Community Health and Public Health Nursing
Domain 6 tests population health: Kenya's devolved system, levels of care, the Kenya Essential Package for Health (KEPH), epidemiology, screening and outbreak response.
Levels of care
- Level 1: community - Community Health Units served by Community Health Promoters.
- Level 2: dispensaries and clinics. Level 3: health centres and maternity homes. Level 4: county hospitals. Level 5: county referral hospitals. Level 6: national referral facilities.
- Counties plan and deliver services; the national Ministry of Health sets policy, norms and standards.
KEPH cohorts
Pregnancy and newborn; early childhood; late childhood; adolescence; adults 15–59; older adults 60 and above. Each has a defined package at each level - a frequent matching question.
Epidemiology
- Incidence = new cases ÷ population at risk ÷ time. Prevalence = all existing cases at a point or over a period.
- Sensitivity detects true positives (good for screening); specificity excludes true negatives (good for confirming).
- Primary prevention: immunisation, health education, safe water. Secondary: screening and early diagnosis. Tertiary: rehabilitation and adherence support.
Worked example
A county of 400,000 people records 1,200 new tuberculosis cases in a year and has 3,000 people on treatment at year end. Reasoning: incidence = 1,200 ÷ 400,000 = 300 per 100,000 per year. Prevalence at year end = 3,000 ÷ 400,000 = 750 per 100,000. Incidence counts onsets; prevalence counts everyone still a case, so it rises when survival improves even if transmission falls.
Traps
Swapping incidence and prevalence; calling a screening test primary prevention; ignoring cold-chain limits (most vaccines 2–8 °C, freeze-sensitive ones never frozen); forgetting that outbreak investigation starts with case definition and verification, not with a press release.