Health situation in India, Concept

of control, Iceberg Phenomenon

Dr Purva Shoor
Asst. Prof. Community
Medicine
Dated 05/11/2016
 Health situation in India
Indicators or vital statistics like MMR,
IMR, Age specific morbidity and
mortality
Indicate variables in extent of a given
population and time constraint,
subject to change
Incidence/Prevalence
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 Communicable Diseases
Malaria
95 percent population lives in
malaria endemic area
80 percent of malaria is reported
from 20 percent(least) populated
areas-tribal, desert, hilly and
inaccessible areas
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 Communicable Diseases
Tuberculosis
1.2 million new cases
annually(incidence)
0.64 million new sputum smear
positive
0.32 million deaths attributable
to TB
Diarrheal Diseases
One in ten child deaths among
under-5 years children
Second most common cause of
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 Communicable Diseases
Pneumonia
4 lakh deaths attributable to it
13-16% deaths in paediatric age
group
Leprosy
India ranks first in new cases of
leprosy annually
Filariasis
Endemic in 250 districts across 20
States and Union Territories of India.
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 Communicable Diseases
HIV/AIDS
India has the third highest
number of people living with HIV
in the world with 2.1 million
infected cases.
HIV treatment coverage is only
36% in India.
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Non Communicable Diseases
These account for 53% of all
deaths and 44% DALY in India
Diabetes Mellitus: India has the
highest number of diabetic cases
in the world.
Cancer: India reports about one
million new cases every year.
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 Non Communicable Diseases
Cardiovascular Diseases: Prevalence
of heart failure in India due to
coronary heart disease, hypertension,
obesity, diabetes and rheumatic heart
disease ranges from anywhere
between 1.3 to 4.6 million
According to the WHO, cardiovascular
diseases, which affect the heart and
the blood vessels resulting in heart
attacks or strokes in extreme cases,
account for 26% of deaths in India, or
2.5 million.
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 Non Communicable Diseases

Cataract is the most common

cause of preventable blindness
in India.

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 Environmental sanitation problems:
Some 400 million people defecate in open
and 44% mothers dispose their childrens
faeces in open.
India accounts for 60% of global and 50%
of its own population open defecation.
About 48% children in India suffer from
some degree of malnutrition.
There is an increased female school
dropout rate in the adolescent age due to
lack of toilet facilities.
Only 25% have drinking water on their
premise

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Health Situation in India Remarks
Communicable Diseases Reduced burden, manageable
epidemics, National Programs
have been oriented, Polio
eradication, National
immunization Schedule, High TB
and HIV burden
Non-communicable Diseases Highest number of Diabetics in
the world, 53% burden of non-
communicable diseases, rise in
cancers due to environmental
pollution and tobacco
consumption
Maternal and Child Health Low performing indicators, Needs
stringent adherence to program
implementation, and provision of
quality care in low performing
states
Sanitation Low access to safe drinking
water, social mobilization towards
prevention of open defecation,
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micronutrient and macronutrient
 Nutritional Problems in
India
Vitamin D Deficiency with spectrum of
diseases
Calcium Deficiency

Vitamin B complex deficiencies: Nearly 80%

Indians have vitamin B12 deficiency-veggies
Zinc deficiency: high among lactating women
in India. Nearly 50% non-pregnant and
lactating women in India have zinc deficiency.

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 Nutritional Problems in India

28% children born in India are of LBW

Protein Energy Malnutrition (PEM):

The prevalence of stunting among
under-five children is 48%, wasting
19% and underweight, 42.5%.
Xerophthalmia is most common
among children aged 1-3 years.

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 Nutritional Problems in India
Nutritional Anaemia: Affects 50%
of population mainly women of
adolescent and child bearing age
groups
Iodine Deficiency Disorders

Fluorosis

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 Other Health problems
Adolescent health
Geriatric age problems owing to
increase in life-span
Maternal health
Mental health
Paediatric population
....................................................
.Vulnerables!!

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Concept of disease
control

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 Control
Malaria- early diagnosis and treatment,
vector control prevents new cases from
occurring!!!
Disease occurs in numbers which ceases
to be of Public health importance!!!
Which means, agent is present, cases may
be present but spread is under CONTROL
as compared to previous years, because
of public health efforts(manageable)
No epidemic but endemicity present, but
not outnumbering usual expectancy

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 Elimination
When new cases are almost
zero!!!
Over the expanse of large
geographic area
But the burden is there, because
Agent is present in the
environment, spread and
carriers are almost not present
through efforts like vaccination,
sanitation, nutrition
Precursor of eradication
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 Eradication
Termination of all transmission
of infection by extermination of
infectious agent
Means: There is no threat of
agent as it is completely unlikely
to affect humans as it is
completely destroyed
Vaccination
No chronic carrier, no known
cases, and no potential of
transmission
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 What do we do to control a disease?

Reduce incidence/new cases-prevent

mosquito breeding and treatment of cases
Reduce duration of disease and risk of
transmission-Malaria prompt treatment,
insecticide treated bed nets
Prevent physical and psychosocial
consequences-early diagnosis and
treatment
Prevent Financial burden- cost of treating
cases reduced for government, manpower
days of labor wasted are reduced

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 Control in chronic diseases
Example: Pandemic of Diabesity
Identify risk factors
List the modifiable
Choose 2-3 modifiable most
likely factors to work upon
Prevent or control its occurrence
before the need to treat

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 Iceberg phenomenon
Disease in a community is compared
to an iceberg
Floating tip-what a physician sees or
symptomatic patients
Submerged portion- under-diagnosed
or inapparent carriers or at risk
people
Waterline-demarcation between
apparent and inapparent
Example hypertension, mental illness,
typhoid Mary
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 How do we plan strategies of
control?
Through a set of national and state
guidelines called Disease control or
eradication programs
To detect if we have achieved what
we are supposed to, and hence
promote health..we perform certain
analysis through
Monitoring
Surveillance
Evaluation
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 Difference between!!
Monitoring?

Surveillance?

Evaluation?
All mentioned are part of control
measures
Dictionary meaning is the same

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Monitoring
Ongoing check through routine
measurements to identify the burden of
the problem by measuring changes in
health status or environment
Example, 1. regular measurement of
childs height and weight is a step
towards monitoring the efficacy of
Anganwadis(ICDS) , 2. MCI inspection
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 Surveillance

Continuous scrutiny of factors affecting

health states and events, their
determinants and distribution through
sophisticated and professional
analysis(epidemiology and statistics)
Example, Every year collecting and
compiling data of weight for age in
children, and investigating factors that
collate with the analysis by the
investigator
It helps to formulate plans and policies of a
program, continuous quality improvement

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 Types of surveillance
Nutritional

Non communicable disease

Demographic
Sentinel

Epidemiological

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 Evaluation
In built in every program
Cross checking that patients are
satisfied, objectives are met within
time laid down in program planning
Gives insight on the most rewarding
process, inputs and outputs of a
program
Example: input-growth charts,
procedure-proper nutrition, output-
normal weight range, outcome-healthy
child and satisfied mothers

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 Summary
India is having enormous population
vulnerable to different communicable
and non-communicable diseases
With increase in life expectancy,
chronic diseases have added burden
Sanitation and hygiene are still
lacking owing to poor water supply
and poverty stricken areas
Very large population in various
terrains with still poor access to
health facilities
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 Summary
Control-Agent not a public health
threat
Elimination-zero new cases reported
but agent present in environment
Eradication-Agent is completely
destroyed, no possibility of spread,
no cases

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 Summary
Monitoring-measurements to detect changes

Surveillance- continuous scrutiny to formulate

future plans, studies factors affecting health
states Sentinel-sites having major influx of a
disease with highest case reporting
Evaluation-cross-checking whether targets
and objectives are met with efficiency,
effectiveness and efficacy

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 THANK YOU!!!

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