You are on page 1of 90

COMMUNITY DIAGNOSIS CDX PART 2

CM3 2010-2011 Department of Family and Community Medicine De La Salle Health Science Campus Estrella P. Gonzaga M.D.
epgonzaga DFCM DLSHSI 2010

CM3 Program/ Project Management Cycle


SITUATIONAL ANALYSIS

CDX

E
PI

I/M

I/M

HEALTH EDUCATION

I/M

epgonzaga DFCM DLSHSI 2010

CDx in the Program/ Project Management Cycle


Step 1: Situational Analysis CDX 1. Plan - CDx Plan Work Plan Evaluation Plan 2. Conduct 3. Reporting

Lit Rev

Step 2. Objective Setting Problem Investigation 1. Plan PI Plan Work Plan Evaluation Plan 2. Conduct 3. Reporting

Step 3: Action Planning

Step 4. Plan for Evaluation

epgonzaga DFCM DLSHSI 2010

Planning Survey Why is the survey being done?

1.1 Planning the CDx


1.

2.

Clarify purpose Identify the objectives

Who will be interviewed? What will be covered?

3. Identify the Methods a. Study Population b. Variables

What instruments will c. Data collection tools d. Data recording and be used to measure processing the conditions?

e. Data analysis 4. Describe report format

Who will do what and 1.2 & 1.3 Plan the Work Activities/ Evaluation when? Attained ? epgonzaga DFCM DLSHSI 2010

ANALYSIS

epgonzaga DFCM DLSHSI 2010

Planning the analysis


Decisions on
- Coding

- Processing

- Computer - Manual Hand tallying Hand sorting - Statistical Analysis - Dummy Tables (skeleton tables row and column headings but no figures) - Statistical Techniques
epgonzaga DFCM DLSHSI 2010

Statistical Analysis
Examine - each variable separately - pairs of variables - sets of three or more variables

epgonzaga DFCM DLSHSI 2010

Statistical Analysis
1. Simple descriptive statistical displays and summaries - Examine the frequency distribution of all variables - Summarize e.g. means, %/ rates * Seek patterns and inconsistencies 2. Relationships between variables - cross tabulations (Contingency table) - diagrams e.g. pie, bar, line
epgonzaga DFCM DLSHSI 2010

STRUCTURE OF DATA CATEGORIES


GENERAL DESCRIPTION
HEALTH

STATUS

Popn

Social

Econ

Envr

Health Sector

Knowledge/ Perception

epgonzaga DFCM DLSHSI 2010

Community Diagnosis Survey Plan 1


DATA CATEGORY DATA (Variables) COLLECTION Source/ Tool General Description HEALTH DETER MINANTS Population Records Review Key informant interview Interview Questionnaire Sec I- A, #2-5 DATA ANALYSIS REPORT

Content analysis

Report Format Sec 4.1

Descriptive Statistics Frequency Distribution Sec 4.2.1 Frequency Distribution Sec 4.2.2 Sec 4.2.1

Health Status

Sec II-A #1,7 Sec III-A, B

Sec 4.2.2

epgonzaga DFCM DLSHSI 2010

DETAILS

DATA CATEGORY General Description

VARIABLES Geography ClimateTemperature Road condition/ How reached Households number Houses spatial arrangement Source of Livelihood Means of transportation Health Resources/ Facilities Infrastructure/ Educational/ Sports Facilities History of Barangay Barangay Council Members Age Sex Civil Status Dependency Ratio Sex Ratio Natural Growth Rate Vital Indices

Population

epgonzaga DFCM DLSHSI 2010

Source: NOH 2005-2010

epgonzaga DFCM DLSHSI 2010

Less than 15 (14) 35%

15 49 (34) 61%

50.4 %M

49.6 %F

65 over 4%

EST.79,503,675.
epgonzaga DFCM DLSHSI 2010 Source: Field Statistics Health Information Service

Community Diagnosis Survey Plan 2


DATA CATEGORY DATA COLLECTION Source/ Tool Social Interview Questionnaire Sec I- A # 6-11 Sec I-C,D Sec 1-B Sec I- E Sec II-A #1,2 Sec II-C,#9 Sec II-D,#2,7 Sec III-A,#6,7,9 Sec III-B,#6,7 DATA ANALYSIS Frequency Distribution Sec 4.2.3 Sec 4.2.4 Sec 4.2.5 Sec 4.2.6.1 REPORT

Sec 4.2.3

Economic Environment Health Sector a. Human Resource

Sec 4.2.4 Sec 4.2.5 Sec 4.2.6.1

epgonzaga DFCM DLSHSI 2010

DATA CATEGORY
Social

Variables

DETAILS

Number and Type of Family Household size Household Head Characteristics Years of residence in community Place of Origin Place of Last Residence Religion Educational Attainment Membership in community organization x type x name Dwelling Unit type of housing material, house ownership, lot ownership, electricity, cooking facility
epgonzaga DFCM DLSHSI 2010

DATA CATEGORY Economic

Variables

DETAILS

Number of Source of Income Type of Main Occupation by gender Type of other source of income by gender Total monthly income by main and other source Income bracket Mean, median, mode Type of water source by distance Practice of boiling water Type of excreta disposal Type of garbage disposal Type of drainage system
epgonzaga DFCM DLSHSI 2010

Environment

DATA CATEGORY Health Sector

Variables

Human Resource

DETAILS

Attendant at birth x Place Prenatal consult x AOG Source of FP Knowledge Source of information on FP method Persons first consulted for illness by Place of consultation Effectiveness of treatment by consulted person Cause of death by person consulted Reason for non-medical attendance
epgonzaga DFCM DLSHSI 2010

Community Diagnosis Survey Plan 3


DATA CATEGORY DATA COLLECTION Source/ Tool DATA ANALYSIS REPORT

Knowledge of Primary Sec IV Health Care Perceived Community Sec V Health Problems/ Causes/ Solutions

Content Analysis Sec 4.2.7 Content analysis with Frequency Distribution Sec 4.2.8 Content Analysis with Frequency Distribution Sec 4.2.9
epgonzaga DFCM DLSHSI 2010

Sec 4.2.7

Sec 4.2.8

Perceived Medical Problems/ Causes/ Solutions

Sec VI

Sec 4.2.9

DETAILS
DATA CATEGORIES PHC concepts Knowledge VARIABLES Preventable Diseases, Protein role, Signs of Normal Pregnancy, Newborn bath and cord care Breastfeeding / Bottle feeding effect on infant Health, Immunizable diseases, Covered Child With fever, Family planning, herbal medicine Safety, Tuberculosis sign, wound cleaning, Burning of garbage, Drugs in Hypertension, Fruits sugar and diabetes Perceived community Health Problems, Solutions Perceived Medical Problems Solutions Health problems, corresponding causes Corresponding solutions Medical problems, corresponding causes Corresponding solutions
epgonzaga DFCM DLSHSI 2010

Summary forms
Frequency distribution: one variable, two or more * Check appropriate Denominators Quantitative measures of central tendency measures of dispersion Qualitative rates ratios
epgonzaga DFCM DLSHSI 2010

Rates
e.g. Prevalence

Numerator : No. of HH of HH Members reporting sick with fever during a six month period Denominator: Total number of HH of total Population

Factor: 10, 100, 1,000, 10,000, 100,000

epgonzaga DFCM DLSHSI 2010

Analysis of problems: 2 of the 5 Q Sec 4.3 (Q1) What is the state of health of the community?
Statement on the overall health condition of the community based on Findings on the 4 life events:

-- births -- 0-6 nutritional status -- morbidity -- mortality

epgonzaga DFCM DLSHSI 2010

HEALTH: Vital Events

NUTRITIONAL STATUS

BIRTH
ILLNESS/ DISEASE

DEATH

epgonzaga DFCM DLSHSI 2010

Sec 4.3 : Health status of the community


Health Events Births Nutrition, 0-6 y.o. Status

Morbidity Mortality

epgonzaga DFCM DLSHSI 2010

DATA CATEGORY Health Status

Variables 1 year Mortality Rates Cause by Age by Sex Households with Deaths

6 months Morbidity Prevalence Rates Cause by Age by Sex Households with Sick Nutritional Status 0 -71 months Weight by Age by Sex Height by Age by Sex
epgonzaga DFCM DLSHSI 2010

Table 2.2.3 Frequency and prevalence rates of the causes of Data Processing/ Organization Morbidity from December 1, 2005 to May 31, 2006 in Bgy. X

Causes of Morbidity

Cases

Prevalence

Fever
Cough

15
6

8.77
3.51

Tonsillitis
Colds

4
2

2.34
1.17

Flu
Dengue

2
1

1.17
0.58

Allergy
Acute Gastroenteritis

1
1
epgonzaga DFCM DLSHSI 2010

0.58
0.58

Sec 4.4 Q2: What are the factors responsible for the health condition of the community?
Identification of factors known to affect the particular health condition Assumption: knowledgeable of event process logical sequence of conditions (factors) that lead to undesirable event

Presentation types 1. Tabular (Cdx use) 2. Graphical e.g Problem tree (Problem investigation use)
epgonzaga DFCM DLSHSI 2010

PREGNANCY 0 9 mos

DELIVERY 24 HOURS

POST PARTUM 0 6 WEEKS

Family Planning
epgonzaga DFCM DLSHSI 2010

Total Fertility Rate: Average number of births that woman would have at the end of her reproductive life Compared to Itself 1999: NCR 2.13 East Visayas 4.73 Urban Rural 3 4.7

Mothers Education without 5.01 Elem 5.0 HS 3.6 College 2.9


Source: National Objectives for Health epgonzaga DFCM DLSHSI 2010

Source: NOH 2005-2010 p. 207


epgonzaga DFCM DLSHSI 2010

epgonzaga DFCM DLSHSI 2010

Sec 4.4: Factors affecting the health status of the community

HEALTH STATUS

CORRELATES
Pop SOCIAL ECONO ENV H SERVCS KAP

BIRTH ILLNESS NUTRITION DEATH

epgonzaga DFCM DLSHSI 2010

HS

CORRELATES P S E Env HHR/HHF K PHC Percept

Birth High CBR

% W M RA

Educ HH Attain incom Moth e er

Attendance % #3 %HH at birth by report place ing proble ms/ cause % FP knowledge % FP use % Prenatal Consult
epgonzaga DFCM DLSHSI 2010

No.8 FP

Table 2.1.1 Frequency and percentage distribution of Data Processing/ Organization households by type of facility usually consulted for simple illness in Bgy. X. 2005 Facility Consulted (simple illness) Freq

Private hospital/clinic

16

% 47.1

Government Hospital
Rural Health center

0
6

0
17.6

Community Health Worker


Self medication

0
11

0
32.4

Others: none
Total

1
34
epgonzaga DFCM DLSHSI 2010

2.9
100

Table 2.1.1 Frequency and percentage distribution of households Organization By Data type of Processing/ facility usually consulted for simple illness in Bgy. X. 2005

Facility Consulted

Simple Illness Serious

Private hospital/clinic
Government Hospital

47.1
0

73.5
11.8

Rural Health center


Community Health Worker

17.6
0

5.9
2.9

Self medication
Others: none

32.4
2.9

0
5.9

Total

100
epgonzaga DFCM DLSHSI 2010

100.0

Table 6.1 Frequency distribution of perceived community health problems in Bgy X. 2005
Community Health Problem Garbage Frequency 12 % 35.3

Frequent colds/ cough of children


Mosquitoes Piggery Air pollution Tall grasses Far from health center Total HH: 34

12
6 5 4 3 1

35.3
17.6 14.7 11.8 8.8 2.9

Total HHepgonzaga with no answer 10 DFCM DLSHSI 2010

Table 6.2 Frequency distribution of perceived community health problems , causes and solutions in Bgy X. 2005
PROBLEM Freq/ % CAUSES Freq / % SOLUTION Freq/ %

Diarrhea

10 / 50

Parents neglect

20/ 100

Teach

Dirty water
Play in flood FLies Garbage Rains

Dasma Water SS
Scold City Hall None

epgonzaga DFCM DLSHSI 2010

Sec 4.5 Current efforts about the health situation


Summarizes

- What the community is doing about it - What the health services is doing about it

epgonzaga DFCM DLSHSI 2010

Interpreting the Findings


1. Make sense of the findings

- Identify problems Aspects of community (variables) in relation to a standard Problem areas = if below the standard
- Explain causes of the problems
epgonzaga DFCM DLSHSI 2010

Interpreting the Findings


1. Make sense of the findings

2. Broader significance

extent to which they may be generalized beyond study population, - wider scientific implications, - research questions raised or unanswered - practical implications e.g. provision of medical care or public health action

epgonzaga DFCM DLSHSI 2010

5. Conclusion Making sense of the Data collected

4.1 Identification of problems areas (compare collected data with standards / reference points)

epgonzaga DFCM DLSHSI 2010

Comparison with Standards /Reference points 1. Acceptable levels - Desired situations Health goals 2. Within same area Trends (time) 3. Within country : Municipality; Province / Region National 4. With other countries Western Pacific South East Asia
epgonzaga DFCM DLSHSI 2010

Sources of standards: (CM3 use) 1. National Objectives for Health 1999-2004 2005-2010 2. National Statistical Coordination Board 3. World Health Organization - World HeaLth Statistics 2010 - Country Health Information 4. UNICEF State of the World Children Report 5. Health of Asia and the Pacific

epgonzaga DFCM DLSHSI 2010

DATA CATEGORY

Standards Findings National Obj for health, 1999-2005 28.4/ 1000 pop or 2.84%

Population CBR Health status Nutritional Status Morbidity

TB = 1.9 / 1000 Ph 0-6 = 350 / 100,000 Polio = 0 Measle = < 3,000 NT = 1 / 1000 LB Dip = <300 cases Perluri = <1,500 cases Pavasit = < 50% Diarrhea = 1% HPN = <15% Cancer = 5 / 10,000
epgonzaga DFCM DLSHSI 2010

DATA Category

STANDARDS (Source/ Year)

Comm X

FINDINGS

Population CBR 23.1/1,000 pop 18.0/ (PHS, 2000)1 1000 20.50/1,000 DIFFERENT pop VALUES (PHS,2004)2

AMONG REFERENCES!

1. National Objectives for Health, 2005-2010 2.Western Pacific Country Health Information Profiles 2008
epgonzaga DFCM DLSHSI 2010

Western Pacific Country Health Information Profiles 2008


epgonzaga DFCM DLSHSI 2010

Findings

- Comparison between the specific condition in community and the standard/ reference

With in Standard Acceptable


Favorable BETTER

BELOW STANDARD NOT ACCEPTABLE


NOT FAVORABLE WORSE
epgonzaga DFCM DLSHSI 2010

TFR : 2.3 in 2010


WITHIN STANDARD VALUES IMPLICATION HIGH OR LOW ACCEPTABLE FAVORABLE BETTER BELOW STANDARD HIGH OR LOW NOT ACCEPTABLE NOT FAVORABLE WORSE

Source: National Objectives for Health


epgonzaga DFCM DLSHSI 2010

epgonzaga DFCM DLSHSI 2010

Infant Mortality Rate


1998

Source: National Objectives for Health

Urban
Rural Lowest

30.9
40.2

Metro Manila Central Luzon Western Visayas

23.7 23.6 26 Highest Eastern Visayas 60.8 ARMM 55.1

Caraga
epgonzaga DFCM DLSHSI 2010

53.2

MATERNAL DEATHS/ 100,000 LIVE BIRTHS

Indonesia: 312 - 385 Philippines : 1970 1995 190 179.7

Malaysia
Thailand Japan Singapore

20
10.7 7.6 4.1

Source: National Objectives for Health epgonzaga DFCM DLSHSI 2010

Maternal Deaths: less 1% of total deaths Lowest Metro Manila Southern Tagalog Highest ARMM Northern Mindanao
Source: National Objectives for Health epgonzaga DFCM DLSHSI 2010

Sec 5.1 : Problem ID


Information Bgy X Standard Findings

Population Health status


Social Economic Environm

Health sector Health services


Knowledge PHC/ Perceptions

epgonzaga DFCM DLSHSI 2010

Sec 5.2 Problem Prioritization


WHO criteria for prioritization:
1. Magnitude of the problem 2. Vulnerability to technology
3. Social concern

4. Existing health policy

epgonzaga DFCM DLSHSI 2010

Magnitude
Severity level of disease or condition Extent of People affected

- Prevalence - Incidence (projected number of new cases) - Case fatality rate (projected no. of
deaths)

- Worsening trend
epgonzaga DFCM DLSHSI 2010

Vulnerability to technology
1. 2. 3. 4. Existence of effective technology Feasibility of implementation of technology Geographical application of technology Multiplicity of effects of technology

epgonzaga DFCM DLSHSI 2010

Social concern

Value attached by community to the Disease/ Condition


- Explicitly expressed as a problem - % of HH reporting Check the perceived causes and solutions for the identified problem (correct knowledge/ LOGICAL SEQUENCE)

epgonzaga DFCM DLSHSI 2010

Existing health policy

1. Presence of an existing policy 2. Relevance of existing health policy to the identified health problem

epgonzaga DFCM DLSHSI 2010

Prioritization process
Scoring system
1. Prepare a scale (0 to 3; 1-5 )

May have different scales depending on nature of problem Describe each point in scale

ensure exclusivity 2. Rate each problem


epgonzaga DFCM DLSHSI 2010

Sec 5.2.1 WHO criteria for prioritization


Points 0 1 M 0- 24 % 25-34% V SC HP None 1-3 years No vaccine < 25 HH report Vaccine for health workers 25 - 49 HH

35- 50%

Vaccine 50 74% free for HH young and old


epgonzaga DFCM DLSHSI 2010

4-6 years

Sec 5.2.2 : Problem prioritization (Application of criteria)


Prob -lems Magnit -ude Vulnera Social Existing -bility concern health to tech policy Total score

CBR

1 Diarrhea 3
(0-5 years)

3 3

1 3

3 3

8 12

epgonzaga DFCM DLSHSI 2010

Sec 5.2.3 List of 3 priority problems


PROBLEMS 1.Diarrhea among 0-5 years 2. High Birth Rate BASIS Highest score 12

2nd highest

8 6

3. High Below Normal WT 3rd highest

From the table of Sec 5.2.2, list the three priority problems with the highest total scores
epgonzaga DFCM DLSHSI 2010

Sec 6. WORK PLAN


Activity Results Persons Date Time Re sources Accomplishme Reasons for nts/ Deviations deviation

epgonzaga DFCM DLSHSI 2010

7. Prepare Report

1. Review the prescribed report format 2. Prepare the draft 3. Get comments (team and preceptor)

4. Finalize the report

epgonzaga DFCM DLSHSI 2010

Report Format
INTRODUCTION (rationale of project) I. Situational Analysis

A. Community Diagnosis B. Problem Investigation II. Project Plan III. Project Implementation IV. Project Evaluation

epgonzaga DFCM DLSHSI 2010

Report Format
I. Situational Analysis

A. Community Diagnosis 1. Rationale (Purpose) 2. Objectives (SMART RESULTS) 3. Methodology 4. Results 5. Conclusion 6. Work Plan / Results 7. Evaluation Plan/ Results
epgonzaga DFCM DLSHSI 2010

Report Format I. Situational Analysis A. Community Diagnosis


1. Rationale

- clarifies the purpose of doing a community diagnosis

epgonzaga DFCM DLSHSI 2010

Report Format I. Situational Analysis A. Community Diagnosis


2. Objectives

General Specific -Measurable, Attainable, REALISTIC, TIME-BOUND


(= RESULTS)
epgonzaga DFCM DLSHSI 2010

Report Format I. Situational Analysis A. Community Diagnosis


3. Methodology: - descriptive vv analytical

- Population: Total, sample - Data collection: Interview, questionnaire, documents / literature review - Data processing: manual/ computer - Data analysis:
epgonzaga DFCM DLSHSI 2010

Report Format I. Situational Analysis A. Community Diagnosis


4. Results

4.1 General description of place ( follow handout outline) geography, climate etc

epgonzaga DFCM DLSHSI 2010

Report Format I. Situational Analysis A. Community Diagnosis


4. Results

4.2 Description of the community - Population Characteristics - health status - socio-economic Tabular or graphical - environment Preceded by a statement - health sector - health services Highlights of table/ graph

epgonzaga DFCM DLSHSI 2010

Report Format I. Situational Analysis A. Community Diagnosis


4. Results

4.3 Description of status of each life event - At birth - Nutritional status - Morbidity - Mortality Tabular
1- 2 statements
epgonzaga DFCM DLSHSI 2010

Report Format I. Situational Analysis A. Community Diagnosis


4. 3
LIFE EVENT
At birth Nutritional Status Morbidity

STATUS

Mortality

epgonzaga DFCM DLSHSI 2010

Report Format I. Situational Analysis A. Community Diagnosis


4. 4. Factors affecting Life Event
LIFE EVENT At birth Nutritional Status Morbidity CORRELATES

Mortality
epgonzaga DFCM DLSHSI 2010

Report Format I. Situational Analysis A. Community Diagnosis

4. 5.
Description of Current Efforts about the Health Situation by the Community and

Health Services

epgonzaga DFCM DLSHSI 2010

Report Format I. Situational Analysis A. Community Diagnosis


5. Conclusion

5.1 Identified Problems (a. detailed list)


Information Population
Health Status

Standards

Comm X

Findings

Socio -econ
Environment

Health Sector
epgonzaga DFCM DLSHSI 2010

Report Format I. Situational Analysis A. Community Diagnosis


5. Conclusion

5.1 b. Table on Problems and Basis


Problems Basis

epgonzaga DFCM DLSHSI 2010

Report Format I. Situational Analysis A. Community Diagnosis


5. Conclusion 5.2 Problem Prioritization

- Using WHO criteria, assign points for each criterion and basis for points - Prioritize the identified health problems using your developed point system for the WHO criteria
epgonzaga DFCM DLSHSI 2010

Sec 5.2.1 WHO criteria for prioritization


Points 0 M V SC < 10 HH report Plenty of children HP None 20 - 25 % No tech

26 30% Available Minimal risk


31- 35% Wide use Multiple effect

11 19 HH
20 34 HH

Existing Less 5 years


5 - 10 years use

epgonzaga DFCM DLSHSI 2010

Report Format I. Situational Analysis A. Community Diagnosis


5. Conclusion

5.2 Problem Prioritization

Prob M P1
P2

SC

EP

Total

Pn
epgonzaga DFCM DLSHSI 2010

Report Format I. Situational Analysis A. Community Diagnosis 5. Conclusion

5.2 Problem Prioritization


Priority Problem Problem 1 Basis

Problem 2
Problem 3

epgonzaga DFCM DLSHSI 2010

6. Monitor the activities


Use the - CDx plan field editing to ensure reliable and valid results - Work plan ensure smooth implementation of activities and provide support to team members (PURPOSE OF PRECEPTORIALS)
epgonzaga DFCM DLSHSI 2010

1.3 Prepare CDx Work Plan (CM3)


Activities/ Results subactivities Plan survey CDx Plan Work Plan Evaln Plan CDx Report July 20/ 21 Person DateTime Resources Team Paper

-.. Conduct -Collection Processing -Analysis


-

Evaluate Knowledge Skills

Student Leader Peer

Exams June 13 Grading July 22- 30 sheets

epgonzaga DFCM DLSHSI 2010

8. Evaluate the CDx

Use the evaluation plan

- attainment of objectives - efficiency of methods

epgonzaga DFCM DLSHSI 2010

1.2. Prepare Evaluation Plan


Activities/ Results subactivities Pepare evaluation design Conduct of data gathering Data analysis Report preparation Objectives Methods defined Activities and data gathered Responses organized / analyzed Oral and Written reports Person Date/Time Resources

June 1- 6

Papers Handout Observatio n sheets Papers, computer Papers, computer, printing

June 14-16

January 30

Feb 1-15

epgonzaga DFCM DLSHSI 2010

Sec 7. EVALUATION PLAN


Activity Results Persons Date Time Re sources Accomplishme Reasons for nts/ Deviations deviation

epgonzaga DFCM DLSHSI 2010

7. Feedback to the community


Provide community copy of the report Present results to community

---confidentiality of data must be respected-feedback must be population rates and not at the individual levels.

epgonzaga DFCM DLSHSI 2010

CDx in the Program/ Project Management Cycle

Phase 1: Planning Step1. Situational Analysis Community Diagnosis (broad) Problem Investigation (specific)
Step 2. Objective Setting Step 3. Action Planning Step 4. Plan for Evaluation

Phase 2: Implementation Phase 3: Evaluation


epgonzaga DFCM DLSHSI 2010

WHAT NEXT !
I. Situational Analysis

A. Community Diagnosis 31 hours work End point: 3 priority problems B. Problem Investigation II. Project Plan III. Project Implementation IV. Project Evaluation
epgonzaga DFCM DLSHSI 2010

Dr. J. Carnate

References
1. Kark, Sidney: The Practice of Community Oriented Primary Health Care. Appleton, Century Crofts, New York. 1981. P. 11 2. Ibid. p. 25 3. Abramson. J.H. Survey Methods in Community Medicine. 4th edition. Churchill Livingstone. Edinburgh London Melbourne and New York 1990. p.315 4. Presentation format/ content adapted from Dr. Carmen Tolabings powerpoint and materials 20052006

epgonzaga DFCM DLSHSI 2010

You might also like