Measuring Health and Disease in Community Health

Question 1

Why measure health or disease?

Answer 1

to improve the health status of a population
- We try to measure diseases and collect information on the health status of a population in order to make a community diagnosis

Question 2

Main reasons for measuring health and disease of a population?

Answer 2

1. identifying and prioritising health problems for action
2. collecting information for planning and management of health care.
3. collecting information for evaluation of health care and disease control programmes
4. early detection and surveillance of epidemic illness and surveillance of endemic illness
5. identifying determinants of disease so as to enable us to prevent them

Question 3

Who need information about the health status of a community or population?

Answer 3

1. Health workers
2. health planners and health service managers (DHO’s, staff of the MOHP, health programme managers)
3. researchers
4. lecturers at health training institutions
5. general public

Question 4

What information is required to make a health profile of a community?

Answer 4

1. demographic
2. socio-economic
3. geographical
4. vital statistics
5. morbidity and mortality
6. health services and health care providers
7. environmental health

Question 5

Examples of demographic information?

Answer 5

1. total population and its sex, age and geographical distribution
2. population growth rate

Question 6

Examples of socio-economic information?

Answer 6

1. ethnic groups
2. political structure
3. means of subsistence
4. average income
5. cultural background
6. level of education)

Question 7

Examples of geographical information?

Answer 7

1. distances within the district
2. location of villages and towns
3. roads
4. transport
5. other means of communication
6. accessibility of areas

Question 8

Examples of vital statistics?

Answer 8

1. crude birth rate
2. crude death rate
3. annual growth rate
4. fertility rate

Question 9

Examples of information on morbidity and mortality?

Answer 9

incidence/prevalence of diseases and their mortality rates `top ten’ of morbidity or mortality

Question 10

Examples of information on health services and health care providers?

Answer 10

1. number of health institutions range of services provided
2. coverage
3. utilisation

Question 11

Examples of information on environmental health?

Answer 11

1. water supplies
2. excreta disposal
3. hygiene

Question 12

Where and how to collect information about the health status of a community?

Answer 12

1. observation (“look and listen”) - qualitative information.
2. resource persons
   e.g. DHO, RHO, health workers, community leaders, project managers
3. hospital/clinic data
   e.g. admission book, OPD register, maternity register, operation theatre register, quarterly returns
4. special registers
   e.g. deaths, births, notifiable diseases, tb-register
5. reports
   e.g. census reports, hospital annual reports, project reports, research reports
6. surveys
   e.g. qualitative and quantitative surveys

Question 13

What are health indicators?

Answer 13

• used to describe the health status of a population or the level of disease present in a population
• Health indicators are a measure that describe the health situation or its changes over time

Question 14

Categories of health indicators?

Answer 14

1. Health status indicators
   - Morbidity indicators
   - Mortality indicators
   - Indicators of nutritional status
2. Health service indicators
3. Health policy indicators
4. Health related socio-economic indicators

Question 15

What are morbidity indicators?

Answer 15

Morbidity indicators describe the frequency of disease

Question 16

What are the 2 main morbidity indicators?

Answer 16

1. incidence
2. prevalence
   Note: Prevalence = Incidence x average duration of the condition

Question 17

What is incidence?

Answer 17

number of new cases, episodes or events related to disease over a defined period of time (commonly one year)

Question 18

What is prevalence?

Answer 18

total number of existing cases, episodes or events related to disease occurring at one point in time (commonly on a particular day)

Question 19

Why are incidence and prevalence important?

Answer 19

1. give absolute numbers of disease cases which are useful to describe workload or to determine need for health services
2. When we need to look at trend over time or to compare disease frequency between different population, district or countries, we use rates.

Question 20

What are incidence and prevalence rates?

Answer 20

1. Incidence rate
   - Incidence related to population at risk over a defined period.
   (often expressed per 1000 population)
2. Prevalence rate
   - Prevalence related to population at risk at one point in time
   (often expressed per 1000 population).

Question 21

What are mortality indicators?

Answer 21

Mortality indicators measure the frequency of death

Question 22

Name the mortality indicators?

Answer 22

1. disease specific mortality rate
2. case fatality rate
3. maternal mortality ratio
4. maternal mortality rate
5. neonatal mortality rate
6. perinatal mortality rate
7. infant mortality rate
8. under five mortality rate
9. child mortality rate

Question 23

Disease specific mortality rate?

Answer 23

The incidence rate of death due to a specified disease related to the population at risk over a defined period

Question 24

Case fatality rate?

Answer 24

Number of patients dying from a disease over a defined period of time, related to the total Number of cases diagnosed in the same period (expressed as %)

Question 25

Maternal mortality ratio?

Answer 25

The number of maternal deaths during a year related to the total number of live births in the same year (expressed per 100,000 live births)

Question 26

Maternal mortality rate?

Answer 26

The number of maternal deaths during a year, related to the total number of women of reproductive age.

Question 27

Definition of maternal death?

Answer 27

- The death of a woman while pregnant or within 42 days (6 weeks) of termination of pregnancy - irrespective of the duration or the site of pregnancy - from any cause related to or aggravated by the pregnancy or its management - but not from accidental causes

Question 28

Neonatal mortality rate?

Answer 28

The number of children who died in the neonatal period (first 28 days after birth) during one year, related to the number of live births during the same year (expressed per 1000 live births)

Question 29

Perinatal mortality rate?

Answer 29

The number of still births (child death after the 28th week of gestation) plus the number of children who died in the first 7 days after birth per year per 1000 total births in the same year

Question 30

Infant mortality ratio?

Answer 30

The number of infants (children under 1 year) who dies during a year, related to the number of live births during the same year (expressed per 1000 live births)

Question 31

Under five mortality rate?

Answer 31

The number of children who died before the age of five during one year, related to the number of live births during the same year (expressed per 1000 live births).

Question 32

Child mortality rate?

Answer 32

The number of children who died between 1 and 4 years of age during one year, related to the number of live births in the same year (expressed per 1000 live births).

Question 33

Name the indicators of nutritional status?

Answer 33

1. % of children of 1-4 years who are stunted (<-2.0 D of reference Ht/Age) 2. % of children of 1-4 years who are wasted (<-2.0 D of reference Wt/Age) 3. % of children below 1 year of age who are severely wasted (-3.0 D of reference Wt/Age)

Question 34

What are the 2 health service indicators?

Answer 34

1. Coverage - the percentage of people or households in need of a health service who actually receive it 2. Utilisation - the number of people who actually use an available health service

Question 35

Examples of coverage?

Answer 35

1. % of households who have access to a safe water supply within 5 km. 2. % of the population which lives within 15 km of a health centre 3. Vaccination coverage (BCG, Polio-0, DTP-1, DTP-3, Measles, TT-1, TT-2, TT-R) 4. % of deliveries attended by a trained health worker

Question 36

Examples of utilisation?

Answer 36

1. Number of new outpatients per total number of people in the catchment area. 2. Average number of antenatal visits per antenatal client 3. Hospital bed occupancy rate 4. Percentage of children of 0-11 months who attended a child welfare clinic (number of first visits of children below 1 year of age at the CWC over a defined period of tie related to the expected number of live births in the catchment area in the same period)

Question 37

What are the health related socio-economic indicators?

Answer 37

1. Total fertility rate - The average number of children a woman would have throughout her childbearing years (15 – 49 years), assuming that current age-specific birth rates remain constant. 2. Literacy rate 3. Gross national product