Department Of Community Medicine - GMC, Siddipet

Epidemiological Exercises

1. (a) What are the various measures of occurrence for a disease? How are the measures of occurrence of a disease related to each
other? (3marks)
(b)A sample of 1500 women in the age group of 70-74 years was selected from the population ofSiddipet.Amongthem,30 were
known cases of Rheumatoid Arthritis. After medical examination, 70 were newly diagnosed as Rheumatoid Arthritis cases.
Calculate the rates of occurrence of Rheumatoid Arthritis in the given sample population?(2marks)

Ans: (A) Measures of occurrence for a disease

i) Incidence
ii) Prevalence

Relationship between Prevalence and Incidence

Prevalence depends upon 2 factors, the incidence and duration of illness.
Given the assumption that the population is stable, and incidence and duration are unchanging, there lationship between
incidence and prevalence can be expressed as:

P=Incidence x Mean duration

(B) Given sample size of women (Sample Population) =1500

Given known cases of Rheumatoid Arthritis= 30
Given newly diagnosed cases of Rheumatoid Arthritis=70
Rates of Occurrence of Rheumatoid Arthritis in the given sample population=?

(i) Incidence = Number of new cases of Rheumatoid Arthritis during a given time period X 1000
Population at risk during that period

Incidence=70/1500 x1000=46.6

Incidence = 46.6 (~47) new cases of Rheumatoid Arthritis per 1000women.

(ii) Prevalence = Number of all current cases (old and new) of Rheumatoid existing at a given point in time X 100
Population at risk during that period

Prevalence = 100/1500x100 = 6.6

Prevalence=6.6 cases per100 women. (~7%)

The above prevalence is 6 units more than the National Prevalence of RA (National Prevalence:1%)
2. (a) What are the various measures for evaluation of a screening test? (3marks)

(b) A Simple and inexpensive screening test was developed to identify person with COPD. To study usefulness of the test,
cases were examined clinically and the results are shown in the following table. Calculate the Positive and Negative
Predictive value of the test. (2marks)
Disease
Yes No Total
Screening Positive 60 20 80
test Result Negative 40 80 120
Total 100 100 200

Ans: (a) Measures for Evaluation of a Screening Test

(i) Sensitivity
(ii) Specificity
(iii)Positive Predictive Value
(iv)Negative Predictive Value
(v)Percentage of False Negatives and False Positives

(b) Given Screening test results to identify COPD are,

Disease
Yes No Total
Screening Positive 60 (a) 20 (b) FP 80
test Result TP
Negative 40 (c) FN 80 (d) TN 120
Total 100 100 200

Total Population that participated in the COPD screening test=200

True Positive Test Results=60 Individuals
True Negative Test Results = 80 Individuals
False Positive Test Results = 20 Individuals False
False Negative Test Results=40 Individuals

Sensitivity = True Positive X 100

True Positive + False Negative

= ax100/a+c = 60x100/60+40
= 6000/100

Sensitivity = 60%

Specificity = True Negative X 100

True Negative + False Positive

= d x 100/ b+d = 80x100/80+20

= 8000/100

Specificity = 80%.
 Positive Predictive value = True Positive X 100
True Positive + False Positive
= ax100/a+b

= 60/60+20 x100

Positive Predictive value = 60/80 x100 = 75%

Negative Predictive value = True Negative X 100

True Negative + False Negative
= d x 100 / c+d

= 80/80+40 x100

Negative Predictive value = 66.6%

False Positive = False Positive X 100

False Positive+ True Negative

= bx100/b+d = 20x100/20+80
= 2000/100
False Positive = 20%

False Negative = False Negative X 100

False Negative + True Positive
= c x 100 / c+a = 40x100/ 40+60
= 4000/100
False Negative = 40%

3. A district has a total population 20,00,000. Of this, male population is 10,00,075 & female population is 9,00,025. Total No. of deaths
for the year 2018 in this district were 2935, out of which, 1,375 were male deaths & 1,560 were female deaths.
a) Calculate the Crude Death Rate of this district for the year2018.(2marks)
b) Calculate Sex Specific Death Rates for this district for the year2018.(2marks)
c) Name 2 Sources for Mortality data in India. (1mark)

Ans: Given,

Total Population of district = 20,00,000

Male Population of district = 10,00,075

Female Population of district= 9,00,025
Total Number of deaths recorded in the district(inyear2018)= 2935
Male death sin the district= 1,375
Female Death sin the district = 1,560
 (a) Crude Death Rate = Total Number of deaths in an year X 1000
Total Population in the year
=2935/20,00,000 x 1000

Crude Death Rate of the district = 1.4 deaths per 1000 population
(b) Sex Specific Death Rates:
Male Death Rate = Number of Male Death in an year X 1000
Total Male population in the year
= 1375/10,00,075 x1000
=1.37 male deaths per 1000 male population

Female Death Rate = Number of Female Death in an year X 1000

Total Female population in the year

= 1560/9,00,025 x1000
=1.73 female deaths per 1000 male population

(c) Sources of Mortality Data in India:

(i) National Census
(ii) Sample Registration System
(iii) Vital Events Registration

4. (a)What are the various Epidemiological Indices for Malaria? (2marks)

(b) Garrepally PHC covering population of 30,000 has following malaria related data for 2018 as follows.

Total number of slides examined =5000

Slides positive for MP = 268
Slides positive for P.falciparum = 30
Calculate the API,SPR of Garrepally for the year 2018. (2marks)

(c) What is the National Program related to Malaria in India? (1mark)

Ans)
(a) Epidemiological Indices for Malaria
i) Annual Parasite Incidence= Total Positive Slides for Malaria in a year x 1000/ Total Population
ii) Annual Blood Examination Rate= Smears examined in a year x 100 / Total Population
iii) Annual Falciparum Incidence= Total Positive P. falciparum in a year x1000/ Total Population
iv) Slide Positivity Rate=Total Positive Slides for Malaria x 100/ Total Slides Examined.
v) Slide Falciparum Rate =Total Positive Slides of P.falciparum x 100/Slides examined
 (b) Given,

Total Population under Garrepally PHC=30,000 People

Total number of slides examined=5000
Total slides positive for Malarial Parasite=268
Total slides positive for P. falciparum=30

(i) Annual Parasite Incidence of year 2018 = Confirmed cases during 1 year X 1000
Population under survelliance

= 268+30 x1000/30000
=293÷30
=9.93 Positive Slides for malarial parasite per 1000 slides
examined.

(ii) Slide Positive Rate = Total Slide Positive for malaria X 100
Total Slides Examined

= 268/5000 x 100

=5.36 Positive Slides for malarial parasite per 100 slides examined

(c) Programme for malaria is National Vector Borne Disease Control Programme(NVBDCP).Vector control
measures:1)Anti-adult measures, 2) Anti-larval measures and 3) Personal protective measures.

5. (a) As per the data recorded in Siddipet,10 women died due to puerperal sepsis, 5 women died during abortion in their
antenatal period, 3 women died in road traffic accidents and 15 women died during labor in the year 2018. There were
8000 live births. Calculate the maternal mortality rate of the town for the year 2018. (2 marks)

(b) List 4 causes of Maternal Mortality in India.(2marks)

(c) Name 2 National Programs or schemes in India directed to reduce maternal mortality. (2marks)

Ans: Given in the year 2018, Siddipet,

(i) Number of women died due to Puerperal Sepsis=10 women

(ii) Number of women died due to Abortion in Antenatal period=5women
(iii) Number of women died during labor =15women
(iv) Number of women died due to Road Traffic Accidents=3women
(v) Number of Live births=8000LiveBirths
 Therefore, Total Number of Maternal Deaths=10+5+ 15=30 Maternal Deaths

(a) Maternal Mortality Rate= Number of Maternal Deaths of Reproductive Age X 100000
Total Number of live births

= 30/8000 x 100000

=375 Maternal deaths per 100000 Live Births

(b) Causes of Maternal Mortality in India

1) Hemorrhage
2) Sepsis
3) Eclampsia
4) Obstructed Labor
5) Unsafe Abortion

(c) National Programme (or) schemes in India to reduce Maternal Mortality

Janani Suraksha Yojana

Janani Shishu Suraksha Karyakram

6. (a) Mention any 2characteristics of a screening test. (2marks)

(b) Calculate the Sensitivity, Specificity, PPV and NPV of USG in diagnosing calculi.(3marks)

Calculi
USG
Present Absent Total
Positive 90(TP) a 20(FP) b 110
Negative 10(FN) c 80(TN) d 90
Total 100 100 200

Ans) (a) Characteristics of Screening Tests:

1. Acceptability
2. Repeatability
3. Validity(accuracy)
4. Yield
 (b) Given Screening test results to identify COPD are,

Total Population that underwent in the USG for diagnosis of Calculi=200 Individuals
True Positive Test Results=90Individuals
True Negative Test Results = 80 Individuals
False Positive Test Results = 20 Individuals
False Negative Test Results=10Individuals

i) Sensitivity = True Positive X 100

True positive + False Negative

=90/90 + 10 x 100= 90 %

ii) Specificity = True Negative x 100

True Negative + False Positive

= 80/80+20 +100= 80 %

iii) Positive Predictive value = True Positive x 100

True Positive + False Positive

= 90/90 + 20 X 100= 81.8%

iv) Negative Predictive value = True Negative x 100

True Negative + False Negative
=80/80+10 x 100 = 88.8%

Given test USG is 90% sensitive and 80% specific in detecting renal calculi.

7. In a study of lung cancer, following data was observed. Total population studied was 810. Out of the 125 lung cancer patients
studied, 80 were smokers. Among the non-cancerous group of 685 members used for comparison, Smokers were 325.

(a) Construct a 2×2 table representing the above data. (1mark)

(b) What type of Epidemiological Study is this? (1mark)
(c) Calculate the Odd’s ratio and Comment?(3marks)

(a)
Disease
RISK Lung cancer present Lung cancer absent Total
FACTOR
Smoker 80 (a) 325 (b) 405
Nonsmoker 45 (c) 360 (d) 405
Total 125 685 810
 (b)This is a case-control type of epidemiological study.

Odds that cases were exposed to smoking =

(c) Odd’s Ratio

Odds that control were exposed to smoking ;

Odd’s ratio = a/b / c/d

= (axd)

(bxc)

= 80 x 360 = 1.97 ~ 2.00

325 x 45

Comment:

Therefore, the smokers are 1.97 times or twice at risk of developing lung cancer than non-smokers

8. A small town with adult population of 25,000 was followed for 10 years to study risk factors for heart disease. The data obtained at the
end of 10 years is as follows.

Heart Disease
Present Absent Total
Smoker 100 9900 10000
Non-Smoker 50 14950 15000
Total 150 24850 25000

(a) What type of epidemiological study design is this?

(b) What measures of disease risk can be calculated using this study design?
(c) Calculate RR of this study population and interpret.

Ans)
(a) Type of epidemiological study design : Prospective Cohort Study

Heart Disease
Present Absent Total
Smoker 100 (a) 9900 (b) 10000
Non-Smoker 50 (c) 14950 15000
(d)
Total 150 24850 25000

(b) Relative risk, Attributable risk, Population-Attributable risk can be calculated using cohort study design.
(c) Relative Risk = Incidence of disease among exposed population
 Incidence of disease among unexposed population

100/10000
50/15000

=3.03

Incidence rate of heart disease is 3.03 times or 200% more chance in the smokers when compared with non smokers.

9. The RNTCP data for Siddipet district was recorded as under for 2019 with a population of 50,00,000. Crude death rate of Siddipet is 6
per 1000 Population.

New sputum positive = 1500

Death due to TB = 150
Cases discharged as cured=80

Calculate, (i) Incidence of TB in2019,

(ii) CFR,
(iii) Specific death rate,
(iv)Proportionate Mortality Rate of TB

Ans: Given,

Total Population for Siddipet District (2019) =50,00,000

New Sputum Positive=1500
Deaths due to TB=150
Cases discharged as cured =80
Crude Death Rate =6 per 1000 population (=>30,000 per 50,00,000 population)
 Total deaths in the population intheyear2019 =30,000

(i) Incidence=No. of new sputum positive cases in the year 2019/ Total population at risk in the year 2019 X 1000
= 1500/50,00,000 X 1000
=0.3 per 1000 per year. Or 30 per 1 lakh population

(ii) Case Fatality Rate of TB = Number of deaths due to TB X 100

Total number of TB Cases

= 150/1500x100
Case Fatality Rate = 10 deaths due to TB per 100 TB cases

(iii) Specific Death Rate of TB = Number of death due to TB X 100000

Total Population of Siddipet

= 150/5000000 X 100000
= 3 deaths due to TB per 1 lakh population.

(iv) Proportional Mortality Rate of TB = Number of deaths due to TB X 100

Total number of deaths in population

=150/30,000 x 100
= 0.5%
10. (a) In Hyderabad cancer hospital, 4000 patients were operated for Ca-cervix in the year1970. Of them 550 cases survived
upto 1975. Calculate survival rate for ca-cervix? (2 marks)
(b)Name the National Program related to cancer in India. (1mark)
(c)What are the Preventive measures for Cancer Cervix? (2marks)

Ans: Given number of patients operated for Cancer Cervix in the year1970=4000

Number of patients survived for Cancer Cervix till the year 1975=550

(a) 5 – year survival rate = Number of cases alive after 5 years X 100
Number of cases alive at beginning

= 550/4000 x 100

= 13.75 % of cancer patients who were operated survived for ≥ 5 years.

(b) National Program related to cancer in India National Programme for Prevention and
Control of Cancer, Diabetes, CVD and Stroke (NPCDCS)

(c) Preventive measures for Cancer Cervix:

(i) VaccinationofyoungadolescentsagainstHPVvaccine(CervarixorGardasil)
(ii) Education to reduce high risk sexual behavior
(iii) Avoiding other risk factors like early marriage and childbearing, smoking
(iv) Regular screening of women and treatment of pre-cancerous lesions.

11.(a)What are Mortality indicators? (2marks)

(b) Name 2 Sources of Mortality data in India. (1mark)
(c) The midyear population of Puppuru is 3,00,000 which had 2,000 live birth 1100 deaths and 65 infant deaths. Calculate
Crude Death Rate and IMR? (2marks)

Ans: (a) Measures of death in a population are known as mortality indicators.

They are traditional methods of measuring health.
They are of 3type: i)Crude Mortality Rates : Crude Death Rate
ii) Specific Mortality Rate : Age Specific Mortality Rate
iii) Special Mortality Rates : Maternal Mortality Rate,
Infant mortality Rates
Case Fatality Rates

(b) Verbal Autopsy, Civil Registration of Death, Hospital Records, Sample Registration System, Mortality survey
 , Health Surveillance data, Post Mortem Records, Burial Ground Records.

(c) Given,
Mid-Year Population=3,00,000
Live births =2000
Infant deaths=65
Total deaths=1100

Crude Death Rate = Total Number of Deaths X 1000

Mid-Year population
= 1100/3,00,000 x 1000
=3.66 per every 1000 Mid-year Population

Infant Mortality Rate = Total Number of Infant Deaths X 1000

Total Live Births

= 65/2000 X 1000

=32.5 per 1000 Live births

12. Calculate requirement of bleaching powder for disinfection of well having height of 7meters, height of water column 5.5
meters and diameter 2.5meters.

of well =
𝜋𝑑2h X 1000
Ans: Volume
4

=3.14x2.5x2.5x5.5/4x1000

=26984lit

6 gm of bleaching powder is required to disinfect 455 lit of water

6gm ---------- 455 litres

 ? --------------26984 lit of water

6X26984/455=355gm of bleaching powder is required to disinfect the well

13.In a Primary School in certain village having 300 students of which 07 students developed diphtheria and 12 students from the
same class having contact with the cases developed diphtheria. Out of 300, 200 students are immunized. Calculate secondary attack
rate. What is the importance of SAR? Mention the SAR of any two diseases.

Ans: Secondary Attack Rate = No. of persons developing disease within a range of IP x 100
Total number of susceptible persons

= (12/93)x100=12.9%

=Secondaryattackrateofdiphtheriainthatprimaryschoolis12.9%.

What is the importance of SAR?

• It is a measure of communicability of a disease

• It helps in evaluating the effectiveness of control measures like isolation & Immunization.
• Helps in understanding a disease of unknown origin is communicable or not

DISEASE SECONDARY

ATTACKRATE
SMALLPOX 30-45%

MEASLES >80%

CHICKEN POX ~90%

MUMPS ~86%

PERTUSIS ~90%

14.Classify epidemics? Identify the graph and interprete?

Ans: Three major types of epidemics

 1. Common source epidemics: a) single exposure or point source epidemics b) continuous or multiple exposure
epidemics
2. Propagated epidemics: a) person to person, b) arthropod vector and c) animal reservoir
3. Slow or modern epidemics.

The above graph has one peak and it is a point source epidemics. Examples: Food poisoning

Main features of point source epidemic are:

1. The epidemic curve rises and falls rapidly with no secondary waves.

2. Theepidemictendstobeexplosivewithclusteringofcaseswithinanarrowintervaloftime.

3. All cases develop within one incubation period of the disease.

15. A circular well with diameter of 2m & depth of water Column 3.6m is to be chlorinated. On doing Horrock’s test, blue colour was
developed in third cup. Calculate the amount of bleaching powder required for disinfection of well. Explain double pot method of
disinfecting well.

Ans: Volume of water = 3.14d2h

4

Volume of water= 3.14x2x2x3.6

4

= 45.2/4=11.304X1000=11304litres

3rdcup showing blue colour discoloration=3 X 2 = 6gms

If 6 gms of bleaching powder is required to disinfect 455 litres of water

No of required grams to disinfect for 11304 litres = 11304 X6/ 455

=149gms

DOUBLE POT METHOD: National Environment Engineering Research Institute, Nagpur-introduced Double Pot method

Requirements: -2 cylindrical pots- one placed inside the other, inside height and diameter is 30cm and 25cm respectively,
for the outer pot. The inner pot with a hole of 1cm diameter in the upper portion and outer pot has hole with same
diameter above 4cm from bottom.

Procedure: A mixture of 1kg bleaching powder + 2kg coarse sand the inner pot filled with mixture and placed inside the
outer pot and outer pot mouth covered with polyethylene foil. The double pot is lowered into the well with rope 1m below
the water level
 Advantages: Can be used for 2-3 wks satisfactorily for a small house hold

Can disinfect wells with 4500 liters of water with a draw flow rate 360-450 liters per day.

Can be used in emergencies.

16. A community block area with mid near population of 95000 there were 2800 live births in the year 2018 following word the
number of deaths:
Number of deaths(>28weeks of gestation)=21Deaths
within7days of birth=33
Deaths within 7-28 days of birth=57
Deaths during 29 days to less than 1 year of age =55
Maternal deaths =4
Under 5 deaths=180

Calculate MMR, still birth rate, perinatal mortality rate, neonatal mortality rate, infant mortality rate and under 5mortality
rate
Ans:

MMR for the year2018

Maternal Mortality Rate = Number of Maternal Deaths of Reproductive Age X 100000

Total Number of live births

=4/2800X 100000

=142 per 100000 live births

PERINATAL MORTALITY RATE

Fetal deaths plus neonatal deaths per1,000 livebirths:
(Late fetal deaths ( 28 weeks of gestation and more) + Early neonatal deaths ( first week) / Number of live
births)X 1,000.
For the year 2018 itis= 21+33/2800X1000
= 19.28 per1000 live births and stillbirths.

NEONATAL MORTALITY RATE

Number of individuals dying at less than 28days of age per 1,000livebirths:

=(Number of deaths of children under 28days of age / Number of live births)X1,000

=33+57X1000/2800
=32.14 per 1000 live births.

INFANT MORTALITY RATE

Deaths of individuals less than 1year of age per 1,000 live births:

=(Number of infant deaths <1yr/Number of live births)X1,000

=145/2800X1000
 =51.7 per1000 live births

17. The no. of children under 1 year of age in the area served by your primary health centre is 2,500, you are currently half way
through a supply period of one month. The stock records show that you have a stock of 1500 doses of measles vaccines
with you. (Measles Wastage Multiplying Factor is 2 for that PHC)

a) Is there too much/too little measles vaccine in stock?

b) What are the possible causes of this situation?
c) What actions would you take to correct?

Solution

• Total no.of children under1year of age = 2500

• No.of Children to be vaccinated per month= 2500/12=208.333=209
• Total dose per child= one dose
• Wastage Multiplication Factor(WMF)for measles=2 1.33

No. of doses required per month= No. of Beneficiaries X No. of Doses X Measles Vaccine Wastage Factor

=209X1X1.33= 278 doses per month

• Stock record available Measles Vaccine stock=1500

• The requirement of doses=278
• Now it is“ half way through month” =278/2=139 doses have to be given
• Excess stock is available = 1500– 139=1361

Inference: There fore, too much measles vaccine is in stock.

b) POSSIBLECAUSESARE

a. Not utilizing properly

b. Inadequate dose
c. Wrong calculation

c) Action

• Distributing remaining doses to other centers or returning back to Vaccine Cold storage.

• Above things to be corrected

18. As a Medical Officer of PHC of Telangana State, with a population of 30,000 you have to order for right quantities of vaccines
required for one year. How will you estimate the vaccine requirements based on number of beneficiaries. (2011 Telangana Census -
Birth rate = 17.8/1000 & IMR = 47/1000) (Estimate vaccine requirement for following vaccines only;

o BCG(WMF=50%); Polio(WMF =90%); Pentavalent (WMF =90%); Measles(WMF =25%)

Solution
 Estimating Eligible beneficiaries:
 Number of pregnant women = Population x Birth rate
 Number of infants at 1 year of age = Population x Birth rate x (1-IMR)
 Vaccine requirements :
 Total number of pregnant women or infants to be covered x Expected coverage x Number of doses of the
vaccine x Wastage multiplication factor / No.of sessions to be held (or number of doses per vial)
 Number of pregnant women = Population x Birth rate
 = 30,000 x 17.8/1000 = 534 live births.
 Number of infants at 1 year of age = Population x Birth rate x(1-IMR)
 = 30000 x 17.8/1000 x 1-47/1000)
 =30000 x17.8/1000 x ( 1000-47/1000)
 = 30000 x 17.8/1000 x 953/1000 = 50890.2/100
 = 508.902 = 509.

Vaccine schedule by age and number of doses.

Vaccine Vaccine schedule by age No of doses

BCG Atbirth 1
Pentavalent At 6,10 &14weeks 3
Polio(OPV) At birth,6,10 &14weeks 4
Measles At 9months 1

Calculating the wastage multiplying factor

The wastage factor is the factor(number)that you multiply your estimated vaccine needed in order to allow for the doses
being wasted.
Wastage multiplying factor(WMF)=100 ÷(100-%wastage rate)
Wastage multiplying factor(WMF)

vaccine Acceptable vaccine wastage rate Formula for WMF WMF

BCG 50% 100 ÷ (100 - 50) 2.00
Polio 10% 100 ÷(100 - 25) 1.11
Pentavalent 10% 100 ÷ (100 - 5) 1.11
Measles 25% 100 ÷(100 - 25) 1.33

• Estimateofactualvaccinedosesneededforvariouspercentagetargetsforimmunizationcoverageforestimated509infantsin30000p
opulation.

• Total number of beneficiaries x Expected coverage x No.of doses of vaccine x WMF

BCG Vaccine Requirement = No.of doses per vial

=509 X 100/100 X 1 X2 = 1018.

Number of vials required = 1018/10 = 101.8

• Total number of beneficiaries x Expected coverage x No.of doses of vaccine x WMF

Polio Vaccine Requirement =
 No.of doses per vial

= 509 x 100/100 x 4 x 1.11

= 2259.96

Number of vials required = 2259.96 / 10 = 226

• Total number of beneficiaries x Expected coverage x No.of doses of vaccinexWMF

Pentavalent Vaccine Requirement = No.of doses per vial

=509x100/100x3x1.11

= 1694.97 /10.

Number of vials required = 1694.97 / 10 = 170

• Total number of beneficiaries x Expected coverage x No.of doses of vaccinexWMF

Measles Vaccine Requirement = No.of doses per vial

= 509x100/100x1x1.33

= 676.97 / 10

Number of vials required = 676.97 / 10 = 68

vaccine No.of Actual no .of WMF No.of doses Vaccine

doses doses needed pervial Vials required
BCG 1 509 2.00 10 101.8
Polio 4 2036 1.11 10 226
Pentavalent 3 1527 1.11 1 170

Measles 1 509 1.33 10 68

19.In a study, left mid arm circumference(MAC) of 500 children aged 3to5 year, attending different anganwadi centers of a taluk
was measured. Data obtained is given here:
 Number of Children
MAC (in cm)

14 100
13.5 150
13 150
12.5 50

12 50
Total 500

How you will interpret the nutritional status of children and give your advice?

Solution:

• Mid arm circumference (MAC) measurement is the easiest method of assessing malnutrition status in children
of 2 to 5 year.

Stratification of nutritional status by mid arm circumference

Number of
Nutritional status MAC(in cm) Anganwadi percentage
Children
Satisfactory >13.5 250 50%
Mild to moderate
malnutrition 12.5-13.5 200 40%

Severe malnutrition <12.5 50 10%

Total 500

Interpretation

a. From the data we can interpret,

b. Out of 500 children studied, nutritional status of 250 children(50%) is satisfactory.
c. 200 children (40%) are having border line malnutrition
d. Only50 children (10%) are severely malnourished.

Advice for supplementation

 a. As Anganwadi Centers have growth charts of weight for age, those who were malnourished may be verified by these
charts. If children are found to be malnourished, supplementary nutrition is advised.

b. Regular nutritional supplementation providing 300 Kcal and 10 gm of protein is continued for normal children.

c. Additional supplementary nutrition of 300 Kcal (i.e. 300 + 300 kcal and 10 + 5-10 gm of protein) protein is provided
to borderline and severely malnourished children.

d. Malnourished children should be regularly kept under supervision.

e. Referral services needed, if the yare not improving.

Additional measures required

a. Iron and folic acid tablets

b. Vitamin A solution

c. De-worming treatment

d. Follow-up care and Periodic surveillance.

e. Nutritional education to mothers

f. Nutritional rehabilitation services for needed.

 Drinking water quality analysis

1. The district public health laboratory has analyzed a sample of water from an area. The analysis report gave the following
details of the water sample. Compare with the acceptable standards and comment on there port.

Parameter Observed value

Turbidity 1NTU
Total dissolved solids 400mg/L
Total hardness 500mg/L
Fluoride 1mg/L
Nitrates 60mg/L
E coli 10/100mL

Answer:
Comparison of the Analysis Report and Acceptable Standards (BIS,India2012):
Maximum permissible
Acceptable Value
Parameter Observed value limits(in the absence of an
alternate source of water)
Turbidity 1NTU 1NTU 1NTU

Total dissolved solids 400mg/L 500mg/L 2000mg/L

Total hardness 500mg/L 200mg/L 600mg/L
Fluoride 1mg/L 1mg/L 1.5mg/L
Nitrates 60mg/L 45mg/L No relaxation
Must not be
E coli 10/100mL detectable in any of No relaxation
the100 mL sample

Comments:
• Turbidity; total dissolved solids and fluoride content are within acceptable limits.
• The given water sample contains E.coli, which must not be present in any 100-mL sample of protected water. Usually,
it indicates faecal contamination. To prevent further contamination of water, the cause(s) should be identified and
measures should be taken to protect the water supply. Chlorination of water should be done.
• Total hardness level is high. High level of hardness may cause scale deposition in the water distribution system and
will result in excess soap consumption and scum formation. Hardness of water should be removed by boiling / by
adding lime or sodium carbonate.
• Nitrate is high in amount. It may be due to excess free ammonia in water. Excess nitrate may be due to the use of
nitrogenous fertilizers and manures in agriculture, waste water disposal and contamination of water with human and
animal excreta. Biological denitrification is required for removal of high nitrate levels in surface water.
Possiblesourceofcontaminationshouldbefoundandpreventivemeasuresshouldbeapplied.
Conclusion: This water is not suitable for drinking.
2.Comment with recommendations on the following water quality report of a water sample from a village.

Parameter Observed value

Turbidity 8NTU
Total dissolved solids 1100mg/L
Total hardness
300mg/L
Fluoride 1mg/L
Nitrates 20mg/L
E coli 10/100mL

Answer:
Comparison of the Analysis Report and Acceptable Standards (BIS,India2012):

Maximum permissible
Acceptable Value
Parameter Observed value limits(in the absence of an
alternate source of water)
Turbidity 8NTU 1NTU 1NTU

Total dissolved solids 1100mg/L 500mg/L 2000mg/L

Total hardness 300mg/L 200mg/L 600mg/L
Fluoride 1mg/L 1mg/L 1.5mg/L
Nitrates 20mg/L 45mg/L No relaxation
Must not be
E coli 10/100mL detectable No relaxation
inanyofthe100 mL
sample

Comments:
• Turbidity of water is high. Drinking water must be free from turbidity. The turbidity or muddiness is due to the presence of
mud, clay, silt and such other particulate matters. Turbidity interferes with disinfection of water.
• Total dissolved solids, fluoride content and Nitrates are with in acceptable limits.
• Total hardness level is with in acceptable limits .
• The given water sample contains E.coli, which must not be present in any 100-mL sample of protected water. Usually,
it indicates faecal contamination. To prevent further contamination of water, the cause(s) should be identified and
measures should be taken to protect the water supply. Chlorination of water should be done.
Conclusion: This water is not suitable for drinking.