Community Diagnosis Health Indicators.ppt
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COMMUNITY DIAGNOSIS
&
HEALTH INDICATORS
BY
Prof.. MAGED SAYED KHATTAB
MRCGP(UK),MHPE(USA),MD(SCU)
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Definition
The diagnosis of disease in an individual patient is
a fundamental idea in medicine. It is based on
signs and symptoms and the making of inferencesfrom them.
When this is applied to a community, it is knownas community diagnosis. The community
diagnosismay be defined as the pattern of disease
in a community described in terms of the
important factors which influence this pattern.
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Community diagnosis is based on
collection and interpretation ofrelevant data such as :
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The community diagnosis is based on collection and interpretation of
the relevant data such as :
(a)The age and sex distribution of a
population; the distribution of population by
social groups
(b)Vital statistics rates such as the birth ateand death rate
(c)The incidence and the prevalence of the
important diseases of the area
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In addition, a doctor must be able to find information on a
wide variety of social and economic factors that may assisthim in making a community diagnosis.
The focus of community diagnosis process is theidentification of the basic health needs and health problemsof the community.
The needs as felt by the community (some of which may haveno connection at all with health) should be next
investigated and listed according to priority for communitytreatment.
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*Community Diagnosis :
1. Demography, including all vital rates.
2. The causes of morbidity and mortality (by
age and sex groups).3. Use of health services including especially
maternal and child health clinics.
4. Nutrition, diet and weaning pattern, andthe growth of preschool and schoolchildren.
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*Community Diagnosis (contd.)
5. Society, culture and socioeconomicstratification.
6. The patterns of leadership andcommunication within the society.
7. Mental health together with an assessment
of the common causes of stress.8. Environment, especially water, housing,
and vectors of disease.
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*Community Diagnosis (contd.)
9. Knowledge, attitudes and practices of thepopulation in respect to health related
activities.10. The detailed epidemiology of any endemic
conditions.
11. The services and resources available fordevelopment especially non medical ones suchas agriculture, veterinary and social services.
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*Community Diagnosis (contd.)
12. The degree of involvement of people in
their own health care including the use of
traditional healers.
13. The reasons for failure of health
programmes in the past and the difficultieslikely to be encountered.
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Health indicators
- Health policy indicators
- Health status indicators
- Health services indicators
- Socioeconomic indicators
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Health policy indicators
Political commitment to PHC /Health for all
Resource allocation to essential programs
Equity in distribution of PHC services
Effective management of health system Level of community involvement
Availability of adequate food basic
sanitation
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Health service indicators
Examples
Growth monitoring indicators
First yearat least five times
2ndyearat least twice
3
rd
yearat least one Immunization coverage
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Health status indicators
Prevalence & incidence of diseases in the
community
Infant mortality rate
Maternal mortality rate
Nutrition indicators
Percent of children under 3rdpercentile
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Socioeconomic indicators
Illiteracy
Unemployment rate
Poverity
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Some important indicators of community
diagnosis
1. Crude birth rateis expressed as
Number of live births reported during a given timeinterval x 1000/ estimated midinterval population
The crude birth rate is expressed per 1000 population
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2. Crude death rateis expressed as
Total number of deaths reported during a giveninterval x 1000/ estimated midinterval population
Crude death rate is expressed per 1000 population
3. Annual rate of growth
When the crude death rate is subtracted from the
crude birth rate, the net residual is the current annualgrowth rate, exclusive of migration. This isexpressed as percent.
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4. Fertility rate
Number of live births reported during a given
time interval x 1000 /estimated number of
women age 15-44 years at midinterval
Fertility rate is expressed per 1000 women age
15-44 years.
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5. Infant mortalityrate is expressed as
Number of deaths among infants under one year ofage x 1000 Total live births in the year
Infant mortality rate is expressed per 1000 live
births in a given time period, usually 1 year.
6. Incidence rateis expressed as
Number of new cases of a specific disease duringa given time interval
Estimated midinterval population at risk
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7. Prevalence rateis expressed as
Number of current cases (old & new) of a specific
disease during a specified time period
Estimated midinterval populationat risk
8. Maternal mortalityrate is expressed as
Number of deaths related to pregnancy during a
given interval x 100.000/
Number of live birth reported during the same
time interval
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Although the true population at riskshould be the number of pregnant
women, this is an impossible figure to
determine. The number of live birthsis chosen because it reflects the
number of pregnant women; thus, this
is a pseudorate, or index.
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HEALTH INDICATORS
Total population (millions)
World : 5,981.0Developed countries: 1,181.0
Developing countries: 4,800.0Egypt : 66.9
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Infant Mortality Rate
Developed countries : 6Developing countries : 65
Egypt : 54
Under-5 Mortality Rate
Developed countries : 7
Developing countries : 96Egypt : 73
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Maternal Mortality RatioDeveloped countries : 27
Developing countries : 480
Egypt : 170
Population Growth rate
Developed countries : 0.1
Developing countries : 1.7Egypt : 2.0
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Total fertility rateDeveloped countries : 1.5
Developing countries : 3.2
Egypt : 3.3.
Gross Domestic Product per Capita (US$)
Developed countries : 19.283
Developing countries : 908Egypt : 1,015
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Sources of information about community diagnosis
1-Census
This is an important source of health information. Itis taken in most countries of the world at regular
intervals, usually of 10 years. It contains a mine ofinformation on subjects not only demographic, butalso social and economic characteristics of the
people, the condition under which they live, how they
work, their income and other basic information. Thisprovides data (such as population by age and sex)needed to compute vital statistics, and other health,demographic and socioeconomic indicators.
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2- Registration of vital events
Whereas census is an intermittent counting of
population, registration of vital events (e.g. births,death) keeps a continuous check on demographic
changes.
The United Nations defines a vital eventsregistration system as including legal registration,
statistical recording and reporting of the
occurrence of, and the collection, compilation,
presentation, analysis and distribution of statistics
pertaining to vital events i.e.live birth, death,
marriage, divorce, etc.
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3-Notification of diseases
Historically notification of infectious diseaseswas the first health information sub-system to
be established. The primary purpose of
notification is to effect prevention and/orcontrol of the disease. Notification is also a
valuable source of morbidity data i.e. the
incidence and distribution of certain specificdiseases.
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4. Health Center Records
A lot of useful information about health care activities and
utilization can be derived from health center records. A study of
health center data provides information on the following aspects:a) common health problems in the community.
b) age and sex distribution of different diseases.
c) prescribing
d) referral (f there is referral register)
e) MCH data provide information about
immunization,weight,height, ante-natal care, family
planning, etc.
f) environmental health data provide information about water,
food,inadequate waste disposal, etc. This data can behelpful in the identification and quantification of
causative factors of disease.
g) health manpower statistics.
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5. Population surveys
The routine statistics collected from the above
sources do not provide all the information about
health and disease in the community. This calls for
population surveys to supplement the routinelycollected statistics or information about community
diagnosis.
The term health survey is used for surveys relatingto any aspect of health-morbidity, mortality,
nutritional status, etc.
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Broadly the following types of surveys would be
covered under health survey :
a) Survey for evaluating the health status of a population,that is community diagnosis of problems of health anddisease. It is information about the distribution of these
problems over time and space that provides thefundamental basis for planning and developing needed
services.b) Survey for investigation of factors affecting health and
disease. These surveys are helpful for studying the naturalhistory of diseases, and for obtaining more informationabout disease aetiology and risk factors.
c) Surveys relating to administration of health services,e.g. use of health services, expenditure, evaluation ofmedical care,etc.
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Conducing health surveys
Population surveys can be conducted in almost any
setting; sampling techniques have been developed so
that estimates at any level of precision desired within
the constraints of available resources can be achieved.
The size of the sample, necessary for a household
survey depends upon the measurement being taken
and the degree of precision needed.
Health surveys can be cross sectional or longitudinal;
descriptive or analytic or both.
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- Breastfeeding indicators
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Title Definition Source
Maternity Services
1. Exclusively
breastfed by
natural mother
Num: No. f infants exclusively breastfed by their natural mothers from birth
to discharge
Denom: No. of infants discharged
Maternal
interviews at
discharge
2. Breast milk
substitutes and
supplies receipt
rate
Num: No. .of mothers who received breast milk substitutes, infant feeding
bottles, or teats at any time prior to discharge or during an antenatal visit to
this facility.
Denom: No. of mothers discharged
Maternal
interviews at
discharge
3 Bottle-fed rate Num: No. of infants who received any food or drink from a bottle in 24hours prior to discharge.
Denom: No. of infants discharged
Maternalinterviews at
discharge
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4. Rooming-in rate Num: No. of infants rooming-in 24 hours a day, beginning within 1 hours of
birth, not separated from mother for more than 1 hours at anytime.
Denom: No. of mothers discharged
Maternal
interviews at
discharge
5. Breastfed rate Num: No. of infants breastfeeding in 24 hours prior to discharge.
Denom: No. of infants discharged.
Maternal
interviews at
discharge.
6. Timely first-
suckling rate
Num : No. of infants who first suckled within 1 hour of birth
Denom: No. .of infants discharged.
Maternal
interviews at
discharge.
Opt.
1
Exclusively
breast milk fed
rate
Num: No. of infants exclusively breast milk fed from birth to discharge.
Denom: No. of infants discharged
Maternal
interview at
discharge
Opt.
2
Pacifier use rate Num: No. of infants who received pacifiers at any time prior to discharge.
Denom: No. of infants discharged
Maternal
interviews at
discharge
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Title Definition Source
Postnatal/outpatient
1. Supplementary
feeding and
supplies
recommendation
rate
Num: No. of mothers of breastfed infants less than 4 months old who
received a recommendation or prescription for breast milk substitutes,
supplementary feeding, bottles or teats during the clinic visit.
Denom: No. of mothers of breastfed infants less than 4 months old attending
the clinic
Maternal
interviews at
exit
2. Supplementary
food and
supplies receipt
rate
Num: No. of mothers of breastfed infants less than 4 months old who receive
breast milk substitutes, supplementary foods, infant feeding bottles or teats,
or coupons for these items during the clinic visit.
Denom; No. of mothers of breastfed infants less than 4 months old attending
the clinic.
Maternal
interviews at
exit
3 Breastfeeding
discouragement
rate
Num: No. of mothers of breastfed infants 4 to 24 months old who were
advised to stop or decrease breastfeeding.
Denom: No. of mothers of breastfed infants 4 to 24 months old attending the
clinic
Maternal
interviews at
exit
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Title Definition Source
Paediatric Inpatient
1. Continued
breastfeeding
rate
Num: No. of mothers of children less than 2 years old who have breastfed
the child within the 24 hours prior to discharge.
Denom: No. of mothers of breastfed children less than 2 years old who were
breastfed at the time of admission
Maternal
interviews at
discharge
2. Access rate Num: No. of mothers of breastfed children less than2 years old who had
access to the child day and night in order to breastfed.
Denom: No. of mother of breastfed children less than 2 years old who were
breastfed at the time of admission
Maternal
interviews at
discharge
3 Bottle-feedinginitiation rate
Num: No. of children less than 2 years old not using a bottle on admissionwho received anything (including ORS) in a bottle during their stay in the
facility
Denom: No. of children less than 2 years old not using a bottle on admission
Maternalinterviews at
discharge
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Title Definition Source
Facilities providing Family Planning Information
1. Lactation
amenorrhea
counseling rate
Num: No. of breastfeeding mothers of infants less than 6 weeks old receiving
information about the contraceptive effect of breastfeeding during the
consultation.
Denom: No. of breastfeeding mothers of infants less than 6 weeks old
attending clinic.
Maternal
interviews at
exit
2. Combined
hormonal
contraceptive
rate.
Num: No. of breastfeeding mothers of infants less than 6 months old given
or prescribed a combined hormonal contraceptive during clinic visit.
Denom: No. of breastfeeding mothers of infants less than 6 months old
attending clinic.
Maternal
interviews at
exit
3 Any hormonal
contraceptive
Num: No. of breastfeeding mothers of infants less than 6 weeks old given or
prescribed any hormonal contraceptive during clinic visit.
Denom: No. of breastfeeding mothers of infants less than 6 weeks old
attending clinic.
Maternal
interviews at
exit
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Thank you