DIPLOMA IN COMMUNITY HEALTH

(COMMUNITY HEALTH EXTENSION WORKERS (CHEW)

PAPER III, 2019

SECTION B: ESSAY MODEL ANSWERS

la. Qualities of a standard Sanitary Dustbin in your household:

(i) It must be made of non-absorbent and not-resistant material

(ii) It must be portable

(iii) It must be constructed to facilitate easy cleaning

(iv) It must be constructed with water tight material

(v) It must contain handle

(vi) It must have a light fitting cover

(vii) It must be placed on raised ground

(viii) It must be emptied on a regular basis (½ mark each for any 5 points (2 ½ marks)

b. Benefits of sanitation in the community:

(i) It helps in reduction of spread of disease

(ii) It reduces occurrences of non-communicable disease

(iii) It improves general aesthetic value of home and community

(iv) It improves the general standard of living

(v) It brings about increase in life expectancy

(vi) It reduces the rate of accident occurrence

(vii) It reduces pest and vector proliferation in the community

(viii) It helps in protection of fire outbreak

(ix) It increases the conducive level of environment (½ mark each for any 5 points (2 ½ marks)

C. Prevention and control of NOISE as an occupational hazard:

(i) Use of personal protective devices e.g. ear plug, ear muffler
(ii) Health education on danger of Noise, its prevention and control

(iii) Substitution of noisy machine for silent ones

(iv) Use of noise proof devices

(v) Proper planning of the working environment

(vi) Automation — replacing human worker by technology

(vii) Training of workers on the use of machine/equipment

(viii) Regular medical check-ups (½ mark each for any 6 points (3marks)

D. Types of Occupational hazard:

(i) Physical hazard

(ii) Biological hazard

(iii) Psychological hazard

(iv) Chemical hazard

(v) Ergonomic hazard

(vi) Mechanical hazard (½ mark for any 4 points (2 marks)

2a. Conditions that can predispose pregnant women to “High Risk”

(i) Bads previous obstetric history

(ii) Vaginal bleeding during pregnancy

(iii) Hypertension especially with oedema

(iv) Elderly primigranda

(v) Very young primigranda

(vi) Multiple pregnancy

(vii) Malpresentation of the foetus

(viii) Chronic illness e.g. Tuberculosis, Hepatitis, HIV/AIDS

(ix) Acute illness e.g. Malaria, Rubella, Chicken pox

(x) Deformities in the pelvices

(xi) Cardiac failure

(xii) Renal disease

(xiii) Diabetes mellitus

(xiv) Pre-eclampsia

(xv) Eclampsia

(xvi) Sickle cell disease

(xvii)Ante partum Haemorrhage

(xviii) Previous rupture of uterus

(xix) Recurrent abortion (½ mark each for any 5 points: (2½ marks)

b. Four (4) stages of labour:

(i) Stage 1/First Stage: Last from onset of strong uterine contractions to the full dilatsation if the
cervical OS

(ii) Stage II/Second Stage: The period from the full dilatation of the cervical OS to the delivery of the
baby or foetus

(iii) Stage III/Third State: Last from the delivery of the baby to the expulsion of the placenta and
control of bleeding

(iv) Stage IV/Fourth State: One hour following the delivery of placenta which is usually a critical
period for post-partum haemorrhage

(½ mark each for each 4 stages (2 marks)

c. Possible causes of post-partum Haemorrhage (PPH):

(1) Mismanagement of the third stage of labour

(ii) Retaib=ned placenta

(iii) Weak uterine contraction and retractions

(iv) Placenta abnormalities

(v) Blood clothing disorders

(vi) Laceration of the gentisal tract

(vii) Fibroids
viii) Antepartum haemorrhage (½ mark each for any 6 points (3 marks)

d. Reasons to warrant removal of Intra uterine Contraceptive Device (IUCD):

(i) Client desires pregnancy

(ii) Menopause, no need for contraception

(iii) Life of IUD has expired

(iv) Accidental pregnancy

(v) Unusual bleeding or pain

(vi) Genital tract malignancy

(vii) Dyspareunia (painful intercourse)

(ix) Partial expulsion of the device

(x) Cervical perforation

(xii) Uterine perforation

(xii) Missing strings .

(xiii) Copious vaginal discharge

(xiv) Allergy to the device (copper types)

(xv) Desire for another method of contraceptive (½ mark each for any 5 points (2 ½ marks)

Part of the Human Tooth:

(i) Enamel: This is found outside the dentine of tooth but very hard a substance because it contains
96% mineral salts which are mainly calcium and phosphate. The enamel is harder than dentine.

(ii) Dentine: Is a living tissue and the second layer ‘of a tooth after the enamel and contains a hard
ivory-like substance that surrounds the pulp cavity. It is softer than the enamel.

(iii) Pulp Cavity: Is a soft connective tissue and the third layer of a tooth which houses blood vessels,
lymph vessels, nerves and pain sensory receptors

(iv) Cementum: Is a bone-like layer which fixes the tooth in its socket and holds the tooth in place

(v) Peridontal Membrance: This fixes the tooth top the jaw bones

(vi) Neck: Is the region or point where the crown and root of the teeth meet
(vii) Blood vessels and Nerves: (½ mark each for any 6 points (3 marks)

b. Common Congenital Abnormalities of the Newborn:

(i) Congenital heart disease

(ii) Down’s syndrome ‘.

(iii) Spina bifida

(iv) Club foot

(v) Phenylketonuria

(vi) Edward’s syndrome

(vii) Cerebral Palsy

(viii) Cleft lip & cleft palate .

(ix) Cystic fibrosis

(x) Fragile syndrome (½ mark each for any 6 points (3 marks)

C. Ways of improving the family and community practice in the implementation of Integrated
Management of Childhood illnesses (IMCI):

(i). Strengthen community participation

(ii) Promote appropriate family response to child illness

(iii) Promote child nutrition

(iv) Encourage adequate environmental sanitation/hand washing

(v) Improve community and family food production e.g. home gardening, small scale fishery,

piggery and poultry

(vi) Counselling on adequate breastfeeding

(vii) Encourage child spacing/family planning.

(viii) Encourage of micro-nutrients supplementation

(ix) -Encourage use of Long Lasting insecticidal treated Nets (LLIN)-

(x) Encourage early care seeking behavior

(xi) Encourage proper use of medication

(xii) Encourage home care for sick child - (½ mark each for any 8 point (4marks)

4a. Definition of the following Terms:

(i) Delusion: A false personal belief that is not subject to reason or contradictory evidence and is not
explained by a person’s usual cultural and religious concepts (so that, for example, it not an article of
faith).

(ii) Flallucination: Perception of objects with no reality usually arising from disorder of the nervous
system or in response to drugs.

(iii) Illusion: is something that appears to exist or be a particular thing but does not actually exist or is
in reality something else.

(iv) Schizophrenia: A mental illness that is characterized by disturbances in thought (such as

delusions), perception (such as hallucinations), and behaviour (such as disorganized speech or

catatonic behaviour), by a loss of emotional responsiveness and extreme apathy, and by

noticeable deterioration in the level of functioning in everyday life.

(v) Hysteria: An uncontrollable outburst of emotion or fear, often characterized

(½ mark each for 5 points (2½ marks)

b. Ways to facilitate the process of rehabilitation of mentally ill person:

(i). Acceptance by, and strong support from the family members for treated persons immediately they
are discharged from the hospital to reduce stigma

(ii) Pleas for acceptance by, and strong support from friends, religious organization and others for
treated persons for social interaction.

(iii) Seeking acceptance for treated persons by their employers after care or encourage gainful self-
employment to earn a living

(iv) Appealing for acceptance for treated persons by their networks (e.g. clubs and associations) to
which they belong before ill-health

(v) Ensuring continuous monitoring of treated persons by family members in order to ensure that they
remain in contact with m:ital health care facilities or health care personnel and also comply with
treatment regimen

(vi) Adequate follow-up in the community to ensure they do not relapse

 (½ mark each for any 5 points (2 ½ marks)

Objectives of school Health Services (SHS):

(i) Counseling pupils, teachers and their parents

(ii) Offer good guidance to children in terms of profession/career

(iii) Provision of special education and treatment for handicapped children

(iv) Promotion and protection of health of school personal

(vi) Appraisal of health status of school children

(vii) Control and prevention of the spread of communicable diseases among school children (viii)
Promotion of optimum sanitary condition of schools

(ix) Provision of emergency care for pupils

(x) Enshrining and inculcating the principles of good health and personal hygiene to pupils.

(½ mark each for any 5 points (2¼ marks)

...

4b. Activities to be carried out in the School Health Clinic:

(i) Physical examination — periodic medical examination at least twice a year for primary or post
primary schools by doctors or community health workers who is also a staff of the school

(ii) Height and weight measurement

(iii) General examination of skin for rashes, ringworm and ulcer (iv) Examination of the eyes, ear, and
throat for infections

(v) Visual acuity test to detect deficiency

(vi) Hearing test to measure hearing ability of children

(vii) Simple laboratory investigation like stool, urine PCV, etc.

(viii) Radiological examination, chest X-ray, screening for tuberculosis and final year pupils

(ix) Mouth examination for dental caries, dental hygiene etc.

(x) Psychological examination by child psychologist among others

(½ mark each for any 5 points (2¼ marks)

5a. General control measure of Communicable diseases:

(i) Early diagnosis of the infection

(ii) Prompt and correct treatment

(iii) Prompt notification to the appropriate health authority

(iv) Isolation of patients/cases which is indicated in the control of acute epidermis

(v) Investigation of the source of infection and extent of outbreak

(vi) Contact and carrier tracing

(vii) Concurrent and terminal disinfection

(viii) Quarantine limitation of the movement of persons who have been exposed to infection

(ix) Protect the susceptible host through immunization

(x) Health education of the target group on mode of transmission and preventive measures

(½ mark for any 5 points (2½ marks)

5b. Common symptoms of Diabetes Mellitus:

(i) Excessive thirst

(ii) Drinking large quantity of water

(iii) Passing larger quantities of urine

(iv) Loss of weight

(v) Frequent occurrence of boils

(vi) Itching of body, including the private parts

(vii) Pain, Numbness, burning or tingling sensation in the limbs

(viii) History of delivery of large babies, still-births, or recurrent abortion in women

(ix) Foot ulcers that fail ion heal

(x) Ants crowding around urine

(xi) Sexual weakness (impotence) (½ mark each for any 5 point (2½ marks)

c. Signs and Symptoms of fracture:

(i) Visible fracture: in an open fracture, the fracture4 bone or bone fragment may be visible.

(ii) Deformity: The body part may appear deformed due to the displacement of the bone.

(iii) Pain: The casualty will probably experience pain at a particular location

(iv) Swelling: There may be swelling (edema)at the suspected fracture site.

(v) Discoloration: The area around the suspected fracture site may be bruised or have hemorrhagic
spots (ecchymosis)

(vi) Crepitation: The fracture bones may make a crackling sound (crepitation) if they rub when the
casualty moves.

(vii) Loss of motion: The casualty may not be able to move the injure limb.

(viii) Loss of pulse: if the fracture bone is interfering with blood circulation, - there may be no

distal to (below) the site of the fracture.

(ix) False motion: There may be motion at a point where there is normally no motion. movement at the
fracture site i: called false motion.

(½ mark for any 5 point (2 ½ mark)

d. Types of Shock:

(i) Anaphylactic Shock: refers to a service and. life-threatening allergic reaction. It can occur as result
of eating particular foods, taking certain medications, or an insect bite.

(ii) Hypovolemic Shock is what happens to the body when a person loses too much blood. As result
the heart is unable to pump enough blood to reach the organs, which can leads to organs which can
leads to organ failure. It’s often the consequences of severe cuts, traumatic injuries internal bleeding, or
endometriosis.

(iii) Septic Shock When a person has an infection, the immune system sends it’s special cells into the
blood to fight it. The process causes inflammation and can lower blood pressure. If the blood pressure
drops too low, the organs may not receive enough oxygen and blood flow, causing the patient to go into
septic shock. This is potentially life threatening.

iv) Neurogenic Shock Occurs when there’s an uneven blood distribution throughout the body. It’s
often the result of a severe injury.to the central nervous system, a spinal injury, or damage to the brain.
Left untreated, it can cause permanent damage to organs or even death.
(v) Cardiogenic Shock occurs when the heart is damaged and can’t pump blood adequately. It’s often
the result of a heart attack. This can lead to organ failure. Although rare, it’s .very difficult to survive
Cardiogenic Shocks

(vi) Hypoglycemic Shock Low blood glucose (hypoglycemia) is when your blood glucose levels falls
low enough that you need to take action to bring them back to your target range.

(½ mark each for any 5 point (2 ½ marks)

6a. Functions of Tongue:

(i) Speech: The tongue is responsible for different sounds depending on how it’s positioned in the
mouth. Since the tongue is so flexible, it can switch positions quickly to make a rapid succession of
sounds

(ii) Taste; buds are responsible for the ability to taste food. There are five different taste sensations’
sweet, sour, salty, bitter and savory.

(iii) Mastication: is the process of combining grinding up food particles with naturally occurring
saliva. Mastication happens at the same time as grinding

(iv) Swallowing: After masticating food particles, the tongue helps round them into masses know as
bolus. Once the esophagus found in the back of the mouth before finding its way to the stomach for
digestion

(½ mark each for any4 points (2 marks)

C. Ways of Preventing Eye Problems:

(i) Encourage immunization of children against measles and Rubella.

(ii) Avoid use of harmful traditional eye medication treatment and practices e.g. sugar, urine, kafura,
self-medication.

(iii)Early detection at birth during immunization, growth monitoring, ore-school and school entry
screening.

(iv) Avoids trauma-beating in head encourage adult supervision of children’s play Periodic medical
check-up.

(v) Keep a balanced diet: Beta-carotene, Lutein, Omega-3, Lycopene, and vitamins C, A, and E are
essential for maintaining your eve health. Make sure that your diet is infused with different foods that
are rich in those nutrients.

(vi) Practice frequent hand washing: Wash your hands regularly to keep bacteria at bay and prevent
them from getting in contact with your eyes, eye glasses, and contact lenses
(vii.) Protect your eyes from the sun: Exposure to sunlight and ultra violet rays increases your risk for
age-related mascular degeneration and may cause cornea sunburn or photo keratitis, put on sun glasses
to protect your eyes. un-protected eye glasses or contact lenses can be worn. Putting c caps, visors and
hats are also advisable.

(ix) Avoid rubbing your eyes The hands are exposed to a lot of dirt, dust and bacteria, and all these can
be easily transferred to your peepers each time you touch or rub them, so avoid putting your hands to
your eyes to prevent infection and irritation.

(x) Wear the appropriate eye safety gear for different activities. No matter what you do, make sure that
your eyes are protected. If you are going swimming, wear goggles to avoid exposing your eyes to
chlorine. Meanwhile, if you are gardening put on s glasses to protect your eyes from dust particles,
bacteria and injuries.

(xi) Keep your surroundings clean. Exposure to dirt and dust can irritate the eyes: so make sure the
places your frequent are well maintained and clean. Change your linens and towels regularly and keep
your workstation clutter-free

(xii) Get enough sleep. Just like the rest of your body, your eyes need to recharge too, and t happens
while your sleep. So make sure that you get sufficient shut-eye each day to keep y eyes revitalized and
healthy.

(xiii) Stay hydrated. Sufficient fluid intake is essential to your body’s overall well-being, including the
eyes. If you are hydrated enough, you prevent your eyes from getting dry and irritated.

(xiv) Don’t smoke. Smoking makes you more susceptible to age-related macular degeneration and
other eye conditions such as cataract. Smoking can also damage the optic nerves, which can have
adverse effects on your vision overtime. -

(xv) Observe the 20-20-20 rule. If you want to keep your eyes in great shape, you should adhere to the
20-20-20 rule, which states that

 Every 20 minutes, look away from computer monitor and fix your gaze On an object that’s feet
away from you.
 Blink 20 successive times to prevent eye dryness
 Every 20 minutes, get out of your seat and take 20 steps. This is not just good for your vision,
but also promotes proper posture and blood throughout the body, yes, it keeps you from being
sedentary too.

(xvi) Use the right kind of eye make-up. If you wear make-up, choose the brands that work well you.
Steer clear of eye shadows, mascara, and eyeliners that cause allergic reactions to your

(1 mark each for any 5 points (5 marks)

7a. Medical problem of the aged:

(i) Impaired vision

(ii) Deafness

(iii) Arthritis

(iv) Senile dementia

(v) Coronary heart diseases

(vi) Loss of libido

(vii) Hypothermia

(viii) Diabetic mellitus

(ix) Hypertension

(x) Mental confusion

(xi) Loss of appetite

(xii) Osteoarthritis

(xiii) Prone to accident

(½ mark for any 6 points. (3 marks)

b. Measures to be adopted .in preventing the aged from home accident:

(i) Health education on causes and prevention of home accidents

(ii) Avoidance of slippery floors/tiles

(iii) Provision of walking sticks -

c. Ways of preventing handicapping conditions:

a. Periodic immunization

b. Early diagnosis and prompt treatment of disease condition

c. Health education

d. Marriage counseling

e. proper management of labour

f. Good antenatal care

g. Adequate nutrition

h. Road safety to prevent accident

(½ 2 mark each for 4 points (2 marks)

d. Effect of the handicapped child on the immediate family:

i. Depression of the parents

ii. Economic drainage on the parent/family

iii. May lead to broken home

iv. Fear of having another children

v. Rejection of the child by extended family

vi. May lead to stigma of the child and the family

vii. Education of the is expensive i.e. special school

(½ mark each for 5 points (2 ½ marks)

 DIPLOMA IN COMMUNITY HEALTH

(COMMUNITY HEALTH EXTENSION WORKERS (CHEW)

PAPER 1, 2019

ESSAY: MODEL ANSWERS

1a. Rights of a client/patient in health care delivery:

i. Right of consideration and respect, privacy and confidentiality.

ii. Unconditioned acceptance as a human being

iii. Receiving health care in accordance with his/her specific needs

iv. Informed, voluntary decision-making, regarding consent and refusal of treatment

v. Confirmation of identity for purposes of diagnosis, care and treatment and correct labeling of his/her:

(a) Person

(b) Possession

(c) Specimens for investigation purpose like blood sample etc.

(d) Record including: monitoring record and reports

(e) His/her body in the case of death

(f) Reasonable expectation regarding his/her treatment

(g) Protection against cross-infection and communicable diseases

(h) Receive prescribe treatment

(i) Die with dignity (½ Mark each for 5 points (2 ½ mark)

b. Code of Conduct for Community Health Practitioners:

i. Set a high standard: A community health practitioner shall set a high standard and not allow
himself/herself to receive gifts favours, or hospitality form a client/patient, or relatives of a
client/patient who is to be or who has been, in his her care.

ii. Intra-professional obligation: A community health practitioner shall maintain friendly relations
with colleagues and be respectful to the senior colleagues.

iii. Use of standing orders: a community health practitioner must use his/her standing orders and other
medical equipment in arriving at any diagnosis and management of his/her patient.
iv. Maintenance of two-way referral system: a community health practitioner shall maintain the
referral system by referring cases beyond his/her job description of the appropriate level.

v. Administering of treatment: A Community Health Practitioner shall not administer any treatment
on a patient without the consent of the patient r his/her relation in case of unconscious or a patient who
cannot speak for himself/herself.

vi. Prompt Attention: A community Health Practitioner shall ensure the safety of his/her patient
whether the relatives are around or not and use whatever means at his/her disposal ta preserve life while
waiting relation’s arrival and assistance

vii. Giving of Evidence: A Community Health Practitioner shall say what he/she knows is the truth
when giving evidence as an expert witness

viii. Use of Uniform: A community health Practitioner must always appear in his/her uniform once on
duty except during emergency and call duty which are outside official working hours

ix. Anti- Professional behaviour: A community Health Practitioner shall be members of the National
Association of Community Health Practitioners of Nigeria being the only legally recognized body to
assist the Board in ensuring professional sanity and dignity in the country. Any Community Health
Practitioner that does not belong to the Association would not be recognized by the Board.

x.. Absenteeism: A community Health Practitioner should not absent himself/herself from duty without
permission.

(½ mark each for any 6 points (3 marks)

c. Duties of a Community Health Practitioner:

1. Caring for the sick and injured considering the resources of the resources of the patient, his family
arid environment and the services available, incorporating personal needs to his//her recovery and
rehabilitation in accordance to the findings and actions of the Standing Orders.

ii. Helping the individual and the family to take positive action in relief of illness and improvement of
his/her individual family and community needs.

iii. Training Others: To function as members of the health team.

iv. Adopting community health services: To correspond with responsible planning, authoritatic
emergencies like disaster, outbreaks; and wars.

v. Evaluating and conducting research to improve health care and adequately meets society’s needs.

vi. Sharing with others in the dissemination of health information to individuals and in the
community (½ mark each for any 5 points (2 ½ marks)
d. Community Health Practitioner and His/hers colleagues Relationship: A Community Health
Practitioner shall:

i. Be honest in his/her professional discussion with colleagues like during report writing

ii. Trust his/her colleagues to elicit cooperation

iii. Have respect for the contribution of others

iv. Take appropriate action to safeguard the client/patient when his/her care is endangered by worker or
others.

(½ mark each for 4 points: (2 marks)

2a. Agents of socialization:

i. Family is the first agent of socialization. Mothers and Fathers, siblings and grandparents, members of
an extended family, all teach a child what he/she needs .to know, and how to relate others.

ii. Peer group is made up of people who are similar in age and social status and who shares interaction.
Peer group socialization begins in the earliest years. As children grow into teenagers, this process
continues. Peer groups are important to adolescents in a new way, as they begin to develop and exert
independence. Peer group provide adolescents’ first major socialization experience outside the realm of
their families.

iii. School children spend about seven hours a day, 180 days a year, in school which makes it hard deny
the importance school has on their socialization. Students are not in school only to study mathematics,
reading, science, and other subjects-. the manifest function of this system. School also serve a latent
function in society socializing children into behaviours like practicing teamwork, following a schedule,
and using textbooks.

iv. Religion- Religion is an important avenue of socialization for many people. Like other institution
churches and mosques teach participants how to interact with the religion’s material culture. Mai
religious institutions also uphold gender norms and contribute to their enforcement through
socialization. Organized religion fosters a shared set of socialized values that are passed through
society.

v. Government Many of the rites of passage people to through today are based on age norm
established by the government. To be defined as an “adult” usually means being eighteen ye old, the
age at which a person becomes legally responsible for him/herself. Any sixty-five ye bid is the start of
“old age” since most people become eligible for senior benefits at that point.

vi. Mass media distribute impersonal information to a wide audience ‘Via television, newspaper radio,
and the internet. With the average person spending over four hours a day in front of t television (and
children averaging even more screen time, media greatly influences social norms. People learn about
objects of material culture (like new technology and transportation options), well as non-material
culture what is true (beliefs). What is important (values) and what is ‘expected (norms).

vii. Workplace is another agent of socialization. At the workplace, a person meets people of different
age group and belonging to different social and cultural backgrounds. This makes him come in close
contact with different thought processes, belief systems etc. The interaction that then happens helps a
person to broaden his/her horizons in terms of social acceptance and tolerance towards the others.

iii. Community- Community is an important informal and active agency of socialization. Just as the
family and school have a great influence upon the child, much in the same way the community also
modifies the behavior of child through social contacts, group activities also and group dynamics in such
a way that he begins to participate in all the desirable activities of the community ‘of which he is an
integral part.

(½ mark each for any 5 points (2 ½ marks)

b. Characteristics/features of culture:

i. Culture is universal to mankind and not peculiar to a particular group

ii. Culture differs from place to place

iii. Culture is continuous and does not die with people

iv. Culture is’ learned over time, it is not inborn in people

v. Culture changes and it is not permanent

vi. Culture grows from generation to generation

vii. Cu1tur can be borrowed especially good cultures

viii. Culture can be inherited from one generation to the other

ix. Culture can transferred from person to person, community to community

(½ mark each for any 5 point (2 ½ marks)

c. Factors that cause forgetting:

i. Interference due to massing of similar learning experiences or over loading of the memory

ii. Fading and decay due to lack of practice and exercise

iii. Insufficient time, which leads to a hasty search of the memory store

iv. Repression arising from strong emotion attachment or guilt feelings Imperfection of the memory
process
v. Change of context or surroundings leading to the removal of reminders and reduction in the
effectiveness of retrieval cues

vi. Fear or anxiety arising from lack of confidence as well as exemplified in stage fright, mental black
out or brain wave

(½ mark each for any 5 points (2 ½ marks)

d. Deviant youth behavior in your community:

i. Drug abuse

ii. Rape

iii. Vicious attack on other and even parents

iv. Youthful vandalisation

v. Examination malpractice

vi. Menacing threat and extension

vii. Truancy

viii. Over speeding

ix. Dangerous experimentation

x. Early sexual behavior

3a. Factors that promote effective health education:

i. Building on what people know

ii. Favourable environment

iii. Elimination of barriers

iv. Treating people with respect

v. Being a good listener

vi. Respect traditions and Cultures

(½ mark each for any 6 points (3 marks)

b. Harmful traditional and cultural practices that influence health behaviour and health action in
the community:
(i) Early/forced female marriage

(ii) Tribal mark/Taboo Scarification.

(iii) Window hood practice

(iv) Food taboo

(v) Female genital mutilations

(vi) Abrupt Weaning

(vii) Cutting umbilical cord using hot knife

(viii) Drinking blue or potash for family planning

(ix) Burning of feet during convulsion

(x) Application of cow dung/yam flour to umbilicus

(xi) Expression of colostrums and discard

(xii) Depriving children from the mother for weaning

(½ mark each for any 8 points (4 marks)

c. Methods of Health Education:

i. Interview: This is a discussion between two people in a question-and —answer from. It is usual’
between the health personnel and the client or patient, especially when an individual has a spec health
problem for which he/she is seeking a solution. This method is ideal for decision-making

(½ marks)

ii. Group Discussion: This is mutual chat sharing of ideas or argument between members of a target
group of ‘about 3-12 individuals who have a common problem. The aim of the discussion is to come up
with a solution from within the group. Usually the health practitioner, who is a member of the group,
guides them through the discussion and acts as a resource person, providing expert advice when
needed.

(½ mark)

iii. Demonstration: This is a real-life activity. A technique in which a sequence of steps is carried e’ to
illustrate a problem, show a procedure or provide a basis for drawing conclusions. This method usually
allows for the-special senses of hearing, sight, touch, feeling and taste to be involved for effective
learning.

(½ mark)
iv. Role play: This is rather a specified form of acting. It is when an individual takes the part of another
character, especially as related to the aspects of human functioning or daily living relation (behavior). It
is a popular tool for portraying a social situation. This method is ideal for attitude development,
mastering decision-making and improving communication skills.

(½ mark)

v. Brainstorming: This is a critical examination of ideas, problems, situation and appraisal of between
the clients or in a committee with the aim of generating solutions. It is an ideal and effective method in
decision making and communication skill development.

(½ mark)

vi. Lecture Method: This involves a straightforward discussion; a pre-planned structured scheme
delivered on a topic. The main value is to prevent a suitable or topic to a large audience of a tars group.
It is common method of providing specific health information. This method is ideal for developing
knowledge and decision-making skills.

(½ mark)

4a. Factors that facilitate integrated service deliver in PHC:

i. A cohesive health team

ii. Functional community development committee (CDC)

iii. Effective and efficient information system

iv. Operational, two ways referral system

v. Efficient drug revolving system

vi. Advocacy Supply of essential drugs pill.

vii. Provision of fund

b. National Health Insurance Scheme (NHIS)

(½ mark each for any 6 points (3 marks)

4b. Advantages of integrated primary care service Delivery:

i. To harness PHC resources in the country, to increase productivity, and to prevent duplicity and
wastage;

ii. To economize in manpower, money and materials

iii. To offer a wider range of services to the community within each PHC unit

iv. To maintain and sustain good order for PEG services

v. To assist the -managers of PEG in adopting a holistic approach to PHC implementation, management
and evaluation

vi. To record the progress of PHC in a way that will serve as a reference for PHC policy- makers, unit
managers, field workers and co-ordinators.

vii. To enhance the provision of comprehensive health care services at the community level

viii. To promote availability and accessibility of health care services to a large number of people in the
community.

ix. To economize in the use of patients time and finance, enhance satisfaction with the service and
enable patients to put their time and money to better use.

x. To sustain the lifespan of the services provided and the interest of the community

xi. To promote job satisfaction for the community health workers

(½ mark each for any 8 points (4 marks)

c. Function of the health team:

(i) Promote health services

(ii) Improve good water supply

(iii) Ensure antenatal services

(iv) Educate the community on children nutritional status

(v) Ensure that each child is immunized within a given community

(vi) Identify diseases that require early treatment or referral community

(vii) Carry out health education in the community

(viii) Liaise with community to find solution to identified health problems

(ix) Encourage community participation

(xi) Health counseling

(½ mark each for any 6 points (3 marks)

5a. Steps involved in Community mobilization

i. Identify community heads / leaders

ii. Make initial contact with the leaders

iii. Communicate your intentions

iv. Acquaint self with the culture and social protocol of the community

v. Arrange for meeting with the community heads and representatives.

vi. Develop an agenda for the meeting with the other health workers.

vii. Attend the meeting.

viii. Explain purpose of the meeting in an acceptable language

ix. Request them to convey the message to other community member and bring feedback in subsequent
meetings

x. Encourage questions and participation from the audience to clarify all issues before meeting
disperses

xi. Decide with the participants the date, time and venue of the next meeting

xii. Have as many meetings as necessary until a consensus is reached:

(½ mark each points 12 (6 marks)

b. Role of community Diagnosis in primary health care:

Community diagnosis identifies resources within the community to solve identified health problems

i. It identifies health and related needs of a community and use them as basis for planning

ii. It enhances interaction between the community and the health workers

iii. Community diagnosis identifies constraints which can be addressed in the planning process

iv. If provides baseline data for evaluation of community interventions treatment.

(½ mark each for any 4 points (2 marks)

c. Methods used in community Diagnosis:

i. Observation/ Physical Examination:

It is very important to 4eterrnine the disease that affect the community through observation and
physical examination because some diseases are not recognized in the community e.g. Anaemia, dental-
care, malnutrition, diabetes. In observation you observe their surroundings, living conditions, eating
habits and life pattern to avoid wrong impression In observation also you are t’ use eyes to see and also
hear some relevant information with your ears.

ii. Interview: This involves communicating with somebody e.g household heads, mothers. These
people who play important role in the community in decision making on health matters or issues. You
should create a good rapport with the person so that he/she will feel free to talk with you and give you
the correct information about what you need. Interview may be face to face (verbally) c through
questionnaire (filling a prepared form).

iii. Group Discussion: In group discussion, unlike interview, is held with groups of people and not
individual. It is useful in getting information on health needs of the community (that is what they feel
as their most pressing problems).

iv. Review of Existing Records: Useful information can be obtained by reviewing existing records
particularly when trying to determine the population of a community the health facilities and the health
personnel as well as disease pattern in the area.

(½ mark each for 4 points)

6a. Methods of Administration of drugs:

(i) Oral: The oral methods takes the form of a pill, capsule or liquid that you swallow. This is the
easiest and most convenient method since it can be done at home:

(ii) Intramuscular drug: are injected into the muscle, usually in the arm, thigh or buttock.

(iii) Subcutaneous drug: are injected into the tissue under the skin instead of into the muscle.

(iv) Intravenous route: A needle is inserted directly into a vein. A solution containing the drug may be
given in a single dose into the vein or by continuous intravenous infusion through a cannula,
Intravenous administration is the best way to deliver a precise dose quickly and in a well- controlled
manner throughout the body.

(v) Intrathecal route: A needle is inserted between two vertebrae from the lower spine and into the
space around the spinal cord. The drug is the injected into the spinal canal. A small amount of local
anesthetic is often used to numb the injection site.

(vi) Sublingual and buccal route: A few drugs are placed under the tongue (taken sublingually)
between the gums and teeth (bucally) so that they can dissolve and be absorbed directly into the small
blood vessels that lie beneath the tongue. These drugs are not swallowed.

(vii) Rectal route: Many drugs that are administered orally can also be administered rectally as a
suppository. In this form, a drug is mixed with a waxy substance that dissolves or liquefies after it is
inserted into the rectum. Because the rectum’s wall is thin and its blood supply rich: the drug is readily
absorbed.
(viii) Vaginal route: Some drugs may be administered vaginally to women as a solution, tablet, cream,
gel, suppository, or ring. The drug is slowly absorbed through the vaginal wall

(ix) Ocular route: Drug use to treat eye disorders (such as glaucoma, conjunctivitis and injuries) can
be mixed with inactive substances to make a liquid, gel, or ointment so that they can be applied to the
eye.

(x) Otic route: Drugs use to treat ear inflammation and infection can be applied directly to the effected
ears. Ear drops containing solutions or suspensions are typically applied only to the outer ear canal.

(xi) Nasal route: If a drug is to be breathed in and absorbed the thin mucous membrane that line the
nasal passages. It must be transformed into tiny droplets in the air (atomized) once absorbed, the drug
enters the blood stream.

(xii) Inhalation route: Drugs administered by inhalation through the mouth must be atomized into
smaller droplets than those administered by the nasal route, so that, the drugs can pass through the
windpipe (trachea) and into the lungs. .,

(xiii) Cataneous route: Drugs applied to the skin are usually used for their local effects and thus are
most commonly used to treat superficial skin disorders, such as psoriasis, eczema, skin infections(viral,
bacterial and fungal) and dry skin.

(½ mark each for any 5 points (2 ½ marks)

b. Advantages of essential drugs:

i. It is economical in terms of cost

ii. It is affordable and accessible since majorly of the population can afford to pay

iii. It enable some agencies related to drugs control to perform effectively

iv. Drug usage in our health facilities can easily be managed

v. It makes prescription of drugs very easy since the drugs are readily available .

vi. The out-stock syndrome in our health facilities is reduced drastically

vii. The reduction in the number of drugs used in the health care system makes purchasing storage and
distribution easier.

(½ mark each for any 5 points (2 ½ marks)

c. Reasons why dugs revolving fund (DRF) may fail:

i. If the initial (speed) capital is underestimated

ii. Prices are set below replacement costs

iii. Failure to collect payment for drugs without equivalent subsidy (for instance from children, the aged
and! or handicapped)

iv. Delays in cash flow, making money received from sales not easily available for subsequent
purchases

v. Rapid programme expansion for which additional capital finds are not available

vi. Losses due to theft of drugs or money, and also due to deterioration of drugs by expiry or spoilage.

vii. Price increase (inflation) outstrips expectation

viii. Lack of business orientation to Drug Revolving Fund.

(½ mark each for any 6 points (3 marks)

d. Steps for issuing Drugs:

i. Filling registration form from requesting unit

ii. Receiving money for quality of drugs to be supplied

iii. Issuing drugs

iv. Balancing ledger book for each drug item by subtracting the new issue from previous balance

v. Issuing the receiving note, sign a receipt voucher.

(½ mark each Tor any 4 points (2 marks)

7a. Factors to consider before conducting outreach services:

i. Cultural practice

ii. Community function (activities of market days)

iii. Social-economic status of the community

iv. Level of education

v. Population means

vi. Location of the community

vii. Logistics support

viii. Available personnel

ix. Natural disasters e.g flooding, earthquake

x. Community disputes e.g. war, clashes

xi. Hard to reach areas e.g. river, bad road

(½ mark each for any 6 points: (3 marks)

b. Factors for the success of an effective referral system:

i. Orientation of all health personnel to the two- way referral system. Some hospital-based personnel are
not aware of the different categories and competence of staff operating at the PHC level. Referral ought
to be accepted despite the fact that is from a lower-level worker. Orientation should include the use of
home based record cards instead of new patients card to maintain continuity of care.

ii. Simple design of forms, providing a systematic way of recording relevant information about patient.
A well designed form should include a feed back mechanism to ensure continuity of care.

iii. Community mobilization. The community must be instructed to arrange transport and any other
assistance needed for referral.

iv. Awareness for theft limitations q the part of the village health worker and the personnel in primary
health centre. When in doubt they must refer patients appropriately. At each stage of referral relevant
information is sent to the centre from which the patient was referred.

(½ mark each for 4 points (2 marks)

c. Consequences of irrationals drug use:

i. Resistance

ii. Adverse possible lethal effects

iii. Addiction

iv. Tolerance

v. Over use of drug

vi. Risk of infection

vii. Antimicrobial resistance

viii. Habituation

(½ mark each for any 6 points (3 mark)

d. Factors which may influence dosage of drugs:

i. Age: Age is an important factor, especially in people at the two extremes of life, i.e. infants, the drug
metabolizing enzymes are not fully developed. As a result, drug dosage in infants need to be reduced.

ii. In the case of elderly patient deteriorating liver may lead to slow drug metabolism, while failing
deteriorating kidney may lead to accumulation and raised blood levels of drugs dosage in such
patients. .

iii. Weight: Weight plays an important role in determining drug dosage. For heavy weight patients,
dosage may be higher than normal, and the reverse is the case for lean individuals. Dosage of some
potent drugs like gentamicin and digoxin is usually based on the weight of the patient i.e. mg/kg.

iv. Surface Area: Dosage of certain potent drug, especially cytotoxic drugs like doxorubicin and
vincristine are based on the body surface area i.e. mg/m2. The height and weight of the patient are
determined and body surface area of the patient estimated in terms of square meter using a scale.

v. Route of Administration: The amount of a drug given to a patient may also depend on the route of
administration. For parenteral routes, absorption is more certain, and hence will require mailer doses
than the oral route, where absorption may be uncertain and irregular.

(½ mark each for 4 points (2 marks)

COMMUNITY HEALTH EXTENSION WORKERS (CHEW)

PAPER 1

ESSAY (70 MARKS)

1. (a) Way by which community health practitioner can relate effectively can relate effectively
with member of the community:

(i) Listen, learn and understand the members of the community.

(ii) Talk, discuss and decide with the members of the community.

(iii) Encourage, organize members of the community to participate, encourage them to take up healthy
behaviors and habits.

(iv) Be involved and actively participate in the community development activities.

(½ mark for any 4 point: 2 marks)

(b) Rights of a practicing community health practitioners are:

(i) Practicing in accordance with the scope, which is legally permissible for specific practice. (ii) Proper
orientation and goal directed in service education in respect of the modes and methods of treatment and
procedure relevant to her working situation.

(iii) Negotiation with the employer for such continuing professional education.

(iv) Advocacy for protection of patients and personnel for when he/she has accepted responsibility.

(v) Equal and full participation in such policy determination, planning and decision making as may
concern the treatment and care of the patient.

(vi) A safe working environment, which is equipped with at least minimum physical, materials and
personal requirements.

(vii) Refusing to carry out a task reasonably regarded as outside the scope of his/her practice and for
which he/she has insufficient training or for which he/she has insufficient knowledge or skill.

(viii) Withholding participation in unethical practice.

(ix) Obtaining written policy guideline and prescriptions concerning the management of his/her

working environment.

(x) Refusing to implement a prescription or to participate in activities, which according to his/her

professional knowledge and judgement, are not in the interest of the patient.

(xi) Disclosure to his/her the diagnosis of patients for whom he/she accepts responsibility.

(xii) A working environment, which is free of threats, intimidation or interference

(xiii) A medical support or referral system to handle emergency situations effectively

(xiv) A manageable workload so that adequate standards of health care can be maintained.

(xv) Wages commensurate to health service rendered.

(½ mark for any 6 points: 3 marks)

(c) Five ways of maintaining cordial relationship between the patient/client

(i). Respect a client/patient irrespective of his/her rank, religion, culture, severity condition.

(ii). Use professional skill and the standing orders as a guide to manage the clients.

(iii). Maintain absolute confidentiality on information concerning the client/patient been reveal

to him/her.

(iv). Provide adequate client/patient care regardless social status, age, and ethnicity.

(v) Share information concerning clients using crucial judgment.

(vi) Be honest in personal and professional activities of the clients.

(vii) Be an adviser to the client instead of a decision maker.

(viii) Give quality care to the clients.

(ix) Explain all procedures to be carried out on the client and make sure he understands and give
consent.

(x) Be aware of the dangers of each procedure to be carried out on a client and prepare for treatment.

(xi) Where necessary, refer immediately, and not to delay.

(½ mark for any 5 points: (2 ½ marks)

(d) General work ethics of a community health practitioner:

(i) Act with sense of maturity: Personal and professional skills contribute to achievement maturity.
Maturity is an achievement which is not dependent on age but on several aspects of personality of many
skills such as the practice of positive habits attitudes and skills contributes to maturity.

(ii) Develop the sense of self-motivation: Have the willingness to learn new ideas, duties and
procedures, especially a willingness to learn about the communities; being served by the health facility.
Being alert when in the health facility and in the community enables the health practitioner to observe
and understand problems that need to be solved and anticipate the client/patient’s or community needs.

(iii) Be accurate in all activities: An error in health practice even when minor could have a lasting
effect on the individual, family or the community. All data, information education, introduction health
activities and programmers, should be as accurate as possible.

(iv) Practice thoroughness: Provide a careful and complete attention to all details of all information
and health activities provided. This involves the ability to listen and take ample notes and pay attention
to the who, when, why, where and how answers and verify information given to you by the
client/patient and/or by the relation.

(v) Practice dependability: That is involve other specialists in health practice and communicates
willingly to work as a team member. The dependable health practitioner asks questions and repeats
instructions to avoid mistake, ask for assistance with unfamiliar tasks from other colleagues and health
practitioners and take complete data.

(vi) Be Flexible: That is respond calmly to even last minutes activities, avoid being under pressure and
handle complex situations with calm, Develop the ability implement new ideas, and good suggestions
with confidence are a mark of flexibility.

(vii) Have a good judgement: Use the knowledge, experience and logic to assess all aspect of a
situation; to ensure for a sound decision. It inspire the confidence of client/patients and members the
community.

(viii) Be Honest: Express in a words and actions the trust given by a client/patient; at all times and in
situations, trustworthy health practitioner understands the serious nature of the patient’s condition and
the confidentiality involved in dealing with; the client/patients. Do not reveal any of a patient’s data and
conversations or any details; which must always remain confidential. Honesty is central integrity and
this is necessary to effectively represent the profession.

(ix) Have Initiatives: There a ‘e routine and guide duties of a health practitioner, however, comes
sometimes where positive actions should be taken outside routine duties; this is where good initiative
becomes important. The ability to move forward and to resolve issues by using one’s initiatives is
valuable skill in health practice.

(x) Possess the ability to solve problems: Analysing situation, asking for advice and planning out the
step needed to accomplish a health programme and activities wisely demonstrates the ability to solve
problems effectively. The result is achieving the goals set to improving the health status of the
community. Like planning for a successful outreach immunization programme, planning for controlling
and epidemic.

(xi) Be-Punctual: Being there on time, allow the health practitioner to organize tasks, Furthermore, be
punctual for all meetings with the members of the community or other organizations. This shows
maturity and responsibility.

(xii) Possess the attitude of efficiency: An efficient health practitioner, plans the day work in advance:
makes plans for completion of jobs and assemble materials and resources necessary to complete tasks.

(xiii) Be a member of the team: Have a positive attitude of a team player, by being generous with time
and providing help where necessary. Part of being a good team player involves simples courtesies like
personal activities in the health facility and in the community.
(xiv) Be tactful: Work with people in ways that show signs of sensitivity to their possible problems and
work towards achieving the goal of solving the problems smoothly and without being offensive. Tactful
manners and speech create goodwill with clients /patients and with other staff members.

(xv) Be assertive: Accurate, dependable and honest, who understands and perform tasks with
intelligence and good judgement, be confident and do step forward to make a point in a positive
manner, He/she contributes positively to a more efficient, more cordial working environment. It is quite
unlike aggressiveness which is hostile and overbearing.

(xvi) Be a member of the professional association: Being a member of the professional i.e.

NACHPN

(½ mark for any 5 points: 2 ½ marks)

2. (a) Qualities of a good poster

(i) It should enhance discussion.

(ii) It should be able to draw quick attention to the public

(iii) It should be conspicuous to the eye of the public

(iv) The work should be legible

(v) It should be simple

(vi) It should be thought challenging

(vii) It should promote needed change in habits of individuals

(½ mark for any 5 points: 2 ½ marks)

b. Types of verbal and non-verbal; communication

Verbal Non-verbal
1. Talking 1. Facial expression
 Discussing  Frowning
 Reading  Smiling
 Debating  Raising eyebrows
 Quarrelling  Closing eyes
2. laughing 2. Gestures (body expressions)
3. Crying  Shaking shoulders
4. Shouting  Shaking hands
5. Yelling  Waving hands
6. Exclaiming  Prostrating
7. Singing  Gait
8. Rhyming 3. Action
9. Belching 4. Stance
10. Sighing 5. Mute
11. Hissing 6. Sharp colourse e.g. red
12. Groaning 7. Signs and posters
13. Whispering 8. Time
9. Physical appearance
10. Touch
11. Silence
12. Listening

verbal ½ mark for any 5 points (2 ½ marks)

Non verbal ½ mark any points (2 ½ marks)

(c) Objectives of communication:

(i) To get things done.

(ii) To learn more about one another.

(iii) To learn about topics of mutual interest.

(iv) To enable people to think or act the ways that positively contributes to their life (health).

(v) To provide a setting for the asking and answering of questions

(vi) To stimulate participation in decision making

(vii) To develop more specialized expectations about out to relate to one another.

(viii) To effectively control activities and programmes

(ix) To listen

(x) To provide entertainment

(½ mark for any 5 point 2 ½ marks)

3. (a) Aims of Primary Health care (PHC)

(i) It makes health care available and accessible to people whenever they live and work

(ii) It makes use of appropriate technology to provide the service.

(iii) It promotes individual arid community self-reliance

(iv) It reduces morbidity and mortality in high risk group or vulnerable group.

(v) It prevents illness in the community through health education.

(vi) It provides adequate and effective health care at the grass root.

(vii) To ensure that in implementing the health programmes, the community must be involved in
planning, implementation and evaluation.

(½ mark each for any 5 points: 2 ½ marks)

(b) Short note of the following terms:

(I) PHC: Is an essential health care based on practical scientifically sound, socially acceptable methods
and technology, made universally accessible to individual and families in the community through their
full participation and at a cost that community and country can afford to maintain at every stage of their
development in the spirit of self-reliance and determination. It means bringing health care service as
close as possible to where people lives and work.

(ii) Quality Assurance: primary Health Care emphasizes an qualitative care both in health facilities
and service even with appropriate technology.

(iii) Cost Recovery: Cost recover refers to recovering money involved in services rendered as in the
use of drug. Therefore, drug revolving fund system is a vital tool in PHC services in order to recover
the cost of drug and revolve it.

(iv) Down-up Approach: It means that PHC Programme requires to be planned from down to up. The
planning is from community level! grassroots to local Government, State and to Federal. The PHC
approach is from bottom to top.

(v) Use of Appropriate Technology: Making use of locally available resources in the community to
solve health and health related problems.

(1 mark for any 5 points: 5 marks)

(c) Reasons why Integrated Service Delivery is difficult or may fail:

(i) Lack of competent and committed staff.

(ii) Inadequate equipment drugs and supplies to cope with the consumers of the services.

(iii) Lack of motivation of existing staff.

(iv) Culture of the people as regards festival, and markets days when services are provided at the health
facilities.

(v) Ignorance on the availability of services by members of the community.

(vi) Communication gap between staff and clients.

(vii) High cost of services.

(viii) Side effect of treatment etc.

(b) Short note on:

(i) Coping Mechanism: Is a means of inventing own consciousness effort to solve personal and
interpersonal problem in order to try and master minimize or tolerates stress conflict. .

(ii) Forgetting: Is the apparent loss e.g. modification of information already encoded and stored in the
individual long term memory. It is a spontaneous or gradual process in which old memories are unable
to be recalled from memory storage.

(iii) Self-Concept: Is a collection of belief about oneself that includes element such as academic
performance, gender identif5j, sexual identify and racial identity.

(iv) Attitudes: Are ways of thinking or feeling about something it is manner of disposition, feeling, F
position with regards to a person.

(v) Memory: Is the processes by which human being encode, stored and retrieve information.

Encoding is the initial perception and registration of information: storage is the retention of encoded
information over tiem: retrieves is the process involved in using stored information.

(1 mark for each 5 points: 5 marks)

4c. Types of memory:

(i) Short Term Memory: Materials are stored for short intervals i.e. for matter of seconds or minutes.

(ii) Long Term memory: Materials are stored for long interval i.e. for days, months, years.

(iii) Sensory Memory: initial momentary recording of information in our sensory system as when a
man first see a person, the memory of the sensory organs of sight is first activated.
 (½ mark for any 5 points: 2 ½ marks)

(a) Socio-cultural behaviour that influences health of the community:

(i) Culture

(ii) Tradition

(iii) Religion/Myth

(iv) Custom

(v) Taboo

(vi) Superstition

(½ marks for any 6 points: 3 marks)

5. (a) Situation Analysis: Is the process of finding out the actual status of health in a given community
which includes information of Local Government Area population by villages, and wards and age,
health budget, health facility by type heath personnel by type and location etc.

(1 mark)

(b) Rationale for situation analysis in PHC

(i) To determine the effectiveness of the health service and to respond to the problems found in the
community or Local Government Area.

(i) To provide complete inventory

(iii) To identify the distribution of health facilities in the community

(iv) To identify category and number of personnel in the facilities

(v) To provide information on the type and adequacy of services provided in all the facilities

(vi) To provide information on the number of settlements in each community or Local Government

(vii) To provide a complete overview of health services, there strength and weakness, health related
problems and infrastructure.

(½ mark each for any 6 points: 3 marks)

(c) The role of Community Diagnosis in PHC: -

(i) The health needs of the community are identified through community diagnosis

(ii) The available resources are identified.

(iii) It provides the platform for planning

(iv) Improves the relationship between the health workers and are community

(v) Helps to address obstacles and constraints.

(vi) Helps to identify the learning needs of the community which is a good basis for health

education.

(vii) Promotes equitable distribution of services within the community

(viii) It makes evaluation of the health program easy

(½ mark for any 6 points: 3 marks)

(d) Advocacy: Is the process of sensitizing the ‘policy makers to programmes.

It is also process of creating awareness concerning any health matter among policy makers in

order to get their support

(e) Rationale for Advocacy:

- Advocacy is necessary for acquaint policy makers of their roles and responsibilities in relation to
identified health goals.

- For policy makers to provide the required support for implementing PHC services

(1 mark each for 2 points: 2 marks)

6 (a) Misoprostol: Indication for use

i. It is used to start labour

ii. It is used to treat stomach ulcer

iii. It is used to prevent and control postpartum Haemorrhage

(1 mark each for 2 points: 2 marks)

Contra Indication

(i) Pregnancy

(ii) Multi-gravida

(in) Cephlo-pelvic disproportion (½ mark for any 2 points: 1 mark)

Side effects:

(i) Fever

(ii) Rigour

(iii) Uterine ruption

(½ mark for any 2 points: 1 mark)

(b) Reasons for Drug-Drug interaction

(i) Misuse and abuse of drugs including alcohol

(ii) Patients fail to comply to directions for these of drug

(iii) Patients use both prescribed drugs and un-prescribed drugs

(iv) Patients on multiple drugs at the same time

(v) Lack of knowledge about some drug.

(vi) Self-medication. (½ marks each for any 4 points: 2 marks)

(c) Definition of self-medication

(1) Self-Medication is a human behavior in which an individual uses a substance or any exogenous
influence to self-administer treatment for physical or psychological ailments.

(marks)

i) Drugs that are abused

(i) Codeine

(ii) Paracetamol

(iii) Antibiotics

(iv) Sedatives e.g. Diazepam

(v) Pentazocin injection

(vi) Aspirin

(vii) Misoprostol

(viii) Tramadol
(ix) Postinor 2 (½ mark each for any 4 point: 2 marks)

(iii) Preventive measures:

(i) Monitoring and supervision of children activities

(ii) Health education in school about danger of abusing drugs.

(iii) Policies against substance abuse in the work place

(½ mark each for 2point: 1 mark)

(d) Steps in Drugs quantification:

(i) Collect information on the number of treatment episodes requiring drug i.e. ordering interval e.g. 6
months.

(ii) Identify major health problems seen in the health facility malaria

(iii) Get standard treatment schedule for each drug formulation or an illness episode

(iv) Calculate the quantity of drug formulation required for each diseases

(½ mark for 4 points: 2 marks)

7. (a) Reasons for referral:

(i) The patient requests that he/she should be referred

(ii) Inadequate facilities

(iii) Inadequate trained personnel at the referring centre.

(iv) When patient is not responding to treatment

(v) When patient condition is getting worst

(vi) When there is need for specialist attention

(vii) When the case is not covered by the standing Order

(viii) When the case require major surgery.

(½ mark for 8 points: 4 marks)

(b) Rationale for outreach/Mobile services:

(i) To extend health services to communities at grass root level that are geographically in accessible e.g.
poor road network.
(ii) For follow-up care of patient that are under treatment

(iii) Extend PHC services to the communities that need special health attention e.g. epi4pmic, refugees
etc.

(iv) To ensure total coverage of PHC service.

(v) To promote ultilization of modern health care services thereby simplifies health planning.

(vi) To assist in the control of infectious diseases through immunization

(vii) To reduce travel cost of referral.

(viii) To provide immediate and effective care. (½ mark for 6 points: 3 marks)

(c) Activities in planning outreach services

(i) The objectives for tie put reach services should be clearly stated in respect of what is to be done,
where, when by whom and with what resources

(ii) Preparation of schedule of visit for each village.

(iii), Prepare duty roster for the staff based availability categories of staff

(iv) Carry out orientation for staff for them to be abreast with the functions

(v) Provide and ensure that equipment, supplies and resources needed for the outreach services are in
good order and available.

(vi) Liaise with the village health workers and community leader in order to ensure that the objective of
programme are achieved.

(vii) Determine if the village health workers and village development have been selected and trained
otherwise arrange for their selection training and logistics.

(½ mark each for 6 points: 3 marks,)

2017 PAPER II

MODEL ANSWERS (70 MARKS)

1a. Functions of water

i. Transport nutrients to cells

ii. Regulations of body temperature

iii. Maintains the needed balance of slate and water

iv. Removes waste product through urine and sweat

v. Provides cushioning for joint and soft tissues

vi. It increases the efficient of immune system in the bone marrow

vii. Provision of moist internal environment which is required by all living cella in the body.

viii. Dilute poisonous substances in the body

ix. Help to reduce stress, anxiety and depression

x. Contained in saliva for diluting the moistened food

(½ mark each 8 points I marks)

b. Factors affecting the Nutritional Status of a community

(i) Seasonal variation: Food production occurs during the raining seasons making food very abundant
and cheap but becomes scarce and costly during dry season

(ii) Lack of transport leading to difficulties in transporting food items to the towns

(iii)Lack of storage facility: Many food items are destroyed and lead to scarce during dry season

(iv) Cultural beliefs about food: some communities forbid eating of certain meat e.g. cow, snails pork,
snake, cat. Etc.

(v) Family size: A large family size often puts a lot of economic and social burden to the family leading
to poor nutrition

(vi) Illiteracy and misplacement of priorities: Lack of adequate diet knowledge can lead to pm
nutritional status

(vii) Political factor: Food production suffers set back if the Government neglect agriculture. (viii)
Natural disasters: Draught, flood and soil erosion can drastically reduce availability of food items

(ix)Environmental hygiene: poor sewage disposal housing drainage can easily contaminate food and
water leading to susceptibility to epidemics

(½ mark each for 6points: 3 marks)

(c) Prevention of Nutritional Problems:

i. Gainful employment

ii. Study of agricultural science and its practice

iii. Government support for increased food production through supply of manure availability

land improved crop, adequate education, improved animals etc.

iv. Health and nutritional education

vi. Population control measures

vii. Good eating practices

viii. Child spacing/family planning

ix. Adequate breastfeeding

x. Immunization

(½ mark each for 6 points: 3 marks)

2a. CHEW Standing Order, 2010 edition section 2: Child Health Section on Arm and

problems page 106:

Clinical Judgement-Severe condition -

Action:

 Immobilize the limb

 Paracétamol 2mths-3years ¼ tab (125-250mg) stat 3yrs-5yrs tab (250mg) stat
 Refer immediately

Health Education

 Prevention of home accident especially accidental ingestion, proper storage, labeling

 Care of wounds and sores
 Nutritional and effects of healing Importance of taking home based record with her any time to
takes baby to the clinic or hospital

Signature:……………………………….

Name:…………………………………..

Designation:………………………….

Date:………………………………..

Edition/page number (1 mark)

Clinical judgement (1mark)

 Action/Health Education (2 mark)

Signature and Date (1mark)

(b) Characteristics of the Normal Pulse

(i) The rate

(ii) The Rhythm

(iii)Volume of Strength

(iv) Tension

(½ mark each for 6 points: 3 marks)

(c) Reaction associated with injunction administration

i. Dizziness

ii. Itching

iii. Perspiration

iv. Loss of consciousness (fainting)

v. Nausea

vi. Tinnitus (ringing in the air)

vii. Blurred vision

(½ mark each for 6 points: 3 marks)

3a. Definition

i. Cold Chain: Is the process of distribution and storage or vaccines in the potent state from the
manufactures to the recipients. It is a logistic system of keeping vaccines cold at the recommended
temperature to ensure their potency.

ii. Herd immunity: A Herd immunity is the level of resistance of a community or group of people to a
particular disease, when herd immunity is low it can be to severe epidemics, when it is high, the
introduction of infection may not lead to propagated spread.
iii. Immunization: The procedure that kept a susceptible person free from disease or helps the person
overcome a disease or the production of immunity against specific diseases by artificial means in a way
of helping to prevent certain diseases especially in childhood

(½ mark each for correct answer 1 ½ marks)

b. Factors to consider when storing vaccine:

i. Store each vaccine at its storage temperature.

ii. Record Temperature twice daily that is morning and evening

iii. insert cold chain monitoring chart which is designed to last for the whole year.

iv. insert functional dial thermometer which will enhance effective monitoring of temperature v.
vaccines, should be arrngec1 accordingly e.g. frozen and non- frozen separately

vi. all received and stored vaccines should be recorded accordingly

vii. vaccine should not be stored at the refrigerators door

viii. tetanus toid, DPT and HBV should be stored at temperature -20C + 40C (½ mark each for 8 points;
4 marks)

c. Ways of acquiring Immunity:

i. By having the disease

ii. By receiving active immunization

iii. By receiving passive immunity

iv. By having maternal antibodies

d. Factors that influence immunity -

i. Age: Young and old people have low immunity

ii. Poor Nutrition: Under nutrition and malnutrition often gravity weaken immune response

iii. Pregnancy: Pregnancy tends to lower immunity and many infection find their way easily in the
body of pregnant woman.

iv. Drugs: Many drugs such as those used to treat malignant conditions show toxicity not only to
malignsty cells but also to normal cells including those involved in immunity.

v. Diseases present in the body: Many infections and disease affect depress immunity, leading to
reduce production to other diseases, poor antibody response e g HIV/AIDS
vi. Genetic factors: The possession of certain genes is linked to immune disorders and some

antoimmune disease (½ mark each for 6 points: 3 marks)

4a. Functional of a bone:

i. The bone provides the supporting framework of the body

ii. The bone gives attachment to muscles and tendon

iii. Provide movement by the action of muscle

iv. Provides of red blood cells in the bone marrow

v. Provides reservoir of calcium.

vi. Forms the boundaries of the cranial, throraci and pelvic cavities protecting organs they contain

(½ mark each for 6 points: 3 marks)

(b) Stages of healing Mechanism of broken bones:

i. Formation of haematoma between the ends of bones and in surrounding soft tissues

ii. Development of acute traumatic inflammation

iii. Accumulation of microphages

iv. Growth of granulation tissue and new blood vessels

v. Development of largen umber of ostecolasts that secrete non-lamellar osteoid

vi. Shaping of the new bone by osteoclasts which removes excess callus

(½ mark each for 6 points: 3 marks)

(c) Diseases of the Digestive system:

(i) Peptic ulcer

(ii) Appendicitis

(iii) Intestinal obstruction

(iv) Constipation

(v) Haemorrhoid
(vi) Sickle cell anaemia

(vii) Varicose vein

(viii) Coronary thrombosis

(ix) Hardening of arteries (Arterioseclerosis)

(x) Angina pectoris

(½ mark each for 4 points: 2 marks)

5a. Laboratory Safety Rules

i. Mouth -pipetting should be avoided. Always use a peppette aid or sucition bulb

ii. Eating, drinking, smoking and apply make-up must not be allowed in the laboratory working area

iii. Wash hands before and after any laboratory procedure, after removing gloves and at other times
before leaving the laboratory

iv. The laboratory should be kept neat, clean and free of materials not relevant to the work

v. Keep the bench area clear of all equipment other than that required for immediate procedure

vi. Centrifuge specimens only in sealed centrifuge buckets to minimize droplets or aerosol spray

vii. Disposable equipment (e.g. gloves) must not be re-used as they may retain contaminated material
and may deteriorate when cleaned

viii. Laboratory coats, gowns, or uniform should be worn in the laboratory, laboratory clothing should
not be worn in non-laboratory area.

ix. Gloves should be worn for all procedures that may involve accidental direct contact with blood,
infectious materials or hazardous chemicals

x. Never put anything in your mouth in the laboratory (e,g, fingers, pens, pencil)

xi. Do not leave cut, open sores, or wounds to possible infection

xii. Avoid injury that might be caused by any sharp object used in the laboratory

xiii. Long or dangling jewelry should not be worn in the laboratory

xiv. Disinfect bench-tops before and after working and whenever contamination is suspected

xv. Do not use bare hands to pick up broken glass. Use a broom or brush and a dustpan

xvi. Disposing safety of specimens of contaminated materials.

 (½ mark each for 10 points: 5 marks)

b. Explanation of Terns

(i) Disinfections:

Disinfection means freeing of an article from some or all life of any kind, which might cause
infection during its use. Disinfection may not kill all forms of life present in or a material. They only
reduce the infectivity of such material. Many disinfectants are in use in health care settings: and must
have been found to inactivate HIV. However chemical disinfectants may not be reliable, because they
may be inactivated by blood or other organic matter present. They may also lose their strength,
especially when stored in a warm place. (1 mark)

ii. Sterilization:

Sterilization is the act of rendering nay substance free from all life of any kind. This means the article
becomes free from microorganism. There is no such thing as being ‘almost sterile’ or practically sterile.
An object is either sterile or is not sterile. There are a number of sterilizing methods in use.

(1 mark)

c. Intestinal parasite that may be found in stool specimen:

i. Ascaris Worms

ii. Trichuris worms

iii. Trichinella Sprialis

iv. Ankylostoma worms

v. Strongloids

vi. Tineasaginata

vii. Giardia Limbia (½ mark each for 6 points: 3 marks)

6a. Identification of training needs of VVHWs:

i. By asking questions

ii. Observation of performance

iii. Discussion

iv. Feedback

v. Review of previous knowledge

vi. Continuous assessment

vii. Review of annual performance record (½ mark each for 4 points: 2 marks)

b. Advantage of on-the-job-training:

i. Increase the efficiency of workers/staff

ii. It boosts the morale of workers

iii. It improves the health status of the workers as they are upgraded to new senior rank

iv. It helps workers to increase speed, proficiency and accuracy at the job site

v. It promotes and fosters job security to workers

(½ mark each for 4 points: 2 marks)

c. Attribute of a leader:

i. Ability to infuse dynamism and courage in the subordinates

ii. A high sense of responsibility, accountability and dedication towards the team

iii. Ability to interact and adjust to the working conditions of the group

iv. Ability to command respect

v. Good listening ability

vi. Capacity of friendliness

vii. Willingness to refrain from dominating others

viii. Gift of cheerfulness (½ mark each for 6 points: 3 marks)

d. Causes of job dissatisfaction in an organization:

i. Inefficient administration: People like to work for an administration that is both efficient and
effective

ii. Incompetent supervision: People expect supervisors to be technically competent, sound and skilled

iii. Poor interpersonal relationship: People ought to be treated fairly, poor human relation between
management and workers deter people from working hard and giving their best

iv. Inadequate pay (poor Remuneration)

v. Bad working condition

vi. Personal qualities of the leader (A team leader or a boss)

(½ mark each for 6 points: 3 marks)

7a. Effectives of improper budgeting in Primary Health Care include:

i. Inadequate equipment

ii. Staff may go on strike

iii. Failure to achieve set objectives

iv. Clients and patients may stop patronizing the health facility

v. Inadequate payment of staff wages

vi. Shortage of drugs in the clinic

vii. Misplacement of priorities

viii. It gives room for fraudulent acts in no small measures

ix. May causes dissatisfaction (½ mark each for 8 points: 4 marks)

b. Objectives of Health Management Information System

i. To set priorities at all levels

ii. To identify major health problems

iii. To provide information which can be used as a management tool for decision making.

iv. To assess the state of health of the population

v. To monitor the progress towards started goals and targets of the health services

vi. To provide indictors for eva1uting the performance of the health services / programme

vii. To provide information to the policy makers/those who need to take action

viii. To assess the impact of health services / programme on the health status of the population

(½ mark each for 7 points: 3½ marks)

c. Formula as applied in vital statistics:

i. Fertility Rate:
 Total Number of Birth in a year x 1000
Number of women aged 15-49 years
ii. Neonatal Mortality Rate:

Number of deaths in infants under 1 month of age x 1000

Number of live births during the year
iii. Still Birth Rate:

Number of foetal deaths of 28 weeks or more weeks of gestation x 1000

Number of live births and still birth
iv. Prevalence Rate:

Number of a person who are sick at a given time x 1000

Average number of person exposed to risk
v. Case Fatality Rate:

Number of deaths ascribed to specific diseases x 1000

Number of reported cases of the specific diseases
(½ mark each for 5 points: 2½ marks)

MODEL ANSWERS
1a. Six (6) ways of protecting sources of water supply
 Keeping waste disposal away from water sources
 Keeping people and animals away from contamination of sources
 Installing fence or other means to prevent contamination of sources
 Installing parapette at least 90cm above ground level
 Installing concrete or impervious the well apron by constructing proper drainage
  Educating the communities on use of two buckets system to fetch water from the well.
 Training VHW on methods of protecting water sources
 Acting as resources person to the VHWs and providing technical advice on protection
of water resources.
 Obtaining random sample of water for analysis using special dip and steri. containers.
Collecting results of water analysis from the ward laboratory.
 Discussing results of water analysis with VHW and Village Development Committee
 Advising on appropriate action to take. (‘/2 mark each — 3 marks,
1b. Factors affecting methods of refuse disposal
 Level of development of the community
 Topography, especially the presence of low-lying ground and pit to be filled.
 The occupation of the majority of the people as the organic wastes can be transformed into
manure.
 Resources available to the people. (1/2 mark each - 2 marks
1c. Personal factors that influence frequency of accident in industry
 Ignorance — an illiterate worker can be ignorant because he cannot read and understand
instruction and signs given on the machine with which he works.
 Training and Experience — Lack of training and experience in the proper handling machine can
increase the frequency of accidents.
 Ill health Defects and Disabilities — accident hazards are increased by illness disabilities (e.g.
hearing or visual defects)
 Fatigue or Sleeplessness — Precision and ability to report promptly to stimuli can be
reduced by fatigue or lack of sleep.
 Alcohol and drugs — alcohol and drugs can lead to impaired attention and judgment.
 Age — younger workers are more prone than older experienced.(’/z marks each — 3 marks)
ld. Occupational diseases which occurrence must be notified or reported in Nigeria
 Lead poisoning
 Phosphorous poisoning
 Mercury poisoning
 Manganese poisoning
  Arsenic poisoning
 Aniline poisoning
 Carbon Bisulphide poisoning
 Benzene poisoning
 Chronic Ulceration of skin a
 Anthrax
 Ionizing radiation
 Toxic juices
 Toxic anaemia . -
 Absestosi (1/2 mark each —2 marks)
2a. Condition that require immediate referral
- Abnormal presentation e.g. buttocks (breech), foot, delay of the head
- Excessive bleeding before and after delivery of birth
- Deep tear or cut of the perineum
- Mother too weak and tired to push baby or placenta out.
- Cord prolapsed or cord presentation
- Prolonged obstructed labour (1/2 mark each —3 marks)
2b. Strategies of Prevention of Mother-to-child Transmission of WV (PMTCT)
- Primary prevention of HIV infection in women of reproduction age and their sexual partners.
- Prevention of unintended pregnancies among HIV positive women
- Prevention of HIV transmission from infected pregnant women to their children
- Treatment care and support for HIV infected women, their children and families
2c. Women who cannot take progestin only injectable contraceptives.
- Women who have acute deep vein thrombosis
- Women who have live tumour -
- Women who are breastfeeding up to six weeks postpartum
- Women who have blood pressure 160/l00m Hg and above.
- Women who have diabetes with vascular complication
- Women who have unexplained vaginal bleeding (before evaluation)
- Women who have multiple risk factor for cardiovascular diseases
 - Women who have current or history of stroke or is chaemic heart diseases
- Women who have noticed tltr migraines with aura getting worse while taking progestin only
injectable
- Women who have rheumatic disease such as lupus erythematosus with positive or unknown
antiphosholipid antibodies.
- Women who have history of breast cancer and no evidence of current disease for 5 years.
(1/2 mark each —.3 marks)
2d. Prevention of the pre-eclampsia and Eclampia in your community.
- Antenatal care regular BP and urinalysis check up
- Early referral
- Skilled and motivated health personnel
- Appropriate drugs and supportive care
- Identification of danger or sign PC
- Avoid delays in obstetrics
- Attachment of millennium Development Goals
- Improving literacy level
- Eradicating poverty and empowering women socio economically
- Involvement of other stakeholder (community and religious leaders) in the management of
pre-eclampsia and eclampsia. (1/2 mark each — 2 marks)
3a. Characteristics of a good complement any food.
- High energy and adequate good quality protein, vitamin and minerals
- Soft consistency to enable the child to swallow early
- Low dietary bulk
- Need for minimal preparation prior to feeding and easy digestibility
- No anti-nutritional fact3rs and low indigestible fiber content
- No artificial colour and flavor. (¼ mark each — 3 marks)

3b. Doses and routes of administration of NPI vaccines:

Contact Minimum Target Type of Dosage Route of Site

Age of Child Vaccine Administration
1st At birth BCG 0.05ml Intradermal Right upper
arm
OPVO 2 drugs Oral Mouth
HBVO Intramuscular
2nd 6 weeks of age Pentavalent 1 0,5ml Oral Anterolateral
(DP.HBV and aspects of
Hib) high
OPV I 2 drops Intramuscular Mouth
3rd 10 weeks of age Pentavalent 2 0,5ml Oral Anterolateral
(DPT.HBV and aspects of
HAIB) high
OPV 2 2 drops Intramuscular Mouth
4th 14 weeks of age Pentavalent 3 0.5ml Oral Anterolateral
(DPT. HBV aspects of
and Hib) high
OPV 3 2 drops Subcutaneous Mouth
5th 9 months Measles 0.5ml Subcutaneous Left upper
arm
Yellow fever 0.5ml Left upper
arm
(1/4 mark for each point – 5 marks).
3c. Factors that promotes plague retention:
1. Cracked teeth
2. Overhanging edges on filling
3. Poorly contained teeth filling
4. Some types of partial dentine
5. Calculus hardened (plaque) (‘/2 mark each — 2 marks)
4a. Definition of Puerperal Psychosis:
Puerperal psychosis also a postperture psychosis is a term that cover a group of mental illness
with a sudden onset of psychotic symptoms following child birth, the onset is abrupt, and symptom
rapidly reach a climax of severity, most often within first four weeks post portum. The most
significant risk factors for puerperial psychosis arc a personal or family history of bicolor disorder or a
previous psychotic episode
4b. Causes of Puerperal Psychosis:
i. The physical strain of delivery, maternal exhaustion, which may be made wet by surgical
intervention
ii. Any infection causing high fever and additional strain
iii. Loss of blood antepartum haem6rrhage or post partumhaemorrhage
iv. Reabsorption of haematoma or other protein containing fluids, allergic reaction
v. Endocrinological disturbance following delivery
vi. Psychologica1 tresses of pregnancy and labour, including emotional stresses pregnancy and
motherhood.
vii. Possibly hereditary factors. ( ½ mark each — 3 ½ marks)
4c. Areas to cover in the physical examination of a school child:
i. Eyes test — for activity of vision, examination for defect e.g. squint, examine for disease e.g.
Vitamin A deficiency, Trachoma, Conductivities etc. examine for anaemia.
ii. Teeth — look for carries, spongy, bleeding gum, pyorrhea etc.
iii. Throat — look for enlarged inflamed tonsils
iv. Ears — test for hearing, look for & discharge
v. Chest — Ausculate heart an dlumps
vi. Abdomen — Plapate enlargement of liver or spleen. L9ok for defects and presence of lump
or hinderness, look for undescended testis.
vii. Limps and spine — test for residual paralysis, look for defects e.g. kyphosis, club foot etc.
look i1or signs of rickets
viii. Skin and hair — Look for red or hypopigmented patches with loss of sensation, look for
ulcers, boxes, ringworm, or scabies, look for presences of lice
ix. If the child has a minor illment, advice the teacher or parent what treatment is to be given.
(½ mark ach — 3 marks)
4d. Roles of CHEW in School Health Services:
1. Health supervision includes such activities Of health assessment, vision and hearing
screening and health deficit identification. .
 2. Health Counseling involve providing interpretation regarding health behavior and
recommendations regarding individual and group health condition
3. Health Education refers to planning, promoting and implementing health instruction as well
as providing consultation services in health relate matter.
5a. i. Infections Agent — Ebola virus is caused by virus of the family filoviridae, genus, Ebola virus.
Five subspecies exists, hamely: Ebola virus (Zaire ebola virus) Sudan virus (sudan Ebola virus); Tai
Forest Virus (Tai forest ebola virus); Bundibugyo virus (Bundibugyoebola virus) and Reston Virus
(Reston ebola virus) (1 mark)
ii. Mode of Transmission — direct contact with the blood or secretions of an infected person. Exposure
to object (such as needles) that have been contaminated with infected secretions. (1mark)
iii. Signs and symptoms — Fever, headache, joint and muscle aches, weakness, diarrhea, (1dmiting,
stomach pain and lack of appetite. Others include: Rashes, red eyes, hiccups, cough, core throat chest
pain, difficulty breathing, difficulty swallowing, bleeding (internal & external).
(2 marks)
iv. Prevention - Barrier nursing techniques include:
- Wearing of protective clothing (such as masks, gloves, gowns, and googles)
- The use of infection control measures
- Isolation of patients. (1 ‘/2 marks)
5b. Characteristics of Non-Communicable Diseases (NCD):
i. The cause is largely unknown
ii. Many factors contribute to their development
iii. The diseases develop slowly over a period of years
iv. They can be controlled or treated if detected ir. early states
v. Certain lifestyle habits or modes of living increases the risk of premature development of
NCD
vi. Risk reduction and preventive measure can delay the development of NCD and reduce
disability or discomfort (½ mark each — 2½ marks)
5c. Preventive measures of Hypertension:
1. Avoid too much intake of salt
2. Avoid or reduce meals that are highs in fats and cholesterol including fried foods.
3. Avoid overeating and reduce weight if you are obese
 4. Avoid too m4ch sugar in your food
5, Exercise regularly, by jogging gently, brisk walking, playing tennis.
6. Control stress and get adequate sleep and rest
7. Check your blood pressure regularly
8. Avoid excessive intake of diary products such s milk, egg york, butter, etc
(½ mark each -2 ½ marks)
6a. Advice to parents with a° hearing impared child:
i. Let the child see your face when you speak to him
ii. Make sure there is good light for the child to see your face
iii. Get the child’s attention before you speak to him
iv. Decrease other distraction — especially loud noises
v. Encourage hard of hearing disorders children to listen and discriminate duff sounds especially
if he is using a hearing aid.
vi. Stand close to the child when you speak
vii. Speak clearly and more slowly
viii. Don’t shout an exaggerate movement
ix. Repeat words and instructions many times
x. Use gestures, drawing, painting — point at things
xi. Encourage lip reading
xii. Don’t eat or chew while talking to the child
xiii. Do not over protect the child
xiv. If the child has a hearing aid he/she must use it.
6c. Procedure for measuring distance vision using snellen chart:
i. Determine the distance between the patient and the chart which must not lip meters or 20 feet.
ii. Explain the procedure to patient and sit the patient comfortably
iii. Test the right eye first, cover left eye with occlude. Be sure that patient is us4 eye.
iv. Test visions by starting with the large letters first, proceed down the chart to the letters the
patient can see. It is advisable to skip lines so as to identify the smallest the patient can read.
v. Record the smallest line in which the patient can see at least half of eh letters.
vi. Repeat the test with left eye
vii. Repeat the test with patient wearing his corrective lenses
 viii. If patient cannot see largest letters, then adopt other method e.g. counting finger.
7a. Objective of the care of the handicapped:
i. Identify the common cause of handicap in the community
ii. Carry out activities aimed at preventing handicap in the community.
iii. Provide care for the handicap
iv. Rehabilitation (medically, mentally and socially) every handicap person in community
v. Mobilize the community to participate in the above. (½ mark each — 2 ½ mark)
7b. Activities to be carried to promote care of the elderly in your community.
1. Care of the elderly is the responsibility of the family and community therefore discourage the
establishment of more old people’s home
2. A day centre equipped with adequate recreational facilities should- be provided for each
community.
3. Organize interstate bus/train excursion for the elderly. (½ mark each — 4 marks)
7c. Golden rules of First Aid:
i. Do first thing first, quickly and without fuss or panic
ii. Give artificial & respiration if breathing has stopped every second counts
iii. Stop any bleeding
iv. Guard against or treat for shock by moving the casualty as little as possible and handling him
gently.
v. Do not attempt too much — do the minimum that is essential to save life and prevent the
condition from worsening
vi. Reassures the casualty and those around also to help lessen anxiety
vii. Do not allow people to crown round as fresh air is essential
viii. Do not remove clothes unnecessarily
ix. Arrange for the removal of the casualty to the care of doctor or hospital as soon as possible.
(1/2 mark each - 3 ½ marks)

PAPER I
SECTION B: EASY QUESTIONS (70 Marks)
(a) Explain five (5) out of the codes of conduct for Community Health Practitioners.(5 marks)
1. Set a high standard: A community health practitioner shall set a ‘high standard and not allow
himself/herself to receive gifts, favours or hospitality from a client/patient, or relatives of a
client/patient who is to be or who has been in his or her care
2. Intra-professional obligation: A community health practitioner shall maintain friendly relations
with colleagues and be respectful to the senior colleagues
3. Use of standing orders: A community health practitioner must use his/her standing orders and
other medical equipments in arriving at any diagnois and management of hi/her patient
4. Maintenance of two-way referral system: A community health practitioner shall maintain the
referral system by referring cases beyond his/her job description to the appropriate level
5. Administering of treatment: A community health practitioner shall not administer any treatment
on a patient or his/her relation in a case of unconscious or a patient who cannot speak for
himself/herself
6. Prompt attention: A community health practitioner shall ensure the safety of his/her patient
whether the relatives, are around or not and use whatever the relatives are around or not and use
whatever means of his/her disposal to preserve life while awaiting relation arrival and assistance
7. Giving of evidence: A community health practitioner shall say what he/she knows is true when
giving evidence as an expert witness. ‘ -
8. Use of uniform: A community health practitioner must always appear in his/her uniform once
on duty except during emergency and call duties which are outside official working hours
9. Anti-professional behaviours: A community health practitioner hal1 be members o?the National
association of community health practitioners of Nigeria being the only legally recognized body
to assist the board in ensuring professional sanity and dignity in the country. Any community
health practitioner that does not belong to the association would not be recognized by the board.
10. Absenteeism: A community health practitioner should not absent himself/herself from duty
without permission
(b) List six (6) duties of Community Health Practitioners (3 marks)
I. Caring for the sick and injured considering the resources of the patient, his family and environment
and the services available, incorporating personal needs to his/her recovery and rehabilitation in
accordance to the finding and actions of the standing orders.
II. Helping the individual and the family to take positive action in relief of illness improvement of
his/her individual family and community needs
III. Training others to function as members of the health team.
IV. Adopting community health services to correspond with responsible planning arthoritatic in
emergency like disasters, outbreak and wars
V. Evaluating and conducting research to improve health care and adequately meet society needs
VI. Sharing with others in the dissemination of health information to individuals and it community
(c) List four (4) Duties of the Community Health Practitioners Registration Board of Nigeria
(CHPRBN). (2 marks)
a. Determining what standard, knowledge and skill are to be attained by a person seeking become
members of the community health and improving those standards from tune to f circumstances
may permit.
b. Board assess and accredits community health course in institutions in college/school of h
technology/school of hygiene and community health training institutions.
c. Securing the maintenance of registered members under this decree as members of I profession
and publication from time to time lists of the members.
d. Conducting examinations in the profession and awarding certificate to successful candidate
appropriate.
e. here shall be establishment for a disciplinary committee to be known as “the community Health
practitioners Disciplinary committee” which shall be charged with the duty considering and
determining any case referred to it by the investigating panel (session 211 decree 61 of 1992):
f. CHPRBN set standards, monitor and discipline members.
g. To ensure the maintenance of training standard in order to ensure the delivery of quality health
services especially at the primary health care level
2. (a) Enumerate five (5) types of Traditional Health Care Delivery. (2 ½ marks)
a. Herbalist
b. Traditional birth attendants
c. Bone setters
d. Traditional psychiatrist I
e. Spiritual healers
f. Oracle men/women
 g. Messengers
h. General practitioners
(b) List five (5) characteristics of Modem Medicine.(2 ½ marks)
1. Modem medicine is scientific because it is based on knowledge derived from careful and
experimentation
2. Modem medicine is team work: It requires the services of many professionals who work in
collaboration for the proper treatment of illnesses
3. Modem medicine practitioners make use of chemoteraphy, surgery, radioteraphy, dietics
education of patients/clients to treat disease.
4. There are specialization in modern medicine and one medical practitioner cannot treat every
sickness
5. Modem medicine is standardized worldwide in the sense that one can be trained in one location
or part of the world and practice successfully in another location or part of the world
6. In Nigeria and elsewhere, the practice of modern medicine controlled by government policies
and ethics of the profession involved
7. Modem medicine in Nigeria is organized in three levels, primary level, which is the entry point,
the secondary level and tertiary level.
8. Referral is made when necessary from the primary level to the secondary level where
specialized service is given and finally to the tertiary level for highly specialized service/care
(c) State the two (2) types of emotion, giving two (2) example of each. (2 marks)
1. Emotion may be pleasant or positive e.g. Joy, Love, Happiness, Smile, Laughter, Election,
Estasy, Amusement, etc.
2. Emotion may also be unpleasant or negative like fear, sorrow, disgust, surprise, jealousy, envy,
hatred anger, aggression, etc.
(d) Enumerate six (6,) factors that may cause forgetting. (3 marks)
1. Interference due to massing of similar learning experiences or overloading of the memory
2. Fading and decay due to lack of practice and exercise
3. Insufficient time, which leads to a hasty search of the memory store.
4. Repreasion arising from strong emotional attachment or guilt feelings
5. Imperfection of the memory process
 6. Change of context or surroundings leading to the removal of reminders and reduction in the
effectiveness of retrival clues.
7. Fear or anxiety arising from lack of confidence as exemplified in stage fight, mental black out
or brain wave
3. (a) Briefly explain the following communication concepts
i. Advocacy (1 mark)
It is the process of creating• awareness concerning any health matter among policy makers in
order to get to or gain their support.
ii) Social mobilization (1 mark)
It is a means of encouraging, inspiring and arousing the interest of people to make them become
actively involved in finding solution to some of their own problems thereby leading to self
reliance& initiatives.
(iii) Behaviour change communication (l. mark)
It is a process of understanding people’s situations and influences, developing messages that
respond to the concerns within those situations and using communication processes and media
to persuade people to increase their knowledge and change the behaviours and practices which
place them at risk.
(iv) Interpersonal communication (1 mark).
It is the face to face verbal and non-verbal exchange of information, ideas or feelings between
individuals or groups.
(v) Mass Media (1 mark)
This is the process of transmitting messages to a large audience through the mass media such as
Television arid Radio
(b) State five (5) ways through which communities can communicate health messages. (2 ½ marks)
 Roles playing
 Story telling (verbal communication)
 Group discussion
 Simulation
 Songs and Drama
 Demonstration
 Counselling
  Dancing
 Non-verbal communication e.g. gestures, body languages
(c) Enumerate five (5) qualities of effective communication (2 ½ marks)
i. Specific objectives
ii. Conciseness - -
iii. Persuasiveness
iv. Timeliness
v. Correctness
vi. Completeness
vii. Feedback
viii. Mutual
ix. Interest
x. Appropriate use of language
xi. Appropriate use of media
4. (a) State five (5) aims of the Basic Health Service Scheme (BHSS) (5 marks)
1. To correct the imbalances crated in the location of health centers thereby increasing the
coverage of medical services
2. To correct the imbalances in the distribution of health services
3. To train and develop man power for the health care services
4. To correct the imbalances between preventive and curative health care-services
5. To provide infrastructural facilities for preventive health care services
6. The use of simple and relevant medical technology appropriate to each community
7. To ensure community mobilization and participation in providing health services
(b) Enumerate five (5) components of the Minimum Ward Health Care package. (2 ½ marks)
1. Eradicate extreme poverty and hunger
2. Achieve universal primary education
3. Promote gender equality and empower women
4. Reduce child mortality
5. Improve maternal health -
6. Combat HIV/AIDS, malaria and other diseases
7. Ensure environmental sustainability
 8. Develop global partnership for development
(c) State five (5) reasons for the integration of health care service delivery in Nigeria. (2 ½ marks)
5. (a) Discuss five (5) constraints you may encounter in conducting community mobilization
participation. (5 marks)
(b) State six (6) Rationales for Community Mobilization (3 marks)
1. To make up for the gross inadequate of our health manpower and equipment, these could be
provided by the community and for their consumption where government is incapable all
meeting the health needs of ever individual in a community. -
2. To identify the health problems in the community, this is because the health needs as Id by the
health workers may be different from the felt needs of the community.
3. To plan their own solutions to their problems.
4. To utilize their own available resources to solve their needs at a cost they can afford.
5. To foster self-reliance. -
6. To foster prompt attention to problems
(c) List four (4) Roles of Situation Analysis in PHC. (2 marks)
1. To determine the effectiveness of healthcare services and to respond to the problems challenges
found in the community or local government area.
2. To provide complete inventory of health facilities in the local government area or community
3. To identify the distribution of health facilities in the community
4. To identify category and number of personnel in the facilities.
5. To provide information on the type and adequacy of services provided in all the facilities
6. To provide information on the number of settlements in each community or local government
area.
7. To provide a complete overview of health services, their strength and weaknesses, health related
problems and infrastructure.
6. (a) Enumerate five (5) sources of drugs (2 ½ marks)
i. Vegetables -
ii. Minerals source ,
iii. Animal source
iv. Synthetic source
v. Antibiotic source
(b) State five (5) factors responsible for the wastage of drugs in a Health Centre. (2 ½ marks)
i. Giving drugs when, diagnosis has not been made
ii. Giving drugs to patients who doesn’t believe in them
iii. Ordering drugs more than necessary so that some expired without being used.
iv. Not observing FIRST IN FIRST OUT (FIFO)
v. Not keeping to the principles of cold chain maintenance makes vaccine to loose their patience
vi. Pilfering
vii. Over prescription on one patient
viii. Poor storage facilities
(c) Identify five (5) objectives of the National Essential Drugs Programme. (2 ½ marks)
i. To make essential drugs easily available to the entire population on continuous basis
ii. To use drugs that are safe and effective
iii. To reduce the cost of drugs through a central bulk purchasing system using generic names
iv. To purchase only necessary drugs for the system, thus saving foreign exchange
v. Introduce a rationale system of drug selection, calculation, procurement and use
vi. Provide training for improved drug management and skill to health workers at all levels
vii. Discourage the production, marketing and sue of fake and counterfeit drugs.
(d) State (5) factors that influence the selection of Essential Drugs. (2 ½ marks)
7. (a) State six (6) reasons for referral of a Client/Patient. (3 marks)
1. When the patient’s condition is rapidly getting worse or deteriorating
2. When indicated in the standing orders “REFER”
3. When patient’s condition is not covered or spelt out in the standing orders.
4. When the patient or his relatives request for the referral
5. Patient’s condition is not responding to therapy
6. When health workers is in doubt of the case in view
7. For specialist sophisticated management
8. When there is no facilities and equipment to manage the case.
9. When there is no expert to manage such a case e.g. internal bleeding and brain surgery
10. For continuity of health care
11. For diagnostic purposes
(b) Enumerate four (4) qualities of a good referral system. (2 marks)
 1. Standardized referral forms
2. Adequate feedback system
3. Willingness of clients and their relations to leave their secured environments o other new
centers.
4. Ability of client and family members to pay for health care and transport fares
5. Good road network an4 transportation
6. Ability of receiving health facility to absorb referred cases.
7. Trust among health practitioners
8. Adequate of documentation of care provided to client
(c) List five (5) services rendered during outreach services. (2 ½ marks)
i. Health education
ii. Antenatal care
iii. Immunizations
iv. Curative medicine
v. Minor sugary
vi. Child’s welfare services
vii. Referral services
viii. Family planning
ix. Treatment of minor ailments
x. Dressing of wounds
xi. Nutritional assessment
xii. Follow-up services
(d) Explain five (5) constraints experienced during outreach services.
i. Poor accessibility e.g. bad roads
ii. ii. Hostility non acceptance of the services by some communities
iii. Insufficient manpower to carry out the services
iv. Insufficient materials Shortage of drugs
v. Language barrier
vi. Poor planning for the services
vii. Poor community mobilization
viii. Community’s culture beliefs, taboos, religions and adamant dogman.
 CHEW 2013 PAPER 11(2) OBJECTIVE
SECTION B: ESSAY QUESTIONS (70 marks)
Answer ALL Questions
1. (a) Enumerate five (5) causes of Nutrition disorders in children under five. (2 ½ marks)
i. Cultural food taboos and food restriction
ii. Low economic status
iii. Poverty
iv. Ignorance/illiteracy
v. Lack of information on nutritional value of locally available food stuffs.
vi. Poor weaning practices
vii. Large family size
viii. Worm infestation
ix. Repeated infections
x. Poor environmental conditions
xi. poor material nutrition
(b) State five (5) preventive measures of Nutritional disorders in children under five.
i. Exclusive breastfeeding
ii. Encourage home garden
iii. Deworming
iv. Good weaning practices
v. Food preparation and demonstration
vi. Family planning.
(c) Enumerate four (4) methods of food preservation (2 marks)
i. Salting .
ii. Refugerating
iii. Canning and Bottling
iv. Sun drying
v. Dehydration
vi. Picking
vii. Fermentation.
viii. The use of chemicals
ix. Osmotic preservation
x. . Preservation by gas
xi. Preservation by antibiotics
xii. Cooking
(d) Fill the table below:
Food classes Nutrients Two (2) examples
1 .Energy giving food Carbohydrate, fats and oils Rice, bread, yam, millet etc.
2.Protective food Minerals, vitamins Fruits, vegetables
3. Body building food Protein Egg, fish, meat, cheese, beans
etc.
2. (a) Use your Standing Order to manage:
A mother brought her ten (10) year old child to the clinic with the complaints of yellow eyes, fever,
nausea and vomiting, abdominal pain. 00n examination, the following observations were made; yellow
eyes, warm to touch with temperature 3 7.5°C, abdominal pain, diarrhoea, cold.
What is your clinical judgment and action to take. (5 marks)
(b) Enumerate five (5) factors to be considered in an interviewing environment. (2 ½ marks)
(c) State five (5) conditions that can prevent taking of temperature orally. (2 ½ marks)
i. Children who are unable or unwilling to cooperate
ii. Delirium
iii. If the patient is liable to convulse
iv. Unconscious patient
v. Where there is local disease of the mouth e.g. stomatitis
vi. Immediately after the patient has had a hotter cold drink
vii. When the patients nose has been packed with quaze
3. (a) Enumerate four (4) factors that affect host immunity. (2 marks)
i. Age
ii. Gender (sex)
iii. Nutrition
iv. Trauma and fatigue
v. Pregnancy
vi. Disease and infection
vii. Hormone
(b) List six (6) non-specific defense mechanisms. (3 marks)
i. Chronic and debilitating diseases e.g. tuberculosis
ii. Genetic factors
iii. Protective covering of the skin
iv. Mucous membrane
v. Secretions
vi. Saliva
vii. Tears
viii. Cough
ix. Sneezing
(c) Explain five (5) factors that affect wound healing. (5 marks)
i. Malnutrition
ii. Radiation
iii. Blood supply
iv. Steroid
v. Vitamins
vi. Age
vii. Infection
4(a) State the cellular contents of Blood. (1 ½ marks)
White blood cells (Leucocytes)
Red blood cells (Erythrocyte)
Platelet (thrombocytes)
(b) List seven (7) components of Plasma. (3 ½ marks)
i. Plasma protein e.g. albumin, globin, fibrinogen, clotting factor
ii. Ignorance substances e.g. sodium chloride, magnesium
iii. Nutrients e.g. glucose, amino acid, fatty acid, glycerol, vitamins.
iv. Organic waste materials e.g. Uric acid, hormones
v. Enzymes e.g. insulin, glucagon
vi. Gases e.g. oxygen, carbondioxide, nitrogen
vii. Cellular contents e.g. red blood cell, white blood cell
viii. thrombocytes e.g. platelet white blood cell.
(c) State five (5) functions of the Human Skeleton. (2 ½ marks)
(d) Enumerate five (5) factors that are involved in the maintenance of normal blood pressure.
i. Age
ii. Sex
iii. Weight
iv. Exercise e
v. Disease and infection
vi. Drugs
5. (a) As a CHEW, How do you plan for the training of JCHEW/VVHW. (4 marks)
i. Set behavioural learning objectives
ii. Choose training methods to meet objectives
iii. Identify resource persons to assist in teaching
iv. Develop a training budget
v. Identify budget items correctly
vi. Estimate realistic costing for each budget items according to local situations
vii. Prepare simple posters, charts and models to help learning.
viii. Decide methods to evaluate training activities
ix, Identify various assessment methods, including merits and demerits of each
x. Select method appropriate to the trainee group and skills taught
xi. Conducting training using participatory adult learn
(b) What do you understand by the term duty roster? (1 mark)
Duty roster is a time table for distribution work among staff members in turns
(c) Describe five (5) morphological characteristics of bacteria. (5 marks)
6. (a) State five (5) differences between commercial and government accounting system.
1 Prepare intervention of external auditors Operate income and expenditure
account based on allocation
2 Profit oriented Non – profit oriented
3 Customers satisfaction Public satisfaction
4 Source of fund is from shareholders and products Source of fund is from budgeting
being manufactured for sale allocation government or donors
5 Entertain intervention of external auditors Internal auditors ensure smooth
accounting flow
6 Accounts are published on daily news paper for shareholders. Account is not being published.
7 Account is published in daily newspaper for share holders Accounts are prepared for
internal consumption
8 Annual account are subject to taxation and therefore must be Not subject to taxation.
sent to Federal Inland Revenue

b) State five (5) factors that motivate employee in an organization. (2 ½ marks)

I. Regular payment of salary
ii. Regular promotion of staff
iii. Staff training
1iv. Encourage good relationship among staff
v. Proper attention to staff needs and the matter and welfare
vi. Recognition of each workers potentials, gifts, personality integrity and self respect
vii. Periodic appraisal of staff performance and productivity
c) Enumerate five (5) reasons why delegation may fail. (2 ½ marks)
Partial delegation for fear that the supervisor will lose his/her position
ii. Delegating responsibility without authority
iii. Junior worker over stepping his/her boundary
iv. Unpreparedness for the job
v. Uncooperative attitude from supervisor or junior workers
vi. Inadequate protection of Junior workers is not protected
vii. If the junior worker is not protected
viii. If the efforts of the junior workers is not appreciated

7. (a) State six (6) objectives of Primary Health Management Information System. (3 marks)
(b) Enumerate four (4) responsibilities at the Local Government Level for effective health information
management. (2 marks)
(c) State four (4) forms of graphic presentation of data (2 marks)
i. Bar chart
ii. Histogram
iii. Frequency polygon
iv. Pictograms
v. Pie charts
(d) The following data represents the performance of Schools of Health Technology in the 2000
National Qualifying Examination.
i. SHT, Akwanga = 60%
ii. SHT,Kuja = 55%
iii. SHT, Elebele = 50%
iv. SHT, Katantga = 75% Present these data in a bar chart. (3 marks)
Performance of schools of health technology in the 2000 national quali14ng examination
2013 CHEW ESSAY QUESTIONS
Paper III
1. (a) State five (5) qualities of an ideal latrine (2 ½ marks)
1. No contamination of surface soil
 2. No handling of fresh faeces
3. No contamination of surface water
4. No contamination of underground water
5. Excreta in accessible to flies or animal
6. No unpleasant odours or un-slightly conditions
7. It should be simple and in expensive in construction operation
8. It should he planed and implemented in accordance with the resources of the community.
9. It should be culturally acceptable to the community.
10. Should have a squatting slab,
11. Hundred metres away from a source of water supply
12. Roof properly
13. Adequately cemented
14. Protected from flies
15. Lined with blocks and having a concrete floor
16. Have a supper structure to provide for privacy of the users
17. Should be constructed of durable materials.
(b) As a CHEW working in Godegodo community, explain five (5) features you will consider
in the construction of a sanitary well (2 ½ marks)
1. l. Location: The first step in well construction is the choosing of a proper site. If bacterial
contamination is to be avoided, the well should be located not less than 5m (S0feet) from likely
sources of contamination.
2. Lining: Should be lined with cement concrete for the first 10 feet extending below water level.
3. The well should have a cover or lid
4. The site must be slightly higher than the nearest sources of contamination e.g; toilet.
5. A sanitary well should have a platform
6. There should be a drainage to carry off spilled water
7. The sanitary well should be equipped with a hand pump
8. There should be a parapet wall up to a height of at least 28 inches above the ground
9. Permanent bucket or drawer with a clean chain should be provided
10. The physical, chemical and bacteriological quality of water should conform to the acceptable
standards of quality of safe and wholesome water.
(c) Enumerate five (5) objectives of occupational health (2 ½ marks)
1. The prevention among workers of departures from health caused by their working conditions.
2. The promotion and maintenance of the highest degree of physical, mental and social wellbeing
of workers in all occupations
3. The protection of workers in their employment from risks resulting from factors adverse to
health
4. The placing and maintenance of the worker in an occupational environment adopted to his
psychological environment; and to summarize.
5. The adaptation of work to man and of each man to his job.
6. (d) There has been an increase in the incidence of silicosis in your community. As a CHEW,
state five (5) preventive measures that you will adopt to ensure the control of the disease (2 ½
marks)
i. Use of protective devices
ii. Pre-employment and periodic medical examination
iii. Adequate lighting and ventilation
2. (a) State seven(7) categories of women who can use progestin- only injectable contraceptives without
restricti9n according to WHO (31/2 marks)
a. Women who cannot use combined oral contraceptives (COC) because of estrogen
related effects.
b. Women who consider injectables most comfortable
c. Lactating mothers
d. Women who have com2hned their family SIZE
e. Women over 35 years of age
f. Women who live under unhygienic conditions
g. Women with sickle cell diseases May decrease frequent of arises
h. • Women who prefer a method that does not require daily activity.
(b) List three (3) causes of infertility in males (2 ½ marks)
i. Poor quality and quantity of sperm
ii. Mumps during or after puberty
iii. Immature spermatozoa
iv. Blockage of the vasdeferens
 v. Sluggish movement of the spermatozoa
vi. Inability to achieve erection and ejaculation
vii. Undescended testicules
(c) Explain five (5) examples of menstrual disorders (2 ½ marks)
1. Amenorrhea (absence of menstrual period)
2. Dysmenorrhoea
3. Menorrhagia
4. Metrorrhagia
5. Polymenorrhoea
6. Oligomenorrhegia
7. Anovulation (failure of the ovary to release an egg)
(d) Enumerate five (5) components of reproductive health (2 ½ marks)
a. Family planning
b. Safe motherhood, including breastfeeding
c. Menopausal/Andropausai concepts
d. Prevention and treatment of sexually transmitted infectioas (STIs)
e. Adolescent Reproductive Health
f. Prevention and managc:ncnt of the consequence of abortion
g. prevention and appropriate treatment of infertility
h. Active discouragement of harmful practices
i. Gender equality, and women empowerment
j. Screening for cancer (b) I
k. Community engagement -
l. Basic emergency obstetrics a.
3. (a) State Five (5) Preventive Measures Of Periodontal Diseases. (2 ½ marks)
1. Periodic cleaning of the teeth by the dentist
2. Good oral hygiene (regular brushing)
3. Reduction of smoking
4. Reduction in the intake of sugar-rich foods between meals
5. Ingestion of adequate fluoridated water especially during the first eight years of life in order to
guarantee the hardening of the enamel and to be more resistance acid decalcification
(b) Enumerate five (5) oral health problems (2 ½ marks) .
a. Dental caries
b. Gingivitis
c. Periodontitis
d. Halitosis
e. Dental plaque
f. Dental calculus
g. CancrumOris
h. Angular stomatitis
(c) Enumerate seven (7) child survival strategies (3 ½ marks)
Adopted by WHO, these strategies are called GOBIFFF
G- Growth monitoring
O- Oral rehydration therapy
B- Breast-feeding
I- Immunization
F- Female Education and Empowerment
F- Food supplementation
F-Family Planning
(d) State three (3) priorities of childhood nutrition intervention adopted in Nigeria. (1 ½ mark)

1. Exclusive breastfeeding
2. Adequate complementary diet
3 Vitamin A supplement

4. (a) Define the following terms: (1/2 marks) each =2 ½ marks)

i. Echolalia
It is the pathological involuntary repetition of phrases or words spoken by another person.
ii. Echopraxia
It is the automatic, repetition of the movements of others. Repetition of actions. iii. Hallucination- false
perception
A sensory impression that has no basis in external stimulation
iv. Delusion
The false idea or belief held by a person which cannot be corrected by reasoning.
v. Phobia- fear of the unknown
An irritant fear produced by a specific situation or object that the patient attempts to avoid.
(b) Enumerate four (4) types of psychosis (2 ½ marks)
a. Functional psychosis
b. Organic psychosis
c. Puèperal psychosis
d. Indian hemp psychosis
e. Alcoholic psychosis
f. Religion psychosis
(c) State six (6) functions of school health services (3 marks)
1. To promote healthy growth and development in al school children
2. To detect any physical and mental defect among children which could affect their learning abilities
in school.
3. To control the spread of communicable disease among school children.
4. To instill principle of health into the school children
5. To promote optimal conditions in the school
6. To provide emergency care to school children
7. To assist student in acquiring
8. To counsel pupils, teacher and parent and other concerning health problems.
9. To assist in the identification and educational therapy for: handicapped children
10. To promote and protect the health of school personal
11. To co-operate with the state, local government and other community health agencies in student
health and welfare
(d) Explain any four (4) ways you will adopt in evaluating, School Health Services in your
Local Government Area (2 marks)
1. Teachers interview: ascertain from the teachers if the children are always sick
2. School abstention record
3. School attendance record
4. Use of case file to find out the common disease conditions that children are always infected with
5. Observation: Observe the children during playing to be able to detect some form of
problems/challenges among them.
(5) (a) Enumerate six(6) symptoms of tuberculosis in children. (3 marks)
1. Persistent cough lasting
2. Fever, Malaise, loss of weight
3. General more weeks
5. Chest pain
6. Coughing up of blood chaemopty
7. Hoarseness
8. Shortness of boa
(b) One of the strategies in mal9ria control is the use of long lasting insecticides treated net (LLIN).
State four (4) benefits of long lasting insecticides treated net.
1. Prevention of insect-borne disease
(c) List four (4) types of cancer which can occur in your community. (2 marks)
1. Breast cancer
2. Cervical cancer
3. Ovarian cancer
4. Uterine cancer
5. Cancer of the testis
6. Prostate cancer
(d) State six (6) modifiable Risk factors associated with coronary heart disease (CHD)
a. Cigarette smoking
b. Hypertension
c. Diabetes mellitus
d. Obesity
e. Excessive consumptions of fatty food
f. Lack of exercise
g. Alcoholism
h. Use of corticosteroids drugs
6. (a) Enumerate six(6) signs and symptoms of swallowed poison. (3 marks)
(b) State eight (8) rules of first am. (4 marks)
(c) List six (6) signs and symptom of sinusitis. (3 marks)
a. Facial pain
b. Purulent nasal discharge
c. Post Nasal drip
d. Disorders of smell
e. Headache
f. Nasal turbinate engorgement
g. Swelling of the upper eyelid
h. Tenderness over the anterior wall of the wall over the individual sinus
7 (a) Enumerate eight (8) ways which the community members can support people with
handicapping condition. (4 marks)
1. Educating patients or guardians on how to take care of their handicapped child
2. Financial support by the community to handicapped person and (or caretaker of handicapped
children).
3. Provision of special education facility in the community
4. Establishment of rehabilitation centers for the handicapped
5. Provision of adequate hospital care
6. Counseling
7. Community mobilization for support of handicapped
(b) List seven (7) common causes of blindness in our community. (3 ½ marks)
Glaucoma
Trachoma
Cataract
Onchocerciasis
Diabetes mellitus .
Vitamin A deficiency
Measles infection
Conjunctivitis
Accident gonorrhea and syphilis
(c) Enumerate five (5) objectives of the National Policy on care of the elderly. (3 ½ marks)
 PAPER 1
SECTION B: ESSAY ANSWERS (70 MARKS)
1. (a) Define Health Term According to WHO:
A group of person who share a common health goal and common objectives determined by
community need and towards the achievement of with each members of the team contributes in
accordance with his/her competence and skills and respecting the function of the others.
(1 mark)
(b) Enumerate six (6) characteristics of a Health Team:
- Co-operation among members
- Having clear-line of communication
- Having a common goal
- Regular meeting of members
- Team spirit for the primary health care services
- Agreed working procedure
- Respect for every member and their work
- All members must trust each other
- Members must be compatible
- The type of job or work must permit team work (3 marks)

(c) Outline eight (8) Health services based on Primary Health Care:
o Health Education concerning prevailing health problems and the methods of preventing
and controlling them.
o Promotion of food supply and proper nutrition
o Adequate supply of safe water and basic sanitation
o Maternal and child health care, including family planning
o Immunization against major infectious diseases
o Prevention and control of locally endemic disease
o Appropriate treatment of common diseases and injuries
o Provision of essential drug
o Community Mental Health care
 o Oral Health — primary eye care (4 marks)
(d) State four (4) primary health care approaches of the Nigeria Health System
- Down-up -Approach
- Emphasis on prevention
- Cost Recovery
- Quality Assurance
2. (a) State six (6) basic principle of effective Health Education
1. Respect for cultural and traditional views
2. Clarity
3. Simplicity
4. Adaptability
5. Ensurance of understanding
6. Effective communication
7. Understanding of the topic
8. Acceptability (3 marks)
(b) Discuss the three (3) main types of IEC media
(1) Audio: These are sound producing materials with which communication could be effected. They are
the teaching aids that appeal to the sense organ of hearing e.g. tape recording, radio. gramophone.
(2) Visuals: These are teaching aids that appeal to the sense organ of sight i.e. the eyes. It gives
pictorial description of an object e.g. posters. leaflets, flannel graphs, etc.
(3) Audio-Visuals: It includes all teaching aids that appeals to both the senses of hearing and sight e.g.
television, video, sound films
(3 marks)
(c) Enumerate four (4) advantages each of oral and written communication:
4 (four) advantages of oral communication
4 (four) advantages of written communication
3. (a) State six (6) reasons why it is necessary for the CHEW to carry out Advocacy
(1) To acquaint policy makers of their roles and responsibilities in relation to identified health goals.
(2) To create a conducive environment which activities will be organized.
(b) Enumerate six (6) - areas in which information could he collected for conducting situation
analysis in a community.
(I) Numbers of settlement in the local government area
(2) Functioning health facilities within the L-.G.A.
(3) Health personnel distribution by type
(4) Type and volume of services provided in all the health facilities.
(5) LGA logistics support
(6) LGA budget
(7) Basic infrastructures that affects health e.g. road, electricity, telephone, portable water.
(8) Educational facilities types
(9) LGA information system. (3 marks)
(c) State four (4) resources needed to conduct House numbering in a community
 Indelible ink
 Brush
 Ladder
 Human resources
 Register
 Pen and ink (2 marks)
(d) State four (4) target audience for Advocacy in your community.
 Policy makers
 Traditional leaders
 District head
 Community Development Committees
 Influential people
 Decision makers (2 marks)
4. (a) Itemise four (4) characteristics of personality:
(i) Extraversion
(ii) Agreeableness
(iii) Conscientiousness
(iv) Neuroticism
(v) Openness (2 marks)
(b) Explain four (4) characteristics of Good memory:
- Rapid Recall
- Rid Recognition
- Good Retention
- Ability to learn a material rapidly
- Utility or service ability (2 marks)
(c) Mention three (3) methods of learning
1. Habit or Associative learning
2. Trail and. error learning
3. Social learning initiative
4. Insight on learning (3 marks)
(d) State three (3) behaviors and attitude expected of a CHEW in the practice of his/her
profession
- Have a generally positive attitude towards work with a cheerful personality. Most of the
clients/patients value the positive personality from the health care provider
- Be warm and attentive, this helps to reassure the client/patient and is a signal of desire to help
- Provide appropriate privacy to his/her clients/patients
-. Offer explanation to patients on charges for services in an honest manner
- Have a genuine desire to help people; this expressed in the way the health practitioner communicates
with people through speech and body language. These allays worry and anxiety common in
patients/clients who come in to the health facility for management advice
(3 marks)
5. (a) In a tabular form, enumerate five (5) diseases each of Affluence and Poverty

(b) Enumerate six (Si factors that influence family size:

- Source of income
- Level of Education
- Standard of living (3 marks)
(c) Write short notes on the following:
i. . Nuclear Family:
The nuclear family is a small and simple family unit or setting which is made up of parents and
their children
ii. Single Parent family:
(1 mark)
6. (a) State five (5) factors that are responsible for wastage of drugs in vein Health centre:
(1) Over prescription of drugs
(2) Over stocking of drugs
(3) Giving of drugs to patients simple on demand
(4) Giving larger doses than necessary
(5) Ordering more drugs than needed so that some drugs expired in the shelf
(6) Exposing of drugs to heat, dampness or light
(7) Giving drugs to patients who do not believe in them and who throw away the drugs or forget to take
it
(8) Using drugs without diagnosis.
(9) Not using refrigerators for vaccines and the vaccines will never be effective any longer
(10) Referring
(11) Not observing feed.
(b) Enumerate five 5 classifications of drugs according to dosage form and give one example
each:
(1) Analgesics — Paracetamol tab/syrup, Acety/Siticylic Aspirin
(2) Anaesthetics — Lidocaine topical/injection
(3) Anti convulsants — Paraldehyda injection
(4) Anti Malaria - Artemether + Lufementrine
(5) Antihelminths — Mehendazole tab
(6) Antibacterial — Benzyl penicillin injection
(7) Anti filarial — Calamine lotirn (5 marks)
(c) Outline the criteria involved in drug selection:
(1) The choice of drugs must be based on the health problems common in the community.
(2) Choosing the drugs adequate and sufficient to each problem by their generic names into
consiplesetion
(3) Reviewing the list annually, taking account of new common health problems
(4) Socio-cultural factors
(5) The drugs must have NAPFDAC registration number
(6) Must be drugs with certificated quality which can be obtained easily from local institution or
through the WHO. (2 ½ marks)
7. (a) State six (6) factors/constraints that could hinder effective referral system:
(1) Poor transportation
(2) Lack of funds from the patents
(3) Non acceptance at higher level
4) No feedback from higher level, authority
(5) Unwillingness of patients/relatives to leave one’s secured environment
(6) There may be nepotism, favoritism preferential treatment for relatives rather than those who need it
most.
(7) Inadequate preparation of hospital physicians for referral technology
(8) Inadequate capacity to take all referred case to higher level. (3 Marks)
(b) State the five (5) levels of Health care delivery identified in the primary health care referral
path
(1) Hospital and Diagnostic services.
(2) Comprehensive Health Centre (CHC)
(3) Primary Health Care (PHC)
(4) Health Pasts/Mobile Health care
(5) Health clinics (2¼ marks)
(c) List four (4) ways the community can support outreach services:
(1) Provision of logistics e.g. vehicle, drugs.
(2) There should be good rapport between the community and health (2 marks) ‘
(d) State five (5) Heath Services that are rendered during outreach services:
- Health Education
- Immunization
- Child Welfare Clinic
- Ante-Natal care -
- Minor Surgery
- Referral Services
- General Outpatient services -
- Treatment of minor ailments.

SECTION B: ESSAY ANSWERS

1. (a) Outline ten (10) characteristics of a healthy house:
- A healthy house should have a satisfactory lighting and ventilation
- Adequate potable water supply
- Adequate sanitary facilities e.g. bathroom, toilet, kitchen
- Adequate refuse collection and disposal facilities
- It should be sited on a well drained soil.
- It should be free from vermins and pests.
- Adequate space to allow tree circulation of flesh air
- Adequate open space for recreational activities and relaxation for mental stimulation
- Separate rooms for living and sleeping which should meet the recommended air space capacity
prescribed by the law of health authority.
- Separate rooms for both children of different sexes that are above 10 years of age.
- Must have adequate space to avoid overcrowding
- It should be sited away from any source of pollution
- It should have an approved building paln.
(b) Discuss five (5) classification of health problems of agricultural workers
(1) Physical hazards, e.g. noise, light, heat, radiation, vibration, high pressure
(2) “Biological hazards, e.g. bacteria, fungi, viruses, rickettsia
(3) Chemical hazards: e.g. gases, lead, mercury,’ vapour, acids, dusts, pesticide, herbicides,
rodenticides, etc.
(4) Mechanical hazards: e.g. faulty machines, moisture of equipment, lack of maintenance
(5) Social hazard: stress
 Diseases affecting them (agricultural workers)
- Physical — deafness, cataract, Arthritis
- Chemical — preunioconiosis, bums, poisoning
- Biological — HIV/AIDS, Helmintheasis, Tetanus, Anthrax
- Social — Neurosis, Psychosis, Depression
2. (a) List five (5) causes of prolong labour:
- Contracted pelvis
- Big baby
- Occipito-posterior position
- Slow effacement of the cervix
- Multiple babies
- Incorrect position of the baby
- Psychological factors such as worries, stress
- Poor uterine contraction
- Disordered uterine action e.g. hypotonic action. With slow cervical dilatation.
- Nipping of the arterior lip of the cervix between the head and the public bone (24 marks)
(b) During labour there are indications which tells if the mother or the baby is distress.
Enumerate six (6) signs of distress in the mother and four (4) in the baby.
S/N MATERNAL DISTRESS FOETAL DISTRESS
1 There will be increase in pulse rate Decrease foetal movement in the womb or
(Tarchycardia) excessive or insufficient material was it

2 Rise in body temperature Abnormal result of gam contraction stress

test
3 Severe dehydration Abnormal amniotic fluid level

4 Abdominal distension Abnormal result of bio-physical profile

5 Death Vaginal bleeding
6 Dark vomities Cramping
7 Increase in respiratory rates Maternal high blood pressure
8 Weakness and Sweating
(c) Enumerate five (5) contraindications of the surgical method of contraception:
- Patient having active infectious e.g. PID — Pelvic Inflammatory Diseases
- Patient with severe heart or lung problems
- Patient with suspected pregnancy
- Women having maternal or infant complication (2 ½ marks)
3. (a) State six (6) benefits of exclusive breast feeding
(b) Outline four (4) diseases targeted in IMCI intervention
- Acute Respiratory infection (ARI)
- Diarrhoea
- Measles
- Malaria
- Malnutrition (2 marks)
(c) State six (6) elements that you will consider in initiating a school health programme for private
school in your community
- Medical inspection of children
- Screening for defects in children
- Assessment of handicapped children for prompt refer
- Health Education activities
- Environmental sanitation activities
- Control of communicable Diseases by means of immunization
- Nutrition programme (3 marks)
(d) List four (4) screening test performed on school children
- Vision screening
- Hearing test
- Mid-upper arm circumference (MUAC)
- Weight, Height measurement. (2 marks)
4. (a) State six (6) complications of sickle cell disease
- Gall stone -
- Acute chest syndrome
- Pulmonary Hypertension
- Stroke
- Leg ulcer that do not heal
- Eye damage
(b) List four (4) risk factors in coronary heart diseases in Nigeria
- Cigarette smoking
- Hypertension
- Diabetes Mellitus
- Obesity
- Lack of exercise
- Excessive consumption of fatty foods; e.g. fatty meat like pork. (2marks):
(c) Discuss Lassa Fever under the following headings:
i. Definition:
Lassa Fever is an acute viral illness with duration I — 4 weeks. It is widely transmitted over west and
central Africa. The reservoir is wild rodents Incubation period is 6—21 days. (1 mark)
ii. Mode of transmission
It is caused by arena virus called the Lassa virus. Human are primarily infected following exposing of
food to dust, when infected rat passes urine or faeces. (1 mark)
iii. Signs and Symptoms:
- Fever
- Malouse
- Muscle pain
- Severe headache
- Cough -
- Chest pain
- Conjunctivitis
- Pharynsitis, Tonsilitis
iv. Prevention/Control
- Reporting to the appropriate health authority
- Early diagonals prompt treatment
- Isolation of suspected case
- Disinfection of patients excrete, secretions, blood, sputum
- Surveillance
- Rodent should not have access to food stuff by proper items
- Restruction of movement.
5. (a) Enumerate six (6) diseases and health condition that are blindness in Nigeria.
- Cataract
- Glaucoma
- Trachoma
- Onchocerciasis
- Vitamin A deficiency
- Measles infection
- Diabetes meilitus
- Conjuctivitis
- Gonorrhoea and syphilis (3 marks)
(b) State six (6) in which hearing loss be prevented in the community
- Immunization
- Health education
- Genetic counseling
- Avoidance of use of antibiotics e.g. streptonyen
- Mother should be treated from infectious
- Avoidanc of alcohol and smoking during pregnancy
- Good Ante-Natal care
- Good nutrition
- Early diagnosis and prompt treatment
- Regular clinic attendance
- Good personal hygiene storage of food associated .with
(c) Outline four (4) functions of the nose
- Respiration The nose is for breathing
- Air conditioning
- Protection
- Olfaction: protective value against approaching dangers
- Resonance
- Reflexes
- Air Equalization performed by Eustachion (2 marks)
(d) List four (4) disease conditions of the throat
- Laryngitis
- Pharyngitis
- Tonsilitis
- Sore throat
- Tocisilo pharyngitis
- Infection
- Foreign body
- Tumours (2 marks)

6. (a) State six (6) changes that are associated with ageing:
- Cardiovascular system
- Respiratory system changes
- Gastro — intestinal tract (GIT) changes
- Changes in Urinary system
- Changes in Endocrine system
- Nervous system changes
- Changes in reproduction systems
- Musculo-skeletal system changes (3 marks)
(b) Enumerate six (6) resources/facilities available to the Aged in the community
- Family members and friends
- Community members
- Associations in the community
- Voluntary agencies
- Governmental and non-governmental organization, e.g. Rd cross society, Rotary club, etc.
- Health visitors
- Hospitals and health centres
- Social and religious groups
- National Health Insurance Scheme (NHIS) (3 marks)
(c) Identify six (6) main groups of disability as categorized by WHO
(1) Persons with fits
(2) Persons with hearing problems
(3) Persons with learning difficulties
(4) Persons with difficulties in moving
(5) Persons with difficulties in seeing
(6) Persons with strange behaviors (2½ marks)
(d) Itemise three (3) methods you can adopt in community with persons with hearing and speech
problems
- Facial gestures
- Use of sign language
- Writing
- Lip reading
- Finger spelling
- Manual signs
- Auditory training e.g. use of hearing aid
- Language training. (1 ½ marks)
7. (a) State six (6) conditions/factors associated with the formation of dental cares
- Frequency consumption of sugary and confectionary sweets
- Poor oral hygiene
- Bacterial substrate
- Gross reduction the amount of Saliva secretion
- Failure to obtain regular dental checkup
- Fluoride deficiency
- Vulnerable tooth surface
- Pregnancy (due to re-absorption of calcium for dentition)
- Nutritional deficiency.
(b) Write short notes on the following:
(i) Anxiety: This is a state of generalized pervasive fear with a feeling of inner tension. Anxiety that
follows a threatening situation is normal because it helps the organism to prepare for defence or flight.
(ii) Depression: is a state of psychomotor retardation where there is physical and mental slowness
characterized of interest, reduced energy, suicidal thoughts and sleep and appetite disturbance go
beyond normal changes.
(iii) Psychosis: is a major mental illness and more serious form of mental illness that often require a
period of hospitalization with total loss of contact with reality, no insight and orientation, appearance s
rough and dirty.
(ii) Acute Abdomen; Acute Abdomen is a condition characterized, by the acute onset of abdominal
pain, colicky or persistent which may be localized or generalized and may be associated with shock and
vomiting.
(iii) First Aid: it can be defined as the immediate first treatment given to a sick or injured person before
the arrival of a medical practitioner or before taking him/her to the hospital
(c) Enumerate four (4) positive mental health habits expected amongst members of your
community
- Adequate rest and sleep
- Adequate nutrition
- Adequate exercise
- Recreation
- Holidays
- Positive way of handling stress situation
- Adequate holidays

CHEW 2011 PAPER 1

SECTION B: ESSAY ANSWER (70 marks)
1a. ETIQUETTE THAT A COMMUNITY HEALTH PRACTITIONER SHOULD OBSERVE
AT WORK
i. Have a generally positive attitude towards work with a cheerful personality
ii. ii. Offer explanation to patients on charges for services in an honest manner
iii. Have a genuine desire to help people; this is expressed in the way the health practitioner
communicates with people through speech and body language
iv. Be warm and attentive, this helps to reassure the client/patient and is a signal of desire to help
 v. Listening with attention communicates acceptance of the person
vi. Provide appropriate privacy to his/her clients/patients
vii. Have empathy always give unconditional positive regard to his/her patients and express
appropriate empathy for their condition.
viii. Establish a good interpersonal relationship with the client/patient for effective interpersonal
relationship
ix. Show appropriate courtesy to clients/patients at all times and under an circumstances
x. Treat all clients/patients with the same amount of sympathy, concern and attention’
xi. Avoid over familiarity through less formal tone, this will make client/patient feel more
comfortable
xii. Avoid smoking and drinking alcohol in the health facility environment
xiii. Dress decently always, whether at work or out of work
xiv. Avoid engaging in marketing, advertisement or sell of items while on duty
xv. Avoid gossips, character assassination(defamation) of colleagues, patients and relations
xvi. Avoid pilfering or stealing health facility property like drugs, equipment, instruments, etc.
b. DEFINITION OF MEDICAL SOCIOLOGY
It is a branch in sociology which is very much concerned with all the actions and factors in illness in
order to bring in the sick person, his relation and the medical personnel to understand how to motivate
the patient to achieve recovery from illness which is the goal of medicine.
It is the study of the availability of medical care and the social impacts of medical professions
It is a sub-discipline of sociology that studies the social causes and consequences of health and illness
in a population.
c. HARMFUL TRADITIONS AND CULTURAL HABITS THAT MAY AFFECT HEALTH
i. Force feeding of children,
ii. ii. Female genital mutilation
iii. Teenage pregnancy
iv. Application of cow dung after cutting umbilical cord of a child
v. Depriving children from their mother for weaning purpose
vi. Cutting of Umbilical cord using hot knife or old razor blade
vii. Drinking blue for family planning
viii. Tattoo marks/scarification
 ix. Food taboos
x. Burning the feet of a child during epileptic fits
xi. Early/forced marriage
xii. Sexual violence/ rape against marriage
xiii. Maltreatment of widows
xiv. Abrupt weaning
xv. Bathing of women’s stomach and private part with very hot water after child birth
2a. METHODS OF PASSING HEALTH MESSAGES TO FAMILIES, INDIVIDUAL AND
COMMUNITIES.
i. Role playing
ii. ii. Story telling (verbal communication)
iii. Group discussion ‘
iv. Simulation r
v. Songs and Drama
vi. Demonstration
vii. Counseling
viii. Dancing
ix. Non-verbal communication ggestures, body languages
b. MAIN GROUPS OF TEACHING AID USED TN COMMUNICATION WITH ONE
EXAMPLE EACH
(1) Audio: These are sound producing materials with which communication could be effected. They
are the teaching aids that appeal to the sense organ of hearing e.g. tape recording, radio, gramaphone
(2) Visuals: These are teaching aids that appeal to the sense organ of sight i.e. the eyes. It gives
pictorial description of an object e.g. posters, leaflets, flannel graphs, etc.
(3) Audio-Visuals: It includes all teaching aids that appeals to both the senses of hearing and sight e.g.
television, video, sound films (3 marks)
c. ADVANTAGES OF WRITTEN COMMUNICATION
i. Easy to preserve
ii. Easy presentation of complex matter
iii. Permanent record
iv. Prevents wastage of tithe and money
 v. Accurate presentation
vi. Use as a reference
vii. Delegation of authority Longevity
viii. Effective communication
3a. PRIMARY HEALTH CARE can be defined as an essential health care based on practical,
scientifically sound and socially acceptable methods and technology made universally accessible to
individuals and families in the community through their development in the spirit of self-reliance and
self-determination.
b. (i) Principle of essential services: This means essential service which promotes health such as
keeping a clean environment, good water supplies, care of mothers during pregnancy and child
birth, Nutrition of children, immunization early treatment of diseases
(ii) Principle of community participation: The challenges at the Primary level of care are to establish
a health care system that will touch the lives of every citizen and tackle the conditions that causes the
highest mortality and morbidity through community participation.
(iii) Principle of intersectoral approach (Multi sectoral collaboration): PHC requires the
collaboration of health and other related sectors for its success -
(iv) The spirit of social justices and Equity: PHC emphasize an equity, equal distribution of health
facilities, health personnel and other supplier between the rural and urban area.
(v) Principle of self-reliance: It is necessary for health to develop skills and strategy they can rely on
to solve health problem in all circumstances so as to sustain primary health care.
(vi) Appropriate Technology: PHC requires the development, adaptation and application of simple
equipment, techniques and method that people can afford and use to solve health problem.
(vii) The principle of availability: Efforts should be made to make PHC available especially essential
drugs and other supplies required in the center so that client will achieve their objectives of attending
the center.
(viii) Principle of accessibility: PHC should be within the reach of the individual, family and
community through easy means of delivering services.
(ix) Principle of Political will: Government approach to P1-IC should be in such a way as to commit
resources in money, material and manpower for implementation of PHC programmes.
(x) Principle of integrated services: It is necessary that PHC resources be coordinated for efficiency
and effectiveness. PHC should be provided in an integrated and comprehensive manner such that all the
services required by an individual, family and community can be obtained together as soon as any one
visit to a health facility. ( ½ mark each for 2 points: 1 marks)
c.
i. Cultural factors
ii. Environmental factors
iii. Personal factors
iv. Geographical factors
d. i. Cultural Factors: Culture is a way of life of a community of peopl& which has been handed
down from one generation to another by way of practice or communication.
ii. Environmental factors: Environment can be defined as the immediate and distant circumstances,
objects, conditions and surroundings of man, plant and animals.
iii. Socio Economic factors: These are Socio-demographic factors that can influence the health status
of the population
iv. Personal factors: The state of health of an individual is determined by certain in personal factors
that may affect his/her health.
v. Geographical factors: These include;
a. Topography
b. Deserts
c. Weather
d. Forest vegetation
e. Draughts
f. Earthquakes
g. Floods, etc.
4a. EMOTION can be defined as the outward expression of an inner feeling or effect, a state
of arousal characterized by alteration of feeling tone and by physiological behavioral changes
b. TYPES OF EMOTION
l. Joy 9. Fear
2. Love 10. Sorrow
3. Happiness 11. Disgust
4. Smile 12. Surprise
5. Laughter 13. Jealousy
6. Elation 14.Envy
7. Ecstasy 15. Hatred
8. Amusement 16. Anger
17. Aggression
c. i. PHARMACOLOGY: It can be defined as the science which deals with the study of drugs as it
relates to their origin, chemical structure, preparation, action, administration, mode of action of drugs in
the body both in health and illness, including their names, metabolism and excretion.
ii. PHARMACOVIGILANCE: Is known as drug safety, is the pharmacological science relating to the
collection, detention, assessment, monitoring and prevention of adverse effects with pharmaceutical
products.
iii. Drugs are chemical substances that have the ability to relieve, cure or prevent any abnormal
condition of the body
iv. PHARMACOKINETJCS.: It is the study of the concentration of a drug during the processes of
absorption, distribution, biotransformation and excretion.
v. IDIOSYNCRATIC: This is an unexpected effect produced by a drug in a given individual.
5a. ROLES OF COMMUNITY DIAGNOSIS IN PHC
i. Identifying health and health related needs of the community and used as basis for planning..
ii. Identifying resources within the community to solve identified problems
iii. Enhances interaction between the community and health workers.
iv. Identifying constrains which can then be addressed in the planning process
v. Provides baseline for evaluation of interventions.
vi. It provides a solid basis for making plans to solve the health problems and meet the identified
health needs
5b. Methods used in community diagnosis
a. Observation
b. Questionnaire
c. Interview
d. Group discussion
e. Review of exiting records
5c. Situation Analysis is the process of finding out the actual status of health in given community such
as information on LGA Population, LGA health budget, Health facility by type and information
supports
5d. INSTRUMENTS USED IN SITUATION ANALYSIS
i. Form “H” — to collect household information
ii. Form “C” — to collect child information -
iii. Form “F” — to collect information On female married and those under 50 years including women
who have never been pregnant
6a. ESSENTIAL DRUGS are those basic drugs that satisfy the basic health needs of the majority of
the population in the community.
b. STEPS FOR THE MANAGEMENT OF ESSENTIAL DRUGS PROGRAMME
i. Selecting from the essential drugs lst those drugs needed at that specific health unit.
ii. Ordering the drugs
iii. Receiving and storing the drugs
iv. Issuing and using the drugs
c. STEPS FOR ORDERING OF DRUGS
i. Determine the ordering interval; i.e. how often to order
ii. ii. List the drugs
iii. Calculate the amount of drugs needed within a specified ordering Interval based on locally and
seasonal usage (e.g. measles vaccines prior to dry season)
iv. Complete a drug requisition form
v. Calculate the cost of the drugs ordered
vi. Forward money for drugs ordered together with the requisition forms
d. ADVANTAGES OF ESSENTIAL DRUGS PROGRAMME
i. It is economical in terms of cost
ii. It is affordable and accessible majority of the population can afford to pay.
iii. It enables some agencies related to drugs control to perform effectively
iv. Drug usage in our health facilities can easily be managed
v. It makes description of drugs very easy since the drugs are readily available
vi. The out-of-stock-syndrome in our health facilities is reduced drastically
vii. The reduction in the number of drugs used in the health care system makes purchasing storage
and distribution easier.
ADVANTAGES OF 2-WAY REFERRAL SYSTEM
It enhances continuity of care.
It promotes adequate follow up
It ensures feed back
It ensures continuity of education.

CHEW 2011 PAPER 2

SECTION B: ESSAY ANSWERS (70 marks)
la. EXCLUSIVE BREASTFEEDING: means initiating breastfeeding within 30 minutes after birth
and for 6 months without adding water, to the body.

lb. ADVANTAGES OF BREASTFEEDING OVER ARTIFICIAL FEEDING

- Breast milk is always clean, safe, free from pathogenic organism
- It is always available
- It is always at correct temperature
- Protects child from infections because it contains antibodies
- Prevents mother from breast cancer and ovarian cancer
- Proper growth and development of the child
- Creates bond between mother and child
- Prevents child from diarrhea

1c. DIRECT AND INDIRECT METHOD

 DIRECT ASSESSMENT
• Physical examination e.g. Head-to-toe
• Anthropometric measurement e.g. Weight, Height Laboratory test
• Skin fold thickness
• Mid-upper arm circumference
 INDIRECT ASSESSMENT
• Pattern of breastfeeding
• The other foods (complementary) offered to the baby
• The number of times each day the child is fed
• Mother’s knowledge regarding diet
• Family food budget.
d. Night blindness! xerophthalmia - Lack of Vitamin A
Beriberi - Lack of vitamin B
Kwashiorkor - Lack of protein
Rickets - Lack of vitamin D
Scurvy - Lack of vitamin C
Goitre - Lack of Iodine
Marasmus -Lack of proteins and calories
2. (a) 20 year old Idris was bitten by a stray dog while returning from school. Manage his condition
with the use of Standing Orders (5 marks)
b. DEFINITION OF WOUND
Wound is a break in the continuity of the skin or mucous membrane paving ways for microorganisms
to invade the affected part of the body
c. TYPES OF WOUND
i. Incised wound: This is a clean wound cut with a sharp objects, e.g. surgical wound during operation
iii. Lacerated wound: The tissue is from resulting in a rugged appearance e.g. wound sustained from
glass or barb wire.
iv. Punctured wound: This is a small perforation of skin usually caused by sharp objects, e.g. bullets,
knife stab, stepping on nails, etc.
v. Cleaned wound: Cleaned uninfected wound be closed by suturing to aid healing
vi. Septic wound: This contains bacteria and pus which may be extracted from the wound.
3a. FACTORS AFFECTING INDIVIDUAL RESISTANCE TO DISEASES.
i. Age
 ii. Sex
iii. Nutrition
iv. Trauma or fatigue
v. Pregnancy
vi. Heredity
vii. Diseases and infections
b. ROUTE OF ADMINISSTERING INJECTIONS
i. Intradermal
ii. Intramuscular’
iii. Intravenaus
iv. Subcutaneous
v. Hypodermic
vi. Intrathecal
4a. FUNCTIONS OF THE BLOOD
1. Transportation of Oxygen from the lungs to the tissues
2. Transport of carbon dioxide from the tissues to the lungs
3. Transport of nutrient materials from the alimentary tract to the tissues and cell waste materials
to the excretory organs, e.g. kidney
4. Transport of hormones secreted by endocrine glands to their target glands and tissues
5. Transport of heat in active tissues to other less active tissues
6. Transport of protective substances, e.g. antibodies, to areas of infection to fight the infection
7. Arrests haemorrhage by producing materials that clot blood, thereby preventing its loss from a
ruptured blood vessel
8. Regulation of body temperature
9. Carries away waste product to the organs, which excrete them. E.g. CO2
10. Blood helps to fight bacterial infection through white blood cells and antibodies
4b. FUNCTIONS OF THE SKIN
1. It forms a protective covering for the body
2. It contains the end organs of the sensory nerves (pain, touch and temperature)
3. It secretes sebum, which oils it and hairs
4. It is capable of absorbing small amounts of oily substances
 5. It gives origin to the hair and nails
6. Some drugs are absorbed through the skin
7. It is an organ of sensation or sense organ
8. Excretory organs helps in the removal of waste products from the body like water and salts
mainly in the form, of sweat (electrolytes)
9. Plays an important role in the regulation of body temperature. The temperature of the body
remains fairly constant at about 36.8°C (98.4°E)
4c. SAFETY PRECAUTIONS IN HANDLING LABORATORY EQUIPMENT
1. Laboratory coat or apron must be worn
2. Do not eat, smoke or drink in the laboratory
3. Do not lick labels; instead use tap water
4. Avoid the habit of holding pencil, pens and markers with lips
5. Keep the laboratory bench clean and scrupulously clean
6. All the laboratory equipment should be handled with care when in use
7. When handling specimens, care must be taken to avoid various diseases
8. Disinfectants should be used to disinfect any instrument before and after use
9. All the specimens investigated should be recorded in the patient’s card aid in the record book.
10. Remember to wash and clean your hands with detergents before and after leaving the laboratory
11. Inculcating needles and loops should be flamed to redness before and after inculcation
12. Cultures should never be taken home from the laboratory
13. Keep test tube cultures in test_ tube race and never lay on the bench top
14. Avoid exposing your eyes to ultra - let light used for sterilization
15. Do not pipette cultures directly by mouth, instead use robber teats or pipette fitters
16. Label all cultures incubated properly with your name, the nature of the specimen and date.
5a. STAFF TRAINING NEEDS USING SIMPLE TRAINING
 ASSESSMENT METHODS
1. By asking question
2. Observation of performance
3. Discussion ‘
4. Feedback
5. Review of previous knowledge
 6. Continuous assessment
7. Review of ann3lal performance record
5b. REASONS WHY STAFF TRAINING IS NECESSARY IN PHC
1. To remove performance deficiencies
2. To match employees abilities with-the job requirements and organizational needs
3. To enhance organizational viability and transformation process
4. To improve the quality and quantity of work
5. Sometimes training is undertaken to enhance the employee’s self esteem
6. To enhance certain behavioural change in the employees
7. To reduce the cost of production and minimize ‘cost
8. To increase productivity and efficiency
5c. STEPS IN CARRYING OUT A TRAINING PROGRAME
- Set behavioural learning objectives
- Choose training methods to meet objectives
- Identify resource persons to assist in training
- Develop a training budget
- Identify budget items correctly (e.g. per diem, materials, feeding, transport, support staff etc.)
- Estimate realistic costing for each budget item according to local situations
- Prepare simple poster, charts and models to help learning.
- Decide methods to evaluate training activities
- Identify various assessment methods, including advantages and disadvantages of each
- Select methods appropriate to the trainee group and skill taught
- Conduct training using participatory adult learning techniques
- Evaluate training
- Conduct on-the-job training during supervisory visits.
6a. SIX (6) FUNCTIONS OF MANAGEMENT BY OBJECTIVE
- Planning
-Organizing
- Staffing
- Directing
- Controlling
- Co-ordinating
- Reporting
- Budgeting
6b. QUALITIES OF A GOOD SUPERVISION
1. Timely
2. Regular
3. Based on set target
4. Culturally acceptable
5. Not be humiliating
6. Encouraging
7. Able to offer timely reward for good performance
6c. ADVANTAGES/MERIT OF DELEGATION
1. It makes the superior officer to attend to more important duties and increase productivity
2. It serves as an incentive to the junior worker to in skills
3. It brings food relationship among workers
4. It makes supervision easier
5. It promotes sense of belonging
6. It allows the subordinate to make decisions according to circumstances surrounding him/her
7. It prevents delay in decision making
6d. IMPLICATIONS OF IMPROPER BUDGETING
1. Inadequate equipment
2. Staff may go on strike
3. Failure to achieve set objectives
4. Clients and patients may stop patronizing the health facility
5. Inadequate payment of staff wages
6. Shortage of drugs in the clinic
7. Misplacement of priorities
8. It gives room for fraudulent acts info small measure
9. May cause dissatisfaction
7a. EVALAUTION: It is the periodic assessment of program to ensure the stated objectives are being
met. It is of two types: Formative evaluation and summative evaluation.
b. Demography is the study of the population in relation to emigration, immigration, language’
diversity.
c. Health statistics: a systematic approach for obtaining, organizing and analyzing health data

CHEW 2O11 PAPERIII

SECTION B: ESSAY ANSWERS (70 mark(s)
la. PHYSICAL ENVIRONMENT: It consists of non-living things and other factors. Some of these
factors include water, air, soil, housing, waste, radiation, climatic factors, etc.
ii. BIOLOGICAL ENVIRONMENT: It encompasses all living things both plants and animals; for
instance man, goat, pigs, bacteria, viruses, fungi, protozoa, insects, rodents, monkey etc.
iii. SOCIAL ENVIRONMENT: It deals with other social attributes, characteristics, factors and
variables of man and to include his customs, culture, taboos, habits, income, religion, occupation,
marriage, divorce, housing, inheritance, eating patterns, clothing, etc.
b. METHODS OF SOLID WASTE DISPOSAL IN THE COMMUNITY
1. Sanitary landfill or controlled tipping: This is a systematic deposition of refuse in low lying
ground, burrow pits or excavations with the idea of filling it up sanitary to reclaim it. Thus making
useless land useful again for some purposes.
2. Incineration: It is a method’ of refuse disposal where by the refuse to be disposed or burnt is first
sorted out and dried on concrete platforms; then tins, irons, broken bottles, etc. are removed and buried,
while the left over is sanitarily burnt in the incineration. The system operates by loading the dried
refuse into the incinerator and fire is set to burn down the refuse in the incinerator. Viz: Bar less, open
bar, baullew and beehive are the four types of incinerators.
3. Hog feeding: It is a method of refuse disposal in which garbage is utilized as hog feed to feed pigs or
swine.
4. Composting: It is a method which involves mixing of household refuse and night soil (excrete) with
the object of providing manure. Solid waste (dry refuse) are mixed up with excrete and then loaded in
chambers which are rectangular in shape, measuring 120cm deep, 180cm wide and 600cm long
5. Phyllis’s method: This is the method of solid waste disposal whereby refuse is heated in the absence
of air to produce gas, oil and coal like residue. This is a new method of refuse disposal, which is being
tested to see if it can be practical on a large scale.
6. Pulverization: This is the method that is mostly practiced in advanced countries and it involves
reducing the quantity of refuse into dust or fine powder and it is done by the use if special mechanical
plants.
7. Crude Tipping or Open Dumping: This is done by dumping refuse in open land or throwing the
refuse into a scripting pit or open space in a disorderly manner. Dumping of this kind require no or little
planning mid maintenance and unskilled personnel
8. Pyrolysis: This is another method of waste disposal by which refuse is neated in the absence of air to
produce gas, oil and coal like residue. The method reduces refuse into gas, oil and coal like materials.
The method is very costly.

1c. PREVENTIVE MEASURES OF INDUSTRIAL ACCIDENT

1. Provision of protective equipment and devices
2. Industrial Health education on accidents and safety strategies
3. Pre-employment and periodic medical examinations 2c.
4. Regular supervision and inspection of factory mental health implication of occupations
5. Organize resources and facilities for training on the job
6. Ensure adequate lighting
7. Ensure adequate ventilation
8. Good house keeping
9. Proper maintenance and replacement of faulty machines 3a.
10. Ensure motivation and good human relationship at places at work to reduce stress and alcoholism
11. An adequate organization of safety and operational measures of policy for each plant and industry.
12. Maintenance of accident records, injuries and death for future planning
13. Proper construction and design of factory with adequate temperature and ventilation
2a. MEDICAL/OBSTERIC CAUSES OF MATERNAL MORTALITY
i. Unsafe abortion
ii. Prolonged! Obstructed labour
iii. Haemorrhage
iv. Peuperal sepsis
v. Hyepertensive disorder in pregnancy
vi. Anaemia 4a.
vii. Post-partum depression
viii. Pregnancy related infections
2b. Types of Abortion
a. Habitual or Recurrent Abortion: The term habitual abortion is used when a patient has had three
or more consecutive spontaneous abortion. Often the cause of such abortions is not known.
b. Missed Abortion: The term is used when the foetus dies and retained in the uterus subsequently, the
signs if threatened abortion subside except for some brownish discharge which is not associated with
pain. The uterus and the breasts fail to grow.
c. Inevitable Abortion: In this ease, the pregnancy cannot be saved because a good position of the
placenta has’ been detached and the cervical is dilating. The vaginal bleeding is severe and some clots
may even be passed.
d. Therapeutic Abortion: It is evacuation of the uterus done by a qualified medical practitioner in the
interest of the mother’s life or her total well-being. The indications are usually medical conditions
threatening the mother’s life or likely to cause gross foetal abnormalities
e. Criminal Abortion: It is an abortion that is illegally procured. Such abortion is often done by
unqualified persons having little regard for the consequences. Risks of sepsis, uterine perforations,
cervical laceration and haemorrhage are associated with criminal abortion. Other dangers are sudden
death and acute-renal failure.
f. Septic Abortion: It is usually a sequel bf incomplete abortion, often criminally induced. The patient
is usually anaemic. ill with a high temperature, rapid pulse, headache, vomiting and lower abdominal
pain. The lochia are profuse and offensive.
2c. SIGNS AND SYMPTOMS OF ECTOPIC PREGNANCY
i. Nausea and breast soreness
ii. Sharp waves of pain in the abdomen, pelvis, shoulder or neck
iii. Severe pain that occurs on one side of the abdomen
iv. Light to heavy vaginal spotting or bleeding
v. Dizziness or fainting
vi. Rectal pressure
3a. COMPONENTS OF SCHOOL HEALTH SERVICES
i. School Health Education
ii. ii. Healthful School living
 iii. School health care services
iv. School Home and Community
v. b. Needs of Newborn
vi. Clearing the airway to avoid airway obstruction
vii. Assess the Apgar Scoring
viii. Provision of warmth
ix. Care of the cord
x. Care of the eyes
xi. Care of the skin
xii. Maintenance of body temperature to avoid hypothermia
xiii. Breast feeding
4a.
NEUROSIS PSYCHOSIS
1. Minor mental iilne,s Major mental illness
2. Has insight Lack of insight
3. No hallucination Presence of hallucination
4. Nodelusjon There is delusion
5. Personality is intact Personality is not intact
6. No disorientation of time, place and There is disorientation of time, place and person
person
7. Appearance is fair Appearance is rough and dirty
8. Thought is intact Thought is disordered
9. Speech is fair There is flight of ideas
10. Mood is fair Mood changes totally
11. No illusion There is ‘illusion
12.No echolalia (echolalia repeated There is echo lalia
words, repetition of another person’s
spoken words)
13. No echopraxia (repeated actions) There is echopraxia

4b. FIRST (1ST) DEGREE BURNS

Here, damage is 1imitd to the epidermis (i.e. the outer layer of the skin).
> There is redness, tenderness, pain, heat and swelling of the affected site
> There is pain
SECOND (2ND) DEGREE BURNS
• This affects both the epidermis (outer) and dermis (second layer) of the skin
• Both epidermis and dermis are destroyed
• Nerve ending are destroyed
• It is associated with pain
THIRD (3RD) DEGREE BURNS
• Full thickness of the skin loss
• Looks waxy and blacken
• Painless
4c.
i. Flames from the fire
ii. Hot metals
iii. Electric or gas fires or caning in contact with live electric wires
iv. Lighting
v. Friction
vi. Strong acids e.g. HCL (Hydrochloric acid) and Lysol
5a. i. Mycobacterium tuberculosis
 It is mainly contracted by droplet infection through coughing, spitting and sneezing by patients
with active tuberculosis C
 It can also be contracted by handling objects contaminated with the saliva or sputum of patients.
 It can be transmitted from animals to humans via contact with infected animals or their products
iii. SIGNS AND SYMPTOMS
• Persistent cough lasting 3 or more weeks 6b
• Sometimes blood stained sputum
• Chest pain; haemoptysis, hoarseness and shortness of breath
• Loss of weight, fatigue, fever and general malaise
iv. PREVENTION AND CONTROL
 Mass vaccination with BCG
  Case finding for new patient
 Treatment of known cases, contact tracing
 Health Education
 Prevention of malnutrition especially in children
 Improvement of social condition e.g. overcrowding
 For contacts and inactive cases, treat with isoniazid
 BCG raccination for the unaffected
 Pasturisation of milk and testing of diary cattle
b.
Cardio-vascular disease (CVD) Sin
• Cancers
• Chronic Respiratory Disease (CRD)
• Renal diseases
• Diabetes mellitus
6a. i. GLAUCOMA: Is a condition of the eye that causes damage to your eye’s optic nerve and get
worse over time. It results from the eye fluid pressure inside the eye, normally the fluid called
Aqueoushumour flows out of the eye through a mesh like channel. If this channel gets blocked, the
liquid build up that is what causes glaucorue. Other causes include:
• A blunt injury to your eye
•Trauna to the eye
• Severe eye infection
• Enlarge cataracts
• Intraocular humor
ii. CATARACT: A cataract is a clouding of the lens in the eye which leads to decrease in vision
SYMPTOMS OF CATARACT
• Faded colours
• Blurring vision
• Halos around the night
Poor vision caused by cataracts may also result in an increased risk of falling and depression. Cataracts
are the cause of half of blindness and 33% of visual impairment worldwide
iii. STYE (HORDELUM): It is a bacterial infection of an oil gland in the eyelid. This results in a red
tender bump at the edge of the eyelid. The outside or the inside of the eyelid cart be affected
iv. TR.ACHOMA: It is an infectious disease caused by bacterium chlamydi4 trachornatis. The
infection causes a roughening of the inner surface of the eyelids. This roughening can lead to pain in
the eyes, breakdown of the outer surface or cornea of the eyes and eventual blindness
v. PTRYGIUM: It is also known as surfer’s eye. The main symptoms is a growth of pink, fleshy tissue
on the conjunctiva. Some pterygia grow slowly throughout a person’s life, while others growing after a
certain point. Pterygia are more common in sunny climates and in the 20-40 age group. It is a pinkish,
triangular-shaped tissue growth on the cornea
6b- First Aid Care you will give to a 10 year old boy with nose bleeding.
- Bleeding from the nose due to any cause which could be local or systematic
- Make him to sit comfortably
- Explain the procedure to him
- Gently put temporary pressure over the alae by pinching the nose while the patient sits upright
- Tell him to open the mouth to breath
- Instruct him to spit any secretion that may conic to the back of the nose into a receiver
- Place ice-cubes inside the gauze and place over eh bridge of the nose in an attempt to’ constrict the
bleeding vessels
- This method is done for 10 minutes
- Usually mild bleed will stop after this procedure
6c
Deafness
Otitis Media
Sinusitis
Rhinitis ‘‘
Epistaxis 4
Laryngitis
Tonsilitis
Pharyngitis
Tonsilo — pharyngitis
7a. MEDIAL CLASSIFICATION IN USE FOR THE AGED
- Elderly fit: Those that are able to manage their lives on their own
- Elderly infirm: Those ‘with some physical defects preventing them from managing their lives on their
own
- Elderly sick: Those needing hospitalization from ailments preventing from managing their lives
without any help
- Elderly psychiatric: Those with mental problems and incapable of being on their own
- Special group: This refers to the elderly who have some disabilities such as being blind and deaf
among others
b. MEASURES FOR REHABILITATING THE HANDICAPPED
• Recognizing and taking appropriate actions on environmental hazards as applicable to the disabled
person e.g. wells, pools of water, potholes, open fife, etc.
• Teaching and working with families of the handicapped on the care and rehabilitation of disabled
persons to be independent and self-reliant
• Keeping a register of names, ages, address and activities of disabled persons in the community
development committee workshops for the handicapped in the community
c. IDENTIFICATION OF A CHILD WITH DIFFICULTY IN HEARING
1. Not responding to or confusing verbal directions
2. Showing no surprise or being startled in situations that would normally evoke such response
3. Rubbing the ears frequently or turning the head in one direction as if trying to locate a sound
4. Complaining of a ringing buzzing sound in the ear,
5. Not responding when called from a distance
6. Requesting a person speaking to him to repeat what he has said; or being slow in answering a simple
question
7. Complaining of discharge from the ear
8. Flowing or bending forward in order to hear or understand what is said to him
9. Gazing at the lips of a person speaking to him instead of the person’s eye
10. Misarticulating simple words
11. Complaining that a normal sound or noise is too loud
12. Avoiding situations that may require him to listen or talk
13. Speaking in abnormally low, high or loud voice
14. Making a response only when he sees the speaker’s face or gesture
 COMMUNITY HEALTH EXTENSION WORKERS
PAPER I
ESSAY
(a) Define the following terms:
i. Ethics.
Is a system (a written document or rules) observed with a very high standard of respect (by a
profession) which guides and controls the moral behaviours and manifests in the character and mind.
ii. Etiquette.
Means code of manners, behavior and actions which are expected of a professional under certain
conditions / circumstances and are observed by all in the profession.
iii. Professional Ethics. (3 marks)
Are a set of rules, code of conducts governing the good practice of community health profession in
Nigeria.
(b) List seven (7) functions of the Community Health Practitioners Registration Board of Nigeria
(CHPRBN). (7 marks)
a. Determining what standard, knowledge and skill are to be attained by a person seeking to become
members of the community health and improving those standards from time to time as circumstances
may permit.
b. The establishment and maintenance of’ a register of persons as member of the profession.
c. Conducting examinations in the profession and awarding certificate to successful candidates as
appropriate.
d. Indexing trainees for various Community Health course.
e. Inspection of schools and institutions where Community Health Practitioners are trained.
f. Accreditation of schools and Community Health Courses in training institutions.
g. Development of training curricula for Community Health Practitioners.
h. Printing and sales of Standing Orders, Curriculum and other relevant publications.
i. Organise and conduct studies, seminars and workshops to upgrade knowledge and skills of
practitioners.
j. Regulation of the professional conduct.
k. Maintenance of discipline among members of the profession.
2. (a) What is Health Education? (1 mark)
Health education adopted by WHO is concerned with charges in knowledge, feelings and behavior of
the people and such health practices are believed to bring about the best possible states of well-being. It
goal is to enable people to practice health behavior in a way that is culturally acceptable.
OR
Health education is the act or science of giving simple accurate scientific information in a way that it
will be understood, accepted, believed and put into practice.
OR
Is a process of helping individuals and group or communities to acquire relevant knowledge and skills
on health in such a way that they voluntarily adapt to positive change in behavior which affect their
health.
OR
Is a process by which health information is successfully imparted in such a way that the recipient is
motivated to make use of the information for the promotion, protection and maintenance or restoration
of a family or community health.
(b) Outline five (5) qualities of a Good Health Educator. (5 marks)
 Must have fact and adequate knowledge of health issues in question.
 Must have good communication skills
 Must be able to send his/her message across to the audience via mass media or inter-personal
communication.
 Must understand cultural patterns or norms of the community and relate to the people us at their
own level.
 Must be a good and sympathetic listener.
 Should be able to create awareness and encourage people to change behaviours towards health
 Should know how to motivate people and bring about behavioural change.
 Must be patient and tolerant.
  Must have the ability to evaluate through asking questions and allowing clients/patients to give
a feedback
 Have the ability to choose the right topic for the target group.
 Should be cheerful and neat ‘in appearance ex
 Must not be boastful but simple.
(c) Discuss eight (8) Barriers to Good Communication. (4 marks)
1. Personality - (e.g. hostile personality, etc.) ad:
2. Socio-economic difference.
3. Inadequate knowledge of the topic.
4. Poor listening
5. Noise — (i.e. Noisy environment, distraction, etc.)
6. Difference in attitude and perception
7. Emotions.
8. Age and sex differences,
3. (a) Define Advocacy. (1 mark)
Advocacy is a process of creating awareness among policy makers concerning any health matter in
order to get their support.
A process of sensitizing with subsequent follow up of policy makers to arouse their interest and
commitment in PHC programme.
OR
(b) As a CHEW, explain the importance of Advocacy to a newly posted JCHEW to your Health
Facility. (4 marks)
 It advances community health policies
 It shapes the debate on community health issues i\.
 It sets the agenda on health issues.
 It empowers the community to speak for itself about its health problems.
 A feasible solution is achieved
 It builds Community agreement that an issue is a priority for action and that the proposed
solutions are acceptable.
(e) State five (5) Focal persons/groups for successful Advocacy (5 marks)
1. The chairman of a local government council.
2. The council’s secretary
3. The village head/clan head
4. The supervisor for health. 6
5. The local government primary health care co-ordinator
6. The local area primary health care committee.
7. District head or head of a traditional council
8. Religious leaders.
9. Women leaders
10. Youths.
4. a) What is Drug? (1 nark)
Drug includes any substances or mixture of substances manufactured, sold or advertized for use in the
diagnosis, treatment, mitigation or prevention of any disease disorder, abnormal physical state, or the
symptoms there of, in monitoring animals.
OR
Drug is a medicine or other substances which has a physiological effect when ingested or otherwise
introduced into the body.
OR
A drug is a chemical substance which when taken or given in the right quantity or in appropriate dosage
forms, alleviate suffering and improves the health and general well-being of the recipient.
(b) Explain the difference between Prescriptive Drugs and Non-prescriptive Drugs giving example of
each. (5 marks)
Prescriptive drugs are drugs that are not safe for use without medical supervision. They are only
dispensed by the order of a licensed medical practitioner who is allowed by law to administer them.
Example — Lexotan, Valium
Non-prescriptive drugs are drugs sold over the counter due to the fact that they can b sold or safely use
without medical supervision or direction. Examples — Folic acid, Multivite.
(c) Identify the drugs listed in table below by their Generic Names:
BRAND Name GENERIC Names
 Phensic, Cafenol,Asprin Acetysalicylic acid
 • Panadol, Chemadel Paracetarnol
 • Valium Diazepam
  • Flagyl Metronidazole
 • Piriton - Chlorphernamine
 • Combantrin Pyrantel
 Septrin Co-trimoxazole
 .Vitamin C Ascorbic Acid
5. (a) State five (5) reasons for Referral. (2 ½ marks)
i. On patient request
ii. When patient condition is rapidly getting worse
iii. When indicated by the standing order
iv. Patient condition not responding to treatment.
v. When health worker is in doubt of case in view.
vi. When health worker is in doubt of case in view
vii. For specialist/sophisticated management.
viii. When there is no facility and equipment to manage the case.
ix. Condition not covered by the standing order
x. For continuity of care
xi. For diagnostic purposes
(b) Enumerate five (5) constraints to Referral (2 ½ marks)
- Poor transportation
- Lack of fund from the patient’s end
- There may be nepotism, egocentrism, favouritism treatment for relatives rather than those who need it
- Non-acceptance at higher level
- No feedback from higher level/authority
- Unwillingness of patient/relatives to leave one’s secured environment
- Inadequate preparation of hospital physician for referral technology
- In the higher level, the capacity to take all referred cases may not be adequate.
(c) List ten (10) disease conditions that a CHEW will refer. (5 marks)
i. Acute appendicitis
ii. Intestinal obstruction
iii. Strangulated hernia
iv. Accident of all type
v. Chronic disease e.g. tuberculosis
vi. Obstetric Emergency condition e.g. Ante-partum hemorrhage, post-partum
vii. Severe burns i.e. 2nd & 3rd degree
viii. Obstructed labour
ix. Acute Asthma
x. Certain condition e.g. Diabetes mellitus
xi. Renal failure
xii. Mental disorder
xiii. Cancer
xiv. Psychosis
xv. Health problems
6. a) As a CHEW, enumerate five (5) functions each of your Clinic based and Community Based
functions. (5 marks)
CLINIC BASED FUNCTIONS OF CHEW
1. Provide integrated prirr1ary Health care services
2. Organize and run integrated primary health care services where community health officer is not
available.
3. Collect and collate monitoring and evaluation data for the national health management information
system (NHMIS) from the community and health facility and forward to the ward level.
4. Carry out with community health officer (where available) the day-to day administration of health
services in the target population.
5. Immunization services.
6. Manage logistics and cold chain system
7. Treat common condition using the Standing orders
8. Carry out sterilization of equipment
9. Promote mental and dental health
10. Perform simple laboratory test e.g. haemoglobin estimation, stool and urine testing, etc.

COMMUNITY BASED FUNCTIONS OF CHEW

1. Explain to the community the primary health care approach of the Nigerian health system and his
role as a member of the health team to link the community with healthcare system.
2. Carry out community mobilization for health action.
3. Familiarize self with target population and health services within the community
4. Initiate the formation and facilitate the effective functioning of the development committees.
5. Attend community Development committees meeting in rotation at least 2 times in a year.
6. Participate in, and supervise primary health care house numbering and placement of home-based
records.
7. Teach the Junior community health extension workers simple methods of data collection and
analysis.
8. Participate in the analysis of data collected.
(b) Discuss five (5) factors that can affect the health of people living in a local community.
1. Cultural factors: Culture is the way people live which has evolved over a long period of time and
goes from generation to generation. The components or culture and custom, beliefs and practices,
taboos and habits. Some cultures are beneficial while others are harmful to health. Harmful cultures
should be discourage.
2. Socio-Economic Factors: This is the relationship of man with his environment and it embraces:
i. poverty — low income
ii. education — little or no education is very dangerous
3. Ignorance — leads to poor habits
4. Poor communication network
5. Environmental factors which includes:
i. Air pollution
ii. Inadequate safe or wholesome water supply.
iii. The presence of waste — improper disposal
iv. Poor road network
v. Inadequate excreta disposal.
6. Personal factors that affect health such as:
- Lack of persona] hygiene
- Education level
- Attitude towards health system
- Awareness about health matters
- Genetic or biological factors.
7. Geographical factors include:
- Topography: nature of soil, rivers, mountains, etc.
- Deserts
- Weather
- Draughts
- Earthquakes
- Floods, etc.
7. (a) Define the term Stress. (1 mark)
Stress is your body’s way of responding to any kind of demand or threat.
OR
Stress is said to be any factor that threatens the health of the body or has an adverse effect on the
functioning, such as injury, disease or worry.
The existence of one form of stress tends to diminish resistance to another form. Constant stress brings
about changes in the balance of hormones in the body.
(b) Enumerate four (4) ways an individual can cope with Stress. (2 marks)
i. Resolve personal conflict
ii. Have positive beliefs about life
iii. Have adequate sleep and rest
iv. Eat balanced diet with plenty of fruits and vegetables
v. Accept what you cannot change
vi. Arrange for holiday with your wife/husband.
(c) List four (4) common Drugs Abused by youths in the community. (2 marks)
i. Marijuana / India hemp
ii. Cocaine
iii. Morphine
iv. Caffeine
v. Analgesics
vi. Antibiotics
vii. Valium / diazepam
viii. Alcohol.
d) State the functions of the Family as a Social Institution. (3 marks)
i. It is the basic unit of socialization.
ii. It provides mode of behavior to the young ones
iii. It regulates sexual and parental behavior
iv. It provides property that are to be shared
v. It takes care of less unfortunate members
vi. It provides means of propagating family names to future generation
(e) Distinguish between Extended and Nuclear Family (2 marks)
Extended Family Nuclear Family
It includes a married pair and their offspring. Nuclear family is limited to a
married pair and their children
It also includes one or more people
related to those who are kins

COMMUNITY HEALTH EXTENSION WORKERS (CHEW) 2

PAPER II
SECTION B: ESSAY QUESTIONS
1. (a) What is an adequate Diet? (1 mark)
An adequate diet is a diet which meets all the nutritional needs of the person.
(b) List four (4) functions each of the following:
(i) Protein. (2 marks)
I. Formation of enzymes, hormones, haemogiobin and anti-toxins.
2. Growth and development of tissue cells from birth and growth stops.
3. Repair and replacement of tissue cells which is constantly undergoing wear and tear e.g. soles of the
feet, nails and skin.
4. Serves as antibodies to protect the body against invading microbes e.g. (gammmaglobulin).
5. Transportation of vital substances throughout the body (e.g. haemoglobin in transport of oxygen and
carbondioxide).
(ii) Fats and Oil. (2 marks)
i. To produce energy and heat
ii. To support certain organs of the body for instance, the eyes and the kidneys.
iii. To transport/storage of fat-soluble vitamins A, D, E, K.
iv, It is used in the formation of cholesterol and steroid hormones
(iii) Carbohydrate. (2 marks)
1. Provides the body with energy
2. It stores energy (b
3. It satisfy hunger
4. It provides food for the foetus
5. It provides food to the brain in form of glucose
6. Helps in the complex burning of fats in the .body.
(c) State the disease conditions associated with deficiency of the following:
(i) Iodine. — Goitre
(ii) Vitamin C.—Scurvy
(iii) Vitamin A.-Night blindness/xerophthqlmia
(iv) Vitamin B12- Anaemia (MegaloblasticAnaemia)
(v) Vitamin B - Beriberi
(vi) Vitamin D-Rickets/ Osteomalacia (3 marks)
2. Label the indicated parts of the Organs below.

(b) State four (4) functions of the Stomach. (2 marks)

i. It produces gastric juice
ii. It acts as a temporary reservoir for food
iii. Absorption of iron
 iv. It helps in binding vitamin B12
v. With gastric juice. It helps in the mixing mechanism of food

(c) State three (3) disease conditions each of the following organs: (3 marks)
1. (a) Define the following terms:
(i) Immunity. (1 mark)
Immunity is the state of resistance to infection conferred by the presence of antibodies capable
of combining with antigens or antitoxins which neutralize toxin or other chemicals.
(ii) Immunization. (1 mark)
Is the process of introducing antigen into the body to stimulate the body to produce specific body.
(iv) Vaccine. (1 mark)
A vaccine is an immune-biological substance designed to produce specific protection against a given
disease. It stimulates the production of antibody.
(iv) Antigen. (1 mark)
This is a substance (vaccine/serum) which introduce into body system under favorable conditions can
stimulate the production of antibody.
(v) Cold Chain. (1 mark)
Cold chain system is the process of storage, maintenance and distribution of vaccines in a potent from
manufacturer to the actual vaccination site.
(b) An Adult was brought to your centre with the complaint of itchy skin and swollen right leg in the
past two weeks.
O/E There was appearance of white threadlike substance and inability to move. B/Pl20/8ommhg,
Temp. 37.5°C (5 marks)
Manage his condition with your Standing Orders.
Suspect Guineaworm (Drancontiasis)
National standing orders for Community Health Officers/CHEW’s
Revised Edition Page 267
Complaints Findings on Clinical Action
Examination Judgment
Swelling of Swelling of the leg Mild condition •Test for
the leg Not pitting on pressure Suspect Filariasis
Elephantiasis Ivermectin 12mg
4tablets, once Daily washing and drying
of affected limb.
Limbs should be elevated when sleeping.
.
4. a)Explain the following terms used in Statistics:
(i) Mean.
An average of a set of values. It is the sum total of: observations divided by the number of
observations.
(ii) Median.
The middle value in a set of measurements when the values are arranged in an array. It is the centrally
located observation when all the observations have been arranged in ascending or descending order.
(iii)Mode. (3 mark)
• The most frequently occurring observation. It is the score with the highest frequency of occurrence in
a population or distribution.
(b) Calculate the mean of the under-listed Data.
0,1,3,4,10,20,23,3040,44 ‘(l mark)
Mean= 0 + 1+3 +4+ 10+ 20 ± 23 + 30 + 40 +44
10
=175
10
Mean = 17.5
(c) Enumerate four (4) factors each that could affect the following:
(i) Blood Pressure. (2 marks)
— Age of patient
— Anxiety! Stress / emotional state
— Obesity
— Certain heart diseases e.g. renal condition
— Endocrine disorder-Thyroxicosis
— Smoking, alcohol
(ii) Pulse Rate. (2 marks)
— Age of the patient
— Sex
— Position of the patient
— Exercise
(iii) Respiration. (2 marks)
Exercise
— Emotion
Age: as you grow older
— Fatigue
— Resting
— Toxaemia — Drugs intake e.g. morphine, depresses respiratory centre
5. (a) Define Budget. (1 mark)
A budget is a financial plan for a defined period of time usually a year.
(b) State four (4) effects each of under-budgeting and over-budgeting in PHC (4 marks)
Effects of under-budgeting
 Inadequate equipment
 Staff may go on strike as a result of non-payment of salary
 Failure to achieve objectives.
 Shortage of drugs in the clinic
 Inadequate staff for the service
 Inadequate vaccines to prevent communicable diseases
 Low patronage of the facility
 Causes dissatisfaction among workers and low morale
 Effects of over budgeting in PHC
 Fraud
 Embezzlement
 Wastage of resources
(c) Write short notes in the following functions of Management in PHC.
(i) Planning.
Planning is deciding in advance What to do, how to do it, when to do it and who is to do it. Planning set
standards for measurement of performance and see if objectives are met or achieved.
(ii) Implementation.
Implementation is the realization of an application, or execution of a plan, idea, model, design
specification, standard algorithm, or policy.
(iii) Staffing. .
The process of having suitable candidates according to their knowledge and skills in an organizations -
(iv) Co-ordination.
This is the resulting state of working together.
(v) Evaluation. (5 marks)
This is periodic assessment of any health programme to ensure that set goals and objectives are
achieved. It is of two types:
i. Formative evaluation a
ii. Summative evaluation
6. (a) Define the following:
(i) Monitoring. (1 mark)
This is the continuous checking of primary health care programmes up to the achievements of
objectives level
(ii) Target Population. (1 mark)
A particular group of people that is identified as the intended recipient of an advertisement, product, or
campaign.
(iii) Health Indicator. (1 mark)
It is the assessment that use to determine the health and health care need of a community but also to
compare the health status of one community to that of another.
(iv) Health Objective. (1 mark)
Can be viewed or seen as the statement of outcome of PHC programme after Implementation of same.
(b) List the Records/Data collection forms that are available for information in the following
levels:
(i) Home level. (2 marks)
• PHC child health chart and treatment card (0-5years)
• PHC personal health care treatment card for (Adult)
(ii) Health Facility Level. (4 marks)
• Clinic Master Card
• Monitoring and Evaluation Forms e.g
o Book 1 HF/1-8: Disease case seen by VVHWS/TBAS
o Book 2 HF1-3.: Tracer disease and outpatient attendance
o Book 3 H/F1-3: Pregnancy outcome
o Book 4 H/F1 1-3: Family Planning record
o Book 5 H/F l -3 :Immunization in health facility
o Book 6 H/F 1-3: In patient care
o Book 7 H/F 1-3: Environmental health sanitation activities
o Book 8 H/F 1-3: Growth monitoring & promotion.
7. (a) As a CHEW in charge of Health Facility, how would you identify the training needs of
JCHEW working with you? - (2 marks)
1. Identify training needs of JCHEW, VVHWs, TBAs
2. Provide on-the-job training as necessary.
3. Teach the ICHEW simple method data analysis
4. Collaborate in the planning implementation and evaluation of training programmes for JCHEW
VVHWs, TBAs
(b) List Four (4) Clinic-Based functions of the JCHEW. (2 marks)
1. Register new clients
2. Weigh clients and record weights accurately
3. Carry out health talks on different health related topics as scheduled
4. Estimate haemoglobin according to established procedure
5. Measure blood pressure according to established/procedure
6. Test urine for sugar, protein and albumen.
(c) Light Eight (8) Books of Accounting used in PHC (4 marks)
 Ledger
 Cashbook
 Books of original entry
 Imprest cash book
  Stock account book
 Balance sheet
 Vouchers
 Invoices
(d) Distinguish between “de facto’ population and ‘de Jure population (2 marks)
“De facto” population is a concept under which individual, or vital events are recorded (or are
attributed) to the geographical area where they were present at k specific time while “De jure”
population a concept under which individuals (or vital events are recorded to a geographical area on the
basis of place of residence.
Types of Probability Sampling Techniques
I. Simple Random sampling Technique
2. Stratified Random sampling technique
3. Systematic random sampling technique
4. Multistage sampling procedure
5. Cluster or (Area) sampling,
6. Comprehensive sampling.

COMMUNITY HEALTH EXTENSION WORKERS (CHEW)

PAPER III
SECTION B: ESSAY QUESTIONS
Answer ALL questions
1. (a) Define Environmental Health. (2 marks)
Environmental health has been defined by the world health organization as the control of all those
factors in man’s physical, biological and social environment which may exercise a deleterious effect on
his physical, mental and social well-being, development and survival.
(b) State eight (8) components of Environmental Health (4 marks)
1. Food hygiene and safety.
2. Waste management
3. Vector and pest control
4. Housing sanitation
5. Epidemiological studies and control of communicable disease
6. Air quality management of monitoring
7. Occupational health and safety
8. Water resources management & sanitation
9. Noise pollution monitoring and prevention
10. Control of frontiers, air and seaport and border crossing.
(c) List four (4) water-borne diseases. (2 mark)
1. Diarrhea
2. Cholera
3. Dysentarv
4. Typhoid fever
5. Salmonella and coli infection
6. Campylobacter
7. Legionellosis
8. Leptospirosis
9. Botulism
10. Poliomyelitis
(d) List four (4) water shortage diseases. (2 marks)
1. Scabies
2. Trachoma
3. Amebic dysentery
4. Cholera
5. Typhoid
6. Giardiasis
7. Hepatitis A and E
8. Hookworm
9. Guineaworm
2. (a) Define Puerperal Sepsis. (1 mark)
Puerperal Sepsis: This is an infection of the genital tract occurring usually within three weeks after
abortion or child birth.
(b) List four (4) signs and symptoms of Puerperal Sepsis. (2 marks)
1. Profuse lochia, which has offensive odour
2. General malaise
3. A general rise in the body temperature to over 38 degree Celsius
4. Increase in pulse rate to over 90 minutes
5. Sub-involution and the uterus is tender to touch
(c) Eight conditions in Pregnancy that require immediate referral. (4 marks)
1. Raise blood pressure 279
2. Eclampsia
3. Bleeding
4. Placenta praevia ‘
5, Anaemia
6. Cephalopelvic disproportion
7. Abnormal presentation of foetus (iii
8. Toxaemia in pregnancy
9. Malaria in pregnancy
10. Liquior drainage
(d) Activities involved in establishing Breast feeding in a newborn baby. (3 marks)
1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
2. Train all health care staff in skills necessary to implements this policy.
3. Inform all pregnant women about the benefits and management of breastfeeding
4. Help mothers initiate breastfeeding within a half hour of birth
5. Show mothers how to breastfeed, and how to maintain lactation even if they should be separated
from their infants
6. Give newborn infants no food or drink other than breast milk, unless medically indicated.
7. Practice rooming-in- allow mothers and infants to remain together — 24hours a day.
8. Encourage breastfeeding on demand
9. Give no artificial teeth to breastfeeding infants
10. Foster the establishment of breastfeeding support groups and mothers to them on discharge
from the hospital or clinic.
5. (a) What is Community Mental Health Care? (1 mark)
Community mental health care refers to all those facilities, apart from hospital care, which are
employed for treating and rehabilitating mentally ill patients in the community.

(b) Explain the importance/benefits of Community Mental Health to members of your

Community
Development Committee. (5 marks)
1. It promotes the spirit of participation in the care of its members.
2. It strengthens family ties. The family is assisted to understand and accept their members who is
mentally ill.
3. It reduces expenses incurred by family members and the government.
4. Absence of stigma and discrimination.
5. Reintegration into the community and living a normal daily life.
6. It brings mental health care services closer to the doorsteps of members of the community.
7. It is accessible, acceptable, available and affordable by community members.
8. prompt treatment of mental disorders.
(c) Describe eight (8) feat4res that could assist you in identifying mentally ill person in the
community. (4 marks)
1. Appearance: .The patient appears neglected; looks rough, dirty, scattered and may go naked.
2. Manner and Attitudes: Abnormal, violent, and may be aggressive.
3. Orientation: Disorientation to time, person, place and things.
4. Mood: Deviation from norms, mute, yelling, crying or excited.
5. Withdrawal: Solitary from the society, lonely and may refuse to mix up with other normal persons.
6. Paranoid: Suspicious
7. Uncoordinated speech.
8. Negative reaction to new environment.
9. No insight and judgment.
10. Hallucination (both visual and auditory)
11. Delusion
6. (a) Discuss AIDs under the following headings:
(i) Definition. (1 mark)
H- Human infecting human beings
I- Immuno deficiency decreased or weakened in the body ability to fight infections and illness
V- Virus a pathogen having the ability to replicate only inside a living cell.
(ii) Causative Agent. (1 mark)
HIV- Human Immunodeficiency Virus
(iii) Mode of Transmission. (2 marks)
1. Sexual contact
2. From infected mother to her child during pregnancy, labour delivery and breastfeeding
3. Transfusion with infected blood or blood products
4. Intravenous drug users
5. Sharing of unsterilized razors during traditional circumcision.
(iv) Signs and symptoms. (3 marks)
a. Weight loss greater than 10% of the body weight
b. Unexplained chronic diarrhea greater than one month
c. Unexplained persistent fever greater than one month
d. Oral candidasis
e. Kaposi Sarcoma
f. Pneumonia
(v) Identify six (6) vulnerable groups to HIVIAIDs. (3 marks)
1. Sex Workers
2. Multiple sex partners
3. HIV exposed children
4. Men who have sex with men (MSM)
5. Persons who engage in unprotected sexual intercourse with infected partner
6. Prospective blood recipient e.g. accident cases
7. Long distance drivers
8. Prisoners “
7. (a) Define Deafness. (1 mark)
Deafness implies total hearing loss to a patient
(b) State eight (8) possible causes of Deafness. (4 marks)
1. Exposure to loud noise
2. Head trauma
3. Viral disease
4. Autoimmune inner ear disease
5. Hearing loss that runs in the family
6. Aging
7. Malformation of the inner ear
8. Meniere’s disease
9. Accident
10. Use of ototoxic drugs during pregnancy
(c) Discuss six (6) Preventive measures for Hearing Loss. (3 marks)
1. Avoid receive blows in the ear
2. Stay away from noise
3. Use of ear plugs to cover your ear in a loud place
4. Do not use sharp or pointed objects in cleaning the ear
5. Health education
6. Use of hearing aid
7. Early diagnosis and treatment of ear infection
(d) List four (4) diseases conditions that could lead to Blindness, (2 marks)
1. Cataracts 3. Trachoma 4. Macular degeneration
2. Glaucoma 5. Diabetic Retinopathy
Past questions and answers