CHAPTER 2: PREVENTIVE HEALTHCARE
Subject: Social Pharmacy
Subject: Social Pharmacy
PHARMACIST'S ROLE = PREVENT + PROTECT + PROMOTE health of community
Demography = Study of human population (its size, growth, distribution, and vital statistics like birth, death, marriage).
D – Death rate E – Emigration M – Migration O – Origin of population G – Growth rate R – Reproduction (birth rate) A – Age structure P – Population density H – Health indicators Y – Yield (sex ratio)
| Term | Simple Meaning | Indian Stats (approx) |
|---|---|---|
| Birth Rate | No. of live births per 1000 population/year | ~18 per 1000 |
| Death Rate | No. of deaths per 1000 population/year | ~6 per 1000 |
| Infant Mortality Rate (IMR) | Deaths of babies <1 year per 1000 live births | ~28 per 1000 |
| Maternal Mortality Rate (MMR) | Deaths of mothers per 1 lakh live births | ~97 per lakh |
| Life Expectancy | Average years a person is expected to live | ~70 years |
| Sex Ratio | Females per 1000 males | ~940 per 1000 |
Family Planning = Planning the number of children and spacing between them using contraceptive methods.
EASY DEFINITION: Family Planning = Right child + Right time + Right number
| Type | Methods | Trick to Remember |
|---|---|---|
| Spacing Methods (Temporary) | Condoms, OCP (pills), IUCD (Copper-T), Injectable (Depo-Provera) | COCCI – Can Overcome Conception Certainly In time |
| Terminal Methods (Permanent) | Tubectomy (female), Vasectomy (male) | TV = Terminal + Vasectomy/Tubectomy |
| Natural Methods | Safe period, Withdrawal method | Nature = No medicines used |
| Emergency Contraception | Morning-after pill (within 72 hrs) | 72 = Emergency window! |
KEY POINT: Pharmacist does NOT prescribe permanent methods — only counsels & refers!
MCH = Healthcare services for pregnant women, newborns, infants, and children to reduce mortality and improve health.
| Service | Description |
|---|---|
| Antenatal Care (ANC) | Care during pregnancy |
| Intranatal Care | Care during delivery |
| Postnatal Care (PNC) | Care after delivery |
| Immunization | Immunization of child |
| Nutritional Supplements | Iron + Folic Acid supplementation |
Visit 1: Before 12 weeks Visit 2: 14–26 weeks Visit 3: 28–34 weeks Visit 4: 36 weeks onward
GOLDEN RULE: Breastfeeding within 1 HOUR of birth + exclusively for 6 MONTHS
| Benefit | For Baby | For Mother |
|---|---|---|
| Nutrition | Complete nutrition – proteins, fats, antibodies | Burns extra 500 cal/day |
| Immunity | Colostrum gives passive immunity (IgA) | Reduces breast cancer risk |
| Bonding | Strong mother-child emotional bond | Reduces postpartum depression |
| Economy | FREE – no cost! | Saves money on formula milk |
| Contraception | – | Natural contraception (LAM method) |
P – Passive immunity (IgA) A – Antibodies & Anti-infective factors V – Vitamins (A, K) E – Easy to digest, prevents infection
IMS = Artificial milk formulas used instead of breast milk. These are HARMFUL if not properly used.
| Ill Effect | Explanation |
|---|---|
| Infections | Bottle/formula easily contaminated with bacteria → diarrhoea, pneumonia |
| Malnutrition | Wrong preparation (overdiluted) → less nutrients for baby |
| Loss of immunity | No antibodies like breast milk → more infections |
| Dental problems | Bottle feeding causes tooth decay ('nursing bottle caries') |
| Mother's health | Mother misses benefits of breastfeeding (cancer risk increases) |
| Financial burden | Formula milk is expensive for poor families |
LAW IN INDIA: IMS (Regulation and Protection of Breast Feeding) Act, 1992 – Bans promotion/advertisement of infant formula milk
| Type | Meaning | Example |
|---|---|---|
| Innate (Natural) Immunity | Born with it – non-specific defense | Skin, tears, stomach acid |
| Acquired Immunity | Developed after exposure | After infection or vaccine |
| Active Immunity | Body MAKES its own antibodies | After disease / after vaccine |
| Passive Immunity | READY-MADE antibodies received from outside | Mother's milk (IgA), Antiserum injection |
| Natural Active | After suffering a disease | Measles infection → lifelong immunity |
| Artificial Active | After receiving vaccine | BCG, MMR vaccines |
| Natural Passive | Antibodies from mother to baby | Through placenta (IgG), Colostrum (IgA) |
| Artificial Passive | Antibodies injected | Anti-tetanus serum (ATS), Antisnake venom |
N – Natural Active (disease itself) A – Artificial Active (vaccine) P – Natural Passive (mother → baby) I – Artificial Passive (injection of antibodies)
Remember: Active = Antibodies MADE by you | Passive = Antibodies GIVEN to you
| Type | What it contains | Examples |
|---|---|---|
| Live Attenuated | Weakened live organisms | BCG, OPV (polio drops), MMR, Varicella |
| Killed/Inactivated | Dead organisms | IPV (injectable polio), Flu vaccine, Rabies |
| Toxoid | Inactivated toxin | DT, TT (Tetanus Toxoid) |
| Subunit/Conjugate | Part of organism (antigen only) | Hepatitis B, Hib, HPV |
| mRNA Vaccine | mRNA to produce antigen in body | COVID-19 (Pfizer, Moderna) |
| Recombinant | Genetically engineered antigen | Hepatitis B (rDNA) |
L – Live Attenuated (e.g., BCG) K – Killed (e.g., Rabies) T – Toxoid (e.g., TT) S – Subunit (e.g., Hep B) M – mRNA (e.g., COVID) R – Recombinant (e.g., rHBsAg)
UIP Started: 1978 → Expanded Programme on Immunization | 1985 → UIP launched across India
| Age | Vaccine | Disease Prevented |
|---|---|---|
| Birth | BCG + OPV-0 + Hepatitis B (1st) | TB, Polio, Hepatitis B |
| 6 weeks | OPV-1 + Penta-1 + Rota-1 + PCV-1 + fIPV-1 | Polio, DPT+HepB+Hib, Diarrhoea, Pneumonia |
| 10 weeks | OPV-2 + Penta-2 + Rota-2 + fIPV-2 | Same as above |
| 14 weeks | OPV-3 + Penta-3 + Rota-3 + PCV-2 | Same as above |
| 9 months | MR (Measles+Rubella) + Vitamin A + PCV Booster | Measles, Rubella |
| 16-24 months | OPV Booster + Penta Booster + MR 2nd dose | All above |
| 5-6 years | DPT Booster-2 + OPV | Diphtheria, Pertussis, Tetanus, Polio |
| 10 years + 16 years | Td (Tetanus + Diphtheria) | Tetanus, Diphtheria |
| Pregnant women | TT (2 doses) | Neonatal Tetanus |
B – BCG O – OPV-0 (Zero dose) P – Polio + Hep B
Cold Chain = System to store and transport vaccines at correct temperature to maintain their effectiveness.
GOLDEN RULE: Temperature = 2°C to 8°C for most vaccines | OPV can be stored at -20°C (frozen)
Water Pollution = Contamination of water sources by harmful substances making it unfit for use.
| Source | Examples |
|---|---|
| Industrial | Factory waste, heavy metals (lead, mercury), dyes |
| Agricultural | Pesticides, fertilizers (nitrates), runoff |
| Domestic/Sewage | Human waste, detergents, garbage dump near water |
| Pharmaceutical | Drugs excreted in urine, unused medicines dumped |
| Biological | Animal excreta, algae bloom |
| Disease | Causative Agent | Route | Prevention |
|---|---|---|---|
| Cholera | Vibrio cholerae | Contaminated water/food | ORS, Vaccination, Safe water |
| Typhoid | Salmonella typhi | Faeco-oral route | Vaccine, Boil water |
| Hepatitis A | Hepatitis A Virus | Contaminated food/water | Vaccine, Hand hygiene |
| Dysentery | Shigella / Amoeba | Contaminated water | Safe water, Hygiene |
| Diarrhoea | E. coli, Rota virus | Oral-faecal | ORS, Hygiene, Vaccine |
| Polio | Poliovirus | Oral-faecal | OPV/IPV vaccine |
| Guinea Worm | Dracunculus | Drinking infested water | Filter water |
| Fluorosis | Excess Fluoride | Groundwater | Defluoridation |
C – Cholera A – Amoebic dysentery T – Typhoid C – Cryptosporidiosis H – Hepatitis A D – Diarrhoea P – Polio F – Fluorosis
Safe water = Free from pathogens, harmful chemicals, and within WHO standards
| Method | How it works |
|---|---|
| Boiling | Kill all pathogens – simplest home method |
| Chlorination | Chlorine kills bacteria (0.5 ppm residual) |
| Filtration | Removes suspended particles (Sand filter, Candle filter) |
| UV Treatment | UV rays kill microorganisms without chemicals |
| Reverse Osmosis (RO) | Removes dissolved salts, heavy metals, bacteria |
| Flocculation + Sedimentation | Alum added → particles settle (used in municipalities) |
Air Pollution = Presence of harmful substances in air in concentrations that affect human health and environment.
| Pollutant | Source | Health Effect |
|---|---|---|
| Carbon Monoxide (CO) | Vehicle exhaust, incomplete burning | Suffocation, headache, death in high dose |
| Sulphur Dioxide (SO2) | Industries, power plants | Bronchitis, acid rain |
| Nitrogen Oxides (NOx) | Vehicles, industry | Lung damage, smog |
| Particulate Matter (PM2.5, PM10) | Dust, smoke, factories | Lung disease, cardiovascular disease |
| Lead (Pb) | Old paints, leaded petrol | Neurotoxicity, especially in children |
| Ozone (O3) | Secondary pollutant from smog | Eye irritation, lung damage |
| Hydrocarbons | Vehicle exhaust, industry | Carcinogenic (cancer) |
C – CO (Carbon monoxide) S – SO2 (Sulphur dioxide) N – NOx N – Nitrogen dioxide P – Particulate Matter (PM) L – Lead O – Ozone
| System Affected | Specific Effects |
|---|---|
| Respiratory | Asthma, Bronchitis, COPD, Lung cancer |
| Cardiovascular | Heart attack, Hypertension |
| Neurological | Lead causes IQ reduction in children |
| Ocular (Eye) | Irritation, Conjunctivitis |
| Dermatological (Skin) | Rashes, Allergic reactions |
Noise Pollution = Unwanted or excessive sound that causes harm to human health and environment.
| Level (dB) | Source | Health Effect |
|---|---|---|
| <40 dB | Whisper, Library | Safe |
| 60–70 dB | Normal conversation, TV | Acceptable |
| 80–90 dB | Heavy traffic, Factory | Hearing damage on prolonged exposure |
| >90 dB | Aircraft, Explosions | Permanent hearing loss |
| >120 dB | Rocket launch | Immediate pain + damage |
WHO LIMIT: 85 dB is the safe limit for 8-hour work exposure
| Method | Description |
|---|---|
| Dilution | Dispose sewage into large water body (river) – NOT recommended today |
| Land Disposal | Sewage used as agricultural fertilizer (after treatment) |
| Sewage Treatment Plant (STP) | 3 stages: Primary → Secondary → Tertiary treatment |
| Septic Tank | Household-level treatment, anaerobic decomposition |
| Oxidation Pond | Sunlight + algae + bacteria treat waste naturally |
PRIMARY TREATMENT – Physical removal (screens, settling tanks) – removes solid particles
↓
SECONDARY TREATMENT – Biological (bacteria break down organic matter)
↓
TERTIARY TREATMENT – Chemical (Chlorination, UV) – kills remaining pathogens
| Method | Used For |
|---|---|
| Landfill | Burying non-hazardous waste underground |
| Incineration | Burning at high temp – used for hospital (biomedical) waste |
| Composting | Organic waste → natural fertilizer |
| Recycling | Reuse of plastic, paper, glass, metal |
| Pyrolysis | High-temp breakdown without oxygen – for plastic waste |
Occupational Disease = Disease caused due to the nature of one's work/profession.
| Occupation | Hazard | Disease |
|---|---|---|
| Coal miners | Coal dust (silica) | Pneumoconiosis / Black lung disease |
| Cotton mill workers | Cotton dust | Byssinosis |
| Farmers | Pesticides | Organophosphate poisoning |
| Painters | Lead paint | Lead poisoning (Plumbism) |
| Welders | Metal fumes | Metal fume fever, Manganism |
| Computer workers | Radiation, posture | Eye strain, Carpal tunnel syndrome |
| Stone cutters | Silica dust | Silicosis |
| Asbestos workers | Asbestos fibres | Asbestosis, Mesothelioma |
P – Pneumoconiosis (coal dust) A – Asbestosis (asbestos) S – Silicosis (silica) S – Siderosis (iron dust)
Pharmaceutical pollution = Contamination of environment by drugs through various routes.
| Source/Route | Explanation |
|---|---|
| Patient Excretion | Drugs excreted in urine/feces enter sewage → rivers |
| Unused Medicines Disposal | Flushing tablets in toilet, throwing in dustbin → soil/water |
| Hospital Waste | IV bags, syringes, expired medicines disposed incorrectly |
| Pharmaceutical Industries | Effluents from manufacturing plants released into water |
| Agriculture/Veterinary | Antibiotics used in livestock → soil and water contamination |
REMEMBER: PHARMACIST is the LAST LINE of defense in preventing pharmaceutical environmental pollution!
| Term | Meaning |
|---|---|
| Drug Misuse | Using a drug for wrong purpose or wrong dose (e.g., taking antibiotics for cold) |
| Drug Abuse | Using a drug for non-medical purpose to get 'high' (e.g., sniffing glue) |
| Drug Dependence | Compulsive need to take a drug repeatedly |
| Tolerance | Need for higher dose to get same effect over time |
| Withdrawal Syndrome | Unpleasant symptoms when drug is stopped suddenly |
| Addiction | Psychological + Physical dependence on a drug |
D – Dependence = Can't stop (need the drug) T – Tolerance = Need more (body adjusts to drug)
| Drug/Category | Examples | Short-term Effect | Long-term Harm |
|---|---|---|---|
| Psychotropics (CNS Depressants) | Benzodiazepines, Barbiturates | Sedation, relaxation, euphoria | Dependence, memory loss, respiratory depression |
| Narcotics/Opioids | Heroin, Morphine, Codeine, Brown sugar | Pain relief, intense euphoria ('rush') | Severe addiction, HIV (sharing needles), death on overdose |
| Alcohol | Beer, Wine, Whisky | Relaxation, disinhibition, slurred speech | Liver cirrhosis, brain damage, accidents |
| Tobacco | Cigarettes, Bidi, Gutka, Pan masala | Mild stimulant effect, relaxation | Lung/oral cancer, heart disease, COPD |
| Cannabis/Marijuana | Ganja, Charas, Hashish | Euphoria, altered perception | Psychosis, memory impairment |
| Stimulants | Cocaine, Amphetamines, Ecstasy (MDMA) | Increased alertness, energy, confidence | Heart attack, psychosis, addiction |
| Inhalants | Glue, paint thinner, petrol | Brief high, dizziness | Brain damage, sudden death |
P – Psychotropics A – Alcohol T – Tobacco C – Cannabis H – Heroin (Narcotics) N – Nicotine
| Area | Impact |
|---|---|
| Family | Violence, neglect, broken homes, financial ruin |
| Society | Crime, accidents, spread of HIV/AIDS, prostitution |
| Workplace | Loss of productivity, absenteeism, accidents |
| Economy | Healthcare burden, lost workforce, crime costs |
| Youth | School dropout, antisocial behaviour, criminal involvement |
| Health System | Overburden of hospitals with overdose, liver disease, HIV cases |
PHARMACIST'S ROLE: Do NOT supply large quantities of sleeping pills/benzodiazepines to at-risk patients. Counsel and refer to psychiatrist.
NATIONAL HELPLINE: Vandrevala Foundation (24x7): 1860-2662-345 | iCall: 9152987821
| Topic | Key Point to Remember |
|---|---|
| Demography & Family Planning | India: 1st nation to adopt family planning (1952). Methods: COCCI trick. IMR ~28. |
| Mother & Child Health / Breastfeeding | Colostrum = PAVE. Breastfeed within 1 hr. IMS Act 1992 bans formula milk ads. |
| Vaccines & Immunity | NAPI-NAPI for immunity types. Vaccine types: LKTSM R. Cold chain: 2-8°C. UIP 1985. |
| Environment & Health | CATCH DPF (waterborne diseases). PM2.5 = lung disease. Sewage: 3 stages. PASS (lung diseases). Pharma waste → AMR. |
| Psychosocial / Drug Abuse | PAT CHN (abused drugs). NDPS Act 1985. Pharmacist: IDENTIFY → COUNSEL → RESTRICT → REFER → REPORT. |
Prepared with care for D. Pharma Students | Social Pharmacy – Chapter 2