It is the presentation about community health problems diagnosis.

1. COMMUNITY DIAGNOSIS
1

2.  Community derived from the Latin word
“communis” “things held in common”, or
suggests a shared pattern of feelings,
behaviour, and lifestyle together with close
and frequent personal relationships with
others.
 Community is a social group determined
geographical boundaries and/ or common
values and interests.
 The knowledge, values, beliefs, and
behaviours of given groups have a major
implication for well-being, morbidity, and
mortality. 2

3.  Diagnosis comes from the Greek word
“diagignoskein” means to distinguish.
 That means “dia” meaning through,
apart and from “gignoskein” meaning
to know.
 Diagnosis is defined as the process of
determining the nature and
circumstances of a diseased condition
by examination.
3

4.  Community diagnosis may be defined as
“determining the pattern of health problems in
a community, including factors which influence
those pattern.”
 The diagnosis of disease in an individual
patient is a fundamental idea in medicine,
based on signs and symptoms and making
inference from them. When this is applied to a
community it is known as “community
diagnosis”.
 Identification and qualification of health
problems in a community as a whole in terms
of mortality and morbidity rates and ratios,
and identification of their correlates to define
those at risk or those in need of health care.
4

5.  Community diagnosis is defined as “a
quantitative and qualitative description of the
health of citizens and the factors which
influence their health. It identifies problems,
proposes areas for improvement and
stimulates action.”
 Community diagnosis process: a means of
examining aggregate and social statistics in
addition to the knowledge of the local
situation, to determine the health needs of
the community.
 Community diagnosis process is the
application of techniques of diagnosis of an
individual to the community. 5

6. AIMS AND OBJECTIVES OF
COMMUNITY DIAGNOSIS
 To define existing problems
 To determine available resources
 Set priorities for planning, implementation and evaluating
health action by and for the community.
 To describe the health, demographic and socio-economic
status of the community
 To identify KAP regarding the common health problem
 To identify the health care seeking behaviours of community
people
 To find out the nutritional status of under 5 children
 To identify the KAP regarding MCH, FP & Immunization
 To describe the personal hygiene and environmental
sanitation status of the community
 To identify the hidden health problem of the community and
explore the available local resources
 To identify the real needs, to prioritize them and to plan,
implement and evaluate it
6

7. Benefits of community
diagnosis
 Provide baseline information about the health status of community
residents
 To assess the health status problems in the area could be
discovered in a careful community diagnosis
 To identify the health needs of the community
 To make people aware of their real health needs
 It is also most important for sustainability
 To explore the resources in the community to address the problem
 To enhance community participation to solve a problem that
conceptualizes sustainability
 Useful and most necessary for mass benefit
 Involves in the decision making process, helps them understand
the difficult choices that need to be made, and builds support and
commitment for addressing health needs on a community wide
basis.
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8. Importance of community
diagnosis
 It provides realistic information about a
community
 It helps to discover the hidden problems of the
community
 It helps proper utilization of the available
resources
 It can be a pioneer step for betterment of rural
community health
 It provides baseline measurement for future
community health problems
 it helps to find the common problems or disease
which are troublesome to the people and are
easily preventable in the community
 It is a tool to disclose the hidden problems that
are not visible to the community people but are
being affected by them. 8

9. COMPONENTS OF COMMUNITY
DIAGNOSIS
 The components or contents of
community diagnosis are multi-
dimentional and comprehensive.
 These indicators help in identifying areas
that need policy and programmed
interventions, setting near and far term
goals, and deciding priorities, besides
understanding them in an integrated
structure.
9

10.  These components may be divided into
two parts.
a) General informative components :- it
contains educational status cultural
status, resources, geographical status,
leadership.
b) Health information components :- it
includes birth rate, death rate, fertility
rate, status of environment sanitation,
maternal-child health, family planning,
etc. 10

11. a) Demographic indicators
i) population statistics
ii) vital statistics
b) Demographic table and population pyramid
i) table
ii) population pyramid
- expansive
- constructive
- stationary
c) Statistical measurement
i) rate
ii) ration
iii) proportion
iv) central tendency
v) mean
vi) media
vii) mode
1. Demography
11

12. 2. Socio-economic and geographic
characteristics
3. Environmental health & sanitation
4. Knowledge, attitude and practice on
health and health issues
5. Maternal and child health
12

13. 6. Assessment of nutritional status
a) Anthropomentry
i) weight for age
ii) height for age
iii) weight for height
iv) low weight for height
v) mid upper arm circumference
(MUAC)
b) Clinical assessment
13

14. 7. Morbidity and disability
8. Availability of health services and
their utilization
9. Community resources (local
resources)
10. Community leaders (local leader)
a) former leader
b) informal leader
11. Culture and tradition
14

15. 1. Demography
 Demography is the scientific study of the human population.
 It deals with five “demographic processes”, namely fertility,
mortality, marriage, and social mobility.
a) Demographic indicators
i) Population statistics:- it includes indicators that measures
the population size, sex, ratio, density (concentration of
individual within a species in a specific geographical area)
and dependency ration (The dependency ratio is a
measure of the number of dependents aged zero to 14
and over the age of 65, compared with the total population
aged 15 to 64.
ii) Vital statistics:- it includes indicators such as birth rate,
death rate, death rate, natural growth rate, life expectancy
at birth, mortality and fertility rates.
15

16. b) Demographic table and population pyramid
**Demographic table
- It is related to the measurement of the human
population based on various vital statistical and
other factors.
- It can be applied to any kind of dynamic
population
- The study of statistics such as birth, death,
income or incidence, and prevalence of
disease, which illustrates the changing
structure of the human population.
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17. 17

18. ** Population pyramid
- It is the true graphical representation of a
population’s age and sex.
- The pyramid has a male on its left and a
female on its right side and a vertical line
separating the male and female.
- There are three types of population
pyramids
a) Expansive:- it is used to describe
populations that are young and growing.
They are often characterized by their
typical “pyramid” shape, which has a
broad base and narrow top.
18

19. b) Constructive :- these are used to
describe populations that are elderly and
shrinking. Constrictive pyramids can
often look like beehives and typically
have an inverted shape with the graph
tapering in at the bottom.
c) stationary:- these are used to describe
populations that are not growing. They
are charcterized by their rectangle
shape, displaying somewhat equal
percentage across age cohorts that taper19

20. 20

21. 21

22. c. Statistical measurement
i) Rate
- It is used to measure the occurrence of
some particular event (development of
the disease or the occurrence of death)
in a population during a given period.
- It is a statement of the risk of
developing a condition.
- It indicates the change in some event
that takes place in a population over
sometime. Eg:- mortality rate, morbidity
rate: incidence and prevalence rate
22

23. ii) Ratio
- It expresses a relation in size between
two random qualities.
- The numerator is not a component of the
denominator.
- The numerator and denominator may
involve an interval of time or may be
instantaneous (immediate) in time.
- Broadly, the ration is the result of dividing
one quantity by another.
- Similarly sex ratio (male : female), doctor
– population ratio, child –women ratio,
etc
23

24. iii) Proportion
- A proportion is a ration that indicates
the relation in the magnitude of a part
of the whole.
- The numerator is always included in
the denominator.
- A proportion is usually expressed as a
percentage (%).
- Eg:- the proportion of diabetics in a
population.
24

25. iv) Central tendency
- It is also known as statistical average
and it implies a value in the
distribution, around which the other
values are distributed.
- It gives a mental picture of the central
value.
- There are several kinds of averages or
central tendencies which are
commonly used.
25

26. a) Mean
- the arithmetic mean is widely used in
the statistical calculation.
- To obtain the mean, the individual
observations are first added together
and then divided by the number of
observations.
- The operation of adding together is
called “summation” and is denoted by
the sign or s.
- The individual observation is denoted
by the sign and the mean is denoted
by the sign called “X.
26

27. b) Median
- The media is an average of a different
kind which does not depend upon the
total and number of items.
- To obtain the median, the data is first
arranged in an ascending or
descending order of magnitude, and
then the value of the middle
observations is located, which is
called the median.
27

28. c) Mode
- It is the commonly occurring value in a
distribution of data. It is the most
frequent item or the most
“fashionable” value in a series of
observations.
28

29. 2. socio-economic & geographic
characteristics
a) socio-economic
- It identifies the associated factors of each
group of people which factor impact public
health.
- The population is distributed by the
following socio-economic indicators:
i. Age
ii. Sex
iii. Education
iv. Occupation
v. Religion
vi. Ethnic group
vii. Types of family
viii. Main income source 29

30. b) Geographic characteristics
- It provides information on health facility
catchment areas.
- The social map was prepared by hand made
taking the help from the leader and senior
persons.
- The following indicator includes in the social
map
i) Road
ii) Government & non-government office
iii) Health facility
iv) School
v) Cluster of houses
vi) Forest
vii) Water sources
30

31. 3. Environmental health &
Sanitation
a) Environmental Health
 According to WHO,
“environment is the aggregate
of all external influences
affecting the life and
development of an organism,
human behaviour, and society.”
 The objective of the study of
environmental health of to
know the ecological conditions
and their influence on the
health of community people.
 Environmental factors includes
i) Drinking water
ii) Excreta disposal
iii) Solid waste disposal
iv) Personal hygiene
v) Housing
vi) Distance of animal kept from
home
vii) Distance of toilet and water
sources
viii) Condition of housing,
lighting, and ventilation
ix) Overall environmental
conditions
31

32. b) Sanitation
 Sanitation refers to public health
condition related to clean drinking water
and adequate treatment and disposal of
human wastes and sewage.
 Sanitation systems aim to protect human
health by providing a clean environment
that will stop the transmission of disease
especially through the fecal-oral route
 Adequate sanitation together with good
hygiene and safe water, is fundamental
to good health and social economic
development.
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33. 4. Knowledge, attitude & practice on health and health
issues
KNOWLEDGE
(Ideas and
understanding
Knowledge means the ability to pursue and use
information, and by understanding, learning
experience, and identifying the studying technologies
 community people shared information and
information in a health field is known as health
knowledge
ATTITUDES
(Perception or
way of thinking)
 attitude indicates the result of making reactions via
some ways in some situations and observes and explains
based on the result of a reaction or combine into one
point of view.
 an attitude is a negative or positive evaluation of an
object which influences a human’s behaviour towards that
objects.
PRACTICE
(actions or
behaviours)
Practice indicate what knowledge and habit work
If people have a health problem, they prefer Dhami,
Jhakri, Pujari. It is traditional medicine so, in community
diagnosis, we should identify treatment system, health 33

34. 5. Maternal and child health
(MCH)
 Maternal & Child Health (MCH) is the health service
provided to mothers (women of their childbearing
age) and children.
 It is a proactive, preventative, and strategic approach
to promoting the good health and development of on
reserve pregnant.
 The program aims to reach all pregnant women and
new parents, with long term support for those
families who require additional services.
 The specific objectives of MCH care focus on the
reduction of maternal, perinatal, infant, and childhood
mortality and morbidity and the promotion of
reproductive health and the physical and
psychological development of the child and
adolescent within the family.
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35. OBJECTIVES of MCH
 To increase knowledge of reproductive and promote
responsible behaviour of adolescents regarding
contraception, safe sex, and prevention of sexually
transmitted infections
 To reduce morbidity and mortality rate due to unsafe
abortion
 To reduce the incidence and prevalence of cervical cancer
 To reduce the incidence and prevalence of STD
 To reduce the transmission of HIV infection
 To reduce female genital mutilation and provide
appropriate care for females who have already undergone
genital mutilation
 To reduce maternal mortality and morbidity due to
pregnancy and childbirth
 To reduce perinatal and neonatal morbidity and mortality
 To promote reproduction health awareness for young
children
 To reduce the levels of unwanted pregnancies in all
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36. 6. Assessment of nutritional
status
 Nutrition is the science of food and its relationship with
health which plays an important role for body growth,
development and maintenance.
 Good nutrition means “maintaining a nutritional status
that enables us to grow well and enjoy good habit”
which includes food factors like protein, vitamins,
minerals, carbohydrates.
 Poor nutrition can lead to reduced immunity, increased
susceptibility to disease, impaired physical and mental
development and reduced productivity.
 The main objective of a “comprehensive” nutritional
survey are to obtain precise information on the
prevalence and geographic distribution of nutritional
problems of a given community and identification of
individuals or problem groups “at risk” or in greatest
36

37. a) Anthropometry
- Anthropos, “man” and Metron
“measurement”.
- It is a branch of anthropometry that involves
the quantitative measurement of the human
body.
- Anthropometry measurement is widely used
to assess the nutritional status of children,
because it is simple, used routinely and less
expensive and results can be quantified.
- Following methods are used to measure
nutritional status
 Weight for age
 Height for age
 Weight for height
37

38.  Weight for age:- weight is measured in Kilograms. A
standard calibrated weight machine is used. If weight
for age is decreased it shows protein energy
malnutrition (underweight)
 Height (length) for age :- height should be taken in a
standing position without footwear and it is measured
in centimetres. If height is decreased chronically it
denotes chronic malnutrition.
 Weight for height:- it helps to determine whether a
child is within rage of “normal” weight for his height.
 Low weight for height : this is known as nutritional
wasting or emaciation (Acute malnutrition). It is
associated with increase risk for mortality and
morbidity.
 MUAC : it is a method of measurement of the body’s
muscle mass. MUAC tale is used to locate the mid
point of the arm then measure the circumference at
the midpoint. The MUAC tape has three color which is
38

39. b) Clinical assessment
- The clinician detects the signs and
symptoms related to nutritional
disorders.
- The preliminary signs appear at the
beginning of malnutrition as follows
a) Anemia
b) Pallor
c) Muscle wasting
d) Edema
e) Goiter
39

40. 8. Availability of health services
and their utilization
 Health service delivery systems that
are safe, accessible, high quality,
people centered and integrated are
critical for moving towards universal
health coverage.
 Service delivery systems are
responsible for providing health
services for patients, persons,
families, communities, and population
40

41. 7. Morbidity & disability
 Morbidity has been defined as “any departure, subjective or
objective, from the state of psychological well being.”
 The WHO Expert Committee on Health Statics noted in its 6th
report that morbidity could be measured in terms of three units:
a) A person who was ill
b) The illness (periods of spells of illness) that these persons
experienced
c) The duration (Days, weeks, etc) of this illness
 These three aspects of morbidity are commonly measured by
morbidity rates or morbidity rations namely frequency,
incidence and prevalence rates.
 Disease frequency is measured by incidence and prevalence.
 The average duration per case of the disability rate, which is
the average no. of days of disability per person, may serve as
a measure of the duration of illness.
 Disability is the percentage of the population, unable to
perform the routine expected, daily activities due to injury or
illness.
41

42. 8. Availability of health services
and their utilization
 Health service delivery systems that are safe,
accessible, high quality, people cantered, and
integrated are critical for moving towards
universal health coverage.
 Services delivery systems are responsible for
providing health services for patients, persons,
families, communities, and populations in
general and not only care for patient.
 While patient cantered care is commonly
understood as focusing on the individual
seeking care, people cantered care
encompasses these clinical encounters and also
includes attention to the health of people in their
communities and their crucial role in shaping
healthy policy and health services.
42

43.  Nepalese people expect quality health
service but some still people do not
satisfy with the health care system.
 Due to lack of health service, people did
not get quality health service, many
factors which direct and indirect impact
in health services.
 Lack of essential medicine,
infrastructures, instruments and qualified
manpower in a health facility.
◦ Qualified manpower do not stay in a remote
area
◦ People refers to go to the traditional healers
◦ In the modern health system, people prefer
to go to private clinics and hospitals compare
to government health services. 43

44. 9. Community resources (Local
resources)
 Community is people and another organization
used as a resource which is available in the
community is also known as a community
resource, people don’t know their available
resource.
 If we use available resources, it improves the
lifestyle and health status of people.
 Assessing community’s strengths, weaknesses,
needs and assets is an essential first step in
planning an effective project.
 By using survey tool, we should find out the
problem and potentiality as like
◦ Nutritional resources
◦ Forest, river, stones and other natural resources
◦ Fruits and nutritional resources
◦ Community member, skilled and educated manpower44

45. 10. Community leaders (local
leaders)
 Leadership is the art of motivating a group of
people to act towards achieving a common
goals.
 A community leader is an important person to
meet befire community diagnosis and it helps
to cordinate with community people
 There are two types of leader in community
◦ Formal leader :- leader who are elected or
selected from authorized persons or
organizations who are in the post of the
government office.
◦ Informal leader:- leader who are not selected
from government office, they affect by their own
experiences, social service, education and work
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46. 11. Culture and tradition
46