dr. malik muhammad abdul razzaq assistant professor department of community medicine
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Dr. Malik Muhammad Abdul Razzaq Assistant Professor Department of Community Medicine Sheikh Zayed Medical College Rahim Yar Khan. Community Medicine A system of delivery of comprehensive health care to the people by a health team in order to improve the health of the community. - PowerPoint PPT PresentationTRANSCRIPT
Dr. Malik Muhammad Abdul Razzaq 1
Dr. Malik Muhammad Abdul Razzaq Assistant Professor
Department of Community Medicine Sheikh Zayed Medical College Rahim Yar Khan
Dr. Malik Muhammad Abdul Razzaq 2
Community MedicineA system of delivery of comprehensive health care to the people by a health team in order to improve the health of
the community
Dr. Malik Muhammad Abdul Razzaq 3
Clinical MedicineClinical Medicine Community MedicineCommunity Medicine
AimAim
To shorten morbidity and To shorten morbidity and prevent mortality in a ill or prevent mortality in a ill or diseased person Explore diseased person Explore methods which would methods which would reverse or eliminate disease reverse or eliminate disease statesstates
To reduce unnecessary To reduce unnecessary morbidity and premature morbidity and premature mortality in the whole mortality in the whole population Explore greatest population Explore greatest potential health potential health improvementimprovement
ObjectiveObjective Cure patient of diseaseCure patient of disease Improve health status of a Improve health status of a communitycommunity
Information Information requiredrequired
Clinical history, Physical Clinical history, Physical examination and laboratory examination and laboratory teststests
Population data, Health Population data, Health problems, disease pattern, problems, disease pattern, availability of health services. availability of health services. Felt needs of the Community.Felt needs of the Community.
DiagnosisDiagnosis Differential diagnosis and Differential diagnosis and probable diagnosisprobable diagnosis
Community DiagnosisCommunity Diagnosis
Action PlanAction PlanTreatment & rehabilitation Treatment & rehabilitation Community health ProgramCommunity health Program
EvaluationEvaluation Follow up and assessmentFollow up and assessment Evaluation of change in health Evaluation of change in health statusstatus
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To measure Health status of a Community / country
Comparison of health status between two communities/Countries.
Assessment of health care needsAllocation of scare resourcesMonitoring & Evaluation of health services,
activities & programmes.The extent to which the objectives &
targets are being attained.
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Indicator:Indicators are an indication of a given situation or a reflection of a situation.
Variable:A characteristic of interest in a study that has different values for different objects and subjects.
- which helps to measure changes- These can indicate direction and speed of change- Serve to compare different areas or groups of people at the same time.
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i. Valid ii. Reliableiii. Sensitive iv. Specificv . feasible vi.
Relevant.
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Mortality indicators Morbidity indicators Disability rates Nutritional status indicators Health care delivery indicators utilization rates Indicators of social and mental health Environmental indicators Socio-economic indicators Health policy Indicators Indicators of quality of life other indictors
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Crude death rate (CDR) Expectation of life Infant mortality rate (IMR) Child mortality rate (CMR) Under -5 Mortality rate (U5MR) Maternal mortality rate (MMR) Disease specific mortality rate (DSMR) Proportional mortality rate
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◦ Incidence and Prevalence◦ Notification rates◦ Attendance rates at out-patient departments,
health centers, etc.◦ Admission, readmission and discharge rates◦ Duration of stay in hospital and◦ Spells of sickness ◦ Absence from work or school.
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a) Event-type indicators:i) Number of days of
restricted activityii) Bed disability daysiii) Work-loss days
iv) School loss days within a specified period
b) Person-type indicators: i) Limitation of mobility ii) Limitation of activity
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a) Anthropometric measurements of preschool children, e.g., weight and height,
mid-arm circumference;b) Heights (and sometimes weights ) of children at school entry; and c) Prevalence of low birth weight – LBW (less than 2.5 kg).
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a) Doctor-population ratiob) Doctor-nurse ratioc) Population –bed ratiod) Population per health center /subcentree) Population per traditional birth attendantf ) Availability of health servicesg) Accessibility of health care servicesh) UtilizationI ) Quality of health care delivery
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Proportion of infants who are “fully immunized” against the 7 EPI diseases.
Proportion of pregnant women who receive antenatal care, or have their deliveries supervised by a trained birth attendant.
Percentage of the population using various methods of family planning.
Bed-occupancy rate (i.e., average daily in-patient /average number of beds).
Average length of stay (i.e., days of care rendered / discharges).
Bed turn-over ratio (i.e., discharges/average beds).
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Rate of population increase Per capita GNP Level of unemployment Dependency ratio Literacy rates, especially female literacy
rate Family size. Housing: the number of persons per room Per capita “calorie” availability Working conditions Income distribution
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1.POPULATION2.FAMILY FORMATION & HOUSEHOLD3.EDUCATIONAL OPPORTUNITIES4.EARNING ACTIVITIES5.SOCIAL SECURITY & FAMILY WELFARE6.HEALTH SERVICES7.NUTRITION 8.INCOME DISTRIBUTION9.ENVIRONMENT10. PUBLIC ORDER & SAFETY11.TIME USE AND LEISURE, RECREATION12.SOCIAL STRATIFICATION AND MOBILITY
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Least developed Least developed countriescountries
Developing countriesDeveloping countries Developed countriesDeveloped countries
1. Life expectancy at birth (2002)1. Life expectancy at birth (2002) 4949 6262 7878
2.IMR (per 1000 live births)(2002)2.IMR (per 1000 live births)(2002) 9999 6262 55
3. Under 5 mortality per 1000 live 3. Under 5 mortality per 1000 live births (2002)births (2002)
158158 9090 77
4. Maternal mortality Rate per 4. Maternal mortality Rate per 100,000 live births (2002)100,000 live births (2002)
890890 440440 1313
5. Doctor-population ratio per 5. Doctor-population ratio per 10,000 (2002)10,000 (2002)
1.41.4 8.48.4 25.225.2
6.Nurse-population ratio per 6.Nurse-population ratio per 10,00010,000
2.22.2 9.69.6 74.274.2
7. GNI, per capita (US $ ) (2002)7. GNI, per capita (US $ ) (2002) 277277 11541154 2821428214
8. Per capita public expenditure 8. Per capita public expenditure on health, US $ in% of GDP on health, US $ in% of GDP
55 44 1414
9. Adult literacy rate (%) (2002)9. Adult literacy rate (%) (2002) 53.353.3 74.574.5 9797
10. Per Capita calories10. Per Capita calories 20992099 26632663 33713371
11. Access to safe water (2002)11. Access to safe water (2002)
% population.% population.
6262 7878 100100
12. Access to adequate 12. Access to adequate sanitation (2002) % population.sanitation (2002) % population.
4444 5252 100100
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Political commitment to health for all Resource allocation, GNP spent Degree of equity distribution of health
services. Community Involvement Organization frame work Managerial Process.
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LIFE EXPECTANCY84.7
82.480.4
76 75.5
82.279.7
63 64
77.7 77.475.4
7369.6
75.8 74
6162.8
0
10
20
30
40
50
60
70
80
90
J apan Sweden UK Kwiat Srilanka Switzer land USA Pakistani India
COUNTRY
YE
AR
S
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WORLD POPULATION (MILLIONS)
791978
1262
1650
2526
3037
3696
4066
4432
5000
5385
58846054
6225
0
1000
2000
3000
4000
5000
6000
7000
Y 1750 Y 1800 Y 1850 Y 1900 Y 1950 Y1960 Y1970 Y1975 Y1980 Y1987 Y1991 Y1998 Y2000 Y2002
YEAR
PO
PU
LA
TIO
N
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POPULATION OF PAKISTAN (MILLIONS)
28.28233.817
42.978
65.341
84.254
113.78
130.58
154.794
0
20
40
60
80
100
120
140
160
180
1941 1951 1961 1972 1981 1991 1998 2006
YEAR
PO
P. I
N M
ILL
ION
S
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Eradicate extreme poverty and hunger Reduce Child Mortality Improve Maternal Health Combat HIV/AIDS, malaria and other diseases Ensure environmental sustainability Develop a global partnership for development
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Comparison of Kerala and all-India Health Statistics
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KeralaKerala All-IndiaAll-India
Death rate/1000(2002)Death rate/1000(2002) 6.46.4 8.18.1
Rural birth rate(2002)Rural birth rate(2002) 16.816.8 25.025.0
Infant mortality rate (2002)Infant mortality rate (2002) 1010 6464
Annual growth rate, per cent Annual growth rate, per cent (2001)(2001)
0.90.9 1.931.93
Life expectancy at birth 2001-06 Life expectancy at birth 2001-06 (Projection)(Projection)
MaleMale
FemaleFemale
66.566.5
71.771.7
7575
61.561.5
64.164.1
65.465.4
Literacy rate, percent(2001)Literacy rate, percent(2001) 90.9290.92 65.3865.38
Female literacy rate (2001)Female literacy rate (2001) 87.8687.86 54.1654.16
Mean age at marriage females Mean age at marriage females (1999)(1999)
22.122.1 19.519.5
Per capita income (2000-01)Per capita income (2000-01) Rs. 21046Rs. 21046 Rs. 16707Rs. 16707
Doctor-population ratio (1991)Doctor-population ratio (1991) 1: 72131: 7213 1:21481:2148
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