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Community Health & Tropical Medicine Revision

Community Health & Tropical Medicine UNMEB Past Papers ✨

Prepared by Nurses Revision! Let's dive in! 😊

Paper 1 - Section A: Objective Questions (MCQs)

1. Which of the following priority areas should a Primary Health Care program focus on?

(a) Personal hygiene and sanitation.
(b) Punishing all thieves.
(c) Having local council meetings.
(d) Creating a link between two parties.

✅Correct Answer: (a) Personal hygiene and sanitation.

Explanation:Primary Health Care (PHC) is all about keeping people healthy where they live. Things like clean water, safe toilets, and keeping yourself clean (personal hygiene) are super important for preventing diseases. This is a direct way to improve health at the community level.(Think about how many diseases spread because of poor sanitation!)
Why other options are wrong:

(b) Punishing thieves: This is important for law and order, but not a health priority area for a health program. That's a job for the police and courts.
(c) Having local council meetings: While local councils are important and can support health programs, the meetings themselves aren't a direct health priority area. They are a way to organize the community.
(d) Creating a link between two parties: This is too general. PHC involves working with many groups, but the core focus is on health activities, not just any kind of link.

2. Which of the following is NOT a pillar of Primary Health Care?

(a) Inter sectoral collaboration.
(b) Community participation.
(c) Appropriate technology.
(d) Accessibility of services.

✅Correct Answer: (d) Accessibility of services.

Explanation:Simple🤔However, when we talk about the specific *pillars* (the main supports) that make PHC work, the widely recognized ones are: Intersectoral Collaboration (different sectors working together), Community Participation (people involved), Appropriate Technology (using suitable tools and methods), and Equitable Distribution of Resources (making sure services are fair and available to everyone).
Why other options are (usually) pillars:

(a) Inter sectoral collaboration: Absolutely a pillar. Health needs help from education, agriculture, water, etc.
(b) Community participation: Essential pillar. PHC is not done *for* the community, but *with* them.
(c) Appropriate technology: Key pillar. Using tools and methods that the community can afford and manage.

3. The major aim of health education in Primary Health Care activities is to

(a) provide appropriate care to the community.
(b) improve health of the community.
(c) meet the needs of the cornmunity.
(d) make a health plan for the future.

✅Correct Answer: (b) improve health of the community.

Explanation:Health education gives people knowledge and skills so they can make healthier choices, prevent diseases, and manage their conditions better. When people do this, the overall health of the community improves!💡It's a tool used to reach the bigger goal of better health.
Why other options are wrong:

(a) provide appropriate care: Health education helps people seek care and manage conditions, but it's not the *provision* of care itself (like giving medicine or treatment).
(c) meet the needs of the community: Health education helps address health needs, but the *major aim* is the positive outcome on health status. Meeting needs is broader than just education.
(d) make a health plan for the future: Making plans is a separate activity, often done by health professionals and community leaders. Education helps inform the plan and get support, but isn't the planning itself.

4. Which of the following factors promote community mobilisation?

(a) Political interest.
(b) Appropriate language.
(c) Past bad experience.
(d) Poor relationship.

✅Correct Answer: (b) Appropriate language.

Explanation:Community mobilisation is about getting people together and motivated to work on a common goal. If you use language that people understand and connect with (appropriate language), they are more likely to get involved and feel included. Good communication is key to building trust and motivation!🗣️🤝
Why other options are wrong:

(a) Political interest: While political *support* can help, political *interest* alone doesn't guarantee the community will mobilize. It's an external factor that might help but isn't a direct *promoter* from within or in the interaction.
(c) Past bad experience: This would definitely *hinder* mobilisation, not promote it. People would be hesitant to join if previous efforts failed or were negative.
(d) Poor relationship: Like bad experiences, poor relationships between health workers and the community, or among community members, will make it harder to mobilize people.

5. Which of the following best explains a community based health program?

(a) The community is involved in planning and implementation.
(b) There is no outside assistance given in running community programs.
(c) Only members of the community are given offices.
(d) Offers training to the community members.

✅Correct Answer: (a) The community is involved in planning and implementation.

Explanation:A community-based program means the community isn't just receiving services, they are active partners in making the program happen. They help decide what's needed (planning) and help carry out the activities (implementation). This involvement makes the program more relevant and sustainable.🧑‍🤝‍🧑🗺️
Why other options are wrong:

(b) There is no outside assistance: Community-based doesn't mean isolated. Outside help (from government, NGOs, etc.) is often needed, but the key is the community's *central role*, not the absence of others.
(c) Only members of the community are given offices: While community members often take leadership roles, this isn't the *defining* feature. The involvement in planning and doing the work is the core idea.
(d) Offers training to the community members: Training is a common activity in community-based programs to build capacity, but it's a *part* of implementation, not the best explanation of the overall concept.

6. Which of the following is NOT a characteristic of a Primary Health Care practical approach?

(a) Have social development dimensions.
(b) Acceptable and affordable.
(c) Making essential health care universally accessible.
(d) Should not be determined by social goals.

✅Correct Answer: (d) Should not be determined by social goals.

Explanation:PHC is strongly driven by social goals like equity, social justice, and community empowerment. It aims to address the *social determinants* of health (like poverty, education). So, saying it "should not be determined by social goals" is completely against the spirit of PHC!🚫🌍
Why other options are characteristics:

(a) Have social development dimensions: Yes, PHC recognizes that health is linked to things like education, income, and equality (social development).
(b) Acceptable and affordable: Yes, for PHC to be practical and used by the community, it must be acceptable (culturally right) and affordable (people can pay for it).
(c) Making essential health care universally accessible: Yes, a core goal is that basic health services are available to everyone, no matter where they live or how much money they have.

7. Which of the following indicates the need for community participation?

(a) Soliciting for external support.
(b) Clear understanding of the project goal.
(c) Good leadership and administration.
(d) Self reliance in the set up projects.

✅Correct Answer: (d) Self reliance in the set up projects.

Explanation:We need community participation because we want the community to eventually be able to manage their own health projects and solutions (self-reliance). Involving them from the start builds their capacity, ownership, and ability to continue activities even without outside help.💪🏠
Why other options are wrong:

(a) Soliciting for external support: External support might be needed, but the *need* for participation is more about empowering the community itself, not just getting funds from outside.
(b) Clear understanding of the project goal: A clear understanding is important for *effective* participation, but the *need* for participation exists even if understanding is initially low; participation helps *build* that understanding.
(c) Good leadership and administration: Good leadership *facilitates* participation, but it's not the *reason* we need participation. The need comes from wanting the community to own and manage the initiative.

8. Which of the following is NOT a concept of equity?

(a) Justice.
(b) Fairness.
(c) Inequality.
(d) Equality.

✅Correct Answer: (c) Inequality.

Explanation:Equity in health means everyone has a fair chance to be as healthy as possible. It's about justice and fairness.⚖️🤝Inequality means there are unfair differences in health status or access to care, which is the *opposite* of equity. While equity doesn't always mean strict *equality* (giving everyone the exact same thing), it means giving different support as needed so everyone can reach a similar good outcome (which is a form of fairness/justice, sometimes called health equity vs. health equality). But inequality is definitely what equity tries to *remove*.
Why other options are related to equity:

(a) Justice: Equity is a fundamental aspect of social justice in health.
(b) Fairness: Equity is essentially about fairness in health opportunities and outcomes.
(d) Equality: While equity is not always the same as giving everyone an *equal amount* of resources, the goal of equity is to achieve greater equality in health outcomes by addressing different needs. It's related, though equity is often seen as the *means* to achieve equality in health.

9. The process of enabling people increase control over the determinants of health and thereby improve their own health is

(a) health education.
(b) health promotion.
(c) health prevention.
(d) health care.

✅Correct Answer: (b) health promotion.

Explanation:This is the classic definition of health promotion, according to the Ottawa Charter!🌟It's about empowering individuals and communities to understand and influence the factors that affect their health (like their environment, lifestyle, social support, etc.).
Why other options are wrong:

(a) health education: This is an important *tool* used in health promotion, but health promotion is broader than just giving information.
(c) health prevention: This is about preventing diseases (e.g., vaccination, hygiene). It's a goal that health promotion helps achieve, but health promotion is the process of empowering people.
(d) health care: This is about treating people who are already sick or injured. Health promotion focuses on keeping people well and addressing the root causes of ill health.

10. Which of the following factors of health does NOT affect the community?

(a) Life style.
(b) Environment.
(c) Health services provision.
(d) Empowerment.

✅Correct Answer: (d) Empowerment.

Explanation:Lifestyle choices (what people eat, whether they smoke), the environment (cleanliness, pollution), and the availability of health services all directly impact the health status of a community.🌍🏥🍎Empowerment is a *process* within health promotion that helps communities gain control and improve their health, but it's not typically listed as a fundamental *factor* or *determinant* of health in the same category as environment or lifestyle. It's more about the community's *capacity* to act on these factors.
Why other options ARE factors affecting community health:

(a) Life style: Community health is the sum of individual healths, and lifestyle choices cluster within communities.
(b) Environment: The physical and social environment (housing, sanitation, safety, social support) directly impacts community health.
(c) Health services provision: Access to quality health services is a major determinant of community health outcomes.

11. Which of the following is the best way to make a community diagnosis?

(a) Attend village gatherings to get information.
(b) Carryout home visits in the community.
(c) Look at existing medical records.
(d) Talk to village leaders and health workers.

✅Correct Answer: (a) Attend village gatherings to get information.

Explanation:A good community diagnosis needs information from many sources.🕵️‍♀️📊🗣️Attending village gatherings is a great way to hear directly from a wide range of community members about what *they* see as health problems, their beliefs, and their resources. It gives you a broad picture of the community's perspective, which is crucial for understanding their real needs. While the other methods are also useful, they only provide a partial view.
Why other options are useful but not the "best" single way:

(b) Carryout home visits: Gives detailed info about individual families, but is time-consuming and doesn't give the full community picture.
(c) Look at existing medical records: Provides clinical data on diseases seen at facilities, but misses many community-level issues, social determinants, and people who don't use facilities.
(d) Talk to village leaders and health workers: Provides important key informant perspectives, but is limited to their view and might miss the voices of ordinary community members.

12. Nurses should assess the health status of a given population at a particular time through

(a) community mobilisation.
(b) clinical diagnosis.
(c) community participation.
(d) community diagnosis.

✅Correct Answer: (d) community diagnosis.

Explanation:Assessing the health status of a whole group of people (a population) is exactly what community diagnosis is!👩‍⚕️📊You look at health problems, their causes, and the resources available in that specific community at a specific time.
Why other options are wrong:

(a) community mobilisation: This is the process of getting the community together to take action, not an assessment method.
(b) clinical diagnosis: This is diagnosing illness in *one* person, not a whole population.
(c) community participation: This is the community being involved in health activities, not a method for assessing their health status.

13. Which of the following types of prevention should be implemented when a person is in a healthy state?

(a) Quaternary.
(b) Secondary.
(c) Primary.
(d) Tertiary.

✅Correct Answer: (c) Primary.

Explanation:Primary prevention happens *before* any disease starts.🛡️The goal is to prevent the disease from ever occurring in a healthy person (e.g., vaccination, promoting healthy eating, using bed nets).
Why other options are wrong:

(a) Quaternary: This is about preventing over-medicalization (too much treatment or testing).
(b) Secondary: This is about detecting a disease *early* when a person might not even have symptoms yet (e.g., screening for high blood pressure).
(d) Tertiary: This is about managing an existing disease to prevent complications, disability, or death (e.g., rehabilitation after a stroke, managing diabetes).

14. An approach that stimulates the community to initiate and maintain the running of health activities at its own cost is called

(a) self reliance.
(b) sustainability.
(c) participation.
(d) appropriate technology.

✅Correct Answer: (a) self reliance.

Explanation:Self-reliance means the community can depend on itself, using its own strengths and resources (including money, represented by "at its own cost") to manage its health programs independently over time.🤝💰
Why other options are wrong:

(b) sustainability: This means the program continues over time, which self-reliance helps achieve, but self-reliance is the *means* (doing it themselves, perhaps at their cost) to achieve sustainability.
(c) participation: This is the involvement of people, which is necessary for self-reliance and sustainability, but not the term for initiating and maintaining *at their own cost*.
(d) appropriate technology: This is about using suitable tools, which helps self-reliance, but isn't the approach of doing it *at their own cost*.

15. An initiative by community members to look for locally available solutions for their health problems is termed as

(a) community mobilisation.
(b) community active participation.
(c) top-down approach.
(d) bottom-up approach.

✅Correct Answer: (d) bottom-up approach.

Explanation:A bottom-up approach means ideas, initiatives, and solutions come from the community members themselves ("the bottom"), based on their local knowledge and resources.🌱📈A top-down approach is when solutions are designed and imposed by external experts or authorities ("the top").
Why other options are wrong:

(a) community mobilisation: This is the *process* of getting people together, which is part of a bottom-up approach, but not the term for the *initiative* of seeking local solutions.
(b) community active participation: This is the *level* of involvement, which is high in a bottom-up approach, but not the term for the *approach* of seeking local solutions.
(c) top-down approach: This is the opposite; solutions come from outside, not locally from within the community.

16. Which of the following is defined as a collection of people identified by a set of shared values?

(a) Family.
(b) Society.
(c) Community.
(d) Communal village.

✅Correct Answer: (c) Community.

Explanation:In public health, a community is often defined as a group of people who share something in common – it could be location (like a village), interests, or values. Shared values are a key way to identify and understand a community.🏘️❤️
Why other options are wrong:

(a) Family: A family is a small unit, while a community is usually larger.
(b) Society: Society is a very broad term for a large group of people living in the same territory, not necessarily defined by a specific set of *shared values* in the way a community is.
(d) Communal village: This is a specific type of community (geographically defined), but the definition provided (shared values) also applies to communities not based purely on location (like a community of people living with diabetes, or a religious community). "Community" is the general term.

17. The step of action where members identify their health needs, prioritize and plan their health activities is community

(a) organisation.
(b) diagnosis.
(c) participation.
(d) mobilisation.

✅Correct Answer: (c) participation.

Explanation:This describes community participation in action!🙋‍♀️💡📝When community members are actively involved in identifying problems (part of diagnosis), deciding which are most important (prioritizing), and figuring out what to do (planning), they are participating in the health process.
Why other options are related but not the direct action step:

(a) organisation: Community organisation is the process of building the structure and capacity for participation, but identifying/prioritizing/planning is the *activity* the organized group does.
(b) diagnosis: Community diagnosis is the *outcome* or *result* of identifying needs, not the action of the members doing it.
(d) mobilisation: This is getting people ready and together, but identifying/prioritizing/planning are specific activities that happen *after* or *during* mobilisation and organisation.

18. A health worker's ability to create interdependent relationships with individuals, groups and organisations to accomplish mutually set objectives is

(a) coalition building.
(b) networking.
(c) empowerment.
(d) development.

✅Correct Answer: (a) coalition building.

Explanation:Creating *interdependent relationships* (meaning everyone relies on each other a bit) with different groups and working towards *mutually set objectives* (shared goals) is exactly what coalition building is about.🤝🎯You bring different partners together who agree to work collaboratively for a common purpose. Networking is important for coalition building, but coalition building is the specific process of forming these alliances for action.
Why other options are related but different:

(b) networking: This is building relationships in general, which is a necessary step before building a coalition, but coalition building is more formal and focused on achieving shared goals.
(c) empowerment: This is about enabling others to gain control and power, which might be an outcome or a process within coalition building, but not the definition of creating the relationships themselves.
(d) development: This is a broad term for progress and improvement, which coalition building can contribute to, but it's not the specific term for forming the relationships for objectives.

19. The following are both principles and pillars of primary healthcare

(a) sustainability.
(b) prioritisation and efficiency.
(c) equity and affordability.
(d) appropriate technology and equity.

✅Correct Answer: (d) appropriate technology and equity.

Explanation:This question is similar to Q2 and relates to the core ideas of PHC.🔄Appropriate Technology is clearly a pillar/component. Equity is a fundamental principle of PHC and also part of the "Equitable Distribution" pillar. Option (d) lists two concepts that are widely recognized as central principles *and* components/pillars of PHC.
Why other options are wrong:

(a) sustainability: This is a very important *goal* or *outcome* of PHC, but not usually listed as one of the foundational *pillars* or *principles* itself, though PHC principles like participation and self-reliance help achieve it.
(b) prioritisation and efficiency: These are good management practices, but not considered core pillars or founding principles of PHC itself.
(c) equity and affordability: Equity is a principle/pillar component. Affordability is part of the accessibility/equity idea. This option is close, but (d) combines Appropriate Technology (a distinct pillar) and Equity (a key principle/pillar component), covering two different core areas.

20. When a nurse determines whether resources were maximised in the implementation phase, she is evaluating

(a) effectiveness.
(b) efficiency.
(c) adequacy.
(d) appropriateness.

✅Correct Answer: (b) efficiency.

Explanation:Efficiency is all about getting the most out of your resources (like money, time, supplies).⏱️💰➡️ResultsIf a nurse checks if resources were "maximized" (used in the best way possible with least waste), she is looking at how efficient the program implementation was.
Why other options are wrong:

(a) effectiveness: This is about whether the program achieved its intended goals, regardless of the resources used.
(c) adequacy: This is about whether there were *enough* resources available in the first place, not how well they were used.
(d) appropriateness: This is about whether the interventions and methods used were suitable for the community and the problem.

Paper 1 - Fill in the Blank Spaces

21. The first step in the process of community empowerment is...?

👉Problem identification

Explanation:Before a community can take control (empowerment), they need to understand their own situation, identify the challenges they face, and recognize their potential to change things. This starts with making them aware or assessing their needs and problems together.🤔➡️💡

22. A concept of PHC that involves provision of immunisation and treatment is...?

👉Provision of essential health care/services

Explanation:Immunisation (prevention) and treatment of common illnesses (cure) are core services that PHC provides. These fall under the idea of making basic, essential health care available to everyone.💉💊🏥

23. The first step to consider when entering the community is carrying out a...?

👉Community survey

Explanation:STEP IN COMMUNITY ENTRY: 1. Preliminary study of the community: Conduct a comprehensive study to gather information about the community’s location, population size, climate conditions, education levels, ethnicity, economic status, standard of living, occupations, and religious affiliations. This information will provide a foundation for understanding the community’s needs and priorities.🗺️🔍

24. A social action process that allows people to gain mastery over their lives is known as...?

👉Empowerment

Explanation:Empowerment is when people get the power and confidence to make decisions and have control over things that affect their lives, including their health. It's about feeling able to make changes.✊✨

25. The study of populations is called...?

👉Demography

Explanation:Demography is the statistical study of human populations. Demography examines the size, structure, and movements of populations over space and time.👩‍🔬📊

26. The process of enabling people to increase control over and to improve their health is known as health...?

👉Health Promotion

Explanation:This is the definition of health promotion again! (See MCQ 9). It's empowering people to take charge of their health and make healthy choices.⬆️❤️

27. Total elimination of a disease from the population is medically termed as...?

👉Eradication

Explanation:When a disease is completely wiped out, gone forever from everywhere in the world, it's called eradication. Elimination is when it's gone from a specific area or country, but still exists elsewhere. "From the population" usually implies complete removal, fitting eradication.❌🦠🌍

28. The best action to prevent spread of measles during an outbreak is...?

👉Immunisation/Vaccination

Explanation:Measles spreads very easily. The fastest and most effective way to stop an outbreak is to give the measles vaccine to everyone who hasn't had it or been vaccinated, especially young children, to build their protection quickly.🩹🛡️

29. Health services whose cost can be met by most of the community members are said to be...?

👉Affordable

Explanation:Affordable services are those that people can pay for without it causing them financial problems. Making health care affordable is a key part of PHC so everyone can access it.💵➡️😊

30. The process that ensures maintenance of a vaccine's potency from the manufacturer to the consumer is...?

👉Cold chain

Explanation:Vaccines must be kept at the right temperature from the factory all the way to the person getting the shot. The system of keeping them cold and effective during transport and storage is called the cold chain.❄️🚚 fridge

Paper 1 - Section B: Short Essay Questions

31.(a) State the five (5) stages of home visiting.

Planning phase:📝Getting ready before you visit. This involves identifying the home, establishing friendly rapport and explaining the purpose of the visit. You observe the home and surroundings, survey the location, and gather information about the families and their health status. Analyzing this information helps identify health situations. You also prepare necessary documents and set objectives and goals for the visit.
Entry & Establishing Rapport:Knock Knock 👋This part isn't explicitly a separate step in the provided text, but it's crucial within the "Planning phase" as you establish friendly rapport and explain the purpose of the visit upon arrival. Making them feel comfortable is key!
Assessment & Intervention:👂觀察🩺This aligns with the "Implementation phase" where the health care provider implements the planned objectives. This includes providing health education, immunization, screening, and addressing sanitary facilities based on the assessment done during the planning phase.
Termination/Ending the Visit:Wrap up 👋This isn't a separate step in the provided text, but it's an important part of completing the "Implementation phase" and transitioning to "Evaluation" and "Follow up." It would involve summarizing, ensuring understanding, and agreeing on next steps.
Post-visit activities/Documentation & Evaluation/Follow up:✍️This combines the "Evaluation phase" and "Follow up." After the main activities, you assess the efficiency and acceptance of the services provided. Documentation of the visit would also fall under this, although not explicitly mentioned as a separate step. The "Follow up" involves monitoring activities to ensure expected proceedings.

31.(b) State five (5) advantages of home visiting.

Allows assessment of the home environment:🏠🔍You can see where and how the family lives, which helps you understand factors affecting their health (like sanitation, safety, living conditions) that you wouldn't see in a clinic.
Provides individualized and family-centred care:🧑‍👩‍👧‍👦❤️You can focus specifically on the family's unique needs and dynamics, tailoring your care and education to their specific situation in their own setting.
Helps build rapport and trust:🤝Visiting people in their own home can make them feel more comfortable and respected, which helps build a strong trusting relationship between the health worker and the family.
Facilitates reaching vulnerable populations:👵 Disabled🤱People who find it hard to come to the clinic (like the elderly, disabled, very sick, or new mothers) can be reached and cared for in their home.
More convenient and comfortable for the family:🛋️ Time savedFamilies don't have to travel, wait in queues, or arrange childcare. It can be less disruptive to their daily life.

32. Explain the four (4) pillars of Primary Health Care.

Equity:🌍➡️👩‍⚕️This pillar means that essential health services and resources should be available to everyone fairly, regardless of where they live, their social status, or how much money they have. It's about reducing inequalities in health access.
Community Participation:🗣️🤝This pillar emphasizes that the community should not just be recipients of health services but should be actively involved in identifying their health problems, planning programs, implementing activities, and evaluating them. Their input and ownership are crucial.
Intersectoral Coordination (or Collaboration):🏥🏫🌾💧Health is influenced by many things beyond just healthcare. This pillar means that the health sector must work together with other sectors like education, agriculture, water and sanitation, housing, etc., to address the root causes of ill health (social determinants).
Appropriate Technology:🔧💡This pillar means using health technologies (methods, equipment, drugs) that are scientifically sound, affordable, culturally acceptable to the community, and can be maintained and used with local resources and skills. It's about choosing what is best and practical for the specific setting, not necessarily the most advanced.

Paper 1 - Section C: Long Essay Questions

33.(a) Define the term 'Primary Health Care'.

Primary Health Care (PHC) is essential health care made universally accessible to individuals and families in the community.🏠🤝It is based on practical, scientifically sound, and socially acceptable methods and technology.🧪🛠️ culturally okIt involves the full participation of the community🧑‍🤝‍🧑and is provided at a cost that the community and country can afford.💰✅PHC is the first level of contact people have with the health system, bringing health care as close as possible to where people live and work.📍🏥Its goal is to improve health outcomes by addressing the main health problems in the community and focusing on prevention, health promotion, and addressing social determinants of health, not just treating sickness.

33.(b) List ten (10) elements of primary health care.

PHC includes these key elements, often remembered by acronyms like 'ELEMENTS':

Education:📚Health education about common health problems and how to prevent and control them.
Locally endemic diseases:🦠Prevention and control of diseases common in the local area (like malaria, TB).
Expanded Programme on Immunisation (EPI):💉Immunisation against major infectious diseases.
Maternal and Child Health (MCH):🤰👶Including family planning services.
Essential Drugs:💊Provision of essential medicines for common conditions.
Nutrition:🍎Promotion of food supply and proper nutrition.
Treatment:🩺🩹Appropriate treatment of common diseases and injuries.
Safe water and sanitation:💧🚽Ensuring access to clean water and basic sanitation facilities.
Mental Health:🧠😊Addressing mental health needs within the community.
Dental Health:🦷Basic dental care and prevention.

33.(c) Outline five (5) roles of the community in primary health care activities.

The community is not just a receiver; they are active partners!

Participation in Planning and Decision-Making:🗣️🗺️Community members help identify their own health needs and problems, prioritize them, and decide on the best ways to address them, alongside health workers.
Contribution of Resources:🏗️💰Communities can contribute their own resources like labour, local materials, land, or even funds to support health activities (e.g., building a health post, digging a well, community health fund).
Implementation of Health Activities:👷‍♀️👩‍🏫Community members can be trained as community health workers, volunteers, or health committee members to carry out various tasks like health education, basic first aid, contact tracing, or running village health teams.
Monitoring and Evaluation:📊🔍Community members can help monitor how programs are working, provide feedback, and participate in evaluating their effectiveness and impact on the community.
Promoting Healthy Behaviours and Practices:🍎🏃‍♀️🚭Community members can influence each other to adopt healthy lifestyles, practice good hygiene, use health services, and support health campaigns within their families and neighbourhoods.

34.(a) Define the term 'school health'.

School health refers to a set of planned activities and programs implemented within the school setting to protect and promote the health and well-being of students, school staff (teachers, administrators), and sometimes the wider community.🏫👩‍🏫🧑‍🎓It includes providing health services, teaching health education, and creating a safe and healthy school environment.🩺📚🌳The goal is to help students learn and grow into healthy adults by addressing their health needs while they are in school.

34.(b) State nine (9) reasons why school health programs are important.

School health programs are crucial for many reasons:

Reach a large, accessible population:🏟️Schools gather large numbers of children and staff regularly, making it an efficient place to deliver health services and education.
Address health issues affecting learning:🧠📖Health problems like poor vision, hearing loss, malnutrition, or infections can make it hard for children to learn. School health helps identify and address these barriers.
Instill healthy habits early:🌱🍎Children form habits early. School health education can teach them about hygiene, healthy eating, physical activity, and preventing risky behaviours that will benefit them for life.
Provide early detection of health problems:👀👂School health services can offer screenings for common issues (eyes, ears, growth) allowing for early detection and intervention before problems become severe.
Offer a safe and supportive environment:🛡️😊A healthy school environment includes safe buildings, sanitation, clean water, and a supportive atmosphere free from violence or bullying, all of which affect physical and mental health.
Promote mental and emotional well-being:😊🧘‍♀️Counselling and support services in schools help students deal with stress, emotional problems, and social challenges.
Link school with family and community health:🏘️🤝🏫Schools can be a focal point for health information and activities that involve parents and the wider community, extending health promotion beyond the school gates.
Prevent infectious disease outbreaks:🧼🚫🦠Programs can implement hygiene measures, vaccinations, and rapid response plans to control outbreaks within the school and prevent spread to the community.
Prepare students for a healthy future:🎓➡️🌟By providing health knowledge and skills, school health programs equip students to make informed health decisions as they grow into adults.

34.(c) Outline seven (7) components of school health.

School health programs typically include several key components working together:

School Health Education:📚🧠Teaching students knowledge and skills about health topics like hygiene, nutrition, preventing diseases (HIV/AIDS, malaria), safety, and healthy relationships.
School Health Services:🩺🩹Providing basic health checks, first aid, managing minor illnesses, giving immunizations, health counselling, and referrals to other health facilities.
Healthy School Environment:🌳💧🚽Ensuring safe buildings, clean water, proper sanitation (toilets), ventilation, lighting, space for physical activity, and a social climate that is supportive and free from harm.
School Nutrition Services:🍎🥪Promoting healthy eating, providing school meals or snacks, and educating students about good nutrition.
School Physical Education and Activity:🏃‍♀️⚽Providing opportunities for regular physical activity and teaching skills for various sports and exercises.
School Counseling, Psychological, and Social Services:😊🗣️🤝Offering support for students' mental and emotional health, addressing social issues, and providing counselling services.
School-Community Health Promotion:🏫🤝🏘️Activities that involve parents, families, and the wider community in supporting school health initiatives and extending health messages beyond the school.

Paper 2 - Section A: Objective Questions (MCQs)

1. The approach of diagnosing and treating a disease in its earliest stage is called ______ prevention.

(a) Primary.
(b) Secondary.
(c) Tertiary.
(d) Health.

✅Correct Answer: (b) Secondary.

Explanation:Secondary prevention is about finding a disease early (diagnosis) and starting treatment quickly to stop it from getting worse or causing complications.🔍💊This happens when the disease has *started*, but ideally before severe symptoms appear.
Why other options are wrong:

(a) Primary: Prevents the disease from starting at all (e.g., vaccination).
(c) Tertiary: Manages an existing disease to prevent disability or complications (e.g., rehabilitation).
(d) Health: This is the state of well-being, not a type of prevention.

2. Which of the following is the most appropriate approach to community entry?

(a) Radio announcement.
(b) Community survey.
(c) Community leaders.
(d) Church leaders.

✅Correct Answer: (c) Community leaders.

Explanation:When you first enter a community to work, it's best to start by meeting with the recognized community leaders (local council, elders, health committee chair, etc.).🤝🔑They can give you permission, introduce you, explain community structure, and help you gain trust. Starting with radio announcements or surveys before meeting leaders can be seen as disrespectful or lead to misunderstanding. Meeting only church leaders might not cover everyone.
Why other options are less appropriate as the *first* step:

(a) Radio announcement: Good for informing later, but not the initial way to build relationships and get approval.
(b) Community survey: This is a method for assessment *after* you've gained entry and permission.
(d) Church leaders: Important in many communities, but focusing only on one type of leader might exclude others or sections of the community. Meeting broader community leaders is usually better initially.

3. Which of the following is NOT related to the importance of school health programme?

(a) Promote provision of medical and dental care.
(b) Promote better nutrition and feeding practices.
(c) Provide counselling services to adolescents.
(d) Tap talents of both male and female students.

✅Correct Answer: (d) Tap talents of both male and female students.

Explanation:School health programs focus on improving health outcomes, behaviors, and the health environment. Providing care, promoting nutrition, and offering counselling are direct health-related activities.🩺🍎🗣️Tapping student talents is an important educational or social goal of the school, but it's not a reason *why* a *health* program is important. Healthy students might be better able to use their talents, but developing talents isn't the core purpose of the health program itself.
Why other options ARE related to school health importance:

(a) Promote provision of medical and dental care: Access to basic care in school is a clear health benefit.
(b) Promote better nutrition and feeding practices: Good nutrition is fundamental to child health and development, a key area for school health.
(c) Provide counselling services to adolescents: Adolescence is a time of unique health challenges, and counselling is a vital support service.

4. Environmental disease control measures include the following EXCEPT;

(a) better housing and living conditions.
(b) provision of safe water supply.
(c) good life styles and healthy habits.
(d) proper disposal of refuse.

✅Correct Answer: (c) good life styles and healthy habits.

Explanation:Environmental control measures are about changing the physical surroundings to prevent disease spread.🏠💧🗑️Housing, water, and waste disposal are all parts of the environment. Lifestyles and habits are about individual behaviors, not the environment itself, although they are related to health.
Why other options ARE environmental control measures:

(a) better housing and living conditions: Reduces overcrowding and exposure to poor sanitation.
(b) provision of safe water supply: Prevents waterborne diseases.
(d) proper disposal of refuse: Reduces breeding grounds for pests and prevents spread of pathogens.

5. The disease that is present the whole time in the community and occurs all year round is referred to as

(a) holoepidermic.
(b) holo endemic.
(c) hyper epidemic.
(d) hypo endemic.

✅Correct Answer: (b) holo endemic.

Explanation:When a disease is always present in a population or region at a stable level, it's called endemic.📍🔄"Holoendemic" is a specific term for a highly endemic disease that affects most people in the population early in life, often leading to some immunity later on (like malaria in some areas). While the question's description ("present the whole time... all year round") could fit basic "endemic", among the options using "endemic," "holo endemic" best describes a significant, constant presence that affects the community widely.
Why other options are wrong:

(a) holoepidermic: Not a standard epidemiological term.
(c) hyper epidemic: Hyperendemic describes a persistent *high* level, but "epidemic" itself means an *increase* beyond the usual level.
(d) hypo endemic: Describes a disease that is endemic but at a *low* level.

6. The type of survey that involves questioning and examining a sample of the population at one point at a period of time is termed as

(a) longitudinal survey.
(b) cross sectional survey.
(c) horizontal survey.
(d) screening.

✅Correct Answer: (b) cross sectional survey.

Explanation:A cross-sectional survey is like taking a snapshot of the population at a specific moment.📸📊You collect data (by asking questions or examining) from a sample of people at one point in time to understand the prevalence of something (like a disease or a behavior).
Why other options are wrong:

(a) longitudinal survey: Follows the same group of people over a period of time, taking measurements at different points.
(c) horizontal survey: Not a standard epidemiological term.
(d) screening: This is a quick test to *identify* potential cases of a disease, not a full survey method.

7. Which of the following is a method of community mobilization?

(a) Political commitment.
(b) Good leadership.
(c) Home visiting.
(d) Guidance and counseling.

✅Correct Answer: (c) Home visiting.

Explanation:Community mobilization involves engaging with individuals and groups to address shared concerns. Home visiting is a direct method of outreach that can build rapport, disseminate information, and encourage participation in community activities. It allows for personalized engagement and can be a crucial first step in connecting with community members who may not attend larger meetings.
Why other options are less direct methods of mobilization:

(a) Political commitment: This is an enabling factor that can support community mobilization efforts, but it's not a method of engaging the community directly.
(b) Good leadership: While essential for guiding and facilitating mobilization, leadership itself is a quality or role, not a specific *method* of reaching and engaging the community.
(d) Guidance and counseling: These are individual-level support services and are not typically used as primary methods for mobilizing a whole community.

8. The best course of action to take when there is an outbreak of measles in the community is to

(a) instruct mothers to feed their community adequately.
(b) instruct mothers to keep their babies home.
(c) give to babies aged 6-11 months vitamin A.
(d) immunize babies aged 6-9 month with measles vaccine.

✅Correct Answer: (d) immunize babies aged 6-9 month with measles vaccine.

Explanation:During a measles outbreak, the most urgent action is to protect those who are most vulnerable and stop the spread.💉🛡️Rapidly vaccinating susceptible young children (often the target group in outbreaks) is the most effective way to build immunity and contain the outbreak. The standard first dose is often around 9 months, but in outbreaks, it can be given as early as 6 months, with a repeat dose later.
Why other options are less effective for outbreak control:

(a) instruct mothers to feed adequately: Good nutrition is important for recovery but doesn't stop transmission.
(b) instruct mothers to keep their babies home: Isolation helps, but vaccination is more proactive and provides lasting protection.
(c) give to babies aged 6-11 months vitamin A: Vitamin A helps reduce the severity of measles, but it doesn't prevent infection or transmission. Vaccination is the primary preventive measure.

9. Which of the following is true with regards to guinea worm infection?

(a) Cyclops are the intermediate hosts.
(b) Larvae enter the body through intact skin.
(c) Female worm may be seen in subcutaneous tissues.
(d) To prevent infestation, step well should be used in bathing.

✅Correct Answer: (a) Cyclops are the intermediate hosts.

Explanation:Guinea worm (Dracunculus medinensis) infection is caused by drinking water containing tiny water fleas called Cyclops, which are infected with guinea worm larvae.💧🔬🐛The Cyclops are the intermediate hosts.
Why other options are false:

(b) Larvae enter the body through intact skin: Infection happens by *drinking* contaminated water, not through the skin.
(c) Female worm may be seen in subcutaneous tissues: The adult female worm migrates through the body and eventually emerges *from* the skin, usually on the leg, often causing a painful blister. You see her emerging, not just passively "seen" under the skin before she comes out.
(d) To prevent infestation, step well should be used in bathing: This is wrong. Step wells are easily contaminated. Using *protected* water sources or filtering water is how you prevent infection. Bathing in infected water sources (like step wells) can spread the disease if an infected person enters the water while their worm is emerging.

10. Hyper pigmentation in onchocererciasis results in

(a) module formation.
(b) blindness.
(c) lizard skin.
(d) calabar swelling.

✅Correct Answer: (c) lizard skin.

Explanation:Onchocerciasis (River Blindness) causes various skin changes.🦎Chronic infection can lead to thickened, dry, scaly skin that resembles lizard skin, often accompanied by changes in pigmentation (both hyperpigmentation - darkening, and depigmentation - lightening, sometimes called "leopard skin"). So, hyperpigmentation is part of the changes that result in the appearance known as "lizard skin".
Why other options are wrong:

(a) module formation: Onchocerciasis causes subcutaneous nodules (lumps) where adult worms live, but hyperpigmentation is a skin symptom, not the nodules themselves.
(b) blindness: Blindness is a severe complication affecting the eyes, not a skin pigmentation issue.
(d) calabar swelling: These are large, temporary swellings associated with Loiasis ("African eye worm"), a different parasitic infection.

11. The single and most important measure in the control of Tuberculosis in the community is

(a) health education.
(b) BCG immunization.
(c) contact tracing.
(d) treatment compliance.

✅Correct Answer: (d) treatment compliance.

Explanation:TB spreads from person to person when someone with active, infectious TB coughs or sneezes. The *most* important thing to stop this is to make sure people who have TB complete their full course of treatment.💊✅This cures them, stops them from spreading the bacteria, and prevents the development of drug-resistant TB. If people stop treatment early, they remain infectious.
Why other options are important but not the *single most* important:

(a) health education: Helps people understand TB and seek care, but doesn't stop spread from already infected, untreated individuals.
(b) BCG immunization: Protects young children from severe forms but is less effective against pulmonary (lung) TB in adults, which is the main source of spread.
(c) contact tracing: Helps find people who might be infected, but they also need treatment/prevention (which relies on *treatment compliance* of the original case).

12. Which of the following gastro-intestinal complication may occur in a child with severe paroxysms of whooping cough?

(a) Gastric ulcer.
(b) Umblical hernia.
(c) Ulcerative colitis.
(d) Pylorospasm.

✅Correct Answer: (b) Umblical hernia.

Explanation:Whooping cough (Pertussis) causes severe, violent coughing fits (paroxysms).Cough! Cough! ➡️ Hernia?This intense coughing significantly increases pressure inside the abdomen. In children, this increased pressure can cause or worsen an umbilical hernia, where part of the intestine pushes through a weak spot near the belly button.
Why other options are unrelated:

(a) Gastric ulcer: Sores in the stomach lining, not caused by coughing pressure.
(c) Ulcerative colitis: Inflammation and ulcers in the large intestine, an inflammatory bowel disease.
(d) Pylorospasm: Spasm of the muscle controlling the exit from the stomach, typically seen in infants causing vomiting, not directly related to whooping cough pressure.

13. Resistance of susceptible individual to certain bacterial or viral infections can be artificially enhanced by

(a) medical treatment.
(b) health education.
(c) immunization.
(d) good nutrition.

✅Correct Answer: (c) immunization.

Explanation:Immunization (vaccination) is specifically designed to artificially train your immune system to recognize and fight off specific bacteria or viruses, making you resistant to them if you are exposed.💉🛡️🦠
Why other options are wrong:

(a) medical treatment: Treats an infection *after* it happens, doesn't prevent it by enhancing resistance beforehand.
(b) health education: Provides information about preventing infection through behavior, but doesn't directly enhance the body's internal resistance.
(d) good nutrition: Supports overall immune function, contributing to general resistance, but immunization provides specific, targeted artificial resistance.

14. An acute bacterial infection characterized by step ladder fever spread through contamination of food and water is

(a) Typhoid.
(b) Malaria.
(c) Measles.
(d) Dysentery.

✅Correct Answer: (a) Typhoid.

Explanation:This describes Typhoid fever perfectly!📈💧🍽️It's caused by Salmonella Typhi bacteria, spreads through contaminated food and water, and a characteristic symptom is the fever rising higher each day in a "step-ladder" pattern.
Why other options are wrong:

(b) Malaria: Caused by a parasite, spread by mosquitoes, and has cyclical fever, not step-ladder.
(c) Measles: Caused by a virus, spread by air, causes rash, and has a different fever pattern.
(d) Dysentery: Bacterial or amoebic, spreads via food/water (fecal-oral), causes severe diarrhea with blood, but step-ladder fever is not a key characteristic.

15. Organisms that usually benefit the person infested are called

(a) pathogens.
(b) commensals.
(c) symbiotics.
(d) parasites.

✅Correct Answer: (c) symbiotics.

Explanation:The question asks about organisms that benefit the *infested person* (the host).😊🐛This describes a mutualistic relationship where both the host and the organism benefit. Mutualism is a type of symbiosis. So, "symbiotics" (referring to organisms in a symbiotic, specifically mutualistic, relationship) is the best fit here, meaning they live together and the host benefits.
Why other options are wrong:

(a) pathogens: Cause harm to the host.
(b) commensals: Benefit themselves without significantly helping *or* harming the host.
(d) parasites: Benefit themselves *at the expense of* the host (cause harm).

16. The primary health care pillar which helps in policy formation, resource allocation, community mobilization and support is called

(a) community participation.
(b) appropriate technology.
(c) political commitment/will.
(d) intersectoral collaboration.

✅Correct Answer: (c) political commitment/will.

Explanation:Political commitment and will from the government and leaders are essential for PHC.Govern 🤝 HealthThey decide on policies, allocate budgets (resources), and provide the necessary support and framework that enables community mobilization and intersectoral work. Without political will, PHC cannot be implemented effectively on a large scale.
Why other options are related but not the driving force for these activities:

(a) community participation: The community's role in the program, enabled by support and policy.
(b) appropriate technology: The suitable tools used in PHC.
(d) intersectoral collaboration: Different sectors working together, which is facilitated by policy and political support.

17. The sustainable development goal builds on a principle called

(a) health for all.
(b) gender inequality.
(c) holistic approach.
(d) leaving no one behind.

✅Correct Answer: (d) leaving no one behind.

Explanation:A core guiding principle of the Sustainable Development Goals (SDGs) is "Leaving No One Behind".🚶‍♀️🚶‍♂️➡️🌟This means making sure that development benefits everyone, especially the poorest and most vulnerable, and that disparities (differences) are reduced across all goals.
Why other options are wrong:

(a) health for all: A key principle of PHC and a goal addressed by SDG 3, but "leaving no one behind" is a broader principle guiding *all* SDGs.
(b) gender inequality: This is a problem the SDGs aim to *solve* (SDG 5), not a principle they are built upon.
(c) holistic approach: The SDGs do take a holistic view (seeing how everything is connected), but "leaving no one behind" is a more specific, named principle guiding their implementation.

18. The following are sustainable development goals EXCEPT;

(a) affordable and clean energy.
(b) climatic action.
(c) to stop accidents.
(d) industry innovation and infrastructure.

✅Correct Answer: (c) to stop accidents.

Explanation:The SDGs are a specific list of 17 global goals.✅✅❌✅Affordable and Clean Energy is SDG 7. Climate Action is SDG 13. Industry, Innovation, and Infrastructure is SDG 9. While reducing accidents is important for safety and health (linked to SDG 3), "to stop accidents" is not one of the 17 named SDGs.
Why other options ARE SDGs:

(a) affordable and clean energy (SDG 7).
(b) climatic action (SDG 13).
(d) industry innovation and infrastructure (SDG 9).

19. Which of the following explains the meaning of appropriate technology?

(a) Drawing up of joint plans.
(b) improving local capacity.
(c) Improving development projects.
(d) Improving community mobilization.

✅Correct Answer: (b) improving local capacity.

Explanation:Appropriate technology means using methods and tools that are suitable for the local setting – they should be affordable, easy to use, and maintainable by people in the community using local resources and skills.🔧➡️💪🏠This directly relates to building and improving the community's capacity to manage health activities themselves.
Why other options are outcomes or other activities:

(a) Drawing up of joint plans: This is part of planning, not the meaning of appropriate technology itself.
(c) Improving development projects: Appropriate technology helps make projects better, but it's a means to an end, not the definition of the technology concept.
(d) Improving community mobilization: Appropriate technology can support mobilization (e.g., simple communication tools), but that's not what the concept of appropriate technology primarily means.

20. Which of the following is NOT a condition for effectiveness of the community health Services?

(a) Availability.
(b) Accessibility.
(c) Equity.
(d) Utilization.

✅Correct Answer: (d) Utilization.

Explanation:Effectiveness means whether the services achieve their intended health outcomes.🩺➡️ healthier?Availability (services exist), Accessibility (people can reach them), and Equity (services are fair) are *conditions* or factors that influence whether services *can be* effective and *will be used*. However, Utilization (whether people *actually use* the services) is an *indicator* of whether services are being accessed, which is important for effectiveness, but it's more of a measure of usage than a *condition* that *ensures* effectiveness itself.🩺➡️Availability: Services need to exist to be effective.🩺➡️Accessibility: People need to be able to reach and use the services (considering factors like location, cost, and transportation).🩺➡️Equity: Services should be fair and available to everyone, regardless of their background. While utilization is a result of effective services (people use services that are available, accessible, and equitable), it's not typically considered a condition for the effectiveness of the services themselves. The effectiveness of the service is determined by its quality and ability to achieve desired health outcomes, assuming people can access and use it.

Paper 2 - Fill in the Blank Spaces

21. Contact tracing of a person who has been exposed to a communicable epidemic disease helps the health worker to carry out...?

👉Disease control

Explanation:When you do contact tracing, you find people who might have caught the disease from an infected person. By finding them quickly, you can test them, treat them if needed, or ask them to isolate. This stops the disease from spreading further, helping to control the outbreak.🔗🕵️‍♀️🚫🦠

22. The component of community health that promotes the well being of the child and her education is called...?

👉School health

Explanation:School health programs focus on the health of children while they are in school.🏫❤️📖They help make sure children are healthy so they can learn well and get a good education.

23. The causative micro organism of jiggers infection is...?

👉Tunga penetrans (Sand flea / Jigger flea)

Explanation:Jiggers are caused by a tiny flea called *Tunga penetrans*.🐜🦶The female flea burrows into the skin (usually feet or toes) and lays eggs, causing itching, pain, and swelling. While the term "microorganism" is not scientifically correct for a flea (which is a visible insect), this is the agent that causes the infection. It is a type of parasite.

24. Severe form of malaria caused by plasmodium falciparum is called...?

👉Malignant malaria / Complicated malaria / Severe malaria

Explanation:Plasmodium falciparum is the most dangerous type of malaria parasite.🦟➡️🤒The illness it causes can be very severe, affecting the brain, kidneys, and other organs. This severe form is often called malignant or complicated malaria.

25. The characteristic sign that appears during the prodromal stage of measles is called...?

👉Koplik's spots

Explanation:Before the famous measles rash appears, tiny white spots with reddish centers can show up inside the mouth, usually on the inside of the cheeks opposite the molars.👄 نقطThese are called Koplik's spots and are a specific sign of measles in the early stage.

26. The period of isolation of an infectious or suspect case to prevent the spread of the disease is called...?

👉Isolation

Explanation:Isolation means separating someone who is sick with an infectious disease (or suspected of being sick) from healthy people.🚪🚫🤧This is done to prevent the germs from spreading to others. Quarantine is for people who were *exposed* but are not yet sick.

27. The recommended dose of BCG given to a child below 12 months is...?

👉0.05ml (intradermal)

Explanation:The BCG vaccine protects against Tuberculosis and is given as a shot into the skin (intradermal). For babies under one year old, the standard dose is 0.05 milliliters.👶💉

28. Evaluation of immunization campaign is by carrying out...?

👉Vaccination coverage rate.

Explanation:To see how well an immunization campaign worked, health workers do things like conduct surveys to find out how many children actually received the vaccine (coverage) and look at disease rates to see if the campaign reduced illness (impact). This is part of an evaluation study or specifically a coverage survey.📊👶📈

29. Health services whose cost can be met by most of the community members are said to be...?

👉Affordable

Explanation:(Same as Paper 1, Q29). If people can pay for health services without struggling financially, those services are affordable.Accessible to wallet 👛

30. The process that ensures maintenance of a vaccine's potency from the manufacturer to the consumer is...?

👉Cold chain

Explanation:(Same as Paper 1, Q30). Keeping vaccines within the correct temperature range from where they are made to where they are given is vital so they work properly. This system is the cold chain.Keep it cool 😎

Paper 2 - Section B: Short Essay Questions

31. Outline five (5) strategies of primary prevention of diseases.

Primary prevention aims to stop diseases from starting in the first place, for healthy people.

Health Education and Promotion:📚🍎🏃‍♀️Teaching people about healthy lifestyles, good hygiene, balanced diet, and the importance of physical activity to prevent various diseases.
Immunization/Vaccination:💉🛡️Giving vaccines to protect individuals from specific infectious diseases (like measles, polio, tetanus) before they are exposed.
Improving Environmental Sanitation:💧🚽🌳Ensuring access to clean and safe drinking water, proper disposal of waste (faeces, refuse), and vector control (like mosquito nets) to prevent infectious diseases.
Specific Protection Measures:🧤🧢Using methods that directly protect against harm, such as using condoms to prevent STIs, wearing helmets when cycling, or using seatbelts in cars.
Nutritional Programs:🥕🍚Promoting adequate and balanced nutrition, providing supplements (like Vitamin A or iron) to prevent deficiency diseases, especially in vulnerable groups like children and pregnant women.

32. Outline five (5) factors that promote community mobilization.

These factors help get a community motivated and organized for action:

Strong Local Leadership:🗣️👍Having respected and dynamic leaders within the community who can inspire, guide, and organize people.
Clear Identification of a Felt Need/Problem:💡🔥When community members clearly see and agree on a problem that affects them, they are more likely to be motivated to act to solve it.
Trust and Good Relationship:🤝😊Building trust between the community members themselves and between the community and external health workers encourages open communication and willingness to work together.
Perceived Benefit/Incentive:🎁🌟When community members believe that participating will bring clear benefits to them or their families, or if there's some form of motivation, they are more likely to get involved.
Effective Communication:📣👂Using clear, simple, and culturally appropriate language and methods to share information, discuss issues, and plan activities ensures everyone understands and feels included.

Paper 2 - Section C: Long Essay Questions

33.(a) Outline five (5) clinical manifestation of scabies.

Scabies is a skin condition caused by tiny mites burrowing into the skin. Here are common signs you would see or hear about:

Intense Itching (Pruritus):😩 itchy!This is the most common symptom, often severe and typically worse at night, which can disturb sleep.
Rash:🔴bumpsSmall red bumps (papules) or tiny blisters can appear on the skin, often in a widespread pattern or clustered in certain areas.
Burrows:〰️Tiny, slightly raised lines that look like tracks or tunnels on the skin surface. These are where the mites burrow. They are often found in the thin skin between fingers, on wrists, elbows, or feet.
Sores or Crusting (especially in severe cases):🩹Scratching the itchy rash can lead to open sores, which can then get infected with bacteria. Crusted scabies is a very severe form with thick crusts containing many mites.
Distribution Pattern:✋ Wrist🦶The rash and burrows often appear in specific body areas where the mites like to live, such as the webs of fingers and toes, wrists, elbows, armpits, waistline, buttocks, and genitals. In infants, the head, neck, palms, and soles can also be affected.

33.(b) Describe the management of an adult patient with scabies.

Managing scabies requires treating not only the patient but also their close contacts and cleaning the environment to prevent reinfection.

Aims of Management of Scabies

Eliminate the mites:🚫🕷️The primary aim is to kill the scabies mites. This is usually done with prescription medicated creams or lotions that are applied to the skin.

Relieve symptoms:🧴 soothing reliefManagement aims to stop the intense itching and irritation caused by the mites. This can involve using anti-itch creams or oral medications.

Prevent spread:🧼🧺 Stop the spreadIt's crucial to prevent the scabies mites from spreading to other people. This involves treating all close contacts of the infected person, even if they don't have symptoms, and thoroughly cleaning or isolating contaminated items like clothing and bedding.

Prevent complications:⚕️ Healing skinScratching can lead to skin infections. Management includes addressing any existing infections and preventing new ones by keeping the skin clean and using treatments that promote healing.

Educate and follow-up:📚🗣️ Stay informedPatients and their contacts need to understand how to use the treatments correctly, how to prevent re-infestation, and what to expect during and after treatment. Follow-up is important to ensure the treatment was successful and to address any ongoing issues.

Management include;

Diagnosis Confirmation:🔍🩺A doctor or nurse examines the skin for the characteristic rash and burrows. Sometimes, a skin scraping is done to look for mites, eggs, or faeces under a microscope.
Application of Scabicide:🧴The most common treatment is a lotion or cream (like Permethrin 5%). The patient is instructed to apply it to their *entire body* from the neck downwards, making sure to cover all skin folds, between fingers and toes, and under nails.
Treatment Duration:⏱️⏰The scabicide is usually left on the skin for a specific time (e.g., 8-14 hours, often overnight) before being washed off. A second application might be recommended a week later to kill mites that hatch from eggs missed in the first treatment.
Treatment of Contacts:🧑‍🤝‍🧑 SimultaenousIt is VITAL that all people who had close, prolonged skin-to-skin contact with the infected person (like family members, sexual partners, or housemates) are treated at the *same time*, even if they don't show symptoms yet. This breaks the cycle of transmission.
Hygiene Measures (Clothing and Bedding):🧺🔥All clothing, bedding, and towels used by the infected person and contacts in the 72 hours before treatment should be washed in hot water (at least 50°C or 122°F) and machine dried on a hot cycle, or dry-cleaned. Items that cannot be washed should be sealed in a plastic bag for at least 72 hours to a week to kill the mites.
Management of Symptoms:soothe 🌬️Itching can continue for a few weeks even after the mites are dead. Antihistamines can be prescribed to help with the itching, and sometimes topical steroid creams for the rash (but not used if scabicide is on).
Follow-up:🔄✅A follow-up appointment might be needed to check if the treatment worked and to manage any persistent symptoms or secondary infections.

33.(c) Outline five (5) prevention and control measures of the above condition (Scabies).

To prevent and control scabies:

Early Diagnosis and Prompt Treatment:⏰💡Quickly identifying people with scabies and treating them as soon as possible stops them from spreading the mites.
Simultaneous Treatment of Contacts:🏠👨‍👩‍👧‍👦Making sure everyone who lived with or had close contact with the infected person gets treated at the same time is essential to prevent reinfection and continued spread.
Proper Hygiene and Environmental Cleaning:🧼🧺Washing clothes, bedding, and towels in hot water and drying them thoroughly helps kill mites that have fallen off the skin.
Avoid Close Skin-to-Skin Contact:🙅‍♀️🤝Avoiding prolonged direct physical contact with someone known to have scabies can prevent transmission.
Health Education:📚🗣️Educating individuals and communities about how scabies spreads, its symptoms, and the importance of treating everyone in the household at once, and hygiene measures.

34.(a) Outline ten (10) sustainable development goals, excluding good health and well being.

The Sustainable Development Goals (SDGs) are a set of 17 global goals adopted by the United Nations. Here are all seventeen, with ten outlined as requested (excluding SDG 3 Good Health and Well-being):

SDG 1: No Poverty➡️💵🚫Ending poverty in all its forms everywhere.
SDG 2: Zero Hunger🍎🥖Ending hunger, achieving food security and improved nutrition, and promoting sustainable agriculture.
**SDG 3: Good Health and Well-being**❤️‍🩹💪Ensuring healthy lives and promoting well-being for all at all ages.
SDG 4: Quality Education📚👩‍🎓Ensuring inclusive and equitable quality education and promoting lifelong learning opportunities for all.
SDG 5: Gender Equality👩=👨Achieving gender equality and empowering all women and girls.
SDG 6: Clean Water and Sanitation💧🚽Ensuring availability and sustainable management of water and sanitation for all.
SDG 7: Affordable and Clean Energy💡☀️Ensuring access to affordable, reliable, sustainable, and modern energy for all.
SDG 8: Decent Work and Economic Growth💼📈Promoting sustained, inclusive, and sustainable economic growth, full and productive employment, and decent work for all.
SDG 9: Industry, Innovation, and Infrastructure🏗️🏭💡Building resilient infrastructure, promoting inclusive and sustainable industrialization, and fostering innovation.
SDG 10: Reduced Inequalities📉⚖️Reducing inequality within and among countries.
SDG 11: Sustainable Cities and Communities🏙️🏘️Making cities and human settlements inclusive, safe, resilient, and sustainable.
SDG 12: Responsible Consumption and Production♻️🛍️Ensuring sustainable consumption and production patterns.
SDG 13: Climate Action🌍🔥❄️Taking urgent action to combat climate change and its impacts.
SDG 14: Life Below Water🐠🌊Conserving and sustainably using the oceans, seas, and marine resources for sustainable development.
SDG 15: Life on Land🌳🦁Protecting, restoring, and promoting sustainable use of terrestrial ecosystems, sustainably managing forests, combating desertification, and halting and reversing land degradation and halting biodiversity loss.
SDG 16: Peace, Justice, and Strong Institutions🕊️⚖️🏛️Promoting peaceful and inclusive societies for sustainable development, providing access to justice for all, and building effective, accountable, and inclusive institutions at all levels.
SDG 17: Partnerships for the Goals🤝🌍Strengthening the means of implementation and revitalizing the global partnership for sustainable development.

34.(b) Explain five (5) targets of the third sustainable development goal. (ensure good health and well being)

SDG 3 is "Ensure healthy lives and promote well-being for all at all ages". It has many targets to achieve this goal. Here are five examples:

Reduce Maternal Mortality:🤰📉A target is to reduce the global maternal mortality ratio (deaths of mothers during pregnancy or childbirth) to less than 70 per 100,000 live births. This means making pregnancy and delivery safer.
End Preventable Child Deaths:👶➡️grow upA target is to end preventable deaths of newborns and children under 5 years old, aiming to reduce neonatal mortality (deaths in the first month) to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births.
Fight Communicable Diseases:🚫🦠 ाA target is to end the epidemics of diseases like AIDS, Tuberculosis, Malaria, and neglected tropical diseases, and combat Hepatitis, water-borne diseases, and other major infectious diseases.
Reduce Non-Communicable Diseases (NCDs):❤️🧠📉A target is to reduce premature deaths from NCDs (like heart disease, cancer, diabetes, lung diseases) by one-third through prevention and treatment, and promote mental health and well-being.
Achieve Universal Health Coverage (UHC):🏥ForAllA target is to achieve UHC, meaning everyone has access to the health services they need, when and where they need them, without facing financial hardship. This includes access to essential medicines and vaccines.

35.(a) Outline five (5) measures that are used to protect a susceptible host from an infectious disease in the community.

These measures focus on strengthening or protecting the person (the susceptible host) so they don't get sick, even if they are exposed to the disease agent:

Immunization:💉🛡️Giving vaccines to a healthy person to make their immune system strong against a specific infection, so they don't get the disease or get a milder form if exposed.
Chemoprophylaxis:💊🛡️Giving medication to a healthy person to prevent them from getting infected, even if exposed (e.g., taking antimalarial drugs when traveling to a malaria area, or medication to prevent TB in contacts).
Health Education and Behaviour Change:📚🧼🚶‍♀️Teaching people about how diseases spread and promoting healthy behaviours like handwashing, safe food handling, safe sex, avoiding crowded places during outbreaks, or using bed nets. This empowers the host to reduce their own risk.
Improved Nutritional Status:🍎💪Ensuring people have good nutrition strengthens their overall immune system, making them less susceptible to infections and better able to fight them off if they do get infected.
Use of Personal Protective Measures:😷🚫🐜Advising individuals to use personal protective equipment like wearing masks (for airborne diseases), using treated bed nets (for malaria), or filtering/treating drinking water at home (for waterborne diseases).

35.(b) Explain five (5) techniques applied in home visiting.

When a health worker visits a home, they use different techniques to interact effectively with the family:

Establishing Rapport and Trust:🤝😊From the moment you arrive, focus on making the family feel comfortable and respected. Be polite, listen actively, show empathy, and build a trusting relationship. This opens the door for effective communication and assessment.
Active Listening:👂🤔Pay full attention to what family members are saying, both verbally and non-verbally. Ask clarifying questions, summarize what you've heard to show you understand, and don't interrupt. This helps uncover their real concerns and needs.
Using Open-ended Questions:❓🗣️Ask questions that require more than just a 'yes' or 'no' answer (e.g., "Tell me about..." or "How have you been managing...?"). This encourages family members to share more information and express their feelings.
Observation:👀🔍While interacting, observe the home environment (cleanliness, safety, resources), the family dynamics (how members interact), the health status of individuals, and their interactions with each other. Observation provides valuable non-verbal information.
Demonstration and Return Demonstration:👩‍🏫➡️🧑‍💻When teaching skills (e.g., how to prepare ORS, how to care for a wound, how to breastfeed), first show the family how to do it (demonstration). Then, ask them to do it themselves while you watch and guide (return demonstration) to make sure they learned correctly.
Collaborative Problem-Solving:🗺️👥💡Work *with* the family to identify solutions to their health problems, rather than just telling them what to do. Discuss options, consider their resources and preferences, and help them choose solutions that work best for them.

Community Health & Tropical Medicine UNMEB Past Papers Read More »

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HIV AND PREGNANCY

HIV (Human Immunodeficiency Virus) is a virus that attacks the body’s immune system, specifically the CD4 cells (T cells), which are important for immune defence.

If untreated, HIV can lead to AIDS (Acquired Immunodeficiency Syndrome), a condition where the immune system is severely weakened.

HIV is a lenti-virus (slow and long acting) and belongs to the Retroviruses group. HIV invades the helper T cells to replicate itself thereby limiting the body’s ability to fight infection . HIV is the virus that causes AIDS, and it has no cure

Types of HIV

HIV-1: This is the most common and widespread type of HIV, accounting for the vast majority of HIV infections globally. It is highly infectious and has several subtypes (or clades), labelled A through K. HIV-1 is the primary cause of the global HIV pandemic and is more aggressive in its progression to AIDS compared to HIV-2.
HIV-2: This type is less common and primarily found in West Africa. It is less transmissible and generally progresses more slowly to AIDS than HIV-1. There are fewer subtypes of HIV-2, labelled A through H.

Modes of HIV Transmission

1. Sexual Contact:

Unprotected Vaginal Sex: HIV can be transmitted through vaginal fluids and semen during unprotected vaginal intercourse..

2. Blood-to-Blood Contact:

Sharing Needles: Using contaminated needles or syringes, common among intravenous drug users, can transmit HIV.
Blood Transfusions: Although rare in countries with stringent blood screening, HIV can be transmitted through infected blood transfusions.
Exposure to Contaminated Blood: Health care workers can be at risk through needle stick injuries or contact with open wounds.

3. Mother-to-Child Transmission:

During Pregnancy: HIV can cross the placenta from mother to baby.
During Childbirth: The baby can be exposed to HIV in the mother’s blood and vaginal fluids during delivery.
Breastfeeding: HIV can be transmitted through breast milk from an infected mother to her child.

4. Other Modes:

Contaminated Medical Equipment: Use of non-sterile instruments during medical or dental procedures can transmit HIV.
Organ and Tissue Transplants: Transplantation of infected organs or tissues, though rare due to screening practices, can transmit HIV.

5. Less Common Modes:

Tattooing and Piercing: If non-sterile needles are used, there is a risk of HIV transmission.
Contact Sports: Although extremely rare, transmission can occur if both participants have open wounds.

Factors That Facilitate Mother-to-Child Transmission of HIV

Maternal Factors:

1. Viral Load and Immune Status:

High Viral Load: Higher levels of HIV in the mother’s blood increase the risk of transmission to the baby.
Low CD4 Count: A weakened immune system due to low CD4 counts enhances transmission risk.
Maternal Acquisition of HIV: New HIV infections during pregnancy or lactation significantly increase transmission risk.

2. Infections and Inflammation:

Vaginal Infections: Infections such as bacterial vaginosis can elevate the risk of HIV transmission.
Chorioamnionitis: Inflammation of the foetal membranes due to infection can facilitate HIV transmission.

3. Access to Antiretroviral Therapy (ART):

Lack of ART: Mothers who do not receive ART are more likely to transmit HIV.
Poor Adherence to ART: Inconsistent use of ART reduces its effectiveness in preventing transmission.
Timing of ART Initiation: Starting ART late in pregnancy or not at all reduces its preventive benefits.

4. Socioeconomic Factors:

Lack of Healthcare Access: Limited access to prenatal care and HIV testing can lead to missed opportunities for prevention.
Education and Awareness: Lack of knowledge about HIV transmission and prevention strategies among pregnant women.

5. Nutritional Status:

Poor Maternal Nutrition: Malnutrition can weaken the mother’s immune system, increasing the risk of transmission.

Labour and Delivery Factors:

6. Delivery Method:

Vaginal Delivery: Higher risk of transmission compared to elective caesarean section, especially if the mother has a high viral load.
Prolonged/Difficult Labour: Increased exposure to maternal fluids during extended or complicated labour can raise the risk.

7. Prematurity:

Premature Birth: Prematurity can increase the risk of transmission due to underdeveloped immune systems in infants.

8. Membrane Rupture:

Prolonged Rupture of Membranes (PROM): Rupture lasting more than 4 hours before delivery increases the risk of HIV transmission.

9. Invasive Monitoring and Procedures:

Use of invasive monitoring or procedures during labour can increase the risk of HIV transmission.

Postnatal Feeding Factors:

10. Breastfeeding Practices:

Prolonged Breastfeeding: Longer duration of breastfeeding increases the risk of HIV transmission.
Breast Health: Conditions like sore nipples, abscesses, or mastitis can increase the risk.
Mixed Feeding: Combining breastfeeding with other foods or fluids increases transmission risk. Exclusive breastfeeding for the first 3-6 months does not show excess transmission compared to formula feeding alone.

11. Exclusive Breastfeeding:

Exclusive breastfeeding means providing breast milk only, without additional fluids, water, food, teats, or pacifiers, and involves on-demand feeding.

12. Oral Health in Infants:

Oral Thrush: Presence of oral thrush in breastfed infants can increase the risk of HIV transmission.

Phases of HIV Entry into Host Cells

Binding: The HIV virus first attaches to the CD4 receptors on the surface of the host cell, typically a type of immune cell called a CD4+ T lymphocyte. HIV’s envelope protein, gp120, specifically binds to the CD4 receptor. This interaction triggers a conformational change in gp120 that allows it to also interact with a co-receptor, usually CCR5 or CXCR4, on the host cell surface. This dual receptor binding is essential for the virus to proceed to the next step.
Fusion: After binding, the HIV viral envelope fuses with the host cell membrane, allowing the viral contents to enter the host cell. The conformational change in gp120 caused by CD4 and co-receptor binding exposes another viral protein, gp41. gp41 facilitates the merging of the viral envelope with the host cell membrane, creating a fusion pore through which the viral capsid containing the viral RNA and enzymes can enter the host cell cytoplasm.
Reverse Transcription: Once inside the host cell, the viral RNA genome is reverse transcribed into DNA. The enzyme reverse transcriptase, carried within the viral capsid, converts the single-stranded viral RNA into double-stranded DNA. This process is error-prone, leading to a high mutation rate which contributes to the virus’s ability to evade the immune system and develop drug resistance.
Integration: The newly synthesized viral DNA is integrated into the host cell’s genome. The viral DNA is transported into the host cell nucleus, where the enzyme integrase integrates it into the host cell’s DNA. This integrated viral DNA is known as a provirus and can remain dormant for a period before becoming active.
Replication: Once integrated, the viral DNA can be transcribed and translated to produce new viral RNA and proteins. The host cell’s machinery reads the integrated viral DNA and begins to produce viral RNA. Some of this RNA will serve as genomes for new viral particles, while others will be used to produce viral proteins through the process of translation.
Assembly: New viral particles are assembled within the host cell. The newly made viral RNA and proteins are transported to the host cell’s surface, where they assemble into new immature viral particles. This assembly process involves the gathering of viral components into a budding virion.
Budding: The new viral particles bud off from the host cell, acquiring an envelope from the host cell membrane in the process. The immature viral particles bud off from the host cell, during which they incorporate a portion of the host cell’s membrane as their envelope. The viral enzyme protease then cleaves certain viral precursor proteins into their mature forms, resulting in a fully mature and infectious virus ready to infect other cells.

Clinical Manifestations of HIV/AIDS

The World Health Organization (WHO) has established a staging system to classify HIV infection and disease progression:

Clinical Stage I:

Asymptomatic: No symptoms of HIV-related illness.
Persistent Generalized Lymphadenopathy: Enlargement of lymph nodes lasting more than three months.
Performance Scale 1: Asymptomatic with normal activity level.

Clinical Stage II:

Moderate Weight Loss: Less than 10% of presumed or measured body weight lost.
Minor Muco-cutaneous Manifestations: Skin conditions like seborrheic dermatitis, prurigo, or fungal nail infections.
Herpes Zoster: History of shingles within the last five years.
Recurrent Upper Respiratory Tract Infections: Such as bacterial sinusitis, tonsillitis, or otitis media.
Performance Scale 2: Symptomatic but normal activity level.

Clinical Stage III:

Severe Weight Loss: More than 10% of presumed or measured body weight lost.
Unexplained Chronic Diarrhoea: Lasting more than one month.
Unexplained Prolonged Fever: Constant or intermittent, lasting more than one month.
Oral Candidiasis: Oral thrush, a fungal infection.
Oral Hairy Leukoplakia: White patches on the tongue or mouth.
Pulmonary Tuberculosis: Active TB infection.
Severe Bacterial Infections: Such as pneumonia, pyomyositis, or bacteremia.
Acute Necrotizing Ulcerative Gingivitis: Severe gum disease.
Unexplained Anaemia, Neutropenia, or Thrombocytopenia: Abnormal blood counts.
Performance Scale 3: Bedridden for less than 50% of the day during the last month.

Clinical Stage IV:

HIV Wasting Syndrome: Weight loss of more than 10% with chronic diarrhoea or prolonged fever.
Pneumocystis Pneumonia (PCP): A severe fungal lung infection.
Toxoplasmosis of the Brain: Brain infection caused by the Toxoplasma parasite.
Cryptosporidiosis: Parasitic infection causing prolonged diarrhea.
Cytomegalovirus Infection: A viral infection affecting various organs.
Progressive Multifocal Leukoencephalopathy (PML): Brain infection causing neurological symptoms.
Lymphoma: Cancer of the lymphatic system.
Kaposi’s Sarcoma: Cancerous skin lesions caused by a herpesvirus.
HIV Encephalopathy: Cognitive and/or motor dysfunction due to HIV infection.
Atypical Disseminated Leishmaniasis: Parasitic infection affecting multiple organs.
Symptomatic HIV-Associated Nephropathy or Cardiomyopathy: Kidney or heart disease associated with HIV.
Performance Scale 4: Bedridden for more than 50% of the day during the last month.

Diagnostic Measures for HIV/AIDS

Pre and Post-Counselling and Consent: Essential for all diagnostic procedures unless in specific circumstances:

Testing of very sick, unconscious, symptomatic, or mentally ill individuals by healthcare teams for better patient management.
Routine testing for individuals likely to pose a risk of HIV infection to others, such as pregnant and breastfeeding mothers, sexual offenders and survivors, and blood or organ donors. These individuals must still be given the opportunity to know their status.

Criteria for Diagnosis: Diagnosis based on:

Clinical Staging Criteria.
Positive HIV Blood Test: Confirmation of HIV infection through serological (antibody) testing.

Testing Protocol: Testing for Adults and Children >18 Months:

Serological (Antibody) Testing: Most common method. Due to the window period between infection and antibody production, negative individuals should be re-tested after three months if exposed.
Reactive Rapid Test: Requires confirmation before diagnosis.

Diagnostic Tests

Screening Tests:

ELISA (Enzyme-Linked Immunosorbent Assay) AglAb Tests: Commonly used to screen blood donations to exclude those in the window period.

Molecular Tests:

PCR (Polymerase Chain Reaction) Tests: Nucleic-Acid Amplification Testing (NAT) detects genetic material of HIV itself, not antibodies or antigens.

Considerations: Testing should consider:

Clinical status, medical history, and risk factors of the individual being tested.
Use of tests in conjunction with patient assessment for accurate diagnosis and appropriate care.

Immediate Connection to HIV Care

If positive, immediate referral to HIV care services for management and treatment initiation.

HIV Testing Provision Protocol

Step 1: Pre-Test Information and Counseling

Provide information on HIV transmission, prevention measures, and testing benefits.
Discuss potential test results, available services, and ensure consent and confidentiality.
Conduct individual risk assessment and complete necessary documentation.

Step 2: HIV Testing

Perform blood-based testing.

For infants below 18 months: Use DNA PCR testing.
For individuals above 18 months: Conduct antibody testing as per testing algorithms.

Step 3: Post-Test Counseling (Individual/Couple)

Assess readiness to receive results and deliver them simply.
Address concerns, provide guidance on disclosure, partner testing, and risk reduction.
Offer information on basic HIV care, ART, and complete documentation.

Step 4: Linkage to Other Services

Provide information on available services and assist in completing referral forms.
Upon enrollment in services, record pre-ART enrollment numbers and transfer relevant information to ART registers.

Principles of HIV Testing Services (HTS)

Confidentiality: Ensure privacy and confidentiality of test results.
Consent: Obtain informed consent from individuals before testing.
Counselling: Offer supportive counselling before and after testing.
Correct Test Result: Ensure accuracy of test results through proper testing procedures.
Connection to Other Services: Facilitate access to appropriate services for individuals testing positive.

Linkage from HIV Testing to Prevention, Care, and Treatment

Linkage is the process of connecting individuals who test positive for HIV to the necessary services.

Successful linkage to care ensures that patients receive the services they need. For HIV-positive clients, linkage should occur promptly, within seven days if within the same facility, and within 30 days for referrals between facilities or from the community. Lay providers are recommended as linkage facilitators.

Types of Linkages:

Internal Facility Linkage: Connecting patients within the same facility.
Inter-Facility Linkage: Connecting patients to another facility.
Community-Facility Linkage: Connecting clients from the community to a health facility.

Internal Facility Linkage Steps:

Post-Test Counselling: Provide accurate results and information about available care.
Next Steps Discussion: Describe the care and treatment process, emphasizing early treatment benefits.
Address Barriers: Identify and overcome any obstacles to linkage.
Involvement: Involve the patient and family in decision-making.
Documentation: Complete client and referral forms.
Escort to Clinic: A linkage facilitator escorts the client to the ART clinic.
Enrollment: Register the patient, open an ART file, and provide preparatory counselling.
Initiation: Start ART if ready, and continue with counselling support.
Integrated Care: Coordinate other services if needed.
Follow-Up: Ensure the patient attends appointments.

Inter-Facility and Community-Facility Linkages:

Inter-Facility Linkage: Refers to connecting patients to another facility. The referring facility should track referred patients and ensure enrollment within 30 days.
Community-Facility Linkage: Connects clients from the community to a health facility. Utilize community health systems and mobilize peer leaders for outreach and follow-up. Linkage should occur within 30 days after diagnosis.

Treatment Modalities of HIV/AIDS

Treatment Modality	Description
Antiretroviral Therapy (ART)	Suppresses viral load to undetectable levels, reducing morbidity, mortality, and transmission of HIV.
Treatment of Acute Bacterial Infections	Addresses immediate bacterial infections.
Prophylaxis and Treatment of Opportunistic Infections	Prevents and manages opportunistic infections.
Maintenance of Good Nutrition	Ensures adequate nutrition to support overall health.
Immunization	Administers vaccines to prevent opportunistic infections.
Management of AIDS-Defining Illnesses	Addresses specific illnesses associated with advanced HIV infection.
Psychological Support for the Family	Provides emotional support and guidance for affected families.
Palliative Care for the Terminally Ill	Offers comfort and support for patients nearing the end of life.

Antiretroviral Drug Treatment

Goal of ART: Suppress viral load to undetectable levels, reducing morbidity, mortality, and transmission of HIV.

When to Initiate ARV:

All HIV-infected children below 12 months.
Clinical AIDS
Mild to moderate symptoms and immunosuppression.

Process of Starting ART:

Assess for opportunistic infections, defer ART if TB or cryptococcal meningitis present.
Offer ART on the same day through an opt-out approach.
If not ready for same-day initiation, agree on a timely ART preparation plan.

Available ARVs in Uganda

Drug Class	Examples
Nucleoside Reverse Transcriptase Inhibitors (NRTIs): Incorporate into the DNA of the virus, thereby stopping the building process.	Tenofovir (TDF), Zidovudine (AZT), Lamivudine (3TC), Abacavir (ABC)
Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs): stop HIV production by binding directly onto the reverse transcriptase enzyme, and prevent the conversion of RNA to DNA.	Efavirenz (EFV), Nevirapine (NVP), Etravirine (ETV)
Integrase Inhibitors: interfere with the HIV DNA’s ability to insert itself into the host DNA and copy itself.	Dolutegravir (DTG), Raltegravir (RAL)
Protease Inhibitors (PIs): prevent HIV from being successfully assembled and released from the infected CD4 cell.	Atazanavir (ATV), Lopinavir (LPV), Darunavir (DRV)
Entry Inhibitors: prevent the HIV virus particle from infecting the CD4 cell.	Enfuvirtide (T-20), Maraviroc

Recommended First Line Regimens in Adults, Adolescents, Pregnant Women and Children

HIV management guidelines are constantly being updated according to evidence and public policy decisions. Always refer to the latest official guidelines.

The 2022 guidelines recommend DOLUTEGRAVIR (DTG) an integrase inhibitor as the anchor ARV in the preferred first and second-line treatment regimens for all HIV infected clients; children, adolescents, men, women (including pregnant women, breastfeeding women, adolescent girls and women of child bearing potential).

Patient Category	Preferred Regimens	Alternative Regimens
Adults and Adolescents
Adults (including pregnant women, breastfeeding mothers, and adolescents ≥30Kg)	TDF + 3TC + DTG	– If DTG is contraindicated: TDF + 3TC + EFV400 – If TDF is contraindicated: TAF + FTC + DTG – If TDF or TAF is contraindicated: ABC + 3TC + DTG – If TDF or TAF and DTG are contraindicated: ABC + 3TC + EFV400 – If EFV and DTG are contraindicated: TDF + 3TC + ATV/r or ABC + 3TC + ATV/r
Children
Children ≥20Kg – <30Kg	ABC + 3TC + DTG	– If DTG is contraindicated: ABC + 3TC + LPV/r (tablets) – If ABC is contraindicated: TAF + FTC + DTG (for children >6 years and >25Kg) – If ABC and TAF are contraindicated: AZT + 3TC + DTG
Children <20Kg	ABC + 3TC + DTG	– If intolerant or appropriate DTG formulations are not available: ABC + 3TC + LPV/r granules – If intolerant to LPV/r: ABC + 3TC + EFV (in children >3 years and >10Kg) – If ABC is contraindicated: AZT + 3TC + DTG or LPV/r

Notes:

Contraindications for DTG include known diabetics, patients on anticonvulsants (carbamazepine, phenytoin, phenobarbital) – use the DTG screening tool prior to DTG initiation.
Contraindications for TDF and TAF include renal disease and/or GFR <60ml/min, weight <30Kg.
TAF can be used in subpopulations with bone density anomalies.
Children will be assessed individually for their ability to correctly take the different formulations of LPV.

Notes from Ministry of Health

For clients on an ABC-3TC-DTG based regimen weighing >25 kg, use the fixed-dose combination of Abacavir/Lamivudine/Dolutegravir 600/300/50 mg instead of the separate pills of Abacavir/Lamivudine 600/300 mg plus Dolutegravir 50 mg.
Use Abacavir/Lamivudine 600/300 mg for patients on the following regimens: ABC-3TC-ATV/r, ABC-3TC-LPV/r, and ABC-3TC-DRV/r.
Use the single pill of Dolutegravir 50 mg for patients on AZT-3TC-DTG based regimens.
For eligible patients on ATV/r and LPV/r, optimize to Dolutegravir.
For PrEP, while the guidelines provide options for the use of either TDF/3TC 300/300 mg or TDF/FTC 300/200 mg, use TDF/FTC 300/200 mg for PrEP in terms of programmatic implementation.

Monitoring of ARV Treatment

The monitoring of patients on antiretroviral therapy (ART) serves several purposes:

Assess Response to ART and Diagnose Treatment Failure
Ensure Safety of Medicines: Identify Side Effects and Toxicity
Evaluate Adherence to ART

Methods of Monitoring ARV Treatment

1. Clinical Monitoring: Involves medical history and physical examination.

2. Laboratory Monitoring: Includes various laboratory tests.

Viral Load Monitoring: Preferred for assessing response to ART and diagnosing treatment failure.
CD4 Monitoring: Recommended in specific scenarios.
Other Minor Laboratory Tests: Includes tests for specific indications.

Viral Load Monitoring

Preferred method for monitoring ART response. A patient who has been on ART for more than 6 months and is responding to ART should have viral suppression (VL <1000 copies/ml) irrespective of the sample type (either DBS or plasma).
Provides an early and more accurate indication of treatment failure and the need to switch from first line to second-line drugs, hence reducing the accumulation of drug resistance mutations and improving clinical outcomes.
Early and accurate indication of treatment failure.
Differentiates between treatment failure and non-adherence.
Recommended frequency: Every six months for children and adolescents under 19 years.

CD4 Monitoring

Baseline CD4 count is essential for assessing opportunistic infection risk.
Recommended for patients with high viral load or advanced clinical disease.

Other Laboratory Tests

Tests	Indication
CrAg	Screen for cryptococcal infection
Complete Blood Count (CBC)	Assess anaemia risk
TB Tests	Suspected tuberculosis
Serum Creatinine	Assess kidney function
ALT, AST	Evaluate liver function
Lipid Profile, Blood Glucose	Assess metabolic health

HIV AND PREGNANCY

In 2004, the WHO reported that 40 million people were infected with HIV/AIDS, including 17.6 million women, 2.7 million children, and 13 million orphans worldwide. In 2005, 700,000 children became infected with HIV, with approximately 95% arising from mother-to-child transmission of HIV (MTCT). Ninety percent of new infections in children occur in Africa due to the near non-existence of PMTCT interventions.

Mother-to-child transmission (MTCT) is the vertical transmission of HIV from mother to child that occurs during pregnancy, childbirth, and breastfeeding. The most probable point of transmission occurs in the late third trimester and even more so during the intrapartum period. In some areas of the world, MTCT has been virtually eliminated thanks to the availability of specific interventions to reduce the risk of transmission. These interventions include:

Effective voluntary and confidential testing and counselling.
Access to Antiretroviral Therapy (ART).
Safe delivery practices.
Availability and safe use of breast milk substitutes.

Factors Affecting Perinatal Transmission

HIV-related Factors:

Viral load: The higher the viral load, the greater the risk of transmission.
Strain variation (genotype): HIV1 or 2.
Biological growth characteristics.
CD4 cell count: Lower CD4 count or decreased CD4
ratio is associated with increased risk of transmission.

Maternal and Obstetric Factors:

Clinical stage: Primary infection with greater viremia is associated with increased risk.
STDs: Increased HIV shedding in genital tract epithelial disruption is associated with an increased risk of transmission.
Sexual behavior: Unprotected sex with multiple partners is associated with increased risk.
Placental abruption: Disruption of fetal-placental barriers increases exposure to the fetus.
Duration of membrane rupture: The transmission rate is directly proportional to the increased duration of rupture of membranes, with a 2% increase for each hour increment.
Gestational age at delivery: Prematurity is associated with increased risk.
Invasive procedures in labor such as episiotomy, vacuum delivery, artificial rupture of membranes.
Modes of delivery: A study in developed countries shows that elective cesarean section done prior to rupture of membranes and labor significantly reduces the risk of perinatal transmission. Planned cesarean section surgery must be considered in the context of the woman’s life and availability of local resources.
Knowledge of HIV status combined with accessibility to and acceptance of ART decreases transmission.
Substance abuse: Substance use during pregnancy is associated with increased risk.

Maternal and Neonatal Factors:

Immature immune system (especially in preterm babies).
Genetic susceptibility.

Breastfeeding:

Without ART, the risk of transmission through breastfeeding by an infected mother may increase the risk to a total of 20-45%.
Where breastfeeding is common and prolonged, transmission through breastfeeding may account for up to half of HIV infections in infants and young children.
Early findings show a low rate of transmission through breastfeeding in the first 3 months in infants receiving prophylaxis with either Lamivudine or Nevirapine.
The risk can be reduced to under 2% by a combination of antiretroviral prophylaxis during pregnancy and delivery, and to the neonate, with elective cesarean section and avoidance of breastfeeding.
Availability of safe breast milk substitutes must be considered, including a safe water supply, when educating and counseling women to avoid breastfeeding.

Strategies for Prevention of Mother-to-Child Transmission (PMTCT):

Primary prevention of HIV among prospective parents.
Prevention of unwanted pregnancy among HIV-infected women.
Prevention of MTCT among HIV-infected mothers through:

Provision of voluntary confidential counseling and testing.
Antiretroviral agents.
Safe delivery practices.
Safe infant feeding practices.
Support for the affected family and the community at large. Education and counseling services may help the woman’s family understand the issues and thus support the woman in her choice to prevent transmission of HIV to her baby.

Components of a Comprehensive HIV Prevention Program:

Health education, provision of information, and counseling on HIV prevention and care, including MTCT.
Voluntary confidential counseling and testing services that are acceptable and accessible.
Quality and focused antenatal care.
Safe delivery practices.
Support and counseling on infant feeding practices.
Family planning services.
Community mobilization and education to decrease stigma and discrimination against, as well as to increase support for, HIV-positive clients.

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PULMONARY TUBERCULOSIS

Pulmonary Tuberculosis is an infectious disease of the lungs caused by acid-fast bacilli known as Mycobacterium.

INCIDENCE:

The incidence ranges between 1% and 2% amongst the hospital deliveries in the tropics, being confined predominantly to the underprivileged sectors of society. Incidence of tuberculosis is rising worldwide with the rising prevalence of HIV infected patients. In 2000, WHO showed the emergence of multidrug resistant tuberculosis (MDR-TB) all over the world. It is a “global health emergency”.

Causes of Tuberculosis in Pregnancy:

TB is caused by the bacterium Mycobacterium tuberculosis. This bacteria spreads through the air when an infected person coughs, sneezes, talks, or sings, releasing tiny droplets containing the bacteria. When a healthy person inhales these droplets, the bacteria can enter the lungs and cause infection.

Incubation Period:

The time between exposure to M. tuberculosis and the onset of symptoms is usually 4-6 weeks, but it can vary widely depending on individual factors.

Mode of Spread:

Droplet Infection: The primary mode of transmission is through airborne droplets released when an infected person coughs, sneezes, talks, or sings. These droplets contain the bacteria, which can be inhaled by a healthy person.
Sputum in Open Air Spaces: The presence of infected sputum in shared spaces can also facilitate transmission.
Drinking Unpasteurized Milk: While less common, bovine tuberculosis can be transmitted through unpasteurized milk.
Inhalation: Inhalation of contaminated dust containing M. tuberculosis can also lead to infection.

Types of Tubercle Bacterium:

Human Tuberculosis: This is the most prevalent form of TB, primarily spread through person-to-person contact through droplet infection.
Bovine Tuberculosis: This form is spread through infected animals, primarily cattle, and can be transmitted to humans through consumption of unpasteurized milk or contact with infected animals.

Types of Tuberculosis:

Pulmonary TB: This is the most common form of TB, affecting the lungs.

Signs & Symptoms:

Persistent Cough: A cough that lasts for more than 3 weeks, often with the production of sputum.
Sputum: Sputum may be purulent (containing pus), blood-stained (hemoptysis), or both.
Evening Fevers: Fluctuations in body temperature, with fever typically occurring in the evening.
Low-grade Fever and Malaise: Feeling unwell with a persistent low-grade fever and fatigue.
Night Sweats: Excessive sweating during the night.
Weight Loss: Significant and unexplained weight loss.
General Lymphadenopathy: Swelling of lymph nodes throughout the body.
Loss of Appetite: Decreased appetite and difficulty eating.
Pleural Effusion: Fluid accumulation in the space between the lungs and the chest wall.
Anemia and Massive Hemoptysis: Severe blood loss from the lungs, along with a decrease in red blood cells.
Enlargement of Cervical Glands: Swelling of lymph nodes in the neck.
Family History of Tuberculosis: Having a close family member with a history of TB increases the risk of infection.
Amenorrhea: Absence of menstruation, particularly in women who are of reproductive age.

Extra Pulmonary TB: This form of TB affects organs other than the lungs. While less common than pulmonary TB, it can be serious and life-threatening.

Affected Areas:

Meninges (Meningitis): Inflammation of the membranes surrounding the brain and spinal cord.
Abdominal Pelvic Organs: Can affect the intestines, stomach, liver, and reproductive organs.
Peritoneum: Inflammation of the membrane lining the abdominal cavity.
Spine (Tuberculous Spondylitis): Infection of the vertebrae, often resulting in pain, stiffness, and deformity.
Lymph Nodes: Swelling and inflammation of lymph nodes, particularly in the neck, armpits, and groin.
Bones: Can affect bones throughout the body, leading to pain, swelling, and joint dysfunction.

Risk Factors for Tuberculosis in Pregnancy:

Pre-existing TB infection: A previous history of TB infection, even if treated, increases the risk of reactivation during pregnancy.
Exposure to infected individuals: Living with or working closely with someone who has TB increases the risk of infection.
Weakened Immune System: Pregnancy can temporarily suppress the immune system, making it easier for the TB bacteria to take hold and multiply.
Malnutrition and Anaemia: Pregnant women who are malnourished or anaemic have a weaker immune system, making them more susceptible to TB infection.
HIV Infection: HIV infection weakens the immune system significantly, increasing the risk of TB infection and making the disease more difficult to treat.
Other Underlying Health Conditions: Conditions like diabetes, chronic kidney failure, and alcoholism can weaken the immune system and increase the risk of TB infection.
Socioeconomic Factors: Poverty, overcrowding, poor sanitation, and inadequate access to healthcare can all contribute to the spread and development of TB.
Environmental Factors: Exposure to dust, smoke, and other airborne irritants can irritate the lungs, making them more susceptible to TB infection.

Diagnosis of Tuberculosis in Pregnancy:

Tuberculin Skin Test (TST): The TST involves injecting a small amount of purified protein derivative (PPD) under the skin. A positive reaction (induration ≥ 5 mm) indicates exposure to TB, especially in high-risk individuals (e.g., those with HIV).
Chest X-ray: A chest X-ray can reveal abnormalities in the lungs consistent with TB infection. However, it is usually performed after 12 weeks of pregnancy to minimize potential risks to the fetus.
Sputum Culture: Early morning sputum samples are collected for three consecutive days and examined for the presence of acid-fast bacilli (AFB), the hallmark of TB.
Gastric Washings: For individuals who cannot produce sputum, gastric washings can be analyzed for AFB.
Diagnostic Bronchoscopy: In some cases, a bronchoscopy, a procedure that allows for visualization of the airways, may be necessary to obtain tissue samples for diagnosis.
Extrapulmonary TB Diagnosis: TB can affect other organs like lymph nodes and bones (although rare in pregnancy).
Direct Amplification Tests: These tests, like PCR (polymerase chain reaction), amplify DNA specific to M. tuberculosis, allowing for sensitive and specific detection.

Investigations:

Sputum examination will reveal the bacilli.
Examination of aspirates for pleural effusion.
Tuberculosis skin test (to show whether the patient has been in contact with tuberculosis bacilli).
Biopsy, e.g., of lymph nodes.
Serology for HIV.
Blood smear for malaria parasites.
Chest X-ray examination.
Erythrocyte sedimentation rate (ESR).
Haemoglobin (HB).
Urinalysis.
Stool examination.

Management in Maternal/Child (M/C) Care:

Aims:

Health education about the disease.
Promote healing.

Procedure when a Mother Comes:

Create a nurse-patient relationship and take history (family, social, medical, and obstetrical).
Observations: Take TPR (temperature, pulse, respiration) and BP (blood pressure).
Conduct general and abdominal examinations.
Reassure the mother, document all findings, and refer her to a hospital.

In Hospital: During Pregnancy:

If sputum is negative, she can be treated as an outpatient before delivery, under the care of a physician and obstetrician.
She should visit ANC (Antenatal Care) regularly.
If she is infectious, she should be admitted to an isolation room.
Histories and observations (BP, TPR) are taken.
General and abdominal examinations are done, and the doctor is informed.
Prepare an examination tray for taking specimens for observations.
When the doctor comes, he examines the patient.

Medical Treatment: New Cases:

2EHRZ 6EH

Ethambutol (E) 25mg/kg.
Isoniazid (H) 300mg.
Rifampicin (R): <50kg: 450mg; ≥50kg: 600mg.
Pyrazinamide (Z): <50kg: 1.5g; ≥50kg: 2.0g.

Other Treatment for TB:

Relapse: Patients treated before, who had initial care but the disease reoccurred later.
Defaulters: Patients who stop treatment regardless of the reason.
Treatment: 2SE (HR) Z/IE (HR) Z/5EHR. Streptomycin 60 injections dose 0.75g (not given in pregnancy due to side effects).

Failures: Patients with positive sputum 2 months after starting treatment.

Treatment: 2 months SE (HR) Z/E (HR) 5 months SE (HR).

Side Effects of Drugs:

Some other drugs: pyridoxine, prednisone for TB meningitis, codeine phosphate to reduce the rate of spread of infectious bacteria.
All patients must be counseled before starting treatment to ensure understanding of the number of drugs, duration of treatment, and expected side effects.

Nursing Care:

Isolation room should be ventilated.
Diet: Plenty of protein and fluids; intake and output should be well recorded.
Rest and sleep: Important during day and night, with occupational therapy.
Hygiene: Daily bath, oral hygiene, spitting in a sputum mug (emptied and disinfected regularly), using disposable handkerchiefs that should be burned, changing and disinfecting bed sheets.
Exercise: Teach deep breathing to expand the lungs.
Position: Sitting up if dyspneic.
Observations: Take T, R, P, and BP; assess general condition and fetal well-being twice a week.
Bowel and bladder: Encourage regular bowel and bladder function.
Reassurance: Provide support and encouragement to the mother.

During Labour: Problems May Include:

Fatigue
Reduced lung function

Doctor’s Case:

Inform the doctor, physician, obstetrician, and paediatrician once labour starts.
Manage the first stage as usual, with Oxygyen if ordered by the doctor. Use sitting up position if dyspneic.
In the second stage, use episiotomy, forceps, or vacuum extraction to reduce over-straining from pushing.
Perform C-section only for specific obstetrical indications, e.g., fetal distress.
Actively manage the third stage to prevent unnecessary blood loss.

During Puerperium:

Manage as other mothers.
If the mother has an active infection, she should breastfeed with a mask, and the baby should be taken back to the nursery.
No Contraindication: Breastfeeding is not contraindicated when a woman is taking anti-tuberculous drugs.
Avoidance: Breastfeeding should be avoided if the infant is also receiving anti-tuberculosis medications to prevent drug accumulation.
Active Lesions: Breastfeeding is contraindicated in cases of active TB. The infant should be isolated from the mother after delivery and given prophylactic isoniazid (10-20 mg/kg/day) for 3 months.
Chemotherapy: If the mother has been on effective chemotherapy for at least two weeks, there is no need to isolate the baby.
If the mother’s sputum is positive, give the baby BCG at birth and protect with isoniazid syrup (2.5mg/kg/day). The vaccine becomes effective in 3-6 weeks; if any family member is infected, separation is advised.
Mantoux test is carried out after 6 weeks.
If the mother is negative or inactive, she can stay with her baby.
Advise rest and sleep, and a well-balanced diet to avoid recurrence of active disease.
Avoid pregnancies until the disease has been controlled for 2 years.
Long-term medical and social follow-up is necessary to monitor the disease and its treatment.

Effects of TB on Pregnancy:

Maternal Effects on Pregnancy:

General Debilitation: TB weakens the mother’s overall health, making it challenging to cope with the demands of pregnancy.
Placental Insufficiency: TB can impair placental function, leading to:

Premature Labor: Increased risk of delivering before term.
Intrauterine Fetal Death: Loss of the fetus during pregnancy.
Intrauterine Growth Retardation (IUGR): The fetus fails to grow at an appropriate rate due to inadequate nutrient and oxygen supply.

Fetal Hypoxia: Reduced oxygen levels in the fetus due to placental insufficiency.
Asphyxia: Severe oxygen deprivation in the fetus, potentially leading to brain damage or death.

During Labour:

Increased Risk of Assisted Deliveries: TB-related complications can increase the need for interventions like forceps or vacuum extraction.
Maternal and Fetal Distress: Both the mother and the fetus may experience complications during labor, such as heart rate abnormalities, due to TB-related physiological changes.
High Prenatal Mortality Rate: The risk of stillbirth is significantly elevated in mothers with TB.

Note: Pregnant or breastfeeding women with TB should be treated with short-course chemotherapy (e.g., Rifampicin, Isoniazid, Pyrazinamide, Ethambutol).

Effects on Puerperium:

Anaemia: TB can worsen existing anaemia or lead to new iron deficiency in the postpartum period.
Poor Lactation: TB can impair breast milk production, impacting infant nutrition.
Lowered Resistance to Infection: The mother’s immune system is compromised, increasing her susceptibility to infections during the postpartum period.

Prevention:

In the Community:

Sensitize and mobilize the community to create awareness about TB.
Health education on ensuring well-ventilated homes, avoiding overcrowding, proper disposal of sputum, covering the mouth when coughing/sneezing, and screening family members.
Encourage good nutrition, drinking pasteurized milk products, disinfecting patients’ belongings, and immunizing children with BCG.
Ensure adequate management of chest infections and encourage mothers to attend ANC.

In Hospital:

Encourage mothers to attend ANC for thorough examinations, histories, and investigations for management.
Keep the hospital environment clean and dispose of refuse properly.
Ensure ward cleanliness by scrubbing floors, dusting windows, and cleaning equipment daily.
Health workers should avoid droplet infections, wash hands after every procedure, and isolate TB patients.

Complications:

Spontaneous Pneumothorax: A collapsed lung due to air leaking into the space between the lung and chest wall.
Pleural Effusion: Fluid buildup in the space between the lung and chest wall.
Gastrointestinal TB: TB infection affecting the digestive system.
Massive Hemolysis: Breakdown of red blood cells, leading to anemia and potentially fatal complications.
TB Meningitis: Infection of the membranes surrounding the brain and spinal cord.
TB Pericarditis: Inflammation of the sac surrounding the heart.
Anaemia: Iron deficiency, which can be exacerbated by TB infection.
Death: In severe cases, TB can be fatal, especially in pregnant women who are immunocompromised.
Hemoptysis: Coughing up blood due to lung damage.
High Maternal Mortality Rate: The risk of death from TB is significantly elevated in pregnant women.

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