Community Health II: Main Exam, 25 March 2024
Mount Kenya University · Department of Community Health, Epidemiology and Biostatistics · Certificate in Health Records and Information Technology · CPH2301
Community Health II past exam 2023/2024 from Mount Kenya University with model answers for each question.
Instructions: ANSWER ALL QUESTION IN SECTION A AND ANY OTHER TWO FROM SECTION
Section A
1. Give two reasons why community fails to participate in immunization programmes. (5 marks)
Model answer
- Lack of awareness – communities do not know the benefits or schedules of vaccines.
- Mistrust or cultural beliefs – fear of side‑effects or religious objections prevents attendance.
2. Name five factors that affect the general immunity of a person. (5 marks)
Model answer
- Age (very young and elderly have weaker immunity)
- Nutritional status (deficiencies in protein, vitamins A, C, D, zinc)
- Stress levels (chronic psychological stress suppresses immune function)
- Presence of chronic diseases (e.g., diabetes, HIV, cancer)
- Lifestyle habits (smoking, excessive alcohol, lack of exercise)
3. Illustrate the factors influencing disease occurrence in Kenya. (5 marks)
Model answer
- Socio‑economic status – poverty limits access to care.
- Education level – low literacy reduces health knowledge.
- Infrastructure – inadequate roads, clinics hinder service delivery.
- Cultural practices – traditional medicine may delay treatment.
- Environmental conditions – malaria‑endemic areas raise disease burden.
4. Using examples describe the principles of managing communicable diseases. (5 marks)
Model answer
- Early detection and isolation – e.g., isolating TB patients to prevent spread.
- Vaccination – routine immunisation against measles and polio.
- Antimicrobial stewardship – judicious antibiotic use to curb resistance.
- Public health education – hand‑washing campaigns to reduce diarrhoea.
- Surveillance – monitoring outbreaks to trigger rapid response.
5. Outline FIVE possible causes of missed opportunities in immunization. (5 marks)
Model answer
- Inadequate record keeping – missed doses not documented.
- Shortage of trained staff – insufficient personnel to administer vaccines.
- Supply chain disruptions – vaccine stockouts or cold‑chain failures.
- Community misconceptions – fear of side‑effects deters uptake.
- Poor appointment systems – lack of reminders leads to missed visits.
6. Enumerate FIVE ways by which Health Education can be used in the promotion of health. (5 marks)
Model answer
- Health talks – group sessions on disease prevention.
- School programmes – integrating health education into curricula.
- Community outreach – mobile clinics delivering information.
- Mass media campaigns – radio, TV adverts promoting healthy habits.
- Peer‑education – training local volunteers to spread messages.
7. Describe the linkage between the community and the health facility and sustainability. (5 marks)
Model answer
- Linkage mechanisms: referral system from community health workers to the nearest health facility for diagnosis and treatment.
- Information flow: regular reporting of community health data (e.g., disease surveillance) to facility staff for planning.
- Feedback loop: health facility provides feedback on case outcomes and updates community health plans.
- Resource sharing: facility supplies medicines, vaccines, and health education materials to community groups.
- Joint planning: community representatives participate in health facility management committees to set priorities.
- Sustainability factors: community ownership through participation and local financing (e.g., user fees, community funds).
- Capacity building: continuous training of community volunteers by facility staff ensures skill retention.
- Monitoring & evaluation: shared indicators allow both sides to track progress and adjust interventions.
- Policy alignment: community activities are integrated into national health strategies, securing government support.
- Infrastructure support: facility assists with building or maintaining community health posts, ensuring long‑term service delivery.
8. Explain the classification categories of communicable diseases. (5 marks)
Model answer
- Acute infections: diseases with rapid onset and short duration (e.g., cholera, influenza).
- Chronic infections: long‑lasting diseases with persistent symptoms (e.g., tuberculosis, HIV/AIDS).
- Epidemic‑prone diseases: occur in sudden outbreaks affecting many people in a short period (e.g., measles, Ebola).
- Endemic diseases: constantly present at a baseline level within a specific area (e.g., malaria in tropical regions).
- Zoonotic diseases: transmitted from animals to humans (e.g., rabies, brucellosis).
- Food‑borne diseases: caused by ingestion of contaminated food or water (e.g., salmonellosis, cholera).
- Sexually transmitted infections (STIs): spread through sexual contact (e.g., syphilis, gonorrhoea).
- Vector‑borne diseases: transmitted by insects or other vectors (e.g., dengue, leishmaniasis).
Section B
9. Community Health Volunteers form a basic workforce of community strategy in the provision of level one services. Discuss any five roles they play. (15 marks)
Model answer
- Health education: conduct community talks on hygiene, nutrition and disease prevention.
- Disease surveillance: identify, record and report cases of priority illnesses to the health facility.
- Referral & follow‑up: escort patients to the health centre and ensure they complete treatment.
- Promotion of immunisation: mobilise families for vaccination campaigns and maintain immunisation registers.
- Distribution of supplies: hand out bed nets, oral rehydration salts, contraceptives and other essential commodities.
- Behaviour change communication: use local media, drama and peer groups to encourage safe practices.
- First‑aid provision: offer basic wound care, treat minor ailments and provide emergency stabilization.
- Community mobilisation: organise health committees, clean‑up days and disaster‑response teams.
- Data collection: compile household surveys and health‑facility utilisation statistics for planning.
- Advocacy: represent community health needs to local leaders and policy makers.
- Support for maternal‑child health: identify pregnant women, promote antenatal visits and assist with safe‑delivery referrals.
- Nutrition monitoring: screen children for malnutrition and refer severe cases for therapeutic feeding.
- Health facility liaison: act as a bridge between the community and health workers, conveying concerns and feedback.
- Capacity building: train other volunteers and community members in basic health skills.
- Emergency response: assist in outbreak investigations, contact tracing and distribution of prophylaxis.
- More answers: participation in health budgeting, record‑keeping of drug stocks, and mentorship of school health clubs.
10. Discuss any three disease frequency measures and give its properties and uses. (15 marks)
Model answer
- Incidence rate: number of new cases per population at risk during a specific time period.
- *Properties*: reflects risk of developing disease; expressed per 1,000 or 100,000 person‑years.
- *Uses*: monitor outbreaks, evaluate preventive interventions.
- Prevalence proportion: total existing cases (new + old) divided by total population at a point or period.
- *Properties*: includes both acute and chronic cases; not a rate of occurrence.
- *Uses*: assess burden of disease, plan health‑service resources.
- Cumulative incidence: proportion of initially disease‑free individuals who develop disease over a defined period.
- *Properties*: does not require person‑time; assumes closed cohort.
- *Uses*: calculate attack rates in epidemics, evaluate vaccine efficacy.
- Incidence density (person‑time rate): new cases divided by total person‑time contributed by the at‑risk population.
- *Properties*: accommodates varying follow‑up times; expressed per person‑years.
- *Uses*: useful in cohort studies with loss to follow‑up.
- Period prevalence: proportion of population with disease at any time during a specified period.
- *Properties*: includes cases that start before and end after the period.
- *Uses*: estimate health‑service demand over a calendar year.
- Point prevalence: proportion of population with disease at a single point in time.
- *Properties*: snapshot measure; easy to compute.
- *Uses*: quick assessment of acute outbreaks.
- Mortality rate: number of deaths due to a specific disease per population per time.
- *Properties*: reflects severity; can be age‑standardised.
- *Uses*: public health priority setting.
- Case‑fatality ratio: proportion of diagnosed cases that result in death.
- *Properties*: measures disease severity, not population risk.
- *Uses*: evaluate clinical management effectiveness.
- More answers: attack rate (a type of cumulative incidence for epidemics) and prevalence‑incidence relationship (prevalence ≈ incidence × duration).
11. Giving an illustration discuss disease determinants. (15 marks)
Model answer
- Biological determinants: genetic susceptibility, age, sex, immune status (e.g., HIV increasing TB risk).
- Behavioural determinants: smoking, unsafe sex, poor nutrition, lack of physical activity.
- Environmental determinants: contaminated water, air pollution, inadequate housing, vector habitats.
- Social‑economic determinants: poverty, education level, employment status, access to health services.
- Cultural determinants: traditional beliefs, health‑seeking behaviours, dietary customs.
- Political/Policy determinants: health legislation, vaccination programmes, taxation on tobacco.
- Healthcare system determinants: availability of medicines, quality of care, health insurance coverage.
- Illustration: a diagram of a pyramid showing individual (biological) at the base, surrounded by behavioural, then environmental, socio‑economic, cultural, and policy layers, all influencing disease outcome.
- Interaction example: low education (social) leads to poor nutrition (behavioural) increasing susceptibility to diarrhoeal disease (biological).
- More answers: occupational exposures, psychosocial stress, migration patterns, and urbanisation effects.