Community Health Diagnosis programm (CDP)


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Community Health Diagnosis programm (CDP)

  1. 1. COMMUNITY DIAGNOSIS PROGRAMME Kishor Adhikari, National Medical College andTeaching Hospital, Birgunj, Nepal
  2. 2.  What is CDP?  Why is CDP needed for Medical students?  Purposes of CDP?  Community diagnosisVs Clinical diagnosis  Methods of CDP? Presentation Outline:
  3. 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. 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. 5. Contd.  The application of techniques of diagnosis of an individual to the community is known as community diagnosis.
  6. 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. 7. Comparing individual diagnosis with community diagnosis clinical diagnosis 1. Obtain a history of the patients’ symptoms. 2. Examine the patient and observe sign. 3. Perform laboratory test , x-ray and others. 4. To infer causation from the history and test result to make the diagnosis. 5. Provide treatment. 6. Follow-up and assess effectiveness of the treatment. Community diagnosis 1. Obtain health awareness of the community by informal meeting and discussions. 2. Obtain measurable facts of causes through basic demographic survey. (indicator) 3. Conduct specific survey based on finding of basic demographic survey. 4. Make inference from the data (indicator) to make the community diagnosis. 5. Prescribe community treatment or community health action as part of community health programme. 6. Evaluate (follow-up) the effect of community (Similarities)
  8. 8. Comparing individual diagnosis with community diagnosis Individual (clinical) diagnosis 1. Patient aware of the problem. 2. Patient take initiative for problem solving. 3. Pathological condition affects patient alone. 4. It may or may not be related to Community diagnosis 1. Community may or may not be aware of the problem. 2. Community rarely takes initiative. 3. Can not be treated as isolated occurrences. 4. Each condition is linked to the inter-related factors in the environment. Differences:
  9. 9. Purposes of Community Diagnosis 1. It helps to identify community needs and problems. 2. It is pre-requisite for planning, implementing and evaluation of health and development programme. 3. It helps to match project organization and services with community needs. 4. It can be used to help the community become conscious of its existing problems and find solution.
  10. 10. Methodology of CDP Systematic activities of CDP (Chronology) 1. Determination of objectives 1. General 2. Specific 2. Selection of community Criteria: a. Convenient accessibility b. Diversity of population based on socio-economic, cultural and religious behavior. c. Administrative and operational feasibility.
  11. 11. 3. Review of literature a. Lecture notes and field reports of seniors. b. Library books and literatures. c. Internet surfing
  12. 12. 4. Planning (what, where, how, when) a. Casual visit to the community (spot map, informal discussion with community members) b. Preliminary data from the respective community (secondary) c. Tentative household survey schedule preparation and pre- testing. d. Making plan of action (emphasis on dates/places/activities/group division/group coordinator etc.)
  13. 13. 4. Data collection a. Primary data (through household survey) b. Secondary data (through records of different organizations) c. Tools for data collection d. Techniques for data collection e. Data editing f. Data analysis and interpretation
  14. 14.  Community presentation to local leaders.  Community presentation to general population. 5. Community presentation
  15. 15. 6. School Health Programme
  16. 16.  Felt need  Observed need  Real need  Need prioritization 7. Micro Health Project
  17. 17. 8. Seminar presentation
  18. 18. 9. Report writing
  19. 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. 20. Purposes of Nutritional assessment 1. Identify individuals or population groups who are malnourished or at risk of becoming malnourished. 2. To develop health care programs that meet the community needs which are defined by the assessment. 3. To measure the effectiveness of the nutritional programs & intervention once initiated
  21. 21. Methods of Nutritional Assessment 1. Direct: deal with individual 2. Indirect: use community health indices.
  22. 22. Direct Methods of Nutritional Assessment These are summarized as ABCD  Anthropometric methods  Biochemical, laboratory methods  Clinical methods  Dietary evaluation methods
  23. 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. 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. 25. Contd.  Kwashiorkor  Marasmus
  26. 26. 2. Assessment of Dietary intake A. Qualitative aspect of food. B. Quantitative aspect of food. C. Social aspect of food
  27. 27. A. Qualitative aspect of food 1. Vegetarian and non-vegetarian food 2. Use of cooking oil: refined or non refined 3. Type of salt used: iodized or non-iodized. 4. Habit of Balanced diet 5. Knowledge about balanced diet
  28. 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. 29. C. Social aspect of nutrition  Knowledge and importance of nutrition.  Food cooking habit.  Storage and distribution of food.  Washing of vegetable.  Cutting of vegetable.
  30. 30. 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,
  31. 31. 3. Anthropometric measurement Among all children below 5 years: 1. Mid upper arm circumference (MUAC) 6+ months 2. Weight 3. Height 4. Weight for age (GOMEZ classification) 5. Water low's classification 6. Chest and head circumference BMI Hip/waist ratio for adult population
  32. 32. 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% = 1st degree malnutrition Between 60 and 74% = 2nd degree malnutrition Under 60% = 3rd degree malnutrition
  33. 33. 784
  34. 34. 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
  35. 35. 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
  36. 36. 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
  37. 37. Contd.  Immunization status of U5 children (not at all, partially immunized, completely immunized)  KAP on delivery kit.
  38. 38. Regarding Children  Birth weight of baby  Percentage of babies suffering from different diseases:  Diarrhoea:  ARI  Measles  Malnutrition  Others
  39. 39. Family planning points should be included on: 1. Number of eligible couple 2. Use of family planning methods 3. Types of contraceptive methods used 4. Sexwise distribution of family planning users 5. Birth spacing 6. Preference of sex of child (male or female) 7. KAP on contraceptive
  40. 40. Contd. 6. Maternal and child health  Number of reproductive aged women  Number of pregnant women  Care during pregnancy 7. Family Planning  Use of contraception  Number of eligible couple  Number of currently married people  Unmet need of family planning
  41. 41. Family planning methods Natural Methods Artificial methods • Abstinence • Coitus interrupts • Safe period (Rhythm Method) • Cervical Mucous Method • Basal Body Temperature • Sympto-thermia Method • Locational Amenorrhea Method (LAM) Temporary Permanent Male Female Male Female Condom Vasectomy •Minilap •Laparoscopy Female condom Diaphragm Foam tab Oral Pills Depot medroxy CupperT Nor-plant Vaginal rings