Self-care is a term representing the range of

health-related decisions and care undertaken by

individuals on their own behalf. Decisions made
at the individual level, in turn, influence
decisions made at the family and ultimately at
the community level. The process on how
decisions are made at these three levels largely
depends on the prevailing socio-cultural settings
MEANING
Self-care is the ability of individuals, families and
communities to promote health, prevent disease, and
maintain health and to cope with illness and disability
with or without the support of a health-care provider
SCOPE OF SELF CARE
Health promotion;
Disease prevention;
Disease control;
Self medication,
Reactive and restorative care;
Referral for institutional/specialist care;
And rehabilitation including palliative care
MECHANISMS TO PROMOTE SELF
CARE
Community empowerment appropriate to the socio-
cultural,
Environmental and linguistic contexts;
Reviewing the roles and responsibilities of supportive
institutions;
Strengthening support networks beyond the health
sector;
Identification and collection of self-care practices,
And listing the health effects;
Media; and schools.

SELF CARE PROMOTION AT
VARIOUS LEVELS
National and subnational levels: Policy and
legislative support, national plan for self-care with
adequate budget. To include self-care intervention in
all relevant programmes and projects.
Community level: Adequately funded microplanning
and sustained support for self-help groups can be
promoted, ensuring adequate representation by
women.
Family and individuals: Continuing education,
support and follow-up including self-care advice, post-
hospitalization
Institutions for self-care promotion: Health
workers communication skills need to be improved,
through pre-service education and in-service
reorientation; local government and other relevant
public sector offices/ organizations; faith-based
groups; self help groups; CBOs/NGOs/ professional
associations; and private sector schools; multisectoral
actors: education; information; industry and the
media
Best practices for self care in
community
1.Health
information/communication/documentation: Involve
the media, youth information centres; document the
experience of self-care, in particular the outcome and
validation of positive and negative practices; community-
based workers facilitate the community to learn; use
popular figures on the mass media to convey messages on
relevant topics and issues; use officials and offices; produce
appropriate literature on best practices for policy-makers as
well the community; create a platform; empower and
facilitate effectively; establish dialogue between the
community and health-service providers.

2.Promotion: Promote community participation
through multisectoral task forces at district/subdistrict
levels assisted by specific technical committees e.g. TB,
HIV/AIDS, provision of information centres, health
campaign e.g. breastfeeding, polio eradication,
measles, Vitamin A supplementation, deworming,
promotion of healthy schools, healthy homes, healthy
workplace, healthy cities, healthy villages; assist the
community t0 develop the capability to negotiate with
other partners/ stakeholders
3. Human resources for health: Health volunteers,
paramedical professionals, family health volunteers,
community health volunteers, selfhelp groups for the
community and home-based care such as womens groups,
adolescents groups, youth and adult groups, elderly
groups; yoga and meditation; users groups for sanitation,
drinking water; family caretakers of particular problems
become experts in taking care; patients
through their own personal experience may become
resource persons; identify the natural leaders in the
community and empower children to be agents of change.


4 .Enabling environment for self-care
accessibility: Complete/correct/ precise information
leaflets after discharge from hospital; examples from
community-based rehabilitation; school health
programmes: for juvenile diabetes, oral health,
personal hygiene, iodine and iron deficiency. For a
comprehensive and sustained effect of medical
intervention, several important aspects are: learning
from failures; strengthening of local administration;
support and enable the peers, colleagues and
caretakers
5. Coordination/collaboration: Multisectoral
collaboration and pooling of resources and
collaborative allocations.

6. Training: capacity-building training, motivational
team building.


Pros and cons of self-medication

Pros
Self-medication might reduce the need for medicine.
There would be reduced burden on the government.
Self-medication reduces indirect/opportunity costs.
Self-medication can provide psychological support to
chronic patients.
It may pressurize medical practitioners to behave more
rationally and to regulate dispensing of drugs.
Self medication can safely use allopathic medicine vis--vis
traditional medicine/homebased therapies;
self- medication can be safe if people are well informed

Cons
Inadequate knowledge about medicine including local
culture barriers.
Selfmedication may increase inconsistencies with
rational use of drugs.
It can increase dependency on guidelines/set-thinking.
It can be expensive if the country depends on imported
medicines.
It might also delay treatment in serious conditions
Self care in context to primary
health care;





ROLE OF COMMUNITY BASED
HEALTH WORKER IN SELF CARE;
Capacity building: Training, refresher training.
Monitoring/evaluation and supportive supervision.
Strengthening basic health workers for self-care.

Information and communication: facilitate people
to take initiatives for better self-care; advocacy role on
behalf of marginalized people; facilitating the
community with other health professionals such as
doctors; Advocacy for self-care; reporting and
documentation.







Activities;
(1) Policy and legislation for self-care are important for self-care
promotion.
(2) Networking among different players will improve collaboration
among health stakeholders and improve access to self-care.
(3)Information, education and communication for supporting selfcare
promotion.
(4) Planning: Bottom-up planning to integrate the grassroot initiatives
supported by adequate resources through resource allocation and
resource mobilization.
(5) Interventions: Establish and strengthen the community-based posts
for launching interventions and for bringing the community and the
service providers closer. Strengthen the capacity of community-based,
private and nongovernmental organizations.
(6) Research and studies on existing self-care practices

GROWTH AND DEVELOPMENT

DEFINITION:-

GROWTH: -A measure of physical maturation signifies an
increase in size of the body and its various organs. Thus it
can be measured in terms of centimeters and kilograms.
DEVELOPMENT: - It is a measure of functional or
physiological maturation its signifies accomplishment t of
mental (acquisition of skills etc) and social (adaptation to
the family and society etc), abilities, unlike growth, it is
rather difficult to assess development
PATTERNS OF GROWTH AND
DEVELOPMENT
1. GROWTH AND DEVELOPMENT ARE CONTINUOUS
PROCESS FROM CONCEPTION UNTIL DEATH.
Although there are highest and lows in terms of the rate at
which growth and development proceed, at all times a
child is growing new cells and learning new skills.
An example of how the rate of growth changes is a
comparison between that of a first year and latter in life.
An infant triples birth weight and increase height by 50%
during the first year of life.

2. GROWTH AND DEVELOPMENT PROCEED IN AN
ORDERLY SEQUENCE
Growth in height occurs in only one sequence from smaller
to larger.
Development also proceeds in predictable order for e.g. the
majority of children sit before they creep, creep before they
stand, and stand before they walk, or walk before they run.
Occasionally a child will progress in different order but
most children follow a predictable sequence of growth and
development.


3. DEFFERENT CHILDLREN PASS THROUGH THE
PREDICTABLE STAGES OF DEIFFENENT RATES:
All stages of development have a range of time rather
than a certain point at which they are usually
accomplished.
Two children may pass through the motor sequence at
different rates.

4. ALL BODY SYSTEMS DO NOT DEVELOP AT THE
SAME RATE:-
Certain body tissues mature more rapidly than others.
For eg. Neurologic tissues experience its peak growth
during the first year of life; where as genital tissue
grows slow until puberty.

5. DEVELOPMENT IS CEPHALOCAUDAL:-
Cephalo is a Greek word meaning head caudal means
tail. Development proceeds from head to tail.
A new born can lift only the head when he or she lies
in a prone position by age 2 months, the infant can lift
the head and chest by 4 months, the head, chest and
part of the abdomen by 5 months when in prone
position and by 1 year child can stand upright and
perhaps walk.
Motor development has proceeded in cephalocaudal
order from the head to the lower extremities.
6. DEVELOPMENT PROCEEDS FROM PROXIMAL TO
DISTAL BODY PARTS:-
This principle is closely related to cephalocaudal
development. It can best be illustrated by tracing the
progress of upper extremity development.
A new born makes little use of arms or hands.
Any movement, expect to put a thumb in the mouth, is a
failing motion. By age 3-4 months the infant has enough
arm control to support the upper body weight on the
forearms and the infant can co-ordinate the hand to scoop
up objects. By 10 months ,the infant can co-ordinate the
arm and thumb and index finger sufficiently well to use to
pick or grasp a pencil or an object


7. DEVELOPMENT PROCEEDS FROM GROSS TO
REFINED SKILLS:-
This principle parallels the preceding one. Because the
child is able to control distal body parts such as finger,
he or she is able to perform fine motor skills.

8. THERE IS AN OPTIMUM TIME FOR INITIATION OF
EXPERIENCES OR LEARNING:-
A child cannot learn tasks until his or her nervous
system is mature enough to allow that particular
learning.
For eg. A child cannot learn to sit, No matter how
much the childs parents have tought and practiced
until his or her nervous system is matured
9. NEONATAL REFLEXES MUST BE LOST BEFORE
DEVELOPMENT CAN PROCEED;-
An infant cannot grasp with skill until the grasping
reflex has faded nor stand steadily until the walking
reflex has faded.
10. A GREAT DEAL OF SKILL AND BEHAVIOUR IS
LEARNED BY PRACTICE:-
An infant practices over and over taking a first step
before he or she accomplishes this securely.

FACTORS
INFLUENCING
GROWTH AND
DEVELOPMENT
ENVIRONMENTAL FACTORS
PRENATAL FACTORS
-MATEANAL MALNUTRITION
-MATERNAL INFECTIONS
-MATERNAL SUBSTANCE ABUSE
-MATERNAL ILLNESS
-HARMONES
-MISCELLANEOUS
POST NATAL FACTORS
-GROWTH PATTERN
-NUTRITION
-CHILD HOOD ILLNESS
-ACUTE ILLNESS
-PHYSICAL ENVIRONMENT
-PSYCHOLOGICAL ENV.
-CULTURAL INFLUENCES
-SOCIOECONOMIC STATUS
-CLIMATE & SEASON
-PLAY & EXERCISE
-BIRTH ORDER OF CHILD
-INTELLIGENCE
-HORMONAL INFLUENCE
GENETIC
FACTORS
RACE
&NATIONALITY
SEX
FACTORS INFLUENCING GROWTH
AND DEVELOPMENT
1. GENETIC:-
It is well known that certain hereditary influences may
have bearing on the ultimate constitution of the body.
Tall parents are likely to have tall off springs.
Transmission of some abnormal genes may result in a
familiar illness which affects the physical and or
functional maturation. Eg. Phenyl ketonuria,
thalassemia, mucopolysacchrodosis, galactosemia etc.

In addition, many inherited disorders, were bio-
chemical defects have yet to be identified or
accompanied by defect in growth and development.
Similarly many chromosomal disorders, including
downs syndrome, turners syndrome etc are known to
manifest in the form of growth and developmental
aberrations
2. NUTRITIONAL: -
Nutritional deficiency of proteins, calories, minerals,
vitamins and essential aminoacids (especially lysine) both
quantitative and qualitative, considerably retards physical
growth and development. Also other debilitating illnesses
which interfere with adequate nutrition (say,
malabsorption syndrome, T.B, malignancy, chronic
diarrhoea, dysentery, and intestinal parasitic infestations)
exert similar effect.
Malnourished mothers particularly if they continue to be
felt poorly during pregnancy are known to produce low
birth weight babies, especially with intra uterine growth
retardation(IUGR
3. SOCIO-ECONOMIC: -
Poverty is associated with diminished growth and
affluence with good growth children from well to do
families usually are better nourished
4. ENVIRONMENTAL AND SEASONAL:-
Physical surroundings (sunshine, hygiene, and living
standard) and psychological and social factors
(relationship and family members) teachers, friends,
etc., affect growth and development.
It has also been observed that maximum weight gain
occurs during fall and maximum height gain during
spring
5. CHRONIC DISEASES:-
Chronic diseases of heart (congenital heart, chronic
rheumatic heart disease ) chest (TB, asthma, cystic
fibrosis) kidneys (nephritic syndrome, nephritis,
bladder neck obstruction liver (cirrhosis hydatid cysts
neoplasms, hypothyroidism, hypopitutarism etc
impair growth.


6. PRENATAL AND INTRAUTERINE:-
IUGR, endometritis, maternal infections like rubella,
cystomegalic inclusion body disease toxoplasmosis,
maternal DM, antithyroid drugs administered for the
thyrotoxicosis etc, adversely affect the fetus and there
by the newborn
7. EMOTIONAL:-
Emotional trauma from unstable family, insecurity ,
siblings jealousy and rivalry, loss of parents,
inadequate schooling etc, all have negative effect on
growth.

VARIOUS PERIODS OF GROWTH:-
PRENATAL:-
Ovum 0-14days
Embryo 14days - 14weeks
Foetus 14weeks _ birth

POSTNATAL:-
Neonate (newborn) first 4 weeks
Infancy first year of life
Toddler 1-3years
Pre-school 3-6 years
School age 6-10 years

Pre pubescent 10-12 years in case of
girls
Pubescent 12-14years in case of girls
12-14 years for boys
Post pubescent 14-18 years for girls
15-20 years for boys.
IMPORTANT CRITERIA FOR
ASSESSMENT OF GROWTH
1. WEIGHT:-
On an average ideal birth weight is said to be
around 3.25kgs. The new born loses up to 10% of his
weight during the first week. It is however, regained
by the age of 10 days. After this weight gain occurs at
a rate of 25-30 gms a day for the first 3 months of 40
gms a month during the rest of the first year of life.
The infant doubles his birth weight by the age of 5
months and triples it by 1 year. He increased it 4
times by 2 years, 5 times by 3 years, 6 times by 5
years and 10 times by 10 year
For convenience to remember:-
Weight at birth = 3.25kgs
3-12 months = Age in months+9 X 2
1-6 =Age in years x2+8
7-12 years = Age in years x 7-5

2 .HEIGHT:-
On a average, the ideal length of a full terms infant at
birth is 50 cms. It rises to 60 cms at 3 months, 70cm at
9 months, 75 cm at one year, 85 cm at 2 years, 95 cm at
3 years and 100 cm at 4 years. There after the child
gains little over 5 cm every year until the onset of
puberty.
For the convenience to remember:-

Height at birth =50 cms
1 year =75cms
2-12 years =Age in years x 6+77



3. HEAD CIRCUMFERENCE:-
Head circumference which represents growth of the
brain, measures
At birth =35 cm
3 months =40 cm
6 months =43 cm
1 year =45 cm
2 year =48 cm
7 year =50 cm
12 year =52 cm



4. HEAD AND CHEST CIRFUMFERENCE RATIO:-
At birth head circumference is larger than chest
circumference by about 2.5cm By 6-12 months both
become equal
After 1 year chest circumference tend to be larger by
2.5cm
By 5 years it is more or less 5 cm greater is size than
the head circumference
5. MID-UPPER AREM CIRCUMFERENCE:-
Let the left arm hang naturally by the side of the
body. Then place the tape firmly but without
compressing the tissues around the upper arm at a
point midway between tip of the acromian and
olecranon process.

6. DENTITION:-
It is not a dependable parameter for assessment of growth since
there is a wide variation in eruption of teeth and its timings. The
average age at which first tooth erupts is 6-7 months. The milk,
deciduous or temporary teeth appear at the rate of one tooth
every month.
Thus, the number of teeth in an infant are = age in months- 6.
By 2-3 years the child has a full set of temporary teeth
numbering 20 generally the lower central and lateral incisors
erupt earlier followed by the first molars, cuspids and second
molars in succession.
Number of teeth:-Temporary= 20
Permanent= 32

It is of value to have serial record of childs weight
periodically on a growth chart or card which is based
on percentile curves. A flat curve indicates a slowed or
arrested growth which must alert the attending doctor
to take action. Both diagnostic so as to its causes and
corrective so as to lead to normal growth once again.

The Chart is meant:-
To make growth a tangible, visible attribute
To create a felt need, a demand for growth
To detect the earliest signs of faltering growth
To reinforce effective behaviour resulting in growth
To illustrate the adverse effects of various negative
events or circumstances son growth (infection,
maternal deprivation, seasonal scarcity etc).
To facilitate the transfer of information to the mother
regarding means to promote growth.


The growth chart is primarily meant for the mother, to
visualize and motivate concern for healthy growth in
her child. It should be sufficiently attractive and
designed to facilitate accurate recording in a simple
manner and enable mothers to recognize growth
fathering at the earliest stage

DEVELOPMENT
Development is the functional maturation of organs an
particularly of the CNS. The contrast, to measuring
physical growth and the measurement of behavioural
development are subject, widely variable and tend to be in
exact and controversial.
There is considerable overlap of the neurologic and
behavioural aspects of development at any particular
chronologic and behavioural aspects of development at any
particular chronologic age.
Environment, socio-cultural patterns nature
verses nurture and genetic factors also influence the
pattern of individual development.

ASSESMENT OF DEVELOPMENT:-
Development assessment is a part of clinical
examination. It is based on observation related to
achievements which are normally expected at a given
chronologic age. Four major criteria of behavior are
used.
Motor
Adoptive or cognitive
Language
Personal or social

Motor development:-
This includes gross motor activity comprising
control of head, trunk and extremities. Fine motor
activity pertains to control of the fine movements of
the fingures. Motor control indicates nEurologic
integrity. Acceleration or delay, however need not
necessarily be related to intellectual abilities.

2. Adoptive or Cognitive development:-
Motor abilities are used to perform actions in
response to environmental stimuli. This includes the
manipulation of objects. The cognitive process begins
with perception. It relates to past experience and
involves memory. The next step is the generation of
ideas and the performance of actions. Intellectual
status can be judged by maturation of cognitive or
adoptive behavior.

3. Language:-
Language development is related to the
perception of sound and production of words and
language is in the form of speech.
4. Personnel or social behavior:-
This is widely variable, depending upon social and
environmental factors. However, some personnel
factors like control of bowel and bladder are related to
neurologic integrity and integrity and have established
value.

IMPORTANT MILE STONES AT A
GLANCE
1. Social smile 4-6 week
2. Head holding 3 months
3. Sits with support 6 months
4. Sits without support 7 months
5. Reaches out for a bright object and gets it 5-6 months
6. Transfers object from one hand to the other 6-7 months
7. Starts imitation a cough 6-7 months
8. Crawls 8-10 months
9. Creeps 10-11 months
10. Stands holding furniture 9 months

11. Stands without support 10-11 months
12. Walks holding furniture 12 months
13. Says one word with meaning 12 months
14. Says 3 words with meaning 13 months
15. Joins 2 or 3 words into sentences 15-18 months
16. Feeds self with spoon 13 months
17. Climbs stairs 15-18 months
- Takes shoes and socks off 15-18 months
- Puts shoes and socks on 24 months
- Takes some clothes off 24 months
- Dresses self fully 3-4 years
- Knows full name and sex 3 years
- Rides tricycle 3 years
- Stand son one leg for seconds 3 years
- Jumps with both feet 3 years
- Builds tower of a blocks

WEIGHT MEASUREMENT

Introduction
Weighing and measuring babies in the
home, in the clinic or children in the school can be
simple mechanical procedure. Weighing and height
measurement is an index of a person continuing
growth and development and may be an index to the
maintenance of health. Excessive loss or gain in
weight may indicate sign of sickness.

Principles of weighing :
The weighing scale must be accurate
The scale platform must be safe and secure to prevent the
child from failing
The mother or nurse must stay with the child when she is
being weighted to prevent falling.
The person being weighed must wear the same amount of
clothing each time he/she is weighed.
record the weight as soon as the scale is read adjust the
scale each time
Place a separate newspaper on the scales after each infant
has been weighed to prevent direct contact with
contamination.

Emphasize the importance of weighing during the
growth period
Have an expert check if the scale periodically for
accuracy
Keep the scale locked when not in use.
Return bat to 0 after each weight has been read and
check to see if the scale is in perfect balance.
To prevent cross infection, the nurse should stand
behind or to the side of the person being weighed to
prevent contact with persons face and mouth.


Types of weighing machine:

All measurements techniques should be standardized
and instruments must be checked frequently.
In a Clinic a beam type weighing scale should be
used because it is more accurate
For Field a portable beam type of machine difficult
to get, so a alter spring machine may be used

Bag Technique
Select a work area where the bag may be set up without
danger of being contaminated by children and domestic
animals in the village.
Spread newspaper or a plastic on a flat surface to create
clean area and place bag on it.
Remove hand washing materials, pen paper and record
from the bag.
Wash hands before doing the procedure under poured or
tap water
Wash hands with bacteriostatic soap if available.
After the procedure wash hands, replace the articles.


Articles needed
Weighing machine
Paper and Pencil or Pen
Newspaper
Hand washing materials
Equipment and setup :
Place the weighing machine in well lighted and well
ventilated area
Check the scales for accuracy
Have each baby undressed completely
School children and mother remove shoes, coat and
any extra clothing









To weigh the infact

Method 1
The machine can be hung from a hook or a nail on the
door or an attendant can hold up.
Attach a pair of weighing pants to the hook of the
scale and adjust the scale to zero then remove the
pants
Put your arms through the leg holes of the weight
pants, while the parents hold the child, grasp the
childs feet and pull his legs through the legs holes.
Make sure that the strap of the pants is in front of the
child.

Attach the strap of the pants to the hook of the scales.
Do not carry the child by the strap along.
Gently lower the child and allow him to hand free.
Check the child position, make sure that he is hanging
free and not touching anything.
Holds the scale and read the weight
Immediately record the weight
Take hold of the child in one arm and gently lift hike
and release the strap from the hook of the scale with
your free hand.

Method 2
In electronic weighing machine
Place the clean paper or clean plastic sheet on the scale
and balance the scale
Place the child on the platform
Read the weight immediately and record the weight
Instruct the mother or nurse to take care of the child

To Weight children and adults :
Have school children and mothers remove shoes, coat
and any clothing
Instruct the person to stand in the middle of the
platform. Be sure that he has not touch anything and
that anything touch him
Ask the person to see straight and record the weight.

AVERAGE WEIGHT INCREASE
DURING THE FIRST FIVE YEARS
AGE PER WEEK
0-3 Months 200 gms
4-6 months 150 gms
7-9 months 100 gms
10-12 months 150-175 gms
WEIGHT INCREMENT PER YEAR
1-2 years 2.5 kgs
3-5years 2.0 kgs
TEMPERATURE MONITORING

DEFENITION
Body temperature may be defined as the degree
of heat maintained by the body or it is the balance
between the heat produced and the heat lost in the
body.

Types:
Core temperature: It is the temperature of the deep
tissues of the body such as the cranium, thorax
abdominal cavity and pelvic cavity. It remains
relatively constant.
Surface temperature. It is the temperature of the skin.
The subcutaneous tissue and fat. It by contrast rise
and falls in response to the environment. The average
body temperature of an adult is between 36.
7O
C and
37
O
C or 98.A
O
F
Purpose:
To establish baseline data for subsequent evaluation.
To identify whether the core temperature is within the
normal range.
To determine changes in the core temperature is
response to specific therapies
To monitor clients at risk for alternations in
temperature
General instructions:

If the client has been taking cold or hot food or fluids
or smoking, the nurse should wait for 30 mts before
taking the temperature orally to ensure that the
temperature of the mouth is not affected by the
temperature of the food, fluid or warm smoke. Avoid
taking oral temperature for older patients, Patients
with BA or cough.
Taking temperature rectally is contraindicated for
clients with MI.
Assess the client accurately and also maintain a safe
environment
Principles :
Meticulous cleaning of thermometers with antiseptic
solution before and after use is essential to prevent the
spread of infection.
The temperature taken by mouth and rectal is more
accurate while auxiliary temperature is least accurate. Take
rectal temperature of all sick children, unconscious
patients and others as indicated.
For accuracy allows the thermometer to remain in the
mouth for 3 mts. Hold the thermometer in the axilla or
groin for 5 mts.
Shake the mercury to 95
0
F or below before taking the
temperature.

When the outside temperature is 100
0
for more place
the bulb of the thermometer in a cold wet sponge at
the instant when removed from the body to prevent
the mercury from rising higher due to the difference
between body and outside temperature.
Keep all thermometers in the shade and in the coolest
part of the building
Accuracy in temperature helps in effective treatment
and medical decision.

Preparation of equipment:
3 Small clean cotton swabs a long strip of cotton to
replace the used thermometer.
Kidney basin to hold moist cotton swabs.
Thermometer
Lubricant for rectal temperature, Paper bag or leaf for
waste.
Hand washing articles.
Paper bag

Procedure :
Select a work area where the bag may be set up without
danger of being contaminated by children and domestic
animals in the village where home facilities are limited the
family may bring a charpoy in the courtyard or on the
verandah for the nurse to use as working area.
Spread newspaper or a plastic on a flat surface to create
clean area and place the bag on it.
Remove hand washing material and wash hands under
poured or tap water. Wash hands with bacteriostatic soap
if available.

Remove apron form the bag and put it on.
Make or step paper bags.
Remove basin, thermometers (return case to the bag)
dressing cotton swabs and place on clean area.
Remove one cotton swab and long strip cotton from
the temperature pack and prepare a soapy swab. Dip
the long piece of cotton into water and squeeze it
apply soap and rub it till the lather occurs place the
soapy swab in clean area.

Clear the thermometer before taking temperature
rinse it under cold running water from bulb to stem.
Wipe the thermometer from bulb to stem with clean
dry cotton swab. Place the same cotton swab in hand
for an oral temperature.
Place the thermometer or probe at the base of the
tongue to the right or left of the frenulum in the
posterior sublingual pocket.
Ask the client to close the lips not the teeth around the
thermometer

Ask the client to close the lips not the teeth around the
thermometer
Leave the thermometer in place a sufficient time for
the temperature to register
Remove the thermometer, wipe in a rotating manner
from stem to build and read. The thermometer is
wipes from the areas of least contamination that of
greatest contamination.
Discard the swab in the paper bag.
Return to the work area and place the thermometer
over soapy swab and roll it and kept
Return to the work area and pickup the soapy swab
and thermometer.
Starting at the top of the thermometer, apply light rapid
friction up and down to produce lather.
Starting at the top and using a firm rotatory motion move the
wet swab downward to the bulb to remove any substances
from he etched grove on the thermometer.
Rinse the thermometer thoroughly under cold running water
allowing the poured water to flow in waste receptive. When
this is not possible use two wet cotton swabs for rinsing.
Pour the water from stem to bulb.

Wipe the thermometer with cotton swab shake down
the thermometer and return it to the container.
Take the cotton ball and disinfect the used articles
with spirit and replace
Close the bag.
Write the report of what was observed what was done
and what instruction given and plan for next visit.
Record the temperature & give health teaching
accordingly.

WARNING SIGNALS
Today the number of persons with heart disease, cancer,
and stroke are increasing. These diseases are responsible
for majority of deaths. Unhealthy life style is a major
contributor for these life taking diseases. According to
Stanford University of School of Medicine in California,
Not only do persons with better health habit survive
longer, but in such persons, disability is postponed
and compressed into fewer years at the end of life."
People should know the early warning signs of the
diseases, because the warning signs can help to consult the
doctor at an early stage of the disease and there is a very
high possibility of treatment of the disease.
Warning sign a physical condition that shows the
presence of a disease

Symptoms/Signs should not ignore are;
Following are some symptoms that should not overlook. One
should not ignore, consult a doctor as soon as possible.
Unexplained weight loss, which may signal such things as
chronic infection, depression or in serious cases, cancer.
Unexplained changes in bowel habits may be due to
inflammatory bowel disease, ulcers, cancers or infections.
Chest pain with a pain in the jaw or arm can be a sign of heart
disease.
Shortness of breath, breathing trouble may indicate lung or
heart disease.
Sudden unexplained headaches, especially in people over 50.
It may be nothing or it may something serious in the brain like
an infection or a tumour.
Sudden weakness or numbness of the face, arm or leg on one
side of the body.
Loss of speech or trouble talking or understanding speech or
blurring or loss of vision. This may indicate a stroke or a
transient ischaemic attack.
Confusion, changes in behaviour or thinking, disorientation,
hallucinations are the warning signs of possible low blood sugar,
possible head injury, side effects of drugs.
Flashing lights in someone who has otherwise normal vision
may be the beginning of retinal detachment.
Hot, red or swollen joints indicate arthritis or joint infection.
Fever (over 37.5 degree C) persisting over a week may mean a
chronic underlying infection, cancer or some other illness.

Warning signs or symptoms of certain diseases are;
Stroke;
Stroke is a result of a clot blocking the flow of blood to the
brain. Ischemic stroke caused by blockage of blood flow to
the brain.
Thrombotic stroke: The clot forms inside the brain. About
50% of the cases are in this type.
In thrombosis, a blood clot completely blocks an artery,
which has been already narrowed by deposition of fatty
substances and high blood cholesterol level.
Hemorrhagic stroke: The blood vessel in the brain bursts
or starts leaking.
Hemorrhagic stroke: This is generally caused by high
blood pressure, ruptured an artery.
Embolic stroke: The clot formed in other part of the body
and travels to the brain. About 20% of the cases are in this
type.

The 5 warning signs of stroke are;
Strokes come in two forms:
Ischemic Stroke: a clot blocks flow of blood in an artery or vessel.
Hemorrhagic Stroke: a blood vessel in the brain bursts.
In both the cases, due to the loss of blood the brain cells starve in
the affected area, causing cells to die. If the cells of important
centers of the organ die, then the ability to speak, walk or
remember suffer. But if the stroke is mild, there may be no impact
on the functions of the body.
The early warning signs of a stroke are:
Sudden weakness, numbness or paralysis of face, arm or leg,
especially on one side of the body, that does not go away in a few
minutes
Sudden blurred or decreased vision in one or both eyes that does
not clear with blinking
Sudden intense headache with no known cause.
Sudden development of difficulty in speaking or understanding
simple statements.
Sudden severe dizziness or trouble in walking or loss of
coordination or loss of balance
If the symptom goes away in a few minutes, they may be
caused by a transient ischemic attack (TIA) or a temporary
stroke, which is a strong sign of a major stroke to occur
soon.
warning signs of heart attack are;
Uncomfortable pressure, fullness, squeezing or pain in the
center of the chest lasting more than a few minutes.
Pain spreading to the shoulders, neck or arms. The pain
may be mild to intense. It may feel like pressure, tightness,
burning, or heavy weight. It may be located in the chest,
upper abdomen, neck, jaw, or inside the arms or shoulders.

Chest discomfort with lightheadedness, fainting,
sweating, nausea or shortness of breath.
Anxiety, nervousness and/or cold, sweaty skin.
Paleness or pallor.
Increased or irregular heart rate.
Feeling of impending doom.

Warning signals of cancer are ;
Millions of people each year are diagnosed with cancer.
Following are the warning signs of cancer.
Changes in bladder or bowel habits that lasts more than 2
weeks.
Thickening or lump in breast or elsewhere.
Unusual bleeding or discharge in cough, urine, vomiting, or
stool.
Change in size or appearance of mole or wart.
Nagging cough or hoarseness lasting more than a few
weeks
Diabetes
Today 240 million people worldwide are living with
diabetes. India currently (2009) has 50.8 million
people..
Diabetes, cardiovascular disease, cancer and chronic
respiratory diseases account for 60 % of all deaths
worldwide.
Insulin hormone is responsible for the conversion of
glucose from food into energy. In people with diabetes,
body stops producing insulin hormone or not in
sufficient amounts. So the glucose stays in the blood
raising them blood glucose levels in people with
diabetes.
Diabetes can have serious complications. Fortunately,
with a healthy lifestyle and with diet management you
can lead a healthy life.

Symptoms of Type 1 Diabetes : Type 2 Diabetes Symptoms
The symptoms of type 1 diabetes and type 2 diabetes are similar
and given below. These symptoms may occur suddenly.
Being excessively thirsty
Passing more urine
Feeling tired
Feeling hungry always
Putting on weight
Slow healing of cuts
Dry and itchy skin , skin infections
Blurred vision
Cramps in legs
STRESS:
Stress is normal physical responses to events that make
to feel threatened or upset and unbalance the life in
some way. When one can sense danger whether its
real or imagined the body's defenses kick into high
gear in a rapid, automatic process known as the fight-
or-flight reaction, or the stress response.
The stress response is the bodys way of protecting the
person. When working properly, it helps the person to
stay focused, energetic, and alert. In emergency
situations, stress can save ones life giving extra
strength to defend.
1 Health problems are caused or exacerbated by stress
are;
Pain of any kind
Heart disease
Digestive problems
Sleep problems
Depression
Obesity
Autoimmune diseases
Skin conditions, such as eczema
Causes of stress

Causes of stress
Top Ten Stressful Life Events
1. Spouses death
2. Divorce
3. Marriage separation
4. Jail term
5. Death of a close relative
6. Injury or illness
7. Marriage
8. Fired from job
9. Marriage reconciliation
10. Retirement

Stress can also be self-generated
Major life changes
Work
Relationship difficulties
Financial problems
Being too busy
Children and family
Inability to accept uncertainty
Pessimism
Negative self-talk
Unrealistic expectations
Perfectionism
Lack of assertiveness


Stress Warning Signs and
Symptoms
Cognitive Symptoms
Memory problems
Inability to concentrate
Poor judgment
Seeing only the negative
Anxious or racing thoughts
Constant worrying
Emotional Symptoms
Moodiness
Irritability or short
temper
Agitation, inability to
relax
Feeling overwhelmed
Sense of loneliness and
isolation
Depression or general
unhappiness


Physical Symptoms
Aches and pains
Diarrhea or constipation
Nausea, dizziness
Chest pain, rapid heartbeat
Loss of sex drive
Frequent colds
Behavioral Symptoms
Eating more or less
Sleeping too much or too
little
Isolating yourself from others
Procrastinating or neglecting
responsibilities
Using alcohol, cigarettes, or
drugs to relax
Nervous habits (e.g. nail
biting, pacing)
Seek health services for
Routine health checkup;

Regular checkups are a valuable tool in maintaining
good health. Taking proper care of health at the right
time can prevent a lot of problems in the future. It's
good to find out that one have a problem, before it is
too late to cure it. So appropriate tests should be done
at the right time
Basic factors of a routine physical
check up:

Medical History: Prior to physical examination, one
should tell to the doctor about diet, exercise,
medication taking, alcohol and tobacco use, sexual
behavior, family history of diseases, such as cancers
like breast, bowel, prostate and melanoma; diabetes,
asthma, glaucoma, gout, heart attack etc. and any
symptoms you may be feeling. This information is vital
because it affects risk factors for various illnesses

Physical Exam: The doctor will check the height,
weight and blood pressure, and listen to heart beats,
lungs and carotid artery for abnormalities such as a
heart murmur or lung obstruction. A doctor who is
very thorough may also check the mouth, ears, lymph
nodes, thyroid and rectum and feel abdomen for
abnormalities, and scan the skin for signs of cancer
Counseling: After the medical history and physical
exam, doctor should talk about any risk factors that may
have and discuss what habits one should change to
maintain good health. The physician will also tells about
what lab tests are need and how often it should be
done..
Lab Tests: Some tests, such as mammography and pap
smears, are usually based on guidelines set by respected
research organizations. In addition, doctor may want to
run tests for diabetes, sexually transmitted diseases,
tuberculosis or prostate cancer, and to screen heart,
liver, kidney, blood and urine
Some tests to detect diseases
Blood pressure: Both high and low pressure have effect
our health badly. High blood pressure can lead to a
heart attack or stroke. Having a yearly blood pressure
test will provide health care professional with a baseline
level to compare during subsequent visits. Once it
detected as not having the normal blood pressure it is
better to check up on a regular basis.

Urine testing: Routine urine test is done to test for
sugar, for any blood and protein that might suggest a
bladder or kidney problem, for hepatitis, infections etc.
Blood Tests: Tests may include blood count, blood
glucose, thyroid function, electrolytes (sodium and
potassium), cholesterol and others, depending on family
history.
Chest X-ray: X-rays can be done to detect lung
abnormalities (tuberculosis, emphysema or lung cancer)
early enough to initiate a successful treatment plan.

Cholesterol level: Every adult should have the
cholesterol level checked occasionally. A high blood
cholesterol level is an important risk factor for coronary
artery disease. If it is high more specific tests like HDL
and LDL cholesterol levels can be done. With increasing
age, the risk decreases and is usually not recommended
for very elderly patients.
repeat the test every two to three years. The EKG shows an
electrical map of the heart rhythm and can indicate any
changes or potential problems including heart attack,
high potassium and irregEKG (Electrocardiogram)Men
and women over 50 should have a baseline EKG done and
ular heartbeat.

Cancer Testing

For women : A Mammogram should be done annually
after age 40, along with monthly BSE (breast self-
examinations). For early detection of pelvic and cervical
cancers, a PAP smear and pelvic exam should be conducted
every one to three years and yearly for women with a higher
risk of disease. A Bone mass density test should be done for
women with high risk of osteoporosis.
Tests for men : Prostate and PSA (prostate specific
antigen) levels should be checked for early detection of
prostate cancer. Prostate checks are suggested in men from
about fifty years of age onwards every year or so.

onwards every year or so.
Fecal occult blood test: This test, which should be
done annually, checks for blood in the stool as an
indicator of possible colorectal cancer.
Colonoscopy and flexible sigmoidoscopy : These
tests are done to detect colon cancer. If you have a
family history or other risk factors for colon cancer,
Colonoscopy is recommended every 10 years. People
over 50 should have a flexible sigmoidoscopy every five
years.

Immunization
Immunization is a way of protecting the human body
against infectious diseases through vaccination.
Immunisation prepares our bodies to fight against
diseases in case one can come into contact with them in
the future.

Babies are born with some natural immunity which they
get from their mother and through breast-feeding. This
gradually wears off as the baby's own immune system
starts to develop.
What is immunization
Immunization is a form of preventive medicine. Its
aim is to protect individuals and communities from
infectious diseases. Immunization operates like an
early warning system. It prepares the body to fight
against infection.


HOW DOES IMMUNIZATION WORK

Through injections, oral drops or scratches on the skin, the body
is exposed to weakened or dead disease-producing
microorganisms or to the toxins they produce. This will cause the
individual to develop the same antibodies and antitoxins that
would have been developed if the person had actually contracted
the disease, in order to fight the disease.
Once the body has been exposed to an infection, the immune
system will "recognize" if the disease were to recur, and produce
antibodies or antitoxins to destroy the infection. The body has to
be exposed to infection once for the immune system to recognize
it. This is done through immunization.



TYPES OF IMMUNIZATION
In passive immunization previously prepared
antibody is injected into the body. This method is not
very effective for long term protection because the
antibodies do not get stored in the body. This type of
immunization is done if quick results are expected. For
e.g. if there has been an outbreak of some epidemic
passive immunization will help

In active immunization weakened or dead antigen is
injected into the body. It stimulates the production of
antibodies which get stored in the body. The body then
is adequately armed against future infections. This is
a slow and steady process and does not work if instant
response is needed

Importance of immunization
Immunization has succeeded in reducing mortality rate
in children. Earlier mortality rate was high because
children had no protection against life taking deadly
diseases. Immunization has therefore succeeded in
keeping deadly diseases at bay
Children are protected against crippling diseases like
polio and they grow up as healthy human beings. Their
growth is not stunted
Reduction in mortality rate has led to the reduction in
birth rate. Immunization consequently has had a
positive impact on the world population

Disadvantages of immunization; There exists the
risk of adverse reactions with vaccinations as well.
Mostly, the reactions associated with vaccinations are
minor in nature, including pain or swelling at the
injection site, mild fever and irritability. In rare cases,
severe reactions have also been noticed. However, the
rate of occurrence cannot be determined as side
effects are usually not reported and there is very less
research being done in the area.


Counselling
It is a type of talking therapy. People talk to a
counsellor about their problems. Counsellors are
trained to listen sympathetically and can help people
deal with any negative thoughts and feelings that they
have.
As well as counselling, there are a number of other
types of talking therapies. For example, cognitive
behavioural therapy (CBT) is a type of talking therapy
that can be used to retrain a persons way of thinking to
help them cope with stressful situations.
Counseling is a process of enabling the patient to
express her/his feelings and create a physical and
psychological environment in which feels confident
enough to take his own decisions.

NICE recommendations

The National Institute for Health and Clinical Excellence
(NICE) recommends certain types of talking therapies for
treating a number of different health conditions.
For example, counselling may be helpful in treating:
depression,
anxiety,
obsessive compulsive disorder (OCD),
post-traumatic stress disorder (PTSD),
long-term illnesses,
eating disorders, such as anorexia nervosa and bulimia, and
substance abuse.

The aims of counselling

Counselling can help people to:
discuss their problems honestly and openly,
deal with issues that are preventing them from
achieving their goals and ambitions, and
have a more positive outlook on life
Qualities of good counselor;

Counselor as a
person
Friendly
Good listener
Helpful Knowledgeable
Credible
Good
communicator
Counselor in
relationship to
the client
Understanding
Empathy
Patience
Sensitive
observation
Styles of doing
councelling
Non-authoritarian
style
Client-centered or
non-directive style
Counsellor-
centered or
authoritarian style
Counsellor-centered or authoritarian style; this is the
simplest to do as there are no rules to follow the counselor
gives advices, makes decisions based on what she thinks is
in the best interest of the client, and expects the client to
follow/heed her advise; it is completely directed by the
counselor.



Client-centered or non-directive style; the
cousellor is passive, is mainly a listener, the client
is active, expresses herself freely, tells the
counselor what she wants, and after careful
reflection and clarification, makes her own
decision.
Non-authoritarian style: neither counselor nor
client-controlled, this style in counseling lies
somewhere between these first two styles; it uses a
variety of techniques


Direct (take place during the face-to-face interaction
with client) client reflection; ventilation of feelings;
providing emotional support (through expression of
interest, understanding assurance and confidence)
giving suggestions and advice.
Indirect: (efforts directed at the clients
environment) involving people who can be of help)
referral to appropriate community resources
Techniques of counseling:
Acceptance
Empathy
Probing
Paraphrasing
Summarizing
Advising
Focus of attention
While interacting with clients cousellor is able to
ACCEPT their ideas and feelings. When counselor do
that, then automatically counselor while EMPATHISE
with clients situation and counselor probing will be
more in tune with his/her through process. Probing is
a particular kind of questioning which is gentle and yet
allows the counselor to reach the basic reason of the
clients dissatisfaction.

PARAPHARASING: this is important technique
essentially means rewording a statement or series of
statements in the same language and style used by the
client. This helps the counselor to find out, whether
she has been able to correctly assess the clients needs
and requirements.

SUMMARISING: and paraphrasing may sound
similar, but actually they are not. While paraphrasing
is restating a statement, by a counselor in his or her
own words, summarizing, on the other hand, means
listing out the main points of the discussion without
going into details.
ADVICE: the counselor can lay out all the options
available to the client. Counselor suggests number of
alternatives, instead of the one or two correct course of
action, thereby allowing the client to make his/her
own choice
Skills of counseling are;
Eye contact
Appropriate facial expression
Body movement cues
Body posture
Verbal prompts
Easy to understand language

Process of councelling
Greeting: Greet with a smile and in a friendly manner
Attention: Concentrate fully on the client
Openness: Use open-ended question to set the
discussion on a voluntary basis
Take notes: Nothing can be mental since some clients
may feel conscious. Basic pint is that counselor should
have total concentration.
Analysis of: Shift the important information from the rest of the
details and information conference it with the client. In case of
gaps left the client fills it up.
Examine alternative: This is a critical stage sine the client has
to assess the opportunities, alternatives solutions. Counselor
should help this process by giving advantages and disadvantages
of a possible course of action.
Helping the client: To resolve dilemma of the client, the desire
for adoption for a possible choice should come from the client. If
it is a voluntary decision it will be faithfully implemented.
Developing action: the counselor should help the client to
think clearly on the possible course of action in order to execute
the idea accepted by the client.

Treatment
Therapy or treatment is the attempted remediation
of a health problem, usually following a diagnosis. In
the medical field, it is synonymous with the word
"treatment". Among psychologists, the term may refer
specifically to psychotherapy or "talk therapy".

TYPES OF
TREATMENT
PROPHYLACTIC
THERAPY
ABORTIVE
THERAPAY
SUPPORTIVE
THERAPY
Preventive therapy or prophylactic therapy is a
treatment that is intended to prevent a medical
condition from occurring. For example, many vaccines
prevent infectious diseases. An abortive therapy is a
treatment that is intended to stop a medical condition
from progressing any further. A medication taken at
the earliest signs of a disease, such as at the very
symptoms of a migraine headache, is an abortive
therapy.

A supportive therapy is one that does not treat or
improve the underlying condition, but instead
increases the patient's comfort Supportive treatment
may be palliative care.


Difference between preventions,
treatments, and cures

A prevention or preventive measure is a way to avoid
an injury, sickness, or disease in the first place, and
generally it will not help someone who is already ill.
A treatment treats a problem, and may lead to its cure,
but treatments often ameliorate a problem only for as
long as the treatment is continued, especially in
chronic diseases
Cures are a subset of treatments that reverse illnesses
completely or end medical problems permanently.
Many diseases that cannot be cured are still treatable.

FOLLOW UP CARE

MEANING OF FOLLOW UP;
An act of renewing contact with sources of
information and reviewing data needed to reinforce or
evaluate a previous action or report, such as
reexamination of an earlier diagnosis or prognosis.
Some further action taken after a procedure is
finished, such as contact by a health care agency days
or weeks after a patient has undergone treatment.
Maintanance of health records and
reports for self and family

1 Assessing the health of the community.
2. Collecting statistics, which are very important to
health authorities.
3. Attention of the doctor or other members of the
health team to specific needs of individuals or families,
and for follow up services.
4. Information of Supervisors in assessing work done.

5.Assessing need for various drugs, transport etc.,
based on number and types of patients.
6. A tool for health education of individuals, families
and communities.
7. Evaluating progress of the health programmes for
replacing.

Records to be maintained in
the sub-centre include:-
1. Village Records, with general information about each
village.
2. Family folders, and individuals health cards.
3. Eligible couple register and record of contraceptives
distributed.
4. Maternal and child health records (Including
antenatal care, child care, Nutrition and
immunizations).

5.Records of distribution of iron and folic acid, also
Vitamin A solution.
6. Vital events Register (Births and deaths).
7. Stock register for receipt, issue and balance of drugs,
contraceptives, stationery etc.
8. Records of medical care and referrals.
9. Inventory of furniture, linen and equipment.

10. Records of meetings with Village Health Guides and
dais, co-workers and supervisors.
11. Monthly reports and other periodic reports as and
when required.
12. Daily dairy.
13. Maps, Charts, Graphs.


HOW TO MAINTAIN RECORDS:-

1`. Record must be kept carefully and in clean
conditions, safe from rats and insects.

2. It is important that records are not luster mislaid.
They are confidential and should be shown only to
authorized persons.

3. Have a good system of filing, family folders, including
records of individuals. Should be divided into
localities and filed in order of house numbers. It is
useful and also to have a register or index cards filed in
alphabetical order of the heads of the families.
4. Records must be readily available and keep up to date.

HOW TO WRITE RECORDS AND REPORTS:-
Remember that the delivery of health services
is not complete until details are written up in the
correct register or record. The last half an hour of each
days work should be reserved for completing the
records.
1. Write them promptly, and keep them up to date.
2. Write legibly, to be understood by others.
3. Keep sentences short and clear.

4. Be accurate and complete in important details.
5. Replace records in their proper place.
6. Consult your supervisor in ease of difficulty in
completing records and wring reports.




Daily Dairy:-
It is not practicable for the health worker to
take registers and large record books while carrying
out village visits, yet memory is unreliable. Therefore a
notebook called dairy is to be carried and used
constantly and the information written up in the
proper record on return to the sub-centre

The purpose of dairy is
1. For immediate record of days activities by the health
worker.
Eg: Home Visits,.
2. To record the name and address of persons to whom
preliminary help has been given , and follow up to be
done or referral if needed.
3. To record observations during village visits and
matters meeting to be reported to the supervisors or
PHC authorities. The information should be neatly,
correctly, and honestly written

Monthly Report:-

At the beginning of each month the health worker has
to complete the report forms and submit one copy to
her supervisor keeping one copy in her file at the sub -
centr 1. Immunization.
2. Communicable diseases.
3. Vital Events.
4. Family planning.


5. Maternal and child health (Including deliveries, care
of the under five and nutrition supplements supplied)
6. Environmental Sanitation.
7. Treatment of minor elements (patient numbers, and
referrals)
8. Health education activities
9. Home visits.
10. Other activities.

WASTE MANAGEMENT AT HOME
AND COMMUNITY

Disposal of refuse:
Refuse means any kind of waste material. Solid refuse
is Applied to, refuse from houses, street sweepings,
commercial and industrial and agricultural operations.
Excrete means human urine and faces. Improper
disposal of these wastes are caused ill health in the
community.
Types of Refuse and hazard:-
1. Dry refuse.
2. Wet refuse.

. Dry refuse or solid refuse
contains
1. Garbage, kitchen, waste, left over food.
2. Rubbish, waste paper, broken glass, bottles, and tins,
bits of metal, plastic and rags.
3. Ashes from burning wood. Charcoal and cow dung
fuel.
4. Animal dung,
5. Street sweepings.
6. Fallen leaves.
7. Dead animals
The various Hazards:-
- Breeding of flies and other insects and rats.
- Encouraging of dogs and cows.
- Growth of bacteria, and spread of infection by means
of flies, dust and contamination of water supply.
- Unpleasant sights and smells.
- Danger of falls, Eg: Due to fruit skin on paths.

2.Wet Refuse or liquid waste
(Sullage water) in a rural community
consists of
1. Waste water from houses after washing clothes,
utensils, vegetables, bathing etc.
2. Waste from public wells and washing places.
3. Waste water from cattle shed and market places.
4. Waste water from industries.

Hazards:- Liquid wastes from pools and cause.
1. Mosquito breeding.
2. Risk of polluting water supply.
3. Dampness of house and danger to foundation of
building.
4. Bad smell.
Methods of Disposal of Dry
refuse:-
1. Burning:- This is the best method of refuse disposal
a. In cineration: By this method bacteria will be killed
and refuse reduced to a small amount of ash. It should
be carried away from houses to avoid smell and smoke,
preferably in an incinerator. In this a chief drawback is
that the refuse is a loss to the community in terms of
manure
2. Feeding to animals:-
Left over food and vegetables waste may be fed to
animals such as pigs. A separate bin may be kept for
this purpose.
3. Burrying:-
In a pit or trench, 3 ft deep, to prevent dogs or rats
from getting at the refuse. Every time when refuse is
dumped, it must be covered with some soil. When
done in a large, this is called Controlled tipping
method. The refused may be broken down by bacteria
into manure which may be used after 3-6 months. And
the pits used again for fresh refuse.

4. Composting : In rural areas this is a very useful
method. The compost pit is made as follows:
a. Select a site near to the house but away from any
water source.
b. Dig a pit 3 meters x 3 meters x a metre deep, or a
little larger if needed.
c. The walls of the pit may be lined with bricks.
d. Fill the pit with alternate layers of house refuse and
cow dung in proportion 3:1 and cover each layer with
soil to avoid fly breeding.

From time to time the compost may be turned and
mixed with a long pole.
f. The top layer should be of refuse covered with earth
to about 30 cm. above ground level. When full, the
compost pit is left for 6 months, after which the
contents can be used as manufreand the pit used again
g. Two such pits will be needed for alternative use.



5. Incineration: Incineration is a form of burning
which is the safest method of refuse disposal,
especially for hospital refuse such as dirty dressings,
but glass and tin should not be included.
Properly constructed incinerators are built and should
be well maintained. The resulting ash may be used for
road making or repair.

6. Dumping on Land :This is a method which can be
used to fill up low-lying land, but is not without health
hazards. The dumping ground must be well away from
houses because it will attract files and rats, and have a
bad smell. To lessen flies, the refuse may be burned.
The land may later be used for cultivation.


7. Disposal of the Dead : Depending on custom and
religious practice, the following methods are used:
a. Burying. Adequate fresh land is needed. Graves are
dut 3-5 feet deep. The burial ground should be on
sandy loam soil, not too close to houses. There should
be a wall around, and trees planted.

b. Cremation or burning. Hindus and Buddhists
usually cremate their dead on the open pyre. Less land
is required for this method, but fuel is needed. The
cremation ground should be well away from any
houses. The modern method of cremation by the use
of a furnace is quicker and uses less space.

METHODS OF DISPOSAL OF WET
REFUSE AND EXCRETA

Disposal of Sullage water:
Soakage pit: This is made as follows:
1. Select a place near the house where waste water runs
out of the house.
2. Dig a pit 2 metres deep and 11/2 metres in diameter.
3. Fill the lowest 1/3 of the pit with stones and bricks of
3/4 size.
4. Fill the middle 1/3 of the pit with stones or bricks of
1/2size.
5. Fill the upper 1/3 of the pit with stones or bricks of
1/4size.

6. The waste water should flow into the soakage pit
through a pipe. The pipe should be empty into a basket
filled with straw and leaves which is placed in the
middle of the upper part of the pit, and which serves as
a filter. This basket should be removed and cleaned or
replaced every 2-3 months.
7. Cover the top layer of the pit with a layer of earth to
above ground level. Build a parapet 10 cm. high round
the top of the pit to protect it from rain water.
8. If the pit starts overflowing, it must be emptied, and
the stones or bricks washed, dried and replaced.

Silage from cattle sheds: Cattle shed floors should
be washed daily and the waster drained away into a
soakage pit.
Disposal of Excreta: In urban areas there is water
carriage system. Large pipes called sewers collect from
house drains and carry away for treatment the excreta
together with sullage water and rain water, called
sewage. In rural areas, usually there is no public
system of sewage
disposal. Village people need to be shown a safe and
practical method of excreta disposal.
.


Types of latrines are:
a. Service type.
b. Sanitary latrines.
c. Simple latrines.

Service type Latrine : This type needs someone to
collect and empty the buckets of night soil (excreta). It
is not recommended except in case of sickness, when a
commode or bedpan is needed.
Sanitary Latrine: This is one which does not cause
nuisance due to sight or smell, the excreta is not left
exposed, and it does not pollute the soil nor any water
source. The best type of sanitary latrine is the water
seal pit latrine.

Simple Latrine for a camp, especially where there is
shortage of water, or for a family where a sanitary
latrine cannot be constructed, this type of latrine is
suitable.
1. Dig a pit about 1/2 metre wide and 1-2 metres deep. It
can be of any length. It should be at least 20 metres
from buildings and water source.
2. Make a platform of wood or cement, with a hole in
the centre, to place over the pit. Make a wooden cover
with handle.
Bio-gas plant In India the use of biogas plant is being
promoted. The plant is expensive to install, but once
installed is of great benefit to the family or community
using it. The principle is that night soil passes from
latrine to a large covered container where
decomposition takes place. Animal waste such as cow
dung is added and the resulting gas can be piped into
the building for use with a gas cooking plate.

Sewage Purification Large quantities of sewage from
a total community is offensive in smell and contains
millions of bacteria. It has to be purified to protect the
health of the community
1. Screening : A metal screen strains out floating
refuse such as bits of wood and rags. This refuse is
disposed of by burying.
2. Grit chamber: This is a long narrow trench where
heavier solids such as sand and gravel will settle, to be
removed later and used for roads or land fillings.

3.. Primary Sedimentation Tank: The sewage flows
through slowly for 6-8 hours while other solids settle
and form a black mud called sludge. The sludge is
pumped out into another tank, while the upper liquid
part called effluent passes on to be further purified.
Sludge is dried to make manure.
4. Biological Treatment One of the following two
types of treatment is used.
a. Trickling filter: This is a round bed of stones. A
pipe with a row of holes rotates at the top of the filter.
The effluent flows through the pipe on to the filter
bed. As it passes through, it gets
oxidised by aerobic bacteria and is purified.

.
b. Activated Sludge Process : The effluent is kept in
a tank for about 6 hours together with a dose of
activated sludge. This sludge contains plenty of aerobic
bacteria. By pumping air into the bottom of the tank,
the mixture is agitated and oxidised. Harmful
organisms such as cholera and typhiod germs are
destroyed by this process.

5. Final Sedimentation: The purified effluent is kept
in a tank for 2 1/2 hours. The sludge that collects is rich
in aerobic bacteria and some is used for the activated
sludge process.
6. Chlorination : Effluent from the Final
sedimentation tank is chlorinated and is then safely
allowed to flow into fields for irrigation or into rivers
or streams.
Other methods of sewage
disposal
1. Oxidation pond : This is a cheap and suitable method
for a small community. It is an open pool 3-5 feet deep
with an inlet and an outlet. The organic matter in
sewage is oxidised, because of the presence of :
a) Sunlight In India this is usually in plentiful supply.
b) Bacteria which feed on the organic matter and
produce carbon dioxide.
c) Algae in the pond. Algae uses up carbon dioxide and
produces oxygen with the help of sunlight.

2. Land Treatment of sewage: This method is used
in some towns. After screening, grit removal and
primary sedimentation, the effluent is used for
cultivation certain food crops such as plants and other
fruits trees, and of some vegetables.
3. Sea Outfall sewage gets diluted and gradually
oxidised in the sea, but there is a chance of solid
matter getting washed back. If this method is used,
the sewage should be carried well
out into deep water.

SENSITIZE AND HANDLE SOCIAL ISSUES AFFECTING
HEALTH AND DEVELOPMENT FOR SELF AND FAMILY

Women empowerment
Meaning;
Women Empowerment refers to increasing
the spiritual, political, social or economic strength of
Women. It often involves the empowered developing
confidence in their own capacities. Empowerment is
probably the totality of the following or similar
capabilities:

Empowerment includes the
following, or similar, capabilities
The ability to make decisions about personal/collective
circumstances
The ability to access information and resources for
decision-making
Ability to consider a range of options from which to
choose (not just yes/no, either/or.)
Ability to exercise assertiveness in collective decision
making
Having positive-thinking about the ability to make
change

Ability to learn and access skills for improving
personal/collective circumstance.
Ability to inform others perceptions though exchange,
education and engagement.
Involving in the growth process and changes that is
never ending and self-initiated
Increasing one's positive self-image and overcoming
stigma
Increasing one's ability in discreet thinking to sort out
right and wrong

GOVERNMENT SCHEMES FOR
EMPOWERMENT OF WOMEN

Department of Womens Empowerment and Child
Development
(a) The Integrated Child Development Services (ICDS)
programme: This is a flagship programme of the
department. While providing `anganwadi(crche)
services and health and nutritional supplements to
infants, ICDSalso provides pre- and post-natal care for
pregnant and lactating mothers.The anganwadi
workers have to dispense iron tablets and iodine-
fortified saltto pregnant and lactating mothers.

(b) Kishori Balika Yojana (scheme for the adolescent
girls): As part of theICDS programme, a special
scheme for the adolescent girls was initiatedfrom 2001
onwards, with assistance from the Government of
India as well asfrom the World Bank. The scheme is
intended for adolescent girls in the 11-18 age group who
belong to the BPL (below poverty line) households
The areas in which training would be provided would
include information about how to take care of their
bodies, the meaning of abalanced diet, importance of
family welfare, beside providing them interpersonal
skills and making them self-confident and training
them in vocational skills so that they can become
independent


the other programmes of the
department include the following;-

Old Age Pension Scheme: This scheme is
applicable to both men andwomen and is meant for
both urban as well as rural areas and provides
Rs 400 per month to those who are above 60 years of
age.


(d) Pension scheme for
widows/homeless/aged/disabled: The scheme
is applicable only in rural areas and is implemented by
the District Social Welfare Officer on the basis of the
recommendation received from the Pradhan of the
Gram Panchayat as well as the Minister,Panchayats,
and forwarded through the Block office..

(e) Financial assistance to destitute widows:
Destitute widows are entitled to receive a sum of Rs.
400 per month. This is a scheme for rural areas and is
to be implemented by the Gram Panchayats,
(f) Financial assistance for re-marriage of
widows: A sum of Rs.11,000 is provided for the re-
marriage of a widow below the age of 35 years.

(g) Grant to female student who has passed
intermediate from BPL
(below poverty line) family to enable her to pursue her
studies: A one time grant of Rs. 25,000 is given to a
female student to enable her to complete her
graduation. This scheme was started in 2006-2007.


social welfare board
Board was set up in 2003. The Board receives funding
from the Central Government to run its schemes and
has six representatives from the Central Social Welfare
Board and six from the State Social Welfare Board. All
the schemes of the Board are implemented through
the NGOs. The Social Welfare Board has a Secretary
who is a government official. ThePresident is a
nominee of the political party in power at the state
level andhas a three year term but her term comes to
an end with the change of government.
These schemes include:

(a) Hostels for working women
(b) Womens Helpline
Family Counseling Centres
(d) Campaign against female foeticide
(e) Vocational training programs
(f ) Creches
(g) Condensed courses for women
(h) Short-stay homes for women



Department of health
In order to reduce the maternal and infant mortality
rates, there is a scheme for the safe delivery of
pregnant mothers as well as care of their infants. The
scheme is applicable to women who belong to the BPL
(below poverty line)households and who are taken to
the government health centre or hospital for their
delivery. A pregnant woman can be accompanied by an
ASHA(health) worker or by the local `dai (midwife)
and an allowance is paid to this person.
In case a pregnant woman delivers her baby in a
hospital in the rural area, she is paid an amount of Rs.
1400/ and Rs. 1000 if she is taken to a hospital in the
urban area. The pregnant woman is also provided the
tetanus injection and the newly born infant is
provided vaccinations against six dangerous diseases at
periodic intervals.

Empowerment and Gender Equity
Schemes

2.1 Department of Education
Under the Sarva Shiksha Abhiyan (Education for
All), several schemes have been initiated to reduce the
gender gap in the education of children. These have
been set up by the Department of Education. These
are:

The scheme also envisages provision of good quality
education to such girls. At the ECCE centres, the
physical and psychological growth and development of
all children in the 3-6 age group, is provided for. The
education department at the district level has the
responsibility for the Education for All programme
(Sarva ShikshaAbhiyan) and Department of Social
Welfare (through the IntegratedChild Development
Services Programme) have the responsibility for
running the ECCE Centres.

b) National Programme on Education for Girls at
Elementary Level
(NPEGEL): Since education is a concurrent subject,
this national programme is also being implemented at
the state level in some select districts and blocks since
2003. It is intended to increase the enrolment rates of
girls belonging to SC/ST communities at the
elementary stage.The scheme intends to focus
attention on the educationally deprived
Kasturba Gandhi Balika Vidyalaya (KGBV): The
scheme draws its legitimacy from the thrust in
national policy documents as well asinternational
discourse that refers to bridging the `gender gap.
Following this thrust, the scheme is being
implemented in educationally backward blocks with a
wider gender gap. The schemeis intended for girls
belonging to the (SCs), (STs), (OBCs), religious
minorities and below poverty line (BPL) households.
Funded by theGovernment of India,
the basic idea behind the scheme is to give a second
chance for mainstreaming rural girls belonging to
deprived social backgrounds who could not study up
to or beyond class V. The second opportunity consists
of the facility to stay in a hostel while studying for the
upper primary stage of elementary education namely
classes VI to VIII. They are set up in areas where there
are a minimum of 50 school going girls who are school
drop-outs. As all the girls are primary school drop-
outs, they are above 10 years of age and are mostly in
their teens.



objectives of women
empowerment;-
I. To ensure that education becomes accessible to the
socially and economically marginalized women and
girls;
II. To encourage and promote a gender-based
discourse in society
III. As a gender-based programme, to create an
ambience in the society for tolerance and mutual
respect for women;
To enhance the self-image and self-confidence of
women
To collectively participate in decision making and seek
equal rights and opportunities for a more egalitarian
society;
To enhance participation of women and girls in formal
and non formal education programmes and to create
an environment in which education can serve the
objectives of womens equality;

To ensure physical, psychological, social, economic
development ofwomen so that they become self-
reliant and can participate in all aspects of societal
development;
To form womens groups at the village level so that
the `sanghas(womens groups) can take collective
action to start the process of social change;
To create an environment whereby women can seek
knowledge andinformation and enable them to play a
positive role in their own development and in the
development of society.



national policy for the women
empowerment



The principle of gender equality is enshrined in the
Indian Constitution in its Preamble, Fundamental
Rights, Fundamental Duties and Directive Principles.
The Constitution not only grants equality to women,
but also empowers the State to adopt measures of
positive discrimination in favour of women.
The goals and objectives;

(i) Creating an environment through positive
economic and social policies for full development of
women to enable them to realize their full potential
(ii) The de-facto enjoyment of all human rights and
fundamental freedom by women on equal basis with
men in all spheres political, economic, social,
cultural and civil
(iii) Equal access to participation and decision making
of women in social, political and economic life of the
nation

(iv) Equal access to women to health care, quality
education at all levels, career and vocational guidance,
employment, equal remuneration, occupational health
and safety, social security and public office etc.
(v) Strengthening legal systems aimed at elimination
of all forms of discrimination against women
(vi) Changing societal attitudes and community
practices by active participation and involvement of
both men and women.
vii) Mainstreaming a gender perspective in the
development process.
(viii) Elimination of discrimination and all forms of
violence against women and the girl child; and
(ix) Building and strengthening partnerships with civil
society, particularly womens organizations




ECON0OMIC EMPOWERMENT
OF WOMEN
Poverty Eradication
There will be improved implementation of
programmes which are already women oriented with
special targets for women. Steps will be taken for
mobilization of poor women and convergence of
services, by offering them a range of economic and
social options, along with necessary support me
asures to enhance their capabilities

MICRO CREDIT

In order to enhance womens access to credit for
consumption and production, the establishment of
new, and strengthening of existing micro-credit
mechanisms and micro-finance institution will be
undertaken so that the outreach of credit is enhanced.
Other supportive measures would be taken to ensure
adequate flow of credit through extant financial
institutions and banks, so that all women below
poverty line have easy access to credit.

WOMEN AND ECONOMY
Womens perspectives will be included in designing
and implementing macro-economic and social policies
by institutionalizing their participation in such
processes. Their contribution to socio-economic
development as producers and workers will be
recognized in the formal and informal sectors
(including home based workers) and appropriate
policies relating to employment and to her working
conditions will be drawn up. Such measures could
include:

GLOBALIZATION
Department of Women & Child Development, it is
evident that there is a need for re-framing policies for
access to employment and quality of employment.
Benefits of the growing global economy have been
unevenly distributed leading to wider economic
disparities, the feminization of poverty, increased
gender inequality through often deteriorating working
conditions and unsafe working environment especially
in the informal economy and rural areas.

WOMEN AND AGRICULTURE
In view of the critical role of women in the agriculture
and allied sectors, as producers, concentrated efforts
will be made to ensure that benefits of training,
extension and various programmes will reach them in
proportion to their numbers. The programmes for
training women in soil conservation, social forestry,
dairy development and other occupations allied to
agriculture like horticulture, livestock including small
animal husbandry, poultry, fisheries etc. will be
expanded to benefit women workers in the agriculture
sector.



WOMEN AND INDUSTRY
The important role played by women in electronics,
information technology and food processing and agro
industry and textiles has been crucial to the
development of these sectors. They would be given
comprehensive support in terms of labour legislation,
social security and other support services to
participate in various industrial sectors
SUPPORT SERVICES
The provision of support services for women, like child
care facilities, including crhes at work places and
educational institutions, homes for the aged and the
disabled will be expanded and improved to create an
enabling environment and to ensure their full
cooperation in social, political and economic life.
Women-friendly personnel policies will also be drawn
up to encourage women to participate effectively in the
developmental process.

2.SOCIAL EMPOWERMENT OF
WOMEN
Equal access to education for women and girls will be
ensured. Special measures will be taken to eliminate
discrimination, universalize education, eradicate
illiteracy, create a gender-sensitive educational system,
increase enrolment and retention rates of girls and
improve the quality of education to facilitate life-long
learning as well as development of
occupation/vocation/technical skills by women
Sectoral time targets in existing policies will be
achieved, with a special focus on girls and women,
particularly those belonging to weaker sections
including the Scheduled Castes/Scheduled
Tribes/Other Backward Classes/Minorities. Gender
sensitive curricula would be developed at all levels of
educational system in order to address sex
stereotyping as one of the causes of gender
discrimination.



1) HEALTH
A holistic approach to womens health which includes
both nutrition and health services will be adopted and
special attention will be given to the needs of women
and the girl at all stages of the life cycle. The reduction
of infant mortality and maternal mortality, which are
sensitive indicators of human development, is a
priority concern. This policy reiterates the national
demographic goals for Infant Mortality Rate (IMR),
Maternal Mortality Rate (MMR) set out in the
National Population Policy 2000. Women should have
access to comprehensive, affordable and quality health
care
To effectively meet problems of infant and maternal
mortality, and early marriage the availability of good
and accurate data at micro level on deaths, birth and
marriages is required. Strict implementation of
registration of births and deaths would be ensured and
registration of marriages would be made compulsory
In accordance with the commitment of the National
Population Policy (2000) to population stabilization,
this Policy recognizes the critical need of men and
women to have access to safe, effective and affordable
methods of family planning of their choice and the
need to suitably address the issues of early marriages
and spacing of children. Interventions such as spread
of education, compulsory registration of marriage
Womens traditional knowledge about health care and
nutrition will be recognized through proper
documentation and its use will be encouraged. The use
of Indian and alternative systems of medicine will be
enhanced within the framework of overall health
infrastructure available for women.
2) NUTRITION
In view of the high risk of malnutrition and disease
that women face at all the three critical stages viz.,
infancy and childhood, adolescent and reproductive
phase, focussed attention would be paid to meeting
the nutritional needs of women at all stages of the life
cycle. This is also important in view of the critical link
between the health of adolescent girls, pregnant and
lactating women with the health of infant and young
children..
7 Intra-household discrimination in nutritional
matters vis-vis girls and women will be sought to be
ended through appropriate strategies. Widespread use
of nutrition education would be made to address the
issues of intra-household imbalances in nutrition and
the special needs of pregnant and lactating women.
Womens participation will also be ensured in the
planning, superintendence and delivery of the system.
3)Drinking water and sanitation
Special attention will be given to the needs of women
in the provision of safe drinking water, sewage
disposal, toilet facilities and sanitation within
accessible reach of households, especially in rural
areas and urban slums. Womens participation will be
ensured in the planning, delivery and maintenance of
such services
4)Housing and shelter
Womens perspectives will be included in housing
policies, planning of housing colonies and provision of
shelter both in rural and urban areas. Special attention
will be given for providing adequate and safe housing
and accommodation for women including single
women, heads of households, working women,
students, apprentices and trainees.
5)Environment
Women will be involved and their perspectives
reflected in the policies and programmes for
environment, conservation and restoration. The vast
majority of rural women still depend on the locally
available non-commercial sources of energy such as
animal dung, crop waste and fuel wood.
. Women will be involved in spreading the use of solar
energy, biogas, smokeless chulahs and other rural
application so as to have a visible impact of these
measures in influencing eco system and in changing
the life styles of rural women.
6)SCIENCE AND TECHNOLOGY
Programmes will be strengthened to bring about a
greater involvement of women in science and
technology. These will include measures to motivate
girls to take up science and technology for higher
education and also ensure that development projects
with scientific and technical inputs involve women
fully.
WOMEN IN DIFFICULT
CIRCUMSTANCES
Programmes will be strengthened to bring about a
greater involvement of women in science and
technology. Special measures would be taken for their
training in areas where they have special skills like
communication and information technology. Efforts to
develop appropriate technologies suited to womens
needs as well as to reduce their drudgery will be given a
special focus too.
WOMEN IN DIFFICULT
CIRCUMSTANCES
In recognition of the diversity of womens situations
and in acknowledgement of the needs of specially
disadvantaged groups, measures and programmes will
be undertaken to provide them. with special
assistance. These groups include women in extreme
poverty, destitute women, women in conflict
situations, women affected by natural calamities,
women in less developed regions, the disabled widows,
elderly women, single women in difficult
circumstances, women heading households, those
displaced from employment, migrants.

VIOLENCE AGAINST WOMEN
All forms of violence against women, physical and
mental, whether at domestic or societal levels,
including those arising from customs, traditions or
accepted practices shall be dealt with effectively with a
view to eliminate its incidence. . A special emphasis
will also be laid on programmes and measures to deal
with trafficking in women and girls.
RIGHTS OF GIRL CHILD
All forms of discrimination against the girl child and
violation of her rights shall be eliminated by
undertaking strong measures both preventive and
punitive within and outside the family. There will be
special emphasis on the needs of the girl child and
earmarking of substantial investments in the areas
relating to food and nutrition, health and education,
and in vocational education. In implementing
programmes for eliminating child labour, there will be
a special focus on girl children.
MASS MEDIA
Media will be used to portray images consistent with
human dignity of girls and women. The Policy will
specifically strive to remove demeaning, degrading
and negative conventional stereotypical images of
women and violence against women. The media would
be encouraged to develop codes of conduct,
professional guidelines and other self regulatory
mechanisms to remove gender stereotypes and
promote balanced portrayals of women and men.

WOMEN ABUSE
The problem of violence against women is not new. A
womans life lies between pleasure at one end and
danger at other end. The type, frequency and intensity
of atrocities on women may vary from time to time or
from place to place. but it is there everywhere.
In other word violence means injurious and
destructive bahaviour which damages the victim
physically, mentally or financially.
1. A women is sexually harassed every 40 minutes
2. A rape occurs----------------------every 36 minutes
3. A woman is kidnapped ----------every 42 minutes
4. A woman is molested------------every 24 minutes
5. A dowry death------------------- every 100 minutes

Violence against women are
Physical, sexual and psychological violence occurring
in the family
Sexual abuse of female children in the household
Dowry-related violence
Marital rape
Other traditional practices harmful to women

Violence related to exploitation
Acts of violence against women also include forced
sterilization &forced abortion &forced use of
contraceptives.
Kidnapping and selling of minor girls
Eve teasing
slavery .
Impact of violence against women;

Violence erodes womens self esteem and shatters their
self confident. Because of the social stigma women are
afraid to speak out openly on violence suffered by
them. By swallowing and suppressing their emotions
they spoil their mental and physical health. Violence
against women is an obstacle to the achievement of
the objective of equality, development and peace.
Violence against women violates and impairs the
enjoyment by women of their human rights and
fundamental freedom..
Why violence against women;
I. Historically unequal power relations between
women and men
II. Influence of culture
III. Lack of access to legal information, aid or protection
IV. Insufficient laws t effectively prohibit violence
against women

V. Absence of means to address the causes and
consequences of violence against women
VI. Media image vow e.g. depiction of rape, sexual
slavery use of women as sex objects
VII. Unemployment
VIII. Strained familial relationship

Strategies to combat violence
against women are;

Developing a holistic ad multidisciplinary approach to
the challenging task of promoting families,
communities and states that are free of violence
against women is necessary and achievable
Educational systems should promote self-respect,
mutual respect and cooperation between women and
men
Boys and girls should be brought up equally without
discrimination from the childhood without assigning a
stereotyped role

Parents should be role models by sharing work and
responsibility equally
Property should be jointly owned by parents
Ensure joint decision-making in upbringing of
children
Educate family members not to give or take dowry
Son preference syndrome should changed through
awareness programmes
Ensure implementation of existing legislations to
provide equal opportunities in employment

Educate family members not to give or take dowry
Son preference syndrome should changed through
awareness programmes
Ensure implementation of existing legislations to
provide equal opportunities in employment
Till prevention of sexual harassment at work place act
is enacted,
Equal opportunities for women in decision making
bodies in all institutions must be mandatory

Womens reservation bill should be passed
immediately
Ensure equal representation for women in all political
parties and its decision making bodies
Gender neutral terms to be used in all shares
Gender bias should be eliminated from curriculum
Women and men can be mobilized to overcome
violence in all its forms and that effective public
measure can be taken to address both causes and
consequence of violence.

CHILD ABUSE

Child sexual abuse is a dark reality that routinely
inflicts our daily lives but in a majority of cases it goes
unnoticed and unreported on account of the
innocence of the victim, stigma attached to the act,
callousness and insensitivity of the investigating and
the law enforcement agencies, etc.

Kinds of Child Abuse
There are five types of child abuse:
a) physical abuse
b) sexual abuse
c) neglect
d) emotional harm
e) exposure to family violence

CATEGORY DEFINITION EXAMPLES
PHYSICAL ABUSE The application of
unreasonable force by an
adult or youth to any part
of a childs body
, forceful shaking,
pushing,grabbing,
throwing, hitting with a
hand, punching, kicking,
biting, hitting with an
object, choking,
strangling, stabbing,
burning, shooting,
poisoning and the
excessive use of restraints
SEXUAL ABUSE Involvement of a child, by
an adult or youth, in an
act of sexual gratification,
or exposure of a child to
sexual contact, activity or
behaviour
NEGLECT
Failure by a parent or
caregiver to provide the
physical or psychological
necessities of life to a child
Failure to supervise,
leading to physical
harm or to sexual
harm; permitting
criminal behaviour;
physical neglect;
medical neglect
EMOTIONAL
HARM
Adult behaviour that harms a child
psychologically, emotionally or
spiritually
unreasonable and abusive
treatment,frequent or
extreme verbal abuse .
emotional neglect, and
direct exposure to
violence between adults
other than primary
caregivers
EXPOSURE TO
FAMILY
VIOLENCE
Circumstances that allow a child to
be aware of violence occurring
between a caregiver and his/her
partner or between other family
members
Allowing a child to see,
hear or otherwise be
exposed to signs of the
violence
Withdrawing A normal child becoming a loner, or
withdrawing from social contacts is one of the first
signs of abuse. As a first sign she may stop talking to
adults, then to friends. The child may also stop caring
about her personal appearance. Overall it will be a
behavior which is totally different from the ones you
know.

Injuries they cannot explain When children have
unexplained injuries. When they wear long sleeves and
pants, are limping or avoiding touch. A single instance
can be dismissed as injury. But there is probably
something wrong if this happens repeatedly.
Unexplained Gifts When your child frequently
brings home gifts and cant explain them. It is wise to
find out if someone with questionable reputation is
giving them these gifts.

Tiredness or sleeping in class A child frequently
becoming tired or falling asleep in class or in the
playground, etc. is a sign that he is being abused and
fears sleeping at home.
Reluctance to visit specific places - If your child
doesn't want to go to specific peoples houses, or
refuses to spend the night alone with Dad, there may
be an issue. Don't force it, but try to find out the
causes as gently as possible.

Sudden Emotional Changes - If there is a sudden
change in the childs behavior from happiness to fear,
anger or anxiety, dont rule out the possibility of abuse.
If you are unable to get to the root of this consult a
therapist.

Child sex abuse
Though there is no universal definition of child
sex abuse, it characteristically refers to a dominant
position of an adult that puts him or her in a position
to coerce a child into a sexual act. Child sex abuse goes
beyond physical abuse to include other forms such as
exposure, voyeurism, and child pornography.

Emotional abuse
A child is said to be emotionally abused when she is
suffering under any of the following conditions:
Inadequate physical care
Absence of medical attention
Inadequate medical care.
Cruel or abusive treatment
Improper supervision
Exploitation of the child's earning capacity
Child neglect
Child neglect involves parents or caregivers
failing to provide the child with basic needs to such an
extent that the childs physical and/or psychological
well-being are damaged or endangered. Neglect can be
classified into three types:
1. Physical neglect
2. Emotional neglect
3. Educational neglect
Physical Neglect
Failure to provide adequate food, clothing, or hygiene
Not paying attention to childs safety, both at home
and outside, such as drunk driving with kids in the car,
leaving a baby unattended etc
Indifference or refusal to provide children the
necessary health care
Abandoning children without providing for their care
or driving them out of home without arranging for
their care

Educational Neglect
Not enrolling a child in school
Permitting or creating reasons whereby a child misses
too many days of school
Not paying attention to a childs special educational
needs
Emotional Neglect
Inadequate nurturing or display of affection
Permitting or turning a blind eye to spousal abuse
Permitting a child to drink alcohol or use recreational
drugs
Failure to intervene and prevent a child's antisocial
behavior
Refusal of or delay in providing necessary
psychological care

Effects of child abuse

1)Emotional Effects of Child Abuse
Low self-esteem
Depression and anxiety
Aggressive behavior/anger issues
Relationship difficulties
Alienation and withdrawal
Personality disorders
Clinginess, neediness
Flashbacks and nightmares

2)Behavioral Effects of Child Abuse

Problems in school and work
Prostitution
Teen pregnancy
Suicide attempts
Criminal or antisocial behavior
Alcohol and drug abuse
Eating disorders
Spousal abuse

MANAGEMENT OF CHILD ABUSE;

It protects the employment of children from any
factory or mine or any another hazardous occupation.
The child labour protection and regulation Act was
enacted in 1986.
The State shall direct its policy in such a manner that
the tender age of children is not abused, children are
given opportunities and facilities to develop in healthy
manner and childhood is protected against
exploitation and against moral and material
abandonment
National Policy on Education emphasized universal
enrolment and universal retention of children at
elementary school stage
Crche services to children of poor working women in
unorganized sector were expanded
Adoption services were promoted
The Juvenile Justice Act was enacted ion 1986
repeating the teen existing children act to deal
effectively with the problem of neglected or juvenile
delinquents
PREVENTION OF CHILD ABUSE
Primary prevention;
Creating general awareness among the people about
the extent and nature of the problem through the mass
media
Education of the general public about the causes of the
problem and its prevention and control
Encouraging family support system, interpersonal
communication, equal distribution of family resources
to all the members

The nurse can teach the parents acceptable and
workable way to discipline children so that the limits
are maintained without causing the child emotional or
physic harm
Developing self-care services like day care facilities for
normal and physically and mentally handicapped
children for their care and supervision, dedication
centre etc

Special care to the mothers, who are predisposed to
hysterical or emotional illness such as the teenage
mothers, and those having several children or family
discord
Improving general health status and socio-economic
status by encouraging the female literacy and prenatal
training, family welfare services to prevent unwanted
pregnancies, income generating activities etc.
Training of health social welfare personnel to
recognize child abuse and activate the implementation
of the childrens act.

Secondary and tertiary level of
prevention
Recognition of child abuse cases, reporting to the
authorities and diagnosis by the doctor
Establishing rapport and investigating the associated
factors
Providing specific care according to the kind of
trauma, good physical care and love to the abused
child
Encouraging parents to participate in the care of the
children

Individual counseling and psychotherapy of the
parents and children to deal with specific psychosocial
and physical problems
Group therapy in the form of self help groups, like the
parents anonymous groups, which is an association
of abusive mothers and community day care centers
where battering parents and their children and
interact and gain support from each other.
Elder abuse

Elder abuse is a general term used to describe harmful
treatment toward an elderly person. This includes
physical abuse, emotional abuse, sexual abuse,
financial exploitation and neglect
The World Health Organization (WHO) defines elder
abuse as "a single or repeated act, or lack of
appropriate action, occurring within any relationship
where there is an expectation of trust which causes
harm or distress to an older person
Abuse may be in the form of
Material exploitation-using money, assets, property
without allowing control and giving benefit of that of
the age owner
Financial deprivation- not letting the older person
has enough resources to meet the daily needs and
maintain adequate quality of life
Property grabbing- making the older person
homeless,
Isolation cutting off the older person from family,
social and community activities

Abandonment- compelling or leaving their older
person to live is an institutions, ashram or old age
homes
Verbal humiliation being insulting, rude,
insensitive disrespectful and adopting ageist attitude
towards older persons
Emotional & psychological treatment- giving
threats generating fear in the mind, increasing
insecurity, inducing stress and strain, exploring to
humiliating behavior
Planning old persons health at risk
neglected.

Types of elder abuse
Physical abuse
Physical elder abuse is non-accidental use of force
against an elderly person that results in physical pain,
injury, or impairment. Such abuse includes not only
physical assaults such as hitting or shoving but the
inappropriate use of drugs, restraints, or confinement
Emotional abuse
In emotional or psychological senior abuse, people
speak to or treat elderly persons in ways that cause
emotional pain or distress.
Verbal forms of emotional elder abuse include
-intimidation through yelling or threats
-humiliation and ridicule habitual blaming or
scapegoating /
Nonverbal psychological elder abuse can take the form
of ignoring the elderly person
-isolating an elder from friends or activities
-terrorizing or menacing the elderly person

Sexual abuse
Sexual elder abuse is contact with an elderly person
without the elders consent. Such contact can involve
physical sex acts, but activities such as showing an
elderly person pornographic material, forcing the
person to watch sex acts, or forcing the elder to
undress are also considered sexual elder abuse
Neglect or abandonment by caregivers
Elder neglect, failure to fulfill a caretaking obligation,
constitutes more than half of all reported cases of
elder abuse. It can be active (intentional) or passive
(unintentional, based on factors such as ignorance or
denial that an elderly charge needs as much care as he
or she does).
Financial exploitation
This involves unauthorized use of an elderly persons
funds or property, either by a caregiver or an outside
scam artist.

Healthcare fraud and abuse
Carried out by unethical doctors, nurses, hospital
personnel, and other professional care providers,
examples of healthcare fraud and abuse regarding
elders include
Not providing healthcare, but charging for it
Overcharging or double-billing for medical care or
services
Overmedicating or undermedicating
Recommending fraudulent remedies for illnesses or
other medical conditions

General signs of abuse
The following are warning signs of some kind of elder
abuse:
Frequent arguments or tension between the caregiver
and the elderly person
Changes in personality or behavior in the elder

Signs and symptoms of elderly
abuse
Physical abuse
Unexplained signs of injury such as bruises, welts, or
scars, especially if they appear symmetrically on two
side of the body
Broken bones, sprains, or dislocations
Report of drug overdose or apparent failure to take
medication regularly
Broken eyeglasses or frames
Signs of being restrained, such as rope marks on wrists
Caregivers refusal to allow to see the elder alone
Emotional abuse
In addition to the general signs above, indications of
emotional elder abuse include
Threatening, belittling, or controlling caregiver
behavior that you witness
Behavior from the elder that mimics dementia, such as
rocking, sucking, or mumbling to oneself

Sexual abuse
Bruises around breasts or genitals
Unexplained venereal disease or genital infections
Unexplained vaginal or anal bleeding
Torn, stained, or bloody underclothing

Neglect by caregivers or self-neglect
Unusual weight loss, malnutrition, dehydration
Untreated physical problems, such as bed sores
Unsanitary living conditions: dirt, bugs, soiled
bedding and clothes
Being left dirty or unbathed
Unsuitable clothing or covering for the weather
Unsafe living conditions (no heat or running water;
faulty electrical wiring, other fire hazards)
Desertion of the elder at a public place

Financial exploitation
Significant withdrawals from the elders accounts
Sudden changes in the elders financial condition
Items or cash missing from the seniors household
Suspicious changes in wills, power of attorney, titles,
and policies
Addition of names to the seniors signature card
Unpaid bills or lack of medical care, although the elder
has enough money to pay for them
Financial activity the senior couldnt have done, such
as an ATM withdrawal when the account holder is
bedridden
Unnecessary services, goods, or subscription
Healthcare fraud and abuse
Duplicate billings for the same medical service or
device
Evidence of overmedication or undermedication
Evidence of inadequate care when bills are paid in full
Problems with the care facility:
- Poorly trained, poorly paid, or insufficient staff
- Crowding
- Inadequate responses to questions about care

How to asses elderly abuse
Assess the elderly person's general appearance.
Evaluate the patient's skin integrity. Are there any cuts
or bruises? Evaluate hygiene, clothing and nutrition.
Does he appear to be undernourished or unwashed?

Look for signs of abuse. This includes bruises, burns,
cuts or lacerations, skin abrasions or broken bones
that may indicate physical abuse. Bruises occurring
around the genitals or breasts may indicate sexual
abuse. Personality changes, depression, withdrawal
from regular activities or a change in mental alertness
may indicate emotional abuse.
Look for signs of neglect. This includes the presence of
bedsores, dehydration, poor hygiene, depression, urine
burns, malnutrition, unexplained weight loss and
repeated hospitalizations due to improper health care.
Examine her financial history. Some indicators of
exploitation or financial abuse include a sudden
change in the elderly person's finances, large
withdrawals from her account, cash or valuables
missing from her home, unpaid bills, the addition of
other names to a credit card and sudden changes made
to a will or other legal document.


Observe the relationship between the patient and his
caregiver. Strained relationships, numerous arguments
and tension can be a sign of a larger problem. If you
observe the caregiver (or another family member)
making threats, belittling the elderly adult or exerting
unnecessary power, this also may indicate emotional
or verbal abuse.

Role of community health nurse in prevention of
abuse elderly;

Creating mass awareness about the problem and
education regarding causes, prevention and control of
the problem
Helping the family develop the family support system
and coping abilities to deal with the family situation
and limited resources
Guidance and counseling of family members
Identification of older abuse cases, participating in
their diagnosis and treatment as prescribed
Providing specific care according to the trauma, good
physical are and lover the abused person and
encouraging the family participation in the care

Prevention of elder abuses by
themselves are

Request help, from friends, relatives, or local respite
care agencies
Find an adult day care program
Stay healthy and get medical care for when necessary.
Adopt stress reduction practices
Seek counseling for depression, which can lead to
elder abuse.
Find a support group for caregivers of the elderly
If having problems with drug or alcohol abuse, get
help

FEMALE FOETICIDE

Female infanticide is the intentional killing of baby
girls due to the preference for male babies and from
the low value associated with the birth of
females. These practices arise in areas where cultural
norms value male children over female children.

FACTS OF FEMALE INFANTICIDE
According to a recent report by the United Nations
Children's Fund (UNICEF)
up to 50 million girls and women are missing from
India' s population as a result of systematic gender
discrimination in India.
In most countries in the world, there are
approximately 105 female births for every 100 males.
In India, there are less than 93 women for every 100
men in the population.
The United Nations says an estimated 2,000 unborn
girls are illegally aborted every day in India.

DEFINATION
Sex-selective abortion (also referred to as son
preference or female deselection) are methods of
sex-selection which are practiced in areas where male
children are valued over female children. Sex-selective
abortion refers to the targeted abortion of
female fetuses; the fetus' sex may be identified
by ultrasound but also rarely by amniocentesis or
another procedure.
Female foeticide: It is defined as aborting a female
foetus after sex determination test or pre natal
diagnostic test which includes:-
Ultra-sonography
Foetoscopy
Placental tissue sampling
Amniocentesis

Female Infanticide:-Infanticide is the practice of
intentionally killing of infant. Therefore female
infanticide is the inhuman killing of the baby girl after
she is born. In the absence of genetic testing,
infanticide was the only inhumane option for
discarding the female child.

CAUSES OF FEMALE FOETICIDE
Financial burden to the family (marriage of daughter ,
dowry and social stigma of having an unmarried
daughter in the house
To keep the wealth within the family
To get rid of the illegitimate children
Superstitious beliefs ( if any one kill a female child, the
next one is sure that to be a son, female child brings ill
lack of family
Believed that boys are economic asset to the family
People believe that if they have no son, they are not
eligible to attain heaven

Prevention of female feticide;
Prohibition of pre-sex determination tests
Free education for women up to college and even post
graduate education in government run institutions
(Similar plans are being implemented in many states
in India)
- Males should stand up to their own moms and dads
when they start chirping about unwanted female
children.

Create a feminine movement so that women feel a
sisterhood towards each other and stand up for a
woman in a neighboring house rather than turn a
blind eye.
- Refuse marriage of women into households or be very
careful of families that have only male children or a
very high percentage of males.
- Do not provide any government incentives to families
that have only males
- Provide extra incentives for families that have more
than one girl child. This will help correct the gender
balance in a few years
- A move away from religious teachings and the
advocacy of a scientific, rational, and humanist
approach.
-The empowerment of women and a strengthening of
womens rights through campaigning against practices
such as dowry, and ensuring strict implementation of
existing legislation
- Ensuring the development of and access to good
health care services.-
- Inculcating a strong ethical code of conduct among
medical professionals, beginning with their training as
undergraduates.

- Simple methods of complaint registration, accessible
to the poorest and most vulnerable women.
-Wide publication in the media of the scale and
seriousness of the practice. NGOs should take a key
role in educating the public on this matter.
-Regular assessment of indicators of status of women
in society, such as sex ratio, and female mortality,
literacy, and economic participation.
It is only by a combination of monitoring, education
campaigns, and effective legal implementation that
the deep-seated attitudes and practices against women
and girls can be eroded

Steps initiated by government
The government has initiated many steps and to bring
an end to this social evil, and to bring a change in the
attitudes of the people in society . It is in this direction
that many laws , Acts and schemes have been initiated,
like :
The Laws favoring Girl Education
The Laws favoring Women's right
The Laws favoring Equal Property Share for a daughter
Other schemes for girlchild

COMMERCIAL SEX WORKERS

MEANING OF PROSTITUTION;
It is an exchange of money for sexual purpose that is
offering sexual intercourse for pay or in other words it
is an act of sexual intercourse in exchange for money.

CAUSES OF PROSTITUTION
Ill treatment by parents.
Bad company,Family prostitutes
Social customs,inability to arrange marriage
Lack of sex education, media.
Prior incest and rape, early marriage
Lack of recreational facilities, ignorance, and
acceptance of prostitution.
Economic causes include poverty and economic
distress.
Psychological causes include desire for physical
pleasure, greed, and dejection
Laws related to prostitution in
India
1. Suppression of Immoral Traffic in Women and Girl
Act -1956.
2. Prevention of Immoral Traffic Act-1956
3. Immoral Traffic (Prevention) Act-1956

The prostitution leads to many health
problems for the prostitutes like:

Cervical cancer
Traumatic brain injury
HIV
STD
Psychological disorders

Prevention of prostitution by;

Strengthening the economic status of women
Improving status of women to make their lives on their
own
Improve the standards of living
Protection young workers when placed in employment
Creating awareness for teenage girls
Sex education in schools
Severe punishment for persons running prostitution
Providing Rehabilitative services
Guidance and counseling services
Family adjustments
Creating awareness by mass media
Strict implementation of laws
FOOD ADULTERATION

Food aduleration is an age-old problem. It consist of a
large number of practices e.g.mixing, substitution,
concealing th e quality, putting up decomposed food
for sale, misbranding or giving false laels and addition
of toxicants.
Adulteration results in two disadvantages for the
consumer first,- he is paying more money for a food
stuff of lower quality.
Secondly some forms of aduleration are
injurious to health even resulting in deaths as
Food materials Common adulterants
Cereals such as wheat, rice
Mud, grits, soapstone bits
Dals
Caol tar dyes, kerasri dal
Turmeric powder Lead chromate powder
Dhania power
starch, cow dung or hose dung powder
Black pepper Dried seeds of papaya
Chilli powder Saw dust, brick powder
Tea power
Black gram husk, tamarind husk, saw dust, used
tea dust
Coffee powder
Date husk, tamarind husk, chicory
Mustard seeds Seeds of prickly poppy argmone
Edible oils
Mineral oils argemone oil
Butter
Starch, animal fat
Ice-cream
Cellulose, starch, non-permitted colours
Sweetmeats
Non-permitted colours
Fresh green peas in packing
Green dye
Ghee
vanaspati