COMMUNITY MEDICINE AN INTRODUCTION By Dr Mahmood Ur

COMMUNITY MEDICINE AN INTRODUCTION By Dr Mahmood Ur Rahman Professor of Community Med 1

Community Medicine The field concerned with the study of health and disease in the defined community or group. Its goal is to identify the health problems and needs of people (community diagnosis) and to plan, implement and evaluate the effectiveness of health care system. 2

GOALS OF MODERN MEDICINE Focus shift from treatment of sick Prevention of Diseases Promotion of health Quality of life improvement for individuals & groups 3

Five Star Doctor Leader Manager Decision Maker Care Provider Communicator 4

Knowledge regarding Population to be served Study of : Demography Patterns of Health and disease Epidemiology Collection, compilation and analysis of data Biostatistics Behavioral factors and their effect on Health Behavioral sciences Control and prevention of diseases Preventive Medicine The food people eat Nutrition Environmental factors and their Environmental Health effects on Health Delivery of Health Care Health Administration and Planning 5

EXAMINATION PATTERN 6

Assessment System (Annual) TERM TESTS: 02 PRE-ANNUAL EXAM Viva and spotting PBL (Problem Based Learning) 7

Annual Examination Marks of Written Paper : 135 Time Allowed = 3 Hrs (Including MCQs) Marks of Internal Assessment : 15 Max Marks : 150 Pass Marks : 75 Written paper will comprise of two parts (A & B) Q– 1 (MCQ) (one best out of five items type from whole course, on separate sheet (Time 30 Min) : 30 Marks 8

Part – A SEQs/SAQs (15 Marks each) Q– 2 PBQ Whole course Q– 3 Epidemiology (Gen & Spec) + Screening of Diseases Q– 4 Statistics Q– 5 Communicable / non communicable diseases 9

Part – B SEQs/SAQs (09 Marks each) Q– 6 Q– 7 MCH and family planning / demography Nutrition / Entomology / Parasitology / Health Education/ Occupational Medicine/ Social / Behavioral Sciences Q– 8 Water / Environmental Health Q– 9 Accidents / Disasters / Smoking / / Substance abuse / School Health / Mental Health / Geriatrics / Housing/ Snake bite Q– 10 HMIS / Medical Ethics / PHC / International Health / Concept of Health and disease / Planning and Management 10

Allocation of Marks Written Paper Max Marks: Internal Assessment: 135 Marks 15 Marks (Based on marks obtained in Theory Papers of Term Tests and Pre Annual exam) Sub Total: 150 Marks 11

Oral & Practical Max Marks: 150 Viva: 100 Marks Spotting: 10 Marks Project: Day Book/Visit Book/Entomology/ Research 25 Marks Internal Assessment: PBL/ Viva Pre Annual: 15 Marks Sub Total: 150 Marks Grand Total: 300 Marks 12

COURSE CONTENTS 13

The complete course of Community Medicine is according to the laid down Syllabus issued by PMDC 14

Core Contents Concepts of Health and disease Introduction to Public Health and Health Systems in Pakistan Epidemiology , Screening and Infectious Disease Control Non Communicable Diseases Biostatistics and HMIS Demography and Population Dynamics Food and nutrition Reproductive and Child Health 15

Core Contents…. School Health Services Environmental health Occupational Health Parasitic Diseases – Prevention and control Zoonotic diseases Arthropods of Public Health Importance Mental Health Behavioral Sciences Health Education and Promotion Disaster Management Medical Ethics 16

Concept of Health and Disease Dimensions and Spectrum of Health Determinants of Health Indicators Primary Healthcare Concept 17

Introduction to Public Health & Health systems in Pakistan Background and concepts Development of Public Health in Pakistan Economics and Health Policy and Planning in Pakistan Health System in Pakistan 18

Epidemiology and Disease Control Background and concepts, uses Basic measurements in epidemiology Epidemiological methods, association and causation investigation of epidemics, screening for disease Research and survey methodology Definitions: infection, contact, host, carriers 19

Dynamics of infectious disease transmission Control of infection Epidemiology, control and prevention of infectious diseases of public health importance Diseases transmitted through inhalation Diseases transmitted through faeco-oral route Diseases of animals conveyed to man Diseases due to direct contact 20

Epidemiology, Control and Prevention of Noninfectious Diseases of Public Health Importance Hypertension Coronary heart disease Cancers Injuries Diabetes Mellitus Obesity Acute Rheumatic fever Ischaemic heart diseases 21

Biostatistics Concepts and uses Data and its types Rate, ratio and proportion Crude, specific and standardized rates Collection and registration of vital events in Pakistan Sources of health related statistics Measures of central tendency (Mean, Mode, Median) 22

Demography and Population Dynamics Concept, Principles, Demographic processes Census, definition, types, methodology Determinants of fertility, mortality Population pyramid and its interpretation Demographic transition, demographic trap Demographic & social implications of high population growth Social mobilization Urbanization 23

Food and Nutrition Concepts of Nutrition Malnutrition at all stages of life Dietary requirements Food hygiene, pasteurization, fortification, adulteration and preservation Food poisoning Assessment of nutritional status of Community 24

Reproductive and Child health Safe motherhood & its components Maternal mortality, causes and prevention Infant care, growth & development, breast feeding, common causes of morbidity and mortality, their prevention and control IMCI (Integrated Management of Childhood Illness) Adolescent health Reproductive tract infections, managing STDs 25

Health of School age Children Role of teachers and role of doctors in maintenance of health Procedures for determining the health status of school children Common health problems of school children 26

Environmental Health Air Composition, pollution, purification, diseases caused by air impurities & their prevention Water, Sources, daily requirement, causes of pollution, its prevention, purification, quality standards, diseases due to polluted water Waste Disposal, Hazards and Safety Measures Radiation sources, types, causes, hazards, prevention Healthful housing, urban & rural slums, Refugee camps and hostels Noise, causes, acceptance level, hazards and control 27

Occupational Health Concepts of occupational Health and Medicine Ergonomics and its Importance Occupational Hazards Principles of prevention and Control Organization of Occupational Health Services Health insurance and Social Security Schemes 28

Arthropods and Their Public Health Importance Common arthropod borne diseases Control of arthropod of medical importance Insecticides and their public health importance 29

Ø Prevention and control of parasitic diseases of public health importance Ø Snake bites, personal protection and management 30

Mental Health Concept, common mental health problems, causes and prevention Juvenile delinquency 31

Behavioural Sciences and Life Style Concept, attitudes, health and illness behaviour Drug abuse, addiction and smoking Child abuse and child labour Role of physical exercise in health and disease 32

Information, Education and Communication (IEC) Concept, aims & objectives Approaches used in public health Contents, principles & stages of health education Communication methods, barriers, and skills in health education Planning, organizing and evaluating a health education programme Social marketing 33

Disaster Definition, classification Natural Disasters like Earthquakes, Floods Epidemic of communicable diseases Man made disasters Accidents, thermonuclear warfare, causes and prevention Magnitude and effects of Disaster and Public Health consequences Disaster preparedness and management 34

Medical Ethics Background concepts and components National recommended guidelines Code of Medical Ethics 35

Practical and Community Based Training Students should have practical experience in: Questionnaire development Data collection Compilation Presentation Analysis Report writing 36

Field Visits Visit to BHU and RHC Visit to an NGO Visit to a primary school to assess the nutritional status of school children Visit to MCH/Reproductive Health Centre to observe the organization, function of the centre, Antenatal care, FP services & Immunization Visit to a hospital to see the hospital waste disposal Visit to an industry Visit to a physical/mental/social rehabilitation centre 37

Skills Development Lab Water purification at domestic level Contraceptives Vaccination including the cold chain Oral Rehydration solution 38

Recommended Reading Park’s Text Book of Preventive and Social Medicine by K Park Public Health and Community Medicine by Ilyas and Ansari Lecture Notes 39

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