CA2: COMMUNITY HEALTH NURSING DAY 1 1

Prof. Aida Garcia, MAN, RN

DEMOGRAPHY
The study of population size, composition, and
distribution
• Population size → number of people
B. Increase due to birth and migration
residing in an area every year
1. Absolute increase → increase per year Pt
• Composition → determining the common
– Po (how many are added in the
description of population in terms of age
population)
o Philippines → more young people
than old; more males are being
Let:
born – equal during teenage years
Pt = population later time
– more old women
Po = population earlier time
t = year interval
I. Sources of Demographic Data
1. Census * → most expensive and time 𝑃𝑡 − 𝑃𝑜
consuming 𝐴𝑏𝑠𝑜𝑙𝑢𝑡𝑒 𝑖𝑛𝑐𝑟𝑒𝑎𝑠𝑒 =
• De jure → residence (basis in the 𝑡
Ph) Example:
• De facto → where the person is o Pt (earlier time) Year 2018
during the TIME of census Population: 26,000
• National government o Po (latter time) Year 2021
• PhP Population: 20,000
• Time
• PSA is responsible for census 26,000 − 20,000
(every 10 years) 𝐴𝑏𝑠𝑜𝑙𝑢𝑡𝑒 𝑖𝑛𝑐𝑟𝑒𝑎𝑠𝑒 =
3
2. Sample Survey
• Small number of people 𝐴𝑏𝑠𝑜𝑙𝑢𝑡𝑒 𝑖𝑛𝑐𝑟𝑒𝑎𝑠𝑒 = 2,000
proportionate to general
population
3. Registration System * 2. Relative increase → %
• Records of vital events (NSO / → known as population growth rate
CRO) → percentage of the population added
• Registration system in the
community → Civil Registrar Let:
Office Pt = population later time
• Doctor → responsible for the Po = population earlier time
registration of birth certificate;
should be done within 30 days 𝑃𝑡 − 𝑃𝑜
𝑅𝑒𝑙𝑎𝑡𝑖𝑣𝑒 𝑖𝑛𝑐𝑟𝑒𝑎𝑠𝑒 =
→ family members can register 𝑃𝑜
during disasters
• Death certificate → issued where Example:
the person died o Po (earlier time) Year 2002
Population: 10,000
II. Population Size o Pt (latter time) Year 2005
Population: 12, 300

Note:
3 factors that change the population
growth:
1. Birth
2. Death
3. Migration
A. Measure population size by increase in
population due to difference of birth and death
Philippines → increase in population
(even during the COVID season)
1. Natural Increase = # of birth - # of death
2. Rate of Natural Increase = CBR – CDR
12,300 − 10,000
𝑅𝑒𝑙𝑎𝑡𝑖𝑣𝑒 𝑖𝑛𝑐𝑟𝑒𝑎𝑠𝑒 =
10,000
𝑅𝑒𝑙𝑎𝑡𝑖𝑣𝑒 𝑖𝑛𝑐𝑟𝑒𝑎𝑠𝑒 = 0.23
= Increase of the population from 2002 to 2005
POPULATION PROJECTION
• A demographic tool
• Basis for statistical projections
• Help government in decision making
III. Population Composition
A. Sex Composition * → compares the number
of females in the community
 2
CA2: COMMUNITY HEALTH NURSING DAY 1
Prof. Aida Garcia, MAN, RN
𝑁𝑜. 𝑜𝑓 𝑚𝑎𝑙𝑒𝑠
𝑆𝑒𝑥 𝑅𝑎𝑡𝑖𝑜 = × 100
𝑁𝑜. 𝑜𝑓 𝑓𝑒𝑚𝑎𝑙𝑒𝑠

* The resulting figure represents the

number of males for every 100 females in the
population

B. Age Composition
1. Median Age → divides population into
two equal parts
→ If the median age is high, the life
expectancy is longer, health care system
is good, and economy is good.
• Gives birth to one child only → negative
(European, Singapore, Japan)
• Gives birth to three and above → rapid
• Gives birth to two children → slow growth
(usually pinapalitan lang ang nanay at
tatay)

Inverted Population Pyramid is described as: *

2. Dependency Ratio → compares

economically dependent and
independent portion of community
• 0 – 14 & 65 above are dependent
• 15 – 64 as independent * Increased elderly population
* Good health system
𝐷𝑒𝑝𝑒𝑛𝑑𝑒𝑛𝑐𝑦 𝑅𝑎𝑡𝑖𝑜 * Effective family planning
𝑡𝑜𝑡𝑎𝑙 𝑝𝑜𝑝. 𝑜𝑓 𝑡ℎ𝑒 0 𝑡𝑜 14 𝑎𝑛𝑑 65 𝑎𝑛𝑑 𝑎𝑏𝑜𝑣𝑒 𝑎𝑔𝑒 𝑔𝑟𝑜𝑢𝑝
= × 100
𝑡𝑜𝑡𝑎𝑙 𝑝𝑜𝑝. 𝑜𝑓 15 − 64 𝑎𝑔𝑒 𝑔𝑟𝑜𝑢𝑝

V. Population Distribution
C. Age and Sex Composition * → presented with
A. Urban rural distribution → illustrate proportion
the use of population pyramid
of urban and rural dwellers
→ pregnant women are usually in the
rural areas
→ more people in the urban areas due to
MIGRATION

B. Crowing index → described by dividing the

number of persons in a household with the
Shows the percentage of male and female, as number of rooms used by the family for sleeping
well as age. → increased crowding index = higher
chance of transferring communicable diseases
Phillipines Population Pyramid
C. Population Density → determines how
congested a place
• Densed area*
• Densely populated = more people in
comparison to their land area (e.g., Metro
Manila)

𝑃𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛
𝑃𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝐷𝑒𝑛𝑠𝑖𝑡𝑦 =
Description → more young; slightly increased 𝐴𝑟𝑒𝑎 (𝑠𝑞 ⁄𝑘𝑚)
male population upon birth; older woman
population is higher 43,000,000
𝑃𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝐷𝑒𝑛𝑠𝑖𝑡𝑦 =
1,320,400
𝑃𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝐷𝑒𝑛𝑠𝑖𝑡𝑦 = 32.6 𝑝𝑒𝑜𝑝𝑙𝑒 𝑝𝑒𝑟 𝑠𝑞𝑢𝑎𝑟𝑒 𝑘𝑖𝑙𝑜𝑚𝑒𝑡𝑒𝑟
Patterns Population Pyramid *

EPIDEMIOLOGY
• A study of disease and death distribution
and occurrence

CA2: COMMUNITY HEALTH NURSING DAY 1
Prof. Aida Garcia, MAN, RN
• Study the factors that leads to illness and
deaths (used for planning)
• Rest on concept of:
o Multiple causation theory
o Levels of prevention
CHN focus
• Promotion and prevention 3. Environment
Uses of Epidemiology (C-HID-SIA)
1. Complete clinical picture of Chronic
disease
2. Study of History of health populations
3. Identify syndromes
4. Diagnose health of community
5. Search for causes of disease
6. Study the work of health services to
improve it
7. Estimate risk of disease, to avoid it
Theories of Disease
THEORY OF DISEASE
Multiple Causation Theory
1. Wheel → core is genetic
2. Web → used in the hospital; points our
risk factors
3. Ecological triad – most useful; used in
infectious diseases and determination of
NCD
1. Primary Prevention
3 Elements of Ecological Triad
1. Agent
• An element, substance or force
• Could be animate or inanimate
• Serve as stimulus for disease
• Forms of agent
o Biological: virus, fungus, parasite
o Chemical: Lead, mercury,
insecticide 2. Secondary Prevention
o Physical: humidity, atmospheric
pressure, radiation (surroundings)
o Mechanical: stab, trauma
o Nutritive: iron or iodine deficiency,
cholesterol
2. Host
• An organism that harbors and provides
nourishment for another organism
• 2 Types of Host Resistance
o Specific Resistance → from 3. Tertiary Prevention
immunization; memory immunity
providing lifetime protection
o Non-specific Resistance (1st
level immunity) → intact skin,
mucous membrane, reflexes such PHASES OF EPIDEMIOLOGY
3
as coughing, lacrimation or
vomiting
→ Maintained through personal
hygiene, environmental
sanitation, proper nutrition and
healthy lifestyle
• The sum total of all external conditions
• 3 Components of Environment
o Physical environment →
surroundings (geophysical /
climate)
o Biological environment → living
things such as plant and animal
o Socio-economic → depend on
economic development or social
disruption
• Disease will occur depending on:
o Host (resistance)
o Agent (number of organism and
virulence)
o Environment (favorable condition)
3 LEVELS OF PREVENTION
• Prevention of emergence of risk factors
and disease
• Intervention performed before agent
enters host and cause illness
• Aims
o To strengthen host resistance
o Inactivate agent
o Interrupt chain of infection
• Includes health promotion such as:
proper nutrition, healthy lifestyle, good
personal habits, safe water supply,
proper disposal of waste & vector control
• Also includes specific measures by:
immunization & prophylaxis
• Aim is
o to identify / treat health problem
immediately
o to control health problem
• Activities are:
o Screening
o Case finding
o Diseases surveillance
o Prompt and appropriate treatment
• Reduce the residual effect of disease
• To maximize capacity of person
• Rehabilitation

CA2: COMMUNITY HEALTH NURSING DAY 1
Prof. Aida Garcia, MAN, RN
1. Descriptive Epidemiology → involves
describing disease distribution and
frequency
→ e.g., RLE task that we did
→ COVID-19 causes death to elderly
and those with comorbidity
2. Analytical Epidemiology → analyze
the cause
3. Intervention or Experimental
Epidemiology → acting to remove the
problem through experimentation or
research to develop NEW METHODS
towards control of health problem
→ apply measures for the first time
4. Evaluation Epidemiology → measures
the effect of health program and services
→ document through “playbook”
Descriptive Epidemiology
(1) Observe the frequency of disease and
patterns of occurrence. This could be done
by describing:
a. Attack Rate → calculate the incidence of
disease in identified population exposed
to infectious agent; every 2 weeks
evaluation in COVID-19
b. Screening → the presumptive
identification of unrecognized disease
(e.g., FBS, BP taking, CBC)
c. Case finding → looking for previously
UNIDENTIFIED cases of disease
d. Sensitivity → the proportion POSITIVE
in screening
→ RT-PCR has high sensitivity
e. Specificity → the proportion NEGATIVE
in screening
(2) Description of the disease as to person,
place and time
a. Herd Immunity → immunity is inversely
proportion to the susceptibility level
b. Epidemic → upward fluctuation of
disease
c. Outbreak → small epidemic
d. Endemic → habitual presence of
disease in a community
→ Philippines: malaria,
schistosomiasis, filariasis
e. Sporadic → disease occurs now and
then (rabies)
f. Pandemic → worldwide presence of
disease
Host
• Chance → depends on the number of
sources of infection
• Exposure or Contact Rate → depends
on the frequency of transmission
→ COVID-19 – recommended time of
exposure: 15–30 minutes
4
(3) Description of disease in terms of DATE
or TIME
a. Short time Fluctuation
o Common Source Epidemic →
simultaneous exposure of disease
to a large number of person due to
1 cause (e.g., cholera)
o Propagated Epidemic → person
to person transmission of disease
b. Cyclic Variation → recurrent
fluctuations of disease (e.g., seasonal
diseases; rainy season = dengue;
summer = sore eyes)
c. Secular Variation → changes in disease
frequency over a period of MANY
YEARS (e.g., tuberculosis rampant even
in the 50’s)
(4) Analyze the general pattern of disease
formulate association in all the data to find
the probable cause (for planning of promotion
and prevention
HEALTH INDICATORS (VITAL STATISTICS)
• Application of statistical measures to vital
events such as:
o Births
o Deaths
o Common illness
• Purpose: to gauge the levels of health,
illness and health services of a
community and the country
• Health indicators include population size,
crude birth rate, crude death date, infant
and maternal death rate, neonatal death
rate and even tuberculosis rate
Common Health Indicators
1. Birth
2. Death
3. Marriages
4. Migration
Common Vital Statistics Indicators
1. Fertility rates
2. Mortality rates
3. Morbidity rates
Definition of Terms
1. Crude Rates → have its denominator the
total population of specific geographic
unit
2. Specific Rates → events occurring to a
specific group are related only to the
affected segment of the population (ex.,
age, sex, educational attainment, marital
status, occupation, race, exposure to
disease and risk factor)
3. Midyear Population → the estimated
population as of July 1 of a specified
year; this is the representative of the
population for the whole year

CA2: COMMUNITY HEALTH NURSING DAY 1
Prof. Aida Garcia, MAN, RN
4. Birth → the complete expulsion or
extraction from the mother of a fetus
irrespective of whether the umbilical cord
has been cut or the placenta is attached
5. Live Birth → the condition wherein the
infant at or some time after birth breathes
spontaneously or shows any other sign of
life such as heartbeat, pulsation of the
umbilical cord has been cut or the
placenta is attached
6. Death → total lack of response to
external stimuli; no muscular movement
especially breathing; no reflexes; & flat
encephalogram (brain waves)
7. Maternal Death → death of any women,
for whatsoever cause; while pregnant or
within 90 days of termination of the
pregnancy; irrespective of the duration of
the pregnancy at the time of termination
or the method by which it was terminated
BIRTH RATES
1. Crude Birth Rate (CBR)
• The number of live births per 1,000 mid-
year total population of the given
geographical area during the year
• Measures how fast people are added to
the population through births
• Used often
• Affected by:
o Fertility / marriage practice in a
location
o Sex and age composition
o Birth registration practice
# 𝑜𝑓 𝑟𝑒𝑔𝑖𝑠𝑡𝑒𝑟𝑒𝑑 𝑙𝑖𝑣𝑒 𝑏𝑖𝑟𝑡ℎ𝑠 𝑖𝑛 𝑎 𝑦𝑒𝑎𝑟
𝐶𝐵𝑅 =
𝑚𝑖𝑑 𝑦𝑒𝑎𝑟 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛
5
MORTALITY RATES
1. Crude Death Rates (CDR)
• Crude because death is affected by
different factors and the denominator is
the population
• Factor that affects CDR:
o Age and sex composition
o Adverse environmental and
occupational condition of area
o Peace and order condition in the
area
# 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 𝑖𝑛 𝑎 𝑦𝑒𝑎𝑟
𝐶𝐷𝑅 = × 1,000
𝑚𝑖𝑑 𝑦𝑒𝑎𝑟 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛, 𝑠𝑎𝑚𝑒 𝑦𝑒𝑎𝑟
3. Specific Mortality Rate (SMR)
• Shows rate of deaths in group with
specific characteristics related to:
o Age
o Sex
o Occupation
o Educational attainment
o Exposure to condition
o Combination of above
# 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 𝑖𝑛 𝑎 𝑠𝑝𝑒𝑐𝑖𝑓𝑖𝑐 𝑔𝑟𝑜𝑢𝑝 𝑖𝑛 𝑎 𝑦𝑒𝑎𝑟
𝑆𝑀𝑅 = × 1,000
𝑚𝑖𝑑 𝑦𝑒𝑎𝑟 𝑝𝑜𝑝. 𝑜𝑓 𝑡ℎ𝑒 𝑠𝑎𝑚𝑒 𝑠𝑝𝑒𝑐𝑖𝑓𝑖𝑐 𝑔𝑟𝑜𝑢𝑝, 𝑠𝑎𝑚𝑒 𝑦𝑒𝑎𝑟
• More valid than CDR when comparing
mortality experiences between groups
• There is high mortality rate among infants
and elderly and its graph shows a J-
shaped or U-shaped curve (age versus
mortality rate)
× 1,000

2. Age Specific Fertility Rate (ASFR)

• Most accurate
• Permits in-depth study on the
o Impact of birth control measures
on fertility
o Differences in fertility at specific
ages throughout the reproductive
period
o Eg., women in 15 to 19 years old
only
𝐴𝑆𝐹𝑅 =
𝑡𝑜𝑡𝑎𝑙 𝑏𝑖𝑟𝑡ℎ𝑠 𝑡𝑜 𝑤𝑜𝑚𝑒𝑛 𝑎𝑔𝑒𝑑 𝑖𝑛 𝑠𝑝𝑒𝑐𝑖𝑓𝑖𝑐 𝑦𝑒𝑎𝑟𝑠
𝑚𝑖𝑑 𝑦𝑒𝑎𝑟 𝑝𝑜𝑝. 𝑜𝑓 𝑤𝑜𝑚𝑒𝑛 𝑎𝑔𝑒𝑑 𝑖𝑛 𝑠𝑝𝑒𝑐𝑖𝑓𝑖𝑐 𝑦𝑒𝑎𝑟𝑠
3. General Fertility Rate
• More specific related to age group
capable of giving birth
• Reproductive age group in the PH: 15 –
44 years old
• Note: 15 – 49 in other countries
# 𝑜𝑓 𝑟𝑒𝑔𝑖𝑠𝑡𝑒𝑟𝑒𝑑 𝑙𝑖𝑣𝑒 𝑏𝑖𝑟𝑡ℎ𝑠 𝑖𝑛 𝑎 𝑦𝑒𝑎𝑟
𝐺𝐹𝑅 =
𝑚𝑖𝑑 𝑦𝑒𝑎𝑟 𝑝𝑜𝑝. 𝑜𝑓 𝑤𝑜𝑚𝑒𝑛 15 − 44 𝑦𝑒𝑎𝑟𝑠 𝑜𝑙𝑑
• In sex and age specific mortality rates,
there is generally a high mortality rate
among males
• In developing countries, high in women of
the reproductive age (than males of
same age)
× 1,000 • Deaths among women in the
reproductive age in developing countries
are due to complications of pregnancy,
childbirth and puerperium
4. Cause of Death Rate (C-DR)
• Crude because it involves whole
population
• Could be made specific by relating
deaths from a specific cause (like TB)
× 1,000 and group to the mid-yr pop of that
specific group (according to sex and age)
CA2: COMMUNITY HEALTH NURSING DAY 1
6

Prof. Aida Garcia, MAN, RN

• Factors that affect this:

o Completeness of registration of
deaths
o Composition of population
o Disease ascertainment level in a
community
# 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 𝑓𝑟𝑜𝑚 𝑎 𝑠𝑝𝑒𝑐𝑖𝑓𝑖𝑐 𝑐𝑎𝑢𝑠𝑒
𝐶 − 𝐷𝑅 = × 1,000
𝑚𝑖𝑑 𝑦𝑒𝑎𝑟 𝑝𝑜𝑝. , 𝑠𝑎𝑚𝑒 𝑦𝑒𝑎𝑟
5. Infant Mortality Rate (IMR)
• Sensitive index of level of health in a
community
• High IMR means low levels of health
standards due to:
o Poor maternal and child health
care
o Poor environmental sanitation
o Poor or deficient health service
delivery
• IMR may be artificially lowered by
increasing registration of birth
• Further sub-divided using:
o Neonatal mortality rate
o Post-neonatal mortality rate
# 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 𝑈𝑁𝐷𝐸𝑅 1 𝑌𝐸𝐴𝑅 𝑜𝑓 𝑎𝑔𝑒 𝑖𝑛 𝑎 𝑐𝑎𝑙𝑒𝑛𝑑𝑎𝑟 𝑦𝑒𝑎𝑟
𝐼𝑀𝑅 =
# 𝑜𝑓 𝑟𝑒𝑔𝑖𝑠𝑡𝑒𝑟𝑒𝑑 𝑙𝑖𝑣𝑒 𝑏𝑖𝑟𝑡ℎ𝑠, 𝑠𝑎𝑚𝑒 𝑦𝑒𝑎𝑟
5.1. Neonatal Mortality Rate (NMR)
• Primarily due to prenatal or genetic
factors
# 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 𝑎𝑚𝑜𝑛𝑔 𝑡ℎ𝑜𝑠𝑒 𝑢𝑛𝑑𝑒𝑟 28 𝑦𝑒𝑎𝑟𝑠 𝑜𝑙𝑑
𝑁𝑀𝑅 =
# 𝑜𝑓 𝑟𝑒𝑔𝑖𝑠𝑡𝑒𝑟𝑒𝑑 𝑙𝑖𝑣𝑒 𝑏𝑖𝑟𝑡ℎ𝑠, 𝑠𝑎𝑚𝑒 𝑦𝑒𝑎𝑟
7. Proportionate Mortality Rate (PMR)
• Expressed in percentage
• Does not show the probability of death
in a given population
• Ex., the denominator does not show the
population at risk of acquiring the
disease
# 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 𝑓𝑟𝑜𝑚 𝑎 𝑝𝑎𝑟𝑡𝑖𝑐𝑢𝑙𝑎𝑟 𝑐𝑎𝑢𝑠𝑒 𝑖𝑛 𝑎 𝑦𝑟
𝑃𝑀𝑅 = × 100
𝑡𝑜𝑡𝑎𝑙 𝑑𝑒𝑎𝑡ℎ𝑠 𝑓𝑟𝑜𝑚 𝑎𝑙𝑙 𝑐𝑎𝑢𝑠𝑒𝑠, 𝑠𝑎𝑚𝑒 𝑦𝑒𝑎𝑟
8. Swaroop’s Index (SI)
• A special type of proportionate mortality
rate measure which is also considered a
sensitive index of the standards of health
care in a country
• Measure is directly proportional to the
health status of the population, where
developed countries have higher
Swaroop’s index than the developing
× 1,000 ones
• A low SI implies that life expectancy is
short
• Ex., A SI of 15% means that 15% dies at
the age of 50 years and above, and 85%
died before reaching the age of 50.
# 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 𝑎𝑚𝑜𝑛𝑔 𝑡ℎ𝑜𝑠𝑒 50 𝑦𝑒𝑎𝑟 & 𝑜𝑣𝑒𝑟 𝑖𝑛 𝑎 𝑐𝑎𝑙𝑒𝑛𝑑𝑎𝑟 𝑦𝑟
𝑆𝐼 = × 100
× 1,000 𝑡𝑜𝑡𝑎𝑙 𝑑𝑒𝑎𝑡ℎ𝑠, 𝑠𝑎𝑚𝑒 𝑦𝑒𝑎𝑟

9. Case Fatality Rate (CF)

5.2. Post-Neonatal Mortality Rate (PNMR)
• Deaths are often caused
environmental, genetic, nutritional and
infectious disease
6. Maternal Mortality Rate (MMR)
• Measures the risk of death from causes
associated with pregnancy and childbirth
• This value is affected by:
o Maternal health practices
o Diagnostic ascertainment
maternal condition or cause of
death
o Completeness or registration of
birth
• Maternal Mortality → MDG 5
• Measures the killing power of a disease
by:
or injury
• A high CFR means a more fatal disease
• CFR is useful in ACUTE infectious
diseases given that all new cases are
reported & most deaths occurred in a
relatively short time after diagnosis
• Since the measure is useful for acute
cases, the time element is the usual
duration of the particular disease and not
annual
• Depends on:
o Nature of the disease
o Diagnostic ascertainment
o Level of reporting of population
of # 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 𝑓𝑟𝑜𝑚 𝑎 𝑠𝑝𝑒𝑐𝑖𝑓𝑖𝑒𝑑 𝑐𝑎𝑢𝑠𝑒
𝐶𝐹 = × 100
# 𝑜𝑓 𝑐𝑎𝑠𝑒𝑠 𝑜𝑓 𝑡ℎ𝑒 𝑠𝑎𝑚𝑒 𝑑𝑖𝑠𝑒𝑎𝑠𝑒
MORBIDITY RATES
1. Incidence Rate (IR)
 7
CA2: COMMUNITY HEALTH NURSING DAY 1
Prof. Aida Garcia, MAN, RN

• Measures the development of a disease for determining success or failure of

in a group exposed to the risk of such in services and action.
a given period of time 3. Indispensable tool in planning,
• Tells of the speed of development of implementation and evaluation of health
disease and is best in determining the program
etiologic factors of a disease
• Rate can be made specific for age and
sex FHSIS (Field Health Services and
• IR is the measure of choice to observe: Information System)
o Acute conditions → when Major network information, sources developed
incidence is usually higher than by the DOH
prevalence
o Outbreaks or epidemics → in the Components
study of causation or etiologic 1. Family Treatment Record
factors of the identified cause 2. Target / Client List
3. Reporting Forms
𝐼𝑅 =
# 𝑜𝑓 𝑛𝑒𝑤 𝑐𝑎𝑠𝑒𝑠 𝑜𝑓 𝑑𝑖𝑠𝑒𝑎𝑠𝑒𝑠 𝑑𝑒𝑣𝑒𝑙𝑜𝑝𝑖𝑛𝑔 𝑓𝑟𝑜𝑚 𝑎 𝑝𝑟𝑑 𝑜𝑓 𝑡𝑖𝑚𝑒
× 1,000 4. Output Report
𝑝𝑜𝑝. 𝑖𝑛 𝑡ℎ𝑒 𝑎𝑟𝑒𝑎 𝑑𝑢𝑟𝑖𝑛𝑔 𝑡ℎ𝑒 𝑠𝑎𝑚𝑒 𝑝𝑟𝑑 𝑜𝑓 𝑡𝑖𝑚𝑒

1. Family Treatment Record

• Fundamental building block or foundation
2. Attack Rate (AR)
of FHSIS
• Used for a limited population group and
• Maintained as part of the systems of
time period, usually during an outbreak or
records
epidemic
• Envelopes = Family Record / Family
• Used in COVID-19 (two-week attack
Envelope
rate)
• Inside are bond papers (Individual
Treatment Record / ITR)
• Contents of ITR: name of the patient,
age, gender, address, family number
• Home-based mother’s record → mother
can take this home unlike the FTR

2. Target / Client List → purpose is to

3. Prevalence Rate (PR) summarize
• Number of existing old and new cases of • Target Group List for Eligible Population
a disease at a given time • Target / Client List of Children 0 – 59
• Measures the proportion of old and new months
cases (or existing cases) of a disease in • Target / Client List for Nutrition
the population • Client List for Pre-Natal Care
• Used as a basis for making decisions in • Client List for Postpartum Care
the administration of health services • Client List for Family Planning (Non-
surgical)
3.1. Point Prevalence • List of TB Symptomatic
# 𝑜𝑓 𝑒𝑥𝑖𝑠𝑡𝑖𝑛𝑔 (𝑂𝐿𝐷 & 𝑁𝐸𝑊 𝑐𝑎𝑠𝑒𝑠)𝑜𝑓 𝑎 𝑑𝑠𝑒 𝑎𝑡 𝑎 𝑔𝑖𝑣𝑒𝑛 𝑡𝑖𝑚𝑒
𝑃𝑜𝑃 =
𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑒𝑥𝑎𝑚𝑖𝑛𝑒𝑑 𝑑𝑢𝑟𝑖𝑛𝑔 𝑡ℎ𝑎𝑡 𝑡𝑖𝑚𝑒
× 1,000 • Client List for TB Cases Under Short
Course Chemotherapy (SCC)
3.2. Period Prevalence • Client List for TB Cases Under Standard
# 𝑜𝑓 𝑒𝑥𝑖𝑠𝑡𝑖𝑛𝑔 (𝑂𝐿𝐷 & 𝑁𝐸𝑊 𝑐𝑎𝑠𝑒𝑠)𝑜𝑓 𝑎 𝑑𝑠𝑒 𝑎𝑡 𝑎 𝑔𝑖𝑣𝑒𝑛 𝑖𝑛𝑡𝑒𝑟𝑣𝑎𝑙 𝑜𝑓 𝑡𝑖𝑚𝑒
𝑃𝑒𝑃 =
𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑒𝑥𝑎𝑚𝑖𝑛𝑒𝑑 𝑑𝑢𝑟𝑖𝑛𝑔 𝑡ℎ𝑎𝑡 𝑖𝑛𝑡𝑒𝑟𝑣𝑎𝑙 𝑜𝑓 𝑡𝑖𝑚𝑒
× 1,000 Regimen (SR)

3. Reporting Forms (Tally / Reporting Forms)

Perinatal Mortality Rate (Perinatal MR) • The only mechanism through which data
are routinely transmitted from one facility
to another
• How often?
o Weekly → dse
o Monthly → family planning, social
hygiene, natality, mortality
o Quarterly → drugs, supplies,
USES OF VITAL STATISTICS
malaria
1. Serve as an index of health condition of
o Annually → population, nutrition
community
o Upon occurrence → maternal,
2. Provides valuable clues to the nature of
perinatal death; COVID-19
health services or actions needed. Basis
CA2: COMMUNITY HEALTH NURSING DAY 1
Prof. Aida Garcia, MAN, RN
4. Output Report

CA2 – CHN – DAY 2
Professor: Aida Garcia MAN, RN
Information Technology & Community Health
eHealth
DEFINITION
- Health is the use of information and
communication and technologies (ICT) for
health (WHO)
*pertains to health situation questions ex. Why
different priority programs are being implemented
Challenges Of Today's Health System
1. Access to health care services
DOH and DOST partnered to this program
Ex. Of local health facility – RHU:Rural
UHU/UHC(Urban Health Center):Urban
Minutes to reach health center – within 30mins
Hours to reach hospital – before 1 hour
In IMCI, for critical and severe child – give the first
dose of antibiotic, specially if the hospital is beyond
1 hour to reach
2. Access to real time information for decision
making.
HEALTH SITUATION
• 70% RURAL - no or limited ACCESS to
QUALITY input/output care services.
• SEGMENTED DISTRIBUTION of health
facilities & provider
• 13% healthcare providers and 40% of tertiary
hospitals are in rural
• Travel time to local health facility - around 39
minutes.
• Access to real time info. - delayed availability
of stats.
• 2001, 2.5% had internet access
• In 10 yrs, to 29% cellphone rate of 80%, 73M
subscribers (2009)
• Ranked 1st in SMS use worldwide
• DOH introduced health information systems.
13
*DOH collaborated with DOST bcs it does
research and diff technologies in the government
Aim: improve access of health data.
Use of eHealth IN THE COMMUNITY
1. Electronic Medical Record (EMR) - med.
info. of pt. stored on computer.
- A medical/health record w/c is received,
recorded, transmitted, stored, processed,
retrieved or produced electronically through
a computer or any other electronic device.
- DOH-developed eMR system,the iClinicSys
2. Telemedicine
- Aimed: better health services to GIDA
(Geographically Isolated and Disadvantages
Areas)
- Telemedicine in local health system:
individual-based health services, it has been
integral to modern consultations in
GIDA/REMOTE AREAS
4 ELEMENTS:
a. AIM: Better outcome
b. Use other ICT
c. Support clinical
d. Cross GIDA barrier
3. Universal Health Care and ICT
- efficiency
- ICT adopted in entire health sector
3 priority health directions KP:
a) Attainment of health related MDG (MDG
connected to health: 4-child, 5-Maternal, 6-
Malaria and HIV)
b) Improved Access to quality hospital &
health care facility
c) Financial risk Protection (health is free for
all)
4. eLearning
- use of electronic tools to aid in teaching
- DOH Academy E-Learning platform
- FDA Academy
CA2 – CHN – DAY 2
Professor: Aida Garcia MAN, RN
eHealth Projects in Philippines Used in
Community Health Practice
eFHSIS
TYPE: Health Info. System and Electronic Reporting
- 1st building block – ITR/ Family Treatment
Record
Devp by DOH:
- FHSIS can be uploaded data
- combined computer mapping w/ additional
database management & data analysis
NTHC Learning video
TYPE: eLearning
- Developed by UP MLA – NTHC; Funded by
USAID
*National Telehealth Center
- Created learning videos for TB, stroke, bird flu &
child poisoning
SPEED (Surveillance in Post Extreme
Emergencies & Disasters)
TYPE: Disaster Mngt & reporting System
- This device/app will be able to help us
immediately give the information about the
calamities and disasters to the office.
Target Beneficiaries:
• Ultimate beneficiaries: disaster-
affected pop.
• Immediate beneficiaries: health
emergency managers & decision-
makers
• Allow CH Nurse submit daily reports
of prevalent diseases STAT after
disaster via SMS, e-mail & other ICT
• Sends Immediate Notification Alerts
(INAs) to CH Nurses for possible
outbreaks based on available data
14
Legal Framework:
RA10121: Phil Disaster Risk Reduction and Mgt Act
of 2010
DOH AO 2004-168: National Policy on Health
Emergency & Disasters
eHealth Projects in Philippines
Philippines 2 main epidemiologic surveillance (ESU
– Epidemiological Surveillance Unit or RESU -
Regional) info. systems being used:
1. Field Health Service Information System
(FHSIS)
2. Phillipine Integrated Disease Surveillance
and Response (PIDSR) System
- Reporting based system of priority diseases
or syndromes & cond. (diseases that needs
to be reported, mandatory) such as Acute
Viral Hepatitis, Dengue, Cholera, Malaria,
Measles & Acute Encephalitis etc.
eHATID
eHealth TABLET - Informed Decision Making of
LGU's (Hatid) – for Mayors
- EMR software apps. for mobile android
devices, dashboard, & Mayor-Doctor
Communication
- a channel for immediate decision making &
sharing of health-related info.
- Mayors will release General Health Records
from the health center kung ano yung
existing or maraming illnesses. It will be
immediately communicate kay mayor
ex. Pagtatae – (Rotavirus) vaccine will be
given.
Event-based Surveillance and Response
System (ESR)
- ESU, RESU, CESU (C-city)
- Online health event surveillance reporting
system.
- for reporting of all health events (existing or
rare) that raise fear, concern, alarm in
community w/c may have known, suspected
or possible impact on human health.

CA2 – CHN – DAY 2
Professor: Aida Garcia MAN, RN
eIMCI
TYPE: ELearning
- Accessible in mobile device
- Developed by Ateneo Innovation Ctr
Buddyworks
TYPE: Telemedicine & Learning
- Allows GIDA to send referrals to med.
Specialist of UP-PGH via SMS & eMail.
- Implemented in 2004 by UP Mla NTHC
(National Telehealth Center)
RxBox
TYPE: Telemedicine
- access to life-saving health care services
GIDA
- It has problem in resources 3M (manpower,
material, money)
- Multi-component device: BP monitor, Pulse
Ox, ECG, FHR monitor, maternal tocometer
& temperature sensor
SEGRIS (Sergworks Rural Health Information
System)
TYPE: Electronic Medical Record for RHU
- Developed by Sergworks, a local software
company in Davao
SHINE (Secure Health Information Network
Exchange)
TYPE: Electronic Medical Record & SMS Reporting
- Allows GIDA to send referrals to med.
specialist of UP-PGH via SMS & eMail
- developed by SMART Communication
CHITS (Community Health Information on
Tracking System)
TYPE: Electronic Medical Record
- developed by Dr. Herman Tolentino, by UP
Mia College of Med, Med Informatics Units.
- Began in Pasay Health Center
15
WAH (Wireless Access for Health)
TYPE: Electronic Medical Record and Health for
Health Information System
- Augment CHITS by connecting RHU in
internet access
- Implemented in 2010 in Tarlac
- by Private- public partnership (PPP) of
Qualcomm, UPM-NTHC,USAID, SMART,
DOH-IMS and others
SPASMS (Synchronized Patient Alert via SMS)
TYPE: Alert System
- reminder for patient on due for follow up
- Ex. TB patient who needs compliance
iHOMIS (Integrated Hospital Operations &
Management Information System)
TYPE: Management system for admitting
outpatient, emergency room, billing and cashier
nursing, pharmacy, dietary, laboratory and
radiology.
If without iHOMIS — Philhealth eClaims System
- A web-based facility developed by Philhealth
for claim reimbursement transactions.
iClinicSys
TYPE: Data Saving System
- DOH-developed eMR system
- feeds into diff. health reporting systems
*Recap: Health care Delivery System 2 owners
Private and Government:
National government – DOH, manages tertiary
hospital
CA2 – CHN – DAY 2
Professor: Aida Garcia MAN, RN
Local government – city and municipality, manages
district hospital and health center
*Local government (LGU) - manages and gives
finances to the health center
*RA 7160 – local government code, law mandates
that some of the work of the national government
would be given to the local government
*EO 138 – new and updated law, also called
MAHANGA Supreme Court Rulling/ MAHANGAS
GARCIA Rulling, law mandates that additional funds
would be given to local government
*ITR - fundamental building block in FSHIS
- after we have saved the data in the iClinicSys, the
data would be now processed, depende kung anung
data ang pinasok pwede syang ma punta sa ibang
app system, example:
Ø Integrated Tuberculosis Information
System (ITIS)
- Has case management module that captures
patient’s demographic profile, TB exam,
record and treatment info
Ø National Rabies Information System
Allows:
- animal bite tx. ctr. To capture bite pt. records
- generate reports for submission to program
managers at all levels of health system.
Ø Mag-Ina (Maternal and Neonatal
Telereferral System (MInTS) *MDG #5
- web-based maternal & neonatal telereferral
system.
- enables lying-in to send referral electronically
for preg & nb to be transferred in higher care
facility.
Power of data & information
1. Patient privacy - NOT compromised
2. Actual time of pt care; GIDA not a limitation
3. Prevents misinterpretation of data - Illegible
handwriting
4. Easy to aggregate data
16
5. Record gets misplaced if there is unlikely
event - Continuity of interoperability of care
eHealth standards & principles
a) Capability building of human resource made
available
b) Harmony - local health solution
implementation
c) Investment - minimum eHealth
d) Progressive realization/monitoring of LHS
ML (local health system maturity level)
e) Serve needs of client or person*
*Among the health standard of eHealth application,
which one is the priority? Serve needs of
client/person
*CHIPS is only mnemonics, pero ang #1 talaga ang
serve needs, look also in your books
eHealth Vision
By 2020 Health will enable widespread access to
health care services, health information, securely
share & exchange patients' information in support to
a safer, quality health care, more equitable &
responsive health system for all Filipino people by
transforming the way information is used to plan,
manage, deliver & monitorhealth services.
Roles of Community Health Nurses in eHealth
1. Monitor Trends - Data & records manager
2. Agent of Change - work closely with
community in implementation
3. Telepresenter - presents case to med.
Specialist
4. Educator - participate in eLearning Video
5. Safeguard records, data privacy as Client
Advocate
Nursing Process in the Care of Population
Groups and Community
Community assessment
- A process that determine community health
status.
- Comprehensive process that identify:
a) strengths
 17
CA2 – CHN – DAY 2
Professor: Aida Garcia MAN, RN
b) resources - NSO: serves as central repository of civil
c) assets registries
d) needs
Ø BIRTH: Facility-based births - Facility
- to come up with an action to solve their
administrator responsible for registration of
existing health problem
event.
A. Community assessment tool
: Outside-facility - physician, nurse, midwife or
1. PRIMARY DATA SOURCES anybody who attended delivery has resp to reg
births. Parent may also register birth.
a) OBSERVATION
- an act of extracting information from subjects : Register w/in 30Days from birth; Register in
being studied. birthplace

OCULAR SURVEY OR WINDSHIELD SURVEY Ø DEATH:

- PD 856. Sanitation Code - mandate Death
- rapid observation of people, envt, srvs. -
Certificate prior to bury.
walking, driving/riding
- Last M.D who attended pt - esp. for
PARTICIPANT OBSERVATION preparation of death certificate; certifying
Cause; Forward certificate to Health officer
- Purposeful observation ( formal/informal w/in 48 hrs
comm. Activities - If w/o med attention- nearest relative >>>> to
- sharing in the life of the community H. officer w/in 48 hrs>>> H.Officer certifying
Cause>>> Direct registration
b) SURVEY - Absent Health Officer - death reported to
- series of questions- systematic data collection- Mayor, Municipal secretary or any
sample of invd/fam SangguniangBayan >>> they issue death
certificate for burial
- Either: Comprehensive or Problem-based - Reg.w/in 30Days upon death at Local
CivilRegistryOffice; place of event
c) INFORMANT INTERVIEW
- Fetal deaths - same process;
- purposeful talk w/ key informant or ordinary - Age: Put Last Age/Birthday; Neonatal:If 1
member of community Day (in mins. & hrs); Then in Days up to 27
days reg in days.
- Formal (from govt); Informal (w/ position in
commu. Ex. From School)
b) HEALTH RECORDS AND REPORTS
d) COMMUNITY FORUM - EO No. 352 - Field Health Service
- an open meeting of members of community Information System (FHSIS): The official,
recording/ reporting system to generate
2. SECONDARY DATA SOURCES health stats.
a) REGISTRY OF VITAL EVENTS c) CENSUS DATA
d) DISEASE REGISTRIES
- ACT 3753 (Civil Registration Law, Philippine - ITIS, Integrated Chronic Non-Communicable
Legislature) Disease Registry System, Philippine
- RA 7160 assigned function of civil registration Registry for Persons with Disability
to local governments

CA2 – CHN – DAY 2
Professor: Aida Garcia MAN, RN
Community Assessment - Summarizing data
Two (2) ways to summarize data.
1. Manually by tallying the data
2. By using computer
3. METHODS TO PRESENT DATA
a) Descriptive Data - presented in narrative reports,
Ex. Geographic data hx of community, belief about
health & illness
b) Numerical Data - presented using table or graphs
*in pie chart – it used only for 3 and below categories
and by group (Maglaya book) while in assigning of
the color, for high frequency use the 1st color of the
rainbow then so on.. (based on the other book)
B. Community Diagnosis
- determine community health status is a process
called community assessment
Consist of 2 parts:
1. N. collects data of community to determine
factors that influence health of pop.
2. Analyze & seeks explanation to occurrence
of healthneeds & problem of community.
Types of Community Diagnosis (data):
1. Comprehensive Community Diagnosis - gen.
info/PROFILE of community (we have no
idea what’s the existing problem, so all the
questions are needed to be asked)
18
2. Problem-Oriented Community Diagnosis - to
specific need of groups (questions are on the
problem on-hand)
Elements of Comprehensive Community
Diagnosis
A) Demographic Variable
- shows size, composition, geographical
character of population
*Which one is part of the demog profile of your
community? A. Pop size B. Pop distribution C. No.
Of children or members of the family = C if asking for
profile, it means the content.
B) Socio-Economic & Cultural Variables
- Affects health of community directly &
indirectly. (1. Social Indicators 2. Economic
Indicators 3. Environmental Indicators
4.Cultural factor)
C) Health and Illness Pattern
- (Leading Morbidity, Mortality etc)
D) Health Resources
- Essential in del of basic services in commu.
Types of Community Diagnosis:
1. Traditional
- Maglalatag ng programs to solve the problem
- Ex. EPI, manchan for pregnant
- In CHN it is called as program not an
intervention, bcs it is a series of action
2. Participatory Action Research
- emphasizes community involvement in
planning, design, implementation,
intervention
: Understand what is impt/relevant to them
: Investigate social roles, responsibility &
health system performance
: bridge gap bet practice & knowledge
Community Diagnosis - Scaling / Priority
Setting
A. Nature of the Condition / Problem presented
B. Magnitude of the Problem
CA2 – CHN – DAY 2
19

Professor: Aida Garcia MAN, RN

C. Modifiability of the Problem - Such as 2018-2020, Eleventh Edition Ex. At-
Risk
D. Preventive Potentials
B) Shuster and Goeppinger format for
E. Social Concern population group (at-risk group).
3-part statement consists of:
*Refers to severity of problem based on a. Health risk or specific prob
POPULATION affected = B b. Specific aggregates or community
*Probability of reducing, controlling or eradicating c. Related factors
problem = C C) Omaha System
- Problem classification Scheme consists 4
*Classified as Health status, health resouces or domains: Environmental, Psychosocial,
health -related = A Physiological, Health-related Behaviors
*Probability of controlling or reducing effects posed - After domain – Problem
by problem = D - ex. DOMAIN: Physiological
PROBLEM: Community disease
*Refers to PERCEPTION of pop or community as MODIFIER: Actual
S/S: Fever
they are AFFECTED by problem = E

Priority Setting (WHO Special Considerations) C.Planning

Three Approaches to Planning Health

• Significance of Problem
- based on # of people community affected a. Integrated Approach
• Level of Community Awareness members - considers other dimension of health such as
health concern lifestyle, environment, health care system.
• Ability to Reduce Risk - Goverment called it whole community
- related to availability of Expertise approach
• Cost of Reducing Risk b. Comprehensive approach
- Considers economic, social & ethical - strikes at the root of the problem
requisites & consequences of planned c. Community - Based Approach
action. - empowers people, participatory
• Ability to identify target population
Community Particiption in PAR
- intervention is a matter of availability of data
resources 1. Grounded Data Collection & analysis
• Availability of Resources - based on lived experiences
- intervene in the reduction of risk, financial & 2. Co-owbership of PAR Projects*
other material resources of the community, - Organizer & Comm JOINTLY defines>
nurse & health agency plan>develop>monitor>eval.problem
3. Capacity Involvement
Stating Community Diagnosis - With the use of training and seminars which
A) NANDA DOH funded, capacity bldg: workshop,
- principal organization for defining, consultation etc.
distribution & integration of standard nrsg - Other principle in PAR: BottomUp in
diagnoses worldwide decision-making
- Recent versions include nursing diagnostic
labels for community levels.
 20
CA2 – CHN – DAY 2
Professor: Aida Garcia MAN, RN
PAR PROJECTS - Vice chair: Sec. Of DENR
- Task: coordinate, monitor, evaluate envt
- Projects to highlight the participatory
health program — health promotion
methodology to det & address urgent needs
of community lACEH Composition
- intended for health promotion & social
- Secretary of Health- Chair
mobilization (active participation)
- Secretary of Environment & Natural
Program evaluation Resources - Vice-Chair

• Ongoing Evaluation - during Members:

implementation
- Secretary of Agriculture
• Terminal Evaluation - 6 - 12 mons after
- Secretary of Science & Technology
completion
- Secretary of Transportation
Ex post E. - undertaken some yrs after
- Secretary of Labor and Employment
completion
- Secretary of Public Works and Highways &
Outcome evaluation – measured by
- Secretary of Trade and Industry
percentage
- Secretary of the Interior and Local
Impact evaluation – what had happened to
Government
their lives in general, as an effect
- Director-General of NEDA
Legal Basis of PAR - Director-General of PIA
- Secretary of DICT (newly constituted
Ø RA 11223 Universal Health Care Act Department)
- cost-effective & high impact intervention for
health promotion & social mobilization NATIONAL ENVIRONMENTAL HEALTH ACTION
- Part of Sec 31 RA 11223 - should be with the PLAN (NEHAP)
participation of the people
New sectors under the National Environmental
ENVIROMENTAL SANITATION PROGRAM Health Action Plan and the proposed TWGs of the
IACEH Implementing Guidelines:
- the STUDY OF ALL MAN'S PHYSICAL
ENVIRONMENT, W/C MAY have • Water Supply, Sanitation & Health
DELETERIOUS EFFECT ON HEALTH • Air Quality & Health
• Solid Waster Management & Health
ENVIRONMENTAL HEALTH
• Chemical Safety and Health
- W.H.O. • Occupational Safety & Health
- Aspect in human health det. By the ff • Food Safety & Health
FACTORS in envt.. • Climate Change & Health
Ø Physical
Ø Chemical Sanitation related dses (communicable and
Ø Biological infectious)
Ø social/ psychosocial 1. Diarrhea
EO 489 2. Intestinal parasitism
3. Schistosomiasis
- lACEH 4. Malaria
- Inter-Agency Committee on Environmental 5. Infectious hepatitis
Health 6. Filariasis
- Chairperson: Secretary of DOH 7. DHF
CA2 – CHN – DAY 2
21

Professor: Aida Garcia MAN, RN

8. TB - yearly
9. Pneumonia - Lab accredited by DOH "Certification of
Potability"
Household with Access to Improved/Safe Water
- DOH/ representative LGU.
Supply
For Disinfection
A) Safe water sources
- Newly constructed water supply
APPROVED TYPES OF WATER SUPPLY
- Repaired
FACILITIES
- (+) bacteria
• LEVEL 1 (POINT SOURCE) - Container disinfection (unimproved)
- Rural. Houses thinly scattered
PROPER EXCRETA & SEWAGE DISPOSAL
(15 -25) families….
PROGRAM
40 - 140 liters day
farthest NOT more than 250 meter away APPROVED TYPES OF TOILET FACILITIES
- Protected well - deep well / shallow
1. LEVEL 1
- Improved dug well
- Non - water carriage toilet facility
- Developed Spring
- Pit latrines / pit privy
- Rainwater cistern w/ outlet, no distribution
network
2. LEVEL 2
• LEVEL II (COMMUNAL FAUCET or STAND-
- Toilet facilities of water carriage type
POSTS)
- Water sealed, flush types w/ septic vault
- A source, reservoir, piped distribution
disposal facilities
network & communal faucet
3. LEVEL III
- 40 to 80 liters of water/day
- water carriage types of toilet facilitiés, septic
- Rural areas
tanks, treatment plant
- Houses densely clustered
- 1 faucet per 4 – 6 households *Sanitation code rulling (latrine-well): Distance:25
- Farthest - not more than 25 meters meters

Other forms of excreta disposal in Philippines

• LEVEL III (WATERWORKS SYSTEM OR
not part of approved
INDIVIDUAL CONNECTIONS)
- Urban, densely populated
- A source, reservoir, piped
- distribution network & household taps.
- Requires minimum disinfection
UNAPPROVED WATER FACILITIES
- Doubtful sources.. open dug wells,
unimproved springs, wells that needs priming
WATER QUALITY & MONITORING
SURVEILLANCE
- STANDARDS OF NATIONAL STANDARDS
FOR DRINKING WATER
- set by DOH
• Pail System/ box-and-can system/ bucket
latrine
- Also known as Box and Can Privy or Bucket
Latrine
- Regular removal and disposal of waste in a
sanitary manner.
- Burial of contents at least 12 inches from the
ground to prevent access to flies or escape
of adult flies.
• Overhung latrine
- The toilet house is constructed over a body
of water
- Consists of a superstructure provided with
latrine floor on top of wooden piles above the
water.
 22
CA2 – CHN – DAY 2
Professor: Aida Garcia MAN, RN
- The disposal of human wastes consists 3. Right Cooking
essentially of defecation into the water.
- 70 degree C
- Unsanitary
4. Right Storage
Documenting/reporting
- Room temp - not more than 2 hrs.
- Households with sanitary toilet – with
approved - Hot env't - above 60 degrees
- Household with complete Basic Sanitation
Facilities - Cold - below or equal to 10 °C
1. Safe water *RULE IN FOOD SAFETY: "When in DOUBT,
2. Sanitary toilet THROW it out'
3. System of garbage disposal
VENDORS
FOOD SAFETY
- Serve only bottled water
• FOOD ESTABLISHMENTS – land based - No plates, serve only sealed
- Sanitary permit requiurements (where:
location of store) DEFINITIONS

• FOOD ESTABLISHMENTS – sea-crafts • VERMIN

- Group of insects or small animals (flies,
- Sanitary permit requiurements (where: port mosquitoes, cockroaches, fleas, lice,
of origin) bedbugs, mice & rats) which are vector of
disease
RATING
• INSECTS
• CLAS A – Exceptional - Flies, mosquitoes, cockroach, bedbug fleas,
• CLASS B – Very Satisfactory lice, ticks, ants or other arthropods.
• CLASS C – Satisfactory • PEST
- Destructive or unwanted insects or other
PERMIT
small animals (rat, mice) that cause
- Posted in conspicuous area — ready for annoyance, discomfort, nuisance or
inspection transmission of disease or damaged to
structures.
FOOD HANDLER • RODENT
- Health certificate - small mammals such (rat & mice)
- Upper left portion of garment characterized by constant growing incisor
- Not allowed – boils, infected wound, GIT, teeth used for gnawing or nibbling.
respiratory infection • VECTOR
- Formalin Ether Concentration Technique - Any organism which transmit infection by
inoculation into the skin or m. Membranes by
4 RIGHTS TO FOOD SAFETY biting, or by deposit of infective that material
1. Right Source on skin, food or other objects or by biological
- fresh reproduction within the organism.
2. Right Preparation

- raw food and cooked foods

 23
CA2 – CHN – DAY 2
Professor: Aida Garcia MAN, RN
PD 856 CODE of Sanitation of the Phillipines - Minimum air space shall be provided as
follows:
MECHANICAL OR PHYSICAL CONTROL
1. School Rooms - 3.00 cubic meters with 1.00
• Rodent trap square meter of floor area per per
• Fly trap 2. Workshops, Factories, and Offices - 12.00
• Mosquito trap cubic meters of air space per person;
• Ultraviolet light 3. Habitable rooms - 14.00 cubic meters of air
• Air curtain space per person.

BIOLOGICAL AND GENETIC CONTROL REVISED Implementing Rules & Regulations

(IRR) OF THE National Building Code of the
• Living predator Phils, to protect health
• Parasites, natural enemies
Ø SECTION 806. Size and Dimension of
• Kills larvae
Rooms
• Non-pollutant
- Minimum sizes of rooms and their least
CHEMICAL CONTROL horizontal dimensions shall be as follows:
1. Rooms for Human Habitations - 6.00
• Insecticides square meters with a least dimension of
• Rodencides 2.00 meters
• Pesticides 2. Kitchens - 3.0 square meters with a least
• Larvicides dimension of 1.50 meters;
3. Bath and toilet - 1.20 square meters with
NATURALISTIC CONTROL
a least dimension of 0.90 meter.
• Nature
• CEILING AND HEIGHT OF HABITABLE
ENVIRONMENTAL SANITATION CONTROL
ROOMS
• Clean-up - Rooms provided with artificial ventilation
• Proper building of dwellings shall have a ceiling, height of not less that
2.40 m (8 ft). measured from floor to the
INTEGRATED CONTROL ceiling.
• Different methods - Rooms with natural ventilation shall have a
ceiling height of not less than 2.70 m (9ft)
BUILT ENVIRONMENT - Mezzanine floors shall have a clear ceiling
height not less than 1.80 m above and below
- Refers to ma made structures that provide
it.
setting for human activities
- Presidential Decree 1096 governs the design
of built environment (National Building Code
of the Philippines)

2004, DPWH REVISED THE Implementing Rules

& Regulations OF THE National Building Code
of the Philippines, these are to protect health

Ø SECTION 807. Air Space Requirements in

Determining the Size of Rooms

CA2: COMMUNITY HEALTH NURSING DAY 1
Prof. Aida Garcia, MAN, RN
CONCEPT OF CHN
> Theoretical Models / Approaches
> National Health Situation
Definition of CHN
- By Jacobson: A learned practice discipline
- The ultimate goal of contributing to the
promotion of the client's ‘OLOF’ (Optimum
Level of Functioning)
This is the highest level of wellness.
- It can be achieved through teaching and
delivery of care = Health education mostly
focused on the promotive and preventive
part.
- By WHO: A special field of nursing.
Ex of fields. OR, ICU, or ER Nursing (These
are curative part)
- In chn the aim is to prevent individuals in
acquiring illness
- Combined: Skills of nursing, public health
and some phases of social assistance.
- Functions: Promotion of health,
improvement of social and physical
conditions, and rehabilitation of illness and
disability.
Better physical health status = Better
society
- By American Nurses Association (ANA)
- Synthesis of Nursing practice and Public
health practice
(Ex. Immunization - Application of nursing
knowledge in injection administration.
- Applied: Promoting and preserving health
- Application is preserving the health of the
people. The aim is not to put them in a
stage of illness. - Health promotion
Philosophy of Community Health Nursing
Definition of Philosophy
- A system of beliefs; basis and guides action
- Philosophy by Margaret Shetland:
It is the worth & dignity of a man.
- Regardless of socioeconomic status,
everyone can access healthcare in a
community health setting.
8
Principles of CHN
By: Mary S. Gardner and Cobb/Jones Leahy
1. Works as a member of the health team
- Ratio of Health care member in every
population:
➔ 1 Doctor: 20,000
➔ 1 Dentist: 50,000
➔ 1 Midwife: 5,000
➔ 1 Sanitary Inspector: 20,000
➔ 1 Nurse: 10,000
➔ 1 Brgy Health Worker: 20 Families
- Brgy health workers - Volunteers
- Nurse - The Manager, performs the
planning and staffing.
- Doctor - Administrative; performs the
financial communication with the
government.
2. Health teaching - PRIMARY RESPONSIBILITY
- Goal is to maintain wellness through giving
health education in several forms (leaflets,
handouts, IEC - Information Education
Communication, text message or SMS alert)
3. Available to all.
- Generalist type of work
4. Recognized needs of CGI
- 4 Levels of clients:
➔ Communities,
➔ Families,
➔ Groups (aggregates or at risk) &
➔ Individual
Nursing Assessment is still the 1st Step in CHN.
5. Fully understand Objectives, Policies of agencies
- Managed by the Government:
➔ National Gov - Tertiary Hospitals
➔ Local Gov - District Hospitals, Provincial
Hospitals, and Health Centers.
- Mayor - Chief executive officer, plans health
objectives & vision aligned with the
Department of health
- Nurse - Implementer of health
objectives/vision
6. Recording and reporting in CHN
- Must be ACCURATE data
- This will be part of research data for
epidemiology, and Event surveillance
reports.

CA2: COMMUNITY HEALTH NURSING DAY 1
Prof. Aida Garcia, MAN, RN
- Event surveillance reports to
Epidemiological Surveillance Unit (reports
happen usually during food poisoning or
cholera incidents)
- Data also being used in community
development teams submitted to the
provincial health unit then passed to the
Department of health, reported up to WHO.
7. Unit of service - FAMILY
- Group based services
- Mother - act as the family representative,
informed about available services for the
whole family.
Healthy families = Healthy community
Family - Unit of service
In Community health nursing, the whole
community is the target/primary client.
8. Makes use of available community health
resources
- Brgy - provides manpower & Volunteers
- Politician - Resources, Venue for event
based activities
- Philanthropist - give donations
9. Periodic evaluation of CHN
- Scorecard - scoring for each cities in
eradicating health problems
Follows a Key performance indicator
- Mayor - accomplishes the Overall
Planning/Managing
- E.O 138, Duterte Admin, Red Revolution
also Called as Mangahas Ruling, Mangahas
Supreme Court ruling, or Mangahas Garcia
Ruling.
Under the Universal healthcare law, medical
students with gov educational scholarships
must work/serve in the Philippines (work for
how long? same # of years the students
have studied)
10, Utilizes an already existing active organization
in community
- Active Participation - to be independent
- Participatory action research
Community must be the one to recognize
and solve the existing problems.
11. Staff education programs - CONTINUOUS
- Provided by agency.
Continues knowledge input for emerging/,re
emerging diseases
9
Features of CHN
● Approach to HEALTH - Preventive
● Prepayment mechanism for consumers
● Levels of clientele - CFGI
● Aggregate or population
● Nature - developmental
Different Fields of CHN
- Community Health Nursing is considered
bröader and more general specialty area
that encompasses subspecialties:
1. Public Health Nursing
- A subspecialty nursing - practice delivered
by an "official" or government.
2. School Health Nursing
- Aim: Promote health of school personnel
and pupils / students.
- aims: Prevent health problems which hinder
students in learning.
3. Community Mental Health Nursing
- Clinical process - includes concepts of:
nursing, mental health, social psychology &
community networks including social
sciences.
- Focus: Mental Health Promotion
Mental health is now included in CHN due
to increasing cases.
Theoretical Models / Approaches
2 APPROACHES:
1) Micróscopic - The individual is the focus
of change (HBM)
- Individualized approach ex. Smoking
cessation
2) Macroscopic - Upstream View: society is
the focus of change (Milio's)
- Policy/Law applicable in the whole
community
1. Health Belief Model (HBM)
- A belief that an individual must know what/
how to do it before they can take action.
One's belief:
> Regarding the chance of getting given cond. -
Perceived Susceptibility
> Regarding the seriousness of a given condition -
Perceived Severity
CA2: COMMUNITY HEALTH NURSING DAY 1
Prof. Aida Garcia, MAN, RN
> Ability of advised action to reduce health risk or
seriousness of a given condition - Perceived
Benefits
> Regarding tangible & psychological costs of an
advised action - Perceived Barriers
> Strategies or conditions in one's environment that
activate readiness to take action - Cue to action
> One's confidence in one's ability to take action to
reduce health risk - Self Efficacy
● Milo's Framework for Prevention
- Health deficits: excess / derived of resources
● Nole Pender's Health Promotion
- Focuses on 3 categories:
a. Individual Characteristics (Prior related
experiences; Personal Behavior),
b. Behavior - specific cognitions that affect
behavioral outcomes
> Perceived Benefits of Action: Strong Motivators
> Perceived unavailability, inconvenience,
expense, difficulty or time
> Perceived Self efficacy (fewer perceived barriers)
- A person’s belief that he is capable of carrying out
a certain behaviour
> Activity-related affect
- Feeling associated w/ behavior - Repeat
Behavior
> Interpersonal Influences
(Family, peers, provident), Norms, Support system,
and Model
> Situational influences
(Options, Demand characteristics, or Aesthetics)
- Perceived options available, demand aesthetics
PRECEDE - PROCEED Model
By: Dr. Lawrence Green & colleagues.
- PRECEDE - Predisposing, Reinforcing and
Enabling Constructs in Educational
Diagnosis and Evaluation.
- PROCEED - Policy, Regulatory, and
Organizational Constructs in Educational
and Environmental Development.
CONCEPT OF THE COMMUNITY
Definition
10
- A group of people w/ common
characteristics or interests.
- Living together within a territory /
geographical boundary.
- People under usual conditions are found
same values, same geographic area, and
same health condition.
Types of Community:
1. Geopolitical community
- Territorial
2. Phenomenological community
- Functional; same social function
Characteristic of Healthy Community:
(Hunt, 1997Duhl, 2002)
- Control over matters affecting community
as a whole; Feeling of empowerment
- Cope with change, solve problems
- Communication - Open channel
- History/Values - Shared sense of being a
community - managing conflicts within the
community.
- Equitable, efficient use of community
resources.
- Structures already existing - allow
subgroups in the community .
Factors Affecting Health of the Community:
3 features of Community: population,
location and social
- Population - ex. In Japan, there is
decline/slow trend in population growth
- Location - ex. Natural calamities
- Social - ex. Poor employment
NATIONAL HEALTH SITUATION *(NOH)
Source: NOH 2017 - 2022
- Poverty Sectors:
farmers, fisherfolk, children, self-employed
and unpaid family workers, and women
belonging to poor families,
had higher poverty incidence than the
general population in 2015.
- Poor sectors cannot attain their needs,
commonly getting ill, and usually availing
free community health services.

CA2: COMMUNITY HEALTH NURSING DAY 1
Prof. Aida Garcia, MAN, RN
DEMOGRAPHICS TRENDS
Figure 1.1 shows that the Philippine population in
2015 was young with children aged zero to four
years and 5 to 9 years comprising the largest age
groups,
● 2015 Census of Population - Philippine
population
- up from 92M in 2010 to 101million persons
in 2015.
● Projected Philippine population.of
103,242,900, 2016/PSA
● Average population growth rate (PGR) of
1.7% annually for the period
- What is the population of the Philippines in
2017?
Given data: The Projected population last
2016 of 103,242,900.
Soln: Get the 1.7% of 103,242,900 then
add.
● Global trend PGR declined from 2000-2010
level of 1.9%
- Decline in global trend
- The Philippines belong to the top 20 most
populated countries in the world.
Population Description:
● Largest age groups:
- Children aged zero to four years and 5 to 9
years.
11
- Followed by those in age groups 10 to 14
years and 15 to 19 years.
- Median age of the total population was 24.3
years, which means that half of the total
population was below this age.
-
To know the oldest/highest age - multiply
the median age, Ex. 24.3 years to 2 = 48.6
years.
● Males outnumber females in the age groups
0 to 54; reversed in older age groups (55
years old and over).
● Dependency ratio:
- Slightly decreased - from 60 to 58
dependents for every 100 persons: remains
relatively high
(Dependents in 2015 - 50 were vouna
dependents and 8 were old dependents).
(PSA, 2017c)
Decrease dependency ratio means there is
increasing job opportunity.
● Population Distribution:
- Luzon - more than half (56.9 percent)
followed by Mindanao (23.9 percent) and
Visayas (19.2 percent).
- In administrative regions,
CALABARZON was the most populated at
14.4 million people
CAR - least populated at 1.7M million
in2015,
Provinces - Twenty-seven of 81 reached >
1 million pop in 2015.
Top 5 most populous provinces:
- Cavite,
- Bulacan,
- Laguna,
- Pangasinan and
- Cebu (excluding its three highly urbanized
cities)
-
Top most populous cities:
- Quezon City (2.94M),
- Manila (1.78M), Davao City (1.63M) &
- Caloocan City (1.58M) had the highest
population (PSA, 2017c).
HEALTH TRENDS
CA2: COMMUNITY HEALTH NURSING DAY 1
Prof. Aida Garcia, MAN, RN
- Selected indicators serve as proxy
measures for determining if the strategies
and interventions implemented by the health
sector and other stakeholders led to overall
improvements in health outcomes.
- Results using selected indicators such as
life expectancy, maternal mortality ratio
(MMR), infant mortality rate (IMR),
under-five mortality rate (U5MR),
prevalence of stunting among under-five
children, and TB prevalence showed mixed
results.
- The average life expectancy improved from
67.1 years in 2000-2005 to 71.6 years in
2015-2020.
- Infant mortality rate decreased from 34 per
1,000 live births to 23 per 1,000 live births
and under-five mortality rate went down
12
from 54 per 1,000 live births to 31 per 1,000
live births.
The rates of decline, however, slowed down
over the period. Meanwhile, the MMR has
minimal progress from 126 per 100,000 live
births in 2012 to 114 per 100,000 live births
in 2015.
- In terms of nutrition, stunting remained
almost unchanged from 33.1 percent in
2005 to 33.4 percent in 2015. Stunting was
observed to be high among those residing
in rural areas (38.1 percent) and those
belonging to the poorest quintiles (49.7
percent)