- Education
- Engineering – better cars
- Enforcement - law
PHC – Demography
Definition: Demography is defined as the scientific study of xtics of human’s population in terms of xture, distribution, growth and development.
- Xture means the distribution of persons present in the pop by sex and age
- Distribution refers to the spread of the pop by certain xtics such as geographical spread.
- Growth refers to changes in pop size i.e. no of person in the pop.
Sources of demographic data:
(1) Census
(2) Vital registration system
(3) Migration records
(4) Special demographic survey
Census is defined as the total head count in a defined geographic region
Uses of census
(1) Planning health services
(2) Determine the dominator of health indices like infant mortality
Types of census
- Defector: Actual pop found on census day. It includes temporary residents and people in transit.
May be bloated up if the area has high migration rate.
¬- Dejure census counts only permanent residents or arbitral resident’s population.
other uses of census
(3) Planning for health and other national goals (millennium dev goals)
(4) Budget ring allocation
(5) Denominator for calculation of vital rates
(6) Monitoring and evaluation of health programme
Demographic processes.
These are events in the pop that determine the size, composition distribution. These are fertility, mortality, marriage, migration and social mobility
Demographic transition is the movement of a country from one stage of demographic cycle to another.
(1) High stationary – High rates, and death rate no pop growth
(2) Early expanding (2nd stage) – Death rates are declining while birth rates remains unchanged. Therefore pop grows.
(3) Late expanding – Death rates decline while birth rates falls pop grows
(4) Low stationary – Low birth rates with low death rates pop does not grow.
(5) Birth rate is lower than death rate. Pop size reduces.
Countries in Sweden and Finland are in stage 5.
Nigeria and other Africa countries are between 2nd and 3rd stage.
Growth rate in Nig is 2.9%
Demographic processes
Fertility – This is the actual bearing of children. It is also called natality
Determinants of fertility
(i) Age at marriage
(ii) Duration of marriage life
(iii) Spacing of children – minimum of 2 years
(iv) Level of education
(v) Religion
(vi) Nutrition
(vii) Contraceptive prevalence
(viii) Economic status
(ix) Social factors.
Population xture
This is a pictorial representation of population in histogram of age and sex. This is called population pyramid.
Horizontal histograms are used. One column reflect male and the other, the female sex, age is represented on the vertical axis.
Interval of the age is 5year interval
There are 3 types of population pyramid
(1) Expansible
(2) Constrictive
(3) Restrictive
The type of population pyramid gives an indication of the ffg:
(1) Level of technological development of the country
(2) Predominant economy
(3) Birth rate
(4) Death rate
(5) Dependency ratio
(6) Sex ratio
(7) Pattern of predominant dx.
Expansile population pyramid
Has a broad base is shows high rate. It tappers to the top – high death rate. It has high death rate and high infant mortality rate. It occurs in developing countries in agrarian economy and it has low life expectancy.
High dependency ratio, low use of contraception, communicable dx predominance.
E.g. of countries are Nigeria, Kenya, Ghana etc.
Triangular pyramid.
Constrictive population pyramid.
Have broad base, broad top; narrow in the middle famine, war and dx e.g. HIV ravaging countries.
Have high dependency ratio, high birth rate, and high death.
E.g. Democratic Republic of Congo, Kenya, somalla, Uganda.
Restrictive population pyramid.
Also called rectan0gular pyramid.
This occurs in developed countries. They have low birth and death rates. The histogram bars are of almost equal size.
Non communicable dx are most common.
E.g. Hungary, Poland, Britain, America.
Dependency ratio = <15 + >65
15 – 65
Sex ratio = M: F
At birth 104: 100
Difference between demographic transition and epidemiological transition
Distinguish between crude rates and specific rates
Distinguish between mortality rates and morbidity rates
Distinguish between De jure and Defacto census.
EPIDEMIOLOGY OF NONCOMMUNICABLE DX (N.C.DX).
NCDX – Impairmt of bodily fxd or xture that necessitates a modification of px normal life and persist over an extended period of time.
Characteristic
(1) Permanence
(2) Residual disability
(3) Non reversible
(4) Requires long period of observation or care.
Requires training of px for rehabilitation.
E.g.: of NCDX.
(1) Trauma - RTA
(2) Neoplasm – cancer
(3) Nutritional deficiency – obesity, xerophtalmia
(4) Genetic or congenital problems – sickle cell, lip, hairy pinna
(5) Metabolic conditions
(6) CVS problems – MI, coronary heart dx
(7) Renal dx – End stage renal failure, chronic nephro
(8) Neurological – stroke
(9) Mental illness
(10) Musculoskeletal disorders – arthritis
(11) Respiratory disorders – Asthma
(12) Endocrine – Diabetes mellitus
Epidemiological patterns of dx.
(1) Traditional patterns – occurs in: developing countries
Developing countries: - There is high crude birth rate, clued DR.
Fertility rates, low life expectancy; high maternal mortality communicable dx predominates.
(2) Transitional pattern: Includes declining crude birth rate, declining crude death rates, fertility rates. Rising life expectancy falling maternal mortality, double dx burden (both NCDx and CDX)
(3) Developed countries pattern:
Low birth rates, low maternal mortality rate, high life expectancy NCDX predominates.
Some NCDX tends to be associate with communicable dx:
(1) Rheumatic heart dx: - caused by sour throat with hemolytic strept.
(2) Cancer of the cervix – HPV,
(3) kaposi sarcoma- HIV
(4) Burkitt lymphoma-HIV,malaria
(5) Primary liver cell carcinoma –HBV
(6) Glomerulonephritis caused by streptococci, skin infection.
(7) Malaria nephropathy
(8) Diabetes mellitus by viral pancreatitis
(9) Cardiomyopathy – Diphtheria, whooping cough
(10) Peptic ulcer dx – helicobacter pyloric
Epidemiological Transition
Traditional pattern of dx in the developing countries are beginning to change. There is a shift from communicable to NCDX. Mixed pattern of dx is therefore noticed in many developing countries.
Reasons for epidemiological transition
(1) Demographical transition:
Declining births, declining mortality and therefore longer life expect racy
(2) Changes in ecology
(3) Changes in lifestyle – nutrition (minerals and mr Biggs) multiple sexual partners
(4) Industrialization and urbanization
NCDX or No communicable conditions of public health importance
(1) Breast cancer.
(2) Cancer of cervic, lung cancer, prostate cancer
Hypertension, diabetes, Rheumatic heart dx
Coronary heart dx (MI)
Stroke mental illness, RTA.
Epidemiology and control of dxes transmitted their respiratory tract.
Dx transmitted the respiratory tracks are air borne dxes
The infective agents old are viruses, bacteria, rickettsia, fungal.
E.g. of viruses
(1) Measles caused by measles virus
(2) Mumps – mump virus
(3) Rubella – Rubella virus
(4) Chicken pox – Vericella zoster virus
(5) Influenza – Influenza virus
Bacteria
(1) Tuberculosis – Microbacterium tuberculosis
(2) Diphtheria – Corynebacteria diphtheriae
(3) meningitis – Neisseria meninigitidis
(4) Pneumonia – Staphylococcus, streptococcus
(5) Pneumonic plague – yersinia pestis
(6) Pertusis – Bordetella pertussis
Rickettsial
(1) Q fever – coxiella burnetti
Fungal
Histoplasmosis – histoplasmosis Duboisi
Reservoir of most of these infections is man.
But rat is the animal reservoir of plague.
Some of these dxes have carrier stage: e.g. in meningitis
A carrier is a person who has not showed the clinical manifestation of the infection / dx
Route of transmission
(1) Droplet
(2) Droplet Nuclei
(3) Dust
Droplets are large particles that usually escape when the pt coughs, sneezes or talk violently e.g. TB PX may contain food debris and micro-organism enveloped in saliva or secretions of upper respirator tract.
Droplet neclei are fragmented droplets and air carries the neclei from one person to another.
Host factors
These are factors in the host that prevent transmission of infection e.g. coughing reflex, sneezing reflex, mucociliary action in the respiratory tract, host immunity: e.g.
An attack of measles confers long life immunity
An attack of plague confers partial immunity
An attack of influenza virus does not confer any immunity of the changes in the strains of the influenza virus.
General method of control of our borne dx.
(1) Elimination of reservior of infection
- treat man reservoir
- destroy the animal reservoir if the animal is a nuisance
- vaccinate the animal reservoir that is useful to you
- Eliminate dust
(2) Interrupting transmission route
- H/E – don’t cough / sneeze any how in public
- Avoid overcrowding: - ideally a TB PX should not go to market
- Good housing and good ventilation
(3) Host susceptibility
- Chemoprophylaxis e.g. INH used to prevent TB
- Immunization
Meascles
Occurrence worldwide
Organism meascles virus
Reservoir man
Transmission Airborne – Droplet
Droplet nuclei
Dust
Special epid. Common in malnourished
Children.
Special epidemiology of measles.
- Maternal protection in 1st 6month of life X 6/12
- Common in malnourished children especially PEM.
Symptons of measles:
Fever, rashes at the 4th day of fever, Xtics koplict spot opposite the 2nd lower molar, complications of pneumonia; conjunctivitis, oral trush, gastroenteritis, measles encephalitis
Incubation period of measles – 10 days x 10/7
Lab Diagnosis – more of a clinical diagnosis, culture the virus and serological techniques / immunological techniques.
Heamagglutination tests.
Control of measles
- Isolation of the child
Address the issue of malnutrition: H/E
- General method of control (elimination, interrupted and host susceptibility)
- Treat the complications
If you suspect the child of measles infection within 48hrs, give measles immunoglobulin, it will prevent progression of the measles from the sub clinical stage to the clinical measles
Meningitis
Occurrence – worldwide
Meningitis belt -: 50 to 150 north of the equator.
Organism- Neisseria meningitides
Reservoir- Man
Transmission- Airborne: Droplet nuclei, dust.
Special Epidemiology
- Rainfall of meningitis belt is of the order of 300 -1200mm
- High waves Epidermis comes in waves usually it starts at end of dry season and disappear when the rain starts/ at onset of rain symptoms
Fever, neck stiffness and positive kerning signs on clinical examination.
Complication: kernicterus, severe jaundice, intercerebral hemorrhage
Incubation period – 3 to 4 days
Lab diagnosis – Nasopharygeal and throat swarb
- CNS specimen and analysis it / CNS analysis
Control – General
- Treat Px with chloramphenicol and penicillin, cephalosporins.
- Treat all contact with the Px within the incubation period
- During meningitis outbreak, do mass vaccination of
Everybody.
TB
Occurrence – worldwide
Organism – microbacterium tuberculosis
Reservoir – man, cattle
Transmission – Airborne : Droplet, droplet nuclei, dusts.
Special Epidemiology
200million cases worldwide, 8million new infection every year and 3million deaths every year. No 1 killer in the world, followed by hepatitis. HIV/ AIDS is no 3.
Without treatment, 50% of TB Px will die, 25% will go into complication and 25% will resolve.
Symptoms
Cough of 3weeks and above; night sweat, low grade fever, coughing blood (heamoptysis), progressive weight loss
Incubation period – 4 to 6 weeks
Lab diagnosis – sputum microcopy using ziebi neelsen method culture of sputum using lowenzing gensing medium
Control – General method
Primary – H/E: warn against bad housing,
- BCG immunization
Treatment of TB
Treat for 18 months.
Secondary – treatment and contact tracing in the last 4 – 6weeks
Territory – management of complications.
Directly observed treatment short course DOTS
DOTS is the latest strategy in the control and mgt of TB
DOTS work every where in the world including Nigeria
There are 5 elements of DOTS.
(1) Diagnosis – History taken, cough of 2months, loss of weight e.t.c.
Hx exam and investigation using sputum microscope (Z.N staining).
Train all health workers to recognize cases of TB and diagnosis it.
(2) Prompt px mgt: - Direct observation for intake of drug for at least the first 2months (initiation period)
(3) Political will to ensure that the drugs are available.
The drugs are INH, pyracinamide, rifampicine, and ethambutol
Thiatezatone (contraindicated in HIV PX)
(4)Monitoring and Evaluation
At the end of imitation period, repeat sputum microscope is should be negative and continue the continuation stage/ phase
If the PX is still true at the end of imitation stage, increase initiation to 3months and reduce continuation stage to 5months.
At the end of 5/12, repeat sputum microscope and at 8/12, repeat it.
(5) Global dynamic movement: stipulates that everybody should contribute its own quota to TB management.
In case of treatment rejection, DOTS is started all over again and streptomycin is included in the treatment (tx rejection – At the end of the 8 months, the px is still true).
Uses of Tuberculin test – check text for details
- For clinical diagnosis
- Identifying susceptible gaps
- Epidemiological surveys
Dr Olowu
Community power xture and comm. Processes and their implementation for the success or failure of health programmes.
Power is always the centre of attraction and seat of authority and in all areas of man’s endavour these is the quite struggles for power. Power can be recognized in terms of money property, influence or clout
Age still plays a role through less pronounced in the present day value system. However some measure of humouring is accorded the old people in the community and the remnance* of the African value system still makes them relevant and they still respected.
In the comm., there is hierarchy and the ‘Bale’ or ‘Oba’ is still the paramount person whose opinion cannot be down played. The implication of thus setups for the success or failure of health programmes is grave / vital. Any successful process must enjoy the support of the comm. Leader and the powerful people in the community.
For a program to be acceptable and embraced, it must be well packaged and sold to the powerful people both by virtue of been the Oba/ Bale or the rich and influential in the community.
If it is a program that can be accorded colorful launching these people must be present at the ceremony and if it involves getting them to publicly endorse or partake in the programme this will go a long way to inform the people that the program is highly recommended and should be supported.
Once the support of these people perceived and acceptable to the power point of the society, approve openly that the program is good, it is most likely the program will succeed.
Failure of a program is almost certain if these people are against or along the line misunderstanding crops up and the program happens to be a good tool to fight among them, and then there will be a problem.
Common vectors and their control.
Vectors are arthropods of medical importance. They are arthropod or organisms or animal is carry and transit an infection directly or indirectly from an infection animal to a human or from an infection human to another human. They live close to man and act as carries of diseases.
E.g.: They are broadly classified into:
Class insecta, class crutaceans and class arachnida.
The mollusca are also vectors. (The snails)
- Insects: female anopheles mosquito (malaria), yellow fever, dengue fever
- Arachnida: human fleas (plague)
- Crustacians: Cyclops (Guinea worm)
Mechamechanism of Transmission
- Direct contact (like in house fly) either with food, sore or any open ulcer.
- Mechanical transmission e.g. housefly has hairy body to carries the agent. When the fly comes in contact with food, it shakes its body and drops the agent
- Biological transmission e.g. mosquito. The agent developed inside the vector without the vector, the agent cannot become infective.
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