Urban Health

Urban Health Indian Medical PG Question 1: Which one of the following indicators is not included in Millennium Development Goals?

• A. Maternal mortality ratio
• B. Suicide rate per 100,000 population
• C. T.B. death rate per 100,000 children (0 – 4 years of age) (Correct Answer)
• D. Under five mortality rate

Urban Health Explanation: ***T.B. death rate per 100,000 children (0 – 4 years of age)*** - While **tuberculosis** was addressed in **MDG 6** (Combat HIV/AIDS, malaria, and other diseases), this **specific age-stratified indicator** was not directly enumerated in the official MDG indicator framework. - The MDG indicators for TB included: **prevalence of tuberculosis**, **tuberculosis incidence rate**, **proportion of tuberculosis cases detected and cured under DOTS**, and general TB death rates - but NOT age-specific pediatric TB mortality rates for the 0-4 year age group. - This makes it the correct answer as it represents a specific metric formulation that was not part of the official MDG monitoring framework, despite TB being included in the broader goals. *Maternal mortality ratio* - The **maternal mortality ratio** was a **key indicator under MDG 5** (Improve Maternal Health). - Target 5.A specifically aimed to reduce the maternal mortality ratio by three-quarters between 1990 and 2015. - This was one of the core reproductive health indicators monitored globally. *Suicide rate per 100,000 population* - The **suicide rate** was not included in the Millennium Development Goals framework. - Mental health indicators, including suicide rates, were notably absent from the MDGs, which focused on infectious diseases, maternal and child health, poverty, education, and environmental sustainability. - However, among the options listed, the **TB death rate for children 0-4 years** is considered the answer because it represents a more specific technical distinction about indicator formulation within a disease area (TB) that WAS included in the MDGs, whereas suicide was entirely outside the MDG scope. *Under five mortality rate* - The **under-five mortality rate** was a **central indicator under MDG 4** (Reduce Child Mortality). - Target 4.A aimed to reduce the under-five mortality rate by two-thirds between 1990 and 2015. - This was measured as deaths per 1,000 live births before age five.

Urban Health Indian Medical PG Question 2: Which of the following best describes the term 'Ivory Towers of Disease'?

• A. Small health centres
• B. Large hospitals (Correct Answer)
• C. Private practitioners
• D. Health insurance companies

Urban Health Explanation: ***Large hospitals*** - The term "Ivory Towers of Disease" metaphorically refers to **large, often academic or university-affiliated hospitals**. - These institutions are perceived as somewhat **isolated from the daily realities** of general practice and community health, focusing on complex cases, research, and specialized care. *Small health centres* - These are typically **community-based facilities** that often serve as the first point of contact for patients. - They are considered more **integrated with the community** rather than isolated, making "Ivory Towers" an inappropriate description. *Private practitioners* - Private practitioners operate their own independent clinics and are usually **deeply embedded within the community**. - They are known for **direct patient interaction** and accessibility, which contrasts with the "Ivory Towers" concept of detachment. *Health insurance companies* - These are financial entities that manage healthcare costs and policies, not actual healthcare providers or facilities. - Their role is administrative and financial, and they are **not directly involved in patient care** delivery in the way a hospital or clinic is.

Urban Health Indian Medical PG Question 3: Consider the following statements: The strategy to eradicate poliomyelitis in India comprised of: 1. Conducting National Immunization Days 2. Mopping up rounds with OPV 3. Acute Flaccid Paralysis surveillance 4. Public awareness through multimedia Which of these statements are correct?

• A. 1 and 3 only
• B. 2 and 4 only
• C. 1, 2 and 3 only
• D. 1, 2, 3 and 4 (Correct Answer)

Urban Health Explanation: ***1, 2, 3 and 4*** * All four strategies—**National Immunization Days (NIDs)**, **mopping-up rounds with OPV**, **Acute Flaccid Paralysis (AFP) surveillance**, and **public awareness campaigns**—were integral to India's successful polio eradication effort. * These components collectively ensured high vaccination coverage, targeted interventions in high-risk areas, effective case detection, and community engagement, leading to the country being declared polio-free. *1 and 3 only* * This option is incomplete as it omits **mopping-up rounds** and **public awareness**, both of which were crucial for achieving and maintaining high herd immunity and community participation. * While **NIDs** and **AFP surveillance** were foundational, they alone would not have been sufficient for complete eradication without the other critical components. *2 and 4 only* * This option overlooks **National Immunization Days (NIDs)**, which were large-scale, nationwide vaccination campaigns fundamental to delivering OPV to a vast population. * It also omits **Acute Flaccid Paralysis (AFP) surveillance**, which was essential for identifying and investigating all suspected polio cases, allowing for rapid response and containment. *1, 2 and 3 only* * This option does not include **public awareness through multimedia**, which was vital for informing parents about the importance of vaccination, addressing vaccine hesitancy, and mobilizing community support during campaigns. * While **NIDs**, **mopping-up rounds**, and **AFP surveillance** targeted the biological and operational aspects, public awareness was critical for the social and behavioral components of the eradication strategy.

Urban Health Indian Medical PG Question 4: According to the National Health Policy, primary urban health centers should be designated for a population of:

• A. 30,000 people
• B. 50,000 people (Correct Answer)
• C. 10,000 people
• D. 1,000,000 people

Urban Health Explanation: **50,000 people** - According to the **National Health Policy (NHP)**, specifically in the context of urban healthcare planning, a **primary urban health center (PUHC)** is designed to cater to a population of approximately **50,000 individuals**. - This population norm ensures adequate access to basic health services for urban populations, considering the higher population density and varied health needs in urban settings compared to rural areas. *30,000 people* - This population norm is typically associated with a **Primary Health Centre (PHC)** in **plain areas** according to the NHP for **rural populations**. - Urban health centers are designed for a larger population base due to differences in population density and healthcare infrastructure. *10,000 people* - This figure more closely aligns with the population norm for a **Sub-Centre** in plain areas, which is the most peripheral and first contact point between the primary healthcare system and the community. - A primary urban health center serves a significantly larger population than a sub-centre. *1,000,000 people* - A population of **one million people** would require a much larger health infrastructure, typically involving multiple hospitals, specialized centers, and a network of primary and secondary care facilities, rather than a single primary urban health center. - This figure is far too large for the designated population coverage of a primary urban health center.

Urban Health Indian Medical PG Question 5: The data regarding two exposures A and B, associated with a disease X in a community is given below: Which one of the following assertions and the reasons given is correct?

• A. Cannot decide, as the precedence of exposure in the community has not been mentioned
• B. Preference to control exposure A, because it has a higher population attributable risk (Correct Answer)
• C. Preference to control exposure B, because it has a higher attributable risk
• D. Preference to control exposure B as it has a higher relative risk

Urban Health Explanation: ***Preference to control exposure A, because it has a higher population attributable risk*** - **Population Attributable Risk (PAR)** quantifies how much of the disease incidence in the *total population* can be attributed to a specific exposure. When deciding on public health interventions, controlling the exposure with the highest PAR will have the **greatest impact on reducing the disease burden** in the community. - In this case, exposure A has a PAR of 70%, meaning 70% of disease X cases in the community can be prevented by eliminating exposure A, while exposure B has a PAR of 50%. Therefore, prioritizing preventive measures for exposure A is more effective from a public health perspective. *Cannot decide, as the precedence of exposure in the community has not been mentioned* - The decision on which exposure to control is primarily based on its **potential impact on public health**, which is best reflected by the Population Attributable Risk (PAR). - The "precedence of exposure" (e.g., which exposure came first or is more fundamental) is not typically the primary factor for public health priority setting when quantitative measures like PAR are available. *Preference to control exposure B, because it has a higher attributable risk* - **Attributable Risk (AR)**, also known as the attributable fraction among the exposed, indicates the proportion of disease among *exposed individuals* that is due to the exposure. While B has a higher AR (90% vs. 80%), this metric does not account for the prevalence of the exposure in the overall population. - A high AR for an exposure that is rare in the population might have less overall public health impact than a lower AR for a very common exposure, which is why PAR is a better guide for population-level interventions. *Preference to control exposure B as it has a higher relative risk* - **Relative Risk (RR)** indicates the strength of the association between an exposure and a disease (i.e., how many times more likely exposed individuals are to develop the disease compared to unexposed individuals). Exposure B has a higher RR (10 vs. 5). - While a higher RR signifies a stronger association, it does not tell you the overall impact on the *community*. An exposure with a very high RR but low prevalence might contribute less to the total disease burden in the population than an exposure with a moderate RR but high prevalence, which is again why PAR is preferred for public health decision-making.

Urban Health Indian Medical PG Question 6: A well of contaminated water resulted in an outbreak of diarrhoea in a community. Which type of epidemic will this exposure present with? 1.Propagated epidemic 2.Common source - continuous exposure 3.Common source - point exposure

• A. 1, 2 and 3
• B. 2 only
• C. 1 and 2 only
• D. 3 only (Correct Answer)

Urban Health Explanation: ***3 only*** - A **common source - point exposure** epidemic occurs when a group of people are exposed to the same harmful source over a relatively **short, defined period**. A contaminated well represents a single source of exposure, and the diarrhea outbreak suggests a rapid onset of illness within the community after this exposure. - The contamination of a well provides a **single, acute event** where affected individuals are exposed around the same time leading to a sharp increase in cases, followed by a decline. *1, 2 and 3* - This option is incorrect because a **propagated epidemic** typically involves person-to-person transmission, which is not the primary mode described for a contaminated water source that causes a widespread outbreak. - A **common source - continuous exposure** involves ongoing or intermittent exposure over a prolonged period, leading to a flatter epidemic curve or multiple peaks, which is less likely for a singular contaminated well event unless the contamination lasts for an extended time. *2 only* - This is incorrect because **common source - continuous exposure** implies prolonged or repeated exposure to the source, potentially due to ongoing contamination of the well, leading to cases occurring over an extended period. - While a contaminated well could potentially lead to continuous exposure if the contamination persists and goes unaddressed, the phrasing "a well of contaminated water resulted in an outbreak" suggests an event with a more defined timeline, fitting point exposure initially. *1 and 2 only* - This option is incorrect because a **propagated epidemic** is characterized by the spread of disease from person to person, often resulting in multiple waves of cases, which is not the primary pattern expected from a contaminated water source. - While continuous exposure could describe a contaminated well that remains active, the initial description of "an outbreak" from a single source often points more directly to a **point exposure** event in its initial phase.

Urban Health Indian Medical PG Question 7: Which of the following services are provided to pregnant women under the Integrated Child Development Scheme (ICDS)?

• A. Health check-up
• B. Nutrition and health education
• C. Immunization against tetanus
• D. Supplementary nutrition (Correct Answer)

Urban Health Explanation: ***Supplementary nutrition*** - **Supplementary nutrition** is the most direct and primary tangible service provided under ICDS specifically targeting pregnant women as beneficiaries. - Under ICDS, pregnant women receive **300 calories and 10-12 grams of protein** for at least 90 days during pregnancy to bridge the calorie and protein gap in their diets. - This is a core service directly provided at Anganwadi centers, ensuring better health outcomes for both mother and developing fetus. - Among all ICDS services for pregnant women, supplementary nutrition is the **most distinctive and substantial direct benefit** that pregnant women receive. *Health check-up* - While health check-ups are part of ICDS package services, they are primarily conducted by ANMs and medical officers from the health system. - Anganwadi Workers facilitate identification, weight monitoring, and referrals, but the comprehensive health examinations are delivered through convergence with the health department rather than as a direct standalone ICDS service. *Nutrition and health education* - Nutrition and health education is indeed provided under ICDS to pregnant women and mothers. - However, it is an **enabling/educational service** rather than a direct tangible provision like supplementary nutrition. - The question likely seeks the most characteristic direct service, which is supplementary nutrition. *Immunization against tetanus* - Immunization services including tetanus toxoid are part of the integrated ICDS-health system approach. - However, vaccines are administered by health workers (ANMs), not by Anganwadi Workers themselves. - ICDS role is primarily facilitative through awareness generation and referral linkages to health facilities.

Urban Health Indian Medical PG Question 8: Which statement best describes the criteria for starting an urban community health center?

• A. Caters to a population of 1-1.5 lakh (Correct Answer)
• B. Referral center for 2-3 primary health centers
• C. Should have a 100-bed facility in metro cities
• D. No sub-district and district hospitals present in the area

Urban Health Explanation: ***Caters to a population of 1-1.5 lakh*** - An **urban community health center (UCHC)** is designed to provide comprehensive primary healthcare services to an urban population of **1 to 1.5 lakh**. - This population criterion ensures effective service delivery and proper resource allocation for a designated urban area. *Referral center for 2-3 primary health centers* - This description typically applies to a **sub-district hospital** or a higher-level facility, which serve as referral centers for multiple primary health centers. - A UCHC primarily focuses on direct provision of primary care, not usually acting as a referral hub for other primary care units. *Should have a 100-bed facility in metro cities* - A **100-bed facility** is characteristic of a larger hospital, such as a district hospital, not an urban community health center. - UCHCs typically have minimal or no inpatient beds, focusing on outpatient services and emergency care rather than extensive hospitalization. *No sub-district and district hospitals present in the area* - This statement is not a criteria for a UCHC; in fact, UCHCs often function within a healthcare system that includes larger hospitals for referral of complex cases. - The presence or absence of higher-level facilities does not define the necessity or establishment of a UCHC.

Urban Health Indian Medical PG Question 9: The crude birth rate for a sub-center with a population of 1000 is 20. What is the estimated number of pregnant women registered in the sub-center during the year?

• A. 110
• B. 80
• C. 60 (Correct Answer)
• D. 100

Urban Health Explanation: ***60*** - The **crude birth rate** of 20 means 20 live births per 1,000 population. For a population of 1,000 people, this means there were **20 live births** in that year. - Using the standard epidemiological formula: **Estimated pregnancies = Live births × 3** - This multiplier of 3 accounts for stillbirths, abortions, miscarriages, and ongoing pregnancies that are registered but may not result in live births. - Therefore: **20 live births × 3 = 60 registered pregnant women** ✓ *110* - This value would require a multiplier of 5.5 (110/20), which is significantly higher than the standard epidemiological estimation. - It overestimates the pregnancy-to-live-birth ratio and does not align with established public health calculations. *80* - This implies a multiplier of 4 (80/20), which exceeds the standard ratio of 3 used in community medicine. - While some regions may have higher pregnancy wastage, this is not the standard calculation method. *100* - This suggests a multiplier of 5 (100/20), which greatly overestimates registered pregnancies relative to live births. - This does not correspond to the accepted formula used in Indian public health programs and NEET PG examinations.

Urban Health Indian Medical PG Question 10: The best indicator for a potential explosiveness of plague outbreak is:

• A. Burrow index
• B. Cheopis index (Correct Answer)
• C. Specific percentage of fleas
• D. Total flea index

Urban Health Explanation: ***Cheopis index*** - The **Cheopis index** (average number of *Xenopsylla cheopis* fleas per rodent) is the **best indicator for explosive plague outbreaks**. - *X. cheopis* (oriental rat flea) is the **primary vector** of *Yersinia pestis* and most efficient at transmission. - When the Cheopis index **exceeds 1.0**, it indicates critical conditions for rapid epidemic spread and explosive outbreak potential. - This index specifically measures the most dangerous vector species, making it the most precise predictor of outbreak explosiveness. *Total flea index* - Measures the average number of **all flea species** per rodent, regardless of vector competence. - While useful for general surveillance, it **lacks specificity** as it includes non-vector or less efficient vector species. - Does not specifically predict explosiveness as effectively as focusing on the primary vector species. *Burrow index* - Reflects rodent population density and activity (number of active burrows per hectare). - Indicates **host availability** but not the immediate transmission risk from vectors. - Important for understanding epizootic conditions but indirect measure of outbreak potential. *Specific percentage of fleas* - This term is **vague and non-standard** in plague epidemiology terminology. - Could refer to various metrics (percentage infected, percentage of specific species) without clear definition. - Not a recognized standardized indicator for plague surveillance.

Urban Health Flashcard 1 of 9

Question: In urban areas, 1 ASHA worker is assigned to a population of _____

Answer: 1000-2500

Urban Health Flashcard 2 of 9

Question: BG Prasad scale was designed to classify the socio-economic status in _____ areas

Answer: urban and rural

Urban Health Flashcard 3 of 9

Question: passive case surveilance for malaria started  with _____

Answer: urban malaria scheme(1971)

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Urban Health Flashcard 4 of 9

Question: integrated vectory managment uses same methods for _____ and _____ in urban areas

Answer: malaria

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Urban Health Flashcard 5 of 9

Question: anopheles _____ spreads malaria in urban areas

Answer: stephensi

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Urban Health Flashcard 6 of 9

Question: national urban health mission(NUHM) was launched in year _____

Answer: 2011

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Urban Health Flashcard 7 of 9

Question: kuppuswamy index is a _____ index

Answer: urban socio economic

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Urban Health Flashcard 8 of 9

Question: land for higher secondary school should be

Answer: >10 acre +>1 acre/100 students

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Urban Health Flashcard 9 of 9

Question: 5db51bc822474d7784e09837a0848bcf-ao-1

Answer: Urban CHC population size

Extra Information: PHC,ANM,USHA