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COMMUNITY DIAGNOSIS

&
HEALTH INDICATORS
BY
Prof.. MAGED SAYED KHATTAB
MRCGP(UK),MHPE(USA),MD(SCU)

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 inferences
from them.
When this is applied to a community, it is known
as community diagnosis. The community
diagnosis may be defined as the pattern of disease
in a community described in terms of the
important factors which influence this pattern.

Community diagnosis is based on


collection and interpretation of
relevant data such as :

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 ate
and death rate
(c)The incidence and the prevalence of the
important diseases of the area

In addition, a doctor must be able to find information on a


wide variety of social and economic factors that may assist
him in making a community diagnosis.
The focus of community diagnosis process is the
identification of the basic health needs and health problems
of the community.
The needs as felt by the community (some of which may have
no connection at all with health) should be next
investigated and listed according to priority for community
treatment.

*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, and
the growth of preschool and school
children.
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*Community Diagnosis (contd.)


5. Society, culture and socioeconomic
stratification.
6. The patterns of leadership and
communication 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 the
population in respect to health related
activities.
10. The detailed epidemiology of any endemic
conditions.
11. The services and resources available for
development especially non medical ones such
as 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 difficulties
likely 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 year at least five times
2nd year at least twice
3rd year at 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 3rd percentile
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Socioeconomic indicators

Illiteracy
Unemployment rate
Poverity

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Some important indicators of community


diagnosis
1. Crude birth rate is expressed as
Number of live births reported during a given time
interval x 1000/ estimated midinterval population
The crude birth rate is expressed per 1000 population

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2. Crude death rate is expressed as


Total number of deaths reported during a given
interval 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 annual
growth rate, exclusive of migration. This is
expressed 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 mortality rate is expressed as


Number of deaths among infants under one year of
age 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 rate is expressed as
Number of new cases of a specific disease during
a given time interval
Estimated midinterval population at risk
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7. Prevalence rate is expressed as


Number of current cases (old & new) of a specific
disease during a specified time period
Estimated midinterval population at risk

8. Maternal mortality rate 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 risk


should be the number of pregnant
women, this is an impossible figure to
determine. The number of live births
is 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 : 5,981.0
Developed countries: 1,181.0
Developing countries: 4,800.0
Egypt : 66.9
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Infant Mortality Rate


Developed countries : 6
Developing countries : 65
Egypt : 54
Under-5 Mortality Rate
Developed countries : 7
Developing countries : 96
Egypt : 73
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Maternal Mortality Ratio


Developed countries : 27
Developing countries : 480
Egypt : 170
Population Growth rate
Developed countries : 0.1
Developing countries : 1.7
Egypt : 2.0
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Total fertility rate


Developed countries : 1.5
Developing countries : 3.2
Egypt : 3.3.
Gross Domestic Product per Capita (US$)
Developed countries : 19.283
Developing countries : 908
Egypt : 1,015
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Community Treatment
Community treatment or community health action is the
sum of steps decided upon to meet the health needs of
the community taking into account the resources
available and the wishes of the people, as revealed by
community diagnosis.
Improvement of water supplies, immunization, health
education, control of specific diseases, health
legislation are examples of community health action or
interventions. Action may be taken at three levels: at
the level of the individual, at the level of the family and
at the level of the community.
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A program of community action must have the


following characteristics:
(a) It must effectively utilize all the available
resources
(b) It must coordinate the efforts of all other
agencies in the community, now termed as
intersectoral coordination,
(c) It must encourage the full participation of the
community in the program
These are the principles on which primary health
care, as defined in the Alma-Ata declaration, is
based.
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Sources of information about community diagnosis


1- Census
This is an important source of health information. It
is taken in most countries of the world at regular
intervals, usually of 10 years. It contains a mine of
information on subjects not only demographic, but
also social and economic characteristics of the
people, the condition under which they live, how they
work, their income and other basic information. This
provides 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 events
registration 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 diseases


was the first health information sub-system to
be established. The primary purpose of
notification is to effect prevention and/or
control of the disease. Notification is also a
valuable source of morbidity data i.e. the
incidence and distribution of certain specific
diseases.
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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 be
helpful 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 routinely
collected statistics or information about community
diagnosis.
The term health survey is used for surveys relating
to 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)

b)

c)

Survey for evaluating the health status of a population,


that is community diagnosis of problems of health and
disease. It is information about the distribution of these
problems over time and space that provides the
fundamental basis for planning and developing needed
services.
Survey for investigation of factors affecting health and
disease. These surveys are helpful for studying the natural
history of diseases, and for obtaining more information
about disease aetiology and risk factors.
Surveys relating to administration of health services,
e.g. use of health services, expenditure, evaluation of
medical 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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From the point of view of the method employed for


data collection, health surveys can be broadly
classified into 4 types :

a) Health interview (face-to-face) survey.


Such as measuring Knowledge, Attitude and
Behaviour (KAB).
b) Health examination survey.
c) Health records survey.
d) Mailed questionnaire survey.

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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

Maternal
interviews at
discharge

Denom: No. of infants discharged

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.

Maternal
interviews at
discharge

Denom: No. of mothers discharged

Bottle-fed rate

Num: No. of infants who received any food or drink from a bottle in 24
hours prior to discharge.

Maternal
interviews at
discharge

Denom: No. of infants discharged

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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.

Maternal
interviews at
discharge

Denom: No. of mothers discharged

5.

Breastfed rate

Num: No. of infants breastfeeding in 24 hours prior to discharge.


Denom: No. of infants discharged.

6.

Timely firstsuckling rate

Num : No. of infants who first suckled within 1 hour of birth


Denom: No. .of infants discharged.

Opt.
1

Opt.
2

Exclusively
breast milk fed
rate

Num: No. of infants exclusively breast milk fed from birth to discharge.

Pacifier use rate

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

Denom: No. of infants discharged

Denom: No. of infants discharged

Maternal
interviews at
discharge.

Maternal
interviews at
discharge.

Maternal
interview at
discharge

Maternal
interviews at
discharge

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Title

Definition

Source

Postnatal/outpatient

1.

2.

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.

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.

Maternal
interviews at
exit

Denom: No. of mothers of breastfed infants less than 4 months old attending
the clinic

Maternal
interviews at
exit

Denom; No. of mothers of breastfed infants less than 4 months old attending
the clinic.

Breastfeeding
discouragement
rate

Num: No. of mothers of breastfed infants 4 to 24 months old who were


advised to stop or decrease breastfeeding.

Maternal
interviews at
exit

Denom: No. of mothers of breastfed infants 4 to 24 months old attending the


clinic

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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.

Maternal
interviews at
discharge

Denom: No. of mothers of breastfed children less than 2 years old who were
breastfed at the time of admission

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.

Maternal
interviews at
discharge

Denom: No. of mother of breastfed children less than 2 years old who were
breastfed at the time of admission

Bottle-feeding
initiation rate

Num: No. of children less than 2 years old not using a bottle on admission
who received anything (including ORS) in a bottle during their stay in the
facility

Maternal
interviews at
discharge

Denom: No. of children less than 2 years old not using a bottle on admission

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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.

Maternal
interviews at
exit

Denom: No. of breastfeeding mothers of infants less than 6 weeks old


attending clinic.

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.

Any hormonal
contraceptive

Num: No. of breastfeeding mothers of infants less than 6 weeks old given or
prescribed any hormonal contraceptive during clinic visit.

Maternal
interviews at
exit

Denom: No. of breastfeeding mothers of infants less than 6 months old


attending clinic.

Maternal
interviews at
exit

Denom: No. of breastfeeding mothers of infants less than 6 weeks old


attending clinic.

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Thank you

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