Kishor Adhikari, National Medical College
andTeaching Hospital, Birgunj, Nepal
What is CDP?
Why is CDP needed for Medical students?
Purposes of CDP?
Community diagnosisVs Clinical diagnosis
Methods of CDP?
“Community diagnosis is a comprehensive
assessment of health status of the community in
relation to it’s social, physical and biological
- Dr. Cynthia Hale et al
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.
The application of techniques of diagnosis of
an individual to the community is known as
The community diagnosis is based on
collection and interpretation of the relevant
The focus should be the identification of the
basic health needs and health problems of
(felt need, observed need and real need)
Comparing individual diagnosis with
1. Obtain a history of the patients’
2. Examine the patient and
3. Perform laboratory test , x-ray
4. To infer causation from the
history and test result to make
5. Provide treatment.
6. Follow-up and assess
effectiveness of the treatment.
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
6. Evaluate (follow-up) the effect of community
Comparing individual diagnosis with
1. Patient aware of the
2. Patient take
4. It may or may not
be related to
1. Community may or may
not be aware of the
2. Community rarely takes
3. Can not be treated as
4. Each condition is linked to
the inter-related factors in
Purposes of Community
1. It helps to identify community needs and
2. It is pre-requisite for planning, implementing
and evaluation of health and development
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
Methodology of CDP
Systematic activities of CDP (Chronology)
1. Determination of objectives
2. Selection of community
a. Convenient accessibility
b. Diversity of population based on socio-economic, cultural and
c. Administrative and operational feasibility.
3. Review of literature
a. Lecture notes and field reports of seniors.
b. Library books and literatures.
c. Internet surfing
4. Planning (what, where, how,
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-
d. Making plan of action (emphasis on dates/places/activities/group
division/group coordinator etc.)
4. Data collection
a. Primary data (through household survey)
b. Secondary data (through records of different
c. Tools for data collection
d. Techniques for data collection
e. Data editing
f. Data analysis and interpretation
Community presentation to local leaders.
Community presentation to general
5. Community presentation
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.
Purposes of Nutritional assessment
1. Identify individuals or population groups
who are malnourished or at risk of
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
Methods of Nutritional Assessment
1. Direct: deal with individual
2. Indirect: use community health
Direct Methods of Nutritional
These are summarized as ABCD
Biochemical, laboratory methods
Dietary evaluation methods
Indirect Methods of Nutritional
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
1. Physical and Clinical examination
Night blindness, Bitot’s spot, corneal
xerosis (xeropthalmia) -A
Enlargement of thyroid (Hypothyrodism) -
Pale conjuntiva, pale palms(Anaemia)- Iron
Absence of knee or ankel jerk (Beriberi)- B1
Pigeon chest, deformed pelvis, curved legs.
Angular stomatitis – B2
3 Ds (pelagra) –Niacin
Swellen and bleeding gums, Scurvy - C
2. Assessment of Dietary
A. Qualitative aspect of food.
B. Quantitative aspect of food.
C. Social aspect of food
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
B. Quantitative aspect of food
Total calorie requirement and daily
consumption of calorie in the family on
the basis of:
Total family members by age and sex.
Number of vulnerable groups
C. Social aspect of
Knowledge and importance of nutrition.
Food cooking habit.
Storage and distribution of food.
Washing of vegetable.
Cutting of vegetable.
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,
3. Anthropometric measurement
Among all children below 5 years:
1. Mid upper arm circumference (MUAC) 6+ months
4. Weight for age (GOMEZ classification)
5. Water low's classification
6. Chest and head circumference
for adult population
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
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
Mid upper arm circumference
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
Maternal and child health
(MCH) points should be covered:
Age at marriage
Age at first pregnancy
ANC visits (Never, one time, 4 times)
Place of delivery
Type of delivery at institution
Post natal care
Immunization status of U5 children (not at all, partially
immunized, completely immunized)
KAP on delivery kit.
Birth weight of baby
Percentage of babies suffering from different diseases:
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
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
Family planning methods
Natural Methods Artificial methods
• Coitus interrupts
• Safe period
• Cervical Mucous
• Basal Body
Male Female Male Female
Condom Vasectomy •Minilap