COMMUNITY PUBLIC HEALTH LECTURE

LESSON 1: INTRODUCTION AND CONCEPTS OF COMMUNITY AND PUBLIC HEALTH

HEALTH
● THE WORD HEALTH IS DERIVED FROM “HAL” WHICH
MEANS “HALE,SOUND,WHOLE”
● WHO (1946)
STATES THAT “HEALTH IS A STATE OF COMPLETE PHYSICAL,
MENTAL AND SOCIAL WELL-BEING AND NOT MERELY THE
ABSENCE OF DISEASE AND INFIRMITY”
HEALTH IS A RESOURCE FOR EVERYDAY LIFE, NOT THE
OBJECT OF LIVING, AND IS A POSITIVE CONCEPT EMPHASIZING
SOCIAL AND PERSONAL RESOURCES AS WELL AS PHYSICAL
CAPABILITIES
● MCKENZIE (2018)
1. A DYNAMIC STATE OR CONDITION OF THE HUMAN
ORGANISM THAT IS MULTIDIMENSIONAL IN NATURE ,
A RESOURCE FOR LIVING AND RESULTS FROM A
PERSON’S INTERACTIONS WITH A ADAPTATIONS TO
HIS OR HER ENVIRONMENT ; THEREFORE; IT CAN
EXIST IN VARYING DEGREES AND IS SPECIFIC TO
EACH INDIVIDUAL AND HIS OR HER SITUATION.
“A PERSON CAN HAVE A DISEASE OR INJURY AND STILL BE
HEALTHY OR AT LEAST WELL”
Determination of a healthy community
➢ Leadership – assess the needs and resources
➢ Public Health Support – public health and social
infrastructure and policies that supports health
➢ Health service delivery – equitable, affordable, and
available quality health care services
PUBLIC HEALTH
"Public Health is ecological in perspective, multisectoral in
scope and collaborative in strategy. It aims to improve the
health of communities through an organized community effort.
Public health infrastructures need to reflect that it is an
interdisciplinary pursuit with a commitment to equity, public
participation, sustainable development, and freedom from war.
As such it is part of a global commitment and strategy". - Ilona
Kickbush
Institute of Medicine (I0M), 1988
➢ What we as a society do collectively to assure the
conditions in which people can be healthy.
PUBLIC HEALTH SYSTEM
• Activities undertaken within the formal structure of
government and the associated efforts of private and
voluntary organizations and individuals.

COMMUNITY

A Collective body of individuals identified by common

characteristics such as geography, interest, experiences,
concerns, or values
Characteristics by the following elements:
➢ Membership – a sense of identity and belonging
➢ Common symbol systems – similar language,
rituals, and ceremonies
➢ Shared values and norms
➢ Mutual influence – community members have
influence and are influenced by each other COMMUNITY HEALTH POPULATION HEALTH
➢ Shared needs and commitment to meeting them
➢ Shared emotional connection- members share the health status of a defined the health outcomes of a
common history, experiences, and mutual support. group of people and the group of individuals,
actions and conditions to including the distribution of
promote, protect, and such outcomes within the

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preserve their health group.

GLOBAL HEALTH

◼ Describes health problems, issues, and concerns that

transcend national boundaries, may be influenced by
circumstances or experiences in other countries, and
are best addressed by cooperative actions and
solutions.

PERSONAL HEALTH VS. COMMUNITY AND PUBLIC HEALTH

ACTIVITIES

PERSONAL HEALTH VS COMMUNITY AND PUBLIC HEALTH

ACTIVITIES FACTORS THAT AFFECT THE HEALTH OF A
COMMUNITY

Personal Health Community and Public

individual actions and
decision-making that affect
the health of an individual or
his or her immediate family
members or friends
Seldom directly affect the
health of others
Individual/personal
approach.
Health Activities
activities that are aimed at
protecting or improving the
health of a population or
community.
Directly affect the health of
the population
Population approach.
Community Organization
The way in which a
community is able to
organize its resources
directly influences its ability
to intervene and solve
problems, including health
problems
Community organizing the
process by which community
groups are helped to identify
common problems or
change targets, mobilize
resources, and develop and
implement strategies for
reaching their collective
goals
Individual Behaviors
The behavior of the
individual community
members contributes to the
health of the entire
community
It takes the concerted effort
of many—if not most—of the
individuals in a community to
make a program work.
Herd immunity the
resistance of a population to
the spread of an infectious
agent based on the
immunity of a high
proportion of individuals.

SOCIAL DETERMINANTS OF HEALTH

HEALTHY PEOPLE 2020

➢ the social determinants of health “are the conditions in
the social, physical, and economic environment in
which people are born, live, work, and age. They
consist of policies, programs, and institutions, and
other aspects of the social structure (including the
government and private sectors), as well as
community factors.”
➢ Are the conditions in the environment that affects a
wide range of health, functioning, and quality of life
outcomes and risks
➢ Conditions, patterns of social engagement, sense of
security and well-being affect the “place” where
people live
Resources
➢ e.g., safe and affordable housing, access to
education, public safety, availability of food, and local
health services

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➢ Can enhance the quality of life of the “place” will

Cavite (1611) Cebu
significantly influence the population health outcomes
Understanding the relationship between how the population
Casa De Caridad in Cebu Hospital de Argentina in
experience the place and the impact of the place on health is
Manila for smallpox and
basic to social and physical determinants of health.
cholera

Infirmaries De. Sta. Cruz in

Laguna (1870)

TWO MILITARY OTHER

HOSPITALS/ASYLUM

Hospital Militar de Manila Hospicio De San Pascual

Baylon in Manila

Hospital Militar de Asylum of St. Vincent De

Zamboanga Paul in Manila for poor girls
(1885)

Founding hospital of San

Jose for Orphaned children
and mentally ill (1782)

Hospital de Argentina in
Manila for smallpox and
cholera

AN ERA FOR CONSTRUCTION OF:

✓ First medical school – UST (1872)
✓ School of midwifery in 1879
✓ Public health laboratory in 1883
✓ Forensic medicine in 1892

AMERICAN MILITARY GOVERNMENT (1895-1907)

➢ During the early occupation of the Americans

witnessed the control of epidemics:
- Cholera, smallpox, plagues
➢ Fight communicable diseases such as:
- Leprosy, diarrhea, malaria, beri-beri (vit. B1
deficiency)
➢ Establishments of health organizations and
administration and general sanitation
➢ establishment of garbage crematory (1899)
➢ First sanitary ordinance and rat control (1901)
HISTORY OF PUBLIC HEALTH IN THE PHILIPPINES ➢ Established that contaminated water and unclean
vegetables are factors in the control of amoebic
PRE-AMERICAN OCCUPATION dysentery
➢ Public health work during the Spanish regime began ➢ Anopheles minimus as causative of malaria (1904)
at the portera of the old Franciscan convent in ➢ Cholera vaccine was tried as compulsory vaccination
Intramuros where indigents in Manila was treated. to school children
➢ Eventually became the “San Juan De Dios Hospital” ➢ Confirmation that plagues in man comes from infected
PRE-AMERICAN OCCUPATION rats.
➢ Opened the leper colony in Culion and compulsory
FIVE GENERALS’ FOUR CONTAGIOUS detection of leprosy
HOSPITALS HOSPITALS ➢ Founding of Manila Medical Society
➢ Founding of Philippine Island Medical Association
San Juan De Dios Hospital San Lazaro Hospital (1577) ➢ Opened the UP College of Medicine (1907)
(1659) ➢ Establishment of Bureau of Science in 1905
Chinese General Hospital Hospital De Palestina in PHILIPPINE ASSEMBLY (1907-1916)
Cavite (1611) camerines sure
➢ Period of several first
Hospicio De San Jose In Hospital de Leprosos in - First institution of the search for germ carriers (1908)

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- First time to use general chemical disinfection as

emergency measures against cholera.
- Inclusion of Hygiene and Physiology in the curriculum
of public elementary schools (1909)
- Start of anti-tuberculosis campaign
- Dissemination of the results of first nutrition survey
- Organization of the Philippine Tuberculosis Society
(1910)
- Opening of Pasteur Prophylaxis treatment against
rabies
- Opening of the Philippine General Hospital (PGH)
- First eradication of Beri-beri among scout by change
of diet.
- First use of dry vaccine against smallpox
- First offering of graduate courses in hygiene and
tropical medicine at the UP College of Medicine
(1913)
- Manufacture and distribution of Tiki-Tiki for treatment
of beri-ber

THE JONES LAW (1916-1936)

- Health administration is retrogression rather then progress.

- Increase Crude death rate and infant mortality rate.
- Increased death caused by smallpox, cholera, typhoid,
malaria, beri-beri, and
tuberculosis.
- A Committee to study the prevalence of typhoid fever was
launched
- Schick Test was first used to determine the susceptibility of
Filipino children to
diphtheria
- Start of leadership of Dr. Jose Fabella, the first secretary of
Health.
- Campaign against hookworm was launched
- Mechanism in the transmission of Aedes aegypti of Dengue
Fever was studies
successfully.
- BS in Education major in health education was offered in U.P

THE COMMONWEALTH (1936-1942)

➢ Establishment of UP School of Public Health

➢ Death rate remained high
➢ Tuberculosis remained uncontrolled
➢ Malaria, beri-beri, and intestinal diseases remained
undiminished
➢ Maternal and Child Health, School Health, Health
education of the public, Public Health Nursing, Public
Health Dentistry, Hospital and Laboratory services
were all strengthened.

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LESSON 2: COMMUNICABLE AND NONCOMMUNICABLE DISEASE

CLASSIFICATION OF DISEASE AND HEALTH

PROBLEMS

Topographic, bodily region or system

- (e.g., GIT disease, Vascular, abdominal)

Anatomic
- Specificity (e.g., heart, liver, kidney)

Physiological
- With underlying functional derangement (e.g.,
respiratory, metabolic)
Pathological COMMUNICABLE DISEASE
- Nature of the disease process (e.g., neoplastic
inflammatory)
Etiologic INFECTIOUS DISEASE
- Based on the cause (e.g,. bacterial, viral, fungal, ➢ Type of disease caused by some specific biological
parasitic) agents or its toxic products that can be transmitted
Epidemiological from an infected animal, or inanimate reservoir to a
- Based on the incidence, distribution, prevention. (e.g., susceptible host.
salmonella – contaminated water)

CAUSATIVE AGENTS FOR DISEASE AND INJURIES

ACUTE VS CHRONIC
ACUTE CHRONIC
NONCOMMUNICABLE DISEASE
Onset Rapid, Sudden Gradual Noninfectious disease (multicausation disease)
➢ Illnesses that cannot be transmitted from one person
Duration Short, limited (3 Indefinite, long
to another
months) term (life-long)
➢ Delineating the cause of NCD’s are more often
Cause Usually single Usually multiple
difficult due multiple contributing factors
and changes
overtime
Diagnosis and Usually accurate Often uncertain
prognosis
intervention Usually effective Often indecisive,
adverse effects
common
outcome Cure possible No cure

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COMMUNICABLE DISEASE

INFECTIVITY VS PATHOGENICITY VS VIRULENCE

INFECTIVITY PATHOGENECITY VIRULENCE
Ability of Capability of a Ability of an
biological agent to communicable infectious agent
enter and grow in disease agent to to cause severe
the host. cause disease in a disease.
susceptible host

CASE – Person who is sick with a disease

CARRIER – person or animal that harbors a specific

communicable agent in the absence of discernible clinical
EXPOSURE OUTCOME disease and serves as a potential source of infection to others.

ZOONOSIS – Communicable disease transmissible under

natural conditions from vertebrate animals to humans

ANTHROPONOSIS – Disease that infects only humans

VEHICLE – inanimate material or object that can serve as a

source of infection.

VECTOR – a living organism, usually an arthropod (e.g.,

mosquito, tick, louse, or flea) that can transmit a communicable
agent to susceptible hosts.

INCUBATION – time interval between initial contact with an

COMMUNICABLE DISEASE MODEL
infectious agent and appearance of the first sign or symptom of
➢ Minimal requirements for the occurrence and spread
disease in question.
of communicable disease in a population – agent,
host, and environment
COMMUNICABILITY – period of communicability is the time
during which an infectious agent may be transferred directly or
indirectly from an infected person to another person, from an
infected animal to humans, or from an infected person to
animals, also known as the “infectious period”

CHAIN OF INFECTION
➢ Model that can be used to visualize the step-by-step
process by which communicable disease spread from
infected person to an uninfected person from the
community
➢ Used to conceptualize the transmission of a
communicable disease from its source to a
susceptible host.

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1. CAUSATIVE AGENT 5. PORTAL OF ENTRY

Any microorganism capable of causing a disease. Refers to the manner in which a pathogen enters a susceptible
➢ Ex: bacteria, virus, parasite, fungi. host.
Must provide access to tissues in which the pathogen can
multiply, or a toxic can act.

6. SUSCEPTIBLE HOST

The final link in the chain of infection

A susceptible host is a person who can become infected by the
infectious agent.

2. RESERVIOR

The habitat where the agent survives, grows and/or multiples.

2nd link in the chain of infection
➢ Ex: human, animal, environment.

NONCOMMUNICABLE DISEASE

3. PORTAL OF EXIT

NONCOMMUNICABLE DISEASE
Path by which an infectious agent leaves its reservoir
➢ respiratory tract, genitourinary tract, gastrointestinal
tract, skin, mucus membrane, placenta. Noncommunicable diseases (NCD’s)
➢ Known as chronic diseases, tend to be of long
4. MODE OF TRANSMISSION duration and are the result of a combination of
genetic, physiologic, environment, and behavioral
Contact Transmission factors
Direct – Immediate transfer of an infectious, agent by direct The main types of NCD are
contact. - Cardiovascular diseases (CVD), hypertension, CHD
➢ Touching, biting, kissing, sexual intercourse, droplet - Cancers
Indirect – transmission involving an intermediate step - Chronic respiratory diseases (COPD, Asthma)
➢ Airborne, vehicle borne, vector borne - Diabetes

Indigestion (through GIT)

Vertical Transmission

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ETIOLOGY – Cause of a disease

CORONARY HEART DISEASE (CHD) – Chronic disease
characterized by damage to the coronary arteries in the heart.
CEREBROVASCULAR DISEASE (STROKE) – Chronic
disease characterized by damage to blood vessels of the brain
resulting in disruption of circulation to the brain.
PREVENTION, INTERVENTION, CONTROL AND
ERADICATION OF DISEASES
PREVENTION – Planning for and taking of action to forestall
the onset of a disease or other health problem.
INTERVENTION – Efforts to control a disease in progress

MALIGNANT NEOPLASM – uncontrolled new tissue growth ERADICATION – Complete elimination or uprooting of a
resulting from cells that have lost control over their growth and disease (e.g, smallpox eradication)
division.

METASTASIS – spread of cancer cells to distant of the body LEVELS OF PREVENTION FOR DISEASE
by the circulatory or lymphatic system. CONTROL

MULTICAUSATION DISEASE MODEL

Visual representation of the host together with various internal

and external factors that promote and protect against disease.

RISK FACTOS

15 LEADING NCD’s (PHILIPPINES)

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PRIMARY PREVENTION (COMMUNICABLE DISEASES)

ACTIVE IMMUNITY – Occurs when exposure to a disease-

causing organism prompts the immune system to develop
antibodies against that disease

PASSIVE IMMUNITY - Occurs when a person receives

antibodies against a disease rather than their immune system
producing them.

ISOLATION – Separation of infected persons from those who

are susceptible

QUARANTINE - Limitation of freedom of movement of those

who have been exposed to a disease and may be incubating it.

DISINFECTION – Killing of communicable disease agents

outside the host.

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LESSON 3: MEDICAL AND PUBLIC HEALTH MICROBIOLOGY

ALEXANDER FLEMMING (1881-1995)
MICROBIOLOGY • He accidentally discovered the antibiotic penicillin
(Penicillin Notatum)
➢ Defined as the study of organisms that are too small
to be seen by the naked eye. BACTERIAL TAXONOMY
➢ Its purpose is to isolate and identify pathogenic
microorganisms.
TAXONOMY
➢ It is an area of biological science that comprises three
HISTORY OF MICROBIOLOGY distinct areas, namely classification, nomenclature,
ANTOINNE VAN LEEWENHOEK (1632 – 1723) and identification.
• Considered as “first true microbiologist” ➢ it is a formal system of organizing, classifying and
• Known as the father of bacteriology and protozoology naming living things.
➢ it is based on the similarities and difference in the
• First person to observe and accurately describe living
genotype and phenotype of organisms.
microorganism, such as bacteria and protozoa.
• Used the term “animalcules” or the tiny living and
I.CLASSIFICATION.
moving cells seen under the microscope.
➢ It is the organization of microorganisms that have
RUDOLF VIRCHOW (1821 – 1902)
similar morphologic, physiologic, and genetic, traits
• Proposed the theory of biogenesis, which states that into specific groups or taxa.
living cells arise only from pre-existing living cells. DESIGNATION DEFINITION DESIGNATION DEFINITION
LOUIS PASTEUR (1822 – 1895) DOMAIN Bacteria and Family Composed of
• Proposed the used of heat in killing microorganism, archaebacteria similar genera
which is now called as aseptic technique KINGDOM Composed of Genus Composed of
• He used the term “vaccine” for an attenuated culture. similar phyla: various
• Developed the anthrax and rabies vaccine similarities of species with
• He improved the wine-making process (fermentation DNA and RNA common
and pasteurization) characteristics
JOHN TYNDALL (1820 – 1893) PHYLUM Composed of Species Is the basic
• Showed that dusts carry agents that could similar classes group or the
contaminate a sterile broth. collection of
FERDINAND COHN (1828 – 1898) bacterial
• He discovered that there are bacteria that could strains with
withstand a series of heating and boiling because of common
heat- resistant structures known as endospores. physiologic
IGNA SEMMELWEIS (1816-1865) and genetic
• He demonstrated that routine handwashing could features.
prevent the spread of disease. CLASS Composed of Subspecies Serotype –
JOSEPH LISTER (1827 - `1912) similar orders Based on
• He introduced the system of antiseptic surgery in serologic
Britain differences
• He pioneered promoting handwashing before and ORDER Composed of Species Biotype –
after operation, the wearing of gloves, sterilizing similar families subdivided Based on
surgical instruments and the use of phenol as in in the biochemical
antimicrobial agent for surgical wound dressing. following differences.
ROBERT KOCH (1843 – 1910) phenotypic
• First to show that bacteria can cause disease differences
• Discovered bacillus anthracis, the causative agent of
anthrax II. NOMENCLATURE
• Discovered mycobacterium tuberculosis, the ➢ It is the naming of microorganisms according to
causative agent of pulmonary tuberculosis. established guidelines
FANNY HESSE (1850 – 1934)
• She suggested the use of agar, a solidifying agent, in Writing the Genus Name
the preparation of culture media 1.it should be capitalized and followed by the species epithet
JULIUS RICHARD (1852- 1921) (specific name). which begins with a lower-case letter:
• He developed the petri dish. 2.both the genus and species should be italized in print- but
EDWARD JENNER (1749 – 1823) underlined when written in script (e.g., mycobacterium
tuberculosis or mycobacterium tuberculosis).
• Introduced the smallpox vaccination through cowpox
3. when bacteria are preferred to as a group, their names are
inoculation.
neither capitalized nor underlined (e.g., streptococci,
ELLIE METCHNIKOFF (1845 – 1916)
staphylococci, salmonella, etc.)
• First to describe the immune system cells and the
process of phagocytosis.

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III. IDENTIFICATION
➢ It is the process by which a microorganism’s key
feature are described. 4 TYPES OF SYSTEMATIC INFECTION
➢ It is the process of discovering and recording the traits A. BACTEREMIA – Presence of bacteria in the blood,
of the organism. invasion without active multiplication.
GENOTYPIC CHARACTERISTICS B. SEPTICEMIA – Active multiplication of the invading
➢ It refers to the organism’s genetic make-up bacteria in the blood
➢ It involves the detection of gene or a part thereof, or C. PYEMIA – Condition wherein pus-producing organism
an RNA product of a specific organism repeatedly invade the bloodstream and localized
➢ E.x base sequencing of DNA or RNA which measures D. TOXEMIA – Presence of toxins in the blood.
the relatedness of two organisms. EXTENT OF INFECTION
PHENOTYPIC CHARACTERISTICS 1.PRIMARY INFECTION
➢ It is based on the features beyond the genetic level. - It is the initial infection that causes the illness.
➢ It includes readily observable characteristics, such as E.X common colds
the morphological feature, as well as analytical
procedures to be detected. 2.SECONDARY INFECTION
➢ E.x: morphology, staining, nutritional requirements - It is caused by opportunistic pathogens after the primary
and biochemical and susceptibility tests. infection has weakened the host’s immune system
PATHOGENESIS
3.LATENT INFECTION (SILENT PHASE)
- It is clinically silent inside the body and causes no noticeable
• Is the development of an infection and disease. illnesses in the host.
Certain virulence agents with mechanisms of
resistance against the host protective factors are 4. MIXED INFECTION
involved in the proliferation of microorganisms and the - It is caused by two or more organisms
progress of diseases. E.X wound infection
INFECTION
• It involves the growth and multiplication of 5. ACUTE INFECTION
microorganisms that cause damage to their host - Type of infection that develops the progresses slowly.
• It is the bodily invasion of pathogenic microorganisms
that reproduce, multiply, and then cause disease 6.CHRONIC INFECTION
through local cellular injury, toxin secretion, or - Infection which develops slowly with milder but longer-lasting
antigen, antibody reaction in the host. symptoms.
TYPES OF INFECTIO ACCORDING TO THE CAUSE
AUTOGENOUS INFECTION 7.INFECTIOUS DOSE 50(ID50)
✓ It is caused by a microorganism from the microbiota - The ID50 is the number of pathogen cells or virions required to
of the host. cause active infection.
LATROGENIC INFECTION - 50% probability to cause an illness.
✓ It is an infection that occurs as the result of some
medical treatment or procedure.
OPPORTUNISTIC INFECTION
✓ It is an infection that affects immunocompromised
host but not the individuals with a normal immune
system
NOSOCOMIAL INFECTION
✓ It is also known as hospital-acquired infection,
4 COMMON TYPES OF NOSOCOMIAL INFECTIONS
◼ Urinary tract infection
◼ Lung infection
◼ Surgical site infection
◼ Blood stream infection

TYPES OF INFECTION ACCORDING TO HOST

DISTRIBUTION
1. LOCAL INFECTION
➢ It means signs and symptoms are confined in one
area.
➢ E.x. boils, otitis, media, infected wound DISEASE
2.FOCAL INFECTION ➢ It is a specific illness or disorder that is characterized
➢ It starts as a local infection before spreading to the by a recognizable set of signs and symptoms which
other parts of the body. are attributable to heredity, infection, diet or
➢ E.x Tonsilitis. environment
3.SYSTEMATIC INFECTION (GENERALIZED INFECTION) ➢ It results when an infection produces notable changes
➢ It means the microbe spreads throughout the body in the human physiology, specifically those that cause
the blood or lymph (general invasion) damage to the body’s organ system

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CLASSIFICAITON OF DISEASE ACCORDING TO

OCCURRENCE
1.SPORADIC DISEASE: Occurs occasionally
2.ENDEMIC DISEASE: Constantly present in a particular
location or population
3.EPIDEMIC DISEASE: Disease that affects a large number of
people in a given population within a short span of time.
4.PANDEMIC DISEASE: Disease that affects population
across large regions around the world.

EFFECTS OF INFECTIOUS DISEASES

SIGNS
✓ Objective changes that can be measured
SYMPTOMS
✓ Subjective indications of the disease in a person
SYNDROME
✓ It is a group of signs and symptoms that are
associated
with a disease.

PHASES OF INFECTIOUS DISEASES

1.INCUBATION PERIOD
➢ Time between the exposure to a pathogenic organism
and the onset of symptoms
2.PRODROMAL PERIOD
➢ The appearance of the signs and symptoms

3.CLINICAL OR ILLNESS PERIOD

➢ Peak of characteristics signs and symptoms of an
infection or a disease.
4.DECLINED PERIOD
➢ It is the period in which the signs and symptoms
begins to subside as the host’s condition improves.
5.CONVALESCENCE OR THE PERIOD OF RECOVERY
➢ Period in which the surviving host is recuperating
towards full recovery.

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LESSON 4: MEDICAL AND PUBLIC HEALTH PARASITOLOGY

TYPE OF HOST
PARASITE-HOST RELATIONSHIP
Accidental or Incidental Host
MAIN FOCUS OF THE PARASITE-HOST RELATIONSHIP - Host other than normal one that is harboring a
parasite

Development of Definitive host

Recognition of Search for
methodologies - Host in which the adult sexual phase of parasite
these patterns of the
to study these development occurs
relationship relationships
patterns
Intermediate Host
- Host in which the larval asexual phase of parasite
development occurs
TYPE OF PARASITE
Reservoir Host
- Host harboring parasites that are parasitic for human
OBLIGATORY PARASITE and from which humans may become infected

◼ Parasite that cannot survive outside of a host. Transport host/Paratenic/Phoretic

EX: VIRUS - Host responsible for transferring a parasite from one
location to another
FACULTATIVE PARASITE
◼ Parasite that is capable of existing independently of a Carrier
host - Parasite-harboring host that is not exhibiting any
EX: STRONGYLOIDES clinical symptoms but can infect others.

ENDOPARASITE
PARASITE-HOST RELATIONSHIP
◼ Parasite that is established inside of a host
EX: PLASMODIUM
SYMBIOSIS
ECTOPARASITE - Living together: the association of two living
◼ Parasite that is established in or on the exterior organisms. Each of a different species
surface of a host COMMENSALISM
EX: FLEAS - Association of two different species of organisms that
is beneficial to one and neutral to the other
MUTUALISM
- Association of two different species of organisms that
STATES OF PARASITISM is beneficial both
PARASITISM
INFESTATION INFECTION - Association of two different species of organisms that
Organism Ectoparasites Endoparasites is beneficial to one at the other’s expense
involved COMMENSAL
Characteristics Lodgment of the Invasion/Modification - Relating to commensalism: the association between
parasite in the of the parasite within two different organisms in which one benefits and has
surface of the host’s body a neutral effect on the other.
susceptible host. PATHOGENIC
- Parasite that has demonstrated the ability to cause
According to pathogenicity disease
a.pathogenic
b.non-pathogenic

According to need for host:

a.obligate
b.facultative
c.accidental/incidental

According to number of hosts required in the life cycle:

a.monoxenous
b.hetexenous

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PARASITIC LIFE CYCLE

INDIRECT
- TWO OR MORE HOST IN LIFE CYCLE

Parasitic life cycle ranges from simple to complex:

These common components.
1.Mode of transmission – present in order to parasite transfer
to susceptible host
2.Infective stage – one can infect susceptible host

3.Diagnostic Stage – certain life cycle stage of parasite that

can be used for diagnosis

Some parasites require only a definitive host, whereas others

also require one or more intermediate hosts. DISEASE PROCESS AND SYMPTOMS

DIRECT - A Parasitic disease may affect the entire body or any

of its part.
- ONLY ONE HOST IN THE ENTIRE LIFE CYCLE
Major Body Associated with such processes
1.Gastrointestinal and Urogenital Tracts
2.Blood and Tissue
3.Liver, Lung, and other major organs
4. Miscellaneous locations

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 CPH LEC 2ND TERM

TREATMENT

There are several options for treating parasitic infections.

- Many of these drugs are toxic to the host and care
should be exercised when selecting proper course of
treatment

PREVENTION AND CONTROL

Prevention and control measures may be taken against every

parasite infective to humans
Preventive measures designed to break the transmission cycle
are crucial for successful parasite eradication

PARASITE NOMENCLATURE AND CLASSIFICATION

Writing the name of parasites:

1.The scientific name of parasites are written in italics and
consist of two components, genus, and species
Ex. Giardia Lamblia
2.When a parasite name first appears in a document, the entire
parasite name is written.
3. Referencing of parasite can be abbreviated by recording
only the first letter of the genera followed by a period, followed
by the entire species name
Ex: giardia intestinalis (G. Intestinalis)

SECOND TERM, BSMT 16

 CPH LEC 2ND TERM

SECOND TERM, BSMT 17

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GENERAL CHARACTERISTICS OF PROTOZOANS GENERAL CHARACTERISTICS OF METAZOANS

◼ Eukaryote, unicellular, with ectoplasm and endoplasm

LOCOMOTORY APPARATUS: ◼ Multicellular with complex structure

Flagella – thread-like, long whip- like structure arising from the ◼ Life stages
surface of the cell ◼ Egg > larva > adult
CILIA – Shorter, needle-like/hair like structures, found all
throughout the cell, Size-relatively larger than unicellular protozoans
Separate sexes

LOCOMOTORY APPARATUS:
Pseudopods/Pseudopodia
- False-feet, temporary cytoplasmic extensions
Undulating membrane
- Flexible sheet of material that joins that flagellum to
the surface of the cell
Apical Complex
- Consist of polar rings, subpellicular tubules, conoid,
rhoptries, and micronemes for penetration and
SPECIMEN COLLETING, PROCESSING AND EXAMINING OF
invasion of target cell.
STOOL SPECIMENS

Considerations in specimen collection:

✓ Fecal specimen should be collected before any
radiologic procedures that use barium sulfate
because it will obscure the visualization of the
parasite
✓ Some medications intakes that may interfere with
detection include:
a. Certain antibiotics – tetracycline
b. Antimalarial medications
c. Antidiarrheal products that are not absorbed-
loperamide
d. Mineral oil
e. Bismuth
✓ Contamination of water that may contain-free living
parasites
✓ Contact with urine through toilet collections is
discouraged because urine may destroy motile
parasites

Considering in specimen collection

✓ The stool specimen should be collected into a clean
waxed, cardboard container, with a wide opening and
tight-fitting lid.
✓ The number of specimens required to diagnose a
parasitic infection depends on
a.type and severity of infection
b.quality of the sample submitted.
c.examination performed

✓ General rule, before the therapy at least three fecal

specimens should be collected

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✓ Castor oil or mineral oil laxative should be avoided 3.Direct smear- detection of motile trophozoites of amoebas
because oil decrease the motility of the trophozoite
form of intestinal protozoa and flagellates
Considerations in specimen collection:
✓ Ensure proper, accurate and correct labeling of the 4. Concentration methods – for enhanced detection of
specimen
✓ For the collection of trophozoite of amoeba and smaller parasites that may not be detected in the direct mount.
flagellates, freshly passed stool in needed.
✓ Cyst form is readily observed in formed stools 5. Permanently stained mount – recommended for
✓ Liquid sample should be examined within half hour of
collection identification of ova and parasites
✓ Soft and semisoft stool should be examined within 1
hour of collection 6. Blood smears – thick and thin blood smears
✓ If examination is not possible right away, the
specimen can be refrigerated at 3 degrees Celsius or 7. Cellophane tape procedure – for detection of
5 degrees Celsius for up to 4 hours
✓ Stool must not be left at room temperature, incubated E.Vermicularis
or frozen
✓ When stool examination within these time constraints 8.Entero string test – for detection of G. Lamblia
is not possible, the stool should be placed into a
preservative such as polyvinyl alcohol (PVA) to
maintain the morphology characteristics, glacial acetic
acid for protozoans’ cysts and trophozoites.

Considerations in specimen collections:

✓ A gross macroscopic examination of feces includes
examination for proglottids and adult worms which
may be visible on the specimen’s surface
✓ Areas containing mucus and blood should be
examined more carefully.
SPECIMEN PROCESSING AND LABORATORY DIAGNOSIS
Proper specimen collection and processing are crucial to
parasite recovery.
Specimen Use
Stool - Most submitted
sample for each
study
- Microscopic (ova
and parasites) and
macroscopic
techniques
- Fresh or preserved
sample
CSF Molecular, culture,
microscopic exam (Ex.
Angiostrongyliasis
cantonensis)
blood Microscopic (Ex.
Plasmodium)
Tissue Biopsy Microscopic (Ex.
Acanthamoeba)
Sputum Microscopic (Ex. P.
Westermanii)
Urine Microscopic (Ex.
Haematobium T. Vaginalis)
Genital Material Microscopic (Ex. T.
Vaginalis)

Examination procedures and methods:

1.Macroscopic Examinations – color, consistency,
visualization of adult worms or proglottids
2.Microscopic Examinations – for identification of parasitic

eggs, cysts, trophozoites

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LESSON 5: COMMUNITY ORGANIZING, BUILDING AND HEALTH PROMOTION

PROGRAMMING

5.PUBLIC POLICY – Wide dissemination of information to

COMMUNITY ORGANIZING/BUILDING encourage the people.
SPECIFIC KNOWLEDGE AND SKILLS IN DEALING WITH 6.PHYSICAL ENVIRONMENT- Collaborative programs to
THE HEALTH ISSUES promote health
1.Able to identify the problems. 7.CULTURE- Reinforcement of health programs as cultural
2.Develop a plan to attack each health problems norms.
3.Gather the necessary resources to carry out that plan
4.Implementation of the plan COMMUNITY ORGANIZING
5.Evaluate the results to determine the degree of progress that ➢
A process by which community groups are helped to
has been achieved identify common problems or change targets, mobilize
For community organizing/building and health promotion resources, and develop and implement strategies for
programming efforts to be successful people must change their reaching their collective goals.
behavior TABLE 5.1 TERMS ASSOCIATED WITH COMMUNITY
ORGANIZING/BUILDING
EVIDENCE
➢ Is the body of data that can be used to make COMMUNITY CAPACITY Community characteristics
decisions. affecting its ability to identify.
➢ Not all evidence is valid, reliable, or fit for purposes Mobilize and address
➢ If they are valid or reliable, not all are created equal. problems
EMPOWERMENT Social action process for
people to gain mastery over
their lives and the lives of
their communities
GRASSROOTS Bottom-up efforts of people
PARTICIPATION taking collective actions on
their own behalf, and they
involve the use of
sophisticated blend of
confrontation and cooperation
in order to achieve their ends
MACRO PRACTICE The methods of professionals
change that deal with issues
beyond the individual, family
and small group level
PARTICIPATION AND Community organizing should
RELEVANCE start where the people are a
and engage community
EVIDENCE-BASED PRACTICE
member an equal
➢ It is when community and public health workers SOCIAL CAPITAL Processes and conditions
systematically find, appraise and use evidence as the among people and
basis for decision making related to community organizations that lead to their
organizing/building and health promotion accomplishing a goal of
programming. mutual social benefit, usually
characterized by interrelated
SOCIO-ECOLOGICAL APPROACH (ECOLOGICAL constructs of trust,
PERSPECTIVE) cooperation, civic
engagement and reciprocity,
reinforced by networking.
➢ Individuals influence and are influenced by their
families, social networks, the organizations in which FACTORS CONTRIBUTING IN THE LOSS OF SENSE OF
they participate (workplace, schools, religious COMMUNITY
organizations) the communities of which they are a 1.Advances in electronics and communications
part, and the society in which they live. 2.Household upgrades
➢ The health behavior of individuals is shaped in part by 3.Increase Mobility
the social context in which they live.
LEVELS OF INFLUENCE ◼ Individuals are now much more independent
1.INTRAPERSONAL – Individual influence ◼ These are changes in the community social structure.
2.INTERPERSONAL- People are encourage by the people
close to them.
3.INSTITUTIONAL OR ORGANIZATIONAL – Employers
develop health programs that engage their employees.
4.COMMUNITY – Passage of ordinances to promote health.

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ASSUMPTIONS OF COMMUNITY ORGANIZING
1.Communities of people can develop the capacity to deal with
their own problems
2.People want to change and can change
3.People should participate in making, adjusting, or controlling
the major changes taking place within their communities.
4.Changes in community living that are self-imposed or self-
developed have a meaning and permanence that imposed
changes do not have.
5.A “holistic approach” can successfully address problems with
which a fragmented approach” cannot cope.
6.Democracy requires cooperative participation and action in
the affairs of the community and people must learn the skills
that make this possible
7. Frequently, communities people need help in organizing to
deal with their needs, just as many individuals require help in
coping with their individual problems.
COMMUNITY ORGANIZING METHOD
STRATEGIES IN PRIMARY METHODS FOR COMMUNITY
ORGANIZING (ROTHMAN TYPOLOGY)
1.Planning and policy practices
◼ The heart of this strategy is data. By using data,
community, and public health workers. Generate
persuasive rationales that lead toward proposing and
enacting particular solutions.
2.Community Capacity Development
◼ Based on empowering those impacted by a problem
with knowledge and skills to understand the problem
and then work cooperatively together to deal with the
problem
◼ Group consensus and social solidarity
3. Social Advocacy
◼ Used to address a problem through the application of
pressure, including confrontation, on those who have
created the problem or stand as a barrier to a solution
to the problem. This strategy creates conflict.
COMMUNITY ORGANIZING METHOD
➢ Although each of these strategies has unique
components, each strategy can be combined with the
others to deal with a community problem.
➢ Whatever strategy is used, they all revolve around a
common theme; the work and resources of many
have a much better change of solving a problem than
the work and resources of a few.
SECOND TERM, BSMT
THE PROCESS OF COMMUNITY ORGANIZING
SUMMARY OF STEPS IN COMMUNITY ORGANIZING AND
BUILDING
(McKenzie, Neiger, Thackeray)
10 STEPS OF THE GENERIC APPROACH
1.recognizing the issue
2.Gaining entry into the community
3. Organizing the people
4. Assessing the community
5. Determining the priorities and setting goals.
6. arriving at a solution and selecting intervention strategies
7. Implementing the plan
8. Evaluating the outcomes of the plan of action
9. Maintaining the outcomes in the community
10. Looping back
THE PROCESS OF COMMUNITY ORGANIZING
1.Recognizing the Issue
➢ The process of community organizing/building begins
when someone recognizes that a problem exists in a
community and decides to do something about it. This
person (or persons) is referred to as the initial
organizer
Grassroots
➢ A process that begins with those who are affected by
the problem/concern, those who initiate community
organization that are members of the community. “In
grassroots, organizing, community groups are built
from scratch, and leadership is developed where
none existed before”
Top-down organization
➢ When individuals from outside the community initiate
community organization.
2.Gaining Entry into the Community
➢ This step may or may not be needed depending on
the status of the initial organizer.
➢ If the initial organizer is from outside the community,
this step is a critical process. This may be the most
crucial step in the whole process.
Gatekeepers
➢ Those who control, both formally and informally, the
political climate of the community.
Thus, the term indicates that you must pass through this “gate”
to get to your priority population. These “power brokers” know
their community, how it functions, and how to accomplish tasks
within it.
3. Organizing the people
➢ Obtaining the support of community members to deal
with the problem.
➢ Best to begin by organizing those who are already
interested in seeing that the problem is solved
➢ It is also important to recruit people from the
subpopulation who are most directly affected by the
problem.
➢ A leader or coordinator must be identified from the
core group. The coordinator must possess the
following.
a.With leadership skills
b.Good knowledge of the concern and the community
c.Someone from within the community.
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Executive participants social service agencies, schools, hospitals and housing

◼ Core group of community members, the backbone of
the workforce and will end up doing the majority of the
work.
3.Organizing the people
Experience of members to be part of the volunteers.
When organizers are expanding their constituencies, they
should be sure to.
1.identify people who are affected by the problem that they are
trying to solve.
2.Provide “perks” for or otherwise reward volunteers.
3.keep volunteer time short
4.match volunteer assignments with the abilities and expertise
of the volunteers.
5.consider providing appropriate training to make sure
volunteers are comfortable with their tasks.
TASK FORCE
◼ A temporary group that is brought together for dealing
with a specific problem
COALITION
◼ Formal alliance of organizations that come together to
work a common goal.
◼ Coalition building is often an important step in
successful community organization
4.Assesing the Community
Community building
◼ An orientation to practice focused on community,
rather than a strategic framework or approach and on
building capacities not fixing problems.
➢ One of the major differences between community
organizing and the never ideas of community building
is the type of assessment that is used to determine
where to focus the community’s efforts.
➢ In the community organizing approach, the
assessment is focused on the needs of the
community, while in community building the
assessment focuses on the assets and capabilities of
the community.
Two reasons for completing an effective and
comprehensive assessment.
1.information is needed for change
2.it is also needed for empowerment.
structures)
3. Potential building blocks – are resources originating outside
the neighborhood and controlled by people outside (e.g welfare
expenditures and public information) the least accessible
assets.
By knowing the needs, assets and capacities of the
community, organizers can work to identify the true concern of
problems of the community and use of the assets of the
community as a foundation for dealing with the concerns or
problems.
5. Determining the priorities and setting goals
- the problems that have been identified must be prioritized
- This prioritization is best achieved through general agreement
or consensus of those who have been organized so that
“ownership” can take hold.
- without this sense of ownership, they will be unwilling to give
of their time and energy to solve it.
FIVE (5) CRITERIA WHEN SELECTING A PRIORITY OR
ISSUE (MILLER)
THE ISSUE OR PROBLEM:
1.Must be winnable
2.must be simple and specific
3.must unite members of the organizing group and must
involve them in a meaningful way in achieving resolution of the
issue.
4.should affect many people and build up the community
5.should be a part of a larger plan or strategy to enhance the
community
6.ARRIVING AT A SOLUTION AND SELECTING
INTERVENTION STRATEGIES
- These are alternative solutions for every community problem.
- a solution involves selecting one or more intervention
strategies
- agree on the best strategy and then select the most
advantageous intervention activity or activities.
- work toward consensus through compromise.

4.Assesing the Community

Needs assessment
◼ It is process by which data about the issues of
concern are collected and analyzed.
Mapping community capacity
◼ It is process of identifying community assets, not
concerns or problems.
◼ It is a process by which organizers literally a map to
identify the different assets of a community.

Category (building blocks) of assets and capacities

(McKnight and Kretzmann)
1.Primary building blocks – are the most accessible assets and
capacities. It can be organized into the assets and capacities
of individual (e.g, skills, talents, and incomes) and those of
organizations or associations (e.g, faith-based and citizen
organization)

4.Assesing the Community

Category (building blocks) of assets and capacities
(McKnight and Kretzmann)
2.Secondary building blocks – are assets located in the
neighborhood but largely controlled by people outside (e.g.

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FINAL STEPS IN THE COMMUNITY

ORGANIZING/BUILDING PROCESS: IMPLEMENTING, CREATING A HEALTH PROMOTION PROGRAM
EVALUATING, MAINTAINING AND LOOPING BACK
Success depends on many factors, including the assistance of
IMPLEMENTING THE PLAN a professional experienced in program planning.
- Implementing the intervention strategy and activities
that were selected in the previous step. Planning models are the means by which structure and
- Implementation of the intervention strategy includes organization are given to the planning process.
identifying and collecting the necessary resources for
implementation and creating the appropriate timeline SOME FREQUENTLY USED PLANNING MODELS
for implementation. 1.Precede-Proceed Model
2.Mobilizing action through planning partnership (MAPP)
EVALUATING THE OUTCOMES OF THE PLAN OF THE 3. Intervention Mapping
ACTION 4. CDCynergy
- Involves comparing the long-term and social 5. Social Marketing Assessment and response tool (SMART)
outcomes of the process to the goals that were set in 6. CDC workplace health model
an earlier step.
- Traditional evaluation of community organizing efforts
are not easy to carry out and have some limitations.
- These are times when evaluations are not well
planned or funded, as such they may fail to capture
the shorter term. System-level effects with which
community organizing is heavily concerned, such as
improvements in organizational collaboration,
community, involvement, capacity, and healthier
public policies or environments.
Lopping Back
- Process to rethink or rework before proceeding
onward in their plan.

HEALTH PROMOTION PROGRAMMING

Health promotion programming has now become an important

tool of community and public health professionals.

Health Education any combination of planned learning

experiences using evidence-based practices and/or sound
theories that provide the opportunity to acquire knowledge,
attitudes and skills needed to adopt and maintain health
behaviors.

Health promotion any planned combination of educational,

political environmental, regulatory, or organizational
mechanisms that support actions and conditions of living
conducive to the health individuals, groups, and communities.

Program Planning – a process by which an intervention is

planned to help meet the needs of a priority population.

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Preplanning is a quasi-step that allows program planners to

gather answers to key questions, which will help to them
understand the community and engage the priority
population (audience), those whom the health promotion
program is intended to serve.

ASSESSING THE NEEDS OF THE PRIORITY

POPULATION

Needs Assessment
Other terms: community analysis, community diagnosis, and
community assessment.

- The process of identifying, analyzing and prioritizing

the needs of a priority population.
- Used to create a useful and effective program for the
priority population
- Planners, with the assistance of the planning
committee, must determine the needs and wants of
the priority population.
- Identifies, prioritizes health, and establishes a
baseline for evaluating program impact.

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- An integral part of the piloting process is collecting

feedback from those in the pilot group.

PHASING IN
- Implementation of an intervention with a series of
small groups instead of the entire population.

EVALUATING THE RESULTS

Planning for evaluation occur during the first stage of program

development and at the end.

TWO-FOLD PURPOSE OF EVALUATION

CREATING AN INTERVENTION
INTERVENTION
- An activity or activities designed to create change in
people
- Planned actions designed to prevent disease or injury
or promote health in the priority population
MULTIPLICITY
- The number of components or activities that make up
the intervention or the size of the intervention.
DOSE
- The number of program units delivered as part of the
intervention.
BEST PRACTICES
- Recommendation for interventions based on critical
review of multiple research and evaluation studies
that substantiate the efficacy of the intervention.
BEST EXPERIENCE
- Intervention strategies used in prior or existing
programs that have not gone through the critical
research and evaluation studies and thus fall short of
best practice criteria.
BEST PROCESSES
- Original intervention strategies that the planners
create based on their knowledge and skills of good
planning processes including the involvement of those
in the priority population and the use of theories and
models.
1.To improve the quality of programs
2.To measure their effectiveness
EVALUATION
◼ Determining the value or worth of an object of interest
by comparing it against a standard of acceptability
STANDARD OF ACCEPTABILITY – A comparative mandates
(policies, and laws), values, norms, comparison/control groups
and the “how much” in an object for the program.
Categories of Evaluation
1.FORMATIVE EVALUATION – The evaluation that is
conducted during the planning and implementing processes to
improve or refine the program.
2.SUMMATIVE EVALUATION – The evaluation that
determines the effect of a program on the priority population
A. IMPACT EVALUATION – the evaluation that focuses on
immediate observable effects of a program
B. OUTCOME EVALUATION – The evaluation that focuses on
the end result of the program

IMPLEMENTING AN INTERVENTION

IMPLEMENTATION
- Putting a planned intervention into action
- The moment of truth, the actual carrying out or putting
into practice the activity or practices that make up the
intervention.
- The act of converting planning, goals, and objectives
into action through administrative structure,
management activities, policies, procedures,
regulation, and organizational actions of new
programs.
PILOT TEST
- A trial run of an intervention
- It is when the intervention is presented to just a few
individuals who are either from the intended priority
population or from a very similar population
- The purpose of pilot testing an intervention is to
determine whether there are any problems with it.
- It is recommended that the intervention be pilot with
the improvements in place before implementation.

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LESSON 6: PUBLIC HEALTH NUTRITION
PUBLIC HEALTH NUTRITION
➢ Is about applying knowledge to the solution of
nutrition-related health problems
➢ Approach focuses on the promotion of good health
(the maintenance of wellbeing or wellness, quality of
life) through nutrition and the primary (and secondary)
prevention of nutrition-related illness in the population
➢ Builds on a foundation of biological and social
sciences, depends on epidemiological evidence and
involves the development and implementation of
programs to improve and maintain health.
HEALTH (WHO)
➢ Defines health as a state of complete mental, physical
and social well-being, and not merely the absence of
disease or infirmity
PUBLIC HEALTH
➢ Is defined as the collective action taken by society to
protect and promote the health of entire populations.
It can be defined as the art and science of preventing
disease, promoting health and prolonging life through
the organized efforts of society.
EPIDEMIOLOGY
➢ Provides a rigorous set of methods to study disease
occurrence in human populations.
PUBLIC HEALTH APPROACHES
NARROW APPROACH
• Focuses on disease prevention and cost containment,
with health defined as the absence of disease
• Theory on the main cause of disease is based on the
way in which individuals live their lives.
• Motivation to change behavior is based on reducing
risk at an individual level.
• Approach links an individual’s own behavior to risk of
disease
• Burden of prevention and health promotion lies with
the individual and seen as their responsibility to
address their risk behavior
• Aimed at identifying immediate and obvious problems
now and addressing them now.
SECOND TERM, BSMT
BROAD APPROACH
➢ Broad approach defines health as more than the
absence of disease.
➢ Links public health science with policy: the action and
structures agreed by society aimed at improving and
maintaining health.
➢ Theoretical model is sociocultural: focuses on the
wider environment and seeks to understand the
factors that enable individuals to make healthy
choices or inhibit them.
➢ Motivating concern is about addressing the underlying
sociostructural factors such as poverty, global issues
and structures at a local, regional, national and
international level that affect health.
NUTRITION ASSESSMENT
➢ Data collected from several different sources to
assess patients’ nutritional needs, because no one
parameter directly measures nutrition status,
determines nutrition problems, or identifies needs.
➢ Estimating the number of calories (kcal) needed per
day is not easy.
➢ Direct measurements are not available except in a
research setting. Although predictive equations are
convenient and inexpensive, their inaccuracy makes
them unreliable for designing an appropriate nutrition
plan.
➢ Both overfeeding and underfeeding are to be avoided.
Both overfeeding and underfeeding are to be avoided.
“ABCD” includes four key areas of data
Anthropometrics assessment
Biochemical assessment
Clinical assessment
Dietary evaluation/assessment
Ecological assessment.
ANTHROPOMETRIC ASSESSMENT
Simple, noninvasive techniques that measures height and
Weight, head circumference, and skinfold thickness.
➢ Effectiveness of single anthropometric measurements
is limited, but certain serial measurements can be
useful to assess body composition changes or growth
over time.
➢ Evaluation of an anthropometric data involves a
comparison of data collected with predetermined
reference limits or cutoff points that allow
classification into one or more risk categories.
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 CPH LEC 2ND TERM

HEIGHT ◼ Overestimate body fat in individuals who have a

➢ Stature (height/length) is important in evaluating muscular build
growth and nutrition status in children, in adults is ◼ Cardiorespiratory fitness (CRF) is a potential modifier
needed for assessment of weight and body size. because the risk of all cause mortality is lowest in the
-Accurate height measurements are important overweight category.
-As people age, their height tends to decline may be related to
Osteoporotic changes, so a current height is valuable
Information.
➢ Men overstate height more often than women, and
the extent of overstating height increases as people
age.
WEIGHT
- Accurately measured, body weight is simple, gross
estimate of body composition. Weight is one of the
most important measurements in assessing nutrition
status and is used to predict energy expenditure. WAIST MEASUREMENT (WC)
- Beam scales with movable but nondetachable - Economical and straight forwarded measure that can
weights or accurate electronic scales are be used to assess abdominal (visceral) fat content
recommended to obtain accurate results. Spring - Circumference greater than 40 inches in mean and 35
scales are not recommended. inches in women indicates risk for disease
- As a nutrition screening took, weights can be used to - Visceral adiposity may vary among racial and ethnic
detect changes that may represent or suggest serious groups
health problems.
- Magnitude and direction of weight change are more
meaningful when dealing with sick debilitated patients
than standardized desirable weight references.
PERCENT WEIGHT CHANGE is a useful nutrition index may
be computed as follows
%Weight change = (usual weight – actual weight) + usual
weight x 100
%Weight TIME NUTRITION
change (in lbs) STATUS
1-2 1 WEEK MODERATE
WEIGHT LOSS
>2 1 WEEK SEVERE
WEIGHT LOSS
5 1 MONTH MODERATE
WEIGHT LOSS
>5 1 MONTH SEVERE
WEIGHT LOSS
EXAMPLE CASE:
Mrs. Andal is admitted to your ward. Her weight on admission WAIST TO HIP RATIO (WHR)
is 120 lbs. During the admissions interview, she ➢ Used for patients with human-immunodeficiency
indicates that 3 months ago she weighed 135 lbs. Her virus-acquired immunodeficiency syndrome (HIV-
percent weight change from her usual weight is AIDS)
calculated with the formula: ➢ Measure waist circumference divided by hip
% Weight change from admission weight = (Usual weight – circumference
Actual weight) ÷ Admission weight x 100
= (135-120) ÷ (135 x 100) = 15 ÷ 135 WAIST TO HEIGHT RATIO (WHtR)
= 0.11 x 100 ➢ Higher predicative capacity than either BMI or WC for
= 11% weight change diabetes, hypertension and cardiovascular risks and
Evaluation: Mrs. Andal’s (actual) weight is 11% less than her outcomes in both men and women.
usual weight. ➢ Measure waist circumference and divide by height
BODY MASS INDEX (BMI) ➢ Simple goal to keep WC to less than half of height
- Ratio of weight to heigh and has been associated with (>0.5)
overall mortality and nutrition risk BIOCHEMICAL ASSESSMENT
- BMI does not determine the body composition (lean
body mass and adipose tissue) gauge of total body fat 1.No single test is available for evaluating short-term response
- Some genetic makers have correlated high body fat to nutrition therapy.
percentages with death from cardiovascular diseases. • Laboratory values should be in conjunction with
anthropometric data, clinical data, and results of
LIMITATIONS OF BODY MASS INDEX dietary intake assessments
◼ Has not been validated in acutely ill patients 2.Some tests may be inappropriate for certain patients
◼ Underestimate body fat in the elderly and others who Ex: Serum Albumin
have lost muscle mass.

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• Might not be useful in the evaluation of protein status DIETARY INTAKE ASSESSMENT
in patients with liver failure because this test assumes
normal liver function.
2.Laboratory tests conducted serially will give more accurate 24-HOUR DIET RECALL
information than a single test. ➢ Patient is asked by a trained interviewer to report all
3. Laboratory test conducted serially will give more accurate foods and beverages consumed during the past 24
information than a single test hours
Biochemical parameters can be used to evaluate visceral ➢ Detailed description of all foods, beverages, cooking
proteins and immune function, which may reflect nutritional methods, brand names, condiments and supplements
status along with portion sizes in common household
VISCERAL PROTEINS – proteins found in internal organs and measures are included.
blood rather than in muscle. It is estimated through ➢ Useful in screening or during a follow-up to evaluate
tests of serum albumin and prealbumin adaptation and compliance with dietary
recommendations.
CLINICAL ASSESSMENT

ECOLOGICAL ASSESSMENT

➢ Sometimes called “environmental assessment” or

“ecological diagnosis”
➢ Indirect method of nutritional assessment that
involves obtaining information from ecological factors
which influences the nutritional status of an individual
or community.
➢ Comprehensive process in which data is collected
about how a child functions in different environments
or settings.
ECOLOGICAL FACTORS AFFECTING NUTRITION
1.socio-economic factors
- society-related economic factors that related to and influence
one another
- composite measure of an individual’s economic and
sociological standing
- accounts for a person’s work experience and economic and
social position in relation to others, based on income,
education, and occupation.
a.Employment – large impact on one’s food intake and
nutrition
◼ Manual Labor – use more energy
◼ Busy or demanding jobs – frequency of meals and
quality of food compromised
◼ Nature of work (shifting schedule, exposure to
hazards, etc) – risk for micronutrient deficiencies.
b. Education
◼ Education influences the choice of employment.
◼ Affects the knowledge and level of understanding on
nutrition and health in general.
c.Income
◼ Dramatically influence the food choices, suggest
purchasing power of a family.
d.Housing condition
◼ Medium through which socio-economic status is
expressed and health determinants operate.
◼ Provides physical security and protection from the
elements and plays a central role in determining an
individual’s physical and social risk environment.

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2. DEMOGRAPHY – Aspects of human’s population include
size and density, composition and distribution.
a.size – actual number of individuals in a population
b.density – measurement of population size per unit area.
c.composition – population described in terms of age and sex.
d. population distribution – pattern of where people live
(urban/rural)
3.GEOGRAPHY AND CLIMATE – Environmental factors
affect opportunities and potential for food production
a. location (coastal/mountainous)
b. altitude (low/high)
c. climate (cold/hot)
4.Agricultural factors
➢ Food is key outcome of agricultural activities, and in
turn, a key input into good nutrition.
➢ Agriculture sector can impact nutrition through the
production, purchase, and consumption of more,
better, and cheaper food.
5. Health system and service delivery
➢ Management and delivery of quality and safe health
services
➢ Help achieve high coverage of a broad range health
and nutrition services, especially for low resource
setting.
6.Cultural factors
➢ Most people food is cultural, not nutritional.
➢ Plant or animal may be considered edible in one
society and inedible in another.
➢ Culture is essential in the understanding the local
causes of malnutrition.
7.Political Factors
➢ Essential to nutrition programs, advocacy, resources
and operations
➢ Determines policy and budget.
➢ Political will, commitment, and leadership.
- Lack of political will is often cited as an obstacle to
progress for nutrition.
STRENGTHS OF ECOLOGICAL DATA
1.Provdes information on the basic causes of malnutrition.
2.Data on some ecological factors can easily be gathered (i.e.,
socioeconomic data, demographics, vital statistics)
3. obtained from secondary data most of the time.
4. aides in decision-making of priority health & nutrition
program.
5. provides opportunity to address the diverse causes of
malnutrition.
6. Effective basis on planning interventions on the national
level.
LIMITATIONS OF ECOLOGICAL DATA
1.Serves only as supplement for other methods of nutritional
assessment
2. should always be used in conjunction with other methods of
nutritional assessment.
3. need to only select/prioritize ecological variables to be
included in a study.
MALNUTRITION
➢ Refers to deficiencies, excess or imbalance in a
person’s intake or energy and/or nutrients
➢ Double burden of malnutrition consists of both
undernutrition and overweight and oesity, as well as
diet-related-noncommunicable-diseases.
SECOND TERM, BSMT
➢Poverty increases the risk of and consequences of
malnutrition
➢ Raises healthcare expenses, lowers productivity and
hinders economic growth.
2 BROAD GROUPS OF CONDITIONS OF MALNUTRITION
(FORM OF MALNUTRITION)
1.Undernutrition – includes stunting, wasting, underweight, and
micronutrient deficiencies.
2.Overnutrition – includes overweight, obesity, and diet-related
noncommunicable diseases.
FORMS OF MANULTRITION
1.UNDERNUTRITION
➢ Denotes insufficient intake of energy and nutrients to
meet an individual needs to maintain good health.
a.stunting
➢ Defined as low height-for-age
➢ Result of chronic or recurrent undernutrition, usually
associated with poverty, poor maternal health and
nutrition, frequent illness, and/or inappropriate feeding
and care in the early life.
➢ Stunting prevents children from reaching their
physical and cognitive potential.
b.Wasting
➢ Defined as low weight-for-height
➢ Indicates and severe weight loss, though it can also
persist for a long time.
➢ Usually occurs when a person has not had food of
adequate quality and quantity and/or they have had
frequent or prolonged illnesses.
➢ Wasting in children is associated with a higher risk of
death if not treated properly.
c.underweight
➢ Any weight computed below the normal BMI.
Common medical condition is anorexia nervosa.
Anorexia is psychological disorder whereby people
become underweight due to deliberately limiting food
intake
D.micronutrient deficiency
➢ Deficiency of the essential vitamins and minerals
which are needed for physiological function and
development. Main micronutrient deficiencies in
developing countries are iodine, vitamin A. and iron.
SEVERE ACUTE MALNUTRITION (SAM)
➢ Severe acute malnutrition in children 6-59 months of
age is defined as weight-for-height less than -3 z-
scores of the presence of edema of both feet, or a
mid-upper arm
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 CPH LEC 2ND TERM
➢ Children with SAM are at risk for hypogylcemia,
hypothermia serious infections, dehydrations, and
severe electrolyte disturbances.
A. Marasmus
➢ Characterized by severe wasting. It is a severe
manifestation of protein-energy malnutrition. It
occurs as a result of total calorie insufficiency.
This leads to overt loss of adipose tissue and
muscle. The child may have a weight-for-height
value that is more than 3 standard deviations
below the average for age or sex. Marasmic
children are extremely thin.
B. Kwashiorkor
➢ is a severe manifestation of protein-energy
malnutrition. It is associated with a poorquality
diet high in carbohydrates but low in protein
content such that the child may have a sufficient
total energy intake. Severe protein insufficiency
leads to characteristic bilateral pitting pedal
edema and ascites.
C. Marasmic-Kwshiorkor
➢ Characterized by severe wasting with edema. Bi-
lateral edema and weightfor-height of less than -2
SD
MICRONUTRIENT DEFICIENCIES
MICRONUTRIENTS
- Known as vitamins and minerals
- Essential components of high-quality diet and have a
profound impact on health.
- Required only in tiny quantities, however they are
essential building blocks of healthy brains, bones, and
bodies.
MICRONUTRIENT DEFIENCY
- Referred to as “hidden hunger” because they develop
gradually over time, their devastating impact not seen
until irreversible damages has been done.
COMMON MICRONUTRIENT DEFICIENCIES
IODINE Deficiency
SECOND TERM, BSMT
- Lead to brain damage in children, particularly during
fetal development and in the first few years of child’s
life.
- Leading causes of preventable mental retardation and
brain damage.
- Can lead to hypothyroidism and cretinism and other
iodine deficiency disorder (IDD)
- Normal requirements for iodine for human averages
150ug per day.
VITAMIN A Deficiency
- Vitamin a consists of retinol (pre-formed-vitamin),
retinal, retinoic acid, and beta-carotene (pro-vitamin)
- Normal function is for normal vision in dim light
- Maintains the integrity and normal function of
glandular and epithelial tissues which lines intestinal,
respiratory and urinary tracts as well as skin and
eyes.
- Support growth (skeletal growth)
- Essential for maintenance of proper immune system.
Ex. Follicular hyperkeratosis, Anorexia and growth retardation,
night blindness, conjunctival xerosis, bitot’s spots,
corneal xerosis, keratomalacia
IRON Deficiency
- Iron is an essential mineral that is needed to form
hemoglobin, an oxygen carrying protein inside red
blood cells.
- - A deficiency in iron can lead to several conditions
such as anemia, risk of hemorrhage during childbirth
that can lead to maternal deaths, vulnerability to
infections, learning disabilities, and delayed
development.
OVERNUTRITION
➢Occurs when an individual has an excessive
consumptions of food, far more than from their dietary
needs.
➢ It can lead to heart disease, obesity, and other dietary
disorders.
Ex. Bulimia, obesity which is a risk factor for diabetes,
hypertension, polycystic ovary syndrome (PCOS),
coronary heart disease, obesity
30
 CPH LEC 2ND TERM

LESSON 8: Environmental and Occupational Health

➢ Breathing ozone can result in variety of health
problems including chest pain, coughing, throat
irritation congestion, bronchitis, emphysema,
ENVIRONMENTAL HEALTH
asthma, and reduced lung function

Health is affected by the quality of the environment.

➢ Repeated exposure to ground-level ozone may
Quality of the environment including air to breath, water to permanently scar lung tissue
drink, food to eat and the type of community to ➢ Excessive levels of ground-level ozone is a
live. phenomenon referred to as a thermal inversion a
condition that occurs when warm air traps cooler air at
ENVIRONMENTAL HEALTH study and management of the surface of the earth.
environmental conditions that affects the health and
well-being of humans.
OUTDOOR AIR POLLUTANTS
ENVIRONMENTAL HAZARDS factors or conditions in the
environment that increase the risk of human injury,
disease, or death. RA 8749: PHILIPPINE CLEAN AIR ACT OF 1999
➢ Act providing for comprehensive air pollution control
policy and for other purposes
OUTDOOR AIR POLLUTANTS
➢ Overall leading agency is the department of
environment and natural resources (DENR) together
AIR POLLUTION with other government agencies such as DOTC,
➢ Contamination of the air that interferes with the DOST, DTI, DOE, PAGASA, PNRI, DEPED AND
comfort, safety CHED
➢ Contamination of the air by substances- gases, liquids WHAT ARE COVERED BY THE CLEAN AIR ACT?
or solids in amounts great enough to harm humans 1.All potential sources of air pollution (mobile, point and area
the environment or the alter climate sources) must comply with the provision of the law, all
emission must be within the air quality standards
Pollutants are generally divided further into 2.mobile sources refer to vehicles like cars, trucks, buses,
PRIMARY POLLUTANT air pollutant emanating directly from jeepneys, tricycles, motorcycles, and vans.
transportation, power and industrial plants and 3.point sources refer to stationary sources such as industrial
refineries. firms and the smokestacks of power plants, hotels
ex: carbon monoxide, carbon dioxide, sulfur dioxide, nitrogen and other establishments.
oxides, hydrocarbons, and suspended particulates 4.area sources refer to sources of emission other than the
SECONDARY POLLUTANT air pollutant formed when primary above, these include smoking, burning of garbage,
air pollutants react with sunlight and other and dust from construction, unpaved grounds.
atmospheric components to form new harmful TABLE 14.1 CRITERIA POLLUTANTS
compounds Pollutants FORM(s) MAJOR
ex: nitrogen dioxide, nitric acid, nitrate salts, sulfur trioxide, (Designation) SOURCES (IN
sulfate salts, sulfuric acid, peroxyacyl nitrates and ORDER OF
ozone. PERCENTAGE
OF
PHOTOCHEMICAL SMOG (BROWN SMOG) CONTRIBUTION)
➢ Haze or fog formed when air pollutants interact Carbon Gas Transportation,
with sunlight monoxide (CO) industrial
INDUSTRIAL SMOG (GRAY SMOG) processes, other
➢ Haze or fog formed primarily by sulfur dioxide solid waste,
and suspended particles from the burning of coal, stationary fuel
also known as gray smog. combustion.
Health problems when air pollution reaches harmful levels Lead (Pb) Metal or Transportation,
ACUTE HEALTH EFFECTS aerosol industrial
Ex: burning eyes, shortness of breath and increased processes,
incidences of colds, coughs, nose irritation and other stationary fuel
respiratory illness combustion, solid
CHRONIC HEALTH EFFECTS waste.
Ex: chronic bronchitis, emphysema and increased incidence of Nitrogen dioxide Gas Stationary fuel
bronchial asthm attacks, and increased risk of lung (NO2) combustion,
cancer. transportation,
industrial
OZONE (O3) processes, solid
➢ Inorganic molecule considered to be pollutant in waste
the atmosphere because it harms human tissues Ground-level gas Transportation,
but considered beneficial in the stratosphere ozone (O3) industrial
because it screens out UV radiation. processes, solid
➢ Represent the single most dangerous air waste, stationary
pollutant

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fuel combustion (purple) Everyone may

Particulate Solid or liquid Industrial experience
matter processes, more serious
stationary fuel health effects.
combustion, Hazardous >300 Health
transportation, (maroon) warnings of
solid waste emergency
Sulfur dioxide Gas Stationary fuel conditions. The
(SO2) combustion, entire
industrial population is
processes, more likely to
transportation be affected.
other wastes.
INDOOR AIR POLLUTANTS
FIGURE 14.3 COLOR CODES FOR VARIOUS AIR
QUALITY INDICES SOURCES OF INDOOR AIR POLLUTANTS
➢ Building and insulation materials, biogenic pollutants,
AIR QUALTIY NUMERICAL MEANING combustion by-products, home furnishings and
INDEX VALUE cleaning agents, radon gas and tobacco smoke
LEVELS OF ASBESTOS
HEALTH ➢ Naturally occurring mineral fiber identified as a class
CONCERN A carcinogen by the EPA. It is harmless if intact and
Good (green) 0-50 Air quality is left alone, but when disturbed, inhaled airborne, fibers
considered can cause serious health problems.
satisfactory, BIOGENIC POLLUTANTS
and air pollution ➢ Airborne materials of biological origin such as living
poses little or and nonliving fungi and their toxins, bacteria, viruses,
no risk. molds, pollens, insect’s parts, and animal dander.
Moderate 51-100 Air quality is These contaminants can trigger allergic reaction,
(yellow) acceptable; including asthma, cause infection illnesses, such as
however for influenza and measles or release disease – producing
some pollutants toxins.
there ay be a REDUCING BIOGENIC POLLUTANTS
moderate 1.Relative humidity level of 30% to 50% (recommended)
health concern 2.remove standing water and any wet or water-damaged
for a every material at home
small number of 3.inspection of house regularly by someone knowledgeable
people who are about indoor air pollutions.
unusually COMBUSTION BY-PRODUCTS
sensitive to air ➢ Include gases (e.g., CO, NO2 And SO2) and
pollution. particulates (e.g ash and soot)
Unhealthy for 101-150 Members of ➢ Major sources of these items are fireplaces, wood
sensitive sensitive stoves, kerosene heaters, candles, incense,
groups groups may secondhand tobacco smoke, and improperly
(orange) experience maintained gas stoves and furnaces.
health effects; VOLATILE ORGANIC COMPOUNDS (VOCs)
the public is not ➢ Compound that exists as vapors over the normal
likely to be range of air pressures and temperatures ex:
affected formaldehyde.
Unhealthy 151-200 Everyone may
(Red) begin to
experience SOURCES OF WATER POLLUTION
health effects;
members of
sensitive WATER POLLUTION
groups may be ➢ Any physical or chemical change in water that can
experience harm living organisms or make the water unfit for
more serious other uses as drinking, domestic use, recreation,
health effects fishing, industry, agriculture, or transportation
Very unhealthy 201-300 Health alert, POINT SOURCE POLLUTION
(purple) everyone may ➢ Refer to a single identifiable source that discharges
experience pollutants into the water, such as a pipe, ditch, or
more serious culvert. Point sources of pollution are relatively easy
health effects to identify control and treat.
➢ Ex: release of pollutants from a factory or sewage
Very unhealthy 201-300 Health alert.
treatment plant.

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 CPH LEC 2ND TERM

NONPOINT SOURCE POLLUTION or drinking raw (unpasteurized) milk (bacterial

➢ All pollution that occurs through the runoff, seepage, outbreaks)
or failing of pollutants into the water where the source
is difficult or impossible to identify.

TYPES OF WATER POLLUTANTS

BIOLOGICAL POLLUTANTS
➢ Living organisms or their products that make water PESTICIDES
unsafe for human consumption PEST
➢ Ex: virus, bacteria, parasites and other undesirable ➢ Any microorganism – a multi-celled animal or plant, or
living microorganisms. a microbe- that has an adverse effect on human
WATERBORNE VIRUSES interests.
PATHOGEN DISEASE/CONDITION PESTICIDE
Poliovirus Polio ➢ Synthetic chemical developed and manufactured for
Hepatitis A virus Hepatitis A the purpose of killing pets
WATERBORNE PARASITES TARGET ORGANISM (TARGET PEST)
Pathogen Disease/condition ➢ Organism (or pest) for which a pesticide is applied
Entamoeba histolytica Amoebiasis NONTARGET ORGANISMS
Giardia lamblia Giardiasis ➢ Other susceptible organisms in the environment, for
Cryptosporidium parvum Cryptosporidiosis which a pesticide was not intended.
WATERBORNE BACTERIA Two most widely used types of pesticides are herbicides
(pesticides that kill plants) and insecticides (pesticides
Pathogen Disease/condition
that kill insects)
Escherichia coli Gastroenteritis
TABLE 14.4 TYPES OF PESTICIDES
Legionella spp. Legionellosis
TYPE OF AGENT TARGET PEST TO BE
Salmonella typhi Typhoid fever
DESTROYED
Shigella spp. Shigellosis or bacillary
Acaricides/miticides Ticks/mites
dysentery
bactericides Bacteria
Vibrio cholera Cholera
fungicides Fungi. Molds
herbicides Weeds, plants
TYPES OF WATER POLLUTANTS insecticides Insects
Larvicides/grubicides Insect larvae
NONBIOLOGICAL POLLUTANTS Molluscicides Snails, slugs
Ex: heat, inorganic, chemicals such as lead, copper, and nematocides worms
arsenic, organic chemicals, and radioactive rodenticides Rats, mice
contaminants.
WATERBORNE DISEASE OUTBREAK (WBDO)
➢ A disease in which at least two persons experience a RA 10611: FOOD SAFETY ACT OF 2013
similar illness after the ingestion of drinking water or An act to strengthen the food safety regulation system in the
after exposure to water used to recreational purposes country to protect consumer health and facilitative
and epidemiological evidence implicates water as the market access of local foods and food products and
probable source of the illness. for other purposes.
RA 9275 – THE PHILIPPINE CLEAN WATER ACT OF 2004 OBJECTIVES OF THIS ACT:
➢ Aims to protect the country’s water bodies from To strengthen the good safety regulatory system in the
pollution from land-based source (industries and country, the state shall adopt the following specific
commercial establishments, agriculture and objectives.
community/household activities) (a) Protect the public from food-borne and water-borne
➢ Provides for comprehensive and integrated strategy illnesses and unsanitary, unwholesome, misbranded
to prevent and minimize pollution through a multi- or adulterated foods.
sectural and participatory approach involving all the (b) Enhance industry and consumer confidence in the
stakeholders food regulatory system and
➢ DENR in coordination with NATIONAL WATER (c) Achieve economic growth and development by
RESOURCES BOARD (NWRB) promoting fair trade practices and sound regulatory
foundation for domestic and international trade.
FOODBORNE DISEASE OUTBREAKS
➢ CDC defines FBDO as the occurrence of two or more
cases of a similar illness resulting from the ingestion
of a common food.
LEADING FACTORS THE CONTRIBUTED TO FBDOs
1.inadequate cooking temperatures or improper holding
temperatures for foods (Especially for bacterial
outbreaks)
2.unsanitary conditions or practices at the point of service,
such as failure to wash hands (norovirus outbreaks);

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 CPH LEC 2ND TERM

Hazardous waste management program (RCRA SUBTITLE C)

Sets national standards for:
◼ Hazardous waste management
◼ Provides for EPA authorization and oversight of state
implementation of RCRA
◼ Includes corrective action authorities to address
releases to the environment.

SOLID AND HAZARDOUS WASTE

SOLID WASTE garbage, refuse, sludge and other discarded

CONTROLLING VECTORBORNE DISEASE
solid materials most solid waste, 95% to 98% can be
traced to agriculture, mining and gas and oil
production and industry VECTOR
NINE MAJOR CATEGORIES ➢ Living organism usually an insect or other arthropod
Paper wood that can transmit a communicable disease agent to a
Yard waste metals susceptible host (e.g, a mosquito or tick)
Food scraps glass and other. VECTORBORNE DISEASE OUTBREAK (VBDO)
Rubber and textiles ➢ Occurrence of an unexpectedly large number of
cases of disease caused by an agent transmitted by
HAZARDOUS WASTE solid waste or combination of solid insects or other arthropods
waste that is dangerous to human health or the
environment that requires special management and
disposal
a waste is hazardous if it is ignitable, corrosive, reactive or
toxic or if it is otherwise designated hazardous by the
EPA

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 CPH LEC 2ND TERM

NATURAL HAZARDS

NATURAL HAZARD
➢ Naturally occurring phenomenon or event that
produces or releases energy in amounts that exceed
human endurance, causing injury, disease, or death
(such as radiation, earthquakes, tsunamis, volcanic
eruptions, hurricanes, tornados, and floods)
NATURAL DISASTER
➢ Natural hazard that results in substantial loss of life or
property.
RADIATION
➢ Process in which energy is emitted as particles or
waves
IONIZING RADIATION
➢ High-energy radiation that can knock an electron out
of orbit, creating an ion, and can thereby damage
living cells and tissues (UV Radiation, gamma rays,
X-rays, Alpha, and beta particles)
ULTRAVIOLET (UV) radiation
➢ Radiant energy with wavelengths of o to 400
nanometers.

PSYCHOLOGICAL AND SOCIOLOGICA HAZARDS

POPULATION GROWTH
➢ Can be attributed or three factors – birth rate, death
rate and migration
➢ When the birth rate an death rate are equal,
population growth is zero
➢ When the birth rate exceeds the death rate, the
population size increase
➢ Increases in population size and per capita
consumption result in an ever-increasing
environmental impact
CARRYING CAPACITY
➢ Maximum impact that can be supported by available
resources (air, water, shelter, etc)

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 CPH LEC 2ND TERM

OCCUPATIONAL HEALTH

UNINTENTIONAL INJURIES IN THE WORKPLACE

MINOR INJURIES
➢ Bruises, cuts, abrasions, and minor burns
MAJOR INJURIES
➢ Amputations, fractures, severe lacerations, eye loses,
acute poisonings, and severe burns
OCCUPATIONAL INJURIES AND ACCIDENTS

PREVENTION AND CONTROL OF UNINTENTIONAL

INJURIES IN THE WORKPLACR

Four fundamental tasks

1.anticipation
2.recognition
3.evaluation
4.control
ANTICIPATION
➢ Involves the foresight to envision future adverse
events and take action to prevent them, a hazard
inventory should be conducted to detect and record
physical, ergonomic, chemical, biological and
psychological hazards in the workplace.
RECOGNITION
➢ Involves surveillance and monitoring of the workplace
for injuries and illnesses, including near misses. It
includes inspections of the workplace for hazards,
monitoring it for toxins recording injuries and
conducting employee health screenings.
EVALUATION
➢ the assessment of the data that were collected during
the recognition and monitoring activities. This includes
toxicological, exposure, and clinical assessment as
well as risk assessment. Epidemiology is part of the
evaluation process. Risk assessment enables the
translation of scientific information about hazards into
decisions and policies that can improve workplace
safety and health
CONTROL
➢ may involve changes in the production process to
make it safer, changes in the work environment to
make it safer, or improvements in the use of personal
protective equipment or apparel to protect individual
workers

WORKPLACE VIOLENCE: INTENTIONAL WORKPLACE

INJURIES

FOUR CATEGORIES OF WORKPLACE VIOLENCE

Criminal intent (Type I)

The perpetrator has no legitimate relationship to the
business or its employees and is usuallycommitting a
crime. This category makes up 85% of the work-
related homicides. Ex. robbery, shoplifting, and
trespassing.

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 CPH LEC 2ND TERM
Customer/client (Type II)
The perpetrator has a legitimate relationship with the business
and becomes violent while being served. This category
includes customers, clients, patients, students, and inmates.
This category represents 3% of the work-related homicides
Worker-on-worker (Type III)
The perpetrator is an employee or past employee of the
business who attacks or threatens another employee or past
employee of the workplace. Worker-on-worker violence
accounts for 7% of workplace homicides.
Personal relationship (Type IV)
The perpetrator usually does not have a relationship with the
business but has a personal relationship with the intended
victim. This category, which includes victims of domestic
violence assaulted or threatened at work, makes up just 2% of
workplace homicides
PREVENTION STRATEGIES
THREE (3) CATEGORIES
1.Environmental designs
2.administrative controls
3.behavior strategies
Before these strategies can be implemented, a workplace
violence prevention policy should be in place
ENVIRONMENTAL DESIGNS
➢ to limit the risk of workplace violence might include
implementing safer cash handling procedures,
physically separating workers from customers,
improving lighting, and installing better security
systems at entrances and exits
ADMINISTRATIVE CONTROLS
➢ include staffing policies (having more staff is generally
safer than having fewer staff ), procedures for
opening and closing the workplace, and reviewing
employee duties (such as handling money) that may
be especially risky
BEHAVIOR STRATEGIES
➢ include training employees in nonviolent response
➢ and conflict resolution and educating employees
about risks associated with specific duties and about
the importance of reporting incidents and adhering to
administrative controls
OCCUPATIONAL ILLNESSES AND DISORDERS
TYPES OF OCCUPATIONAL ILLNESSES
➢ Occupational diseases can be categorized by cause
and by the organ or organ system affected
MUSCULOSKELETAL DISORDERS
➢ are the most frequently reported occupational
disorders. They include both acute and chronic injury
to muscles, tendons, ligaments, nerves, joints, bones,
and supporting vasculature. Ex. carpal tunnel
syndrome and noise-induced hearing loss
SECOND TERM, BSMT
SKIN-DISEASE AND DISORDERS
➢ includes allergic and irritant dermatitis, eczema, rash,
oil acne, chrome ulcers, and chemical burns
NOISE-INDUCED HEARING LOSS
➢ is another form of repeated trauma. Most of the cases
were reported within manufacturing; within the
manufacturing sector, 51% of the cases were
associated with manufacturing.
TYPES OF OCCUPATIONAL ILLNESSES
RESPIRATORY DISORDERS
➢ Occupational respiratory disorders are the result of
the inhalation of toxic substances present in the
workplace.
➢ - Mining is a dangerous occupation because of
exposure to injuries and to coal dust, which can cause
chronic lung disease.
➢ Ex. Work-related asthma (WRA) – most common
Pneumoconiosis - a fibrotic lung disease caused by
the inhalation of dusts, especially mineral dusts.
➢ Types: coal workers’ pneumoconiosis (black lung
pneumoconiosis)
➢ Asbestosis – is an acute or chronic lung disease
caused by the deposition of asbestos fibers on lungs.
➢ Silicosis - an acute or chronic lung disease caused by
the inhalation of free crystalline silica
➢ Byssinosis - an acute or chronic lung disease caused
by the inhalation of cotton, flax, or hemp dusts (brown
lung disease)
Prevention and Control of Occupational Diseases and
Disorder
➢ Requires the vigilance of employer and employee
alike and the assistance of governmental agencies.
➢ The agent-host-environment disease model is
applicable to preventive strategies.
Specific activities that should be employed to control
occupational diseases include:
1. Identification and evaluation of agents
2. Standard setting for the handling of and exposure to
causative agents
3. Elimination or substitution of causative factors
4. Engineering controls to provide for a safer work area
5. Environmental monitoring
6. Medical screenings
7. Personal protective devices
8. Health promotion
9. Disease surveillance
10. Therapeutic medical care and rehabilitation, and
compliance activities
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LESSON 9: ALCOHOL, TABACCO AND OTHER DRUGS: A COMMUNUITY CONCERN

DEFINITIONS

Drug -> a substance other than food or vitamins that when

takes in small quantities alters one’s physical, mental
or emotional state.
Psychoactive drugs -> are drugs that alter sensory
perceptions, mood, thought processes, or behavior.
Drug use -> nonevaluative term referring to drug taking
behavior in general; regardless of whether the
behavior is appropriate.
Physical Dependence -> physiological state in which
discontinued drug use results in clinical illness.

Drug abuse
➢ Use of a drug when it is detrimental to one’s health or
well-being
➢ Occurs when one takes a prescription or
nonprescription drug for a purpose other than that for
which It is medically approved
➢ Use of alcohol and nicotine by those under the legal
age is considered drug abuse
Drug misuse
➢ Inappropriate use of prescription or nonprescription
drugs
Drug (chemical) dependence
FACTORS THAT CONTRIBUTE TO ALCOHOL,
➢ Psychological and sometimes physicals state
TOBACCO AND OTHER DRUG ABUSE
characterized by a craving for a drug.
➢ Users feel that drug is necessary for normal
functioning.
TWO TYPES OF FACTORS

RISK FACTORS
◼ Factors that increase the probability of drug use.
PROTECTIVE FACTORS
◼ Factors that lower the probability of drug use.

People with a high number of risk factors are said to be

vulnerable to drug abuse or dependence. While those
who have few risk factors and more protective factors
are said to be resistant to drug abuse.
Risk and protective factors can be either genetic (inherited) or
environmental.

ENVIRONMENTAL RISK FACTORS

1.PERSONAL FACTORS
➢ Include personality traits, such as impulsiveness,
depressive mood, susceptibility to stress or possibly
personality disturbances.
2.HOME AND FAMILY LIFE
➢ Family structure, family dynamics, quality of parenting
and family problems can all contribute to drug
experimentation by children and adolescents.
3. SCHOOL PEER AND GROUPS
➢ Perceived and actual drug use by peers influences
attitudes and choices by adolescents.
➢ Perceived support of drinking by peers is the single
most important factor in an adolescent’s choice to
drink.

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4.SOCIOCULTURAL ENVIRONMENT 6.ALCOHOL RELATED BIRTH DEFECTS (ARBD)

➢ Notion of environmental risk includes the effects of ◼ People with ARBD might have problems with the
sociocultural and physical setting on drug-taking heart, kidneys, or bones or with hearing.
behavior 7.ALCOHOL RELATED NEURODEVELOPMENTAL
➢ Environmental risk for drug-taking can stem from DISORDER (ARND)
one’s immediate neighborhood or from society at ◼ People with ARND might have intellectual disabilities
large. and problems with behavior and learning. They might
do poorly in school and have difficulties with math,
memory, attention, judgments and poor impulse
TYPES OF DRUGS ABUSED AND RESULTING
control.
PROBLEMS
TYPES OF DRUGS ABUSED AND RESULTING
PROBLEMS
LEGAL DRUG
◼ Drugs that can be legally bought and sold in the
marketplace, including those that are closely LEGAL DRUG
regulated like morphine: those that are lightly
regulated, like alcohol and tobacco; and still others. NICOTIME
That are not regulated at all, like caffeine. ➢ Is the psychoactive and addictive drug present in
ALCOHOL -> number one problem drug by almost any tobacco products such as cigarettes, e-cigarettes,
standard of measurement cigars, smokeless or “spit” tobacco (chewing tobacco
➢ Number of those who abuse it and snuff) and pipe tobacco
➢ Number of injuries and injury death it causes ➢ Tobacco use is the single most preventable cause of
➢ Amount of money spent on it disease, disability, and death
➢ Social and economic costs to society through broken HEALTH CONSEQUENCES OF TOBACCO USE
homes and lost wage. 1.increased risk for heart disease
PROBLEM DRINKER 2.lung cancer
➢ One for whom alcohol consumption results in a 3.chronic obstructive lung disease
medical, social, or other type of problem. They begin 4.stroke.
to experience personal, interpersonal, legal or 5. emphysema and other conditions
financial problems because of their alcohol
consumption.
TYPE OF DRUG ABUSED AND RESULTING PROBLEMS
ALCOHOLISM
◼ Disease characterized by impaired control over
drinking, preoccupation with drinking and continued ENVIRONMENTAL TOBACCO SMOKE (ETS)
use of alcohol despite adverse consequences. SECONDHAND SMOKE)
◼ Alcoholism is a primary, chronic disease with genetic, ◼ The effects of environmental tobacco some (ETS)
psychosocial, and environmental factors influencing or secondhand smoke indicated that adults and
its development and manifestations. children who inhale the tobacco smoke of others
(passive smoking) are also at increased risk for
Two (2) important characteristics of alcoholism cardiac and respiratory illnesses.
1.Physical dependence on alcohol LEGAL DRUG
2.loss of control over one’s drinking. OVER – THE – COUNTER (OTC) DRUGS
◼ Over-the-counter (OTC) drugs (nonprescription drugs)
Blood Alcohol concentration (BAC) – Percentage of drugs (Except tobacco and alcohol) that can be
concentration of alcohol in the blood. legally purchased without a physician’s prescription
Include in the category are:
1.internal analgestics
COMMUNITY HEALTH PROBLEMS RESULTING FROM
Ex: aspirin, acetaminophen (tylenol) and ibuprofen (advil)
DRINKING
2.cough and cold remedies (robitussin)
3. emetics
1.Underage drinking 4.laxatives
2.Vehicular accident 5.mouthwashes
3.Unintentional injuries 6.vitamins and many others.
Ex. Drowning, falls, fires, and burns
TYPE OF DRUG ABUSED AND RESULTING PROBLEMS
4. INTENTIONAL VIOLENCE
Ex: child abuse, rape and other sexual assault, homicide,
assault, suicide and spouse and partner abuse. LEGAL DRUG
5. FETAL ALCOHOL SPECTRUM DISORDER (FASD) PRESCRIPTION DRUGS
◼ Range of disorders cause by prenatal exposure to ◼ Purchased only with a physician’s (or dentists) written
alcohol instructions (prescription)
◼ Cause by drinking during pregnancy and include ◼ Prescription drugs are also subject to misuse and
diagnoses such as fetal alcohol syndrome (FAS), abuse.
alcohol – related birth defects (ARBD) and alcohol- TYPE OF MISUSE
related neurodevelopmental disorders (ARND) 1.RE-USE OF PREVIOUSLY PRESCRIBED OTC DRUGS
2.GIVING OF ONE PERSON’S PRESCRIPTION DRUG TO
ANOTHER.

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ILLEGAL DRUG (CONTROLLED SUBSTANCES) TREATMENT

➢ Goal of treatment is to remove the physical,
CONTROLLED SUBSTANCES emotional, and environmental conditions that have
◼ Drugs regulated by the “comprehensive dangerous contributed to drug dependency.
drugs act of 2002” including all illegal drugs and ➢ Treatment aims to reduce demand for drugs
prescription drugs that are subject to abuse and can ➢ Also aims to save money
produce dependence ➢ Drug abuse treatment, what happens after the initial
ILLICIT (ILLEGAL) DRUGS treatment phase is critical
◼ Drugs that cannot be legally manufactured, distributed ➢ Aftercare the continuing care provided to the
or sold, and that usually lack recognized medicinal recovering former drug abuser, involves peer group or
value. self-help-support group meetings.
ILLEGAL DRUG (CONTROLLED SUBSTANCES) PUBLIC POLICY
1.Marijuana ➢ Embodies the guiding principles and course of action
2.synthetic marijuana pursued by governments to solve practical problems
3.narcotics (opium, morphine, heroin) affecting society.
4.cocaine and crack, cocaine ➢ Public policy should guide the budget discussion that
5.stimulants (amphetamines) ultimately determine how much a community spends
6.depressants (barbiturates, benzodiazapines) for education, treatment, and law enforcement.
7.club drugs and designer drugs
8.anabolic drugs (steroids) ELEMENTS OF PREVENTION
9.inhalants (psychoactive breathable chemicals)
LAW ENFORCEMENT
PREVENTION AND CONTROL OF DRUG ABUSE ➢ Law enforcement in drug abuse prevention and
The prevention and control of alcohol and other drug abuse
control is the application of federal, state and local law
required a knowledge of the
to arrest, jail, bring to trial and sentence those who
1.causes of drug-taking behavior break drug law or break laws because of drug use.
2.sources of illicit drugs The primary rules of law enforcement in a drug abuse
3.drug laws
prevention and control program are to:
4.treatment programs
1.control drug use;
5.community organizing skills 2.control crime, especially crime related to drug use and drug
6.persistence trafficking0 the buying, selling, manufacturing, or
7.cooperation among a vast array of concerned individuals and
transporting of illegal drugs.
official and unofficial agencies
3.prevent the establishment of crime organizations and
LEVELS OF PREVENTION 4.protect neighborhoods, law enforcement is concerned with
limiting the supply of drugs in the community by
interrupting the source, transit and distribution of
PRIMARY PREVEVENTION
drugs.
➢ Progress is aimed at those who have never used
drugs, and their goal is to prevent or forestall the
GOVERNMENTAL DRUG PREVENTION AND CONTROL
initiation of drug use
AGENCIES AND PROGRAMS
1.drug education programs that stress primary prevention of
➢ Governmental agencies involved in drug abuse
drug and alcohol use are most appropriate
prevention, and treatment include a multitude of
2.any activity that would reduce the likelihood of primary drug
federal, state, and local agencies. It aims is to reduce
use.
either the supply of or the demand for drugs.
Ex.
1.raising the price of alcohol
NONGOVERNMENTAL DRUG PREVENTION AND
2.increasing cigarette taxes
CONTROL AGENCIES AND PROGRAMS
3.arresting a neighborhood drug pusher.
1.Community based drug education programs
2.school-based drug education programs
ELEMENTS OF PREVENTION
3.workplace-based drug education programs
Four basic elements play a role in drug abuse prevention and
4. voluntary health agencies
control
1.education
1.community-based drug education programs
2.treatment
- occur in a variety of setting such as childcare facilities, public
3.public policy
housing, religious institutions, businesses and health
4.enforcement
care facilities.
Community based drug education programs are most
EDUCATION
likely to be successful when they include six key
➢ The purpose of drug abuse education is to:
features
1.limit the demand for drug providing information about drugs
1.a comprehensive strategy
and dangers of drug abuse.
2.an indirect approach to drug prevention.
2.changing attitudes and beliefs about drugs
3. goal of empowering youth
3.providing the skills necessary to abstain from drugs.
4. participatory approach
4.and ultimately changing drug abuse behavior.
6. highly structured activities

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2.SCHOOL-BASED DRUG EDUCATION PROGRAMS

➢ Most health educators believe that a strong
comprehensive school health education program --
one that occupies a permanent and prominent place
in the school curriculum – is the best defense against
all health problems, including drug abuse.
3. WORKPLACE-BASED DRUG EDUCATION PROGRAMS
➢ Had also become apparent to all that drug abuse is
not just a personal health problem and a law
enforcement problem, but that it also is a behavior
that affects the safety and productivity of others
especially at work.
➢ Substance abuses (1) are less productive (2) miss
more workdays (3) are more likely to injure
themselves and (4) file more workers compensation
claims than their non-substance-abusing counterparts

4. VOLUNTARY HEALTH AGENCIES

➢ Drug prevention and control programs are carried out
at the local level with the cooperation and effort of
many communities’ members
➢ Large number of voluntary health agencies have been
founded to prevent or control the social and personal
consequences of alcohol, tobacco and other drug
abuse.

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LESSON 10: INTRODUCTION TO BIOSTATISTICS
WHAT IS BIOSTATISTICS
Biostatistics -> branch of statistics that is applied to biological
sciences.
◼ Deals with collection, organization, analysis, and
interpretation of biological data
◼ Data: information that is represented by numbers,
organized by variables.
Mainly covers such fields as public health, medicine and
human biology, genetics, nutrition. Etc
Generally used to refer recorded data.
Ex: number of patients attending a hospital, number of
infected, number of symptomatic
Francis Galton -> father of biostatistics
IMPORTANCE OF BIOSTATISTICS IN HEALTH SCIENCE
STATISTICS HELPS IN FINDING:
◼ Leading cause of death
◼ Important causes of sickness or disease
◼ Trend of disease
◼ Which is age, sex, social class, profession, or other
demographic data being most affected.
◼ Level of health
◼ Population composition, growth, and density
◼ Priority health programs
◼ Priority population
VARIABLS
◼ Characteristics of interest that varies from one
observation to another
◼ An attribute that describes a persons, place or thing
VARIABLES ACCORDING TO HOW THEY ARE
EXPRESSED OR MEASURED
I.QUALITATIVE VARIABLES (CATEGORICAL)
➢ Variables that yield observation on which individuals
can be categorized according to some characteristics
or quality. These are variables that are names or
labels.
Ex: sex (male of female) occupation (employed/unemployed)
civil status (single/married)
II.QUANTITATIVE VARIABLE (NUMERIC)
➢ Variables that yield observation that can be
measured. This represents a measurable quantity
Two types of quantitative variables
1.discrete data, (No children in family, blood sugar, BP age)
2.continuous data – measurement is precise (temperature,
height, weight)
VARIABLES ACCORDING TO LEVELS OF
MEASUREMENT
1.Nominal (Categorical) – one that has two or more
categories, but there is no intrinsic ordering to the
categories
ex: hair color, yes or no question, sex, material status
2. Ordinal – similar to categorical variables however, there is
clear ordering of the categories
ex: economic status, educational, attainment, rank order
SECOND TERM, BSMT
3. Interval – interval variable is similar to an ordinal variable,
except that the intervals between the values of the
numerical variable are equally spaced.
Ex: times of the day, income level on a continuous scale, dates
4.Ratio - has all the properties of an interval variable, but also
has a clear definition of o.o The only difference
between the ratio variable and interval is the ratio
variable already has a zero value
Ex: temperature, concentration, enzyme activity.
VARIABLES
Variable according to causal relationships
1.independent variable
Ex: exposure or treatment
2.dependent variables
Ex: outcome
3. confounding variable
SOURCES OF STATISTICAL DATA
1.Experiments
➢ Performed to collect data for investigations and
research by one or more workers
2.surveys
➢ Carried out for epidemiological studies in the field by
trained teams to find incidence or prevalence of
health or disease in a community
3.records
➢ These are the registers or books maintained over a
long period for vital “statistics”
4.census
➢ Is an important source of health information, it is
defined by united nations as “the total process of
collecting compiling, and publishing demographic,
economic and social data pertaining at a specified
time or times, to all persons in a country”
Data can be collected:
1.Primary data: data are obtained by investigator himself
2.secondary data- data are already recorded
DESCRIPTIVE vs. ANALYTICAL STATISTICS
DESCRIPTIVE
◼ Provide a description of the variable under
consideration
Ex: “how much?”, “how regularly”, “what percentage?” , “what
time?”. “What is?”
Descriptive statistics:
Qualitative data:
◼ Measures of central tendency (mean, median, mode)
◼ Measures of dispersion (variance, standard,
deviation, range, IQR)
◼ Measures of location (quartile, decile, percentile)
Categorical data:
◼ Frequency and percentage
ANALYTICAL
◼ Examine the relationship between two variables
Ex: “what is the relationship/association/correlation between
variable X and variable Y?”, “how does variable X
affect variable Y?”
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 CPH LEC 2ND TERM

➢Identify causes, reason, motives for action: look for

USE OF HEALTH INDICATORS
creative solutions to the problem
➢ Explanatory or predictive
➢ What statistical tests to use depends on variable type 1.Determination of factors that may contribute to causation and
and measurement level. control of disease
DEMOGRAPHY 2.identifaction of public health problems and needs
◼ δημoσ (demos) = population; γραφια (graphia) = 3.for indicating priorities for resource allocation
description, writing 4.for monitoring and evaluation of health programs

Fertility Mortality Morbidity

✓ the empirical, statistical, and mathematical study of indicators indicators indicators
human populations
✓ concerned with reasons for changes in populations Crude birth rate Crude-death Incidence
and its implications General fertility rate Prevalence
focuses on the following rate Specific Attack rate
✓ population size, composition, distribution mortality rate
✓ changes in population size and composition Cause-of-death
✓ components to these changes (fertility, mortality, rate
migration) Infant mortality
✓ factors affecting these components rate
Neonatal
USE OF DEMOGRAPHY mortality rate
Post-neonatal
mortality rate
Demography can be used for planning and priority setting of Maternal
resource allocation though; mortality rate
1.determination of the population distribution per area Proportional
2.determination of growth (or decline) in population size mortality ratio
3.prediction of population size Case fatality
4.establishments of the relationships or trend between rate
population characteristics (e.g. life expectancy M vs F from
2010 ro 2020)

CRUDE BIRTH RATE (CBR)

WHAT ARE HEALTH INDICATORS?

Quantitative measures that describe and summarize various
aspects of the health status of a population, or performance of
a health system
◼ information contained there with are comparable and
actionable; progress can be tracked over time
◼ usually expressed as ration, proportion or rates
TERMS FOR POPULATION MEASUREMENT
◼Measures how fast people are added to the
population through births
Crude rate because the denominator is not just the birthing
population (also includes women outside child-
bearing age, mean, children)
Affected by; fertility/marriage patterns; age-sex composition;
accuracy of registration

RATIO
◼ relationship between two numbers in which one is
divided by the other
PROPORTION
◼ ratio of two numbers where the numerator is subset of
the denominator; may be expressed as;
- number between o and i
- percentage = [number between o and] x 100; “per
100”
- number per 1.000
- number per 100,000
RATE
◼ refers to the occurrence of events over a given
internal of time relative to the total person-time of
exposure/at risk

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GENERAL FERTILITY RATE (GFR)

CAUSE SPECIFIC MORTALITY RATE

◼ Most specific than CBR since birth are related to the - Mortality rate from a specific disease or condition
segment of the population deemed capable of giving Crude rate because the denominator is the population not
birth at risk

◼ Affected by completeness of registration of deaths,

composition of the population and level of disease
ascertainment in the community
◼ Use in determining the leading cause of mortality

ADVANTAGES
◼ More refined measure of fertility
◼ Preferred fertility indicator in population with skewed
age-sex structures.
DISADVANTAGES INFANT MORTALITY RATE (IMR)
◼ Provides no insight into individual-level childbearing
behavior Useful indicator of a country’s level of health and
-
◼ Not all women within the childbearing age group are development
capable of giving birth - Can be artificially lowered just by improving birth
registration
CRUDE DEATH RATE (CDR) Maybe subdivided into:
◼ Neonatal mortality ratio: include death in the first 28
Measures how fact mortality occurs in a given population days of life
◼ Post-neonatal mortality ratio: include deaths after
- Affected by age-sex composition, adverse first 28 days of life but before one year
environmental and occupational conditions, peace
and order conditions
- Should be interpreted with caution when used for
comparing 2 or more populations
- Does not take into account the age composition of the
population
- Does not take into account the age composition of the MATERNAL MORTALITY RATIO (MMR)
population
◼ Measures the occurrence of maternal deaths

WHO: “Maternal death is the death of a woman while

pregnant or within 42 days of termination of
pregnancy, irrespective of the duration and the site of
thepregnancy, from any cause related to or
aggravated by the pregnancy or its
management, but not from accidental or incidental
SPECIFIC MORTALITY RATES causes.

Rates which measure the force of mortality in specific - Reflects the level of obstetric risk in a population
subgroups of the populations - Affected by maternal health practices, diagnostics,
ascertainment, and completeness of birth registration
◼ Age-specific - Ideal denominator: number of pregnancies
◼ Sex-specific
◼ Age-sex-specific
◼ Occupation-specific
◼ Cause-specific

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PROPORTIONATE MORTALITY RATIO (PMR)
Measures the proportion of total deaths occurring in a
particular population group or from a particular cause
◼ Each cause is expressed as a percentage of all
deaths
◼ Sum of the causes must add to 100%
Difference with specific rate is that a denominator used is the
total number of deaths and NOT the population size
CASE FATALITY RATE (CFR)
Measures how many afflicted with a disease die from said
disease
- High CFR indicates that disease is fatal (“killing
power” of the disease)
Time element not annual but usual duration of the disease
Affected by the nature of the disease, diagnostics,
ascertainment, and level of reporting in the population
LIFE EXPECTANCY AT BIRTH
◼ Average number of years that newborns is expected
to live in current mortality rates continue to apply
◼ Reflects the overall mortality level of a population
MORBIDITY MEASURES
Measures the occurrence of illness or conditions in a
community
Two types
1.prevalence
2.incidence (attack rate)
PREVALENCE (PREVALENCE PROPORTION)
Measures the proportion of existing cases of disease in the
population at a point or (short) period of time
- Reflects both incidence and the probability of
surviving with disease
- More useful in describing chronic conditions such a
congenital defect, non-communicative disease
(NCDs), non-lethal degenerative disease with no clear
onset, psychiatric conditions
SECOND TERM, BSMT
INCIDENCE
- Measures the development of a disease in a group
exposed to the risk of the disease in a period
- Gives information on the speed of development of a
disease condition
- More appropriately used to describe acute conditions
- Measure of choice in determining etiologic factors
Two types of incidence measures
1.incidence proportion
2.incidence density (incidence rate)
INCIDENCE PROPORTION
- Proportion of disease-free individuals who contact the
disease within a specified period of time
- Average risk or developing the disease
- Assumes a fixed population and no competing
risks
- Called attack rate for infection when implicit referent
period is the duration of the outbreak
- Sometimes referred to as cumulative incidence
INCIDENCE DENSITY (ID)
- Rate at which new cases occur
- Deals with a dynamic population by using total
person-time at risk as its denominator
Total person-time at risk is equal to the
◼ Sum of each individual’s time at risk, or under
observation that each person’s remained
◼ Product of the average population size and length of
follow-up (n x t)
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 CPH LEC 2ND TERM

- “person-years” or “persons per year”

- Person-time assumes that the probability of disease
during the study period is constant
- Incidence density = incidence rate

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