DCM COMMUNITY HEALTH EXAM – MARKING GUIDE

1. Explain with examples the three determinants of health 6 marks

1. Human biology (People who come from families whose members had a more
active lifestyle and followed healthier diets, non-smoking and non-drinking are
more likely to follow the same pattern in their life; Health can also be affected by
gender).
2. Environment (poverty, education level, lifestyles, employment/ working
conditions, culture, sexual orientation; physical environment like: clean water,
air, safe houses, communities, roads)
3. Health services (Quality and access of the services e.g. distance, physical
barriers, cost of services, unavailability of the service)

2. People in the community sometimes fail to access the available health services. Outline four
factors that can affect access to the health services.
4 marks
1. Distance
2. Physical barriers
3. Cost of services
4. Unavailability of the service (lack of equipment and supplies, infrastructure, and
skilled health personnel).

3. Explain with examples the difference between Primary and Secondary prevention of disease.
8 marks
Primary Prevention
1. Helps to keep people healthy.
2. Done before illness occurs
3. Aimed at people and the environment where they live.
Examples:
o Immunization
o Nutrition
o Personal hygiene
o Good health behaviour e.g. washing hands, fruits
o Child spacing
o Chemoprophylaxis
o Safe water supplies
o Safe excreta and rubbish disposal
o Disinfection and sterilization
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 o Good food hygiene
o Vector and animal reservoir control
o Good working and living conditions
Secondary Prevention
 It is the prevention of disease soon after it starts but before symptoms appear.
 This takes place before the patient diagnoses himself/herself as sick.
 It is also known as preclinical or subclinical or pre-symptomatic stage.
 Two types of secondary prevention exist: Screening and Surveillance
Examples of screening:
o Weighing of babies and young children
o Routine examination of stool and urine specimens
o Examining pregnant women for early signs of complications in their
pregnancy
o Tracing of contacts of a person with an infectious disease such as TB and
Leprosy

4. Outline in detail the immunization schedule for Malawi 16 marks

5. a) Mention five local effects of worm infestations in human beings

5 marks
1. Mechanical damage of bowel mucosa due to biting and burrowing.
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 2. Inflammatory response
3. Obstruction of bowel lumen
4. Abdominal pain due to stimulation of reflex peristalsis
5. Malabsorption

b) Outline the life cycle of a hookworm and explain how you can help
prevent man from getting infected. 7 marks

Prevention is by:
 Observing good sanitation.
 Avoiding contact with human feaces.

6. a) Outline the elements of Primary Health Care 8 marks

1. Education for Health
2. Locally Endemic Diseases control
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 3. Expanded Program on Immunization (EPI)
4. Maternal and Child Health including responsible
parenthood
5. Essential Drugs
6. Nutrition
7. Treatment of communicable and non-
communicable diseases
8. Safe water and sanitation

b) Explain the four pillars of Primary Health Care 8 marks

 Equitable distribution of PHC
o The PHC must be given to all individuals in equal amount in the
community irrespective of their gender, age, colour, urban, rural, and
social class
 Community participation toward achievement of PHC
o There must be a continuing effort to secure meaningful involvement of
the community in the planning, implementation and maintenance of
health services.
 Use of Appropriate technology
o Appropriate technology is one that is scientifically sound, adaptable to
local needs, acceptable to those who apply it and those for whom it is used
and can be maintained by the people themselves in keeping with the
principle of self reliance with the resources the community and country
can afford.
o According to this pillar, technology should be provided that is accessible,
affordable, feasible and culturally acceptable to the community for the
promotion of the PHC
 Multi- sectoral Approach
o Health of a community cannot be improved by intervention within just
the health sector without other sectors that are equally important in
promoting the community’s health and self –reliance.
7. You have been sent to work at Kabudula Rural Hospital as a Clinical officer. One of the tasks
you may wish to undertake as a new member of staff is to get to know people and their
problems so that you provide better services to them.

1. What will you do to know the people you will be serving and their problems?
1 mark

 Perform a Community assessment

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2. Mention the steps you will follow to achieve the task in ‘a’ above
7 marks
 Set aims or goals
 Collect data
 Collate and analyze data
 Make a community diagnosis
 Plan intervention measures
 Implement interventions
 Evaluate