FINALS: CHN II
obtain data when needed
Indicators of Health
-Perfectly healthy w/o presence of disease
-Vital statistics of the area
-The community and the people can fulfill their
roles and responsibility
Health
-Health is defined as “a state of complete
physical, mental and social wellbeing and
not merely the absence of disease or
infirmity-WHO
-This statement has been amplified to
include the ability to lead as “socially and
economically life”
-Health cannot be measured in exact
measurable forms
-Hence measurement have been framed in
terms of illness (or lack of health),
consequences of ill-health (morbidity,
mortality) & economic, occupation &
domestic factors that promote ill health all
the antithesis of health
Indicators of Health
-Indicator also termed as index or variable
is only an indication of a given situation or a
reflection of that situation
-health indicator is a variable, susceptible
to direct measurement, that reflects the state
of health of persons in a community
-Indicators help to measure the extent to
which the objectives and targets of a
programme are being attained
-Health index is a numerical indication of
the health of a given population derived from
a specified composite formula
Characteristics
-Valid: they should actually measure that
they are supposed to measure
-Reliable: the results should be the same
when measured by different people in similar
circumstances
-Sensitive: they should be sensitive to
changes in the situation concerned
-Specific: they should reflect changes only
in the situation concerned
-Feasible: they should have the ability to
-Relevant: they should contribute to the
understanding of the phenomenon of
interest
Uses of Indicators of Health
-Measurement of the health of the
community
-Description of the health of the community
-Comparison of the health of different
communities
-Identification of health needs and
prioritizing them
-Concurrent evaluation and terminal
evaluation of health services
-Planning and allocation of health resources
-Measurement of health successes
Classification of Indicators of Health
-Mortality indicators
-Morbidity Indicators
-Disability rates
-Nutritional Status or Nutritional Indicators
-Health Care Delivery Indicators
-Utilization Rates
-Indicators of Social and Mental Health
-Environmental Indicators
-Socio-economic Indicators
-Health Policy Indicators
-Indicators of Quality of Life
-Other Indicators
Mortality Indicators
1. Crude Death Rate
-Fair indicator of the comparative health
of the people.
-It is defined as the number of deaths per 1000
population per year in a given community,
usually the mid-year population
-The usefulness is restricted because it is
influenced by the age-sex composition of the
population, socioeconomic and socio-cultural
environment of the communities
-Current CDR is 7.48 deaths/1,000 population
2. Expectation of Life
-The average number of years that will be lived
by those born alive into a population if the
current age specific mortality rates persist
-It is a statistical abstraction based on existing Incidence
age-specific death rate -The number of new events or new cases of a
-Estimated for both sexes separately disease in a defined population, within a
-Good indicator of socioeconomic specified period of time
development -E.g incidence of TB (new sputum positive
-Positive health indicator of long time cases) is 168 per 100,000 per year
survival
-Life expectancy at birth: Prevalence
Total Population: 66.8 years -The total number of all individuals who
Male: 65.77 years; Female: 67.95 years have an attribute or disease at a particular
time divided by population at risk of having
3. Infant mortality rate attribute or disease at this point in time
-The ratio of deaths under 1 year of age in a -reflects the chronicity of the disease
given year to the total number of live births in the -E.g Prevalence of TB (new sputum+ve cases) is
same year, usually expressed as a rate per 249 per 100,000 per year
1000 live births
-Indicator of health status of not only 2. Notification rates is calculated from the
infants but also whole population and reporting to public authorities of certain
socioeconomic conditions disease e.g yellow fever, poliomyelitis
-Sensitive indicator of availability, -They provide information regarding
utilization & effectiveness of health care, geographic clustering of infections,
particularly perinatal care quality of reporting system etc.
-Current IMR: 47.57/1000 live birth
3. Attendance rates at OPDs and at health
Child Mortality Rate centers
-The number of deaths at ages 1-4 years in 4. Admission, Readmission and discharge
a given year, per 1000 children in that age rates
group at the mid-point of the year 5. Duration of stay in hospital—reflects the
-Correlates with inadequate MCH services, virulence and resistance developed by the
malnutrition, low immunization coverage etiological factor
and environmental factors 6. Spells of sickness or absence from work
-Current rate: 18/1000 or school,
-Other indicators are perinatal mortality -Reflects economical loss to the
rate, Neonatal mortality rate, stillbirth, etc. community
-Correlates with inadequate antenatal care 7. Hospital data constitute a basic and
and perinatal care primary source of information about diseases
prevalent in the community
Mortality Indicators
-Maternal Mortality Rate Disability Rates
-Disease Specific Death rate Disability rates are of two categories
-Proportional Mortality Rate
-Event type indicators
Morbidity Indicators -number of days of restricted activity
-The frequency with which a disease appears in -bed disability days
a population. -work-loss days within a specified period
-Reveal the burden of ill health in a community, -Person type indicators
but do not measure the subclinical or in -Limitation of mobility e.g confined to bed,
apparent disease states. confined to house, special aid in getting
around
1. Incidence and Prevalence
 -limitation of activity e.g. limitation to
perform the basic activities of daily living e.g
eating, washing, dressing, etc.
Nutritional Status Indicators
-Nutritional Status is a positive health
indicator
-Newborns are measured for their
i. Birth-weight ii-Length etc
-They reflect the maternal nutrition
status
-Anthropometric measurement of pre-school
children
i. weight measure acute malnutrition
ii Height: measure chronic malnutrition
-Growth Monitoring of Children is done by
measuring weight- for age, height for age,
weight for height, head and chest
circumference and mid-arm circumference
-In adults underweight, obesity and anemia
are generally considered reliable nutritional
indicators.
Health Care Delivery Indicators
-These indicators reflect the equity of
distribution of health resources in different
parts of the country and of the provision of
health care
-Doctor-population ratio—1/1700 (sug. Norm
1/3500)
-Nurse-population ratio—0.8/1000 (sug.norm
1/500)
-Population-bed-ratio—8.9/10,000
Utilization Rates
-Utilization Rates or actual rates is expressed
as the promotion of people in need of a
service who actually receive it in a given
period, usually a year
-It depends on availability & accessibility of
health services and the attitude of an individual
towards health care system
-They direct attention towards discharge of
social responsibility for the organization in
delivery of services
-E.g.
1. Proportion of infants who are fully
immunized-43%
2. Proportion of pregnant women who receive
ANC care or have institutional deliveries
3. Percentage of population who adopt family
planning
4. Bed occupancy ratio, bed-turn over ratio,
etc.
Indicators of Social and Mental Health
-These include rates of suicide, homicide, other
crime road traffic accident, juvenile
delinquency, alcohol and substance abuse,
domestic violence, battered-baby syndrome,
etc.
-These indicators provide a guide to social
action for improving the health of people
-Social and mental health of the children
depend on their parents
-E.g. Substance abuse in orphan children
Environmental Indicators
-These reflect the quality of physical and
biological environment in which diseases
occur and people live
-The most important are those measuring the
proportion of population having access to safe
drinking water and sanitation facilities
-These indicators explains the prevalence of
communicable diseases in a community
-The other indicators are those measuring the
pollution of air and water, radiation, noise
pollution, exposure to toxic substances in food
and water
Socioeconomic Indicators
-These do not directly measure health but are
important in interpreting health indicators
-These are,
-rate of growth of population: India-
decadal (2001-2011)-17.64%, annual
(2011)-1.344% Karnataka-17.51% (2001-
2011)
-Family size India-4.8 Karnata-4.6
-Housing—the number of persons per room
-Per capita “calorie” available
-Countries with favourable socioeconomic
indicators have reported less health related
problems
Health Policy Indicators
-The most important indicator of political
commitment is allocation of adequate
resources
-The relevant indicators are:
 -Proportion of GNP spent on health services- -Income distribution
8.7% -Work conditions
-Proportion of GNP spent on health-related -Adult literacy rate
activities like water supply and sanitation & -Housing
Housing and nutrition-8.5% -Food availability
-Proportion of total health resources devoted
primary health care 3. Indicators for the provision of health
care
Indicators of Quality of Life -Availability
-Life expectancy is no longer important -Accessibility
-The Quality of Life has gained its importance -Utilisation
-Quality of care
-Physical Quality of Life Index
-It consolidates infant mortality, life expectancy 4. Health Status Indicators
at age of 1 year and literacy -Low birth weight
-For each component the performance of -Nutritional status and psychosocial
individual country is placed on a scale of 1 of development of children
100. -Infant mortality
-The composite index is calculated by averaging -Child mortality rate (1-4 years)
the three indicators giving equal weight to each -Life expectancy at birth
of them. -Maternal mortality rate
-The resulting is placed on the 0 to 100 scale -Disease specific mortality
-Morbidity—incidence and prevalence
Human Development Index -Disability prevalence
-It is defined as a composite index combining
indicators representing 3 dimensions— Summary
i. longevity (life expectancy at birth) -Health not measured directly but using
ii-knowledge (2/3 adult literacy rate and 1/3 indicators
mean years of schooling) -Indicator should be valid, sensitive, specific,
iii. income (real GDP per capita in purchasing reliable, relevant and feasible
power parity in US dollars) -Used in measuring, describing, comparing,
identifying health needs and planning and
Other Indicators Series evaluation of health services.
Health For All Indicators
-For monitoring the progress towards the goal
of Health for All by 2000, the WHO has listed
the following four categories of indicators.

1. Health Policy Indicators

-Political commitment to HFA (Health For All)
-Resource allocation
-Degree of equity of distribution of health
services
-Community involvement
-Organizational framework and managerial
process

2. Social and economic indicators

related to health
-Rate of population growth
-GNP or GDP
Health Indicators In The Community (PPT)
Health Indicators
-A list of information that would determine the
health of a particular community or
country.
-Population size
-Crude birth rate
-Crude death rate
-Infant and maternal death rates, neonatal
death rates
-Even tuberculosis death rate
Vital Statistics
-Application of statistical measures to vital
events.
-Utilized to gauge the levels of health, illness
and health services of a community and the
country.
How to Compute for fertility rates
Fertility Rates
-Crude birth rates
-General fertility rates
Crude Birth Rates
-Measure of one characteristics of the natural
growth or increase of a population
CBR= (Number of registered live birth in a
year/Midyear population, same year) X 1000
Example: The total population as July 1, 2020
is 109, 543, 263 Filipinos. The total live birth
on the same year is 1, 900, 250. What is the
Crude Birth Rtae in 2020?
CBR= (1, 900, 250/109, 543, 263) X 1000
=0.017 x 1000
=17
Interpretation:
-There are 17 live births in every 1000
population
General Fertility Rate
-More specific than the CBR since births are
related to the segment of the population that
are capable of giving birth.
-Reproductive age group of women in the
Philippines is 15-49 years of age.
GFR= (Number of registered live births in a
year/Midyear population of women 15-49 years
of age) X 1000
Example: There are a total of 1,900,250 live
births in 2020. The population is 109, 543,
263. There are 52, 580, 766 women in the same
year and 27, 341, 998 belongs to women of
reproductive age group.
GFR= (1, 900, 250/ 27, 341, 998) X 1000
=0.069 x 1000
=69
Interpretation:
-There are 69 live births in every 1000 women
of reproductive age in the Philippines in 2020
How to Compute for Mortality Rates
Mortality Rates
-Crude Mortality Rate
-Specific Mortality rate
-Cause of Death Rate
-Infant Mortality Rate
-Neonatal and Post Natal Rate
-Maternal Mortality Rate
-Case Fatality Rate
Crude Mortality Rate/Crude Death Rate
CDR= (Number of deaths in a year/ Midyear
population, same year) X 1000
Example: There are a total of 109, 543, 263 in
the year 2020. The deaths reaches 1, 000, 673.
34, 672 of the total deaths are due to Covid 19.
CDR= (1, 000, 673/ 109, 543, 263) X 1000
=0.009 x 1000
=9 Deaths
Interpretation:
-There are 9 deaths in every 1000 population
Specific Mortality Rate
-Shows rates of deaths in groups with specific
characteristics according to:
A. Age
B. Sex
C. Occupation
D. Education
E. Exposure to risk factors
F. Combination of the above

Specific Death Rate
SMR= (Number of deaths from a specified
group/Mid year population, same year) X 1000
Example:
There are 200, 203 deaths among 65 years old
older out of the total deaths of 1,000, 673 in
2020. The population in that year 109, 543,
263
SMR= (200, 203/109, 543, 263) X 1000
=0.0018 x 1000
=1.82
Interpretation:
-There are 1-2 deaths in every 1000 population
among 65 years old and above age group.
Cause of Death Rate
-Made specific by relating the deaths from a
specific cause and group the mid-year
population of that specific group
-Factors that affect this rate include:
-Completeness of registration of deaths
-Composition of the population, and
-Disease ascertainment level in the
community
C-DR= (Number of deaths from a specified
cause/Mid year population, same year) X 1000
Example: There are 200, 203 deaths among 65
years old older out of the total deaths of 1,000,
673 in 2020. 34, 672 deaths due to Covid 19.
The population in that year 109, 543, 263
C-DR= (34, 672/109, 543, 263) X 1000
=0.31
Interpretation:
-There are 0.31 deaths in every 1000
population because of Covid 19
Infant Mortality Rate
-Measures the risk of dying during the 1st year
of life
-Sensitive index of level of health in a
community
-High IMR means low levels of health standards
due to:
a. Poor maternal and child health care,
B. Nutritional problems
C. Poor environmental sanitation, and
D. Poor or deficient health service delivery.
-Infant mortality rate may be further
subdivided into:
-Neonatal Mortality Rate
-Post-Neonatal Mortality Rate
-The subdivision is noteworthy because:
a. Neonatal deaths are primarily due to
prenatal or genetic factors
B. Post—neonatal deaths are often cause by
environmental, genetic, nutritional and
infectious diseases
Infant Mortality Rate
IMR = (Number of deaths under 1 year of age
in a calendar year/ Number of registered live
births, same year) X 1000
Neonatal Mortality Rate
IMR= (Number of deaths under 28 days of age
in a calendar year/number of registered live
births, same year) X 1000
Post-Neonatal Mortality Rate
PNMR= (Number of deaths over 28 days less
than 1 year of age in a calendar year/ Number
of registered live births, same year) X 1000
Example:
There are 109, 543, 263 population in 2020.
The total live births is 1, 943, 976. There are a
total of 157, 450 deaths occurred in the first
year of life. 59, 755 of it happens during the
first 28 days after birth. Compute for the Post-
Neonatal Death rate.
Post Neonatal Death: 157, 450-59, 755= 97,
695
PNDR= (97, 695/1, 943, 776) X 1000
=0.05 x 1000
= 50 deaths
Interpretation:
-There are 50 deaths in every 1000 live births
occurred over 28 days after birth in children
less than 1 year old.
HEALTH IN THE PHILIPPINES Birth rate (births 23.4 (NDHS
per 1,000 2008)
Status and System population) 2,162,303 live
Halo-halo births per year
Death rate (Deaths 5.48 (NSO 2007)
- The name of this Filipino dessert translates per 1,000 515,192.34
to “Mix-mix” in English. To prepare this population) deaths/year
sweet treat, a variety of sweet fruits are
packed beneath crushed ice and topped
Top Ten Cause of Mortality
with milk and ice cream.
Cause Total Rate
The Halo-Halo that is the Philippines!
1. Diseases of the 70,861 84.8
- Halo-halo in terms of heart
o Population profile 2. Diseases of the 51,680 61.8
o Values and Perspectives on Health vascular system
o Health care delivery and financing 3. Malignant 40,524 48.9
Neoplasms
The Filipino Population 4. Accidents 34,483 41.3
5. Pneumonia 32,098 38.4
6. Tuberculosis 26,770 31.0
7. Unclassified 21,278 25.5
8. Chronic lower 18,975 22.7
respiratory diseases
9. Diabetes mellitus 16,552 19.8
10. Conditions 13,180 15.8
originating from the
perinatal period

-
Mortality Trend: Communicable Diseases,
The Philippine Government Malignant Neoplasms & Diseases of the Heart,
The Catholic Church Philippines, 1953-2005

Brief History of the Philippines

- Pre-colonial Times (Before 1521)

- Spanish colonialism (1521-1898)
- American regime (1898-1945)
- Japanese puppet republic (1941-1945)
- The Third Republic (1945-present)

Demographic Characteristics

Population, total 94,013,200 -

(in millions) (Projected, NSO
2007) Towards the attainment of MDGs
Population < 25 52.8% (Projected, Indicators 2015 Target Accomplishmen
years (% of total NSO 2007) t
population) 49,617,400 M MDG 4:
Filipinos Under 5 26.7 34 (2008
Population > 60 6.7% (Projected, mortality NDHS)
years (% of total NSO 2007) rate (per
population) 6,637,100 M 1,000 live
Filipinos births)
 Infant 19.0 (2008 NDHS) - Information
mortality - Medical products
rate (per - Financing
1,000 live - Leadership
births) o Access coverage
MDG 5: o Quality safety
Maternal 52 162 (2006 FPS) ▪ Improved health
mortality ▪ Responsiveness
ratio (per ▪ Risk protection
100,000 ▪ Improved efficiency
live births)
Proportion 70.0 (2010 62 (2005 Organization of Health Services
of births NOH) NDHS)
attended
by skilled
health
professiona
l
MDG 6:
Prevalence <1% 5,364 <1%
of cases (1984-
HIV/AIDS 2010)
among -
high risk - Public Private Sector Imbalance
groups o Highly resourced private sector servicing
Malaria 62/100,000 21.6/100,000 20-30% of population
morbidity pop; 38,135 pop; 19,555 o Health promotion/Disease prevention lag
rate cases (based cases (2009) behind Curative Service provision
from 1990 - Fragmentation of Services
baseline)
o Overspecialization of curative services
Malaria 0.75; 456 0.026; 24 o Devolution of health services – national
mortality deaths deaths (2009)
and local
rate (based from
o Weak regulatory mechanisms
1990
baseline)
TB 137/100,000 129 (2008);
morbidity ; 128,798 121,277 cases Health Care Financing in the Philippines
rate cases (2010
NOH)
TB <44/100,000 41.0 (2007) Share of health expenditure per GNP
mortality ; 41,366
rate deaths
(PhilPACT)
TB case 70% 75%
detection (NTB,2007)
rate
TB cure 85% 83%
rate (NTB,2007)

Six Building Blocks

-
- Service delivery
- Health workforce
Total Expenditure on Health as a Percentage The near poor and the lower middle classes can
of GDP become improvised to meet out of pocket for
health care

The very poor don’t even have pockets

Human Resources for Health

-
Distribution of Health Expenditure by Use of
Funds Health Worker Migration
-Overpopulation
-Maldistribution
-High out-migration
-Nil in-migration
-Low return migration

“It is estimated that 70% of all health workers

are employed in a private health sector that
serves only the 30% of the population that can
afford to pay for their health care.”
-
Distribution of Health Expenditure by “Sixty percent of our countrymen who succumb
Source of Funds to sickness die without seeing a doctor”

LEB over 80 years IMR less than 10 MM less

than 15

LEB under 60 years IMR over 90 MM over 150

-
PhilHealth
- Article 2, Section 2, R.A. 7875 as amended:
- Compulsory Coverage – All citizens of the
Philippines shall be required to enroll in the
National Health Insurance Program in order
to avoid adverse selection and social 87% of poorest quintile deliver at home
inequity
71% by hilots
Only those with money (i.e.. the rich) can fully
pay for out-of-pocket payments and often they 84% of richest quintiles deliver in health facility
have generous health insurance
77% by doctors
 Priority Health Policy Directions of the
Aquino Administration
1. A roadmap towards universal health
care through a refocused PhilHealth
2. Particular attention to the construction,
rehabilitation, and support of health
facilities.
-LGU/regional hospitals
-Rural health units
Maternal Mortality Rate -Barangay health stations
Per 100,000 Livebirths, UNDP Revision 3. Attainment of Millenium Development
Goals 4, 5 and 6
Country 1985-2002 -Reduction of maternal, neonatal,
Philippines 170 infant mortality
Thailand 36
-Support to contain/eliminate age old
Malaysia 30
pubic health diseases (malaria,
South Korea 20
dengue, TB)
Japan 8
Italy 7
Alma Ata Declaration, 1978
Spain 0
-“The Conference strongly reaffirms that
More than 3, 000 Filipina mothers die
health…is a fundamental human right”
UNNECESSARILY annually
-“The existing gross inequality in the health
status of the people particularly between
Reproductive Health Bill
developed and developing countries as well as
within countries is politically, socially and
economically unacceptable”
Right to Health of the People
-Section 15: The state shall protect and
promote the right to health of the people and
instill health consciousness among them

Social Determinants
DOH DO No. 2011-0188
(Kalusugan Pangkalahatan Universal health
Care)

Basic Question: What good does it do to treat
people’s illnesses…
-Only to send them back to the conditions
that made them sick?
“The doctor of the future will give no medicine,
but will interest his patients in the care of he
human frame, in diet, and in the cause and
prevention of disease”-Thomas Alva Edison
“It is my aspiration that health will finally be
seen not as a blessing to be wished for, but as
a human right to be fight for.”—Kofi Annan
The Power of Medicine
-“Medicine is a social science, and politics is
nothing else but medicine on a large scale.
Medicine, as a social science, as the science of
human beings, has the obligation to point out
problems and to attempt their theoretical
solution, the politician, the practical
anthropologist, must find the means for their
actual solution…The physicians are the
natural attorneys of the poor, and social
problems fall to a large extent within their
jurisdiction”—Dr. Rudolf Virchow (Father of
Social Medicine)
The Power of Young People
“The youth are the hope of the Fatherland”—
Dr. Jose Rizal
Principles of epidemiology
Epidemiology
-The study of distribution and determinants of
disease frequency in man (MacMahon, 1960)
-The study of the distribution and
determinants of health-related states or events
in specified populations, and the application of
this study to the control of health problems
(John M Last, 1960)
The three Dimensions in Epidemiology are:
PERSON
-Whom does the disease affect, age, sex,
ethnicity, income, rural vs urban etc.
PLACE
-Where does the disease occur? Rural/Urban
TIME
-During which period of the month, year, dry,
months, wet season, etc.
*They are used to describe the pattern of
disease occurrence
AIMS OF EPIDEMIOLOGY
-According to the International Epidemiological
Association (IAE), epidemiology has three main
aims which are to:
-Describe the distribution and magnitude of
health and disease problems in human
populations.
-Identify the etiological factors (risk factors)
in the pathogenesis of disease.
-Provide the data essential to the planning,
implementation, and evaluation of services
for the prevention, control and treatment of
disease and to the setting up priorities
among those services.
*The ultimate aim is to eliminate or reduce the
health problem or its consequences.
*To promote the health and well-being of
society as a whole.
Uses of Epidemiology
-Disease surveillance
-Search for causes
-Determining the natural history of disease
-Searching for prognostic factors
-Testing for new treatments
-Diagnostic testing
Natural History of Disease
 Psychological environment. Psychological
factors can affect health and well-being
negatively.
-Poverty
-Urbanisation
Migration
-Exposure to stressful situation such as
bereavement, desertion, loss of employment,
birth of handicapped child may produce
feelings of anxiety depression, anger,
frustration

Epidemiological Triad Spectrum of Disease

-Agent -The spectrum of disease is a graphic
-Host representation of variations in manifestation of
-Environment the disease.
-At one end of the disease spectrum is the sub-
Agent Host and Environmental Factors clinical infections which are not ordinarily
AGENT Factors: identified and at the other end is fatal illness.
Virus, bacteria, rickettsiae, protozoa, etc. -The spectrum includes sub-clinical, signs and
-Depends on infectivity, pathogenicity symptoms, illness, disability, chronic illness,
and virulence death.
Nutrient agents (fats, CHO, proteins, vitamins -The different manifestations of the disease are
and minerals) simply reflections of individuals’ different
-Physical agents: heat, cold, humidity, states of immunity and receptivity.
pressure, radiation, electricity, sound, etc. -The sequence of events in the spectrum of
-Chemical agents: allergens, metals, fumes, disease can be interrupted by early diagnosis
dust, insecticides and treatment or by preventive action.
-Mechanical agents: crushing, tearing,
sprains and Multifactorial Causation of Disease
dislocations -Single causation of disease like the germ
-Social agents: poverty, smoking, alcohol, theory is oversimplification.
drugs, social isolation -Disease is due to multiple factors.
-We now look beyond the ‘germ theory’ and look
Host factors into total life situation and the community in
-Demographic factors: age, sex, ethnicity search of multiple (risk) factors of the disease.
-Biological factors: genetic factors, -Social, economic, cultural, genetic and
biochemical levels of blood, immunological psychological factors.
factors -TB is not only due to bacillus. Poverty,
-Social and economic status, education, overcrowding, and malnutrition are
occupation, marital status, housing also contributing factors.
-Lifestyle factors like personality, traits, living -Coronary heart disease can be due to
habits, physical exercise, alcohol, drugs, and excess intake of fat, smoking, lack of
smoking exercise, obesity, etc.

Environmental factors Web of Causation of Disease-MacMahon and

-Physical environment (air, water, soil, Pugh
housing, climate, geography, heat, light, noise,
debris, radiation)
-Biological environment (virus, bacteria,
insects, rodents, animals and plants)
 Cyclo-propagative—The agent changes in
form and number, e.g. malaria parasite in
mosquito
Cyclic developmental—The agent only
undergoes developmental but no
multiplication, e.g. microfilaria in mosquito
-It can be from one generation to another or
vertical transmission (transovarian
transmission)
-It can be trans-stadial transmission (from 1
Mechanism of Transmission stage of life cycle to another, e.g. nymph to
adult)
-Injection of salivary fluid during biting, or by
A. Direct transmission
regurgitation or deposition on the skin or other
material capable of penetrating through the
1. Direct contact
bite wound
Touching, kissing, biting, sexual
intercourse
Direct and Indirect Transmission
2. Direct projection
-Droplet spread – droplet spray into the
conjunctiva or into the mucous
membrane of eye, nose or mouth during
sneezing, coughing, spitting, singing or
talking (usually 1 metre).

B. Indirect transmission
1. Vehicle borne
-Contaminated inanimate materials
Fomites (soiled clothes, hankies, toys,
bedding, eating utensils, surgical instruments
or dressing): diphtheria, typhoid fever,
dysentery, hepatitis A, intestinal parasites
Water- and food-borne diseases: typhoid
fever, cholera, polio, hepatitis A, food
poisoning and intestinal parasites
Milk: typhoid, cholera
Biological products: blood (Hepatitis B,
malaria, syphilis, brucellosis, trypanosomiasis,
infectious mononucleosis, cytomegalovirus
infection)
-Serum, tissue organs (cytomegalovirus)
2. Vectorborne
-Mechanical-carried bacteria by insects, e.g.
fly (cholera, typhoid)
-Biological propagation
-Propagative—the organism multiplies in
vector but no change in form (multiplication),
e.g. plague bacilli in rat flea
3. Airborne
-Dissemination of microbial aerosols to
suitable portal of entry, usually the
respiratory tract.
Droplet nuclei (tiny particles 1–10 microns
range) They may be formed by:
-Evaporation of droplets coughed or
sneezed in the air
-Aerosols generated purposely as in
laboratory, abattoirs
-The droplet nuclei may remain for a long
period of time
-Some retain infectivity and virulence while
others lose it
-Particles of 1–5 microns are liable to be drawn
into the alveoli
-E. g. tuberculosis, influenza, chicken pox,
measles, Q fever, and many other respiratory
infections
Dust – Some of the larger droplets which are
expelled during talking, coughing, or sneezing
settle down by their sheer weight on the floor,
carpet, furniture, clothes, linen bedding.
E.g. pneumonia, tuberculosis, Q fever,
coccidoidomycosis and psittacosis, fungus
spores
4. Transplacental transmission
Transmitted from placenta to the baby
E.g. syphilis
Incubation Period
The time interval between initial contact with
an infectious agent and the appearance of the
first sign or symptoms of the disease. E.g.
Cholera 2–3 days
Dengue 3–14 days
Chicken pox 2–3 weeks
Communicable Period (Period of
Communicability)
-The time period during which an infectious
agent may be transferred directly or indirectly
-from an infected person to another person
-from an infected animal to man
-from an infected person to an animal including
arthropods.
-Chicken pox is 1–2 days before the
occurrence of rash and 5 days after the 1st
crop of vesicles.
-Dengue is infective to mosquitoes before the
end of febrile period with an average of 5
days. The mosquito then becomes infective
for life.
Iceberg Phenomena
-This concept is closely related to spectrum of
disease.
-The floating tip of the iceberg is what the
physicians see in the community and seek
treatment (clinical cases).
-The vast submerged portion of the iceberg
represents the hidden mass of disease (latent,
unapparent, pre-symptomatic, undiagnosed
cases, carriers) which the physician does not
see.
-A larger number of people do not seek
treatment compared to the ‘tip’ of the iceberg –
those who seek treatment.
Incidence and Prevalence
-Incidence is the number of new cases.
-Incidence rate is the frequency of occurrence
of new illness in a population.
-Prevalence is the number of new and old cases.
-Prevalence rate is the total number of cases
(old and new) in a population in a given point
in time.
-Point prevalence is the number of persons in a
defined population who had a specified disease
or condition at a particular point in time
(usually the time the survey was done).
-Period prevalence is the number of persons
who had a specified disease at any time during
the specified time interval.
-Data on population is not easily available. The
mid-year population is often used as the
denominator as it is considered a good estimate
of the average number of people at risk.
-Factors that influence prevalence rates
include severity of illness, duration of illness
and the number of new cases.
Incidence Rate (I)=No. of children who get a
disease during certain period X Animal Reservoirs
1000/Population at risk
Prevalence Rate (P)
Point prevalence rate= No. of people who have
a disease in a specified time X 1000/
Population exposed to the risk at that point in
time
Prevalence of disease may be increased by
-Longer duration of disease
-Prolongation of life without cure
-Increase in incidence
-Improved diagnostic facilities
-Immigration of susceptible people
-Prevalence is dependent on incidence and
duration of disease or
P = I x D, I = P/D, D = P/I
(P is prevalence, I is incidence, D is duration
of the disease)
Reservoirs of Infection
Any person animal or, plant, soil or substance
(or combination of these) in which an infectious
agent lives or multiplies. On which it depends
primarily for survival and where it reproduces
in such a manner that it can be transmitted to
a susceptible host.
E.g. mosquito for malaria, filaria and
dengue
-These places of growth and multiplication are
known as reservoirs of infection.
-Reservoirs can be:
-Human reservoirs
-Animal reservoirs
-Other reservoirs
Human Reservoirs
Cases
-Some diseases are infective in the late
incubation period as well as in the clinical
stage, e.g. diphtheria, chicken pox.
-Most diseases are infective during some
portion of the clinical stage.
Subclinical infection
-Person has no symptoms or the symptoms
may be atypical. Since it is not detected, the
risk to community is great.
-Ratio of mild or subclinical infections or severe
infections varies for different diseases.
The main animal reservoirs are domestic
animals and rodents. Wild animals are also
reservoir for certain diseases.
Insect vectors bridge the gap between man and
animals in a number of diseases.
Other reservoirs
-Soil
Carrier
-A person or animal that harbours an
infectious agent in the absence of clear clinical
disease and serves as a potential source of
infection.
-Healthy carrier (asymptomatic carrier)—
Has the disease but does not show sign and
symptoms.
-E.g. Hepatitis B, diphtheria, typhoid, etc.
Incubatory carrier—A person who can
transmit the infection (during the incubation
period) before they become symptomatic, e.g.
hepatitis A.
Convalescent carrier—Those who continue
to shed the organisms for variable periods of
time after an acute illness (during the
convalescent period), e.g. typhoid fever,
shigellosis
Chronic Carriers
-Some carriers could be chronic or
permanent and others could be transient.
-Chronic or permanent carriers harbour
the organisms for long periods of time
(years). 2–5 % of typhoid cases become
chronic carriers, e.g. typhoid Mary.
-Transient carriers harbour the organisms
for a short period of time.
-The efficacy of the human reservoir depends
on
-the manner in which the infective agent
is extruded.
-the length of time the reservoir remains
infective.
Epidemic Management
Epidemic: The occurrence in a community or
region of cases of an illness (or an outbreak)
clearly in excess of expectancy. The number of
cases will vary according to the infectious
agent, size, and type of population exposed,
previous experience or lack of exposure to the
disease and time and place of occurrence
Endemic: Constant presence of a disease or
infectious agent within a geographical area
Pandemic: Global occurrence of a disease, e.g.
cholera, bird flu

Primary index case: The first case or group of

cases arising from the introduction of an agent
into the community
Secondary case: People who acquire infection
from the primary index case

Common Source Epidemic Propagated Epidemic

Common Source Epidemic (Point Source
Epidemic)
-The epidemic curve rises and falls rapidly
with no secondary waves.
-The epidemic tends to be
explosive with clustering
of cases within a narrow
interval of time.
-All the cases develop within
one incubation period of
the disease.
-They can result from air,
water, food, soil, etc.
-Outbreak is from person to person
transmission of the infectious agent, e.g.
measles, whooping cough
-The epidemic occurs over a long period (more
than one incubation period)
-Secondary and tertiary peaks occur
-Some epidemics may have both types of
source, initially resulting from common source
and subsequently resulting from person to
person spread.
-Person to person spread
-Epidemic of Polio and Hepatitis B
-Speed depends upon herd
immunity, opportunities of
contact, and secondary
attack rate
-Occurs where there are
large number of susceptible
are aggregated
-More than 1 incubation
period

Common Source: Repeated Exposure

-Sometimes the exposure from the same source
may be prolonged.
-E.g. A prostitute may be a common source in
a gonorrhea outbreak, a well with
contaminated water may be infected
Epidemic Measures -Sexual Lifestyle
-Verification of diagnosis -Stress Management
-Spurious report, may arise from
misinterpretation of data Specific Protection
-Confirmation of diagnosis -Vaccination against preventable diseases
-Confirmation of the existence of an epidemic like Diphtheria, Pertussis, Tetanus,
E.g. 2 cases of dengue, 1 case of cholera, Whooping cough, Hepatitis B, Haemophilus
etc. Influenza, Poliomyelitis, Measles, etc.
-Defining the population at risk -Attention to personal hygiene, genetic
Getting the map of the area and screening
counting the population -Provision of adequate housing and
-Rapid search for all cases and their recreation
characteristics -Protection against occupational hazards
-Surveys, epidemiological case sheet, search
for more cases Chemoprophylaxis
-Data analysis (time, place, person) -Chloroquine against malaria
-Preventive measures to be taken
Population at risk to SECONDARY PREVENTION
be educated Early Diagnosis and Treatment
-Effective treatment -Screening test to diagnose diseases
facilities -Borderline Hypertension (130/80-84)
-Ensure safe water supply -Diabetes: control blood sugar by diet and
-Food handling treatment
-Investigation -Cervical cancers: do Pap smear
-Sewage disposal -Breast self-examination (BSE) and
-Vaccination if necessary mammography for breast cancer

Three Levels of Prevention (Leavell and Disability Limitation: prevent complications

Clarke) Rheumatoid Arthritis
Definition -Exercise to maintain muscle mass and
-Prevention is an activity which protects the range of joint movement
individual or population from the exposure Diabetes
to the causes of disease, disability or injury -Care of the skin and feet to prevent
or which enhances the ability to withstand infection, gangrene, amputation of toes and
the onslaught of specific causative agents. feet, prevent retinopathy, nephropathy,
Primary prevention neuropathy
-Health promotion (healthy lifestyle, Poliomyelitis
wellness) -Avoid injections, physical exercise during
-Specific protection (immunisation) acute phase to minimize paralysis of muscle
Secondary prevention
-Early diagnosis and prompt treatment TERTIARY PREVENTION
-Disability limitation Rehabilitation
Tertiary Prevention -When a defect or disability has occurred,
-Rehabilitation the aim is to restore maximum function
-Poliomyelitis residual paralysis from
PRIMARY PREVENTION polio can be overcome by use of calliper
Health Promotion splints or other devices
-Healthy Lifestyle -Visual and hearing defects
-Breast feeding -Mild refractive errors can be corrected
-Diet and Physical Exercise by use of glasses
-Tobacco Smoking -Partial deafness can be corrected by
-Alcohol and Drug Abuse wearing hearing devices
Public Health Nursing VS Community
Public Health by: Dr. C.E Winslow (1982)
-the Science and ART of preventing disease,
PROLONGING Life, Promoting health and
EFFICIENCY through;
a. ORGANIZED community effort for the
sanitation of the environment
b. control of communicable disease
c. the education of individuals in personal
hygiene
d. the organization of medical and nursing
services for the early diagnosis and treatment
of disease
e. the development of social machinery to
ensure everyone a standard of living adequate
for the maintenance of health for everyone
Public Health by Hanlon (1984)
-Public health dedicated to the common
attainment of the highest level of physical,
mental and social well-being and longevity
consistent with available knowledge and
resources at a given time and place.
Public Health Nursing by WHO
-WHOECoN defines public health as special
field of nursing that combines the skills of
nursing and public health and some phases of
social assistance and functions as part of the
total public health program for the promotion
of health, the improvement of the conditions in
the social and physical environment,
rehabilitations of illness and disability.
Public Health Nursing
-Refers to the practice of nursing in national
and local government health departments
(which includes Health Centers and RHU) and
public schools
-It is community Health Centers and RHU) and
public schools
-It is community health nursing practiced in
the public sector
-“A specialized filed of nursing that combines
the skills of nursing, public health and some
phases of social assistance and functions as
part of the total public health program for the
promotion of health, the improvement of the
conditions in the social and physical
environment, rehabilitation of illness and
disability” (WHO Expert Committee of Nursing)
DOH
-A unique blend of nursing and public health
practice woven into a human service that,
properly developed and applied has a
tremendous impact of human well being.
-Its responsibilities extend to the care and
supervision of individuals and families in their
homes, in place of work, in schools and clinics
Community Health Nursing
-A service rendered by a professional nurse
with communities, groups, families, individuals
at home, in health centers, in clinics, in
schools, in palces of work for the promotion of
health, prevention of illness, care of the sick at
home and rehabilitation (Ruth Freeman)
-Some definitions indicates CHN is broader
than PHN because it encompasses “nursing
practice in a wide variety of community services
and consumer advocate areas, and in variety of
roles, at times including independent practice,
CHN is certainly not confined to PHN agencies.”
(Jacobson)
-A field of nursing that is a blend or synthesis
of nursing practice with public health using
primary health care as the tool in the delivery
of health services
-A service rendered by professional nurse to
individuals, families, communities and
populations groups in health centers, clinics,
schools and the workplace in order to promote
health, prevent illness, provide care for the sick
at their respective homes, provide effective
rehabilitation.
Philosophy of Community Health Nurse
-The philosophy of CHN is based on the worth
and dignity of men
-This philosophy of care is based on the belief
that care directed to the individual, the family,
and the group contributes to the healthcare of
the population as a whole
Goals of Community Health Nurse
-To assist the individual, family and
community in attaining their highest level of
holistic health which is attained through
multidisciplinary effort and to promote
reciprocally supportive relationship between
people and their physical and social
environment

Community Health (CH) vs Public Health
(PH)
CH: Identification of needs and the protection
and improvement of collective health within a
geographically defined area
PH: Activities that society undertake to assure
the conditions in which people can be healthy
Community Health Nursing
-A unique blend of nursing and public health
practice woven into a human service that,
properly developed and applied has a
tremendous impact on human well-being
Population-focused Nursing:
Community or public health nursing is
population based.
Care may be given to individuals and families,
but its purpose is the improvement of the
health of the population as whole
Population-focused practice
-Focus on the entire population
-Is based on assessment of the populations’
health status
-Considers the broad determinants of health
-Emphasizes all levels of prevention
-Intervenes with communities, systems,
individuals and families
The mission of community health nursing:
-The primary mission of community health
nursing is improving the overall health of the
population through health promotion, illness
prevention, and protection of the public from a
wide variety of biological, behavioral, social and
environmental threats
-Promote the good life in all of its physical,
social, psychological, cultural and economic
aspects (Uosukainen, 2001)
CHN by Dr. Ruth Freeman
is a service rendered by a professional nurse
(CHN/PHN) with community, groups, families
and individuals at home , in health centers ,in
clinics ,in schools ,in places of work for the
promotion of health , prevention of illness ,care
of the sick at home and rehabilitation .
Philosophy of CHN
Dr Margaret Shetland, mentioned that the
PHILOSOPHY OF CHN is based on the worth
and dignity of man.
Community Health Nursing (CHN) is a vital
part of Public Health and there are 12
Principles the govern CHN
1. CHN is based on the recognized needs of
individuals, families and communities, groups
and individuals.
2. The CHNurse must understand FULLY the
objectives and policies of the agency he
represents.
3. CHN considers the family as the unit of
service.
4. CHN must be available to all regardless of
race, creed, color or socio-economic status
5. The CHNurse works as a member of the
health team
6. There must provision of periodic evaluation
of CHN services
7. Health teaching is a basic and primary
responsibility of the community health nurse.
8. Opportunities and continuing staff
education program for nurses must be provided
by the CHN agency. The CHN is responsible for
his own professional growth.
9. The Community Health Nurse use available
community health resources.
10. Active participation of the individual, family
and community in planning and making
decisions for their health care needs,
determine, to a large extent, the success of the
CHN programs.
11. There must be provision of for educative
supervision in CHN
12. There should be accurate recording and
reporting in CHN
Recipients of Care by Community Health
Nurses
1. The Individual: Specific person/client in
various stages of health or illness
2. The Family: Group of people affiliated by
consanguinity, affinity or co-residence,
Basic unit of society
3. Population Groups: Nuclear, Conjugal,
Extended, Single-parent, Blended,
Traditional
4. Community:
 -Vulnerable groups or those at
risk of developing certain
health or health related
problems
-A broad term for fellowship or
organized society
-A group of people sharing
common geographic
boundaries and or common
values and interests
-The group which functions
within a particular socio-
cultural context and varying
physical environment
Directing
-Communicating and conveying to the health
workers what have transpired during the
planning and organizing
Coordinating
-Getting their acts together
-Singing the same tune
-Harmony, achievement of objectives and the
development of teamwork
Controlling
-Measures and corrects the activities or
functions of the people so that objectives are
met

Evaluating
The Community Health Nurse
-Assessing or appraising performance by
-The priority of community health nurse is to
comparing it with the performance standards
promote and maintain health and prevent the
and performing the needed modifications or
occurrence of disease or illness
revisions
-Conducts a continuing and comprehensive
practice that is preventive, promotive, curative
CHNurse:
and rehabilitative
Role model
-Delivers nursing services in community
Provides good example/model of healthful
settings
living to the public/community.
-Participation of all consumers of health care is
encouraged in the development of community
Health Monitor
activities
Coordinator of Services
-Management Functions of the Community
Providing of Nursing Care
Health Nurse:
-Develops the family’s capability to take care of
-Planning
the sick, disabled or dependent member
-Directing
-Provides direct nursing care to the sick,
-Controlling
disabled in the home, clinic, school or place of
-Organizing
work
-Coordinating
-Provides continuity of patient care
-Evaluating
Trainer/Counselor/Health Educator
Planning
-Conducts premarital counselling
-Establish the VMGO
-Train BHWs
-Attainment and maintenance of optimum
-Seminars on basic health services
individual and community health
Community Organizer
-Initiates and participates in community
Organizing
development
-Putting order and system
-Responsible for motivating and enhancing
-3 Components of community health
community participation in terms of planning,
organizing
organizing and implementing and evaluating
Man/people-health care workers
health program/services
Work-machine and equipment
Interpersonal relationships
Change Agent
-Motivates changes in health behavior of
individuals, families, group and community
 including lifestyle in order to promote and
maintain health.
Manager/Supervisor
-Interprets and implements program Policies
Memoranda and circulars
Researcher
-Participates/assists in the conduct of surveys,
studies and researchers on nursing and health-
related subjects
-Coordinates w/ GOs & NGOs in the
implementation of studies/research
-Detects deviation from health of individuals,
families groups of the community through
contacts/visits with them
-Uses symptomatic and objective observation
and other forms of data gathering
-Morbidity
-Registry
-Questionnaire
-Checklist
-Anecdote report
-Record to monitor growth and
development
-Health status of individuals, families
and communities
Planner/Programmer
-Formulates nursing component of health
plans
-In doctor-less area, she/he is responsible for
the formulation of the municipal health plan.
-Implements the nursing assistance to rural
health midwives in health matters like target
setting etc.
-Identifies needs, priorities and problems of
individuals, families and communities
The Community Health Nurse-Activities
1. Home Visit
-A professional face to face
contact made by a nurse to the
patient or the family in order to
provide necessary health care
activities and further attain an
objective of the agency
Purpose of Home Visit
-Gather all available information
-Confirm all the data gathered during the home
visit
-Prioritize the needs which have been identified
by the family
-Involve the individual and family from
assessment to the implementation phases
Phases in Home Visitation
Preparatory Phase
-Review existing records or referral data before
-Notify the family of your intent to visit
-Introduce self and explain the purpose
Home Visit Phase
-Actual visit to the patient
-Conduct assessment, planning, and health
teaching
-Perform nursing interventions as needed
Post Visit Phase
-Record the data in the chart
Plan for your next visit
-Referral to other health professionals
Component of Community Health Practice
-Community health practice can be best
understood by examining six basic
components, which, when combined,
encompass its services and programs, These
components are:
1. Promotion of health
-Includes all efforts to move people closer to
optimal well-being or higher levels of wellness
The goal of health promotion:
-Is to enable people to exercise control over
their well-being and ultimately improve their
health
-Is to raise levels of wellness for individuals,
families, populations and communities
3.Treatment of disorders
-It focuses on the illness end of the continuum
and is the remedial aspect of community health
practice
--This occurs by three methods:
1. Direct service to people with health problem
2. Indirect service that helps people to obtain
treatment
3. Development programs to correct unhealthy
conditions
4.Rehabilitation
-The fourth component of community health
practice, involves efforts to reduce disability
and, as much as possible, restore function.
-People whose handicaps are congenital or
acquired through illness or accident e.g.
Stroke, heart condition, amputation, mental
illness
5.Evaluation
-The process by which that practices is
analyzed, judged, and improved according to
established goals and standards
6.Research
-Is systematic investigation to discover facts
affecting community health and community
health practice, solve problems, and explore
improved methods of health services.
COVID-19 ORIENTATION to CAMPUS
COVID 19 What is it?
- Virus
- Highly contagious
- Has already developed numerous variants
throughout the world, which allow it to spread
quicker than the original sars-cov-2 virus (Covid-19).
- Omicron is the latest variant of concern and
research has indicated that it is more infectious, has
a shorter incubation period (two to four days), and
may be better at evading the immune response
generated by both vaccines and natural immunities.
- There is no confirming data on the severity of
symptoms, compared to previous circulating
variants.
Why is this so concerning?
- Pandemic fatigue has developed, making it difficult
for individuals to continue to comply with the
various strategies to contain the virus.
- Numbers of individuals in isolation, anxiety, and
mental health issues are arising for various reasons.
- With the variants spreading quicker;
- It can put a strain on the healthcare resources
(Covid-19 test sites, doctor’s offices, hospitals, labs)
- Existing health issues continue to compound, as
surgeries are cancelled and people will continue to
avoid obtaining healthcare for routine preventative
measures
- It can put a strain on community resources (ex: taxi
services and ambulance services take longer for turn
around due to disinfectant processes, increased
costs)
How does it spread?
- Through respiratory droplets
- The virus can live as an aerosol in a closed area, up
to 3 hours after an individual leaves the space.
- The virus is released in the air as an aerosol when
an infected individual coughs or sneezes
- Close prolonged contact (defined as 15 minutes
within a 24 timeframe), or breathing the same
infected air for 15 minutes
- Touching an infected area and then touching your
eyes, nose or mouth
VULNERABLE POPULATIONS THAT MAY PUT YOU AT
INCREASED RISK FOR DEVELOPING SEVERE COVID 19
- older adults (increasing risk with each decade,
especially over 60 years)
- people of any age with chronic medical conditions
(for example, lung disease, heart disease, high blood
pressure, diabetes, kidney disease, liver disease,
stroke or dementia)
- people of any age who are immunocompromised,
including those with an underlying medical
condition (for example, cancer) or taking
medications which lower the immune system (for
example, chemotherapy)
- people living with obesity (BMI of 40 or higher)
- Anyone who is:
o An older adult
o At risk due to underlying medical conditions (e.g.
heart disease, hypertension, diabetes, chronic
respiratory diseases, cancer)
o At risk due to a compromised immune system
from a medical condition or treatment (e.g.
chemotherapy)
- Anyone who has:
o Difficulty reading, speaking, understanding or
communicating
o Difficulty accessing medical care or health advice
o Difficulty doing preventive activities, like
frequent hand washing and covering coughs and
sneezes
o Ongoing specialized medical care or needs
specific medical supplies
o Ongoing supervision needs or support for
maintaining independence
o Difficulty accessing transportation
o Economic barriers
o Unstable employment or inflexible working
conditions
o Social or geographic isolation, like in remote and
isolated communities
o Insecure, inadequate, or nonexistent housing
conditions
INDIVIDUALS MORE LIKELY TO BE EXPOSED TO COVID 19
- Their jobs or occupations require them to be in
contact with large numbers of people, which
increases their chances of being exposed to
someone who has COVID-19
- They live in group settings where the COVID-19 virus
may transmit more easily (for example, long-term
care facilities, correctional facilities, shelters, or
group residences)
- They face barriers that limit their ability to access or
implement effective public health measures (for
example, individuals with disabilities who encounter
non-accessible information, services, facilities,
and/or language barriers)
SETTINGS ASSOCIATED WITH INCREASED RISK
- Closed spaces
o With poor ventilation
- Crowded spaces
o With many people nearby
- Close contact scenarios, where minimum 1 metres
(3 ft) distancing cannot be maintained
o Such as close-range conversation
- Close range conversations
- Settings where there may be singing, shouting, or
heavy breathing
- ***Try and avoid spaces where theses scenarios
overlap, especially if masks are not being worn
- Ex: closed spaces that are crowded with close-range
conversations
RISKS
- The overall risk for citizens of acquiring Covid-19
remains high
- The risk remains unique to the area and varies
between and within communities
WHAT HAPPENS WHEN YOU GET EXPOSED?
- The virus gets in your body through your eyes, nose,
or mouth
- It attaches to the ACE2 receptors in the body, which
is a protein that lines our organs (lungs, heart, blood
vessels, kidneys, liver, GI tract)
- Once it attaches to these proteins, it causes
inflammation
- This can overwhelm your immune system
- Under certain conditions (increased risk factors
discussed later), there is an increased risk of
experiencing severe symptoms of the COVID-19, or
even death
INCUBATION
- Once you are exposed to COVID-19, you can develop
symptoms up to 14 days after exposure.
- Preliminary research indicates that Omicron is more
infectious, has a shorter incubation period (two to
four days), and may be better at evading the
 immune response generated by both vaccines and
natural immunities.
- There is no confirming data on the severity of
symptoms, compared to previous circulating
variants.
- Symptoms can vary from person to person and
within different age groups.
- Severity of symptoms can range from mild to
severe.
INFECTION AND RECOVERY
- A person with COVID-19 is generally considered
infectious
- Beginning 48 before symptoms started, or if no
symptoms, 48 hours before the positive test was
taken
- Ending 10 full days after the start of symptoms (or
10 full days from test date if no symptoms) AND
feeling better (no fever and improving).
- You need to self-isolate while you are considered
infectious to limit further spread.
- You are considered recovered when you are no
longer infectious: typically, 10 days after symptoms
have started (with first day of symptoms being
considered Day zero), no fever, AND you are feeling
better
- For the immediate three months (90 days) after you
are considered recovered, COVID-19 testing is
typically not recommended. If you develop
symptoms in these 3 months, you must self-isolate
until symptoms resolve.
RECOVERY TIMEFRAME
- Most people with COVID-19 recover or feel better
within two weeks.
- Severe cases can take longer than 6 weeks and may
or may not cause permanent damage to your
organs.
- Long-haulers are considered individuals who have
persistent symptoms for 4 weeks or longer that are
continuous or arise weeks or months after initial
recovery.
o Many will suffer for months, and report
prolonged, multisystem involvement and
significant disability.
o Long haulers Symptoms
▪ Tiredness or fatigue
▪ Difficulty thinking or concentrating/ brain fog
▪ Difficulty breathing or shortness of breath
▪ Dizziness on standing
▪ Cough
▪ Headache
▪ Chest or stomach pain
▪ Change in smell or taste
TO DECREASE RISK OF EXPOSURE
- If you have symptoms, even if they are mild- stay
home and get tested
- Wear a mask when you experience symptoms and
are in close contact with others
o Ex: accessing medical care
- Follow Public Health Directives
o Physical distance, handwashing, wear a mask,
adhere to gathering limits
WHAT TO DO IF EXPERIENCING SYMPTOMS
- If in the past 48 hours you have had, or you are
currently experiencing:
o Cough (new or worsening)
▪ OR Two or more of the following symptoms:
• Fever (chills, sweats)
• Headache
• Runny nose or nasal congestion
• Sore throat
• Shortness of breath or difficulty breathing
- Self-isolate immediately and complete a COVID self-
assessment
TESTING STRATEGIES AS OF DECEMBER 27, 2021
- With the significant increase of COVID-19 cases in
Nova Scotia, testing strategies have changed.
- Beginning December 27, individuals who require a
COVID-19 test will need to perform a self-
assessment.
- PCR tests will be available for certain individuals
that remain more vulnerable or meet certain
criteria.
PCR TESTING ELIGIBILITY
- People who have symptoms, or have been identified
as a close contact of a positive case, AND
o are considered at increased risk for severe
disease
o live in congregate settings, OR
o are integral to keeping our health system running
- Testing required for a medical procedure
- Partially or unvaccinated travelers who need 2
negative PCR tests to stop isolating after at least 7
days
RAPID TESTING ELIGIBILITY
- All other symptomatic persons or identified as close
contacts can book an appointment for a rapid test
pick-up at a COVID-19 Testing Centre. Drop-in
appointments are NOT available.
- If you have rapid test kits at home, it is important to
note:
- 2 negative tests, 48 hours apart = negative (unless
you are not fully vaccinated and have ongoing
symptoms, in which case you need a third negative
test)
- 1 positive = positive – no confirmation PCR test
necessary.
- If you are using a rapid test and your result is
positive, you do not need to do a follow up PCR test.
You have COVID-19 and you need to isolate and
notify your close contacts.
I’VE TESTED POSITIVE FOR COVID 19 WHAT DO I DO?
- Immediate Actions:
- Self-isolate right away
- Ask your household contacts to self-isolate right
away.
- Reach out to close contacts
- ***All household contacts will need to self-isolate
until they receive a negative test result (collected at
least 72 hours after the last exposure).
WHAT SHOULD I EXPECT IF I TEST POSITIVE WITH A PCR
TEST?
- Expect a text message, email, or phone call from
Public Health.
People with a cell phone will receive a text
notification to confirm you have tested positive.
Please note: If you have a landline, you will still
receive this information in your call from Public
Health.
- Register for Public Health’s daily check-in service. A
link to this service will be included in your text
notification.
- Expect a call from the COVID Community Virtual
Care Team (CCVCT).
These calls – and calls from Public Health – may
show up as an unknown number. It’s important that
you answer the phone. A virtual care team member
will call you to give you information and tools to
help monitor and manage your symptoms at home.
They can send you a pulse oximeter. This is a device
that measures the percentage of oxygen in your
blood. They will also tell you how to use it.
- Seek medical help if your symptoms get worse by
calling 811 or 911.
INFORMATION FOR CLOSE CONTACTS
- I am: FULLY vaccinated
- Self-isolate immediately and follow the instructions
below:
- I have symptoms and am fully vaccinated:
- Complete a test immediately and then again 72
hours after the last
exposure. You can only exit isolation if:
- PCR test: A PCR test collected at least 3 days (72
hours) after your last exposure is negative AND you
are feeling better (fever has resolved and other
symptoms are improving).
- Rapid tests: Two rapid tests completed 24-48 hours
apart are BOTH negative AND you are feeling better
(fever has resolved and other symptoms are
improving). The first of the two rapid tests should be
collected at least 3 days (72 hours) after your last
exposure.
- If you have ongoing symptoms, remain in isolation.
Re-test in 24-48 hours and only leave isolation once
you are feeling better.
- If you do not complete testing, you are required to
isolate a full 10 days from your symptom onset.
CLOSE CONTACTS
- Some individuals will need to isolate longer
depending on their vaccination status and whether
they are able to break contact from the person who
has tested positive for COVID-19.
- **The significant surge in COVID-19 cases in Nova
Scotia has resulted in a backlog in Public Health
contacting positive cases and close contacts. Public
Health asks that you notify any social contacts.
WHAT HAS THE GOVERNMENT DONE TO HELP BREAK
THE CYCLE OF INFECTION?
- Canadian and the Nova Scotia governments have
implemented a standard prevention method to limit
the spread of coronavirus within our
communities. This varies according to vaccination
 rates and hospitalizations and is unique to each
provincial re-opening phase.
- Education, Public Health Directives, timely access to
vaccines, symptomatic testing, providing resources
to move through the pandemic, and awareness
communication related to positive cases and
mitigating further spread.
WHAT HAS ACADIA UNIVERSITY DONE TO MAKE IT SAFE
FOR EVERYONE?
- We have followed the Hierarchy of Controls and
implemented the following policies and protocols
on campus:
o Elimination Controls
o Substitution Controls (not applicable)
o Engineering Controls
o Administrative Controls
o PPE (personal protective equipment)
- ELIMINATION CONTROLS
o Daily self-assessment (If you feel unwell-STAY
home or in your residence). Go online and
perform a self-assessment at https://covid-self-
assessment.novascotia.ca/en to determine the
appropriate testing strategy unique to your
situation.
o Options for virtual meetings for faculty, staff and
students
o Proactive contact tracing on campus
- CONTACT TRACING ON CAMPUS
o CCTV
o Class attendance records,
o Acadia Wi-Fi, and
o Electronic Access Controls.
- ENGINEERING CONTROLS
o Physical distancing measures have been
implemented according to Nova Scotia Public
Health and the Government of Nova Scotia
o Restricting numbers of occupants in elevators
and small spaces
o Physical barriers have been considered and
implemented where physical distancing is not
possible (following provincial directives)
o Increased the number of handwashing stations in
high traffic areas
o Re-routed ventilation to bring in more fresh air
into the buildings on campus
- ADMINISTRATIVE CONTROLS
o Implemented policies, procedures, and protocols
to maintain safety and compliance with
provincial directives and to protect our
vulnerable campus members.
o Implemented a COVID-19 vaccination strategy
for campus members, to protect those
individuals that are most vulnerable.
o Educated faculty, staff and students on COVID-19
awareness, prevention and importance of
compliance
o Increased number of cleanings in high touch
areas and high traffic areas (above routine
cleaning) such as doorknobs, light switches, and
faucets
o Advanced planning, clear communication, and
appropriate training, regarding addressing
potential positive COVID-19 cases
- PERSONAL PROTECTIVE EQUIPMENT (PPE)
o PPE is used when other controls cannot be met
o Wear a mask (3-ply mask, which is now
recommended with the Omicron variant)
o Launder non-medical cloth masks appropriately
after each use
o Face shields, gloves, gowns, and 3-ply disposable
face masks will be supplied to those individuals
that may encounter someone with potential
symptoms while in the course of their duties
(e.g., quarantine/ self-isolation/ isolation
periods)
- WHAT CAN YOU DO? GET VACCINATED
o Pfizer-BioNTech Comirnaty, Moderna
Spikevax and AstraZeneca Vaxzevria are
approved for use in Canada as 2-dose COVID-19
vaccines. Janssen (Johnson & Johnson) is
approved for use in Canada as 1-dose COVID-19
vaccine.
o Each vaccine has different recommendations on
who can receive it and different levels of efficacy.
o People who choose to receive a viral vector
vaccine (AstraZeneca or Janssen) should be
aware that AstraZeneca and Janssen (Johnson &
Johnson):
▪ are less effective than mRNA vaccines (Pfizer
or Moderna)
▪ are not available for a booster dose (booster
doses must be mRNA vaccines)
▪ have a risk of a serious but rare blood clotting
disorder, Vaccine Induced Immune
 Thrombotic Thrombocytopenia (VITT), up to 6
weeks after you get vaccinated
o The National Advisory Committee on
Immunization recommends that people under 30
receive the Pfizer vaccine due to a rare but
increased risk of myocarditis and pericarditis
following the use of Moderna vaccine in this age
group.
o Vaccine interchangeability
▪ Anyone who received a first dose of Pfizer,
Moderna or AstraZeneca can receive a second
dose of either Pfizer or Moderna.
- IMPORTANCE OF MASKING
o Mask-wearing is an integral part of a
comprehensive approach to reducing COVID-19
transmission in both indoor or outdoor settings
o Especially important where there is widespread
transmission and social distancing is difficult as
well as indoor settings with poor ventilation
(regardless of ability to distance)
o The rationale for wearing masks in the
community is primarily to contain secretions of
and prevent transmission from individuals with
infection, including those who have
asymptomatic or pre-symptomatic infection
- ACADIA’S MASK POLICY
o Wear a mask especially when you are unable to
maintain physical distancing of 2 metre (6 feet).
o Review and follow Acadia’s COVID-19 Mask
Policy
o wearing a mask is asked to contact Safety and
Security for assistance
▪ MARK USE IS REQUIRED in all classrooms and
publicly accessible indoor spaces and when
social distancing is not possible
WHAT CAN YOU DO TO PREVENT INFECTION?
- Stay informed and follow Canadian and Nova Scotia
Public Health directives
- Strive for approximately 1-metre
(3-foot) distancing
- (when possible) on campus and 2 metre distancing
in the mask-free study spaces
- Clean high touch areas in your living and working
space routinely
WHAT ELSE CAN YOU DO?
- Practice good cough etiquette
o Use a tissue - Wash your hands
oCough or sneeze into your elbow - Wash your
hands
o Avoid touching your eyes, nose, and mouth -
Wash your hands
- Stay healthy to maintain a good immune system
o Exercise routinely
o Maintain good nutritional habits
o Get adequate and routine sleep
- Get your COVID-19 vaccination
DON’T FORGET
- Practice good hand hygiene.
- Wash your hands…
o Before and after preparing food
o After touching pets
o After handling waste or dirty laundry
o After going to the washroom
o When your hands look dirty
o After touching surfaces used by others
WHAT IS EXPECTED FROM ACADIA UNIVERSITY FACULTY
AND STAFF?
- All members of the Acadia community are required
to do a daily self-assessment of symptoms and avoid
leaving their home or residence, if they feel unwell.
Visit the following site to determine your testing
and isolation requirements:
- Before returning to campus, Acadia’s faculty and
staff should familiarize themselves with the updated
- Before returning to campus, Acadia’s faculty and
staff are encouraged to be fully vaccinated or seek
medical exemption, which is outlined here:
- Acadia faculty & staff are required to adhere to
Acadia’s Mask Policy. If you need an exemption,
please refer to Acadia’s Mask Policy for direction.
o Reviewing Code of Conduct – Adaptation of Res
version with update
o Review & Sign off on Pledge
o SYMPTOMS:
▪ Stay home and Call 811
▪ If you are asked to self isolate – call Safety
and security
QUIZ 1 21/25 -Meet members of the community to
determine their culture and values
Refers to ill health an individual and the levels -Assess the nurse’s own assets, strengths, and
of ill health in a population or group ability to contribute
-Morbidity -Ask other nursing staff their perceptions of the
community’s needs
Measures the frequency of occurrence of new -Review discussions and decisions from
cases of a certain disease during a given period previous meetings
of time
Incidence rate Which of the following statements are False?
-Urban people are less healthy than rural
people
The most sensitive measurement of the various
-Women suffer a number of conditions that
aspects of the health conditions of the
relate to their weak social positions
community is
-Poor people suffer more smoking and alcohol
-IMR (Infant Mortality Rate)
related disease than better-off people, as a
share of their total burden of disease
Which of the following are basic indicators of a
-The higher a country’s GDP per person, the
country’s health?
more money it is likely to spend on health
-Neonatal mortality rate, life expectancy,
maternal mortality ratio
Health care delivery is public health concern of
the 21st century
Refers to the rate of death during the first 28
-True
days after live birth, expressed as the number
-False
of such deaths per 1000 live births
-Neonatal mortality
Information about morbidity and mortality
_maternal mortality
gives the health-care worker data to identify
-Infant mortality
-High-risk age groups for certain disease or
-under 5 mortality rate
hazards
-Effectiveness of treatment
An indication of how long a person can expect
-life span statistics
to live and it is also mother number of years of
-cost-effective treatment for the general
life remaining to a person at a particular age if
population
death rates do not change
-Life expectancy
Assessment of community health resources
should include
Individuals with lower socioeconomic status
-Available health agencies, facilities,
have a poorer health status
equipment and health manpower
-True
-Member of houses, corresponding appliances,
-False
and facilities
-Education of houses, corresponding
Student nurse identify the characteristics of
appliances and facilities
health indicators which includes (SATA)
-Education of family members
-Relevant, feasible, sensitive, valid, reliable,
-Health facilities and housing condition
specific
Crude death rate refers to the average annual
A new public health nurse carefully assessed
number of deaths a year per 1000 of the
all the local mortality and morbidity data in
population
preparation for making appropriate planning
-True
suggestions at a meeting next-week. What
-False
other action is crucial before the nurse can feel
prepared?
The number or rate of new cases of a disease
during a specific time, usually a 12 month
period
-Incidence
Heath status refers to
-Health economic resources
-People and environmental factors
-Individual and family potential
-Values and customs of people
The number or proportion of cases of a
particular disease or condition present in a
population at a given time
-Prevalence
-Infant mortality rate
A variety of health indicators are used by health
providers, policy makers, and community
health nurses to measure the health of the
community. Indicators that illustrate the
health status of a community and may be
useful in analyzing health patterns over time
include
-Mortality, Life expectancy, cancer
incidence rates, morbidity

Infant mortality rates are based on infant

deaths that occur
-Before 1 year of age, per 1000 live births

Refers to death, particularly at a group or

population level?
-Mortality rate

Demographic is concerned with the following

Except:
-increase in incidence of particular diseases
presumed to be brought about by mitigation
-Size of population in the past, present and
future
-spatial distribution of people in a particular
territory
-Characteristics of the population especially
age, sex, socioeconomic status. Etc.

Politics and religion are examples of social and

cultural factors
-True
-False

Nurse is obtaining data about the community

leading diseases and death. Why would a
public health nurse want to know about
morbidity and mortality statistics on the local,
state and national level?
-To be able to observe the community’s
statistics over time and compare the
community with other communities

The statistic widely used to compare the health

status of different populations is: