PSM Booster by DR Mukhmohit Singh

Mukhmohit’s 20 POINT PSM BOOSTER Dose – Oct 2019
For updates: telegram Group t.me/mukhmohit01 or www.mukhmohit.com
20 POINT PSM BOOSTER

Updates at Glance: October 2019
SECTION 1 - UPDATES IN MCH
1. SUMAN – surakshit matritva ashwasan
a. Free ANC, delivery and post-natal care
b. free treatment for sick new neonates
2. RMNCH+A – 5 x 5 matrix, focus on adolescent
3. Nutritional rehabilitation centres
Services:
a. 24-hour monitoring and childcare
b. treatment of medical complications
c. therapeutic feeding
d. sensory stimulation and emotional care
e. counselling, demonstrations, assessment of risk factors
f. follow ups
Management
a. stabilization phase – starter diet
b. transition phase - Catch up diet
c. rehabilitation phase - normal feeding at home
Follow-up
a. weekly for first month, and then once in 14 days till discharge from the program
4. LAQSHYA - Labor Room Quality Improvement Initiative

5. Lactational management centres – to promote breast feeding and human milk donor
6. PMSMA – PM surakshit matritva abhiyan – 9th of every month, free ANC at all
empaneled hospitals
7. INAP – India Newborn action plan - Targets
a. Ending Preventable Newborn Deaths to achieve “Single Digit NMR” by 2030, with
all the states to individually achieve this target by 2035.
b. Ending Preventable Stillbirths to achieve “Single Digit SBR” by 2030, with all the
states to individually achieve this target by 2035
8. MAA – Mothers’ absolute affection – to promote breast feeding
9. Mission parivar vikas – to promote use of contraception
a. newer contraception as ANTRA, Chaaya, and iPill
Compiled and Edited by Mukhmohit singh @PSM Simplified, 2019 1

SECTION 2 - UPDATES IN MoHFW- other schemes

1. AMRIT – Affordable Medicines and reliable implants for treatment
a. to reduce the expenditure incurred by patients on treatment of cancer and heart
diseases
b. The project has been floated in a tie-up with government owned HLL Lifecare
Ltd (HLL) which is deputed to establish and run the AMRIT chain of
pharmacies across the country
2. PMSSY – PM Swasthya suraksha Yojna – for providing tertiary level health care,
opening of AIIMS like institutes in India
3. Kayakalp – for sanitation and cleanliness in public hospitals
4. Nirmal gram – for cleanliness and sanitation with safe water supply in villages
5. Swachh bharat – for cleanliness, sanitation and solid waste management in the country
6. Ujala, Ujjwala, Ujjawala
a. UJJAWALA: A Comprehensive Scheme for Prevention of trafficking and
Rescue, Rehabilitation and Re-integration of Victims of Trafficking and
Commercial Sexual Exploitation
b. Pradhan Mantri Ujjwala Yojana (PMUY) – safer fuels, petroleum ministry
c. National Ujala distribution scheme – for energy efficient lighting by LED bulbs
7. Indradhanush in health
a. Mission Indradhanush - for safe vaccine and universal vaccine coverage
b. Indradhanush scheme – for clean bed sheets, 7 days, 7 colored bedsheets in ESI
hospitals
8. AB-PMJAY - Ayushman bharat – PM Jan Arogya Yojna
a. 50 crore population, 10 Cr families
b. Health insurance of upto 5 Lac INR per family
c. No limit of age, gender, type of disease, members in family
9. AMB – Anemia Mukt bharat
a. 6 x 6 x 6 program – 6 targets, 6 interventions, 6 institutional mechanisms
b. IFA tablets to all beneficiaries
c. deworming to all beneficiaries
10. POSHAN – PM overarching scheme for holistic nutrition
a. Decrease LBW and stunting by 2% every year
b. Decrease anemia by 3% every year
11. Jai Vigyan – to know about Rheumatic fever prevalence, streptococcal infection
prevalence, deeper understanding of pathology of RHD and RF, vaccine development
for RHD/RF
12. Vyoshri Yojna – for safeguarding the health of elderly population
13. Information technology updates:
a. m-cessation – for tobacco cessation
b. m-diabetes – for Diabetes primary, secondary prevention
c. e-raktkosh – for safe blood donation and blood bank services
d. Mera aspatal – platform for feedback from public and private hospitals
e. My health record – personal health record locker
f. NHP Swasth bharat mobile application

SECTION 3 – ESI update:

https://www.esic.nic.in/ update July 2019
1. Employer contribution – 3.25% of monthly wage (4% in few states)

2. Employee contribution – 0.75% of monthly wage (1% in few states)
3. The state government’s share in the ESI contribution is 1/8th and that by the central
government is 7/8th
4. ESI benefit is not given to worker with salary more than 21,000 INR per month
(25,000 INR for people with disability)
5. Sickness benefit (SB): upto 70% wage for 91 Days
a. eligibility – 78 days contribution in previous 6 months
6. Extended sickness benefit – upto 80% wage for 34 diseases, SB extended upto TWO
years
7. Enhanced Sickness benefit: full wage benefit for 7 days and 14 days for sterilization
by male and female respectively.
8. Maternity benefit payable for upto 26 weeks (extendedable by 1 month on medical
advice)
9. Old Age medical care – Medical care is also provided to retired and permanently
disabled insured persons and their spouses on payment of a token annual premium of
Rs.120/- .
10. Funeral expense – 15000 INR
Rajiv Gandhi Shramik Kalyan Yojana: Unemployment allowance

An Insured Person who become unemployed after being insured three or more years, due to
closure of factory/establishment, retrenchment or permanent invalidity are entitled for:
• Unemployment Allowance equal to 50% of wage for a maximum period of upto Two
Years.
• Medical care for self and family from ESI Hospitals/Dispensaries
• Vocational Training provided for upgrading skills - Expenditure on fee/travelling
allowance borne by ESIC
Atal Beemit Vyakti Kalyan Yojana:

• Once in lifetime - cash compensation for upto 90 days, not exceeding 25% of average
day earning
• Eligibility:
o atleast TWO years of insurable employment with more than 78 days presence
and contribution towards ESI

SECTION 4 – FAQ + Controversies

Most Frequent asked Data:
Date: Oct 2019 Birth rate Death rate IMR Natural growth MMR
rate
India 20.2 6.3 33 13.9 130
Maximum Bihar 26.4 Chhattisgarh 7.5 MP 42 Bihar 20.6 Assam 237
Minimum A&N 11.4 Nagaland 3.6 Nagaland 7 Puducherry 5.9 Kerala 46
Sex ratio: 991, Child sex ratio (0-6 years) – 916.

Source: NFHS 4 report, page 70. http://rchiips.org/nfhs/NFHS-4Reports/India.pdf
Controversaries
1. ASHA – 1 ASHA / 1000 population
2. DALY – Disability Adjusted Life years
• for population impact of fatal and non-fatal disabling conditions
• assessment of health impact
3. Literacy Rate: Kerala (91.98%) > Tripura (83.15%)
Source:
http://www.pincodeindia.net/literacy-rate.php, https://www.census2011.co.in/
http://rchiips.org/NFHS/NFHS-4Reports/India.pdf
4. Rabies –
a. RIG is NOT recommended to be repeated (once in lifetime)
b. repeat vaccination (on re-exposure) is done only if the previous vaccination
(either pre or post exposure vaccine) was done MORE THAN three months
ago
5. National deworming days – 10 Feb and 10 Aug, 400 mg Albendazole to all children 2-
19 years and 200 mg for age 1-2 years children (note: initially this program was
launched as single day on 10 feb, later on many started twice annually albendazole
tablets on 10 feb and 10 august)
6. IFA tablets – 60 mg iron + 500 mcg folic acid (note ferrous sulphate has good
absorption and is preferred component in the IFA tablets) by Anemia Mukt Bharat
7. MUAC – Mid Upper arm circumference. UNICEF’s Shakir Tape
a. Mild malnutrition – 11.5 – 12.5 cms
b. severe Malnutrition - < 11.5 cms

Modes of transmission
EBOLA Virus Disease
The virus spreads through direct contact (such as through broken skin or mucous membranes
in the eyes, nose, or mouth) with:
• Blood or body fluids (urine, saliva, sweat, feces, vomit, breast milk, and semen) of a
person who is sick with or has died from Ebola Virus Disease (EVD)
• Objects (such as needles and syringes) contaminated with body fluids from a person
sick with EVD or the body of a person who died from EVD
• Infected fruit bats or nonhuman primates (such as apes and monkeys)
• Semen from a man who recovered from EVD (through oral, vaginal, or anal sex).
Note: There is no evidence that Ebola can be spread through sex or other contact with vaginal
fluids from a woman who has had Ebola
ZIKA Virus disease

• Zika is spread mostly by the bite of an infected Aedes species mosquito (Ae. aegypti
and Ae. albopictus).
• Zika can be passed from a pregnant woman to her fetus and lead to birth defects
• Zika can be passed through sex from a person who has Zika to his or her partners.
Condoms can reduce the chance of getting Zika from sex. Condoms include male and
female condoms.
Disease Infectivity Period Period of Isolation

Diphtheria 2-4 weeks from onset Till 2 consecutive negative
nose/throat swabs
Pertussis 1 week before to 3 weeks after onset 4 weeks or till paroxysm ceases
of paroxysmal stage
Influenza 1-4 days 3 days after symptoms start
Measles 4 days before & 4 days after rash Onset of catarrhal to 3rd day of
rash
Mumps 7 days before and 7 days after onset Till swelling subsides
of symptoms
Chickenpox 2 days before and 5 days after rash 6 days after onset of rash
Polio 7-10 days before & after onset of 2 weeks for adults & 6 weeks in
symptoms Children
October Breast cancer awareness month

April Last week World immunization week
August 1st week breast feeding week
September 1st week National nutritional week
June National anti-malaria month

Important Days
• Jan 30 World Leprosy Day
• Feb 04 World Cancer Day
• March 03 World Hearing day
• March 22 World water day
• March 23 World meteorological day
• March 24 World TB day
• April 07 World health day
• April 25 World Malaria day
• April 28 World day for occupational safety
• May 01 World Labor Day
• May 09 World thalassemia day
• May 17 World hypertension day
• May 31 World anti-tobacco day
• June 05 World environment day
• July 01 Mid-year population counting day
• July 06 World zoonoses day
• July 11 World population day
• July 28 World hepatitis day
• August 20 World Mosquito day
• September 08 World Literacy day
• September 10 World anti suicide day
• September 21 World Alzheimer day,
• September 21 World marrow donor day
• September 23 International day of sign languages
• September 26 World contraception day
• September 28 World rabies day
• September 29 World heart day
• October 6 World cerebral palsy day
• October 10 World Sight day
• October 10 World mental health day
• October 12 World arthritis Day
• October 15 Global handwashing day
• October 16 World food day
• October 17 World trauma day
nd
• October 2 Wednesday World disaster reduction day
nd
• October 2 Thursday World sight day
th
• October 24 UN Day, world polio day
• November 11 World diabetes day
• November 19 World toilet and sanitation day
• December 01 World AIDS day

SECTION 5 – GLOBAL HEALTH

Sustainable development goals - Survive – Thrive & Transform
Health
1. Reduce global maternal mortality to less than 70 per 100,000 live births
2. Reduce newborn mortality to at least as low as 12 per 1,000 live births in every
country
3. Reduce under-five mortality to at least as low as 25 per 1,000 live births in every
country
4. End epidemics of HIV, tuberculosis, malaria, neglected tropical diseases and other
communicable diseases
5. Reduce by one third premature mortality from non-communicable diseases and
promote mental health and well-being
Global action Plan

GAPPD - Global plan for prevention and control of pneumonia and diarrhoea –
Goals for 2025
Reduce mortality in Under 5 to less than 3/1000 Live births

Reduce mortality from diarrhoea in under 5 to less than 1/1000 Live births
Reduce incidence of severe pneumonia in under 5 to less than 75% compared to 2010 levels
Reduce incidence of severe diarrhoea in under 5 to less than 75% compared to 2010 levels
Reduce prevalence of Stunting in under 5 to less than 40% compared to 2010 levels
to achieve by end of 2025

ü 90% coverage of each vaccine
ü 90% access to diarrhoea and pneumonia case management
ü atleast 50% coverage of exclusive breast feeding till 6 months
ü virtual elimination of Pediatric HIV
WHO Global action plan for prevention of NCD’s 2013-2020
Variable Target
Harmful use of alcohol in national context 10% relative reduction
Prevalence of insufficient physical activity 10% relative reduction
Mean population intake of salt/sodium 10% relative reduction
Tobacco use in 15+ years 30% relative reduction
Premature mortality from CVD, cancer, diabetes and chronic 25% relative reduction
respiratory disease
Prevalence of high blood pressure 25% relative reduction
Increased incidence of diabetes and obesity Halt
Atleast 50% of the eligible people to receive drug therapy and counselling to prevent heart
attack and stroke
Atleast 80% availability of affordable technology and essential medicines including generics
required to treat major NCD’s in both public and private health facilities

SECTION 6 – RNTCP / Tuberculosis:

Diagnostic Algorithm – Pulmonary Tuberculosis – Update 2019
Paediatric
Diagnostic Algorithm – Extra Pulmonary Tuberculosis – Update 2019

Diagnostic Algorithm – Pediatric Pulmonary Tuberculosis – Update 2019
CXR highly suggestive
Decision for starting Anti TB regimen

1. Fist line regime (for cat I and II) - at all TB centers, PHC, CHC
2. District TB center – (District level)
a. MDR TB regimen
b. Rifampicin resistant TB regimen
c. Mono drug resistant TB
3. National DR TB centers
a. XDR TB
b. MDR and other poly drug resistance
c. other mixed pattern Drug resistance
TB preventive therapy

INH 10 mg/kg OD x 6 months
check for risk of drug induced hepatitis
indications:
- all children < 6 years contact of a SP case
- HIV positive children (no age bar) with TST positive and contacts of TB case
- All TST positive children (no age bar) on immunosuppressive therapy
- children born to TB positive mother diagnosed in pregnancy (after ruling out
congenital TB and administration of BCG Vaccine)

The new TB regimes are:

1. 2HRZE + 4HRE for all new TB case and previously treated TB patients
2. Shorter MDR Regime: (4-6) Mfxh Km* Eto Cfz Z Hh E + (5) Mfxh Cfz Z E
3. Conventional MDR and RR TB Regime: (6-9) Lfx Km Eto Cs Z E + (18) Lfx Eto Cs
E
4. INH resistant (mono drug) – 6 months ZERO (Levofloxacin, Rifampicin, Ethambutol,
Pyrazinamide)
5. XDR regime – use of OBR with DST (optimized basal regime with drug sensitivity
testing)
6. BPaL (Bedaquiline + Pretomanid + Linezolid) – from NixTB trials. for XDRTB,
failures of MDR TB treatment regime. BPaL along with OBR maybe initiated at
selected centers.
Indications for giving Bedaquiline

1. MDR/RR-TB patients with resistance to any/all Fluoroquinolones OR to any/all Second
Line Injectables
2. XDR-TB patients
3. Mixed pattern resistant TB patients
4. Treatment failures of MDR-TB + FQ/SLI resistance OR XDR-TB
5. MDR/RR-TB patients with extensive pulmonary lesions, advanced disease and others
deemed at higher baseline risk for poor outcomes
Some recent changes in RNTCP (Summary Oct 2019)

1. All previously treated cases also need to be initiated on standard first line regimen (2
HRZE+4 HRE)
2. CB NAAT at baseline to rule our Rifampicin resistance.
3. FL-LPA to be offered to all Previously treated patients at baseline itself to know INH
susceptibility status.
4. No need to wait for the FL-LPA results to start on First line regimen.
5. Fortnight clinical review, ophthalmic examination of all TB patients
6. Cases without specimens can be directly initiated on First-line regime (need to be
followed up clinically / radiologically to identify any non-response).
7. Honorarium for
a. Nikshay Poshan Yojna – 500 INR for all patients on ATT for nutritional
support
b. Treatment supporters same for New patient and previously treated – INR 1000
c. Drug Resistant Case: Rs. 2000/- at completion of intensive phase, Rs. 3000/-
at completion of treatment

SECTION 7 – Leprosy:
Leprosy new treatment:
Drug sensitive Leprosy
Drug Adult dosage Children (10-14 yrs.) Children < 10 yrs. or < 40Kg
Rifampicin 600 mg once monthly 450 mg once monthly 10 mg/kg once monthly
Clofazamine 300 mg monthly 150 mg monthly 6 mg/kg monthly
50 mg daily 50 mg daily 1 mg/kg daily
Dapsone 100 mg daily 50 mg daily 2 mg/kg daily
Duration of treatment
multibacillary – 12 months
Paucibacillary – 6 months
Drug resistance leprosy (24 months treatment)
6 months Daily 18 months Daily

Ofloxacin Ofloxacin or Minocycline
Rifampicin resistance Minocycline Clofazamine
Clofazamine
Ofloxacin Ofloxacin
Rifampicin resistance Clarithromycin Clofazamine
Clofazamine
Rif + Oflox resistance Minocycline Minocycline or Clarithromycin
Clarithromycin Clofazamine
Clofazamine
Rifampicin Prophylaxis
Age / weight Rifampicin dose

15 years and above 600 mg
10 – 14 years 450 mg
Children 6-9 years (weight > 20 kg) 300 mg
Children < 20 kg (and > 2 years) 10-15 mg/kg

SECTION 8 - HIV
Updates summary:
1. 90-90-90 targets – 90% of all HIV to be detected, 90% to be treated and 90% of all
treated should achieve a viral load remission
2. TREAT ALL PLHIV
3. Diagnosis of HIV infection in infants and children aged less than 18 months of age by
DNA PCR test for age > 6 weeks but < 18 months.
HIV treatment:
1. First line regime: Tenofovir + Lamivudine + Efavirenz
2. For all ARV naive patients except those with
a. known renal disease (or)
b. HIV-2 or HIV-1 & 2 infection (or)
c. women with single dose Nevirapine exposure in past pregnancy
3. renal disease: Abacavir + Lamivudine + Efavirenz
4. HIV 1 and HIV 2 coinfection: Tenofovir + Lamivudine + Lopinavir/ritonavir
5. ART regimen for pregnant women having prior exposure to NNRTI for PPTCT -
TDF + 3TC and LPV/r
6. Post exposure prophylaxis – (to be continued for 4 weeks)
a. Tenofovir (300) + Lamivudine (300)- One tablet once daily
b. Lopinavir (200) + Ritonavir (50)-Two FDC tablets twice daily
7. Cotrimoxazole preventive therapy
a. One double strength tablet – 800 sulphamethoxazole + 160 mg trimethoprim
b. START – CD4 < 350 / mm3
c. STOP - CD4>350 on two occasions six months apart + ascending trend of
CD4 + no WHO stage 3,4
8. Immunizations in HIV
a. ALL vaccines are to be given to the child born to HIV positive mother
b. Live vaccine are NOT recommended if child is SYMPTOMATIC for HIV
and/or CD4 count is < 15%
c. desirable vaccines over and above the routine national immunization vaccines
are:
i. inactivated hep A
ii. pneumococcal conjugate vaccine
iii. inactivated influenza vaccine
iv. varicella vaccine (subject to child immunological status)
9. new NACO projects:
a. Nirantar scheme – in MP, Odisha and other states. To improve access to HIV
prevention, care and treatment services
b. Link Worker Scheme: It involves highly motivated and trained community
members, responsible for establishing links between the community on one
hand and information, commodities and services on the other
c. Sunrise Project – for North eastern states, for drug abusers and other high risk
groups for primary and secondary prevention in HIV

10. Newer vaccine for HIV
a. Recombinant subunit vaccine (rAAV – recombinant adeno associated virus
vaccine)
b. Peptide vaccine
c. DNA vaccine
d. Recombinant vector vaccines (Ankara vaccine)
e. Replicons
11. National strategic Plan for HIV/AIDS - 2017-2024
a. Objective 1: Reduce 80% new infections by 2024 (Baseline 2010)
b. Objective 2: Ensure 95% of estimated PLHIV know their status by 2024
c. Objective 3: Ensure 95% PLHIV have ART initiation and retention by 2024,
for
d. sustained viral suppression
e. Objective 4: Eliminate mother-to-child transmission of HIV and Syphilis by
2020
f. Objective 5: Eliminate HIV/AIDS related stigma and discrimination by 2020
g. Objective 6: Facilitate sustainable NACP service delivery by 2024
NACO HIV treatment and care facilities:
Selected medical colleges Centers of excellence and ART plus centers

Medical colleges and district level hospitals ART centers
Sub district level hospitals and CHC Link ART centers
NACO Counselling services:
State and district level hospitals, medical Standalone ICTC centers

colleges
Sub district level, CHC, Civil hospitals Standalone ICTC, facility ICTC
Village level – PHC, Private hospitals, NGOs Standalone ICTC, facility ICTC
Community level HIV screening using whole blood finger prick
test, mobile ICTC reaching vulnerable
population and High-risk groups or unreached
population
Categorization of districts based on HIV as public health problem

Prevalence of HIV in ANC Prevalence in high risk groups
females
A >1% -NA-
B < 1% > 5% in the high-risk groups
C < 1% < 5% in the high-risk groups, with known hot spots
D < 1% < 5% in the high-risk groups, with no known hot spots
Hot spots: aggregation of high risk groups as migrant laborer , truck drivers, factory workers,
drug abusers

SECTION 9 – Malaria Management update

1. Pl Vivax (no area specific treatment, its same for whole country)
a. chloroquine @ 25 mg/kg OVER 3 days
i. Day 1 – 10 mg/kg
ii. Day 2 – 10 mg/kg
iii. Day 3 – 5 mg/kg
b. Primaquine @ 0.25 mg/kg x 14 days
2. Pl. Falciparum – in North Eastern States (NES)
a. Co-formulated ACT-AL with:
i. Artemether 20 mg
ii. Lumefantrine 120 mg
b. Primaquine @ 0.75 mg/kg body weight on Day 2, single dose
3. Pl. Falciparum – in all states (except NES)
a. artemisinin based combination therapy - ACT-SP with
i. Artesunate 4mg/kg body weight x 3 days
ii. Sulphadoxine 25 mg/kg body weight on Day 1
iii. Pyrimethamine 1.25 mg/kg body weight on Day 1
b. Primaquine @ 0.75 mg/kg body weight on Day 2, single dose
Note:
• SP is not given to child age < 5 months
• ACT-SP is not given to pregnant females
• ACT AL is not given to
o Pregnant females
o child weight < 5kg
• Primaquine is contraindicated in
o G6PD
o child age < 1 year
o pregnant females
4. Treatment in pregnancy:
• 1st trimester – quinine salt 10 mg/kg 3 times daily for 7 days
• 2nd and 3rd trimester – Area specific ACT (ACT-AL or ACT-SP)
SECTION 10 – Influenza update

1. Vaccine:
a. Flu (killed) inactivated vaccine – Michigan, Colorado, Phuket, Switzerland strains
b. Flu live vaccine – not very commonly used, nasal spray, contraindicated in immune
deficient states
2. Treatment
a. oseltamivir 75 mg BD for 5 days (extended to 10 days if fever persist on day 6)
b. Baloxavir marboxil (new FDA approved drug) is a novel oral selective inhibitor of
influenza cap-dependent endonuclease that blocks influenza proliferation by
inhibiting the initiation of mRNA synthesis.

SECTION 11 – Polio and NPSP

POLIO EPIDEMIOLOGY
v most outbreaks due to polio type 1
v man is the only reservoir of infection
v most infections are subclinical
v subclinical infections contribute to majority of cases of polio.
v It shows an iceberg phenomenon
v infective material: faeces of the infected persons
v period of communicability: most infectious 7-10 days before and after the onset of
symptoms.
v more in males (3:1 for male: female ratio)
v age: 50% of all cases are reported in infancy
v shows seasonal variation: from June to September
v mode of transmission: feco-oral route, direct contact and direct droplet spread
v incubation period: 7-14 days (3-30 days)
v clinical spectrum:
o inapparent infection ~ 90-95% of all infections
o abortive infection ~ 4-8% of all infections
o non-paralytic polio ~1% of infections
o paralytic polio < 1% of all infections
polio virus
v WPV type 2 is not detected since 1999
v WPV type 3 is not detected since Nov 2012
v Most epidemics were ported from WPV Type 1
v Switch from tOPV to bOPV in April-May 2016
v bOPV contains – P1 and P3
v FIPV (fractional IPV) is scheduled at 6- and 14-weeks intradermal injection, 0.1 mL
in right upper arm
National Polio Surveillance Program

v AFP surveillance:
o AFP reporting rate
§ should be more than 1AFP case /100,000 / year
§ in all children < 15 years of age
§ sensitive indicator for ability to detect polio in community
o stool adequacy rate
§ should be more than 80%
§ indicator for operation efficacy of program
§ the stool sample should reach the laboratory within 72 hours of
collection
v Surveillance Indicators
o completeness of reporting >80% of expected AFP surveillance
o sensitivity of surveillance > 1 AFP / lac / year in age < 15 years
o completeness of case investigation > 80% adequate stool sample collection
o completeness of follow up > 80% AFP cases should have the
residual paralysis check at 60 days

SECTION 12 – Cancer Update:
Source: WHO, International agency for research on cancer. Globocon 2018.

India fact sheet
1. Most common cancer in INDIA
MALE (India) FEMALE (India) Both gender (India)

Lip and oral cavity (16.1%) Breast cancer (27.7%) Breast cancer (14%)
Lung (8.5%) Cervix uteri (16.5%) Lip and oral cavity (10.4%)
Stomach (6.8%) Ovary (6.2%) Cervix uteri (8.4%)
Colorectal (6.4%) Lip oral cavity (4.8%) Lung (5.9%)
Oesophagus (5.9%) Colorectal (3.4%) Stomach (5%)
Mortality ranks due to cancer

1. Breast cancer (11.1%)
2. Lip and oral cavity (9.3%)
3. Lung (8.1%)
4. Cervix uteri (7.7%)
5. Stomach (6.6%)
For further reading: https://gco.iarc.fr/today/data/factsheets/populations/356-india-fact-

sheets.pdf
SECTION 13 – Rashtriya Bal Swasthya Karyakram

DEFECTS DEVELOPMENTAL DELAYS
1. Neural tube defect 15. Vision Impairment
2. Down's Syndrome 16. Hearing Impairment
3. Cleft Lip & Palate / Cleft palate alone 17. Neuro-motor Impairment
4. Talipes (club foot) 18. Motor delay
5. Developmental dysplasia of the hip 19. Cognitive delay
6. Congenital cataract 20. Language delay
7. Congenital deafness 21. Behaviour disorder (Autism)
8. Congenital heart diseases 22. Learning disorder
9. Retinopathy of Prematurity 23. Attention deficit hyperactivity disorder
DEFICIENCIES DISEASES OF CHILDHOOD
10. Anaemia especially Severe anaemia 24. Skin conditions (Scabies, fungal
11. Vitamin A deficiency (Bitot spot) infection and Eczema)
12. Vitamin D Deficiency, (Rickets) 25. Otitis Media
13. Severe Acute Malnutrition 26. Rheumatic heart disease
14. Goiter 27. Reactive airway disease
28.Dental conditions
29. Convulsive disorders

SECTION 14 – Anemia Mukt bharat
AGE GROUP DOSE
Bi-weekly 1ml Iron and Folic Acid syrup. Each ml Iron and Folic Acid
Children 6-59 months of syrup containing 20 mg elemental Iron + 100 mcg of Folic Acid.
age Bottle (50ml) to have an ‘auto-dispenser’ and information leaflet as
per MoHFW guidelines in the mono-carton
Weekly, 1 Iron and Folic Acid tablet. Each tablet containing 45 mg

Children 5-9 years of age
elemental Iron + 400 mcg Folic Acid, sugar-coated, pink-colour.
School-going Adolescent
Girls and Boys, 10-19 years
of age Out-of-school
elemental Iron + 500 mcg Folic Acid, sugar-coated, blue-colour.
Adolescent Girls, 10-19
years of age
Women of Reproductive
Age (non-pregnant, non-
lactating) 20-49 years
elemental Iron + 500 mcg Folic Acid, sugar-coated and red-colour.
(Under Mission Parivar
Vikas)
Daily, 1 Iron and Folic Acid tablet starting from the fourth month of
Pregnant Women and pregnancy (that is from the second trimester), continued throughout
Lactating Mothers (of 0-6 pregnancy (minimum 180 days during pregnancy) and to be
months child) continued for 180 days, post-partum Each tablet containing 60 mg
elemental Iron + 500 mcg Folic Acid, sugar-coated and red-colour.
SECTION 15 – Salient features ICD -11 Classification

v 3 volumes
v Arabic numbered chapter
v 4 categories with 2 subcategories first character of the chapter correlates to the chapter
number
v 26 chapters – new chapter on sleep wake disorders, immune mediated diseases
v terminal letter ‘Y’ is reserved for the residual category ‘other specified’ and the terminal
letter ‘Z’ is reserved for the residual category ‘unspecified’

SECTION 16 – Rabies April 2018 – WHO recommendations
Category 1 Category 2 Category 3
No previous Wound wash Wound wash Wound wash

immunization
No PEP required 1. ID - 2 site – 0,3,7 1. ID - 2 site – 0,3,7
2. IM – 1 site – 2. IM – 1 site –
0,3,7,14-28 0,3,7,14-28
3. IM 2 site day 0 + 3. IM 2 site day 0 + 1
1 site IM 7,21 site IM 7,21
RIG is NOT indicated RIG is recommended

Previously Wound wash Wound Wash + vaccine* Wound Wash + vaccine*
immunized No PEP required 1. ID – 1 site 0,3 1. ID – 1 site 0,3
individuals of all 2. ID – 4 site day 0 2. ID – 4 site day 0
ages 3. IM – 1 site day 3. IM – 1 site day 0,3
(*Vaccine is NOT 0,3
given if PEP RIG is NOT indicated
received within < 3 RIG is NOT indicated
months previously)
Pre-Exposure Prophylaxis:
ID – 2 site 0,7
IM – 1 site 0,7
keep checking the Vaccine induced neutralizing antibody (VNA levels)
if VNA < 0.5 IU/mL (usually within 1-2 years) - ID or IM is recommended
SECTION 17 – Nutritional Functional indicators
Function Physiological parameter Indicator

Structural Erythrocyte fragility Vit E, Selenium
integrity Capillary fragility Vit C
Tensile strength Copper
Host defence Leucocyte chemotaxis Protein energy, zinc
system Leucocyte phagocytic and bactericidal Protein energy, iron
capacity
Delayed cutaneous hypersensitivity Protein energy, Zn
Haemostasis Prothrombin time Vit K
Reproduction Sperm counts Zn, Vit E, energy
Nerve function Nerve conductions Vit B1, B12
Dark adaptations Vit A, Zn
EEG Protein energy
Work capacity Heart rate Iron, Protein energy
Vasopressor response Vitamin C

SECTION 18 – Biomedical waste guidelines
CATEGORY SUB HEADING EXAMPLE

a. Human
Tissue, organ, fetus, placenta
anatomical waste
b. Animal
Animal parts
anatomical waste
c. Soiled waste Cotton, swab, dressings, plaster casts, face masks
d. Expired or
discarded Discarded tablets medicines, capsules, cytotoxic
medicine or chemicals
Cytotoxic Waste
e. Chemical waste Disinfectants, chemical in biologicals
Yellow
f. Chemical liquid Lab reagents, X ray film developer, floor
Category waste or infected washing fluids, formalin, infected fluids aspirated
body fluids from body
g. discarded linen,
mattress, beddings
Bed sheets, blankets, mattress soiled with
contaminated with
blood/body fluids
blood or body
fluid
h. Microbiology,
biotechnology, Culture plate, blood bags, vaccines (with
other clinical medications), glucometer strips
laboratory waste
Red Contaminated waste Plastic tubing, urine bags, vacutainers (plastic),
Category (rubber, tube, plastic) gloves, catheters, Ryle’s tube
Hypodermic needles, AD syringes, syringe with
White Sharps and metals fixed needles, knives, blades, scalpels, LP needle,
Category IV needle, trocars
Glass bottles, empty vaccine vials, broken
Blue Glassware
ampules
Category Metallic body implants Body implants, Plates, Screws, Wires

SECTION 19 – Immunization Update:
Important Adverse effects of vaccines:

BCG- Lymphadenitis
DPT- Uncontrollable cry, hypotensive, hypo-responsive episodes, Seizures
Measles- Toxic Shock Syndrome (due to denaturation of vaccine), Seizures, Immune
Thrombocytopenic Purpura, Sub acute Sclerosing Pan-encephalitis (rare)
Rota virus- Intussusception.

**anaphylaxis can be seen with any vaccine.
SECTION 20 – Important Data with source

Source: http://censusindia.gov.in/vital_statistics/SRS_Bulletins/Bulletins.html
MMR - https://niti.gov.in/content/maternal-mortality-ratio-mmr-100000-live-births
NFHS - http://rchiips.org/nfhs/
IDSP - https://idsp.nic.in/
Census: http://censusindia.gov.in/, http://www.censusindia.net/
DATA


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Mukhmohit’s 20 POINT PSM BOOSTER Dose – Oct 2019

For updates: telegram Group t.me/mukhmohit01 or www.mukhmohit.com

20 POINT PSM BOOSTER

4. LAQSHYA - Labor Room Quality Improvement Initiative

Compiled and Edited by Mukhmohit singh @PSM Simplified, 2019 1

SECTION 2 - UPDATES IN MoHFW- other schemes

Compiled and Edited by Mukhmohit singh @PSM Simplified, 2019 2

SECTION 3 – ESI update:

1. Employer contribution – 3.25% of monthly wage (4% in few states)

Rajiv Gandhi Shramik Kalyan Yojana: Unemployment allowance

Atal Beemit Vyakti Kalyan Yojana:

Compiled and Edited by Mukhmohit singh @PSM Simplified, 2019 3

SECTION 4 – FAQ + Controversies

Sex ratio: 991, Child sex ratio (0-6 years) – 916.

Compiled and Edited by Mukhmohit singh @PSM Simplified, 2019 4

ZIKA Virus disease

Disease Infectivity Period Period of Isolation

October Breast cancer awareness month

Compiled and Edited by Mukhmohit singh @PSM Simplified, 2019 5

Compiled and Edited by Mukhmohit singh @PSM Simplified, 2019 6

SECTION 5 – GLOBAL HEALTH

Global action Plan

Reduce mortality in Under 5 to less than 3/1000 Live births

to achieve by end of 2025

WHO Global action plan for prevention of NCD’s 2013-2020

Compiled and Edited by Mukhmohit singh @PSM Simplified, 2019 7

SECTION 6 – RNTCP / Tuberculosis:

Diagnostic Algorithm – Extra Pulmonary Tuberculosis – Update 2019

Compiled and Edited by Mukhmohit singh @PSM Simplified, 2019 8

Diagnostic Algorithm – Pediatric Pulmonary Tuberculosis – Update 2019

CXR highly suggestive

Decision for starting Anti TB regimen

Compiled and Edited by Mukhmohit singh @PSM Simplified, 2019 9

The new TB regimes are:

Indications for giving Bedaquiline

Some recent changes in RNTCP (Summary Oct 2019)

Compiled and Edited by Mukhmohit singh @PSM Simplified, 2019 10

Drug sensitive Leprosy

Drug resistance leprosy (24 months treatment)

6 months Daily 18 months Daily

Age / weight Rifampicin dose

Compiled and Edited by Mukhmohit singh @PSM Simplified, 2019 11

Compiled and Edited by Mukhmohit singh @PSM Simplified, 2019 12

NACO HIV treatment and care facilities:

Selected medical colleges Centers of excellence and ART plus centers

NACO Counselling services:

State and district level hospitals, medical Standalone ICTC centers

Categorization of districts based on HIV as public health problem

Compiled and Edited by Mukhmohit singh @PSM Simplified, 2019 13

SECTION 9 – Malaria Management update

SECTION 10 – Influenza update

Compiled and Edited by Mukhmohit singh @PSM Simplified, 2019 14

SECTION 11 – Polio and NPSP

National Polio Surveillance Program

Compiled and Edited by Mukhmohit singh @PSM Simplified, 2019 15

SECTION 12 – Cancer Update:

Source: WHO, International agency for research on cancer. Globocon 2018.

1. Most common cancer in INDIA