[EPI] 2.06 Community Diagnosis - Dr.zulueta

EPIDEMIOLOGY

2.06 COMMUNITY DIAGNOSIS Dr. Zulueta | March 1,2017 OUTLINE

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Introduction to Community Diagnosis A. Definition of Community Diagnosis B. Aims of Community Diagnosis C. Sources of Data II. Epidemiologic Methods for Community Diagnosis A. Steps of Epidemiologic Methods B. Definition of the Problem C. Appraisal of Existing Facts D. Hypothesis Formulation E. Practical Application III. Mini Quiz IV. Table OBJECTIVES: At the end of the lecture, the student should be able to: 1. Discuss the specific steps in conducting community diagnosis. Legend: Remember (Exams)

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I. INTRODUCTION TO COMMUNITY DIAGNOSIS A. Definition of Community Diagnosis 1. For this topic, community refers to the rural community or the urban poor 2. Pattern of diseases in a community, described in terms of the factors influencing this pattern (Gupta and Mahajan, 2003) 3. Means of examining aggregate health and social statistics, liberally spiced with knowledge of the local situation, to determine health needs of a community (North Carolina State Center for Health and Environmental Statistics) 4. Method of assessing a community’s needs and characteristics that takes into account its social dynamics and other factors affecting internal problemsolving capacity 5. Also called community assessment, or CHA (community health assessment) or CHNA (community health needs assessment) 6. Basically means identifying needs of a community and addressing those needs by finding a solution 7. Systematic process involving the community to identify and analyze community health needs and assets in order to prioritize these needs, and to plan and act upon unmet community health needs (CDC, 2015)

B. Aims of Community Diagnosis 1. Identify and quantify health problems in community on basis of morbidity and mortality rates and ratios 2. Identify individuals or groups in community who are at risk in developing the disease or who needs healthcare TRANSCRIBERS

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Note: Ultimate goal: develop strategies to address the community’s health needs and identified issues (CDC, 2015)

C. Sources of Data  Primary data - obtained by the investigator personally to aid in answering different objectives or purposes he/she has set for his/her study o Collected first-hand through surveys, listening sessions, interviews and observations (CDC, 2015)  Secondary data - quantified health data can be obtained from other sources or previously existing data o Collected by another entity or for another purpose (CDC, 2015)  Note: If (1) money, (2) manpower, (3) time and (4) equipment permit, always use primary data. II. EPIDEMIOLOGIC METHODS FOR COMMUNITY DIAGNOSIS A. Steps of Epidemiologic Methods 1. Definition of problem 2. Appraisal of existing facts 3. Hypothesis formulation 4. Practical application B. Definition of a Problem 1. What is the present status (nature and extent) of the problem? 2. Is it a major or minor problem? a. Prioritization of problems due to limited resources b. Leading causes of morbidity and mortality = major 3. How much is the economic cost of the problem? a. Total Economic Costs (TEC): TEC = CoT + CoD + CoED + CoP b. Cost of Treatment (CoT): CoT = (number of cases) (amount of drugs + hospitalization + other medical expenses) c. Cost of Disability (CoD): CoD = (number of cases) (average number of days lost due to illness) (daily wage cost) i. Daily wage cost = PhP 466.00 + daily COLA (cost-of-living adjustment) ii. Daily wage cost for 2017: Php 491.00 (see Appendix, Table 1) d. Cost of Early Death (CoED): CoED = (number of deaths due to a specific cause) (years lost due to early death) (expected annual wage) e. Cost of Prevention (CoP): CoP = (total health budget allotted for a specific disease) / disorder EDITOR

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Disability Adjusted Life Years (DALY): DALY = YLL + YLD i. Years of Life Lost due to premature death or mortality (YLL): YLL = N x L 1. N: number of deaths 2. L: standard life expectancy at age of death in years ii. Years Lost due to Disability (YLD): YLD = I x DW x L 1. I: number of incident cases 2. DW: disability weight 3. L: standard life expectancy at age of death in years

C. Appraisal of Existing Facts ● Know host, agent and environment ● What information do you need in order to identify factors that may have contributed to occurrence of the problem? Why do you need these data? ● What is the present level of knowledge (i.e., literature review) with regards to etiology of an identified problem? ● What are the disease patterns according to: (descriptive epidemiology) ○ Person: age group, culture, civil status, educational attainment, social class, state of nutrition, occupation ○ Place: regional, geographic differences ■ E.g. Filariasis is more common in places with abaca ○ Time of occurrence: secular trend ● What are the characteristics of the host/individual that influence the pattern of the disease? ○ Age distribution ● What are the characteristics of the disease agent that influence the pattern of disease? ○ Nature or virulence factors of the disease agent ○ Mode of transmission ● Note: What is easier to control: agent or host? ○ It depends. If the agent is strong and host is vulnerable, then the host will be infected. On the other hand, the host will not be infected if the agent is weak and the host has good immune status. ● Why do these disease patterns occur? ○ Geographic distribution ■ Related to differences in socioeconomic development and cultural differences ■ Related to environmental conditions and access to health services

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Seasonal variation ■ Fluctuation of disease occurrence within a calendar year, reflecting climatic changes ■ Dry months / season ■ Wet months / season ■ E.g. It is most appropriate to give the influenza vaccine just before the rainy season at around May

D. Hypothesis Formulation ● What are the possible explanations for the existence and level of the identified disease or health problem? ● Cite specific reasons or factors which directly or indirectly affect the status of the disease or health problem in the community. ● Are the reasons or explanations given really existent or applicable to the community only or the whole country? ● How do you consolidate the knowledge gained in the preceding part (appraisal of existing facts) to formulate a hypothesis of causation? E. Practical Application ● Propose solutions to identified problems ○ Prevent, diagnose and treat early ● In general, what may be done to improve, if not altogether solve, the identified disease or health problem in the community and in the country? ● Are there existing activities or programs (Department of Health) being done presently to address the problem? ● For identified prevalent diseases, what specific measures may be applied on: ○ Host or population ○ Disease agent or sources of problem ○ Means of transmission ● Note: Prevalent diseases = cross-sectional studies ● What resources in the community may be utilized to address the identified problem? ○ Roles of community agencies: LGUs (local government units) and NGOs (nongovernment organizations) ○ Roles of medical practitioners and allied health professionals ● What preventive measures (primary, secondary, tertiary) can be done to control disease and remedy health problem at level of: ○ Individual ○ Family members ○ Community ● Note: PDR for preventive measures: prevent, diagnose and treat early, and rehabilitate

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Primary data must be used when which of the following is/are permitted? a. Money b. Manpower c. Time d. Equipment e. All of the above f. None of the above For prevalent diseases, which type/s of study should be used? a. Case-control study b. Cohort study c. Cross-sectional study d. Ecologic study e. All of the above f. None of the above The epidemiologic method consists of the following, except: a. Hypothesis formulation b. Appraisal of existing facts c. Practical application d. Definition of problem e. All of the above f. None of the above The TEC (total economic costs) is the summation of the following, except: a. CoT b. DALY c. CoP d. CoED e. CoD f. None of the above Why is it important to identify whether a health problem is major or minor (i.e., prioritization of certain problems)? a. Because major problems require more time to be solved b. Because minor problems demand less time to be solved c. Because there is limited resources d. Because there is abundant resources e. a and c only f. None of the above

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Centers for Disease Control and Prevention. (2015). Data and Benchmarks. Retrieved from https://www.cdc.gov/stltpublichealth/cha/data.html Zulueta, J. (2017). Community Diagnosis. Lecture, JMC Auditiorium 1, UERMMMCI, Quezon City, Philippines.

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Centers for Disease Control and Prevention. (2015). Community Health Assessments & Health Improvement Plans. Retrieved from https://www.cdc.gov/stltpublichealth/cha/plan.html TRANSCRIBERS

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Sector/Industry

Basic Wage

COLA Integrati on

New Basic Wage

New COLA

New Minimum Wage Rate

Non-agriculture (including private hospitals with bed capacity of 100 or less)

Php 466.00

Php 15.00

Php 481.00

Php 10.00

Php 491.00

Php 429.00

Php 15.00

Php 444.00

Php 10.00

Php 454.00

Agriculture (plantation and non-plantation) Retail/service establishments employing 15 workers or less Manufacturing establishments employing less than 10 workers

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