COMMUNITY DIAGNOSIS PROGRAMME

Kishor Adhikari, National Medical College and Teaching Hospital, Birgunj, Nepal

What is CDP? Why is CDP needed for Medical

students? Purposes of CDP? Community diagnosis Vs Clinical

diagnosis Methods of CDP?

Presentation Outline:

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

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.

Contd.

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

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)

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 health action

(Similarities)

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 environment.

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:

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.

Methodology of CDP

Systematic activities of CDP (Chronology)

1. Determination of objectives1. 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.

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, 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.)

4. Data collection

a. Primary data (through household survey)

b. Secondary data (through records of different organizations)

c. Tools for data collectiond. Techniques for data collectione. Data editingf. Data analysis and interpretation

Community presentation to local leaders.

Community presentation to general population.

5. Community presentation

6. School Health Programme

Felt need Observed need Real need

Need prioritization

7. Micro Health Project

8. Seminar presentation

9. Report writing

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.  

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

Methods of Nutritional Assessment

1. Direct: deal with individual 2. Indirect: use community

health indices.

Direct Methods of Nutritional Assessment

These are summarized as ABCD

Anthropometric methods Biochemical, laboratory

methods Clinical methods Dietary evaluation methods

Indirect Methods of Nutritional Assessment

These include three categories:Ecological variables including crop productionEconomic factors e.g. per capita income, population density & social habitsVital 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) -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

Contd.

Kwashiorkor Marasmus

2. Assessment of Dietary intake

A. Qualitative aspect of food.B. Quantitative aspect of food.C. Social aspect of food

A. Qualitative aspect of food1. Vegetarian and non-vegetarian

food2. Use of cooking oil: refined or non

refined3. Type of salt used: iodized or non-

iodized.4. Habit of Balanced diet 5. Knowledge about balanced diet

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

C. Social aspect of nutrition

Knowledge and importance of nutrition.

Food cooking habit. Storage and distribution of food. Washing of vegetable. Cutting of vegetable.

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,

3. Anthropometric measurement

Among all children below 5 years: 1. Mid upper arm circumference (MUAC) 6+

months2. Weight 3. Height4. Weight for age (GOMEZ classification)5. Water low's classification 6. Chest and head circumference

BMIHip/waist ratio

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

784\

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 ageNutritional status Stunting (Ht/Ag%) Wasting (wt/Ht%)

Normal >95 >90Mildly impaired 87.5 - 95 80 – 90Moderately impaired 80 – 87.5 70 – 80Severely impaired <80 <70

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

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

Contd.

Immunization status of U5 children (not at all, partially immunized, completely immunized)

KAP on delivery kit.

Regarding Children

Birth weight of baby Percentage of babies suffering from different

diseases: Diarrhoea: ARI Measles Malnutrition Others

Family planning points should be included on:

1. Number of eligible couple2. Use of family planning methods3. Types of contraceptive methods used4. Sexwise distribution of family planning

users5. Birth spacing6. Preference of sex of child (male or

female)7. KAP on contraceptive

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

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 • Laparosco

py

Female condom

DiaphragmFoam tabOral Pills

Depot medroxy Cupper TNor-plant

Vaginal rings

Thank you