches on the skin
Patches on skin with non sensation
43
Knots like a rope and swelling in limbs
44
45
&
I
Leprosy
48
Wounds on private parts with higher edges, no
Syphilis
pain, history of intercourse
49
Patches on skin, boils or redness which cannot be
[interpreted
Code
No.
Main symptom / other indications
Watery motions, vomiting, total dryness
51
Diarrhoea and vomiting with stomach-ache
52
Diarrhoea with mucous, vomiting, fever
59
Diarrhoea and vomiting which is different from
above descriptions and cannot be understood.
61
Main symptom / other indications
Diarrhoea, stomach-ache, fever
62
f
i
I
J
Diarrhoea incomprehensible
46
I_____
48
49
Possible
Diagnosis
Cholera
Food poisoning
Bacilutic Dysentery
i
5
50
51
52
59
Possible
Diagnosis
________
06 Other types of Motion
wiThmodons3103130^3^6 mUC°US
bleedi^&ebic Dysentery'
t
45
47
05 Diarrhoea and Vomiting
60
44
Jaundice
Swelling on skin, redness, pain, boils (At the point
of an earlier injection on operation)
Code
No.
43
Paleness of outer and inner lining of skin, eyes,
Anaemia
mouth, fatigue, weakness
47
50
4
40
Filariasis
Dryness of skin, mouth and eyes, depression on
Dehydration
the head
46 _ Yellow skin, yellowness of eyes (in the white part)
C
Possible
Diagnosis
Infectious Diarrhoea
6
60
6162
128]
Code
No.
Main symptom / other indications
Possible
Diagnosis
07 Other problems of the stomach
7
70
Stomach-ache, stiffening of stomach
Acute Abdomen
70
71
Stomach-ache, vomiting
Indigestion
71
72
Swollen stomach
Tumour Ascitis
72
73
Pain in the rectum, bleeding with stools
Piles
73
74
Worms excreted with faeces or with vomiting
Worm infestation
74
Main symptom / other indications
Possible
Diagnosis
Code
No.
e
s
€
C
c
80
_________________ _______08 Cough____________
Chronic cough (more than 3 months, weight loss, Possibly TB
bleeding with phlegm, mild fever)
8
80
31
Above symptoms with pathological report of TB
TB
81
C
82
Excessive
problem
breathing Pneumonia
82
e
83
Excessive cough, muscular
running nose, throat ache
headache, Influenza
83
84
Excessive cough, fever, bark-like sound of cough
Whooping cough
84
85
Excessive cough and fever
Acute bronchitis
85
(
86
Excessive cough and fever
86
c
Code
No.
cough,
fever,
chest-pain,
pain,
Main symptom / other indications
€
€
•
C
V
Possible
Diagnosis
09 Upper respiratory tract infections
9
t
90
Unnatural condition in the nose and throat, mucous, Common cold
cough and fever_______________________________
90
91
92
Pharyngitis, fever, difficulty in swallowing__________ Sore throat
Sore throat, feeling of layer on throat, mild fever
Diphtheria
91
92
c
4
§
Code
No.
100
101
Main symptom / other indications
Possible
Diagnosis
________________ 010 Difficulty in breathing_____
Difficult breathing, panting, chest-pain, swelling on Heart Disease
legs/feet_________ ____________________________
Difficult breathing, breathlessness, cough
Asthma,
Emphecema,
Chronic Bronchitis
10
€
100
(
<
101
(
(
t
(
(
A
|129
Code
No.
110
111
112
113
(
(
(
114
115
116
117
Main symptom / other indications
-yp-------- -1 Urinary and Reproductive Tract Problems
senTattonZP^^^er and thirst' frec^uen (Diabetes
_ oensaiion of urine
Blood through urine
Systostosomiosis
pus
Urinary infection
No urine
"
Menstruation problems
Code
No.
11
110
111
112
113
--------- ---
-- ----- —
____
Renal shut down
Urinary obstruction
Genital Infection
Menstruation
Disorders
Main
ft-------------------------------- ^2 Eye Problems
120 EjPaque spots in the eyes
121
122
123 Lack of night vision
124
125
Possible
Diagnosis
Improper vision
Other Eye problems
Possible
Diagnosis
-------- --------
----------
114
115
116
117
___ I
__ Eye Opacitis
__ Eye Infection
__ Blindness
Deficiency
of
12
120
121
122
123
Vitamin A
124
125
Code
No.
n/,ain
Possible
Diagnosis
llfrobjems
of Head and Throat
w
wI
130 Jlnflammation of tongue /
/ mouth, pain
131 __ Tooth-ache
Inflamed mouth
~
132 Bleeding mouth/nose
Tooth-ache
133 _ O^her mouth problems
134 Swelling in throat,
moving while swallowing,
Goiter
_ painless
135 . Pain or flow ofear
136 [Hard of hearing
Ear Infection
----- 1—
I
- --------------------
13
130
131
132
133
134
135
136
I
11301
Code
No.
140
141
142
143
144
145
146
147
148
149
Code
No.
150
151
152
153
154
155
Code
No.
160
161
162
163
164
Main symptom / other indications
Possible
Diagnosis
_____ _____________ 14 Spinal Problems
Hydrophobia, history of animal bite, seizure______
Rabies
Locked jaw, erratic muscular movement, history o
Tetanus
injury or delivery
Paralysis and unconsciousness
Stroke_______
Sharp head-ache, giddiness
Hypertension
Unnatural / hallucinatory behaviour_____
Mental disorder
Excessive alcoholism, weakened physical, mentallAlcohol Abuse
social ability
Use of medicine for addiction, weakening of all Drug abuse
abilities
Fit attack and unconsciousness
Epilepsy
Paralysis and unusual symptoms
Unconsciousness coma, cause not understood
Main symptom / other indications
_____________ Problems of new-born infants
Natural birth, alive
Still-birth
------------------Injury due to delivery / technique
Weight loss of baby, underweight, premature
Abnormal body/limbs or their function
140
141
142
143
144
145
<
146
<
<
e
147
148
149
t
€
Possible
Diagnosis
_________________ 15 Maternity Problems
Natural conception
Complicated symptom during (conception like Complicated
bleeding, swelling of legs, UTI, fever,, anaemia
----------- 1 __ Pregnancy
Miscarriage/Abortion
Abortion
Natural Delivery
Problems during delivery like intestinal bleeding, Complicated
swelling of legs, grean pain, prolonged period birth
causing fatigue, early bursting of - Reproductive
Tract injury
Symptoms of infection within 6 weeks of deliver, Complicated
fever wound in reproductive
tract?)_______________ Purperium
--------------------------------- - --------Main symptom / other indications
14
15
150
151
child
152
153
154
f
(
<
(
155
4
(
Possible
Diagnosis
Still birth__________
Birth injury________
Immaturity________
Congenital Anomaly
(
4
16
160
161
162
163
164
(
4
(
(
(
(
(
(.
C
(
C
c
e
c
131
<
Code
c
r
No.
Main symptom / other indications
Possible
Diagnosis
171
172
_________________ 17 Common Problems
Weakness, weight loss, anaemia, swelling, history Malnourishment
of irregular diet______________
Discoloured hair, no other symptom____________ Kwashiorkor
Faster slow pulse, weakness, pale face, immobility Shock
171
172
173
174
175
Weakness, fatigue, no other symptom
Weight loss with no other symptom
Pain and swelling in muscles or bones
173
174
175
176
178
Pain unlisted above
Weakening of physical, mental ability due to old Senility
age (above 65 only)____________________
170
Code
No.
Arthritis
Rheumatism
Main symptom / other indications
Possible
Diagnosis
18 Serious Injury (Beyond mere Dressing)
180
181
182
183
184
185
186
187
188
189
Code
No.
(
190
191
192
193
194
195
196
197
Bone injury
Fracture_______
Joint Dislocation
Traumatic
Amputation
Displacement of joint
Cutting off of part of limbs / body
Torn part of body (which can be rejoined)
Collection of blood
near injury
_______________________________
Haematoma
Injury caused by part of body being crushed under Crushing injury
some heavy object
Entry of some object into the body through a Foreign body
part/pore_____________
Burning___________
Burns
Poisoning (Except by food)_____________
Poisoning
Other serious injuries ___________
Main symptom / other indications
19 Normal Injury
Scratches____________
Injury by sharp object________
Black and blue appearance of hurt area
Muscle injury______
Cramped muscle________
Internal clotting__________
Scratched organ_______
Any other injury
17
170
176
178
l______
18~
180
181
182
183
185
186
187
188
189
Possible
Diagnosis
Laceration
Puncture
Bruise
Sprain
Strain
Contusion
Abrasion
Code
No.
Main symptom / other indications
200
201
202
_________ 20 Disease and Cause of death - untold
Cause outside the list
Sudden death where cause is unclear
Unknown cause of death
19
190
191
192
193
194
195~
196
197
Possible
Diagnosis
20
120
201r_
2°;n
I
<
132
I Code
Main symptom / other indications
No.
E1Q
E11
E12
E13
E14
E15
E16
E17
E18
E19
Code
No.
|
External Causes of Injury
Unintentional poisoning (other then food)
Injury due to vehicle ~~
Any other accident
Suicide, self-infected wound
Murder, effort to kill
---------Unreported violence (to self or other)
_________ ____________ Health Service
S10 Outpatient - External Treatment
S 11 Injection Immunisation
S 12 Oral Medicine
S 13 Bandage
"
S 14 Normal delivery
————
S 15 Other normal technique
S 16 T/lother-chfld care
S 17 Counseling for family planning
8 18 Counselling
'
8 19 [Other unlisted services
4
E-1
E10
E11
E12
E13
E14
E15
E16
E17
E18
E19
Bite / Sting
Unknown burning
Sudden drowning
Fall
Main symptom / other indications
(
Possible
Diagnosis
I
<
<
I
c
Possible
Diagnosis
810
S 11
S 12
S 13
S 14
S 15
S 16
S 17
S 18
S 19
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133]
Meanings
f
f
Diagnosis
(
Communicable Diseases
Agent
To decide the nature of the illness after studying the
symptoms and signs
Diseases spreading from person to person
Substance affecting physical, chemical or biological factor
i
(
Host
(
Environment
The animal or plant inside which germs / organisms can
grow
The surrounding area which affects an organism
(
(
(
f
Epidemic
Endemic
Resistance
Many people getting the same diseases simultaneously
A disease recurring in a given geographical area, more
than in other areas
The energy to resist disease
(
(
Vaccine
(
(
Inflammation
(
(
Immunology
Bodies that catalyse the body to produce antibodies to
prevent certain diseases
A chain of reactions from tissues caused by physical,
chemical or infectious effects.
The study of the mechanism of resistance by a body.
(
Disease
Not having a normal health
(
Community Health
(
Health Promotion
(
(
(
(
The condition of the health of a whole group of people
which depends on various factors like social, financial,
political, environmental etc.
To make improvements in conditions of health,
maintain health to prevent disease.
to
- Media
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