Field presentation of St. Louise community of Bangkok by Shreejeet Shrestha

ST. LOUIS COMMUNITYGroup 3

5th September 2013

Group Members

Chidchanok Jirasingh Cho Cho Hmwe Manash Shrestha Midori Suzuki Nandi U Naseer Ahmed Nyan Nyein Chan Kyaw Rattanaporn Arsa Shreejeet Shrestha Takuma Kato Thet Ko Aung

Acknowledgements

Facilitators Dr. Tawee Saiwichai Dr. Pimsurang Taechaboonsermsak Arjan Jongkol Podang Ms. Piyathida Leadpuangsuda

Resource Person Ms. Kunya Impradit

Introduction

St. Louis Community is located in Kate Sathon 11, nearby Assumption College Primary Section.

There are 111 households, 368 population(male 167 and female 201)

1 Health center for St. Louis Community

Community Map

Community profile

0-4.95-9.9

10-14.915-19.920-24.925-29.930-34.935-39.940-44.945-49.950-54.955-59.960-64.965-69.970-74.975-79.980-84.985-89.9

90+

6 4 2 0 2 4 6 8

Population pyramid of St. Louis Community

female maleNo of people

Male45%

Fe-male55%

Gender

Single35%

Married28%

Wid-owed0%

Di-vorced

5%

Un-known31%

Marital Status

Reference: Secondary data from Community health Centre 14

Health StatusIlliterate

11%

Pre-primary education

35%

Primary school1%

Secondary school21%

High school13%

Bachelor degree14%

Unknown5%

Education


Problem List

Hypertension Diabetes Mellitus Cardio Vascular Disease Diarrhea Respiratory Infection Tuberculosis Traffic accident Dermatitis Renal failure Pneumonia Flu Hand Foot Mouth Disease Conjunctivitis


Diseases Frequency Percent

Insulin dependent diabetes mellitus 2 8.3

Unspecified diabetes mellitus 4 16.7

Disorders of lipoprotein metabolism and other lipidemias

1 4.2

Schizophrenia 1 4.2

Essential(primacy) hypertension 14 58.3

Allergic confect dermatitis 1 4.2

Unspecified renal failure 1 4.2

Total 24 100.0

Reference: Secondary data from St.LouisLocal health center

Prioritization (before data collection)

DiseaseMagnitud

e(wt. =3)

Severity(wt. =5)

Public Concern

Feasibility

(wt. =5)

Total score

Hypertension (5*3) (4*5) (4*5) (55)

Diabetes Mellitus (4*3) (4*5) (3*5) (47)

Cardio Vascular Disease

(3*3) (5*5) (3*5) (49)

Tuberculosis (3*3) (5*5) (2*5) (44)

Theoretical Web of causation

Less exercise

Essential

Hypertension

Family History

Obesity

Smoking

Salty food

Family Problem Old Age

Less knowledge

Less sleep

Stress

Poor Social Capital

Too much work

Low education status

Culture

Low economic status

Community Relationship Individual

Congested area

Alcohol

Fatty food

50% of people are migrants

Shortage of space for exercise

Reference: Heise et al., 1999; Krug et al.,2002; CDC, 2004Thailand Healthy Lifestyle Strategic Plan B.E. 2554-2563

Methodology

Study design: Cross sectional Date: 1st September 2013 (Sunday)

Research question To estimate the prevalence of Hypertension and

risk factors Target population

Middle aged (35 and above) community people Method of data collection:

Household survey using developed questionnaire Key Informant Interview Observation

Questionnaire development

Questionnaire to measure the prevalence of disease and their risk factors was developed using priority matrix and ecological model.

The questionnaire was translated into Thai language for use in the survey

Back Translation was done to test the similarity with the original English questionnaire.

Sample size determination

Sample size(n)= Z2pq/d2

Z= Zα/2 (α=0.1) = 1.645 p= prevalence of HTN = 0.2 (from

secondary data of public health center 14) q= 1-p d= precision = 0.05

n= 174

Sampling technique Purposive or convenient sampling

Reference: http://drjim.0catch.com/samsize-ral.pdf

Data collection

Results

27 households

30 individuals

11 male 19 female

Results

Mean Age: 55.77 years old

3; 10% 1

6; 53%

6; 20%

4; 13%

1; 3%

Education StatusIlliterate Primary

school High school Certificate Graduate

Prevalence of disease and risk factor

Disease Prevalence (%)

Hypertension 36.7

Diabetes Mellitus

0

Heart Disease 3.3

Tuberculosis 0

Risk Factor Prevalence (%)

Smoking 50

Alcohol drinking 30

Oily food 69.2

Low income 36.7

High salt diet 63.3

Stress 50

No exercise 27

Perception on susceptibility

People’s perceived susceptibility(Q. Are you at the risk of following question?)

Risk Factor Percentage (%)

Hypertension 43.3

Diabetes Milles 10.0

Cardiovascular Disease 13.3

Tuberculosis 3.3

Perception on risk factors

People’s awareness for risk factor(Q. Among the following, which do you think are risk factors of hypertension?)

Risk Factor Percentage (%)

Less sleep 63.3

Alcohol drinking 60.0

Smoking 63.3

Stress 63.3

Less exercise 63.3

Interpersonal / Social

Factor Percentage (%)

Are you a member of any social group? 30.0

Are you active in your community? 26.7

When you have some trouble,do you have anybody who you can trust in your community?

80.0

Do you have any stress in your life? 63.3

Are you satisfied with your quality of life? 76.7

Key Informant Interview

Key person Community Health Volunteers (unpaid, but trained)

Hypertension is a public health concern in this area

Stress, smoking are the risk factor to HT in this area

No outbreak of communicable diseases

Aerobics 15mins (Mon-Fridays)

Almost people cook by themselves

People aged over 40 have routine health check every 3 months. (Blood Pressure, Blood sugar, weight…)

Observation

Prioritization (after data collection)

DiseaseMagnitud

e(wt.=3)

Severity(wt.=5)

Public Concern(wt.=5)

Feasibility

(wt.=5)

Total score

Hypertension (5*3) (4*5) (4.5*5) (4*5) 77.5

Diabetes Mellitus (4*3) (4*5) (2.5*5) (3*5) 59.5

Cardio Vascular Disease

(3*3) (5*5) (3*5) (3*5) 64

Tuberculosis (3*3) (5*5) (2*5) (2*5) 54

Actual Web of causation

Less exercise

Essential

Hypertension

Family History

Obesity

Smoking

Salty food

Family Problem Old Age

Less knowledge

Less sleep

Stress

Poor Social Capital

Too much work

Low education status

Culture

Low economic status

Community Relationship Individual

Congested Area

Alcohol

Fatty food

50% of people are migrants

Shortage of space for exercise

Prevalence30%Prevalencez50%

Prevalence63.3%

Prevalence69.2%Proportion

54%

Proportion 36.7%

Proportion 73.3%

Proportion 50%

Reference: Heise et al., 1999; Krug et al.,2002; CDC, 2004Thailand Healthy Lifestyle Strategic Plan B.E. 2554-2563

Proportion 40%

Proportion 63.3%

SWOT Analysis

35

Strengths• People cook by themselves

• Good accessibility to community health

center

• Almost all of household take newspaper

• They have their own exercise program

Weaknesses• Narrow street

• High proportion of migrants

• Not well mobilized community

• Lack of knowledge

• No space for recreation

• Low capacity of community health center

Opportunities• Unused park

• Less number of community

• Routine screening program started by

Metropolitan government

• Some hospitals are nearby

Threats• Economic gap in community

• Some high building around the

community

• Westernization

• Future complications of HTN

SWOT ANALYSIS (STRATEGY)

SW Strategy•Increase capacity of local health community•Nutrition classes + Diet control•Increase knowledge of community people

SO Strategy•Increase referral system•Increase exercise and physical activity

WO Strategy •Renovate and maintain park for recreation place•Increase community participation•Promote screening program of Metropolitan government

ST Strategy•Reduce stress•Reduce future complication of Hypertension

Logical Framework for

Project

GOAL

•Narrative summary

•Objectively verifiable indicator

•Means of verification

•Important Assumption

•Reduce the burden of hypertension

•50% reduction of incidence of hypertension

•20% reduction of incidence of complications of HTN

•End of the project survey•Local Health Centre Records

•Reporting of each case

ObjectiveNarrative summary Objectively verifiable

indicatorMeans of verification

Important Assumption

1. To reduce the risk behavior for hypertension

•50% reduction in proportion of people taking high salty and fatty food.

•50% reduction in proportion of people not exercising

•30% Reduction in proportion of people who smoke, drink alcohol.

•Observation, Diet log, Checklist, Survey

•Participation & cooperation of community and people

Objective

Narrative summary Objectively verifiable indicator

Means of verification


2. To empower people on hypertension prevention and control

•60% increase in proportion of people with knowledge about hypertension

•80% of local health volunteer and community volunteer are able to screen, educate and refer patients of hypertension

•Establishment of community surveillance system

•Formation of community volunteer group

•KAP survey •Interview

•Observation•Reports•Records of local health centre

•Observation•Report

•Observation •Report

•Timely conduction of activities with motivation from community

Objective




3. To improve referral system

4. To improve adherence of medication

•80% of cases with complication of hypertension reach to hospital in 30 minutes

•90% of cases with hypertension take the medication regularly

•Records from local health centre and hospital

•Daily medication log kept by the patients •Survey

•No heavy traffic•Availability of ambulance

•Availability of medicine

Output

Narrative Summary

Objectively verifiable indicator


Assumptions

1. Community people with reduced risk behavior

•70% of people maintain good diet practice

•70% of people do exercise at least 30 minutes per day

•30% of smokers quit smoking

•30% of alcoholic reduce intake of alcohol

•Diet log•Survey•Cooking club report

•Observation•Monitoring report

•Survey

•Survey

•The availability of vegetables, fruit, poultry, fish, etc

Reference: From Burden to "Best buy": Reducing the Economic impact of NCD in low-middle income countries

Output

Narrative Summary



Assumptions

2. Community people with improved knowledge on Hypertension

•90% of people have knowledge about Hypertension prevention and control

•Survey•Test questions with guideline

•Every members of community participate in the training program

Output

Narrative Summary



Assumptions

3. Strengthened capacity of local health volunteer

•3 out of 4 of the local health volunteers have improved knowledge to screen and educate patients of hypertension

•Test questions•Interview•Observation

4. Efficient referral system

•3 out of 4 of the local health volunteers able to refer complications of hypertension

•80% of cases with complication of hypertension reach to hospital in 30 minutes

•Records from local health centre and hospital

Output

Narrative Summary



Assumptions

5. Hypertensive patients with good adherence

•90% of cases with hypertension take the medication regularly

•Daily medication log kept by the patients •Survey

Process

Narrative summary




1. Diet Control Program:

1.1 Nutrition and cooking class

1.2 Running of cooking club

2. Exercise program:

2.1 Advocacy and participation for renovation and maintenance of park for recreation and exercise.

2.2 Training for aerobics instructor

•Twice a year

•One time establishment and smooth functioning

•Advocacy meetings, One time renovation and three monthly monitoring for maintenance

•Once a year

•Record and report

•Observation, Record and report

•Meeting reports, Observation, Monitoring reports

•report

•Participation & cooperation of community and people

Process

Narrative summary




3. Anti tobacco and alcohol program

4. Health Education on Hypertension:

•Training to community volunteer group

•Periodic Health talk by the volunteer group

•No. of pamphlets, poster and leaf lets distributed

•Twice a year

•Once in three months

•Distribution list

•Training report


Process

Narrative summary




5. Training to the local health volunteer on updated information on HTN, community mobilization, project management etc.

6. Setting up community surveillance system.

7. Formation of community volunteer group

•Twice a year

•Establishment of community surveillance system

•One time formation

•Training report

•Registry and report


Process




8. Networking with the nearby hospital for smooth referral.

9. Provision of management handbook

•Meetings once every two months

•No. of handbook distributed

•Meeting report

•Distribution list

Input

Narrative Summary

Objective verifiable indicator

Mean of Verification


•Project Staff •Trainers•Community volunteer•Exercise Trainer

•Reports•Name lists•Photo

•Need to have contracts till project end (at least 3 years)

•Training Materials•IEC promo/ materials -leaflets-pamphlets-posters-notepads•Nutrition guidelines•Handbooks

•100 copies•30 sets•50 pieces•10 dozens•50 pieces•30 pieces•200 pieces

•Training Reports, Receipts, Distribution list

•Technical effective materials

•Estimated Budget(3 years)

•10,000 USD •Financial records, Double entry book keeping system, audit reports

•Timely release of budget

Reference Department of Epidemiology, Facualty of Public Health, Mahidol

University. Principle of Epidemiology Book 2. Bangkok: Department of Epidemiology, Facualty of Public Health, Mahidol University, 2008

Chaweewon Boonshuyar. Biostatistics: A Foundation for Health Sciences Research. Bangkok: Sena Printing, 2007

Somchart Toraksa. Principle of Hospital Administration Book 1. Bangkok: Expernet Co. Ltd., 2004

Nawarat Suwannapong and Chaweewon Boonshuyar. Evaluation and Planning/Public Health Project. Bangkok: Committee of AIDS private development organization, 1999

Veranuch Robsuntisuk. How important of reducing salt intake in hypertensive patients?, 2006 (Brocheur)

CDC. Healthy Plan-it™ a tool for planning and managing public health programs. Atlanta: CDC, 2005

A K Banerjee, Hypertension and dietary fat intake. J R Soc Med. 1987 October; 80(10): 660–661.

Non-Communicable Disease Information Center. Crude Mortality Rate, 2005 (Online) Available URL:http://www.thaincdinfo.com

THANK YOU VERY MUCH

Field presentation of St. Louise community of Bangkok by Shreejeet Shrestha

Healthcare

Transcript of Field presentation of St. Louise community of Bangkok by Shreejeet Shrestha