KENYA MEDICAL TRAINING COLLEGE.

COMMUNITY DIAGNOSIS DONE AT NGELECHOM.

Name; Emmy Chepkoech

Reg no;D/UPCH/24075/877

Course; Community Health Officer.

Unit Title; Community Diagnosis

Task; Community Diagnosis Field Study

Date Begun;

Date Ended;

Community Diagnosis report submitted in partial fulfillment for the requirements for the award of a
Diploma in Community Health Officer of Kenya medical Training college.

Submitted To; Kenya Medical Training college.

DECLARATION.

I Herby Emmy chepkoech declare that the report entitled the community Diagnosis report submitted by
me to the Kenya medical Training college under the department of health promotion and community
Health in the faculty of public Health sciences.

I further declare that this is my original work and has not been presented for a certificate or an award in
any other institution.

Sign;…………………..........................Date...................................

Name,.............................................

ACKNOWLEDGMENT

First ,I would like to thank the Almighty for the far.Also, thanks goes to Asinge Location,the senior chief
Willimina Akol,The community Health Promoters and the Community at large for providing a favourable
environment to Undertake the survey.

Also, acknowledge the following individuals;

 Dr.Steve Email ....Head of Department CHA

 Dr. Antony Pascal...Unit lecturer
 Dr. Flevia Mulala......PHO Aludeka
 Dr. Akia Catherine....CHA Aludeka
 Dr. Mercy Olyma ... Lecturer

DEDICATION
I Herby dedicate this community Diagnosis report to my lovely family and friends for there tireless
inspiration, financial support, determination and encouragement which made me achieve this
goal.Special thanks goes to Almighty for the provision of good health and strength throughout the
survey.Also, thanks goes to the public Health Officer Asinge Location Dr. Flevian Mulala and Community
Health Assistant Dr. Catherine Akia.Also to my esteemed head of department Teso campus Mr. Steve
Emai for His tireless efforts to ensure the survey ended successfully . Lastly to my unit Lecturer Mr
Antony Pascal and Madam Harriet for there tireless efforts.

LIST OF ACRONYMS

 Kmtc... Kenya medical Training college

 PHO... Public Health Officer
 CHA ... Community Health Assistant
 CHP... Community Health Promoters
 MOH.... Ministry of Health
 FIC..... Fully immunized children
 CU.... community unit

TABLE OF CONTENT

Declaration...................................................i

Acknowledgment........................................ii

Dedication...................................................iii

List of Acronyms .......................................iv

CHAPTER ONE: BACKGROUND INFORMATION

Introduction

1.0 Overview ...................................'........................3

1.1 Background .......................................................4

1.2. Objectives...........................................................5

1.3 Components of community Diagnosis...........5

1.4. Limitations of the survey...................................6

1.4. Definition of terms

CHAPTER TWO: METHODOLOGY

2.0 Overview

2.1. Research Design...............................................7

2.2. Study area..........................................................7

2.3. Study population................................................7

2.4. Methods of investigation...................................7

2.5. Sampling criteria.................................................8

2.6. Data collection Procédure .................................8

CHAPTER THREE: PERMISSION SEEKING .......8

3.0 Overview

3.1. Activity one

CHAPTER FOUR ; MAPPING THE COMMUNITY.....9

4.0 Overview

4.1 Activity Two

CHAPTER FIVE. ; DEVELOPMENT OF DATA COLLECTION TOOL..10

5.0 overview
5.1 Activity Three

CHAPTER SIX. ; PAIRING STUDENTS WITH CHP...................11

6.0 overview

6.1 Activity Four

CHAPTER SEVEN ; PRE TESTING OF TOOL............................12

7.0. Overview

7.1 Activity Five

CHAPTER EIGHT. ;FINE TUNING OF TOOL................................13

8.0 overview

8.1. Activity Six

CHAPTER NINE. ; REFINING OF PRE TESTED TOOL..................13

9.0 Overview

9.1 Activity Seven

CHAPTER TEN. ;DATA COLLECTION.............................................14

10.0. Overview

10.1. Activity Eight

CHAPTER ELEVEN. ;DATA ANALYSIS .............................................15

11.0. Overview

11.1. Activity Nine

DISCUSSION AND FINDINGS............................................................. 21

FEEDBACK TO THE COMMUNITY........................................................21

CONCLUSION .............................................................22

RECOMMENDATIONS ................................................22,23

CHAPTER ONE

1.0 overview
Two weeks fieldwork on community Diagnosis in Asinge Location is a routine practice to orient a student
on community activities of community Health Officer in Primary Health care .

Community Diagnosis is a process through which health workers together with members of the
community identify the community's priority health problems and together make plans of action and
implement them .

1.1. BACKGROUND

Ngelechom is situated in Busia County,Teso South sub County,Chakol North ward,Chakol Division,Asinge
Location and Aludeka sub location

1.2. OBJECTIVES OF COMMUNITY DIAGNOSIS

1. To analyze the health status of the community

2. To evaluate the health resources, services,and systems of care within the community
3. Asses attitudes towards community health services and issues
4. Identify priorities, establish goals and determine courses of action to improve the health status
of the community
5. Establish an epidemiologic baseline for measuring improvement over time

1.3. COMPONENTS OF COMMUNITY DIAGNOSIS

 A description of the demographics of the population

 Socio cultural and behavior aspects of the community
 A general description of health problems by different strata of the population
 Availability of health resources in the community and the pattern of delivery and utilization
 Non health resources and their role in future improvement
 Knowledge, attitude and practice of the population in respect of health related activities.

1.4. LIMITATIONS OF THE SURVEY.

Among the challenges encountered during the survey include;

 Language barrier
 Hostility from community members
 Illiteracy
 Ignorance of some community members

1.4. DEFINITION OF TERMS

 Community. Is a group of people living in the same geographical location and share same
characteristics and resources
  Community Diagnosis. Is a qualitative and quantitative description of the health status of
citizens and factors which influence there health.
 Household. A group of people who live together and share a meal
 Health. Is a state of complete physical, mental and social wellbeing and not merely in the
absence of disease and infirmity.
 Village. A small settlement usually round in rural setting
 Family. A group of two or more persons related by birth, marriage or adoption who live
together.
 Community needs assessment. A process by which the community officer collects data about
the community in order to identify factors which may influence the deaths ,illness of the
population

CHAPTER TWO : METHODOLOGY

2.0. Overview

2.1. Research Design

A research design is the plan , structure and strategy of investigation of answering the survey questions.

The research design of choice used in the community Diagnosis was survey research design.

It's the systematic gathering of information.

2.2 Study area

The study area of choice for the community Diagnosis was Ngelechom.

Ngelechom is found in Busia County,Teso South sub County,Chakol North ward ,Chakol Division,Asinge
Location and Aludeka sub location.The main economic activity in ngelechom is farming.The area is also
occupied by a group of Plain Nilotes ,a group of Teso Community.

Asinge location has 4 community Units.

2.3. Study population

During the survey,data was gathered from all gender and age.

Both men ,women, Youths and children were considerd the study population.

2.4. Methods of investigation

The tool of choice used to Undertake the community Diagnosis was the use of a questionnaire.

A questionnaire is a set of standardized questions designed to collect information about a specific aspect
in the community .

The questionnaire was choosed because;

 It's simple to use

 It's Economical
 It gathers only the required information
 It allows for both open and close ended questions

2.5. Sampling Criteria

The sampling criteria of choice during the survey was simple random sampling where individuals in
Ngelechom were selected randomly to participate giving each member of the community an equal
chance of being selected.Thus,every sampling unit in the population had an equal chance of being
included in the sample.

2.6. Data collection Procédure

During the data collection in the survey, individuals from household were interviewed, questions were
asked by the guide of a questionnaire and recorded well

CHAPTER THREE; PERMISSION SEEKING

3.0 Overview

This chapter contains all the discussions and findings during the survey.
3.1. Activity one ; PERMISSION SEEKING

The first step in the field was to ask permission from the ministry of health (MOH) and the area chief
before proceeding with community Assessment.

The lectures and I accompanied by fellow students visited Asinge Location where we went to the chiefs
office.The meeting was held ,and those who attended included ;the area senior chief , Aludeka Public
Health Officer and Community Health Assistant.We were given a chance and we introduced ourselves
and clearly stated the objectives of the survey and our plans of action.The area chief Willimina Akol
oriented us on the map of Asinge Location.She then reassured us of good security and support in the
community.The area chief also promised to mobilize the community.
3.2. CHAPTER FOUR .MAPPING THE COMMUNITY.

On the set day, accompanied by the lecturers ,CHPs and students,we went through the community to
know more about it and determine the geographical location in the community in order to familiarize
with it and establish a distinct map of Ngelechom.
3.3. CHAPTER FIVE .;DEVELOPMENT OF TOOL .

Together with lecturers and the other students,we developed a tool to be used in data collection during
the survey.

The tool of choice was a Questionnaire.The questionnaire was choosed because it's simple,it saves time
and suitable for special type of responses, it also allows for open and closed ended questions.

The questionnaire had distinct sections which included ;

 PART A ; Socio Demographic information

 PART B ; Water, sanitation, hygiene and housing
 PART C ; Nutrition and Family Health

3.4.CHAPTER SIX ; PAIRING STUDENTS WITH CHP

On the day , students were paired into groups of 6; students per group.

The unit Lecturer Mr Antony Pascal then assigned a Community Health Promoter to each group
3.5. CHAPTER SEVEN ; PRETESTING OF THE TOOL.

During the day,I together with my group members together with the assigned CHP Mrs Jane went
through Ngelechom village with developed questionnaire asking questions in different households and
recording them

The common challenges encountered during the day included;

  Language barrier
 Ignorance from few community members
 High expectations from us by community members
 Lack of honesty from community members

The importance of PRETESTING include;

1. To identify errors in the questionnaire

2. To familiarize with the questions in the questionnaire
3. It helped to discover if the various parts of the questionnaire glow in a logical order.

3.6. CHAPTER EIGHT ; FINE TUNING OF TOOL

The unit Lecturers together with other lecturers went through the tool to make sure that the
questionnaire are effective, friendly and therefore community members will not find it difficult to
answer them
3.7. CHAPTER NINE :;REFINING THE PRETESTED TOOL

Together with fellow students and our unit Lecturer ,we identified common mistakes made in
the questionnaire and made corrections where necessary.
Some mistakes identified in the questionnaire included
 Typing Error
 Irrelevancy of some questions
 Some key important questions missing

3.8. CHAPTER TEN. ; DATA COLLECTION

On the data collection days ,we were assigned to collect data from 10 Households in Ngelechom.

On the first day of data collection,it began well ,I accompanied my fellow group members and our
assigned CHP visited households to collect data . Though presence of some challenges,I managed to
collect data from 5 households considering key indicators filling the questionnaire effectively.

Likewise on the second day ,I also managed to gather data from 5 household accompanied by a CHP I
collected data in ongoroi village,Asinge location.

The challenges encountered during data collection included

 Language barrier
 Hostility from community members
 Poor timing
SUMMARIZED DATA
PART A; SOCIO DEMOGRAPHIC INFORMATION.

AGe Gender Marital status Occupation Source of

income

41-50 Female Married Self employed Business

51 and above Female Married Self employed Farming

41-50 Male Married Self employed Farming

31-40 Male Widower Employed Farming

41-50 Female Married Self employed Farming

41-50 Female Married Self employed Farming

51 and above Female Widow Employed Salary

51 and above Female Married Self employed Farming

41-50 Female Married Self employed Farming

21-30 Female Single Student None

PART B;WATER, SANITATION, HYGIENE AND HOUSING

Main source of Water Presence of How often Type of Compound

drinking water Treatment latrine take bathe Housing general
cleanliness

Borehole Yes Yes When Semi Clean

necessary permanent

Borehole Yes No Everyday Permanent Very clean

Rain water Yes Yes When Semi Somehow

necessary permanent clean

Borehole Yes Yes When Semi Clean

necessary permanent

Pipe water No Yes When Temporary Clean

necessary

Borehole Yes Yes Everyday Permanent Very clean

Surface water Yes Yes When Temporary Very dirty
necessary

Surface water Yes Yes Everyday Permanent Clean

Borehole Yes No When Semi Somehow

necessary permanent clean

PART C; NUTRITION AND FAMILY HEALTH

Main source Staple food Any child Presence of Used family With NHIF Problem of
of food under 5 mosquito planning rodents
net

Own Ugali Yes Yes 3 month Yes

production injection

Own Ugali No Yes None No Yes

production

Own Ugali No Yes None No Yes

production

Buf from Ugali No Yes IUCD No Yes

market

Own Cassava Yes No 3 month Yes Yes

production injection

Own Ugali Yes Yes 3 month Yes Yes

production injection

Work Ugali Yes Yes Implant No Yes

Own Rice No Yes 3 month No Yes

production injection

Own Ugali No Yes Pills No No

production

3.9 CHAPTER ELEVEN ; DATA ANALYSIS

 After data collection,I was able to analyze data as follows.
Part A : SOCIO-DEMOGRAPHIC INFORMATION
1.Age

Most people I collected data from ranged at 51years and above amounting to 40% and the rest as
follows.

2.Gender

Most people I collected data from were female amounting to 80% and men 20%

This was because most men were out for work

3.Marital status
Most of the people I collected data from were married

4.Education level

Most people in Ngelechom only completed their studies in primary school thus showing the low literacy
level of the community.
5.Source of income

Most people in Ngelechom source their income from Farming.

Occupation of the respondents

Monthly household expenditure

PART B 1 : WATER

Main source of drinking water in Ngelechom was from the Borehole

In addition,most people in Ngelechom treat their water by use of chlorine

PART B 2: SANITATION

The survey revealed that most people in Ngelechom had a functional latrines which were in good
condition

PART B 3 : HYGIENE

The survey revealed that most people in Ngelechom only take bathe when necessary on some important
occasions
PART B 4 HOUSING

Most Houses in Ngelechom were permanent,some semi permanent.

Most Houses were in good condition and it had all the qualities of a healthful house

E.g

 Adequate ventilation
 Adequate security
 Offers privacy
 Have a hanging line
 Have a dish rack
 Have a waste disposal pit
PART C 1 : NUTRITION

The main source of food for most households in Ngelechom was from their own production.

The staple food in Ngelechom was Ugali.

PART C 2. : FAMILY HEALTH

Some percentage of households in Ngelechom had children under 5 and those with ,followed the
criteria of fully immunized children (FIC).

Most people in Ngelechom also have heard about family planning and among the most used family
planning methods included 3 months injection, implants,pills and IUCD

DISCUSSION AND FINDINGS

Overview

It contains the discussions of the analyzed data

Discussion of results in thematic areas below;

1.SOCIO DEMOGRAPHIC CHARACTERISTICS.

The study involved 10 Households and I managed to capture all my forecasted sample size.Most of the
respondents were female accounting to 90%.This is because most men in the study area were out for
work during my time of data collection.The age of all respondents were above 18 years ,this confirms
the validity of the information.Majority of the households were headed by father (80%)and other by
mothers (20%) and non by children.The study area also had different religious groups and of the 10
Households I visited,all were Christians .with regards of occupation, majority of residents of Ngelechom
were farmers and business personnel.

2. NUTRITION

The study results show that most of the households sampled obtain food from their own farms 70% and
30% of the population buy from the market.The staple food among Ngelechom residents was Ugali.In
addition,the residents have a strong food security as most of them grow their own food.

3.HEALTH SEEKING BEHAVIORS.

Majority of the people from the households I visited seek for health attention from the health facility
and others by the help of CHPs.A few others seek for health services from traditionalists.

4. SANITATION AND HYGIENE

Majority of the sampled households I visited uses borehole water (about 80%)and the rest 20% use rain
water thus showing good indicator of safety of water .From the households I visited,100% of them drink
treated water and all of them uses chlorine to treat water.majority of the people dispose of their
rubbish safely in a compost pit and others in the garden for manure accounting to high percentage of
clean compounds recorded.In the 10 Households I visited,I observed that 100% of them dispose their
human waste in a pit latrine.Among the households,80% of them had their own toilets while 20% of
them uses their neighbors latrines.

5. FAMILY HEALTH

In most of the households I visited, most had children under 5.The parents ensured that the children
were fully immunized by checking on the children's clinic books

Most of the people in Ngelechom also don't have a health insurance card making hard for them to
receive adequate medical treatment.

Most of the households in Ngelechom had nets which were functional.

In addition, most women of reproductive age in Ngelechom had Heard about family planning and most
were using them.Found out that 30% of The population had developed a negative attitude towards
family planning due to the early side effects exposed when used earlier

FEEDBACK TO THE COMMUNITY

On the set date and day, after analyzing the data,I accompanied fellow students and lecturers to the
community to present our findings.

The meeting was held in Asinge location assistant chief's office and those who attended the meeting
included HOD CHA department Mr Steve Emai, Aludeka community unit CHA Mrs.Akia Catherine,
Aludeka assistant chief Mr.Mical Ekeya,The CHPs and fellow students.

We received a warm reception from the area, students were choosed among us to present the findings
to the community.In the meeting we also adviced the community on their areas of improvement and
applaud their strengths.

CONCLUSION

The study has revealed that health and health status of people of Ngelechom live below expected levels.

The majority of health status include

 Low level of income

 Ignorance about some essential factors like routine medical check ups
 Poor housing facilities among some community members
 Long distance from reliable source of water
 Poor nutrition
 Long distance to the health facility
 Poor sanitation and hygiene
  High rates of alcoholism among some community members

RECOMMENDATIONS
1.To the ministry of health.
 To train CHPs on sensitization of toilet use
 To carry out outreaches in areas that cannot be easily reached by clients
 PHO/CHA to be mobilized to spray homes with vermin
 To ensure adequate provision of services in health facilities
 To train more CHPs to help in disease prevention at community level.

2. To the ministry of water

 To ensure treatment of water at water sources

 To sensitize community on water treatment
 To channel available water to households

3. To the ministry of Roads

 To improve the quality of roads and pathways in the community

 To ensure roads to the health facility are well maintained

4. To the ministry of Education

 To install more medical Training institutes to train more health workers

 To set strong and valid polices on cases of school dropouts

5.To the ministry of agriculture, livestock,fisheries and irrigation

 To provide support to farmers and those relying on own production

 To provide a suitable market of there products in foreign countries

6. To the ministry of Finance

To allocate more funds to the health sector