CHN 1240

• Community diagnosis


  A process through which health workers together with members of the community identify the community's priority health problems, and together make plans of action and implement them
• Purpose of community diagnosis

  • It points out where the health services should put their main efforts and resources
  • The community must identify its problems, prioritise them and draw a plan of action to address the identified problems
• Community diagnosis


  • It emphasises total community involvement
  • The community knows its problems and priorities better than the health worker
  • When they actively participate in solving these issues they become bound by the decisions they make and feel motivated to see the plans through
• Health indicators in community

  • Morbidity indicators
  • Mortality 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 indicators
• Patient diagnosis


  • 1. Greet and welcome the patient and offer them a seat
  • 2. Ask for the patient's name, age, sex, marital, status and patient's residential address
  • 3. Take history including details of the patient's progress so far
  • 4. Perform a physical examination
  • 5. Carry out or request special investigations
  • 6. Prescribe the most appropriate treatment
  • 7. Give the patient a date to return for review
  • 8. Discharge the patient as they improve
• Community diagnosis


  • You collect information about: Local people and their environment
  • The number of people and their distribution
  • The diseases the local people suffer from
  • The organisation of local health services
  • You then make a community diagnosis by identifying the main health problems and the reasons for them
  • Identify priority health problems and plan a community health programme or treatment to solve these problems
• Tools used in patient diagnosis

  • Sphygmomanometer (BP machine)
  • Stethoscope
  • Weighing scales
  • Thermometer
  • Chairs
  • Record books
• Tools used in community diagnosis

  • Maps
  • Weighing scale
  • Specimen bottles
  • Questionnaires
• Difference between patient diagnosis and community diagnosis

  • Patient diagnosis views the patient as a client and uses tools like BP machine, stethoscope etc.
  • Community diagnosis views the community as a client and uses survey tools like maps, questionnaires etc. The amount of data is much greater and requires more analysis.
• Information to be collected in community diagnosis

  • Demographic data and vital health statistics
  • Utilisation of health services especially maternal and child health
  • Causes of morbidity and mortality (by age and sex)
  • State of nutrition, diet, weaning patterns and growth of children
  • Patterns of leadership and communication within the community
  • State of mental health and common causes of stress
  • State of the environment including water, housing and disease vectors
  • The community's knowledge, attitudes and practices (KAP) in relation to health-related activities
  • Epidemiological details of endemic diseases
  • Available resources and services for overall development of health-related activities
  • Socio-cultural and socio-economic class divisions within the community
• Incidence


  Number of new cases of a disease or condition occurring over any specified time, calculated as number of new cases in a specified period divided by population at risk during the period and multiplied by 1000
• Prevalence


  Total number of cases of a disease or condition at a particular time, whether new or old, calculated as number of existing cases divided by total population at a point in time and multiplied by 1000
• Infant Mortality Rate (IMR)


  Number of deaths of children less than one year of age per 1000 live births, calculated as number of infant deaths divided by number of live births and multiplied by 1000
• Crude Birth Rate (CBR)

  Number of births per 1,000 population, calculated as number of births divided by mid-year population and multiplied by 1000
• Crude Death Rate (CDR)


  Number of deaths in one year per 1,000 population, also called Crude Mortality Rate, calculated as number of deaths in a year divided by mid-year population and multiplied by 1000
• Rate of Natural Increase (RNI)


  Difference between birth rate and death rate per 1,000 population, expressed as a percentage, indicating the annual rate of population growth without migration
• Dependency Ratio


  Ratio of (potentially) economically active population to the retired population and children under 18 years of age, giving an estimate of the number of dependants per worker
• Maternal Mortality Rate (MMR)


  Number of women who die as a result of child bearing in a given year per 100,000 live births, calculated as number of maternal deaths divided by number of live births that year and multiplied by 100,000
• Case Fatality Rate (CFR)


  Proportion of episodes of illness that result in death, calculated as number of deaths due to a given disease divided by number of cases of that disease in a given period and multiplied by 100
• Early Neonatal Mortality Rate (ENMR)


  Death of a live-born baby within the first seven days of life, calculated as number of neonatal deaths 0-6 days divided by total number of live births and multiplied by 1000
• Late Neonatal Mortality Rate (LNMR)


  Death of a live-born baby between 7-27 days of life, calculated as number of neonatal deaths 7-27 days divided by total number of live births and multiplied by 1000
• Neonatal Mortality Rate


  Death of a live-born baby within the first 28 days of life, calculated as number of neonatal deaths divided by total number of live births and multiplied by 1000
• Ethical considerations in community diagnosis

  • Obtaining permission to enter the community
  • Obtaining informed consent before interviewing
  • Establishing rapport before exploring sensitive areas
  • Ensuring confidentiality of data collected
  • Selecting good interviewers
  • Training interviewers
• The process of community diagnosis

  1. Exploration

  2. Planning of the survey

  3. Developing and pre-testing survey tools

  4. Execution of the survey and data analysis

  5. Report writing, dissemination and community action
• Exploration phase activities


  1. Seeking permission and informing leaders

  2. Seeking reactions of community members

  3. Gathering background data about the community
• Background data to gather

  • Overview of the health profile of the district
  • Boundaries, maps and population of the area
  • Region, municipality/city, land area, subdivisions
  • Demography: geographic distribution, age-sex structure, migration, age dependency, birth/death rate, ethnic distribution, density
• Planning phase activities


  1. Formulation of survey objectives

  2. Identifying survey setting

  3. Selection of survey day

  4. Identifying aspects to be covered

  5. Identifying data collection instruments

  6. Identification of how data will be collected

  7. Selection and training of interviewers
• Qualities of interviewees


  • Literate and well known to the community
  • Ability to display right attitudes and opinions
  • Able to explain questionnaire effectively
  • Able to use survey tools
  • Able to establish good rapport
  • Good listeners and sensitive
  • Able to relate well to community members
• Sampling


  Process of selecting a number of individuals or units to represent the larger group, with the aim of getting the same information as surveying the whole population
• Study population


  The entire group of individuals, events or objects that have common observable characteristics, clearly defined according to age, sex, residence etc.
• Accessible population


  A group of individuals, objects and events with characteristics comparable to the target population and relevant to the study
• Representative sample


  A group from the study population that has all the important/relevant characteristics of the total population
• Sampling techniques


  • Probability sampling
  • Non-probability sampling
• Before sampling, a sampling frame must be developed - a list of all units that make up the study population
• Study population


  A group of individuals, objects and events with characteristics comparable to the target population and relevant to the study
• Representative sample


  A group from the study population, which has all the important/relevant characteristics of the total population
• Sampling frame


  A list of all units that make up the study population
• Sampling techniques


  • Probability sampling
  • Non-probability sampling
• Tools used to measure a community's health status

  • Questionnaires
  • Focus group discussions
  • Measurements, physical examination and laboratory tests
  • Key informant interviews
  • Maps
  • Weighing scale
  • Specimen bottles
• Questionnaire


  A set of standardised questions designed to collect information about a specific aspect or issue in the community