MSB 105 Introduction to Community Health Tutor Guide PDF

MSB105 HEALTH TOCOMMUNITY INTRODUCTION TUTORGUIDE MOI UNIVERSITY OFHEALTH COLLEGE SCIENCES OFDENTISTRY / SCHOOL scHooLoF MEDICINE ELDORET,KENYA ...

MSB105 HEALTH TOCOMMUNITY INTRODUCTION TUTORGUIDE MOI UNIVERSITY OFHEALTH COLLEGE SCIENCES OFDENTISTRY / SCHOOL scHooLoF MEDICINE ELDORET,KENYA  MSB 105: Introduction to Community Health, (COBES I) Tutorial Booklet COURSB COORDINATOR: Ms. J. B. Baliddawa BA. Msc. Dip Biostatistics& Epidemiology Dept.of BehavioralSciencesand Ethics. ACKNOWLEDGEMENTS T'heCourseCoordinatorwishes to thank the following departmentsfor their inputs into the developmentof this booklet: Epidemiology and PreventiveMedicine, Flealth Management and Health Economics, Nutrition, Nursing Sciences,Environmental Health, Behavioral Sciences,Microbiology. Parasitology,and ReproductiveHealth The School of Medicine acknowledsesthe financial assistancefrom the Dean, School of Medicine. NOVEMBER2010. PrintedAug.2018 Printing Unit Layout by Collegeof Health Sciences  MSB 105: lntroduction to Comntunity Health, (COBES I) Tutorial Booklet INTRODUCTION The establishmentof Faculty of Health Sciencesin February1988was inline with the overall philosophy of Moi University of developing appropriate manpower in Health with a communityorientedperspective. Community BasedEducationand Service(COBES) activities are a major componentof the Schoolsof Medicine and Dentistry It constitutesabout24Yoof the total learningperiod" The goal of COBES is to train a health professionalwho will be able to work in the community while placing emphasison promotive and preventive health care. Within the MBChB, B.Sc. Nursing, and BDS training programmethere is provision for severalweeksof COBE,Sattachmenteachyear up to fifth and fourth year respectively. In the secondacademicyear,the studentswill spendsix weeksliving and working in selected rural communitieswhere they will learn about the health problems,participatein providing health services and cany out relevant essentialhealth research. For the first two years the studentswill actively participatein primary health care activities in the community and will be exposedto healthmanagementand servicedelivery at the health centerlevel. In their third and fourth years the studentswill be involved in various essentialhealth researchprojects and implementation of appropriate interventions. The fifth year for MBChB. BDS and the fourth year for BSc. Nursing is devotedto gaining experiencein the managementand delivery of health servicesat the district level. The year one orientation is designedto give studentsoverall theoretical perspectivesand practicesfor their COBES field placementin the subsequentyears.Studentsreceivedinputs from a variety of departments.It is expectedthat a comprehensivereport will be written and presentedto membersof the Schoolsof Medicine and Dentistry at the end of the secondyear of COBES field placement.  MSB 105: Introduction to Community Health, (COBES I) Tutorial Booklet COURSE OBJECTIVES At the end of the course,the studentswill be able to: 1. Describethe organizationand structureof health care delivery systemsand role of healthcareproviders 2. Outline the conceptsand principles of Primary Health Care (PHC) and Community Diagnosisin Kenya 3. Describethe immediate and underlying factors that affect the health and nutritional status of individuals and conduct a of a Community Diagnosis in the field of placement. 4. Statethe priority of health problemsin Kenya, their aetiology and factors associated with them in a specific rural community 5. Explain the conceptsof a community, its organizationand resources,and carry out a in the areaof attachment. nutritional assessment 6. Describeand apply the basic principles of epidemiology,anthropology,biostatistics and demography,nutritional assessment. 7" State the basic componentsof computersand explain the use of computersin data managementand work processing  MSB t05: Introduction to Community Health, (COBES l) Tutorial Booklel PREAMBLE TO THE TUTORIAL PROBLEMS AREAS: 1" Community organizationand its resources. 2" Researchmethods (qualitative, quantitative,developmentdata collection tools and ethicalissues). 3. Basic principlesof epidemiologyand demography. 4" Basic principlesof biostatistics. 5" Health caredelivery systemsin Kenya. 6. Primary health care. 7. Factorsaffectingnutritional statusin a community.  MSB 105: Introduction to Communitv Health, (COBES I) Tutorial Booklet AREAS: 1" Community organizationand its resources. 2. Researchmethods (qualitative, quantitative,developmentdata collection tools and ethicalissues). 3. Basic principlesof epidemiologyand demography. 4" Basicprinciples of biostatistics. 5. Health caredelivery systemsin Kenya. 6. Primary health care. 7. Factorsaffecting nutritional statusin a community.  MSB 105: lntroduction to Community Health, (COBES I) Tutorial Booklet TUTORIAL PROBLEM 1 Two new studentsPaul, who hails from Uriri and Mohammedfrom Dujis met at the schoolof medicine.While getting to know eachother,they describedtheir social backgrounds.In their discussion,they commented on the agricultual resourcesin the local county. They were surprisedto learn that even urban areasare under administrative control of chiefs. Theme: Community organizationand its resources. Objectives: * Describethe conceptsof a community" * Outline the community organizatronand structure. o Leadership o Social n Outline the community resources o Natural resources. o Human resources. o Infrastructure. U"r^1 Informal o Natural resources. o Human resources. o Infrastructure.  MSB 105: Introduction to Community Health, (COBES I) Tutorill Booklet TUTORIAL PROBLEM 2 (a) COBES studentswere prepadng to collect data in the field and were guided to use the quantitativeresearchmethods. They were advisedto ensureall aspectsof methodologywere addressed.With the help of their supervisor,they developedresearchtools as well as their field activities. Theme: QuantitativeResearchMethods Objectives: * Understandand apply the various Quantitative ResearchMethods in the Community" "i. Develop appropriatetools for datacollectionquantitativemethods.  MSB 105:Introduction to Community Health, (COBES I) Tutorial Booklet TUTORTAL PROBLEM 2 (b) COBES students were preparing to collect data using the various qualitative research methods. The natureof information requiredthat they use severaldata collection instruments and tools. They debatedamongstthemselvesabout the most appropriatetools, considering the advantagesand disadvantagesofeach. Objectives:.... Understandand apply the various Qualitative ResearchMethods in the Community. * Developappropriatetools for datacollectionqualitativemethods.  MSB 105:Introduction to Community Health, (COBES I) Tutorial Booklet TUTORIAL PROBLEMS 2 (c) The residentsof Shamakhokhocomplained to their leadershipthat they were not comfortable with a group of studentsasking them questions. They further statedthat they were not aware of who the studentswere, why they were in the community and what their purposewas" The local District Officer intervenedto rectify the situation' Theme: Ethical issuesin research Objectives: t Ethical principlesand valuesthat governresearchprotocol. 'i' Application of the principles in research. * The role of the InstitutionalResearchand Ethics Committee.  MSB 105: Inlroduction to Community Health, (COBES I) Tutorial Booklet TUTORIAL PROBLEM 3 (a) During a COBES placement at Corner Mbaya Health Centre the studentswere asked to participate in an outreach programme involving residual spraying of insecticidesin the householdswithin the catchmentarea. This was as a result of many people falling sick. The Public Health Officer led the studentsin the residual spraying and held a discussionon diseasepatterns in the area. Later in the afternoon they participated in an HIV & AIDS awareness campaign. Theme: Basic Principles of Epidemiology Objectives: * Health and disease- causation,naturalhistory,measurementof diseasefrequencyand distribution. r'. Epidemiologyof HIV / AIDS. 10  MSB 105: Introduction to Communrtv Health, (COBES I) Tutorial Booklet TUTORTALPROBLEM 3 (b) KM Constituency development: meeting where he invited all the local The MP of KM had a constituencydevelopment-stakeholders university students from his constituency. In his speech he stated that the constituency had experiencedan explosion in population growth and there was need to update the constituency's populationand demographiccharacteristicsfor the purposeof planning. A year one MBChB student from Moi University who attended the meeting asked the MP to explain to the meeting the of populationgrowth in the constituency. determinantsand the consequences Theme: Demography and demographicvariables Areas: r Characteristicsof a population o Populationsize o Populationdensities o Populationstructure o Natality and mortality rateswithin a population o Factors affecting population growth of an area o of populationgrowth Consequences o Demographicvariablesand applicationof demographicdata LI  MSB 105:Introduction to Communifv Health, (COBES I) Tutorial Booklet TUTOARIAL PROBLE 4 KapsisiywaHealth Center Records: COBES I studentsat the School of Medicine visited Nandi North District and sampledone health center (Kapsisiywa) for a study on how health records are handled in the district. After discussionswith the recordspersonnelat the centerthe studentsrequestedto be allowed to accessthe raw data. The Clinical officer at the centeraskedthe studentsto processthe raw data and help in the interpretationof the information in their records. The studentsanalyzed the dataand presentedthis in variousways. Theme: Basic Principles of Biostatistics Areas: {. Outline samplingtechniques * DistinguishbetweenRaw dataand processeddata.i. Statisticaldataanalysismethods.i. Data presentation.i. Data interpretation t2  MSB 105:Introduction to Community Health, (COBES I) Tutorial Booklet TUTORIAL PROBLEM 5 - DR. UG Dr UG was recently appointed as the medical officer-in-chargeof health in Uasin Gishu County. In her acceptancespeechshe noted shortageof healthcareworkers and suppliesleading to patientsresorting to folk healers.To curb this she promised to hire more health workers, retrainthe existing ones to cope with the ever changinghealth problems and ensureconstant supply of medication. The governorthanked her and promised to allocatemore resourcesto be distributed fairly from the health centersto the County hospital. He was happy to report having received two ambulancesfor emergencyevacuationto regionaland nationalreferral centers. Theme: Health Care Delivery SystemsIn Kenya. Objectives: * I-evelsof healthcare".i. Providersand usersof healthcare. t Role of healthcareproviders. * Informal healthcare. 13  MSB 105: Introduction to Communifv Health, (COBES I) Tutorial Booklet TUTORIAL PROBLEM 6 The Medical Officer of Health in-charge of Siaya County called for a meeting of his membersof staff to discussthe extentto which primary health care activitieshave succeeded in their county. He reminded staff that WHO is interestedin the PHC strategies.From the reportsgiven by those who were implementingthe various elements,it was noted that there was some degreeof success.The meeting resolvedto identify priority health areaswhich neededto be addressed. Theme: Primary Health Care in Kenya" Objectives: * Define PHC. t Describeelementsof PHC. t Explain how elementsof PHC are implemented. t Identify limitations of PHC t4  MSB 105:Introduction to Community Health, (COBES I) Tutorial Booklet TUTORIAL PROBLEM 7 David is a five year old boy from a large family. His father is a small scale farmer, who never went beyond primary school. David has two siblings who are younger than him and are regularly taken to a local health centre for generalmedical check-up,which is done for childrenbelow five years. One of them was found to be stunted. Theme: Factors affecting the Nutritional Statusof a Community. Objectives:.i. Food availability and security..i. Education and culture. * Environmental and social economic factors affecting nutrition. "i. Maternal and child health care. * Nutritional and dietary assessment. LEARNING EXPERIENCE l. PBL Tutorials 2. Community Placement 3. Health CenterPlacement 4. Lectures/Overviews 5. Exercises 15  MSB 105: Introduction to Community Health, (COBES I) Tutorial Booklet LEARNING RtrSOURCES A. TEXTBOOKS 1. Trieff, NormanM., EnvironmentalandHealth2ndEdition.Ann Arbor Science1981 2. Last, John M., Public Health and Human Ecology. EastNorwalk; Appleton and Lange, 1987 3. Mausner, Judith S. Epidemiologyt An Introductory Text. Philadephia: W.B. Sauners Company1984 4^ Vogel, L. C^ Muller, A.S et al. Health and Diseasesin Kenya Nairobi. East African Literature Bureau,1974 5. Manson-Bahr,P.E.C. Manson Tropical Diseases9thEdition Philadelphia,Bculliere Tindal, 1981 6. Barker,D.J.P.PracticalEpidemiology3'dEd. Edinburg:ChurchilLivingstone,1982 1. Lwanga, S. Kaghgwa. Biostatistics of Medical studentsKampala: East African Literature Bureau,1975 8. Casarettand Doull'S Toxicology:The basic scienceof poison. Edited by John Doull et al New York Macmillan PublishingCo., 1980 9. Republieof Kenya. KenyaPopulationandHousingCensus.Nairobi, 1989. 10. Macmahon, Brian" Epidemiology; principle and methods. Boston; Little Brown and Company,1970. 11" National Guidelines in implementationof primary health care Kenya Edited by DR. James MAneno, Nairobi Ministry of Health,governmentof Kenya, 1986 12. Akinsola.H.A.A., A-z of A CommunityHealth and SocialMedicine in Medical and Nursing practice 13. WHO publicationsand primaryHealthCare B. RESOURCE PERSONS L Dept. of Epidemiology 2. Dept of BehavioralSciences 3. Dep.Medicine t6  MSB 105: Introduction to Community Health, (COBES I) Tutorial Booklet 4. Dept of Nutrition 5" Dept. of Health Managementand Health Economics 6. Dept of Microbiology and Parasitology 7" Dept. of EnvironmentalHealth 8" Health Care Personnel 9. Commuinty Leaders 10. Communitiessurroundingplace of placement C. FIELD STATIONS I " Amukura Health Center 2. Bokoli Health Center 3. ChulaimboHealth Center 4. KabuchaiHealth Center 5. Makunga Health Center 5. MatayosHealth Center 7. Mbale Health Center 8. Mosoriot Health Center 9. Naitiri Health Center 10. NambaleHealth Center 11. NyaheraHealth Center 12. SirisiaHealthCenter 13. Turbo Health Center SELF ASSESMENT QUESTIONS 1. Define the followins rates:. Crude death ratel Age specific deathrate Birth rate Fertility rate Infant motality rate Neonatal death rate Perinatal death rate Maternal mortality rate 77  MSB 105:Introduction to Community Health, (COBES I) Tutorial Booklet 2. Describethe various roles of healthcadresin your COBES field placementhealthcenter 3. How can health information databe usedto: a) Explain diseasepatterns? b) Plan healthservices 4. How do cultural and Socio-economicfactorsaffect populationchange? 5. Describethe following componentsof populationchange a) Fertility b) Births c) Mortality d) Deaths e) Migration 0 Territorial movement 6. What factorsaffect the quality of the following data: a) Census? b) Samplesurvey? c) Vital registration? 7. Why is the diseasesurveillanceimportant? 8. Define mortality and casefatality rate. 9. Explain how industrialtechnologycan contributeto the environmentalpollution. 10. Describeenvironmentalhazardslikely to affectthe healthof a community. 11. In a District of 125,000peopletherewere 4,800 live birth in 1985of whom 150 died before they were a week old. Therewere also 200 still born babies. a) The birth rate is 38.4 per thousand b) The perinatalmortality rate is 70 per thousand c) The perinatalmortality rate is a good indicationof maternalhealth servicesin the district d) The still birth rateis 200 x 1000/4,800 e) The still birth rate is a good indicatorof the hospitalobstetricservices 12. Demographicinformation is obtainedfrom the following: L8  MSB 105: Introduction to Community Health, (COBES I) Tutorial Booklet a) The lO-yearnational census b) Registrationof births and deaths c) Countingthe peopleliving in the country d) District medical officer reports e) Samplesurveysof the population tr3. The following are vital statistics: a) Bed occupancyratesin hospitals b) Attendanceratesat health institutions c) Birth rates d) Grossnationalproduct e) Deathrates 14. To facilitate entry into a community, efforts should be made to identify and hold meetings with the: a) Health workers servingthe community b) Politiciansrepresentingthe community c) Tradiotionalleadersin the community d) Opinion leadersin the community ofheads ofhouseholds e) Representatives 15" Mass immunizationis a type of: a) Non-specificprimary preventivemeasure b) Specificprimary preventivemeasure c) Secondarypreventivemeasure d) Tertiary preventivemeasure e) Health promotive measures 16. The following are componentsof Primary Health Care a) Food and nutrition b) Environmentalhealth c) Treatmentof chronically ill patients d) Health Education 19  MSB 105:Introduction to Communitv Health, (COBES I) Tutorial Booklet 17. When new treatment is developedthat preventsdeath but does not produce recovery from diseasethe following will occur: a) Prevelanceof the diseasewill increase b) Incidenceof diseasewill occur c) Incidenceof the diseasewill decrease d) Prevelanceof the diseasewill remainthe same 18. Which of the following expressthe relationshipbetweenincidence(l), Prevalence(P), and Mean Duration (MD) of a disease a) 1:pxMD b) P: I xMD c) P1P:pxl d) 1:p+MD e) P:1+MD 19. The immunitywhich follows measlesinfectionis: a) Natural active immunity b) Natural passiveimmunity c) Artificialactive imrnunity d) Arlificial passiveimmunity e) Artificial acquiredimmunity 20. List the characteristicsof communities. 2l. Write a brief descriptionof audio-visualaids 22^ List fbur objectivesof Primary Health Care 23^ a) What is a diseasedeterminant b)Namethreedeterminantsyou have studied c) Give 2 examplesof eachof the threedeterminantsabove 24. What is meantby the terms: a) Demographictransition?(Identifl, 3 phases) b) Demographictrap (Identify 4 phases) Illustrateyour answerwith agraphin eachcase 20  MSB 105: Introduction to Community Health, (COBES I) Tutorial Booklet Describewhy demographicentrapmentmay occur 25. The following are measuresof the spreadof a distribution a) Interquartilerange b) Standarddeviation c) Range d) Median e) Mode 26. Qualitativedataare normally presentedin agraphform using: a) Pictograms b) Polygonfrequency c) Propotionalbar charts d) Fie diagrams e) Semi logarithmic graphs 27. Defrne arate Give two (2) examplesof motality ratesshowingthe numerator,denominatorand the constant (K) 28. A random sample is often beyond the reach of many practicing doctors. A biopsy specimen and a syr;ingefull of blood are not randomsamplesbut they are neverthelessuseful. A particulardoctor' patientsare not a randomsampleof the local populationfrom which they are drawn. What should a doctor do if he discoversan interestinfact aboutthem: a) Refuseto write it up in the journals becauseit is not a random sample b) Write and call it a randomsamPle c) Write it up and point out if it is a non-randomsample Selecta correctresponseand commenton why you have selectedit. 29. List three health serviceswhich were provided in the health center which you were placed during COBES field attachmentexperience. What is the title and responsibilitiesof the personin chargeof the servicesyou listed 30. Draw a diagramof the organizationof the healthcaresystemof Kenya. and 31. Most people in the rural communitiesin Kenya seek treatmentboth from Biochemical field Ethnomedicalsources. Di:cuss this statementbasingyour argumentson your COBES placement. 21,  MSB 105: Introduction to Communifv IIealth, (COBES I) Tutorial Booklet 32. Describehow anv of the followine factorsaffect the needfor nutrients. a) Rate of growth b) Pregnancy c) Physicalactivity 33. a)List four main nutritional problemsin developingcountries b)Use a diagramto describethe relationshipbetweenhouseholdfood security availability of healthservicesand how this affectsthe healthof an individual 34. Give two examples in each of the following category of infections, and their aetiological agents. Discusstheir preventionand control i. Faecal - Oral ii. Water - Washed iii. Water - Based iv. Water - Relatedinsectvector v. Excreta- Related vi. Immunizablediseases vii. STI viii. URTI 35.Definethe term Environment.Briefly outline 5 pollutantsof eachof the following areas: a) Air b) Water c) l-and - For each of the above named areasname the sourcesof two pollutants and their effectsto health 36. In a prospectivestudy ofdisease,the cohort originally selectedconsistof a) Personswho are found to havethe disease b) Personswithout disease c) Personswith the factor under investigation d) Personswith family history of disease e) Personswithout the factor under investigation 37. The risk of acquiringa diseaseis measuredby the: 22  MSB 105:Introduction to Community Health, (COBES l) Tutorial Booklet a) Incidencerate b) Incidencerate times the averagedurationof the disease c) Incidencerate divided by the prevalencerate d) Prevalencerate e) Prevalencerate times the averagedurationof the disease 38. Advantagesofcohort over case-controlstudiesare: a) The are cheaper b) They are easierto cary out c) They offer strongerevidencefor diseasecausation d) They are better investigatingrare diseases e) They requiresmall samplessizes COURSEEVALUATION l. Genericquestionnaire 2. Form A: Assessmentof studentperformanceduring COBES posting of Tutor Skills 3. Form B: StudentAssessment 4. Form C:.COBES programmeevaluationby students 5. Form D: Assessmentof the COBES programmeby health centerstaff 6. Form E: StudentsWritten ReportAssessment 1. Form F: Assessmentof StudentsOral Presentation 8. Form G: Students'PeerAssessment 23