1. Community Medicine Community Medicine A system of delivery of comprehensive health care to the people by a health team in order to improve the health of the community

2. . Clinical Medicine Community Medicine Aim To shorten morbidity and prevent mortality in a ill or diseased person Explore methods which would reverse or eliminate disease states To reduce unnecessary morbidity and premature mortality in the whole population Explore greatest potential health improvement Objective Cure patient of disease Improve health status of a community Information required Clinical history, Physical examination and laboratory tests Population data, Health problems, disease pattern, availability of health services. Felt needs of the Community. Diagnosis Differential diagnosis and probable diagnosis Community Diagnosis Action Plan Treatment & rehabilitation Community health Program Evaluation Follow up and assessment Evaluation of change in health status

4. Health Indicators  To measure Health status of a Community / country  Comparison of health status between two communities/Countries.  Assessment of health care needs  Allocation of scare resources  Monitoring & Evaluation of health services, activities & programmes.  The extent to which the objectives & targets are being attained.

5. Indicator: Indicators are an indication of a given situation or a reflection of a situation. Variable: A characteristic of interest in a study that has different values for different objects and subjects. - which helps to measure changes - These can indicate direction and speed of change - Serve to compare different areas or groups of people at the same time.

6. Characteristics of an indicator:- i. Validii. Reliable iii. Sensitive iv. Specific v. feasiblevi. Relevant.

7. Health Indicators  Mortality indicators  Morbidity indicators  Disability rates  Nutritional status indicators  Health care delivery indicators  utilization rates  Indicators of social and mental health  Environmental indicators  Socio-economic indicators  Health policy Indicators  Indicators of quality of life  other indictors

8. Mortality Indicators  Crude death rate (CDR)  Expectation of life  Infant mortality rate (IMR)  Child mortality rate (CMR)  Under -5 Mortality rate (U5MR)  Maternal mortality rate (MMR)  Disease specific mortality rate (DSMR)  Proportional mortality rate

9. Morbidity Indicators –Incidence and Prevalence –Notification rates –Attendance rates at out-patient departments, health centers, etc. –Admission, readmission and discharge rates –Duration of stay in hospital and –Spells of sickness –Absence from work or school.

10. Disability Indicators a) Event-type indicators: i) Number of days of restricted activity ii) Bed disability days iii) Work-loss days iv) School loss days within a specified period iv) School loss days within a specified period b) Person-type indicators: i) Limitation of mobility i) Limitation of mobility ii) Limitation of activity ii) Limitation of activity

11. Nutritional Status Indicators a)Anthropometric measurements of preschool children, e.g., weight and height, mid-arm circumference; preschool children, e.g., weight and height, mid-arm circumference; b) Heights (and sometimes weights ) of children at school entry; and children at school entry; and c) Prevalence of low birth weight – LBW (less than 2.5 kg). (less than 2.5 kg).

12. Health Care Delivery indicators a) Doctor-population ratio b) Doctor-nurse ratio c) Population –bed ratio d) Population per health center /subcentre e) Population per traditional birth attendant f ) Availability of health services g) Accessibility of health care services h) Utilization I ) Quality of health care delivery

13. Utilization rates  Proportion of infants who are “fully immunized” against the 7 EPI diseases.  Proportion of pregnant women who receive antenatal care, or have their deliveries supervised by a trained birth attendant.  Percentage of the population using various methods of family planning.  Bed-occupancy rate (i.e., average daily in-patient /average number of beds).  Average length of stay (i.e., days of care rendered / discharges).  Bed turn-over ratio (i.e., discharges/average beds).

14. Socio-economic indicators  Rate of population increase  Per capita GNP  Level of unemployment  Dependency ratio  Literacy rates, especially female literacy rate  Family size.  Housing: the number of persons per room  Per capita “calorie” availability  Working conditions  Income distribution

15. SOCIAL INDICATORS 1.POPULATION 2.FAMILY FORMATION & HOUSEHOLD 3.EDUCATIONAL OPPORTUNITIES 4.EARNING ACTIVITIES 5.SOCIAL SECURITY & FAMILY WELFARE 6.HEALTH SERVICES 7.NUTRITION8.INCOME DISTRIBUTION 9.ENVIRONMENT10. PUBLIC ORDER & SAFETY 11.TIME USE AND LEISURE, RECREATION 12.SOCIAL STRATIFICATION AND MOBILITY

16. Selected health and socio-economic indicators Least developed countries Developing countries Developed countries 1. Life expectancy at birth (2002) 496278 2.IMR (per 1000 live births)(2002) 99625 3. Under 5 mortality per 1000 live births (2002) 158907 4. Maternal mortality Rate per 100,000 live births (2002) 89044013 5. Doctor-population ratio per 10,000 (2002) 1.48.425.2 6.Nurse-population ratio per 10,000 2.29.674.2 7. GNI, per capita (US $ ) (2002) 277115428214 8. Per capita public expenditure on health, US $ in% of GDP 5414 9. Adult literacy rate (%) (2002) 53.374.597 10. Per Capita calories 209926633371 11. Access to safe water (2002) % population. 6278100 12. Access to adequate sanitation (2002) % population. 4452100

17. Health Policy Indicators  Political commitment to health for all  Resource allocation, GNP spent  Degree of equity distribution of health services.  Community Involvement  Organization frame work  Managerial Process.

21. MILLENNIUM DEVELOPMENT GOAL INDICATORS  Eradicate extreme poverty and hunger  Reduce Child Mortality  Improve Maternal Health  Combat HIV/AIDS, malaria and other diseases  Ensure environmental sustainability  Develop a global partnership for development

22. Comparison of Kerala and all-India Health Statistics KeralaAll-India Death rate/1000(2002) 6.48.1 Rural birth rate(2002) 16.825.0 Infant mortality rate (2002) 1064 Annual growth rate, per cent (2001) 0.91.93 Life expectancy at birth 2001-06 (Projection) Male Male Female Female66.571.77561.564.165.4 Literacy rate, percent(2001) 90.9265.38 Female literacy rate (2001) 87.8654.16 Mean age at marriage females (1999) 22.119.5 Per capita income (2000-01) Rs. 21046 Rs. 16707 Doctor-population ratio (1991) 1: 7213 1:2148