Eco-System Factors That Affect Community Health (OLOF)

Determinants (variables) of Health of the Community 5. Educator – Gives KSA, better informed choices

1. Political 3 aspect of Health Teaching

 This factor pertains to the power and a. Information – provision of knowledge
authority to regulate the environment
b. Education - change thru KSA
 Examples: Safety, Oppression, People
c. Communication – exchange of info
empowerment
6. Researchers/statistician/recorder- analyzes data
2. Health care Delivery System to predict future phenomenon
 One component of this factor is the 7. Role Model – shows examples of good behavior
primary health care which is in 8. Change agent – influences & motivate others
partnership approach good behavior
 GOAL: effective provision of health 9. Health advocate – aids people in asserting their
services that are community-based and rights, promotes self-care and self-determination
accessible 10. Case manager – oversees all aspect of care to
 Components: Preventive, Curative and facilitate delivery of cost-efficient care; to
rehabilitative individualize and coordinate care
11. Hospice care – providing nursing care skills in a
3. Behavioral home setting
 Culture: Smoking
 Habits: Intake of Alcoholic drinks]Ethnic 7 Functions of PHN
 Customs: substance abuse, lack of
exercise 1. Management function
2. Supervisory function
4. Socio-Economic Influences 3. Nursing care function
 Employment 4. Collaborating & coordinating function
 Education 5. Health promotion & education function
 Housing 6. Training function
7. Research function
5. Environmental Influences
 Air A. Application of Public Health Tools in
 Food Community Diagnosis
 Water waste
1. Demography
 Urban/rural noise
a. Sources of demographic data
 Radiation
b. Population size
 Pollution
c. Population composition
6. Heredity d. Population distribution
 Genetic Endowment 2. Health Statistics, Health Indicators and
 Defects Implications
 Strengths a. Crude birth rate
 Risk b. Crude death rate
o Familial c. Specific rates of mortality
o Ethnic d. Leading causes of mortality
o Racial e. Leading cause of morbidity
f. Life expectancy

PUBLIC HEALTH 1. DEMOGRAPHY

Definitions
 Public health as the science and art preventing
disease, prolonging life and efficiency to enable
every citizen to realize his birthright of health
and longevity.
CHN Roles of the nurse
 Is the scientific and statistical study of
population
 It includes the size, structure, composition and
distribution of these population and spatial
and/or temporal changes in them in response to
time, birth, migration, ageing, and death
 Greek: demos= the people
Grapho= writing

1. Clinician – focus on the health of individual

2. Community organizer – facilitate & empower
people
3. Collaborator – coordinates community resources
4. Counselor – listening, give feedback & support
  Age dependency ratio
3. Other characteristics
 Educational attainment
 Occupational group
 Economic group
 Ethnic group
 Religion

4. Urban-Rural
5. Crowding index- indicates the ease by w/c a
communicable disease can be transmitted
from a host to another susceptible host
2. Sources of Demographic Data 6. Population density- determine the
a. Social Observation congestion of the area/place.
 Study of the social and physical order in f. Studies and researches
urban neighborhoods

b. Family Records

c. Population census
 The procedure of systematically acquiring
and recording information about the
members of a given population
 It is a regularly occurring and official count
of a particular population

Type of census
1. De jure- people are assigned to a place
where they are at the time of the census
2. De facto- people are assigned to a place Vital Statistics (Health Statistics)
where they are physically present at the time
of the census  Refers to the systematic study and the
application of statistical measurements to vital
d. Registration of vital data events such as births, illness, marriages,
 Is an administrative system used by the divorces/separations and deaths is uterlized to
government to record vital events which gauge the levels of health, illness and health
occur in the population, live births, still births services of a community
 A government database recording the birth and
e. Health survey death of individual w/in
 Are nationally-represented household Implications of health Statistics
survey that provide data for a wide range
monitoring and impact evaluating indicators 1. A tool for planning, implementing, and
in the area of population, health and nutrition evaluating health programs
 Population size: the number of individual 2. Serves as indexes of the health condition
organism in a population, denoted as N obtained in a community or population group
3. Provide variables as to the nature of health
Population Composition services or action needed
4. Serves as basis for determining the success on
 The distribution w/in a group of people of
specified individual attributes such as
1. Sex
 Sex ratio
2. Age
 Age distribution
 Median age
 TYPES OF HEALTH INDICATORS

MORBIDITY Philippine Health Education

Types of Health Indicators Population 107,668,231 (July 2014 est.)

 is a measure of the risk of developing some new
condition within a specified period of time a. 0-14 years:
 illnesses affecting the population group  33.7% (male 18.493,668/female
Age 17,753,359)
structure
1. Incidence Rate (IR) b. 15-24 years:
 reported new cases affecting the  19% (male 10,416,358/female
population group 10,044,724)
 Formula:
c. 25-54 years:
IR = new cases of disease x 100  37% (male 20,031,638/female
Population 19,796,545)

d. 55-64 years:
MORTALITY  5.8% (male 2,882,719/female
 Reports causes of death 3,372,485)

1. Crude Death Rate (CDR) e. 65 years and over:

 overall total reported death  4.5% (male 2,103,596/female
 Formula: 2,773,139) (2014 est.)

CDR = overall total deaths x 1000

Population Dependency  total dependency ratio: 60.7%
ratios  youth dependency ratio: 54.3%
2. Maternal Mortality Rate (MMR)  elderly dependency ratio: 6.4%
 maternal deaths due to maternal causes  potential support ratio: 15.6 (2014
 Formula: est.)

MMR = number of maternal deaths x 1000

Registered Live Births Median age  total: 23.5 years
 male: 23 years
 female: 24 years (2014 est.)

3. Neonatal Mortality Rate (NMR) Population  1.81% (2014 est.)

growth rate
 number of deaths among neonates
(newborn 0-28 days or less than 1 Net  -1.23 migrant(s)/ 1,000 population
month) migration (2014 est.)
 Formula: rate

NMR = number of neonatal deaths x 1000 Urbanization  Urban population: 48.8% of total
Registered Live Births population (2011)
 Rate of urbanization: 2.16% annual
rate of change (2010-15 est.)
4. Infant Mortality Rate (IMR) 
 number of infant deaths 0-12 months or Major Cities  MANILA (capital) 11.862 million;
less than 1 year old - population  Davao 1,565 million;
 Formula:  Cebu City 855,000;
 Zamboanga 884,000 (2011)
IMR = number of infant deaths x 1000 Literacy  definition: age 15 and over can read
Registered Live Births
and write
 total population: 95.4%
5. Swaroop's Index (SI)
 male: 95%
 deaths among individuals in the age  female: 95.8% (2008 est.)
group 50 and above
 Formula:

SI= number of deaths (individual >50 years old) x 100

Total Deaths
 EPIDEMIOLOGY

 the study of distribution of disease or physiologic Importance of Epidemiology in Public Health:

condition among human population and the factors 1. serve as the backbone of the prevention of
affecting such distribution diseases
 the study of the pattern of occurrence and
distribution of health conditions such as disease,
death, deformities or disabilities on human Uses of Epidemiology according to Morris
populations 1. to study the history of the health population and
the occurrences of disease
A. Susceptible population 2. to diagnose the health of the community and the
 at risk to develop, acquire or experience condition of people
the disease 3. to study the work of health services with a view
of improving them
B. Immune Population 4. to estimate the risks of disease, accidents,
 those that did not experience the
disease, usually individuals develop Patterns Susceptible Immune
resistance against the disease Population Population
Epidemic 80% (more than 20%
Importance of Epidemiology 50%)
1. prevention of disease Endemic 50% 50%
2. prolong life Sporadic 20% 80%
 promote physical health and efficiency Pandemic ---- ----
through organized community efforts

Basic Concepts of Epidemiology

1. Epidemiologic Triad A. Direct Transmission

2. Transmission  Direct contact refers to close contact
3. Incubation Period that results in exposure to skin and body
4. Herd immunity secretions.
 Organisms can be transmitted from one
part of a person's body, such as their
1. Epidemiologic Triad skin or an infected wound, to another
 The triad consists of an part of their own body or to another
extemal agent, a host individual.
and an environment in  direct contact:
which host and agent o host-to-host
are brought together, o droplet spread from one host to
causing the disease to another
occur in the host.  Some diseases that are transmissible by
 A vector is an organism direct contact include:
which transmits infection a. Athlete's foot
by conveying the pathogen from one host to b. Impetigo
another without causing disease itself, may be c. Syphilis (on rare occasions,
part of the infectious process. if an uninfected person
canker spots)
d. Warts
2. Modes of Transmission e. Conjunctivitis
Transmission
 in the traditional epidemiologic triad model, B. Indirect Transmission
transmission occurs when the agent leaves  the transfer of an infectious agent from a
its reservoir or host through a portal of exit reservoir to a susceptible host by
 is conveyed by a mode of transmission to suspended air particles, inanimate
enter through an appropriate portal of entry objects (vehicles or fomites), or animate
to infect a susceptible host intermediaries (vectors)
 occurs when organisms from an infected
host or other reservoir are transmitted to
 a susceptible host via an inanimate
object or fomite
 In the hospital environment fomites
which can become. contaminated and
act as sources of infection include
medical equipment such as
endoscopes, clothing, bedding,
dressings and sinks
 gastrointestinal pathogens such as
Salmonella can be transmitted in this
way
C. Droplet Infection
 the transmission of infectious agents in
droplets from respiratory secretions by
coughing, sneezing or talking, is another
form of contact transmission.
 Pathogens that are transmitted in this
way are the cold and influenza viruses
and the bacteria responsible for
tuberculosis.
 Diseases that are commonly spread by
coughing or sneezing include:
a. Bacterial Meningitis
b. Chickenpox
c. Common cold
d. Influenza Mumps
e. Strep throat
f. Tuberculosis
g. Measles
h. Rubella
D. Oral Transmission
 diseases that are transmitted primarily by
oral means may be caught through direct
oral contact such as kissing, or by indirect
contact such as by sharing a drinking glass
or a cigarette.
 diseases that are known to be transmissible
by kissing or by other direct or indirect oral
contact:
 Cytomegalovirus infections
 Herpes simplex virus (especially HSV-1)
 Infectious mononucleosis
E. Fecal-oral transmission
 Direct contact is rare in this route, for
humans at least.
 More common are the indirect routes;
foodstuffs or water become contaminated
(by people not washing their hands before
preparing food, or untreated sewage being
released into a drinking water supply) and
the people who eat and drink them become
infected.
 in developing countries must sewage is
discharged in the environment or on
cropland as of 2006 even in developed
countries there are periodic system failures
resulting in unsanitary sewer overflow
 This is the typical mode of transmission for
the infectious agents:
 Cholera
 Hepatitis A
 Polio
 Rotavirus
 Salmonella
 parasites e.o. Ascaris lumbricoid
F. Sexual Transmission
 refers to any disease that can be caught
during sexual activity with another
person, including vaginal or anal sex or
(less commonly) through oral sex.
 Transmission is either directly between
surfaces in contact during intercourse or
from secretions (semen or the fluid
secreted by the excited female) which
carry infectious agents that get into the
partner's blood stream through tiny tears
in the penis, vagina or rectum (this is a
more usual route for viruses).
 anal sex is considerably more
hazardous since the rectum than the
penis opens more tears in vagina, as
the vagina is more elastic and more
accommodating
 Some diseases transmissible by the
sexual route include:
 HIV/AIDS – Chlamydia
 Genital warts
 Gonorrhea
 Hepatitis B
 Syphilis
G. Oral sexual transmission
 Sexually Transmitted Diseases such as HIV
and Hepatitis B are thought to not normally
be transmitted through mouth-to-mouth
contact, although it is possible to transmit
some STDs between the genitals and the
mouth, during oral sex.
 In the case of HIV this possibility has been
established. It is also responsible for the
increased incidence of herpes simplex virus
1 (which is usually responsible for oral
infections) in genital infections and the
increased incidence of the type 2 virus
(more common)
H. Vertical Transmission
 This is from mother to child, often in utero or
during childbirth (also referred to as
perinatal infection). It occurs more rarely via
breast milk.
 Infectious diseases that can be transmitted
in this way include: HIV, Hepatitis B and
Syphilis.
I. latrogenic transmission
 Transmission due to medical procedures,
such as injection or transplantation of
infected material.
 Some diseases that can be transmitted
iatrogenically include:
 o Creutzfeldt-Jakob Disease by
injection of contaminated human
growth hormone.
o MRSA infection is often acquired as
a result of a stay in hospital
3. Incubation Period
 the period from the moment of exposure to
an infectious agent until signs and
symptoms of the disease appear
4. Herd Immunity
 also called as "Community Immunity"
 the principle of community immunity applies
to control a variety of contagious diseases,
including influenza, measles, mumps,
rotavirus, and pneumococcal disease
 describes a form of immunity that occurs
when the vaccination of a significant portion
of a population (or herd) provides a measure
of protection for individuals who have not
developed immunity
Herd Immunity Theory
 proposes that, in contagious diseases
that are transmitted from individual to
individual, chains of infection are likely
to be disrupted when large numbers of a
population are immune or less
susceptible to the disease
 the greater the proportion of individuals
who are resistant, the smaller the
probability that a susceptible individual
will come into contact with an infectious
individual
 applies only to diseases that are
contagious.*
 It does not apply to diseases such as
tetanus (which is infectious, but is not
contagious), where the vaccine protects
only the vaccinated person from
disease. Nor does it apply to the IPV
poliomyelitis vaccine that protects the
individual from viremia and paralytic
polio but does not prevent the fecal-oral
spread of infection
Herd Immunity (cont.)
 Contact immunity - wherein a vaccinated
individual can 'pass on' the vaccine to another
individual through contact.
 The proportion of immune individuals in a
population above which a disease may no
longer persist is the herd immunity threshold.
 Its value varies with the virulence of the disease,
the efficacy of the vaccine, and the contact
parameter for the population.
Outline on the Operational Procedure During a Disease
Outbreak
1. Team Organization
2. Epidemiological Investigation
3. Collection of Laboratory Specimens
4. Treatment of Patients and Contacts
5. Immunization Campaign
6. Environmental Sanitation
7. Health Education
8. Involvement of Other Agencies
9. Reporting
Steps in EPIDEMIOLOGICAL INVESTIGATION
1. Establish fact of presence of epidemic
 Verify diagnosis
 Reporting
 Is there an unusual prevalence of the
disease
2. Establish time and space relationship of the
disease
 Are the cases limited to or concentrated
in a particular area?
 Relation of cases by days of onset to
onset of the first known cases (usually
done in weeks)
3. Relate to characteristics of the group in the
community
 Relation of cases to age, groups, sex,
color, Occupation, school attendance,
past immunization.
 Relation of sanitary facilities
 Relation to milk and food supply
 Relation of cases to other cases and
known carriers if any
4. Correlate all data obtained
 Summarize the data
 Draw final conclusion
 Establish source of epidemic and the
manner of the spread
 Make suggestions as to the control and
preventions of future outbreaks