Doctorate of Medicine [MD] (Community Medicine) From JIPMER, Pondicherry

COURSE CONTENTS

1) CONCEPTS IN HEALTH

1. Definition of Health; appreciation of health as a relative concept; determinants of health.

2. Characteristics of agent, host and environmental factors is health and disease and the multifactorial etiology of disease.

3. Understanding of various levels of prevention with appropriate examples.

4. Indices used in measurement of health.

5. Health situation in India: demography, mortality and morbidity profile and the existing health facilities in health services.

6. Difficulties in measurement of health.

2) EPIDIMOLOGY

1. Use of epidemiological tools to make a community diagnosis of the health situation in order to formulate appropriate intervention measures.

2. Epidemiology: definition, concept and role in health and disease.

3. Definition of the terms used in describing disease transmission and control

4. Natural history of a disease and its application in planning intervention.

5. Modes of transmission and measures for prevention and control of communicable and non-communicable disease, including Integrated Disease Surveillance Project (IDSP)

6. Principal sources of epidemiological data.

7. Definition, calculation and interpretation of the measures of frequency of diseases and mortality.

8. Common sampling techniques, simple statistical methods for the analysis, interpretation and presentation of data frequency distribution, measures of central tendency, measures of variability, statistical tests of significance and their application.

9. Burden of diseases in respect to premature mortality due to re-emerging communicable diseases and morbidity due to non-communicable diseases.

10. Need and uses of screening tests.

11. Accuracy and clinical value of diagnostic and screening tests (sensitivity, specificity, & predictive values).

12. Epidemiology of communicable and non- communicable diseases of public health importance and their control.

13. Epidemiological basis of national programmes.

14. Awareness of programmes for control of non-communicable diseases.

15. (a) Planning and investigation of an epidemic of communicable diseases in a community setting.

 (b) Institution of control measures and evaluation of the effectiveness of these measures.

16. Various types of epidemiological study designs.

17. The derivation of normal values and the criteria for intervention in case of abnormal values.

18. Planning an intervention programme with community participation based on the community diagnosis.

19. Applications of computers in epidemiology.

20. Critical evaluation of published research.

21. GIS Mapping

22. Mathematical Modeling in Epidemiology

3) EPIDEMIOLOGY OF SPECIFIC DISEASES

The specific objectives of selected communicable and non-communicable diseases of public health importance for which National Disease Control/ Eradication Programmes have been formulated are described here. The idea of formulating objectives for a few diseases is to highlight their importance and to emphasize certain learning outcomes. Infective hepatitis, ARI, T.B. Malaria, Filariasis, STDs & AIDS, Diarrhoeal diseases, Kala Azar, Mental Health, Coronary heart disease, Blindness, Hypertension, Leprosy, ACCIDENTS, JE, VPDs, Plague, Chickenpox, SARS, avian flu, etc.

1. Extent of the problem, epidemiology and natural history of the disease.

2. Relative public health importance of a particular disease in a given area.

3. Influence of social, cultural and ecological factors on the epidemiology of the disease.

4. Control of communicable and non-communicable disease by:

5.1 Diagnosing and treating a case and in doing so demonstrate skills in:

i) Clinical methods

ii) Use of essential laboratory techniques

 iii) Selection of appropriate treatment regimes.

 iv) Follow-up of cases.

5.2 Principles of planning, implementing and evaluating control measures for the diseases at the community level bearing in mind the relative importance of the disease.

6. Institution of programmes for the education of individuals and communities.

7. Investigating a disease epidemic.

8. Knowledge of the National Health Disease Control Programmes.

9. Level of awareness of causation and prevention of diseases amongst individuals and communities.

10. Control of communicable and non- communicable disease by diagnosing and treating a case and in doing so, demonstrate skills in: Instituting measures, where necessary, for preventing disabilities/ deformities. Rehabilitation of the patient.

11. Training of health workers in disease surveillance, control and treatment, health education.

12. Managerial skills in the area of

(i) Planning and organization of health services.

(ii) Supervision.

(iii) Collection and compilation of data,

(iv) Maintenance of records,

(v) Transmission of data.

4) BIOSTATISTICS

1.1 The scope and uses of biostatistics.

1.2 Collection, classification and presentation of statistical data.

1.3 Analysis and interpretation of data.

2. Obtaining information, computing indices (rates and ratio) and making comparisons.

3. Apply statistical methods in designing of studies.

(a) Choosing of appropriate sampling methods and sample size.

(b) Applying suitable test of significance.

(c) Use of statistical tables.

(d) Application of appropriate statistical software (packages, like SPSS, Epi Info, etc.)

5) ENTOMOLOGY

1. Role of vectors in the causation of diseases.

2. Steps in management of a case of insecticide toxicity.

3. Identifying features of and mode of transmission of vector borne diseases

4. Methods of vector control with advantage and limitations of each.

5. Mode of action, dose and application cycle of commonly used insecticides.

6) ENVIRONMENTAL SANITATION

1. (a) Awareness of relation of Environment to health.

(b) Awareness of the concept of safe and whole some water.

(c) Awareness of the requirements of a sanitary source of water.

(d) Understanding the methods of purification of water on small scale with stress on chlorination of water.

(e) Various biological standards.

2. Concepts of safe disposal of human excreta.

3. Physical, chemical standards; tests for assessing quality of water.

4. Disposal of solid waste, liquid wastes both in the context of urban and rural conditions in the community.

5. Problems in the disposal of refuse, sullage and sewage.

6. (a) Sources, health hazards and control of environmental pollution.

(b) Influence of physical factors- like heat, humidity, cold, radiation and noise – on the health of the individual and community.

(c) Standards of housing and the effect of poor housing on health.

7. Low cost sanitation in rural areas

7) REPRODUCTIVE & CHILD HEALTH (RCH)

1. Need for specialized services for women and children.

2. Magnitude of morbidity and mortality in these groups in a given area.

3. Local customs and practices during pregnancy, childbirth and lactation.

4. Concepts of ?high risk? and ?MCH package?, child survival and Safe motherhood, integrated Child Development Service Scheme and other existing regional programmes.

5. Under-5: morbidity, mortality, high risk and care.

6. Monitoring of growth and development and use of Road to Health Chart.

7. Immunization

- All respects (Basics of immunization; immunizing agents; administration, storage and transportation of vaccines; cold chain, side effects & complications etc.)

- Newer vaccine.

8. Organization, implementation and evaluation of programmes for mothers and children as per National Programme guidelines.

9. Role of Genetics in Community Health and Genetic Counseling at Primary Care Level.

10. National Policy for Children; IYCF; IMNCI

8) DEMOGRAPHY & FAMILY PLANNING

1. Definition of demography and its relation to community Health.

2. Stages of the demography cycle and their impact on population.

3. Definition, calculation and interpretation of demographic indices like birth rate, death rate, growth rate, fertility rates.

4. Reasons for rapid population growth in the world, especially in India.

5. Need for population control measures and the National Population Policy.

6. Identify and describe the different family planning methods and their advantage and shortcomings.

7. Principles of Counseling; Client satisfaction.

8. Medical Termination of Pregnancy Act.

9. Organizational, technical and operational aspects of the National Family Welfare Programme and Participation in the implementation of the Programme. Target Free Approach.

10. Give guidelines for MTP and infertility services.

11. Recent advances in contraception.

12. National Population Policies.

9) HEALTH PLANNING AND MANAGEMENT

1. Public Health Administration, regionalization, comprehensive health care, Primary Health Care, delivery of health care, planning, management, evaluation, National Health Policy, Development of Health Service in India and various committee reports.

2. Components of health care delivery.

(i) Describe the salient features of the National Health Policy concerning:

(a) Provision of medical care;

(b) Primary health care and Health for All;

(c)Health manpower development;

(d) Planned development of health care facilities;

(e) Encouragement of indigenous systems of medicine.

(ii) Explain the process of health planning in India by demonstrating awareness of:

- Various important milestones in the history of health planning including various committees and their recommendations.

- The health systems and health infrastructure at centre, state district and block levels.

- The inter-relationship between community development block and primary health centre.

- The organization, function and staffing pattern of community health centre, primary health centre, rural health centre and sub-centre etc.

- The job descriptions of health supervisor (male and female); health workers; village health guide; Anganwadi workers; traditional birth attendants.

- The activities of the health team at the primary health centre, community health centre, district hospital.

3. Familiarity with management techniques: define and explain principles of management; explain broad functions of management; personnel and materials management.

4. The components of health care delivery, For this, he should;

- Appreciate the need for International Health Regulations and Disease surveillance.

- Be aware of the constitutional provisions for health in India.

- Enumerate the major divisions of responsibilities and functions (concerning health) of the union, local and the state governments.

- Appreciate the role of national, international voluntary agencies in health care delivery.

5. Explain general principles of health economics and various techniques of health management e.g., cost-effectiveness, cost-benefit etc.

6. Management: Public health program Management, Hospital/Health care delivery system Administration, Logistic/Material Management, Finance Management Disaster Management etc

7. Legal-enforcement in Public Health (PFA Act, PNDT Act, Organ Transplant Act, Magic Remedial and Advertisement Act, Detention for strict DOTS implementation among drug abusers, alcohol addicts, etc.

8. National Rural Health Mission

10) NUTRITION

1. Nutritional problems of the country; Role of nutrition in Health & Disease.

2. Common sources of various nutrients and special nutritional requirement according to age, sex, activity, physiological conditions.

3. Nutritional assessment of individual, families and the community by selecting and using appropriate methods such as: anthropometry, clinical, dietary, laboratory techniques.

4. Compare recommended allowances of individual and families with actual intake.

5. Plan and recommend a suitable diet for the individuals and families bearing in mind local availability of foods, economic status etc.

6. Common nutritional disorders: protein energy malnutrition, Vit. A deficiency, anemia, iodine deficiency disorders, fluorosis, food toxin diseases and their control and management.

7. National Nutritional Policy.

8. National programmes in nutrition and their evaluation.

9. Food adulteration: prevention and control.

11) SOCIAL AND BEHAVIORAL SCIENCES

1. Conduction of a clinico-social evaluation of the individual in relation to social, economic and cultural aspects; educational and residential background; attitude to health, disease and to health services; the individual‘s family and community.

2. Assessment of barriers in health behavior and identification of obstacles to good health, recovery from sickness and to leading a socially and economically productive life.

3. Development of a good doctor- patient relationship, public relations and community participation for health sectors.

4. Identification of social factors related to health and disease in the context of urban and rural societies.

5. Impact of urbanization on health and disease.

12) SCHOOL HEALTH

1. Problems of school and adolescents; objectives of the School Health Programme.

2. Activities of the Programmes like:

(a) Carrying out periodic medical examination of the children and the teachers.

(b) Immunization of the children in the school.

(c) Health Education.

(d) Mid-day meals.

3. Obtaining participation of the teachers in the school health programme including maintenance of records; defining health practices; early detection of abnormalities.

4. Organization, implementation, supervision and evaluation of School Health Programme.

5. Oro-dental Health

13) OCCUPATIONAL HEALTH

1. Relate the history of symptoms with the specific occupation including agriculture.

2. Identification of the physical, chemical and biological hazards to which workers are exposed to while working in a specific occupational environment.

3. Diagnostic criteria of various occupational diseases.

4. Preventive measures against these diseases including accident prevention.

5. Various legislations in relation to occupational health.

6. Employees State Insurance Scheme.

14) HEALTH EDUCATION (BEHAVIORAL CHANGE COMMUNICATION)

1. Communicate effectively with individuals, family and community using tools and techniques of information, education, and communication. To do so, the student should:

(a) Appreciate principles of communication and barriers to effective communication.

(b) Principles, methods and evaluation of health education.

(c) List various methods of health education with their advantages and disadvantages.

(d) Select and use appropriate media (simple audiovisual aids) for effective health education.

2. Use every opportunity for health education of the individual, family and the community.

15) RURAL HEALTH

1. Describe the roadmap for making health services available at the doorsteps in the villages, in light of the National Rural Health Mission (NRHM).

2. Plan, execute, and evaluate health activities in concordance with the stated objectives of the NRHM.

3. Relate health in the village with the Millennium Development Goals that are specific to health, viz.,

Goal 4: Reduction in Child Mortality

Goal 5: Improve Maternal Health

Goal 6: Combat HIV/AIDS, Malaria and other diseases

Goal 7: Ensure Sustainable Environment

16) URBAN HEALTH

1. Common health problems (Medical, Social, Environmental, Economic, Psychological) of urban slum dwellers.

2. Organization of health services for slums dwellers.

3. Organization of health services in urban areas.

4. National Urban Health Mission

17) HEALTH ECONOMICS

 1. Macro- and micro-economics, Health Financing and Health Insurance

18) TRIBAL HEALTH

1. Tribal Health: Managing reaching to unreached, other areas of recent interest like increased prevalence of HIV infection among tribes of Andaman, Yaws among tribes of Orissa-post-eradication status, Leprosy among tribes of Dangs of Gujaratpost-elimination status

19) TEACHING & TRAINING

1. Able to act as a good teacher/ facilitator. For this, he/she will require:

- Knowledge of general principles of teaching/ learning, methods of instructions, methods of evaluation.

- Knowledge of various teaching aids (including audio-visual aids) and skills to use them correctly.