Community medicine and public health is about 3% of NRE Step I, roughly 6 of 200 items, and PM&DC's table gives it 6. It is the most Pakistan-specific domain after forensic medicine: the health system and primary health care, the Lady Health Worker Programme, the EPI schedule and cold chain, typhoid conjugate vaccine, polio and AFP surveillance, TB control and DOTS, malaria, dengue, hepatitis programmes, maternal and child health and nutrition, together with epidemiology, biostatistics and demography. Foreign curricula rarely teach the Pakistani programmes, so these six items are where prepared candidates gain most over unprepared ones.
Weight and expected item count
Six items is about six minutes of paper time. The domain splits between Pakistani programme knowledge, which must be learned from official sources, and epidemiology and biostatistics, which are universal and can be learned from rules and calculations. Both halves are learnable in a week.
What is tested
| Block | Topics |
|---|---|
| Health system | Structure of the Pakistani health system and primary health care; the Lady Health Worker Programme and community health services |
| Immunisation and communicable disease control | EPI schedule and cold chain; typhoid conjugate vaccine and typhoid control; polio eradication and AFP surveillance; TB control (DOTS, case finding, drug-resistant TB programme); malaria control; dengue prevention and outbreak control; hepatitis B and C prevention, screening and provincial control programmes |
| Maternal, child and nutrition | Maternal and child health, MMR, antenatal and postnatal care; nutrition programmes, stunting and micronutrient deficiencies |
| Epidemiology and statistics | Study designs, bias, confounding, screening tests; measures of central tendency, tests, confidence intervals |
| Demography | Fertility indicators and population pyramids |
| Environment and disasters | Water, sanitation, occupational health; disaster management, floods and outbreak response |
| Non-communicable disease and ethics | Diabetes, hypertension and tobacco control; health education, communication and research ethics |
Local guideline points
- EPI: launched in 1978. Hepatitis B was added in 2002, Hib in 2009, PCV in 2012, IPV in 2015 and rotavirus in 2017. TCV began in Sindh in 2019 and went nationwide in 2022. MR replaced measles vaccine in 2021. All EPI vaccines are free at government facilities. Confirm the age-by-age card on epi.gov.pk.
- TCV: a single dose, safe from six months, with at least four years of protection. In Pakistan it is given at 9 months with MR dose 1 (secondary sources; confirm).
- Polio: Pakistan and Afghanistan are the only countries with endemic wild poliovirus type 1. Surveillance uses AFP reporting and environmental sampling; the NEOC coordinates the programme.
- TB: DOTS through the National TB Control Programme in the public sector, with GeneXpert as the first test for presumptive TB under current WHO policy.
- Hepatitis: the national programme began in 2005, with provincial hepatitis control programmes from 2010. WHO's 2030 elimination targets are an 80% fall in new infections, 90% diagnosed, 80% treated and a 65% fall in mortality.
- Lady Health Worker Programme: launched in 1994; female community health workers deliver maternal and child health, family planning and EPI support in rural and peri-urban areas.
The sources behind each fact are in local guidelines you must know.
Three typical traps
- Guessing the schedule. A stem about a child with a missed dose asks what to give now. If you have not seen the current card you will guess. Write the card from memory, then check it against epi.gov.pk, and repeat until you can write it without errors.
- Confusing incidence, prevalence and rates. Epidemiology items test the correct denominator: attack rate, case-fatality, mortality rate, odds ratio versus relative risk. Do ten worked calculations by hand.
- Misreading screening statistics. Sensitivity, specificity, positive and negative predictive value and how prevalence changes them are a standard source of lost marks. Draw the two-by-two table every time.
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How to revise it
| Session | Do this |
|---|---|
| 1 | Health system, primary care and the LHW Programme; maternal and child health programmes |
| 2 | EPI card, cold chain, contraindications; TCV and MR facts |
| 3 | TB, malaria, dengue, hepatitis, polio: programme, case definition, control measures |
| 4 | Epidemiology: designs, bias, confounding, screening tests; 15 worked calculations |
| 5 | Biostatistics, demography, environment, disasters, NCDs, ethics; mixed block of 25 |
Because most facts are programme-specific, schedule short repeat sessions of 20 minutes in later weeks. The study plan shows where to place them.
Core facts to state without notes
- Sensitivity and specificity: sensitivity is true positives over all with the disease; specificity is true negatives over all without it. Predictive values change with prevalence; sensitivity and specificity do not.
- Study designs: a cohort study gives relative risk and follows exposed and unexposed people; a case-control study gives an odds ratio and starts from the outcome; a cross-sectional study gives prevalence.
- Bias and confounding: selection and information bias are errors in design or measurement; a confounder is associated with both exposure and outcome. Randomisation, matching and stratification address confounding.
- Averages: in a skewed distribution the median is preferred to the mean. Standard deviation describes spread; a 95% confidence interval that includes 1 for a ratio means no statistically significant effect.
- Tests: the chi-square test compares proportions; the t-test compares means of two groups.
- Prevention levels: primary prevents disease (immunisation), secondary detects it early (screening), tertiary limits disability (rehabilitation).
- Demography: read a population pyramid for age structure; know the definitions of crude birth rate, total fertility rate and infant mortality rate.
Links to other domains
Community medicine overlaps with paediatrics (immunisation, IMCI), medicine (infections), obstetrics (maternal health) and forensic medicine (occupational and environmental poisoning).
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Frequently asked questions
How many community medicine questions are in NRE Step I?
PM&DC's table gives community medicine 6 items, about 3% of the 200-question paper.
What Pakistani programmes should I know?
The EPI schedule and cold chain, typhoid conjugate vaccine, the Lady Health Worker Programme, the National TB Control Programme (DOTS), malaria, dengue and hepatitis control, polio eradication and AFP surveillance, and maternal and child health services.
When did Pakistan introduce typhoid conjugate vaccine?
In Sindh in 2019, in Punjab and Islamabad in 2021 and nationwide in 2022, according to WHO's Pakistan EPI page.
Is biostatistics tested?
Yes. The syllabus lists measures of central tendency, tests, confidence intervals, study designs, bias, confounding and screening tests.
Which countries still have wild poliovirus?
Pakistan and Afghanistan are the only countries with endemic wild poliovirus type 1, according to the Global Polio Eradication Initiative.
Where can I check the current EPI schedule?
On the official EPI Pakistan site, epi.gov.pk. Secondary sources place MR dose 1 and TCV at 9 months and MR dose 2 at 15 months, but check the current card.