Department of

Community Medicine

CATALOUGE
 CONTENTS

Sr. No. Topic

1 Nutrition
2 Immunization
3 Contraceptive Methods
4 Water and Sanitation
5 Medical Entomology
6 Disinfectants
7 Insecticides
8 Biostatistics
 NUTRITION
INDEX

Sr. No. Name

1 Classification of Foods
2 Cereals
3 Rice and Wheat
4 Parboiling
5 Millets
6 Pulses (Legumes)
7 Soyabean
8 Vegetables
9 Fruits
10 Nuts & Oilseeds
11 Milk
12 Egg, Fish, Meat
 1) Classification of Foods

Foods can be classified in various ways :-

1) Depending on predominant function (most important classification)

i) Body building foods: These are rich in proteins .eg. Milk, meat, eggs, fish
ii) Energy yielding foods:- These are rich in fats or carbohydrates eg. Oil,
cereals, potatoes
iii) Protective foods: These are rich in minerals, vitamins or proteins eg.
Vegetables & fruits.

2) Based on origin :
i) Foods of Animal origin eg. Milk, Meat, Eggs, Fish
ii) Foods of vegetable origin eg. Cereals, Pulses, vegetable oils

3) Based on chemical composition

i) Carbohydrates
ii) Proteins
iii) Fats & Oils
iv) Minerals
v) Vitamins

4) Based on Nutritive value

i) Cereals & millets
ii) Pulses
iii) Vegetables
iv) Fruits
v) Nuts & Oilseeds
vi) Animal foods
vii) Fats & oils
viii) Sugar & Jaggery
ix) Condiments & spices
x) Miscellaneous foods
 2) Cereals

These constitute the BULK of the daily diet. Rice forms the Staple diet of more
than 50% of the people of the world. Wheat is consumed next to rice. Maize is
also eaten. This is also used as food for cattle and poultry.

Functions:-

 Main source of Energy

 They give about 350 Kcal / 100g.
 They give 6-12% proteins. These are however poor in Lysine.
 When cereals are eaten together with pulses (‘dal’), as in a normal Indian
diet, it becomes more complete. Cereals and pulse proteins Complement
each other as regards presence of essential amino acids.
 Recommended daily intake about 400 g/day.
 3) Rice and Wheat

Rice

 It is paddy without the husk

 Has 3 layers Embryo, Endosperm & Aleurone from inside outwards
 Embryo and Aleurone are rich in essential nutrients
 Endosperm is rich in Starch.
 During the process of milling, washing & cooking there is significant loss of
nutritive factors – 15% of proteins and 60-75% of vitamins may be cost. This
may lead to ‘Beri-Beri’
 It gives 345 Kcal /100g., 6.8% proteins

Wheat

 It gives 346 Kcal / 100g

 It has a protein content of 11.8 g%
 It is richer in vitamins than rice
 Whole grain flour (‘atta’, brown flour) is richer than white flour (‘maida’) in
protein content.
 4) Parboiling

This is an ancient Indian technique of preserving Rice

Procedure
 Paddy is soaked in hot water (650 – 700c) for 3-4 hours. This swells up the
grains.
 Water is drained off. The soaked paddy is STEAMED for 5-10 min.
 The paddy is later dried and either homepound or milled.

Advantages
 The nutrients are better preserved. They are driven in from the aleurone
layer to endosperm during parboiling.
 The grain becomes harder and thereby more resistant to insect invasion.

Disadvantage
 Development of ‘off-flavour’.
 5) Millets

These are smaller grains which are ground and eaten without having the outer layer
removed. These are Jowar (Shorgum), Bajra (Pearl millet) Ragi and other.

Jowar
 This is a major crop in India
next to wheat and rice. It is a
staple diet for many people.
Protein Content 10.4 %
 Limiting amino acids : Lysine,
Threonine
 It gives 349 Kcal / 100g

Bajra (Pearl Millet)

 This is grown in dry belts of
Rajasthan, Maharashtra and
Gujrat
 Staple diet of some people
 Rich in CALCIUM (42 mg%)
and IRON (8 mg%)
 It gives 361 Kcal/100g.

Ragi
 Popular in AP and Karnataka
 Very cheap
 Very high Calcium content –
344 mg%
 High IRON content 3.9 mg%
 It gives 328 Kcal/100g.
 6) Pulses (Legumes)
These are various types of grams or ‘dhals’

Bengal Gram (Chana Dhal) Red Gram (Tuvor Dhal)

Green Gram (Moong Dhal) Black Gram (Urad Dhal)
Lentils (Masur Dhal) Peas & Beans
Soyabean

Functions:
 Major source of protein in an Indian diet
 They contain 20-25% protein
 These are however poor in Methionine & Cystein
 These are rich in Lysine
 High content of Minerals & B-gr. Vitamins
 Germinating pulses are richer in Vit.C & Vit.B
 They have certain anti-nutritive substances like phytates & tannins in
the raw state which are destroyed by cooking.
 Energy provided is around 350 Kcal/ 100g.
 They add variety and taste to the diet.
 Recommended daily intake of about 20g / day
 7) Soyabean

 This is the richest source of nutrients among pulses

 It has 43% proteins, 20% fats, 4% Minerals.
 The proteins of soya bean are of a High nutritive value.
 The limiting amino acid is Methionine
 It can be eaten in various forms such as : Cooked ‘dhal’, powdered and
mixed with atta, soya milk and curds and in baby foods.
 It is a high energy yielding, low cost, weaning food.
 It gives 432 Kcal/100g.

Drawback:
 Unpopular in India
 8) Vegetables

These are classified as Protective foods. They contribute vitamins, minerals and
dietary fibre. They also add variety to the diet.
They are of 3 types:-
1. Green Leaves: - eg. Palak (spinach), amaranth, cabbage and fenugreek (methi)
 Darker the leaf, greater the nutritive value.
 Rich sources of carotenes, calcium, iron and vitamin C.
 Leaf proteins are good sources of lysine
 Iron from green leaves has low availability due to presence of oxalates
 They add bulk to the diet.
 Recommended intake 40g / day. They give 25-50 Kcal / 100g
2. Roots & Tubers:- eg. Potato, sweet potato, carrots, radish
 Poor in proteins, minerals and vitamins
 Some (potato, sweet potato) are rich in carbohydrates
 Crrots are rich in B carotene (Vit.A precursor). Recommended intake 50-60
g/day
3. Other Vegetables:- eg. Brinjal, tomato, cauliflower, lady’s finger etc.
 Fair sources of vitamins and minerals
 Add variety to diet.
 9) Fruits

These are invaluable in the human diet. They are rich sources of vitamins
and minerals. As fruits are eaten in a raw state, their bioavailability is also higher.
Recommended intake is 85 g/day.
Briefly:-
1. Mango : a) High caloric value due to high sugar content 74 Kcal/100g
b) Rich source of Vit.A 2210 mcg /100g
2. Sitaphal : a) Rich source of calories – 104 Kcal / 100g
b) Rich source of calcium – 17 mg%
3. Banana : a) calories 104 Kcal / 100g
b) Good source of fibre and K+
4 Papaya : Rich source of Vit .A 2740 mcg / 100g
5 Amla : Rich source of Vit. C – 600 mg %
6 Dry fruits : a) High caloric value of 315 Kcal / 100g
b) Good sources of iron and calcium
7. Guava : a) High caloric value of 51 Kcal / 100g
b) Rich source of Vit.C 212 mg%
8. Orange : Rich source of Vit. A 2240mcg/ 100g.
 10) Nuts & Oilseeds

 Ground Nut Walnut

 Almonds Coconut
 Cpottpm Seeds Mustard Seeds
 Cashewnuts Sunflower Seeds
 Pistachio Sesame Seeds
 Ground Nut Walnut
 Almonds Coconut
 Cpottpm Seeds Mustard Seeds
 Cashewnuts Sunflower Seeds
 Pistachio Sesame Seeds
Features
 These contain good amounts of FAT 40-65 %
 Good quality protein in small bulk
 Good sources of B group vitamins
 Cashewnuts, almonds, pistachio are good sources of IRON
 Oil Seeds : eg. Ground Nut yield oil and residue. The residue (oil
cakes) can be formulated into acceptable foods rich in protein eg.
‘Balahar’ Indian multipurpose food, balanced malt food.
 11) Milk

 Best and most complete of all foods

 Rich in Proteins, Fats, Sugars, Vitamins, Minerals

Proteins :
The major milk proteins are Casein, Lactalbumin and Lactglobulin. All the
essential amino acids are present in milk proteins.

Fats :
Fat content is from 3.4 – 8.8 % . It is a good source of Retinol and Vitamin
D.

Sugar :
Lactose is the milk sugar. It is less sweet as compared to sucrose and is
easily fermented.

Minerals :
It is rich in calcium, Phosphorus, sodium, Magnesium, Cobalt, Copper and
Iodine. It is particularly very rich in Calcium. It is a poor source of Iron.

Vitamins : Rich in all vitamins except Vitamin C.

 12) Egg, Fish, Meat
Egg :-
 It contains all the nutrients except carbohydrate & Vit.C
 Composition – 12% shell, 58% egg white, 30% egg yolk
 The average weight of an egg is 60 grams
 Each egg (60 g) contains :- 6g proteins 6g fats 30 mg calcium
1.5 mg Iron and gives energy of 70 Kcal.
 Egg contains all the essential amino acids : NPU of Egg is 100
 It contains all vitamins except vitamin C
 It is also a good source of Ca, Fe, Zn, P
 Raw egg is not assimilated due to presence of AVIDIN, an anti nutritive
substance which is destroyed by heat. Hence, boiled egg is superior to
raw egg.

Fish :
 Good source of proteins of high biological value
 Good source of fats containing Vit.A, Vit. D and unsaturated fatty acids.
 Bones are rich in calcium, seafish lobsters, oysters are rich in Iodine
Meat (Flesh of cattle, sheap and goats)
 Supplies 15-20% proteins rich in essential amino acids.
 Fe, Zn and B vitamins are provided. Iron from meat is absorbed well.
 Poor in calcium
 Rich in non-essential saturated fats.
 IMMUNIZATION

Index
Sr.
Name of Topic
No.

National Immunization Schedule for

1 Infants, Children and Pregnant Women
(india)

2 BCG VACCINE

ORAL (SABIN) POLIO VACCINE

3
(OPV)

4 MEASLES VACCINE

5 DPT VACCINE
 NATIONAL IMMUNIZATION SCHEDULE FOR INFANTS, CHILDREN
AND PREGNANT WOMEN (INDIA)

Vaccine When to give Dose Route Site

For Pregnant Women
TT-1 Early in pregnancy 0.5ml Intra-muscular Upper arm
TT-2 4 weeks after TT-1* 0.5ml Intra-muscular Upper arm
TT-Booster If received 2TT doses in 0.5ml Intra-muscular Upper arm
pregnancy within last 3 years *
For Infants
BCG At birth or as early as possible 0.1ml Intra-dermal Left upper arm
till one year of age (0.05ml =<
1 month)
Hepatitis B At birth or as early as possible 0.5ml Intra-muscular Antero-lateral
within 24 hours side of mid
thigh
OPV-0 At birth or as early as possible 2 drops Oral Oral
within first 15 days
OPV 1,2 & At 6 weeks, 10 weeks & 14 2 drops Oral Oral
3 weeks
DPT 1,2 & At 6 weeks, 10 weeks & 14 0.5ml Intra-muscular Antero-lateral
3 weeks side of mid
thigh
Hepatitis B At 6 weeks, 10 weeks & 14 0.5ml Intra-muscular Antero-lateral
1,2 & 3 weeks side of mid
thigh
Measles 9 completed months – 12 0.5ml Sub-cutaneous Anterior side of
months. (give upto 5 years if mid thigh
not received at 9-12 months)
Vit. A (First At 9 months with measles 1 ml Oral Oral
dose) (1 lakh IU)
For Children
DPT 16-24 months 0.5ml Intra-muscular Antero-lateral
booster side of mid
thigh
OPV 16-24 months 2 drops Oral Oral
booster
Measles 16-24 months 0.5ml Sub-cutaneous Anterior side of
(2nd dose) mid thigh
Japanese 16-24 months with DPT/OPV 0.5ml Sub-cutaneous Left upper arm
Encephalitis booster
**
Vit.A *** 16 months with DPT/OPV 2 ml Oral Oral
(2nd to 9th booster. Then, one dose every 6 (2 lakh IU)
doses) months upto the age of 5 years
DPT 5-6 years 0.5ml Intra-muscular Upper arm
booster
TT 10 years & 16 years 0.5ml Intra- muscular Upper arm
*Give TT-2 or booster doses before 36 weeks of pregnancy. However, give
this even if more than 36 weeks have passed. Give TT to women in labour, if
she has not previously received TT

**SA 14-14-2 Vaccine, in selected endemic district of the Uttar Pradesh, West
Bengal, Karnataka, Assam.

*** 2nd to 9th doses of vitamin A can be administered to children 1-5 years old
during biannual rounds, in collaboration with ICDS.

Note:
a. Interval between two doses of DPT, OPV and Hepatitis B should not
be less than 1 month.

b. Minor cough, cold and mild fever are not a contraindication for
vaccination

c. If child has diarrhea, give a dose of OPV, but do not count the dose
and ask the mother to return in four weeks for missing dose

d. Pentavalent Vaccine (DPT + Hepatitis B + Hib) has been introduce in

NIS in the state of Kerala,Tamil Nadu, Goa, Haryana, Gujarat,
Karnataka and Jammu & Kashmir at 6, 10,& 14 weeks of age and it
will be soon (from 1st November 2015) introduce in Maharashtra.
 BCG VACCINE
 Bacille Calmette Guerin
 Live attenuated vaccine, developed from avirulent strain of M. bovis
 Freeze dried vaccine (more stable preparation)
 Diluents for reconstituting vaccine- Normal saline
 Reconstituted vaccine should be used within 3 hours
 Storage- Store between 2- 8 deg. Celsius (Upper compartment of ILR)
 Dose- 0.05 ml (for age below 4 week) , 0.1ml (for age above 4 week )
 Route- Intradermal by tuberculin syringe, just above the insertion of (left) Deltoid
 Age- at birth or at 6 week of age
 Phenomena after vaccination- papules at site which reaches 4 to 8 mm diameter in about
5 weeks then subsides or break into shallow ulcer, healing occur spontaneously within 6 to
12 weeks leaving a permanent tiny, round scar typically 4 to 8mm in diameter
 Complication- prolonged severe ulceration at site of vaccination, suppurative
lymphadenitis, osteomyelitis, disseminated BCG infection
 Protective value - duration of protection is from 15 to 20 years, protective value various
from 0 to 80 percents, it gives an appreciable degree of protection from childhood
tuberculosis
 Contraindication- generalized eczema, infective dermatosis, hypogamaglobulinaemia,
systematic HIV infection, condition leading to deficient immunity, pregnancy
 BCG Vaccination and HIV Infection- HIV positive infant may receive BCG vaccine
only when asymptomatic and living in area where TB is highly endemic (like India)
 Combined Vaccination- Two live vaccine can be given at the same time at two different
site or there should be at least one month interval between two live vaccination, live
vaccine can be given along with killed or toxoid vaccine .
 ORAL (SABIN) POLIO VACCINE (OPV)

 Live attenuated vaccine

 Trivalent vaccine containing 3 types of polio viruses
 Containing i) over 3,00,000 TCID 50 of type 1 virus ii) over 1,00,000 TCID 50 of type 2
virus iii) over 3,00,000 TCID 50 of type 3 virus per dose

National immunization Schedule of OPV

 OPV – “0” dose - At birth
 OPV- 1 – At 6 weeks (along with DPT-1)
 OPV- 2 – At 10 weeks (along with DPT-2)
 OPV- 3 – At 14 weeks (along with DPT-3)
 OPV- booster – At 18-24 months (along with DPT-booster)
 Dose and Mode of administration
 Dose 2 drops, orally (use dropper supplied with vial of OPV Vaccine)

Storage
 Lower compartment of ILR or can be store in Deep freezer

Development of immunity
 On administration, live vaccine strain infect intestinal epithelial cells—replication occurs—
transport to peyer’s patches—secondary multiplication with viraemia occurs—virus
spreads to other area of body –resulting in production of circulating abtibodies which
prevent dissemination of the virus to nervous system and prevent paralytic polio

HERD IMMUNITY
 The vaccine progeny excreted in faeces and secondary spread occurs to household contacts
and susceptible contact in the community. Non-immunized person may therefore be
immunized. For widespread heard immunity approximately 66% of community should be
immunized
ADVANTAGES
 Easy to administer not required train person
 Induced both humoral and intestinal immunity
 Antibodies are quickly produced in large proportion of vaccinees , even a single dose elicits
(except in tropical countries) substantial immunity
 Vaccine excretes the virus and so infects others who are also immunized thereby
 Useful in controlling epidemics
 Relatively inexpensive
COMPLICATION
 OPV is remarkably free of complication
 However particularly type 3 virus do mutated in the course of their multiplication in
vaccinated children and rare cases of vaccine associated paralytic polio occurred in
recipients of vaccine and their contacts
 Risk is 1 case per million vaccinees and in close contact of vaccinees 1 case per 5 million
doses of vaccine
CONTRAINDICATION
 Acute infectious diseases, fevers, diarrhea, dysentery, leukemia, malignancies, receiving
corticosteroid
 MEASLES VACCINE

 Live attenuated vaccine

National immunization schedule

 At 9 month of age
 Diluents for Reconstitution- Distilled water
 Reconstituted vaccine should be used within 1 hour (loses about 50% of its potency after 1
hrs at 200C)
 Reconstituted vaccine must be stored in the dark at 2-8 0C and used within 4 hours

DOSE & ROUTE

 0.5ml subcutaneous on anterolateral aspect of thigh , single dose

STORAGE
 Vaccine and Diluents store in Lower compartment of ILR (between 2-8 Deg.C)

REACTION
 Mild measles like reaction – fever and rash 5 to 10 days after immunization but in reduced
frequency and severity

CONTACTS
 If susceptible contacts over 9-12 months received vaccine within 3 days of exposure, can
be protected against measles
ADVERSE EFFECT
 Toxic shock syndrome (TSS)- occurs if vaccine is contaminated or same vial is used for
more than one session on same day or for next day

COMBINED VACCINE
 Measles vaccine can be combined with other live attenuated vaccine such as mumps ,
rubella vaccine (MMR)
 DPT VACCINE

 (Diptheria, tetanus- Toxoid; Pertussis – Killed vaccine)

 Immunized simultaneously against three diseases, viz., Diphtheria, Pertussis, Tetanus
 Pertussis component enhance the potency of diphtheria toxoid

Composition of DPT Vaccines

Contents Glaxo (per 0.5ml) Kasauli
Diphtheria Toxoid 25 Lf 30 Lf
Tetanus Toxoid 5Lf 10Lf
B. Pertussis (millions) 20,000 32,000
Al. phosphate 2.5 mg 3 mg
Thiomersal, B.P. 0.01% 0.01%

 Storage: Should not be frozen

 Stored between 4 to 8 deg.C (upper compartment of ILR)
 DOSES & Schedule: 0.5ml deep intramuscular, Anterolateral aspect of thigh.
 At 6 weeks, 10 weeks, 14 weeks and booster at 16 – 24 months of age.
 Interval between two doses should not be less than 4 weeks

REACTION:
 Fever and mild local reaction
 Severe complication are neurological (encephalitis / encephalopathy , Prolonged
convulsions, infantile spasms, Reye’ s syndrome ) and are primarily due to Pertussis
component of vaccine, estimated risk is 1: 170,000 doses administered
CONTRACEPTIVE METHODS
INDEX

Sr. No. Name of Topic

1 Definition & Classification

2 Barrier methods

3 Intra- Uterine Devices

4 Hormonal Contraceptives

5 Post Conceptional Methods

6 Centchroman

7 Miscellaneous Methods
 1.Definition & Classification
Definition:
Family planning is defined as ‘a way of thinking & living that is adopted
voluntarily, upon the basis of knowledge, attitudes and responsible decisions by
individuals & couple, in order to promote the health and welfare of the family
group and thus contribute effectively to the social development of the country.’
Classification
I Spacing methods
1) Barrier methods
a) Physical methods
b) Chemical methods
c) Combined methods
2) IUD
3) Hormonal methods
4) Post-conceptional methods
5) Miscellaneous

II Terminal Methods
1) Male sterilization
2) Female sterilization

Conventional contraceptive - The methods that require action at the time of

sexual intercourse e.g. condom, spermicidal jelly, vaginal sponge
 2. Barrier methods

i) Male Condom (nirodh)

Method: Sapcing, barrier , conventional contraceptive
Device: Thin latex (rubber sheath) device
Mechanism of action: Prevents the semen being deposited in vagina
Instructions to use: Use new condom for each act.
Fitted by unrolling on erect penis
Proper care to be taken during use to prevent spillage

Advantages :
i) Easily available
ii) Safe & inexpensive
iii) Easy to use
iv) No side effects
v) Provide protection against pregnancy STI & HIV / AIDS.
Disadvantages:
i) It can slip off or tear during coitus due to incorrect use.
ii) Interferes with sex sensation locally.
Side effect: Allergy to latex
Failure rate: Varies from 2-3 to more than 20 per 100 woman years.
 ii) Female condom
Method: Spacing, barrier , conventional contraceptive
Device: Soft, thin, transparent17 cm long pouch made of polyurathane
plastic,Latex prelubricated with silicon
Condom fits loosely inside the vagina. It has flexible rings at
both ends. Internal ring is small and anchors the cervix.
Outer ring is large and stays outside.
Mechanism of action: Prevents the semen being deposited in vagina
Instructions to use: Use new condom for each act.
Inserted just before and removed soon after sex
Outer ring should remain outside vagina, ensure that
penis enters inside condom. Remove the condom by
holding outer ring and twisting.

Advantages : Easy to use

No side effects
Provide protection against pregnancy STI & HIV / AIDS
It empowers the woman to have a choice, especially
important in sex workers to protect from genital infection.
Disadvantages: Costly, high failure rate

Side effect: Mild irritation and Allergy to latex

Failure rate: 20-25 per 100 woman years of exposure
Trade name : Femidom
 ii) Diaphragm ( Dutch cap)

Advantages –
i) Total absence of risk & medical contraindications

Disadvantages –
i) Trained person is required to demonstrate the technique of insertion.
ii) Toxic shock syndrome if left in place for longer time .
iii) In rural areas difficult to practice.
iv) Good vaginal tone is required

Failure rate: 1.9 per 100 woman year

iv) Vaginal Sponge

Trade name: Today

It is a small polyurethane foam sponge 5cm x 2.5 cm, saturated with the
spermicide nonoxynol -9. It is to be inserted into the vagina prior to the
intercourse.

Advantages –
i) It offers some protection against STD & HIV /AIDS
ii) It empowers the woman to have a choice, especially important in the
sex workers.

Disadvantages -
i) High failure rate 10-20 / 100 woman-years
ii) It should used with other methods eg .condoms
iii) If used repeatedly for long time, it can cause erosions in the vagina
thereby increases the chances of HIV transmission
 3) Intra- Uterine Devices

Types: Non- Medicated IUD & Medicated IUD

Non- Medicated IUDs are known as Ist generation IUD eg.Lippe loop
Medicated IUDs are II nd generation IUD- eg Cu T
III rd generation IUD –eg progestasert
Copper –T

Method: Spacing, second generation intrauterine device.

Device: Small flexible plastic frame of silver core, wrapped with copper wire
Mechanism of action : It acts as foreign body in the uterus causing cellular &
biochemical changes in the endometrium & uterine fluids. These
changes impair viability of gamete reducing chances of implantation.
Copper enhances cellular response of endometrium and hampers
sperm survival.
Progesterone containing IUDs increases the viscocity of cervical
mucus making entry of sperm difficult.
Ideal Time for insertion of CuT:
Within 10 days of menstrual period
Post partum-Within 48 hrs after delivery
Post puerperal- 6 to 8 weeks after delivery
Post MTP- immediately after 1st trimester and 4 weeks after 2nd
trimester MTP.
Emergency contraceptive- Within 5 days of unprotected sex
Insertion Method: Withdrawal method
Advantages: Simple, inexpensive, reversible, no systemic side effects,
no need for continued motivation
Disadvantages: Needs trained person for insertion
Needs yearly follow up and periodic replacement
Contraindications:
Absolute: Suspected pregnancy, PID, vaginal bleeding, Ca cervix,
previous ectopic pregnancy
Relative: anaemia, h/o PID, menorrhagia ,congenital uterine
malformation
Side effects: severe pain, excessive and irregular bleeding, perforation, PID,
ectopic pregnancy
Failure rate: 1.5 / 100 women years of exposure

Life span :
CuT 380A -10 yrs Levonorgestrel -7 yrs
Cu T 200 -5 yrs Progestasert -1 yr
Nova T -5 yrs

The ideal IUD candidate: A woman

-who has borne at least one child

-has no history of pelvic disease
-has normal menstrual periods
-is willing to check the IUD tail
-has access to follow up and treatment of potential problems
-is in monogamous relationship
 4) Hormonal Contraceptives

Classified as-
A) Oral pills
1) Combined pills eg Mala D, Mala N
2) Progesterone only pills
3) Post coital pill
4) Once-a-month pill
5) Male pill
B) Depot (slow release) formulation
1) Injectables – DMPA, NET-EN
2) Subcutaneous implants – Norplant, Norplant (R)2
3) Vaginal rings
Combined pills

Trade name: Mala D, Mala N, Choice,

etc
Contents :Levonorgestrol 0.15 mg,
Ethynil oestradiol 0.03 mg

Mode of action- prevents the ovum formation in ovary by blocking pituitary

secretion of gonadotropins. It also makes cervical mucus thick & scanty.

Failure rate: less than 1/ 100 woman-years

Adverse effects-
Cardiovascular effects- hypertension, cerebral thrombosis, venous thrombosis,
myocardial infarction
Metabolic effects- reduction in HDL, increased blood glucose
Other Adverse effects- Hepatocellular adenoma, cholestatic jaundice
Common effects- weight gain, headache, migraine, breast tenderness, break-
through bleeding
Progesterone only pills – advised to older women to avoid cardiovascular risks
of combined pills.
Emergency Contraception /Post coital or ‘morning after’ contraception is
recommended within 72 hrs of unprotected intercourse. Two methods are
available:
a. IUD-insert CuT within 5 days.
b. Hormonal-
Levonorgestrol 0.75 mg within 72 hrs of unprotected sex and 2nd tablet after
12 hrs of first dose Or
Four oral contraceptives containing 30 mcg of ethinyl estradiol within 72 hrs
of unprotected sex and 4 tablets after 12 hours. Or
Mifepristone 10 mg once within 72 hrs.

Depot (slow release) formulation

Depot Medroxy progesterone acetate (DMPA) –
Intramuscular injection of 150 mg every three months
NET-EN – Norethisterone enanthate - IM inj of 200 mg every 2 months.
Mode of action: Inhibition of ovulation
Progesteronic action on cervical mucus

Adverse effects:
Disruption of normal menstruation , pronged heavy bleeding , amenorrhea
 5) Post Conceptional Methods (Termination of pregnancy )

Types:
Menstrual regulation
Menstrual induction
Abortion

Menstrual regulation
Simple method
Consists of aspiration of uterine contents within 6 to 14 days of missed periods.
complications: Immediate : Uterine perforation, trauma
late: tendency to abortion or premature labour, infertility,
menstrual disorders, increase in ectopic pregnancy, Rh isoimmnisation

Menstrual induction
Intrauterine application of 1-5 mg soln. of prostaglandin F2. This causes
disturbances of progesterone-prostaglandin balance leading to sustained
contraction of uterus for 7 minutes. Cyclic contraction lasts for 3-4 hours.
Bleeding continues for 7-8 days.

Oral abortifacient
Mifepristone (RU 486) 200 mg orally on day1 followed by misoprostol
800 mcg vaginally either immediately or within 6-8 hrs.
Or
Mifepristone (RU 486) 600 mg orally on day1 followed by misoprostol
400 mcg orally on day 3.
 6) Centchroman

Trade name: Saheli

This is non–steroidal, non-hormonal contraceptive to be used by woman.
It acts by preventing the proliferation of endometrium & thereby making it
unsuitable for embryo implantation, also affects the motility of fallopian tubes.
Dose: 30 mg twice a week for 12 weeks, then 30 mg once a week only
Advantages : 1) No side effects as those of hormonal contraceptive
2) Low failure rate
3) Easy reversibility
Disadvantage: Prolongation of menstrual cycle in a few women.
 7) Miscellaneous Methods

1) Abstinence

2) Coitus interrupts

3) Safe periods (rhythm method )

Failure rate : Very high 21 /100 woman-years

4) Natural family planning methods

Basal body temperature methods
Cervical mucus methods
Symthothermic methods

5) Breast feeding

6) Birth control vaccine: still under trial. vaccine prepared from B subunit of
HCG
WATER & SANITATION
INDEX

Sr. No. Name

1 Sanitary Well

2 Rapid Sand Filter

3 Slow sand filter

4 Berkefeld filter

5 Chamberland filter

6 Horrock’s apparatus

7 Chloroscope

8 Winchester quart bottle

9 Methods of Solid Waste Disposal

10 Septic Tank

11 Soakage Pit

12 Bio-Gas Plant / Gobar Gas Plant

 1) Sanitary Well

Structure
 Location : Minimum 15 meters away from contamination source
 Lined by bricks upto a depth of 6 mt. and 3 feet above the ground level
 Concrete cover
 3 feet wide platform around with a drain.
 Hand pump

Chlorination of the well -

 Once every week usually
 Daily during epidemic
 Done with bleaching powder, after estimating chlorine demand
 Water must not be drawn immediately after addition of bleaching powder
 Best time for chlorination is evening
 2) Rapid Sand Filter

Types - 1. Gravity type e.g. Paterson’s type

2. Pressure type e.g. Candy’s type
Mechanism:
Initially raw water is added with alum and subjected to rapid mixing.
Followed by flocculation resulting in the formation of precipitate of
aluminium
hydroxide. Aluminium hydroxide settles in sedimentation tank.
Water now reaches to rapid sand filter.
 Effective size of sand particles: 0.4-0.7mm.
 Rate of filtration: 5 – 15 m3/m2/hr.
Advantages :
 Filtration is 40 -50 times faster than slow sand filter
 Loss of head of 6 – 8 feet is allowed
 Cleaning is done by back washing.
 3) Slow sand filter

 Biological filter
 Large scale water purification
 Vital layer: “Schmutzdecke Zoogleal Layer”.
 Hold back bacteria & organic matter & oxidises ammonical nitrogen into
nitrogen
 Rate of filtration is slow
 Occupies large space
 Remove turbidity and colours
 Complete removal of bacteria (E. coli)
 4) Berkefeld filter

 For household purification of water

 Candle is the main part made of kieselgurh or infusorial earth
 Filter bacteria but not viruses
 It is better to filter water through a piece of cloth before filling the candle, as
this prevents clogging
 5) Chamberland filter

 Pressure filter
 Directly fitted to tap
 Filter material is an unglazed porcelain pipe fitted with metal holder
 Must be cleaned with brush under hot water once a week
 6) Horrock’s apparatus
This is used to determine the amount of bleaching powder required for
disinfection of well water.
Contents –
 6 white cups & 1 black cup
 2 metal spoons, each of 2 gms. Capacity
 7 glass stirring rods, 1 special pipette, 2 droppers
 Starch iodide indicator solution
 Instruction manual
Mechanism of use:
Stock solution is prepared in Black cup with 2 gms of bleaching powder & water
upto circular mark.
White cups filled with water upto brim.
Using the pipette add 1 drop of stock solution to first white cup, 2 drops to the
second and so on till the sixth cup.
Water in all cups is stirred using the different glass rod.
One hour is given for action of chlorine.
After 1 hr , 3 drops of starch-iodine indicator are added to each of 6 cups.
Development of blue colour indicates the presence of free chlorine.
Rank of cup (first showing blue colour) * 2 gms = Bleaching powder required to
disinfect 455 litre of well water .
Modified Horrocks' method of chlorination :
Equipment:
• 5 containers (any type — as long as they are all the same size. Plastic drinks bottles
may be used).
• A measuring device to measure out the solid chlorine product. The exact size of the
spoon is not critical, but identical amounts must be measured out each time, so use a
level spoonful, for example. Use a spoon which measures out about 1g, as this will
help in the calculations.
• A device to dispense small quantities of liquid (a small 1ml or 5ml syringe would
be suitable).
• Dpd test equipment
Method:
1. Label the five containers 1 to 5.
2. Place one level spoonful of chlorine product (bleaching powder or HTH) into the first
container. If the spoon has a capacity of 1g, there is now 1g of chlorine product in the
container. 3. Add a few drops of the water to be chlorinated, and mix to a paste (dissolving
the chlorine-product powder).
4. Dilute the paste with enough water to fill the container. If the container holds one litre, it
now contains one spoonful per litre, or in this case, one gram per litre. If we take 1ml out
of this container, this will contain 1mg of chlorine product (1 litre = 1000ml, and 1g =
1000mg).
5. Fill containers 2, 3, 4, and 5 to capacity (1 litre) with the water to be chlorinated.
6. Transfer 2ml of the liquid from container 1 to container 2, 4 ml to container 3; 6ml to
container 4; and 8ml to container 5. Container 2 will then have 2mg/l; container 3, 4mg/l;
container 4, 6mg/l; and container 5, 8mg/l.
7. Leave containers 2, 3, 4 and 5 to stand for at least 30 minutes — this is the minimum
contact time required for the chlorine to disinfect the water.
8. Test the water in each container for residual chlorine content using the Dpd test kit.
9. The container with the lowest concentration of chlorine equal to or more than 0.4mg/l
indicates how much chlorine powder should be added to the water being disinfected.
Example
A water supply from a well with water column of 70 m3 needs chlorinating to make it safe
to drink. Tests on the water — using the modified Horrocks’ method — indicated residual
chlorine concentrations (after 30 minutes) of 0, 0.2, 0.5 and 1.0mg/litre in containers 2, 3,
4, and 5 respectively. Therefore, container 4, with a residual concentration of 0.5mg/l, had
the lowest residual chlorine concentration equal to or exceeding 0.4mg/l. The concentration
of chlorine product added to container 4 was 6mg/l. For a supply of 70m3 /day, therefore,
the amount of chlorine product to be used is calculated as: 70 x 1000 litres x 6mg/l = 420
000mg = 420g = 0.42kg.
Superchlorination -
 Addition of large doses of chlorine to water
 Applicable to heavily polluted waters whose quality fluctuates greatly
 Usually followed by De-chlorination i.e. removal of excess chlorine after disinfection
 De-chlorination is done by Sodium bisulphate, Sodium thiosulphate & Sulphur
dioxide
Break Point Chlorination: When chlorine is added to water, organic matter gets oxidised.
The point at which free chlorine appears, is called Break Point & corresponding dosage is
the chlorine demand of water.
 7) Chloroscope

 Used for measuring residual chlorine in water.

 Used with O- toluidine test.
 Coloured test tube with deep hole in the middle.
 Colour compared with standard.

Chlorination of water –
H2O + Cl2 = HCl + HOCl
HOCl = H + OCl
Disinfection action is mainly because of hypochlorous acid (HOCl).
Ideal ph of water = 7.
Chlorinating agent: Chlorine gas, Chloramines, Perchloron.

Action of Chlorine –
 Bactericidal
 Destroys taste & odour producing constituents
 Controls algae & slime
 8) Winchester quart bottle

 Sample collected appropriately

 Bottle must have a label
 Contents of label: Date, Time, Place of collection, Source of sample,
Geographical condition, Weather condition in the past 24 hr, Reason for
collection, history of epidemic in the area, Examination required
 Bottle must be sealed & transported in ice box. Bottle must reach lab within 2
to 3 hrs.

9) Solid Waste Disposal

Solid wastes are unwanted or discarded waste matter from houses, street sweeping,
commercial, industries & agricultural operation.
Sewage: Waste water from community, containing solid & liquid excreta.
Sullage: Waste water does not contain human excreta.
Sludge: Solid settled down in septic tank.

Methods of solid waste Disposal –

 Dumping
 Controlled Tipping or Sanitary Landfill
 Composting
 Manure Pits
 Burial
 10) Septic Tank

This is a water-tight masonry tank into which household sewage is admitted for
treatment
Design – Single chambered
Doubled chambered
It can be used for individual houses, small group of houses & institutions.
Capacity - 20-30 gallon or 2 ½ - 5 c.ft. per number of users
Total depth - 1.5 – 2 meter
Liquid depth of about 1.2 meters, air space 30 cms.
Submerged inlet and outlet pipes.
Concrete slab cover.
Retention period of 24 hrs.
 11) Soakage Pit

Used for disposal of waste water i.e. sullage

Design & working -
A trench 3 mt long, 1 mt deep and 1 mt wide is dug up. This is sufficient for the
sullage disposal from a single household.
The trench is filled with large stones.
A kerosene tin with a perforated bottom is placed just below the house drain, on
the stones, such that 20 cm are below and 15 cm above the ground.
The tin is filled with straw or dried grass to filter solid wastes.
The layer of stones is covered with old bamboo matting or old sacks, tin sheets or
tarred mats to prevent mud from getting in and fill up the crevices.
The matting is covered with mud upto ground level.

12) Bio-Gas Plant / Gobar Gas Plant

Requirement:
Cow / animal dung, human feces
Dung must be well mixed with water (4:5)
Thus solid concentration is 8.1%
End product is methane & solid manure

Uses :
 Sanitary disposal of animal/human excreta
 Cooking gas made available, less indoor pollution, saves on wood/forest
 Lighting of lamps
 Manure-fertilizer in field
 MEDICAL ENTOMOLOGY

INDEX

1) Introduction & Classification

2) Vector

3) Mosquito

4) Housefly

5) Sand fly

6) Lice

7) Rat flea

8) Ticks

9) Mites

10) Cyclops

11) Reduviid bug

 1) Introduction & Classification

Arthropods living close to man act as vectors or carriers of disease.

Arthropod-borne diseases constitute a major health problem in India. A study of the
arthropods of medical importance is known as Medical Entomology.
Classification
Class Insecta
1) Mosquitoes - Anophilines
Culicines
2) Flies - House fly
Sand fly
Tse Tse fly
Black fly
3) Human lice - Head & body lice
Crab lice
4) Fleas - Rat fleas
Sand fleas
5) Reduviid bug (Cone – nose bug)

Class Arachnida
1) Ticks - Hard ticks
Soft ticks
2) Mites - Leptotrombidium mite ( Chiggers )
Itch mite

Class Crustacea
1) Cyclops
 2) Vector

An arthropod or any living carrier (eg. Snail) that transports an infectious

agent to a susceptible individual. The infection may be transmitted by inoculation
into or through the skin or mucous membrane by biting or by depositing the
infective material on skin, food or other objects.

Vector Borne Transmission

Types - Direct contact
Mechanical transmission
Biological transmission

1) Direct Contact –
The arthropods are directly transferred from man to man through close
contact e.g. Scabies, Pediculosis

2) Mechanical Transmission –
The disease agent is transmitted mechanically by arthropods through feet-
soiling, proboscis or by passage through its GIT and passive excretion.
e.g. – The transmission of diarrhea, dysentery, typhoid, food poisoning & trachoma
by house fly.

3) Biological Transmission
When the disease agent multiplies or undergoes some developmental change
with or without multiplication in the arthropod host, it is called as biological
transmission.
Types – Propagative
Cyclo-propagative
Cyclo-developmental
Propagative- Only multiplication of disease agent takes place in vector.
e.g. plague bacilli in rat flea.

Cyclo-propagative- The disease agent undergoes cyclical change and multiplies in

the body of vector. e.g. malarial parasite in anophiline mosquito.
Cyclo-developmental-When the disease agent undergoes cyclical change but does
not multiply in the body of vector.e.g. filarial parasite in culex mosquito &
guineaworm embryo in cyclops.

Trans-ovarian transmission - When disease agent is transmitted from infected

female to progeny in vector.

Trans-stadial transmission -When disease agent is transmitted from one stage of

the life cycle to another. e.g. nymph to adult.

Principle of arthropod control

 Environmental control
 Chemical control
 Biological control
 Genetic control

‘Integrated approach’ of vector control combines two or more methods with a

view to obtain maximum results with minimum efforts to avoid excessive use of any
one method. This helps in reducing insecticide resistance & minimizing
environmental pollution.
 3) Mosquito

Life cycle- Egg - 1-2 days Larva - 5-7 days

Pupa - 1-2 days Adult - 7-10 days

Disease spread by mosquito

1) Anopheles - Malaria
Filaria (not in India)
2) Culex - Bancroftian filariasis
Japanese encephalitis
West Nile fever, Viral arthritis
3) Aedes- Dengue, Dengue hemorrhagic fever
Chikungunya fever, Chikungunya hemorrhagic fever
Rift valley fever, Yellow fever (not in India)
4) Mansonoids- Malayan (Brugian) filariasis, Chikungunya fever

Breeding places
Anopheles- Clean stagnant water
Culex- Polluted stagnant water
Aedes- Artificial collection of water
Mansonoides- Water pond with aquatic plant

Mosquito control measures

1) Anti larval measures

Environmental control
Elimination of breeding places
Underground drainage
Proper disposal of waste water
Engineering measures like filling & leveling
Removal of aquatic plant (for mansonia)
Disposal of broken tins, buckets, bottles, coconut shells (for aedes)
 Chemical control
1) Mosquito larvicidal oil (mineral oil) applied 40-90 liters per hectare about a
week,kills by suffocation.
2) Paris green mainly effective (kills) against anopheles larvae (surface
feeders). Stomach poison used as 2% dust, 1 kg per hectare of water surface
3) Abate 1 ppm

Biological control
Fishes feed on larvae e.g. Gambusia affinis, Leibster reticularis,
Coelomomyces (fungus)

2) Anti adult measures

1) Residual spray: sprayed on walls & roof e.g. DDT 1-2 gm/ sq. meter
on wall twice in a year, Malathion 1 gm/ sq. meter on walls every 3 months
2) Space sprays: e.g. pyrethrum extract 1 oz per 100 cubic feet of 0.1%
pyrethrum solution. Residual insecticide can also be used by special ULV (Ultra-
Low-Volume) machine.
3) Genetic and newer techniques: e.g. sterilization of male mosquitoes
by irradiation, growth inhibition, chromosomal translocations.

3) Protection against mosquito bite

Screening of houses - with copper or bronze gauge having 16 meshes to the
inch is recommended.
Mosquito nets - The size in the openings of the nets should not exceed
0.0475 inch in any diameter.
Protective clothing & Repellents- Di-ethyl-toluamide (DEET)
 4) Housefly Musca domestica

Life cycle Egg 8-24 hrs Larva 2-7 days

Pupa 3-6 days Adult 15-25 days
Diseases spread
Diarrhoeal diseases, Dysenteries
Cholera,Typhoid, Poliomyelitis,
Infectious conjunctivitis
Trachoma, Anthrax, Yaws
Breeding place
Fresh horse manure
Human excreta
Manure of other animals
Garbage
Decaying fruits & vegetables
Rubbish dumps containing organic matter
Control measures
1) Environmental control: Sanitary disposal of sewage, refuse, garbage, clean
houses & clean surrounding conditions.
2) Chemical control:
Larvicides - 0.5 % diazinon or 2% dichlorvas applied as 28-56 lt/sq meter.
Residual spray- 5% DDT or 5% methoxychlor, 5% malathion applied as 5 liters per
100 sq. meter surface.
Space spray- Mainly pyrethrum extract with pyrethrin 0.1% applied as 1 oz per
1000 cubic feet of space
Baits cords & ribbons with insecticides such as diazinon
3) Fly papers: Adhesive mixture (resin with castor oil in ratio of appr. 2:1)
4) Protection against flies: Screens with 14 meshes to an inch for houses, covering
food.
5) Health education: Mainly for environmental control, food hygiene
 5) Sand fly - Phlebotomus argentipes

Life cycle
Egg 7 days Larva 2 wks
Pupa 1wk Adult 2 wks
Diseases spread
Kala azar (Visceral leishmaniasis);
Sand fly fever
Oriental sore
Breeding Places
Dark places in vicinity of cattle sheds and poultry

Control measures

1) Environmental control:
Proper shades for cattle and poultry houses with no cracks, removing
vegetations within 50 yards limits.
Human inhabitations should be away from the animals sheds.

2) Chemical control:
DDT 1-2 gm / sq M or 0.25gm /sq M of Lindane as residual sprays.
For cattle sheds and close by human dwellings.
 6) Lice

Pediculus corporis / capitis

Life cycle
Egg 6-9 days
Larva 10-15 days
Adult 30-50 days
Diseases spread-
Epidemic typhus,
Relapsing fever,
Trench fever,
Dermatitis

Control measures:

1) Personal Hygiene
Regular daily bath with cleaning of hair,
Washing of clothes with hot water,
Launder clothes, autoclaving clothes if necessary.

2) Chemical Control
0.5 % Malathion lotion for hair, Carbaryl dust for clothes and hairs
second application should be given after 7 days for newly hatched
lice.
 7) Rat flea (Xenopsylla cheopis)

Life cycle
Egg 2-7 days
Larva 2 wks
Pupa 1-2wk
Adult 1month -1yr

Diseases spread
Plague (Bubonic),
Endemic/murine typhus fever,
Chiggerosis,
Hymenolepis diminuta

Control measures

1) Rat control
Sanitation, trapping, and rodenticides (usually zinc sulphide)

2) Flea control-
3% BHC, 2% carbaryl, 5% malathion applied to floors and walls upto 1 foot
height

3) Repellant- di-ethyl- toluamide or benzyl benzoate

 8) Ticks
Life cycle
Egg 1-3 wks
Larva 3-13 days
Nymph about 1yr or more
Adult 4-30 wks

Diseases spread-
Hard ticks–
Tick typhus fever, Viral Encephalitis
Viral haemorrhagic fever eg Kyasanur forest disease
Tularaemia, Tick paralysis,
Human babesiosis

Soft tick -Q fever, Relapsing fever, KFD

Control measures

1) Environmental control-
Filling of cracks & crevices in ground, particularly near buildings &
paths, good houses with no cracks
general measures, cleanliness of domestic animals,
Individual personal hygiene, protective clothing

2) Chemical control-
DDT/ Malathion-1-2 lbs/ acre
DDT/ Malathion-5% in dusting powder

3) Protection of workers-
To wear protective clothing impregnated with insect-repellant,
Effective are Benzyl Benzoate and Di-ethyl-toluamide.
 9) Mites

Life cycle-
Egg 1 wks
Larva 1-2 wks
Nymph 1-3 wks
Adult 6 months

Diseases spread
Leptotrombidium – scrub typhus fever
Sarcoptes or Acarus scabiei (itch mite)- scabies

Control measures

1) Measures for control of leptotrombidium are same as for ticks

2) Acarus scabiei control measures

a) Personal hygiene: daily bath and cleaning of clothes frequently

b) Treat all the family members at the same time and boil the clothes
including towels and bedsheets

c) Scrub bath followed by treatment with 25% Lindane or 1% benzyl

benzoate lotion or 5% Permethrin cream applied to whole body
below the chin, as two applications at 24 hrs intervals
 10) Cyclops (water flea)

Life cycle

Adult lives for 3 months in fresh water collection. It is 1mm in length, has a
pear shaped body, a forked tail, 2 pairs of antennae, 5 pairs of legs & a small eye.
Diseases spread
Dracontiasis (Guinea worm disease),
Diphyllobothrium latum infestation (fish tape worm)

Control measures

1) Environmental measures-
Piped water supply, tube wells ( abolition of step wells)
2) Physical- straining of water, boiling of water
3) Chemical measures- chlorination of water 5ppm, abate 1 ppm
4) Biological – barbel and gambusia fish feed on Cyclops.

11) Reduviid bug Cone- nose bugs

Diseases transmitted
Chagas disease or African trypanosomiasis
Life cycle
The bugs are of large size, about 1 inch in length. They live exclusively on blood of
animals including Man. The bugs though found in India, are not incriminated in
transmission of any disease.

Control measures
Residual spraying with HCH 0.5 gm/ sq mt or Dieldrin 1gm /sq mt.
DISINFECTANTS
PHENOL
Identification: Phenol (Carbolic acid)

Nature: Dark oily liquid with aromatic smell

Crude phenol is a mixture of phenol

and cresol

Action: Chemical disinfectant

Two percent of phenol destroys and

inhibits the growth of harmful

microbes (out-side the body) by

coagulating the protoplasm of

bacteria.

Use: Used as disinfectant and deodorant

(>10%)

Used on inanimate objects and

excreta

Used as Deodorant (10%) in toilets

and for mopping floors (5%)

Pure phenol is used as a standard to

compare the germicidal activity of

disinfectants. (Rideal Walker coefficient).

DETTOL

Identification: Dettol

Nature: chloroxylenol Antiseptic (used on

living tissues)

Action: Active against gram +ve but not on

gram -ve bacteria.

Inactivated by organic matter.

Uses: To clean wounds and ulcers.

5 percent is used for general

disinfection of-Instruments, plastic

equipment (contact period 15

minute).
SAVLON
Identification: Savlon

Nature: Disinfectant-Quaternary ammonium

compound

Combination of Cetavlon and

Hibitane

Action: Surface disinfectant

Uses: Disinfection of plastics (20 minute),

thermometer (3 minute)

Disinfection of wounds.
BLEACHING POWDER
Identification: Bleaching Powder (CaOCl2)

Nature: White amorphous powder with

Chlorinated lime is called bleaching

powder.

Fresh bleaching powder contains 33

percent of available chlorine

Rapidly loses its chlorine content on

exposure to air light and moisture

Hence, stored in dark, cool and dry

place in closed, non-erosive

containers

Action: Germicidal effect is by

hypochlorous acid, nascent oxygen

and chlorine

Uses: Disinfection of water

Disinfection of feces, urine and pus

Used as a toilet deodorant.

HALOGEN TABLETS
Identification: Halogen tablets (Chlorine tablets)

Nature: White tablets containing chlorine

Action: Germicidal-effect is by

hypochlorous acid, nascent oxygen

and chlorine

Uses: Disinfection of the water during

travel, camps and emergency

Dose: 0.5 gm for 20 liter of water

Less effective on turbid water.

LIME
Identification: lime

Nature: White in color, stony in consistency

Action: Disinfectant, quick lime (freshly

burnt) is a powerful disinfectant

10-20 percent aqueous suspension is

“milk of lime” (lime: water, 1:4)

Uses: Disinfection of feces, urine, 10-20

percent for two hour.

Used for smearing the walls

Deodorant-Cattle shed, stables,

public urinals, latrines

Can be used for disinfecting the

water, but it increases the

hardness of water and gives

objectionable taste.
POTASSIUM PERMANGANATE
Identification: Potassium permanganate

Nature: Reddish brown crystals with no

smell

Action: Disinfectant and oxidizing agent

By oxidizing organic matter, it

destroys bacteria

Action is not continuous and is

unreliable

Uses: Weak solution (1 in 1000 strength)

is used to disinfect vegetables and

fruits
POVIDONE IODINE
Identification: Povidone iodine

Nature: Complexes of iodine, water soluble

Action: Active bactericidal agent with

sporicidal action. Also acts on fungi,

Virus, protozoa and yeast.

Non-irritant, does not stain the skin

Action is reduced in the presence

of organic matter

Uses: Wound and skin disinfection.

TINCTURE IODINE
Identification: Tincture iodine

Nature: Liquid disinfectant

Action: Effective skin antiseptic

Quick in action, cheap, stains the

skin

May produce allergic reactions

Kills cholera and enteric organisms

effectively

Uses: Solution used for disinfection of

skin Disinfection of plastic appliance

(1 in 2500 aqueous solution)

Disinfection of water in camps (1 in

20,000 aqueous solution).

ALUM
Identification: Alum

Nature: Alum is aluminum sulphate, stony in

consistency, white in color

Action: Acts as a chemical coagulant

Helps in sedimentation (settles

down the impurities and bacteria in

water)

Uses: Used to remove turbidity of water

before subjecting to rapid sand

filtration

(5-40 mg/liter)

Used in defluoridation of water

(Nalgonda technique).
SOAP
Identification: Soap

Nature: Detergent, cleansing agent

Action: Lather formed with water, removes

adhering bacteria

Poor disinfecting power

Uses: Hand washing, bathing and sanitary

measures.
INSECTICIDES
PARIS GREEN

Identififcation: Paris green

Nature: Copper-aceto-arsenite

Emerald-green, micro crystalline

powder

Insoluble but floats on water

Contains 50 percent of arsenious

oxide

Action: Larvicidal-Stomach poison for

anopheline larvae

Does not render water unsuitable for

domestic use

Uses: Larvicidal-250 to 500 gm/acre of

water to kill anopheles larvae

Paris green is mixed with diluents like road

dust/soap stone powder in 1:5 ratio and

dusted over breeding places once in a week

DICHLORO-DIPHENYL-TRICHLOROETHANE (DDT)

Identification: Dichloro-diphenyl-trichloroethane

(DDT)

Nature: White amorphous crystalline powder

with fruity odor Insoluble in water

dissolves in organic solvents

Action: Contact poison, acts on the nervous

system of insect’s

Residual action lasts up to 6 month

Para-isomer is the active fraction

Uses: Widely used insecticide to destroy

mosquito, lice, fleas, ticks, bugs

Application: Residual spray-100 to 200 mg/sq foot area

Suspension (5%)-One gallon over 1000 sq

feet ' Environmental pollution, insecticidal

resistance, unknown effects on human

beings restricts the indiscriminate use of

DDT
MOSQUITO COIL/ LIQUID

Identification: mosquito coil / liquid

Nature: insecticide

Coil contains allethrin-1%

Liquid contains permethrine,

transfluthrin

Action: smoke or vapor generated acts as an

insecticide.

May cause allergic reaction to some.

MOSQUITO REPELLENT

Identification: mosquito repellent

Nature: N methylphthalaten,

N- diethylbenzamide

Action: repels adult mosquitoes, mites, ticks,

sand flies.

Act by discouraging arthropods from

attacking.

Uses: for personal protection from mosquito

bite.

35% solution/ cream is applied to

exposed skin

5% solution is used to impregnate

nets/ cloths.
HEXACHLOROCYCLO HEX A N E (HCH)

Identification: benzyne hexachloride/ BHC

Nature: White colored powder with a musty

smell

Insoluble in water, but soluble in

organic solvent Insecticide, acts as

contact poison

Action: Insecticide, acts as contact poison

Gamma isomer is the active

constituent Insecticidal action is

effective for < 3 month

Uses: Used as insecticide

Application-20 to 50 mg (gamma-

Hexachlorocyclohexane (HCH) per

square foot of spraying surface.

 BIOSTATISTICS

INDEX

Sr. No. Name of topic

1 Normal distribution

2 Measures of central tendency

3 Measures of dispersion

4 Graphical presentation

5 Sampling Methods To
Determine the Sample Plan
 Normal Distribution
Properties of Normal Distribution:

 It is one of the most important distribution in Statistics.

 It is also known as a Gaussian distribution.
 Most of the biological variables follow Normal Distribution.
 Many distributions are either derived from Normal distribution or
approximated to normal distribution.

Application of Normal Distribution:

• To determine normal limits of any characteristic which follows normal

distribution?
• To determine percentile of a given value of any characteristic which
follows normal distribution?
 MEASURES OF CENTRAL TENDENCY

There are three Common measures of central tendency:

i) Mean ii) Median iii) Mode

These measures, also called ‘Centering constants’ provide a summary or a

single representing value of the observations.

Mean :
It is the most common and useful measure of central tendency. The Arithmetic
mean is computed by adding all the values in a series and dividing the sum by
the number of values.
n
 X
x  x  ........  x
_ _ i
Symbolically, X  1 2 n OR X  i 1
n n

Median :
If a series of values of a variable are arranged in ascending or
descending order of magnitude, then the value of the middle term or the
average of the values of middle two terms according to the number of values
either odd or even respectively, is called median.

Median is a positional average.

It divides the arranged series in two equal parts.

Mode :
Mode of a series of values of a variable is that value which occurs with the
maximum frequency.
 MEASURES OF DISPERSION

Absolute measures of deviations : Relative measures of deviations

Range Coefficient of Range

Quartile Deviation Coefficient of Q.D.

Mean Deviation Coefficient of Mean Deviation

Standard Deviation Coefficient of Variation

a) RANGE AND COEFFICIENT OF RANGE :

Range is obtained by subtracting of lowest value in a series of values
from the highest value.

Range = Largest – Smallest = L – S

Largest  Smallest
Coefficient of Range =
Largest  Smallest

b) STANDARD DEVIATION :
It is the most important measure of dispersion.

Standard deviation is defined as the square root of the average (mean) of the
squared deviation of all the values from their mean.

It is usually denoted by Greek letter  , pronounced as sigma.

n _

(X i  X )2 _
i.e.  i 1
Where, X  mean n= total number of values.
n

The square of standard deviation  2 is known as variance.

σ σ
Coefficient of S. D. = _
& Coefficient of Variation = _
X 100
X X
 GRAPHICAL PRESENTATION
“A picture is worth 1000 words”
Linear graph Epidemic curve
.

It is used to represent a trend over a period of time This gives the chronological distribution of the
or for a continuous type of data. number of cases of disease i.e. the distribution
in time.
Histogram Bar diagram

It is used for continuous data. It is a graphic It represents discrete data

representation of a frequency distribution.
Pie diagram Scatter diagram

Pie chart of populations of English native

speakers

It is useful to show the relationship between

Pie diagram is used to represent proportions, areas two variables. The patterns of relationship, if
of sectors of a circle represent proportions any can be seen.
 Sampling Methods To Determine the Sample Plan
Developing a Sample Plan Six steps
• Probability samples: Step 1:
Ones in which members of the Define the relevant population. Specify the
population have a known chance geographic locations, and time for the
(probability) of being selected sampling units.
1. Simple Random Sampling Step 2:
2. Systematic Random Sampling
Obtain a population list, if possible; may only
3. Stratified Random Sampling be some type of sample frame. List brokers,
4. Cluster Sampling government units, customer lists, association
lists etc.

Step 3:

Design the sample method (size and method).

Step 4:
Draw the sample.
Select the sample unit and gain the
• Non-probability samples:
information
Instances in which the Drop-down substitution
chances (probability) of selecting Over sampling
members from the population are Re sampling
unknown
Step 5: Assess the sample
1. Convenience Sampling
2. Judgment Sampling Sample validation – compare sample profile
with population profile; check non-responders
3. Quota Sampling

Step 6:
Resample if necessary.