Social Pharmacy PDF Notes: PREVENTIVE HEALTHCARE

Demography can be defined as the scientific study which deals with the study of human population, all aspects of population progress, welfare, death in a family, birth and age. It also includes the studies of standard of living as well as properties.

It has five stages mainly.

1. First stage-It is also called as high stationary stage. It is characterized by high birth rate & high death rate which cancels each other.
2. Second stage– It is also called as early expanding stage. Here there is a decrease in death rate & the birth rate remains the same. Therefore, the population expands.
3. Third stage– It is also called as low stationary stage. There is low birth rate & low death rate so population becomes stationary.
4. Fourth stage– It is the declining stage. Here the population begins to declines as the birth rate is lower than the death rate.
5. Fifth stage – Population begins to decline as birth rate is lower than death rate. East European countries like Germany & Hungary are now in this stage.

Family Planning means to plan & limit the size of the family in accordance with the social, economic and health conditions, so as to ensure that the family is happy both physically & mentally.

• Natural Method

1. a) Sexual abstinence method

Abstinence – or not having sex – is the best way to avoid getting a sexually transmitted disease (STD) and prevent an unplanned pregnancy.

1. b) Coitus interruptus

      The principle of this method is the male withdraws his penis before ejaculation and prevents deposition of semen into vagina.

      Disadvantages

• It gives sexual unsatisfaction to both partners.
• It is not reliable method because small amount of lubricating fluid which enters into vagina may contain sperms.
• It keeps strain on man’s self-control.

1. c) Safe period method or Rhythm Method

      This is also known as ‘calender method’. One week before menstruation and one week after menstruation is considered as a safe period. During these days ovulation does not occur and conception can be avoided.

      Advantages

• It is a natural means of birth control.
• It does not require an artificial means.

      Disadvantages

• It is not reliable.
• It is difficult to find out safe period for a particular woman whose menstruation period changes.
• It requires arithmetic calculations.
• Many times there is no cooperation between the sexes.
• To be used by only educated and responsible couples.
• High failure rates.
• Ectopic pregnancies.

Mechanical Methods

1. a) Condom

A condom is a thin, loose-fitting pouch or sheath that protects against sexually transmitted diseases (STDs) or infections (STIs). As a barrier method of birth control (contraception), condoms prevent pregnancy by keeping a male’s sperm from reaching a female’s eggs.

Advantages

• These are easy to use.
• They are cheap in cost.
• No medical supervision required.

Disadvantage

• May slip off or tear during coitus.
• May interfere the sexual enjoyment of sexual intercourse.
• It is not 100% efficient.
• It is used only once a time.
• Possible to burst the condom.

1. b) Diaphragm

There are the vaginal barriers made up of synthetic rubber or plastic. These devices close off the entrance of womb. These are inserted into the vagina and are fixed on the cervix before intercourse and must remain in place for not less than 6 hours after sexual inter course.

Advantages

• These are reliable.
• No risks and side effects.
• Do not interfere with sexual pleasure.
• They are easy to handle and cheap.

Disadvantages

• Initially training by physician is needed to learn insertion of diaphragm.
• It is difficult to determine the size which fits the woman well.
• It requires careful attention to wash it, dry it, store it and protect it.
• In some cases diaphragm may be pushed away by the penis.
• Some women have allergy to diaphragm and cap.

1. c) Intrauterine devices

There are the medicated devices made up of either plastic or metal, intended to release a small quantity of contraceptive drug into the uterus in a sustained manner over a prolonged period of time. They prevent implantation of fertilized ovum in the uterus.

Types of IUD:

1) First generation IUDS; Eg: Lippe’s loop.

2) Second generation IUDS; Eg: Copper-T, Copper-7.

3) Third generation IUDS; Eg: Progestasert.

1) First Generation IUDS:

1. They are inert, non – medicated devices made of polyethylene or other polymers.
2. They have in different shapes and sizes like loops, spirals, coils and rings Lippe’s loop are the commonly used vehicle.

Advantages:

• It can be easy insertion.
• Cheap and safe.
• Reversible method.
• Does not interfere with sexual pleasure.

Dis-Advantages:

• Need trained person for insertion.
• Should be replaced periodically (2-4 years).
• Needs sufficient follow up.

2) Second Generation:

7. The second generations IUDs are copper containing devices. They include copper-T, Copper-7. Nova-T and multi load devices.
8. They act by releasing copper into the uterus. The copper ions may affect sperm motility and alters the composition of cervical mucosa.
9. It causes foreign body reaction in uterus and prevent pregnancy.

Advantages:

• Low expulsion rate,
• Less side-effects like pain and bleeding,
• Easier to fit,
• Increased contraceptive effect,
• Effective as post coital contraceptives, if inserted within 3-5 days of unprotected intercourse.

3) Third Generation: (Eg: progestasert).

1. These devices act by releasing a hormone.
2. It is a T-shaped device filled with hormone progesterone.
3. It acts by slowly releasing 65 micrograms of the hormone daily in the uterus.
4. It has a direct local action on the cervical mucosa and sperms.
5. Regular replacement if necessary.

• Chemical methods:

  The purpose of using chemical contraceptives is to stop the sperms progress completely the female or kill them before entering into the uterus of female. These contraceptives contain spermicide which kills the sperms.

1. Foam tablets: These are kept into vagina for 5 minutes before intercoitus. At body temperature they melt and produce a foam which acts as a barrier for the entry of sperms into uterus.
2. Pastes and jellies: These are pushed into vagina with the help of applicator called as jelly applicator. Sufficient time is to be given to spread the chemical on the mouth of the uterus.
3. Soluble tablets: These are kept into vagina for 5 minutes before intercoitus. At body temperature, they melt and spread the chemical on the mouth of uterus which kills the sperms.

        Advantages of Chemical Contraceptives

• These are easy to obtain and simple to use.
• They are reliable and give good sexual satisfaction.
• Some chemicals also have lubricating action.

        Disadvantages of Chemical Contraceptives

• High failure rates.
• Must be used immediately before intercourse.
• Some products can cause itching, burning and uneasiness.
• Some people do not like perfumes used in pastes and jellies.
• These devices should be used only once.
• Simple chemical barriers are not reliable hence they must be used with physical barriers such as condoms, caps.
• Simple chemical barriers are not reliable hence they must be used with physical barriers such as condoms, caps.

1. a) Vasectomy (MALE STERILISATION): In this method, a piece of vas deferens of about 1 cm length is removed after clamping. The ends are ligated and then folded back on themselves and sutured. Now the cut ends face away from each other.

Advice after vasectomy

1. The patient should be told that he is not sterile immediately after operation. He is sterile only after 30 ejaculations.
2. He must use contraceptives till aspermia is established.
3. He must avoid cycling or lifting heavy weights for 15 days.

Complications of vasectomy:

1. Operative complications like hematoma and infections.
2. Sperm granuloma accompanied by pain and swelling.
3. Spontaneous recanalization.
4. Psychological disturbances like loss of sexual vigor, impotence, fatigue.

1. b) Tubectomy (Female sterilization): It is done by two procedures:
2. i) Minilaparotomy: It is a modification of abdominal tubectomy. It is a very simple procedure done under local anesthesia. It requires a very small abdominal incision of 2.5 to 3 cm in length. It is a safe, efficient and easy procedure with less complication.
3. ii) Laparoscopy: It is done through abdominal approach with a specialized instrument called “laparoscope”. The abdomen is inflated with gas (carbon dioxide, nitrous oxide or air).Then the instrument is introduced into the abdominal cavity to visualize the fallopian tubes. The tubes are occluded with fallopian rings (or clips).

Advantages of laparoscopy are short operating time, shorter stay in the hospital and a small scar, rarely puncture of large blood vessels and other complications may occur. BWT

The pharmacist comes across a number of people. The illiterates or the less educated peoples are unaware of the benefits of family planning; therefore the pharmacist plays a very important role in the family planning & removing any fears about family planning.

The pharmacist can promote family planning by:

• Displaying family planning posters in hospital & drug store.
• Advising peoples about family planning & spacing of children’s.
• By distributing pamphlets which give an information about family planning.
• To explain about the various oral contraceptives & the others techniques of family planning.
• Guide people to hospital & family planning centers for vasectomy & tubectomy.
• They should motivate people towards the family planning.
• They should remove the fear &misconception about family planning from people’s mind.