Community Health Nursing II (Population Groups and

Community as Clients)

Module #7 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

Lesson Title: PUBLIC HEALTH TOOLS Materials:

Learning Targets: Pen, paper, index card, book, and class List
At the end of the module, students will be able to:
1. Apply public health tools in assessing the health status of the
community; References:
2. Discuss the different public health tools in assessing the health
status of the community; and, Famorca, Z., Nies, M., McEwen, M. (2013).
3. Enumerate the different public health tools in assessing the Nursing Care of the Community. Singapore:
health status of the community. Elsevier
Other References:

Cuevas, F. P., (2007). Public Health Nursing

in the Philippines (10th edition). Manila,
Philippines.
De Belen, R. & De Belen, D. V., (2008). A
Praxis in Community Health Nursing. 1672
Quezon Avenue South Triangle, Quezon City.

Maglaya, A., (2004). Nursing Practice in the

Community (4th edition). Philippines

A. LESSON PREVIEW/REVIEW

Instruction: Match column A with Column B.

A B Answer
A. Correlation data for two variables
Line graph
B. For comparisons of absolute or relative counts and rates between categories
Bar graph
C. Shows breakdown of a group or total where the number of categories is not
Histogram too many

Proportional Chart D. presentation of frequency distribution or measurement

E. Shows trend data or changes with time or age with respect to some other
Scattered diagram
variable

B. MAIN LESSON

APPLICATION OF PUBLIC HEALTH TOOLS IN COMMUNITY HEALTH NURSING

Tools in Measuring and Analyzing Community Health Problems:

1. Epidemiology
2. Biostatistics

Tools in Identifying Community Needs:

3. Demography
4. Vital statistics
5. Epidemiology

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 Community Health Nursing II (Population Groups and
Community as Clients)

Module #7 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

Demography
⎯ It is the science which deals with the study of human population’s size, composition and distribution in space.
⎯ Population size refers to the number of people in a given place or area at a given time.
⎯ Population composition pertains to certain variables like age, sex, occupation or educational level.

Sources of Demographic Data

⎯ Censuses
⎯ Sample surveys
⎯ Registration systems

Census
⎯ Defined as an official and periodic enumeration of population.
⎯ 2 ways of assigning people when census is taken
✓ De jure Method – people are assigned to the place where they usually live regardless of where they are at the
time of census
✓ De facto Method – people are assigned to the place where they are physically present at the time of the census
regardless of their usual place of residence

Population Size (Births and Deaths)

1.
Natural increase = Number of births – Number of deaths
(specified year) (specified year) (specified year)
2.

Rate of Natural increase = Crude birth rate – Crude death rate

(specified year) (specified year) (specified year)

Population Size (Two Census Periods)

1. Absolute increase per year measures the number of people that are added to the population per year.
Absolute increase per year = Pt – P0
t
Where: Pt = population size at a later time
P0 = population size at an earlier time
t = number of years between 0 and t

2. Relative increase is the actual difference between the two census counts expressed in percent relative
to the population size made during an earlier census.

Relative increase = Pt – P0
P0

Where: Pt = population size at a later time

P0 = population size at an earlier time

Population Composition
⎯ A composition of the population commonly described in terms of age and sex.

THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 2

 Community Health Nursing II (Population Groups and
Community as Clients)

Module #7 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

1. Sex composition
⎯ Sex ratio – number of males to the number of females
2. Age composition
⎯ Median Age – divides the population into two equal parts. So, if the median age is said to be 19 years old. It
means half of the population belongs to 19 years and above, while the other half belongs to ages below 19 years
old.
⎯ Dependency Ratio – compares the number of economically dependent with the economic productive group in the
population. The economically dependent are those that belong to the 0-14 and 65 above age groups. Considered
to be economically productive are those within the 15 - 64 age group. The dependency ratio represents the
number of economically dependent for every 100 economically productive.

3. Age and Sex Composition – age and sex composition of the population can be described at the same time using
population pyramid. It is a graphical presentation of the age and sex composition of the population.

Population Distribution

1. Urban-Rural Distribution
⎯ Simply illustrates the proportion of the people living in urban compared to rural areas
2. Crowding Index
⎯ Describe the ease by which a communicable disease will be transmitted from one host to another susceptible
host. This is described by dividing the number of persons in a household with the number of rooms used by the
family for sleeping
3. Population Density
⎯ Determine how congested a place is. It can be computed by dividing the number of people living in a given land
area.

Vital Statistics
⎯ It estimates the extent or magnitude of health needs and problems in the community.
⎯ Vital Statistics refers to the systematics study of vital events such as births, illnesses, marriages, divorce, separation
and deaths.
✓ Statistics of disease (morbidity) and death (mortality) indicate the state of health of a community and the success
or failure of health work.
✓ Statistic on population and the characteristics such as age and sex, distribution are obtained from the National
Statistics Office (NSO).
✓ Births and Deaths are registered in the Office of the Local Civil Registrar of the municipality or city. In cities, births
and deaths are registered at the City Health Department.

Use of Vital Statistics:

⎯ Statistic on population and the characteristics such as age and sex, distribution are obtained from the National
Statistics Office (NSO).
⎯ Births and Deaths are registered in the Office of the Local Civil Registrar of the municipality or city. In cities, births and
deaths are registered at the City Health Department.
⎯ Indicates of the health and illness status of a community
⎯ Serves as bases of planning, implementing, monitoring and evaluating community health nursing programs and
services

Sources of Data:
⎯ Population census
⎯ Registration of Vital data
⎯ Health Survey
⎯ Studies and research

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 Community Health Nursing II (Population Groups and
Community as Clients)

Module #7 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

Rates and Ratios:

⎯ Rate shows the relationship between a vital event and those persons exposed to the occurrence of said event, within
a given area and during a specified u it of time, it is evident that the person experiencing the event (Numerator) must
come from the total population exposed to the risk of same event (Denominator).

4. Ratio is used to describe the relationship between two (2) numerical quantities or measures of events without taking
particular considerations to the time or place. These qualities need not necessarily represent the same entities,
although the unit of measures must be the same for both numerator and denominator of the ratio.
5. Crude or General Rates. Referred to the total living population. It must be presumed that the total population was
exposed to the risk of the occurrence of the event.
6. Specific Rate. The relationship for a specific population class or group. It limits the occurrence of the event to the
portion of the population definitely exposed to it.
7. Crude Birth Rate (CBR). A measure of one characteristics of the natural growth or increase of population.
⎯ Crude Death Rate (CDR). A measure of one mortality from all causes which may result in a decrease of population
⎯ Infant Mortality Rate (IMR). Measures the risk of dying during the 1st year of life. It is a good index of the general
health conditions of a community since it reflects the changes in the environmental and medical condition of a
community.
⎯ Maternal Mortality Rate (MMR). Measures the risk of dying from causes related to pregnancy, childbirth and
puerperium. It is an index of the obstetrical care needed and received by women in a community.
⎯ Fetal Death Rate (FDR. Measure’s pregnancy wastage. Death of the product of conception occurs prior to its
complete expulsion, irrespective of duration of pregnancy.
⎯ Neonatal Death Rate (NDR). Describes more accurately the risk of exposure of certain classes or groups to
particular diseases. To understand the forces of mortality, the rates should be made specific provided the data are
available for both the population and the event in their specifications. Specific rates render more comparable and thus
reveal problem of public health.
⎯ Specific Death Rate (SDR). Describes more accurately the risk of exposure of certain classes or groups to particular
diseases. To understand the forces of mortality, the rates should be made specific provided the data are available for
both the population and the event in their specifications. Specific rates render more comparable and thus reveal the
problem of public health.
⎯ Incidence Rate (IR). Measure’s frequency of occurrence of the phenomenon during a given period of time
⎯ Prevalence Rate (PR). Measures the proportion of the population which exhibits a particular disease at a particular
time. This can only be determined following a survey of the population concerned, deals with total (new and old)
number of cases.
⎯ Attack Rate (AR). A more accurate measure of the risk of exposure.
⎯ Proportionate Mortality (Death Ratios). Shows the numerical relationship between deaths from all causes (or group
old causes), age (or group of age) etc., and the total no. of deaths from all causes in all ages taken together.
⎯ Case of Fatality Ratio (CFR). Index of a killing power of a disease and is influenced by incomplete reporting and
poor morbidity data.

Vital Statistics

Crude Birth Rate (CBR)

Total No. of live births registered in a given calendar year
CBR= ---------------------------------------------------------------------------------------------1,000
Estimated population as of July 1 same of year

Crude Death Rate (CDR)

Total No. of deaths registered in a given calendar year
CDR= -------------------------------------------------------------------------------------------- 1,000
Estimated population as of July 1 same year

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 Community Health Nursing II (Population Groups and
Community as Clients)

Module #7 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

Infant Mortality Rate (IMR)

Total No. of death under 1 year of age
registered in a given calendar year
IMR= --------------------------------------------------------------------------------------------- 1,000
Total No. of registered live births of same calendar year

Maternal Mortality Rate (MMR)

Total No. of deaths from maternal causes
registered for a given year
MMR= ----------------------------------------------------------------------------------- 1,000
Total No. of live birth registered of same year

Fetal Death Rate (FDR)

Total no. of fetal deaths registered in a
Given calendar year
FDR= --------------------------------------------------------------------------------------1,000
Total No. of live births registered of same year

Neonatal Death Rate (NDR)

No. of Deaths under 28 days of age registered
In a given calendar year
NDR= ------------------------------------------------------------------------------------ 1,000
No. of live births registered of same year

Specific Death Rate (SDR)

Deaths in specific class/ group registered in a given year
Specific Death Rate=------------------------------------------------------------------------------------- 100,000
Estimated population as of July 1 in same
specified class/ group of said year

Cause Specific Death Rate

No. of death from specific cause registered in a given year
Cause Specific Death Rate= ----------------------------------------------------------------------------------------- 100, 000
Estimated population as of July 1st of same year

Age Specific Death Rate

No. of death in a particular age group registered
in a given calendar year
Age Specific Death Rate= -------------------------------------------------------------------------------- 100,000
Estimated population as of July 1st
in same age group of same year

Sex Specific Death Rate

No. of deaths of a certain sex registered
in a given calendar year

THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 5

 Community Health Nursing II (Population Groups and
Community as Clients)

Module #7 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

Sex Specific Death Rate= -------------------------------------------------------------------- 100,000

Estimated population as of July 1
in same sex from same year

Incidence Rate (IR)

No. of new cases of a particular disease registered
during a specified period of time
Incidence Rate= ----------------------------------------------------------------------------------------------- 100,000
Population at Risk

Prevalence Rate (PR)

No. of new and old of a certain disease
Registered at a given time
Prevalence Rate= ------------------------------------------------------------------------------------------------- 100
Total No. of persons examined at the same given time

Attack Rate (AR)

No. of persons acquiring a disease registered
in a given year
Attack Rate= -------------------------------------------------------------------------------------------- 100
No. of exposed to same disease in the same year

Proportionate Mortality (PM)

No. of registered deaths from specific cause or age
for a given calendar year
Proportionate Mortality=-------------------------------------------------------------------------------------------- 100
No. of registration deaths from all causes,
all ages in same year

Case Fatality Ratio (CFR)

No. of registered deaths from same specific
disease in same year.
CPR= ---------------------------------------------------------------------------------------------------- 100
No. of registered cases from same specific disease in same year

EPIDEMIOLOGY

It is defined as the study of the occurrence and distribution of health conditions such as disease, death, deformities or
disabilities on human population. It is also concerned with the study of probable factors that influence the development of
these health conditions.

It is used to analyze the different factors that contribute to the disease development.

Two important Concepts

1. Multiple Causation Theory
Three models that explain the multiple causation theory
⎯ The wheel
⎯ The web

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 Community Health Nursing II (Population Groups and
Community as Clients)

Module #7 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

⎯ The ecologic triad

o Ecologic triad is the most helpful

Herd immunity – is the probability of a group or community developing an epidemic upon introduction of an infectious
agent.

2. Levels of Prevention of Health Problems

A. Primary Prevention
⎯ It aims to strengthen host resistance, inactivate the agent or interrupt the chain of infection through environmental
manipulation.

⎯ Prevention of emergence of risk factors (primordial prevention)

⎯ Removal of risk factors or reduction of their levels (specific protection)
• E.g., Personal surveillance, quarantine, segregation or isolation, proper nutrition, safe water supply and water
disposal system, vector control, promotion of healthy lifestyle and good personal habits
⎯ Specific measures: immunization and prophylaxis

B. Secondary Prevention
⎯ It aims to identify and treat existing problems at the earliest possible time.
• E.g., Screening, case finding, disease surveillance, prompt and appropriate treatment

C. Tertiary Prevention
⎯ It aims to limit disability progression. It attempts to reduce the magnitude or severity of the residual effects of
communicable or non-communicable diseases.
• E.g., Rehabilitation – drug abuse; Workshops – Person with disability

Phases of Epidemiologic Approach

1. Descriptive Epidemiology - concerned with disease distribution and frequency

2. Analytical Epidemiology - attempts to analyze the causes and determinants of disease through hypothesis testing
3. Intervention or Experimental Epidemiology - answers questions about the effectiveness of new methods for
controlling diseases or improving underlying conditions
4. Evaluation Epidemiology - attempts to measure the effectiveness of different health services and program

CHECK FOR UNDERSTANDING

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed.

Data:

Province of Tarlac as of 1st July 2019 Province of Tarlac as of 1st July 2018
Total no. of Population - 2, 381, 000 Total no. of Population - 1, 167, 000
Total no. of death (all causes) - 43, 000 Total no. of death (all causes) - 23, 000
Total no. Births - 340, 000 Total no. Births - 940, 000
CDR = 18.06 CDR = 19.71
CBR = 142.80 CBR = 805.48
Male = 1023450
Female = 1357550

THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 7

 Community Health Nursing II (Population Groups and
Community as Clients)

Module #7 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

1. Natural increase (2019):

Answer:

2. Rate of natural increase (2019)

Answer:

3. Absolute increase per year (2018 and 2019)

Answer:

4. Relative increase
Answer:

THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 8

 Community Health Nursing II (Population Groups and
Community as Clients)

Module #7 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

5. Sex composition
Answer:

For numbers 6 -10

Province of Tarlac as of 1st July 2019

⎯ Total no. of death (all causes) - 43, 000
⎯ Total no. Births - 340, 000
⎯ Total no. of reported dengue cases: 73, 636
⎯ Total no. of population exposed to dengue: 134,000
⎯ Total no. death (dengue) - 940

6. What is the Crude Birth Rate?

Answer: ______________________

7. Measure the possibility in the decrease of the population per 1000.

Answer: ______________________

8. What is the index killing power of dengue cases?

Answer: ______________________

9. What is the risk of exposure of the population to dengue?

Answer: ______________________

10. What is the index of the obstetrical care needed and received by women in a community?
Answer: ______________________

C. LESSON WRAP-UP

AL Activity: Muddiest Point

In today’s session, what was least clear to you?

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