Professional Documents
Culture Documents
CM3 2010-2011 Department of Family and Community Medicine De La Salle Health Science Campus Estrella P. Gonzaga M.D.
epgonzaga DFCM DLSHSI 2010
CDX
E
PI
I/M
I/M
HEALTH EDUCATION
I/M
Lit Rev
Step 2. Objective Setting Problem Investigation 1. Plan PI Plan Work Plan Evaluation Plan 2. Conduct 3. Reporting
2.
What instruments will c. Data collection tools d. Data recording and be used to measure processing the conditions?
Who will do what and 1.2 & 1.3 Plan the Work Activities/ Evaluation when? Attained ? epgonzaga DFCM DLSHSI 2010
ANALYSIS
- 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
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
STATUS
Popn
Social
Econ
Envr
Health Sector
Knowledge/ Perception
Content analysis
Descriptive Statistics Frequency Distribution Sec 4.2.1 Frequency Distribution Sec 4.2.2 Sec 4.2.1
Health Status
Sec 4.2.2
DETAILS
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
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
Sec 4.2.3
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
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
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
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
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
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:
NUTRITIONAL STATUS
BIRTH
ILLNESS/ DISEASE
DEATH
Morbidity Mortality
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
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
HEALTH STATUS
CORRELATES
Pop SOCIAL ECONO ENV H SERVCS KAP
HS
% W M RA
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
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
Private hospital/clinic
Government Hospital
47.1
0
73.5
11.8
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
12
6 5 4 3 1
35.3
17.6 14.7 11.8 8.8 2.9
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
- What the community is doing about it - What the health services is doing about it
- 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
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
4.1 Identification of problems areas (compare collected data with standards / reference points)
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
DATA CATEGORY
Standards Findings National Obj for health, 1999-2005 28.4/ 1000 pop or 2.84%
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
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
Findings
- Comparison between the specific condition in community and the standard/ reference
Urban
Rural Lowest
30.9
40.2
Caraga
epgonzaga DFCM DLSHSI 2010
53.2
Malaysia
Thailand Japan Singapore
20
10.7 7.6 4.1
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
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
Social concern
1. Presence of an existing policy 2. Relevance of existing health policy to the identified health problem
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
35- 50%
4-6 years
CBR
1 Diarrhea 3
(0-5 years)
3 3
1 3
3 3
8 12
2nd highest
8 6
From the table of Sec 5.2.2, list the three priority problems with the highest total scores
epgonzaga DFCM DLSHSI 2010
7. Prepare Report
1. Review the prescribed report format 2. Prepare the draft 3. Get comments (team and preceptor)
Report Format
INTRODUCTION (rationale of project) I. Situational Analysis
A. Community Diagnosis B. Problem Investigation II. Project Plan III. Project Implementation IV. Project Evaluation
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
- Population: Total, sample - Data collection: Interview, questionnaire, documents / literature review - Data processing: manual/ computer - Data analysis:
epgonzaga DFCM DLSHSI 2010
4.1 General description of place ( follow handout outline) geography, climate etc
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
4.3 Description of status of each life event - At birth - Nutritional status - Morbidity - Mortality Tabular
1- 2 statements
epgonzaga DFCM DLSHSI 2010
STATUS
Mortality
Mortality
epgonzaga DFCM DLSHSI 2010
4. 5.
Description of Current Efforts about the Health Situation by the Community and
Health Services
Standards
Comm X
Findings
Socio -econ
Environment
Health Sector
epgonzaga DFCM DLSHSI 2010
- 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
11 19 HH
20 34 HH
Prob M P1
P2
SC
EP
Total
Pn
epgonzaga DFCM DLSHSI 2010
Problem 2
Problem 3
June 1- 6
June 14-16
January 30
Feb 1-15
---confidentiality of data must be respected-feedback must be population rates and not at the individual levels.
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
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