COMMUNITY HEALTH NURSING 2 PAPER SOLUTION NO-8- 04/09/2019

Q-1

a) Describe the causes of over population in India. ભારતમાં વસ્તી વધારાના કારણો વર્ણવો. 03

Causes of Overpopulation in India:

1.Lack of Contraceptive Awareness:

Many patients do not have sufficient awareness about Contraceptive. They are unaware of contraceptive methods like Oral Pills, Intrauterine Devices, Barrier Methods. Due to this lack of knowledge, unwanted pregnancies increase and the population rate increases rapidly.

2.High Fertility Rate:

Fertility Rate* means how many children a female can give birth to during her life. Some regions in India still have very high fertility rates. Especially in rural areas where women remain in Reproductive Age for many years and conceive continuous pregnancies.

3.Low Use of Modern Contraception:

The availability of technical methods of Modern Contraception such as Hormonal Implants, Copper T, and Emergency Pills is low or patients are skeptical about its effectiveness. Due to which recurrent pregnancies are seen.

4.Early Marriage and Repeated Pregnancies:

Many people get married at a younger age, due to which they stay in the Fertile Period for a long time. As a result, repeated pregnancies often occur, due to which the population increases rapidly.

5.High Infant Survival Rate:

Today, due to medical advancement, the rate of Infant Mortality has decreased. Earlier, where parents gave birth to more children because they believed that something might die, today those children remain alive. Due to which overpopulation increases.

6.Low Female Literacy and Empowerment:

In many families, the decision-making rights of females are less. They cannot decide how to decide about reproductive choices. Along with this, due to lack of education, they also stay away from contraceptive use.

7.Cultural and Religious Beliefs:

Many societies believe that a child is the will of God and Family Planning is a sin. Females often conceive pregnancies, especially for male children. These cultural beliefs are responsible for population growth.

8.Lack of Access to Quality Healthcare Services:

In many areas, proper Gynecological Consultation, Counseling and Family Welfare Clinics are not available to patients. Due to this, patients do not have proper guidance on which method to adopt.

9.Poor Implementation of Population Policies:

Despite the existence of Government Policies, they are not implemented properly. The effectiveness of Sterilization Camps and Awareness Programs in rural areas is less.

10.Urban Migration and Resource Pressure:

Migration from rural areas to cities increases population pressure on cities. As a result, Urban Slums are created and the burden on the Public Health system increases.

11.Male Child Preference:

Many patients have a preference for a male child in their families. Gender Bias leads to multiple pregnancies, which encourages population growth.

Overpopulation in India is a multi-dimensional challenge involving medical, sociocultural, economic and educational factors. To control it, it is necessary that dynamic steps are taken in the country towards Sexual Health Education, Accessible Contraceptive Services, Empowered Women and Strong Policy Implementation.

b) Describe the effects of over population in our country. આપણા દેશમાં વસ્તીવધારાને કારણે થતી અસરોનું વર્ણન કરો.04

1.Burden on Healthcare Infrastructure:

Overpopulation puts excessive pressure on Healthcare Facilities. Overcrowding occurs in Hospitals and Clinics due to more patients. Long queues in Outpatient Departments, Delayed Diagnosis and Inadequate Treatment cases increase.

2.Increase in Communicable and Vector-Borne Diseases:

Where the population is high, there is less sanitation and hygiene. As a result, patients are more likely to suffer from diseases like Tuberculosis, Dengue, Malaria and Cholera.

3.Nutritional Deficiencies and Malnutrition:

Increasing population puts pressure on the Food Supply. As a result, there is a shortage of Essential Nutrients. Especially in Children and Pregnant Patients, Protein Energy Malnutrition and Micronutrient Deficiencies are seen.

4.Inadequate Maternal and Neonatal Care:

Due to more patients, there is less availability of Gynecological Services. As a result, Prenatal Care, Institutional Deliveries and Neonatal Intensive Care are affected.

5.Mental Health Disorders:

Social Stressors, Unemployment and Resource Scarcity that come with overpopulation increase the risk of Anxiety, Depression and Substance Use Disorders in patients.

6.Low Doctor-to-Patient Ratio:

As the number of patients increases, Doctor Availability decreases. India’s Doctor-Patient Ratio is much lower than the criteria as per the World Health Organization. Due to which Personalized Care cannot be provided.

7.Environmental Health Hazards:

Population growth increases Pollution Levels. Due to Air Pollution, Chronic Obstructive Pulmonary Disease, Bronchial Asthma and Allergies increase in patients.

8.Increased Infant and Maternal Mortality:

Where health centers are overloaded, Essential Obstetric Services are not available in sufficient quantity. Due to which Maternal Mortality Rate and Infant Mortality Rate increase.

9. Urban Slum Expansion and Poor Living Conditions:

Overpopulation in big cities promotes Slum Development. In such places, Clean Water, Sewage Management and Disease Control are less effective.

10. Strain on Public Health Budget:

The increasing population puts pressure on the Budget Allocation of the government’s health programs. This means that Preventive Healthcare, Immunization and Rehabilitation Services for patients also decrease.

All the effects of overpopulation have negative effects on individual, social and national health levels. In such a situation, there is a need to make strong efforts towards Health Policy Reform, Efficient Resource Management and Population Stabilization Strategies. Only then can our country achieve a Sustainable Health System.

c) What are the steps to be taken to control the population in India? ભારતમાં વસ્તી વધારાને નિયંત્રણ કરવા કયાં કયાં પગલાં લેવા જોઈએ? 05

Population Control Measures in India:

1.Comprehensive Sex Education:

Consistent and scientific sex education brings awareness about reproductive health among the patients. Schools and colleges should educate the students about puberty, conception, contraception and sexually transmitted infections. This educational process helps the individual to take the right decision from the beginning.

2.Accessible Contraceptive Methods:

Government and health authorities should make services like condoms, oral pills, intrauterine devices and emergency contraception easily available to the patients. Free distribution and educational sessions should be held at the workplace, school or rural health centers of the individual.

3.Female and Male Sterilization:

Permanent contraceptive methods like tubectomy for females and vasectomy for males are the most effective for population control. Free treatment and consultation for sterilization should be provided to patients in government hospitals and health camps.

4.Family Planning Counseling:

Personal counseling on family size and birth spacing should be provided to patients of reproductive age at health centers. Counseling removes psychological reservations of the patients and creates awareness.

5.Delayed Marriage Campaign:

Increasing the age of marriage will delay the time of parentalhood of the patient. Due to which the fertility rate automatically decreases. Marriage delay awareness programs are necessary for young patients at school and college levels.

6. Incentivized Family Planning Programs:

Patients who adopt family planning should be given priority in monetary rewards, health insurance benefits and government schemes. These programs encourage patients towards contraceptive use.

7. Use of Digital and Mass Media Awareness:

The message reaches the patients directly through family planning advertisements, short films and educational guidelines on social media, TV, radio and public places. Animated and infographic formats are considered more effective.

8.Public Health Infrastructure Development:

Increase the facilities of reproductive health centers in remote areas and urban slums. Provide regular consulting to patients through trained health workers, nurses and community health agents.

9.Policy Implementation and Legal Measures:

Implement family planning strictly. Make two-child norm, pre-marital counseling mandatory. Bring family size limit from the government for patients which is beneficial in terms of health and economy.

10.Women Empowerment and Higher Education:

When females get higher education, job opportunities and decision-making power, they become more aware of their reproductive health and family size. Highly educated women show lower fertility rates.

A realistic, medically based and organized strategy is required for population control. By providing contraceptive services, education and counseling to every patient, the population growth of the country can be controlled. For this, the combined efforts of the government, health workers and society are indispensable.

OR

a) Write down the hazards of large family. મોટા પરિવાર ને કારણે થતા જોખમો લખો.03

The emotional life of a large family often brings with it many health risks and medical complications. It becomes difficult to maintain proper healthcare, nutrition, emotional support and sanitary conditions for each patient living in a large family. Below is a complete and precise description of all the possible risks of a large family with medical terminology:

1. Overcrowding:

When many family members live in the same house, overcrowding occurs in the physical space. Due to this, the patient experiences sleep disturbance, high blood pressure, and overactivity of the adrenal gland that releases stress hormones. In the long run, this causes anxiety and immune dysfunction.

2.Poor Sanitation and Hygiene

Living together with many members makes it difficult to maintain hygiene. The risk of gastroenteritis, scabies, helminthic worm infestation, and urinary tract infection increases. Infectious diseases can spread rapidly due to the inability to maintain meticulous hygienic control.

3.Nutritional Deficiencies

If family finances are limited, the patient does not get adequate nutrition. Especially, deficiency of nutrients like Iron, Vitamin D, Vitamin A, and Calcium causes conditions like Severe Anemia, Night Blindness, and Rickets in children and pregnant patients.

4.Mental Health Disorders

Due to lack of adequate emotional support from parents, patients develop Depressive Disorder, Obsessive-Compulsive Disorder, and Generalized Anxiety Disorder. Teenage Burnout Syndrome is also seen in young patients.

5. Increased Risk of Communicable Diseases

Large families have more close contact, due to which communicable diseases such as Tuberculosis, Hepatitis A, Conjunctivitis, and Foodborne Poisoning spread rapidly. Pediatric patients are especially at high risk if there is no vaccination coverage.

6. Financial Constraints:

Many patients find it difficult to manage their medical expenses, schooling, and nutrition-related expenses. Regular health check-ups, diagnostic testing, and medicine supply are not possible for multiple patients. This leads to a decrease in the quality of health of the patient.

7.Reproductive Health Burden

Lack of family planning leads to frequent pregnancies. Serious conditions like uterine prolapse, endometriosis, and postpartum complications are seen in female patients. Due to excessive pregnancies, nutritional storage decreases, which also increases the risk of maternal mortality.

8.Developmental Delay in Children

Lack of attention and mental stimulation leads to speech delay, autism spectrum disorder, and learning disabilities in children. If the brain development of pediatric patients is not provided with a proper environment, cognitive functions remain low.

9. Educational Inequality:

It becomes difficult for all children to get a good and customized education. Due to the lack of learning support for patients with special needs, school dropout, academic failure, and confidence loss are seen.

10. Delayed Medical Intervention

If there are many patients, it becomes challenging for everyone to get timely medical diagnosis and treatment. Due to this, chronic diseases such as diabetes, hypertension, and kidney disorders can develop and are detected at a late stage.

11.Parental Burnout

Constant care and daily responsibilities for many children leads to Parental Burnout. This leads to chronic fatigue, muscle pain, and psychosomatic disorders in parents.

12.Sibling Rivalry and Behavioural Disorders

Rivalry for attention occurs between many children in the same household. This leads to anger issues, conduct disorder, and personality disturbance in patients.

13.Neglect of Elderly Patients:

In a large family, there is not enough focus on senior patients. This can cause them to develop osteoarthritis and dementia.

b) Describe the advantages of small family. નાના પરિવારના ફાયદા જણાવો 04

Advantages of Small Family:

1) Better Financial Stability:

A primary advantage of a small family is that it maintains financial stability. In order to support fewer children, parents can allocate more financial resources per child. This includes education, health care services, extracurricular activities, and overall quality of life.

Small families have fewer expenses compared to large families, which allows them to save more, invest, fund college, and plan better for future expenses such as retirement.

2) Closer parent child relationship:

In small families, parents can give each child more personal attention and emotional support. Due to which a close relationship forms between parents and children and communication between parents and children also increases. Children in small families may experience less rivalry and competition with siblings for parental attention, due to which the child develops a strong sense of security and self-esteem.

3) Reduce Environmental Impact:

Small families use fewer resources and produce less waste than large families. This makes a positive contribution to environmental sustainability by reducing carbon footprints, energy consumption and overall ecological impact.

4) Improved Education Opportunity:

Parents in small families have more financial resources available to invest in their children’s education. This can include tuition for private schools, enrichment programs, tutoring and educational materials. Children from small families have better access to educational opportunities and can receive more personalized educational support from parents and teachers.

5) Enhance career opportunity and mobility:

Smaller families have greater flexibility in career choices, job relocation, and professional development opportunities. Parents have more time and energy to focus on advancing their careers without the constraints of the responsibilities of a large family. This flexibility also leads to improvements in job satisfaction and increases in earning opportunities, leading to a better life out of the home.

6) Healthier Parental Wellbeing:

Parenting fewer children can reduce stress and physical strain on parents, especially mothers. It provides opportunities for good maternal health before, during and after pregnancy. Multiple pregnancy-related challenges are less common in small families. Such as maternal complications and risks of child birth.

Thus, small families have advantages such as financial stability, close parent-child relationships, and reduced environmental impact. Along with these advantages, they also present challenges related to social dynamics, parental expectations, and family support systems.

(c) Describe the role of a nurse in family welfare programone. કટુંબ કલ્યાણ કાર્યક્રમમાં નર્સની ભૂમિકા વિગતવાર વર્ણન કરો.05

Role of Nurse in Family Welfare Program:

The role of a nurse in a family welfare program is diverse and multifaceted. Nurses play different roles in different settings of family welfare services. It usually depends on their post and their capacity to perform the work.

The role of Community Health Nurse (CHN) in family welfare services is important to promote reproductive health, family planning and overall well-being in the community.
Here are the main aspects of their role:

1) Survey work:

The nurse collects demographic facts through surveys.

She makes a list of the house numbers and their locations in the community.
The nurse collects information about pregnant mothers, eligible couples, contraceptive users, children and children below school going age through the survey.

Then the couples are classified into high, medium and low priority.

To collect feedback on how many couples are using contraceptives and how many people are not using them to form further action plans.

2) Health Education:

To provide education about health and family planning to the individual, family and community.

To make people aware about available family planning services.

To provide education and detailed information about different types of contraceptives to the couples so that they can adopt them according to their choice.

To provide education to mothers or to breastfeed their children for at least one year as it works as a natural contraceptive.

To provide education in the community on immunization, nutrition, first aid and personal and environmental hygiene.

3) Coordinator and Provider of Family Welfare Services:

To supply various types of contraceptives available to eligible couples.

To arrange family planning clinics and camps to create awareness about the needs and available services among the people.

To follow the rules and regulations of the State Government and the State and to provide direct services within legal and professional limits.

It coordinates the services of gynecologists and other family welfare services personnel.

5) Motivation function:

Motivates eligible couples to adopt small family norms by using contraceptives.

Works to explain the need and importance of family planning.

Identify women who need medical termination of pregnancy and refer them to doctors early.

Establish depots for adequate contraceptive supply and distribution in every village so that adequate supply of contraceptives can be ensured.

6) Administrative Role:

To determine the date and location of family planning clinics, arrange equipment, supplies and other resources in the clinics.

To supervise and guide multipurpose health workers in the clinics and distribute contraceptives and insert and remove IUDs.

To provide assistance to the medical officer in conducting the clinics.

To organize family planning camps and assist doctors in male-female and female sterilization operations.

To maintain aseptic technique during operations.

To provide follow-up services to couples who have accepted the family planning method.

To plan and evaluate education programs.

7) Consultant:

As a coordinator in family welfare services and as a direct care provider, it is important to consult with them before starting any kind of health care program in the community.

8) Counselor:

A nurse counsels eligible couples and target couples on different contraceptive methods and provides them with the opportunity to choose the best suitable method for spacing.

9) Supervisory Role:

As a supervisor, a nurse working in the family welfare department encourages her staff to actively participate in the family welfare program.

As a supervisor, the nurse organizes in-service education programs for health workers, professionals, and nursing personnel.

10) Domiciliary Services:

Home visits are an important part of the family program. These services are provided by multipurpose health workers and health assistants.

Among the services, education and motivation are provided to eligible couples.

If using IUD and pills, advice for follow-up and education for follow-up in cases of vasectomy, tubectomy, medical termination of pregnancy (MTP).

Domiciliary care is provided to antenatal, postnatal, newborn and toddler.

Provide referral services if anyone has post-operative complications.

11) Record Maintenance:

The nurse is responsible for maintaining all records in the family planning program such as,

•Eligible Couple Records,

•Target Couple Records,

•Intrauterine Devices Records,

•Sterilization Operation Records,

•Clinic and Camp Records,

•Health Education Activity Records,

•Training Records,

•Medical Records etc.

The nurse is responsible for preparing monthly reports and submitting them to the authorities.

12) Role in Research: The Community Health Nurse is a primary member of the multi-disciplinary research team. The nurse has to cooperate and participate in the research activities of the Family Welfare Services.

13) Evaluation Role: The nurse evaluates the work performed in the family welfare program and prepares its reports. On the basis of this evaluation, any further changes are made in the implementation of the program and the desirable targets are achieved.

14) Collaborator:

The community health nurse works for the improvement of health care services by collaborating with health teachers and non-government organizations in the community.

The nurse works collaboratively with doctors, dispensers, vaccinators, trained birth attendants, and lady health visitors to provide family welfare services in the community.

Community health nurses play a crucial role in empowering individuals and families to make informed decisions about their reproductive health, supporting healthy pregnancy and childbirth, and contributing to the overall well-being of the community through effective family welfare programs.

Q-2

a) Describe all major health problems in India ભારતની મુખ્ય સ્વાસ્થ્ય સમસ્યાઓ વર્ણવો 08

Major Health Problems of India:

India faces a variety of health challenges reflecting its large and diverse population, socio-economic disparities and healthcare infrastructure.

A health problem is a condition in which a person is unable to function normally.

Some of the major health problems in India include:

1) Communicable diseases,

2) Non-communicable diseases,

3) Nutritional problems,

4) Environmental problems,

5) Medical care problems,

6) Population problems

•>1) Communicable diseases:

Communicable diseases are diseases that are transmitted from one person to another by infectious agents or their toxic products. This transmission can mainly occur directly or indirectly. Its transmission can occur through contact with body fluids, respiratory droplets, and contact with contaminated surfaces.
Communicable diseases are a major health problem in India and 54% of deaths in India are due to communicable diseases.

Communicable diseases such as malaria, tuberculosis, diarrhea,
Acute respiratory diseases,
Filariasis,
HIV/AIDS,
Sexually transmitted diseases (STD)/Sexually transmitted infections (STI).

These communicable diseases are considered a major health problem in India.

a) Malaria:

Malaria is a major health problem in India.

Malaria is caused by the Plasmodium parasite which is transmitted through the bite of mosquitoes. There are four types of malarial parasites:

1) Plasmodium vivax,

2) Plasmodium ovale,

3) Plasmodium malariae

4) Plasmodium falciparum.

Malaria continues to be a major health problem in India. Although the total number of cases has decreased compared to previous years, the incidence of Plasmodium falciparum has increased.

According to WHO, malaria affects 36% of the world’s population, with India contributing more than 70% of the 2.5 million cases reported in South East Asia, while 2/3 of the Indian population lives in malaria zones, with the highest incidence of malaria cases occurring in the states of Madhya Pradesh, Chhattisgarh, Jharkhand, Odisha, Andhra Pradesh, Maharashtra, West Bengal and the North Eastern states.

During 2015, 1.13 million malaria cases were reported, of which P. falciparum accounted for 67% of the cases, while 287 deaths were reported.

b) Tuberculosis:

Tuberculosis is a bacterial disease caused by Mycobacterium tuberculosis. Tuberculosis bacteria affect the lungs and are spread by sneezing, coughing.
India is the country with the highest TB burden. It remains a major health problem. One-fifth of the world’s incidence of tuberculosis disease is found in India alone.

Every year, about 2.2 million people develop tuberculosis disease, of which 0.62 million are new smear-positive highly infectious cases and 0.24 million people die from tuberculosis disease every year.
According to WHO 2010, tuberculosis in India was estimated to be 249 per 100,000 population and the mortality rate due to tuberculosis disease was 23 per 100,000 population.

( C ) Leprosy:

Leprosy is another major health problem in India.

It is a bacterial disease caused by the bacteria Mycobacterium Leprae. It is transmitted by close contact with an infected person. The disease affects the skin, mucous membranes, and nervous system, causing skin discoloration and nerve damage.
Leprosy is a major health problem in India. According to the World Health Organization (WHO), India accounts for 65% of new cases of leprosy. During 2013-14, 1.27 lakh cases were detected. Of these, 9.49% were in children under 15 years of age and the deformity was grade II.
Of these, 51.48% were estimated to be multibacillary. All states and union territories report cases of leprosy. However, there are significant differences not only between one state and another but also between one district and another.
India is home to 54% of the world’s leprosy.

( d ) Diarrhea:

Diarrhea is caused by bacteria, viruses and other disease conditions.

Diarrheal diseases are considered a major cause of morbidity and mortality in children under five years of age.
There are about 11.67 million cases of diarrheal diseases which occur in India due to poor environmental conditions.
In 2013, more than 100,000 children under the age of 11 months died due to diarrhea.
Diarrhea is the second leading killer disease of young children worldwide after pneumonia.
India has the highest number of diarrheal diseases. Diarrhea is a preventable and treatable disease. It is also the leading cause of malnutrition in children under five years of age.
More than 2.3 million children die every year, of which 334,000 children die due to diarrhoeal diseases.

(e) Acute Respiratory Diseases:

Acute respiratory diseases are a major cause of morbidity and mortality in children under five years of age in India.
During 2014, 34.81 million episodes of acute respiratory diseases were reported with 2,932 deaths.

( f) Filariasis:

Filariasis is endemic in about 255 districts of 16 states and five union territories in India. About 630 million population is at risk. To achieve elimination of LF (Lymphatic Filariasis), GOI (Government of India) has started Nationwide Annual Mass Drug Administration (MDA) with annual single recommended dose of Diethylcarbamazine Citrate tablets, besides increasing home-based foot care and hydrocele operations.

The National Filariasis Control Programme was launched in 1955.

( G )HIV/AIDS:

HIV( Human Immunodeficiency Virus)/AIDS( Acquired Immunodeficiency Syndrome.

AIDS( Acquired Immunodeficiency Syndrome) is caused by exposure to infected blood semen(vaginal fluid).

The Indian Ministry of Health and Family Welfare estimated that the prevalence of HIV among adults (15-49 years) in 2011 was 0.27%, while the number of people living with HIV was 420,88,642, the number of new HIV infections in adults was 1,16,456 and the annual number is .

( h) STD/ STI:

More than 1 million people get sexually transmitted infections every day. Every year, about 550 million people get STIs- Chlamydia, Gonorrhea, Syphilis and Get sick from trichomoniasis.
More than 530 million people have genital herpes. More than 290 million women have human papillomavirus infection. Most STI infections present without symptoms. These sexually transmitted infections can be transmitted from mother to child through the placenta or during delivery of the baby.

2) Noncommunicable Diseases:

Noncommunicable diseases are diseases that are not spread by infection or other people, but are usually caused by unhealthy behavior. They are the leading cause of death worldwide and pose a major threat to health and development, especially in low- and middle-income countries.

Noncommunicable diseases include

Cardiovascular disease,

Hypertension,

Cancer,

Diabetes Diseases like diabetes mellitus,

mental disorders,

tobacco consumption,

alcoholism,

accidents,

chronic lung diseases,

cataracts,

and

strokes are involved.

( a ) Cardiovascular Disease:

Ischemic heart disease is a major cause of death which is generally increasing rapidly in economically developed countries and developing countries and is estimated to be the single most important cause of death in India by the year 2015.

According to WHO, an estimated 17 million people died from heart-related diseases in 2005, which was 30% of global deaths. And about 80% of these deaths occurred in low and middle income countries like India. According to the World Health Federation, 35% of cardiovascular diseases in India occur in the age group of 35-64 years. It happens in between.

( b ) Cancer:

Cancer has become an important health problem in India.

Every year, about 7-9 lakh cases are estimated to occur. It is estimated that there are 25 lakh cases of cancer in the country. Out of this, half of the total cancer cases are related to tobacco consumption in males and 20% of tobacco related cases are in females.

Every year, about 1 million tobacco related deaths occur.
Approximately 50% of deaths in developing countries are due to cancer. Breast cancer-20.01,
Cervical cancer-14.42 and ovarian cancer-5.6 were recorded in women.

Currently, India has the highest number of oral cancer cases in the world due to tobacco chewing in its rural areas.

(c) Diabetes Mellitus:

India is often referred to as the “diabetes capital of the world” due to the high prevalence of diabetes, especially type 2 diabetes. The rate of diabetes is increasing due to genetic predisposition, urbanization and dietary changes.

In 2011, it was estimated that 62.4 million people were affected by diabetes mellitus, an increase of about 2 million in just 1 year.
In India, 77.2 million people are estimated to have pre-diabetes.
About 4.4 million Indians in their most productive years of 20 to 79 years are unaware that they have diabetes. In 2011, diabetes killed about 1 million people in India.
India’s rural population is more affected by diabetes (34 million), while the urban population (28 million) is affected by diabetes mellitus. India ranks second after China.

( d ) Mental Disorders:

Mental disorders contribute to 13% of the global disease burden. According to the National Institute of Mental Health (NIMH), the prevalence rate of schizophrenia in India is 1.1% of the total population, while the overall lifetime prevalence of mental disorders in the total population is 10-12%.

( e ) Tobacco Consumption:

According to the National Family Health Survey-3, the prevalence of smoking among males and females in the age group of 15-49 years was 32.7% and 1.4% respectively.

Among the youth, 40% of males and 5% of females use tobacco.
19% of males smoke cigarettes or bidis and 30% use paan rasala, gutkha or other tobacco.
Tobacco use in any form is a major cause of cancer, especially oral cancer in people who chew tobacco.

( f ) Alcoholism:

The pattern of alcohol intake in India varies with geographical area. Punjab, Andhra Pradesh, Goa and the North-Eastern states have the highest incidence where alcohol intake is higher among males than the rest of the country. Female alcohol intake is higher in Arunachal Pradesh, Assam and Sikkim. The estimated alcohol consumers in 2005 were 62.5 million and out of these, 10.6 million are alcohol addicts in India.

( G ) Accidents:

According to WHO, road accidents in India have increased from 1.32 lakh (in 2010) to 1.43 lakh (in 2011).

During 1990-2000, the number of deaths due to accidents was 47%, of which 93% were due to unnatural causes and 7% due to natural causes.

The mortality rate due to accidents in the age group below 14 years was 8.2%; 15-44 years was 62%, 45-59 years was 20% and the age group above 60 years was 9.2%.

( h) Chronic Lung Disease:

Chronic lung diseases include conditions like chronic obstructive pulmonary disease (COPD) and asthma, which are aggravated by air pollution and tobacco use.

(I) Cataract:

In India, more than 12 million people are blind. Refractive error accounts for 19.70% of cases. Cataract surgery with intraocular lens (IOL) implantation has increased significantly from less than 5% in 1994 to 95% in 2011-12.

( j) Strokes:

The increase in coronary heart disease and stroke in India is mainly observed in urban communities than in rural communities. Cardiovascular diseases, mainly heart disease and stroke, were the cause of death in 17.5 million individuals.
After heart disease, stroke is the second leading cause of death with 5.8 million fatal cases per year, of which 40% are in people under 70 years of age. About 12% of strokes occur in the population under 40 years of age. The number of stroke cases in India has increased by 17.5% in the last few decades.

3) Nutritional Problems:

The major nutritional problems seen in India include,

PEM (Protein Energy Malnutrition),

Nutritional Anemia,

Low Birth Weight Babies,

Xerophthalmia (Nutritional Blindness),

Iodine Deficiency Disorder,

Latherism,

Fluorosis.

a)PEM (Protein Energy Malnutrition):

Protein Energy Malnutrition is a problem seen due to deficiency of protein and calories and it is seen due to low consumption of food.

Protein Energy Malnutrition is generally of two types.

1) Kwasiorkor

Which is seen due to deficiency of protein.

2) Marasmus

It is seen due to calorie deficiency.

Thus, due to protein and calorie deficiency, the weight of the child is seen less than its age.
Protein energy mal nutrition is caused by insufficient food or food gap.
This problem is seen in every state of India.
But nutritional marasmus is seen in more quantity than kwashiorkor.

(b) Nutritional anemia:

Nutritional anemia is usually seen due to inadequate nutritious diet.
Generally, 60 to 80% of women have anemia condition due to vitamin B12 deficiency.
Adult girls are seen in more quantity.

( c) Low Birth Weight Babies:

Low birth weight babies are usually seen in developing countries where the baby weighs less than 2.5 kg at birth and its main cause is maternal malnutrition or anemia.

( d ) Xerophthalmia:

Xerophthalmia means dry eye. This is a medical condition in which there is no production of tears in the eye. This condition is usually seen due to deficiency of Vitamin A (Av) and this condition is mainly seen in children below 1 to 3 years of age.

( e ) Iodine Deficiency Disorders:

Iodine deficiency causes goiter in which there is enlargement of the thyroid gland which is located in the neck. 71 million people in India are affected by goiter.

( f ) Lathyrus:

Lathyrus is caused by a particular type of lentil. This type of problem is especially seen with the saffron lentil (Lathyrus sativus). In which weakness, muscular spasm, weakness and paraplegia are seen. In India, this problem is especially seen in states like Madhya Pradesh, Jharkhand and Bihar.

( h ) Fluorosis:

Fluorosis is caused due to excessive fluoride content in drinking water. Fluorosis is also a major health problem in India. It is seen in Tamil Nadu, Andhra Pradesh, Punjab, Bihar, Rajasthan, Kerala and Jharkhand.

4) Environmental Problem:

Environmental problem is mainly seen due to two reasons.

( I ) Lack of safe drinking water,

( II ) Improper sanitation method for excreta disposal

These two reasons mainly cause soil pollution and water pollution.

Currently, safe water is available in 95% of urban areas and 79% in rural areas.

And facilities for excreta disposal are available in 61% of urban areas and only 15% in rural areas, which leads to soil pollution.

Apart from this, environmental pollution is also seen in urban areas due to vehicle exhaust, improper disposal of waste products from factories, which affects the health of the people.

5) Medical Care Problem:

Medical care is seen to be more developed in urban areas than in village areas.

In urban areas, due to overcrowding in hospitals, inadequate staff and drugs and medicines not being available in adequate amounts, it also affects the health of the people.

While in rural areas, 80% of the population believes in the indigenous system of medicine, along with inadequate health resources, it affects the health of the people.

The lack of proper distribution of health care services in urban and rural areas also affects the health of the people.

Due to lack of adequate manpower, material, money, and inadequate health services in the village, health problems are created due to which morbidity and mortality are seen.

6) Population Problem:

Population problem is one of the biggest health problems of India which affects many aspects of development including employment, education, housing, health care sanitation and environment.

India comes second in population after China.

People migrate from rural to urban areas to get more facilities due to which population density increases in urban areas.

Thus, the following health problems are seen in India.

b) What are the controlling measures for STD? એસ.ટી.ડી. ને નિયંત્રિત કરવા નાં પગલાં કયા છે? 04

Measures to Control STD (Sexually Transmitted Diseases):

Controlling measures for sexually transmitted diseases involve a combination of strategies focusing on prevention, diagnosis, treatment, and public health interventions.

The controlling measures for sexually transmitted diseases (STD) are as follows:

1) Preventive Measures:

Health Education and Promotion

Awareness:

Providing education to the public about sexually transmitted diseases (STD), their modes of transmission, and preventive measures through community outreach, schools, media, and health care facilities.

Behavioral Intervention:

Adopting safer sexual behavior such as using barrier methods of contraception and reducing the number of sexual partners.

Prevention Program:

It involves implementing a comprehensive sexual health education program that includes programs on STD prevention and contraception.

Access to Contraception:

Ensuring availability and access to contraceptives to reduce the risk of unintended pregnancy, which increases the risk of transmission of STDs (Sexually Transmitted Diseases).

Vaccination: HPV (Human Papilloma Virus) Vaccine:

Promote and administer the Human Papilloma Virus (HPV) vaccine to prevent HPV infection, which can lead to cervical cancer and other genital cancers.

Hepatitis B Vaccine:

Provide universal vaccination against hepatitis B virus to prevent liver disease and reduce transmission through sexual contact.

2) Screening and Early Detection:

Routine Testing:

Test for common sexually transmitted diseases, including,
HIV, syphilis, gonorrhea, chlamydia, and human papillomavirus (HPV).

Screen for sexually transmitted diseases regularly as part of comprehensive health visits.

Partner Notification:

Encourage individuals diagnosed with an STD to notify their sexual partners and seek diagnosis and treatment to prevent further transmission.

3) Treatment and Management:

Early diagnosis of sexually transmitted diseases (STDs) and, once diagnosed, appropriate antibiotic and antiviral medications to cure the infection, relieve symptoms, and prevent complications.

Partner Treatment:

Proper testing of sexual partners of individuals diagnosed with a sexually transmitted infection (STI) to prevent further infection and transmission and to prevent complications.

4) Public Health Interventions:

Surveillance and Monitoring:

Monitoring the prevalence and trends of STDs through surveillance systems to inform public health strategies and effectively allocate resources.

Outreach and Testing Programs:

Implementing outreach programs, mobile clinics, and community-based testing initiatives to reach underserved populations and promote testing for STDs.

Contact Tracing:

Conducting contact tracing to identify and notify individuals who have been exposed to an STD, offering testing, and providing counseling and treatment services.

5) Promotion of Vaccine Availability:

Promote and implement vaccination programs for preventable STDs such as HPV (Human Papilloma Virus) and Hepatitis B to reduce the incidence of associated cancers and liver diseases.

6) Addressing Social and Behavioral Determinants:

Health Equity:

Addressing social determinants of health such as poverty, stigma, discrimination, and lack of health care facilities leads to health inequities that increase the risk of sexually transmitted infections (STIs).

Behavioral Counseling

Provide behavioral counseling and support services to empower individuals to adopt safe sexual practices and reduce risk factors.

7) Research and Innovation:

Provide support for research initiatives to develop new diagnostic tools, treatments, vaccines, and preventive strategies for sexually transmitted diseases.

By implementing these compliant control measures, public health authorities, health care providers, and communities can effectively reduce the burden of STDs, promote sexual health, and improve overall population health outcomes.

OR

a) Write the principles and purposes of home visiting હોમ વીઝીટીંગના સિધ્ધાંતો અને હેતુઓ લખો. 08

Principles of Home Visiting

1.Need Based Visit:

Home visiting should be done on the basis of the individual needs of the patient. The visit should not be just for formality but should be as per the health condition and nursing care requirement of the patient.

2.Planning:

The visit should be planned and systematic before. The time, objective and interventions of each visit should be planned so that continuity and effectiveness can be maintained.

3.Flexibility:

It is necessary to make changes according to the condition during the home visit. Home care should be provided in a manner that suits the environment according to the condition of the patient and his/her environment.

4.Privacy and Confidentiality:

It is necessary to keep the patient’s personal information and health status confidential during home visits. It should not be disclosed to others.

5.Relationship Building:

A relationship based on trust and understanding should be established with the patient and his family. This increases compliance and cooperation.

6.Continuity of Care:

Continuous care should be provided to the patient through home visits at regular intervals so that continuity in chronic condition and rehabilitation is maintained.

7.Use of Resources:

Proper use of available local resources such as anganwadi, primary health center or local support groups should be made during the visit.

8.Cost Effectiveness:

Home visits should be cost-effective for the patient. This can save transportation costs and hospital visits.

9.Documentation:

It is necessary to keep an accurate and complete record of each visit. It should include a note of assessment, intervention and outcome.

Purposes of Home Visiting:

1.Health Assessment:

Home visits are conducted to observe and evaluate the physical, mental, emotional and social status of the patient.

2.Health Education:

The main purpose is to provide knowledge about disease prevention, nutrition, hygiene and lifestyle to the patient and his family.

3.Follow-up Care:

Follow-up care is provided to the patient to maintain continuity after discharge from the hospital.

4.Early Detection:

Identifying risk factors and early signs of disease and preventing progression to serious conditions.

5.Health Promotion:

Home visits are conducted to increase awareness among the patient and family and develop positive health behaviors.

6.Curative Services:

Basic curative services such as wound dressing, medication administration, injection therapy, etc. are provided through home visits.

7.Rehabilitation Services:

Home visits are essential to regain functional independence after long-term illness or disability.

8.Emotional and Psychological Support:

Mental well-being can be maintained by providing emotional guidance, counseling, and motivation to the patient and family.

9.Monitoring and Evaluation:

Assessing the effectiveness of the care plan by observing the patient’s health progress.

10.Building Community Relationship:

Home visits are beneficial in developing collaboration and mutual understanding between nurses and the community.

These principles and purposes are common to all nursing practices, which are essential for effective home care.

b) What will you do to increase the number of deliveries in PHC? પી.એચ.સી માં પ્રસુતીઓ ની સંખ્યા વધારવા માટે તમે શું કરશો? 04

Detailed Approach to Enhance Institutional Deliveries at Primary Health Center (PHC):

1.Antenatal Care Strengthening:

Educate pregnant females for regular checkups in each trimester. Counsel the patient in detail about possible complications, danger signs and delivery planning during antenatal consultation.

2.Health Education and Counseling:

Increase awareness on maternal health at the village level. Educate women and family members about labor pain, safe delivery, and institutional delivery through face to face counseling.

3.Birth Planning and Complication Readiness:

Prepare delivery location, transport mode, blood donor and emergency contact for each pregnant woman in advance. Along with this, the patient should be told to refer to PHC immediately if labor starts at any time.

4.Skilled Birth Attendance:

Keep qualified and trained health staff like Nurse Midwife, ANM and Medical Officer available at PHC 24 hours a day.

5.Facility Readiness and Infrastructure:

The delivery room should be well equipped. Necessary equipment like Fetal Doppler, Sterile Delivery Kit, Resuscitation Tray, Oxygen Support etc. should be available. Cleanliness and privacy are essential.

6.Community Linkage via ASHA (Asha):

Monthly home visits of every pregnant patient by ASHA workers for surveillance, follow up and counseling. Encourage every patient for PHC delivery and give them a strong message that hospital delivery is safer.

7.Incentive Schemes Awareness:

Provide information about Janni Suraksha Yojana and other state subsidy schemes. Tell the patient that through Institutional Delivery they will get notified benefits which will be economically helpful for them.

8.Emergency Transport System:

Develop infrastructure to reach the patient to the PHC in a timely manner by creating links with 108 ambulance service and other local transport.

9.Referral Mechanism:

If a complicated case comes to PHC, then there should be a well-developed referral plan to immediately refer it to FRU or District Hospital.

10.Feedback and Quality Improvement:

After delivery, improve PHC services based on the feedback of the patient and his family. Institutional Delivery increases at the level of patient satisfaction.

To increase Institutional Deliveries, only medical services are not enough, but education, counseling, incentives, emergency services and trust building approach are needed in Holistic Approach. All this is also possible only with Continuous Surveillance and Community Participation.

Q: 3 Write short answers (Any Two) ટુંકમા જવાબો લખો (કોઈ પણ બે) 2×6= 12

1.Describe the Millennium development goals. મીલેનીયમ ડેવલપમેન્ટ ગોલ વર્ણવો.

Millennium Development Goals

The Millennium Development Goals (MDGs) were eight global goals established by the United Nations in 2000 to combat extreme poverty and improve global health by 2015.

Each goal had specific targets and indicators to measure progress.

1) Eradicate Extreme Poverty and Hunger

The goal aims to halve the proportion of people living on less than $1.25 a day and achieve food security for all. It seeks to eradicate extreme poverty and focus on malnutrition through a range of programmes focused on economic development, food security and poverty reduction strategies.

2) Achieve Universal Primary Education

In this, the target was to ensure that all children complete a full course of primary schooling, regardless of gender or background.

This involves not only increasing school enrolment rates but also removing barriers to education such as child labour, inadequate school infrastructure and socio-cultural factors.

3) Promote Gender Equality and Empower Women.

This goal seeks to eliminate gender disparities in primary and secondary education and empower women in all aspects of life.

It addresses issues such as educational inequality, discrimination in employment and violence against women, with the aim of creating equal opportunities for both sexes.

4) Reduce Child Mortality

The goal was to reduce by two-thirds (2/3) the mortality rate among children under five years of age.

Efforts under this goal include improving child health through better nutrition, vaccination programs, and access to health care services to combat preventable diseases and reduce infant and child deaths.

5) Improve Maternal Health

The goal is to reduce by three-quarters (3/4) the maternal mortality ratio and improve reproductive health.

It focuses on increasing access to maternal health care services,

skilled birth attendants and family planning resources to reduce pregnancy and childbirth-related deaths.

6) Combat HIV/AIDS, Malaria and Other Diseases

Its goal was to prevent and reverse the transmission of HIV/AIDS, malaria and other major diseases.

This includes prevention, treatment and care efforts, as well as initiatives to reduce the incidence of these diseases through public health campaigns and to increase access to medical services.

7) Ensure Environmental Sustainability

This goal seeks to integrate the principles of sustainable development into national policies and reverse environmental degradation.

Its aim was to reduce deforestation, promote clean water and sanitation, and address issues such as climate change and biodiversity loss.

8) Develop a Global Partnership for Development

This final goal focuses on creating a global environment conducive to development by enhancing international cooperation.

It includes goals to increase aid to developing countries, improve trade opportunities, address debt relief, and promote technology transfer.

Thus, a total of 8 goals are involved in the Millennium Development Goals.

2.Narrate the care of physically & mentally challenged child. શારિરીક અને માનસિક વિકલાંગ બાળકની સારવાર વર્ણવો.

Holistic and Multidisciplinary Management for Special Needs Children

Physically and mentally challenged patients require a well-planned and proper care method, in which a full range of medical, therapeutic and educational services are provided by a multi-disciplinary team. The treatment of such patients is not limited to clinical management alone, but requires lifelong rehabilitation and support.

1.Early Detection and Developmental Screening:

Developmental Screening is necessary for symptoms like Milestone Delay, Neuromotor Dysfunction or Cognitive Impairment seen in the patient from the very beginning. Timely Referral and Diagnosis allows for good therapeutic intervention.

2.Clinical Evaluation and Medical Treatment:

Specialized medical care is required for physical conditions such as Cerebral Palsy, Muscular Dystrophy or mental conditions such as Autism Spectrum Disorder, Intellectual Disability, Attention Deficit Hyperactivity Disorder. A complete evaluation of neurological, metabolic, and environmental factors should be done.

3.Physiotherapy and Occupational Therapy:

Strengthening exercises, postural training, and mobility support are necessary to improve physical function. Occupational therapy develops daily living skills and functional independence.

4.Speech and Language Therapy:

For cases like Delayed Speech, Dysarthria, or Aphasia, the patient’s communication skills are improved through regular therapy by a Speech Therapist.

5.Behavior Modification and Psychological Support:

Psychological Counseling and Behavior Therapy are required to manage the patient’s behavioral problems like Aggression, Self-Injury, or Anxiety along with multiple interventions.

6.Special Education and Individualized Learning Plan:

For learning difficulties, the patient should be admitted to a Special School or Inclusive Education Program. Personalized support is provided through an Individualized Education Plan (IEP).

7.Parental Counseling and Home-Based Support:

Providing guidance sessions and home training modules for parents and caregivers can help them become more active and self-reliant in the patient’s daily care.

8.Use of Assistive Devices and Adaptive Equipment:

Tools such as wheelchairs, orthotic devices, communication aids, and feeding tools help the patient in their functional activities and help in enhancing their quality of life.

9.Nutritional Assessment and Feeding Support:

A personalized nutritional plan by a Clinical Dietitian is required for malnutrition, swallowing difficulties, or non-oral feeding.

10.Vocational Training and Social Integration:

Self-reliance and self-esteem are developed for the patient through Vocational Skill Development, Social Participation Programs and Community Inclusion Workshops.

Medical treatment alone is not enough to care for physically and mentally challenged patients. Continuous therapeutic support, parental education, and community inclusion ensure the complete development and sustainable rehabilitation of the patient. This approach is a powerful step towards human rights, dignity and social equality.

3.Explain the steps to improve environmental sanitation પર્યાવરણીય સ્વચ્છતા વધારવાનાં પગલાં સમજાવશે.

Steps to Improve Environmental Sanitation:

1.Waste Segregation and Proper Disposal:

It is very important to segregate waste according to its type such as biodegradable and non-biodegradable materials. In a hospital or clinical setting, biomedical waste should be placed in color-coded bins. Infectious material should be disposed of by autoclave, incinerator or chemical disinfection.

2.Clean Water Supply and Filtration:

Purified water is very important for patients and healthcare workers. There should be a water treatment plant at the community level. To prevent waterborne pathogens like Escherichia coli, Vibrio cholerae etc., it is necessary to have a UV or reverse osmosis system.

3.Vector Control Measures:

It is very important to prevent disease transmission from vectors like mosquito, fly and rodent. Use techniques like insecticide spray, larvicide and fogging. There should be an effective strategy especially for controlling diseases like dengue and malaria.

4.Personal Protective Equipment and Hygiene:

Personal Protective Equipment (PPE) such as gloves, masks, gowns and face shields should be used appropriately in healthcare settings. Alcohol-based hand sanitizer or antiseptic solution should be used for hand hygiene.

5.Proper Sewage Management System:

There should be a plan to treat sewage in a proper manner to prevent the spread of colonel bacteria, helminths and viruses. Treated water should be reused only for agricultural purposes.

6.Public Health Education and Awareness:

It is very important to educate the public about sanitation protocols, infection prevention and responsible waste handling through health education and awareness campaigns.

7.Regular Monitoring and Surveillance:

Regular monitoring should be done on all aspects of environmental sanitation. Risk factors and occurring pathogens can be detected timely through a surveillance system.

8.Hospital Infection Control Programs:

There should be an infection control committee in the healthcare facility. Standard Operating Procedures (SOP) and cleaning protocols should be followed.

9.Biomedical Waste Handling Training:

Healthcare workers and support staff must be trained on biomedical waste management to prevent nosocomial infections.

10.Implementation of Legal and Regulatory Framework:

Laws like Environment Protection Act, Biomedical Waste Management Rules should be strictly implemented.

Continuous monitoring, education and proper resource allocation are required for all these steps. An effective environmental sanitation system is essential not only for patient health but also for overall public health.

4.Explain about barrier methods in family planning ફેમિલી પ્લાનિંગમાં બેરિયર મેથડસ વિશે સમજાવો.

Temporary methods are generally used to postpone birth and to space births. This method is mostly used by couples who do not want children or who want to space children.

Barrier method: Barrier method prevents the connection of sperm with the ovum. It is called barrier method. This barrier method prevents sperm from being deposited in the vagina and also prevents sperm from penetrating the cervical canal. It usually uses mechanical, chemical and combined methods.

Physical method: Includes male condom, female condom, diaphragm, vaginal sponge.

Chemical Method:

Cream: Delfen/Pharmatex

Jelly: Coromax, Volper Paste.

Foam Tablet: Aerosol Foams, Chlorimin T, Contab.

Combination: It usually uses a combination of mechanical and chemical methods.

Combination Method: It uses a combination of mechanical and chemical methods.

1) Male Condom: Male condom is a male barrier contraceptive. It comes from the Latin word “condom” and was invented by Dr. Condom. The latest condoms are available in different sizes. They are 160-180 mm in length, 49-52 mm in width and 0.04-0.07 mm in thickness. They are plain or teatwad with a tip for semen collection. They are available in different colors. Among them,
Dry type Ex: Nirodh (Government Supply) and Kohinoor,
Prelubricated type Ex: Durex, Kamasutra and or spermicidal ones Ex: Raksha etc. are available.
It is an effective and very widely used device which does not have any side effects and can also prevent pregnancy. Condoms prevent both male and female from sexually transmitted diseases (STD).

Advantages:

Cheap and has no contra-indications and side effects.

Disposable for use, simple and easy to carry.

It provides protection against sexually transmitted diseases (STD) and pelvic inflammatory disease (PID).

Reduces the incidence of tubal infertility and ectopic pregnancy.

Used when coitus is irregular and infrequent.

Prevents premature ejaculation.

Used when pills and IUCD are contraindicated.

Disadvantages:
Sleep or breaks occur during coitus.

Sexual pleasure remains insufficient. Psychological disturbances remain.

Latex allergy can occur.

2) Female condom: Female condom is a newly developed female barrier contraceptive that combines the features of a diaphragm and a condom. It is made of synthetic latex or polyurethane. It has a similar structure in which the internal ring covers the cervix and the external ring remains on the outside of the vagina. It is prelubricated with silicone and does not require spermicide.

Advantages:
It prevents STDs (sexually transmitted diseases) more effectively than male condoms because some female condoms also cover the perineum.

Since it is made of polyurethane, it does not cause allergic reactions.

Male condoms are more convenient because they require pre-coitus insertion and are less likely to break.

Disadvantages:

Expensive.

Some women have difficulty inserting.

Failure rate 5-21/100 women.

3) Vaginal diaphragm: This is an intravaginal device made of synthetic rubber, flexible metal, or plastic material. Its diameter is 5 to 10 cm. It has a flexible rim, usually made of spring or metal. A medical or paramedical person is required to measure its size. Its rim extends from the upper end of the posterior fornix in the vagina to its lower end at the back of the symphysis pubis, completely covering the cervix. It should be kept in place for a minimum of 6 hours after sexual intercourse. The failure rate is 4-12/100 women.

4) Vaginal Sponge: This combined vaginal barrier contraceptive is a sponge made of polyurethane. It contains 1gm Nonoxonal-9 spermicide. Its shape is like a mushroom cap. Its concave side covers the cervix in the upper vagina. Vaginal sponge is easy to use, it has to be moistened with water and inserted into the vagina after kneading. It remains effective for 24 hours. It releases 125 – 150 mg of Nonoxonal in 24 hours.

Chemical Method: Its other name is also spermicide because it kills sperm, thus preventing chemical contraceptive pregnancy.

Ex: Foam tablet, aerosol, cream, jelly, paste, suppository, soluble film etc. All these are inserted deep into the vagina 15 minutes before the spermicide coat.

Advantages:
It is easy to use.
It is not very expensive and increases vaginal lubrication.

Dish Advantages:
It has to be inserted deep in all the places where the form reaches and before every sexual activity. The couple may experience irritation and burning sensation.

Combined method: When a barrier method is used along with a chemical method, it is called a combined method, which usually provides double protection.

Q-4 Write short note (Any Three) ટુંક નોંધ લખો (કોઇ પણ ત્રણ)3 × 4 = 12

1.RNTCP Components – RNTCP ના ઘટકો

Components of RNTCP
Revised National Tuberculosis Control Program:

1.Political and Administrative Commitment:

Political leadership and administrative support are very important for the success of RNTCP. A steady and strong commitment is required for resource allocation, funding and policy implementation at the national and state levels.

2.Quality Sputum Microscopy:

Sputum examination is the main pillar for diagnosis. Microscopy centres with quality control mechanisms where acid-fast bacilli are identified by Ziehl-Neelsen staining technique.

3.Directly Observed Treatment Short-Course DOTS:

Anti-tubercular therapy is taken by the patient under medical supervision. DOTS is a structured model of ensuring the patient completes the treatment under discipline.

4.Drug Supply and Logistics Management:

There should be an efficient drug storage and distribution system to ensure drug supply and timely availability. This involves first-line drugs such as Isoniazid, Rifampicin, Pyrazinamide, Ethambutol.

5.Monitoring and Evaluation:

The performance of the program is assessed through regular reporting, review and field evaluation. A checklist of TB notification system, treatment outcomes and quality indicators is prepared.

6.Human Resource Development and Training:

Health workers are provided with updated knowledge for diagnosis, reporting, patient care and management through training. Medical Officers, Tuberculosis Health Visitors (TBHV) and Laboratory Technicians are given regular training.

7.Involvement of NGO and Private Sector:

It is necessary to establish a public-private mechanism for tuberculosis control. Patient coverage increases through the involvement of NGOs, private practitioners and community leaders.

8.Laboratory Network Strengthening:

Inclusion of laboratory diagnostic facilities such as CBNAAT (Cartridge Based Nucleic Acid Amplification Test) and advanced molecular diagnostic techniques like Line Probe Assay in the National Lab Network.

9.Drug Resistant TB Management:

Adopting a special model of care for Multi Drug Resistant TB (MDR-TB) and Extensively Drug Resistant TB (XDR-TB). Second line drugs such as Levofloxacin, Linezolid, Bedaquiline are used.

10.Active Case Finding and Contact Tracing:

TB screening should be done in high risk populations like HIV positive patients, young children and immunosuppressed patients. Timely tracing of household contacts of TB patients and prophylactic therapy is very important.

11.Integration with National Health Programs:

RNTCP should be aligned with the targets of National Health Mission and Universal Health Coverage so that synergy can be created.

12.Digital Surveillance and Notification System:

Patient registration, treatment update, drug delivery and follow-up tracking are ensured through national portals like Nikshay.

With all these components, RNTCP is a comprehensive TB control framework, based on a patient-centric and evidence-based medical approach.

2.Demographic stages- ડેમોગ્રાફીક સ્ટેજીસ

There are mainly 5 stages of the demographic cycle.

1) First stage = High stationary stage,

2) Second stage = Early expanding,

3) Third stage = Late expanding,

4) Fourth stage = Low stationary,

5) Fifth stage = Decline stage

1) First stage = High stationary stage: In the high stationary stage, there are no changes in the size and composition of the population.

Birth rate: ↑High
Death rate: ↑High

Because in it, high birth rate and high death rate i.e. both cancel each other and due to which the population remains stationary (stable).

Till the middle of the 17th century, the world’s population was in this stage and India was in this stage till 1920.

Ex: India in 1920

2)Second Stage= Early Expanding: In the second stage, the death rate decreases in the early expanding stage because health conditions improve and the birth rate remains unchanged.

Birth rate: ↑Unchanged
Death rate: ↓Decline

In the early expanding stage, the birth rate does not change but the death rate decreases due to which there is a slight increase in the size of the population.

The world’s population was in this stage from the middle of the 17th century to the middle of the 19th century. India was in this stage from 1921 to 1950

Ex: South Asia, Africa

3)Third stage = Late expanding: In the third stage late expanding stage, the death rate declines a little more and the birth rate declines a little

Birth rate: ↓slide (slightly) decline

Death rate: ↓further decline

In the late expanding stage, the birth rate declines a little while the death rate declines a little more but since the birth rate is slightly higher than the death rate, population growth is seen in it.

Ex: china,Singapore and india

4) Fourth stage= Low Stationary: In the fourth stage low stationary stage, birth rate becomes low and death rate also becomes low due to which population is seen stationary (stable).

Birth rate: ↓low
Death rate: ↓low

Due to low birth rate and death rate in this stage, population is seen to be stable and this is generally seen mainly in developed and industrialized countries.

Zero population growth is recorded in Australia during 1980-1985.

Ex:=Australia in 1980-1985.

5) Fifth stage=Decline stage: In the fifth stage decline stage, birth rate becomes further low while death rate remains unchanged due to which population is seen to decrease.

Birth Rate: ↓Further Low
Death Rate: ↓Unchange

Thus, in this decline stage, there is a decrease in population due to the decrease in birth rate and while there is a death rate, this stage is usually seen in Germany and Hungary.

Ex:= Germany and Hungary.

Demographic cycles help to explain how populations evolve and transition through different stages of development, affected by socio-economic factors, technological advancement and cultural changes.

3.Injectable Contraceptives – ઇન્જેક્ટેબલ કોન્ટ્રાસેપ્ટીવ્સ

Injectable contraception includes two types:

1) Long-acting progestin:

1) Depot- Medroxyprogesterone Acetate (DMPA) – 150 mg every 3 months.

2) Norethisterone Enanthate (NET – EN) – 200 mg every 2 months.

2) Combined injectable:

DMPA 25 mg + Estradiol Cypionate 5mg (Cyclofem) – Monthly.

NET – EN 50 mg + Estradiol Valerate 5mg (Mesigyana) – Monthly.

1) Long acting progestin:

1) Depot- Medroxyprogesterone acetate (DMPA) – 150 mg intramuscular injection is provided every 3 months.
It usually provides protection against pregnancy for up to three months.
1) It suppresses ovulation.
2) It has an indirect effect on the endometrium.
3) It decreases the motility of the fallopian tubes.
All these mechanisms of action can prevent pregnancy.

Timing: Within 7 days of the menstrual cycle, immediately after abortion and MTP, within 7 days postpartum, 6 weeks postpartum in breastfeeding patients.

2) Norethisterone Enanthate (NET – EN): – 200 mg every 2 months.

This injectable usually provides protection from pregnancy for up to two months.

Advantages:
Highly effective,
Provides long-term protection from pregnancy.
Does not interfere with sexual activity.
Can be used at any age.
Reduces the risk of endometrial cancer and uterine fibroids.

Side-effects:

Irregular menstrual bleeding.
Amenorrhea.
Weight gain.
Breast tenderness.
Nausea.
Hair loss.

Contraindications:
Hypertension.
Cardiovascular disease.
Breast cancer.

2) Combined injectable:

DMPA 25 mg + Estradiol Cypionate 5mg (Cyclofem)- Monthly.

NET – EN 50 mg + Estradiol Valerate 5mg (Mesigyana)- Monthly.

Combined injectables usually contain estrogen and progesterone, which are usually taken every month, which can be plus or minus 3 days.

4.Functions of PHC – PHC ના કાર્યો

Functions of Primary Health Center:

To provide health services in rural areas, Primary Health Center (PHC) was established by the Bhor Committee. In plain areas, a PHC is established for a population of 30,000, while in hilly, tribal, and backwater areas, a PHC is established for a population of 20,000, which provides health care services to the people of the community.

The functions of Primary Health Center (PHC) are as follows:

1) Medical Care

2) MCH Services Including Family Planning.

3) Safe Water Supply and Basic Sanitation.

4) Prevention and Control of Locally Endemic Diseases

5) Collection and Reporting of Vital Statistics.

6) Education about health.

7) National Health Program Establishment and Awareness

8) Referral Services

9) Training of Health Guide, Health Worker, Local Midwife and Health Assistant.

10) Basic Laboratory Services.

Description:

•>1) Medical Care:

Primary Health Center provides basic medical care to treat acute and chronic health conditions. It also provides outpatient services through diagnosis, treatment and treatment for minor illnesses and injuries.

PHC medical care is essential to meet the immediate health needs of the community.

In medical care, patients are provided with tablets, injections, dressings, and other treatments according to their diseases, in addition to this, preventive, curative, and promotive care is provided.

2) MCH (Maternal and Child Health) Services Including Family Planning:

Comprehensive maternal and child health care is provided in the primary health center, which includes prenatal care,

antenatal checkup,

safe delivery services,

postnatal care,

and immunization for children is also provided.

To support family planning initiatives,

family planning,

counseling,

contraceptive,

and reproductive health services are provided.

This also includes RCH in maternal and child health, in which care is taken from the mother to the adolescent in reproductive child health.

This includes antenatal care, nutrition, hygiene, immunization, and laboratory examination of the mother, etc.

Regular checkups, observation, and education about family planning are provided in the post-natal period.

3) Safe Water Supply and Basic Sanitation:

Primary Health Center works to improve public health in the community by providing safe drinking water and sanitation facilities in the community.

Primary Health Centers promote hygienic practices, clean water sources, and education on sanitation to prevent water-borne diseases and improve the overall health of the community.

Steps are taken to maintain environmental cleanliness, in which people are educated on basic sanitation, excreta disposal, and cleanliness of kitchens and gardens.

In addition, there should be drinking water wells and taps for safe water supply, which should be chlorinated.

4) Prevention and Control of Locally Endemic Diseases:

Primary Health Centers play a crucial role in the prevention, surveillance, and control of locally endemic diseases.

Measures are taken to prevent diseases, including providing vaccination, providing treatment for endemic diseases, and monitoring the trends to prevent disease outbreaks.

5) Collection and Reporting of Vital Statistics:

Primary Health Centers work to collect and report vital statistics such as birth rate, death rate, and the incidence of any disease in a particular community. The data collected is essential for health planning, resource allocation, improvement of health outcomes and monitoring of health trends to prioritize health interventions.

6) Education about Health:

Primary Health Center provides education to individuals and communities about preventive health practices, nutrition, hygiene, sanitation and disease prevention strategies.

Primary Health Center organizes health education sessions, workshops and seminars to bring about improvement in health conditions.

7) National Health Program Establishment and Awareness:

Primary Health Centers implement the National Health Program and accompanying measures, the main aim of which is to,

target specific health issues, including immunization drives,

disease eradication efforts, nutrition supplementation, and health awareness campaigns.

They spread awareness about national health priorities and encourage community participation in health initiatives.

Every National Health Program has an important function. Services related to the National Health Program are provided in the clinic such as,

Anemia Control Program,

Malaria, Diarrhea, Leprosy, Immunization, TB Control Program, Supplementary Program. Referring the mother for additional services in abnormal conditions during labor, referring her to the Primary Health Center by the Female Health Worker, Auxiliary and Nurse Midwife or Medical Officer.

8) Referral Services:

When the patient needs any specialist medical treatment or needs to make any specific diagnosis and if its facilities are not available in the Primary Health Center, then the Primary Health Center also does the work of referring the patient.

Primary Health Center provides immediate referral services as per the needs of the patient, due to which the health condition of the patient can be improved and complications can be prevented.

9) Training of Health Guide Health Workers, Local Doctors, and Health Assistants.

Primary Health Center conducts training programs in which training is provided to community health workers, traditional birth attendants, health assistants, and other health care personnel to improve their skills and knowledge.

The main focus of this training is to promote health, prevent diseases, improve the skills of health care personnel in maternal and child health, and basic medical care.

10) Basic Laboratory Services:

Primary Health Center conducts basic laboratory services in which tests like diagnostic tests, blood tests, microscopic tests, urine tests etc. are done.

All these functions provided by Primary Health Center provide preventive, promotive, curative care to the community due to which the overall health condition of the people of the community can be improved and its well-being can be maintained.

5.Functions of WHO – WHO ના કાર્યો.

Functions of World Health Organization(WHO):

1) Prevention and control of specific diseases.

2) Development of comprehensive health services.

3) Family health.

4) Environmental health.

5) Health statistics.

6) Biomedical research.

7) Health literature and information.

8) Cooperation with other organizations.

1) Prevention and control of specific diseases:

WHO works to prevent and control specific diseases at the global level through initiatives such as vaccination campaigns, disease surveillance, and dissemination of best practices for disease management.

In which measures are taken to prevent communicable and non-communicable diseases.

Such as, providing proper immunization to prevent children from diseases.

2) Development of Comprehensive Health Services:

WHO promotes the development of comprehensive health services by providing technical guidance and support to countries to strengthen their health systems, ensure access to essential health services and promote global health coverage.

In this, measures to promote comprehensive health services in other nations and countries are taken by WHO.

3) Family Health:

WHO focuses on family health by advocating for maternal and child health, promoting family planning services, ensuring proper access to reproductive health services, and addressing issues related to adolescent health.

Family health has been a major program of the World Health Organization’s activities since 1970.

Family health is further subdivided into maternal and child health care,

human reproduction, nutrition, and health education.

The main focus of family health is usually to improve their quality of life.

4) Environmental Health:

WHO works to reduce environmental health problems by setting education and guidelines for air quality, water quality, sanitation and waste management.

It works to reduce environmental risks to human health and promotes sustainable development practices.

5) Health Statistics:

The World Health Organization provides assistance to countries in planning, operating and improving their medical records and national health information systems.

WHO collects, analyses and disseminates health-related data and statistics globally. This involves monitoring health trends, evaluating health inequalities, and providing evidence-based information for policy making and resource allocation.

6) Biomedical Research:

WHO promotes biomedical research by supporting biomedical research, encouraging collaboration between researchers and institutions globally, and facilitating the translation of research findings into public health policies and practices.

7) Health Literature and Information:

WHO produces health literature and information resources, including guidelines, reports, publications, and educational materials.

These resources are disseminated to government health care workers and the public to promote health literacy and informed decision-making.

8) Cooperation with Other Organizations:

The World Health Organization maintains working relationships with the United Nations and other specialist agencies.

The World Health Organization also establishes relationships with many international organizations.

Activities of the World Health Organization:

Eradication of malaria.

Control of tuberculosis and communicable diseases.

Reproductive and child health.

Health laboratory services.

Health statistics.

Medical rehabilitation.

Public health administration.

Quality Control of Drugs.

Health in Medical and Nursing Education.etc.

Q-5 Define following (Any Six) વ્યાખ્યા આપો (કોઇ પણ છ)6 × 2 = 12

1.Comprehensive Health care. કોમ્પ્રાહેન્સીવ હેલ્થ કેર

Comprehensive Health Care is a medical service structure in which holistic treatment is available to the patient for physical, mental and social benefits. This covers prevention, promotion, curative care, rehabilitation and palliative care. Comprehensive health care is a system of patient-centered, continuous and coordinated health services that should be universally available for all age groups and medical conditions.

2.Demography. ડેમોગ્રાફી

Demos means people
Graphine means the record.

Demography
The scientific study of human population and its elements i.e. size, composition and distribution is called demography. Demography is the scientific study of population.

Concept of Demography

Demography is a branch of science that studies human population and focuses on only three elements.

1) Any changes in the size of the population i.e. increase or decrease in size.

2) Structure of the population (basic of age and size).

3) Geographical distribution on the basis of state or region.

3.DOTS – ડોટ્સ

DOTS stands for Directly Observed Treatment Short Course, a strategy for tuberculosis management advocated by the World Health Organization (WHO). In this, patients take anti-tubercular drugs regularly and under supervision to maintain drug adherence and prevent the development of resistant strains. DOTS involves components such as patient registration, drug delivery, follow-up and treatment monitoring, which are very effective for tuberculosis control.

4.Fertility – ફર્ટીલીટી

જ્યારે ચિલ્ડ્રન ને કન્સીવ કરવા માટેની તથા તેને બિયરિંગ કરવા માટેની એબિલિટી હોય તો તેને ફર્ટિલિટી કહેવામાં આવે છે. ફર્ટીલિટી એટલે ઓફસ્પ્રિંગ ને પ્રોડ્યુસ કરવા માટેની નેચરલ કેપેસિટી ને ફર્ટિલિટી કહેવામાં આવે છે.

5.Vital Statistics – વાઇટલ સ્ટેટીસ્ટીક

Vital Statistics are statistical information that is related to the basic events of life such as birth, death, marriage, divorce and population change. These statistics are important for measuring the health status of a country, social development and the effectiveness of health services. Vital Statistics form the basis for policy making, planning and resource allocation in the field of public health. Vital Statistics are regularly compiled by health departments and government agencies so that health-related activities can be monitored and evaluated.

6.Target Couple – ટાર્ગેટ કપલ

Target couples are couples who have 2 to 3 live children and need to be highly motivated about family planning.

7.Planning – પ્લાનીન્ગ

Planning is a scientific and organized process for a health care system in which the path is determined to achieve health objectives through the appropriate use of health resources, manpower, finance and infrastructure. Planning involves data collection, analysis, target setting, strategy development and implementation framework. Effective planning helps in reducing the incidence and prevalence of health problems and improving the accessibility and quality of patient care.

8.Disability – ડીસએબીલીટી

Disability is a long-term impairment in a person’s intellectual, physical, mental or sensory abilities that interferes with their ability to effectively carry out their daily routines. According to the World Health Organization, disability is a complex condition that arises from the three-fold combination of impairment, activity limitation, and participation restriction. Disability is understood from medical, social and demographic perspectives and has a direct impact on a person’s quality of life.

Q-6(A) Fill in the blanks. ખાલી જગ્યાઓ પૂરો. 05

1.ICDS stands for…… ICDS નું આખુ નામ…… Integrated Child Development Services(ઈન્ટિગ્રેટેડ ચાઇલ્ડ ડેવલપમેન્ટ સર્વિસિસ)

2…….is the scientific study of the human population…….ને હ્યુમન પોપ્યુલેશન ની સાઈન્ટિફીક સ્ટડી કહેવામાં આવે છે. Demography(ડેમોગ્રાફી)

3.Nyay Panchayat consists of…… members from panchayat. ન્યાયપંચાયતમા પંચાયતના……સભ્યોનો સમાવેશ થાય છે. 5 members(5 સભ્યો)

4.NRHM & NUHM are managed by ministry For…..NRHM અને NUHM એ……મીનીસ્ટ્રી દ્વારા મેનેજ થાય છે. Ministry of Health and Family Welfare (મીનીસ્ટ્રી ઑફ હેલ્થ એન્ડ ફેમિલી વેલફેર)

5.Three tire structure of local self-government in India is know as….. લોકલ સેલ્ફ ગવર્નમેન્ટમાં થ્રી ટાયર સ્ટ્રકચરને ભારતમાં બીજા કયા નામે ઓળખવામાં આવે છે……Panchayati Raj (પંચાયતી રાજ)

B) Write Multiple Choice Questions.નીચેના માથી સાચો જવાબ લખો 05

1.Which are the following is called “Health Survey & Planning Committee”? નીચેનામાંથી કઈ “હેલ્થ સર્વે અને પ્લાનીંગ કમીટી” કહેવાય છે?

a. Bhore committee (1946)

b. Mudaliar comquittoc (1962)

c. Chadha committc (1966)

d. Jain committee (1966-67)

2.National Goitre control programme was launched in…… નેશનલ ગોઈટર કંટ્રોલ પ્રોામ આ વર્ષે શરૂ કરવામાં આવ્યો.

a. 1952

b. 1957

c. 1962

d. 1967

3.Which of the following is not a preventive step of diarcheal diseases?
નીચેના માંથી કર્યું પગલું ઝાડા ના અટકાવ માટે નથી.

a. Sanitation

b. ORT

C. Health education

d. Immunization

4.Data regarding birth, death and marriages are called……જન્મ, મરણ અને લગ્નના ડેટા ને કહેવાય છે.

a. Statistics

b. bio statistics

c. Health statistics

d. vital statistics

5.Whooping cough is caused by…… વુપિંગ કફ આના કારણે થાય છે.

a. Varicella zoster

b. Paramyxo virus

c. Bordetella Pertussis

d. Enterovirus

(C) Match the following, જોડકા જોડો.

A B

1)PHC – પી.એચ.સી. 1) Diarrhea – ડાયેરીયા

2) International women’s day 2) 7th April – 7 એપ્રિલ ઇન્ટરનેશનલ વુમનશ દિવસ

3) ORS – ઓ.આર.એસ 3) Covers 30,000 population – 30,000 ની વસ્તી આવરી લે છે.

4) CHC – સી એચ સી 4) 8 th March – 8 માર્ચ

5) WHO day – ડબ્લુ. એચ. ઓ ડે 5) Covers 1.2 lakh population – ૧.૨ લાખ વસ્તી આવરી લે છે.

6) Fever – તાવ

(C) Correct answer

A	Correct answer
1) PHC – પી.એચ.સી.	3) Covers 30,000 population – 30,000 ની વસ્તી આવરી લે છે
2) International Women’s Day – ઈન્ટરનેશનલ વુમનશ દિવસ	4) 8th March – 8 માર્ચ
3) ORS – ઓ.આર.એસ	1) Diarrhea – ડાયેરીયા
4) CHC – સી.એચ.સી.	5) Covers 1.2 lakh population – ૧.૨ લાખ વસ્તી આવરી લે છે
5) WHO Day – ડબ્લ્યુ.એચ.ઓ. ડે	2) 7th April – 7 એપ્રિલ

PHC covers ~30,000 population in plain areas.

CHC (Community Health Centre) covers ~1.2 lakh population.

ORS (Oral Rehydration Solution) is used to manage diarrhea.

International Women’s Day is celebrated on March 8.

WHO Day is observed globally on April 7.