1st Clinical Posting

Department of Community Medicine
GMERS Medical College, Gotri, Vadodara

1st clinical posting
Handouts for academic purpose
Index
S. no.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
Topic
Micronutrients and Macronutrients
Nutritive value of food items
Balanced Diet & Dietary guidelines
Food Adulteration, Food Safety & Security Act
Nutritional Disorder of Public Health Importance
Baroda Dairy
National Guidelines on Infants and Young Child Feeding
Physical Activity
Introduction to Entomology, Cyclops, Rodents
Flea, Tick, Mite
Housefly, Sand fly, Louse
Mosquitoes
Malaria Filaria Unit
Purification of Water Small Scale
Purification of Water on Large Scale
Surveillance of Water Quality
Meteorological Equipments
Excreta disposal in Unsewered area
Sewage treatment
Biomedical Waste Management
Gujarat Pollution Control Board
Solid Waste Disposal & Ward Sanitary Office
Page no.
3
15
23
32
34
47
52
63
65
68
71
74
76
78
81
84
88
91
94
98
104
107
Micronutrients and Macronutrients

The word nutrition is used to refer to the processes of the intake, digestion and
assimilation of nutrients and the application of this knowledge to maintain health and
combat disease.
Food: Food is a substance eaten or drunk to maintain life and growth. The foods are
generally classified into cereals (wheat, rice, maize etc.), legumes (pulses and peas),
nuts and oilseeds, vegetables, fruits, milk and milk products and flesh foods (fish, meat
and chicken and egg). Diet, on the other hand is what a person habitually eats and
drinks.
Nutrients: The nutrients are chemical substances that are present in the food we eat.
The important nutrients are proteins, fats, carbohydrates, vitamins and minerals.
Energy: Energy is required for maintaining the body temperature and vital activity of
organs, for mechanical work and for growth. Even when an individual is at complete
rest and no physical work is being carried out, energy is required for the activity of
internal organs and to maintain the body temperature. Table 1 shows major
contributors of energy to our diet.
Major contributors of energy to our diet-(some row foods & their energy content per
100kg)
Food stuff
Energy( kcal )
Food stuff
Energy( kcal )
Cereals & Millets
Non vegetarian foods
Wheat flour
341
Egg ( hen )
173
Rice polished
345
Fish ( hulsa )
273
Bajra
361
Chicken
109
Maize dry
342
Mutton ( lean )
118
Ragi
328
Pork ( muscle )
114
Pulses & Legumes
Milk & Milk products
Bengal gram
360
Milk, cow
67
Soya bean
432
Milk, buffalo
117
Rajmah
346
Milk, human
65
Red gram (arhar)
335
Butter
729
Green gram (Moong)
334
Ghee
900
Lentil (masoor)
343
Cheese
348
Pea dry
315
Curd
60
Fruit & Vegetables
Nuts
Banana
116
Groundnut
567
Apple
59
Cashew nut
596
Grapes, pale green
71
Coconut, fresh
444
Custard apple
104
Miscellaneous
Jack fruit
88
Jiggery
383
Raisins
308
Sugar
398
Potato
97
Veg oils
900
Macronutrients
There are four macronutrients.
Protein
Major sources including their protein content (g per 100g)
Food item(source)
Protein content (g)
Food item(source)
Eggs
13.3
Milk ( cow )
Meat (goat, lean)
21.4
Fish ( hulas )
Pulses ( red gram )
22.3
Soya bean
Groundnuts
25.3
Wheat flour
Rice ( raw, milled )
6.8
French beans
Protein content (g)

3.2
21.8
43.2
12.1
1.7
Quality of Proteins
Quantitatively the quality of a protein is worked out in terms of biological value,

digestibility co-efficient, net protein utilization and protein efficiency ratio. The working
formulae for each of these parameters are shown in the Box- 2. The net protein
utilization (NPU) is the most commonly used parameter. A protein with an NPU of more
than 65 is considered as of optimum quality. Egg protein is considered to have an NPU
of 100 and is considered as ideal or reference protein against which other proteins are
compared with.
Quality of proteins
The quality of protein depends upon its amino acid composition. A protein containing all
amino acids consider as a ideal. Egg protein is taken as reference protein.
Biological value (BV)=
Digestibility co-efficient =
Net protein utilization (NPU) =
Protein efficiency ratio (PER) =
Recommended Dietary Allowance (RDA) for Proteins: The requirement of proteins is
generally accepted to be 1g/ Kg/day for adults. So the recommended dietary allowance for a
reference adult male works out to 60g/day and for a reference adult female it is 50g/day. An
additional allowance of 15g/day is recommended for pregnancy. During lactation extra
allowance of 25g in the first 6 months and 18g in the subsequent 6 months is recommended.
Children have a higher protein requirement. An attempt is also made to elaborate as to how this
requirement could be met in the typical Indian conditions. Some tips on improving the
consumption of proteins is given here.
Recommendations on Diet for Proteins
Eat nutritionally balanced diet to get adequate protein.

Meat and fish are good sources.
Vegetarians must eat proper combination of plant proteins from both cereal and
pulses groups
Include Soyabean in your diet

Two to three servings of protein-rich food must be ensured every day
One serving may be equivalent to :
- One to two cups of cooked meat, poultry, fish
- Half cup of cooked dry beans/ lentils/ legumes
- One egg
- Handful of fried/roasted- salted groundnuts
- Handful of roasted Bengal grams
Fat
Sources of fats:
Dietary fats are derived from two main sources:
(a) Animal Sources: They are milk and milk products (ghee, butter), lard, egg and fish
oils. Animal fats in general are poor sources of essential fatty acids with the exception of
certain marine fish oils such as cod liver oil and sardine oil, but they are good sources of
retinol and cholecalciferol.
(b) Vegetable Sources: They include various edible oils such as groundnut, gingerly,
mustard, cottonseed, safflower, rapeseed, palm and coconut oil. Vegetable oils with the
exception of coconut oil are all rich sources of essential fatty acids, but they lack retinol
and cholecalciferol except red palm oil which is rich in carotenoids.
Major sources including their fat content (g/100g)
Food item (source)
Eggs(hen)
Milk, cow
Meat (goat lean)
Fish (hilsa)
Ghee
Butter
Groundnut
Mustard seeds
Coconut ,fresh
Sunflower seeds
Fat content (g/100g)

13.3
4.1
3.6
19.4
100
81.0
40.1
39.7
41.6
52.1
Visible and invisible fats:

The visible fats are generally derived from animal fats e.g. butter or ghee or from plant
(vegetable) oils like groundnut, mustard, coconut, sunflower or safflower seeds. It is
now believed that the bare minimal requirement of visible fats to meet the essential
fatty acid requirements is 15 to 25 g per day. The upper limit is fixed at 30% of the total
energy intake or less than 80 g / day.
Some amount of fat is present in all food stuffs. From the nutritional standpoint,
important of them are cereals, pulses, oilseeds, nuts, milk, eggs and meat. Contrary to
general awareness, this invisible fat contributes substantially to the total fat
consumption and essential fatty acid intake of our diet.
Cereals and pulses which are otherwise perceived to be poor in fats contribute
significantly towards fat intake of an Indian diet. This is because most Indians depend
on the staple of cereals, consumed in a large quantity. The invisible fats may account
for 20 to 50% of all fats consumed, depending on the type of diet. It should however
contribute to not less than 6% of total energy or about 15g of invisible fats per day.
Types of Fatty Acids
Saturated Fatty Acids (SFA) : Saturate (Latin, to fill, in this case with hydrogen).
Saturated Fatty acids have a relatively high melting point and tend to be solid at room
temperature. These are obtained from animal storage fats and their products e.g. meat
fat, lard, milk, butter, cheese and cream. Fats from plant origin tend to be unsaturated
with the exception of coconut oil and palm oil. A high intake of SFA is associated with an
increase in LDL and total cholesterol and thus increases the risk of atherogenesis and
cardiovascular disease. Some examples of SFAs are Myristic acid, Palmitic acid and
Stearic acid.
Monounsaturated Fatty Acids (MUFA) : MUFA contain only one double bond and are
usually liquid (oil) at room temperature. Olive oil and rapeseed oil are good dietary
sources of MUFA. MUFA are also present in meat fat and lard. Dietary MUFA does not
raise plasma cholesterol. They lower LDL cholesterol without affecting the HDL. Oleic
acid is an example of MUFA.
Polyunsaturated Fatty Acids (PUFA) : PUFA contain two or more double bonds and they
too are liquid at room temperature. They are easily oxidized in food and in the body.
PUFA have a vital role in immune response, blood clotting and inflammation. PUFA are
divided into omega-3 (3) or omega 6 (6) groupsof PUFA. Omega-3 ()
polyunsaturated fatty acids PUFA are found in fish and fish oils. The health benefits of
these include reducing the cardiovascular risk factors (see Box - 4). Research also
indicates their beneficial role in cognitive function of brain. Some common omega-3
fatty acids are -linolenic acid (linseed, soyabean, rapeseed, leafy vegetables),
eicosepentaenoic acid (marine algae, fish oils) and docosahexenoic acid (fish oils).
Why fats in diet? : If the contemporary literature is to be believed, one tends to agree
that fats are well known for their role in causation of many chronic diseases rather than
any worthwhile virtue! Then why should fat be consumed at all and how much? The
main functions of fat are elaborated in the Box - 5.
Unlike proteins where the precise intake, assimilation, excretion and thus requirement
can be worked out, the quantity of fats that should be included in a well balanced diet is
a matter of conjecture. The following aspects however are important in considering the
recommendation for fat intake:
a) The quantity of fat intake should be good enough so that requirement of essential
fatty acids (which are a component of fats) is met.
b) Absorption of fat soluble vitamins should not be compromised.
c) Fat intake should be sufficient enough to make diet palatable.
d) Some stores must be maintained in the body to tide over a lean period.
e) It should not be so much in quantity that it causes undesirable effects on health.
Quantity of Fat:
With an improving economy and a richer lifestyle we tend to consume higher calories
especially from the fat source. Higher calories lead to obesity and many other lifestyle
diseases. A high level of fat in diet is notorious in the causation of atherosclerosis and so
is a major risk factor for Cardiovascular Diseases (CVD) including coronary artery
disease and strokes. Any amount that contributes to more than 30% of total calorie
intake is considered as high. Low physical activity and sedentary lifestyle further
augment the risk.
Tips on fat intake
1) Food preparation
a) Use minimal oil for preparation
b) Rotate the types of oil used
2) Meat
a) Prefer fish to poultry
b) Prefer poultry to mutton/beef/pork
c) Limit added oils in meat preparations
d) Use only lean cuts of meat
3) Eggs
a) Avoid more than one egg a day
b)Avoid adding oil to egg preparations
c) Use egg white freely
4) Milk
a) Prefer low fat milk
Carbohydrates
Classification: From the nutritional or functional point of view, carbohydrates can be

divided into two categories.
(a) Available carbohydrates: These are the carbohydrates which can be digested in the
upper gastrointestinal tract, absorbed and utilized. These are further sub-classified as
polysaccharides, disaccharides, monosaccharides.
(i) Polysaccharides such as starch, dextrin and glycogen
(ii) Disaccharides such as lactose, sucrose and maltose
(iii) Monosaccharides such as glucose, fructose and galactose.
(b) Dietary Fibre: The second category comprises of unavailable carbohydrates or
dietary fibre, which are difficult to digest. These are cellulose, hemicellulose, gums,
pectins etc.
Sources of Carbohydrates: The major source of dietary carbohydrates in an Indian set
up is starch from cereal grains, millets, legumes, roots and tubers.
With increasing prosperity as in industrial societies, sugar has replaced complex
carbohydrates as the main source. The presence of monosaccharides (free glucose or
fructose) is limited to fruits and vegetables; otherwise they are not abundant in natural
foods. Fructose is found in honey, fruits and vegetables. Sucrose and Lactose are the
commonest disaccharides. Sucrose is extracted from sugar cane. Table sugar is 99%
sucrose. Sucrose gets hydrolysed into glucose and fructose. Lactose is found in milk. It is
hydrolysed to glucose and galactose. Maltose is present in malted wheat and barley.
Other sources are nuts and seeds.
Requirement of Carbohydrates: In a prudent diet carbohydrates should contribute to
60 to 70% of total energy (1). This translates to about 360 to 400g carbohydrates for a
2400 Kcal diet.
Micronutrients
There are two classes of micronutrients: Vitamins and Minerals. The following pages
contain useful information of select micronutrients.
Iron
Function: needed for haemoglobin synthesis, mental function and body defense.
Deficiency Disorder: Anaemia.
Iron deficiency is common particularly in women of reproductive age and in children.
Iron deficiency during pregnancy increases maternal mortality and low birth weight in
infants. In children, it increases susceptibility to infection and impairs learning ability.
Sources:
Animal Sources liver, meat, poultry and fish.
Plant sources - legumes, cereals, green leafy vegetables, jaggery, dry fruits
Iron bio-availability is poor from plant foods but is good from animal foods. Fruits rich
in vitamin C like gooseberries (amla), guava and citrus fruits improve iron absorption
from plant foods.
Beverages like tea bind dietary iron and make it unavailable. Hence, they should be
avoided before, during or soon after a meal.
RDA:
Adult Male
Adult Female
Pregnant Female
Lactating mother
RDA (mg / day)

17
21
35
21
Prophylaxis:
Since iron intake from Indian diets is often inadequate, the following routine
prophylactic iron supplements (with folic acid) are recommended per day for the
special vulnerable groups for at least 100 days a year as per the Policy Guideline on Iron
Folic Acid Supplementation, 2007, by Ministry of H & FW, GoI.
a) Pregnant Women & Adolescent Girls - 100 mg Iron, 500 mcg Folic acid
b) Children 6 months to 60 months 20 mg iron and 100 mcg folic acid
c) Children 6 10 years 30 mg iron and 250 mcg folic acid
Folic Acid
Function: essential for the synthesis of haemoglobin and DNA and promotes birth
weight of infants.
Deficiency Disorder: Anaemia, Congenital malformations
Deficiency is common particularly during pregnancy and lactation during which
requirements are higher.
Sources: liver, meat, dairy products, cereals, fruits, green leafy vegetables. Overcooking
destroys folic acid causing deficiency.
RDA:
RDA (mcg / day)
Adult male & female 200
Pregnancy
500
Lactation
300
Children
80 120
Prophylaxis:
500 mcg of folic acid supplementation is advised pre-conceptionally and throughout
pregnancy for women with history of congenital anomalies (neural tube defects, cleft
palate)
Iodine
Iodine is one of the important micronutrients from Public Health Nutrition point of
view. It has also been included in the research and advocacy activities by Micronutrient
Initiative (MI), a leading International Health Organization working in the field of
nutrition. There is a separate National Iodine Deficiency Control Programme (NIDDCP)
in India launched by GoI in 1962.
Function: Iodine is required for formation of thyroid hormones which are necessary for
growth and development.
Deficiency Disorder: Hypothyroidism; Goitre; iodine deficiency during pregnancy leads
to cretinism, still births, abortions and retarded physical & mental development of the
child.
Sources:
Sea Foods and Cod liver oil are richest sources.
Major portion of iodine we get comes from food and the remaining from drinking water.
With the wide-spread availability and use, Iodised Salt, now, forms the main source of
Iodine in Indian Diets.
RDA: 150 mcg per day in Adults.
Prophylaxis:
All households should use only Iodised salt in their food preparation. As per the NIDDCP
the norms for iodine content in salt are
30 parts per million (ppm) Iodine at manufacturer level and
15 parts per million of Iodine at consumer level
Spot Testing Kits are also available to estimate the iodine content of the Iodised salt.
The Government Department of Health & Family Welfare, Department of Industries,
Department of Railways, Department of Civil Supplies and agency like salt nominees are
involved in the NIDDCP.
Vitamin A
Function: Vitamin A is required in synthesis of rhodopsin pigment required for vision in

dim light, for maintaining integrity of epithelium, for skeletal growth, and as antiinfective substance especially among children.
Deficiency Disorder:
Ocular Manifestations- Night Blindness, Conjunctival & Corneal Xerosis, Bitots spots,
Keratomalacia
Extra-occular manifestations anorexia, growth retardation, increased due to
respiratory and intestinal infections which are important causes of under - 5 morbidity
and mortality.
Sources:
1) Animal
Liver, eggs, butter, cheese, milk, fish, meat.
Fish liver oils are the richest sources but they are generally used as nutritional
supplements rather than as food sources.
2) Plant
Green leafy vegetables (spinach, amaranth) are cheapest sources. Darker the
green leaves, higher is the carotene content
Green and yellow fruits (mango, papaya, pumpkin)
Carrots
RDA:
Group
Adult male & female
Pregnancy
Lactation
Infants
Retinol (mcg / day)

600
800
950
350
Group
Children 1 6 yrs
Children 7 9 yrs
Adolescents 10 17 yrs
Retinol(mcg/ day)
400
600
600
Prophylaxis:
As per the Guidelines of National Vitamin A Prophylaxis Programme in India Vitamin A
supplementation is given as follows:
Children 6 months 1 year: 1,00,000 IU of Vitamin A in oil (retinol palmitate)
Children 1 5 years: 2,00,000 IU of Vitamin A every 6 monthly
10
In Gujarat, two doses at 6 monthly intervals are given during the months of February
and August (Bi-annual rounds) to all the children under 5 years of age.
Vitamin C
Function: serves as anti-oxidant, needed in collagen formation and increases iron

absorption from vegetable foods.
Deficiency Disorder: Scurvy manifested as swollen and bleeding gums, subcutaneous
bruising or bleeding into the skins or joints, delayed wound healing, anemia and
weakness.
Sources:
Fresh fruits amla, guava, lime, orange, tomato
Germinating pulses
Green leafy vegetables cabbage, amaranth, spinach
RDA: 40 mg per day for adults
Vitamin D
Function: promotes intestinal absorption of calcium and phosphorus and also

stimulates bone mineralization; thus important in calcium metabolism
Deficiency Disorder:
Rickets commonly seen among children 6 m to 2 yrs
Osteomalacia more common in pregnant and lactating women
Sources:
1) Sunlight: synthesized in body by action of UV rays of sunlight.
2) Foods: Vit D occurs only in foods of animal origin e.g. Liver, egg yolk, butter, cheese.
3) Others: Fish liver oils although the richest sources, are not taken as food but instead
taken as supplements and foods artificially fortified with Vit D e.g. vanaspati ghee,
milk, infant foods
Prevention:
With rapid changes in the lifestyle especially among urban Indians there is a tendency
to spend large amount of day time indoors which prevents exposure to sunlight.
Therefore it becomes imperative to ensure adequate exposure to sunlight. This is also
important for children and parents should be specifically educated about this.
Calcium
Function: formation of bones and teeth, coagulation of blood, skeletal and cardiac
muscle functioning, milk production, cell membrane integrity, metabolism of enzymes
and hormones
Deficiency Disorder: No major deficiency diseases.
Sources:
Rich sources are Milk and milk products (cheese, curd, skimmed milk, and
buttermilk), eggs and fish. Calcium in milk occurs in form of calcium
caseinogenate which is easily digested.
11
Cheapest sources in Indian diet are green leafy vegetables, cereals and millets.
Ragi is particularly rich in calcium. Some limiting factors reduce the absorption
of calcium from green leafy vegetables and cereals.
RDA: 600 mg per day for adults
Prophylaxis:
The requirements of calcium increase during pregnancy and lactation hence following
supplements are commonly given during these periods.
Pregnancy 500 mg calcium everyday for 100 days during the last trimester
Lactation 500 mg daily for first 100 days post-natal
Summary Tables
Vitamins
Fat soluble vitamins
RDA
600g/day
Vitamin
Vitamin a(retinol,
retinal, carotenes,
(cryptoxanthins)
Function
Vision, integrity
of epithelium,
gene regulation,
antioxidant
Vitamin
D(cholecalciferol,
D1,(ergocalciferol,D2)
Calcium
homeostasis,
bone
metabolism
Cellular
membrane
antioxidant
100-400 iu/day(child)
Clotting of
blood, calcium
metabolism
120g/
day(males)90g/day
(females)
Vitamin E
(Tocopherols)
Vitamin K
(phylloquinone,
menaquinone,
menadione)
Vitamin
Vitamin C
(Ascorbic
acid)
Vitamin B1
(thiamine)
Vitamin B2
(Riboflavin)
12mg/day
Deficiency
Exophthalmia,
dry skin,
impaired
immunity, growth
and reproduction
Rickets in
children
osteomalacia in
adults
Ribs breakdown,
anaemia, nerve
damage,
retinopathy
Bleeding
tendencies
Water soluble vitamins

Function
RDA
Deficiency
Reductant in hydroxylations 40mg/day Scurvy: spongy, bleeding
in collagen & carnitine
gums, fatigue, hemarthrosis
synthesis Metabolism of
Drugs.
Normal growth coenzyme
for decarboxylation of
2-keto acids &
transketolation reactions
Normal growth coenzyme
in redox reactions of fatty
acids & TCA cycle
0.5mg/
1000kcal
Beribericardiac(wet),neuritic(dry)
& infantile
0.6mg/
1000kcal
Ariboflavinosis: magenta
tongue, cheilosis ,angular
stomatitis, corneal ulcer
Sources
Retinol (animal
foods):liver , egg,
meat, milk
provitamin A (plant
foods ) yellow ,green
vegetable
Synthesized in skin
with exposure to
sunlight; fish oils,
milk
Vegetable oils, green
vegetables, cereal
germ, nuts, seeds
Synthesis by
intestinal bacteria,
green vegetables
Soya oil, liver, milk
Sources
Citrus fruits:guava, amla,
green vegetables,
Tomatoes,
strawberries
Mart, liver,
legumes, wheat
germ
Milk, meat, green
,vegetables
12
Niacin
(nicotinic
acid,
nicotinamide)
Vitamin B6
Folic acid
Vitamin B12
Coenzyme for
dehydrogenases
6.6mg
per 1000
kcal
Pellagra ,characterized br3

Ds-dermatitis, diarrheal,
dementia
Meat, groundnuts,
legumes, grains
Coenzyme in amino acid

metabolism
Coenzyme in single
carbon metabolism
2mg/day
Anaemia, neuritis,
convulsions
Megaloblastic anaemia
Coenzyme in amino acid,

propionate & single
carbon fragment
metabolism
1mg/day
Grains, seeds
,poultry, meat
Liver ,green
vegetables , yeast,
fruits
Liver, lean meat,
fish ,seafood ,milk
100mg
per day
Pernicious anaemia
Minerals
Mineral
Calcium
Phosphorus
Sodium
Potassium
Magnesium
The macro minerals

Function
RDA
Bone & teeth
Adults: 400 mg
formation, blood
Pregnancy &
clotting, muscle
Lactation 1 g
contraction,
nerve
transmission
Bone & teeth
1g
formation,
energy
metabolism,
nucleic acid
synthesis, acid
base balance
Extracellular
5g
fluid component,
water balance
acid base
balance: nerve
transmission,
muscle action
Major
5g
intracellular fluid
component, acid
base
Balance: nerve
transmission,
muscle action
Coenzyme in
metabolic
reactions, Nerve
conduction
350 g
Deficiency
Tetany Rickets,
Osteoporosis
Sources
Dairy products,
Meat products,
Leafy vegetables
Not seen often

can cause bone
loos, anorexia
Dairy products,
Meat products,
Leafy vegetables
Cramps, Acidbase imbalance,

Water imbalance
Table salt
Muscae
weakness,
Arrhythmias
Fresh fruits,
meats whole
grains,
vegetables
Tremors, spasm
Meat, cheese,
eggs, nuts,
legumes
13
The Micro minerals

Mineral
Function
RDA
Deficiency
Iron
Haemoglobin &
Male: 28mg
Anaemia, fatigability,
Myoglobin
Female:30m impaired immune
Formation ,
g
function
cellular oxidation
Pregnareactions, antibody ncy:38mg
formation
Lactation:30
mg
Iodine
Thyroxine
Adults
Goitre, cretinism,
synthesis
150mg
hypothyroidism,
Pregnancy
infertility, still births
200mg
Zinc
Essential enzyme
15mg
Retarded sexual &
constituent,
physical activity;
Protein
impaired wound
metabolism
healing
,immune function,
insulin storage,
sexual maturation
Selenium Antioxidant
70mg
Impaired immune
function forms
function, Keshena
glutathione
disease
peroxidase ,spares
vitamin E
Fluoride Bone & teeth
<1mg
Dental caries
constituent
Sources
Meat products,
liver, green
leafy vegetables
Iodized salt
,plant products
grown in iodine
rich soil
Dairy products,
meat products,
Eggs, Whole
grains
Liver, meats
,whole ,grains,
sea food
Fluorinated
water,
toothpaste
14
Nutritive value of food items

Cereals
Sr.
No.
Nutrient
Bajra
1
2
3
4
5
6
7
8
9
10
11
12
13
Protein (gm)
Fat (gm)
Fiber (gm)
Carbohydrates (gm)
Energy (Cal)
Calcium (mg)
Iron (mg)
Carotene (ug)
Thiamine (mg)
Riboflavin (mg)
Niacin (mg)
Folic acid (ug)
Vit.C (mg)
11.6.
5
1.2
67.5
361
42
8
132
0.33
0.25
2.3
45.5
0
Content per 100 gm of edible portion

Parboiled
Rice raw
Wheat
hand
milled
Whole
pounded Rice
8.5
6.8
11.8
0.6
0.5
1.5
0.2
1.2
77.4
78.2
71.2
349
345
346
10
10
41
2.8
0.7
5.3
9
0
64
0.27
0.06
0.45
0.12
0.06
0.17
4
1.9
5.5
8
36.6
0
0
0
Bajra (Pearl Millet)

Bajra can be grown in the dry belts where other cereal crops such as maize or wheat
would not survive. Hence, it is primarily consumed in the states of Rajasthan,
Gujarat and Madhya Pradesh.
The protein in Bajra is deficient in lysine and threonine.
The iron and fat content of Bajra is the highest among all cereals and millets.
It is also relatively rich in calcium, carotene, riboflavin, niacin and folic acid.
Rice
Rice is the staple diet in southern part of India.
Milling and polishing cause the greatest nutritional loss. During processing the B complex vitamins, fibre and proteins are lost to a great extent.
The nutritive losses because of milling, polishing, and other processing and cooking
practices can be prevented by parboiling. It involves soaking the paddy in hot water
followed by steaming and drying. This paddy is then finally home pounded or
milled for final use.
Rice also loses substantial amount of water soluble vitamins and minerals when the
water used for washing and cooking is discarded.
15
Wheat whole
Wheat is the most widely consumed cereal in North India. It is used to make flour
(atta for chapattis and puri), maida for bread, dalia and also suji, to make various
savouries.
Wheat protein is poor as it is deficient in the essential amino acids lysine and
threonine. Pulse proteins are rich in these deficient amino acids. So, a
predominantly cereal diet should be supplemented with other sources of proteins
like the pulses, especially for the vegetarians. This is called as the supplementary
action of proteins.
Hard milling, extraction and discarding the bran causes loss of fibre, vitamins and
proteins. It is advisable to consume whole wheat atta and dalia. Products made up
of refined flour like white bread, biscuits, cakes, noodles and burgers should be
discouraged.
Pulses
Sr.
No.
1
2
3
4
5
6
7
8
9
10
11
12
13

Nutrient
Protein (gm)
Fat (gm)
Fibre (gm)
Carbohydrates (gm)
Energy (Cal)
Calcium (mg)
Iron (mg)
Carotene (ug)
Thiamine (mg)
Riboflavin (mg)
Niacin (mg)
Folic acid (ug)
Vit.C (mg)
Bengal
gram
(Chana)
17.1
5.3
3.9
60.9
360
202
4.6
189
0.30
0.15
2.9
186
3
Peas
Dry
19.7
1.1
4.5
56.5
315
75
7.05
39
0.47
0.19
3.4
7.5
0
Green
Gram
(Mug)
24
1.3
4.1
56.7
334
124
4.4
94
0.47
0.27
2.1
0
Red gram
(Tuvar)
Soyabean
22.3
1.7
1.5
57.6
335
73
2.7
132
0.45
0.19
2.9
103
0
43.2
19.5
3.7
20.9
432
240
10.4
426
0.73
0.39
3.2
100
-
Pulses and legumes comprise of dried peas, beans, dals and grams and are an
integral part of the Indian diet.
Pulses and legumes have high protein content of about 20-25g %. Although they are
poor in methionine and cysteine and the biological values of their protein is inferior
to foods of animal origin (meat, fish eggs and milk), they are a substantial source of
proteins for those not consuming meat.
16
Pulse protein is rich in lysine which compensates for the low lysine content of
cereal proteins. They are an important source of vitamins and minerals like
calcium, iron and vitamin B.
Germination / sprouting increases the Vitamin C and Vitamin B content of the
pulses and also improve the digestibility.
Soya bean
Soya bean is a pulse which has very high protein and fat content. It is also rich in
iron, carotene, niacin and folic acid.
The nutritive value of soya bean proteins is equivalent to milk proteins even though
the protein quality is inferior.
The bland taste of unprocessed soya bean can be made up by suitably cooking or
processing it. It can be simply cooked as dal or can be prepared with other legumes
as mixed dal. Its flour can be mixed in wheat flour to make it more nutritious. Soya
milk and curd is also popular. It can be processed to fried nuggets, which are
relished by the children.
The soya bean oil is one of the very few oils rich in alpha-linolenic acid (>5%)
besides its high contents of linoleic acid (50 %).
Nuts
Sr.
No.
1
2
3
4
5
6
7
8
9
10
11
12
13
Nutrient
Protein (gm)
Fat (gm)
Fibre (gm)
Carbohydrates
(gm)
Energy (Cal)
Calcium (mg)
Iron (mg)
Carotene (ug)
Thiamine (mg)
Riboflavin (mg)
Niacin (mg)
Folic acid (ug)
Vit.C (mg)
Almonds
20.8
58.9
1.7
10.5
Cashew
21.2
46.9
1.3
22.3
Pistachio
19.8
53.5
2.1
16.2
Walnut
15.6
64.5
2.6
11
Groundnut
655
230
5.09
0
0.24
0.57
4.4
0
596
50
5.81
60
0.63
0.19
1.2
0
626
140
7.7
144
0.67
0.28
2.3
-
687
100
2.64
6
0.45
0.40
1
0
567
90
2.5
37
0.90
0.13
19.9
20
0
25.3
40.1
3.1
26.1
Nut is the common name used for identifying a number of dry fruits or seeds of
some plants. One interesting fact about nuts is that they can be termed as both fruits
and seeds.
17
Nuts have a very high nutritive value. Nuts have a high fat and protein content and
hence a high energy value.
They are a good source of vitamins, minerals and antioxidants.
Pistachio is rich in iron, containing 7.7 mg/100g.
Almond and cashew nuts are also moderate sources of iron and proteins.
Ground nut
Groundnuts are the cheapest and arguably the most nutritious of all nuts.
It contains almost as much oils and fats as an oilseed does (40%). Its MUFA
content is one of the highest amongst all Indian oilseeds, at 50% (exceeded only
by mustard and rape seed). Its protein content is very high (25.3%). Its niacin
content is 5 to 20 times higher than other nuts.
A household item in many Indian states, it is relished boiled, roasted, fried or
simply salted. Groundnut chikki (with jaggery) is not only favourite with
children, but is extremely nutritious even for the pregnant and lactating.
Multipurpose food used in national nutritional programme is made using a
mixture of 75 percent groundnut flour and 25 percent roasted red gram. It is
further fortified with vitamins and minerals. It is a rich source of proteins.
Egg
Sr. No.
1
2
3
4
5
6
7
8
9
10
11
12
13
Nutrient
Protein (gm)
Fat (gm)
Fibre (gm)
Carbohydrates (gm)
Energy (Cal)
Calcium (mg)
Iron (mg)
Carotene (ug)
Thiamine (mg)
Riboflavin (mg)
Niacin (mg)
Folic acid (ug)
Vit.C (mg)
Content per 100 gm

13.3
13.3
173
60
2.1
420
0.1
0.4
0.1
78.3
0
Egg has a high nutritive value. An egg contains about 6 g protein and 6 g of fat and
provides about 70 Kcal.
The proteins are of a high biological value. The NPU of egg protein is 100 and is
taken as the standard protein, to compare other proteins with.
It also has a high cholesterol content of 250mg. The fat present in the yolk is finely
emulsified and hence easily assimilated.
The minerals and vitamins exist in the yolk, which is also a valuable source of
calcium, phosphorus, iron and vitamins A and D.
18
The white of the egg is one of the best sources of riboflavin. It is however deficient in
Vitamin C.
Milk
Sr. No.
1
2
3
4
5
6
7
8
9
10
11
12
13
Nutrient
Protein (gm)
Fat (gm)
Fibre (gm)
Carbohydrates (gm)
Energy (Cal)
Calcium (mg)
Iron (mg)
Carotene (ug)
Thiamine (mg)
Riboflavin (mg)
Niacin (mg)
Folic acid (ug)
Vit.C (mg)
Cow
3.2
4.1
4.4
67
120
0.2
53
0.05
0.19
0.1
8.5
2
Content per 100 gm

Buffalo
4.3
6.5
5
117
220
0.2
48
0.04
0.1
0.1
5.6
1
Human
1.1
3.4
7.4
65
28
41
0.02
0.02
3
Milk is the complete food on which the young one may subsist for up to six months.
The human milk might be poorer than cows or buffalos milk, but is adequate for the
infant.
Milk is used to prepare curd, yogurt, butter, ghee and buttermilk. These are used
extensively for the preparation of many traditional Indian sweets.
All the important nutrients are well represented in milk except for iron and nicotinic
acid. Milk proteins are caseinogens (85%), lactalbumin (12%) and lactglobulin (3%).
These proteins are of high biological value and are rich in tryptophan and cystein.
Calcium caseinogenate is a complex formed with calcium in milk.
Milk fat is an emulsion of extremely fine particles of the glycerides of butyric,
palmitic and oleic acid rendering it easily digestible and this is especially so in cows
milk. Milk is also rich in linoleic acid and oleic acid.
Milk is a good source of vitamin A and D as well. Milk contains more than 30 types of
sugars, Lactose being the most predominant of them. Milk is also very rich in
calcium and phosphorus.
Curd: Curd is traditionally relished in the Indian diet. It is produced by the action of
lactobacilli on lactose (in milk), which is broken down to lactic acid. Curd and whole
butter milk are easily digestible. They have the same nutritive value as that of the
original milk from which they were prepared, being very good sources of protein,
calcium, vitamin A and riboflavin.
Cream, Butter and Ghee: Cream, butter and ghee are the various types of fats
extracted from milk. Cream can be extracted by centrifugation of unboiled milk.
19
Butter is the fat extracted from buttermilk. Ghee is the clear fat extracted after
boiling butter. Cream has nutritive value in between whole milk and butter. 100gm
butter yields about 729 Kcal. On the other hand, ghee is almost 100% fat, 100 g of
ghee yielding 900 Kcal.
Skimmed and Toned Milk: The milk available in market may be pure milk from cow
or buffalo or a mixture of both. Skimmed milk is the one from which fat has been
removed. This is useful for those who have been recommended low fat in diet.
Toned milk can be manufactured by adding 1 part water and 1/8 part skimmed milk
to 1 part milk. It becomes quite similar to cows milk.
Tinned Milk: Powdered or tinned milk could be an alternative to whole milk when
fresh milk cannot be made available. Condensed, evaporated or homogenized milk
can be tinned. It could be sweetened or unsweetened. Condensed milk contains 50
percent cane sugar, which is a good preservative. Dried or powered milk is
reconstituted by adding 7 volumes of boiled water just before consumption. Tinned
milk should be reconstituted as per instructions.
Fruits
Fruits hold a special place in the nutrition of man. Being eaten raw and fresh, the
minerals, vitamins and phytochemicals present in them, do not get destroyed through
heat and fire. Fruits can be classified into citrus, non-citrus and dry fruits.
Nutritive Value
a) Vitamins and Antioxidants: Citrus fruits like oranges, lime, lemon, mosambi, malta,
etc are rich sources of vitamin C. Guava and amla too are very rich sources of vitamin C.
Papaya and mango are rich in carotene and moderately rich in vitamin C. Pineapples,
strawberries and papaya are moderately rich sources of vitamin C. Yellow peaches are a
good source of carotene. Banana, orange and strawberries are moderate sources of
folates. Dried fruits like dry figs provide thiamin, niacin and riboflavin. Dried apricots
and prunes are rich in vitamin A
b) Minerals: Watermelon is rich in iron. Custard apple is rich in phosphorus and iron.
Apricots, lime, guava and figs are rich in calcium. Apricots are rich in zinc too. Banana
and apples are moderately rich in potassium. Dried fruits: Raisins, figs, dates and dry
apricots are rich in iron. Dried figs are also rich in phosphorus, calcium, potassium and
zinc.
c) Energy: Banana and plantain have high energy value.
d) Fibre: Fruits are rich in fibres. Their soluble fibre is particularly useful in inhibiting
the rapid absorption of glucose and lipids from the intestine. This is helpful in
prevention of hyperglycemia and hyperlipidaemias.
Fruits and Vegetables
How much should we consume?
The Indian Council of Medical Research recommends that every individual should
consume at least 300 g of vegetables (GLV: 50 g; Other vegetables: 200 g; Roots &
20
Tubers: 50 g) in a day. In addition, fresh fruits (100 g) should be consumed regularly.

Since requirements of iron and folic acid are higher for pregnant women they should
consume 100g of leafy vegetables daily. High calorie vegetables and fruits should be
restricted for over weight/ obese subjects.
Which vegetables and fruits should be consumed?
One should consume fresh, locally available seasonal vegetables and fruits. They have
more micronutrients and are tasty. However no single fruit or vegetable provides all the
nutrients one needs. The key lies in eating a variety of them and in different colours.
Include commonly consumed leafy greens, tomatoes and other vegetables, apart from
those which are yellow, orange, red, deep red, purple coloured citrus fruits.
What care needs to be taken while consuming fruits and vegetables?
Vitamins are lost during washing of cut vegetables and cooking of foodstuffs. However,
proper methods of cooking can substantially reduce these losses. Nutrient loss is high
when the vegetables are washed after cutting or when they are cut into small pieces for
cooking. Consumption of properly washed raw and fresh vegetables is always beneficial.
Green leafy Vegetables (GLVs)
Greens that are commonly used in Indian recipes include spinach (palak), fenugreek
leaves (methi), mustard greens (sarson ka saag), amaranth (thotakoora), drumstick
leaves, Colocasia leaves and Cabbage Lettuce.
Dark GLVs are rich sources of minerals (iron, calcium, potassium, and magnesium)
and vitamins (vitamins K, C, E and many of the B vitamins). They also contain
important phytochemicals, anti-oxidants and fibre.
Greens are low in calories, have no cholesterol, and are fat-free.
The phytochemicals in GLVs are required for delaying ageing and preventing the
processes which lead to diseases such as cataract, cardio-vascular diseases, diabetes
and cancer.
Dietary fibre from GLVs is important for proper bowel function, to reduce chronic
constipation, diverticular disease, haemorrhoids coronary heart diseases, diabetes
and obesity. They also reduce plasma cholesterol. The protective role of dietary fibre
against colon cancer has long been recognized.
Antioxidants present in GLVs restrict the damage that reactive oxygen free radicals
can cause to the cell and cellular components. They are of primary biological value in
giving protection from certain diseases which have origin in deleterious free radical
reactions. They are atherosclerosis, cancer, inflammatory joint diseases, asthma and
diabetes.
Meat
Meat is a word commonly used for the flesh of cattle (beef), goat and sheep (mutton),
pig (pork) or chicken. It is regarded as a food of high nutritive value. Where a typical
diet is heavily dependent on one type of cereal or root crop, meat, even in small
amounts, complements the staple food.
Nutritive Value:
21
It is a good source of high quality protein (15 to 20g per 100g). Moreover this
protein is qualitatively as good as that of fish, egg, milk, cheese and other dairy
produce, since it contains all essential amino acids.
It is also a good source of most B vitamins like nicotinic acid. Meat is rich in
phosphorous but poor in calcium.
Liver, a component of meat, too has not only high quality proteins but also vitamin A
and vitamin B complex.
Meat is also rich in minerals especially iron and zinc. The iron content of meat is of
the heme variety which has high bioavailability.
Meat has a high content of fat including the saturated fatty acids, which may be a
risk for good health.
Meat also needs to be inspected in slaughter houses since it may contain larval forms of
some parasites which are harmful to man.
Fish
Fish is called "rich food for poor people," since it provides essential nourishment,
especially quality proteins and fats (macronutrients), vitamins and minerals
(micronutrients). Fish also contributes to food security as an important
accompaniment to rice based diets in Asia.
Fish has high quantity of proteins (15 - 25g/100g), which are of high biological value
and are easily digestible.
The fat content of fish varies depending on the species as well as the season but, in
general, fish have less fat than red meats. Fat from fish contain unsaturated fatty
acids including the omega 3 fatty acids.
Fish is a rich source of vitamins, particularly vitamins A and D from fatty species, as
well as thiamin, riboflavin and niacin. Vitamin A from fish is more readily available
to the body than from plant foods. Vitamin D present in fish liver and oils is crucial
for bone growth.
The minerals present in fish include iron, calcium, zinc, iodine (from marine fish),
phosphorus, selenium and fluorine. Sea fish is particularly rich in Iodine.
Freshness of fresh-water fish is indicated by a stiff body, bright, clear and bulging
eyes, reddish gills, tight scales and absence of stale odour or discolouration. Fresh
fish will not show any pitting on finger pressure.
22
Balanced Diet
What is a balanced diet?
A balanced diet is one which provides all the nutrients in required amounts and proper
proportions. It can easily be achieved through a blend of the four basic food groups. The
quantities of foods needed to meet the nutrient requirements vary with age, gender,
physiological status and physical activity. A balanced diet should provide around 5060% of total calories from carbohydrates, preferably from complex carbo-hydrates,
about 10-15% from proteins and 20-30% from both visible and invisible fat.
In addition, a balanced diet should provide other non-nutrients such as dietary fibre,
antioxidants and phytochemicals which bestow positive health benefits. Antioxidants
such as vitamins C and E, beta-carotene, riboflavin and selenium protect the human
body from free radical damage. Other phytochemicals such as polyphenols, flavones,
etc., also afford protection against oxidant damage. Spices like turmeric, ginger, garlic,
cumin and cloves are rich in antioxidants.
Recommended Dietary Allowances or Intakes (RDA or RDI)
The RDA of a nutrient is the amount (of that nutrient) sufficient for the maintenance of
health in nearly all people (11). It is an estimate that corresponds to mean intake of the
given nutrient + 2 Standard Deviation (that is about 25% of the mean has been added).
It covers the requirement of 97.5% of the population. This is the safe level of intake and
the chances of this level being inadequate is not more than 2.5%. This safe level
approach is however not used for defining the energy requirement, as any excess of
energy intake is as undesirable as its inadequate intake. Hence for defining the RDA of
energy only the average requirement is considered.
Can the RDA be Applied to Individuals?
It must be appreciated that the RDA is the mean requirement figure for a nutrient
(except energy), to which an allowance corresponding to 2 SD has been added. There
are several individuals in a population whose requirement is actually well below or
above the RDA. If all the students in a class of 100 were to eat food exactly as per their
RDA about half would loose and the other half would gain weight, to the extent of being
seriously undernourished or obese after a year! It is because the RDA for energy is a
catering average; individuals however consume as per their appetite, which follows
their energy expenditure. The RDA can therefore, not be used as standard to determine
whether or not a given individuals requirement of a nutrient has been met. It is
therefore important to keep the principles of probability in mind and be cautious, when
applying RDA at an individual level.
Please refer to the textbook for the RDA for various nutrients for various groups.
The following is a suggested guideline for distribution of food articles in a balanced diet.
23
Balanced diet for Adults- Sedentary/Moderate/Heavy activity (No of portions)

g/portion
Cereals and
millets
Pulses
Milk and milk
products
Roots and tubers
Green leafy
vegetables
Other vegetables
Fruits
Sugar
Fat
30
Type of work
Sedentary
Moderate
Man Woman Man Woman
12.5
9
15
11
Heavy
Man Woman
20
16
30
100ml
2.5
3
2
3
3
3
2.5
3
4
3
3
3
100
100
2
1
2
1
2
1
2
1
2
1
2
1
100
100
5
5
2
1
4
5
2
1
4
4
2
1
6
6
2
1
6
5
2
1
11
8
2
1
9
6
Balanced diet for infants, children & adolescents (number of portions)

Food
Groups
Gm /
portio
n
30
30
100
Cereals& &millets
Pulses
Milk(ml)&milk
products
Roots & tubers
100
Green leafy vegetable100
Other vegetable
100
Fruits
100
Sugar
5
Fat/oil(visible)
5
Infants
6-12
months
0.5
0.25
4a
Years
1-3 4-6
2
1
5
4
1.0
5
0.5
0.25
0.25
1
2
4
0.5
0.5
0.5
1
3
5
1
0.5
1
1
4
5
7-9
6
2
5
10-12
Girls
8
2
5
Boys
10
2
5
13-15
Girls Boys
11 14
2
2.5
5
5
16-18
Girls
11
2.5
5
Boys
15
3
5
1
1
1
1
4
6
1
1
2
1
6
7
1
1
2
1
6
7
1
1
2
1
5
8
2
1
2
1
5
7
2
1
2
1
6
10
1.5
1
2
1
4
9
Quantity in dictates top milk, for breastfed infants, 200ml top milk is required.
One portion of pulse may be exchanged with one potion (50g)of egg/meat/chicken/fish.
For infants introduce egg/meat/chicken/fish around 9 months.
Specific recommendations as compared to sedentary women/men/children:
1-6 years- to 3/4 the amount of ordeals, pulses and vegetable and extra cup of
milk.
7-12years-extra cup of milk.
Adolescent girls-extra cup of milk.
Adolescent boys-Diet of sedentary man with extra cup of milk.
24
PORTION SIZES & MENU PLAN

Portion Size Of Foods (raw) & Nutrients
g/portion
Energy(kcal) Protein(g)
Carbohydrate(g)
Fat(g)
Cereals & millets 30
100
3.0
20
0.8
pulses
30
100
6.0
15
0.7
egg
50
85
7.0
7.0
Meat/chicken/fish 50
100
9.0
7.0
Milk(ml)& milk
100
70
3.0
5
3.0
products
Roots & tubers
100
80
1.3
18
Green leafy
100
46
3.6
0.4
vegetables
Other vegetables 100
28
1.7
0.2
Fruits
100
40
10
sugar
5
20
5
Fat & oils(visible) 5
45
5.0
Common Measurements
Here is an indicative list of the common measurements used in diet history. One should
try to be more precise whenever possible while taking diet history.
Utensil
Gm/ml Equivalent
1 Cup
200 ml
1 Katori of cooked vegetable 30 gms
1 Katori of cooked rice
40 gms
1 teaspoonful
5 gms/ 5 ml
1 tablespoonful
15 gms/ 15 ml
1 Roti (medium sized)
35 gms
Methods of Diet Survey
1) Weighment of Raw food:
Weighing of all food that is going to be cooked
Disadvantage: wastage is also included
2) Weighment of cooked food:
Cooked food is weighted before consumption.
Disadvantage: not easily accepted by people.
3) Oral Questionnaire method:
It is Useful for carrying out diet survey of large number of people in a short time.
Inquiry about their usual diet pattern is made (both quality and quantity).
Disadvantage: Forgetfulness, overestimation or underestimation.
4) 24-hour Recall:
Inquire about the diet which was taken since same time yesterday
Disadvantage: lunch or dinner at feast / festival.
5) Diet diary:
25
Note down all the food articles consumed in a note book for 1 week.
Disadvantage: not useful for illiterate people
6) Stock inventory method:
Ask about the food stocks stored at the house.
7) Duplicate sample method:
Keep a duplicate sample of whatever diet is consumed
Disadvantage: not easily acceptable
8) Food frequency method:
Number of time a given food article is consumed in a month, week, days,
Disadvantage: not useful as an individual method. Quantity of food not estimated.
Quick methods for Diet History
Cereals
Stock inventory method , stock divided
by the number of members
Pulses
Weighment of raw food
Green leafy vegetables
Frequency: daily, weekly
Other vegetables and fruits
Roots and tubers
Milk
Oil
Sugar and Jaggery
Eggs
Non-vegetarian food
Snacks, Junk foods, Fast-foods
26
Dietary guidelines
1) Eat variety of foods to ensue a balanced diet
a) Variety in food is not only the spice of life but also the essence of nutrition and
health.
b) A diet consisting of foods from several food groups provides all the required
nutrients in proper amounts.
c) Cereals, millets and pulses are major sources of most nutrients.
d) Milk which provides good quality proteins and calcium must be an essential item
of the diet, particularly for infants, children and women.
e) Oils and nuts are calorie-rich foods, and are useful for increasing the energy
density specially in children. This is particularly useful for undernourished
children.
f) Inclusion of eggs, flesh foods and fish enhances the quality of diet. However,
vegetarians can derive almost all the nutrients from diets consisting of cereals,
pulses, vegetables, fruits and milk-based diets.
g) Vegetables and fruits provide protective substances such as vitamins/ minerals/
phytonutrients.
h) Diversified diets with a judicious choice from a variety food groups provide the
necessary nutrients.
2) Ensure provision of extra food and healthcare to pregnant and lactating women.
a) Eat more food during pregnancy.
b) Eat more whole grains, sprouted grams and fermented foods.
c) Take milk/meat/eggs in adequate amounts.
d) Eat plenty of vegetables and fruits.
e) Avoid superstitions and food taboos.
f) Do not use alcohol and tobacco. Take medicines only when prescribed.
g) Take iron, folate and calcium supplements regularly, after 14-16 weeks of
pregnancy and continue the same during lactation.
3) Promote exclusive breastfeeding for six months and encourage breastfeeding till
two years.
a) Start breast-feeding within an hour after delivery and do not discard colostrum.
b) Breast-feed exclusively (not even water) for a minimum of six months if the
growth of the infant is adequate.
c) Continue breast-feeding in addition to nutrient-rich complementary foods
(weaning foods), preferably upto 2 years.
d) Breast-feed the infant frequently and on demand to establish and maintain good
milk supply.
e) Take a nutritionally adequate diet both during pregnancy and lactation.
f) Avoid tobacco (smoking and chewing), alcohol and drugs during lactation.
g) Ensure active family support for breast-feeding.
4) Feed home based semi solid foods to the infant after six months.
a) Breast-milk alone is not enough for infants after 6 months of age.
27
b) Complementary food should be given after 6 months of age, in addition to breastfeeding.

c) Do not delay complementary feeding.
d) Feed low-cost home-made complementary foods.
e) Feed complementary food on demand 3-4 times a day.
f) Provide fruits and well cooked vegetables.
g) Observe hygienic practices while preparing and feeding the complementary food.
h) Read nutrition label on baby foods carefully.
5) Ensure adequate and appropriate diets for children and adolescents both in health
and sickness.
a) Take extra care in feeding a young child and include soft cooked vegetables and
seasonal fruits.
b) Give plenty of milk and milk products to children and adolescents.
c) Promote physical activity and appropriate lifestyle practices
d) Discourage overeating as well as indiscriminate dieting.
EAT CALCIUM-RICH FOODS
Calcium is needed for growth and bone development.
Children require more calcium
Calcium prevents osteoporosis (thinning of bones).
Milk, curds and nuts are rich sources of bio-available calcium (Ragi and GLV
are also good dietary sources of calcium).
Regular exercise reduces calcium loss from bones.
Exposure to sunlight maintains vitamin D status which helps in calcium
absorption
DURING ILLNESS
Never starve the child.
Feed energy-rich cereal-pulse diets with milk and mashed vegetables.
Feed small quantities at frequent intervals.
Continue breast-feeding.
Give plenty of fluids during illness.
Use oral rehydration solution to prevent and correct dehydration during
diarrhoeal episodes.
6) Eat plenty of vegetables and fruits.
a) Normal diet, to be wholesome and tasty, should include fresh vegetables and
fruits, which are store houses of micronutrients
b) Vegetables/fruits are rich sources of micronutrients.
c) Fruits and vegetables also provide phytonutrients and fibre which are of vital
health significance
d) They help in prevention of micronutrient malnutrition and certain chronic
diseases such as cardiovascular diseases, cataract and cancer.
e) Fresh fruits are nutritionally superior to fruit juices.
28
f) Include green leafy vegetables in daily diet.

g) Eat as much of other vegetables as possible daily.
h) Eat vegetables/ fruits in all your meals in various forms (curry, soups, mixed
with curd, added to pulse preparations and rice)
i) Consume raw and fresh vegetables as salads.
j) Grow the family's requirements of vegetables in the kitchen garden if
k) Green leafy vegetables, when properly cleaned and cooked, are safe even for
infants.
l) Let different varieties of vegetables and fruits add colour to your plate and
vitality to your life.
m) Beta carotene rich foods like dark green, yellow and orange colored vegetables
and fruits (GLVs, carrots, papaya and mangoes) protect from vitamin A
deficiency.
7) Ensure moderate use of edible oils and animal foods and very less use of ghee/
butter/ vanaspati.
a) Take just enough fat.
b) Substitute part of visible fat and invisible fat from animal foods with whole nuts.
c) Moderate the use of animal foods containing high fat, SFA and cholesterol.
d) Limit use of ghee, butter and as a cooking oil.
e) Choose low fat dairy foods in place of regular whole fat.
f) Eat foods rich in a-linolenic (n-3) acid like legumes, green leafy vegetables, and
fenugreek and mustard seeds.
g) Eat fish more frequently (at least 100-200g fish/week prefer it over meat and
poultry and limit/avoid organ meats (liver, kidney, brain etc)).
h) Egg has several important nutrients but is high in cholesterol. Limit the
consumption to 3 eggs/ week.
i) Minimize consumption of premixed ready- to- eat fast foods, bakery foods and
processed foods prepared in hydrogenated fat.
j) Use of re heated fats and oils should be avoided.
k) Consume variety of foods and maintain moderation to get good proportions of all
fatty acids and derive optimal health benefits.
8) Overeating should be avoided to prevent overweight and obesity.
a) Slow and steady reduction in body weight is advised.
b) Severe fasting may lead to health hazards.
c) Achieve energy balance and appropriate weight for height
d) Encourage physical activity
e) Eat small meals regularly at frequent intervals.
f) Cut down on sugar, salt, fatty foods and alcohol.
g) Promote complex carbohydrates and fiber rich diets
h) Increase consumption of fruits and vegetables, legumes, whole grains and nuts.
i) Limit energy intake from total fat and shift fat consumption from saturated to
unsaturated
29
j) Eliminate the use of trans-fatty acids rich vanaspati in foods (bakery products
and sweets).
k) Use low fat milk.
9) Exercise regularly and be physically active to maintain ideal body weight.
a) A minimum 30-45 minutes brisk walk/physical activity of modern intensity
improves overall health.
b) Include warm-up and cool- down periods, before and after exercise regimen.
c) Forty five minutes per day of moderate intensity physical activity provides many
health benefits.
10) Use salt in moderation/ Restrict salt intake to minimum.
a) Restrict the intake of added salt from an early age.
b) Develop a taste for foods/diets low in salt.
c) Restrict intake of preserved and processed foods like papads, pickles, sauces,
ketchup, salted biscuits, chips, cheese and salted fish.
d) Eat plenty of vegetables and fruits to provide adequate potassium.
e) Use always iodized salt.
11) Ensure the use of safe and clean foods.
a) Buy food items from reliable sources after careful examination.
b) Wash vegetables and fruits thoroughly before use.
c) Store the raw and cooked food properly and prevent microbial, rodent and insect
invasion.
d) Refrigerate perishable food items till consumption.
e) Maintain good personal hygiene and keep the cooking and food storage areas
clean and safe.
12) Practice right cooking methods and healthy eating habits.
a) Avoid food faddism and discard erroneous food beliefs.
b) Do not wash food grains repeatedly before cooking.
c) Do not wash vegetables after cutting.
d) Do not soak the cut vegetables in water for long periods.
e) Do not discard the excess water left over after cooking. Use only sufficient water
for cooking.
f) Cook foods in vessels covered with lids.
g) Prefer pressure/steam cooking to deep frying/roasting.
h) Encourage consumption of sprouted/fermented foods.
i) Avoid use of baking soda while cooking pulses and vegetables.
j) Do not reheat the left over oil repeatedly.
13) Drink plenty of water and take beverages in moderation.
a) Drink enough of safe and wholesome water to meet daily fluid requirements.
b) Drink boiled water, when safety of the water is in doubt.
c) Consume at least 250 ml of boiled or pasteurized milk per day.
d) Drink natural and fresh fruit juices instead of carbonated beverages.
e) Prefer tea over coffee.
f) Avoid alcohol. Those who drink, should limit its intake.
30
14) Minimize the use of processed foods rich in salt, sugar and fats.
a) Prefer traditional, homemade foods.
b) Avoid replacing meals with snack foods.
c) Limit consumption of sugar and unhealthy processed foods which provide only
(empty) calories.
d) Prefer fortified processed foods.
e) Always read food label (given on containers) regarding nutrients, shelf-life and
the additives used
15) Include micronutrient rich foods in the diets of elderly people to enable them to be
fit and active.
a) Eat a variety of nutrient-rich foods.
b) Match food intake with physical activity.
c) Eat food in many divided portions in a day.
d) Avoid fried, salty and spicy foods.
e) Consume adequate water to avoid dehydration.
f) Exercise regular
31
Food Adulteration, Food Safety & Security Act

Fortification: Process whereby nutrients are added to foods (in relatively small
quantities) to maintain or improve quality of diet
Iodization of salt
Vitamin A & D in Vanaspati ghee
Vitamin A & D in Milk
Fluoridation of water
Food enrichment: Synonymous with fortification and refers to the addition of
micronutrients to a food which are lost during processing.
Micronutrients to white rice
Food additives: Non nutritious substances which are added intentionally in food
generally in small quantity to improve its appearance, flavour, texture or storage
properties.
First category:
Coloring agents (Turmeric)
Flavoring agents (Vanilla essence)
Sweeteners (Saccharine)
Preservatives (Acetic acid)
Second category:
Contaminants
Food adulteration
Mixing,
Substitution,
Concealing the quality,
Putting up decomposed food for sale,
Misbranding or giving false labels
Addition of toxicants to the food articles.
Adulteration of food
( Common Adulterants )
Prevention
1. Food Safety Laws
2. Prevention of Food Adulteration Act, 1954
3. Fruit Products Order, 1955
4. Meat Food Products Order, 1973
5. Vegetable Oil Products (Control) Order, 1947
6. Edible Oils Packaging (Regulation) Order, 1988
7. Solvent Extracted Oil, De-oiled Meal and Edible Flour (Control) Order, 1967
8. Milk and Milk Products Order, 1992
9. Any order under Essential Commodities Act, 1955 relating to food
32
10. Food Safety and Standards Act (FSSA)

11. In 2006 Food Safety and Standards Act, 2006 came into enforcement with
two objective :
a. To introduce a single statute relating to food and
b. To provide for scientific development of the food processing industry
PFA, 1954
Multiple Authorities
Adulteration
Inspection / Control
Insufficient Enforcement
FSSA, 2006
Single Authority
Safety
Monitoring Surveillance
Full time District Officer, Food
Safety Personnel officer under FSC
Penalty fees:
Penalty for substandard
food
Rs 5 lacs
Penalty for misbranded food
Rs 3 lacs
Penalty on misleading
advertisement
Rs 10 lacs
Food containing extraneous

matter
Rs 1 lac
Penalty for unhygienic

processing of food
Rs 1 lacs
Punishment for unsafe food

Which-Does not result in injury
Non--grievous injury
Grievous injury
Death
6 Months Imprisonment and 1 lacs

1 Year Imprisonment and 3 Lacs
6 Y Imprisonment and 5 Lacs
7 Y or Life Imprisonment and 10 Lacs
Compensation to consumer
Death
Grievous injury
5 lac rupees
3 Lac
1 Lac
33
Nutritional Disorder of Public Health Importance

They are
Low Birth Weight (LBW)
Protein Energy Malnutrition(PEM) or Protein Calorie Malnutrition(PEM)
Xerophthalmia
Nutritional anaemia
Iodine deficiency disorder
Endemic fluorosis
Lathyrism
Low Birth Weight (LBW)

Its a major public health problem in many developing countries
Birth weight less than 2500 gm
About 28 % babies born in India are LBW as compared to 4 % in developed
countries
proportion of LBW high -suffering from fetal growth retardation
proportion of LBW low- pre-term
Maternal malnutrition and anemia appears to be significant risk factors in its
occurrence.
Also other causes are like hard physical labour during pregnancy, and illnesses
especially infections.
Short maternal stature, very young age, high parity, smoking, close birth interval
are associated factors.
Protein Energy Malnutrition (PEM) or Protein Calorie Malnutrition

(PCM)
A state of nutrition in which a deficiency or excess (or imbalance) of energy,

protein and other nutrients causing measurable adverse effects on tissue/body
structure and function and clinical outcome
Protein energy malnutrition is the term applied to a class of clinical
manifestations of protein lack and energy inadequacy
Terminology PEM was adopted by WHO as the major limiting factors in the diet
are both energy and protein
Deficiency of the protein is never isolated and is always associated with lack of
energy
Its a Major health and nutrition problem in India
Occurs particularly in weakling and children in the first year of life
Not only an important cause of childhood morbidity and mortality but also to
permanent impairment of physical and mental growth of those children
According to NFHS III in India 46%children <3 years are underweight, where as
19% are wasted and 38% are stunted
34
In Gujarat according to NFHS III 47% children <3 years are underwight,17% are
wasted and 42 % are stunted
Concept of PEM is that its clinical form
Kwashiorkor
Marasmus
Incidence of PEM in India in pre-school age children is 1-2 percent.
Nearly 80 percent cases of PEM are the intermediate one, that is the mild and
moderate cases which frequently go unrecognized.
Problem of PEM exist in all states and that nutritional Marasmus is more
frequent than kwashiorkor.
In earlier it was widely held that it was due to protein deficiency. But over a time,
the concept of protein gap has given place to the concept of food gap.
PEM is primarily due to:
A. an inadequate intake of food(food gap) both in quality and quantity and
B. Infection notably diarrhoea, respiratory infection, measles, and intestinal warms
which increase requirements for calories, protein and other nutrients, while
decreasing their absorption and utilization.
Its a vicious circle- infection contributing to malnutrition and malnutrition
contributing to infection, both acting synergistically.
Malnutrition / Infection cycle
There are numerous other contributory factors in the web of causation, viz.
poor environment condition,
large family size,
poor maternal health,
failure of lactation,
premature termination of breast feeding,
And adverse cultural practices relating to child rearing and weaning such
as the use of over diluted cows milk and discarding cooking water from
cereals and delayed supplementary feeding.
It is self-perpetuating
A child nutritional status at any point of time depends on his or her past
nutritional history, which may particularly account for the present status.
35
Also this history linked with the mothers health and nutritional status
Malnutrition is measured by ANTHROPOMETRY:

Measured by weight for age, height for age and weight for height.
Low wt for age means?
Low ht for age means?
Low wt for ht means?
ANTHROPOMETRIC MEASUREMENTS
(A) Age Dependent Measurements
1. Weight:
Formulas for calculating weight:
0-1 year- X+9/2
X is age in months of 1st year
1-6 years- 2x+8
X is age in completed years
7-12 years- 7X-5/2 X is in completed years
2. Height:
Formulas:
0-1 year 50+2X X is completed months of 1st year
1-2 year 75+X

X is completed months of 2nd
2-12 year -6X+77 X is completed year

3. Head Circumference:
4. Chest Circumference:
Normally chest circumference
Crosses that of head at the age of 9
Months it is delayed in chronic
Malnutrition.
Weight for age (%)=

Weight of the child / Weight of a normal child of same age X 100
Height for age (%)=
Height of the child /Height of a normal child of same age X100
(B). Age independent.
36
1. Weight for height (%) =

Weight of the child / Weight of a normal child at same height
X 100
2. Mid arm circumference:
3. Reliable estimation of muscle mass
4. Used for child in age group 1-5 buy
ETIOLOGY
Poverty: commonest cause- inability to buy food.
Under nutrition
Diminished work capacity
Low earning and poverty
Maternal malnutrition
Infection
Population growth : in birth rate is disproportionate to in food production
Inadequate distribution of food in the family
Feeding habits
High pressure advertising of baby foods
Socio-cultural factors
Theories regarding etiology of PEM:

1. Classical Theory:
Oedema in kwashiorkor is due to Hypo-albuminemia, whereas marasmus occurs primarily
due to lack of energy.
2. Gopalans disadaptation theory:
Outcome of the PE deficiency is determined by the body response of a child.
Chronic adaptation Marasmus
Acute response (fails to adapt) Kwashiorkor
3. Gopalans theory of free radicals:
Most recent
Imbalance in free radical generation and safe disposal
37
Classification of PEM:
Etiological classification:
Primary malnutrition: Primarily due to dietary deficiency
Secondary : As an effect of some other illness
IAP classification:
Grade
Wt./age(%)
1
80-71
2
70-61
3
60-51
4
<= 50
Gomezs classification:
Grade
Normal
1.mild
2.moderate
3.severe
Welcomes classification:
Edelman
Wt./age(%)
60-80
Kwashiorkor
<60
Marasmic Kwashiorkor
Wt./age(%)
90-110
75-89
60-74
<60
Edgemont
Under nutrition
marasmus
McLarens classification (Stunting):

Grade
normal
1
2
3
Ht./age(%)
>95
95-90
90-85
<85
Waterlaws classification (Wasting):

Grade
Normal
1
2
3
Wt./Ht.(%)
>90
81-90
71-80
<=70
Weight for height (Waterlaws):

Weight for height
>=80%
<80%
height
Label
>=90%
<90%
>=90%
<90%
Normal
stunted
Wasted
Wasted and stunted
38
Malnutrition classification:
Wasting wt. /ht.(%)
Normal
Wasting wt. /ht.(%)
Normal
Stunting ht. /Age (%)

Normal
Stunting ht. /Age (%)

Normal
Malnutrition
Acute Malnutrition
Chronic malnutrition
Acute on chronic malnutrition
Malnutrition
Acute Malnutrition
Chronic malnutrition
Acute on chronic malnutrition
Colour coded classification by Mid-upper arm circumference in cm by Sakirs tape:
Based on subcutaneous fat (Udanis Classification):

Grade I: Loss of fat from axilla
Grade II: Loss of fat from abdominal and gluteal region
Grade III: Loss of fat from chest and neck
Grade IV: Loss of fat from buccal pad
Kanavatis Formula:
Grade
Normal
Mild
Moderate
Severe
KF=MAC/HC
>0.31
0.31-0.28
0.279-0.25
0.249
Clinical Classification:
Kwashiorkor-Primarily due to lack of protein associated with energy.
Marasmus-result of lack of energy accompanies with protein deficiency
Marasmickwashiorkor :Overlap of clinical picture of both
Clinical features:
Mild to moderate under-nutrition:
If the dietary intake is less for a short period
Child appear slow and less energetic
If persist for a longer time
Growth may be affected more in weight than in height
Crossing of chest circumference over head circumference is delayed
Buttocks flattened
39
Winging of the scapula

Abdomen become distended
If persist for a long time child may develop marasmus or kwashiorkor
Marasmus
The term is derived from Greek word

Usually seen in child <3 yrs: More common in 1st year of life
Gross wasting of muscles and sc fat.
Marked stunting and no oedema
Weight60%of expected weight for age
Face look prematurely aged, hollow cheeks -Monkey faces
Loose fold of skin over buttock and inner thigh become evident(buccal fat still
preserved till last)
Hair become hypopigmented
Abdomen distended
Bony points become prominent
Baby appears alert and often irritate
Kwashiorkor
40
The term is introduced by Prof. Williams, for the disease in Ghana, meaning red
boy because of pigmentary changes due to a disease.
Markedly retarded growth
Common among older infants and preschool children
Upper limb muscles become wasted, lower limb appears swollen.
Wasting is masked by oedema
Psychomotor changes:
Lethargic
Show little interest in surrounding
Appetite become impaired
Oedema:
Pitting in nature
Causes
Hypoalbuminemia
Retention of fluid and water
Free radical induced damage
Starts from LL and involve upper limb and face
Face appear moon shaped and puffy-moon faces
Other changes:
Hepatomegaly
Hair changes: flag sign-partly pigmented and partly hypopigmented
Skin changes: flaky paint dermatosis-erythema followed by hyperpigmentation,
this hyperpigmented skin disquamate to expose raw hypopigmented skin.
Repeated infections
Treatment
Based on severity:
A) Treatment of complication :( SHIELDED)
S-Sugar deficiency
H-hypothermia
I-Infections
EL-Electrolyte imbalance
DE-Dehydration
D-Deficiency of Fe/Vitamins
B) Dietary Therapy :( BEST) (1-6 weeks)
B- Beginning of feeding (0-7days): Start with 80kcal/kg/day and 0.7gm/kg/day on first
day upto 150 kcal/kg/day and protein 2-3gm/kg/day on 7 day
E- Energy dense food-150-220/kcal/kg/day and 4-5 gm/kg/day with the help of energy
dense homemade food e.g.
BesanPanjiri giving 500 kcal& 9 gm protein/100gm,
Hyderabadi mixture
Khichdi with added oil/ghee/curd
S- Stimulation-human contact and emotional support including tender loving care(TLC)
41
T- Transfer to home based diet

Treatment in mild to moderate malnutrition:
Home based treatment
150 kcal/kg/day and protein 2-3gm/kg/day
Food prepared at home
Keep surveillance to stop from slipping down in severe grade.
Preventive measures:
No simple solution for malnutrition
Many types of action are necessary
For prevention of PEM
a)
Health promotion
b)
Specific protection
c)
Early diagnosis and treatment
d)
Rehabilitation
(A) Health promotion
For pregnant and lactating women(education & distribution of supplement)
Promotion of breast feeding
Development of low cost weaning foods
Measures to improve family diet
Nutritional education
Home economics
Family planning and spacing of birth
Family environment
(B)
Specific protection
Childs diet must contain protein and energy rich foods, milk, egg, fruits also.
Immunization
Food fortification
(C)
Early Diagnosis and treatment:
Periodic surveillance
Early diagnosis of any lag in growth
Early diagnosis and treatment of infections and diarrhoea
Deworming of heavily infested children
Supplementary feeding programmes
(D)
Rehabilitation
Nutritional rehabilitation services
Hospital treatment
Follow-up care
42
Difference between Clinical features of Marasmus and Kwashiorkor:

Features
Marasmus
Kwashiorkor
Muscle wasting
Obvious
May hidden by oedema
Fat wasting
Severe loss of subcutaneous fat
Fat usually retained
Oedema
Absent
Present involving lower legs,
face and arms
Weight for height
Very low
Low or normal (masked by
oedema)
Mental changes
Irritable
Apathic
Appetite
Good
Poor
Diarrhoea
Often
Often
Skin changes
None
Diffuse pigmentation, flaky
paint dermatosis
Hair changes
Seldom
Sparse, silky, easily pulled out
Hepatic enlargement
None
sometimes
Xerophthalmia
All the ocular manifestation of Vit A deficiency
Most common in 1-3 yr
Related to weaning
Associated with PEM
Skimmed milk is a major culprit
Rice eating states: Andhra, TN, Karnataka, Bihar, west Bengal.
Prevention & Control:
WHO has given 3 categories for the prevention:
Short term:
Vitamin A prophylaxis schedule
Individual
Oral dose
Timing
Children< 12 months
1lakh IU
Once every 4-6 month
Children> 12 months
2 lakh IU
Once every 4-6 months
Women child bearing age
3 lakh IU
Within 1 month of delivery
Pregnant and lactating women
20000 IU
Once every week
Medium term:
Food fortification
Long term:
Green leafy vegetables
Breast feeding
Safe and adequate water supply
Construction of sanitary latrine
Immunization against infectious diseases
Prompt treatment of diarrhoea
Better feeding and health education
43
Vitamin A deficiency in India:

About 5.7% of children suffer from eye sign of Vit A deficiency
Prevalence of Bitots spot is 0.5 %
only 21% of 12 to 35 months receive Vit A
in 1970 national program for prevention of blindness for preschool children
In 1992 children aged 9 months to 3 years
Under RCH new guide lines covers all children up to 5 yr
Nutritional anaemia:
Haemoglobin content of the blood below normal as a result of deficiency of one
or more essential nutrients regardless of the cause of such deficiency
2/3rd of pregnant and of non pregnant are anaemic in developing countries
Silent emergency
Except Punjab all other states have prevalence of 50% among pregnant women.
As per DLHS adolescent girls -72.6% prevalence
Causes of Anaemia:
Poor bioavailability
Menstruation
Malaria, hook worm
Detrimental effects of Anaemia:
Pregnancy
Infection
Work capacity
Interventions:
If severe Hb<10 mg/dl high doses of iron or BT
If 10-12 mg/dl
Iron folic acid supplementation under national nutritional anemia prophylaxis
program
Mothers- 100 mg iron tablet 0.5 mg folic acid given daily until 2-3 months after
hb returns to normal
Children <6 yr - 20 mg iron 0.1 mg folic acid for 100 days
Children 6-10 yr -30 mg iron 0.25 mg folic acid
Adolescent same as adult
Iron fortification
Other strategies : control of malaria , control of hook worm infestation, nutrition
education
Iodine deficiency disorders

Goitre
Hypothyroid
Sub normal intelligence, delayed motor milestones, mental deficiency, hearing
defect, speech defect
44
Strabismus, nystagmus
Spasticity(extra pyramidal)
Neuro muscular weakness
Endemic cretinism
IUD
Epidemiological assessment of iodine deficiency:
Prevalence of goitre
Prevalence of cretinism
Urinary iodine excretion
T3 T4 TSH
Prevalence of neonatal hypothyroidism(sensitive indicator for environmental
iodine deficiency )
Goitre control:
Iodized salt (PFA act )
30 ppm at production level
15 ppm at consumer level
Salt fortified with iodine and iron
Iodized oil- IM injection 1 ml will provide protection for 4 years ,less practicable
Oral iodized oil
Iodine monitoring
Man power training for legal enforcement and public education
Mass communication
Endemic fluorosis
Where fluorine 3-5 mg/dl
WHO limit 1.5 mg/dl
international 1.0 mg/dl
0.5 -0.8 mg/dl recommended acceptable limit
Types:
1. Dental flu0rosis
2. Skeletal flu0rosis
3. Genu valgum In AP & TN- where Jowar as a staple diet
Intervention:
1. Changing the water supply- running surface water
2. Chemical treatment- NEERI Nagpur Nalgonda technique addition of lime and
alum flocculation sedimentation filtration
3. Fluoride tooth paste- not recommended for children below 6 yr
Lathyrism:
Its paralyzing disease of humans and animals
In human it is neuro-lathyrism because it affects the nervous system, and in
animal it is osteo-lathyrism because pathological changes occur in bones
45
resulting in skeletal deformities.

Neurolathyrismis a crippling disease of the nervous system characterized by
gradually developing spastic paralysis of lower limbs, occurring mostly in adults
consuming the pulse, lathyrus sativus in large quantities.
Prevalent in parts of MP, UP, and orissa.
Also in Maharashtra, west Bengal, Gujarat, Assam.
Lathyrus sativus is commonly known as Khesari Dhal
Also name like teora dhal, batra, gharas, matra.
Seed of L.sativus have triangular shape and grey color.
Over 30 % of this dhal if taken over a period of 2-6 months will result in neurolathyrism.
The toxin present in seeds has been identified as Beta Oxalyl Amino Alanine
(BOAA) crysline and water soluble.
Diseases mainly occurs in young men 15-45 years
Stages:
A. Latent stage: apparently healthy, if stress ungainly gait-important for
prevention-if pulse is withdrawn from the diet
B. No stick stage: short jerky steps
C. One stick stage: crossed legs-walk on toes, muscle stiffness
D. Two stick stage: excessive bending of knee, 2 crutches
E. Crawler stage: knee joint can not bear wt.
Interventions:
1. Vitamin C prophylaxis
2. Banning of crop: it should never be more than quarter of total cereal and pulses
taken per day
3. Removal of toxin
Steeping method soaking in hot water
Parboiling-soaking in lime water
Education
Socio economic changes
Genetic approach-selective cultivation of lathyrus containing <0.1 % of toxin
46
Baroda Dairy
Baroda dairy known as Baroda District Co-Operative Milk Producers Union Limited,
Vadodara is a district level milk processing industry established in the year 1957
registered under Gujarat state co-operative societies act. There are total 1405 primary
milk co-op societies under Baroda dairy (2014).
The farmers own the dairy; their elected representatives manage the village societies
and the district union. They employ professionals to operate the dairy and manage its
business. The dairy aims to provide remunerative returns to the milk producers and
serve the interest of Indian consumers by providing quality milk products through the
federation - M/S Gujarat Co-Operative Milk Marketing Federation Limited.
The plant can process up to 5 lac litres of milk per day. The main process of the plant
pasteurization is done with the help of HTST (High Temp Short Time) Pasteurization.
The milk is standardized in various Fat/SNF contents and packed.
Type of Milk
Amul Gold Milk
Amul Shakti Milk
Amul Cow Milk
Amul Slim n Trim Milk
Fat (%)
6.0
4.5
3.5
1.5
SNF (%)
9.0
8.5
8.5
9.0
Quality Management
The union is certified for ISO 22000:2005, Food Safety Management System in the year
2009.
Environment Management System complies AS/NZS ISO14001:2004.
Milk Hygiene
There is a potential of disease causation through milk when it is not handled
hygienically. Diseases which can be conveyed through milk are bovine tuberculosis, Q
fever, food poisoning, diarrhoea and dysenteries, septic sore throat, cholera, enteric
fever, viral hepatitis, diphtheria etc.
The milk hygiene begins at its source of production namely the dairy farm.
A dairy consists of the farm, the milk depot and the pasteurization and bottling/ packing
plant, staff changing rooms, and a manure disposal yard. The dairy proper has milk
receiving, pooling, cooling and blending room.
To prevent outbreaks of milk borne diseases, hygiene of cattle, personnel, equipment,
process (of milking and pasteurization), as well as sanitary packing and delivery should
be ensured. A periodical medical examination of personnel, inspection of premises and
equipments, veterinary inspection of cattle, scrutiny of the process in the dairy,
47
inspection of functional efficiency of the farm, depot and plant, and laboratory tests for
purity and quality of pasteurization are required to be carried out.
These measures should ensure the following:
Care of Cattle:
A clean, airy, cool and spacious cattle shed is of prime importance. Ample water supply
for drinking, to wash the cattle sheds and bathe the cattle should be available. Fodder,
cottonseed, oilcake, bran and meal consisting of a coarsely crushed mixture of grains
must be given to each animal. Stores should be rat proof. Sick animals must be
immediately isolated and contacts segregated. Cattle should be inspected by a
veterinary surgeon at least once a month.
Cow Sheds:
The cow shed should be well drained and higher than the surrounding ground. The floor
area per cattle head should be minimum 6 m2. The walls should be of reinforced
concrete and whitewashed inside. Good cross ventilation is essential. The shed should
be well lit. The whole flooring should be of impervious concrete. The sheds should be
washed every day and cleaned twice a day. They should be sprayed with insecticide
once a week.
Disposal of Cattle Dung and Sullage:
All channels carrying Sullage and liquid cattle dung should always be made of concrete.
Semisolid cattle dung, a potent source of fly breeding, should be removed daily to a cow
dung depot made of concrete and situated at least 200 m away from the cattle sheds.
Ant fly measures must be ensured.
Health of Workers:
Medical inspection of the employees should be carried out very regularly and
frequently, strict attention being paid to personal cleanliness. A regular immunization
against enteric group of fevers must be ensured. All cases of illnesses, especially
diarrhoea, dysentery, enteric fever, infected fingers or boils, running nose or ears, sore
throat, or cough must be attended to. Exclusion of carriers of communicable diseases
should also be rigidly enforced. All indoor workers should scrub their hands thoroughly
with soap, hot water and a nail brush and change into their working clothes including
cotton masks. All workers should have adequate sanitary and bathing facilities. They
should wash their hands with soap and water before entering the processing premises
or milking.
Pasteurization:
Boiling kills the microorganisms but is likely to adversely affect the quality, taste and
flavour of milk, as milk constituents are heat-labile. Pasteurization involves rapidly
heating milk (to less than the boiling point), maintaining it uniformly over a definite
period and rapidly cooling it. This destroys most of the pathogenic microorganisms,
reduces the total quantity of all the microorganisms without affecting its inherent
qualities (taste and flavour). It may not sterilize milk but makes it non-infective, retains
its nutritive and aesthetic qualities and improves its keeping quality. The important
pathogens that are destroyed by pasteurization of milk are M tuberculosis, B abortus,
48
Streptococci and Staphylococci and the non-lactose fermenting pathogenic organisms of

the Salmonella-Shigella group. The subsequent rapid cooling of the heated milk inhibits
the multiplication of any viable residual microorganisms or of the ones subsequently
gaining access to the liquid. The low temperature must be maintained till the milk is
consumed. The nutritive value of pasteurized milk remains reasonably satisfactory. Its
fat, protein, calcium, phosphorus, and vitamins A and D contents are not affected. There
is a 10% loss of vitamins B and 20% loss of vitamin C. Pasteurization improves the
keeping quality of milk, reduces the number of bacteria, and destroys tuberculosis
bacilli and other pathogenic organisms except spores and thermoduric bacteria.
However, milk with a high bacterial count in a raw state will not pasteurize so efficiently
as clean milk. Pasteurized milk can be preserved for 8 to 12 hours at 18C.
Methods of Pasteurization:
(a) Holder (Vat) method: This method consists of heating the milk to the temperatures
between 63C and 65.5 C and holding it in large tanks at that temperature for 30 min
before cooling it rapidly to 5C. Milk gets heated efficiently and pathogenic bacteria are
killed with certainty. From these holding tanks, the milk runs directly to the cooler and
then to the packing / bottling machine through a closed system.
(b) Continuous Flow Method: This method is the modification of the Holder method.
The milk is first heated to 63C or more and then led through a series of heated metal
coils so that the milk remains at that temperature in the apparatus for 30 minutes.
(c) High Temperature Short Time (HTST) Method: In this method milk is heated to 72C
for 15 seconds and then rapidly cooled to 4C.
(d) Ultra high temperature (UHT) Method: Milk is rapidly heated usually in two stages,
the second stage being under pressure, between 125 to 150 C for a few seconds only.
It is then rapidly cooled and packed / bottled as quickly as possible.
(e) Pasteurization in Bottles: The filled bottles can also be pasteurized. They are well
sealed and heated by a shower of hot water or steam. The simplest method is to place
the milk bottles in water-bath brought to 63C held there for 30 min and then chilled.
The theoretical risk of contamination after pasteurization is entirely eliminated.
Supervision of Pasteurization Process:
The pasteurization process needs constant supervision and the following are the most
important factors to ensure efficient pasteurization:
(a) Raw milk must be clean and free from extraneous matter.
(b) A pasteurization chart should show the range of and the period for which the
temperature, as specified for the method, was maintained.
(c) Milk must be protected from contamination during cooling and bottling / packing;
unprotected open coolers are undesirable.
(d) Excessive foaming of milk must be avoided as the temperature of the foam is too low
to kill pathogens and may even encourage the growth of thermophilic organisms.
(e) The apparatus must be efficiently cleaned and sterilized after each days work.
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(f) Besides ensuring efficient supervision, the process of pasteurization should be

checked from time to time by the colorimetric Phosphatase test as described earlier.
(g) If there is any doubt, about the effectiveness of pasteurization, the issue of such milk
must be reconsidered.
It is much safer for the consumer to assume that the milk he receives is untreated and is
therefore boiled rather than to enjoy a false security.
Inspection of Milk:
Inspection of milk involves physical and laboratory tests. Objectives of inspecting fresh
milk are to detect visible dirt, deterioration, adulteration, nutritive quality, keeping
quality, and to ascertain efficiency of pasteurization. The physical tests involve the
inspection and taste of milk.
Laboratory Tests
Specific Gravity: The specific gravity of milk should be 1.029 to 1.033, but milk diluted
with water can be readily restored to its normal specific gravity by adding sugar or
cornflour.
Chemical Tests: A further chemical analysis is necessary to detect adulteration.
(i) Gerbers Test: Gerbers Test is carried out for estimation of fat.
(ii) Total Solids: These are estimated by the evaporation of whole milk in a water bath
and then weighing the dried residue Solids Not Fat (SNF) are estimated by deducting
the fat value from the total solids.
(iii) Methylene Blue Test: It is carried out for testing the keeping quality and bacterial
contamination in the milk. The basis of the test is that the dye is reduced and
decolorized by the bacterial enzymes. The rate of reduction is an index of the extent of
bacterial contamination. One ml of Methylene blue solution of 1: 300,000 strength is
added to 10 ml of milk sample in a test tube and then incubated at 37 C in a water bath
or incubator. The mixture should not decolorize within 5 hours. If kept at room
temperature above 37 C it should not decolorize within 4 hours.
(iv)Phosphatase Test: This test is meant for ascertaining the efficiency of pasteurization
and depends on the fact that the enzyme Phosphatase is destroyed by the pasteurization
temperatures; but not completely destroyed at a lower temperature, or in a shorter
period than that required for pasteurization. Milk containing as little as 0.25 percent of
raw milk in the properly pasteurized milk still contains detectable quantities of enzyme.
The test is performed by addition of disodium phenyl-phosphate to pasteurized milk.
The enzyme phosphatase, if present, splits up the phenol by means of a phenol test
reagent which gives different shades of blue colour depending upon the amount of
phosphatase enzyme present. The colour is matched against the standard colours in a
Lovibond colorimeter. Pasteurized milk must not contain more than 2.3 Lovibond units.
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(v) Bacteriological Tests: These are rarely carried out as a routine but when indicated,
are used for detection of M tuberculosis, B abortus or some other bacteria. Under such
circumstances 100 ml of milk is centrifuged at 3000 rpm for half an hour. Deposits of
centrifuged milk also can be cultured for other organisms in appropriate media such as
the Wilson Blair medium for the enteric group of organisms and the tellurite medium
for C diphtheria.
Inspection of Dairies and Milk Depots: The dairy should be inspected in a definite
sequence and with a view to scrutinize all details in the process of production of milk /
milk products, their wholesomeness, quality and safety for consumers. All the concerns
described above should be covered. Sampling of milk may be carried out periodically at
the dairy farm, milk depot and also at various points on the consumer line. The tests for
nutritional ingredients, adulteration, pasteurization, bacterial contamination and
keeping may be specifically requested as indicated.
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National Guidelines on Infants and Young Child Feeding

MINISTRY OF WOMEN AND CHILD DEVELOPMENT
(FOOD AND NUTRITION BOARD)
GOVERNMENT OF INDIA
Correct Norms for IYCF

Initiation of breastfeeding immediately after birth, preferably within one hour.
Exclusive breastfeeding for the first six months i.e., the infants receives only
breast milk and nothing else, no other milk. Food, drink or water.
Appropriate and adequate complementary feeding from six months of age
while continuing breastfeeding.
Continued breastfeeding up to the age of two years or beyond.
Introduction
Infant and young child nutrition has been engaging the attention of scientists and
planners since long for the very simple reason that growth rate in the life of human
beings is maximum during the first year of life and infant feeding practices comprising
of both the breastfeeding as well as complementary feeding have major role in
determining the nutritional status of the child. The link between malnutrition and
infant feeding has been well established.
Recent scientific evidence reveals that malnutrition has been responsible,
directly or indirectly, for 60% of all deaths among children under five years annually.
Over 2/3 of these deaths are often associated with inappropriate feeding practices and
occur during the first year of life. Only 35% of infants world-wide are exclusively
breastfed during the first four months of life and complementary feeding begins either
too early or too late with foods which are often nutritionally inadequate and unsafe.
Poor feeding practices in infancy and early childhood, resulting in malnutrition,
contribute to impaired cognitive and social development, poor school performance and
reduced productivity in later life. Poor feeding practices are, therefore, a major threat
to social and economic development as they are among the most serious obstacles to
attaining and maintaining health of this important age group.
Optimal Infant and Young Child Feeding practices - especially early initiation and
exclusive breastfeeding for the first six months of life - help ensure young children the
best possible start to life. Breastfeeding is natures way of nurturing the child, creating a
strong bond between the mother and the child.
It provides development and learning opportunities to the infant, stimulating all
five senses of the child sight, smell, hearing, taste, and touch. Breastfeeding fosters
emotional security and affection, with a lifelong impact on psychosocial development.
Special fatty acids in breast milk lead to increased intelligence quotients (IQs) and
better visual acuity. A breastfed baby is likely to have an IQ of around 8 points higher
than a non-breastfed baby.
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Breastfeeding is not only important for young child survival, health, nutrition,
the development of the babys trust and sense of security but it also enhances brain
development and learning readiness as well.
Tenth Five Year Plan Goals
The Tenth Plan has set specific nutrition goals to be achieved by 2007.
The major goals are:
1. Intensify nutrition and health education to improve infant and child feeding and
caring practices so as to:
a. bring down the prevalence of under-weight children under three years
from the current level of 47 per cent to 40 per cent;
b. reduce prevalence of severe Under nutrition in children in the 0-6 years
age group by 50 per cent;
2. Enhance Early Initiation of Breastfeeding (colostrums feeding) from the current
level of 15.8 per cent to 50 per cent;
3. Enhance the Exclusive Breastfeeding rate for the first six months from the
current rate of 55.2 per cent (for 0-3 months) to 80 per cent; and
4. Enhance the Complementary Feeding rate at six months from the current level of
33.5 per cent to 75 per cent.
Objectives of IYCF
To advocate the cause of infant and young child nutrition and its improvement
through optimal feeding practices nationwide,
To disseminate widely the correct norms of breastfeeding and complementary
feeding from policy making level to the public at large in different parts of the
country in regional languages,
To help plan efforts for raising awareness and increasing commitment of the
concerned sectors of the Government, national organizations and professional
groups for achieving optimal feeding practices for infants and young children,
To achieve the national goals for Infant and Young Child Feeding practices set by
the Planning Commission for the Tenth Five Year Plan so as to achieve reduction
in malnutrition levels in children.
A. APPROPRIATE INFANT AND YOUNG CHILD FEEDING PRACTICES
Breastfeeding is an unequalled way of providing ideal food for the healthy
growth and development of infants; it is also an integral part of the reproductive
process with important implications for the health of mothers. As a global public health
recommendation, infants should be exclusively breastfed for the first six months of life
to achieve optimal growth, development and health. Thereafter, to meet their evolving
nutritional requirements, infants should receive nutritionally adequate and safe
complementary foods while breastfeeding continues for up to two years of age or
beyond WHO, 2002.
Breastfeeding
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The human milk has inherent anti-infective properties which no other milk has. This
protective function of human milk is particularly important in developing countries
where there is much exposure to infection. Some of the advantages of breastfeeding
are:
Breast milk is the best natural food for babies.
Breast milk is always clean.
Breast milk protects the baby from diseases.
Breast milk makes the child more intelligent.
Breast milk is available 24 hours a day and requires no special
preparation.
Breast milk is natures gift to the infant and does not need to be
purchased.
Breastfeeding makes a special relationship between mother and baby.
Breastfeeding helps parents to space their children.
Breastfeeding helps a mother to shed extra weight gained during
pregnancy.
Early Initiation of Breastfeeding
Early initiation of breastfeeding is extremely important for establishing
successful lactation as well as for providing Colostrum (mothers first milk) to the
baby. Ideally, the baby should receive the first breastfeed as soon as possible and
preferably within one hour of birth.
The new born baby is very active during the first half an hour and if the baby is
kept with the mother and effort is made to breastfeed, the infant learns sucking very
fast. This early suckling by the infant starts the process of milk formation in the mother
and helps in early secretion of breast milk.
In case of caesarean deliveries, new born infants can be started with
breastfeeding within 4-6 hours with support to the mother.
Newborn babies should be kept close to their mothers to provide warmth and
ensure frequent feeding. This also helps in early secretion of breast milk and better milk
flow.
Value of Colostrum
The milk secreted after the child birth for the first few days is called Colostrum. It is
yellowish in color and sticky. It is highly nutritious and contains anti-infective
substances. It is very rich in vitamin A. Colostrum has more protein, sometimes up
to 10%. It has less fat and the carbohydrate lactose than the mature milk.
Feeding Colostrum to the baby helps in building stores of nutrients and antiinfective substances (antibodies) in the babys body. The anti-infective substances
protect the baby from infectious diseases such as diarrhoea, to which the child might
be exposed during the first few weeks after birth.
Exclusive breastfeeding
Exclusive breastfeeding means that babies are given only breast milk and
nothing else no other milk, food, drinks and not ever water. During the first six
months exclusive breastfeeding should be practiced.
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Breast milk provides best and complete nourishment to the baby during the first
six months. The babies who are exclusively breastfed do not require anything else
namely additional food or fluid, herbal water, glucose water, fruit drinks or water
during the first six months. Breast milk alone is adequate to meet the hydration
requirements even under the extremely hot and dry summer conditions prevailing in
the country. It must be remembered that benefits of breastfeeding are reduced if it is
not exclusive breastfeeding.
Complementary Feeding
Complementary feeding is extremely essential from six months of age, while
continuing breastfeeding, to meet the growing needs of the growing baby. Infants grow
at a very rapid rate. The rate of growth at this stage is incomparable to that in later
period of life. An infant weighing around 3kg at birth doubles its weight by six months
and by one year the weight triples and the body length increases to one and a half times
than at birth. Most of the organs of the body grow rapidly, both structurally and
functionally during the early years of life and then later on, the growth slows down.
Most of the growth in the nervous system and brain is complete in the first two years of
life. In order to achieve optimum growth and development, there is an increased
demand for a regular supply of raw material in the form of better nutrition.
Breast milk is an excellent food and meets all nutritional requirements of the
baby for the first six months. However, after six months of age, breast milk alone is not
enough to make an infant grow well, other foods are also needed. This is because the
infant is growing in size and its activities are also increasing.
Complementary feeding should be started at six months of age. The purpose of
complementary feeding is to complement the breast milk and make certain that the
young child continues to have enough energy, protein and other nutrients to grow
normally.
It is important that breastfeeding is continued up to the age of two years or
beyond as it provides useful amounts of energy, good quality protein and other
nutrients.
Active feeding styles for complementary feeding are also important. Appropriate
feeding styles can provide significant learning opportunities through responsive
caregiver interaction, enhancing brain development in the most crucial first three years.
First food for the baby
The staple cereal of the family should be used to make the first food for an infant.
Porridge can be made with suji (semolina), broken wheat, atta (wheat flour)
ground rice, ragi, millet etc, by using a little water or milk, if available.
Roasted flour of any cereal can be mixed with boiled water, sugar and a little fat
to make the first complementary food for the baby and could be started on the
day the child becomes six months old. Adding sugar or jaggery and ghee or oil is
important as it increases the energy value of the food.
In the beginning the porridge could be made a little thinner but as the child grows
older the consistency has to be thicker. A thick porridge is more nutritious than a
thin one.
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In case a family cannot prepare the porridge for the infant separately, pieces of
half chapatti could be soaked in half a cup of milk or boiled water, mashed
properly and fed to the baby after adding sugar and fat.
Fruits like banana, papaya, chikoo, mango etc could be given at this age in a
mashed form.
Traditional foods for infants
Most traditional foods given to infants in different parts of the country are
examples of mixed foods like Khichdi, Dalia, suji kheer, upma, idly, dokhla, bhaatbhaji etc. For instance, mashed idly with a little oil and sugar is a good
complementary food for the infant. Similarly bhaat can be made more nutritious
by adding some cooked dal or vegetable to it. Khichdi can be made more
nutritious by adding one or two vegetables in it while cooking.
Modified family food
Pieces of chapati could be soaked in half a katori of dal and some vegetable, if
available. The mixed food could be mashed well and fed to the baby after adding
a little oil. If necessary the mixture could be passed through a sieve to get a semisolid paste. Modifying familys food is one of the most effective ways of ensuring
complementary feeding of infants.
Instant Infant Foods
Infant food mixes can be made at home from food grains available in the
household. These mixes can be stored at least for a month and enable frequent
feeding of infants.
One can take three parts of any cereal (rice/wheat) or millet (ragi, bajra jowar),
one part of any pulse (moong/channa/arhar) and half part of groundnuts or
white til, if available. The food items should be roasted separately, ground, mixed
properly and stored in airtight containers. For feeding, take two tablespoons of
this infant food mix, add boiled hot water or milk, sugar or jaggery and oil/ghee
and mix well. Cooked and mashed carrot, pumpkin or green leafy vegetables
could be added to the porridge, if available. The infant food mix could also be
made into preparations like halwa, burfi, upma, dalia etc, and given to the child.
Protective foods
Protective foods like milk, curd, lassi, egg, fish and fruits and vegetables are also
important to help in the healthy growth of the infants. Green leafy vegetables,
carrots, pumpkin and seasonal fruits like papaya, mango, chikoo, banana etc., are
important to ensure good vitamin A and iron status of the child.
Energy Density of Infant Foods
It is important to give small energy dense feeds at frequent intervals to the child
with a view to ensure adequate energy intake by the child.
Energy density of foods given to infants and young children can be increased in
four different ways:
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1. By adding a teaspoonful of oil or ghee in every feed. Fat is a concentrated

source of energy and substantially increases energy content of food without
increasing the bulk.
2. By adding sugar or jaggery to the childs food. Children need more energy
and hence adequate amounts of sugar or jaggery should be added to childs
food.
3. By giving malted foods. Malting reduces viscosity of the foods and hence
child can eat more at a time. Malting is germinating whole grain cereal or
pulse, drying it after germination and grinding. Infant Food Mixes prepared
after malting the cereal or pulse will provide more energy to the child. Flours
of malted food when mixed with other foods help in reducing the viscosity of
that food. Amylase Rich Flour (ARF) is the scientific name given to flours of
malted foods and must be utilized in infant foods.
4. By feeding thick mixtures young infant particularly during 6-9 months
requires thick but smooth mixtures as hard pieces in the semi-solid food may
cause difficulty if swallowed. The semi-solid foods for young infants can be
passed through a sieve by pressing with a ladle to ensure that the mixed food
is smooth and uniform without any big pieces or lumps.
Frequency of feeding
Infants and young children need to be fed 5-6 times a day in addition to
breastfeeding. It must be remembered that inadequate feeding of infants and
young children during the first two years is the main cause of malnutrition.
Continued Breastfeeding
Breastfeeding must be continued up to the age of two years or beyond.
Continuing breastfeeding while giving adequate complementary foods to the
baby provides all the benefits of breastfeeding to the baby. In other words, the
child gets energy, high quality protein, vitamin A, anti-infective properties and
other nutrients besides achieving emotional satisfaction from the breastfeeding
much needed for optimum development of the child. Breastfeeding especially at
night ensures sustained lactation.
As the child starts taking complementary foods well, the child should be given
breastfeeding first and then the complementary food. This will ensure adequate
lactation.
Active feeding
Adopting caring attitude while feeding the baby like talking to the child,
playing with the child stimulates appetite and development.
One-two year old child should be given food on a separate plate and
encouraged to eat on its own.
Eating at the same time and at the same place also helps in improving
appetite and avoids distractions.
Growth Monitoring and Promotion (GMP)
Weighing the child regularly and plotting the weight on the health card is an
important tool to monitor the growth of the baby. Infants and young children
57
should be weighed every month in the presence of their mothers and the growth
status of the child should be explained to the mother.
Ensuring safety of complementary foods
Hands should be washed with soap and water before handling the food as
germs that cannot be seen in dirty hands can be passed on to the food.
Utensils used should be scrubbed, washed well, dried and kept covered.
Cooking kills most germs. The foods prepared for infants should be
cooked properly so as to destroy harmful bacteria present, if any.
After cooking, handle the food as little as possible and keep it in a covered
container protected from dust and flies.
Cooked foods should not be kept for more than one to two hours in hot
climate unless there is a facility to store them at refrigeration
temperature.
The hands of both mother and child should be washed before feeding the
child.
Utilizing the available nutrition and health services
There is a number of nutrition and health services are available for children in
the village, at the sub-centre, at the Primary Health Centre, under Reproductive
and Child Health (RCH) Programme, Integrated child Development Services
(ICDS) Scheme etc. Every effort should be made to encourage the community
members to make use of these facilities so as to promote child health.
Feeding during and after illness
A sick child needs more nourishment so that he could fight infections without
using up nutrient reserves of his body. However, a child may lose appetite and
may refuse to eat, but the child needs adequate nutrition to get better from
illness.
Appropriate feeding during and after illness is important to avoid weight loss
and other nutrient deficiencies.
Make sure that children with measles, diarrhoea and respiratory infections eat
plenty of vitamin A rich foods. A massive dose of vitamin A could also be given to
such children in consultation with the medical officer.
After the illness when the child is recovering, a nutritious diet with sufficient
energy, protein and other nutrients is necessary to enable him to catch up
growth and replacement of nutrient stores.
Feeding In Exceptionally Difficult Circumstances
Malnourished infants
Infants and young children who are malnourished are most often found in
environments where improving the quality and quantity of food intake is particularly
problematic. To prevent a recurrence and to overcome the effects of chronic
malnutrition, these children need extra attention both during the early rehabilitation
phase and over the longer term. Continued frequent breastfeeding and, when
necessary, relactation are important preventive steps since malnutrition often has its
origin in inadequate or disrupted breastfeeding.
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Mothers of malnourished children could be invited in a camp and provided with

a fortnights ration of roasted cereal-pulse mixes with instructions. The children could
be followed up every fortnight for growth monitoring, health check up and supply of
instant food ration for a period of three months. When malnourished children improve
with appropriate feeding, they themselves would become educational tools for others.
Preterm or Low Birth Weight Infants
Breast milk is particularly important for preterm infants and babies with low
birth weight (newborn with less than 2.5kg weight) as they are at increased risk of
infection, long term ill health and death. Preterm baby should be fed every two hourly
during the day and night.
Keep preterm or low birth weight baby warm.
Practice Kangaroo care. Kangaroo care is a care given to a preterm baby in which
baby is kept between the mothers breast for skin to skin contact as long as
possible as it simulates intrauterine environment and growth.
This helps the baby in two ways,
(i)
The child gets the warmth of the mothers body, and
(ii)
The baby can suck the milk from the mothers breasts as and when
required. Such babies may need to suck more often for shorter
duration. If the baby is not able to suck, expressed breast milk may
be fed with katori or tube.
Feeding During Emergencies
Infants and young children are among the most vulnerable victims of natural or
human induced emergencies.
Interrupted breastfeeding and inappropriate
complementary feeding heighten the risk of malnutrition, illness and mortality
Emphasis should be on protecting, promoting and supporting breastfeeding and
ensuring timely, safe and appropriate complementary feeding.
Pregnant and lactating women should receive priority in food distribution and
should be provided extra food in addition to general ration.
Complementary feeding of infants aged six months to two years should receive
priority.
Donated food should be appropriate for the age of the child.
Immediate nutritional and care needs of orphans and unaccompanied children
should be taken care of.
Efforts should be made to reduce ill effects of artificial feeding by ensuring
adequate and sustainable supplies of breast milk substitutes, proper preparation
of artificial feeds, supply of safe drinking water, appropriate sanitation, adequate
cooking utensils and fuel.
Feeding in Maternal HIV
The absolute risk of HIV transmission through breastfeeding for more than one
year globally between 10% and 20% - needs to be balanced against the increased risk
of mortality and morbidity when infants are not breastfed. Risk factors during
breastfeeding that increase transmission includes breast pathology like sore nipples or
59
even sub clinical mastitis, which are preventable problems through good breastfeeding
and lactation management support to mothers.
All HIV infected mothers should receive counselling, which should include
provision of general information about meeting their own nutritional requirements, and
about the risks and benefits of various feeding options, and specific guidance in
selecting the option most likely to be suitable for their situation. The manifold
advantages of breastfeeding even with some risk of HIV transmission should be
explained to the HIV positive mothers.
If artificial feeding is NOT affordable, feasible, acceptable, safe and sustainable
(AFASS), then only exclusive breastfeeding must be recommended during the first six
months of life. These guidelines imply that till one can ensure all these 5 AFASS factors,
it would not be safe to provide artificial feeding in HIV positive mothers. To achieve
appropriate infant feeding practices in HIV positive mothers, capacity building of
counselors and health workers, including doctors and nursing staff, is mandatory to
ensure either exclusive breastfeeding or exclusive artificial feeding as chosen by the
mother.
B. OPERATIONAL GUIDELINES FOR PROMOTION OF APPROPRIATE INFANT AND
YOUNG CHILD FEEDING
Obligations and Responsibilities
Central and State Governments, national and international organizations and other
concerned parties share responsibility for improving the feeding of infants and young
children so as to bring down the prevalence of malnutrition in children, and for
mobilizing required resources human, financial and organizational. The Departments
of Women and Child Development, and Health and Family Welfare has a special
responsibility to contribute to optimal infant and young child nutrition. In this context,
due attention needs to be given to the monitoring of the implementation of the Infant
Milk Substitutes, Feeding Bottles and Infant Foods (Regulation of Production, Supply
and Distribution) Act 1992 and its subsequent amendment(s).
Institutional Promotion
Nutrition and Health professional bodies
Nutrition and Health professional bodies, which include Home Science (Food and
Nutrition) and medical faculties, schools of public health, public and private
institutions for training nutrition and health workers (including midwives, nurses,
nutritionists and dieticians), and professional associations should have the following
main responsibilities towards their students or membership:
Ensuring that basic education and training cover lactation physiology,
exclusive and continued breastfeeding, complementary feeding, feeding in
difficult circumstances, meeting the nutritional needs of infants who have to
be fed on breast-milk substitutes, and the legislation and other measures
adopted;
Training in how to provide skilled support for exclusive and continued
breastfeeding and appropriate complementary feeding in all neonatal,
pediatric, reproductive health, nutritional and community health services;
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Promoting achievement and maintenance of baby friendly status by

maternity hospitals, wards and clinics, consistent with the Ten steps to
successful breastfeeding and the principle of not accepting free or low cost
supplies of breast milk substitutes, feeding bottles and teats.
Nongovernmental organisations
The aims and objectives of a wide variety of nongovernmental organizations
operating locally, nationally and internationally include promoting the adequate
food and nutrition needs of young children and families.
Providing their members accurate, up-to-date information about infant and
young child feeding;
Integrating skilled support for infant and young child feeding in community
based interventions and ensuring effective linkages with the nutrition and
health care system;
Contributing to the creation of mother and child friendly communities and
workplaces that routinely support appropriate infant and young child
feeding;
Working for full implementation of the principles and aim of the IMS Act;
Community based support, including that provided by other mothers, peer
breastfeeding counselors and certified lactation consultants, can effectively
enable women to feed their children appropriately. Most communities have
self help traditions that could readily serve as a base for building or
expanding suitable support systems to help families in this regard.
Commercial enterprises
Manufacturers and distributors of industrially processed foods intended for
infants and young children also have a constructive role to play in achieving the
aim of these guidelines. They are responsible for monitoring their marketing
practices according to the principles and aim of the IMS Act and the National
Guidelines on Infant and Young Child Feeding.
Other Groups
Many other components of society have potentially influential roles in promoting
good feeding practices. These elements include:
Education authorities, which help to shape the attitudes of children and
adolescents about infant and young child feeding accurate information
should be provided through schools and other educational channels to
promote greater awareness and positive perceptions;
Mass media, which influence popular attitudes towards parenting, child care
and infant feeding, should portray these in accordance with the National
Guidelines on Infant and Young Child Feeding. It should help create a climate
of nutritional awareness in the country by launching special programmes on
Infant and Young Child Nutrition on AIR and Doordarshan;
61
Child-care facilities, which permit working mothers to care for their infants
and young children, should support and facilitate continued breastfeeding
and breast milk feeding.
International organizations
They should serve as advocates for increased human, financial and institutional
resources for the universal implementation of these guidelines. Specific
contributions of international organizations to facilitate the work of governments
include the following:
Developing norms and standards.
Supporting national capacity building.
Sensitizing and training policy makers;
Improving women and child development and health workers skills in
support of optimal infant and young child feeding;
Revising related pre-service curricula for doctors, nurses, midwives,
nutritionists, dietitians, auxiliary health workers and other groups as
necessary;
Planning and monitoring the Baby-friendly Hospital Initiative and expanding
it beyond the maternity care setting;
Supporting social mobilization activities, for example using the mass media to
promote appropriate infant feeding practices and educating media
representatives;
Supporting research on marketing practices and the International Code.
These National Guidelines on Infant and Young Child Feeding provide governments and
societys other main agents with both a valuable opportunity and a practical instrument
for rededicating themselves, individually and collectively, to protecting, promoting and
supporting safe and adequate feeding for infants and young children.
62
Physical Activity
Physical inactivity is now identified as the fourth leading risk factor for global mortality.
Physical inactivity levels are raising in many countries with major implications for the
prevalence of non-communicable diseases (NCDs) and the general health of the
population worldwide.
The focus of the Global Recommendations on Physical Activity for Health is primary
prevention of NCDs through physical activity at population level.
Recommended levels of physical activity for health:
517 years old
For children and young people of this age group physical activity includes play, games,
sports, transportation, recreation, physical education or planned exercise, in the context
of family, school, and community activities. In order to improve cardiorespiratory and
muscular fitness, bone health, cardiovascular and metabolic health biomarkers and
reduced symptoms of anxiety and depression, the following are recommended:
1. Children and young people aged 517 years old should accumulate at least 60
minutes of moderate to vigorous-intensity physical activity daily.
2. Physical activity of amounts greater than 60 minutes daily will provide additional
health benefits.
3. Most of daily physical activity should be aerobic. Vigorous-intensity activities
should be incorporated, including those that strengthen muscle and bone, at least
3 times per week.
1864 years old
For adults of this age group, physical activity includes recreational or leisure-time
physical activity, transportation (e.g. walking or cycling), occupational (i.e. work),
household chores, play, games, sports or planned exercise, in the context of daily, family,
and community activities. In order to improve cardio respiratory and muscular fitness,
bone health and reduce the risk of NCDs and depression the following are
recommended:
1. Adults aged 1864 years should do at least 150 minutes of moderate-intensity
aerobic physical activity throughout the week, or do at least 75 minutes of
vigorous-intensity aerobic physical activity throughout the week, or an equivalent
combination of moderate- and vigorous-intensity activity.
2. Aerobic activity should be performed in bouts of at least 10 minutes duration.
3. For additional health benefits, adults should increase their moderate-intensity
aerobic physical activity to 300 minutes per week, or engage in 150 minutes of
vigorous-intensity aerobic physical activity per week, or an equivalent
combination of moderate- and vigorous-intensity activity.
4. Muscle-strengthening activities should be done involving major muscle groups on
2 or more days a week.
65 years old and above
For adults of this age group, physical activity includes recreational or leisure-time
physical activity, transportation (e.g. walking or cycling), occupational (if the person is
63
still engaged in work), household chores, play, games, sports or planned exercise, in the
context of daily, family, and community activities. In order to improve cardio
respiratory and muscular fitness, bone and functional health, and reduce the risk of
NCDs, depression and cognitive decline, the following are recommended:
1. Adults aged 65 years and above should do at least 150 minutes of moderateintensity aerobic physical activity throughout the week, or do at least 75 minutes
of vigorous-intensity aerobic physical activity throughout the week, or an
equivalent combination of moderate- and vigorous-intensity activity.
2. Aerobic activity should be performed in bouts of at least 10 minutes duration.
3. For additional health benefits, adults aged 65 years and above should increase
their moderate intensity aerobic physical activity to 300 minutes per week, or
engage in 150 minutes of vigorous intensity aerobic physical activity per week, or
an equivalent combination of moderate- and vigorous intensity activity.
4. Adults of this age group with poor mobility should perform physical activity to
enhance balance and prevent falls on 3 or more days per week.
5. Muscle-strengthening activities should be done involving major muscle groups, on
2 or more days a week.
6. When adults of this age group cannot do the recommended amounts of physical
activity due to health conditions, they should be as physically active as their
abilities and conditions allow.
Overall, across all the age groups, the benefits of implementing the above
recommendations, and of being physically active, outweigh the harms. At the
recommended level of 150 minutes per week of moderate intensity activity,
musculoskeletal injury rates appear to be uncommon. In a population-based approach,
in order to decrease the risks of musculoskeletal injuries, it would be appropriate to
encourage a moderate start with gradual progress to higher levels of physical activity.
64
MEDICAL ENTOMOLOGY
Introduction to Entomology, Cyclops, Rodents
Introduction
Study of arthropods of medical importance known as Medical Entomology

Bilateral symmetrical segmented body, supported by exoskeleton (chitin),
Absence of vertebrae.
Vector:
It is defined as an arthropod or any living carrier that transport an infectious
agent to a susceptible individual by inoculating into or through the skin/mucous
membrane or by depositing infected material on skin/food or other object.
Medical importance: They transmit the disease directly or indirectly
Classification:
Mode of transmission:
Transmissions
Direct Contact
From man to man
Scabies
pediculosis
Propagative
Only multiplication
No developmental
Plague bacilli in rat
flea
Mechanical
Diarrhea
Dysentery
Typhoid
Trachoma
Cyclo propagative
Multiplication
developmental
Malaria parasites in
mosquito
Biological
Cyclodevelopmental
No multiplication
developmental
Filaria parasite
in mosquito
65
Some terminology:
Extrinsic incubation period:
It is the period of time required for the disease agent to undergo multiplication
or a phase of cyclic development or both inside the body of arthropod Eg. In
malaria 10- 14 days
Definitive host:
It is a one which the sexual phase of the development or life cycle of the
parasite takes place
Eg. Female anopheline mosquito in malaria
Intermediate host:
It is one in which asexual phase of the development or life cycle of the parasite
takes place
Eg. Cyclops in dracontiasis
Metamorphosis: Changes that take place in size, shape and structure during the
different stages of life cycle of the arthropod from the stage of egg to adult stage
Cyclops
Morphological features: Pear shaped semitransparent body consist of a pair of

antennules, antennae and single pigmented eye, 5 pairs of legs. In female, Ovisacs
attached to abdomen
Diseases:
1) Guinea worm disease or dracunculiasis (dracunculus medinensis)
Cyclops is intermediate host
This disease eliminate from India in Feb 2000
The last 5 countries in the world Sudan, Ghana, Mali, Niger, and Nigeria to
eradicate this disease
2) Fish-tape worm (diphylobothrium latum)
Control measures:
a) Physical ( defensive measures)
i. Straining of water
ii. Boiling of water
b) Chemical ( offensive measures)
i. Chlorination of water- dose 5 ppm
ii. Lime : dose 1gm/litre
iii. Abate: dose 1mg/litre(method of choice)
c) Biological: barbel fish & gambusia fish
The most satisfactory and permanent method to provide chlorinated piped
water supply and filling the infested water bodies
66
Rodents
Diseases:
Bacterial Diseases
Plague, Tularemia, Salmonellosis
Viral Diseases
Lassa Fever, Hemorrhagic Fever, Encephalitis
Rickettsial Diseases Scrub Typhus, Murine Typhus,
Rickettsial Pox
Parasitic Diseases
Hymenolepsis Diminuata ,
Leishmaniasis, Amoebiasis, Trichinosis, Chagas Disease
Others
Rat bite fever, Leptospirosis, Histoplasmosis, Ring worm
Control measures:
1. Sanitation Measures
2. Trapping
3. Rodenticides: Barium Carbonate, Zinc Phosphide
Multiple Doses (cumulative) Poisons: Warfarin, Diphacinone, Coumafuryl
and Pindone
4. Fumigation: Fumigants: Calcium Cyanide (cynogas/cymag), Carbon
Disulphide, Methyl Bromide, and Sulphur Dioxide.
Cynogas pumped into rat burrows by a special foot pump called the
cynogas pump
5. Chemosterilants
67
Flea, Tick, Mite

Flea
Genera and species of fleas
Their name according to their host like rat flea, dog fleas, cat fleas, human fleas etc..
Rat flea: X. cheopis, X.astia, X. brazilliensis
Dog flea and cat flea: ctenophalus canis and ctenophalus felis
Sand flea: tunga penetrans
Human flea: pulex irritans
Rat Flea
Morphology:
Size 1-2 mm. Wingless insect
Bilaterally compressed, hard skinned, brown coloured wingless insects
The entire body covered with bristles directed backwards.
The posterior part of abdomen in male consist of coiled structure called
aedegus and in female a bag like structure called as spermatheca.
Both sexes are hematophagus. It can jump to height of 8-10 inches
Live for 2 years and capable of resisting starvation for several months( 46months)
Mechanical transmission:
1. Biologically
2. Mechanical transmission
3. By Defecation
Biologically:
It is propagative type.
By biting and this is chief mode of transmission of the disease plague
Ratflea sucking the blood of the infected rats, ingest plague bacilli which multiply
in the proventriculus and block it, Whether it block partially or completely the
flea is called as Blocked flea or partially blocked flea respectively
Partially blocked flea more dangerous because blood is regurgitated with greater
force and large number of plague bacilli will be inoculated and it lives longer
than blocked flea
Flea indices:
Indicators which help to know the density of fleas in general and the density of
particular species of fleas which indicate the possible outbreak of plague and
control measures of fleas
Counting of rat flea by trap
General flea index: average number of fleas of all species found per rodent.
Normal range is 3-5
Specific flea index: average number of fleas of each species found per rodent.
Any x.cheopis index more than 1.0 indicative of outbreak of plague
Control measures :
1. Insecticides :
DDT 10% or Malathion 5% dusted over the rat runs, burrows of rats, under
gunny bags and Gamma-HCH Carbaryl, Diazinon 2%, etc.
68
2. Flea Repellents: Diethyltoluamide, Benzyl benzoate

3. Rodent control: Cynogas fumigation in enclosed area. Kill rats, ratflea, eggs and
pupae
Tick
Ixodidae Hard tick
Argasidae Soft tick
Sarcoptidae Itch mite
Ticks are of 2 types: Hard tick & soft tick
Morphology:
Body is oval, dorsoventrally compressed
Not distinctly divisible into head, thorax and abdomen
chitinous shield or scutum are present in hard tick (Absent in soft tick)
In the male hard ticks, scutum covers the entire dorsal surface and in female
covers only a small portion anteriorly
Family
Capitulum
Scutum
Spiracles
Starvation
Blood Meal
Found
Lays eggs
Nymphal stage
Life cycle
Disease
Hard Tick
Ixodidae
Anteriorly
present
Behind 4th pair of legs
Cannot resist
continuous
Always on body of host day
and night
100-1000 in one sitting
one
2 months
Tick Typhus, Tick Paralysis,
Tularemia,
Viral hemmoragic fever,
Viral Encephalitis, RMSF,
Human babesiosis
Soft Tick
Argasidae
ventrally
absent
Between 3rd and 4th pair of legs
Can resist for months
Intermittent
Cracks and crevices in day time and
on body of host during night time
20-100 over a long period of time
Five
9-10 months
Endemic relapsing fever
Control measures:
1) Insecticidal control:
Application of insecticide over forest areas (hot spots) using aircraft mounted
equipments.
fenthion or propoxur 2.24kg/hct
2) Personal protective measures:
Adequate clothing and repellants (DEET, indolane, BB lotion)
Daily examination of body and removal of tick by Placing the ends of tweezers
around the base of the mouth part and while applying the gentle pressure pull
the tick up slowly and steadily until it releases the hold. Do not twist, squash or
smother it on any substance
3) Environmental control
69
Itch Mite
They themselves are the causative agents but dont transmit the disease
Morphology:
Size: 0.4 mm, Females are larger than males
Body like of tortoise, globular round above and flat below in shape and covered
with bristles.
Body shows no demarcations. capitulum is distinct anterioly
4 pairs of legs. In Female anterior 2 pairs of legs have suckers and posterior 2
pairs end in bristles . Male has sucker on all the legs except 3rd pair which
distinguishes it from female.
Disease: Scabies
Mode of transmission
Female itch mite starts burrowing into upper layer of epidermis.
All along the site of burrow female lays eggs. Since the eggs are laid in tunnel it
called ovigerous tunnels. The eggs hatch into larvae and then nymph .They also dig
into skin of host making papules at the site of digging causing considerable itching
and irresistible scratching.
Scratching provide ways nymph to escape to the skin.
Small size nymph develop into male adults and larger nymph develop into female
adults
Site of lesion
The body parts of host for oviposition are axilla, inguinal region, perineal region,
scrotum, below the breasts, back of the knees, web of fingers, toes
Itching is common symptom and is due to acrid fluid secretion
2nd infection is due to scratching
Control measures:
1) Personal hygiene
2) Drugs: known as sarcopticide
Simultaneously treatment to all members of household k/a blanket treatment
a) Benzyl benzoate- 25% lotion
b) Single application of permithrin
c) Twice application of crtomiton ointment
d) Thrice application of Tetmosol 5% solution
e) Four time application of Sulphur ointment 2.5-10%
How to apply sarcopticide: Apply lotion from head to toe except eyes, nose and mouth at
the bed time Next morning scrubbing bath with warm water and soap
All the clothes including towel, bedsheet, napkin etc.. Wash into warm water and dried
in sunlight Repeat same procedure after 7 days and simultaneously treatment to all
family members
70
Housefly, Sand fly, Louse

Housefly
GENUS: Musca
SPECIES. : Domestica and vicinia are common
Very active during daytime and during summer season when the humidity is low
Most of the house flies are non biting
Morphology:
Typical winged insect, bigger and stouter than mosquito
Head compound eyes, antennae, proboscis, palpi
Proboscis has oral disc at the tip for sucking liquid food
Eyes of male close together and female are widely apart
last segment of the antenna made bears a projection called Arista
(sensory function) bearing stiff hairs called Spinules.
Each leg is provided with a pair of pads( Pulvilli) which enable fly to walk
on polished surface. Hair on pulvilli called tenent hair secrete sticky
substance and the pathogen get easily attached
Life history: Female lay eggs in 5 -6 sitting, each sitting lay 120- 150 eggs. Fly lays eggs
from 600- 900 during her life time. The egg hatch in 8-24 hours, but in summer may
within 3 hours
Habits: Vomit drop (contain more pathogens than fly specks) , Feeding Habits,
Defecation, Resting Habits, Restlessness, Dispersal
Diseases transmitted:
Cholera, Typhoid, Dysentery, Amoebiasis ,Polio, Anthrax , Trachoma, Yaws
Control measures:
Environmental control:
Storing garbage, kitchen waste and others are in bins with tight lids
Efficient collection, removal and disposal of refuse by incineration, composting
and sanitary landfill
Provision of sanitary latrines
Stopping open air defecation
Chemical Control
1. Insecticides :
Residual spray- DDT 5%, lindane(0.5%), diazinon 2 %, malathion 5% +
sugar, fenthion(2.5%) The addition of sugar to formulation enhance their
effectiveness
Baits: solid or liquid, Poisoned baits containing 1 to 2% diazinon,
malathion, dichlorvos, ronel and dimethocate. Liquid bait with same
insecticide with 10% sugar
71
Cheapest bait: Mixing 3 tsf of commercial formalin with one pint of

water or milk with little sugar
Cords & ribbons
Space sprays DDT, pyrethrum extract
2. Fly paper( trapping): A mixture of resin, groundnut oil and Vaseline is
smeared on both side of a paper or ribbon and hung like festoons from
ceiling.
3. Tangle foot poison bait
Sandfly
Genus: phlebotomus
Species: P.Argentipes , P.Papatasii , P.Sergenti
Smaller than mosquito, very hairy insect
They dont fly by choice but only hop by legs
Rest in cracks and crevices of the walls in dark rooms, cattle sheds and appear
during night times
Female sand flies bite and require blood meal
Bite even through cloths and painful and irritating preferably at wrists and
ankles
Morphology:
Head A pair of big eyes, a proboscis, a pair of palpi and a pair of hairy antennae
Thorax
A pair of lanceolate shape hairy wings and held up vertically in V shape
while at rest
The 2nd longitudinal vein on the wings branches twice and the first
branching take place in the middle of the wing
3 pairs of long slender hairy legs, disproportionately to the size of the body
and adopted for hopping or jumping
DISEASES :
Kala azar, Sand fly fever, oriental sore
CONTROL MEASURES:
1. Sanitation:
Filling up cracks and crevices of house-walls by cement plastering
Location of cattle sheds and poultry houses away from the human habitations
2. Insecticides:
Spraying of human dwelling, cattle sheds with insecticides upto 6 feet
DDT 1-2 gm/m2 (1-2yrs) or
Lindane 0.25 gm / m2 (3 months)
72
Louse
(Common name: ju and likh)
Genus & spp. :
Pediculus Capitis (head louse)
Pediculus Corporis (body louse)
Phthirus Pubis (pubic louse or crab louse)
Body chitinous, flattened dorso-ventrally, divided into head, thorax and
abdomen.
Thorax and abdomen is a fused mass.
Head is conical contains mouth parts, a pair of antennae, proboscis and a pair of
eyes.
3 pairs of jointed legs attached to thorax. Last segment bears a thumb (tibial
thumb) and terminates in claws with which it holds to the hairs of the host firmly
The last abdominal segment is cleft or bifid in females and rounded off in males in
which aedegus or penis is attached
Diseases:
1) Pediculosis
2) Dermatitis (Vagabonds disease)
3) Epidemic typhus (Rickettsia Prowazeki)
4) Trench fever (R. quintana)
5) Relapsing fever (Borrelia recurrentis)
Crab louse:
(pubic louse Phthirus pubis)
found in pubic hair.
Short and stout, square shaped body, Head impacted on the thorax
Thorax is broader than abdomen
Powerful legs with claws, 1st pair of leg is slender than others
Does not transmit any disease
Control measures:1) Defensive measures:
Health education related to personal hygiene
a) Daily bath
b) Washing & ironing cloths
2) Offensive measures :
Insecticidal control
Malathion
For head and crab lice: 0.5% lotion followed by head bath after 1 days
For body lice: 1% powder over the chest, axilla, inner surface of cloths, socks
and repeated after 1 week
a) Mass Delousing using carbaryl dust
b) Benzyl benzoate lotion
73
Mosquitoes
Phylum: Arthropoda
Class: Insecta
Order: Diptera
Family: Culicidae
Tribes: Culicini & Anophelini
Subfamily: Culicinae
&
Anophelinae
Genus: Culex, Aedes, Mansonia & Anopheles

Differences:
Table-1: Important differences in Anophelini and culicine mosquitoes

Stage
Egg
Anophelini
1.Boat Shaped
2. Laid singly
3. Possess lateral floats
Larva
1.No siphon tube but only apertures

on 8th abdominal segment
2.Larvae rest parallel to surface of
water
3. Swim with swift wriggling
movements
4.Palmate hairs for floatation arranged
in pairs on all abdominal segments
Pupa
1.Pupa is comma shaped

2.In Anophelini, respiratory trumpets
are short stumpy and funnel shaped
1.wings usually spotted
2.Rests at an angle to surface, with the
exception of A cullicifacies
3.In the males, palpi are long and club
at the termination; in females, they are
as long as proboscis and straight
Adult
Culicine
1. Elongated
2. Aggregation occurs into rafts of
hundreds of eggs in Culex
3. Aedes eggs are laid singly
4. Mansonia eggs are laid on under
surface of leaves of aquatic plants in star
shaped clusters.
1.Single siphon tube on 8th abdominal
segment
-In Culex, siphon tube is long narrow
-In aedes, it is short and broad
-In Mansonia, larvae are attached
through siphon tube to roots of aquatic
plants
2. Larvae rest at angle to surface
3. Swim with snail or worm like
movements
4. No palmate hairs for floatation
1.Pupa is comma shaped
2.In culicine, respiratory trumpets are
longer, slender and trumpet shaped
wings usually not spotted
Rests parallel to the surface,
Thorax is humped
In the males, palpi long and tapering and
deflected out; in females, palpi are much
shorter than proboscis and budlike
Breeding places:
Anopheles: clean water
Culex: dirty and polluted water
Aedes : Artificial accumulation of water e.g.
Behind refrigetor & coolers,
Storage tanks,
74
Earthen pots and other receptacles with rain water,

In flower vases,
Tyres,
Broken glasses,
Plastic containers and tins which have been discarded.
Mansonia: water containing aquatic vegetation
Mosquito borne disease
Anopheles:
Malaria
Filaria
Culex:
Filaria
JE
West nile fever
Viral arthrities
Aedes:
Yellow fever
Dengue
Chickungunya fever
Rift vally fever
filaria
Mansonia:
Filaria
Chickungunya fever
Mosquito control measures
1. Antilarval measures:
a) Environmental control: source reduction
b) Chemical control:
i. Mineral oils: MLO, fuel oil, kerosene.
ii. Peris green
iii. Synthetic pyrethroids: abate, malathion, fenthion, chlorpyrifos.
c) Biolarvicide: Bacillus thuringiensis iserailensis (Bti)-Endotoxin : 2.5%
suspension, 1 lit/50 m2, once every 2 weeks.
d) Biological control: Larvivorous fish
2. Anti-adult measures:
a) Residual spray: malathion, propoxur
b) Space spray: pyrethrum, ULV spray of fenithrothion & malathion
c) Genetic control
3. Protection against mosquito-bite:
a) Mosquito net: ITBN treated with Deltamethrin
b) Screening: of windows, not >0.0475 inch in any diameter.
c) Repellants : DEET, indalone, diethyl benzamide, dimethyl phathalate.
75
Malaria Filaria Unit

National Vector Borne Disease Control Programme (NVBDCP) is implemented
for the prevention and control of vector borne diseases namely: Malaria, Filaria,
Kala-azar, Japanese Encephalitis (JE), Dengue, Chikungunya
Staff pattern at malaria filaria unit:
1. District malaria officer
2. District health officer
3. Chief medical officer
4. Assistant malaria officer
5. Malaria inspectors
Activities:
Surveillance: Blood collection and smear examination for fever patients.
Treatment: All positive patients on smear examination are given radical
treatment as prescribed.
Vector control:
Anti larval measures:
(1) Environmental control- through elimination of breeding places. It is known
as source reduction and comprises of minor engineering methods such as
filling, leveling and drainage of breeding places.
(2) Chemical control- Oil like diesel oil, kerosene and various fractions of crude
oil when applied on water, spreads and forms and forms a thin film, which cuts
off the air supply to the mosquito larvae and pupae. Synthetic insecticides like
Fenthion, Chlorpyrifos and Abate are the most effective larvicides.
(3) Biological controlSmall fishes like Gambusia affinis and Lebister
Reticulatus which feed on mosquito larvae can be used in burrow pits, sewage
oxidation ponds, cisterns and farm ponds.
Anti adult measures: Space Spray: Synthetic pyrethroids spray 2 rounds at an
interval of 6 weeks ex. DDT, Malathion.
The aims of the Malaria case management are:
To provide prompt and complete treatment to all suspected/ confirmed
cases of malaria
To prevent progression of mild cases of malaria in to severe or
complicated from of malaria
To prevent deaths from severe and complicated malaria
To prevent transmission of malaria
To minimize risk of spread of drug resistant parasites by use of effective
drugs in appropriate dosage by everyone.
Diagnosis and Treatment of Malaria:
For malaria control, the main thrust of the National Vector Borne Diseases
Control programme (NVBDCP) is on early diagnosis and prompt, complete and
effective treatment.
76
Malaria diagnosis is carried out by microscopic examination of blood films

collected by active and passive agencies.
Health agencies and volunteers treating fever cases in inaccessible areas are
being provided with Rapid Diagnostic Test (RDT) kits (Pf specific so far and
now Bivalent RDT) for diagnosis of Malaria cases so as to provide full radical
treatment to the confirmed cases.
It is stressed that all fever cases should be suspected of malaria after ruling out
other common causes and should be investigated for confirmation of malaria
by Microscopy or Rapid Diagnostic Kit (RDK) so as to ensure treatment with
full therapeutic dose with appropriate drug to all confirmed cases. The
medicine chosen will depend upon whether the patient has vivax malaria or
falciparum malaria as diagnosed by the blood test.
Presumptive treatment of malaria with a single dose of chloroquine has been
stopped.
In all cases of suspected malaria which cannot be immediately confirmed by
tests, full treatment with chloroquine for 3 days should be given.
The flow charts in different settings for diagnosis and drug selection for the
within 24 hours are
treatment Where microscopy
of result is available
malaria
as
under
Suspected malaria case
Take slide and send for microscopic examination
Positive for
P. vivax
Treat with
CQ for 3
days
PQ 0.25 mg
per kg body
weight daily
for 14 days
Positive for P.
falciparum
In North Eastern states:
Age-specific ACT-AL for
3 days + PQ Single dose
on second day
In other states: Treat
with: ACT-SP for 3 days
+ PQ Single dose on
second day
Positive for Mixed

infection
In Northeastern states:
Treat with: Age-specific
ACT-AL for 3 days +
Primaquine 0.25 mg per
kg body weight daily for
14 days.
In other states: SP-ACT 3
days + Primaquine 0.25
mg per kg body weight
daily for 14 days.
Negative
No antimalarial
treatment
Treat as per
clinical
diagnosis
ACT-AL - Artemisinin-based Combination Therapy- Artemether - Lumefantrine

ACT-SP- Artemisinin-based Combination Therapy (Artesunate+SulfadoxinePyrimethamine)
CQ - Chloroquine , PQ - Primaquine
77
Purification of Water Small Scale

BOILING:
It is a satisfactory method of purifying water for household purposes.
Water must be brought to rolling boil for 5-10 minutes kills all bacteria, spore, cyst,
ova and yield sterilized water.
It temporary removes hardness by driving off carbon dioxide and ppting calcium
carbonate.
Disadvantage:
Taste of water is altered.
No residual protection against subsequent microbial contamination.
DISTILLATION: not commonly used due to higher cost, used in Labs. etc.
ADDITION OF CHEMICALS
Bleaching Powder: 5% solution Dose: 3-6 drops/L contact time of
hour.
Chlorine Tablets/Halazone Tablets. one tablet/litre.
Iodine Solution: 02 drops of 2% Soln./litre
KMnO4: an amount that gives just pink coloration to the Water.
Alum: used for turbid water
CHLORINATION
It is the most widely used method for water purification, both on large as well as on
small scale.
It is the most reliable and cheapest method.
Properties of Chlorine
Action of Chlorine
H2O + CL2
HCL + HOCL (Hypochlorous acid
H + OCL (Hypochlorite ions)
Disinfecting An of Cl- is mainly due to HOCL [70-80 % more effective] >>> some
extent due to OCL
Effect of pH on chlorination process:
Chorine act best pH of around 7 [predominance of HOCL]
When pH >8.5
90% HOCL gets ionized to OCL-----unreliable as a disinfectant
METHODS OF CHLORINATION
Chlorine Gas:
Cheap, quick in action, efficient and easy to apply but as it is irritant to eyes and
poisonous,
a special instrument (Paterson chloronome) is required for measuring, regulating and
administering the gaseous chlorine to water supplies
Used for large scale chlorination-water filtration plant good for disinfecting small
quantity of water
1 tablet [0.5g] =20 lit of water
Crush tab. & add into pot- use after 1 hr of contact period
78
Bleaching Powder:
White amorphous powder, pungent smell of chlorine, very unstable compound , on
exposure to air, light, & moisture, it rapidly loses its chlorine content, mixed with excess
of Stabilized Bleach, stored in dark, cool, dry place in a closed container & chlorine
content of the stock should be checked frequently.
Mainly use for chlorination of well.
Chlorine solution:
Prepared from bleaching powder
If 4 kg of bleaching powder with 25% available chlorine is mixed with 20 liters of water,
it will give a 5% solution of chlorine.
Readymade chlorine solution in different strength also available in market
BREAK POINT CHLORINATION
SUPERCHLORINATION
Addition of large doses of the chlorine to the water
5gm/ 1000lit -1.5 to 2 PPM
ORTHOTOLIDINE (OT) TEST
To Detect both Free & Combined Cl Reagent:
OT dissolved in 10% HCL
0.1 ml (2 drops) reagent in 1ml of water
Yellow colour matched with standard color disc
Free cl10 sec
free & combined chlorine: 15-20 min
ORTHOTOLIDINE ARSENITE (OTA) TEST
Modification of OT test
Measured free & combined cl separately
Error caused by interfering substance (nitrite, fe, mn) is overcomed
Quickest and simplest method for FRC:
DPD (Diethyl Paraphenylene Diamine) indicator test
DISINFECTION OF WELLS
STEPS:
1. Find the volume of water in a well:
3.14 x (d)2 x h
Volume(litres)=
------------------------------ x 1000
4
One cubic meter = 1,000 litres of water
2. Find the amount of bleaching powder required for disinfection: Horrocks Apparatus
Contnd..
3. Dissolve Bleaching Powder in water
4. Delivery of Chlorine solution into the well
5. Contact period
6. OT test
79
Example: What is the amount of bleaching powder required for chlorinating round well
measuring 4 mtrs diameter and depth of water column 6 mts?
[Horrocks apparatus- 3rd cup shows blue colour]
Volume of water in well=3.14*42*6 * 1000 = 75360 lit
4
3rd cup=6 gm bleaching powder/455 lit
So bleaching powder required =6*75360/455=993.76 gm
Cartridges
Higher conc. site
Allow only water molecules to pass not bacteria/heavy molecules
RO
high performance reverse osmosis components
Stage 1: Sediment Water Filter reduces silt, sand, rust and other physical particles.
Stage 2: Carbon Block Water Filter reduces chlorine, taste, odors and organic impurities.
Stage 3: Carbon Block Water Filter further reduction of chlorine, taste, odors and
organic impurities
Stage 4: Reverse Osmosis Membrane separates clean water from the rejected impurities
down to 0.0001 microns.
Stage 5: Coconut Shell Carbon Filter a final polishing process assures you of great
tasting, crystal clear water.
Air-Gap Faucet: NSF/Prop 65 Lead-Free long reach chrome RO faucet.
Reverse Osmosis Tank: NSF 4 gallon pressurized water storage tank.
Color-coded tubing: NSF/FDA approved tubing, 3/8" and 1/4".
Fast Flow, 1st gallon in 50 seconds with 3/8" tubing from tank to faucet
80
Purification of Water on Large Scale

(Water Filtration Plant)
Two Types of Filters:
I- Slow Sand Filter (Biological) Filtration
Supernatant water: 1-1.5 m

Provides constant head of water to overcome the resistance of the filter bed
promote the downward flow of the water thro sand bed.
Provides waiting period of some hours (3-12 hrs) for the raw water to undergo
partial purification by sedimentation & oxidation & partial agglomeration
A bed of graded sand
Most important part of the filter
Thickness about 1 mtr
Sand : preferably rounded with effective diameter of 0.2-0.3 mm
Supported by graded gravel (30-40 cm deep)
Water percolates through the bed and gets filtered by
Mechanical straining, sedimentation, adsorption, oxidation and bacterial action
Rate of filtration: 0.1-0.4 m3/hour/m2
Vital Layer
The Heart of Slow Sand Filter
Surface of the sand bed gets covered with a slimy growth known as
Schmutzdecke, vital layer or zoological layer or biological layer
It is slimy gelatinous, consists of algae, plankton, diatoms and bacteria.
The formation of this layer is known as RIPENING of the filter, which may take
several days to fully develop (2-3 cm)
Removes organic matter, holds back bacteria, oxidizes ammonical nitrogen to
nitrates and yield a bacteria free water
Until the vital layer is fully formed, filter only worked as a mechanical strainer &
so for the first few days filter water run to the waste.
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An under-drainage system -porous of perforated pipes at the bottom of filter -Provides

an outlet to the filtered water and supports the filter medium
A system of filter control valves: Venturi meter -To maintain constant rate of
filtration-measures the resistance of the sand bad or loss of head
Filter cleaning
When the bad resistance increases to such an extent that the regulating valve has to be
kept fully open, filter bed needs to be cleaned.
Cleaning is done by Draining of supernatant water & Scrapping of the top portion of the
sand bed to a depth of 1-2 cm
After 20-30 scrapings, new bed (filter) is required to be constructed
Advantages
Simple to construct and operate
Cheaper
Physical, Chemical & Bacteriological quality of water is very high
Reduces bacterial count by 99.9% & E. coli by 99%
Disadvantages
Old fashioned and outdated method of water purification (but still in use)
Initial cost is low but maintenance cost is much more than rapid sand filter
These filters need a lot of space
II: RAPID SAND FILTER (MECHANICAL) FILTRATION
Open/gravity typePATERSON FILTER
Closed/pressure type Candys Filter
Steps of filtration
Coagulation: Alum is added 5-40 mg/liter depending upon turbidity,
Rapid mixing of Alum: By violent agitation in a mixing chamber for few
minutes
Flocculation: Slow & gentle stirring of the treated water for about 30
minutes
Results in formation of thick, copious, white flocculent precipitate of
aluminum hydroxide
Sedimentation-For 2-6 hours
Flocculent precipitate together with impurities and bacteria
95% of the flocculent needs to be removed before the water enters the
rapid sand filter
Filter beds
Each unit has a surface of 80-90 m2
Supernatant water 1 to 1.5 mtr
Depth of sand bed 1 mtr
Effective size of the sand particle is 0.4-0.7 mm
Supported graded gravel 30-40 cm
Filtration rate 5-15 m3 / m2/ hr
Filtration
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Retained alum- flocs is held back on sand bed, forms a slimy layer [comparable to
the zoological layer in slow sand filter] which adsorbs bacteria from water.
Oxidation of ammonia also takes place during the passage of water
Cleaning & Maintenance
When the loss of head reaches 7-8 ft, it needs to be cleaned by Backwashing.
Backwashing is done by reversing the flow of water through the sand bed which
dislodges the impurities and cleans up sand bed.
Compressed air can be used in back washing
Advantages
Disadvantages
Can deal with raw water directly

Occupies less space
Filtration is rapid
Washing of the filter is easy
More flexibility in operation
Removes color effectively
Relatively high skill operation

Costlier
Removes bacteria by 98-99%
Slow sand filter
Rapid sand filter
Space
Occupies large area
Small area
Rate filtration
0.1-0.4 m3/m2/ hour
5-15 m3 / m2/ hour
Effective size of sand
0.2-0.3 mm
0.4-0.7 mm
Preliminary treatment
Plain sedimentation
Chemical
coagulation
sedimentation
Washing
By scraping the sand bed
Backwashing
Operation
Less skilled
Highly skilled
Loss of head allowed
4 feet
6-8 feet
Removal of turbidity
Good
Good
Removal of colour
fair
Good
Removal of bacteria
99.9-99.99 %
98-99%
&
83
Surveillance of Water Quality

A.
B.
C.
D.
E.
Water sampling
Acceptability aspect
Chemical aspect
Microbiological aspects
Radiological aspect
Water Sampling
Indication:
To detect any contamination of water
As investigation procedure in water born epidemic
To detect pollution of water by industrial, agricultural
Chemical analysis to detect fluorosis, cardiovascular diseases
Location of sampling points : representative of the different sources from which water
is obtained by the public or enters the system.
Source : each locality
distribution networks
points at which water is delivered to the consumer
Samples for Physical & chemical examination: Winchester Quart bottle: capacity of 2.5
lit.
Samples for Bacteriological examination: collected in clean sterile bottles of capacity
200-250 ml
1. Sampling from a tap or pump outlet
Clean the tap
Remove from the tap any attachments that may cause splashing.
Using a clean cloth, wipe the outlet to remove any dirt.
Open the tap
Turn on the tap at maximum flow and let the water run for 12 minutes in order
to flush the interior of the nozzle & to discharge the stagnant water in service
pipe.
Sterilize the tap:
with help of gas burner, or an ignited alcohol-soaked
cotton-wool swab 1-2minutes / UNTIL it is unbearably HOT to touch
Open the tap before Sampling The tape should be cooled by allowing the water to
flow for 12 minutes at a medium flow rate.
Do not adjust the flow after it
has been set.
Open the sterilized bottle The bottle should be held near the base with one hand
and carefully unscrew the cap or pull out the stopper & cover over it and held in
the fingers
Fill the bottle
While holding the cap and protective cover face downwards (to prevent entry of
dust, which may contaminate the sample), immediately hold the bottle under the
84
gentle stream of the water from the tape, avoiding splashing. A small air space
should be left to make shaking before analysis easier.
Stopper or cap the bottle -fix the brown paper protective cover in place with the
string.
2. Sampling from WELL and similar sources
With a piece of string, attach a clean weight to the sampling bottle. Lower the bottle,
into the well, by unwinding the string slowly. Do not allow the bottle to touch the sides
of the well. Immerse the bottle completely in water and lower it well below the surface
without hitting the bottom or disturbing any sediment.
3. Samples form the River or streams
It should not be taken too near the bank or too far away from the point of dsraw off.
hold the bottle and plunge its neck down-wards 20 cm below the surface of the water.
The bottle is then turned until the neck points slightly up-wards, the mouth being
directed towards the current.
Transport
The bacteriological examination of the sample should be commenced as soon as
possible after collection.
Where this is not feasible, sample should be kept in ice until it is taken for
analysis.
And this ice samples should be analyzed within 48 hrs of collection
Certain particulars regarding the date & time of collection and dispatch, source of
water, particulars of recent rainfall and findings of the sanitary survey should
also be supplied with the sample.
ACCEPTABILITY ASPECT
Physical parameters:
Turbidity: <5 NTU
o free from turbidity as it hampers disinfection process n micro determination
o due to particulate matter, inorganic sub-inadequate treatment or resuspension
of sediments
Colour: 5-25 Hz:
due to organic sub, fe, mn, industrial waste etc
Taste & odour: contamination by chemicals or product of water treatment
Temperature: cold water more palatable
Inorganic constituents:1) Chlorides: - 200 mg/litre. The maximum permission level is 600 mg/litre
2) Ammonia: - includes the non-ionized (NH3) and ionized (NH4+). Natural levels in
ground and surface water are usually below 0.2mg/litre.
Ammonia contamination in water indicator of possible bacterial, sewage and waste
pollution
3) Ph:- One of the main objective in controlling PH is to minimize corrosion and
incrustation in the distribution system. Ph levels of <7 may cause severe corrosion
of metal in the distribution pipes and >8 leads to decrease in the efficiency of the
chlorine disinfection process. An acceptable pH of drinking water is from 6.5 to 8.5.
85
4) H2S:- 0.05 and 0.1 mg/litre

The rotten eggs odour of hydrogen is particularly noticeable in some ground
water and in stagnant drinking water ,as a result of oxygen depletion and
subsequent reduction of sulphate by bacterial activity.
5) Iron: a 0.3 mg/litre, iron stains laundry and plumbing fixtures.
6) Sodium: - the average taste threshold for sodium is about 200 mg/litre.
7) Sulphate: - The present of the sulphate in drinking water can cause noticeable taste.
Taste impairment varies with the nature of the associated cation & taste
impairment is minimal at levels below 250 mg/litre.
8) Total dissolved solids (TDS):- The palatability of water with a TDS level of less
than 600 mg/litre is considered to be good .Drinking water is becomes increasingly
unpalatable at TDS levels greater than 1200 mg/litre. Water with extremely low
concentration of TDS may be unacceptable because its flat, insipid taste.
9) Zinc: - Zinc imparts an undesirable astringent taste. Taste threshold concentration
4 mg/litre.
10) Manganese: - below 0.1 mg/litre are usually acceptable, at above 0.1 mg/litre
manganese in water supplies stains sanitary ware and laundry, and cause
undesirable taste in beverages.
11) Copper: - It increases the corrosion of galvanized iron and steel fitting. Staining of
laundry and sanitary ware occurs at concentration above 1 mg/ litre.
12) Aluminium: - concentration in excess of 0.2 mg/litre often leads to deposition of
aluminium hydroxide floc in distribution system
13 Arsenic: - Arsenic is introduced into water through the dissolution of minerals and
ores, from industrial effluents, and from atmospheric deposition. Guideline value 0.01
mg/litre
14. Cadmium: - pollution is caused by contamination from fertilizers. Guideline value
0.003 mg/litre
15. Chromium: guideline value for Chromium is established at 0.05 mg/litre
16. Cyanide: as a consequence of industrial contamination. Its effects mainly on
thyroid and nervous system
guideline value for Cyanide is 0.07 mg/litre is
considered to be safe.
17. Fluoride:-1.5 ppm
18. Lead-0.01mg/lit
19. Mercury .001
20. Nitrate & nitrite: pollution is caused by Livestock or septic systems, Household
waste water,
Fertilizers. Desirable: 45 mg/l, Permissible: 100 mg/lit
Organic constituents: PAH & pesticides
86
BACTERIOLOGICAL ANALYSIS OF WATER

o Coliform: fecal (E.coli) & non fecal gp (klebseilla) Indicate water is
contaminated with faeces at any level
o Fecal streptococci: recent contamination
o Cl. perfringence:
o capable for survive longer time than coliform- so there presence along
with coliform- faecal contamination
o In absence of coliform-remote contamination
Presumptive Coliform Test
Multiple tube method: based on most probable number (MPN) of coliform in 100 ml of
water a measured quantity of water (0.1, 1, 10, 50ml) inoculated into tubes of
McConckey Lactose Bile Salt Broth with bromcresol purple as an indicator----incubated
for 48 hrs
Based on number of tubes showing fermentation of acid and gas which is an estimate of
the MPN of coliform in 100 ml of sample water Presumptive Coliform count can be
calculated.
WHO Guidelines
Number of E.coli present
Inference
0-10
Reasonable quality
10-100
Polluted
100-1000
Dangerous
> 1000
Very Dangerous
87
Meteorological Equipments
Meteorology is science that deals with the study of changes occurring in the
atmosphere. It includes following factors:
1. Atmospheric Pressure
2. Air temp
3. Humidity
4. Rainfall
5. Air velocity
6. Direction of Wind
7. Movement of clouds & character of weather
1. Atmospheric Pressure:
The pressure at earths surface close to sea is 760 mm of hg. It is called as one atmo.
Pressure Man is physiologically adopted to live at this pressure.
Atmospheric pressure falls as altitude increase & Rise as altitude decrease. (Pressure
increases at the rate of 1 atmosphere for each 33 feet depth below sea level.)
Measurement: Instrument used for measuring atmospheric pressure is known as
Barometer.
Three kinds:
Fortins Barometer,
Kew Pattern Station Barometer-widely used by IMD
Aneroid barometer (devoid of fluid-Hg)
Effect of atmospheric pressure on Health
High Altitude: Acute mountain sickness & High altitude Pulmonary oedema
Low altitude: Caissons disease
2. Air Temperature
Factors which influence air temperature are: Latitude of place, Altitude, Direction of
wind, & Proximity to sea
Measurement: Mercury Thermometer & Alcohol Thermometer
Essential conditions:
Air should have a direct access to the bulb
It should be protected against radiant heat.
Specially approved screen called Stevenson Screen-mercury thermometerprotect from direct sunlight/rain with free circulation
Dry Bulb Thermometer:
Ordinary thermometer/glass thermometers
Sensing head protected from radiant heat by a polished silver or aluminium
shield
Protected against radiant heat, rain & direct sun-- so, Mounted on Stevenson
screen
Wet Bulb Thermometer:
88
Bulb is kept wet by muslin cloth.

Evaporation of water from cloth lowers the temperature of mercury
Show a lower temperature reading than the dry bulb Thermometer
it measures the effect of humidity on evaporation and effect of air movement on
ambient temperature.
Globe Thermometer:
Use: For direct measurement of mean radiant temperature of the surrounding.
Hollow copper bulb 15 cm in diameter and is coated outside with black paint which
absorbs the radiant heat from the surrounding objects. A specially calibrated mercury
thermometer is inserted, with its bulb at the center of the globe.
Registers a higher temperature than ordinary thermometer as Affected by both air
temperature & radiant heat.
Kata Thermometer:
Uses: Measure cooling power of air & for recording low air velocities
meter silvered bulb 38 to 35C M112003
3. Humidity:
Moisture content or amount of water vapour in the air is referred to as humidity.
Absolute humidity:
Actual amt of moisture or Weight of water vapour in the unit volume of air.
Expressed as gm/cubic meter of air.
Relative humidity: % of moisture present in the air.
More commonly employed than absolute humidity to express moisture content of
air.
RH>65 %, the air inside the room feels sticky & uncomfortable.
RH<30 % is also unpleasant, produce drying of skin/nasal mucosa.
Sling psychrometer: Consist of 2 mercury thermometers, wet & dry mounted side by side.
Principle: By rotating the instrument, bulbs are exposed to air at definite velocity.
Wet bulb is first moistened with distilled water; the instrument is then rotated at the
rate of 4 revolution/sec for 15 sec, so as to obtain desirable air speed of about 5m/sec.
Reading of the wet bulb is then noted.
It is again whirled for about 10 sec & reading of wet bulb is noted
Repeated several times till 2 successive reading of wet bulb are identical.
Reading of dry bulb is then noted.
By use of suitable charts RH of air may be obtained from reading of psychrometer.
Precipitation: Measured by SYMONS RAIN GAUGE.
Funnel for receiving rainfall has a diameter of 5 inches.
Rain gauge should be exactly horizontal & 1 foot above the ground level, fixed in a
concrete foundation.
Rain fall is measured in a millimetre/time unit (mm/day or mm/month)
4. Air velocity: Measured by ANEMOMETER, measured in m/ sec.
0.5 m/ sec = complete calm
89
3.3 m/ sec = slight breeze with leaves rustling

10 m/ sec = strong wind, larger branches of trees moving
15 -20 m/ sec = storm
25 -30 m/ sec = gale
>30 m/ sec = hurricane
Wind direction: Observed by an instrument called WIND VANE
There is an arrow which turns freely about the vertical axis.
Erected at a height of 10 m above the ground level.
If the arrow remains motion less for about 3 min, the wind is described as a calm.
5. Cloud & Weather observation:

Clouds are observed for their form, amount, direction & height.
Meteorological satellite are now being used for automatic picture taking to give an idea
of cloud
90
Excreta disposal in Unsewered area

Human excreta are source of infections and one of the important causes of
environmental pollution so they should be properly disposed off.
Public health Importance:
Health Hazards
Soil pollution
Water pollution
Contamination of food
Propagation of flies
Diseases transmitted:
Enteric fever
Dysentery
Diarrhoea
Cholera
Hookworm
Ascariasis
Viral hepatitis
Gastroenteritis
Social aspects
Nuisance- bad smell,
Breeding places of flies
Foul and dirty place
Costly and difficult to install
Unawareness about GIT disease transmission
Daily habbit pattern
Extent of problem in India
GIT Disorders-5 million deaths/year; 50 million suffer/year
80% pop lives in rural area
Open air defecation
Misbelieve-filth should not be inside the house
Lack of knowledge of importance of using sanitary latrine
Lack of amenities of sewerage system
Ill maintained latrines
Urban slum; overflow of sewerage system
91
Methods of excreta disposal: Sanitary Latrines

1. Bore hole latrine: 30-40 cm diameter, 20ft depth
Merits: No need of sweeper
Dark pit-no flies breeding
No danger to water pollution-as not so deep
Demerits: not in use now as fills rapidly & Auger is required
2. Dug well or Pit latrine: 75 cm diameter
10-12 ft deep
easy to construct
Longer life -5 members for 5 yrs
3. Water seal type of latrine
Advantage: no flies access n no smell nuisance

Direct type of latrine: pit directly below sq plate
Indirect latrine: pot away
P.R.A.I type: planning research & action institute
R.C.A type: widely accepted; designed by research cum action project
Location: 15 met away
Squatting plate
Pan:
Trap: its a band pipe of 7.5 cm in size connected to pan above and holds
the water.
Connecting pipe : when pit is away from the latrine it is known as indirect
type
VIP latrine: screen at 10 cm diameter & 0.5m above the level of the latrine roof
Sulabh shauchalaya
92
4. Septic tank
Disposal of excreta n liquid waste from individual dwelling, small gp of houses &
institution with adequate water supply but no access to public sewerage system
Capacity 20-30 gallon; Depth 5-7 ft
Liquid depth 4 ft
Air space 12
Retention period 24 hrs
Solids (sludge) settle down attacked by anaerobic bacteria n fungi=anaerobic
digestion (1st stage)
Broken down to simpler compound
Liquid pass out of outlet pipe-effluent which is dispersed into trench-percolated
into subsoil-Aerobic bacteria in soil attack organic matter in affluent make
stable end product=aerobic oxidation (2nd stage)
Maintenance:
Dont use phenol disinfectant-injurious to bacterial flora
Desludging once a yr
Newly built septic tank first filled with water upto outlet level then seeded with
ripe sludge drawn from another tank to provide right type of bacteria
5. Aqua privy
6. Latrines for fair, camps or mela: Temporary use
Shallow trench latrine:
1ft wide; 3-5 ft deep
One week capacity
When trench is filled to 12 inch below ground level, Covered with earth,
Compacted and Dig new trench
Deep trench latrine: 6-8 ft deep; 30-35 inch wide
Last for Few wks to few months
Pit latrine
Western commode type
With jet
Without jet
Spray type of jet-prevent proctitis
93
Sewage treatment
Sewage treatment is the process of removing contaminants from wastewater and
household sewage, both runoff (effluents) and domestic. It includes physical, chemical,
and biological processes to remove physical, chemical and biological contaminants & to
produce a environmentally-safe disposable effluent.
Sewage is Waste water from a community, containing solid and liquid excreta, derived
from houses, street and yard washing, factories and industries
Sullage is Waste water that doesnt contain human excreta waste water from kitchens
and bathrooms.
Health aspects
Creation of nuisance, unsightliness and unpleasant odors
Breeding of flies and mosquitoes
Pollution of soil and water supplies
Contamination of food
Increase in incidence of disease, esp Enteric and Helminthic diseases
Composition of sewage
99.9% water 0.1% Solid (Organic/Inorganic)
Organic matter decomposes.offensive odors
Numerous living organisms / ONE GRAM of FAECES
o 1,000 million of E.coli,
o 10-100 million of faecal streptococci,
o 1-10 million spores of Cl.perfringens
Aim of Sewage Purification
convert sewage water into an effluent of an acceptable standard of purity
can be disposed safely-Stabilize the organic matter
Standard: Indicate the organic content of the sewage-How much oxygen is utilized by a
sample of sewage
Indicator of strength of sewage
Biochemical Oxygen Demand (BOD)
o The amount of oxygen absorbed by a sample of sewage during a
specified period, generally 5 days, at a specified temperature,
generally 20C for the aerobic destruction or use of organic matter by
living organisms
o Value ranges from 1mg/l 300mg/l
Chemical Oxygen Demand (COD)
It is the amount of oxygen absorbed by a sample of sewage (during a
specified period, at a specified temperature) for oxidation of organic
matter by strong chemical oxidiser.
Suspended Solids: The amount of suspended solids in domestic sewage (100
500 ppm (mg/l))
94
Modern Sewage Treatment

Based on biological principles of sewage purification
Decomposition/Purification of sewage/organic matter brought about
by the action of anaerobic and aerobic bacteria.
Aerobic Process
Efficient method of reducing the load of organic matter
Requires continuous supply of free dissolved oxygen
Broken down into simpler compounds CO2, Water, Ammonia, Nitrites, Nitrates
and Sulphates.
By the action of bacterial organisms including fungi and protozoa.
Anaerobic Process
Sewage is highly concentrated and contains plenty of solids the anaerobic
process is highly effective..
End products Methane, Ammonia, CO2, and H2
Process overview
Sewage can be treated close to where it is created, a decentralised system, (in septic
tanks, biofilters or aerobic treatment systems), or be collected and transported via a
network of pipes and pump stations to a municipal treatment plant, a centralised
system.
It generally involves three stages, called primary, secondary and tertiary treatment.
Primary treatment consists of temporarily holding the sewage in a quiescent
basin where heavy solids can settle to the bottom while oil, grease and lighter
solids float to the surface. The settled and floating materials are removed and the
remaining liquid may be discharged or subjected to secondary treatment.
Secondary treatment removes dissolved and suspended biological matter.

Secondary treatment is typically performed by indigenous, water-borne microorganisms in a managed habitat. Secondary treatment may require a separation
process to remove the micro-organisms from the treated water prior to
discharge or tertiary treatment.
Tertiary treatment is sometimes defined as anything more than primary and

secondary treatment in order to allow rejection into a highly sensitive or fragile
ecosystem (estuaries, low-flow rivers, coral reefs,...). Treated water is sometimes
disinfected chemically or physically (for example, by lagoons and microfiltration)
prior to discharge into a stream, river, bay, lagoon or wetland, or it can be used
for the irrigation of a golf course, green way or park. If it is sufficiently clean, it
can also be used for groundwater recharge or agricultural purposes.
Primary Treatment
Pre-treatment: Pre-treatment removes materials that can be easily collected from the
raw waste water before they damage or clog the pumps and skimmers of primary
treatment clarifiers (trash, tree limbs, leaves, etc.).
95
Screening: The influent sewage water is screened to remove all large objects like cans,
rags, sticks, plastic packets etc. carried in the sewage stream. This is most commonly
done with an automated mechanically raked bar screen in modern plants serving large
populations, whilst in smaller or less modern plants a manually cleaned screen may be
used. The raking action of a mechanical bar screen is typically paced according to the
accumulation on the bar screens and/or flow rate. The solids are collected and later
disposed in a landfill or incinerated. Bar screens or mesh screens of varying sizes may
be used to optimize solids removal. If gross solids are not removed they become
entrained in pipes and moving parts of the treatment plant and can cause substantial
damage and inefficiency in the process.
Grit removal: Long narrow chamber-approx 10 20 meters in length; designed as to
maintain a constant velocity of 1 foot per second & detention period of 30 sec to 1 min
To allow the settlement of heavier solids while permitting organic matter to pass trough
These particles are removed because they may damage pumps and other equipment.
Flow equalization: Equalization basins may be used for temporary storage of diurnal or
wet-weather flow peaks temporarily hold incoming sewage during plant maintenance
and a means of diluting and distributing batch discharges of toxic or high-strength
waste which might otherwise inhibit biological secondary treatment (including portable
toilet waste, vehicle holding tanks, and septic tank pumpers).
Fat and grease removal: In some larger plants, fat and grease is removed by passing the
sewage through a small tank where skimmers collect the fat floating on the surface.
Primary Sedimentation Tanks: Sewage flows through large tanks, commonly called
"primary clarifiers" or "primary sedimentation tanks." The tanks are used to settle
sludge while grease and oils rise to the surface and are skimmed off. Primary settling
tanks are usually equipped with mechanically driven scrapers that continually drive the
collected sludge towards a hopper in the base of the tank where it is pumped to sludge
treatment facilities.
Secondary Treatment
Secondary treatment is designed to substantially degrade the biological content of the
sewage which are derived from human waste, food waste, soaps and detergent. The
majority of municipal plants treat the settled sewage liquor using aerobic biological
processes. The bacteria and protozoa consume biodegradable soluble organic
contaminants (e.g. sugars, fats, organic short-chain carbon molecules, etc.) and bind
much of the less soluble fractions into floc.
Activated sludge Process:- Aeration tanks. A filter removes a small percentage of the
suspended organic matter, while the majority of the organic matter undergoes a change
of character, only due to the biological oxidation and nitrification taking place in the
filter. With this aerobic oxidation and nitrification, the organic solids are converted into
96
coagulated suspended mass, which is heavier and bulkier, and can settle to the bottom
of a tank. The effluent of the filter is therefore passed through a sedimentation tank,
called a secondary clarifier, secondary settling tank or humus tank. The process traps
particulate material and can, under ideal conditions, convert ammonia to nitrite and
nitrate ultimately to nitrogen gas.
Secondary Sedimentation tank: Sewage is detained for 2-3 hours; Sludge is known as
Aerated Sludge, Inoffensive, and Rich in aerobic bacteria, Nitrogen, Phosphate & act as
Valuable manure.
Tertiary Treatment
Chlorination of effluent: free from pathogen before ultimate disposal
Disposal of Effluent
Disposal by dilution: Rivers, Sea
Disposal on land
Effluent should not have more than 30mg/L of suspended solids and 5 day BOD
should not exceed 20mg/L
97
Biomedical Waste Management

Definition:
According to Bio-Medical Waste Rules, 1998 BIOMEDICAL WASTE means Any Waste,
Which is Generated During The Diagnosis, Treatment Or Immunization Of Human Beings
Or Animals Or In Research Activities Pertaining Thereto or in The Production or Testing of
Biologicals And Including Categories As Mentioned In Schedule I
The waste produced in the course of health care activities
Higher potential for infection and injury than any other type of waste
Heath care waste if inadequately treated and managed can have adverse impact on
the environment and on public health through air, land and water pollution
Sources:
Government hospital, Private hospital
Nursing homes
Physicians / dentists office / Dispensaries/ PHC
Medical research and training institute
Mortuaries
Blood banks and collection centres
Animal houses/ slaughter houses
Laboratories, Vaccination centres
Bio-technology institutions
Average distribution of health care waste

80% the normal domestic and urban waste
15% pathological and infectious waste
1% sharps waste
3% chemical and pharmaceutical waste
< 1% special waste- radioactive or cytotoxic, pressurized containers
-4 kg/bed/ day-govt hospital
-2 kg/bed/day-pvt hosp
Main groups at risk
Health Care Team medical doctors, nurses, health care auxiliaries and hospital
management personnel
Patients in health care establishments
Visitors to health care establishments
Workers in support service; laundries, waste handling and transportation
Workers in waste disposal facilities; landfills, incinerators including scavengers
98
Classification of Health-Care Waste

WASTE
CATEGO TYPE OF WASTE
RY
TREATMENT AND
DISPOSAL OPTION
Category Human Anatomical Waste

No. 1
(Human tissues, organs, body parts)
Incineration /
deep burial
Animal Waste
(Animal tissues, organs, body parts, carcasses,
Category bleeding parts, fluid, blood and experimental animals
No. 2
used in research, waste generated by veterinary
hospitals and colleges, discharge from hospitals,
animal houses)
Incineration /
deep burial
Microbiology & Biotechnology Waste (Wastes from

laboratory cultures, stocks or specimen of live micro
organisms or attenuated vaccines, human and animal
Category
cell cultures used in research and infectious agents
No. 3
from research and industrial laboratories, wastes
from production of Biologicals, toxins and devices
used for transfer of cultures)
Local autoclaving/
microwaving /
incineration
Disinfecting (chemical
Waste Sharps (Needles, syringes, scalpels, blades,
treatment )
Category
glass, etc. that may cause puncture and cuts. This
/ autoclaving /
No. 4
includes both used and unused sharps)
microwaving and
mutilation / shredding
Incineration /
Discarded Medicine and Cytotoxic drugs (Wastes
Category
destruction and drugs
comprising of outdated, contaminated and discarded
No. 5
disposal in secured
medicines)
landfills
Soiled Waste (Items contaminated with body fluids
Category including cotton, dressings, soiled plaster casts, lines,
No. 6
bedding and other materials contaminated with
blood.)
Incineration/
autoclaving /
microwaving
Disinfecting by chemical
Solid Waste (Waste generated from disposable items
Category
treatment / autoclaving
other than the waste sharps such as tubing, catheters,
No. 7
/ microwaving and
intravenous sets, etc.)
mutilation / shredding
Liquid Waste (Waste generated from the laboratory Disinfecting by chemical
Category
and washing, cleaning, house-keeping and
treatment and
No. 8
disinfecting activities)
discharge into drains
Category Incineration Ash (Ash from incineration of any Disposal in municipal
No. 9
biomedical waste)
landfill
99
Chemical treatment and

Chemical Waste (Chemicals used in production of
Category
discharge into drains
biologicals, chemicals used in disinfecting, as
No.10
for liquids and secured
insecticides, etc.)
landfill for solids.
Steps for Waste Management
Step 1. Segregation: Always segregate waste into infectious and non-infectious waste at
source of generation in the health care facility.
Yellow Bags: Amputated Limbs, Placenta, Intestine, Uterus, Ovary etc.
Blue Bags: Needles, Scalples, Blades, Glass ampoules and Syringes etc. that may
cause puncture and cuts. This includes both used and unused sharps.
Red Bags: Cotton pads, Swabs, Gauge Pieces, Dressings, Bandages, Cloths,
Bedsheets and Plaster castes, Soiled with blood, Pus, Vomits, Sputum and other
Body Fluids.
Black Bags: Wastes comprising of out dated, contaminated and discarded
medicines, solid chemicals used for disinfection in Lab & Hospitals as insecticides
Step 2. Collection and storage:
Always collect waste in covered bins upto 3/4th level & clean the bins regularly
with soap & water.
Never overfill the bins,
Never mix infectious and non-infectious waste in the same bin
Never store waste beyond 48 hrs.
Step 3. Transportation:
Always transport waste in closed container
Use dedicated waste collection bin
Transport waste through a pre-defined route within health care facilty (never
transport through crowded area)
Step 4. Treatment and disposal
Disposable Syringes
Dos
Always wear protective gears like gloves while handling needles and syringes
Always mutilate/ cut the tip of the syringe and the needle with a needle and hub
cutter before disinfecting them
Remember to detach the barrel and the plunger before disinfecting the syringe
Disinfect the mutilated needles and the syringes with 1% bleaching powder
solution at least for one hour
After that collect in puncture proof container
Final disposal of disinfected and mutilated syringes in general waste
stream/recycling
Donts
Never mix sharps with other waste streams
Never throw the needles and the syringes without mutilation and disinfection
into the waste bin
100
Never recap or bend needles

Never discard the sharps in polybags
Never burn the syringes
Never dispose the sharps in open areas
Broken Glasses
Dos
Always safely cut and discard the ampoules and vials in sharps container -blue
Finally dispose the broken glasses in sharps pit
Donts
Never cut the ampoules in such a way that they can hurt others
Never break glass sharps manually
Metal Sharps
Dos
Discard the metal sharps like blades, lancets and scalples in puncture proof
container with disinfectant solution
Finally dispose the metal sharps in sharps pit
Donts
Never dispose sharps in non secure area
Never discard the metal sharps in non-puncture proof containers
Anatomical Waste
Always segregate anatomical parts from other waste streams at the source of
generation in yellow bags/containers
Collect anatomical waste like placenta in closed bags/covered bins at the source
of generation
Transport the placenta from source of generation to final disposal site in covered
bins/ bags
Dispose the placenta along with disinfectant in secure deep burial pit
Sputum Cups and Slides
Always wear personal protective gears like gloves and masks while handling
sputum cups and slides
Dispose the sputum cups and slides in two covered containers with 5% Sodium
Hypochlorite solution for at least one hour
After disinfection dispose the:
o Sputum cups into burial pits
o Slides into sharps pit
o Liquid waste into drains
Plastic Waste
Dos
Always cut/puncture the plastic waste such as intra-venous tubes, bottles,
syringes, latex gloves and mask by scissors before disinfection
Disinfect the plastics with 1% bleaching powder for one hour
Dispose the disinfected and mutilated plastics in municipal dumps or send for
recycling
101
Donts
Never dispose used plastics without any pre-treatment like disinfection and
mutilation before final disposal
Never reuse the disposable gloves and masks
Liquid Waste: blood, body fluid, pus, any discharge from wounds or liquid chemicals
Dos
Clean the liquid waste spill by adding equal or more quantity of bleaching
powder solution and leave the area for 30 minutes
Wipe the area with a swab/cloth
Discard the swab/cloth after cleaning the area into red bin meant for infectious
waste
If possible dispose the liquid waste into the drains
Donts
Never clean liquid waste spills without adding disinfectant to the spills
Never reuse the cloth used for cleaning the spills for any other purpose
Mercury Spills
Dos
Always wear personal protective gears like gloves and masks while handling
mercury spills from breaking of thermometers or leaking blood pressure
equipments.
Always collect mercury droplets together by using two cardboard pieces.
Drop the collected mercury into a bottle having some water. Tightly cover the
bottles lid.
Send the bottle containing mercury back to the stores.
Donts
Never touch the mercury with bare hands.
Never throw the mercury in waste bins or drain.
Mercury is a hazardous chemical used in different instruments like
thermometers and blood pressure instruments within the health care facilities. It
has to be managed properly to ensure it does not cause harm to the health care
workers and the community at large.
Soiled Linen Management
Always wear gloves while handling soiled linen
Fold the soiled linen in such a manner that you do not get in contact with the
soiled part
Add disinfectant to the soiled linen before sending it to washing
Store washed linens in clean and sterile area
Use of Disinfectants
Store bleaching powder in dry, dark and cool places
The bleaching powder container should always be kept closed
While preparing 1% bleaching powder solution add 1 table spoon of bleaching
powder in 1 litre water
Stir the solution well
102
After the solution is ready, pour the solution in the waste bin meant for
disinfection of used plastics and sharps
Always remember to prepare new bleaching powder solution every day. Only
use freshly prepared bleaching powder solution each day
Ordinary bleach can be used as disinfectant
Standards for Deep Burial Pit
A pit or trench should be dug about 2 meters deep. It should be half filled with
waste, and then covered with lime within 50 cm of the surface, before filling the
rest of the pit with soil.
It must be ensured that animals do not have any access to burial sites. Covers of
galvanized iron/ wire meshes may be used.
On each occasion, when wastes are added to the pit, a layer of 10 cm of soil shall
be added to cover the wastes.
Burial must be performed under close and dedicated supervision.
The deep burial site should be relatively impermeable and no shallow well
should be close to the site.
The pits should be distant from habitation, and sited so as to ensure that no
contamination occurs of any surface water or ground water. The area should not
be prone to flooding or erosion.
The location of the deep burial site will be authorised by the prescribed
authority.
The institution shall maintain a record of all pits for deep burial
Let the waste of the sick not contaminate the lives of The Healthy
103
Gujarat Pollution Control Board

GPCB Overview
GPCB - Gujarat Pollution Control Board, was constituted by Government of Gujarat on
15th October, 1974 in accordance with the provision of the Water Act, 1974. The GPCB
continued its efforts towards environment related better pollution control and
improved management. Several critical issues in the field of environment are being
tackled by the Board through its existing Regional Offices.
Gujarat Pollution Control Board - Head Office - GANDHINAGAR
Objectives
The major objectives of the Board are centred around the Pollution Control and the
protection of the environmental quality. These are outlined as under:
Bring about all round improvement in the quality of the environment in the State by
effective implementation of the laws.
Control of pollution at source to the maximum extent possible with due regard to
technological achievement and economic viability as well as sensitivity of the receiving
environment. This objective is being fulfilled through laying down the disposal
standards as well as gaseous emission standards.
Identifications of sites and development of procedures and methods for the disposal of
hazardous wastes.
Maximisation of re-use and re-cycle of sewage and trade effluent on land for irrigation
and for industrial purpose after giving appropriate treatment and thereby economising
and saving on the use of water. The practice also helps in stopping pollution of water
due to reduction in discharges of waste into water bodies.
104
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
Minimisation of adverse effect of pollution by selecting suitable locations for the

establishment of new industrial projects.
Co-ordination with other agencies of the State Government and local authorities to
encourage the Common Effluent Treatment Plants and Treatment Stabilisation Disposal
Facilities.
Close co-ordination and rapport with educational institutions, non government
organisations, Industries Associations, Government organisations, etc. to create
environmental awareness.
Committees
Members of the Gujarat Pollution Control Board
Technical Committee
Selection Committee
Promotion Committee
Purchase Committee
Staff Strength for each Cadre of the Board
Functions & Priorities
The function of the Board is to enforce the provisions of the following Acts, Rules and
Directives issued by the Authorities from time to time.
The Water (Prevention and Control of Pollution) Act, 1974
The Water (Prevention and Control of Pollution) Cess Act, 1977
The Air (Prevention and Control of Pollution) Act, 1981
The Environment Protection Act, 1986, various relevant Rules notified thereof:
The Hazardous Waste (Management and Handling) Rules, 1989;
The Manufacture, Storage and Import of Hazardous Chemicals Rules, 1989;
The Coastal Zone Regulation -Declaration Notification, 1991;
The Environmental Clearance [including EIA - Environment, Impact Assessment] for
expansion/modernisation of activity or new projects Procedure Notification, 1994;
The Environment Public Hearing Rules, 1997;
The Bio-Medical Waste (Management and Handling) Rules, 1998;
The Rules for the Manufacture, Use, Import, Export and Storage of Hazardous microorganism
Genetically Engineered Organism Cell, 1989;
Plastics Manufacture, Sale & Usage Rules-1999 as amended 2003;
Utilisation of Fly Ash - Notification of Directions, 1999;
The Noise Pollution (Regulation and Control) Rules, 2000;
The Ozone Depleting Substances (Regulation and Control) Rules, 2000;
The Municipal Solid Waste (Management and Handling) Rules, 2000; and
The Batteries (Management & Handling) Rules, 2001
The Environmental Audit Scheme, 1996.
The Public Liability Insurance Act, 1991
Activities
Programmes under the Xth Five Year Plan
Public Consultation
105
Monitoring of Common Facilities

Vehicular Pollution Control
Action against Defaulters of Pollution Control Acts
Research and Development
Monitoring of Coastal Areas
Monitoring of Important Water Bodies
Processing and finalisation of consent applications under the Water Act
Processing and finalisation of consent applications under the Air Act
Hazardous Waste Management
Consent to Establish [formerly known as NOC/No Objection Certificates] concerning
location clearance
The Bio-Medical Waste (Management and Handling) Rules, 1998
The Municipal Solid Wastes (Management & Handling) Rules, 2000
106
Solid Waste Disposal & Ward Sanitary Office

Each municipal corporation is divided into small parts for smoother administration &
workload distribution, which are known as WARD.
Total population of Vadodara city is around 18-19 lakhs. Governing body for
administration in Vadodara city is known as Vadodara Municipal Seva Sadan (VMSS).
There are 4 zones (north, south, east and west) and 12 administrative wards (29
election wards) under VMSS. As per the Bombay Provisional Municipal Act (BPMCA
1949) applicable in Gujarat, all municipal corporations has to provide basic facilities
like safe water, basic sanitation including sewerage system, electricity including street
lights, fire safety etc. to their citizens.
Staff
Municipal Commissioner is the chief officer assisted by Deputy Municipal
Commissioners for different sections and Assistant Municipal Commissioners at Zone
level. In the Health department chief officer in VMSS is known as Medical Officer of
Health (MOH).
At ward level following staff is working:
Ward officer, Senior Sanitary Inspector, Sanitary Inspector, Sanitary Sub-inspector,
Supervisor, Mukadim, Sweepers etc.
Departments of Ward Office
1. Sanitation
2. Engineering
3. Revenue
4. Malaria & Filarial Unit
5. Encroachment Removing Department
Functions of Ward Office
Sanitation Department
Solid Waste Disposal: At present there are two methods are in operation in VMSS for
solid waste collection. 1) Door to door collection with the help of waste collecting van
and 2) Provision of public dust bins at various places of ward area. The collected soled
waste finally transported to the waste disposal site at Vadsar where it is disposed by
sanitary land fill method.
Sullage and Sewage Disposal: Sewerage System is in place for collection and transport of
Sullage water and sewage. It finally reaches to sewage treatment plants for final
disposal.
Disposal of Dead animals: done within 24hrs
Other Services: During epidemic prone seasons- Insecticide spray, distribution of
chlorine tablets, Collection of water samples and testing at Public Health Laboratory
(PHL). Special sanitation services provided during fairs, public functions etc. to prevent
epidemic.
Engineering Department
107
Administered by Chief Engineer and Assistant engineers. This department carries out
works like Construction & maintenance of roads, pipelines for drinking water supply,
sewerage system etc.
Revenue Department
This department collects various taxes like road tax, water tax, house tax, service tax etc
from households as well as commercial establishments like shops, hotels, theaters etc. It
also looks after recruitment of workers, salary of staff etc.
Malaria & Filarial Unit: This unit looks after the activities in relation to prevention of
vector-borne diseases like insecticide spray, application of MLO (Mosquito Larvicidal
Oil) etc.
Birth & Death Registration: All ward offices provides service of registration of birth and
deaths taken place in their area.
Licensing: of any commercial places like shops, hotels etc.
Encroaching Department: deals with removal of illegal constructions, cattle, dog etc.
Solid Waste Disposal Urban Area
Urban areas include cities and towns and have a higher density of population by virtue
of which the quantity of solid wastes generated is very high
Major constituent of waste is putrescible organic matter with the balance of the content
comprising of metal, glass, ceramics, plastics, textiles, dirt and wood in proportions
depending on the local factors.
While the quantity of paper waste increases with the rise in income of the countries, the
density, moisture content and proportion of food waste is more in the waste generated
in low income countries.
Studies conducted by National Environmental Engineering Research Institute (NEERI),
Nagpur have shown that in India out of the wastes generated, the biodegradable
fraction is very high due to the habit of using plenty of fresh vegetables in food
preparation.
The proportion of ash and fine earth content in the waste are also high due to the
inclusion of the street sweepings, drain silt and construction and demolition debris in it.
The most ideal arrangement for collection of solid waste in an urban area would be
door-to-door collection of waste material by a team of waste handlers. However this is
not practicable in all places in the cities especially in the urban slums.
Solid Waste Disposal in an Urban Slum
Urban slums comprise a congregation of temporary or semi permanent structures,
which are constructed by the new settlers in an urban area, due to lack of proper
housing facilities and in most instances by illegal occupation of land.
These settlements usually house people from low socio-economic strata, who are poorly
educated and as a consequence show a lack of awareness regarding the hygiene and
sanitation issues especially related to solid waste management.
The houses in slums are constructed in rows with a narrow path in between them. The
storm drainage system is usually rudimentary and temporarily constructed.
108
The slum dwellers use common toilets and bathing facilities, where the waste water or
night soil is connected to the sewers or in certain instances to the larger storm water
drains.
Disposal of solid wastes in the slums has the following peculiarities:
Quantity of waste generated is lesser as compared to other areas in the urban
locality.
Solid wastes mostly comprise of used bottles, tins, plastics and ashes, since most of
the salvageable items are recycled.
Animal manure and feeds are a significant part of solid wastes from slums since
small farm animals co-habit with humans.
Vegetable peels and kitchen wastes are discarded in large quantities while the food
product packages are not usually a part of the waste matter.
Slums localities in the various cities also have small-scale industries, which
generate waste materials.
There is no existing system of door-to-door collection of waste items. The people in
the slum community deposit their garbage in the public bins located centrally.
The roads/paths in the slums are narrow, hence the refuse lorries are unable to
negotiate the paths and therefore the waste bins are placed at fewer points.
The wastes from these bins require more frequent emptying to prevent waste
matter to spill over in the ground below and create nuisance.
Adequate sorting of the wastes take place in the bins located in the slum localities,
hence the remaining waste meant for final disposal is non-recyclable matter.
Waste Disposal
Waste disposal in slums in carried out in the same manner as the solid waste, which is
disposed from the rest of the municipal locality.
109

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Department of Community Medicine

GMERS Medical College, Gotri, Vadodara

Micronutrients and Macronutrients

Protein content (g)

Quantitatively the quality of a protein is worked out in terms of biological value,

Eat nutritionally balanced diet to get adequate protein.

Include Soyabean in your diet

Fat content (g/100g)

Visible and invisible fats:

Classification: From the nutritional or functional point of view, carbohydrates can be

RDA (mg / day)

Function: Vitamin A is required in synthesis of rhodopsin pigment required for vision in

Retinol (mcg / day)

Function: serves as anti-oxidant, needed in collagen formation and increases iron

Function: promotes intestinal absorption of calcium and phosphorus and also

Water soluble vitamins

Pellagra ,characterized br3

Coenzyme in amino acid

Coenzyme in amino acid,

The macro minerals

Not seen often

Cramps, Acidbase imbalance,

The Micro minerals

Nutritive value of food items

Content per 100 gm of edible portion

Bajra (Pearl Millet)

Content per 100 gm of edible portion

Content per 100 gm of edible portion

Content per 100 gm

Content per 100 gm

Tubers: 50 g) in a day. In addition, fresh fruits (100 g) should be consumed regularly.

Balanced diet for Adults- Sedentary/Moderate/Heavy activity (No of portions)

Balanced diet for infants, children & adolescents (number of portions)

PORTION SIZES & MENU PLAN

b) Complementary food should be given after 6 months of age, in addition to breastfeeding.

f) Include green leafy vegetables in daily diet.

Food Adulteration, Food Safety & Security Act

10. Food Safety and Standards Act (FSSA)

Penalty for misbranded food

Food containing extraneous

Penalty for unhygienic

Punishment for unsafe food

6 Months Imprisonment and 1 lacs

Nutritional Disorder of Public Health Importance

Low Birth Weight (LBW)

Protein Energy Malnutrition (PEM) or Protein Calorie Malnutrition

A state of nutrition in which a deficiency or excess (or imbalance) of energy,

Malnutrition is measured by ANTHROPOMETRY:

1-2 year 75+X

2-12 year -6X+77 X is completed year

Weight for age (%)=

(B). Age independent.

1. Weight for height (%) =

Theories regarding etiology of PEM:

McLarens classification (Stunting):

Waterlaws classification (Wasting):

Weight for height (Waterlaws):

Wasting wt. /ht.(%)

Stunting ht. /Age (%)

Stunting ht. /Age (%)

Colour coded classification by Mid-upper arm circumference in cm by Sakirs tape:

Based on subcutaneous fat (Udanis Classification):

Winging of the scapula

The term is derived from Greek word