Neet PG PSM Update: Important Topics

Preventive and Social Medicine ( PSM), if prepared properly can indeed be a high scoring topic for an aspirant. An important part of PSM would include being up-to date with the various activities taken up by the government for promotion of public health and prevention of diseases including various health programmes and interventions. One also needs to be updated with latest statistics and indices reflecting the public health of the country. Moreover, knowledge of vaccinations can indeed by a game changer in this section

For the benefit of the aspirants, here are some important topics that one needs to be updated in relation to the public health of the country

MISSION INDRADHANUSH

Launching Date: 25^th December 2014

Diseases Covered: Diphtheria, whooping cough, tetanus, polio, tuberculosis, measles and hepatitis B.

Goal: To vaccinate all under-fives by the year 2020.

Time period: January to June 2015

Placed Covered: First Phase – 201 high focus districts.

Campaign mode: "catch-up" strategy.

Technical Supporters: WHO, UNICEF, Rotary International

• Mission Indradhanush was launched by Ministry of Health and Family Welfare (MOHFW) Government of India on 25^th December, 2014.


• The objective of this mission is to ensure that all children under the age of two years as well as pregnant women are fully immunized with seven vaccine preventable diseases.


• The Mission Indradhanush, depicting seven colours the rainbow, aims to cover all those children by 2020 who are either unvaccinated, or are partially vaccinated against even vaccine preventable disease.
  
  
  
  • Diphtheria
  
  
  • Pertussis (Whooping Cough)
  
  
  • Tetanus
  
  
  • Tuberculosis
  
  
  • Polio
  
  
  • Hepatitis B
  
  
  • Measles
  
  
  
  

In addition to this, vaccines for Japanese Encephalitis (JE) and Haemophilus influenzae type B (HIB) are also being provided in selected states.

INTRODUCTION OF PENTAVALENT VACCINE (DPT + HEP-B + HIB)

India introduced pentavalent vaccine containing DPT, hepatitis B and Hib vaccines in two states viz. Kerala and Tamil Nadu under routine immunization programme from December 2011. DPT and hepatitis B vaccination require 6 injections to deliver primary doss. With the introduction of pentavalent vaccine, a new antigen, i.e., Hib has been added which protects against haemophilus influenza type B (associated with pneumonia and meningitis) and number of injections are reduced to 3. The vaccine has been expanded to 6 more states, i.e., Haryana, Jammu and Kashmir. Gujarat, Karnataka, Goa and Puducherry in 2012-13. Further expansion is plannedto 11 states in October 2014 and rest of 15 states from April 2015.

Maternal and Child Health (MCH) Wing

Most healthy facilities, especially those at secondary and tertiary level are high case load of pregnant women and newborn due to increase in institutional deliveries following launch of JSY and JSSK. Therefore, it has been decided that dedicated Maternal and Child Health Wings will be established in high case load facilities with adequate provision of beds. The new MCH wings will be comprehensive units (30/50/100 bedded) with antenatal waiting rooms, labour wing, essential newborn care room, SNCU, operation theatre, blood storage units and a postnatal ward and an academic wing. This will ensure provision of emergency maternal and newborn care services as well as 48 hours stay, i.e., quality postnatal care to mothers and newborns.

New initiatives in 12^th Five Year Plan

1. In order to raise coverage of piped water supply, toilet coverage and strengthening of institutions and systems in rural drinking water and rural sanitation sectors the Ministry has proposed a Rural Water Supply and Sanitation Project for low income states;


2. Enhancement of service levels for rural water supply from the norm of 40 lpcd to 55 lpcd for designing of system. The target being at least 50 per cent of rural population in the country to have access to water within their household premises or within 100 meters radius, with at least 30 per cent having individual household connections, as against 13 per cent today.

Rural Sanitation Programme

1. Nirmal Bharat Abhiyan (NBA)

In 2012, a paradigm shift was made in the Total Sanitation Campaign, by launching the Nirmal Bharat Abhiyan, in the 12^th Fiver Year Plan. The objective of NBA is to achieve sustainable behavioural change with provision of sanitary facilities in entire communities in a phased manner, saturation mode with "Nirmal Grams" as outcomes.

2. Swachh Bharat Abhiyan (SBA)

Prime Minister Shri Narendra Modi launched country's biggest cleanliness drive on 2^nd October 2014. The campaign aims to accomplish a vision of clean India by 2^nd October 2019.

3. Global Hunger Index (GHI)

The Global Hunger Index (GHI) is a tool designed to comprehensively measure and track hunger globally, by region and country. It highlights successes and failures in hunger reduction. It is calculated each year by the International Food Policy Research Institute.

GHI combines three equally weighted indicators into one index:

1. Undernourishment: the proportion of undernourished people as a percentage of the population (reflecting) the share of the population with insufficient calorie intake);


2. Child underweight: the proportion of children under the age of five who are underweight (that is, have low weight for their age, reflecting wasting, stunted growth, or both), which is one indicator of child undernutrition; and


3. Child mortality: the mortality rate of children under the age of five (partially reflecting the fatal synergy of inadequate food intake and unhealthy environments).

The global hunger index is calculated by the following formula:



Proportion of undernourished population (PNU)

+ Children under weight (CUW) +

Child mortality in per centage (CM)

GHI= 3

For India the GHI for the year 2014 is:

17.0 + 30.7 + 5.6

= 17.8

NACP – IV Strategies

1. Saturating quality HIV prevention services to all HRG groups, based on emerging behaviour patterns and evidence


2. Strengthening needle exchange Programme, drug substitution programme and providing Opioid Substitution Therapy (OST)


3. Reaching out to MSM and Transgender communities


4. Addressing the issues related to coverage and management of rural interventions


5. Providing quality STI/RTI services.


6. Expand the ICTC services and strengthen referral linkages


7. Strengthening positive prevention


8. Strengthening management structure of blood transfusion services


9. Implementing National EQAS for all participating labs at district and above for HIV related diagnostic services.

Strategic Information Management System (SIMS)

1. National Integrated Biological & Behavioural Surveillance(IBBS)
   among HRG & Bridge Groups


2. National Data Analysis Plan


3. National Research Plan


4. Transforming SIMS into an integrated decision support system with advanced analytic and Geographic Information System (GIS) capabilities


5. Institutionalizing Data Quality Monitoring System for routine programme data collection


6. Institutionalizing data use for decision making

Twelfth Five Year Plan (2012 – 2017)

Indicators for Twelfth Five Year Plan

1. Reduction of Infant Mortality Rate (IMR) to 25.


2. Reduction of Maternal Mortality Ratio (MMR) to 100.


3. Reduction of Total Fertility Rate (TFR) to 2.1: India is on track for the achievement of a TFR target of 2.1 by 2017.


4. Prevention and reduction of under-nutrition in children under 3 years of half of NFHS – 3 (2005 – 06) levels.


5. Prevention and reduction of anaemia among women aged 15 – 19 years to 28 per cent
   .


6. Raising child sex ratio in the 0 – 6 years age group from 914 to 950.


7. Reduction of poor household's out-of-pocket expenditure.

National health goals for communicable diseases under Twelfth Five Year Plan

Disease	Twelfth plan goal
Tuberculosis	Reduce annual incidence and mortality by half
Leprosy	Reduce prevalence to < 1/10,000 population and incidence to zero in all districts
Malaria	Annual malaria incidence of <1/10,000
Filariasis	< 1 per cent microfilaria prevalence in all districts
Dengue	Sustaining case fatality rate of < 1 per cent
Chikunguniya	Containment of outbreaks
Japanese Encephalitis	Reduction in mortality by 30 per cent
Kala – azar	Elimination by 2015, that is, <1 case per 10,000 population in all blocks
HIV/AIDS	Reduce new infections to zero and provide comprehensive care and support to all persons living with HIV/AIDS and treatment services for all those who require it.

RMNCH + A strategies

Adolescent Health Programme

1. Adolescent nutrition; iron and folic acid supplement.
   
   
   
   1. Administration of supervised weekly iron – folic acid supplement of 100 mg elemental iron and 500 mg folic acid using a fixed day approach.
   
   
   
   


2. Facility-based adolescent reproductive and sexual health services (ARSH) (Adolescent health clinics)
   
   
   
   2. Adolescent Friendly Health Clinics (AFHC): Through Adolescent Friendly Health Clinics, routine check-up at primary, secondary and tertiary levels of care is provided on fixed day clinics. At present 6,302 AFHCs are functional across the country providing services, information and commodities to more than 2.5 million adolescents for varied health related needs such as contraceptives provision, management of menstrual problems, RTI/STI management, antenatal care and anaemia.
   
   
   
   


3. Information and counselling on adolescent sexual reproductive health and other health issues.


4. Menstrual hygiene.
   
   
   
   1. Ensuring regular availability of sanitary napkins to the adolescents;
   
   
   2. Sourcing and procurement of sanitary napkins;
   
   
   3. Storage and distribution of sanitary napkins to the adolescent girls;
   
   
   4. Training of ASHA and nodal teachers in menstrual health, and
   
   
   5. Safe disposal of sanitary napkins.
   
   
   
   


5. Preventive health check-ups.

RNTCP

New Initiatives Under RNTCP

1. The RNTCP has completed the feasibility study of introducing GeneXpert in RNTCP in 18 Tuberculosis Units in 12 states. RNTCP is currently using CB NAAT for the diagnosis of tuberculosis and MDT-TB in high risk population like HIV positive and paediatric groups.


2. Nikshay: TB surveillance using case based web based IT system


3. TB Notifications


4. Ban on TB Serology

Sustainable Development Goals (SDGS)

• Transforming our world: 2030 Agenda for Sustainable Development – An intergovernmental set of 17 aspiration Goals with 169 targets


• Post 2015 Development Agenda (successor to MDGs)


• Direct Health related goals: One (Goal)


• Direct Health disparities addressing goal: Six (Goals 1 – 6)
  
  
  
  • End Poverty in all its form everywhere
  
  
  • End Hunger, achieve food security and improved nutrition and promote sustainable agriculture
  
  
  • Ensure Healthy lives and promote well-being for all at all ages
  
  
  • Ensure inclusive and equitable Education and promote lifelong learning opportunities for all
  
  
  • Achieve Gender equality and empower women and girls.
  
  
  • Ensure inclusive and equitable quality Education and promote lifelong learning opportunities for all
  
  
  • Ensure access to affordable, reliable, sustainable and modern Energy for all.
  
  
  • Sustained, inclusive and sustainable Economic growth, full and productive employment and decent work for all.
  
  
  • Build resilient infrastructure, promote inclusive and sustainable, Industrialization and foster innovation
  
  
  • Reduce Inequality within and among countries
  
  
  • Make cities and Human Settlement inclusive, safe, resilient and sustainable
  
  
  • Ensure sustainable Consumption and Production patterns
  
  
  • Take urgent action to combat Climate change and its impacts
  
  
  • Conserve and sustainably use the Oceans, Seas and Marine resources and sustainable development
  
  
  • Protect, restore and promote sustainable use of Terrestrial ecosystems, sustainably manage forests, combat desertification and halt and reverse land degradation and half biodiversity loss
  
  
  • Promote peaceful and inclusive Societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levels.
  
  
  • Strengthen the means of implementation and revitalize the Global partnership for sustainable development.
  
  
  
  

CENSUS OF INDIA 2011

• Total population: 1210 million population as on 00.00 hrs 1^st March 2001


• Sex ratio: 940 female per 1000 males
  
  
  
  • Child – sex ratio: 914 girls per 1000 boys (0 – 6 years)
  
  
  
  


• Dependency ratio: 54 per 100 (0.54)


• Density of population: 382 persons per square km


• Literacy Level (aged 7 years and older): 74%
  
  
  
  • Males 82%
  
  
  • Females 65%
  
  
  
  


• Growth rate
  
  
  
  • Decadal Growth Rate: 17.64%
  
  
  • Annual Growth Rate: 1.64%
  
  
  
  

HIGH LEVEL EXPERT GROUP (HLEG) REPORT ON UNIVERSAL HEALTH COVERAGE (UHC)

Definition of UHC: Ensuring equitable access for all Indian citizens to affordable, appropriate health services of assured quality as well as public health services addressing the wider determinants of health, with the government being the guarantor and enabler.



Five levels of health care

• Level 1: Villages, Community level in Urban areas


• Level 2: Sub Health Centres (SHCs)


• Level 3: Primary Health Centres (PHCs)


• Level 4: Community Health Centres (CHCs)


• Level 5: District Hospitals, Medical Colleges, Other tertiary care institutions

URBAN HEALTH CARE SYSTEM

Urban Family Centres (UFWC)	Urban Health Posts (UHP)
Type I: 1 per 1000 – 25000 population	Type A: 1 per < 5000
Type II: 1 per 25000 – 50000 population	Type B: 1 per 5000 – 10000
Type III: 1 per > 50000 population	Type D: 1 per 25000 - 50000

Other Recommendations

• 3 years bachelor or rural health (BRHC) degree program (carde of rural health care practitioners for recruitment and placement at SHCs)


• National health and medical facilities accreditation unit (NHMFAU): Regulatory and accreditation body on management and institutional reforms


• Setting district health knowledge institute: DHKI for districts with population > 500,000

ZIKA VIRUS

WHAT IS ZIKA?

Zika is a virus spread by mosquitos and is related to yellow fever, West Nile and dengue. Only about 1 in 5 people infected with Zika virus actually become ill and experience mild symptoms such as fever, rash, joint pain or conjunctivitis. Individuals infected with Zika virus rarely require hospitalization and very few deaths have ever been reported.

Though not yet scientifically proven, experts strongly suspect a causal relationship between maternal Zika infection during pregnancy and adverse fetal outcomes, such as congenital microcephaly, a rare neurological condition in which an infant's head is significantly smaller than those of other children of the same age and sex and often results in developmental issues.



HISTORY
Zika virus was first discovered in the Zika Forest in Uganda in 1947. Since then small outbreaks have occurred in Africa, Southeast Asia and the Pacific Islands in May 2015.

The Pan American Health Organization (PAHO) issued an alert regarding the first confirmed Zika virus infections in Brazil. The virus has now spread too many countries across the Americas. On February 1, 2015, the World Health Organization Director-General declared that the recent cluster of microcephaly cases and other neurological disorders reported in Brazil, following a similar cluster in French Polynesia in 2014, constitutes a Public Health Emergency of International Concern.
TRANSMISSION
Zika virus is transmitted to people through the bite of an infected Aedes species mosquito and through sexual contact with an infected male partner. It is possible that a woman infected with the virus could pass it to her baby during pregnancy, but more studies are being conducted on this path of transmission. To date, there are no reports of infants getting Zika virus through breastmilk. Spread of the virus through blood transfusion has been reported.
PREVENTION
There is no vaccine to prevent Zika virus. When traveling to countries where Zika virus or other viruses spread by mosquitoes are found, the Centers for Disease Control and Prevention (CDC) recommends avoiding mosquito bites. To avoid being bitten by mosquitos, CDC recommendations include:

• Wearing long-sleeved shirts and long pants.


• Staying in places with air conditioning or that use window and door screens to keep mosquitoes outside.


• Using Environmental Protection Agency (EPA)-registered insect repellents and follow the directions.

TREATMENT
There is no specific medication to help treat Zika virus infection. To treat the symptoms the CDC recommends getting plenty of rest, drinking fluids to prevent dehydration and taking medications such as acetaminophen to relieve fever and pain.

Rashtriya kishor swasthya karyakram (RKSK)

• The Ministry of Health & Family Welfare has launched a health programme for adolescents, in the group of 10 – 19 years, which would target their nutrition, reproductive health and substance abuse, among other issues.


• The Rashtriya Kishor Swasthya Karyakram was launched on 7^th January, 2014. The key principle of this programme is adolescent participation and leadership, Equity and inclusion, Gender Equity and strategic partnerships with other sectors and stakeholders.


• The programme envisions enabling all adolescents in India to realize their full potential by making informed and responsible decisions related to their health and well-being and by accessing the services and support they need to do so.


• To guide the implementation of this programme, MOHFW in collaboration with UNFPA has developed a National Adolescent Health Strategy.


• It realigns the existing clinic – based curative approach to focus on a more holistic model based on a continuum of care for adolescent health and development needs.


• The Rashtriya Kishor Swasthya Karyakram (National Adolescent Health Programme), will comprehensively address the health needs of the 243 million adolescents.


• It introduces community – based interventions through peer educators, and is underpinned by collaborations with other ministers and state governments.

Objectives:

• Improve Nutrition


• Improve Sexual and Reproductive Health


• Enhance Mental Health


• Prevent Injuries and violence


• Prevent substance misuse

VISION 2020

• The 'Right to Sight' is the common agenda launched by the WHO and Task Force of International organization to combat blindness, as 80% of global blindness is avoidable.


• Five conditions that have been identified as immediate priorities within VISION 2020 are -
  
  
  
  • Trachoma
  
  
  • Refractive errors and Low vision
  
  
  • Onchocerciasis
  
  
  • Childhood blindness
  
  
  • Cataract
  
  
  
  

Janani – Shishu Suraksha Karyakram (JSSK)

• All pregnant women delivering at public health institutions to have absolutely free and no expense delivery, including caesarean section.


• The entitlement include
  
  
  
  • Free drugs and consumables, free diet upto 3 days during normal delivery and upto 7 days for C – section,
  
  
  • Free diagnostics
  
  
  • Free blood wherever required
  
  
  • Free transport from home to institution, between facilities in case referral and drop back at home.
  
  
  
  


• Similar entitlements have been put in place for all sick newborns accessing public health institutions for treatment till 30 days after birth.


• This has now been expanded to cover sign infants.

The author, Dr Mukesh Bhatia is a renowned medical educationist, having experience in the medical education sector for more than 35 years and is currently the Chairman of Dr Bhatia Medical Institute, one of the most prominent PG Medical Coaching Institutes in India.