Epidemiology is the study of patterns of disease and injury in human populations and the application of the study to control health problems. Epidemiology focuses on identifying the distribution, determinants and the frequency of the disease within a population.
It is the study of human health in populations, studying the causes of illness, how a disease is spread and how to control the disease.
Health surveys are very important in evaluating a population health. Applications used in this study are the distribution, determinants and the frequency of the health problems. (Fragar, L.J.; Gray, E.J.; Franklin, R. & Petrauskas, V., 1997).
As a community health nurse in a semi-remote rural health service in Australia, i have realized that the community in the area is cut-off from quality health care. The only health service available in the area is 60 kilometer away from the nearest regional hospital.
The community is mainly involved in farming and most of the victims in the health center are those involved in farming accidents. Due to lack of education in the region, spousal abuse, substance abuse and risk-taking behaviors are very common in the region. Members of this community lack health messages and as a result have poor nutritional habits. Children in the region are not taken for immunizations.
Prevalence is the total number of cases of a disease on health problem in a population at a given time, and assists in measuring the commonality of a particular disease. It also assists in the probability of certain diagnosis. Incidence is the rate of emergence of new cases of a particular disease in a given population. Morbidity is the rate at which death occurs in a given population due to a certain disease.
In this Australian community, farming accidents have the highest prevalence among those who visit the health services. Male farmers face a 40% increase in age standardized death. Most male deaths result from farm injury and cardiovascular diseases. The type of the agriculture enterprise in the region, determines the type of injury experienced by the farmers. Women in the community carry their children and toddlers to the farm which is a major risk to a child. Most children and toddlers drown in the dams and water bodies in the farm. In other cases these children are injured by nurses and other farm animals. I found out that only 8% of injured children in 1989-1992 were involved in farm work activity, mothers can avoid this by leaving their children at home.
Tractors, farm vehicles and motorcycles are the major causes of injuries in the farms. This is mainly due to vehicle roll over and run-over which mainly lead to death. 2 and 4- wheeled motorcycles are the major cause of accidents in the farm. The lack of education in the community has lead to pesticide being a major threat. Farmers here lack the knowledge of how to use and dispose off the pesticides leading to high risk of direct exposure to poison. I realized that rural workers and other farmers who handled dogs were at a high risk of contracting hydatid disease. This is a very significant disease in Australia but it is under-reported.
Majority of farmers in the community are over the age of 50 years. This increased age in farming poses a major threat to their health. The increased age leads to an increased prevalence in degeneration medical conditions. They result to more stress and risk of injury.
Approximately 120 people die from non-intentional injury on the farms. Most male farmers die from road traffic accidents on the use of tractors and motorcycles. Cardiovascular disease deaths are above 50% among the male population. Suicide rates among Australian farmers are high in males than females. Suicide deaths are major problems among farmers in this community. (Wilcock Allart, 2006).
The farming accidents cases in this community overwhelm the services at the health center making it difficult to handle all the patients. Most patients here die due to lack of enough quality health care. The nursing workforce in the health services is small compared to the number of victims that visit the health center.
High speed vehicle accidents in the region cause an overwhelming effect in the health center. Most drivers in the region are unqualified and inexperienced leading to many road accidents. Hit and run and crash accidents affect the health centers because they involve a large number of victims and with the limited staff and resources in the health center, the quality of health care provided is poor and ineffective.
Drivers driving under the influence of alcohol are most prone to road accidents. The poor condition of roads in the region has also contributed to increased road accidents. Victims of vehicle accidents who are seriously injured lack proper services at the health center, causing their death. The long distant between the health center and the nearest regional hospital makes it difficult to transfer patients to the hospital. The hospital’s ambulance is in a deteriorated state and cannot be used to transfer patients.
Incidence of vehicle accidents is highest during the harvesting seasons. When farmers market their products, most of their income is used in alcohol consumption. Increased use of alcohol results to increased rates of vehicle accidents mainly by rolling over, crashing and high speeding. Research has shown that men are the main victims of high speed vehicle accidents in this community. (Carrington, K. & Phillips J., 2003).
Spousal abuse is physical violence between a male and female partner, most commonly initiated by the male partner. In this region women experience spousal abuse at far greater rates than men do. Lack of education in the region is a major contributor to spousal abuse causing men to view women as the minority gender and treat them with disrespect and abuse. Women in the region are abused physically, sexually and emotionally by their partners. They are intimidated and deprived of their human rights and threatened with violence if they disobey their partners.
Spousal abuse on women has negative effects including emotional and psychological effects. Most women who are victims of the abuse are ashamed to speak out and often use lies to explain their conditions in the health centers. The abuse leaves women physically and emotionally scarred. As a result, psychiatry cases are high in the health centers such as depression, post traumatic depression and emotional instability. The health center is inadequately equipped to handle such cases and as a result most psychological cases develop to serious mental cases (UnitGarnaut, J & Lim-Applegate, H, 1998).
Some forms of spousal abuse are extreme, especially where men use physical abuse. They may use hard substances or hot water to hurt the women. Such cases may require a transfer to a bigger hospital, but due to the distance and poor roads, many women in the region lose their lives to spousal abuse.
Failure to immunize
Poor education and lack of health messages in the community has resulted in a greater percentage of women giving birth at home. When children are delivered at home, they miss the chance of getting their immunizations. The lack of health services has also contributed to this misfortune. As a result most children die before the age of one year and those that survive have many health problems. The children therefore are taken to hospital with a range of illnesses that sometimes are hard to diagnose.
Lack of education, lack of health messages and lack of a proper source of income has led to nutritional deficiency in the community. Most children in the region are malnourished and in poor health. Teenage girls and women are also in poor health due to poor health habits. In a community that has poor nutritional standards a lot of illnesses are bound to be present. Nurses are overburdened to relay this information to an indigenous community.
As a result of poverty, young girls and middle aged women have taken to prostitution to increase their source of income. This behaviour increases the risk of sexually transmitted diseases in the region. This is a challenge for the health centers because patients with STD’s rarely come for health services. Alcohol consumption among men is risky behavior that has led to fatal road accidents and spousal abuse.
This triad represents the relationship between the host, agents and the environment. A host is susceptible to infections, infected, immune or dead. The agents represent the infectious agents that cause a disease in a given population. The agents may include worms, bacteria or viruses. Environment shows how the environment contributes to the prevalence, incidence and morbidity of a particular disease in a certain community. It also includes, how the environment responds to the outbreak (Ahlbom A. & Norell, S. (1999).
Primary prevention strategy
One of the primary prevention strategy, I would use for the community is banning children and elderly people from the farms. Children below the age of seven years and elderly people above the age of 55 years should not be involved in farming activities. This way numbers of death in children will reduce. This will also ensure that only middle aged healthy adults are involved in farming activities. As a result, injuries due to drowning, stress related injuries and vehicle accidents in the farm will reduce.
Secondary prevention strategy
As a secondary strategy, I will recommend more nurses and health staff to be deployed to this region. More health centers that are well equipped should be opened in the community. With availability of health services, medications and quality healthcare death rates in the community will decrease.
Women will be encouraged to deliver their babies in the health center and as a result, children will be fully immunized and followed-up and mothers will be given proper nutritional counseling. Women and their partners will also be advised to restrain from risk-involving behaviors. This means that incase of a tragedy the community’s health care services will be ready for it.
Tertiary prevention strategy
Community health education programmes to be held in the community will educate the members on the importance of healthcare. They will be advised to take their children to health centers for check-ups regularly. Men will be advised to respect their partners and to stop getting involved in risk-behaviors such as prostitution. Women will be encouraged to use contraceptives and deliver their babies in hospitals to increase their survival rates.
Ahlbom A. & Norell, S. (1999). Introduction to modern epidemiology. Epidemiology Resources Inc.
Carrington, K. & Phillips J., (2003). Domestic Violence in Australia—an Overview of the Issues] Australian Parliament House Library E-Briefs: Online Only issued 2003.
Fragar, L.J.; Gray, E.J.; Franklin, R. & Petrauskas, V. (1997). A picture of health? A Preliminary report of the health of country Australians. Australian Agricultural Health
Friis RH & Sellers T A (1999). Epidemiology for public health practice 2nd ed., Aspen Publishers, Inc.
UnitGarnaut, J & Lim-Applegate, H (1998). People in farming. ABARE Research Report 98.6, Canberra.
Wilcock Allart. (2006). An occupational perspective of health. SLACK incorporated.