PSM LRR Analysis (A-Z)

Dr. Asma • FMGE 2026

Table of Contents ▼

A - Vitamin A Prophylaxis & Treatment

Prophylaxis Schedule

  • 9 Months: 1 Lakh IU (with Measles/MR vaccine).
  • 1 to 5 Years: 2 Lakh IU every 6 months.
  • Total Doses: 9 doses.
  • Total Amount: 17 Lakh IU (or 17 ml).
  • Note: 1 ml = 1 Lakh IU.

Treatment of Vitamin A Deficiency

Schedule: Day 0, Day 1, Day 14 (or Day 1, 2, 14).

  • < 6 months: 50,000 IU.
  • 6 - 12 months (or < 8kg): 1 Lakh IU.
  • > 12 months (or > 8kg): 2 Lakh IU.
  • Severe Acute Malnutrition (SAM): Give 1 dose regardless of symptoms (unless given in last 1 month).
    SAM Criteria: Weight for Height < -3 SD OR Mid-Upper Arm Circumference < 11.5 cm.

Xerophthalmia Classification (WHO):
XN (Night blindness - 1st symptom) -> X1A (Conjunctival Xerosis) -> X1B (Bitot Spots) -> X2 (Corneal Xerosis) -> X3A (Corneal Ulcer < 1/3) -> X3B (Corneal Ulcer > 1/3) -> XS (Scar).

B - Biostatistics

Central Tendency & Dispersion

  • Mean: Average. Affected by extreme values.
  • Median: Middlemost value. Best for skewed data.
  • Mode: Most frequent value.
  • Normal Distribution (Gaussian): Mean = Median = Mode. Bell-shaped.
    1 SD: 68% coverage.
    2 SD: 95% coverage.
    3 SD: 99% coverage.
  • Skewed Distribution:
    Right (Positive) Skew: Mean > Median > Mode. Tail to right.
    Left (Negative) Skew: Mean < Median < Mode. Tail to left.

Tests of Significance

Test Usage
Paired t-test Quantitative data, Same group (Before vs After).
Unpaired t-test Quantitative data, 2 Different groups.
ANOVA Quantitative data, > 2 groups (e.g., 3 groups).
Chi-Square Test Qualitative data, 2 or more groups.

C - Control, Elimination, Eradication

  • Control: Reducing disease to a low level.
  • Elimination: No new cases in a geographic area.
    Eliminated from India: Polio (2014), MNT (2016), Trachoma (2017), Yaws, Guinea Worm.
    Targets: Malaria (2030), TB (2025), Leprosy/Filaria/Kala-azar (2027).
  • Eradication: Complete removal from the world.
    Only Disease Eradicated: Smallpox (1980).

D - Disaster Management

Triage (Color Coding)

  • Red (Immediate): Life-threatening but salvageable. Highest priority.
  • Yellow (Urgent): Can wait a few hours. Moderate priority.
  • Green (Ambulatory): Minor injuries ("Walking Wounded"). Low priority.
  • Black (Dead/Moribund): Dead or unsalvageable. Least priority.

Triage is done AT THE SITE of disaster.

Disaster Cycle: Impact -> Response -> Recovery -> Rehabilitation -> Mitigation -> Preparedness.

Most Common Post-Disaster Disease: Gastroenteritis.

Water Chlorination: Post-disaster residual chlorine should be 0.7 mg/L (Normal is 0.5 mg/L).

E - Epidemiology Study Designs

Observational Studies

  • Case Control: Retrospective. Starts with Disease. Goes back to Risk Factor.
    Measure: Odds Ratio (OR) = AD/BC. Good for rare diseases.
  • Cohort: Prospective/Retrospective. Starts with Exposure. Follows up for Disease.
    Measure: Relative Risk (RR) = Incidence(Exp)/Incidence(Non-Exp). Best for establishing causality (Temporality).
  • Cross-Sectional: Snapshot at one point in time. Measures Prevalence.

Experimental Studies

  • Randomized Control Trial (RCT): Gold standard for new drugs/interventions.
    Blinding: Removes bias.
    • Single Blind: Subject doesn't know.
    • Double Blind: Subject + Investigator don't know (MC used).
    • Triple Blind: Subject + Investigator + Analyzer don't know (Best).

Hill's Criteria for Causality

Mnemonic: "Temporality is King"

  • Temporality: Cause MUST precede effect (Essential). Best by Cohort.
  • Strength of Association: High RR/OR.
  • Specificity: One cause = One disease (Weakest criteria).
  • Consistency: Repeated results in different settings.
  • Biological Plausibility: Makes biological sense.

F - Family Planning & Fertility

Indicators

  • Total Fertility Rate (TFR): Avg children a woman has. Target 2.1. Current ~2.0.
  • Gross Reproduction Rate (GRR): Girls born to a woman (No mortality).
  • Net Reproduction Rate (NRR): Girls born to a woman (With mortality). Target NRR = 1.
  • Pearl Index: Failures per 100 woman-years. (Failure / Months x 1200).

Contraceptive Failure Rates

  • Best: Implants/Vasectomy/OCPs (< 0.1 - 0.3).
  • Worst: Natural methods / Vaginal Sponge.
  • IUCD (Cu-T 380A): Lifespan 10 years.
  • OCP Contraindications: Breast Ca, Liver disease, Vaginal bleeding (undiagnosed), Migraine with aura, HTN/CVD.

Centchroman (Chhaya/Saheli)

Non-steroidal, SERM. Once a week pill (Twice weekly for first 3 months). Developed by CDRI Lucknow.

H - Health Indicators

PQLI vs HDI

Index Components Range
PQLI (Physical Quality of Life Index) 1. Infant Mortality Rate (IMR)
2. Life Expectancy at age 1
3. Literacy Rate		 0 to 100
HDI (Human Development Index) 1. Life Expectancy at Birth
2. Mean years of Schooling (Literacy)
3. Income (GNI per capita)		 0 to 1

I - Immunization (NIS)

Schedule Highlights

  • Birth: BCG, OPV-0, Hep-B (within 24 hrs).
  • 6, 10, 14 Weeks: Pentavalent (DPT+HepB+Hib), OPV (1,2,3), Rotavirus, fIPV (6,14), PCV (6,14).
  • 9 Months: MR-1 (Right arm, SC), JE-1, PCV Booster, fIPV-3, Vit A (1 Lakh IU).
  • 16-24 Months: MR-2, JE-2, DPT Booster-1, OPV Booster.
  • 5-6 Years: DPT Booster-2.
  • 10 & 16 Years: Td (Tetanus-Diphtheria).
  • Pregnant Women: Td-1, Td-2 (4 weeks apart). Or Td-Booster if vaccinated < 3 years.

Open Vial Policy: Can reuse opened vial for up to 28 days IF: VVM is valid, not expired, cold chain maintained.
Applicable to: DPT, TT, Hep-B, Pentavalent, OPV, IPV.
NOT Applicable to: BCG, Measles, MR, JE, Rotavirus (Reconstituted vaccines must be used within 4 hours).

N - National Health Programs

  • NTEP (TB): Goal Elimination by 2025.
    Rx: 2 HRZE + 4 HRE.
    MDR-TB: BPaL-M regimen (Bedaquiline, Pretomanid, Linezolid, Moxifloxacin).
    Nikshay Poshan Yojana: ₹500/month (Now ₹1000/month proposed/updated in some contexts) for nutrition.
  • NVBDCP (Vector Borne): Malaria target 2030. Dengue, Chikungunya, JE, Kala-azar, Filaria.
  • RBSK: Screening 4Ds (Defects, Deficiencies, Diseases, Developmental delays). 0-18 years.
  • JSSK: Free delivery, drugs, diet, transport for pregnant women & sick infants (up to 1 year).
  • PMSMA: Free ANC by specialist on 9th of every month.
  • Anemia Mukt Bharat (6x6x6):
    Prophylaxis: IFA Red tablet (Woman): 60mg Fe + 500mcg Folic Acid. Weekly.
    Pregnant: Daily Red tablet (Start 2nd trimester).

W - Biomedical Waste Management

Bag Color Waste Type Treatment
Yellow Anatomical (Human/Animal), Pathological waste, Soiled waste (Blood), Expired drugs, Cytotoxic. Incineration / Deep Burial
Red Recyclable (Plastics, Tubing, Catheters, Gloves). Autoclaving / Microwaving / Shredding
White (Puncture proof) Sharps (Needles, Blades, Scalpels). Autoclaving / Dry Heat -> Pit/Encapsulation
Blue (Cardboard) Glassware, Metallic implants. Disinfection -> Recycling

Note: All bags must be Non-Chlorinated. Maximum storage time is 48 hours.