Public Health and Preventive Medicine: Measurement, Outbreaks, and Control
Public Health and Preventive Medicine in the Myanmar MMLE tests population-level reasoning: epidemiology measures, outbreak investigation, surveillance, immunization, and national programmes for TB, malaria, HIV, and maternal and child health. The exam expects calculations, a clear case definition, and control measures that can be implemented before the investigation is complete.
Core rules
- Incidence = new cases divided by the population at risk over a stated time; prevalence = all existing cases divided by the population at a point in time.
- Attack rate in an outbreak = cases among exposed divided by total exposed, multiplied by 100; compare exposed and unexposed groups.
- Outbreak steps: verify the diagnosis, confirm the outbreak, write a case definition, build a line list, describe person-place-time, generate hypotheses, and control.
- TB control uses case finding, DOTS, and contact tracing; malaria control uses vector control, long-lasting insecticidal nets, and artemisinin-based combination therapy.
Worked example
In a village of 500 people, 60 develop diarrhoea after a wedding. Of 300 attendees, 50 become ill; of 200 non-attendees, 10 become ill. Reasoning: attack rate in attendees is 50/300 = 16.7%; in non-attendees it is 10/200 = 5%. The relative risk is about 3.3, suggesting the wedding exposure. Investigate food and water, start oral rehydration, chlorinate water, and promote hand hygiene while continuing surveillance.
Traps
Confusing incidence with prevalence; using the whole population as the denominator instead of those at risk; failing to define a case; and waiting for laboratory confirmation before basic control measures.