Will help D. Pharm faculty and students.

1. Preventive healthcare – Role of
Pharmacists in the
following
Mrs. R. H. Mishal
Incharge HOD, D. Pharm
Sir Dr. M. S. Gosavi College of Pharmaceutical
Education & Research,
Nashik.

2. Definitions:
i) Demography: is the scientific study of the human
population. It is mainly concerned with (1) Changes in
population size, (2) The distribution of population. 3)
composition
ii) Fertility: Is defined as the ability to bear the children.
OR
The ability to produce offspring or children.
iii) Family planning: is a way of living and thinking that is
adopted voluntarily upon the basis of knowledge, attitude and
responsible decisions by individuals and couples in order to
promote the health and welfare of the family group and thus
contribute effectively to the social development of the country.
iv) Contraceptive: is an agent used to prevent conception i.e.
pregnancy.

3. Demographic cycle:
Demographic Cycle: It comprises of following 5 stages –
1. First Stage: (High Stationary Stage): The feature of this phase is both
natality i.e. birth rate and mortality i.e. death rate are very high. Both
cancel each other keeping the population steady. India was in this phase till
1920.
(Stationary/constant) ( BR & DR same)
2. Second Stage: (Early Expanding Stage): Here mortality (death rate)
starts falling down but birth rate remains same i.e. higher. As a result, the
population starts increasing (expanding). At present African and South
Asian countries are in this phase.
(BR same, DR falls)
3. Third Stage: (Late Expanding Stage): Here mortality continues to fall
but birth rate also starts decreasing. But yet Natality remains higher than
Mortality. So, the population continues to increase. China, India, Singapore
are at this stage.
(BR falls, DR further falls)

4. Demographic cycle:
4. Fourth Stage: (Low Stationary Stage): It is
also called Zero Growth stage as Natality equals Mortality and
both are lowered. So net population growth is zero. Many
developed countries have reached this stage in the last 20
years.
(BR equals DR)
5. Fifth Stage: (Negative Growth Stage) (Declining
stage): Here Mortality is higher than Natality. So, there is a
decline in population size. Reasons behind are advancement in
medical science and facing problems of population increase.
Germany and Hungary are presently at this stage.
(BR falls further than DR)

5. What is family planning
Family planning (according to WHO in 1971) is defined as “the
way of living and thinking that is adopted voluntarily, upon the
basis of knowledge, attitudes and responsible decisions by
individuals and couples in order to promote the health and
welfare of the family and thus contributes effectively to the
social development of a country.”
OR
Family planning is the way to decide the number and timings
of children in the family. so it is the way of life adopted by
married couples to promote the health and welfare of their
families. and later it has been renamed as “Family Welfare
Programme”.

6. Family Planning: It is the basic human right it refers
to the practices that help individuals or couples to
attain the following objectives.
Objectives of family planning:
1.To avoid unwanted birth.
2.To bring about a wanted birth.
3.To regulate the interval between pregnancies.
4.To control the time at which birth occurs in relation
to ages of parents.
5.To determine the no. of child in the family.

7. Scope of family planning :
Family planning has a wide scope and includes the following activities:
1. Proper spacing and limitation of birth.
2. Investigations and advice on sterility.
3. Education for parenthood.
4. Sex education.
5. Screening of the reproductive system for pathological conditions.
6. Premarital consultation and examinations.
7. Marriage counselling.
8. Providing services for unmarried mothers, their care and adoption
services.
9. Carrying out pregnancy tests.
10. Providing nutrition guidance.
Only a couple can decide about the size of the family they would like to
have which includes the number of children and spacing between the
children married couples can avoid unwanted pregnancies and can
regulate the proper spacing by adopting family planning measures.
Contraception is only one of these measures.

8. Methods of contraception :
Following are the methods of contraception available at
present –
A) Temporary Methods
1. Barrier methods:
(a) Physical methods: i) Condom ii) Diaphragm iii) Vaginal
sponge
(b) Chemical methods: i) Foams ii) Creams iii) Suppositories
iv) Soluble films
2. Intra – uterine device (IUDs):
(a) First generation Non-medicated IUDs: Loops as Lippes
loop
(b) Second generation Medicated IUDs:
i) Metal containing IUDs: Copper- 7, Copper T – 200, T. Cu-
380 A or Ag
(c) Third Generation Hormone containing IUDs: Progestasert

9. 3. Hormonal methods:
(a) Hormonal pills:
1.Combined pill: Mala –N, Mala –D
2.Progestogen only pill (POP)
3.Post coital pill: Tab. Unwanted 72, Tab. I pill 72
4.Once a month pill
5. Male pill
6. Saheli ( Centchroman)
(b) Slow release preparations:
1.Injectable: DMPA ( Depot – medroxyprogesterone acetate )and NET-EN
(norethisteon enantate )
2. Subcutaneous implants: Norplant
3. Vaginal rings
4. Post conceptional methods
(a) Menstrual regulation
(b) Menstrual induction
(c) Abortion (MTP)

10. B) Permanent Methods:
1. Male sterilization (Vasectomy)
2. Female Sterilization (Tubectomy).
C) Miscellaneous methods
1.Behavioural methods
(a) Abstinence
(b) Coitus interruptus
(c) Safe period use method
(d) Vaginal washing method
Each of the contraceptive methods have their own advantages and
disadvantages, so the adoption of a particular method amongst the given is
purely a matter of individual couples preference.

11. Mother and Child Health:
The role of a Pharmacist in Mother and Child care.
· Make the parents aware of and supply vitamins and nutritional supplements,
including folic acid and iron supplements and also promote cessation of alcohol
and nicotine use.
· Pharmacists recommend drug therapy, dosages, and duration of the essential
medicine during the pregnancy and also decide the drug for developing embryo.
· Pharmacists make decisions regarding the accessibility of critical medications
in labour and delivery and provide required sterile medication products during
delivery.
· Pharmacists, support breastfeeding (when replacement feeding is acceptable,
feasible, affordable, sustainable and safe, avoidance of all breastfeeding by HIV-
infected mothers is recommended).
· Pharmacists supply the effective treatment to the child and drug therapy (Oral
rehydration salts and Zinc therapy) and also ensure no deficiencies quality,
purity, or potency of medicinal products.
· Pharmacists also participated in health programs and are aware of the parents
to any disease conditions and provide the proper precaution.

12. Various Program for Mother and Child Care.
1. Janani Shishu Suraksha Karyakram
2. Janani Suraksha Yojana
3. Pradhan Mantri Surakshit Matritva Abhiyan
(PMSMA)

13. Janani Shishu Suraksha Karyakaram
(JSSK) was launched in June 2011 to eliminate out-of-pocket
expenses for both pregnant women and sick infants.
Essential care is provided to the mother and her neonate
within 48 hours. This postnatal period is critical for
identification and management of complication of post-delivery. In
case of institutional delivery accessing availing this care is a little
easier.
In 2014, the programme was extended to all ante-natal &
post-natal complications of pregnancy and similar entitlements have
been put in place for all sick newborns and infants (up to one year of
age) accessing public health institutions for treatment.

14. JANANI SURAKSHA YOJANA
Janani Suraksha Yojana (JSY) is a safe motherhood intervention
under the National Health Mission.
It is being implemented with the objective of reducing maternal and
neonatal mortality by promoting institutional delivery among poor
pregnant women.
The scheme, launched on 12 April 2005 by the Hon’ble Prime
Minister, is under implementation in all states and Union Territories
(UTs), with a special focus on Low Performing States (LPS).
JSY is a centrally sponsored scheme, which integrates cash assistance
with delivery and post-delivery care.

15. PRADHAN MANTRI SURAKSHIT MATRITVA ABHIYAN
Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) was launched
to provide fixed-day assured, comprehensive and quality antenatal
care universally to all pregnant women (in 2nd and 3rd trimester) on
the 9th of every month.
Using the principles of a single window system, it is envisaged
that a minimum package of investigations and medicines such as IFA
and calcium supplements etc would be provided to all pregnant
women attending the PMSMA clinics.
One of the critical components of the Abhiyan is identification
and follow-up of high risk pregnancies and red stickers are added on
to the Mother and Child Protection cards of women with high risk
pregnancies.

16. Importance of Breast feeding:
Breastfeeding is the activity by which, nourishing the newborn baby
with milk from the breast and completing their nutritional demand
for proper growth and development up to a certain period.
Breast milk contains water, proteins, carbohydrates, antibodies, fats,
hormones, vitamins, minerals and other immune cells etc.
During the pregnancy, female mammary glands undergo
differentiation and start producing milk towards the end of
pregnancy by the process called lactation.
The milk produced during the initial few days of lactation is called
colostrum which contains several antibodies absolutely essential to
develop natural resistance for newborn babies.
Breastfeeding during the initial period of infant growth is
recommended by doctors for bringing up a healthy baby.

17. Benefits for Child
Milk is the essential nutrient for the growing baby. It helps in many ways like…
1. Improve resistance power—Mother milk contains the many antibodies, which
are responsible for the protection of child against the disease. IgA is the major
immunoglobulin in human colostrum and milk.
2. Resistance is provided by milk against diseases like…..
Asthma, respiratory disease, obesity, diabetes, ear infections, gastro- intestinal
infections, cancer and any syndrome etc.
3. Fulfill nutrients supply—Milk are the best food supplement for the growing baby
because it contains the essential supplement (vitamins, minerals, proteins, amino
acids, fat or lipids etc) in required and abundant amount.
4. Proper growth and development—Due to involvement of supplement, it helps in
proper growth and development and of body parts (bone, muscle, liver, brain,
heart etc.) and also provide the strength to body parts.

18. Benefits for Mother
Breastfeeding is simply not responsible for a baby growth
apart from this, it is also responsible for maternal health.
In mother keep it safe from many conditions.
Diabetes, ovarian cancer, regulated cholesterol level,
breast cancer, high blood pressure etc.

19. SUBSTITUTES FOR INFANT MILK
In some conditions mother is not able to breastfeed due to reasons
(low milk production, severe disease condition etc.) then substitute
or alternative milk are the one way to fulfil the baby needs other
than the mother milk.
Substitute milk is a synthetic form of liquid/powder nutrition
designed to closely mimic the nutrient quality and composition of
breast milk.
It provides a similar amount of calories, fat, and proteins as breast
milk.
In dire situations, you may offer pasteurized cow, sheep, or goat milk
(full fat) and alternative milk (pea protein or soy are best) for 2-3
days as long as these are not the primary source of nutrition.

20. IDEAL CHARACTERISTIC OF INFANT SUBSTITUTE MILK.
Almost equal to the breast milk like( color, smell, taste, texture
Provide all the nutrition(calorie, protein, fat, vitamin, minerals)
Do not cause any allergic reaction.
Easily digestible for infant.
Easily absorbable for infant.
Easily available and low economy.
Do not cause any disease condition.
Disease/ill-related to substituted milk.
Substituted milk some time causes the severe allergic reaction in
infants and cause eczema, rashes.
Some infants are not able to digest the substitute milk, so it cause the
diarrhea and increase the risk of necrotizing enterocolitis (NEC).

21. Bottle feeding
Bottle feeding is a system, which provides an identical
condition/environment that is similar to breastfeeding and
nourishes the baby by providing nutrient full supplements.
During the bottle feeding, hold your baby in a proper manner and
take the bottle to come close to the baby and incline the bottle at an
angle (45-90).
Some precautions/activities are required for bottle feeding.
Proper cleaning and hygiene required for the bottle feeding.
To ensure the feeding supplement, which are healthy for baby or not.
To ensure the feeding bottle (plastic, stainless steel) are compatible
with the feeding supplement.
Try that as much as the feeding is made , give the baby drink
immediately and do not leave it for later because supplement are
easily deteriorate by the environment.
Proper condition and proper position are required for the best
feeding.

22. Vaccine:
Vaccine is the chemical substances or biological preparation which provides
the active acquired immunity against any disease.
Generally vaccine contains the resemble microorganism or chemical
substances (toxins, surface protein etc.) in inactive/killed form.
During the vaccination, vaccine are injected in the body, after that it behaves
as a antigen or foreign substance to the body, so our body work against this
substances and produced the antibodies create a immunity.
It is called that primary response against disease.
After that immunity are developed and stored in the memory cells of the
brain regarding to the previous infections.
In future any similar infections occur then our immune system gives rapid
response and fight against disease this is called secondary response by
producing antibodies.
Vaccines play a major role in prophylactic and therapeutics in many diseases.

23. Antigen:
Antigens are those substances that stimulate the immune system to
produce antibodies (protective body). It behaves like foreign
particles (bacteria, virus) for recipient body and cause undesirable
changes, and then recipient body protects itself by producing the
antibodies.
Antibody:
Antibody is the proteinaceous protective modification produced by
the immune system in response to the presence of
the foreign substances like bacteria, viruses etc and neutralize their
activities. It is also called immunoglobulin.

24. Types of Vaccines:
1. Live attenuated vaccine (LAV):
Live attenuated vaccines (LAV) are prepared by pathogens (virus or
bacteria) which cause the infections or disease that have been
weakened under laboratory condition. Live microorganisms provide
continual antigenic stimulation giving sufficient time for memory cell
production. Due to their weak activity it cause no or very mild
disease. Example: Tuberculosis (BCG), Oral polio vaccine (OPV),
Measles, Rotavirus, Yellow fever.
2. Inactivated vaccine (Killed vaccine):
Inactivated vaccines are prepared by the method of killing antigens
through the physical or chemical processes.
These killed organisms cannot cause risk of inducing the disease and
they are also considered more stable than LAV vaccines.
Example: Whole cell pertussis, Inactivated polio virus (IPV)

25. 3. Subunit vaccine (Purified antigen):
Subunit vaccines contains the antigenic parts ( disease causing
portion) of antigen. Like inactivated vaccine it also not contains the
live components of antigen, it is only contains the antigenic parts like
surface protein, conjugated chemicals, polysaccharide etc.
Example: Acellular pertussis, Haemophilus influenza type b
Pneumococcal, Hepatitis B.
4. Toxoid vaccine (Inactivated Toxoid):
Toxoid vaccines are based on the toxin produced by certain bacteria
(e.g. tetanus or diphtheria). Released toxin is used to prepare the
vaccine and these parts are necessary to elicit a protective immune
response and produce antibody.
Example: Tetanus Toxoid (TT), Diphtheria Toxoid.

26. On the basis of components vaccine are also divided into
two parts:
1. Monovalent and polyvalent vaccine:
A monovalent vaccine contains a single strain of disease
causing specific antigen. Example: Measles vaccine while,
Polyvalent vaccine contains two or more strains/serotypes
of disease causing specific antigen. Example: OPV
2. Combination vaccine:
In combination vaccine many antigen are combined in the
single injection that can prevent different diseases or that
protect against multiple strains of infectious agents
causing the same disease. Example: Combination vaccine
DPT(Diphtheria, Pertussis and Tetanus antigens)

27. Ideal characteristics of vaccine:
Should not cause any allergic reaction.
Easily administrable without any harm.
Easy to store not shows any incompatibility with storage
materials.
Easily available and low economic value.
Not cause any disease condition and rapidly produces
antibody effects.