CHN NOTES:

4 Clients of Community Health Nursing

-Individuals
-Families
-Groups
-Community as a whole (both seen as a client & setting)

Vital Health Statistics

● Statistics
- refers to a systematic approach of obtaining (data collection process),
organizing and analyzing (using statistical formulas) numerical facts so that
CONCLUSION​ may be drawn to them

● Vital Health Statistics

-the systematic study of the vital events: ​births, morbidities/illness, marriage &
deaths
-​ recording and reporting are very important factor

● Health Indicators
-summary measures designed to describe aspects of health or health system
performance.

Types:
1. Health Status Indicators
- Refers to illnesses and death
2. Population Indicators
- Refers to the given population of the community & general fertility rate
(people who have the capacity to change the population)
3. Provision of Health Care
- Refers to the effectiveness of the programs in the community
4. Risk Reduction Indicators
- a form of indicator that focuses on the preventive aspect. To help us
understand on future calamities
5. Social, Economic Health Indicators
- The different components in the society that reflect on matters of health
- Food, education, etc.
6. Environmental
- Clean air, portable water, noise pollution
7. Disability
- Occupational hazards
8. Health Policy
- Law making
Importance of Vital Health Statistics: 
- Gives a picture of how Health a community is
- Provides valuable clues as to the nature of health services or actions needed in a
community
- Maintains accurate and updated vital statistical records and reports

Morbidity Indicators 
- Based on the disease-specific incidence for the common and severe diseases
- Answers the epidemiologic questions: What are the health problems in the area? How
many cases occur in the area?

Prevalence Proportion (P)

- Measures the ​total number of existing cases​ of a disease at a particular point in time
- Provides an indication of the magnitude of a health problem and is used for projecting
the scope of health services needed
- Formula:

Number of Existing cases of a disease at a particular point in time ​X F (factor rate)

Number of people examined at that point of time

Incidence Proportion
- Only measure the​ NEW​ cases, episodes, or events occurring over a specified period
- Bets indicator whether the condition is decreasing, increasing or remaining static;
evaluating the effectiveness of health interventions
- Formula:

Number of NEW cases that developed during the period ​ X F (factor rate/100)
Number of persons followed up

Attack Rate
- Useful in outbreak investigation
- Used when the risk period of the occurrence of disease is very short
- Formula:

Number of Persons Acquiring a diseases in a period of occurrence​ X 100

Total number of persons exposed to same disease

MORTALITY INDICATORS 
- Provide important information of the health status of the people in the community
Crude Death Rate
- Measure of one’s mortality from all causes which may result in a decrease population
- Formula:

Total no. of Deaths registered in a calendar year​ X 1,000

Estimated mid-year population of the same year

Specific Mortality Rate

- Describes more accurately the risk of exposure of certain classes or groups to a
particular disease
- Ex of specific death can be by: cause, sex or age
- Formula:

Total no. of Deaths in a specific group registered in a calendar year​ X 1,000

Estimated mid-year population of the same year

Fetal Death Rate

- Death from conception prior to its complete expulsion
- Measure of pregnancy wastage
- Formula:

Total no. of Fetal deaths registered in a calendar​ X 1,000

Total no. of Live births of the same year

Maternal Mortality Rate

- Measures the risk of dying from causes related to pregnancy, childbirth and puerperium
(direct maternal causes)
- An index of obstetrical care received by women in a community
- Formula:

Total no. of Maternal death causes registered in a calendar year ​ X 1,000

Total no. of Live births of the same year

Neonatal Mortality Rate

- An index of prenatal care and obstetrical management of newborn
- Measures the risk of dying during the first month (28 days) of life
- Formula:

Total no. of Deaths under 28 days registered in a calendar year​ X 1,000

Total no. of Live births of the same year

Post- Neonatal Mortality Rate

- An index of environmental, nutritional and infections in a community
 - Risk of dying from 28 days to 1 year of age
- Formula:
Total no. of Deaths 28 days to less than 1 year in a calendar ​ X 1,000
Total no. of Live births of the same year

Infant Mortality Rate

- Good index of the general health condition of the community
- Measures the risk of the dying during the first year of life
- Neonatal + Post-Neonatal Mortality rate
- Formula:
Total no. of Deaths under 1 year old registered in a calendar year ​ X 1,000
Total no. of Live Births of the same year

Swaroop’s Index
- Measures the longevity of life
- Index of death above 50 years old
- Formula:
Total no. of deaths above 5o years old registered in a calendar year ​ X 100
Total death of the same year

Case Fatality Ratio

- Index of a killing power of a disease and is influenced by incomplete reporting and poor
morbidity data
- Formula:
No. of registered deaths from a specific disease in a give year ​ X 100
Total no. of registered cases in the same year

POPULATION INDICATORS 
- Include not only the population growth indicators but also other population dynamics that
can affect the age-sex stucture of the population and vice-versa

Crude Birth Rate

- Measure of one’s natural growth or increase of a population
- Formula:
Number of Registered Live births in a year ​ X 1,000
Mid-year population

General Fertility Rate

- Related to the segment of the population deemed to be capable of giving birth
(Philippines: 15-44 years old)
- Formula:
 Number of Registered Live Births in a year ​ X 1,000
Mid-year population of Women age 15-44 years old

EPIDEMIOLOGY 
- The study of occurrences and distribution of diseases as well as the distribution and
determinants of health states or events in specified population
- Concerned not only with diseases and disabilities but also with more positive health
states and the improvement of health.

Importance:
- Backbone of disease prevention
- Describe the distribution of health status in terms of age, se, rac and geography
- Explains the patterns of disease distribution in term of causal factors

Types:
1. Descriptive
- Examining the distribution of a disease in a population and observing the ​basic
features​ of distribution in terms of time, lace and person.
- Typical study design: Community Health Survey

2. Analytical
- Testing a ​specific hypothesis​ about a relationship of a disease to a putative
cause, by conducting an epidemiologic study that relates the exposure of interest
to the disease of interest.
- Typical Study design Cohort, Case Control

Uses:
- To study the health history of the population
- To diagnose the health of the community
- To examine the work of health services with a view of improving them
- To estimate the risk of diseases, accidents and the chances of avoiding them
- To search for causes of health and disease

Functions of the Health Worker:

1. Implement public health surveillance
2. Monitor local health personnel
3. Conduct or assist outbreak investigation, rapid surveys and program evaluation

Multiple Causation of Disease Theory

- Disease development does not rest on a single cause. Health conditions result from a
multiple of factors.
- Disease: Pathogen, Environment, Host
Levels of Prevention
1. Primary
- Health promotion and disease prevention
- Client is totally well
- Personal hygienic measures, exercise, balance nutrition
2. Secondary
- Early detection and simple treatment
- Both wellness & illness
- Simple treatment
- Manifesting signs and symptoms of disease
3. Tertiary
- Rehabilitation
- Patient is in a state of illness
- To prevent further complications/ loss of function
- Patient is diagnosed with a medical condition

Patterns of Disease Distribution

● Sporadic
- Few isolated and unrelated cases in each locality
● Endemic
- Continuous occurrence throughout a period
● Epidemic (Outbreak)
- Occurrence is of unusually large number of cases in a relatively short period of
time
● Pandemic
- Simultaneous occurrence of epidemic of the same disease in several countries

Outline Plan for an Epidemiological Investigation

1. Establish facts of presence of epidemic
- Verify the diagnosis and reports
- Is there an unusual prevalence of the disease?
2. Establish time and space relationship of the disease
- Cases in any geographical location
- Onset of the first known case
3. Relation to the characteristics of the group of community
- Age, sex, occuaptin and school attendance
- Sanitary facilities, milk and food supply
- Carries/Asymptomatic
4. Correlation of ALL data obtained
- Summarize the data
- Formulate final conclusion
- Suggestions for future outbreaks
Steps in Outbreak Investigation
1. Prepare for Field Work
- Administration
- Investigation
- Scientific knowledge
- Supplies and equipment
- Consultation
2. Establish the existence of an outbreak
- Cluster cases
- Identify outbreak
- Compare current numbers
3. Verify Diagnosis
- Ensure proper diagnosis of reported cases
- Review clinical/ laboratory findings
- Visit patients
4. Define and Identify Cases
- Establish a case definition (standardized set of criteria for the health condition)
- Identify and count cases (identify information demographic, clinical, risk)
5. Perform descriptive epidemiology
- Describe the available data
- Person, time & place, exposure
6. Formulate hypotheses
- Development and test
- Evaluate
- Refine and execute additional studies
7. Implement Control and prevention measures
- Prevent additional cases
- Conduct contact tracing
- Prevent outbreaks in the future
8. Communication findings
- Writing full report
- Meetings and discussions
- Local mass media
- Local government officials
- Regional health authorities
- Department of HEALTH
9. Follow up Recommendations
- Look at activities if they were successful
- Ask health status
- Reduction of health problem