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What is Health

● Earlier, health was thought to be just the absence of disease (Biomedical Concept).
● But now, it means being at peace with oneself, the community, God, and the cosmos.
● In 1977, the 30th World Health Assembly (an important global meeting) decided that health is not just
about being free from illness but includes many other factors.

Different Concepts of Health

There are three major ways to understand health:

a) Ecological Concept

● Health depends on a balance between humans and their environment.

● If the balance is disturbed (like pollution, poor sanitation, or climate changes), it can lead to diseases.
● Example: Dirty water can cause infections like cholera.

b) Psycho-social Concept

● Health is not just about the body but also about how people feel mentally, socially, and emotionally.
● It is influenced by:
○ Social factors: Relationships, family, and community support.
○ Psychological factors: Stress, anxiety, and mental health.
○ Cultural factors: Beliefs, traditions, and values.
○ Political factors: Government policies and healthcare systems.
● Example: Mental stress due to work pressure can affect physical health.

c) Holistic Concept

● This concept combines all factors mentioned above.

● It suggests that to stay healthy, we need to take care of our body, mind, relationships, environment,
and spiritual well-being.
● Example: A person who eats well, exercises, has good relationships, and feels emotionally stable is
considered truly healthy.

WHO Definition of Health:

● "Health is a state of complete physical, mental, and social well-being and not merely the absence of
disease or infirmity."
● It also includes the ability to lead a socially and economically productive life.

Dimensions of Health:

a) Main Dimensions:

1. Physical Dimension:
○ Refers to the proper functioning of the body.
○ A healthy person has no illness or physical discomfort.
○ Example: Eating healthy, exercising, and avoiding infections.
2. Mental Dimension:
○ Refers to emotional and psychological well-being.
○ A mentally healthy person can handle stress and maintain balance.
○ Example: Coping with problems, managing stress, and staying positive.
3. Social Dimension:
○ Refers to the ability to build and maintain healthy relationships.
○ Good communication, teamwork, and mutual respect are signs of social health.
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○ Example: Having supportive friends and family.
4. Spiritual Dimension:
○ Refers to a sense of purpose, meaning, and connection with a higher power.
○ It gives inner peace and satisfaction.
○ Example: Practicing meditation, prayer, or reflecting on life’s purpose.
5. Emotional Dimension:
○ Refers to understanding and managing emotions effectively.
○ Emotional health helps a person handle stress and build positive relationships.
○ Example: Expressing feelings appropriately and staying calm under pressure.

6. Vocational Dimension:
○ Refers to being satisfied and productive in your work or career.
○ A healthy work-life balance contributes to overall well-being.
○ Example: Enjoying your job and maintaining work-life balance.

b) Other Dimensions:

● Philosophical Dimension: Understanding of life and existence.

● Nutritional Dimension: Balanced diet and proper nutrition.
● Cultural Dimension: Influence of cultural beliefs on health.
● Socio-economic Dimension: Impact of income, education, and status.
● Environmental Dimension: Clean and safe surroundings.
● Educational Dimension: Awareness and knowledge about health.
● Creative Dimension: Using creativity to improve well-being.

Positive Health and Concept of Well-being

Positive Health

● Positive Health means the perfect functioning of the body and mind.
● It is not just about the absence of disease but also about:
○ Physical fitness – No illness and a strong body.
○ Mental well-being – Peace of mind and good emotional health.
○ Social well-being – Good relationships and being part of a supportive community.

Concept of Well-being

Well-being means feeling happy, healthy, and satisfied with life. It includes:

a) Standard of Living

● Standard of Living refers to the usual level of comfort and material goods a person enjoys.
● It includes:
○ Education level – How educated a person is.
○ Food and nutrition – Quality and quantity of food available.
○ Housing and shelter – Type and condition of the home.
○ Clothing and appearance – Basic clothing needs.
○ Recreational services – Opportunities for fun, hobbies, and relaxation.
○ Other services – Healthcare, transport, and sanitation.

✅ WHO Definition:

● According to the World Health Organization (WHO), standard of living includes:

○ Income and occupation – How much a person earns and their type of job.
○ Housing standards – Quality and safety of the living space.
○ Sanitation and nutrition – Cleanliness and availability of healthy food.
○ Health and education services – Access to healthcare and schooling.
○ Recreational and other services – Facilities that contribute to a better life.
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b) Level of Living

● Level of Living goes beyond material things and looks at 9 components:

1. Health – Overall physical and mental condition.
2. Food consumption – Nutrition and diet.
3. Education – Access to learning and knowledge.
4. Occupation and working conditions – Type of work and environment.
5. Housing – Quality of living space.
6. Social security – Protection and assistance during times of need.
7. Clothing – Basic apparel requirements.
8. Recreation and leisure – Time for fun, relaxation, and hobbies.
9. Human rights – Basic freedoms and protection.

✅ Objective:

● The goal is to improve human well-being, where health is considered the most important
component.

c) Quality of Life

● Quality of Life refers to the subjective feelings of happiness and satisfaction.

● It includes:
○ Happiness – Feeling content and positive.
○ Satisfaction – Feeling fulfilled with life.
○ Freedom of speech – Ability to express opinions freely.
○ Sense of justice – Feeling treated fairly and equally.

✅ Main Point:

● Quality of life depends on how emotionally, mentally, and socially satisfied a person feels, not just
material wealth.

Summary:

● Positive Health means the perfect balance of physical, mental, and social well-being.
● Well-being includes three major parts:
○ Standard of Living – Basic needs like food, shelter, and education.
○ Level of Living – Broader factors like health, work, and rights.
○ Quality of Life – Happiness, satisfaction, and freedom.
● Good health is the most important part of well-being.

Determinants of Health Conditions

1. Biological Determinant: These are factors related to genetics

and body functions that affect health.

● Genetic Predisposition: Inherited traits that may

increase the risk of certain diseases.
● Age: Health risks vary with age, e.g., older people are more prone to chronic diseases.
● Sex: Men and women may experience different health conditions.
● Physiological Conditions: Body functions and systems influence overall health.

2. Behavioral Determinants: These are lifestyle choices and habits that impact health.
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● Diet and Nutrition:

○ Double Burden of Disease: Some children are malnourished (underweight), while others are
obese.
● Physical Activity:

○ WHO Recommendation: At least 150 minutes of moderate physical activity per week.
○ NFHS-5 (2019-21):
■ 18.7% of women in India are underweight.
■ 24% are overweight or obese.
● Substance Abuse: Use of tobacco, smoking, drugs, and alcohol harms health.

● Stress Management: Chronic stress affects both physical and mental health.

3. Environmental Determinants

Factors in the environment that influence health.

● Air and Water Quality:

○ According to WHO, air pollution contributes to approximately 7 million premature deaths

annually due to respiratory and cardiovascular diseases.
● Sanitation and Hygiene:

○ UNICEF (2020):
■ Neonatal mortality in India reduced to 20 per 1,000 live births.
■ Under-5 mortality reduced to 32 per 1,000 live births.
● Housing Conditions: Poor housing may increase the risk of diseases.

● Climate Change: Heat stress and vector-borne diseases affect health.

4. Socioeconomic Determinants

These include social and economic factors that affect health.

● Income and Poverty: Low income leads to poor health outcomes.

● Education: Better education is linked to improved health.
● Occupation: Job conditions affect overall well-being.
● Social Support: Strong support reduces stress and improves well-being.
● Political Conditions: Government policies influence public health.

Summary:

Health is influenced by biological, behavioral, environmental, and socioeconomic factors. Improving lifestyle,
environment, and education can lead to better health outcomes.

Health Indicators: Measuring Population Health

What Are Health Indicators?

Health indicators (HIs) are used to measure and track the health status of a population. They provide data that
helps in identifying health trends, evaluating policies, and improving healthcare systems.

1. Mortality Indicators

These indicators measure death rates and life expectancy.

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● Crude Death Rate (CDR): Number of deaths per 1,000 people per year.
● Infant Mortality Rate (IMR): Number of infant deaths (under 1 year) per 1,000 live births.
● Maternal Mortality Rate (MMR): Number of maternal deaths per 100,000 live births.
● Life Expectancy: Average number of years a person is expected to live.

2. Morbidity Indicators

These indicators assess the presence of diseases in a population.

● Incidence Rate: Number of new cases of a disease per 1,000 people in a given time period.
● Prevalence Rate: Total number of existing cases of a disease per 1,000 people.

3. Disability Indicators

These indicators measure the impact of diseases and disabilities on quality of life.

● Disability-Adjusted Life Years (DALY): Years lost due to illness, disability, or premature death.
● Quality-Adjusted Life Years (QALY): Years of life adjusted for the quality of life.

4. Nutritional Indicators

These indicators assess the nutritional status of the population.

● Stunting: Low height for age due to chronic malnutrition.

● Wasting: Low weight for height due to acute malnutrition.
● Underweight: Low weight for age, indicating poor nutrition.

5. Healthcare Delivery Indicators

These indicators assess the availability and quality of healthcare services.

● Doctor-to-Population Ratio: Number of doctors available per 1,000 people.

● Hospital Bed Occupancy Rate: Percentage of hospital beds occupied at a given time.

6. Social and Mental Health Indicators

These indicators assess the well-being of a society.

● Crime Rates: Reflects safety and security levels, impacting mental health.

7. Environmental Indicators

These indicators evaluate the impact of the environment on health.

● Air Quality Index (AQI): Measures air pollution levels.

● Access to Safe Drinking Water: Percentage of the population with access to clean water.

8. Composite Indicators

These combine various factors to give a broad picture of population health.

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● Physical Quality of Life Index (PQLI):

○ Life Expectancy at Age One: The average number of years a person is expected to live after
reaching one year of age.
○ Infant Mortality Rate (IMR): The number of infant deaths (under 1 year) per 1,000 live births.
A lower IMR indicates better healthcare and living conditions.
○ Literacy Rate: The percentage of people who can read and write. Higher literacy improves
awareness and decision-making about health and lifestyle.

● Human Development Index (HDI):

○ Life expectancy at birth.

■ The average number of years a newborn is expected to live. Higher life expectancy
reflects better healthcare and living conditions.
○ Education index (mean and expected years of schooling).
■ Mean Years of Schooling: Average years of education received by adults.
■ Expected Years of Schooling: Number of years a child is expected to attend school.
○ Gross National Income (GNI) per capita.
■ The total income generated by a country divided by its population. It indicates the
standard of living and economic development.

Summary:

Health indicators help in understanding and improving population health by tracking mortality, disease
patterns, nutrition, healthcare access, and environmental factors.

Concept of Disease

A disease is a condition that makes the body work differently than it should. It can cause symptoms like pain,
fever, or weakness. Diseases can happen because of germs, inherited traits, or things in the environment. They
can upset the body's normal balance and may need treatment to help the person get better.

Classification of Disease

A. Infectious vs. Non-Infectious Diseases

(i) Infectious Diseases

These are diseases caused by microorganisms like bacteria, viruses, fungi, and parasites. They can spread from
one person to another.

Examples:
1. Tuberculosis (TB)
2. Influenza (Flu)
3. COVID-19
4. Malaria
5. HIV/AIDS
6. Hepatitis B and C
7. Dengue Fever
8. Cholera
9. Typhoid Fever
10. Measles
11. Chickenpox
12. Rabies
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Modes of Transmission:

● Droplet Transmission: Spreads through coughing or sneezing (human-to-human).

● Aerosol Generating Procedures: Happens during medical or dental procedures.
● Gastrointestinal Secretions: Spread through feces, saliva, or anal secretions.
● Fomites: Transmission through contaminated surfaces.
● Sexually Transmitted: Spread through semen.
● Other Body Fluids: Includes blood, urine, and tears.
● Mother to Child Transmission: Happens before birth (intrauterine transmission).

Types of Contact:

● Direct Contact: Physical contact with an infected person.

● Indirect Contact: Contact with contaminated surfaces or objects.
● Vector-Borne Diseases: Spread through insects like mosquitoes.
● Airborne Diseases: Spread through the air.

(ii) Non-Infectious Diseases

These diseases are not caused by microorganisms and do not spread from person to person.

Causes:

● Genetic Factors: Inherited from parents.

● Lifestyle Choices: Poor diet, lack of exercise, smoking, etc.
● Environmental Exposures: Pollution, radiation, etc.

Examples:

● Diabetes Mellitus
● Hypertension
● Cancer

Risk Factors:

● Genetic Predisposition: Family history of the disease.

● Lifestyle Choices: Healthy fats (PUFA) should be included in the diet.
● Environmental Factors

★ Disease: Identified by doctors based on symptoms.

★ Sickness: A social term referring to how society views an ill person.
★ Syndrome: A group of symptoms occurring together.

Acute vs. Chronic Diseases

(i) Acute Diseases

● Definition: Sudden onset and short duration.

● Resolution: May go away on their own or require medical treatment.
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Examples:

● Common Cold
● Appendicitis
● Acute Bronchitis

(ii) Chronic Diseases

Definition: Develop slowly and last for a long time, often for life.

Management: Requires continuous medical care.

Examples:

● Diabetes
● Hypertension
● Asthma
● Arthritis
● Chronic Kidney Disease

Congenital vs. Acquired Diseases

(i) Congenital Disease

Definition: Present at birth, caused by genetic factors or abnormalities during development.

Examples:

● Down Syndrome
● Cleft Palate
● Congenital Heart Defects
● Sickle Cell Anemia
● Spina Bifida

(ii) Acquired Diseases

Definition: Develop after birth due to infections, environmental factors, or lifestyle choices.

Examples-

● Tuberculosis
● Malaria
● HIV/AIDS
● Chronic Obstructive Pulmonary Disease (COPD)
● Cancer

Classification of Diseases

Diseases can be classified based on various criteria:

1. By Cause (Etiology)
o Infectious Diseases: Caused by pathogens such as bacteria, viruses, fungi, or parasites (e.g.,
tuberculosis, COVID-19).
o Non-infectious Diseases: Result from genetic, environmental, or lifestyle factors (e.g.,
diabetes, cancer).
2. By Mode of Transmission
o Communicable Diseases: Spread from person to person (e.g., influenza, HIV).
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o Non-communicable Diseases: Not contagious; often linked to genetics, lifestyle, or
environmental factors (e.g., heart disease, asthma).
3. By Duration
o Acute Diseases: Develop rapidly and last for a short period (e.g., influenza).
o Chronic Diseases: Persist for a long time, often for life (e.g., arthritis).
4. By System Affected
o Respiratory Diseases: Affect the lungs and airways (e.g., asthma).
o Cardiovascular Diseases: Affect the heart and blood vessels (e.g., hypertension).
o Neurological Diseases: Affect the brain and nervous system (e.g., Alzheimer's).
5. By Origin
o Congenital Diseases: Present at birth (e.g., Down syndrome).
o Acquired Diseases: Develop after birth due to infection, injury, or lifestyle (e.g.,
tuberculosis).
6. By Severity
o Mild Diseases: Cause minimal impact on daily life (e.g., common cold).
o Severe Diseases: Significantly impact health and may be life-threatening (e.g., cancer).
7. By Pathological Changes
o Structural Diseases: Involve anatomical changes (e.g., tumors).
o Functional Diseases: Affect body functions without visible structural changes (e.g.,
migraines).

The natural history of disease refers to the progression of a disease in an individual over time, without medical
intervention. It describes the stages a disease goes through from its initial development to its final outcome.

Stages of the Natural History of Disease

1. Stage of Susceptibility
o The person is healthy but at risk of developing the disease.
o Risk factors like poor lifestyle, genetic predisposition, or environmental exposure increase
the likelihood of illness.
2. Stage of Subclinical Disease (Incubation or Latent Period)
o The disease has begun to develop, but there are no noticeable symptoms yet.
o For infectious diseases, this is known as the incubation period.
o For chronic diseases, this hidden phase is called the latent period.
3. Stage of Clinical Disease
o Symptoms become visible. These may range from mild to severe.
o Diagnosis and medical treatment often occur at this stage.
4. Stage of Recovery, Disability, or Death
o Depending on the disease and treatment, the outcome may be full recovery, lasting health
issues (disability), or death in severe cases.

Example: Influenza (Flu)

● Susceptibility: Being in close contact with someone infected.

● Subclinical Stage: The virus is present, but you don’t feel sick yet.
● Clinical Stage: Symptoms like fever, cough, and body aches appear.
● Outcome: Recovery with rest, or complications if the illness worsens.

Understanding these stages helps in disease prevention, early diagnosis, and effective treatment planning.

The pre-pathogenesis stage is the first phase in the natural history of disease. This stage occurs before the
disease actually develops in the body.

Key Features of the Pre-Pathogenesis Stage

● The person is still healthy but may be exposed to risk factors.

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● The disease-causing agent (pathogen) has not yet entered the body.
● Factors like lifestyle, environment, and genetic conditions may increase the chance of illness.

The pathogenesis stage is the phase in the natural history of disease where the disease process starts
developing in the body. This stage begins when the harmful agent (like a virus, bacteria, or toxin) enters the
body and initiates changes that may lead to illness.

Key Features of the Pathogenesis Stage

● The pathogen has invaded the body, and internal changes are taking place.
● This stage is divided into two parts:

1. Subclinical Phase (Early Pathogenesis):

o The disease is developing, but no symptoms are present yet.
o For infectious diseases, this is called the incubation period.
o For chronic diseases, it's known as the latent period.
2. Clinical Phase:
o Symptoms appear, ranging from mild to severe.
o This is when diagnosis and treatment usually happen.

The four stages of prevention expand on the traditional three levels by adding a crucial step before primary
prevention. These stages are:

1. Primordial Prevention

● Focuses on preventing the development of risk factors before they emerge.

● Targets social, economic, and environmental conditions that influence health.
● Aims to create healthier living conditions to reduce the likelihood of diseases appearing in the first
place.

Examples:

● Promoting healthy eating habits in schools.

● Implementing policies to reduce air pollution.
● Encouraging physical activity as part of community planning.

2. Primary Prevention

● Focuses on preventing the onset of disease by controlling risk factors.

● Targets individuals who are healthy but at risk.

Examples:

● Vaccinations.
● Promoting exercise, healthy diets, and smoking cessation.
● Using protective equipment like helmets and seat belts.

3. Secondary Prevention

● Focuses on early detection and prompt treatment to halt disease progression.

● Targets individuals who already have the disease but may not yet show symptoms.
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Examples:

● Cancer screening programs.

● Blood pressure checks to detect hypertension early.
● Routine dental check-ups to prevent cavities.

4. Tertiary Prevention

● Focuses on reducing complications, disability, and improving quality of life for those with established
diseases.
● Aims to minimize the impact of chronic conditions.

Examples:

● Rehabilitation programs after a stroke.

● Insulin therapy for diabetes management.
● Support groups for mental health conditions.

Summary:

● Primordial = Prevent risk factors.

● Primary = Prevent disease.
● Secondary = Detect and treat early.
● Tertiary = Manage and reduce long-term effects.

Community Diagnosis (Understanding Health Issues)

1. Defining the Community – Identify the people and location being studied, considering social and economic
factors.

Example: We choose to study a village where many children are thin and weak because they don’t have
enough healthy food.

2. Collecting Data – Gather information from surveys, hospital records, and interviews.

Example: We go house to house and ask families about their food, water, and illnesses

3. Analyzing Health Problems – Identify common diseases and risk factors.

Example: We discover that in a crowded city area, many people have tuberculosis (a serious lung disease)
because they live too close to each other and don’t get enough fresh air.

4. Assessing Health Needs – Find gaps in healthcare services and vulnerable groups.

Example: In a tribal area, pregnant women don’t have doctors nearby, so they don’t get proper check-ups
before having their babies.

5. Prioritizing Issues – Decide which health problems need urgent action.

Example: In a village where people suffer from both malaria and high blood pressure, we focus on malaria first
because it spreads quickly and can make people very sick in a short time.
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6. Involving the Community – Work with local leaders, healthcare workers, and organizations.

Example: We team up with schoolteachers to teach children about handwashing and clean water.

7. Planning and Implementing Solutions – Create and apply action plans like mobile clinics.

Example: We bring a mobile health clinic to a remote village where there is no hospital.

8. Monitoring and Evaluation – Check if the solutions are working.

Example: After vaccination camps, we check if fewer babies are dying from diseases.

Community Treatment Approaches (Solving Health Issues)

1. Prevention – Vaccination programs, hygiene campaigns.

2. Treatment – Providing healthcare through clinics and mobile units.

3. Rehabilitation – Helping people recover, such as physiotherapy or addiction support.

4. Palliative Care – Providing comfort for terminally ill patients at home.

Example Case Study

A rural area had high maternal deaths. Solutions included awareness programs, better emergency care, and
trained health workers. As a result, hospital births increased by 50%, and maternal deaths dropped by 30%.

Conclusion

By diagnosing and addressing community health issues, long-term improvements in public health can be
achieved.

ICEBERG MODEL

The Iceberg Model is used in community diagnosis to explain that health problems we see (like diseases) are
just the tip of the iceberg. The real causes of these problems are hidden underneath, just like the bigger part of
the iceberg under the water.

Parts of the Iceberg Model

1. Visible Part (Above the Water) → The Symptoms

These are the obvious health problems we can see, such as diseases, deaths, or hospital visits.

Example: Many children in a village are getting sick with diarrhea.

2. Hidden Part (Below the Water) → The Causes of the Problem

Just Below the Surface: Immediate Causes → These are the direct reasons for the disease.

Example: The children are drinking dirty water.

Deeper Below: Underlying Causes → These are problems related to the community’s lifestyle, behavior, and
environment.
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Example: There is no clean water supply in the village, and people don’t know about hygiene.

Deepest Level: Root Causes → These are big social and economic issues that affect the whole community.

Example: The government has not built proper water facilities because the village is poor and lacks resources.

Example of the Iceberg Model in Real Life

Let’s say a lot of people in a city have lung diseases.

Above the Water (Symptoms): Many patients come to hospitals with lung problems.

Just Below the Surface (Immediate Causes): The air in the city is polluted.

Deeper Below (Underlying Causes): There are too many factories and vehicles releasing smoke, and people
don’t wear masks.

Deepest Level (Root Causes): There are no strict government laws to control pollution, and industries don’t
care about the environment.

Why is the Iceberg Model Important?

It helps us understand that health problems are not just about diseases, but about deeper social, economic,
and environmental issues.

Instead of only treating the disease, we solve the root causes to prevent future problems.

It reminds us that real change needs deep thinking and action, not just quick fixes.

So, when we diagnose a community, we don’t just treat the symptoms (what we see), but we dig deeper to
solve the hidden issues under the iceberg

■Basic triad Of analytic Epidemiology

□Agent

□host

□environment

Epidemiological Triads

The occurrence and transmission of diseases are intricately linked to the interplay between three main factors:
agent, host, and environment.

1. Agent :

The agent is the entity responsible for causing a disease.

There are several types:

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• Biological Agents: These are the microorganisms responsible for causing diseases. Types include:

• Bacteria (e.g., Staphylococcus aureus causing skin infections).

• Viruses (e.g., Influenza virus). • Fungi (e.g., Candida albicans causing oral thrush).

• Parasites (e.g., Plasmodium falciparum causing malaria).

• Prions (e.g., causing Creutzfeldt-Jakob disease).

•Mechanical Agents: Exposure to chronic friction and other Mechanical forces ex.
Injuries,fractures,dislocation, etc.

. • Chemical Agents: Harmful substances that lead to disease or health issues. ◦ Example: Lead exposure can
cause lead poisoning; pesticides may lead to poisoning.

•Physical Agents: Environmental factors like radiation, heat, or trauma that trigger diseases. ◦ Example:
Prolonged exposure to UV radiation can result in skin cancer; loud noise may lead to hearing loss.

• Nutritional agents: Diseases caused by inadequate nutrients. ◦ Example: Lack of vitamin C causes scurvy;
iodine deficiency leads to goiter.

• Social and Behavioral Agents: Risky behaviors or social factors leading to diseases, ◦ Example: Smoking
causes lung cancer; alcohol consumption can lead to liver cirrhosis.

2. Host

The host is the organism (typically human or animal) that harbors the disease. Several factors influence
susceptibility:

• Biological Characteristics: Age, sex, genetic makeup, and immunity. ◦ Example: Older adults are more prone
to influenza; genetic predisposition may increase the risk of Type 2 diabetes. • Lifestyle and Behavior: Activities
or habits that increase exposure to agents. ◦ Example: Poor hygiene can lead to cholera; lack of exercise may
lead to obesity.

• Pre-existing Conditions: Chronic illnesses that weaken immunity. ◦ Example: People with HIV are more
susceptible to opportunistic infections like tuberculosis.

• Socioeconomic Status: Living conditions and access to healthcare ◦ Example: Malnourishment in low-income
populations can lead to diseases like kwashiorkor

3. Environment The environment consists of external factors and conditions that allow the agent to survive
and influence the host.
Environmental factors that can significantly impact the transmission dynamics of diseases are:-

• Physical Environment: Climate, geography, and pollution levels. ◦ Example: Warm, humid climates are
conducive to mosquito breeding, increasing malaria transmission; exposure to air pollution can lead to
respiratory illnesses like asthma.
• Social Environment: Human interactions, population density, and cultural practices. ◦ Example: Overcrowded
urban areas can accelerate the spread of airborne diseases like tuberculosis; unhygienic community practices,
such as lack of handwashing, promote the spread of gastrointestinal infections like cholera.
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• Economic Environment: Access to healthcare, education, and public health infrastructure. ◦ Example: Poor
sanitation systems in underdeveloped areas contribute to the spread of waterborne diseases like typhoid; lack
of immunization programs can result in outbreaks of preventable diseases like measles.
• Ecological Environment: The interaction between humans, animals, and ecosystems. ◦ Example:
Deforestation can bring humans into closer contact with zoonotic reservoirs like bats, which may lead to the
emergence of diseases such as Ebola.

The cycle of infection

The cycle of infection:-

The cycle of infection involves several essential components:

● reservoirs,
● portal of exit,
● modes of transmission,
● portal of entry,
● susceptible host, and
● infectious agents.
The cycle of infection involves several essential components: reservoirs, portal of exit, modes of transmission,
portal of entry, susceptible host, and infectious agents.

1. Infectious Agents
These are the microorganisms responsible for causing diseases. Types include:
• Bacteria (e.g., Staphylococcus aureus causing skin infections)
. • Viruses (e.g., Influenza virus)
• Fungi (e.g., Candida albicans causing oral thrush).
• Parasites (e.g., Plasmodium falciparum causing malaria).
• Prions (e.g., causing Creutzfeldt-Jakob disease).
2. Reservoirs
The reservoir is where the infectious agent resides, grows, and multiplies. These can be:
• Humans: People with symptomatic or asymptomatic infections. ◦ Example: A person with tuberculosis.
• Animals: Often referred to as zoonotic reservoirs. ◦ Example: Rodents for Hantavirus: bats for rabies
. • Environment: Soil, water, or other inanimate objects. ◦ Example: Clostridium tetani (tetanus-causing
bacteria) in soil.
3. Portal of Exit
This is the path by which the infectious agent leaves the reservoir to infect others. Common portals include:
• Respiratory Secretions: Sneezing or coughing (e.g., Influenza, COVID-19).
• Bodily Fluids: Blood, urine, or feces (e.g., HIV, Hepatitis B).
• Skin Lesions: Open wounds or cuts (e.g., Streptococcus infections).
• Other Exits: Semen, vaginal secretions, or breast milk (e.g., STDs).
4. Modes of Transmission
This is how the agent moves from the reservoir to the host. Categories include:
• Direct Contact: Physical contact, such as touching or sexual activity. ◦ Example: Spread of STDs like syphilis.
• Indirect Contact: Through contaminated objects (fomites). ◦ Examp/e: Shared needles in Hepatitis B.
• Droplet Transmission: Large respiratory droplets in close contact. ◦ Examp/e: Spread of Influenza through
sneezing,
• Airborne: Small particles suspended in air. ◦ Example: Tuberculosis spreads via aerosols.
• Vector-Borne: Through insects or animals. ◦ Example: Malaria spread by mosquitoes.
• Waterborne/Foodborne: Ingestion of contaminated water or food. ◦ Example: Cholera through contaminated
water.
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5. Portal of Entry This is the route through which an infectious agent enters a new host. Common portals
include:
• Respiratory Tract: Inhalation of droplets (e.g., COVID-19).
• Digestive Tract: Consuming contaminated food or water (e.g., typhoid fever).
• Skin: Entry through cuts, wounds, or intact skin (e.g., tetanus)
. • Mucous Membranes: Eyes, nose, or mouth (e.g., measles).
• Bloodstream: Through needles or insect bites (e.g., malaria).
6. Susceptible Host
A susceptible host is a person or organism who lacks immunity or is more vulnerable to infection. Factors
influencing susceptibility include:
• Age: Children and elderly have weaker immune system
. • Immunity: Lack of vaccination or natural immunity (e.g., non-immunized individuals are susceptible to
measles).
• Health Conditions: Chronic diseases like diabetes or HIV can suppress immunity.
• Lifestyle: Poor nutrition, smoking, or lack of exercise may weaken the immune system.
By interrupting one or more components of this cycle-such as improving hygiene, vaccinating susceptible
hosts, or eliminating vectors--disease transmission can be effectively prevented.

Characteristics of invasion of disease by agent

These characteristics often determine:

1. How easily an infectious agent spreads (infectivity).
2. How likely it is to cause disease (pathogenicity).
3. The severity of the disease it causes (virulence).
4. Its interaction with the immune system (antigenicity).

Incubation: Time interval between initial contact with an infectious agent and appearance of the first sign or
symptom of disease in question.

Communicability: Period of communicability is the time during which an infectious agent may be transferred
directly or indirectly from an infected person to another person, from an infected animal to humans, or from
an infected person to animals. Also known as the ‘infectious period’.

Latent Period: The period between exposure and the onset of the period of communicability, which may be
shorter or longer than incubation period.

Susceptibility: The state of being susceptible (easily affected / infected). A susceptible person does not possess
sufficient resistance against a particular pathogen to prevent contracting that infection or disease when
exposed to the pathogen.

Immunity: The condition of being immune, protected against an infectious disease conferred either by an
immune response generated by immunisation or previous infection. Different types of immunity include:

Active Immunity: resistance developed by a host in response to a stimulus by an antigen (infecting agent or
vaccine), usually characterised by antibody produced by the host.
Passive Immunity: Immunity conferred by an antibody produced in another host and acquired naturally by an
infant from its mother or artificially by administration of antibody-containing preparations e.g. anti-serum or
immunoglobulin.
Specific Immunity: A state of altered responsiveness to a specific substance acquired through immunisation or
natural infection. In certain diseases this protection can last for the life of the individual.
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Acquired Immunity: Resistance acquired by a host as a result of previous exposure to a natural pathogen or
foreign substance for the host e.g. immunity to measles following measles infection.
Herd immunity: The level of immunity in a population which prevents epidemics, based on the resistance to
infection of a proportion of individual members of the group sufficient to prevent widespread infection
amongst non-immune members . The proportion required varies according to agent, transmission
characteristics and distribution of immune and susceptibles within the population.

Types of carriers
A. Type
1. Incubatory: are those who shed the infectious agent during the
incubation period of disease.
2. Convalescent: those who continue to shed the disease agent during the
period of convalscence.
3. Healthy: these emerge from subclinical cases.
B. Duration
1. Temporary: are those who shed the infectious agent for short periods
of time.
2. Chronic: is one who excretes the infectious agent for indefinite
periods.
C. By Portal of exit
Urinary, intestinal, respiratory, others. In typhoid fever urinary carrier is more
dangerous than the intestinal carrier

Disease spread rate

1. Epidemic

Definition: A sudden increase in the number of disease cases in a specific population, region, or community,
surpassing the expected levels.

Scope: Restricted to a particular area but may spread if not controlled.

Example:

The 2014 Ebola outbreak in West Africa affected countries like Guinea, Liberia, and Sierra Leone.

2. Pandemic

Definition: A large-scale outbreak of a disease that spreads across multiple countries and continents, impacting
a significant portion of the global population.

Scope: Global or international.

Example:

The COVID-19 pandemic that began in 2019 spread worldwide, affecting millions.

The 1918 Spanish Flu infected nearly one-third of the world’s population.

3. Endemic
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Definition: A disease that is consistently present within a specific geographic region or population, with
predictable and stable patterns over time.

Scope: Confined to a particular area and occurs regularly.

Example:

Malaria remains endemic in many parts of sub-Saharan Africa.

Chickenpox is endemic in most parts of the world due to low-level but continuous transmission.

4. Sporadic

Definition: Diseases that occur infrequently and irregularly, with isolated or scattered cases that do not follow
a predictable pattern.

Scope: Scattered and isolated.

Example:

Rabies cases in humans occur sporadically, often after animal bites.

Tetanus occurs sporadically in areas with low immunization coverage.

Summary:

Epidemic: Rapidly spreading in a region.

Pandemic: Global spread of disease.

Endemic: Persistent occurrence in a region.

Sporadic: Rare, irregular cases.

VACCINES
It is an immunobiological substance designed to produce specific protection
against a given disease.
It stimulates the production of protective antibody and other immune
mechanisms.
Live vaccines
Live vaccines (ex: BCG, measles, oral polio) are prepared from live
microorganisms.
These organisms have been passed repeatedly in the laboratory in tissue
culture or chick embryos and have lost their capacity to induce full blown
disease but retain their immunogenicity.
Inactivated or killed vaccines
Organisms killed by heat or chemicals, when infected into the body stimulate
active immunity. They are usually safe but less efficacy than live vaccines.
Toxoids
Certain microorganisms produce exotoxins ex: diphtheria and tetanus bacilli.
The toxins produced by these organisms detoxified and used in the preparation
of vaccines.
Cellular fractions
Vaccines, in certain instances, are produced from extracted cellular fractions.
Ex: meningococcal vaccine from the polysaccharide antigen of cell wall.
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Combinations
If more than one kind of immunizing agent is included in the vaccine, it is
called a mixed or combined vaccine. Ex: DPT, DP, DT, DPT and typhoid.