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 Presentation

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Page 1: Dr. Malik Muhammad Abdul Razzaq  Assistant Professor Department of Community Medicine

Dr. Malik Muhammad Abdul Razzaq 1

Page 2: Dr. Malik Muhammad Abdul Razzaq  Assistant Professor Department of Community Medicine

Dr. Malik Muhammad Abdul Razzaq Assistant Professor

Department of Community Medicine Sheikh Zayed Medical College Rahim Yar Khan

Dr. Malik Muhammad Abdul Razzaq 2

Page 3: Dr. Malik Muhammad Abdul Razzaq  Assistant Professor Department of Community Medicine

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

Page 4: Dr. Malik Muhammad Abdul Razzaq  Assistant Professor Department of Community Medicine

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

Dr. Malik Muhammad Abdul Razzaq 4

Page 5: Dr. Malik Muhammad Abdul Razzaq  Assistant Professor Department of Community Medicine

Dr. Malik Muhammad Abdul Razzaq 5

Page 6: Dr. Malik Muhammad Abdul Razzaq  Assistant Professor Department of Community Medicine

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.

Dr. Malik Muhammad Abdul Razzaq 6

Page 7: Dr. Malik Muhammad Abdul Razzaq  Assistant Professor Department of Community Medicine

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.

Dr. Malik Muhammad Abdul Razzaq 7

Page 8: Dr. Malik Muhammad Abdul Razzaq  Assistant Professor Department of Community Medicine

i. Valid ii. Reliableiii. Sensitive iv. Specificv . feasible vi.

Relevant.

Dr. Malik Muhammad Abdul Razzaq 8

Page 9: Dr. Malik Muhammad Abdul Razzaq  Assistant Professor Department of Community Medicine

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

Dr. Malik Muhammad Abdul Razzaq 9

Page 10: Dr. Malik Muhammad Abdul Razzaq  Assistant Professor Department of Community Medicine

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

Dr. Malik Muhammad Abdul Razzaq 10

Page 11: Dr. Malik Muhammad Abdul Razzaq  Assistant Professor Department of Community Medicine

◦ 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.

Dr. Malik Muhammad Abdul Razzaq 11

Page 12: Dr. Malik Muhammad Abdul Razzaq  Assistant Professor Department of Community Medicine

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

Dr. Malik Muhammad Abdul Razzaq 12

Page 13: Dr. Malik Muhammad Abdul Razzaq  Assistant Professor Department of Community Medicine

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).

Dr. Malik Muhammad Abdul Razzaq 13

Page 14: Dr. Malik Muhammad Abdul Razzaq  Assistant Professor Department of Community Medicine

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

Dr. Malik Muhammad Abdul Razzaq 14

Page 15: Dr. Malik Muhammad Abdul Razzaq  Assistant Professor Department of Community Medicine

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).

Dr. Malik Muhammad Abdul Razzaq 15

Page 16: Dr. Malik Muhammad Abdul Razzaq  Assistant Professor Department of Community Medicine

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

Dr. Malik Muhammad Abdul Razzaq 16

Page 17: Dr. Malik Muhammad Abdul Razzaq  Assistant Professor Department of Community Medicine

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

Dr. Malik Muhammad Abdul Razzaq 17

Page 18: Dr. Malik Muhammad Abdul Razzaq  Assistant Professor Department of Community Medicine

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

Dr. Malik Muhammad Abdul Razzaq 18

Page 19: Dr. Malik Muhammad Abdul Razzaq  Assistant Professor Department of Community Medicine

Political commitment to health for all Resource allocation, GNP spent Degree of equity distribution of health

services. Community Involvement Organization frame work Managerial Process.

Dr. Malik Muhammad Abdul Razzaq 19

Page 20: Dr. Malik Muhammad Abdul Razzaq  Assistant Professor Department of Community Medicine

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

Dr. Malik Muhammad Abdul Razzaq 20

Page 21: Dr. Malik Muhammad Abdul Razzaq  Assistant Professor Department of Community Medicine

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

Dr. Malik Muhammad Abdul Razzaq 21

Page 22: Dr. Malik Muhammad Abdul Razzaq  Assistant Professor Department of Community Medicine

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

Dr. Malik Muhammad Abdul Razzaq 22

Page 23: Dr. Malik Muhammad Abdul Razzaq  Assistant Professor Department of Community Medicine

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

Dr. Malik Muhammad Abdul Razzaq 23

Page 24: Dr. Malik Muhammad Abdul Razzaq  Assistant Professor Department of Community Medicine

Comparison of Kerala and all-India Health Statistics

Dr. Malik Muhammad Abdul Razzaq 24

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

Page 25: Dr. Malik Muhammad Abdul Razzaq  Assistant Professor Department of Community Medicine

Dr. Malik Muhammad Abdul Razzaq 25