The lecturer slide was prepared for Medical/Nursing/Public health students

1. COMMUNITY DIAGNOSIS
PROGRAMME
Kishor Adhikari, National Medical College
andTeaching Hospital, Birgunj, Nepal

2.  What is CDP?
 Why is CDP needed for Medical students?
 Purposes of CDP?
 Community diagnosisVs Clinical diagnosis
 Methods of CDP?
Presentation Outline:

3. Community Diagnosis
 “Community diagnosis is a comprehensive
assessment of health status of the community in
relation to it’s social, physical and biological
environment.”
- Dr. Cynthia Hale et al

4. Community Diagnosis
 Community diagnosis generally refers to
the identification and quantification of
health problems in a community as a whole
in terms of mortality and morbidity rates
and ratios, and identification of their
correlates for the purpose of defining those
at risk or those in need of health care.

5. Contd.
 The application of techniques of diagnosis of
an individual to the community is known as
community diagnosis.

6. Contd.
 The community diagnosis is based on
collection and interpretation of the relevant
data:
 The focus should be the identification of the
basic health needs and health problems of
the community.
(felt need, observed need and real need)

7. Comparing individual diagnosis with
community diagnosis
clinical diagnosis
1. Obtain a history of the patients’
symptoms.
2. Examine the patient and
observe sign.
3. Perform laboratory test , x-ray
and others.
4. To infer causation from the
history and test result to make
the diagnosis.
5. Provide treatment.
6. Follow-up and assess
effectiveness of the treatment.
Community diagnosis
1. Obtain health awareness of the community by
informal meeting and discussions.
2. Obtain measurable facts of causes through
basic demographic survey. (indicator)
3. Conduct specific survey based on finding of
basic demographic survey.
4. Make inference from the data (indicator) to
make the community diagnosis.
5. Prescribe community treatment or community
health action as part of community health
programme.
6. Evaluate (follow-up) the effect of community
(Similarities)

8. Comparing individual diagnosis with
community diagnosis
Individual (clinical)
diagnosis
1. Patient aware of the
problem.
2. Patient take
initiative for
problem solving.
3. Pathological
condition affects
patient alone.
4. It may or may not
be related to
Community diagnosis
1. Community may or may
not be aware of the
problem.
2. Community rarely takes
initiative.
3. Can not be treated as
isolated occurrences.
4. Each condition is linked to
the inter-related factors in
the environment.
Differences:

9. Purposes of Community
Diagnosis
1. It helps to identify community needs and
problems.
2. It is pre-requisite for planning, implementing
and evaluation of health and development
programme.
3. It helps to match project organization and
services with community needs.
4. It can be used to help the community become
conscious of its existing problems and find
solution.

10. Methodology of CDP
Systematic activities of CDP (Chronology)
1. Determination of objectives
1. General
2. Specific
2. Selection of community
Criteria:
a. Convenient accessibility
b. Diversity of population based on socio-economic, cultural and
religious behavior.
c. Administrative and operational feasibility.

11. 3. Review of literature
a. Lecture notes and field reports of seniors.
b. Library books and literatures.
c. Internet surfing

12. 4. Planning (what, where, how,
when)
a. Casual visit to the community (spot map, informal discussion
with community members)
b. Preliminary data from the respective community (secondary)
c. Tentative household survey schedule preparation and pre-
testing.
d. Making plan of action (emphasis on dates/places/activities/group
division/group coordinator etc.)

13. 4. Data collection
a. Primary data (through household survey)
b. Secondary data (through records of different
organizations)
c. Tools for data collection
d. Techniques for data collection
e. Data editing
f. Data analysis and interpretation

14.  Community presentation to local leaders.
 Community presentation to general
population.
5. Community presentation

15. 6. School Health Programme

16.  Felt need
 Observed need
 Real need
 Need prioritization
7. Micro Health Project

17. 8. Seminar presentation

18. 9. Report writing

19. Nutritional assessment
 Evaluation and measurement of
nutritional variables in order to assess the level
of nutrition or the nutritional status of the individual or
community as a whole.

20. Purposes of Nutritional assessment
1. Identify individuals or population groups
who are malnourished or at risk of
becoming malnourished.
2. To develop health care programs that
meet the community needs which are
defined by the assessment.
3. To measure the effectiveness of the
nutritional programs & intervention once
initiated

21. Methods of Nutritional Assessment
1. Direct: deal with individual
2. Indirect: use community health
indices.

22. Direct Methods of Nutritional
Assessment
These are summarized as ABCD
 Anthropometric methods
 Biochemical, laboratory methods
 Clinical methods
 Dietary evaluation methods

23. Indirect Methods of Nutritional
Assessment
These include three categories:
Ecological variables including crop production
Economic factors e.g. per capita income,
population density & social habits
Vital health statistics particularly infant &
under 5 mortality & fertility index

24. 1. Physical and Clinical examination
 Night blindness, Bitot’s spot, corneal
xerosis (xeropthalmia) -A
 Enlargement of thyroid (Hypothyrodism) -
IDD
 Pale conjuntiva, pale palms(Anaemia)- Iron
 Absence of knee or ankel jerk (Beriberi)- B1
 Pigeon chest, deformed pelvis, curved legs.
(Rickets)-D
 Angular stomatitis – B2
 3 Ds (pelagra) –Niacin
 Swellen and bleeding gums, Scurvy - C

25. Contd.
 Kwashiorkor
 Marasmus

26. 2. Assessment of Dietary
intake
A. Qualitative aspect of food.
B. Quantitative aspect of food.
C. Social aspect of food

27. A. Qualitative aspect of food
1. Vegetarian and non-vegetarian food
2. Use of cooking oil: refined or non refined
3. Type of salt used: iodized or non-iodized.
4. Habit of Balanced diet
5. Knowledge about balanced diet

28. B. Quantitative aspect of food
intake
 Total calorie requirement and daily
consumption of calorie in the family on
the basis of:
 Total family members by age and sex.
 Physical activities.
 Number of vulnerable groups

29. C. Social aspect of
nutrition
 Knowledge and importance of nutrition.
 Food cooking habit.
 Storage and distribution of food.
 Washing of vegetable.
 Cutting of vegetable.

30. Contd.
 Types of utensils used.
 Place of storage of food grain.
 Preference of food distribution in the family.
 Food taboo/ forbidden foods
 Addiction habits: tobacco, paan, gudkha,
khaini, cigarette, alcohol, Ganja,

31. 3. Anthropometric measurement
Among all children below 5 years:
1. Mid upper arm circumference (MUAC) 6+ months
2. Weight
3. Height
4. Weight for age (GOMEZ classification)
5. Water low's classification
6. Chest and head circumference
BMI
Hip/waist ratio
for adult population

32. GOMEZ classification of PEM
Wt. of the child
 Weight for age = X 100
Wt. of a normal child of same age
Between 90 and 110% = Normal nutritional status
Between 75 and 89% = 1st degree malnutrition
Between 60 and 74% = 2nd degree malnutrition
Under 60% = 3rd degree malnutrition

33. 784

34. Waterlow’s classification
 Wight/Height (%) = Weight of the child X 1oo
weight of a normal child at same height
Height/Age = Height of the child X 1oo
Ht. of a normal child at same age
Nutritional status Stunting (Ht/Ag%) Wasting (wt/Ht%)
Normal >95 >90
Mildly impaired 87.5 - 95 80 – 90
Moderately impaired 80 – 87.5 70 – 80
Severely impaired <80 <70

35. Mid upper arm circumference
(MUAC)
 MUAC is the circumference of the left upper arm,
measured at the mid-point between the tip of the
shoulder and the tip of the elbow (olecranon process
and the acromium).
 <12.5 cm = sever malnutrition
 12.5-13.5 cm = mild-moderate malnutrition
 >12.5 cm = satisfactory nutritional status

36. Maternal and child health
(MCH) points should be covered:
Regarding mother:
 Age at marriage
 Age at first pregnancy
 ANC visits (Never, one time, 4 times)
 TT vaccine
 Place of delivery
 Birth attendant
 Type of delivery at institution
 Post natal care
 Colostrum feeding

37. Contd.
 Immunization status of U5 children (not at all, partially
immunized, completely immunized)
 KAP on delivery kit.

38. Regarding Children
 Birth weight of baby
 Percentage of babies suffering from different diseases:
 Diarrhoea:
 ARI
 Measles
 Malnutrition
 Others

39. Family planning
points should be included on:
1. Number of eligible couple
2. Use of family planning methods
3. Types of contraceptive methods used
4. Sexwise distribution of family planning users
5. Birth spacing
6. Preference of sex of child (male or female)
7. KAP on contraceptive

40. Contd.
6. Maternal and child health
 Number of reproductive aged women
 Number of pregnant women
 Care during pregnancy
7. Family Planning
 Use of contraception
 Number of eligible couple
 Number of currently married people
 Unmet need of family planning

41. Family planning methods
Natural Methods Artificial methods
• Abstinence
• Coitus interrupts
• Safe period
(Rhythm Method)
• Cervical Mucous
Method
• Basal Body
Temperature
• Sympto-thermia
Method
• Locational
Amenorrhea
Method (LAM)
Temporary Permanent
Male Female Male Female
Condom Vasectomy •Minilap
•Laparoscopy
Female condom
Diaphragm
Foam tab
Oral Pills
Depot medroxy
CupperT
Nor-plant
Vaginal rings