COMMUNITY HEALTH CLINICAL MEDICINE LEVEL 1.pptx

It's a clinical Medicine topic

1. COMMUNITY HEALTH Written by Michael Mutisya Msc pUBLIC HEALTH , Bsc ph- JKUAT,CLI-MED &Surg (Kmtc –Nrb)

2. Introduction to community health Due to interrelationships of this topic, lesson 1and 2 are going to to be combined. What to learn in this lesson: Defination of terms on community health Types of communities Preventive Curative Promotive Rehabilitative health

3. Introduction to community health DEFINATION OF TERMS IN COMMUNITY HEALTH Health: is a state of complete physical,mental and social well being and not merely the absence of disease or infirmity. Environment: All that is external to individual . It is divided into physical, biological and social cultural Environmental health: …… comprises of all those aspects of human health including quality of life, that are determined by physical,biological social factors in the environment . Public health: is the science and art of preventing diseases ,prolonging life and promoting mental and physical health and efficiency through organized community efforts for the sanitation

4. COMMUNITY HEALTH Is apart of health care that is concerned with the health of the whole population and prevention of diseases through community participation.It involves: Establishing the health status of the community Planning for community services Managing and utilizing health facilities Community health care focus is in the population and how specific social determinants of health and disease influence well being. Community health emphasizes how well the community can be mobilized and and empowered to improve on the conditions within their homes, behavior, social cultural interaction , effective use of resources so as to achieve the best possible level of well being.

5. Definition of terms … .cont The term community health also refers to : Population medicine Social medicine Community medicine Preventive medicine Research has shown that prevention of diseases, health promotion and effective rehabilitation has far reaching positive effects in health and social economic activities.

6. Community Is a group of people (a large or small group) living in certain geographical area working together for a common goal. It shares the same resources water,climate, and geographical conditions health services administration and leadership . They also share the same disadvantages such as shortages, risks, and dangers. Community is made up of the following: Individual Family Community

7. Individuals Each individual you is different and unique. Each has got a mixture of characteristics of which some they share with others and some of which are part of a particular culture. Culture is all those things which people learn, share and pass on later to generation One of essential things is language for it is the means by which people communicate with one another. Thus as a health worker, you must be able to communicate with indivinduals in the community where you work and acquire some knowledge of the language they speak. It is also important to be able to show respect and understanding for other people and their culture as well as knowing their local practices like greetings. In some communities, they may follow their traditional believes, others may be both sided consulting modern medicine at the dispensary and traditional and faith healers so that they can get rid of what is the real cause of the disease. For that reason, as a health worker, you ought to understand the human behavior and the factors that influence their behavior.

8. Types of communities

9. Family Is a group of two or more persons, who share emotional bonds and materials things, usually live in the same house hold, are related by blood, marriage or adoption and sexual relationship is socially approved by the parents. The family is very important social group in community health. It provides love, security, and a sense of belonging for Indivinduals from the time they are born. Many of the people characteristics are influenced by the family. A child learns from the family what behavior is acceptable in the community and the language its parents speak. Families have a strong influence on what each other member does. Often, there is an important figure in the family who makes the decisions or whose opinions are highly valued. Thus the opinion of the people in he family may be more important to a person than the opinion of the health worker This ultimately has got an important effects on health behavior and the use of health services.

10. Types of families There are different types of families in a community. Look at each in turn. 1.The Nuclear Family This consists of a husband and a wife with or without children. This type of family brings forth children (family of procreation). Children born in this family consider it to be the family of their origin. 2. The Extended Family This is also called a joint extended family. This family includes members of nuclear families and other relatives, aunts, uncles, cousins, nephews and grandparents. 3. Single Parent Family This is formed when one parent brings up children alone either because of divorce, separation, death or desertion of their spouse. 4.The Blended Family This type of family is formed when husband and wife bring into the new marriage unrelated children from their previous marriages.

11. Functions of a family The family has many important functions, these include: Bringing about a sense of togetherness and a balance between individual and shared (mutual) action by each family member; nurturance and trust; stability and integrity of the group; interdependence and the ability to meet demands for survival and development Socializing its members into the larger community Teaching respect for individual members and their property. This includes respect for differences among the family members and others Teaching tolerance, fairness and a sense of right or wrong among its members and others Caring for its members and developing a sense of trust between and among its members Providing an environment for learning and internalising individual and gender roles and responsibilities

12. Factors affecting family health The health of a family can be influenced by both internal and external factors: Internal factors: Family size Structure Type of members Relationships Biological characteristics and values External factors are: Family locality Climate and terrain Water supply and air Biological environment : insects, rodents, Housing

13. Functions of community health Having seen the different components that make up a community, now look at the functions of the community. The functions of a community include: Transmitting and sharing information, ideas and beliefs. Educating its children about their culture ( socialising ) and welcoming newcomers into the group’s culture ( acculturation) Producing and distributing services and goods Providing companionship and support to individual members and smaller groups Sharing and utilising space for living, schools, health facilities, fields, roads etc. Protecting individual and group rights and welfare

14. Characteristics of a good community Safe healthy environment relatively free from natural and man-made hazards Community members value hygiene Clean water Nutritious food Available and utilization of health facilities Available and accessibility of suitable educational,social and recreational facilities Gainful occupation There is sound communication structure Communal and participatory approach when tackling community problem

15. Problems affecting the health of a community Unsanitary environment Overcrowding Poverty Unclean and inadequate water supply Lack of nutritious food Unsafe environment Epidemic and endemic disease Unstable family life IX. Illiteracy and ignorance X. Poor leadership and lack of participation XI. Adverse weather conditions XII. Poor infrastructure XIII. Political instability

16. Levels of community activity The people can provide health workers with resources (Money, men, material), logistics, and shaping the plan [ SUPPORT] They can Utopias and and join the health service [ PARTICIPATION] They can be more than mere consumers , i.e. They can take part in planning and evaluation of service [ INVOLVEMENT]

17. Aims of community health Community health aims to achieve the following Improved sanitation in the environment Prioritisation of the community’s needs Control of communicable diseases Health education to promote healthy behaviour and practices Early diagnosis and prevention of disease Disease surveillance Case/contact tracing and treatment Empowerment of all individuals to realize their rights and responsibilities for the attainment of good health for all.

18. Goals of community health The main goals of community health are to : Identify community health problems and needs Plan ways of meeting community health needs Implement activities geared towards meeting the community health needs Evaluate the impact of community health services/activities

19. Benefits of community health A successful community health programme is one in which the community and health care providers collaborate to achieve the following benefits: Increased life expectancy (life span) of every individual Decreased mortality rates particularly of mothers and children Decreased morbidity rates from all causes An increase in the total well being (physical, mental and social) of every individual An increase in the quality of life for all people Overall social and economic development of the population Equitable distribution of resources Having looked at the aims, goals, and benefits of community health, you will now explore the activities which you are expected to undertake in community health, also referred to as the scope of community health.

20. Community health activities Community health assessment and diagnosis Information, education and communication Environmental sanitation and supply of adequate clean wholesome water Food hygiene and household food security Personal hygiene Vector and pest control Control of communicable diseases Provision of prenatal services to pregnant women Provision of family planning services Provision of child health/welfare services for children under five years old

21. Community health activities [cont] Provision of school health services Home visiting and home-based nursing care Occupational/industrial health Care of the disabled, the elderly, the disadvantaged , the chronically ill Inter-sectoral collaboration Health education, counseling , and the training of other health workers

22. Principles of community health Before you explore the principles of community health, first look at the definition of the word ‘principle’. A principle can be defined as: A basic belief, theory, or rule that has a major influence on the way in which something is done. Principles are the basic ideas of conduct or rules of action. Principles of Community Health (Alma Ata Declaration - WHO 1978) Availability of health care for all people and at a cost they can afford Promotive and preventive aspects of health care Integration of curative and preventive services Active participation of individuals and communities in the planning and provision of care Development of maximum potential for self-care Utilisation of all levels and types of community manpower Inter-sectoral approach

23. Lesson 2

24. Epidemiological triad The triad describes the relationship between various factors that cause disease and how they interact to determine disease occurrence. The factors, namely agent and host , interact in the environment to cause disease in humans. The natural progression of a disease is influenced by the following factors: The causative agent(s) The susceptible host The environment The vector(s) in some diseases

25. Epidemiological triad

26. Epidemiological triad [1] 1.The agent is the harmful etiological factor that causes health problems. The etiological factor (agent) may cause disease either by its presence or by its absence. The causative agent may be a substance, living or non-living, excessively present or lacking, tangible or non-tangible. 2. Physical Agents These include mechanical forces such as friction, extreme heat, cold, humidity, pressure, sound, radiation, electricity, etc. 3. Biological Agents Living organisms, such as bacteria, fungi, chlamydia, rickettsiae, protozoa, viruses, mycoplasma, helminths. 4. Chemical Agents Endogenous chemical agents are those which are made by the body as a result of abnormal metabolism, for example urea (uremia), serum bilirubin (jaundice), ketones (ketosis, keto- acidosis), uric acid (gout), calcium carbonate(renal stones), etc .

27. Epidemiological triad [2] Exogenous chemical agents : arise from outside the body, for example allergens, meals, fumes, gases, insecticides, etc. Exogenous chemical agents may enter into the body tissues through inhalation, ingestion or inoculation. Genetic Agents :Transmitted from parent to child through genes. Nutrient Agents :Excessive or deficient intake of nutrients. This results in malnutrition related diseases such as the most common Protein Energy Malnutrition (PEM), for example kwashiorkor and marusmus . Other examples include iron deficiency anaemia

28. Epidemiological triad [3] Excessive or Relative Lack Endocrine disorders, for example diabetes mellitus (lack of insulin), thyrotoxicosis (excess thyroid hormone). Immunodeficiency (HIV infection, some drugs). The human or animal that comes into contact with and is affected by the agent is the host. Some factors within the host determine its interaction with the agent. Age: Some diseases are more common in certain age groups: Childhood : measles, whooping cough, chickenpox. Adulthood: diabetes mellitus, cardiovascular diseases. Old age: pneumonia, cancers and arteriosclerosis.

29. Epidemiological triad[4] Lifestyle : Lifestyle choices such as: dietary habits, smoking, alcohol consumption, substance abuse, casual sexual intercourse. Nutrition : Nutritional status is a major factor where food is either of inadequate quantity, quality or both. Tradition : Tradition (culture, custom): food beliefs, child- rearing practices, rituals (for example female genital mutilation ).

30. Epidemiological triad[5] Mobility: International and local travel, which may expose an individual to new diseases. Immune Status : Lack of previous exposure to a disease, lack of vaccination, or poor natural immunity (immune deficiency). All these are referred to as intrinsic factors.

31. Epidemiological triad [7] Biological: This includes all the living things in and around where humans live. The living things include animals, plants and micro-organisms. Social and Economic: This is the human society in which every human being lives. Men and women live among others in groups in which there are shared values, customs, habits, beliefs, attitude and culture. Conflicts among human beings lead to tension which may cause mental and behavioural disorders. Examples of social economic factors include; Housing, water, lighting, sanitation, area of residence, food, education, occupation, working environment and health care among others.

32. LESSON 3

33. Prevention Is the art and science of health promotion, diseases prevention , disability

34. Levels of prevention Diseases evolve over time and the pathological changes become less reversible as the disease process continues. There are three stages in the development of a disease, namely, healthy, sub- clinical or pre-symptomatic, and clinical. It is obvious that the best sort of prevention is that applied before the person becomes ill. A three-level model for intervention, based on the stages of the disease, was developed by Level and Clark (1965). The three levels of the model are: Primary prevention of disease Secondary prevention of disease Tertiary prevention of disease

35. 1. Primary prevention This is the actual prevention of a disease. Primary prevention is carried out before the disease or dysfunction has occurred in the body. It is directed at decreasing the risks of acquiring the disease. Primary prevention methods applied to people and the environment include: health education; environmental sanitation ; supply of clean safe water ; adequate nutrition ; rest; sleep; recreation; personal hygiene; good working conditions; good housing; regular medical checkups; screening for disease; genetic screening and counseling; immunization against specific disease; avoidance of home, traffic, and industrial accidents. Remember: Prevention is better than cure.

36. 2. Secondary prevention Secondary prevention aims at diagnosing a disease early and treating it even before the symptoms have appeared. This is the second stage of disease which is called sub-clinical or pre-symptomatic. The main goal is to cure the disease completely in its early stages or slow down its progression, in order to prevent the development of complication and disability. This kind of prevention often requires screening, to find the people who have the illness but don't know they have it .

37. What happens in secondary prevention Activities of Secondary Prevention Screening tests to detect early the pre- symptomatic physiological and anatomical indicators of disease, for example pap smear, random blood sugar test ,. Case finding and case-tracing . Screening surveys and examinations . Mass treatment and campaigns. Adequate treatment of disease . Follow-up of treated patients at special clinics and at their homes. Remember : Secondary prevention detects disease early by screening and starts treatment promptly

38. 3. Tertiary prevention This means diagnosing and treating people who are already sick with a disease, in order to reduce suffering, cure the disease, and prevent disability . Hence, aim is to: reduce or limit impairment and disability, minimize suffering caused by existing disease, promote the patients adjustment to irremediable condition If a permanent disability such as blindness or paralysis remains, then special rehabilitation services may be necessary. Most of the curative work that goes on in the outpatient and inpatient departments occurs at this stage of disease.

39. Curative In this stage, a susceptible person develops clinical illness. The disease causing organism make the individual to start feeling unwell. Thus, he goes to seek medical consultation. The susceptible host may be given medication like analgesics, antibiotics or chemotherapy and after taking them, he gets cured. So, the aim of curative is to cure a disease. Additionally, the person may be done laboratory and radiology investigations and be treated according to the outcome of the results and subsequently get cured and his health be restored back to normal. That's curative

40. Promotive [1] Health Promotion is the process of helping people to adopt healthier patterns of behaviour. Terminology: the term Health Education i s still used, but some people feel it implies only one part of this process – the giving of information and motivation. The term Health Promotion, which has come from the AIDS field, is commonly fashionable. Information, Education and Communication (IEC) is used in the Family Planning field. The newest name is BCC – Behavioural Change and Communication. Classic Health Education describes the kind of short talks to groups of mothers which are given so often in PHC, about nutrition or preventing diarrhoea or whatever. Often these talks are, top-down and one-way – examples of the "empty bottles" approach that sees people as empty bottles, which only need to be filled up with scientific knowledge for them to change behaviour .

41. Promotive [2 ] Now, workers focus on Behaviour Change; this can only happen if and when the individual gets the right skills. Take for example a young girl at risk of sexual exploitation and HIV infection. Good health BCC might help her to learn how to say “No”, might point her to other ways to earn a living and support her six orphan brothers and sisters. This is done after the girl and the Educator analysis why she might make certain choices rather than others. So the approach is to provide some new information and motivation for change; it might start by considering sessions on FP or Malaria in an MCH Clinic and conclude that: • The information is directed at mothers, but cannot help If husbands or mothers-in-law make decisions; These people must be offered an information session as well, and at a good time. • Health education may be used where community mobilisation is a better way to go – if malaria is the problem, a community can reduce infection with weed-clearing and smoke. Means and materials are also important – for malaria control, they need medicines, mosquito nets and the money to buy them. Perhaps a cash crop?

42. Health promotion includes the following Health education Environmental modification (reducing air pollution, safe water , sanitary latrines, control of insects, and improving housings Engineering lifestyle ( anti smoking campaign, condom promotion,etc Genetic and marriage counseling so as to prevent congenital diseases Increasing the standard of living ( the income, education, and occupational status) Health legislation I.e. forming rigid standards of health care

43. Specific protection This are measures which target particular disease: Immunization Nutrient supplementation (vitamin A , iodine) Protection against occupational hazard ( masks, PPE) Avoiding allergens Quality control of consumer products

44. Disability limitation

45. Rehabilitative Rehabilitation is to restore to a condition of good health, ability to work. It assists a person in recovering from a deteriorating condition. The people to be rehabilitated are: Drug and substance abuse addicts Persons with disabilities like amputation, Persons with mental and psychiatric disorders Persons with chronic disease conditions like leprosy

46. Reasons for rehabilitation Prevention for loss of function Slowing the rate of loss of functions Improvement or restoration of function Compensation for lost functions Maintenance of current function

47. Types of handicaps Physical :- poliomyelitis Mental:- autism Social:- orphans REHABILITATION: There is combined use of: Medical, social,educational and vocational measures For training and retraining the disabled person To the highest level of rehabilitation

48. FOUR DIMENSIONS OF REHABILITATION Medical : if possible restoration of function (physiotherapy/gadgets etc) Vocational:- restoration of the capacity to earn a livelihood (training and creating jobs) Social: re- introduction into family and society as a whole involving everyone to maintain the same relationship with this person Psychic: restoration of self confidence and self esteem.