10 health problems in india

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Health problems in india Kiran randhawa Army college of nursing

INTRODUCTION:

INTRODUCTION There are so many health problems prevalent in India. Some of the health problems are eradicated and some problems are still existing. Some National health programmes eg Malaria control programme, AIDS control programmes has been launched in India.

CLASSIFICATION:

CLASSIFICATION COMMUNICABLE DISEASE PROBLEMS NUTRITIONAL PROBLEMS ENVIRONMENTAL SANITATION PROBLEMS MEDICAL CARE PROBLEMS POPULATION PROBLEMS

COMMUNICABLE DISEASE PROBLEMS:

COMMUNICABLE DISEASE PROBLEMS Communicable diseases continue to be major problem in India. Diseases considered to be of great importance are: Malaria Tuberculosis Diarrhoea Acute respiratory disease

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Contd.. AIDS OTHERS

MALARIA:

MALARIA Malaria continue to be major health problem in India. During year 2003 there were 943 reported malaria deaths in country. It is protozoal infection with parasite of genus plasmodium. Mode of transmission : vector transmission, direct transmission through blood transfusion, needle in drug addict congenital malaria .

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Contd.. Incubation period : vary from 12 to 18 days, depending upon species. Clinical features : cold stage : onset is with lassitude, severe headache, nausea, chilly sensation, temperature 39-41c . Period last from 15minutes to 1 hour.

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Contd.. Hot stage : skin is hot and dry to touch, intense headache, rapid respiration, Period lasts from 2to6 hours. Sweating stage : fever comes down with profuse sweating, patient feels relaxed. Period lasts from 2-4hours.

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Contd… Management p.vivax , p.ovale , p.malariae infections should be treated with chloroquine 600mg, base followed by 300mg base in 6 hours, later 150mg base 12 hourly for 2 more days. Check vitals 4 hourly . Maintain Intake and output chart .

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Contd… Monitor level of consciousness using glassgow coma scale , paediatric coma scale ( blantyre coma scale) For unconscious patients maintain clear airway,give lateral or semi prone position, oxygen administration, physiotherapy, parenteral antimicrobials.

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Contd.. In case of severe anaemia whole blood transfusion can be done. If convulsions occur give IV diazepam (0.15 mg\kg ) For fever analgesics as PCM can be given , tepid sponging is done.

TUBERCULOSIS:

TUBERCULOSIS It is another leading public health problem in India. The number of deaths estimated to be about 5 lakhs every year. Causative agent : mycobacterium tuberculosis. Mode of transmission : droplet infection Incubation period : it may be weeks, months or years. Tuberculin positive stage in 3 to 6 weeks duration.

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Contd… Clinical manifestations: Loss of weight Fatigue Cough with expectoration Hemoptysis High fever Night sweats

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Contd… Dyspnoea Chest pain Hoarseness of voice

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Contd… Diagnostic measures Sputum test X-rays Mantoux test Family history Signs and symptoms

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Contd.. Treatment: For 18-24 months, Drugs used for standard treatment are: streptomysin injection isoniazid tablets ( 5mg/kg) thiacetazone tablets Modern drugs as pyrazinaamide (1500mg), ethambutol (1200mg), rifampicin (450mg) are available.

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Contd… DOTS chemotherapy (directly observe treatment short coarse) Nutritious diet , when patient is on anti-tuberculosis drugs. Safe disposal of sputum. Patient should cover the mouth with clean cloth, that should be washed and dried in sunlight.

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Contd… Isolation : clothes, utensils, personel belongings until sputum becomes negative. Teach patient about general hygiene, nutrition, toxic effects of drugs. Contact examination of family members. Follow up : periodic check up of patient after treatment is important for at least 2 years.

ACUTE RESPIRATORY DISEASE:

ACUTE RESPIRATORY DISEASE It is one of the major cause of morbidity and mortality in children below 5 years of age. Etiology Aspiration Drug ingestion and overdose. Prolonged inhalation of high concentration of O2, smoke, corrosive substances.

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Contd.. Trauma, major surgery Fat or air emboli Clinical manifestations : Dyspnoea Hypoxemia

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Contd… Assessment and diagnostic findings : Severe hypoxemia Intercoastal retraction Crackles Management: O2 administration Antioxidant therapy

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Contd… Corticosteroid therapy Antisepsis agents Nutritional therapy Nebulization therapy Chest physiotherapy Suctioning Mechanical ventilation

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Contd… Reduce anxiety of patient Provide rest

DIARRHOEA:

DIARRHOEA Diarrhoea constitutes one of major causes of morbidity and mortality in children below 5 years of age. It continue in India due to poor environment condition. Causative agent : Acute watery diarrhoea: Rota virus, salmonella, E.coli. Acute bloody diarrhoea: shigella, amoeabiasis.

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Contd.. Mode of transmission : fecal oral route. Clinical manifestations: acute diarrhoea is an attack of sudden onset of diarrhoea, lasting to 3-7 days or even upto 10-14 days. passage of loose , liquid or watery stool usually more than 3 times a day.

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Contd.. Inflammatory diarrhoea : abdominal pain, fever, stools are frequent, blood stained, pus cells, mucous containing small in volume. Non inflammatory diarrhoea: nausea, vomiting, abdominal pain, fever, voluminous and watery stools.

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Contd… Control and prevention : confirmation of cause of diarrhoea is done with help of laboratory tests. Notification to local health authority. Assessment of dehydration and rehydration is done with help of oral fluids, I.V fluids, ORS.

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Contd.. Soft, easily digestable food is given. Breast milk is best for infants and should be continued in diarrhoea also. There should be provision of safe water supply, sanitary latrines. Antibiotics as ciprofloxacin 500 mg 12 hourly for 3 days, metronidazole etc.

LEPROSY:

LEPROSY The prevalence rate of leprosy is about 2.3 per 10000 population. India accounts for about 60% of leprosy cases in world. Causative agent : mycobacterium leprae Two types : infectious type (lepromatous ) non infectious type(tuberculoid)

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Contd.. Mode of transmission : droplet and contact transmission. Incubation period : 3-5 years.

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Contd… Clinical manifestations : Common organs involved are nerve, eye, skin, bone and internal organs. Hypopigmented patches and Thickened nerves Nodules on skin , face , ears. Claw hand deformity

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Contd… In late phase: loss of fingers, nasal depression, foot drop, claw toes, planter ulcers are seen.

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Contd.. Diagnostic tests : Lepromin test : 0.1ml of lepromin ID on inner aspect of forearm is given, reaction is read after 48 hours and on 21 day. If induration and redness is more than 10 mm at 48 hours, it is positive. on 21 day nodule of more than 5mm is positive.

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Contd.. Skin tissue from ears, nasal smear, skin patches for bacteriological examination.

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Contd.. Management: Objectives for treatment are: to cure the patient to prevent deformity to interrupt transmission of infection

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Contd.. Multi drug therapy : rifampicin 600mgm Clofazimine 300mgm- 100mgm Dapsone 100 mgm Dapsone monotherapy : adult dose 100mgm , in children aged 6-14 50mgm daily, below 6 years 25mgm daily.

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Contd.. Examination of family members Early detect signs of leprosy as light colored patches appear on skin. Tell patient about side effects of drugs, leprosy is not result of sin, not hereditary. If there is loss of sensation in hands , protect from burns, cuts, wounds.

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Contd.. Skin care, foot care, eye care should be done. At early stage it may spread to others. If burns, cuts, lesions present don’t neglect as it can cause ulcers and eventually deformity.

AIDS:

AIDS The problem of AIDS is increasing in magnitude every year. It is estimated that by the end of year 2003, there were about 5.1 million case of HIV positives. Causative agent: human immuno deficiency virus. Incubation period : 6 months to 7 years.

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Contd… Mode of transmission : parenteral route sexual transmission perinatal transmission

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Contd.. Clinical manifestations: Loss of weight of more than 10% body weight. Fever more than 1 month duration. Diarrhoea Amenorrhoea Infections as herpes zoster, kaposi sarcoma, lymphoma, vasculitis, gingivitis etc.

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Contd.. GI system: persistent diarrhoea, colitis, dysphagia, perianal discomfort. Respiratory system: persistent cough, hemoptysis, pleural effusion. Neurological system: headache, dementia, visual impairement, meningitis, seizures

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Contd.. Hematological, renal, cardiac, endocrinal and reproductive manifestations. Hemiplegia, peripheral neuropathy, lymphoma.

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Contd.. Diagnosis: Physical examination Check for STD. HIV test (western blot test) CDcell count CD4/CD8 ratio Chest x-ray

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Contd… Management: Drugs : zidovudine (AZT) (Retrovir) 500-600mg orally daily TDS. protease inhibitor eg saquinavir 600mg orally TDS dailly. non nucleoside reverse transcriptase inhibitor eg nevirapine 200mg orally daily for 2 weeks, then 200mg orally BD daily.

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Contd… Avoid needle stick injury,. Before blood transfusion check donor for AIDS, other diseases. Screening of pregnant mother for HIV AIDS. prevent transmission through blood, blood products, semen, tissues, organ transplantation.

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Contd.. Gloves, masks, protective glasses, gown should be worn during invasive procedures. Counselling about strengths, limitations, resourses should be given.

POLIOMYLITIS:

POLIOMYLITIS It is highly infectious disease caused by polio virus. Incidence : usually affects children below 5 years of age. Incubation period : 7 to 14 days Mode of transmission : feco-oral route, droplet infection

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Contd.. Period of communicability : most infectious 7 to 10 days before and after onset of symptoms.

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Contd. Clinical manifestations : In beginning stage, complaints of fever, headache, fatigue , restlessness, vomiting, diarrhoea. cough and cold. paralysis may occur in legs, face, larynx, oesophagus, person may become permanent handicapped.

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Contd.. Diagnostic test: by signs and symptoms physical examination study of virus Complications: paralysis or permanent deformity.

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contd… Management: Symptomatic treatment Physiotherapy Immunization: it is essential to immunize every child against polio by 6 months of age. Two types of vaccine are inactivated polio vaccine, oral polio vaccine.

SMALL POX:

SMALL POX This disease is caused by varicella virus and remained to be highly infectious and fatal among children. WHO declared on 8 may 1980 that small pox had been eradicated . In 1982, small pox vaccination was stopped.

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Contd.. Sign and symptoms : Sudden onset of fever, headache, backache, vomiting and sometimes convulsions. On third day of fever a typical rash appears, which is centrifugal in distribution, passes stages of macule, papule, pustule and scab with subsequent scarring.

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Contd… Pox virus disease after eradication of small pox. Accidental infection with laboratory associated stocks. Infection with animal pox virus.

OTHERS:

OTHERS Kala azar, meningitis, viral hepatitis, encephalitis, enteric fever and helminthic infestations are other important communicable diseases in india and other countries.

NUTRITIONAL PROBLEMS:

NUTRITIONAL PROBLEMS India consist of small group of well fed and a very large group of undernourished. The specific problems in the country are: Protein energy malnutrition Nutritional anaemia Low birth weight Xerophthalmia (nutritional blindness) Iodine deficiency disorders

PROTEIN ENERGY MALNUTRITION:

PROTEIN ENERGY MALNUTRITION The incidence of severe cases is 1to 2% in preschool children. Diseases due to deficiencies of protein and calories occurs commonly among weaned infants, and preschool children in India.

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contd.. KWASHIORKIR It is caused by deficiency of protein in diet. Symptoms Growth failure Muscle wasting Oedema Loss of appetite

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Contd.. Change in colour of skin and hairs Anaemia Vitamin A deficiency diarrhoea

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Contd.. NUTRITIONAL MARASMUS It is caused by severe deficiency of proteins and calories in diet. Symptoms : Growth retardation Severe wasting of muscles Loss of subcutaneous fat

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Contd.. Signs of dehydration Dry eyes Aneamia Eye lesions due to vitamin A deficiency

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Contd.. Treatment: Give readily digestable diet , rich in proteins, calories, all essential nutrients. Synthetic vitamin A administration. Fat is introduced in diet from second week of treatment.

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Contd.. Diet consist of skim milk powder, sugar, cooked cereals,and bananas. Treatment of any bacterial or parasitic infection if present. Daily calorie intake should be 140-150 cal/kg and protein intake 3-5 gm/kg body weight.

NUTRITIONAL ANAEMIA:

NUTRITIONAL ANAEMIA India has highest prevalence of nutritional anaemia in women and children. Causes: iron deficiency folic acid and vitamin b12 deficiency

CONTD..:

CONTD.. Signs and hazards : Exhaustion Difficulty in breathing Suffocation Headache Blurring of vision Excessive sleep

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contd.. Paler skin Anorexia Oedema Cardiac problems Patient can die also.

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Contd. Treatment: Depends upon Hb level Iron tablets 200mg till it is controlled. Iron syrups for children Blood transfusion in severe stage. For prevention, 180 mg ferrous sulphate, 0.5 mg folic acid tab is given for 2-3months daily ,till Hb becomes normal.

LOW BIRTH WEIGHT:

LOW BIRTH WEIGHT This is another public health problem in developing countries. About 30%babies are born with weight less than 2.5 kg weight. Causes: Maternal malnutrition and anaemia Infection Uncontrolled fertility

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Contd.. Prevention: Nutritious diet of pregnant women. Control of maternal infections Incubatory care to low birth weight. Proper feeding Infection control of low birth weight.

XEROPHTHALMIA:

XEROPHTHALMIA Also called nutritional blindness. About 0.04% of total blindness in India is attributed to vitamin deficiency.Keratomalacia has been major cause of nutritional blindness in children between 1-3 years of age.

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Contd.. Effects of vitamin A deficiency: Night blinndness Xerosis conjuctiva Xerosis cornea Bitots spots Keratomalacia Follicular hyperkeratosis

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Contd.. Treatment and prevention : Mild to moderate case: 10 gm of fat soluble vitamin A for period of 10 days. Severe case: 50 gm daily for few weeks. Fortification of food with vitamin A. Protect children from PEM, diarrhoea, measles and respiratory diseases.

IODINE DEFICIENCY DISORDER:

IODINE DEFICIENCY DISORDER Goitre and other iodine deficiency disorders are endemic in sub Himalayan regions. Symptoms: Swelling in neck ,usually painless but creates deformity. Breathing difficulty due to suppressed trachia.

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contd.. Treatment: Thyroidectomy Prevented by regular use of iodised salt. Avoid goitrogenic food as cabbage, cauliflower, radish as these substances react with iodine present in food and make it unavailable.

OTHERS:

OTHERS other nutritional problems of importance are lathyrism, endemic fluorosis , adulteration of food stuffs in certain parts of country.

ENVIRONMENTAL SANITATION:

ENVIRONMENTAL SANITATION The most difficult problem to tackle in this country is environmental sanitation problem, which is multifactorial and multifaceted.

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Contd.. Main environmental problems in India are: Air and water pollution Depletion of natural resources Improper waste disposal and low level of sanitation Sound pollution Traffic pressure

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Contd.. Degradation of land Industralization and urbanization Radiation hazards Excessive use of fertilizers and chemicals in agriculture. Destruction of forests

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Contd.. The cycle of increasing population, poverty, illeteracy, unemployment further increases environmental problems.

MEDICAL CARE PROBLEMS:

MEDICAL CARE PROBLEMS In India national health policies are made but financial resources are considered inadequate to furnish the cost of running such services. In rural area 74% population doesn’t get benefit of modern curative and preventive health services.

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Contd.. Approx 80% of health services are concentrated in urban area but with uneven distribution of doctors. Thus major medical care problem in India is inadequate distribution of available health resources between urban and rural area, lack of penetration of health services to social periphery.

POPULATION PROBLEM:

POPULATION PROBLEM The population problem is one of the biggest problem faced by our country. It has affected on all aspects of housing, health care, sanitation, and environment Our population has already reached one billion. The government has set goal of 1% population growth by year 2003 but current is 1..93%.

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Contd.. Needs and measures to control population Increase age of marriage. Education Sex education Increasing recreational facilities Liberal l

SUMMARIZATION:

SUMMARIZATION INTRODUCTION CLASSIFICATION COMMUNICABLE DISEASE PROBLEMS MALARIA TUBERCULOSIS DIARRHOEA

CONTD..:

CONTD.. ACUTE RESPIRATORY DISEASES LEPROSY AIDS OTHERS NUTRITIONAL PROBLEMS PROTEIN ENERGY MALNUTRITIOIN NUTRITIONAL ANAEMIA

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CONTD.. LOW BIRTH WEIGHT XEROPHTHALMIA IODINE DEFICIENCY DISORDER OTHERS ENVIRONMENTAL SANITATION MEDICAL CARE PROBLEMS POPULATION PROBLEM

BIBLIOGRAPHY:

BIBLIOGRAPHY Dr M. swaminathan, ‘hand book of food and nutrition’, 5ed, Banglor press publishers, Pp 33,43,45,102,103. Park.k,preventive and social book of food and nutrition’, Banarsidas publishors, Pp 691-693.

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Contd.. Prabhakara GN ‘ text book of community health for nurses, peepee publishors, Pp 274, 449 Suddarth’s and brunner, ‘text book of medical surgical nursing’, 10ed, lippincott williams publishers, Pp 545-546

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Contd.. Swankar keshav, ‘community health nursing’ ,2ed, N.R brothers publishers,Pp 386,477,484,130 TNAI, ‘manual of community health nursing’, Pp 439,391,392,393,357

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contd www.google.com (23 sept 2007)

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