For Public Health community presentation

1. Group 3
5th September 2013

2.  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

3.  Facilitators
 Dr. Tawee Saiwichai
 Dr. Pimsurang Taechaboonsermsak
 Arjan Jongkol Podang
 Ms. Piyathida Leadpuangsuda
 Resource Person
 Ms. Kunya Impradit

4.  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

7. 6 4 2 0 2 4 6 8
0-4.9
5-9.9
10-14.9
15-19.9
20-24.9
25-29.9
30-34.9
35-39.9
40-44.9
45-49.9
50-54.9
55-59.9
60-64.9
65-69.9
70-74.9
75-79.9
80-84.9
85-89.9
90+
Population pyramid of St. Louis
Community
female maleNo of people

8. Male
45%Female
55%
Gender
Single
35%
Married
29%Widowe
d
0%
Divorced
5%
Unknow
n
31%
Marital Status
Reference: Secondary data from Community health Centre 14

9. Illiterate
11%
Pre-primary
education
35%
Primary school
1%
Secondary school
21%
High school
13%
Bachelor degree
14%
Unknown
5%
Education
Reference: Secondary data from Community health Centre 14

10.  Hypertension
 Diabetes Mellitus
 Cardio Vascular Disease
 Diarrhea
 Respiratory Infection
 Tuberculosis
 Traffic accident
 Dermatitis
 Renal failure
 Pneumonia
 Flu
 Hand Foot Mouth Disease
 Conjunctivitis
Reference: Secondary data from Community health Centre 14

11. 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

12. Disease
Magnitude
(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)

13. 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, 2004
Thailand Healthy Lifestyle Strategic Plan B.E. 2554-2563

14.  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

15.  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.

16.  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

20. 27 households
30 individuals
11 male 19 female

21.  Mean Age: 55.77 years old
3, 10%
16, 54%
6, 20%
4, 13%
1, 3%
Education Status
Illiterate
Primary
school
High school
Certificate
Graduate

22. 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

23. 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

24. 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

25. 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

26.  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

27.  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…)

33. Disease
Magnitude
(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

34. 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, 2004
Thailand Healthy Lifestyle Strategic Plan B.E. 2554-2563
Proportion 40%
Proportion 63.3%

35. 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

36. 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

37. Logical Framework
for Project

38. 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

39. Objective
Narrative summary Objectively verifiable
indicator
Means 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

40. Objective
Narrative summary Objectively verifiable
indicator
Means of
verification
Important
Assumption
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

41. Objective
Narrative summary Objectively verifiable
indicator
Means of
verification
Important
Assumption
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

42. Output
Narrative
Summary
Objectively
verifiable indicator
Means of
verification
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

43. Output
Narrative
Summary
Objectively
verifiable indicator
Means of
verification
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

44. Output
Narrative
Summary
Objectively
verifiable indicator
Means of
verification
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
•Records from
local health centre
and hospital

45. Output
Narrative
Summary
Objectively
verifiable indicator
Means of
verification
Assumptions
5. Hypertensive
patients with good
adherence
•90% of cases with
hypertension take
the medication
regularly
•Daily medication
log kept by the
patients
•Survey

46. Process
Narrative summary Objectively verifiable
indicator
Means of
verification
Important
Assumption
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

47. Process
Narrative summary Objectively verifiable
indicator
Means of
verification
Important
Assumption
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
•Record and
report

48. Process
Narrative summary Objectively verifiable
indicator
Means of
verification
Important
Assumption
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
•Record and
report

49. Process
Narrative summary Objectively verifiable
indicator
Means of
verification
Important
Assumption
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

50. Input
Narrative Summary Objective verifiable
indicator
Mean of
Verification
Important
Assumption
•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

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 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