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# Lectue III - Vital statistics.ppt

COMMUNITY HEALTH NURSING

COMMUNITY HEALTH NURSING

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### Lectue III - Vital statistics.ppt

1. 1. HEALTH STATISTICS AND EPIDEMIOLOGY
2. 2. 1. Tools 1. Demography  Study of population size, composition and spatial distribution as affected by births, deaths and migration. a. Sources of Data  Census – complete enumeration of the population 2 Ways of Assigning People 1. De Jure – People were assigned to the place where assigned to the place they usually live regardless of where they are at the time of census. 2. De Facto – People were assigned to the place where they are physically present at are at the time of census regardless, of their usual place of residence.
3. 3. b. Population Size c. Composition  Age Distribution  Sex Ratio  Population Pyramid  Median age – age below which 50% of the population falls and above which 50% of the population falls. The lower the median age, the younger the population (high fertility, high death rates).  Age – Dependency Ratio – used as an index of age-induced economic drain on human resources
4. 4.  Other characteristics:  a. occupational groups  b. economic groups  c. educational attainment  d. ethnic group d. Distribution  Urban-Rural – shows the proportion of people living in urban compared to the rural areas  Crowding Index – indicates the ease by which a communicable disease can be transmitted from 1 host to another susceptible host.  Population Density – determines congestion of the place
5. 5. 2. Health Indicators
6. 6. VITALSTATISTICS  Statistics refers to a systematic approach of obtaining, organizing and analyzing numerical facts so that conclusion may be drawn from them.  Vital statistics refers to the systematic study of vital events such as births, illnesses, marriages, divorce, separation and deaths.  Statistics of disease(morbidity) and death(mortality) indicate the state of health of the community and the success or failure of the health work.  Statistic on population and the characteristic such as age and sex, distribution are obtained from the National Statistics Office(NSO).
7. 7. Use of Vital Statistics:  Indices of the health and illness status of a community.  Serves as bases for planning, implementing, monitoring and evaluating community health nursing programs and services.  Sources of Data:  Population census  Registration of vital data  Health survey  Studies and researches
8. 8.  Rates and Ratios:  Rate- shows the relationship between a vital event and those persons exposed to the occurrence of said event, within a given area and during a specifies unit of time.  Ratio- is used to describe the relationship between two (2) numerical quantities or measures of events without taking particular considerations to the time or place.  Crude or General Rates- referred to the total living population.  Specific Rate- specific population, class or group.
9. 9.  Crude Birth Rate- measure of one characteristic of the natural growth or increase of a population. Total No. of live births registered in a given calendar year CBR= ---------------------------------------------------------------- X 1,000 Estimated population as of July 1 of same year  Crude Death Rate- a measure of one mortality from all causes which may result in a decrease of population Total No. of live deaths registered in a given calendar year CDR= ---------------------------------------------------------------------- X 1,000 Estimated population as of July 1 of same year
10. 10.  Infant Mortality Rate- measure the risk of dying during the first year of life. Total No. of live death under 1 year of age registered in a given calendar year IMR= -------------------------------------------------------------------------- X 1,000 Total No. of registered live births of same calendar year  Maternal Mortality Rate- measure the risk of dying from all causes related to pregnancy, childbirth and puerperium. Total No. deaths from maternal causes registered each year MMR= ------------------------------------------------------------------------- X 1,000 Total No. of registered live births of same year
11. 11.  Infant Mortality Rate- measure the risk of dying during the first year of life. Total No. of live death under 1 year of age registered in a given calendar year IMR= -------------------------------------------------------------------------- X 1,000 Total No. of registered live births of same calendar year  Maternal Mortality Rate- measure the risk of dying from all causes related to pregnancy, childbirth and puerperium. Total No. deaths from maternal causes registered in a given year MMR= -------------------------------------------------------------------------- X 1,000 Total No. of registered live births of same year
12. 12.  Specific Death Rate- describes more accurately the risk of exposure of certain classes or groups to a particular disease. Deaths in specific class/group registered in a given calendar year Specific Death Rate= ------------------------------------------------------- X 100,000 Estimated population as of July 1 in same specified class/group of said year
13. 13.  Adjusted or Standardized Rate Methods:  By applying observed specific rates to some standard population  By applying specific rates of standard population to corresponding classes or groups of the local population  Case Fatality Ratio- index of a killing power of disease and is influenced by incomplete reporting and poor morbidity data. No. of registered deaths from a specific disease for a given year PM= -------------------------------------------------------------- X 100 No. of registered cases from specific disease in same year
14. 14. Presentation of Data  Line or curved graphs- shows peaks, valleys and seasonal trends  Bar graphs- represents or expresses a quantity in terms of rates or percentages of a particular observation  Area Diagram- (Pie Charts)- shows the relative importance of parts to the whole. Functions of the Nurse  Collects data  Tabulates data  analyzes and interprets data  Evaluates data  Recommends redirection and/ or strengthening of specific areas of health programs as needed.
15. 15. Philippine Health Situation Population  Chart and table of Philippines population from 1950 to 2020. United Nations projections are also included through the year 2100.  The current population of Philippines in 2020 is 109,581,078, a 1.35% increase from 2019.  The population of Philippines in 2019 was 108,116,615, a 1.37% increase from 2018.  The population of Philippines in 2018 was 106,651,394, a 1.41% increase from 2017.  The population of Philippines in 2017 was 105,172,925, a 1.46% increase from 2016.
16. 16. Life Expectancy  Chart and table of Philippines life expectancy from 1950 to 2020. United Nations projections are also included through the year 2100.  The current life expectancy for Philippines in 2020 is 71.28 years, a 0.18% increase from 2019.  The life expectancy for Philippines in 2019 was 71.16 years, a 0.18% increase from 2018.  The life expectancy for Philippines in 2018 was 71.03 years, a 0.23% increase from 2017.  The life expectancy for Philippines in 2017 was 70.87 years, a 0.23% increase from 2016.
17. 17. Crude Birth Rate  Chart and table of the Philippines birth rate from 1950 to 2020. United Nations projections are also included through the year 2100.  The current birth rate for Philippines in 2020 is 20.177 births per 1000 people, a 0.98% decline from 2019.  The birth rate for Philippines in 2019 was 20.377 births per 1000 people, a 0.97% decline from 2018.  The birth rate for Philippines in 2018 was 20.576 births per 1000 people, a 3.31% decline from 2017.  The birth rate for Philippines in 2017 was 21.280 births per 1000 people, a 3.2% decline from 2016.
18. 18. Infant Mortality Rate  Chart and table of the Philippines infant mortality rate from 1950 to 2020. United Nations projections are also included through the year 2100.  The current infant mortality rate for Philippines in 2020 is 18.815 deaths per 1000 live births, a 2.2% decline from 2019.  The infant mortality rate for Philippines in 2019 was 19.239 deaths per 1000 live births, a 2.16% decline from 2018.  The infant mortality rate for Philippines in 2018 was 19.663 deaths per 1000 live births, a 3.96% decline from 2017.  The infant mortality rate for Philippines in 2017 was 20.474 deaths per 1000 live births, a 3.81% decline from 2016.
19. 19. EPIDEMIOLOGY  Epidemiology is the study of occurrences and distribution of diseases as well as the distribution and determinants of health states or events in specified population, and the application of this study to the control of health problems. This emphasizes that epidemiologist are concerned not only with deaths, illness and disability, but also with more positive health states and with the means to improve health.  Two main areas of investigation are concerned in the definition, the study of the distribution of disease and the search for the determinants (causes) of the disease and its observed distributions. The first area describes the distribution of health status in terms of age, gender, race, geography, time and so on might be considered in an expansion of the discipline of demography to health and diseases. The second area involves explanations of the patterns of disease contribution in terms of casual factors.  Epidemiology , therefore is the backbone of the prevention disease.
20. 20. Uses of Epidemiology: According to Morris, epidemiology is used to:  Study the history of the health population and the rise and fall of diseases and changes in their character.  Diagnose the health of the community and the condition of people to measure the distribution and dimension of illness in terms of incidence, prevalence, disability and mortality, to set health problems in perspective and to define their relative importance and to identify groups needing special attention.  Study the work of health services with the view of improving them. Operational research shows how the community expectations can result in the actual provisions of service .  Estimate the risk of disease, accidents , defects and the changes of avoiding them.  Identify syndromes by describing the distribution and association of clinical phenomena in the population.  Complete the clinical picture of chronic disease and describe their natural history.  Search for causes of health and disease by comparing the experience of groups that are clearly defined by their composition, inheritance, experience, behavior and environments.
21. 21.  Figure 4- The Epidemiology Triangle HOST AGENT ENVIRONMENT
22. 22. The Epidemiology Triangle  The Epidemiology Triangle consists of three component – host, environment and agent. The model implies that each must be analyzed and understood for comprehensions and prediction of patterns of a disease. A change in any of the component will alter an existing equilibrium to increase or decrease of the disease.  The host is any organism that harbors and provides nourishment for another organism.  Agent is the intrinsic property of microorganism to survive and multiply in the environment to produce disease.  Environment is the sum total of all external condition and influences that effects the development of an organism which can be biological, social and physical.
23. 23. The three component of the environment:  Physical Environment – composed of the inanimate surroundings such as the geophysical conditions of the climate.  Biological environment makes up the living things around us such as plants and animal life.  Socio-economic environment which may be in the form of level of economic development of the community, presence of social disruptions and the like.
24. 24.  Approach to Disease and its Determinants  The present epidemiology approach is based on the interaction of the host, the causative agent, and the environment.  The presence of infectious materials varies with the duration and the extent of its excretion from an infected person the climactic conditions affecting survival of the agent, route of entry into the host and the existence of alternative reservoirs or host of the agent.
25. 25. Classifications of Agents, Hosts and Environmental Factors which determine the occurrence of Disease in Human Population 1.Agents of Disease a. Nutritive elements b. Chemical agents c. Physical agents d. Infectious agents
26. 26. 2. Host factors ( Intrinsic Factors) – influences exposure, susceptibility or response to agents. a.Genetic b. Age c. Sex d. Ethnic group e. Physiologic f. Immunologic Experience g. Inter- current or pre-existing disease h. Human behavior
27. 27. 3. Environmental factors (Extrinsic factors) – influences existence of the agent, exposure, or susceptibility to agent. A. Physical environment B. Biologic environment C. Socio-economic environment
28. 28. Disease Distribution  The methods and technique of epidemiology are desired to detect the cause of a disease in relation to the characteristics of the person who ahs it or to a factor present in his environment. Since neither population and environment of different times or places are similar, these characteristics and factors are called epidemiology variables.
29. 29. Time refers to both the period during which the cases of the disease being studied were exposed to the source of infection and the period during which the illness occurred. Persons refers to the characteristics of the individual who were exposed and who contacted the infection or the disease in question. Place refers to the features, factors or conditions which existed in or described the environment in which the disease occurred.
30. 30. Patterns of Occurrence and Distribution  The variables of disease as to person, time, and place are reflected in distinct patterns of occurrence and distribution in each community. 1.Sporadic occurrence is the intermittent occurrence of e few isolated and unrelated cases in each locality. The cases are few and scattered, so that there is no apparent relationship between them, and they occur on and off, intermittently, through a period. 2.Endemic occurrence is the continuous occurrence throughout a period, of the usual number of cases in each locality. The disease is therefore always occurring in the locality and the level of occurrence is less or more constant through a period.
31. 31. 3.Epidemic occurrence is of unusually large number of cases in a relatively short period of time. There is no disproportionate relationship between the number of cases and the period of occurrence, the more acute is the disproportion, the more urgent and serious is the problem. 4. Pandemic is the simultaneous occurrence of epidemic of the same disease in several countries.
32. 32. Epidemics Factor’s Contributory to Epidemic Occurrence:  Agent Factor – the result of the introduction of new disease agents in the population.  Host Factors – are related to lower resistance as a result of exposure to the elements during floods or other disaster, to relaxed supervision of water and milk supply or sewage disposal, or to changed habit of eating.  Environmental factors – changes in the physical environment: temperature, humidity, rainfall may directly or indirectly influence equilibrium of agent and host.
33. 33. Outline of Plan for Epidemiological Investigation 1. Establish fact of presence of epidemic 2. Establish time and space relationship of the disease 3. Establish time and space relationship of the disease 4. Correlation of all data
34. 34. Epidemiology and Surveillance Units  Epidemiology and Surveillance Units have been established in regional and some local office as support to the public health system. As an epidemiologic information service, the unit is mainly responsible for providing timely and accurate information on diseases in the locality. Among its responsibility includes:  Surveillance of infectious diseases with outbreak potential  Assisting local government units in investigation of outbreak and their control  Developing information package on public health.  Providing technical assistance related to epidemiology.
35. 35. Public Health Surveillance Public Health Surveillance is an on-going systematic collection, analysis, interpretation and dissemination of health data. Surveillance system is often considered in information loops or cycles involving health care providers, public health agencies and the public.
36. 36. ROLEOFTHENURSEIN SURVEILLANCE One of the areas where public health nurse function as researcher is disease surveillance. Surveillance is a continuous collection and analysis of data of cases and death.  The objectives of surveillance are:  1.To measure the magnitude of the problem.  2. To measure the effect of the control program.
37. 37. The National Epidemic Sentinel Surveillance System (NESSS) and its Role National Epidemic Sentinel Surveillance System is a hospital-based information system that monitors the occurrence of infectious diseases with outbreak potential. It also serves as a supplemental information system of the Development of Health.
38. 38. Objectives:  To provide early warning on occurrence of outbreaks  To provide program managers, policy makers, and public administrators, rapid accurate and timely information so that inventive and control measures can be instituted. The NESSS Data shows:  Trends of cases across time  Demographic characteristics of cases  Estimates of case fatality ratio  Clustering of cases in geographical area  Information to formulate hypothesis for disease causation
39. 39. Disease Under Surveillance (NESSS)  Laboratory Diagnosed Cholera Hepatitis A Hepatitis B Malaria Typhoid Fever
40. 40. Clinically Diagnosed  Dengue Hemorrhagic Fever  Diphtheria  Measles  Meningococcal disease  Neonatal tetanus  Non neonatal tetanus  Pertussis  Rabies  Leptospirosis  Acute Flaccid Paralysis (poliomyelitis)
41. 41.  Under Surveillance System: Acute Flaccid paralysis Measles Maternal and neonatal tetanus Paralytic shellfish poisoning fireworks and related injury HIV / AIDS
42. 42. Importance of Outbreak Investigation:  Control and prevention measure  Severity and risk to others  Research opportunities  Public, political or legal concerns  Training Sources:  Surveillance data  Medical practitioner  Affected persons / group  Concerned citizen  Media
43. 43. Steps in Outbreak Investigation: Step 1 – Prepare for field work  Investigation  Scientific knowledge  Supplies / equipment  Administration  Administrative procedures like travel documents, allowance  Consultation  Know expected role  Local contact person
44. 44. Step 2 – Establish the existence or an outbreak  Cluster – is an aggregation of cases in each are over a particular period without regards to whether the number of cases is more than the expected.  Outbreak or an epidemic – is the occurrence of more cases of disease rather than expected in each area or among a specific group of people over a particular period.  Compare the current number of cases with the numbers of cases from comparable period during the previous years.  Surveillance records  Hospital records, registries, mortality statistics  Data from neighboring areas  Community survey
45. 45. Step 3 – Verify diagnosis  Ensure proper diagnosis of reported cases  Rule out laboratory error as basis for the increase in diagnosed cases  Reviews clinical findings  Review laboratory results  Summarize clinical findings with the frequency distribution  Visit patients
46. 46. Step 4 – Define and Identify cases  A. Establish a case definition  Standards set of criteria for the health condition;  Clinical criteria ( signs and symptoms)  Restrictions by time, place, persons  Apply without bias  Note – exposure or risk factor is not included in the case definition  B. Identify and count cases  Identify information – name, address, contact number  Demographic information – age, sex, race and occupation  Clinical information – death of onset, hospitalization, death  Risk factors information – food or water sources, toilet facility  Reporter information
47. 47. Step 5 – Perform descriptive epidemiology  Describe and orient the data in terms of time, place and person  Characterized by time  Characterized by place  Characterized by persons
48. 48. Step 6 – Developing Hypothesis  Consider  Source of agent  Mode of transmission  Vectors of transmission  Risk Factors  Hypothesis should be testable
49. 49. Step 7 – Evaluate hypothesis by: Comparing with established facts Use of analytical epidemiology Case control studies Retrospective control studies
50. 50. Step 8 – Refine hypothesis and execute additional studies because:  Unrevealing analytical studies = poor hypothesis  May need more specific exposure histories  May need mire specific control group Step 9 – Implement control and prevention measures  Prevent additional cases  Prevent outbreaks in the future
51. 51. Step 10 – Communicate findings  Through;  Writing and disseminating full report  Meetings and discussions  Local and mass media Step 11 - Follow- up Recommendations What activities have been undertaken? If health status has improved If health problems has been reduced
52. 52. Function of the Epidemiology Nurse:  Implement public health surveillance  Monitor local health personnel conducting disease surveillance  Conduct and / or assist other health personnel in outbreak investigation  Assist in the conduct of rapid surveys and surveillance during disasters  Assist in the conduct of surveys, program evaluation, and other epidemiologic studies.  Assist in the conduct of training course in epidemiology  Assist the epidemiologist in preparing the annual report and financial plan.  Responsible for inventory and maintenance of epidemiology and surveillance unit (ESU) equipment
53. 53. Specific Role during Epidemiological Investigations:  Maintains surveillance of the occurrence of notifiable disease.  Coordinates with other members of the health team during the disease outbreak  Participates in case findings and collection of laboratory specimens  Isolates cases of communicable disease.  Renders nursing care, teaches and supervises giving care.  Performs and teach household members method, concurrent and terminal disinfection.
54. 54.  Gives health teachings to prevent further spreads of disease to individual and families.  Follow up cases and contacts  Organizes, coordinates and conducts community health education campaign / meetings.  Refers cases when necessary  Coordinates with other concerned community agencies.  Accomplishes and keeps records and reports and submits to proper office / agency.
55. 55. Activity: