NCM113-COMMUNITY HEALTH NURSING II 5.

Application of principles of management

and organization in the delivery of health
WHAT IS COMMUNITY HEALTH NURSING? services to the community.
1. (Ruth B. Freeman), it refers to a service
rendered by a professional nurse with CLIENTELE OF THE CHN
communities, groups, families, individuals » Individual
at home, in health centers, in clinics, in » Family
schools, in places of work for the
promotion of health, prevention of illness, Freeman (1981), identified health task of the
care of the sick at home and rehabilitation. family:
2. According to W.H.O.: It is a specialized 1. Recognizing interruptions of health
field of nursing, public health and some development
phases of social assistance that functions 2. Seeking health care
as part of the total public health program 3. Managing health and non-health crises
for the promotion of health, improvement 4. Providing nursing care to the sick,
of the conditions of social and physical disabled and dependent member of the
environment, rehabilitation of illness and family
disability. 5. Maintaining a home environment
3. According to Jacobson: It is a learned conducive to good health and personal
practice discipline with the ultimate goal of development
contributing as individuals and in 6. Maintaining a reciprocal relationship with
collaboration with others, the promotion of the community and health situations
the client’s optimum level of functioning
thru teaching and delivery of care. CLIENTELE OF THE CHN
4. According to American Nurses » Population group – is a group of people
Association (ANA): Community health who share common characteristics,
nursing practice promotes and preserves developmental stage or common
the health populations by integrating the exposure to particular environmental
skills and knowledge relevant to both factors and consequently common health
nursing and public health. The practice is problems:
comprehensive and general and is not  e.g. children, men, women,
limited to a particular age, diagnostic farmers, factory workers,
group, or episodic care. commercial workers, prisoners,
military men, and elderly
CHN HIGHLIGHTS THE FOLLOWING
IMPORTANT POINTS:
1. The goal of professional practice is the COMMUNITY - A group of people sharing
promotion and preservation of health of common geographic boundaries and common
populations. values and interests
2. The nature of practice is comprehensive,
general, continual and not episodic CHARACTERISTICS OF A COMMUNITY
3. The knowledge base comes from nursing 1. It is defined by its geographic boundaries
and public health within certain identifiable characteristics.
4. The different levels of clientele-individuals, 2. It is made up of institutions organized into
families and groups a social system with the institutions and
5. The practitioner’s recognition of the organizations linked in a complex network
primacy of the population as whole having a formal and informal power
structure and a communication system
CHN CONCEPTS FROM THE SCIENCE OF 3. A common or shared interest that binds
PUBLIC HEALTH: the members together exists
1. Emphasis on the importance of the 4. It has an area with fluid boundaries within
greatest good for the greatest number which a problem can be identified and
2. Assessing health needs, planning, solved
implementing and evaluating the impact of 5. It has a population aggregate concept
health services on population groups
3. Priority of health-promotive and disease- CHARACTERISTICS OF A HEALTHY
preventive COMMUNITY
4. Tools for measuring and analyzing 1. Awareness that we are community
community health problems 2. Conservation of natural resources
 3. Recognition of, and respect for, the CLIENT’S RIGHTS IN ANY SETTING
existence of subgroups » Right to accurate and accurate and
4. Participation of subgroups in community adequate information with the respect of
affairs the nurse or health care professional to
5. Preparation to meet crises the patient’s refusal to the administration
6. Ability to problem solve of care
7. Communication trough open channels » Right to safe and quality care –this is
8. Resources available to all dependent on the competency of the
9. Setting of disputes through legitimate health care professional
mechanisms » Right to Privacy – the patient’s medical
10. Participation by citizens in decision records should be treated with
making confidentiality
11. Wellness of a high degree among its
members RIGHT AND RESPONSIBILITY FOR HEALTH

HEALTH & WELLNESS Health is basic human right

» The Universal Declaration of Human
Health – (WHO) is a state of complete physical, Rights Article 25 Section 1 – States that
mental and social wellbeing, not merely an “Everyone has the right to a standard of
absence of disease or infirmity. living adequate for the health and well-
being of himself and of his family,
10 Determinants of health by the WHO including food, clothing, housing and
1. Income and social status medical care and necessary social
2. Education services, and the right to security in the
3. Physical environment event of unemployment, sickness,
4. Employment and working conditions disability, widowhood, old age or other
5. Social support networks lack of livelihood in circumstances beyond
6. Culture his control.
7. Genetics
8. Personal behavior and coping skills LAWS AFFECTING PRACTICE OF PUBLIC
9. Health services HEALTH NURSING
10. Gender
EXISTING LAWS AND STANDARDS THAT
High-level wellness – according to Dunn, as an GOVERNS SAFE NURSING PRACTICE.
integrated method of functioning which is oriented 1. Republic Act No. 6713 – March 25, 1983
toward maximizing the potential which the known as the Code of Conduct and
individual is capable. It requires that the individual Ethical Standards for Public Officials and
maintain a continuum of balance and purposeful Employees
direction within the environment where he is 2. Republic Act No. 7305 – is known as
functioning. Magna Carta for Public Health Workers:
3. Republic Act No. 6758 – standardized the
Prerequisites for Health salaries of government employees which
The fundamental conditions and resources for includes the nursing personnel
health are: 4. Republic Act 9173 – Philippine Nursing
1. Peace, Act of 2002, An act providing for a more
2. Shelter, responsive nursing profession, repealing
3. Education, for the purpose RA 7164 otherwise known
4. Food, as Philippine Nursing Act of 1991 and for
5. Income, other purposes
6. A stable eco-system,
7. Sustainable resources, COMMUNITY HEALTH DEVELOPMENT
8. Social justice, and equity. CONCEPTS, PRINCIPLES AND STRATEGIES

ETHICO LEGAL ASPECTS OF CHN PRACTICE Conceptual Framework

What is legal? Goal: Health for All Filipinos and Health in the
 If the practitioner works in Hands of the People by the year 2020
accordance with the law and its Mission: To strengthen the health care system by
provisions increasing opportunities and supporting the
 However not all legal points are conditions wherein people will manage their own
ethical or socially acceptable health care
PRIMARY HEALTH CARE CONCEPTS HEALTH PROMOTION
1. Cooperation of the Community » Is the process of enabling people to
2. Capability of people to determine and increase control over, and to improve,
analyze their own problems cooperates in their health.
finding ways or solution to their problems » To reach a state of complete physical,
and acceptance of their problems mental and social well-being, an individual
3. Voluntary Community Involvement or group must be able to identify and to
4. Villagers work to ensure better living of the realize aspirations, to satisfy needs, and
community to change or cope with the environment
5. Basic Needs » Health is, therefore, seen as a resource
6. PHC to Achieve a Better Quality of Life. for everyday life, not the objective of living.
7. Self-Reliance » Health is a positive concept emphasizing
8. PHC activities must be in harmony with social and personal resources, as well as
existing institutions and daily life of the physical capacities
community
Health Promotion Action Means:
PHC AS A PUBLIC HEALTH SERVICE 1. Building Healthy Public Policy
PHC must be related to public health services in 2. Creating Supportive Environments
such aspects as technical support, referral of 3. Strengthening Community Actions
patients for medical treatment, provision of 4. Developing Personal Skills
continuing education, provision of health 5. Reorienting Health Services
information 6. Moving into the Future

PHC AS AN APPROPRIATE STRATEGY THEORIES & MODELS OF HEALTH

PHC work should be feasible in its application for PROMOTION
problem-solving appropriate to social conditions
and problems being encountered. Its pattern of DIFFERENCE OF THEORY AND MODEL
work need not be identical in all villages. THEORY:
» An integrated set of propositions that
ESSENTIAL ELEMENTS OF PRIMARY serve as an explanation for a
HEALTH CARE phenomenon.
E – Education for health » A systematic arrangement of fundamental
L – Locally-Endemic Disease Control principles that provide a basis for
E – Expanded Program on Immunization explaining certain happening of life.
M – Maternal and Child Health MODEL:
E – Essential Drugs » A subclass of theory. It provides for
N – Nutrition investigating and or addressing a
T – Treatment of Communicable Diseases phenomenon.
S – Safe Water and Sanitation » Does not attempt to explain the processes
underlying learning, but only to represent
LEVELS OF HEALTH CARE AND REFERRAL them
SYSTEM » Provides the vehicle for applying the
1.Primary Level Facilities theories
2. Secondary Level Facilities
3. Tertiary Level Facilities 1. BANDURA’S SOCIAL COGNITIVE THEORY
(ALBERT BANDURA)
» This theory provides a framework for
human behavior.
» The theory identifies human behavior as
an interaction of personal factors,
behavior, and the environment
Social cognitive theory is helpful for
understanding and predicting both
individual and group behavior and
identifying methods in which behavior can
be modified or changed.
» In the model, the interaction between the
person and behavior involves the
influences of a person’s thoughts and
actions.
 » The interaction between the person and 3. HEALTH PROMOTION/EDUCATION
the environment involves human beliefs (GREEN AND KREUTER)
and cognitive competencies that are » “Health promotion" can be defined as "any
developed and modified by social combination of educational and
influences and structures within the environmental supports for actions and
environment. conditions of living conducive to health"
» The third interaction, between the (Green and Kreuter, 1999).
environment and behavior, involves a » Health education aims at learning
person’s behavior determining the aspects experiences and voluntary actions people
of their environment and in turn their take, individually or collectively, for their
behavior is modified by that environment. own health, the health of others, or the
common good of the community.
2. HEALTH BELIEF MODEL » Health education as "any combination of
IRWIN ROSENSTOCK, HOCHBAUM, AND learning experiences designed to facilitate
OTHERS. voluntary actions conducive to health"
» Who were working in the U.S. Public (Green and Kreuter, 1999) emphasizes
health service to explain the failure of the importance of multiple determinants of
people participating in programs to behavior.
prevent and detect disease. » The task for health promotion, beyond
» The health belief model is a theoretical health education, is how to make more
model that can be used to guide health healthful choices easier choices.
promotion and disease prevention » Health education provides the
programs. consciousness-raising, concern-arousing,
» It is used to explain and predict individual and action-stimulating impetus for the
changes in health behaviors. public involvement and commitment to
» It is one of the most widely used models social reform essential to its success in a
for understanding health behaviors. democracy.
» It is based on the theory that a person's
willingness to change their health HEALTH PROMOTION/EDUCATION
behaviors is primarily due to the following GREEN AND KREUTER
factors: » The most appropriate "center of gravity"
 Perceived Susceptibility for health promotion is the community.
People will not change their health » A "community" may be a town or county in
behaviors unless they believe that sparsely populated areas; or it may be a
they are at risk. neighborhood, worksite, or school in more
 Perceived Severity populous metropolitan areas.
The probability that a person will » It can also apply to groups of people not
change his/her health behaviors to sharing a specific geographic association,
avoid a consequence depends on but sharing social, cultural, political, or
how serious he or she considers economic interests that link them together.
the consequence to be.
 Perceived Benefits Community health promotion requires the
It's difficult to convince people to participation of local leadership and social
change a behavior if there isn't networks to facilitate the transmission and uptake
something in it for them. of interventions for the overall population.
 Perceived Barriers
One of the major reasons people NATIONAL HEALTH SITUATION
don't change their health behaviors
is that they think that doing so is The National Health Situation gives us an idea of
going to be hard. Sometimes it's the health situation in the communities where
not just a matter of physical nurses work
difficulty, but social difficulty as example: goiter is highly prevalent in the
well. Changing your health mountain province while schistosomiasis is
behaviors can cost effort, money, endemic in Leyte
and time.
PHILIPPINE SITUATIONER » TFR in the Philippines remains high
» POPULATION: 110.8 million compared to the neighboring SE Asian
» POPCOM: Number of Filipinos in 2021 Countries
estimated at 110.8 million, Sizes of » Rural women have more children than
families trending lower at 4 members | urban women; uneducated women also
» Annual growth rate of 2.11% have more children than those who are
» With effects of the COVID-19 pandemic with college education
such as service delivery disruptions on » In 1995, the IMR was 48.9 per 1000 live
family planning factored-in, the figure is births
estimated to swell at 111.1 million, » Under-five mortality rate in the same year
affecting mainly the under-1 age group was 67/ 1000 live births
due to increased unplanned pregnancies » The maternal mortality rate was 1.8/ 1000
» Broken down by sex, there will be more live births
males in this group at 36,139,866 than
females at 35,138,630. This implies the LEADING CAUSES OF MORTALITY AMONG
need for the country to create at least a FILIPINOS:
half a million new jobs next year, posing a 1. Heart disease
huge challenge for the labor sector in the 2. Diseases of the vascular system
midst of the pandemic. 3. Pneumonias
4. Malignant neoplasms
HEALTH CRISIS UPDATES 5. TB, all forms
(COVID-19: PANDEMIC) 6. Accidents
7. COPD and allied conditions
8. Other diseases of the respiratory system
9. Diarrheal diseases

LEADING CAUSES OF INFANT MORTALITY

1. Respiratory conditions of the fetus and
newborn
2. Pneumonias
3. Congenital anomalies
4. Birth injury and difficult labor
5. Diarrheal diseases
PHILIPPINES: MORBIDITY & MORTALITY 6. Septicemia
» Morbidity-refers to the cases of illness in a 7. Measles
given population in a specified period of 8. Meningitis
time. 9. Other diseases of the respiratory system
» Mortality-refers to the cases of deaths in a 10. Avitaminosis and other nutritional deficiency
given population in a specified period of
time LEADING CAUSES OF MATERNAL
» According to the DOH top leading causes MORTALITY
of MORBIDITY in the Philippines includes 1. Normal delivery and other complications r/t
all forms respiratory diseases, pregnancy occurring in the course of labor,
hypertension, kidney and urinary tract delivery, and puerperium
problems, all forms of diarrheal diseases, 2. Hypertension complicating pregnancy,
and diabetes mellitus. childbirth and puerperium
» For MORTALITY, it includes 3. Postpartum hemorrhage
cardiovascular diseases, 4. Pregnancy with abortive outcome
pneumonias, malignant 5. Hemorrhages r/t pregnancy
neoplasms/cancers, all forms of
tuberculosis, accidents, COPD and allied THE HEALTH CARE DELIVERY SYSTEM
conditions, diabetes » the totality of all policies, infrastructures,
mellitus, nephritis/nephritic syndrome and facilities, equipment, products, human
other diseases of respiratory system. resources, and services that address the
health needs, problem and concerns of all
BIRTHS AND DEATHS people
» 1997: CBR- 28.4 per 1000 population
» CDR- 6.1 per 1000 population
» Rate of Natural Increase:22.3
TWO SECTORS 4. More responsive health systems
1. Public sector 5. Equitable health care financing
» Largely financed through tax-based
budgeting system ELEMENTS OF FOURMULA ONE
» Health care is generally given free at the » Health financing- to foster greater and
» point of service sustained investments in health
» Consists of the national and local » Health Regulation-to ensure quality and
government agencies affordability of health goods and services
» Health service delivery- to ensure the
2. Private Sector accessibility and availability of basic and
» for profit and nonprofit providers essential health care
» health care is paid through user fees at » Good governance- to enhance health
the point of service system performance at the national and
 e.g. clinics, hospitals, health local levels
insurance, medicines, vaccines,
facilities, equipment DOH PROGRAMS
- Adolescent and Youth Health and Development
NATIONAL HEALTH SYSTEM Program
DEPARTMENT OF HEALTH - Botika Ng Barangay
» The government agency mandated to - Breastfeeding Program / Mother and Baby
protect the health of the people - Friendly Hospital Initiative
» The biggest health care provider of the - Blood Donation Program
national government - Cancer Control Program
» Takes the lead in the formulation of - Child Health
policies and standards related to health - Diabetes Mellitus Prevention Program
facilities, health products, and human - Dengue Control Program
resources - Dental Health Program
» Provides the local government units - Doctors to the Barrios (DttB) Program
(LGUs) the necessary support in - Emerging Disease Control Program
managing their local health system. - Environmental Health
- Expanded Program on Immunization
GOAL: HEALTH SECTOR REFORM AGENDA - Family Planning
(HSRA) - Food and Waterborne Diseases Prevention and
» Health Sector reform is the overriding goal - Control Program
of the DOH. Support mechanisms will be - Food Fortification Program
through sound organizational - FOURmula One
development, strong policies, systems and - Garantisadong Pambata
procedures, capable human resources - GMA 50 / Parallel Drug Importation (PDI)
and adequate financial resources - Healthy Lifestyle Program
- Knock-Out Tigdas
5 MAJOR REFORMS CONTAINED IN THE - Leprosy Control Program
HSRA ARE: - Malaria Control Program
1. Provide fiscal autonomy to government - Measles Elimination Campaign (Ligtas Tigdas)
hospitals - National Cardiovascular Disease Prevention and
2. Secure funding for priority public health Control Program
programs - National Filariasis Elimination Program
3. Promote the development of local health - National Mental Health Program
systems and ensure its effective - Natural Family Planning
performance - Newborn Screening
4. Strengthen the capacities of health - Nutrition
regulatory agencies - Occupational Health Program
5. Expand the coverage of the National - Health Development Program for Older Persons
Health Insurance Program (Elderly Health)
- Pinoy MD
FRAMEWORK FOR IMPLEMENTATION - Persons with Disabilities Program
OF HSRA: FOURMULA ONE FOR HEALTH - Prevention of Blindness Program
1. implementation framework for health - Rabies Control Program
sector - Safe Motherhood and Women's Health
2. reforms under the current administration - Schistosomiasis Control Program
3. Better health outcomes - Smoking Cessation Program
- Soil Transmitted Helmenthiasis performance current competencies
- TB Control Program expression of client’s desire

NURSING PRACTICE IN THE COMMUNITY 2. Presence of Health Threats

» These are conditions that are conducive to
PROCESSES IN COMMUNITY HEALTH disease and accident, or may result to
NURSING failure to maintain wellness or realize
health potential.
» E.g. Presence of Risk Factors of specific
disease, accident hazards, poor home/
environmental conditions, family history of
hereditary disease, threat of cross
infection, faulty eating habits, poor
environmental sanitation, unhealthy
lifestyle/personal habits

3. Presence of Health Deficits

» These are instances of failure in health
maintenance
» e.g. Illness states, diagnosed or
undiagnosed by medical practitioner,
disability, transient (aphasia or temporary
paralysis after a CVA), permanent (leg
PHASES OF THE NURSING PROCESS amputation secondary to diabetes,
lameness from polio)

4. Presence of Stress Points

» Foreseeable Crisis
» Anticipated periods of unusual demand on
the individual or family in terms of
adjustment/family resources.
» e.g. marriage, pregnancy, parenthood,
divorce, separation, loss of job,
menopause death
ASSESSMENT DATA FOR INDIVIDUALS,
FAMILIES, AND COMMUNITIES FIELDS, AND ROLES OF CHN

DIFFERENT FIELDS OF CHN

1. School Health Nursing
2. Occupational Health Nursing
3. Community Mental Health Nursing
4. Clinical Settings (Clinics, RHU)

ROLES OF THE PUBLIC HEALTH NURSE

1. Clinician - who is a health care provider,
taking care of the sick people at home or
in the RHU
2. Health Educator - who aims towards
health promotion and illness prevention
through dissemination of correct
information; educating people
CATEGORIES/TYPOLOGY OF HEALTH 3. Facilitator - who establishes multi-sectoral
PROBLEMS linkages by referral system
1. Presence of Wellness Condition 4. Supervisor - who monitors and supervises
» Stated as Potential or Readiness the performance of midwives
» A clinical or nursing judgment about a 5. Health Advocate - who speaks on behalf
client transition form a specific level of of the client
wellness or capability to a higher level 6. Collaborator - who working with other
(NANDA, 2001) health team member
» Wellness Potential: It is a nursing
judgement on wellness state or
LESSON 2: a) Urban-rural distribution – illustrates the
proportion of the people living in urban
TOOLS USED IN COMMUNITY DIAGNOSIS compared to the rural areas
1. Demography b) Crowding index – describe the ease by
2. Vital statistics which a communicable disease will be
3. Epidemiology transmitted from one host to another
susceptible host. This is describes by
DEMOGRAPHY dividing the number of persons in a
» is the science which deals with the study household with the number of rooms used
of the human population’s size, by the family for sleeping
composition and distribution in space c) Population density – determine how
congested a place is and has implications
» Population – refers to the number of in terms of the adequacy of basic health
people in a given place or area at a given services present in the community
time
VITAL AND HEALTH STATISTIC
» Population composition – characteristics » a tool in estimating the extent or
of the population in relation to certain magnitude of health needs and problems
variables such as age, sex, occupation or in the community
educational level
STATISTICS
» People are distributed in a specific » it refers to a systematic approach of
geographic location obtaining, organizing and analyzing
numerical facts so tat conclusion may be
SOURCES OF DEMOGRAPHIC DATA drawn from them.
1. Census
2. Sample survey VITAL STATISTICS
3. Registration system » refers to the systematic study of vital
Census – an official and periodic enumeration of events such as births, illnesses,
population. Demographic, economic and social marriages, divorce, separation and deaths
data are collected from a specified population
group. USE OF VITAL STATISTICS
» Indices of the health and illness status of a
Two ways of assigning people community.
» de facto method – the people are » Serves as bases for planning,
assigned to the place where they are implementing, monitoring and evaluating
physically present at the time of the community health nursing programs and
census regardless of their usual place of services.
residence
» de jure method – is done when people are SOURCES OF DATA
assigned to the place where they usually 1. Population census
live regardless of where they are at the 2. Registration of vital data
time of the census 3. Health survey
» Sample survey – demographic information 4. Studies and researches
is collected from a sample of a given
population. Results can be generalized for RATES AND RATIOS
the whole population. » Rate – shows the relationship between a
» Registration system – collected by the civil vital event and those persons exposed to
registrar’s office deal with recording of the occurrence of said event, with a given
vital events in the community. (births, area and during a specified unit of time.
deaths, marriages, divorces and the like).
» Ratio – is used to describe the relationship
POPULATION DISTRIBUTION between 2 numerical quantities or
» this can be describes in terms of urban- measures of events without taking
rural distribution, population density and particular considerations to the time or
crowding index for proper allocation of place.
resources based on concentration of
population in a certain place » 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 EPIDEMIOLOGY
the event. » it is the study of occurrences and
distribution of diseases as well as
» SPECIFIC RATE –the relationship is for a distribution and determinants of health
specific population class or group. It limits states or events in specified population,
the occurrence of the event to the portion and the application of this study to the
of the population definitely exposed to it. control of health problems.

» INFANT MORTALITY RATE – measures USES OF EPIDEMIOLOGY:

the risk of dying during the 1st year of life. According to Morris, epidemiology is used to:
It is a good index of the general health of 1. Study the history of the health population
a community since it reflects the changes and the rise and fall of diseases and
in the environment and medical condition changes in their character.
of the community. 2. Diagnose the health of the community and
the condition of people to measure the
» MATERNAL MORTALITY RATE- distribution and dimension of illness in
measures the risk of dying from causes terms of incidence, prevalence, disability
related to pregnancy, childbirth and and mortality, to set health problems in
puerperium. It is an index of the obstetrical perspective and to define their relative
care needed and received by women in a importance and to identify groups needing
community. special attention.
3. Study the work of health services with a
» FETAL DEATH RATE – measures view of improving them. Operational
pregnancy wastage. Death of the product research shows how community
of conception occurs prior to its complete expectations can result in the actual
expulsion, irrespective of duration of provisions of service.
pregnancy. 4. Estimate the risk of disease, accident,
defects and the chances of avoiding them.
» NEONATAL DEATH RATE – measures 5. Complete the clinical picture of chronic
the risk of dying the 1st month of life. It disease and describe their natural history.
serves as an index of the effects of 6. Identify syndromes by describing the
prenatal care and obstetrical management distribution and association of clinical
of the newborn. phenomena in the population.
7. Search for causes of health and disease
by comparing the experience of groups
that are clearly defined by their
» INCIDENCE RATE – measures the
composition, inheritance, experience,
frequency of occurrence of the behavior and environments.
phenomena during a given period of time.

» PREVALENCE RATE – measures the THE EPIDEMIOLOGIC TRIANGLE

proportion of the population which exhibits
a particular disease at a particular time. HOST
This can only be determined following a » Is any organism that harbors and provides
survey of the population concerned, deals nourishment for another organism.
with total number of cases. » Are related to lower resistance as a result
of exposure to the elements during floods
or disasters.
FUNCTIONS OF THE NURSE
AGENT
1. Collects data » The intrinsic property of microorganism to
2. Tabulates analyzes and interprets data survive and multiply in the environment to
3. Evaluates data produce disease.
4. Recommends redirection and/ or » The result of the introduction of new
strengthening of specific areas of health disease agents into the population.
programs as needed.
ENVIRONMENT
» The sum total of all external condition and
influences that affects the development of
an organism which can be biological,
 social, and physical. The environment » Epidemic period: a period during which
affects both the agents and host. the reported number of cases of a disease
» Changes in the physical environment; exceed the expected, or usual number for
temperature, humidity, rainfall may directly that period.
or indirectly influence equilibrium of agent
and host » Year: For many diseases the incidence
(Frequency of occurrence) is not uniform
during each of 12 consecutive months.
Instead, the frequency is greater in one
season than any of the others. These
seasonal variations are associated with
variations in the risk of exposure of
susceptible to the source of infection.

» Period of Consecutive years: recording

the reported cases of a disease over a
period of years-by weeks, months or year
of occurrence – useful in predicting the
probable future incidence of the disease
and in planning appropriate prevention
and control programs.

PATTERNS OF DISEASE OCCURRENCE AND

THREE COMPONENTS OF THE DISTRIBUTION
ENVIRONMENT 1. SPORADIC OCCURRENCE
1. PHYSICAL ENVIRONMENT – is composed of » It is the intermittent occurrence of a few
the inanimate surroundings such as the isolated and unrelated cases in a given
geophysical conditions of the climate. locality.
2. BIOLOGICAL ENVIRONMENT – makes up the » The cases are few and scattered, so that
living things around us such as plants and animal there is no apparent relationship between
life. them and they occur on and off,
3. SOCIO-ECONOMIC ENVIRONMENT- may be intermittently, through a period of time.
in the form of level of economic development of 2. ENDEMIC OCCURRENCE
the community, presence of social disruptions » It is the continuous occurrence throughout
and the like. a period of time, of the usual number of
cases in a given locality.
DISEASE DISTRIBUTION » The disease is therefore always occurring
» The method and technique of in the locality and the level of occurrence
epidemiology are desired to detect the is more or less constant throughout a
cause of a disease in relation to the period of time.
characteristic of the person who has it or 3. EPIDEMIC OCCURRENCE
to a factor present in his environment. » It is of unusually large number of cases in
These variables are studied since they a relatively short period of time.
determine the individuals and populations » There is a disproportionate relationship
at greatest risks of acquiring particular between the number of cases and the
disease, and knowledge of these period of occurrence, the more acute is
associations may have predictive value. the disproportion, the more urgent and
serious of the problem.
» Time- refers to the period during which the 4. PANDEMIC
cases of the disease being studied were » It is the simultaneous occurrence of
exposed to the source of infection and the epidemic of the same disease in several
period during which the illness occurred. countries. It is another occurrence from an
This analysis of cases by time enables the international perspective
formulation of hypotheses concerning time
and source of infection, mode of
transmission, and causative agent.