Community Health and Public Health Nursing
Community Health and Public Health Nursing tests prevention, epidemiology and programme delivery for populations rather than individuals. Egyptian content often draws on national campaigns - hepatitis C elimination, polio eradication, tuberculosis DOTS and maternal and child health outreach - and on how nurses work with families, schools and municipalities.
Levels of prevention
- Primordial: address social determinants and healthy public policy.
- Primary: immunisation, health education, safe water, smoking prevention - acting before disease occurs.
- Secondary: screening and early detection, such as Pap smear, mammography, TB contact tracing and blood pressure screening.
- Tertiary: rehabilitation and limiting disability after disease.
- Quaternary: avoiding over-medicalisation.
Epidemiology measures
- Incidence: new cases divided by the population at risk over a period - measures risk.
- Prevalence: all existing cases divided by the total population - measures burden, and rises with longer survival.
- Attack rate in outbreaks: cases divided by the exposed group.
- Maternal mortality ratio: maternal deaths per 100,000 live births; infant mortality per 1,000 live births.
- Sensitivity: ability of a test to identify true positives; specificity: true negatives. A screening test needs high sensitivity.
Communicable disease control
Chain of infection: agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host - break any link. For tuberculosis, find and treat cases through DOTS, ventilate rooms and use airborne precautions. For hepatitis A and typhoid, focus on water, sanitation and hand hygiene. For measles, maintain herd immunity with two MMR doses. For vector-borne disease such as dengue or filariasis, control standing water.
Outbreak investigation steps
Confirm the diagnosis and establish a case definition; verify that an outbreak exists; describe cases by time, place and person; generate hypotheses; test them with a case-control or cohort study; implement control measures; communicate and write the report.
Worked example
In a town of 20,000 people, 300 new cases of hepatitis A are reported over six weeks, mostly in one district using a shared water tank. Reasoning: calculate the attack rate - 300 divided by 20,000 multiplied by 100 equals 1.5%. Clustering by water source suggests a common-vehicle point-source outbreak. Actions: case definition, line list, water sampling and chlorination, health education on boiling water and hand hygiene, and surveillance for new cases. Prevalence is the wrong measure here because you want the risk of new infection.
Traps that cost marks
- Confusing incidence with prevalence.
- Calling a Pap smear primary prevention.
- Recommending antibiotics for viral outbreaks.
- Forgetting that screening programmes need follow-up and treatment to work.