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ESSENTIALS OF COMMUNITY MEDICINE: A PRATICAL APPROACH (pb)2006
Author: DA. HIREMATH
ISBN: 8180613445
Year: 2006
Publisher: JAYPEE BROTHERS MEDICAL PUBLISHERS PVT LTD.
Category: COMMUNITY MEDICINE
Edition: 1
Format: Paperback
Language: English
Pages: 337
 ABOUT THE TITLE
Book written in a format which has simple, short & accurate answers as asked in practicals & viva-voice,serves as a ready reference material for the students, useful for a quick preview for a last minute review exam,meant for bds, mbbs & md students.
Untitled Document
 TABLE OF CONTENTS
1. Present Health Status 1-6
• Disease Burden 1
• Reasons for High Disease Burden 1
• Communicable Diseases 2
• Chronic Noncommunicable Diseases and Conditions 2
?? Nutritional Deficiencies 2
• Maternal and Child Health 3
?? Burden of Occupational Diseases and Injuries 3
?? Clinical Diagnosis and Community Diagnosis 5
• Notifiable Diseases 5
2. Family 7-9
• Family 7
?? Definition 7
?? Types of Family 7
?? Special Objectives 8
?? Method of Study 8
?? Family—A Dynamic Unit 8
• General Information for Students 9
3. Economics 10-15
• Poverty Line 10
• Per Capita Income 10
• Overcrowding 10
?? Accepted Standards 11
?? Sex Separation 11
?? Housing 11
?? Social Classification 11
4. Communicable Diseases 16-75
• Communicable Disease 16
?? Definition 16
• Tuberculosis 18
?? Sites Affected 18
?? Economic Burden of Tuberculosis 18
?? Epidemiological Indices 19
?? Communicability 19
?? Case Finding 20
?? Chemoprophylaxis 21
?? Treatment 21
?? Important Definitions 23
• Pediatric Tuberculosis 25
?? Pediatrics DOTS 25
?? Directly Observed Therapy Short-course (DOTS) 27
?? Structure of the RNTCP 28
?? Reasons for Dropout of the Treatment 29
?? National TB Control Program 29
?? Objectives of NTCP (1962) 30
?? Disinfection of Sputum 30
?? DOTS-Plus Strategy 30
?? Green Light Committee Initiative 32
?? HIV Infection and Risk of Tuberculosis 32
• Leprosy 33
?? History 33
?? Burden of Leprosy 33
?? Essential Indicators for Leprosy 34
?? Epidemiology 35
?? Lepromatous Leprosy 37
?? Diagnosis 38
?? Bacteriological Examination 40
?? Treatment of Reversal Reaction 44
?? Treatment of ENL Reaction 46
?? Completion of Treatment and Cure 46
• Leprosy Control 47
?? Leprosy Control Programs 47
?? Health Education 48
?? Rehabilitation 49
?? Leprosy Organizations in India 49
?? National Leprosy Eradication Program (NLEP) 50
?? Modified Leprosy Elimination Campaigns 50
?? Special Action Projects for the Elimination of Leprosy 51
?? Global Leprosy Elimination Program 51
• Filariasis 52
?? Burden of Disease 52
?? Epidemiology 52
?? Clinical Manifestations 53
?? Control Measures 53
?? National Filaria Control Program 54
• Diarrhea and Dysentery 54
?? Definition 54
?? Dysentery 55
?? Problem of Diarrheal Disease 55
• Cholera 56
?? Epidemiology 56
?? Disinfection 62
?? Diarrheal Diseases Control Program 63
• Scabies 66
?? Epidemiology 66
?? Clinical Features 67
?? Complications 67
?? Variants 68
?? Control of Scabies 68
• Sexually Transmitted Diseases 68
?? What are Sexually Transmitted Diseases? 68
?? Why is STD Control an Important Component of HIV/AIDS Prevention? 68
?? What are the Symptoms of STDs? 69
?? How can One Protect Oneself from STDs? 69
?? How can Reinfection of STDs be prevented? 69
?? What are the Approaches to STD Management? 70
?? What is the Syndrome Approach? 70
?? The Steps Involved in Adopting a Syndromic Approach 71
?? Syndromic Case Management necessitates Clinical Examination of the Patient 71
?? Syndromic Case Management 72
?? Advantages of the Syndromic Case Management 72
?? Treatment for the Most Common STD Associated Syndromes 73
?? National STD Control Program 74
5. Noncommunicable Diseases 76-100
• Coronary Heart Disease 76
?? Definition 76
?? Measurement the Burden of Disease 77
?? Epidemiology 77
?? Risk Factors for CHD 77
?? Medical Treatment 78
?? Prevention and Control 79
?? Population Strategy 79
• Hypertension 80
?? Prevalence 80
?? Risk Stratification 80
?? Pharmacologic Treatment Initiation 81
• Obesity 82
?? Prevalence 82
?? Assessment of Obesity 83
?? Clinical Features of Obesity 85
?? Complications 85
?? Treatment 85
?? Prevention and Control 86
• Rheumatic Heart Disease 86
?? Prevalence 87
?? Clinical Features 87
?? Diagnosis 87
?? Prevention and Control 88
• Mental Health 88
?? Prevalence 88
?? Classification 89
?? Etiology 89
?? Organic Conditions 89
?? Social Pathological Causes 90
?? Environmental Factors 90
?? Warning Signals of Poor Mental Health 90
?? Prevention and Control 90
?? National Mental Health Program 91
?? Aims 91
?? Objectives 91
?? Strategies 91
• Diabetes Mellitus 92
?? Latent Diabetic 92
?? Black Zone 92
?? Clinical Classification of Diabetes Mellitus as Adopted by WHO 92
?? Epidemiology 93
?? Environmental Factors 93
?? Social Factors 93
?? Clinical Features 93
?? Complications 93
?? Investigations 94
?? Prevention and Care 94
?? National Diabetes Control Program 95
?? Objectives 95
• Cancer 96
?? Prevalence 96
• Causes of Cancer 98
?? Environment 98
?? Genetic 98
?? Primary Prevention 98
?? Health Education Regarding “Danger Signals” 99
?? Secondary Prevention 99
?? Treatment for Cancer 99
• National Cancer Control Program (NCCP) 99
?? Basic Steps 99
?? Goals of NCCP 99
?? District Cancer Control Program 99
?? Carcinoma of Breast 99
?? Carcinoma of Lung 100
6. Maternity and Child Health 101-133
?? In Developing Countries 101
?? Causes of Maternal Death 101
?? Conceptual Framework of Safe Motherhood 102
?? Risk Approach 102
• Reproductive and Child Health Program 103
?? Definition of RCH 103
• Major Elements of RCH Program 104
?? Reproductive Health Elements 104
?? Child Survival Elements 104
?? State Committee on Voluntary Action 105
?? Contents of Kits Supplied to Subcenter and First Referral Unit (FRU) 105
?? Under RCH Program 106
?? Methods to Estimate Requirements for MCH Services 107
• Antenatal Care 107
?? Objectives of Antenatal Visit 107
?? Specific Protection 108
• Maternal and Child Health 108
?? RCH-II and Family Planning 108
?? Program Implementation Plan (PIP) 109
?? Janani Suraksha Yojana 109
?? Mamta Scheme—An Example of Public Private Partnership in Health Care 111
?? Health Care Services for the Beneficiaries under the Scheme 112
?? Eligibility Criteria for Beneficiaries under the Scheme 112
?? Registration of Beneficiaries under the Scheme 112
?? Prevention of Patient to Child Transmission (PPTCT) 112
?? Role of Maternal and Child Health Services in the Prevention of HIV Infection in Infants and Young Children Program. 113
?? Integration of PPTCT within Postnatal MCH Services 114
?? Key Points 114
?? Infant Feeding Formula 115
• Intranatal Care 116
?? Care at Birth 116
• Postnatal Care 116
?? Objectives of Postnatal Care 116
?? Warm Chain 117
?? High-Risk Infants 117
• Malnutrition 117
?? Definition 117
?? Classification 117
?? Nutritional Problems 118
?? Epidemiology 118
• Protein-Energy Malnutrition 119
?? Definition 119
?? Types of PEM 119
?? Clinical Features 119
?? Clinical Features 120
?? Signs 120
?? Classification of PEM 120
?? Epidemiology of Malnutrition 122
?? Examination of the Case 124
?? Weighing Procedure 124
?? Height or Length 126
?? Midarm Circumference 128
?? Head and Chest Circumference 129
?? General Procedures for Treatment of Severe PEM 129
?? Calculation of Expected Weight of the Child 131
?? Calculation of Expected Height of the Child 132
?? Surface Area According to Weight 132
?? Calculation of Pediatrics Doses 132
• Breastfeeding 132
?? A to Z Benefits for Baby 132
?? Advantages to Mother 132
7. Reproductive and Child Health 134-154
?? Qualities of Good Contraceptives 134
?? Methods of Family Planning 136
?? Emerging Oral Contraception 142
?? Give Specific Instructions 143
?? Important 144
?? Give Advice on Common Problems 144
?? Explain Specific Reasons to Return to the Health Care Provider 144
?? Introduction to Injectable Contraceptives 145
?? Mechanism of Action 145
?? Advantages and Disadvantages of Injectable Contraceptives 145
• Subcutaneous DMPA and Home Injection 147
?? Centchroman 147
?? Family Planning Insurance Scheme 148
?? Medical Methods of Abortion 149
?? Mifepristone and Misoprostol 149
?? Future Fertility 150
• Manual Vacuum Aspiration (MVA) 150
?? Methods of Uterine Evacuation 150
• Calculation of the Effective Couple Protection Rate (ECPR) 152
?? Effective Protection 152
?? Pearl Index 153
?? Important Facts about Contraceptives 153
8. Immunization 155-187
• National Immunization Schedule 155
?? Immunization of Pregnant Woman 155
?? Determine Needs and Requirement 156
?? Difference between EPI and UIP 157
?? National Immunization Schedule 157
?? Estimation of Requirements of Syringes and Needles 158
?? Estimation of Requirements of Sterilization Equipment 159
?? Estimation of Vaccine Needs 159
?? Estimation of Cold Chain Requirements 160
?? Determine Training Needs 161
?? Estimation of Requirements of Immunization Cards 162
?? Estimation of Vaccine Requirements 162
?? Maintain Vaccines 164
?? Maintain Equipment 165
?? Vaccine 166
?? Oral Polio 168
?? National Immunization Schedule 168
?? Development of Immunity 168
?? Strategies for Polio Eradication 170
?? Current Four Basic Strategies to Eradicate Polio 170
?? National Immunization Days 171
?? Intensive Pulse Polio Immunization (IPPI) 175
?? Vaccine Vial Monitoring 176
?? Measles Vaccine 176
?? Adverse Effects of Vaccine 177
?? Combined Vaccine 178
?? Urban Measles Campaign 178
?? Diphtheria Immunization 178
?? Composition of DPT Vaccines 179
?? Tetanus Toxoid 180
?? Active and Passive Immunization 182
?? Elimination of Neonatal Tetanus 182
?? Anti-Rabies Vaccine 182
?? Anti-Snake Venom 184
?? Newer Vaccines 185
9. Nutrition 188-214
?? Dietetics 188
?? Balanced Diet 188
?? Assessment of Nutritional Status 190
?? Assessment of the Energy Requirement for Family 191
?? Cereals and Millets 191
?? Pulses (Legumes) 192
?? Fruits 194
?? Nuts and Oil Seeds 195
?? Nutrient Requirements during Pregnancy 196
?? Rich Sources of Essential Nutrients 199
?? Protein Requirements 200
?? Principles in Calculating Balanced Diet 200
• Balanced Diets 200
?? Balanced Diet for Children 201
?? Average Weight of Vegetables 204
xx Essentials of Community Medicine—A Practical Approach
?? Approximate Weight of Foods Equal to 1 Level Katori (Bowl) of
150 ml Volume 205
?? Average Weight of Nuts and Spices 205
10. Medical Entomology and Worm Infestations 215-227
• Arthropods 215
?? Arthropods of Medical Importance 215
?? Mosquito 217
?? Mosquito-borne Diseases 217
?? Mosquito Control Measures 220
?? Ticks 220
?? Houseflies 221
• Public Health Importance of Worm Infestation 224
?? Ascariasis 224
?? Enterobius vermicularis 225
?? Trichuris trichiura 225
11. Disinfection 228-233
• Definitions (Disinfectant or Germicide) 228
?? Disinfectant 228
?? Antiseptic 228
?? Deodorant 228
?? Detergent 228
?? Sterilization 228
?? Disinfection 228
?? Types of Disinfection 229
?? Disinfecting Agents 229
?? Natural Agents 230
?? Physical Agents 230
?? Chemical Disinfectants 231
12. Insecticides and Rodenticides 234-237
• Insecticides and Pesticides 234
?? Classification 235
?? DDT (Dichloro-diphenyl-trichloroethane) 235
?? HCH (BHC) Hexachlorocyclohexane 236
?? Malathion 236
?? Mineral Oil 236
?? Paris Green (Copper aceto-arsenite) 237
13. Environmental Models 238-245
• Chloroscope/Chlorinometer 238
?? Procedure 238
• Dry and Wet Bulb Thermometer (Hygrometer) 238
?? Procedure 239
• Maximum and Minimum Thermometer 239
?? Procedure 239
• Kata Thermometer 240
?? Used for Measuring 240
?? Procedure 240
• Globe Thermometer 240
?? Procedure 240
?? Sling Psychrometer 241
?? Procedure 241
?? Gully Trap 242
• Soak Pit 242
• Slow Sand Filter 244
?? Rapid Sand Filter 245
14. Water Analysis 246-252
• Determination of Total Hardness 246
?? Theory 246
?? Procedure 246
• Bacteriology of Water 247
?? Bacteriological Examination of Water 247
• Steps in Well Disinfection 250
?? Find the Volume of Water in a Well 250
?? Find the Amount of Bleaching Powder Required for Disinfection 250
?? Procedure 251
?? Dissolve Bleaching Powder in Water 251
?? Delivery of Chlorine Solution into the Well 251
?? Contact Period 251
?? Orthotolidine Arsenite Test 252
15. Bacteriology of Milk 253-254
• Bacteria in Milk 253
?? Types of Bacteria in Milk 253
?? Bacteriological Examination 253
Staining, Culture Media and Microscopy of Slides of Public Health Importance
• Gram Stain 255
?? Aim 255
?? Requirement 255
?? Procedure 255
?? Result 255
• Ziehl-Neelsen Stain 256
?? Aim 256
?? Procedure 256
?? Result 256
• Albert Stain 256
?? Aim 256
?? Requirement 256
?? Procedure 257
?? Result 257
16. 255-263
• Culture Media 257
?? Types of Media 257
• Microscopic Slides 258
?? Mycobacterium tuberculosis 259
?? Mycobacterium leprae 259
?? Treponema pallidum 259
?? Neisseria meningitidis 260
?? Corynebacterium diphtheriae 261
?? Neisseria gonorrhoeae 261
?? Clostridium tetani 261
?? Leptospira 262
17. Hospital Waste Management 264-279
?? Type of Hospital Waste 265
?? Hazards and Risks from Hospital Waste Exposure 266
• Hospital Waste Disposal 266
?? Categories of Biomedical Waste 267
?? Objectives of Plan 268
• Planning and Organization 268
?? Organization 269
?? Staff Appraisal on Hospital Waste Management 269
?? Waste Disposal Strategy 270
• Incinerators 272
?? Site for Incinerator 272
?? Standards for Incinerators 272
?? Inertization 276
?? Legislative Framework 276
?? Summary of Biomedical Waste Rules 276
?? What You should Know and Do 277
18. National Rural Health Mission (2005-2012) 280-296
• Goals 281
• Strategies 281
?? Core Strategies 281
?? Supplementary Strategies 282
• Plan of Action 282
?? Component (A): Accredited Social Health Activists 282
?? Component (B): Strengthening Sub-Centers 283
?? Component (C): Strengthening Primary Health Centers 283
?? Component (D): Strengthening CHCs for First Referral Care 284
?? Component (E): District Health Plan 284
?? Component (F): Converging Sanitation and Hygiene under NRHM 284
?? Component (G): Strengthening Disease Control Programs 285
?? Component (H): Public-Private Partnership for Public Health Goals, including Regulation of Private Sector 285
?? Component (I): New Health Financing Mechanisms 285
?? Component (J): Reorienting Health/Medical Education to support Rural Health Issues 286
• Institutional Mechanisms 286
• Technical Support 287
?? Program Management Support Center 287
?? Health Trust of India 287
• Role of State Governments Under NRHM 288
• Focus on the North-Eastern States 288
• Role of Panchayati Raj Institutions 288
• Role of NGOs in the Mission 289
• Mainstreaming Ayush 289
• Funding Arrangements 289
• Timelines (for Major Components) 290
• Outcomes 290
• National Level 290
?? Community Level 291
• Monitoring and Evaluation 291
?? Is NRHM a New Program of the Government of India? 292
?? What is the Institutional Setup at National, State and District Levels? 292
• National Urban Health Mission 292
?? Goal 293
?? Core Strategies 293
?? Components of Urban Health Mission (UHM) 293
?? Targets 294
?? Urban Health Delivery Model 294
?? At Community Level (Urban Social Health Activist, USHA) 294
?? Essential Service to be Rendered by the USHA 294
?? Primary Urban Health Center 295
19. Sanitation of Camps 297-301
• Camp Site 297
• Accommodation and Equipment 298
?? Water 298
• Food and Cooking Arrangements 298
• Disposal of Refuse and Excreta 299
?? Dry Camp and Kitchen Refuse 299
?? Liquid Waste 299
?? Disposal of Feces 300
• Disposal of Stable Litter 301
20. Indian Systems of Medicine 302-307
• Ayurveda System of Medicine 302
• Siddha System of Medicine 303
?? Introduction and Origin 303
?? Basic Concepts 303
?? Diagnosis and Treatment 303
• Unani System of Medicine 304
?? Origin and Development 304
?? Fundamental Principles 304
• Diagnosis and Treatment 304
• Homeopathy 305
• Yoga 306
• Naturopathy 307
• Allopathy 307
?? Methods 307
21. Adolescent Health 308-315
?? Population Profile: Ages 10 to 24 Years in India 308
?? Characteristics 308
• Physical Changes during Adolescent 309
• Puberty Changes in Adolescent 310
?? Puberty in Girls 310
?? Psychological and Behavioral Changes 310
?? Impact of Adolescence 310
?? Adolescent Health Problems 311
• Emotional Problems 311
• Educational Problems 311
?? Reasons for Adolescent Reluctant to seek Help 312
?? Prevention 312
?? Syllabus for Adolescent Health Education 312
?? Life Skills 312
?? Adolescent Friendly Health Center Services 313
?? Criteria for Adolescent Friendly Health Worker 313
?? Criteria for Adolescent Friendly Health Center 313
?? Adolescent Girls Scheme 314
• Beneficiaries 314
?? Scheme I: Girl-to-Girl Approach 314
?? Scheme II: Balika Mandal 314
?? Interventions 315
?? Training 315
22. Integrated Disease Surveillance Project 2004-2009 316-334
• Project Objectives 316
• Specific Objectives 316
• Phasing of IDSP Covering the States of India 316
?? Project Activities 317
• Sentinal Surveillance under IDSP 317
• Regular Periodic Survey 317
• National Surveillance Unit 318
• State Surveillance Unit 318
• District Level Unit 318
• District Surveillance Unit 318
?? Functions of the District Surveillance Unit 318
• District Epidemiological Cell 320
• Levels of Response to Different Triggers 321
?? Malaria Triggers 322
?? Cholera Triggers 322
?? Typhoid Fever Triggers 322
Polio Trigger 322
Plague Triggers 323
Japanese Encephalitis Triggers 323
Dengue Triggers 323
Triggers for Syndromic Surveillance 323
• Surveillance of Noncommunicable Diseases 332
?? Aims 332
?? NCD Risk Factors 332
?? Program for Control and Treatment of Occupational Diseases 332
?? List 332
?? Etiological Classification of Occupational Disorders 332
?? Proposed Projects for Occupational Diseases under National Program for Control and Treatment of Occupational Diseases 333
?? Global Strategy of Occupational Health 333
?? Monitoring and Evaluation 334
23. Integrated Management of Neonatal and Childhood Illnesses 335-338
• Components of IMNCI in India 335
• IMNCI Strategy in India 335
?? Timeline of IMNCI 337
?? The IMNCI-PLUS 338
24. Community-Based Rehabilitation 339-345
• Hard Facts 339
• Need of Rehabilitation Service 340
?? Seven National Levels Institutes 340
?? Government Rehabilitation Services 340
?? Objectives 340
?? District Rehabilitation Center (DRC) Project 340
?? Regional Rehabilitation Training Center (RRTC) 341
?? National Information Center on Disability and Rehabilitation (NICDR) 341
?? Role of Primary Health Centers for Disability Rehabilitation 342
?? Model Method of Implementation of CBR Using Primary Health Centers 343
?? Orientation of Medical Officers Working in Primary Health Centers to Disability Management 344
?? Expected Benefits of the Program 345
25. Social Security 346-349
• Workforce in India 346
?? Organized and Unorganized Sectors 346
• Functions of Social Security Division 347
?? List of Subjects 347
?? New Initiative in Social Security 349
26. Swine Flu 350-352
• Transmission 350
• Signs and Symptoms 351
?? Cause of Death 351
?? Facility Management 351
?? Herd Management 351
27. Hospital Statistics 353-355
• Daily Analysis 353
• Monthly Reports 353
• Census 353
• Death Rate 353
28. Biostatistics 356-377
?? Definitions of Statistics 356
?? Use of Biostatistics 357
• Collection and Presentation of Data 357
?? Frequency Table 358
• Graphical Representation of Data 358
?? Graphs 358
?? Bar Diagram 358
?? Histogram 359
?? Frequency Polygon 360
?? Pie Diagram 360
?? The Ogive 360
• Centering Constants (Measures of Central Tendency) 361
?? Arithmetic Mean 361
?? Median 362
?? Mode 362
• Measures of Variation 362
?? Range 362
?? Mean Deviation (MD) 363
?? Standard Deviation (SD) 363
?? Coefficient of Variation (CV) 363
?? Quartile Deviation (QD) 363
?? Percentile 364
?? Tests of Statistical Comparison of Two Groups 364
?? Test of Significance (for Large Size) 364
?? Test of Significance (for Small Sample Size) 366
?? t-tests for Unpaired Data 366
?? t-tests for Paired Data 367
?? Steps for Paired t-test 367
?? Standard Error of Proportion (Large Sample Size) 367
?? Standard Error of Difference between Two Proportions (Large Sample) 368
?? Probability of a Larger Value of ‘t’ 369
?? Normal Distribution 370
?? Table of the Unit Normal Distribution 371
?? Chi-square Test (?2-Test) 372
?? Table of Chi-square 372
?? Formula 373
?? Fallacies in Biostatistics 373
?? Vital Statistics 374
?? Geometrical Progression Method 374
?? Measures of Vital Statistics 374
• International Death Certificate—Cause of Death 377
29. Problems 378-407
• Environmental Problems 378
?? Problems 378
• Biostatistics 381
?? Limitations of the Mean 384
• Correlation and Regression 387
?? Problems 389
• Demography 392
• Epidemiological and Nutritional Exercises 399
?? Miscellaneous Problems 404
30. Visits 408-434
• Integrated Counseling and Testing Center (ICTC) 408
• Visit to Blind School 409
?? Admission Criteria 409
?? Government Authority 409
?? National and International Agencies 410
• A Visit to Deaf and Dumb School 410
?? Staffing Pattern 411
?? Rules and Regulations 411
• Visit to District Health Laboratory 411
?? Staffing Pattern 411
?? Functions 411
• Visit to Primary Health Center (PHC) 412
?? Functions of the PHC 412
?? Staffing Pattern 412
• Postpartum Center 413
?? Functions of Postpartum Unit 414
?? Department of Obstetrics and Gynecology 415
?? Monitoring and Evaluation Aspects 415
?? Broad Functions 416
• Delivery of Integrated Services for Maternal and Child Health, Family Planning, Nutrition and Immunization 416
• The Baby Friendly Hospital Initiative 417
?? What is BFHI? 417
?? Why this Program? 417
?? What is New About it? 417
?? What is this Program All About? Can it be Simply Described in a Few Words? 418
?? What are the Benefits of Making My Hospital Baby Friendly? 418
?? What are the Investments Needed and What is the Cost Involved? 419
?? What should I do to get My Hospital Recognized as Baby Friendly Hospital? 419
• World Breastfeeding Week 419
?? What are Our Problems? 419
• Anganwadi 421
• Integrated Child Development Scheme 421
?? Objectives 422
?? Organizational Set-up 422
• Visit to District Tuberculosis Center 425
?? National Tuberculosis Program (NTP) 425
• Visit to District Rehabilitation Center 426
?? Services Provided 426
?? National Program for Rehabilitation of Persons with Disabilities 427
• Visit to Places of Natural Calamities 427
?? Disasters 427
• School Health Service 430
?? Benefits of School Health Programs 430
?? Objectives of School Health Service 431
?? School Health Program in India 431
?? Aspects of School Health Service 431
• Visit to District Leprosy Center 432
?? District Infrastructure 432
?? Goal of National Health Policy 2002—Elimination of Leprosy by 2005 433
Appendix 435
Index 447
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