Attack rate is a type of incidence rate which is mainly used during epidemics. All of them ate the food that was served for dinner. The next day Tir 8, 90 of the people who ate that food developed diarrhea. Calculate the attack rate of diarrhea which occurred on Tir 8, Uses incidence rate Incidence rate is important as a fundamental tool for etiologic studies of diseases since it is a direct measure of risk.
If the incidence rate is significantly higher in one area, then the cause of that disease can be systematically searched. Prevalence rate Prevalence rate measures the number of people in a population who have a disease at a given time.
It includes both new and old cases. The major type of prevalence is point prevalence rate. Point Prevalence rate: measures the proportion of a population with a certain condition at a given point in time. Point prevalence rate can be determined by conducting cross-sectional study. The total number of students in that school was The health extension worker examined all the students for trachoma. Hundred students were found to have trachoma.
Calculate the point prevalence rate of trachoma for that school. Rates whose denominators are the total population are commonly calculated using either the mid - interval population or the average population. This is done because population size fluctuates over time due to births, deaths and migration. It reflects the risk of death in that community or country. Currently the Crude Death Rate in Ethiopia is That means out of total population about 13 people die each year. Calculate the mortality rate Crude death rate for females.
Example: In there were tuberculosis patients in one region. Out of the patients died in the same year. Calculate the case fatality rate of tuberculosis. Two hundred of them died before 28 days after birth. Death during the neonatal period is largely due to prematurity, malformations, accidents or injuries at birth, and lack of cleanliness and sterility during or after delivery. In addition, it reflects the inadequacy of antenatal care.
Thus, it is high among people who have little health care, chiefly because infections, such as pneumonia, diarrhea and malaria, are common among their infants. Malnutrition is also one of the killer of infants in developing countries. The infant mortality rate in Ethiopia is one of the highest in the world That means out of live births about 97 die before they celebrate their first birth day.
In the same year children under five years of age died. Calculate the under five-mortality rate U5MR. The Maternal Mortality Rate in Ethiopia is estimated to be per , live births. That means in , live births, around mothers die each year due to pregnancy related causes. The incidence rate of tuberculosis. The period prevalence rate of tuberculosis. The case fatality rate of tuberculosis. The Neonatal mortality rate.
The infant mortality rate. Sources of Data There are different sources of data on health and health related conditions in the community. Each source has advantages and limitations. The information obtained from these sources is used for health planning, programming and evaluation of health services. The major sources are the following. Census: Census is defined as a periodic count or enumeration of a population. In Ethiopia census was conducted twice, i.
Crude birth rate, crude death rate, age specific mortality rate and sex specific mortality rate are some of the examples of the indicators that could be calculated. Vital statistics: This is a system by which all births and deaths occurring nationnwide are registered, reported and compiled centrally. Certificate is issued for each birth and death. It is the source of information for the calculation of birth and death rates.
There is no nationwide birth and death registration system in Ethiopia but the system should be established in the future. Health Service Records All health institutions report their activities to the Ministry of Health through the regional health bureaus. The Ministry compiles, analyzes and publishes it in the health service directory.
It is therefore the major source of health information in Ethiopia. Those patients who remained at home are not reported. Notification of Infectious Diseases There are some internationally notifiable diseases. Moreover, every country has its own list of notifiable diseases. The major problems related to this source health service records are low compliance and delays in reporting. Health Surveys Health surveys are studies conducted on a representative sample population to obtain more comprehensive data for monitoring the health status of a population.
Surveys of specific diseases: These are studies conducted on each specific disease. Surveys of general health status: These are studies on general health status of the population.
They are based on interview, physical examination and laboratory tests. They are expensive. Methods of data collection The main methods of collecting information are: 1. Observation 2. Interview and questionniares 3. Documentary sources - Clinical records and other personal records, death certificates, publications etc. State the different sources of health information.
What is the major source of health information in Ethiopia? Discuss the problems related to health service records as source of health data. If you want to know the number of people in your kebele who are properly using latrines, which method of data collection would be appropriate?
Some diseases are usually present at a predictable level. This is called the expected level. But sometimes they occur in excess of what is expected. The examples of expected level are endemic and hyper endemic. When the disease occur as epidemic, outbreak, and pandemic it is considered as excess of what is expected. Endemic: Presence of a disease at more or less stable level.
Malaria is endemic in the lowland areas of Ethiopia. Hyper endemic: Persistently high level of disease occurrence. Sporadic: Occasional or irregular occurrence of a disease. When diseases occur sporadically they may occur as epidemic. Epidemic: The occurrence of disease or other health related condition in excess of the usual frequency in a given area or among a specific group of people over a particular period of time.
Outbreak: Epidemics of shorter duration covering a more limited area. Pandemic: An epidemic involving several countries or continents affecting a large number of people. The definition of epidemic indicates that the term can have a broad meaning.
It may include any kind of disease or injury including non — infectious diseases. There is no general rule about the number of cases that must exist for a disease to be considered an epidemic.
It is important to note that this level varies for different diseases and different circumstances. An epidemic may cover a small area within a city, or an entire nation or may have a worldwide distribution. It may encompass any time period ranging from few hours chemical intoxication, bacterial food poisoning , a few weeks influenza, hepatitis to several years AIDS.
A disease that remains epidemic over many years eventually may be considered endemic. Common Source Epidemics:- Disease occurs as a result of exposure of a group of susceptible persons to a common source of a pathogen, often at the same time or within a brief time period.
When the exposure is simultaneous, the resulting cases develop within one incubation period of the disease and this is called a point source epidemic. The epidemic curve in a point source epidemic will commonly show a sharp rise and fall. Food borne epidemic following an event where the food was served to many people is a good example of point source epidemic. If the exposure to a common source continues over time it will result in a continuous common source epidemic. The epidemic curve may have a wide peak because of the range of exposures and the range of incubation periods.
It can occur through direct person to person transmission or it can involve more complex cycles in which the agent must pass through a vector as in malaria.
Propagated spread usually results in an epidemic curve with a relatively gentle upslope and somewhat steeper tail. An outbreak of malaria is a good example of propagated epidemic. When it is difficult to differentiate the two types of epidemics by the epidemic curve, spot map studying the geographic distribution can help.
Mixed Epidemics:- The epidemic begins with a single, common source of an infectious agent with subsequent propagated spread.
Many food borne pathogens result in mixed epidemics. Uncovering outbreaks Outbreaks are detected in one of the following ways: a. Through timely analysis of routine surveillance data b. Report from clinician. Report from the community, either from the affected group or concerned citizen. Prepare for fieldwork. Before leaving for the field you should be well prepared to under take the investigation. Arrange where and when to meet them. Verify confirm the existence of an epidemic This initial determination is often made on the basis of available data.
Compare the number of cases with the past levels to identify whether the present occurrence is in excess of its usual frequency. Verify confirm the diagnosis.
Always consider whether initial reports are correct. Carry out clinical and laboratory investigations on the reported cases. For example the already collected blood film slides can be seen by laboratory experts to check whether the initial report was correct. It is important to investigate the index case the first case that comes to the attention of health authorities and other early cases.
The importance of the index case and other early cases for diseases that are known to occur in epidemic form, such as relapsing fever, is as an indication to health authorities of the possible start of an outbreak.
The sooner the index case and other early cases are investigated, the greater the opportunity to arrest the outbreak at earliest stage possible.
The health extension worker requests support from the Woreda Health Office or the nearest Health Center for confirming the diagnosis. Case definition is defined as a standard set of criteria to differentiate between cases and non cases. Possible: A case with fewer of typical clinical features.
Cases can better be identified by active case detection using all available means including house to house visits. They can also be identified by stimulated passive case detection, for example by alerting the public about the epidemic and requesting them to report to the nearest health institution when they have signs and symptoms of that disease.
The health extension worker can identify and count cases based on the sign and symptoms of the disease. If there is effective drug for the treatment of that disease, cases can be treated while identifying them.
Additionally other control measures can be taken side by side to arrest the epidemic before many people are affected. Describe the epidemic with respect to person, place and time Each case must be defined according to standard epidemiologic parameters: the date of onset of the illness, the place where the person lives or became ill, and the sociodemographic characteristics age, sex, education level, occupation.
The tools to be used when characterizing the epidemic are epidemic curve, spot map and attack rates. In epidemic curve the distribution of cases is plotted over time, usually in the form of histogram, with the date of onset of cases on the horizontal axis, and the number of cases corresponding to each date of onset on the vertical axis. Spot map is a map of locality where the outbreak has occurred, on which the location of cases is plotted.
The spot map is often helpful in detecting the source of an outbreak. Mapping disease can be done at kebele, woreda, regional, and national level.
One limitation of spot map is that it does not take into account underlying geographic differences in population density. Thus the spot map needs to be supplemented by calculation of place specific attack rates. Person specific attack rates: The tool that is important for the analysis of disease outbreaks by personal characteristics is person specific attack rates like attack rates by age, sex, occupation, income, religion etc.
Identify the causes of the epidemic All factors that can contribute to the occurrence of the epidemic should be assessed.
The epidemic investigating team should try to answer questions like: Why did this epidemic occur? Is the temperature favorable for the transmission of the diseases? Are there breeding sites for the breeding of vectors? Etc Confirmation of the diagnosis can be done by using additional tests which are more accurate. In addition to knowing the etiologic agent, more emphasis should be given to identify the risk factors.
Investigate the environmental conditions such as food sanitation, suspected breeding sites, animal reservoirs, according to the type of disease outbreak being investigated. Management of epidemic and follow up Although it is discussed late, intervention must start as soon as possible depending on the specific circumstances. One might aim control measures at the specific agent, source, or reservoir.
For example, an outbreak might be controlled by destroying contaminated foods, disinfecting contaminated water, or destroying mosquito breeding sites or an infectious food handler could be suspended from the job and treated. General principles in the management of epidemics Management of epidemics requires an urgent and intelligent use of appropriate measures against the spread of the disease. However, the actions can be generally categorized as presented below to facilitate easy understanding of the strategies.
Measures Directed Against the Reservoir Understanding the nature of the reservoir is necessary in the selection of an appropriate control methods and their likelihood of success. Isolation of infected persons. This is separation of infected persons from non-infected for the period of communicability.
This is not suitable in the control of diseases in which a large proportion are inapparent infection without signs and symptoms or in which maximal infectivity precedes overt illness. Treatment to make them noninfectious- e. Quarantine- is the limitation of freedom of movement of apparently healthy persons or animals who have been exposed to a case of infectious disease.
Usually imposed for the duration of the usual maximal incubation period of the disease. Cholera, Plague, and yellow fever are the three internationally quarantinable diseases by international agreement. Now quarantine is replaced in some countries by active surveillance of the individuals; maintaining close supervision over possible contacts of ill persons to detect infection or illness promptly; their freedom of movement is not restricted. Measures that interrupt the transmission of organisms Action to prevent transmission of disease by ingestion: i.
Purification of water ii. Pasteurization of milk iii. Inspection procedures to ensure safe food supply. Improve housing conditions.
In the case of diseases that involve an intermediate host for transmission, for example schistosomiasis, clearing irrigation farms from snails is an appropriate measure. After the epidemic is controlled, strict follow up mechanisms should be designed so as to prevent similar epidemics in the future. The report should follow the usual scientific format: introduction, methods, results, discussion, and recommendations.
Hundred cases of malaria were seen in the health post which is found in your kebele in October Can you say there was epidemic of malaria in October ? Suppose epidemic of common cold occur in your area.
What type of epidemic is this one? Point source epidemic b. Common source epidemic with continued exposure c. Propagated epidemic d. Mixed epidemic 3. Suppose epidemic of relapsing fever occur in your area. Mixed epidemic 4. Ten patients come to you to seek treatment because they have fever and severe headache. They also informed you that there are many other similar cases in their village.
How do you investigate this epidemic?. Suppose malaria epidemic occur in your kebele. How do you control it? Passive surveillance Passive surveillance may be defined as a mechanism for routine surveillance based on passive case detection and on the routine recording and reporting system.
The information provider comes to the health institutions for help, be it medical or other preventive and promotive health services. It involves collection of data as part of routine provision of health services. It involves collection of data from communities such as in house-to-house surveys or mobilizing communities to some central point where data can be collected.
This can be arranged by assigning health personnel to collect information on presence or absence of new cases of a particular disease at regular intervals. Unlike passive surveillance, it cannot be used for routine purposes.
There are certain conditions where active surveillance is appropriate. Data collection and recording 2. Data compilation, analysis and interpretation 3. Reporting and notification 4. Dissemination of information 9.
In this strategy several activities from the different vertical programs are coordinated and streamlined in order to make best use of scarce resources. The activities are combined taking advantage of similar surveillance functions, skills, resources, and target population.
Integrated disease surveillance strategy recommends coordination and integration of surveillance activities for diseases of public health importance. Diseases included in the integrated disease surveillance system Among the most prevalent health problems 21 twenty one communicable diseases and conditions are selected for integrated disease surveillance to be implemented in Ethiopia. What is the purpose of surveillance? What is the difference between active and passive surveillance? What is the most important use of active surveillance?
What are the activities in surveillance? What is the advantage of integrated disease surveillance strategy? Mausner and Bahn. Introductory text of epidemiology. Second Edition. Shiferaw M and Fenta H. Epidemiology - A manual for students and health workers in Ethiopia.
Fletcher M. Principles and practice of Epidemiology. Barker DJP. Practical Epidemiology. Epidemiology in community health. Jane McCusker series 6. A short textbook of preventive medicine for the tropics. Benenson AS. Control of communicable disease in man. Applied Epidemiology. Theory to Practice. Oxford University Press. Kenneth J. Rothman, Sander Greenland.
Modern Epidemiology. Berhane Y. Principle of Epidemiology. Lecture Note. Rockett IRH. Population and Health: An Introduction to Epidemiology. A publication of the Population reference Bureau. Second Edition, December , 54 4.
Epidemiology in Medicine. USA, First Edition, By using our site, you agree to our collection of information through the use of cookies. To learn more, view our Privacy Policy. To browse Academia. Log in with Facebook Log in with Google. Remember me on this computer. Enter the email address you signed up with and we'll email you a reset link. Need an account? Click here to sign up. Download Free PDF. Kidane Berhe. A short summary of this paper.
Legal and political 10 min examples when possible. Note down their answers on a flip chart. Step 6 Present the participants with the definitions, using PP1. Annex 1. You can ask participants, if: Any statement surprised them? Did the statements indicate that gender is inborn or learned? Note that these biological women and men, and in some cultures a third or characteristics are not mutually exclusive; however, other gender.
Born with. Not born with. Universal, A-historical Gender roles vary greatly in different societies, No variation from culture to culture or time to time.
Cannot be changed, except with the medical Although deeply rooted, gender roles can be treatment. Example: Only women can give birth. Only women Example: The expectation of men to be economic can breastfeed. However, women prove able to do traditionally male jobs as well as men e. Women give birth to babies, men don't. Girls are gentle, boys are rough. In one case, when a child brought up as a girl learned that he was actually a boy, his school marks improved dramatically.
Amongst Indian agriculture workers, women are paid per cent of the male wage. In Europe, most long-distance truck drivers are men. Women can breastfeed babies, men can bottle-feed babies. Most building-site workers in Britain are men. In ancient Egypt men stayed at home and did weaving. Women handled family business. Women inherited property and men did not. Men's voices break at puberty; women's do not. In one study of cultures, there were 5 in which men did all the cooking, and 36 in which women did all the housebuilding.
According to UN statistics, women do 67 per cent of the world's work, yet their earnings for it amount to only 10 per cent of the world's income. There are more women than men in the caring professions such as nursing. Men are susceptible to prostate cancer, women are not. Example: A family has limited funds, and both Example: Provision of leadership training for women or daughter and son need new pair of shoes for the new establishing quotas for women in decision-making positions school year, but only one can get new shoes this year.
If the family decides and who in the family decides?
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