Hamees Atef

COMMUNITY WRITTEN
CHAPTER 3:
1-Define carrier and mention its types, with examples. (Feb 15, May 16, Jan +
May 17 Aug 16)
 A carrier is an apparently healthy individual (without showing manifestations of disease
i.e. without an apparent disease) who is infected and harbors pathogenic organisms as
a foci of infection in different parts of their body. The organism finds exit through body
fluids/excreta and can spread infection
 TYPES:
- Incubatory carrier, ex: rubella, influenza, typhoid, cholera, poliomyelitis, AIDS, HBV
- Convalescent carriers, ex: typhoid, cholera, poliomyelitis, HBV
- Contact Carrier, ex: typhoid for 2 wks, cholera, poliomyelitis
- Healthy Carrier, ex: typhoid for 2 wks, poliomyelitis, HBV

2- Define Zoonosis and state its forms. May 17

Infectious diseases that are transmissible under normal conditions from animals to humans
Forms:
1- Strictly zoonotic diseases: reservoirs of infection are animals only (no man to man
transmission)
2- Both animals and man are the reservoirs ex: yellow fever

3- Enlist immunization for children in first 18 months of life. Jul 15

 HBV: first 24hrs
 OPV: zero dose at birth
 BCG: zero dose at birth
 OPV-sabin: 2m, 4m, 6m, 9m, 12, 18m (booster)
 IPV-salk: 2m, 4m, 6m
 PENTA (diphtheria, tetanus, pertussis, HBV, haemophilus b): 2m, 4m, 6m
 MMR: 12m, 18m (booster)
 DPT: 18m (booster)
 Vitamin A: one capsule at 9m and two capsules at 18m

4- Define chemoprophylaxis and state its limitations & give examples. Mar +
May2 16
-Chemoprophylaxis: Antimicrobial drugs administered for specific prevention of certain
infectious diseases. It is given to prevent the development of disease, or carrier state, either
Pre or Post exposure
-Limitations of Chemoprophylaxis:
 Adverse effects of given drugs
 Reactions and toxicity
 Costly if given on a wide scale
 Development of drug resistant strains of organisms
 Provide temporary protection protection
-Drugs Commonly Used for Chemoprophylaxis:
 Penicillin (long acting) to prevent rheumatic fever.
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 Tetracycline: Oral capsules or tablets, to prevent Cholera and Plague.

 INH. Oral isonicotinic acid hydrazide, for prevention of Tuberculosis
 Rifampin: Oral, to prevent meningococcal meningitis

5- Describe the preventive measures for health care associated infections

(HAIs). May 18
1- effective infection control committee: it should be developed in any health care facility
having inpatient departments of more than 30 beds
It should be made of key personnel from various health facility departments with the
director
It has to set policies and regulations, and monitor the performance in prevemntion and
control of hospital infection
2- measures for health care providers:
- Free of infection
- Protection by active immunization (especially HBV), chemoprophylaxis, seroprophylaxis
- Management of occupational exposures to infections
- Education and training about standard precautions( include hand hygiene, protective
equipment, safe injection practices, safe handeling of contaminated equipment or surfaces,
respiratory hygiene/cough etiquette)
3- surveillance of HAIs:
It is essential for early case finding and supervision on hospitalised cases to: screen,
diagnose, proper management
4- sanitary environment:
a- sanitary health care facility env including: 1- sanitary handling, ttt and disposal of
biomedical waste. 2- disinfection of air of opening theaters, premature units, certain labs
and wards when necessary by uv rays
b- sanitary of surrounding area: all area around the health facility should be clean and free
of breeding places for insects, rats, dust, waste collections
5- sterllization and asepsis
6- chemoprophylaxis for all patients under certain circumstances of unsatisfactory
fulfilment of asepsis and unavoidable risk of infection
7- administrative regulations to ensure adherence to infection control rules, staff
performance, sterilization, asepsis and control of hospital visits companions

6- Mention the mode of transmission (MOT) of meningococcal meningitis and

the specific preventive measures. May + Nov 17, Nov 18
Modes of transmission:
1- Direct droplet infection when a susceptible contact breathes in air droplets coming out
from the source of infection while coughing, sneezing, or talking loudly. It is the main mode
of transmission. Close and prolonged contact is needed.
2- Indirect droplet infection: through droplet nuclei (air borne) or touching the mucous
membrane of mouth, nose and eyes with cigarettes, hands, articles, and fomite freshly
contaminated with nasopharyngeal discharges
Specific prevention:
1- conjugate vaccine: they produce both cell mediated and humoral immunity after 10 days
Available vaccines include monovalent (A or C) and tetravalent (A,C,Y,W)
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The tetravalent vaccine is given 0.5ml S.C, it gives 85% type specific protection and it can be
repeated every 3 years according to the circumstances
Indications:
- preteens and teens
- high risk adults who are potentially exposed to infection
- pilgrims are given one does before leaving
Complications: mostly no serious problems but some may have sore arm, fever, muscle
aches, rash
Contraindications: person who had a severe allergy to any vaccine component
NB: polysaccharide vaccines are used during a response to outbreaks and protein based
vaccines has been recently developed and used in some local countries
2- chemoprophylaxis: Rifampicin 600mg twice daily for 2 days and half the dose for children
for close contacts especially during outbreaks and epidemics

7- Mention MOT and specific prevention of Tuberculosis. May2 16 2

Mode of transmission:
1- direct droplet infection (main mode)
2- indirect droplet infection (airborne) as well as contaminated dust
3- In utero infection (rare)
Specific prevention:
1- BCG: live attenuated vaccine from m bovis given once in lifetime intradermally in lt
deltoid, it stimulates development of cell mediated immunity within 3m
-it protects against both pulmonary and extra pul TB for 7-10y, up to 15y and even 60y
-protection in infants and children is 70-80% and its main value is to protect against tb
meningitis and military tb which is commonest under 5y, while in adults there is no reliable
protection it can vary from 70-80% to none
-indications:
- Compulsory at birth
- Adults who have –ve tuberculin skin test and considered from dangerous group
(food handlers, teachers) or risk groups (close contacts, certain occupations)
- Small children in countries where tb is common who have –ve tuberculin test and
continually exposed
-contraindications: +ve tuberculin test, pregnancy, immunocompromised
-complications: if given wrong it can cause local necrosis, suppuration, lymphadenitis
General comp: rigors, reactivation of dormant focus of infection
NB: in children if scar is present then vaccine has worked if scar is absent carry mantoux test
and if –ve repeat BCG
2- Chemoprophylaxis: isonicotinic acid hydrazide, 5mg/kg for 6-12m, given to prevent latent
infection in high risk tuberculin +ve ex: close contacts, chronically debilitated patients with
additional risk factors, recent tuberculin +ve or BCG not yet protective
3- combined

8- Mention MOT and specific prevention / preventive measure of Measles.

Nov 15, Aug 16, Nov 18
Mode of transmission:
1- direct droplet (main)
2- indirect droplet (airborne) or touching mucus membranes (third person role)
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3- in utero especially in 1st trimester

Specific prevention:
1- active immunization:
MMR vaccine which is live attenuated strains of measles, mumps, rubella given 0.5ml S.C in
right arm, it provides protective humoral immunity 7 days after vaccination. It gives a long
lasting immunity with high protection 99% after 2 doses in measles and rubella but 77% for
mumps (88% after 2nd dose)
-indications:
 Compulsory in 2 doses at 12 and 18m
 Older children, adolescent girls and boys
 Premarital females and married females one dose atleast 3m before pregnancy
-contraindications: pregnancy and immunocompromised
-complications: no serious comp, may be just sore arm, fever, mild rash
NB: post exposure active immunization. However the susceptible should be recognized
within 72 hr max of exposure to measles
2-passive immunization (seroprophylaxis):
Normal human immunoglobulin (NHIG) can provide short term protection against measles if
given within 6 days of exposure
Even after NHIG MMR is still required
NB: people shiuld not be vaccinated with MMR for atleast 5m after receiving NHIG
NB: NHIG is restricted in immunocompromised and susceptible children that are not
vaccinated yet.

9- Reservoir and specific prevention of Influenza. Nov 20

Reservoirs:
Humans, occasionally birds and swines
-cases: in form of clinical disease
-subclinical infections
-incubatory carriers
Specific prevention:
1- vaccination:
a- inactivated vaccine: prepared from 3 or 4 circulating flu virus strains, it is given in 2 doses
0.5ml each IM, then 1 does is needed each consecutive year
it provides humoral immunity 14 days after vaccination, its effectiveness ranges from 25-
40%
-indications:
- annually before influenza season in groups with risk of serious illness from the flu ex:
adults above 50y, children between 6m and 5y, pregnant women, people with heart or
breathing, hepatic, renal, neurologic, hematologic or metabolic disorders, obese with BMI
more than 40, people with low immunity due to specific ttt like steroids or cancer ttt
- also can be given for health care providers and contacts
-contraindications: children younger than 6m and people who had severe reaction to flu
vaccine before
-complications: mild ex: sorness, fever, headache
b- live attenuated vaccine: not used in Egypt, it is prepared same way as inactivated vaccine
and given annually before influenza season as nasal spray
2- chemoprophylaxis: oseltamivir
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- indiacted for immediate protection in epidemics to high risk and confined groups
- side effects may occur in 5-10%
- it is contraindicated in reduced kidney functions, psychological and neuro diseases

10-Definitions:
Endemic Spread: A disease constantly present in the community, due to maintenance of
infection by existing ecological factors (host, agent and environment) Spread of infection
shows: Sporadic cases that appear here and there, unrelated and Carriers of infection in
some diseases.
Epidemic spread: Increased number of cases significantly more than the usual pattern of
spread of the disease. An epidemic is characterized by the fact that all the cases are
interrelated i.e., have certain features in common regarding. Time i.e. All cases appear
within a certain period and Place: All cases are reported within the same community or area
Outbreak Spread: An outbreak is a localized epidemic that involves a confined group or
closed community, as camp, school, nursery, institute, or hospital. Outbreak shows the
characteristic features of epidemic
Pandemic Spread: an epidemic of a particular infectious disease that spreads in between
countries, and simultaneously involves some countries of the world.
Enzootic Spread: It is endemic spread of infectious diseases in animals, with the potential
risk of transmission to man, e.g., Tuberculosis and brucellosis in cattle
Epizootic Spread: It is epidemic spread of infectious diseases in animals, with the potential
risk of transmission to man e.g., Rift Valley fever, and foot and mouth disease in cattle

11-International measures
-To prevent transmission of certain infectious diseases from one country to another,
quarantine measures were previously used for cholera, yellow fever and plague (small pox
was included before eradication).
-The WHO recent legal instructions for international measures, - The International Health
Regulations (IHR) 2005 - included other infections that can cause serious public health
impact and spread rapidly internationally e.g., poliomyelitis due to wild type poliovirus,
human influenza caused by a new subtype and severe acute respiratory syndrome (SARS).
-The purpose of IHR is to prevent, protect against, control, and provide a public health
response to the international spread of disease in ways that are appropriate with and
restricted to public health risks, and which avoid unnecessary interference with
international traffic and trade.
International measures are applied for: International travelers, Imported animals: e.g.,
Monkey, for yellow fever. Imported goods: Raw wool hides (skin) and hair: quarantined for
anthrax, where imported goods must be associated with "authorized disinfection certificate

12- Difference between elimination and eradication

ELIMINATION ERADICATION
It means that existing endemic infectious It is getting rid of causative organism, and
disease is so controlled to reach the level of consequently of disease, in certain area,
"no reported cases" country or worldwide: no reported cases,
This is usually by protection of at-risk nor reservoirs of infection.
groups or population. The causative agent Ex:
is not necessarily eliminated
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Ex: Poliomyelitis and measles are in the way 1-Variola (smallpox): the WHO has declared
to be eliminated, and then eradicated in worldwide eradication of disease in 1978.
Egypt No cases are reported since then.
2-Rabies: some developed countries have
eradicated the disease in pet animals (dogs
and cats).
13- Enumerate steps of outbreak investigation * all chapter is imp*
1- Prepare the field work
2- Establish the existence of an outbreak
3- Verify the diagnosis
4- Define and identify the case
5- Perform descriptive epidemiology (in terms of time, place and person)
6- Develop Hypotheses
7- Evaluate hypotheses
8- Refine hypotheses and carry out additional studies
9- Implement control and prevention measures
10- Communicate findings
11- Initiate or maintain surveillance

14-Global public health security p 57

15- Define surveillance and mention its types
Definition: It is the ongoing collection and analysis of health- related data about a clinical
syndrome-that has a significant impact on population - to timely detect or anticipate disease
outbreaks among populations which is then followed by making decisions and taking timely
public health actions in terms of planning, Implementation and evaluation of prevention and
control measures.
Types:
 Passive surveillance
 Active surveillance
 Special studies
16- Give examples of diseases transmitted by contact / vector borne
Contact: tetanus, STD (HIV, HBV, HCV), rabies
Vector: yellow fever, filariasis, malaria

17- Standard prevention Measures

1- general preventive measures: environment sanitation, raising awareness, health
promotion mainly by nutrition
2- specific preventive measures: active and passive immunization, chemopropylaxis
3- international prevention

18- Mention the reservoir of infection, MOT, and preventive measures for
HIV infection. May 17
Reservoir: humans: cases and carriers. Human cases and chronic incubatory carriers lasting
up to 10 years or more
Modes of transmission:
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1. Direct contact transmission: by sexual contact through unprotected intercourse among

homosexuals and heterosexuals.
2. Contact of abraded skin or mucous membranes with body secretions such as blood, CSF
or semen and vaginal discharges.
3. Blood transmission: through the use of HIV-contaminated needles and syringes, I.V drug
users, transfusion of infected unscreened blood or blood products and the transplantation
of HIV-infected tissues or organs are among the potential hazards.
4. Mother to child transmission (MTCT) -Vertical transmission: From 15-35% of infants born
to HIV-positive mothers are infected at birth. MTCT occurs through breast feeding in about
50% of cases.
5. Although the virus may be found in saliva, tears, urine, and bronchial secretions, contact
transmission with these secretions has not been reported.
Prevention: General:
1. Social welfare, health promotion and health education about prevention of illegal sexual
relations. Provision of facilities for easy marriage and for recreation as sports. Provision of
chance of work to youth in order to earn money.
2. It is also important to use disposable syringes and sharp objects and do not share needles
for any purposes. Sanitary precautions during any piercing procedures, dental procedures,
surgical operations and haemodialysis must be followed. Usage of personal protective
equipments as gloves, masks, gowns or goggles and hand washing should be applied.
3. Avoiding sexual activity with intravenous drug users, persons with multiple sexual
partners known or suspected to have AIDS. Usage of condoms consistently and correctly will
prevent transmission of HIV.
4. Testing blood donors and blood products: • For being free from HIV. • from donors who
have engaged in no HIV risk behaviors and • from donors who have been previously tested
negative for HIV antibodies
5. Routine HIV testing and counseling in areas of high prevalence. Routine HIV testing in
antenatal clinics and avoidance of pregnancy in HIV seropositive female.
6. Prevention of congenital infection by treatment of mother during pregnancy by highly
active antiretroviral therapy (HAART). HIV women should not breast feed their infants.
7. Immunization of HIV infected children with BCG, DPT, measles, MMR, hepatitis B vaccines
to guard against infection of the corresponding diseases in highly susceptible immune-
compromised persons.
8. Health care facilities for early diagnosis and treatment must be provided and encourage
their use by making them culturally and economically acceptable.
9. Some vaccines are under trial as whole virus vaccine, core protein vaccine.
10.International measures: Annual reports are sent to the WHO. International travelers
should be aware that some countries serologically screen incoming travelers especially
those with extended visits. They also advised to use condom in the era of AIDS.
- Specific: vaccines are under trial, unavailable chemoprophylaxis

19- Mention MOT and specific prevention of Hepatitis B. May2 16, Jan + Mar
+ May 17, May 19
1. Per-cutaneous (IV, IM, SC, intradermal) and per-mucosal exposure to infective body
fluids: e.g., infected syringes, needles etc.
2. Infected unscreened blood transfusion.
3. Organ transplantation: when donors are not accurately investigated.
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4. Renal dialysis: if contaminated hemodialysis machine and instruments are used.

5. Sexual contact with infected sex partners.
6. Perinatal mother-to-infant transmission.
Specific prevention:
a- active immunization: yeast recombinant HB vaccine given in 3 doses, 0.5ml IM at 0,1,6m
and if continuous exposure 1ml booster dose every 5y. it gives protective neutralizing
antibodies in 96% of vaccines
 It is compulsory at 4 doses 0, 2, 4, 6m (PENTA)
 Medical and para medical personnel
 Medical and paramedical students
 Cases with repeated blood transfusion or hemodialysis
 Sexual partners and household contacts of +ve persons
 International travellers to areas with chronic HBV
b-seroprophylaxis: human specific immunoglobulin which has anti-HBsAg
used as prophylaxis in new borns to +ve mothers and individuals suspecting percutaneous
or permucosal exposure to +ve blood
c- combined: given to –newborns of infected mothers (1 dose of HBIG within 12hrs and at
same time vaccination 1st dose at different site 0.5ml IM, then 2 doses at 1, 6m)
-post exposure immunization
20- Give an account on MOT of Hepatitis C. Nov 15
Same as HBV but:
-HCV is primarily transmitted parenterally.
-Sexual and perinatal mother-to-infant transmissions have been documented but appear far
less efficient

21- What are the specific preventive measures for rabies in human? Feb 15
p.125
CHAPTER 6
1- Mention 5/4 principles of management. Aug 16 Jan 20
1- Management by objectives
2- learning from experience
3- division of labor
4- convergence of work
5- substitution and proper use of resources
6- delegation
7- setting priorities

2- State items for problem identification and priority setting. Mar 17

Problem identification:
a- problem definition: each problem should cover:
 Nature, extent and magnitude including who is affected and which age, social class,
geographic area
 Trend of problem whether inc, dec, stationary
 Consequences of the problem
b- analysis of the problem: to understand causes using fish bone and 5 why techniques
priority settings: should consider:
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 The magnitude and extent of the problem

 Seriousness which has 4 components (urgency, severity, economic costs, impact on
others)
 Effect on productivity and other socioeconomic implications
 Availability of cheap feasible technologies for prevention and control

3- Describe the meaning of strategic planning for an organization and

mention the steps to be followed in strategic planning for an organization.
Jan 17
-Strategic planning is a process of looking into the future and identifying trends and issues
against which to align organizational direction It helps to improve performance, solve
problems, and ensure stability and sustainability of an organization or program
-Strategic Planning is 3 - 5 years plan that would go into several steps to reach preset goals
that the organızation would like to achieve the future.
The steps:
1. Setting or updating organization vision and mission
2. Organization situation analysis: Strengths, Weaknessęs, Opportunities, and Threats
Challenges (SWOT/SWOC)
3. Problem solving
4. Identify the problems (the difference between the present and the desired situation)
5. Prioritize the problems
6. Establish goals and objectives
7. Select solutions
8. Continue with the following steps
9. Put an action plan (consider organization stability)
10. Implement, monitor and evaluate
11. Update your plans

4- State personal characteristics of effective leader. Aug 16

- Mental ability intelligence, superior judgment. decisiveness, knowledge and fluency
Speech.
-Personality factors such as having a vision, positive attitude, self-confidence, personality
integrity, desire for high ambition, concerns about achievements, high people orientation,
and a desire for responsibility
-Leaders are often active participants in various activities, they interact well with people.

5- Mention 6 dimensions of quality in health care. Mar 19

2A 2C 3E PST
 Accessibility
 Acceptability/patient centered
 Competency
 Continuity
 Effectiveness
 Efficiency
 Equity
 Prevention/early detection
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 Safety
 Timeliness

6- Define patient safety and state/describe all/4/3 international patient

safety goals. May 17, Mar 18, May + Nov 19, Jan + May 21
It is reduction of risk of unnecessary harm that could be associated with health care to the
minimum
GOALS:
Goal one: Identify patient correctly: Use at least two patient identifiers before
administrating medications or blood products taking blood samples, etc
Do no use the patient room, bed number to identify the patient
Bracelet with e bar code is one of the best identifiers
Goal two: Improve effective communication among health care team:
-for verbal or telephone orders: verify the complete order by having the person receiving
the order read back the order
-list the abbreviations and symbol that could cause confusion in order not to be used
throughout the organization
Goal Three: Improve the safety of using medication
-Enlist the look-alike, sound-alike drugs and prevent error involving the interchange of these
drugs
-Label medications, medication containers (e.g. syringe, medicine cups), or other solutions
in peri-operative and other procedural settings
Goal Four: Eliminate wrong site, wrong-Patient and wrong-Procedure surgery
-Preoperative verification of the process via the available documents
-Surgical site marking process with patient involvement before anesthesia
Goal Five: Reduce the risk of health care- acquired infections
-Comply with hand hygiene guidelines
-Implement practices to prevent central line associated blood stream infections and surgical
site infections
Goal Six: Reduce the risk of patient harm resulting from falls:
Implement and evaluate a fall reduction program

7- Define management, effectiveness, efficiency, planning

-Management is getting things effectively done to achieve desired objectives through
proper planning, efficient implementation, and evaluation to assess achievements and
identify the needs for re-planning. Management is thus a dynamic process
-Effectiveness is the degree to which a stated objective is being achieved
-Efficiency is the optimized (balanced) use of resources (human resources, equipment,
supplies, money, space, information and time.
-Planning is the process of formulating objectives and determining the steps which will be
employed in attaining them

8- Define leadership and compare between managers and leaders

Leadership is the art or process of influencing people so that they will strive willingly toward
the achievement of a group goal
MANAGER LEADER
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 Does things right  Does the right things right

 Relies on systems  Relies on people
 Maintains work  Develops work
 Counts on control  Counts on trust

9- List the steps of implementation functions

 Organizing
 Staffing
 Directing and leadership
 Coordination of work and team building
 Recording and reporting
 Monitoring
 Supervision

10- List the skills needed for management

 Communication
 Decision making and problem solving
 People management and team building
 Negotiation
 Change management
 Creative thinking
 Risk management

11- Mention the criteria for selecting appropriate solutions

1- the foreseen effectiveness of the proposed solution and visibility
2- technical feasibility reflecting the use of appropriate technology and availability of
needed resources, plus social acceptability
3- political and institutional support

12- List planning functions Diagram ???

12- Economics (read all) p179

CHAPTER 10
1- Define maternal mortality and mention its causes. Jul 15, May + Aug 16,
Nov 17, Jul 20
It is the 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 aggrevated
by the pregnancy or its management but not from accidental or incidental causes.
Causes:
a-Direct obstetric causes: (80%)
 Hemorrhage: Bleeding in early pregnancy, antepartum & postpartum (1st cause in
Egypt)
 Pregnancy induced hypertension (2nd)
 Genital Sepsis (puerperal and post abortive)
 Unsafe abortion
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 Obstructed labor
 Other: thromboembolism, postpartum collapse: hypovolemic shock, neurogenic
shock, septic Shock, amniotic fluid embolism
b- Indirect causes: these are from diseases which exist before or during pregnancy and are
aggrevated by physiological changes of pregnancy ex: heart disease (rheumatic 1st in Egypt),
anemia (2nd), Diabetes.

2- Mention factors contributing in maternal mortality. Nov 18

a- Factors related to mother:
 Poor living conditions & insanitary environment.
 Low per capita income
 Illiteracy or low educational level, faulty traditional habits
 High parity ( > 5)
 Extremes of age ( less than 18 & more than 40)
 Negligence of utilization of heaIth services
 Unwanted pregnancy
b- Factors related to health care services:
 Lack of quality antennal, natal & postnatal care services
 No or poor quality ANC for early detection of at risk cases
 Unavailability of trained heath Care providers Obstetrcians, GP, midwives
 Shortage in heaIth facilities resources regarding equipment, drugs, anasethia, blood ,
ambulance

3- Direct & indirect causes of maternal mortality. Nov 19, Jan 21

AS Q1
4- Enlist four lethal outcomes of pregnancy. Feb + Jul 15
 Abortion
 Still birth
 Death in early neonatal period

5- Discuss measures to lower maternal mortality. Jul 15

I-Policy Level: Community development to improve health of all the population especially
future parents These are multi-sectoral interventions, where all ministries should be
involved.
II- Programmatic level: Support the sustainability of the following seven programs E the
(Responsibility of the Ministry of Health and Population).
 Premarital care
 Antenatal care
 Natal care
 A Postnatal and post-abortion care
 Pre-conceptional and interpregnancy services
 Family planning services
 Management of STDS
III- Service delivery level:
-Ensure the availability of resources e.g., manpower, medications, supplies and equipment.
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-Improve service provision:

 Improve the capacity of health facilities (PHC & hospitals) by increasing their number
emergency training of health providers, obstetric services, increasing the number of
health providers continuous equity in the distribution of the health facilities and
specialized physicians all over the country
 Improving the quality of performance through setting standers and regulations to
ensure effective services. Continuous training, evaluation and accountability are very
important to achieve quality health services
IV- Community level: Demand creation to utilize services through marketing, increase
awareness, community mobilization and involvement to improve the quality and the client
satisfaction of the maternal care program.

6- Describe 4 premarital services. May 21

i- Health education: Health education would cover topics related to family life and
reproductive health in general. The future parents are advised about the appropriate time
for the first pregnancy and optimal birth spacing intervals, the importance of antenatal care
visit early in pregnancy, precautions to be taken in pregnancy e-g., to avoid taking any drugs
or be exposed to other teratogenic hazards.
ii. Counseling: Counseling is directed to specific health problems, either related to the
health of the individual him/herself, or to the expected offspring.
iii. Genetic counseling: is a specific form of counseling to advise the parents about the
probabilities of having a congenital or hereditary disease. It is done either in the premarital
period, or during inter-conception care, usually after having such a problem with the
previous child. Genetic counseling include study of the pedigree (through family history for
both partners), and chromosomal studies (Karyotyping) for cases that could be discovered
through this technique.
iv. Immunization: If the female mentioned that she was not immunized against rubella.
Advice immunization with the live attenuated German measles vaccines at least three
months before marriage. Advise couples to be vaccinated against Hepatitis B. It is
recommended in some countries that females should also be vaccinated against cervical
cancer by Human Papilloma virus (HPV) vaccine.
v. Management of cases and referral to specialists: if any clinical condition is discovered
during the premarital screening.

7- State the objectives of antenatal care (ANC) and mention five of its
components. Mar 16
 Health promotions of expected mothers
 Prevention of complications and hazards during pregnancy
 Early detection and proper management of morbidity
 Health education of the mother about health care of the baby
Components of ANC:
 Registration and record keeping
 Periodic examination, including lab tests
 Health education
 Nutrition care
 Immunization
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 Risk detection and management

 Home visiting
 Referral as needed
 Social care

8- Health Education Messages to pregnant woman in Antenatal Care. Nov 20

1- importance of ANC, recommended dates, and date of next visit
2- life style, the need to dec strenuous physical work, have enough rest and sleep, have
adequate diet, personal hygiene, care of teeth
3- avoid taking any drugs during pregnancy
4- alarming signals of pregnancy: vaginal bleeding, persistent abdominal pain, severe and
persistent morning sickness, persistent headaches, blurring of vision, leakage of water
from vagina, stoppage of fetal movements for more than 4 hrs in late pregnancy,
swelling of feet, fingers or face, vaginal discharge with itching or odor
5- in advanced pregnancy:
 breast feeding and preparation of breast and nipples
 preparation for labor and signs of onset of labor
 essentials of baby care
 birth spacing

9- Identify the components of nutritional care for pregnant mother during

ANC visits at 1ry health care centers. Jan 17
1- nutritional assessment: repeated weighing, hemoglobin estimation, clinical examination
for malnutrition, dietary assessment
2-nitrition education
3- nutrition supplementation
4- correction of nutritional deficiencies

10- Describe the nutritional assessment for pregnant women conducted in

1ry health care centres. Nov 18
1-repeated weighing: excessive weight increase indicates occult oedema which may be
manifestation of PIH or obesity which is a predisposing factor for PIH
2-hemoglobin estimation: measure for anemia, anemia is diagnosed if hb level is below
11g/100ml
3- clinical examination for malnutrition
4- dietary assessment: asking about foods usually eaten using the last 24 hr recall method
for semi-quantitative and qualitative analysis to identify major deficiencies in mother diet

11- Define the at-risk approach in maternal health program and illustrate
using 4 examples of factors detected from history. Mar 17
It is a method by which we ensure that everyone is receiving a standard level of care and
that more care is given to those at risk according to the type of risk
Factors:
 age less than 18 or more than 40
 first or 5th or more pregnancy
 Hamees Atef

 pregnancy spacing less than 2y

 history of giving birth to a baby less than 2.5kg or more than 4kg
 previous fetal death
 repeated abortions
 history of CS
 previous preterm
 history of sever toxemia after pregnancy
 history of baby who needed intensive care
 history of severe psychological troubles in previous preg
 cervical tear
 chronic diseases or STD

12- State components of comprehensive reproductive health. May 19

1. Safe motherhood: prenatal care, safe delivery, essential obstetric care (EOC), newborn
care, postnatal care and breast feeding
2. Promotion of child health and gender equality
3. Promotion of adolescent health
4. Elimination of harmful practices for girls and women e.g., female genital mutilation (FGM
e.g., female circumcision/ female genital cutting), premature marriage, and domestic and
sexual violence against women.
5. Sexual health, information and counseling
6. Stressing the supportive role of husband to create demand for reproductive health
services.
7. Family planning, information and services
8. Prevention and management of complications of abortion
9. Prevention and management of infertility in both men and women.
10. Prevention and management of reproductive tract infections
11. Prevention and management of sexually transmitted diseases.
12. Management of non-infectious conditions of the reproductive system, complications of
female genital mutilation and other gynecological morbidities and reproductive heath
problems such as those associated with menopause, menstrual disorders, cervical cell
changes, genital prolapse...etc.
13. Prevention and management of reproduction related disorders such as hypertension,
anemia, chronic energy deficiency (CED), and obesity

13- Mention the components of premarital examination

1- premarital assessment:
 identification data
 personal medical history
 family history
 clinical examination
 lab investigations
2- premarital services: health education, counseling, genetic counseling, immunization,
management of cases and referral to specialist

14- Give short account on pregnancy wastage

 Hamees Atef

It is unfavorable outcome of pregnancy

1- the lethal outcome: complete loss of pregnancy products either by abortion, still birth or
death in the early neonatal period which ends seven completed days after birth
2- the sub-lethal outcomes: birth of a child with some form of disease or abnormality
including preterm, low birth weight, congenital anomalies, birth injuries, intra-uterine
infections

15- Enlist nutritional supplements needed in pregnancy

 iron 60mg once or twice daily
 folic acid 600 micrograms/day
 calcium
 multivitamins
16- Immunization & risk detection
Immunization: all pregnant mothers should be immune to tetanus to prevent tetanus
neonatorum and puerperal tetanus, if not previously immunized give 2 doses of tetanus
toxoid 4-6wks apart after 1st trimester. If previously immunized give a booster dose. The last
dose of vaccination should be a month before delievery.
Risk detection:see q 11

17- Principles of good natal and postnatal care

 clean delivery: clean hands, surface, cord cutting
 avoid unnecessary vaginal examinations and episiotomies
 early detection and referral to a specialized hospital of cases with prolonged or
obstructive labor or with impending risk detected during labor
 resuscitation, proper care for the newborns, and sterile dressing for the umbilicus’
 eye drops a s chemoprophylaxis to prevent ophthalmia neonatorum
postnatal p224

18- Mention under five child morbidities. Mar 18, Jan 20

Neonatal morbidities:
 preterm and low birth weight
 congenital abnormalities
 infections
 injuries
postanatal and child health morbidities:
 diarrhea
 acute respiratory tract infections
 malnutrition: iron def anemia, PEM, vitA def, IDD, rickets
 injuries

19- Mention the commonest mal-nutrition disorders among under 5 children.

Jan 17
iron def anemia, PEM, vitA def, IDD, rickets (less common)

20- Intrauterine environmental risk factors of congenital anomalies. Mar 21

 Hamees Atef

 infections including rubella in 1st T, syphilis, toxoplasmosis, cytomegalic inclusion

disease, any viral infection
 live vaccines
 drugs especially in 1st trimester
 radiation
 malnutrition: iodine def causes cretinism, minor disturbances of metabolic
exchanges between mother and fetus may lead to malformation of developing organ
 smoking (active or passive)

21- Discuss nutritional care components of child health program. Nov 15 10

A- Direct intervention:
1- nutritional assessment: growth monitoring
2- nutrition education: promotion of breast feeding, proper weaning practices, feeding the
sick child during illness
3- nutritional supplementation:
 vitamin A at 9m and 18m, 100000IU orally after 1 year 200,000IU
 vitamin D once at 2 m 200,000IU IM
 iron supplement orally 6mg/kg /day for 2m at 7m and then at 15 or 18m
 nutrition correction to any malnutrition
 referral of the malnourished when needed
B- Indirect intervention:
 health education, immunization, birth spacing, prevention and control of parasitic
disease and infectious diseases especially diarrhea and ARI

22- Short account on Health problems affecting infants. Jul 15

Diarreha and ARI p236
23- Enumerate factors contributing to under 5 child health problems
1- socioeconomic factors:
 The availability and accessibility to quality health services especialy maternal and
child health care programmes
 Sanitation and access to pure water supply.
 Adequacy of food supply within the country
 Literacy rate.
 Income levels.
 Access to information through mass media e.g., television and radio
 The gross national product (GNP) per capita, which is a measure of the economic
condition in the country.
2- Family factors:
 The housing conditions, and sanitation within the house and its environment
 Family size.
 The socio-economic condition of the family including education, occupation for both
parents, and income.
 Crowding index (number persons per room).
 Food availability and habits.
 Cultural factors and habits.
 Health awareness and life style.
 Hamees Atef

 Health condition of the different members of the family

 Previous infant and child death in the family.
 Maternal age, materal health, or death of mother.
3-child factors:
 Sex of the child: Egypt In females are at a higher risk than males due to gender
inequality that is specially noticed with lower Socio-economic classes.
 Serial order:The first is at a higher risk than the second, the risk increases after the
fifth child.
 Child spacing less than two years between pregnancies.
 Health problems occuring to the mother during pregnancy
 Condition of the child at birth, pre-term, low birth weight (LBW), multiple
pregnancies, a child with congenital malformations, birth injuries . . etc
 A child who is not breast-fed.
 Improper weaning practices
 A malnourished child.
 Repeated infections.

24- Hazards of preterm

 Impaired regulation of body temperature due to immaturity of the heat regulating
center.
 Increased risk of infection due to immaturity of the immune system and deficiency of
naturally acquired materal antibodies. Pneumonia and septicemia are fatal condition
 Malnutrition due to deficiency in body stores and poor suckling\
 Increased risk of hemorrhage due to increased capillary fragility and possible
deficiency in the coagulation mechanism
 Kernicterus associated with hemorrhage, hemolysis and immaturity of the liver
functions
 Respiratory distress syndrome.
 Retrolental fibroplasia may occur due to increased concentration of oxygen.
25- Growth charts

CHAPTER 5:
1- Mention six reasons of the increasing prevalence of NCDs. Mar 16, May 18,
Mar 19
(1) The demographic transition: The decrease in mortality and fertility resulted in increase
in life expectancy with subsequent increase in the proportion of the elderly populations.
(2) The epidemiologic transition: There is shift from mortality from communicable diseases
(due to the use immunizations and antibiotics etc.) to mortality from NCDs which have
chronic nature.
(3) Nutrition Transition: There is a shift in the pattern of nutrition to a diet high in total fat,
sugar and other refined carbohydrates and low in polyunsaturated fatty acids and fibers.
Such pattern resulted in increasing the prevalence of obesity and subsequent NCDs.
(4) The multi-factorial nature of the risk factors for the non-communicable diseases: •
Unlike communicable disease, it is difficult to identify the specific cause-effect relationship
in NCDs. • The multiplicity of the risk factors associated with a specific NCD limits the
 Hamees Atef

opportunities to have specific intervention for prevention and control. • The risk factors are
related to genetic, environment, culture and behavior, which represent a challenging issue
to public health programs.
(5) Migration of population across different cultures: The individuals who migrate from
low-risk culture (e.g. rural areas) to high-risk culture (e.g. urban areas) follow the life-style of
the new culture and demonstrate increased risk for NCDs.
(6) International communication: • International communication, multinational business
and new food technologies have resulted in new life-styles and new food products favoring
the occurrence of NCDs. • Communication through the mass media/satellites/internet,
overseas travel, and international food marketing introduce dietary patterns which
predispose to NCDs. • Adolescents and youth are exposed to modernization in concepts and
behavior. Their exposure to the risks of NCDs early in the life cycle results in the
development of a large cohort with health problems during adulthood and older age.
(7) Environmental changes: The increase in the level of physical and chemical air pollution is
associated with high prevalence of NCDs.
(8) Limited use of scientific progress in management of NCDs: There are rapid and
successful achievements in the science of risk detection, use of medication and technologies
to prevent and control NCDs.

2- Enlist Risk factors for coronary heart diseases (CHD). Nov 15

Modifiable: nutrition, smoking, overweight/obesity, physical inactivity, uncontrolled blood
pressure, elevated levels of cholesterol, and blood sugar
Non-modifiable: (not in the book) age, sex, genetic

3- Mention modifiable risk factors for CHD. Nov 19 same as Q2

4- Diseases as a risk factor of CHD. Mar 21
Hypertension, elevated cholesterol (dyslipidaemia), diabetes, obesity

5- Role of diet as a risk and protective factor for Diabetes. May 17

Obesity, high sugar consumptions can cause type 2 diabetes and significantly contributes in
the progress of diabetes complications
-reducing red and processed meats, sugar sweetened beverages and alcohol while
increasing consumption of whole grains can prevent long term complications of diabetes
and even reverse type 2 diabetes

6- Compare risk factors for type I and type II Diabetes. Nov 17, Nov 18
-type 1: inherited genetic disorder that can be triggered by viral inf( mumps, rubella, CMV)
and environmental factors as early cow milk
-type 2: genetics, age, sedentary life, obesity, smoking, stress

7- State risk factors for Cancer. May 16 State environmental risk factors for
cancer. Aug 16
1- biological carcinogens: viral, bacterial, parasitic infections, hormonal and genetic factors
2- chemical carcinogens: food and water contamination and tobacco smoking
3- physical carcinogens: UV rays and ionizing rafiations
 Hamees Atef

8- State biological risk factors for cancer. Jan 17, Nov 18

viral, bacterial, parasitic infections, hormonal and genetic factors

9- Mention the role of diet as a risk and protective factor for cancer. May 17
-low intakes of fruits and vegetables  lung cancer (increase fruit and vegetable
consumption)
-High intakes of meat and fat and low intake of fruits, vegetables, fibers, vitamins and
minerals colorectal cancer (stop consumption of meat especially preserved meats can
reduce the risk)
-Poor dietary habits leading to obesity breast cancer( maintain health weight)

10- Discuss 4 risk factors for chronic obstructive pulmonary disease (COPD).
May 21
Genetic and environmental factors and they include:
Air pollution, tobacco smoke and second-hand smoke, indoor and outdoor air pollution,
occupational exposures and socioeconomic factors

11- Enlist the risk factors for NCDs

I. Environmental exposures.
II. Modifiable behavioral risk factors
• Unhealthy diet • Tobacco use
• Physical inactivity • Harmful use of alcohol
III. Non-modifiable risk factors
• Age • Sex • Genetics
• Ethnicity • Personality type
IV. Metabolic/biological risk factors The four key metabolic/physiological changes that
increase the risk of NCDs:
• Raised blood pressure, • Overweight/obesity, • Hyperglycemia (high blood glucose levels)

12- Describe the role of PHC physicians in prevention and control of NCDs
1. Health education to improve the lifestyle.
2. Nutrition education to prevent nutrition-related diseases.
3. Identify the high-risk groups for NCDs.
4. Early detection of the diseases by conduction of screening tests to the high-risk groups.
5. Referral of the identified cases to specialists.
6. Follow up of referred cases to ensure compliance to treatment & following healthy
behavior.

CHAPTER 9:
1- Explain the purpose for community needs assessment
To promote the health status and to solve relevant problems in a community we should:
 Understand the community, know all the people
 Identify community needs, the actual and the felt
 Plan and implement health programs with full involvement of the community
Services intended to help people will be most effective if:
 People identify their problems and know the cause and underlying factors
 Hamees Atef

 They realize there are solutions

 Have confidence in their own capabilities
 Help in planning, implementation, monitoring and evaluation of interventions

2- Define 1ry health care. Nov 17, May + Nov 18

It is an essential health care mad accessible to individuals and families by means acceptable
to them, through their full participation at a cost that the community and the country can
afford

3- Short account on/ state principles of 1ry Health Care? Jul 15, May 18
 Affordable by people: they can pay for the cost incurred by utilization of the service
 Acceptable to people: measured by utilization
 Accessible geographical, social, financial
 Appropriate to meet the health needs of the population

4- State the 8/6/4 of the essential elements of 1ry health care. May + Nov 17,
May + Nov 18, Nov 20, Mar 21
1- Health education concerning prevailing health problems, their prevention and control.
2- Promotion of food supply and proper nutrition.
3- Basic sanitation and safe water supply.
4- Maternal and child health (MCH), including family planning
5- Immunization
6- Prevention and control of locally endemic diseases address priority health problems
7- Appropriate treatment of common diseases and injuries.
8- essential drug list to cover the local needs according to the disease load in the community

CHAPTER 16:
1- Discuss the (age) dependency ratio. Mar 17
It is the ratio of persons in the dependent ages (<15 and >64) to those at the working age
(16-64). It is usually expressed as the number of persons in the dependent age for every 100
persons in the working age
- It indicates the economic burden that the working proportion of a population must carry,
the higher the ratio the heavier the burden
- It affects health, social pattern, and labor force quality

2- Short account/ (state types) Population Pyramid. Jul 15, Jan 17

It graphically displays the age and sex compositions in bar charts and shows the proportion
of males and females
 The base width: young age group
 The top width: old age group
 The height: average duration of life expectancy
 The symmetry: similarity/differences in proportion of M & F in same age group
Types:
 Expansive population: has larger number of people in younger ages (developing
countries)
 Hamees Atef

 Constrictive population: small number of people in younger ages (countries in

transition phase)
 Stationary population: has roughly equal no of people in all age groups and tapering
off gradually at older ages (developed countries)

3- Egypt’s population pyramid characteristics and the current population

problem dimensions. May 18
Estimated Egypt population in 2020 was 100.5million
Comparing Egypt data for 1996 and 2020 concluded that
 Proportion of <15y decreased from 38 to 33.8%. due to family planning that reduced
birth rate from 28 to 23 lives births per thousand population
 Increase in 15-64 age group to 61.5%
 Proportion of >64y increased to 4.9%
Egypt population problem: have 3 dimensions
A- rapid population growth
B- Improper population distribution (cairo having heaviest density)
C- Improper population characteristics (high level of unemployment, high dependency age
ratio, high economic dependency ratio, minor role of women in development programs)

4- State different methods for estimation of population

1. Natural Increase Method: The differences between live births and deaths (natural
increase of the population) in the years following the census are added to the census
population to get the estimated population of a given year.
2. Arithmetic Method: The annual increase of the population of a given area can be
calculated by dividing the difference between two consecutive censuses, by the number of
years in-between
3. Graphic Method: In this method a number of successive census populations are plotted
on a graph, and joined together by a straight line. The line then extended over future years.
4. Geometric Method: The geometric method is the most accurate method for estimation of
the population. This is because the population growth is geometrical. A special formula is
used to find out the annual rate of population increase that can be applied to the last census
population, to get the estimated population of a given year.

5- Compare between census and estimated population

CENSUS ESTIAMTED
Census population is the no. of population It is the number of population in any of the
in census year inter-census or post-census, obtained by
Census is process of: applying a method of estimation of census
-enumeration of all persons in different population
parts at specific time
- collection of demographic and
socioeconomic data Ex: age, sex, etc..
- Census taking is repeated at intervals
usually every 10y

6- Discuss the demographic transition zone

 Hamees Atef

It states that a population's fertility and mortality will both decline from high to low levels as
a result of economic and social development. The decline in mortality usually precedes the
decline in fertility, resulting in high population growth during the transition period.
Stages of demographic transition:
Stage 1: High birth rate and high death rate = little or no increase in the population (High
potential population).
Stage 2: High birth rate and falling death rate = high growth rate (Transitional population).
Stage 3: Declining birth rate and relatively low death rate = slow population growth
(Balanced population).
Stage 4: Low birth rate and low death rate = very low or no population growth

7- What is life expectancy, its importance with special reference to situation

in Egypt
Life expectancy at birth is the average number of years the newborn is going to live.
Similarly, life expectancy at any given age is the average number of years an individual of
that age is expected to live.
Importance: Life expectancy is one of the indicators that can assess the improvement in
health status and health services in the community.

7- Discuss the latest Egyptian population trends as regards size, change, and
structure
AS Q3

DON,T FORGET CHAPTER 12