Community sheet # 3 - Haitham Al-noti

[Shadi Jarrar]

بسم الله الرحمن الرحيم

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my community sheet .doc
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In The Name Of God

In the previous two lectures , we have started our speech about PHC's ( primary health care) definition ….. components….. , and it's structures. Anyway , in this lec. The doc starts with speaking about the importance of the people education….awareness toward their life style to be able to get the benefits of the available services in the community ( coz if the required services are available without certain level of awareness, we can't manage them in the suitable way.) .

We need to know that PHC role in the community( isn't restricted to the management and treatment of sick patient ( with diseases in their acute stages) as we may think ) is preventive .only 10% of the PHC possibilities are directed toward services that are used in the treatment and giving medication to the sick patienst . 90% of the possibilities are directed toward the services used in the prevention of diseases .. screening…. health promotion, ..and take care of the pregnant women and infants .

Nowadays, we can note a significant progression in the health status in our community ( in other communities as well) e.g. :

- the coverage of vaccination increases from 60-70% in the previous years to 98% recently ( reach 85% for tuberculosis ……. )
- the percentage of pregnant women ( seen by doctors before delivery)increases from 30% to 96% .
- Just 1% of the delivery cases occur at homes.

Now, what are the indicators used to express the health status in any community ( e.g. in Jordan )?

- mortality ( or morbidity ) rate due to the progression of the acute diseases ( to their final stages)
it reflects the availability of the services in the community ( it becomes less in the developed countries ).
by the way, which category gives the most sensitive indicator about the mortality rate ( infants , adult , elderly , or may be mortality rate of certain disease e.g. cancer) ?
actually it is the infant category ( babies from the first day to the end of the first year) that considered to be fragile human being , and they may die due to congenital abnormalities or infectious reasons.
- the coverage of the vaccination ( and it's role in the health promotion).
- The rate of visits to the womanly clinics by the pregnant ladies.


# here , we need to know that the mortality rate decreases with age
Until the age of 60 after that the mortality rate increase again .

• indicators of current Health status and health care in Jordan :

A - infant mortality :. as we said before the infant is the most sensitive indicator among other category
It decrease from 130 in 1960 to 35 per 1000 live birth in 1992 to 22 in 2002 to 19 in 2007( and it might reach 15 in 2010)
Here just to let you know:

# neonatal category ranges from time zero of the baby life until the end of the first month . of course it is more sensitive than infant category but it isn’t widely used .
# perinatal category includes two weeks before and after birth and again it is the most sensitive among the rest .
# childhood between 1- 5 years and it's contribution in the general mortality rate is just 0.1 of the infants category contribution ..


B - life expectancy : depends on the degree of health promotion , services availability ………… so we find that the life expectancy is expected to be high in the developed communities ( it estimated to be roughly 74 year in the developed countries with 2-4 years more or less between males and females……… in general females have higher life expectancy than males.

* in Jordan life expectancy has progressed from 49 in 1965 to 66 in 1990 to 72 in 2004 ( these are general indicators )

C - fertility rate ( or total fertility )
high fertility rate indicates low devices level and the opposite is true
that is more and more pregnancy ( and resultant abortion in some cases ) will result in poor maternal health
# less total fertility = less mortality rate
In Jordan, fertility rate decrease from 7 in 1982 to 5.6 …. 3.7 in 2002….. 3.6 in 2007 .

# note : there is a drop from 7 to 3.6 during 20 years …… but just 0.1 in the last 5 years , this is due to the difficulty of progression after certain level due to the presence of religious , culture,……… limitation .

# in the western countries and other developed countries the fertility rate doesn't exceed 2.5 – 3.0.

D- infectious diseases have been eradicated …… e.g. small-pox ( a small spots or spread skin rash ( jadary ) was eradicated on 1979 ………….. polio disease is eradicated thesedays ..tuberculosis ….. and the list continues …

# the first PHC center in Jordan was established on 1985 , and according to it's first study :
Just 47% of the PHC possibilities are directed toward the health promotion ( preventive purposes , Of course this percentage increases to reach 80-90% nowadays )….. 50% are directed toward diseases management ( 10% for infectious diseases , 10% for digestive problem ,,another 10% for diarrhea ………..) . in the western countries it is not exceed 5% .

# in Jordan : the morbidity of the infectious diseases is reduced (due to the use of vaccination except in some epidemic cases e.g. on 1994 the rate of polio increases suddenly from 1 to 37 ) ,but this isn't true for the chronic and degenerative diseases which appear to increase and become high when we compare it with the previous category. This fact differs between communities ( in some of them infectious diseases are high ) .


• The provider of the PHC services are :

- public section ( governmental one ) which plays the major role in the community .( MOH(MINISTRY OF HEALTH) AND RMS (ROYAL MALATRY SERVICES).

- Hospital of the university ( ju hospital )

- UNRWA

- Private section ( it's role is less than that of the public one )



# the Jordan community is
- small and highly urbanized. The medical staff is well organized and reach the area around cities ( up to 20% ) ,but sometimes we have some difficulties to find a highly regular nurse … technician … in the time you can find a highly prepared dentist … cardiologist .
- water availability and waste disposal
- intermediate to high skilled staff ( was discussed )

# department distribution:

In this part the doc starts to number the departments that are classified under the umbrella of PHC( to know the services It offers) like:

- health promotion ( yandarj ta7tha )
e.g., school health care

- clinic and PHC( 2l5yadat 2l5arjyah ) + venereal diseases department ( 2mra9' saryah)
Include the treatment of the chronic diseases like diabetes , hypertension.

- environmental health department ( check this part please coz it isn't clear in the recording )


# Every community has it's own priorities in the management of it's PHC program toward certain health section more than others according to their conditions e.g. :

- toward the elder people in the developed communities ( their percentage reach 20% ) … this isn't accurate about our community coz their percentage are much less in our country ( on the other hand we have more concentration on the maternal and infant health)


- according to the studies that were published on 1979 ( in Jordan ) the major leading cause to death is the cardiovascular diseases (23%)….. diarrhea …… infectious diseases … car accidents …. Cancers ………. ( notice that the infectious diseases still have a role here )

- another study on 1991 : the cardiovascular diseases still the major cause with higher contribution ( 39% ) …. Car accident .. cancers ( have increased role ) …… diarrhea …… infectious diseases ( have less role).

- in the most recent study the cardiovascular diseases still the leading cause ( 41% )

- neonatal death consider to be ( cause # 6 in 1979 but # 3 in the later studies , why ?

due to the progression of the diagnostic science , a lot of the neonatal death that is considered to be classified under other categories previously have been added gradually to this category .


- there are differences in the priorities between countries of different incomes as follow :

# countries of low income : in the previous years the infectious diseases considered to be the leading cause of death ( due to their poor services availability), but nowadays the cardiovascular diseases may be considered to be the leading cause of death in general
.

# countries of high income : the coronary heat diseases considered to be the leading cause of death


# countries of intermediate income: the cardiovascular diseases and stroke are considered to be the leading cause of death





So, as a conclusion :
# the leading cause of death in general ( in the developed and developing countries ) is ……. The cardiovascular diseases

# the leading cause of death in the developing country is …..
The infectious diseases

Best of luck
Done by : haitham al-noti