1. Definition & Concepts
• Health – A state of complete physical, mental, social well-being (WHO, 1948).
• Community Health – Health of a group of people living in a defined geographical area.
• Public Health – Science & art of preventing disease, prolonging life, promoting health through organized efforts.
• Community Health Nursing – Nursing service to individuals, families, and communities to promote and maintain health.
2. Levels of Prevention
A. Primordial Prevention
• Preventing emergence of risk factors
(e.g., banning junk food in school).
B. Primary Prevention
• Before disease occurs
• Includes Health promotion (education, diet, exercise) & Specific protection (immunization, sanitation).
C. Secondary Prevention
• Early diagnosis and treatment
(e.g., screening tests – BP, Pap smear).
D. Tertiary Prevention
• Disability limitation & rehabilitation
(e.g., physiotherapy for stroke patient).
3. Principles of Community Health Nursing
• Equitable distribution
• Community participation
• Intersectoral coordination
• Appropriate technology
• Focus on prevention & health promotion
4. Health Indicators
• Mortality indicators: IMR, MMR, CDR, U5MR
IMR: Infant Mortality Rate – The number of infant deaths per 1,000 live births
MMR: Maternal Mortality Rate – The number of maternal deaths per 100,000 live births
CDR: Child Disability Rate – The number of children with disabilities per 1,000 live births.
U5MR: Under 5 Mortality Rate– U5MR is Under 5 Mortality Rate. It measures the number of deaths of children under five years of age per 1,000 live births, serving as a critical indicator of child health and healthcare quality in populations worldwide.
• Morbidity indicators: Incidence, prevalence
• Nutritional indicators: Height-for-age, weight-for-age
• Socio-economic indicators: Literacy, housing, income
• Quality of Life indicators: HDI, PQLI
HDI- Human Development Index.
India’s RANK-130 in 2025
The Human Development Index (HDI) is a summary measure of average achievement in three basic dimensions of human development: a long and healthy life, access to knowledge, and a decent standard of living. It is published annually by the United Nations Development Programme (UNDP).
As of the 2025 Human Development Report, India ranks 130th out of 193 countries in the Human Development Index (HDI). This ranking reflects an improvement from 133rd in 2022, with an HDI value increasing from 0.676 to 0.685 in 2023.
Neighbors: India’s rank is lower than several of its neighbors, including China (75), Sri Lanka (78), Bhutan (125), and Bangladesh (129). It ranks higher than Nepal (146) and Pakistan (164).
PQLI- Physical Quality of Life Index
5. Epidemiology Basics
Definitions
• Epidemiology – Study of distribution & determinants of diseases.
• Endemic – Disease constantly present in an area.
• Epidemic – Sudden increase in cases.
• Pandemic – Worldwide epidemic.
• Sporadic – Occasional cases.
Epidemic Curve Types
• Point source
• Continuous common source
• Propagated epidemic
6. Chain of Infection
1. Agent
2. Reservoir
3. Portal of exit
4. Mode of transmission
5. Portal of entry
6. Susceptible host
Modes of Transmission
• Direct: contact, droplet
• Indirect: vector, fomite, vehicle
• Airborne, fecal–oral, transplacental
7. Family Health Nursing
Types of Family
• Nuclear, extended, joint, broken, single-parent.
Family Health Assessment
• Health history
• Socio-economic profile
• Environmental conditions
• Nutritional assessment
• Immunization status
8. Maternal & Child Health (MCH)
Antenatal Care
• Minimum 4 ANC visits
• TT/Tdap immunization
• IFA tablets 180–360
• Weight, BP, fetal growth monitoring
Postnatal Care
• Breastfeeding within 1 hour
• Exclusive breastfeeding for 6 months
• Newborn care: warmth, cord care, immunization
9. National Health Programs (Important for CNET)
• NHM – National Health Mission
• RNTCP / NTEP – TB control
• NVBDCP – Vector-borne disease control
• NPCDCS – Diabetes, hypertension, cancer
• NACP – HIV/AIDS
• UIP – Universal Immunization Program
• ICDS – Child nutrition program
• Janani Suraksha Yojana (JSY)
• Ayushman Bharat – Health & Wellness Centres
10. Immunization
National Immunization Schedule
• At birth – BCG, OPV-0, Hep-B
• 6, 10, 14 weeks – DPT, IPV, Hib, Hep-B, Rotavirus, PCV
• 9 months – Measles/Rubella
• 16–24 months – Booster doses
Cold Chain Equipment
• ILR, Deep freezer
• Ice packs, Vaccine carriers
• Optimum temperature: 2°C–8°C
11. Primary Health Care (PHC)
Alma-Ata Declaration, 1978
Principles:
• Accessibility
• Community participation
• Health promotion
• Affordable technology
• Intersectoral coordination
Health Workers & Structure
• ASHAs – Community link workers
• ANM – Maternal/child health
• MPW – Multi-purpose worker
• PHC – 1 per 30,000 population
• Sub-center – 1 per 5,000 population
12. Communication in Health Education
Methods
• Individual (interview, counseling)
• Group (lecture, demonstration, role play)
• Mass (TV, radio, posters)
AIDS of Teaching
• Charts, flipbooks, models, posters
13. Environmental Health
Water Purification
• Boiling – best method
• Chlorination – 0.5 ppm residual chlorine
Waste Disposal
• Biomedical waste color coding
• Incineration, autoclaving, deep burial
14. Vital Statistics
• Birth rate = (Live births / Mid-year population) × 1000
• Death rate = (Deaths / Mid-year population) × 1000
• IMR = Deaths <1 year / 1000 live births
15. Roles of Community Health Nurse
• Health educator
• Counselor
• Care provider
• Supervisor
• Researcher
• Management & leadership