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233Introduction to Microbiology
6. Write agent, clinical features, mode of transmission,
diagnosis, treatment, prevention, and control of
chikungunya.
7. Write agent, clinical features, mode of transmission,
diagnosis, treatment, prevention and control of filariasis.
8. Write agent, clinical features, mode of transmission,
diagnosis, treatment, prevention and control of dengue.
9. Write agent, mode of transmission, clinical features,
diagnosis, treatment, prevention, and control of leprosy.
10. Define diabetes. Discuss the types, clinical features,
diagnosis, treatment, prevention, and control of malaria.
11. Explain the mode of transmission, clinical features,
diagnosis, treatment, prevention, and control of AIDS.
Short Answer Questions (5 Marks)
1. Write laboratory diagnosis and control of cholera.
2. What are the symptoms of cholera?
3. Write preventive measures in the control of SARS.
4. What is the mode of transmission of SARS?
5. What is the mode of transmission of Ebola virus infection?
6. Write the causative agent of influenza.
7. Write diagnostic methods for the detection of influenza.
8. Write preventive measures in the control of influenza.
9. What is the mode of transmission of influenza?
10. Define and classify ARI.
11. Name the pathogens causing acute respiratory infections.
12. Write clinical features of ARI.
13. Write mode of transmission of chikungunya.
14. Discuss prevention and control of malaria.
15. Write the mode of transmission of dengue.
16. Discuss treatment and control of dengue.
17. Write the mode of transmission of malaria.
18. Discuss prevention and control of malaria.
19. Write treatment and control of malaria.
20. Write prevention and control of lymphatic filariasis.
234 Social Pharmacy
Very Short Answer Questions (2 Marks)
1. Define SARS.
2. Write the causative agent of cholera.
3. Write the causative agent of SARS.
4. Write the causative agent of EVD.
5. Write the causative agent of dengue.
6. What is lymphatic filariasis?
7. What is the incubation period of cholera?
8. What are the drugs of choice in cholera?
9. What is the preferred specimen for diagnosis of Ebola virus
infection?
10. What is the incubation period of influenza?
11. Name the drugs used in the treatment of influenza.
12. Name the vaccines available against the influenza virus.
13. Write about the prevention/control of pneumonia.
14. Write a classification of communicable diseases.
15. Write preventive measures for SARS.
Multiple Choice Questions [answers are in bold]
1. The drug of choice in cholera is:
a. Mefloquine
b. Chloroquine
c. Sulphonamide
d. All of the above
2. Latrines and surfaces contaminated with feces should be
cleaned using:
a. Solution of 1:9 parts of household bleach with water
b. Phenol
c. UV rays
d. Formaldehyde
3. Causative agent for SARS belongs to which family of
virus?
a. Orthomyxoviridae
b. Paramyxoviridae
c. Coronaviridae
d. Picornaviridae
235Introduction to Microbiology
6. Chikungunya is a:
a. Viral disease
b. Fungal disease
c. Bacterial disease
d. None of above
7. Which of the following diseases is transmitted by
mosquitoes?
a. Dengue
b. Cholera
c. AIDS
d. SARS
8. Causative agent for Ebola virus disease (EVD) belongs to
which family of virus?
a. Paramyxoviridae
b. Coronaviridae
c. Herpesviridae
d. Filoviridae
9. The incubation period for influenza is:
a. 1–3 days
b. 5–7days
c. 12 days
d. 20 days
10. Incubation period for lymphatic filariasis:
a. 12 days
b. 1 month
c. 30 days
d. 6 months–1 year
11. What is the primary mode of transmission for influenza
(flu)?
a. Direct contact with infected skin
b. Contaminated water
c. Airborne droplets
d. Vector-borne transmission
12. Which of the following diseases is caused by a paramyxo-
virus?
a. Tuberculosis
b. Measles
236 Social Pharmacy
c. Chickenpox
d. MERS
13. What is the incubation period for avian-flu?
a. 2 to 8 days
b. 14 to 16 days
c. 9 to 12 days
d. 16 to 18 days
14. Which disease is characterized by puffy cheeks, parotitis,
and a swollen jaw?
a. Measles
b. Chickenpox
c. Rubella
d. Mumps
15. What is the primary source of infection for SARS?
a. Contaminated food
b. Infected mosquitoes
c. Respiratory droplets
d. Direct contact with animals
16. Which disease is known as German measles?
a. Rubella
b. Mumps
c. Influenza
d. Avian-flu
17. What is the causative organism of Middle East respiratory
syndrome (MERS)?
a. Varicella zoster virus
b. Influenza virus
c. Middle East respiratory syndrome Coronavirus
(MERS-CoV)
d. Rubivirus
18. What is the primary reservoir for avian influenza type A
viruses?
a. Dogs
b. Pigs
c. Birds
d. Monkeys
237Introduction to Microbiology
19. Which vaccine is mentioned as being available for COVID-
19 in the text?
a. Polio vaccine
b. Covaxin
c. Diphtheria, tetanus, and pertussis vaccine (Adsorbed)
d. Hepatitis B vaccine
20. What is the causative organism of diphtheria?
a. Streptococcus pneumoniae
b. Corynebacterium diphtheriae
c. Haemophilus influenzae
d. Mycobacterium tuberculosis
21. How is amoebiasis primarily transmitted?
a. Airborne transmission
b. Contaminated food and water
c. Direct contact with infected persons
d. Sexual contact
22. Which antibiotic is mentioned as a treatment for whoop-
ing cough?
a. Amoxicillin
b. Erythromycin
c. Ciprofloxacin
d. Doxycycline
238 Social Pharmacy
INTRODUCTION
Community means a group of people living together in such a
way that the members share not only one or more specific
interests (like occupational, educational, etc.) but also the basic
conditions of a common life. The hallmark of a community is
that one’s life may be wholly lived within it. One cannot live a
whole life within a club or a business group. But one can
certainly live wholly within a tribe a village or a city.
Community service is a non-paying job performed by one
person or a group of people for the benefit of their community.
Engaging in community service provides healthcare workers
with the opportunity to become active members of their
community and has a lasting, positive impact on society at
large. Community service or volunteerism enables healthcare
workers to acquire skills and knowledge, as well as provides a
service to those who need it most.
Community health is a major field of study within the
medical and clinical sciences, which focuses on the
maintenance, protection, and improvement of the health status
of communities via the prevention, diagnosis, and treatment
of disease, illness, injury, and other physical and mental
impairments.
Healthcare
WHO defines community health as “environmental, social, and
economic resources to sustain emotional and physical well-
being among people in ways that advance their aspirations and
satisfy their needs in their unique environment”.
Introduction to Health Systems
and Ongoing Health Programs
5
239Introduction to Health Systems
Health service delivery systems are responsible for providing
healthcare services. High-quality, safe, easily accessible,
integrated health service delivery systems are critical for
moving towards universal health coverage in the community.
Healthcare is delivered by health professionals (doctors,
pharmacists, paramedical staff, etc.) and includes work done
in providing primary care, secondary care, and tertiary care to
individuals, families, communities, and populations in general.
Patient-centered care mainly focuses on the patient while
people-centered care encompasses clinical encounters, with
special attention to the health of people, and plays a crucial
role in shaping health policy and health services.
Levels of Healthcare
Healthcare is customarily described as consisting of a three-
tier pattern as follows:
1. Primary Healthcare
The concept of primary healthcare concept was adopted in 1978
at the Alma Ata conference jointly organized by the World
Health Organization (WHO) and UNICEF in the USA. It
formed the basis of ‘Health for All’ by 2000 AD. It signifies the
first level of contact between individuals, families, and
communities with the health system. It is an integral part of a
country’s health system and is based upon the participation of
the people themselves. It can provide comprehensive care
ranging from promotion and prevention to treatment,
rehabilitation, and palliative care.
In rural areas, primary healthcare is provided through a
network of primary health centres (PHC) and their sub centers
(SC) whereas, in urban areas, it is provided through health posts
and family welfare centres. At the village level, primary
healthcare is provided by the village health guide (VHG) and
the trained dai.
The key elements of primary healthcare include:
1. Availability of essential medicines like paracetamol in
all healthcare facilities.
2. Prevention and control of locally endemic diseases.
240 Social Pharmacy
3. Health education.
4. Maternal, child health and family planning.
5. Universal immunization program.
6. An adequate supply of safe food and food supple-
ments.
7. Treatment of communicable and non-communicable
diseases.
8. Safe water supply and basic sanitation.
Principles of primary healthcare
1. Equitable distribution of health services.
2. Cost-effective and good quality technology, e.g. vaccine
vial monitor.
3. Community participation for promotion and maintenance
of health.
4. Intersectoral coordination.
Fig. 5.1: Components of primary healthcare
2. Secondary Healthcare
This refers to the second level of healthcare. At this level,
specialized facilities are available to deal with the complex
241Introduction to Health Systems
health problems referred from the primary level. It serves as
the first referral level.
The community health centers (CHC) at the block level and
the district hospitals provide secondary healthcare.
3. Tertiary Healthcare
This refers to the third level of the health system, which
provides facilities for specialized consultative care usually on
referral from primary and secondary medical care. Sophisti-
cated investigations and therapeutic procedures can be
performed at this level. Tertiary healthcare is provided by
intensive care units, medical college hospitals, and super
specialty hospitals.
Table 5.1: Health facilities in rural and urban areas
Health facility Rural areas Urban areas
Primary health- Sub-centers and primary Swasthya Chowki,
care providers health centre (PHC) urban primary
health centre (UPHC)
Secondary health- Community health centre, Urban community
care providers subdistrict hospitals and health centre
district hospitals
Tertiary health- Medical colleges and Medical colleges and
care providers super specialty hospitals super specialty
hospitals
Healthcare in Rural Areas
The lack of access to quality healthcare is particularly acute in
the rural areas in India, which accounts for more than two-
thirds of Indians living in villages, but the healthcare facilities
in these areas are grossly unsatisfactory. Thus, poor people
get poor healthcare.
Barriers to Healthcare Access in Rural Areas
The rural residents experience the following barriers to health
care access:
1. Distance and transportation: Rural populations mostly
have to travel long distances to access healthcare services.
242 Social Pharmacy
Public or private transportation services are often lacking
in rural areas or pose a significant burden in terms of travel
time and cost.
2. Health insurance: Individuals living in rural areas mostly
do not have health insurance coverage due to affordability
issues. They face delays in receiving healthcare facilities
due to the limited supply of rural healthcare providers
who offer low-cost or charity healthcare as compared to
their urban counterparts.
3. Poor health literacy: Health literacy is a major barrier to
healthcare access. Most of the people in rural areas have a
lower level of education and thus are less capable of
understanding health information and instructions given
by the healthcare providers. Additionally, they are less
efficient in navigating the healthcare systems as compared
to their urban counterparts.
4. Social stigma and privacy issues: In rural areas, there is
little social stigma. Privacy concerns are more likely to act
as barriers to healthcare access. Rural residents feel shy in
seeking care for conditions associated with stigma like
substance abuse, mental health, pregnancy, sexual health,
or even common chronic illnesses due to unease or privacy
concerns. In villages, almost all people are known to each
other. Patients feel fear or concerns about family, friends,
or people, who are frequently friends, or family members
of healthcare providers. They do not want to disclose to
others about health conditions that are not openly
discussed like counselling or HIV testing services. The
integration of behavioral health services with primary care
healthcare services in the same building can help ease
patient concerns.
5. Shortage of healthcare providers: A shortage of health-
care providers in rural communities impacts healthcare
access. Appropriate healthcare services must be made
available in rural areas so that rural residents may obtain
sufficient access promptly. Even if an adequate supply of
healthcare services exists in the rural community, there are
other factors to consider in terms of healthcare access. For