Community Health Diagnosis programm (CDP)

The lecturer slide was prepared for Medical/Nursing/Public health students

1. Community Diagnosis Programme Kishor Adhikari , National Medical College and Teaching Hospital, Birgunj, Nepal

2. What is CDP? Why is CDP needed for Medical students? Purposes of CDP? Community diagnosis Vs Clinical diagnosis Methods of CDP? Presentation Outline:

3. Community Diagnosis “ Community diagnosis is a comprehensive assessment of health status of the community in relation to it’s social, physical and biological environment.” - Dr. Cynthia Hale et al

4. Community Diagnosis Community diagnosis generally refers to the identification and quantification of health problems in a community as a whole in terms of mortality and morbidity rates and ratios, and identification of their correlates for the purpose of defining those at risk or those in need of health care.

5. Contd. The application of techniques of diagnosis of an individual to the community is known as community diagnosis.

6. Contd. The community diagnosis is based on collection and interpretation of the relevant data: The focus should be the identification of the basic health needs and health problems of the community. (felt need, observed need and real need)

7. Comparing individual diagnosis with community diagnosis clinical diagnosis Obtain a history of the patients’ symptoms . Examine the patient and observe sign. Perform laboratory test , x-ray and others. To infer causation from the history and test result to make the diagnosis. Provide treatment. Follow-up and assess effectiveness of the treatment. Community diagnosis Obtain health awareness of the community by informal meeting and discussions. Obtain measurable facts of causes through basic demographic survey. (indicator) Conduct specific survey based on finding of basic demographic survey. Make inference from the data (indicator) to make the community diagnosis. Prescribe community treatment or community health action as part of community health programme . Evaluate (follow-up) the effect of community health action (Similarities)

8. Comparing individual diagnosis with community diagnosis Individual (clinical) diagnosis Patient aware of the problem. Patient take initiative for problem solving. Pathological condition affects patient alone. It may or may not be related to environment. Community diagnosis Community may or may not be aware of the problem. Community rarely takes initiative. Can not be treated as isolated occurrences. Each condition is linked to the inter-related factors in the environment. Differences:

9. Purposes of Community Diagnosis It helps to identify community needs and problems. It is pre-requisite for planning, implementing and evaluation of health and development programme. It helps to match project organization and services with community needs. It can be used to help the community become conscious of its existing problems and find solution.

10. Methodology of CDP Systematic activities of CDP (Chronology) Determination of objectives General Specific Selection of community C riteria: Convenient accessibility Diversity of population based on socio-economic, cultural and religious behavior. Administrative and operational feasibility.

11. 3. Review of literature Lecture notes and field reports of seniors. Library books and literatures. Internet surfing

12. 4. Planning (what, where, how, when) Casual visit to the community ( spot map , informal discussion with community members) Preliminary data from the respective community (secondary) Tentative household survey schedule preparation and pre-testing. Making plan of action (emphasis on dates/places/activities/group division/group coordinator etc.)

13. 4. Data collection Primary data (through household survey ) Secondary data (through records of different organizations) Tools for data collection Techniques for data collection Data editing Data analysis and interpretation

14. Community presentation to local leaders. Community presentation to general population. 5. Community presentation

15. 6. School Health Programme

16. Felt need Observed need Real need Need prioritization 7. Micro Health Project

17. 8. Seminar presentation

18. 9. Report writing

19. Nutritional assessment Evaluation and measurement of nutritional variables in order to assess the level of nutrition or the nutritional status of the individual or community as a whole.  

20. Purposes of Nutritional assessment Identify individuals or population groups who are malnourished or at risk of becoming malnourished. To develop health care programs that meet the community needs which are defined by the assessment. To measure the effectiveness of the nutritional programs & intervention once initiated

21. Methods of Nutritional Assessment 1. Direct: deal with individual 2. Indirect: use community health indices.

22. Direct Methods of Nutritional Assessment These are summarized as ABCD Anthropometric methods Biochemical, laboratory methods Clinical methods Dietary evaluation methods

23. Indirect Methods of Nutritional Assessment These include three categories: Ecological variables including crop production Economic factors e.g. per capita income, population density & social habits Vital health statistics particularly infant & under 5 mortality & fertility index

24. 1. Physical and Clinical examination Night blindness, Bitot’s spot, corneal xerosis ( xeropthalmia ) -A Enlargement of thyroid ( Hypothyrodism ) -IDD Pale conjuntiva , pale palms( Anaemia )- Iron Absence of knee or ankel jerk (Beriberi)- B1 Pigeon chest, deformed pelvis, curved legs. (Rickets)-D Angular stomatitis – B2 3 Ds ( pelagra ) –Niacin Swellen and bleeding gums, Scurvy - C

25. Contd. Kwashiorkor Marasmus

26. 2. Assessment of Dietary intake A. Qualitative aspect of food. B. Quantitative aspect of food. C. Social aspect of food

27. A. Qualitative aspect of food Vegetarian and non-vegetarian food Use of cooking oil: refined or non refined Type of salt used: iodized or non-iodized. Habit of Balanced diet Knowledge about balanced diet

28. B. Quantitative aspect of food intake Total calorie requirement and daily consumption of calorie in the family on the basis of: Total family members by age and sex. Physical activities. Number of vulnerable groups

29. Energy requirement Based on three elements: Energy required for basal metabolism rate (BMR). Energy required for daily activities. Energy expenditure for occupational work.

30. Energy requirement of an adult person: Activity Male Female Light 1.7XBMR 1.7XBMR Moderate 2.7XBMR 2.2XBMR heavy 3.8XBMR 2.8XBMR 1 K Cal / kg body weight/ hour is needed for Basal metabolic rate BMR)

31. C. Social aspect of nutrition Knowledge and importance of nutrition. Food cooking habit. Storage and distribution of food. Washing of vegetable. Cutting of vegetable.

32. Contd. Types of utensils used. Place of storage of food grain. Preference of food distribution in the family. Food taboo/ forbidden foods Addiction habits: tobacco, paan, gudkha, khaini, cigarette, alcohol, Ganja,

33. 3. Anthropometric measurement Among all children below 5 years: Mid upper arm circumference (MUAC) 6+ months Weight Height Weight for age (GOMEZ classification) Water low's classification Chest and head circumference BMI Hip/waist ratio for adult population

34. GOMEZ classification of PEM Wt. of the child Weight for age = X 100 Wt. of a normal child of same age Between 90 and 110% = Normal nutritional status Between 75 and 89% = 1 st degree malnutrition Between 60 and 74% = 2 nd degree malnutrition Under 60% = 3 rd degree malnutrition

35. 784 \

36. Waterlow’s classification Wight/Height (%) = Weight of the child X 1oo weight of a normal child at same height Height/Age = Height of the child X 1oo Ht. of a normal child at same age Nutritional status Stunting (Ht/Ag%) Wasting (wt/Ht%) Normal >95 >90 Mildly impaired 87.5 - 95 80 – 90 Moderately impaired 80 – 87.5 70 – 80 Severely impaired <80 <70

37. Head and chest circumference Time of measurement Head circumference Chest circumference At birth 34 cm 32 cm By 6-9 months Equal Equal After 9 months Less than chest More than head

38. Mid upper arm circumference (MUAC) MUAC is the circumference of the left upper arm, measured at the mid-point between the tip of the shoulder and the tip of the elbow (olecranon process and the acromium). <12.5 cm = sever malnutrition 12.5-13.5 cm = mild-moderate malnutrition >12.5 cm = satisfactory nutritional status

39. Maternal and child health (MCH) points should be covered: Regarding mother: Age at marriage Age at first pregnancy ANC visits (Never, one time, 4 times) TT vaccine Place of delivery Birth attendant Type of delivery at institution Post natal care Colostrum feeding

40. Contd. Immunization status of U5 children (not at all, partially immunized, completely immunized) KAP on delivery kit.

41. Regarding Children Birth weight of baby Percentage of babies suffering from different diseases: Diarrhoea: ARI Measles Malnutrition Others

42. Family planning points should be included on: Number of eligible couple Use of family planning methods Types of contraceptive methods used Sexwise distribution of family planning users Birth spacing Preference of sex of child (male or female) KAP on contraceptive