HNS 107

COMMUNITY HEALTH
NURSING

Part One
Background Information and
historical developments

Dr. Wakasiaka Sabina, PhD, MPH,RN

MAIN OBJECTIVE

Main Objective

 Community Health Aims to Prevent Disease,

Early Deaths and Disability.
Course Content
Part 1
1. Definitions,
2. Concept of Com Health,
3. Historical development
4. Disease causation circle,
5. Natural history of disease and common
terminologies.
Part 2
1. Measurements of Disease,
2. Study Designs,
3. Disease Surveillance,
4. Demography,
5. Occupational and Environmental Health
 PART ONE:
Introduction to Community Health and
Epidemiology.

1) Introduction to historical events that

influenced the development of community
Health.

2) Describe the Disease causation circle.

3) Describe the Natural History of Disease.

4) Introduction to common Epidemiological

 DEFINITION

Defining Community
 The word community has its origin in Latin
“communit”
Note: Community was derived from the
word communis.
-Communis has more than 100 definitions
from which community was derived.

 TheWorld Health Organization has defined

community as a social group determined by
geographic boundaries and /or common
values and interests.
INTERPRETATION OF THE TERM
COMMUNITY

 These
definitions state that community
members know and interact with one
another.

 Thecommunity functions within a

particular social structure.

 The community creates norms, values, and

social institutions within which members
learn and assume roles.
 WHAT DISTINGUISHES COM HEALTH AS A
SPECIALTY?
1. Population Focused: Primary focus is on
populations living freely in the community as
opposed to those that are institutionalized.

2. Community Orientate: An imperative to

work with community members to carry
our core public health functions.

3. Health and Preventive Focus: Main

emphasis is on strategies for health
promotion, health maintenance and disease
prevention.
 HISTORY OF PUBLIC HEALTH AND
COMMUNITY HEALTH NURSING.

Why Learn History?

Nurses use an historical approach to illuminate

both the profession’s present and the future.

v Who are community /public health nurses?

v How can the past contribute to who they are today?

v Whatare the places and times in which the

community and public health nurses have worked
and continue to work?
 THE ANCIENT GREEK

q Community health is as old as mankind.

q All
people and all cultures have been
concerned with the events surrounding birth,
death, and illness.

q The ancient Greek sought a harmonious

relationship with nature by linking individual
health to the environment.

q Although the majority of the people were

poor, the privileged classes valued: Personal
cleanliness, exercise, diet, and sanitation.
 THE ROMAN EMPIRE

q The
classical Roman civilization viewed
medicine from a community health and social
medicine perspective.

q They emphasized regulation of medical

practice and punishment for negligence.

q Ensured provision of pure water through a

complex system of settling basins and
reservoirs.

q They established the sewage systems and

drainage of swamps and supervision of street
cleaning and public food preparation.
 14TH TO 17TH CENTURY
The Renaissance Period
q From 14-17th AD, human dignity was
recognized, this influenced health practices.
q Science and technology advanced during this

period, this inversely supported the advance of

medicine and public health.
q However, public health measures continued to
be rudimentary.
q Social organization increased leading to
improved
movement of cities, but many areas continued to
depend upon private enterprise for water
 19TH CENTURY
THE INDUSTRIAL REVOLUTION IN EUROPE

q Industrial revolution in Europe brought

tremendous advances in transportation,
communication and other forms of technology
which led to deep social upheaval.

q Previous care giving structures, which had

depended on assistance of family, neighbors, and
friends, became inadequate because of migration,
urbanization and changing demand.

q During this period, Roman Catholic and

Protestant women continued to provide nursing
care in institutions and sometimes in the home,
but their number was small.
BRITAIN

q In1601, England enacted the Elizabethan

Poor Law which guaranteed medical care for
poor, blind and ‘lame’ individuals.
q Catholic and Protestant women continued to
provide nursing care in institutions and
in homes (small numbers of nurses).
q Many of these women were uneducated,
untrained.
q Sometimes they were referred to as:drunken,
dirty and dishonest.
q Practice of medicine became more complex
requiring a more skilled care giver.

q Effortsby Florence Nightingale

revolutionalized nursing during this period.
 AMERICAS COLONIAL PERIOD

q Justlike in Europe, In the early years of

America’s settlement, the care of the sick
was usually informal and was provided by
household members, almost always women.

q Thewomen were also responsible for growing

or gathering healing herbs in season for use
throughout the year.

q Earlyin the 1800s, there was an increasing

urban population hence the traditional health
system became insufficient.
 LILIAN WALD
q Between19th-20 Century, Lilian Wald
revolutionized Public health nursing
q Born in 1867, become a nurse after Vassar
College refused to admit her at age 16.

q She made a home visit in 1883 to see a

mother who had post perterm hemorrhage
for 2 days.

q This experience was an eye opener as to the

injustices in health care delivery for those who
have and those who have not.

q She believed that home visits should be like “ a

friendly visit” and not an impersonal paid
LILIAN WALD

q She used epidemiological methods to

campaign for health promotion and social
policies.

q In
1909, she established the first
Community health nursing program for
workers.

q Shebelieved that a healthier workforce

increases productivity.

q She established the concept of rural health

LILIAN WALD
q Shealigned nursing care with official
agency thereby arranging for nurses to
wear an budge of the agency.

q She introduced home nursing care on a

fee-for –service.
q Established an effective cost accounting
system for visiting nurses.
q Advertised for nurse recruitment (radio
& newspaper).
q Her work helped reduce mortality from
infectious diseases!
COMMUNITY HEALTH NURSING TODAY

q Com. Health Nursing celebrated ‘Century

of Caring’ in 1993.

q Today Community health nurses look at

history for inspiration, explanation and
prediction.

q Com Health is now a sub specialty in

medicine with highly trained and skilled
providers.

q The challenge remains in the containment

ASSIGNMENT 1-HISTORY OF COMMUNITY
HEALTH NURSING IN AFRICA

Divide The Class in Five Groups.

Group 1 & 5,9: Describe the historical development of

Community Health Nursing in Kenya.

Group 2 & 6,10: Describe the historical development of

Community Health Nursing in East Africa.

Group 3 & 7: Describe the historical development of

Community Health Nursing South Africa.

Group 4 & 8: Describe the historical development of

Community Health Nursing in Ethiopia and Eritrea.
PART TWO
EPIDEMIOLOGY
OVER VIEW

 Epidemiology investigates the

distribution or patterns of health
events in populations and the
determinants that influence those
patterns.
BASIC CONCEPTS IN EPIDEMIOLOGY

 Epidemiologic Triangle Comprises of the

following: Agent, Host, and Environment.

 In epidemiology you need to understand

that disease results from complex relations
among:

1) Causal Agents,
2) Susceptible Host or persons and
3) Environmental factors.
 THE EPIDEMIOLOGIC TRIANGLE.

 The three elements that form the Epi - Triangle

are: AGENT, HOST AND ENVIRONMENT.

ENVIROMENT

Disease
AGENTT Outcome HOST
 EPI-TRIANGLE CONT’
 As Figure 1 suggests, agent and host, as well as
their interaction are influenced by the
environment in which they exist.
 At the same time the Host and Agent may
influence the environment itself.
 Causal relationships are often more complex than
the epidemiologic triangle conveys.
 It is important to know that a disease may be
caused by multiple factors.
 Hence, the need to recognize the complex
interrelationships of numerous factors interacting,
sometimes in subtle ways, to increase (or decrease)
risk of a given disease.
 EXAMPLE OF INTERACTIONS IN THE TRIANGLE

Agent HOST ENVIRONMENT Disease

Outcomes

Infectious agents Genetic susceptibility Climate

(Temperature,
(Bacteria, Rainfall)
Viruses, Fungi,
Parasites) Plant and animal life
Immutable (Agent or Reservoirs
Chemical agents characteristics (Age or Habitats for Agent)
And Gender)
(Heavy Metal, Human population
Toxic Chemicals, distribution
Pesticides) (Crowding, Social
Acquired Support)
Physical Agents characteristics
(Radiation, Heat, (Immunologic Status Socioeconomic factor
Cold, Machinery) Lifestyle Factors (Diet (Education, Resources,
and Exercise) Access to Care)
Working conditions
 MEASURES OF MORBIDITY

 Prevalence is very distinct from Incidence

 Prevalence is a measurement of ALL

individuals affected by the disease within a
particular period of time.

 Incidenceis a measurement of the number

of NEW individuals who contract a disease
during a particular period of time.
PREVALENCE

 The aim of prevalence surveys is to find out

the % of the population with a given disease
or specific characteristic.
Example;
-What % of the population has breast
cancer or Malaria or Malnutrition.

These questions can also be expressed as;

what is the prevalence of breast cancer or
malaria or malnutrition in the community?.
PREVALENCE

When you plan for such surveys, you

must answer these key Qs;
1. What is the population to be
surveyed?
2 Who will you include? Total
population or sub-group? What ages
will be included?
q Prevalence may be expressed in
different ways depending on how
large % is.
q If the % is 1 or greater the
PREVALENCE

Example: A survey of 40 form one students

at St. Mary’s school show that 30 girls
were pregnant while taking KCPE Exams
The % who were pregnant is: 30 x 100 =
75%

40
Therefore the prevalence pregnant teens at
the school is 75%

If the % is less than 1%, the prevalence is

 REMEMBER!!!
A prevalence rate is not an estimate of the
risk of developing disease because it is a
function of both the rate at which new cases
develop and how long those cases remain in
the population.

 In this example, the prevalence of breast

cancer in this population of women is a
function of how many new cases develop and
how long women live with the cancer.
 CONT’
Ø The duration of a disease is affected by case fatality
and cure.
Ø ( What this indicates is that women with a
history of the ca breast are counted in
prevalence rate even though they may have
been cured.)
Ø A disease with a short duration (e.g. Ebola, Cholera)
may not have a high prevalence rate even if the rate
of new cases are high, because cases do not
accumulate owing to fast deaths.
Note: A disease with a long course will have a
higher prevalence rate than a rapidly fatal disease
that has the same rate of new cases (Ca prostate vs.
Ebola).
INCIDENCE
Incidence rate:
 Incidence rate is the number of NEW cases
developing in a population at risk during a specified
time.

 A cumulative incidence rate estimates the risk of

developing the disease in that population during
that time.
 The population at risk is defined as persons without
the disease but who are at risk of acquiring it.

 Note that existing (or prevalent) cases are excluded

from the population at risk for this calculation,
since they already have the condition and are no
longer at risk of developing it.
INCIDENCE
Incidence rate is expressed as:

Number of New Cases occurring over 1 year period x 1,000

Total Population
Example:
In the year 2019, 1,500 children were reported
to have measles at Geiko village, the total
population in this village is 50,000.
Calculate the incidence rate.

1,500 x1000 = 30 cases per 1,000 per year

50,000
 DIFFERENCE BETWEEN PREVALENCE AND
INCIDENCE
Incidence Prevalence

New cases only included New and old cases are

included.

Measured over a period of Measured at a point in time.

time (9-12 months) (4-6 weeks)

Hard to measure Easy to measure

Used to evaluate Can not be used for

effectiveness of primary evaluation.
prevention
EPIDEMIOLOGICAL METHODS
OBSERVATIONAL STUDIES

1. Descriptive Studies
 Descriptive studies describes the
distribution of disease, death and
other health outcomes in the
population.
 It observes the person, place, and time,
providing a picture of how things are
or how things have been.

 Thewho, where and when of disease

patterns.
OBSERVATIONAL STUDIES CONT’

2. Analytical Studies
 Analytical Studies search for the
determinants of the patterns
observed- The how and why.
 This implies that epidemiologic
concepts and methods are used to
identify what factors, characteristics,
exposures, or behaviors might account
for differences in the observed
patterns of disease occurrence.
OBSERVATIONAL STUDIES CONT’

 Descriptiveand analytic studies are

observational, meaning the investigator
observes events as they are or have
been and does not intervene to change
anything or to introduce a new factor.
CROSS-SECTIONAL STUDIES
 The cross-section study provides a snap short, or
cross section of a population or group.

 Information is collected on current health status,

personal characteristics and potential risk factors
or exposures all at once.

 The cross-sectional study is characterized by the

simultaneous collection of information necessary
for the classification of exposures and outcome
status, although there may be historical
information collected (e.g.), on past diet or
history of rational exposure).
 CROSS-SECTIONAL STUDIES CONT’
 Cross-section studies are sometimes called
Prevalence studies because they provide the
frequency of exiting cases of a disease in a
population.

 Cross-sectional studies evaluate the association of

a factor with a health problem.

 It compares the prevalence of a disease in those

with the factor (or exposure) and the prevalence
in the un-exposed.

 Cross-sectional studies are subject to bias resulting

from selective survival (i.e., existing cases who
have survived to be in the study may be different
from case diagnosed about the same time who
have died and are NOT available FOR inclusion).
 CASE-CONTROL STUDIES
Ø This is a TWO ARM STUDY design i.e.

Ø A) Cases- These subject are enrolled because they are

known to HAVE the outcome of interest (e,g HIV
positive).

Ø B) Controls - Subjects are known NOT to have outcome

of interest (e,g HIV Negative) .

Ø Case-control status is verified using a clear case

definition and some previously determined method or
protocol
(e.g., by an examination, laboratory test, or medical
chart review).
Ø Information is then collected on the exposures or
 CASE-CONTROL STUDIES

 The question in a case- control study is, “Do

persons with the outcome of interest (cases)
have the exposure characteristic (or a history of
the exposure) more frequently than those
without the outcome (controls)?”
 Given the way subjects are selected for a case-
control study, incidence or prevalence can be
calculated directly.
 In a case-controls study, an odds ratio tells
how much more or less than among controls.
 The ratio of these two odds provides an
estimate of the relative risk.
 CASE-CONTROL STUDIES
Disadvantages
1. Because these studies begin with existing cases,
differential survival can produce biased results.
-However use of Recently diagnosed, or “incident,”
cases may reduce this bias.

2.Because exposure information is obtained from

subject recall or past records, there may be errors
in exposure assessment or misclassification.

Ø As a result of the sampling on disease status, case-

control studies are limited to a single outcome,
although they may investigate a number of
potential risk factors.
 COHORT STUDIES

Definition:
 A Cohort is a group of people who share a common
characteristic or experience within a defined period.
(e.g., age mates, same occupation, are exposed to a
drug or a vaccine, etc.)
 Cohort study designs allow for calculation of incidence
rates and therefore estimates risk of disease.
 This is because of the ability to observe the development
of outcomes.(e.g. Prophylaxis STI study among CSW).

 Cohort studies may be prospective or retrospective.

 A cohort study is often undertaken to obtain evidence to

try to refute the existence of a suspected association
between cause and disease OR between two
drug/products.
PROSPECTIVE COHORT STUDIES

 In a prospective cohort study (also called a

longitudinal or follow-up study).
 Subject are classified on the basis of the exposure at
the beginning of the follow-up period e.g. CSW who
take prophylaxis and those who don't.

 The subjects are then followed for some period of time

to ascertain the occurrence of disease in each group.

 The question is, “Do persons with the factor (or

exposure) of interest develop (or avoid) the outcome
more common than those without the factor (or
exposure)?”
 Example: Does Condom use reduce STI/HIV Infection
among CSW?
 ADVANTAGES OF PROSPECTIVE COHORT
STUDIES
Advantages
 Long observation period of an individual.

 Ability to collect data at regular intervals.

 Recall error is reduced.

Disadvantages
 Expensive to conduct.

 Sensitive to attrition e.g. political unrest

 Take a long time to generate useful data.

 RETROSPECTIVE COHORT STUDIES

 A RETROSPECTIVE STUDY is a longitudinal study

that looks back in time.
 Retrospective cohort studies (also called Historical
cohort) may be conducted entirely using past records.

 One relies on existing records, such as employment,

insurance, or hospital records, to define a cohort
who is classified as having been exposed or unexposed
at some time in the past.

For instance a researcher may look up the medical

records of previous years to look for a trend e.g. HIV
infection among CSW.
 ADVANTAGES

 Retrospective cohort studies combine some of the

advantages and disadvantages of case-control study
and prospective cohort studies.

 The obvious advantage of this approach is the time

savings because one does not have to wait for new cases
of disease to develop.

 Advantages are largely related to the reliance on

existing historical records.

 Retrospective cohort studies frequently are used in

occupational epidemiology where industrial records are
available to investigate work-related exposures and
health outcomes.
EXPERIMENTAL STUDY

1.Clinical Trials
2.Community Trials
EXPERIMENTAL STUDIES
 The study designs discussed so far are called
observational studies because the investigator
observes the association between exposures
and outcomes as they exist but does not
intervene to alter the presence or level of
any exposure or behavior.

 Studies in which the investigator initiates

some treatment or intervention that may
influence the risk or course of disease are
called INTERVENTION, OR EXPERIMENTAL,
STUDIES.
CLINICAL TRIALS

 In clinical trials, the research issue is

generally the efficacy of a medical treatment
for disease, such as a new drug or existing
drug used in a new or different way.
 Surgical technique or other treatment.

 The preferred method of subject allocation in

clinical trial is randomization.
 Randomization avoids the bias that may
result if subjects self-select into one group or
the other or if the investigator or clinician
chooses subjects for each group.
 COMMUNITY TRIALS
 Community trials are similar to clinical trials
in that an investigator determines the
exposure or intervention.

 Butin this case the issue is often health

promotion and disease prevention rather than
treatment of existing disease.

 The intervention is usually undertaken on a

large scale, with the unit of treatment
allocation being a community, region, or group
rather than individuals.
COMMUNITY TRIALS CONT’

 Although a pharmaceutical product may

be involved in a community trial, such as
fluoridation of water or mass
immunization or hand washing or
iodization of salt, community trials often
involve educational, pragmatic or policy
interventions.

 Studying the effect of physical activity on

diabetes prognosis, increasing availability
of healthy foods, treated mosquito are
example of community interventions.
COMMUNITY TRIALS
 Although community trials provide the best
means of testing whether changes in
knowledge or behavior, policy, programs, or
other mass interventions are effective, they
are not without problems.
 For many interventions, it may take years
for the effectiveness of the intervention to
be evident.
 In the meantime, other factors also may
influence the outcome positively or
negatively(making the intervention look less
effective than it really was).
COMMUNITY TRIALS

 Difficult
to compare community
populations because interventions are
often difficult to determine.

 Also,
because community trials are often
undertaken on a large scale and over
long periods of time, they can be
expensive.
Natural History of Disease
Levels of disease Prevention
Common Terminologies
INTRODUCTION
 Epidemiology deals with communicable and no
communicable disease distribution, etiology,
prevention, and control.

 Communicable diseases (also called infectious

diseases) are those that can be transmitted
directly or indirectly to a susceptible person
through contact, inhalation, or ingestion.

 Non communicable diseases are those that

cannot be transmitted to others, either
directly or indirectly. These are non-infectious
diseases, such as diabetes, skin cancer, or
stroke.
NATURAL HISTORY OF DISEASE
 Everydisease in a host follows a
potentially predictable life cycle from
onset to final outcome, which is
known as its natural history.

 Understanding the natural history of

disease is important to clinicians in
establishing appropriate treatment
and accurate prognosis.

 Itis important in developing effective

disease prevention and control
strategies.
CONT ’

 Thelife cycle or natural history of a

particular disease will vary somewhat
from individual to individual,

 Differentdiseases will have their own

distinct natural histories, but there
are four common stages that most
disease manifests:
THE STAGES

Stage 1. Susceptility

Stage 2. Presymptomatic disease

Stage 3. Clinical disease

Stage 4. Diminished capacity

CONT

Stage 1: Susceptibility

 The stage of susceptibility recedes the onset of

disease.

 The disease has not yet developed, but the host

is susceptible due to the presence of risk factors.

 Individuals with high serum cholesterol,

hypertension, a sedentary lifestyle, and diabetes,
for example, have an increased risk of
developing coronary heart disease.
CONT
Stage 2: Presymptomatic disease

 Here the disease process has begun, but no overt

signs or symptoms are evident to the host.

 In Non-Communicable diseases, this stage

includes the incubation period, which is the time
between the invasion of an infectious agent and
the development of the first signs or symptoms
of the disease.

 A carrier of a communicable disease is an

individual who has no symptoms of the disease
but nevertheless harbors the causative agent.
CONT’
Stage 3: Clinical Disease:
The individual exhibits signs and symptoms of
the disease.

Stage 4. Diminished Capacity

The individual may receive inadequate or no

treatment and so the disease remains un-
dissolved. This stage is also referred to as late
clinical stage.
LEVELS OF DISEASE PREVENTION
 The definition of epidemiology encompasses
preventing and controlling diseases in human
populations.
 This is usually accomplished using three levels of
prevention.

Level 1. Primary prevention:

This level seeks to reduce the frequency of new

cases of disease occurring in a population and, is
most applicable to persons who are in the stage of
susceptibility.
CONT’
 Primary prevention strategies emphasize general
health promotion, risk factor reduction, and
other health protective measures.

 These strategies include health education and

health promotion programs designed to foster
healthier lifestyles and environmental health
programs designed to improve environmental
quality.

 examples of primary prevention measures include

immunization against communicable diseases;
exercise, stress management, chlorination and
filtration of public water supplies.
CONT’

Level 2. Secondary prevention:

q This level attempts to reduce the number of
existing cases in a population and, therefore, is
most appropriately aimed those in the stage of
presymptomatec disease or the early stage of
clinical disease.
q Secondary prevention focuses on early detection
and swift treatment of disease.

q Its purpose is to cure disease, slow its

progression, or reduce its impact on individuals
or communities.

q e.g screening for disease, i.e mammography for

breast cancer detection; the Pap test for cervical
cancer detection etc
CONT’
 Level3. Tertiary prevention: This stage is
most applicable during the late clinical stage
or the stage of diminished capacity.

 This
level tries to limit disability and
improve functioning following disease or its
complications, often through rehabilitation.

 Tertiary Prevention strategies involve both

therapeutic and rehabilitative measures once
disease is firmly established. Example:
treatment of diabetics to prevent
complication of the disease and the ongoing
management of chronic heart disease
patients with medication, diet, exercise, and
 DEFINITION OF TERMS
Outbreak: A sudden occurrence of an epidemic in relatively
limited geographic area.

While an outbreak is usually limited to a small geographical

area, an Epidemic covers larger geographical areas & has
more than one focal point.

Outbreak Epidemiology: Study of a disease cluster or epidemic

in order to control or prevent further spread of the disease in
the population.

Surveillance is a systematic collection, analysis and

interpretation of data essential to the planning,
implementation and evaluation of public health practice, and
the timely dissemination of this information for public health
action.

Sporadic case: A case that cannot be linked epidemiologically

to other cases of the same illness.
CONT
Risk Factors:
q These are factors associated with ill health,
disability, disease or death.
q In practice risk factors do not operate in
isolation. They often coexist and interact
with one another.
DISEASE OUTBREAKS
DISEASE OUTBREAK
OBJECTIVES OF OUT BREAK INVESTIGATION (OI)

q Primary- to control the spread of

disease
q To determine the causes of disease,
its source and mode of transmission.

q To determine who is at risk.

q To determine what Exposures/

Predispose to disease.

q To know the magnitude of the

problem
OBJECTIVES CONTINUED….

q Identify NEW agent

q Determine the effectiveness of

control measures

q Identify methods for present & future

prevention & control

q Research & training opportunities

q Public, Political and legal concerns
TRIGGER EVENTS & WARNING SIGNS
1. Clustering of cases/deaths in time/space
2. Unusual increase in cases/deaths
3. Shift in age distribution of cases
4. High vector density
5. Acute hemorrhagic fever or acute fever
or diarrhea
6. Severe dehydration following diarrhea in
patients above 5 years age.
7. Unusual isolate
DISEASES REQUIRING INVESTIGATIONS

q Endemic diseases with epidemic potential

– Malaria, Cholera, Measles, Hepatitis,
Meningococcal Meningitis.

q Even a single case of diseases for which

eradication/elimination goals have been set
e.g. polio.

q Rare but internationally important diseases

with high case fatality rates – yellow fever,
Ebola or Outbreaks of unknown etiology
EMERGENCY RESPONSES

qThe basic general lines of action during

epidemics include:

1. Preparedness and Interventions

(investigations).

2. Success in dealing with an epidemic

depends largely on the state of
preparedness achieved in advance of
any action.

3. It would be an error to consider as an

epidemic, unrecognized endemic
situation or a mere seasonal increase in
the incidence of a disease.
INVESTIGATIONS
1. Recognition and response to a request for
assistance.
2. Check initial information
3. Formulate a plan of action
4. Prepare for field work
5. Confirm the existence of epidemic
6. Verify the diagnosis
7. Identify and count cases/exposed persons
8. Orient data in terms of person, place & time
INVESTIGATIONS CONTINUED…..

q Choose a study design

q Collect specimens for lab analysis
q Conduct environmental investigations
q Formulate & test hypotheses
q Implement control measures
q Conduct additional studies
q Prepare a written report
q Communicate the findings
NOTIFIABLE DISEASES
HEALTH RECORDS
VITAL HEALTH STATISTICS
 BACKGROUND AND HISTORY
q The evolution of emerging infectious
disease surveillance spans many
decades and continues to grow with
the advent of newly available
technology.

q Thesurveillance process is a complex

one that involves:
1. Identifying cases of a new or previously
unrecognized disease in a population,
2. Identifying clusters of the disease and its
epidemiological characteristics, and
tracking it over time to observe and
document patterns.
 CONT’
ü 3. This is accompanied by a process of
verification to ensure that all reports of cases
are accurate and scientifically verifiable.

ü 4. In the past, this process was often done by

phone, resulting in considerable delays in
relaying surveillance data to the appropriate
public health officials.

ü 5. However, the availability of computers and

the Internet has dramatically changed the
disease surveillance process.
 DEFINITION
Public health surveillance refers to the process of
q

collecting, analyzing, and interpreting data about

biological events, diseases, risk factors, and related
health events so as to disseminate information to
decision makers.

q Outbreaks are defined by the World Health

Organization (WHO) as "urgent emergencies
accompanied by rapid efforts to save lives and
prevent further cases."

q Emerging infectious diseases: "diseases of

infectious origin whose incidence in humans has
increased within the recent past or threatens to
increase in the near future.“
 GLOBAL TRENDS IN OUTBREAK
SURVEILLANCE

The World Health Organization (WHO), an expansive
international health organization devoted to promoting and
ensuring health in populations the world over, represents one
of the leading agencies involved in monitoring and reporting
disease outbreaks.

 In 2007, WHO adopted the new International Health

Regulations (IHR).

 The implementation of the IHR represented a milestone in

the application of international law to public health practice,
because for the first time it allowed a public health agency
(WHO) to use surveillance information from unofficial sources.
 ELECTRONIC OUTBREAK REPORTING SYSTEMS
USED BY THE WHO ARE AS FOLLOWS

1.Global Outbreak Alert and Response Network (GOARN): A

unified network of several surveillance
networks for real-time collection of disease
intelligence; this

Consists of four phases: systematic detection,

outbreak verification, real time alerts, and rapid response.
2. Global Public Health Intelligence Network (GPHIN):
Amulti-lingual public health information system that
continuously searches global media for information on disease
outbreaks and related events so as to provide early warning to
the public.
SITUATION IN KENYA
Step 1
Local Health Unit Sub-County Hospital
County Hospital National Hospital- MOH
CDC WHO
Step 2. Pallarel Reporting System
The Public Health Laboratory Information
System, is an information system used by
public health labs throughout the country to
collect, analyze, and disseminate data and to
detect outbreaks.
Step 3. CDC: Centre for Disease Control
Step 4. WHO: World Health Organization.
 LESSONS LEARNED
q Public health professionals have identified a number of
problems in the process of outbreak detection. These
include:

1) Obsolete infrastructure that prevents the system

from responding to complex infectious agents

2) Outdated epidemiological methods.

3) Lack of skills and resources at laboratories.

4) Dispensing of inappropriate interventions and

 NOTIFIABLE DISEASES

To be notified by
To be notified by Clinicians

ü Leprosy laboratories
ü Measles .  Anthrax .
ü Meningococcal disease .
ü Poliomyelitis .  Botulism .
ü Rabies .  Brucellosis
Smallpox .
 Chancroid
ü
ü Syphilis
ü Tetanus  Chlamydia trachomatis
ü Tuberculosis  Cholera .
Typhoid .
Cryptosporidiosis
ü
ü Typhus (epidemic) .
ü  Diphtheria
Viral hemorrhagic fevers . .
ü Yellow fever . Notification is made by telephone
as soon as a provisional
diagnosis is made.
HEALTH RECORDS
The following terms are used interchangeably:
 EHR:-Electronic Health Record
 EPR: Electronic Patient Record
 EMR: Electronic Medical Record.

 The EMR can be defined as the legal data source

for the patient record created and maintained
within an institution, such as a hospital, clinic,
or physician office, to give patients, physicians
and other health care providers, employers, and
payers or insurers access to a patient's medical
records across facilities.

 Paper Records: Mainly used in our setup.

HEALTH RECORDS
 Your name, birth date, blood type and
emergency contact
 Date of last physical

 Dates and results of tests and screenings

 Major illnesses and surgeries, with dates

 A list of your medicines, dosages and how long

you've taken them
 Any allergies

 Any chronic diseases

 Any history of illnesses in your family

ADVANTAGES
q Accurate data storage
q Can be shared across hospitals & Research
Institutions.
q Promotes evidence based medicine in
research and disease surveillance
Disadvantages
q Costly

q Privacy concerns

q Time consuming when entering data in

computer as opposed to paper chart.
END OF PART 2