An observational-analytical study was carried out whose function was the analysis of the situation of 50 families belonging to the Family Medical Clinic (CMF) # 11, selected by means of simple random group sampling, characterized by geographic and population variables, (determining their behavior), the health determinants and the main problems were analyzed to define alternative solutions that would improve the health level of the sample studied.
It was found that the same prevailed in the female sex (56%), and adolescence the predominant age group (10.7%), the presence of bad environmental conditions, inadequate lifestyles: incorrect diet (27%), sedentary lifestyle (17%)) and smoking (8.2%), leading to the appearance of chronic non-communicable and communicable diseases, predominating first. An action plan was proposed to solve the main problems identified.
Keywords: situation, health, office, doctor
Health Situation Analysis (ASIS) is the methodology used to identify and prioritize the health problems of a given community. It represents the explanatory moment of the strategic approach to planning. This analysis represents the result of measuring the health status of the community or, what is the same, its health situation at a specific historical moment. It constitutes the fundamental working instrument of the family doctor located in any sector of the population since it allows her to self-evaluate her work and draw guidelines for an adequate action plan. It is a process of community agreement of interests to establish priorities in Health. With the preparation of this study we approach the reality of a community, and the process of how social actors understand and conceive themselves,to publicize the successes obtained in the area, as well as the problems that still concern the basic health team and the population.
Therefore, supported by the Analysis of the Health Situation as a fundamental tool in the investigative work of the community, we have proposed to investigate the community corresponding to Office No. 11 in the San Cristóbal Popular Council 1 with the objective of establishing the Diagnosis of the Situation of health. So in this analysis, in addition to offering the basic information on the characteristics of our territory and geographic location, we have focused on the difficulties that have prevailed during the analysis period (October-November 2015) to subsequently adopt an intervention plan. with specific measures and with certain deadlines that in the future will improve the state of health of the community in which it is executed
OBJECTIVES
GENERAL:
Prepare the Health Situation Analysis of Family Medical Office No. 11 during the period October-November 2015.
SPECIFIC:
- Identify the demographic characteristics of the clinic. Know the distribution of the population by age groups and sex. Determine the level of education and occupation of the members of the selected sample. Know the distribution of the population by dispensary groups. Determine the incidence of communicable diseases.Determine the incidence and prevalence of chronic non-communicable diseases . Define the main risk factors to which the study population is subjected, as well as the main causes of death and disease . Characterize the families studied according to their functionality and ontogenesis .Describe the resources available and the services provided in the office and the polyclinic. Identify the main problems and establish priorities. Make an action and execution plan aimed at improving the existing health situation .
SUMMARY DESCRIPTION OF THE METHOD
A descriptive study was carried out on the Health Situation of Medical Office No. 11, Artemisa province, at the end of 2015, with a total population of 2000 inhabitants, taking as study sample 159 of them.
For this research, information was obtained from the following sources:
- Documentary review of family health history, individual, consultation sheet and field, immunization and cytology card holder, statistical documents, hygiene, laboratory and polyclinic vectors. Qualitative techniques such as interviewing the elderly, natural leaders of the community, randomly chosen members of the community, president of the CDRs, doctor and nurse from the clinic and other members of the Basic Work Team, observation of internal hygiene conditions of the home, personal information of the inhabitants and the surrounding environment, method ranking that allowed each of the identified problems to be prioritized.
Different indicators (ratio, percentages, indices and rates) were used for the analysis of most of the points analyzed in the health diagnosis.
We will mention some of them:
- Sex Ratio Birth Rate General Fertility Rate Age-specific Fertility Rate Abortion Rate and Rate General Mortality Rate Mortality Rate by Causes Infant Mortality Rate Low Weight Index Services and Resources Indicators
The results are shown in the form of tables and graphs for your better understanding.
GENERAL SECTOR CONTEXT
The Family Medical Office No. 11 corresponding to the Camilo Cienfuegos University Polyclinic is located in the Popular Council Number 1, in the Noel Camano neighborhood of the municipality of San Cristóbal, with an approximate territorial extension of 1.8 km2, 100% of the population is urban and the population density is high.
The office geographically limits:
North: National Highway
South: Calle Nodarse
This: Huberto Núñez Street
West: Calle Capitán Reyes
Fig. 1. Map of the municipality. Approximate location of office No. 11.
Political, Economic and Social Context
Community that has 7CDR and 3 constituencies, characterized by being vast in terms of available resources. This is due to the existence of several educational centers, such as: “José Licourt Domínguez” Pre-University, “Anexa” Elementary School, “8 de Especial” School October ”, IPU Eduardo García Lavandero, ESPA Julito Díaz. In addition to several important economic objectives, among them:“ Tiempos Nuevos ”winery, butcher, cafeteria, small square, pharmacy, pumping point, repair shop for electrical items, item shop various, Military Committee service area, as well as currency and private kiosks.
HEALTH DETERMINANTS
Health is a balance, it is tension, it is conflict and it is an attempt to reach higher levels of well-being, it transcends clinical and biology integrating itself into a social dimension, therefore the state of health of the population is determined by:
- Conditions and lifestyles 50% Environment 20% Human Biology 20% Organization of Health Services 10%
Fig. 2. Mac Lalonde's cake (1974)
CONDITIONS OF THE PHYSICAL ENVIRONMENT
Communication channels:
In our community the communication routes that predominate are the sidewalks between buildings, where most of these are in unfavorable conditions, the roads are in good condition, paved, with moderate traffic signaling. There are free spaces between the buildings that serve as access to them, in poor condition, unpaved, which favor the stagnation of water, difficult to drain, which could constitute potential breeding places for mosquitoes.
Quality and supply of drinking water:
The water supply comes from the Carrillo supply source, whose disinfection system is by chlorine gas, it is also a good quality water, backed by the analysis of water samples in the microbiology laboratory, whose information is provided by the technician of hygiene and epidemiology of the institution.
The distribution network has some leaks (behind the winery building, next to the cafeteria and behind the video room), this, together with the alternative water service, leads to its contamination due to the pressure difference.
Another problem to point out is the amount of deposits in the homes, some not suitable for receiving the liquid, which also constitutes a risk that the water that the population finally ingests is not adequate, not to mention the little habit of the population of boiling drinking water. Also the tanks and cisterns of buildings are not treated in the best way, since disinfection is scarce or almost nil.
Availability of sanitary and sewer services:
All buildings are connected to the sewerage network, which in turn goes to the Carrillo stabilization lagoon. Most of the individual houses do not have access to the sewer, since this does not exist, so they have intra-household toilets that pour into ditches. There is no outdoor fecalism.
Atmospheric pollution:
There are no factories or industries that release toxic gases into the atmosphere in our area. In dry season, dust from the streets affects the population.
Illumination:
The lighting is insufficient and is based on the lights on the balconies of the buildings, which is low and does not illuminate the entire front. There are public lanterns on the streets, but in some of them the focus and / or the cables are missing for their correct operation..
Noises:
The total of our population is exposed to noise since we have some educational centers (semi-boarding, pre-university, basic secondary), in addition to the non-observance of the rules of coexistence, also in our town animal-drawn cars and public transport transit.
State of lots and patios:
Most of our population, as it resides in buildings, does not have its own lots or patios, that is, the gardens and backyards are collective, although many neighbors have fenced in and consider it their own, which are inspected by the hygiene and epidemiology and have always been found to be in good condition, so much so that a mosquito outbreak has never been found in our area.
Domestic and breeding animals:
In a large part of the houses there are domestic animals (dogs, cats, birds), there are also breeding animals in some of the patios, which do not comply with the established hygiene standards since they are very close to the houses, which affects negatively environmental health.
Disposal of solid and liquid residuals:
Solid residuals are deposited in supiaderos, these being in a better constructive state than in previous years, but even the garbage continues to flow outwards, either due to the air or animals. The collection must be on alternate days The collection of garbage by the community service and the frequency is every two days, already counting on a deposit container to accumulate it for later collection.
Vector source and rodents:
There are a large number of vector generating sources, they can be easily verified, although in these months of the year their control becomes a little more difficult since the rainy season favors the proliferation of mosquitoes, so control measures are always present both by the community and the competent authorities, with the carrying out of the focal order by the working group of the Office. The population also refers to the existence of flies, especially in the surroundings of the supiaderos, cockroaches, although these to a lesser extent.
Housing structural conditions:
The whole of our population lives in buildings which are in good constructive condition, although some of the houses have poorly maintained doors and windows, there are water leaks, mainly on the last floors, due to the poor condition of the roofs and the first for the poor quality of the water pipes.
Overcrowding rate:
In the sample studied, the overcrowding index is not considered high, since there is a good distribution of rooms according to the people who live in the houses.
Available resources:
In the area where the institution is located, we have educational centers, such as: “José Licourt Domínguez” Pre-University, “Anexa” Primary School, “8 de Octubre” Special School, IPU Eduardo García Lavandero, ESPA Julito Díaz. In addition to various objectives economic of importance among them: “New Times” winery, butcher, cafeteria, square, pharmacy, pumping point, repair shop for electrical items, various items shop, Military Committee service area, as well as currency and private kiosks; which achieves a level of product acquisition in a fast and organized manner, improving the level of satisfaction of the needs of the population. These facilities become important sources of employment for the working-age population.
MODE, CONDITIONS AND LIFESTYLES
TABLE I: DISTRIBUTION OF THE POPULATION ACCORDING TO THE LEVEL OF EMPLOYMENT. FAMILY MEDICAL OFFICE NO 11, SAN CRISTÓBAL, OCTOBER-NOVEMBER 2015.
| Employment level | Not. | % |
| State employees | 41 | 25.8 |
| Unemployed | 5 | 3.1 |
| Self-employed | twenty-one | 13.2 |
| Housewives | 26 | 16.4 |
| Students | 30 | 18.9 |
| Non-school age | two | 1.2 |
| Retired | 3. 4 | 21.4 |
| Total | 159 | 100 |
N: 159
Analysis:
Most of the population studied is linked to a total of 41 state workers, followed by 34 retirees, 30 students and 26 housewives, who contribute to CDR and FMC activities. There are 21 self-employed and only 5 unemployed and in non-school age there are 2 children. Based on the foregoing, it is appreciated that the level of unemployment is low in this population, however, it is necessary to work with the labor body and the mass organizations to incorporate these individuals into socially useful work.
TABLE II: DISTRIBUTION OF THE POPULATION ACCORDING TO SCHOOL LEVEL. FAMILY MEDICAL OFFICE NO 11, SAN CRISTÓBAL, OCTOBER-NOVEMBER 2015.
| Schooling level | Not. | % |
| Illiterate | two | 1.3 |
| Infants | one | 0.6 |
| Preschool | 4 | 2.5 |
| Unfinished primary | 12 | 7.5 |
| Primary finished | 13 | 8.2 |
| Unfinished high school | 7 | 4.4 |
| Secondary finished | 38 | 24 |
| Unfinished high school | 10 | 6.3 |
| High school completed | 40 | 25 |
| Unfinished university | 6 | 3.8 |
| University finished | 26 | 16.4 |
| Total | 159 | 100 |
N: 159
Analysis:
The table shows the level of schooling of the studied population, prevailing the pre-university finished with 40 people for 25% which favors the good development and understanding of the activities that are planned by the health personnel of the office, it is observed that only 1.3% of the population is illiterate and all correspond to the elderly. There are 2 cases of dropping out of school.
Cultural and recreational possibilities:
Cultural and recreational activities are organized by the CDRs and other mass organizations, but only on certain dates. The community has a cultural promoter, but there is no institution where to carry out cultural activities. The sports areas of the school institutions located in the areas near the clinic are used by the population for the systematic practice of physical exercise.
Religious beliefs
Religion, on this belief in the population we have a number of patients who belong to the Catholic Church, in addition to other religions such as: the Baptist, the Seventh-day Adventists and the Jehovah's Witnesses.
Transportation availability
The population has access to all land routes, counting in the municipality with a train terminal that can be easily accessed by the population, as well as the national highway and the central highway. In the town the most common means of transport are horse carriages and pedicabs.
Availability of Electric power:
In this aspect there are no difficulties since the total population has electricity and the existence in the municipality of the generator sets has made it possible for this service not to be interrupted, except in exceptional situations where due to a failure or breakage this is seen disrupted.
Food availability:
Our population receives a basic monthly fee for food, in addition to having a cafeteria, state food distribution centers such as wineries, butchers, food stalls and private kiosks, as well as own-account vendors of food products, mainly meat and agricultural products that are within the monetary reach of a part of the population.
Communication:
In all the houses there are televisions, radios and in some there is the possibility of the existence of a telephone. There is a postal service in the municipality that can be accessed by the population of the doctor's office, which provides the possibility of communication and receiving information in a systematic way. It has a considerable number of public telephones although some are deteriorated.
Sanitary Culture:
In general hygiene is adequate, however we have to continue reinforcing the issue of food hygiene, also due to the economic situation that the country is going through many families use animal fat for consumption and for which there is a high index of cardiovascular and other diseases, in addition a large number of the population is a smoker with whom work must continue to avoid future complications in the community. So the health culture, despite the dissemination and promotion of correct life habits, is still insufficient.
Social behavior and coexistence:
Our population is based on interpersonal relationships of harmony, respect, solidarity. In general, coexistence is good, sometimes there are fights and criminal acts but these are rejected by the vast majority of the population. We have 2 dropout cases.
Monthly per capita of economic income:
In general, the per capita of economic income of our population is good, given the large amount of it incorporated into the work environment. The average per capita is over 100 pesos in the 159 families that make up the universe of our study, satisfying the basic needs of our population.
Family functioning:
Number of families: 46
Functional: 27
Moderately functional: 9
Dysfunctional: 10
One-person households: 4
In this study it was found that most of the families are functional, according to the interviews and visits to the families it was found that there was a home harmony between them with an adequate distribution of household chores and in most of them they were They were about marriages or small family nuclei, on the other hand, the fundamental causes of dysfunction are given by: lack of communication between members, impermeability, roles of overburdened family members and non-recognition of the leading role of the female figure and evil family management of adolescents.
Breastfeeding:
In the sample chosen for our study in the months of October and November, we had 1 infants older than 6 months and found mixed breastfeeding.
DEMOGRAPHIC CHARACTERISTICS:
TABLE III: DISTRIBUTION OF THE POPULATION BY AGE AND SEX. FAMILY DOCTOR'S OFFICE NO. 11, SAN CRISTÓBAL, OCTOBER-NOVEMBER 2015
|
Age groups |
Male | Female | Total | |||
| Not. | % | Not. | % | Not. | % | |
| Under 1 year | one | 1.4 | 0 | 0 | one | 0.6 |
| 1 to 4 years | 0 | 0 | two | 2.2 | two | 1.3 |
| 5 to 9 years | 4 | 5.7 | 3 | 3.4 | 7 | 4.4 |
| 10 to 14 years | 4 | 5.7 | 5 | 5.6 | 9 | 5.7 |
| 15 to 19 years | 13 | 18.5 | 4 | 4.5 | 17 | 10.7 |
| 20-24 years | 3 | 4.2 | 6 | 6.7 | 9 | 5.7 |
| 25 to 29 years | 6 | 8.6 | two | 2.2 | 8 | 5 |
| 30 to 34 years | 3 | 4.2 | 7 | 7.9 | 10 | 6.3 |
| 35 to 39 years | 5 | 7.1 | 5 | 5.6 | 10 | 6.3 |
| 40 to 44 years | 5 | 7.1 | 7 | 7.9 | 12 | 7.5 |
| 45 to 49 years | 3 | 4.2 | 9 | 10.1 | 12 | 7.5 |
| 50 to 54 years | 5 | 7.1 | 5 | 5.6 | 10 | 6.3 |
| 55 to 59 years | 5 | 7.1 | 4 | 4.5 | 5 | 3.1 |
| 60 to 64 years | two | 2.8 | 7 | 7.9 | 9 | 5.7 |
| 65 to 69 years | 4 | 5.7 | 12 | 13.5 | 16 | 10.1 |
| 70 to 74 years | 7 | 10 | 6 | 6.7 | 13 | 8.1 |
| 75 and over | 4 | 5.7 | 5 | 5.6 | 9 | 5.7 |
| Total | 70 | 100 | 89 | 100 | 159 | 100 |
N: 159
Analysis:
As can be seen in the table above, there is a predominance of the female population (55.9%), the age group of 15-19 years prevailing, in the one under 1 year of age we only found 1 infant.
MIGRATIONS:
During the period under review, no families from other places have been received in our community.
TABLE IV: CLASSIFICATION OF FAMILIES ACCORDING TO ONTOGENESIS. FAMILY DOCTOR'S OFFICE NO. 11, SAN CRISTÓBAL, OCTOBER-NOVEMBER 2015
| Families | Quantity | % |
| Nuclear | 38 | 82.6 |
| Extensive | 8 | 17.4 |
| Expanded | 0 | 0 |
| TOTAL | 46 | 100 |
N: 46
Analysis:
Our study population is grouped into 46 families, of which 38 are nuclear, 8 are extensive, and we do not have expanded nuclei.
MAIN FAMILY PROBLEMS:
Biological:
- Non-communicable and disabling chronic diseases. Presence of risk factors.
Psychological:
- Suicidal risk.
Socioeconomic:
- In a small number of families there is a low family per capita.
Environmental Hygienic:
- Sanitary hygiene problems in some homes and patios. Pipe leaks in some places (behind the warehouse building, next to the cafeteria and behind the video room).
MAIN RISK FACTORS:
Individual risk factors:
- For the adult population:
Smoking: 13
Sedentary lifestyle: 27
Obesity: 7
Alcoholism: 5
Self-medication: 97
- For the child-youth population:
Postnatal harm: 0
Chronic Diseases: 2
Family risk factors:
Cores with overcrowding: 5
Homes with inadequate conditions: 1
Difficulties between cohabitants: 2
Alcohol related problems: 1
Chronic psychiatric patients: 1
Educational risk factors:
No educational risk factors were found in the school institutions we have.
Occupational risk factors:
- Dangerousness Night time Poor lighting Health workers Toxic materials
Community or social risk factors:
- Dark streets and parks. Moderate number of traffic signs. Lack of recreation. The ring road. Leaks in the water supply network. Litters with a large amount of garbage.
MORBIDITY
TABLE V: DISTRIBUTION OF THE POPULATION ACCORDING TO DISPENSARY GROUPS. FAMILY MEDICAL OFFICE NO 11, SAN CRISTÓBAL, OCTOBER-NOVEMBER 2015.
| Variant | Not. | % |
| Group I * | 3. 4 | 21.4 |
| Group II * | 48 | 30.2 |
| Group III * | 74 | 46.5 |
| Group IV * | 3 | 1.9 |
| Total | 159 | 100 |
N: 159
GROUP I *: SUPPOSEDLY HEALTHY
GROUP II *: WITH RISKS
GROUP III *: SICK
GROUP IV *: WITH SEQUELS
Analysis:
Out of a total of 159 patients studied, 46.5% of these were found in dispensary group III with 74 cases, 48 were grouped in group II, 34 were found to be healthy, and only 3 cases were found in group IV. The aforementioned forces us to undertake actions for the prevention and control of risk factors, as well as in the follow-up and control of Chronic Non-Communicable Diseases (CNCDs) to avoid progression towards serious or complicated forms.
| Risk factor's | Not. | % |
| Smoking | 13 | 8.2 |
| Alcoholism | 5 | 3.1 |
| Sedentary | 27 | 17 |
| Bad eating habits | 43 | 27 |
| Suicidal Risk | eleven | 7 |
| Accident risk | 93 | 58.5 |
| Self-medication | 97 | 61 |
| Obesity | 7 | 0.6 |
| Leptospirosis risk | 6 | 3.8 |
| Overcrowding | 5 | 3.1 |
| STI risk | 3. 4 | 21.3 |
| Preconception risk | 5 | 3.1 |
TABLE VI: RISK FACTORS PRESENT IN THE STUDY POPULATION. FAMILY MEDICAL OFFICE NO 11, SAN CRISTÓBAL, OCTOBER-NOVEMBER 2015.
N: 159
Analysis:
As can be seen in the table of risk factors, there is a great predominance of self-medication over all the other health problems found that 61% of people who take medications do it on their own without having a doctor, in second place is the risk of accidents since the whole of our population lives in buildings, where there are stairs and balconies that constitute risks especially for the extreme ages of life, in addition to having the Circunvalación road which has a dangerous curve and various educational institutes around it. It is followed in order of frequency by bad eating habits, representing 27%, the risk of getting sick from sexually transmitted infections, with 21.3% prevailing adolescence as the riskiest age.Sedentary lifestyle also fosters 17% regardless of the risks present in the community. Smoking, a problem that, despite not being at the top of our study, does not mean that its incidence has less value, since this is a factor in which we must not stop exhausting our efforts, since it constitutes a risk for many diseases that give rise to fret with life. We also identified suicide risk, obesity, leptospirosis risk, alcoholism, preconception risk and overcrowding with a lower incidence.Smoking, a problem that, despite not being at the top of our study, does not mean that its incidence has less value, since this is a factor in which we must not stop exhausting our efforts, since it constitutes a risk for many diseases that give rise to fret with life. We also identified suicide risk, obesity, leptospirosis risk, alcoholism, preconception risk and overcrowding with a lower incidence.Smoking, a problem that, despite not being at the top of our study, does not mean that its incidence has less value, since this is a factor in which we must not stop exhausting our efforts, since it constitutes a risk for many diseases that give rise to fret with life. We also identified suicide risk, obesity, leptospirosis risk, alcoholism, preconception risk and overcrowding with a lower incidence.
TABLE VII: COMMUNICABLE DISEASES AFFECTING THE STUDY POPULATION. FAMILY DOCTOR'S OFFICE NO. 11, SAN CRISTÓBAL, OCTOBER-NOVEMBER 2015.
| Diseases | Not. | % |
| GO TO | 13 | 8.2 |
| EDA | 6 | 3.8 |
| Pediculosis | 5 | 3.1 |
| Viral conjunctivitis | two | 1.3 |
| Dengue | - | - |
| Hepatitis A | - | - |
| Chickenpox | - | - |
| TB | - | - |
| Blennorrhagia | - | - |
| Syphilis | - | - |
| Accumulated condyloma | - | - |
| AIDS | - | - |
| Total | 159 | 100 |
N: 159
Analysis:
Among the communicable diseases that affect the population, ARI and EDA stand out with the highest number of cases, although this number could increase if we consider that many patients do not go to the doctor for this reason and self-medicate, so Epidemiological surveillance should be extreme when cases are reported in our area.
TABLE VIII: CHRONIC NONCOMMUNICABLE DISEASES AFFECTING THE STUDY POPULATION. FAMILY DOCTOR'S OFFICE NO. 11, SAN CRISTÓBAL, OCTOBER-NOVEMBER 2015.
| Disease | Not. | % |
| Arterial hypertension | 43 | 27 |
| Type II diabetes mellitus | 10 | 6.3 |
| Bronchial asthma | 9 | 5.7 |
| Heart disease | eleven | 6.9 |
| Chronic diseases of the digestive system | 5 | 3.1 |
| SOMA diseases | 4 | 2.5 |
| Metabolic endocrine diseases | 8 | 5 |
| Blood diseases | one | 0.6 |
| Malignant tumors | two | 1.3 |
| Cerebrovascular diseases | one | 0.6 |
| Others | 3 | 1.9 |
N: 159
Analysis:
The previous table shows the behavior of chronic non-communicable diseases where Arterial Hypertension prevails over the others with 27%, followed by 6.9% for heart diseases, Diabetes Mellitus type II, Bronchial Asthma, Endocrine Diseases Metabolic and Chronic Digestive. All these pathologies require strict control and monitoring by the basic team to prevent their progression to severe forms and improve the quality of life of patients who suffer from them.
MEDICAL ASSISTANCE
In the health area to which the office belongs, we have a polyclinic that provides multiple services:
Clinical and microbiological laboratory.
X-rays.
Stomatology.
Ultrasound.
Vaccination.
Ophthalmology.
Sterilization.
Menstrual regulation.
EKG
We have specialists in community genetics, as well as basic specialties (Internal Medicine, Obstetrics, Pediatrics, Psychology). Patients who need interconsultation with other specialties and the performance of more specialized diagnostic exams are provided through the work agreement with the Comandante Pinares hospital, there is also a pharmacy that dispenses the necessary medications to the population and a guard service. 24 hour emergency room.
TABLE IX: OPERATION OF THE CLUBS. FAMILY DOCTOR'S OFFICE NO. 11, SAN CRISTÓBAL, OCTOBER-NOVEMBER 2015.
| Clubs | Universe | Incorporated |
| Pregnant | - | - |
| Infants | one | one |
| Teenagers | 25 | 25 |
| Grandparents | 47 | twenty |
| Total | 63 | 46 |
Analysis:
Regarding the functioning of the clubs, we have achieved specifically in infants. There are irregularities in terms of student attendance at the club, due to the fact that a large part of them are studying, with the majority participation of students from Basic and Polytechnic Secondary.
Regarding the grandparents club, despite the fact that 100% of these are not incorporated, it is one of the clubs with the best functioning, however, work continues on the incorporation of all of them to said club and an improvement has been seen regarding acceptance by them.
TABLE X: BEHAVIOR OF BREASTFEEDING. FAMILY DOCTOR'S OFFICE NO. 11, SAN CRISTÓBAL, OCTOBER-NOVEMBER 2015.
|
Age |
Quantity |
LME | LMM | THE | |||
| Not. | % | Not. | % | Not. | % | ||
| Less than 6 months | - | - | - | - | - | - | - |
| More than 6 months | one | - | - | one | 100 | - | - |
| Total | one | - | - | one | 100 | - | - |
Analysis:
E n the sample there is only one infant who is older than 6 months and is with mixed breastfeeding, is an achievement that was up to 6 months exclusive breastfeeding..
TABLE XI: DISTRIBUTION OF INFANTS BY RISK. FAMILY DOCTOR'S OFFICE NO. 11, SAN CRISTÓBAL, OCTOBER-NOVEMBER 2015.
| INFANTS | Not. | % |
| At Risk | - | - |
| Risk free | one | 100 |
| TOTAL | one | 100 |
Analysis:
Infants born in the period under review are considered safe so far. It is at this stage that we must intensify the care and attention, both by the Health Team and by their families, for the early identification of risk factors.
Immune level:
The infant reported in the families studied has received the vaccines corresponding to their age, as established by the vaccination program.
The rest of the population has an adequate immune level. The population that is exposed to occupational hazards or due to engaging in agriculture in a particular way, is protected with the antileptospirosis vaccine, as well as the Tetanus Toxoid vaccine.
TABLE XII: CYTOLOGY PROGRAM. FAMILY DOCTOR'S OFFICE NO. 11, SAN CRISTÓBAL, OCTOBER-NOVEMBER 2015.
| Cytology | Scheduled | Made | % |
| Re-exam | 48 | 48 | 96 |
| New cases | two | two | 4 |
| TOTAL | fifty | fifty | 100 |
Analysis:
As it can be seen in the previous table, all the scheduled exams were performed, which is satisfactory since it is of great importance for the early detection of cervical cancer and to intervene in time.
TABLE XIII: BREAST CANCER CONTROL PROGRAM. FAMILY DOCTOR'S OFFICE NO. 11, SAN CRISTÓBAL, OCTOBER-NOVEMBER 2015.
| Breast exam | Scheduled | Made | % |
| Cases | 80 | 78 | 92 |
Analysis:
T he table shows the total number of women who had to undergo the breast examination of them, 92% had it done, which means a large part of the goal set. Educational talks were also held where the self-examination technique and the advantages of carrying it out were explained, which is highly satisfying for the Basic Work Team since this is one of the fundamental pillars in the breast cancer prevention program
ACCIDENT PROGRAM:
Home accidents: 12
Traffic accidents: -
School accidents: -
Work accidents: 2
Among the accidents that occurred in the period under review, we count on the first place being accidents at home, where falls in older adults and children predominate, as well as injuries in housewives. This situation alerts us to extreme prevention measures in homes and outdoor areas.
ANALYSIS OF MORTALITY
Regarding the assessment of this important section, we were satisfied that we had not presented any deceased, either by natural or violent cause, nor were there cases of maternal and child mortality, denoting all of this the good work and operation of the community health team..
Infant Mortality: 0
Maternal Mortality: 0
General Mortality: 0
REVENUE IN THE PERIOD ANALYZED
Household Income: 8
Hospital admissions: 2
Income in the Maternal Home: 0
It can be said that the main causes of household income are ARI, as well as the decompensation of some chronic diseases. Admissions to the hospital were mainly due to surgical causes.
PROBLEMATIZATION:
For the identification of the problems we use techniques such as: brainstorming or brainstorming, Ishikawa and the technique of nominal groups that within the characteristics of these is that of generating ideas in a short time.
OF BIOLOGICAL DETERMINANTS
- Increase in chronic diseases such as High Blood Pressure, heart disease, Type II Diabetes Mellitus, Bronchial Asthma, Endocrine Metabolic Diseases and Chronic Digestive Diseases.
OF THE ECOLOGICAL DETERMINATES
- Difficulties with water supply, storage and quality. Inadequate disposal of solid residuals. Lack of street and park lighting.
OF SOCIAL AND BEHAVIORAL DETERMINANTS
- Presence of risk factors (Bad eating habits, Smoking, Alcoholism and preconception risk etc.) High incidence of the self-medicating population and irrational use of it. Presence of dysfunctional family nuclei. Lack of a recreational site.
PRIORITIZATION OF PROBLEMS BY THE RANKING METHOD
| problems | TO | B | C | D | AND | F | Total |
| Increase in chronic diseases | two | two | one | one | 0 | one | 7 |
| Difficulties with water supply, storage and quality. | two | one | one | one | 0 | 0 | 5 |
| Improper disposal of solid residuals | one | two | two | 0 | two | two | 9 |
| Lack of street and park lighting. | two | one | 0 | two | 0 | one | 6 |
| Presence of risk factors (Bad eating habits, Smoking, Alcoholism and preconception risk etc.) | two | two | 0 | two | 0 | two | 8 |
| High incidence of the self-medicating population and irrational use of it. | two | two | two | two | two | 0 | 10 |
| Presence of dysfunctional family nuclei. | two | one | 0 | one | 0 | 0 | 4 |
| Lack of a recreational site. | one | 0 | 0 | two | 0 | 0 | 3 |
A: Frequency
B: Gravity
C: Vulnerability
D: Trend
E: Availability of resources
F: Consistency with the mission of the planner.
After the discussion of the Health Situation analyzing each of the existing problems and taking into account the frequency, severity, resolution, tendency, availability of resources, coherence with the mission of the planner, we came to establish the following order of priorities for the same:
- High incidence of the self-medicating population and irrational use of it Inadequate disposal of solid residuals Presence of risk factors (Bad eating habits, Smoking, Alcoholism and preconception risk etc.) Increase in chronic diseases Lack of lighting in streets and parks. Difficulties with water supply, storage and quality. Presence of dysfunctional family nuclei. Lack of a recreational site.
CROSS IMPACT MATRIX
INTERACTIVE FORCES
INTERNAL FORCES EXTERNAL FORCES
STRENGTHS WEAKNESSES OPPORTUNITIES THREATS
STRENGTHS:
- The Basic Health Team constitutes an organizational and special unit. Geographical accessibility because all the patients live close to the High professional preparation of the members of the Basic Health Team. Interest of the members of the Basic health team to solve the problems of the Community. Provision of Basic Health Team services at flexible hours. Support from neighbors and community leaders. Existence of centers that benefit the population.
WEAKNESSES
- Lack of community motivation. Health culture still inadequate in the population. Lack of material resources.
OPPORTUNITIES
- Existence of a Municipal Health Council Interest of the Health Sector and the Polyclinic to have excellent Primary Health Care Existence of prioritized Programs that benefit the population Promotion by the National Health System Support by the governmental organizations. Reorganization of the territory from the creation of the new province.
THREATS
- Commercial embargo that Cuba is subjected to. Inadequate disposal of solid residuals. Instability in the water supply.
ACTION PLAN
Problem No. 1: High incidence of the self-medicating population and irrational use of it.
Objective: Reduce the inappropriate consumption of medications as well as counteract their adverse effects.
| Activities | Run | Control | Means | Date | Measurement criteria | |
| M | H | |||||
| Guide the population on the importance of the proper use of medications | Nurse | Doctor | Yes | Yes | 1st Tuesday of each month | 90% |
| Health hearing for the population on the consequences of self-medication. | Doctor, Nurse. | President of the CDR and FMC. | Yes | Yes | 2nd Wednesday of each month | 70% |
| Propaganda on adverse drug reactions | President of the CDR and FMC. | Zonal leaders | Yes | Yes | Permanent | 60% |
| Adequate planning of consultations and areas to assess the need for adequate medication and dosage. | Doctor, Nurse | Basic working group | yes | Yes | 1st Monday of each month | 100% |
Problem No. 2: Inadequate disposal of solid residuals
Objective: Achieve the adequate disposal of solid residuals.
| Activities | Run | Control | Means | Date | Measurement criteria | |
| M | H | |||||
| Analysis of the consequences of bad water sources. | Health brigade member | Nurse | Not | Yes | December 15, 2015 | 70% |
| Sanitary hearings on environmental hygiene | Health brigade member | Vector technician | Not | Yes | 2nd Monday of each month | 75% |
| Place posters related to the protection of the environment | FMC President | CoR President | Yes | Yes | Permanent | 60% |
| Organize volunteer work for CDR | Responsible for the organizational events of the CDR | CoR President | Yes | Yes | Alternate weekend of December 2015 | 90% |
| Coordinate with community members the remodeling or expansion of the supiaderos | Zone group leader | Vector Group Technician | yes | yes | December 14, 2015 | 90% |
Problem No. 3: Presence of risk factors (Bad eating habits, Smoking, Alcoholism and preconception risk etc.)
Objective: Early diagnosis, monitoring and control of patients with risk factors and patients.
| Activities | Run | Control | Means | Date | Measurement criteria | |
| M | H | |||||
| Educational talk to the population about the harmful effects of the different RF. | Nurse | Doctor | Yes | Yes | Wednesday and Friday of the month of December 2015 | 75% |
| Graphic advertising on RF | FMC President | CoR President | Yes | Yes | Permanent | 60% |
| Promote in smokers attendance at the tobacco cessation consultation and the services provided by the rehabilitation room for the control of RF | CoR President | Zonal leaders | Yes | Yes | Tuesday and Thursday of the month of December 2015 | 80% |
Problem No. 4: Increase in chronic diseases
Objective: Early diagnosis, monitoring and control of these patients.
| Activities | Run | Control | Means | Date | Measurement criteria | |
| M | H | |||||
| Promote the importance of performing physical exercises. | Professor of Physical Culture | Nurse | Yes | Yes | Monday, Wednesday and Friday of the month of December 2015 | 75% |
| Keeping our patients compensated in order to avoid exacerbation of the disease. | Nurse | Doctor | Yes | Yes | Permanent | 100% |
| Adequate planning of consultations and grounds to assess the health situation of our patients. | Nurse and Doctor | GBT boss | Yes | Yes | Permanent | 100% |
Problem No. 5: Lack of street and park lighting.
Goal: Enlighten much of the community
| Activities | Run | Control | Means | Date | Measurement criteria | |
| M | H | |||||
| Coordinate with the electric company to repair the Lampposts in poor condition. | Zonal leaders | CoR President | Yes | Yes | December 1, 2015 | 70% |
| Educational talk to the population about the risk of accidents, especially in the elderly. | CoR President | Nurse | Yes | Yes | December 19, 2015 | 80% |
Problem No. 6: Difficulties with water supply, storage and quality.
Objective: Achieve adequate storage and water quality.
| Activities | Run | Control | Means | Date | Measurement criteria | |
| M | H | |||||
| Talk about the importance of water treatment | Health brigade member | Nurse | Yes | Yes | 3rd Thursday of December 2015 | 80% |
| Visits to water providers to assess the proper performance of their disinfection. | Hygiene technician | Leader is zoned | Not | Yes | 2nd Thursday of each month | 70% |
| Conduct talks on the correct storage of drinking water | Health brigade member | Nurse | Yes | Yes | December 9 and 23, 2015 | 85% |
| Carry out periodic evaluations to determine the quality of the water supply piping system. | Health brigade member | CoR President | Yes | Yes | The last Friday of each month | 80% |
CONCLUSIONS
- There is a predominance of the female sex over the male. The largest number of the study population is between the ages of 15-19 years. 25% of the study sample has a pre-university level of education, which facilitates understanding of the issues that will be communicated to it to solve. The studied population is dispensed in a greater number in group III. The studied population has inadequate lifestyles that lead to the appearance of risk factors responsible for the large number of chronic non-communicable diseases The main diseases that affect the population are Hypertension with 27%, followed by 6.9% for heart disease, Type II Diabetes Mellitus, Bronchial Asthma, Endocrine Metabolic Diseases and Chronic Digestive Diseases.The main problem affecting the community is the high incidence of the self-medicating population and irrational use of it.
BIBLIOGRAPHY
- Sheets of charge of the statistics department of the polyclinic Camilo Cienfuegos Ramos Domínguez, Benito: Social Medicine Public Health in Cuba, Education, Havana 1990. Ochoa Soto, Rosaida: Epidemiology of non-diarrheal disease Álvarez Cintes, Roberto: Topics in Comprehensive General Medicine. Transmissible Science Publishing. Editorial Pueblo and Education. Havana 1992. Toledo Curbelo: Foundations of Public Health I. Medical Sciences Editorial, Havana 2004.Benenson, Abran: Manual of communicable diseases. Editorial (OPS). Scientific publication # 564.MINSAP: National Statistical Yearbook of Health. Cuba 2009.MC Millos Young, Robertson: Sexually transmitted diseases. Scientific-technical editorial. Havana city. Encarta Encyclopedia 2007.Analysis of Health Situation in Office # 11 of September 2014 - November 2014.
