community diagnosis health indicators.ppt

8/10/2019 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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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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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.


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.


Maternal

interview at

discharge

Opt.

2

Pacifier use rate Num: No. of infants who received pacifiers at any time prior to discharge.


Maternal

interviews at

discharge


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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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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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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

community diagnosis health indicators.ppt

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