Technology of

Public Health

Sciences

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 Primary Health Care
Definition
PHC is the essential health care made of accessible to all individuals & families by
being acceptable and appropriate, through their full participation and at a cost that
the people and country can afford
Levels of Care
Primary health care
• The “first” level of contact between the individual and the health system.
• Responds for 80% of the community needs
• Urban & rural facilities
• Provide by general practitioners
• Essential health care (PHC) is provided.
• A majority of prevailing health problems can be satisfactorily managed.
• The closest to the people.
• Provided by the primary health centers.
Secondary health care
• Higher level of curative care, Responds for 15% of the community needs
• Provided in public & district hospitals & polyclinics Provide by general
specialist, More complex problems are dealt with, The 1st referral level
Tertiary health care
• Provides advanced level of health care & technology
• Responds for 5% of the community needs
• Offers super-specialist care
• Provided by regional/central level institution.
• Provide training programs
Principles of PHC
1- PHC is the first line of contact between the health sector & the public
2- Essential Health Care: preventive, curative & health promotion services
3- Accessible:
 Geographic accessibility , Social accessibility, Financial accessibility
4- Affordable: people can pay for the cost
5- Acceptable: people feel the importance of PHC
6- Appropriate: meet the health need of the population
The Eight Elements of PHC
1. Health Education
2. Promotion of food supply & proper nutrition

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 3. basic sanitation & safe water supply
4. Maternal & child health (MCH) including family planning
5. Immunization
6. Prevention & control of endemic diseases
7. Appropriate treatment of common diseases & injuries
8. Essential drug list to cover the local needs

Maternal Health Care

Maternal Health Care Program
Component: antenatal care, natal care, postnatal care, inter-pregnancy care
Ante Natal Care
Components
1- Registration & record keeping
• Booking for ANC should start within first 6 weeks after the last menstrual
cycle
• Delay in registration would miss the period of organogenesis
• The mother should get the health card
• The time of initiation of ANC is influenced by women awareness
2- ANC periodic visits & clinical Examination
Return Visits:
• Once every month till 7th month.
• Once every 2 weeks till the 9th month
• Once every week during the 9th month, till labor. the mother should receive
a minimum of 4 ANC visits
• 1st visit in the first 3 months of pregnancy : history, examination, Health
education
• 2nd& 3rd visit in the 5th& 6th months : periodic examination , treatment,
health education referral & tetanus toxoid vaccination
• 4th visit in the 8th month: periodic examination , treatment, health education
referral, and sonar
• 5th visit in the 9thmonth: verify fetal presentation & lie and set the plan for
delivery.
Components of Care in the First ANC Visit
History
• Personal history, Family history , Medical and surgical history
• Menstrual history , Obstetrical history

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History of present pregnancy
Clinical & Laboratory Examinations
• Weight & Height measurement, clinical check up
• Urine should be tested for sugar, ketones and protein.
• Blood examination for blood group, RH, blood sugar, Hemoglobin
• Examination for fundal height after weeks of gestation
• Risk factors assessment
3- Health Education during ANC
• Physiological changes during pregnancy ,Weight gain
• Fresh air and sunshine, Rest and sleep, adequate Nutrition , Daily activities
,Exercises and relaxation, Hygiene ,Smoking
• Teeth , Bladder and bowel, Sexual counseling, Medications
• Infection , Irradiation, Occupational and environmental hazards
• Travel, Follow up , Minor discomforts ,Signs of potential complications
4- Nutrition Assessment, Education and Supplementation
Nutrition assessment:
• Measurement of body weight, Hemoglobin estimation
• Clinical examination, Dietary assessment
Nutrition Education
• Focus on adequate diet
• Daily consumption of fresh fruits and vegetables
• Daily consumption of milk or milk product
• Avoid excessive salt
Nutrition supplementation
• Iron 60 mg of elemental iron once or twice daily for the non-anemic mothers
at 24 weeks of gestation & extends 3-6 months after delivery
• Folic acid
• Calcium in 2nd trimester
5- Tetanus Toxoid Immunization : The first two shots are given at least four
weeks apart, and the third shot is given six to 12 months after the second shot.
After the initial tetanus series, booster shots are recommended every 10 years.

6- Risk Detection and Management

• Identification of mothers who are at risk of mortality, morbidity
• Everyone is receiving a standard level of health care and more care is given
to those at risk

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 7- Referral services:
• PHC physicians have to refer the identified at risk mothers at any time of
pregnancy or labor to the hospital
8- Home visit:
• Follow up the dropouts from the MCH/ANC
• To provide health education
9- Social care
• Mother of low socioeconomic status, non-educated women
• Women living in rural areas
Maternal Health Problems
Causes of Maternal Mortality in Egypt
Direct obstetric causes: hemorrhage, hypertension, puerperal sepsis and post
abortive, thromboembolism, rupture uterus
Indirect causes: resulting from diseases existing before or occur during pregnancy
and aggravated by physiological changes of pregnancy as: cardiovascular diseases
especially Rheumatic heart diseases, anemia, DM, hepatitis, cancer
• Maternal health problem related to/or aggravated by pregnancy, labour, and
puerperium
Maternal Malnutrition:
1. Iron deficiency anemia with or without folic acid deficiency
2. Wasting due to low energy and protein intake3-Iodine deficiency
4- Osteomalacia: due to calcium deficiency 5-Obesity
Maternal Mortality Indicators
Maternal Mortality Ratio (MMR)= 67 deaths/100.000 live births
No. Of deaths of mothers due to causes related to pregnancy, labour& puerperium in certain year
& locality
____________________________________________ X 100000
No. Of live births in the same year and locality
Maternal Mortality Rate (MMR)
No. Of deaths of mothers due to causes related to pregnancy, labour
& puerperium in certain year & locality
__________________________________ X 1000
No. Of females in the child bearing period (15-49) in the same year and locality

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 Child Health Program
Components
1- Registration and record keeping
• The 1st visit to MCH center is preferred to be at the age of 30-40 days
• A medical record is to be prepared for each child during the 1st visit
• A health card is prepared to be used as “medical record for the whole life”
2- Periodic medical examination
A- Full clinical and laboratory investigation:
systemic clinical examination of the child
• Four times in the 1st year, twice in the second year, once every year till the
school age
B- Monitoring the growth and development of the child
A- Development monitoring: monitoring of development services include periodic
assessment for specific milestones compared to standard children development
B- Growth monitoring
• It is a visible display of a child’s physical growth and development.
• Growth chart offers a simple and inexpensive way of monitoring weight gain.
• Any deviation from “normal” detected by comparison with reference curves. It
has two reference curves.
• Upper reference curve -the median (50th percentile) for boys.
• Space between two growth curves called weight channel or road to health – zone
of normality for most population.
Step of Growth Monitoring
• Anthropometric measurements
• Plotting/record the child data and measurements in the growth chart
• Interpretation of the growth curve to detect falters
• If there is deviation from the normal pattern, investigate the cause
• Management of the cause
• More frequent monitoring until the child is back to normal rate of growth
Interpretation
• 1st degree (grade 1) malnutrition- child’s weight between 80% and 70% lines.
• 2nd degree (grade 2 or moderate) malnutrition –child’s weight between 70% and
60% lines.
• 3rd degree (grade 3 severe) malnutrition weight below 60% line.
• Grade 4-weight below 50% line.
• Weight b/w top 2 lines –considered satisfactory.

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 3- Health Education
4- Nutrition care
Nutrition supplementation to children:
 Vitamin A at age 9 months and 15, or 18 is given with the vaccines (the
recommended dose in Egypt is 100,000 IU ,after 1 year the dose 200.000 IU
 Vitamin D at the age of 2 months once at a dose of 200.000 IU intramuscular
 Iron supplementation
5-Immunization

Infants and Preschool Vaccine Dosage & Route of administration

After birth Sabin, OPV Zero dose, 2 drops on tongue
BCG 0.1ml, intradermal upper left arm no tuberculin
2,4,6 months Sabin, OPV 2 drops on tongue
pentavalent vaccine (DPT, 0.5 ml, IM Outer left mid-thigh
Hepatitis B, Haemophilus
Influenza type B)
9 months Sabin, OPV 2 drops on tongue
12 months Sabin, OPV 2 drops on tongue
MMR + Vitamin A Primary, one dose, 0.5 ml SC right arm
18 Months (booster dose) Sabin, OPV 2 drops on tongue
DPT 0.5 IM Outer left mid-thigh
MMR + Vitamin A 0.5 ml SC right arm

6- Management of sick children

• Early detection & management of sick children
• The integrated Management of Childhood Illness (IMCI) services include control of
diarrheal diseases , ARI, malnutrition
7- Referral services: Child care clinic staff should identify children who need to be
referred to higher levels of care to get specialized services
8- Out-reach services include:
• Providing services to people through home visiting ( for health education, immunization).
MCH services provided in the remote services deprived areas by mobile clinic
9- Social Care:
• To deal with the socioeconomic factors contributing to child morbidity & mortality

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 Rural Health
Where the agriculture is the main occupation of the population forms 58% of the
total population.
Problems of the rural communities
1- Socioeconomic Problems
2- Educational Problems
3- Cultural Believes that Contradict Good Health Behavior
4- Medical Services
5- Environmental Sanitation
a- Village Planning
b- Housing:
c- Water supply
d- Waste Disposal
d- Waste Disposal
e- Insects & Rodents
f- Food Sanitation
6- Urbanization Problem
Urbanization is the process of migration of people from rural to urban areas
Causes:
• Limited rural resources
• Better chance for work in the rural areas
• Better standard of living
• Students & their families migrate to urban areas
Hazards:
• Development of the slum areas
• Spread of communicable diseases (T.B., streptococcal infections)
• The social & psychological problems
• Deprive the village from the productive adults with subsequent failure of
rural community development
Control:
• Rural community development
• Motivation of educated adults to work in their native villages
• Motivate the providers of social , educational, & health services to live in
rural areas
• Set laws and regulations that control the migration process from the rural to
urban areas

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 Environmental Health
Air
Outdoor Air Pollution
Source in Egypt:
• Dust and sand , Power plants, Industrial wastes as the cement plants of Helwan,
, Motor vehicles, Garbage incineration and burning
Health Hazards:
Immediate or short term effects:
• Acute symptoms: eye irritation, respiratory irritation, bronchitis
• Headache, fatigue, nausea, allergic reactions, asthma
Long term effects:
• Respiratory morbidities: chronic bronchitis, asthma, emphysema
• Carcinogenic effects
• Abortion, congenital anomalies
• Psycho-somatic diseases & depression
Global Warming
• It has been recognized recently as a hazard to human health, it refers to the
gradual steady increase in the average temperature of the earth's surface over
the past 100 years
• It is due to continuous buildup of greenhouse gases in the atmosphere (carbon
dioxide, methane, nitrogen oxide)
• These gases enhance the troposphere's heat trapping capacity by allowing
incoming solar radiation , which heats the earth to pass & traps some heat that
is being radiated back to space from earth
Global warming can be reduced by:
• The use of more efficient energy technologies
• Limiting population growth
• Conserving energy
• The kyoto protocol (1997): which is an international and legally binding
protocol, the purpose of which is to reduce emissions of greenhouse gases,
was signed in 2005 by about 140 nations. The protocol requires developed
countries to reduce emissions by targeted amounts.
Ozone Depletion
• O3:a gas composed of three atoms of oxygen
• bluish gas that is harmful to breathe

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 • Nearly 90% of the Earth's ozone is in the stratosphere and is referred to as
the ozone layer
• Ozone absorbs a band of ultraviolet radiation called UVB
Effects
-- Skin Cancer (melanoma and nonmelanoma)
-- Premature aging of the skin and other skin problems
-- Cataracts and other eye damage
-- Immune system suppression
• The ozone hole is defined as the area having less than 220 dobson units
(DU) of ozone in the overhead column (i.e., between the ground and space).
Indoor Air Pollution
Sources
• There are many sources of indoor air pollution. Tobacco smoke, cooking,
heating appliances, and vapors cause pollution inside buildings.
• Pollution exposure at home and work is often greater than outdoors. Both
indoor and outdoor pollution need to be controlled and/or prevented
Effects of indoor air pollution
• Different groups of individuals are affected by air pollution in different ways.
• Some individuals are much more sensitive to pollutants than are others.
• Young children and elderly people often suffer more from the effects of air
pollution.
• People with health problems such as asthma, heart and lung disease may also suffer
more when the air is polluted.
Short-term effects include irritation to the eyes, nose and throat, and upper
respiratory infections such as bronchitis and pneumonia. Other symptoms can
include headaches, nausea, and allergic reactions.
• Short-term air pollution can aggravate the medical conditions of individuals
with asthma
Long-term health effects can include chronic respiratory disease, lung cancer,
heart disease, and even damage to the brain, nerves, liver, or kidneys.
Continual exposure to air pollution affects the lungs of growing children and may
aggravate or complicate medical conditions in the elderly.
Prevention:
• Avoid the sources of pollution as possible
• Proper ventilation

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 Water Quality and Health
Sources of water in Egypt
Nile River
• Main and almost exclusive resource of fresh water is the Nile River.
Rainfall and flash floods:
Groundwater in the deserts and Sinai
Possible desalination of sea water
Purification of Water
• It is a source of water that is not contaminated by dirt, bacteria, or chemicals
I-Steps of large scale water purification
• Precipitation by using Aluminum sulfate which helps to get rid of suspended
matter and 30% of the bacterial content
• Filtration get rid of 95% of the organisms
• Disinfection using chlorine : dose is 0.6 part per million to leave residual chlorine
of 0.2 ppm
II- deep underground water: needs no treatment but recently in areas where iron &
manganese are causing problems several methods used to precipitate these 2
elements
III- Shallow wells:
• Located wells at least 30 meters away from sources of contamination as latrines,
sheds
• Build a raised wall or a fence around the well to keep animals away
Other methods:
• Bacterial filters
• Boiling water
• The zeer in rural areas if properly used act as a water filter
Hospital Waste
Hospital Waste Management
A waste management plan should address these components of waste management:
Waste Labeling
• Should be established as part of a healthcare waste management plan
• Recommended waste label content:
– Date - Type of waste
• Point of generation (to allow tracking), Weight should be routinely
recorded, where possible.

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Waste Collection
• Should be established as part of a healthcare waste management plan
– Should ensure that waste from each area is collected at least daily
(except for sharps)
– Should ensure that containers are not overfilled
– Should ensure segregation is maintained
• Sharp waste should be collected when the box is 3/4th filled
Sorting: separating waste by type into color coded bags at the place where it is
generated
• Only a small % of the waste generate by a health care facility is medical waste
that must be specially handled
• Sorting at the generation site can reduce the amount that needs special handling
• Separate containers should be used for disposing general and medical wastes
• Colored plastic bags should be used to help distinguish between general and
medical wastes
A 3-bin system for waste sorting should be established as follow:
• Red bags used for infectious and pathologic waste that needs to be incinerated
• Yellow bags used for radioactive waste to be dealt with by atomic energy
institutions
• Black bags are for general waste
Waste Handling
• Should be established as part of a healthcare waste management plan
• Requires use of proper PPE
• Requires use of good body mechanics: the way we move when conducting activities
• Good body mechanics could protect the body from injury.
Interim storage: sorting waste within the facility until it can be transported for
final disposal
Final disposal: elimination of solid medical waste, liquid medical waste, sharps.
Big hospitals may have their own system for incineration
Sharps disposal: sharps should be discarded in safety boxes

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 Occupational Health
Definition by WHO: promotion and maintenance of the highest degree of physical,
mental and social well-being of workers in all occupations.
Occupational Hazards
1- Physical Agents
1- Heat
Heat cramps
Etiology: the body will loss water through evaporation of sweat, loss of fluid and
sodium chloride, causing heat cramps
Manifestations:
• Sever intermittent cramps of voluntary muscles
• May be the visceral muscles causing nausea, vomiting and colic
Prevention:
• Ensure physical fitness of workers
• Cooling of work place
• Giving suitable dose of prophylactic sodium chloride tablets
Treatment: Adequate dose of sodium chloride oral
Heat exhaustion:
Etiology: heat loss by sweating and marked peripheral vasodilatation
Manifestations: wet skin due to sweating, collapse and circulatory failure
Heat stroke
Etiology: failure of the body to loss heat in hot humid air
Manifestations: hyperpyrexia 40C or more, very hot dry skin, muscle cramps,
irritability.
Prevention: fulfilling requirements of cooling power of air
Management: the case must be immediately removed from adverse environment
and lowering body temperature by all means as ice bath give saline intravenously
Sun stroke: it is a form of heat stroke that result from severe exposure to sun rays
Etiology: action of sun rays, causing meningeal irritation, together with interference
with heat loss from the body
2- Cold: workers are exposed to low atmospheric temperature in cold storage rooms
Chilling & predisposing to respiratory infection: if body temperature reaches
below 28C confusion and loss of consciousness occur & death occur when body
temperature fall to 21C
Frost bite: caused by freezing conditions which cut off circulation, usually in
extremities (hands, feet, ears, nose), which may be permanently affected. Frost-
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bitten areas are cold, pale or marbled-looking, solid to the touch, and painless (until
circulation is restored).
Prevention: using suitable protective clothing & heating by radiators
3- High Pressure
Caisson workers and sea divers are exposed to high pressure while staying
deeply under water
If the process of decompression (returning to the surface) is rapid, they show
manifestations of caisson disease
Etiology:
• On exposure to high pressure more oxygen and nitrogen gases dissolve in
blood
• On rapid decompression there is rapid lowering of pressure causes bubbling
of the more dissolved gases
• Oxygen is going to be utilized by the tissues while nitrogen bubbles cause
embolic phenomena
Manifestations:
• Mild: skin manifestations, pain in the joints and muscles
• Moderate: meniere,s syndrome due to emboli labyrinth , manifested by
headache, nausea, vomiting, nystagmus, staggering gait, deafness
• Sever: emboli in CNS, parenthesis & weakness to total paralysis of the
lower extremities, monoplegia. Emboli in the heart & lung haemoptysis
Prevention: decompression of worker must be slow enough
Treatment: recompression where nitrogen bubbles re-dissolve, followed by slow
enough decompression in special pressure regulated unit
4- Low Pressure (high altitude sickness hypoxia) (mountain)
Hypoxia: is due to decrease O2 at high altitudes
Mechanical effects:
– Displacement of middle ear
– Abdominal distension by gases
– Dysnea & rupture emphysema
– Tooth ache
Physical effects:
– CNS: nausea, vomiting , mental confusion, disturbed speech
– GIT: nausea, vomiting , loss of appetite , abdominal pain
– CVS: tachycardia, increase in cardiac out put
Respiration: rapid deep respiration & periodic breathing

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Chronic Effect: increase pulmonary ventilation, blood pressure, O2 dissociation
curve, decrease metabolism
Prophylaxis: pressurized aeroplanes, supply O2 breathing apparatus, special
training of pilot, never work above 4000 meter height
5- Noise
6-Radiation
7-Poor lighting
8-Vibration
1-Chemical Agents
Pneumoconiosis
Silicosis: is the most frequent and disabling pneumoconiosis caused by inhalation
of silica dust that induces fibro-nodular reaction of the lung
Exposure: workers in the following industries are exposed to silica dust:
• Glass, pottery, ceramic, industries
• Sand blasting and mineral polishing
• Foundry workers
Manifestations:
• The lung shows nodular fibrosis after years of exposure
• The case suffer from progressive dyspnea, cough
• Right heart failure & total incapacity
• Increase the susceptibility to pulmonary tuberculosis
Asbestosis: is a mixture of fibrous silicates about 20 microns long
• Asbestos is used for manufacture of fireproof, and insulation material
Etiology:
• Inhalation of asbestos fibers causing diffuse fibrous scarring of lung, pleural
thickening and emphysema
• Cases of asbestosis are more susceptible to lung cancer
Byssinosis: due to exposure to cotton dust during two processes:
• Opening cotton bales, and spreading compressed lint
• Ginning of cotton
Etiology: allergen found in cotton dust, producing bronchospasm
Clinical picture:
1- Monday fever:
• It is the initial stage that appears after 10 or more years of exposure
• It is characterized by transient recurrent attacks of irritating cough and
respiratory manifestations:

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 • Appear on returning to work after weekend or other leaves , for some days
then disappear
Reappear after the next leave or rest and so on
2- Stage of asthma and bronchitis attacks
3- Stage of severe chronic bronchitis-emphysema syndrome, after about 20
years of exposure: stage of complete disability
Bagassosis
• Bagasse is the cellulose fiber of cane sugar after extraction of sugar
• It is dried to be used for manufacture of hardboard and insulating material
• Crushing bagasse in manufacture gives dust
• Inhalation of that dust causes bagassosis with acute respiratory
manifestations , after weeks of exposure
Farmers' Lung: is a disease condition caused by inhalation of spore bearing dust ,
on handling mouldy hay and straw
• Shortly after exposure, the farmer shows general and respiratory
manifestations (cough, dyspnea) , which are mild , temporary and self-
limited
• Manifestations disappear on stopping exposure to reappear on re-exposure
and so on
Benign pneumoconiosis
• Dust of iron, calcium, tin, barium, and coal is inert “Benign
pneumoconiosis”
• Anthracosis: coal miner's pneumoconiosis, coal dust disease: is caused by
long exposure to high concentrations of coal dust, in coal mining.
Prevention of pneumoconiosis
1- Dust control:
• Extraction of dust once formed during industrial process by local exhaust
ventilation system, the most effective measure
• Fine water – spray by special devices
2- Segregation of dusty process and automation of work if possible
3- Personal protection by masks or respirators
4- Health appraisal of exposed workers
• pre-placement medical examination
• Periodic medical examination
• Screened cases could either return to same work, with precautions and
supervision or shift to other work , according to medical decision

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