BASIC CONCEPTS

HEALTH

Health is a state of complete physical, mental and social well-being

and not merely an absence of disease

WHO

 Illness
Disease
Sickness

Illness
A persons personal experience of a physical or psychological
disturbance.
Disease
An adverse physical state consisting of a physiological/ psychological
dysfunction usually diagnosed by a qualified professional.
Sickness
A social state signifying an impaired social role for those who are ill.
A state of social dysfunction.

Types of Diseases
Hereditary
Traumatic
Infective
Neoplastic
Nutritional
Metabolic
Degenerative
Allergic
Auto-immune

Disease Control / Prevention

Disease Control:
Reduction/ Containment
Elimination
Eradication

Disease Prevention:
Primary
Protection
Promotion

Secondary:
Early Diagnosis
Treatment
Tertiary:

Rehabilitation
Limiting Disability

HEALTH INDICATORS
Mortality
Morbidity
Nutritional status
Mental health
Disability
Service delivery & Utilization
Socio-economic status
Quality of life

Mortality Indicators
Crude Death Rate
Maternal Mortality ratio
Infant Mortality Rate
Child Mortality Rate
Under 5 Mortality rate
Neonatal Mortality rate
Post neo-natal Mortality rate
Perinatal Mortality rate

Crude Death Rate

Number of deaths (from all causes) per 1000 estimated midyear population in one year, in a given place.

Number of deaths during the year x 1000

Mid-year population

Maternal Mortality Ratio

Death of a women while pregnant or within 42 days of

termination of pregnancy, irrespective of the duration and site
of pregnancy, from any cause related to or aggravated by the
pregnancy or its management but not from accidental or
incidental causes.
Number of female deaths due to complications
of pregnancy & childbirth and within 42 days
after delivery from puerperal causes in an area
x 1,00,000
in a given year
_
Total live births in the same year

Neonatal Mortality rate

Deaths occurring during the neonatal period, i.e, commencing at birth
(Day 0) and ending 28 completed days after birth (Day 27).

No of children < 28 days of age died in a year

No of live births in the same year

x 1000

Post neo-natal Mortality rate

Deaths occurring from 28th day of life to under 1 year.

No of children 28-364 days of age died in a year x 1000

No of live births in the same year

IMR = NMR + PNMR

Perinatal Mortality rate

Includes
Late fetal deaths (28 weeks gestation and more)
Early neonatal deaths

Late fetal deaths + Early neonatal deaths in a year x 1000

No of live births in the same year

Infant Mortality Rate

Number of infant deaths registered in a given year per 1000 of live births
in the same year.

No. of children less than 1 yr age died in a year x 1000

Number of live births in the same year

Child Mortality Rate

Number of deaths at ages of 1-4 years in a given year, per 1000 children
in that age group at mid-point of the year concerned.

No of children 1-4 yrs of age died in a year x 1000

No of children in same age-group at mid-year

Under 5 Mortality rate

Number of deaths at ages of 0-5 years in a given year, per 1000 children in
that age group at the mid-point of the year concerned.

No of children 0-5 years of age died in a year

No of children in same age-group at mid-year

x 1000

Morbidity Indicators

Incidence
Prevalence

Incidence Rate of a disease

Number of new cases occurring in a defined population
during a specified period of time.

No of new cases of a specific disease

during a given time period
Population at risk during that period

x 100

Prevalence Rate
Point Prevalence: All current cases (new and old) existing
at a given point of time
Period Prevalence: All current cases existing over a period
of time.
No of all current cases of a specific disease
existing at a given point of time______
Estimated population at a given point of time

x 100

Prevalence depends on 2 factors:

Incidence
Duration of illness

Assuming that incidence & duration of illness are not changing in a

stable population:
PIxD
Longer the duration of disease, greater its prevalence

Nutritional Status Indicators

Nutritional status of women and children indicates a good standard
of assessment of aggregate health.

May be assessed by anthropometric measurements:

Weight
Height
Body Mass Index
Hemoglobin test

Social & Mental Health Indicators

Suicide
Homicide
Acts of violence: DV, Civil unrest
Female feticide
Child labour
Alcohol & Drug Abuse
Others

 Female Feticide: Selectively abortion of female foetus after

pre- natal sex determination, thus avoiding the birth of girls
Child Labour:
Age 5-11: 1 hr of economic work or 28 hrs of domestic work /
week.
Age 12-14: 14hrs of economic work or 28hrs of domestic
work / week.

Age 15-17: 43 hrs of economic and domestic work/ week.

 Domestic Violence: Acts of violence or abuse against a

person living in one's household, esp. a member of one's
immediate family.
Civil Unrest:
Illegal Parades
Sit-ins
Forms of obstructions
Riots
Sabotage

Determinants of Health
Poverty
Education
Physical Environment
Employment
Gender
Social Support
Culture
Personal behavior
Urbanization

SOCIAL ENVIRONMENT
Education, Occupation,
Income, Relationships,
Urbanization, Culture, etc

PHYSICAL ENVIRONMENT
Geography, Climate, Food,
Housing, Water, etc
PERSONAL TRAITS
Age, Sex, Immunity,
Genetic Background,
habits, etc.

HEALTH
(Physical, Mental and Social)

HEALTH SERVICES
Health Promotion, Disease
Prevention, Treatment,
Rehabilitation

Millennium Development Goals - UNDP

for 2015
1 Eradicate extreme poverty and hunger
2 Achieve universal primary education
3 Promote gender equality and empower women
4 Reduce child mortality
5 Improve maternal health
6 Combat HIV/AIDS, malaria and other diseases
7 Ensure environmental sustainability
8 Develop a global partnership for development

India
IMR: 41 (SRS 2013)
MMR: 190 (SRS 2010-12)
TFR: 2.5 (SRS 2010)
Malnutrition among children: 40.4 % (NFHS III)

Anemia among women and girls: 55.3 % (NFHS III)

Sex Ratio: 940 (Census 2011)

HEALTH & DISEASE

 Impairment
Disability
Handicap

Disease Burden
Losses from Pre-mature death: Difference between actual age at
death and life expectancy at that age.
Loss of Healthy life resulting from disability.
DALY
Disability-adjusted Life years
DALY = YLL + YLD

YLL

Years of Lost life (due to mortality)

YLL = Expected life at that age in - Actual age
a low-mortality population
of death

Exercise
Suppose, average age of a person at the time of death from disease X
is 40
Suppose, average life expectancy at age 40 is 60.
Average YLL = ?
If 25 people died of disease X in a year, total YLL = ?

YLD
Years lost to disability (due to morbidity)
Suppose a person suffered from acute depression for a full year, during
which he failed to perform activities what he could do in a normal
period.
Suppose he was able to perform 25% of normal activities during this
period.
Hence, he lost 75 % (0.75 year) of his healthy life, as if he lived 3
months of disability free life and remained dead for rest 9 months.
Hence, 9 months is the loss of disability-adjusted life year.

YLD = I x D x S x P
I: Incidence Rate
D: Average Duration of disease
S: Degree of Severity of disease
P: Population

Severity Index
Disability Class

Degree of
Severity

Indicator

0.00 0.02

Vitiligo on face

0.02 0.12

Watery diarrhea, severe sore throat, severe anemia

0.12 0.24

RA, Angina

0.24 0.36

Below knee amputation, deafness

0.36 0.50

Mild mental retardness, down syndrome

0.50 0.70

Major depression, blindness

0.70 1.00

Active Psychosis, dementia, severe migraine

Exercise
Suppose the population of a town is 3,00,000.
There are always some TB patients among them.
Suppose1500 new TB cases are detected.
Assume that, on an average, a person suffers 9 months from
disease.
Now assume that the TB patients are 20% disabled during illness.
YLD = ?

Proportional Mortality (%)

Diabetes
2%

Other NCDs
10%

Respiratory
Diseases
11%
Cancers
6%

CVD
24%

Communicable,
Maternal &
Nutritional
Conditions
37%

Injuries
10%

Epidemiological Triad
All manifestations of human disease are the consequence of
the interplay between

Host

Agent
Environment

 HOST: is the particular person or group of people susceptible to

illness.
Host factors include: age, sex, marital status, specific immunity,
genetic, occupation, education, religion, lifestyle, health status,
behavior etc.
AGENT: is the direct cause of disease without which a specific
disease cannot occur. It may be
Exogenous: From pollution of the environment - physical,
chemical or biological.
Endogenous: psychological and mental disorders.
An agent could be:

Biological (microorganisms)
Chemical (toxins, drugs, tobacco)
Physical (fire, radiation, trauma)
Nutritional (lack of, excess or imbalance)

 Environment:
It is the medium where man lives.
It includes all what is external to the agent and host.
It is divided into:
The Physical Environment: Weather, Light, Air quality, Water, Radiation, Pressure
(altitude), Noise, etc
The Biologic Environment: Infectious agents of disease, Reservoir of infection,
Vehicles of transmission as mosquitoes & flies, and Modes of propagation as air
and water)
Socio-economic Environment: Overall economic and political organizations of a
society where individuals live.

Dynamics of Disease
Stage I: Latent Stage/ Incubation period
It is the interval between the entry of disease cause into
the body and beginning of first non-specific symptoms
and signs of disease
There are no manifestations of disease during this stage
Length of incubation period depends on:
The rate of proliferation of the causative agent
Host defense mechanisms
Previous sensitization of the host body by exposure to
disease agent
Dosage of infectious agent

Stage II: Prodromal

Arising first non-specific symptoms and signs of disease
Symptoms: Manifestations of the disease that are perceived by
the patient.
Signs: Manifestations of the disease that are observed by the
clinician.
Stage III: Manifestation of disease
There are specific symptoms and signs of specific disease.

Stage IV: Disease Conclusion

Healing and convalescence
Chronic disease
Disability or Death

Classification of disease
Acute disease
With rapid onset, short duration (occurs and subsides within
days, weeks or few months) and Predictable.
Chronic disease
Its course takes longer periods (longer than 3 months &
sometimes for the remainder of one's life).
Permanent Impairment
Residual physical or Cognitive disability
Condition may fluctuate
Greater psychological impact

Communicable (or infectious) Diseases:

Disease caused by a specific infectious agent (organism) or its
products, and is transmissible from one individual to another.
Agents of infectious diseases are usually known.
E.g. Influenza, Measles, HIV, Tuberculosis, Poliomyelitis
Non-Communicable Diseases:
Disease can not be transmitted from infected person to another
one.
Delineating the agents of these diseases is often difficult because
several or even many factors may contribute to the development
of a given non-communicable health condition
E.g. Cancer, Diabetes, Hypertension, Heart attack - Stroke,
Hypoglycaemia.

Patterns of Frequency of Disease occurrence in

the community
Epidemic
Pandemic

Endemic

Epidemic (Disease Outbreak):

A sudden occurrence of group of illnesses of similar nature;
affecting large number of the population in a community or a
specific geographic area; clearly in excess of normal
expectancy; and derived from a common or propagated source.
Generally, there is a large number of cases in a short time.
Examples:
Occurrence of Cholera in a community getting water from the
same contaminated source
Salmonella food poisoning in a group of individuals who get
food from the same contaminated source in a camp.

Endemic: The habitual presence of a disease within a given geographic area,

continuously, without importation from outside
Why ?
Factors controlling disease existence and persistence are present all the time).

Pandemic:
A disease spreads from one country to another (occurs at the same time in
different countries).
Example: Avian Flu pandemic, and HIV pandemic.

Rural HealthCare System In

India

Center
Sub-Center
Primary Health Center
Community Health Center

Population Norms
Plain Area Hilly/ Tribal Area
5, 000
3, 000
30, 000
20, 000
1, 20, 000
80, 000

Sub-Centre
Most Peripheral and first contact point between the primary
healthcare system and the community.
Each Sub-centre is manned by 1 Auxiliary Nurse Midwife (ANM) and
1 Male Health Worker (MHW)
1 Lady Health Worker (LHW) supervises 6 SCs.
Provides services in relation to following:
-

Maternal and Child Health

Family Welfare
Nutrition
Immunization
Diarrhea control
Control of Communicable diseases programs

Primary Health Centre

First point of contact point between village community and
the Medical Officer.
Provide curative, preventive, promotive and Family welfare
services.
4-6 beds for patients.
Referral Unit for 6 SCs.
Manpower:
-

1 Medical Officer + 1 AYUSH

3 Staff nurse, 1 ANM, 1 LHV, 1 MHA, Health educator
Pharmacist, Lab Technician
2 Clerks, Driver, 4 Class IV

Community Health Centre

30-50 bedded with one OT, X-Ray, Labor Rooms and
Laboratory facilities.
Referral centre for 4 PHCs
6 Medical Specialists: Surgeon, Anesthetist, Physician,
Gynecologist, Pediatrician and Eye Surgeon
24 paramedical and other staff.

Rural Health Statistics

EAG States

Infrastructure

Functioning

Required

% Gap

SCs

68060

93781

27

PHCs

10766

15369

30

CHCs

2062

3840

46

SCs

80064

84486

PHCs

13121

13844

CHCs

2747

3454

20

SCs

148124

178267

12

PHCs

23887

29213

18

CHCs

4809

7294

34

Non- EAG States

India Total

Cadre

In-position

Requirement

% Gap

Specialists

6935

58352

88

Doctors

26329

109484

76

Pharmacists

24671

58389

58

Radiographers

2221

14588

85

Lab Technician

16208

80308

80

Nurses

65344

138623

53

ANMs

187675

393041

52