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PUBLIC HEALTH AND PREVENTIVE MEDICINE
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??????????? The Department of Public Health and Preventive Medicine (DPH&PM) is providing primary health care services through a network of 1415 primary health centers (PHCs) and 8682 health sub centers (HSCs) spread over the entire State. Out of this 25 PHCs and 50 HSCs are located in tribal areas. 1436 HSCs are located in Adi Dravida colonies. The policy of the Government is to provide a healthy and disease free life to the people of Tamil Nadu. Towards this goal, the Government have been formulating and implementing several public health programmes and rendering effective primary health care.
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??????????? The PHCs and HSCs provide preventive, promotive, curative and rehabilitative health care services. All PHCs have been equipped with basic facilities like cold chain equipments, surgical instruments for surgeries and deliveries, etc. Most of the Block PHCs have facilities for sterilization and for detection of cataract cases and treatment of minor eye ailments. Sufficient drugs are supplied to the PHCs/HSCs through the Tamil Nadu Medical Services Corporation.
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??????????? Average out patient per day per PHC has increased from 79 in 2000 – 2001 to 118 in 2004 - 2005.?? Deliveries conducted in PHCs increased from 54,505 in 2000-2001 to 76,447 in? 2004-2005 (upto Feb.).
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??????????? The policy of this Government is to provide 30-bedded institutions at the rate of one per block where there is no district head quarters hospitals, taluk/ non-taluk hospitals and upgraded PHCs. These institutions will have modern equipments like ultra sonogram, portable ECG, X-ray with improved laboratory facilities and ambulance. In 2001-2002, 21 PHCs were upgraded. During 2002-2003, under Prime Minister’s? Gramodaya Yojana Scheme, 20 PHCs were upgraded and 17 Primary Health Centres were upgraded under NABARD loan assistance. During 2003-2004,? under? Prime Minister Gramodaya Yojana Scheme, 35 PHCs were upgraded. During 2004-2005, the Government have accorded sanction for the upgradation of 11 PHCs (2 with trauma care facilities) under Prime Minister’s Gramodaya Yojana Scheme. In all 104 Primary Health Centres have been upgraded during the last four years.
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??????????? At present 1368 PHCs are functioning in Government buildings.? 37 PHCs are functioning in private / panchayat union buildings. Construction of PHC buildings is in progress in the remaining? PHCs.?
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??????????? 424 PHCs had telephone facilities. During 2003-2004, 67 PHCs were given telephone facilities under the RCH Project. During the year 2004-2005, telephones have been sanctioned to 150 PHCs at a cost of Rs. 4.20 lakhs. Telephone facilities for the remaining 774 PHCs will be provided under the Reproductive and Child Health Project.
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??????????? ?Immunisation against vaccine preventable diseases is sustained at 100% every year. Apart from routine immunization, Pulse Polio Immunisation (PPI) is conducted every year.? The ninth round of PPI was conducted during 2004, covering 72 lakh children below 5 years of age.
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??????????? Hepatitis ‘B’ vaccination programme is being implemented in Chennai slum areas and four districts namely Virudhunagar,? Ramnad,? Madurai and? The Nilgiris.??? Around 1.70 lakh infants are benefited.
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??????????? MMR?? and?? rubella?? vaccination?? programme had been launched as a pilot project in five Blocks drawn from the 5 districts namely Cuddalore, Perambalur, Theni, Thiruvannamalai and Vellore.? 24,919 children aged? 2 to 5 years and 22,390 adolescent girls in the age group of 10-15 years were given MMR and? Rubella vaccination respectively. This vaccination helps to prevent congenital deformity in newborn babies.
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??????????? Maternal and child health care services are? the most important of all the services provided by the Department. The services provided are antenatal registration and checkup, administering vaccination against tetanus, immunization against vaccine preventable diseases, delivery care and post natal care. Total deliveries conducted by trained staff and institutional deliveries accounts to 99.6%.
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??????????? ?Iron and folic acid tablets, oral rehydration salt packets, vitamin-A solution and other essential drugs needed for MCH activities and for the treatment of minor ailments are supplied through kits A and B. Besides these, other essential obstetric equipments are supplied every year to HSCs. To improve institutional services, labor boards will be supplied to 1000 HSCs.?? During 2004-05, for MCH activities a total outlay of Rs.173.64 lakhs was allocated for drugs and medicines for HSCs and a total outlay of Rs.192.9 lakhs was allotted for PHCs.
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?The urban local bodies are sanctioned with a one fourth grant-in-aid towards the cost of medicine etc. for running the MCH Care Centres in the respective Municipalities and provided with necessary guidance. An amount of Rs.11.82 lakhs have been provided as grant? for the? year 2004 – 2005.
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??????????? Iron and Folic acid tablets were given to pregnant women, nursing women and pre school children under the National Programme.? Previously the adolescent group was completely left out.? As?? adolescent girls are in need of better nutrition, a programme for prevention of iron deficiency anaemia among adolescent girls (10-19? years) is being implemented.
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Ferrous sulphate tablets (L) are given weekly once on Thursdays to about 53.00 lakhs adolescent girls for control of anaemia, and the follow-up is done? on Saturdays.
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??????????? The national programme on vitamin ‘A’ deficiency covers the children in the age group 6-36 months. In Tamil Nadu, this programme has been extended to the age group 6-60 months.??????????? The Government have sanctioned the administration of one dose (2ml) of vitamin A solution to lactating postnatal mothers throughout Tamil Nadu. This will improve the vitamin ‘A’ nutritional status among the infants through the transmission of vitamin ‘A’ in the breast milk. The mothers will be educated on the importance of exclusive breast-feeding of newborns. The programme?? is expected to cover about 12 lakh?? mothers. The?? project?? cost?? is Rs 15.00 lakhs.
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??????????? The Government of India have already taken a policy decision to introduce Indian Systems of Medicine (ISM) drugs at the HSC level as part of the Reproductive Child Health drug supply. Select VHNs have already been supplied with kits containing ISM drugs.? A pilot programme? with ISM drugs for reducing anemia is being started in two blocks of Thiruvannamalai district.
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??????????? The School Health Programme (SHP) in the State has been revamped to provide comprehensive health care services to all students in Government and Government-aided schools from first to twelfth standards. All Thursdays are observed as ‘Schools Health Days’. All Saturdays are observed as ‘Referral Days’. Two teachers in each school are identified to co-ordinate and assist in the effective implementation of the scheme. Students studying in higher classes are identified to work as ‘Health Guides’. School Health Cards have been printed and supplied. These health cards will be issued to the students along with the Transfer Certificate when they leave the school.? Health appraisal register, referral register and drug stock register are printed and supplied. Medicines worth Rs. 300 lakhs are supplied through TNMSC.
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??????????? Up to December 2004, out of 40,308 targeted schools, 23,892 schools were visited by the medical teams, 41.7 lakhs children were treated and 45,701 children were referred to higher medical institutions.
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S.No |
Diseases |
Percentage upto December 2004 |
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1. |
Dental Carries |
10.19 |
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2. |
Worm Infestation |
9.52 |
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3. |
Acute Respiratory Infection |
12.35 |
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4. |
Anemia |
3.18 |
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5. |
Vitamin A deficiency |
1.82 |
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6. |
Scabies |
1.13 |
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7. |
Defective Vision |
0.16 |
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8. |
Otitis Media |
0.34 |
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9. |
Leprosy |
0.05 |
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10. |
Defective Hearing |
0.04 |
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11. |
Rheumatic Heart Disease |
0.04 |
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12. |
Tuberculosis |
0.09 |
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13. |
Goitre |
0.04 |
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??????????? Control of communicable diseases is one of the major achievements of the public health system, especially for diseases occurring in epidemic forms. Acute diarrhoeal diseases and cholera are common among the water-borne diseases in Tamil Nadu. In an effort to minimize this danger, 57,425 water sources were chlorinated in 2004. Administration of oral rehydration salt has been popularized.
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??????????? Tamil Nadu is one of the States which was very badly affected by Tsunami. Medical treatment was? given to 2,49,191 persons for? diseases like acute diarrhoeal diseases, acute respiratory infections, fever and? skin diseases etc.
The following preventive measures were undertaken:
1)????? Environment hygiene:
a)????? Disinfections of shelters, camps, and affected areas with bleaching powder, phenyle and slaked lime was carried out.
b)????? Chlorination of all drinking water sources and providing protected water through lorries, etc. was done.
c)????? Vector control measures like anti-fly measures, anti-larval measures, anti-adult mosquito measures and vector density monitoring were undertaken.
2)????? Information Education and Communication Activities (IEC):
IEC activities like distribution of hand bills, putting up of banners, exhibition of cinema slides, advertising in local newspapers and inter-personal communication? were carried out to educate the affected community on prevention of epidemics.
3)????? Immunisation and Surveillance:
One dose each of measles vaccination, vitamin ‘A’ and oral polio vaccine were given to prevent mortality and morbidity among children under five years. Oral Rehydration Salt was also distributed to all the affected families. Food sanitation was supervised by the Health team.
4)????? Disease surveillance:
Epidemic disease surveillance teams were formed to identify any water borne and vector-borne diseases in the affected and non-affected areas. A disease surveillance system has been set up in Nagapattinam, Cuddalore, Kancheepuram, and Kanniyakumari districts with WHO support. Disinfectants, bleaching powder, chlorine tablets, water tanks, beds, mattresses etc. were procured with the support of UNICEF and distributed in the affected areas.
5)????? Mobilization of Manpower:
800 medical officers, 1600 para medical staff and 3000 field workers were involved in rendering medical relief in the affected areas. 700 vehicles were also mobilized for this purpose. ?
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??????????? The water analysis laboratories established at Chennai and Coimbatore collect and examine water samples from various protected water sources to control pollution and contamination of drinking water.? These laboratories also assist Tamil Nadu Pollution Control Board (TNPCB) in examining samples of industrial wastes. Air pollution surveys are also carried out around the industries to assess air quality. 26182 water samples have been tested during 2004 by these laboratories.
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??????????? The Government is taking measures to control the adulteration of food by implementing Prevention of Food Adulteration Act 1954 and Rules, 1955.?? At present, 481 local bodies are implementing the Act. During 2004-05, (up to December 2004) 3067 samples were analyzed, out of which 472 samples were found adulterated.? The percentage of adulteration is 15.39%.? In 84 cases, prosecution was launched.? There were 30 cases where offenders were convicted. 28 of them were fined and sent to prison. One offender was fined? and another let off with a warning. The sale of non-iodised salt has been banned with effect from 1.1.95.? The ban has been extended for another 5 years with effect from 1.1.2005. Smoking and spitting in the place of public work or use and in public service vehicles have also been prohibited in the State of Tamil Nadu with effect from 14.5.03.
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The registration of births and deaths at the place of occurrence is compulsory and is enforced throughout the State as per the Registration of Births and Deaths Act,? 1969 and as per Tamil Nadu Registration of Births and Deaths Rules, 2000. The birth rate of Tamil Nadu is 18.5 per 1000 population and death rate is 7.7 per 1000 population. The infant mortality rate (IMR) is 44 per 1000 live births (SRS 2002).?
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In order to create awareness on birth registration, a massive national campaign was organized from 14.11.03 onwards, in which 33.00 lakh birth certificates were? issued free of cost to children below 10 years.
Registration of Tsunami Deaths
?????????? Specific instructions were given to district registrars (DRO) regarding the registration of deaths and missing persons in Tsunami affected areas, with reference to the guidelines issued by the Registrar General of India.
??????????? Malaria is prevalent mainly in urban areas in Tamil Nadu. Out of the total malaria cases reported in the State, 73.9%? are occurring in urban? areas and 26.1% in rural areas. Malaria cases are detected through active and passive surveillance and vector control measures are taken by this department.
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??????????? The national filaria control programme is implemented in Tamil Nadu since 1957. Recent advances in the field of filariasis control have indicated that an annual single dose of mass Diethylcarbamazine Citrate (DEC) tablets administration for at least 5 consecutive years is one of the most cost-effective methods of eliminating this disease. Mass DEC administration has been carried out covering 2.68 crores of people in the seventh round of mass DEC administration held during the year 2004 to eliminate lymphatic filariasis in 13 filaria-endemic districts.
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For plague surveillance activities, the IVCZ is the nodal agency. The infrastructure available in this institute is utilized to conduct various training programmes, workshops and seminars.?
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At present 7 leptospirosis clinics are functioning in taluk and district headquarters hospitals of Madurai and Tiruvallur districts. For early diagnosis, treatment and control measures, test kits have been procured and supplied to the above clinics and other districts reporting cases.?
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??????????? Japanese encephalitis (JE) unit has been established at Cuddalore, Villupuram and Perambalur with the monitoring unit at headquarters for JE vector control activities. JE immunisation programme has been carried out in selected villages in Perambalur district.? Anticipated residual insecticidal spray and fogging operations are being carried out in JE-prone villages and also in the areas where suspected JE cases are reported. During the year 2001, 119 cases and 18 deaths due to JE were reported. These figures have come down to 88 cases and 9 deaths during 2004.
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??????????? The NLEP was launched in 1954-55. Tamil Nadu has done commendable work in the field of leprosy eradication. The prevalence rate which was 4.1/10,000 in 2001 has been brought down to 1.4/ 10,000 in January 2005.?
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??????????? Tamil Nadu State has been quite successful in controlling and eradicating communicable diseases. For various non-communicable diseases like cancer, diabetes, heart ailments, however, the required specialized treatment is not easily available to rural people. To provide necessary skilled treatment at the doorsteps of the community, speciality medical camps to detect diseases like cancer, diabetes, heart ailments, hypertension and geriatric problems were conducted at the rate of one per block during 2003-04. The Government allotted an amount of Rs 259.39 lakhs during 2003-2004 for the conduct of 385 camps.? 374 camps have been conducted benefiting 813259 persons. For the year 2004-05, an amount of Rs 345.27 lakhs has been sanctioned by the Government for conducting 385 speciality medical camps.
Dental Health Programme in PHCs
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??????????? The Specialty Camps conducted during the years 2002-03 and 2003-04, showed that there is a demand for dental health services. But dental health check-up camps require elaborate facilities. Hence, Government of Tamil Nadu has introduced primary Dental Care Units (DCUs)at 16 PHCs in 4 Districts viz., Salem, Dharmapuri, Namakkal and Theni. For the year 2004-05, the DCUs have been extended to 8 more PHCs in Nagercoil and Dindigul districts.
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Integrated Diseases Surveillance Programme (IDSP) launched in Tamil Nadu
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Disease surveillance is the backbone of an effective public health administration.? It is a process of systematic collection of data on the incidence and prevalence of various diseases for the purpose of taking appropriate action for prevention and control. In Tamil Nadu, the total cost of the IDSP works out to Rs.25.42 crores. This includes, 1) Infrastructure development for IDSP cell and labs. 2) Lab equipments and consumables. 3) Online communication system,
4) Training, 5) Sentinel Surveillance Units,
6) Administrative expenses and contingencies.
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Congenital Disorders and Birth defect registry programme in Tamil Nadu
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??????????? Tamil Nadu has launched a pioneering scheme to enumerate congenital defects in children under 15 years of age. Training the village level workers to identify visible congenital defects in children under 15 years of age has been completed.? All the villages in Tamil Nadu are covered under this scheme.
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Rural Diabetics Survey in Tamil Nadu
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??????????? Diabetes is emerging as the most important non-communicable diseases in Tamil Nadu. Various studies have reported prevalence rates of 5 to 12 %.? The studies are mostly Urban/Semi urban. The comprehensive free health checkup camps and specialty camps have indicated 5% prevalence in rural areas. Accordingly, a pilot project on diabetes control in the district of Kancheepuram at a cost of Rs.5 lakhs is being implemented. Awareness campaigns and rapid surveillance studies are also being undertaken.
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??????????? There are 45 mobile health units (MHUs) functioning in 26 HUDs in Tamil Nadu? under PMGY scheme. An amount of Rs 200.70 lakhs has been sanctioned for drugs and POL to 45 MHUs. Upto December 2004, the total number of beneficiaries were 7,15,088. One more MHU has been sanctioned in Coimbatore during 2004-2005.
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In order to ensure that the doctors and public health field staff are kept updated in respect of various programmes, in-service training programmes are organized by this department. Regional level training institutions have been established at Egmore, Poonamallee, Madurai, Salem, Villupuram, Gandhigram and Tiruvarankulam.
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??????????? ? A month-long induction training on public health administration is given to newly-recruited assistant surgeons at the Institute of Public Health (IPH), Poonamallee, Health and Family Welfare Training Centres (HFWTCs) at Egmore and Madurai, Health Management Development Institutes (HMDIs) at Villupuram and Salem and in Gandhigram. In addition, one week of training on management is given at Anna Institute of Management. Foundation “B? Training for 21 days is also given to the newly recruited assistant surgeons.
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