Community Health Nursing - Unit 3 Notes

SECTION 1: EPIDEMIOLOGY

Definition

• Unit of study = defined population (not an individual, unlike clinical medicine)
• The epidemiologist studies the relationship between cases and the population in the form of a rate

Aims of Epidemiology (IEA)

1. To describe the distribution and magnitude of health and disease problems in human populations
2. To identify aetiological factors (risk factors) in the pathogenesis of disease
3. To provide data for planning, implementation and evaluation of preventive and therapeutic services

• Eliminate or reduce the health problem or its consequences
• Promote the health and well-being of society

Types of Epidemiological Studies

1. Descriptive Epidemiology

• When is the disease occurring? - Time distribution
• Where is it occurring? - Place distribution
• Who is getting the disease? - Person distribution

1. Define the population to be studied
2. Define the disease under study
3. Describe disease by time, place, person
4. Measurement of disease
5. Compare with known indices
6. Formulate an aetiological hypothesis

2. Analytical Epidemiology

3. Experimental Epidemiology

Basic Measurements in Epidemiology

• (a) Mortality - death rates
• (b) Morbidity - disease rates
• (c) Disability - functional limitation
• (d) Natality - birth rates
• (e) Distribution of disease characteristics
• (f) Medical needs and health care utilization
• (g) Environmental factors causing disease
• (h) Demographic variables

Epidemiology vs. Clinical Medicine

SECTION 2: PRIMARY HEALTH CARE (PHC)

Background - Health for All

Definition of PHC (Alma-Ata, 1978)

Principles of PHC

1. Social equity - services for all
2. Nation-wide coverage
3. Self-reliance - "Health by the people"
4. Intersectoral coordination
5. People's involvement in planning and implementation

Components/Elements of PHC (Alma-Ata Declaration)

1. Education about prevailing health problems and methods of preventing/controlling them
2. Promotion of food supply and proper nutrition
3. Adequate supply of safe water and basic sanitation
4. Maternal and child health care, including family planning
5. Immunization against infectious diseases
6. Prevention and control of endemic diseases
7. Appropriate treatment of common diseases and injuries
8. Provision of essential drugs

The list can be modified to fit local circumstances - some countries added mental health, physical handicaps, and care of the elderly.

Obstacles to PHC in India

• Shortage of health manpower
• Entrenchment of a curative culture in the existing health system
• High concentration of health services in urban areas

SECTION 3: FAMILY HEALTH

Concept

• Social and physical environment
• Lifestyle and behaviour

• Health promotion and disease prevention
• Early diagnosis and care of the sick
• Childbearing and child rearing
• Promoting a healthy lifestyle in children

Role of the Community Health Nurse in Family Health

• Promote the family's capacity for self-care
• Health education on disease prevention and control (malaria, TB, leprosy, filaria, goitre)
• Mental health support - especially during critical life periods:
  • Mother after childbirth
  • Child entering school for the first time
  • Adolescent career decisions
  • Starting a new family
  • Widowhood
• Accident prevention education
• Family planning counselling

Disease Prevention and Control

SECTION 4: ENVIRONMENTAL HEALTH & SANITATION

WHO's Role in Environmental Health

• Quality of air, water, and food
• Health conditions of work
• Radiation protection
• Early identification of hazards from new technology

Key WHO Programmes

• WHO Environmental Health Criteria Programme
• WHO Environmental Health Monitoring Programme

Basic Environmental Health Activities (under PHC)

• Adequate supply of safe drinking water
• Basic sanitation (latrines, waste disposal)
• Sanitary housing
• Control of vectors and disease carriers
• Food safety and hygiene

Health Statistics and Surveillance

• Weekly Epidemiological Record
• World Health Statistics Quarterly and Annual
• International Classification of Diseases (ICD) - updated every 10 years; ICD-10 effective from 1st January 1993

SECTION 5: SCHOOL HEALTH

Definition & Importance

Historical Development in India

• 1909 - First medical examination of school children, Baroda
• 1946 - Bhore Committee: school health services practically non-existent
• 1953 - Secondary Education Committee emphasized need for medical examination and school feeding
• 1960 - Govt. of India formed a School Health Committee
• 1961 - Committee report submitted with recommendations

Health Problems of the School Child

1. Malnutrition
2. Infectious diseases
3. Intestinal parasites
4. Diseases of skin, eye, and ear
5. Dental caries

Objectives of School Health Service

1. Promotion of positive health
2. Prevention of diseases
3. Early diagnosis, treatment and follow-up of defects
4. Awakening health consciousness in children
5. Provision of a healthful environment

Aspects/Components of School Health Service

1. Health appraisal of school children and school personnel
2. Remedial measures and follow-up
3. Prevention of communicable diseases
4. Healthful school environment
5. Nutritional services
6. First-aid and emergency care
7. Mental health services
8. Dental health services
9. Eye health services - early detection of refractive errors, trachoma, vitamin A administration
10. Health education (most important element)
11. Education of handicapped children
12. School health records - cumulative records maintained on each student

Health Education in Schools covers:

1. Personal hygiene - skin, hair, teeth, clothing, posture, avoiding smoking
2. Environmental health - community action participation (vaccination, fly control, sanitary well construction)
3. Family life education - attitudes toward human reproduction

"Every school child is a health worker" - in developing countries

School Health Administration

SECTION 6: OCCUPATIONAL HEALTH

Background in India

• State shall protect health and strength of workers - men, women, and children
• State shall secure just and humane conditions of work

Key Legislative Measures

• Indian Factories Act, 1948
• Coal Mines Labour Welfare Act, 1947
• Employees State Insurance Act (ESI Act), 1948

Important Historical Reports

• Adarkar's Report on Health Insurance for Industrial Workers (1945)
• Report of the Health Survey and Development Committee (Bhore Committee, 1946)
• Report on Health of Industrial Workers (Thomas Bedford, 1946)
• Report on Health of Workers in Plantation (Jones, 1947)

Organizational Structure

• Directorate General, Factory Inspection and Advisory Service (set up 1945) - advises on health, welfare and safety of industrial workers
• Central Labour Institute, Mumbai (set up 1960) - scientific study of occupational health
• Regional Labour Institutes at Kanpur, Kolkata, Chennai

Services under Central/Regional Labour Institutes

QUICK REVISION - KEY POINTS