University of Pretoria



WBOT Individual Health Status Assessment (HSA)Version 1, 30 September 2013Revised 24 February 2014Revised October 2014Revision 05 February 2015The structure of the individual health status assessment Item numberItem typeContentItemPage1Individual registration6[S][Surname, Name, DOB, ID/BC,{Age}, Gender, Relation, Vulnerability]-6[S/C]Edit information-6[C]Communication16[C]Reason for communication difficulty(1)6[C]Interview assistance(1)7[Q]Consent39[Q]Residence status19[Q]Education19[Q]Studying19[Q]School18[Q]Occupational status19[Q]Individual income1(-2)10[Q]Grant (MC)1-311[Q]Applicatin for Grant112Individual “triage”11[Q]Health problem111Individual assessment142Life style14[C]Body mass - Stunkard card114[M]Height114[M]Weight + Readiness for change214[Q]Physical activity + Readiness for change215[Q]Active smoking + Readiness for change216[Q]Snuff use116[Q]Passive smoking116[Q]Alcohol QF217[Q]Alcohol RAPS4(4)18[Q]Drugs ever1120[Q]Drugs present(11)203General health (Sensory and Performance/Activity)22[Q]Vision Screening123[Q]Vision Care(1)23[Q]Hearing Screening 123[Q]Hearing Care (1)23[C]Hearing Test(1)23[Q]Performance status224[Q]Bedridden124[Q]Home Based Care1254Oral health26[Q]Teeth brushing126[Q]Oral health assessment5265Chronic/Non-communicable Diseases28Hypertension29[Q]Current diagnosis and care1(-2)29[C]BP screen1(-2)29Diabetes mellitus30[Q]Current diagnosis and care1(-2)30[S]Risk assessmentAge30[S]BMI/Stunkardt31[M]Waist circumference31[S]Physical activity31[Q]Nutrition/Vegetables131[S/Q]BP treatment(1)31[Q]High glucose ever131[Q]Family history131[Q/M]Glucose measurement232Coronary heart disease/heart attack33[Q]Current diagnosis and care1(-2)33[Q]Diagnostic screen233[S]Risk assessment33Peripheral arterial vascular disease38[Q]Current diagnosis and care138[Q]Diagnostic screen238Cerebro-vascular disease38[Q]Current diagnosis and care138[Q]Diagnostic screen538Chronic lung disease39[Q]Current diagnosis and care1(-2)39[Q]Diagnostic screen339Epilepsy/Cerebral fit39[Q]Current diagnosis and care1(-2)39[Q]Diagnostic screen140Chronic joint disease40[Q]Current diagnosis and care1(-2)40Chronic pain40[Q]Chronic pain40[Q]Location of painMC(7)41Sleeping problems41[Q]Sleeping problem141Mental health (screening)41[Q]Depression - Diagnostic screening2(-10)42[Q]Dementia/Cognitive disorder – Diagnostic screening1(-5)44Other chronic diseases/conditions45[Q]Other chronic diseases/conditions1456TB algorithm 44[Q]Currently taking TB treatment149[Q]Green Card(1)49[Q]optional: Documentation TB treatment(x)49[Q]Ever taken TB treatment before150[Q]optional: Documentation TB history(x)50[Q]TB treatment in the past 12 months(1)51[Q]Currently diagnosed with TB but not taking treatment151[Q]optional: Documentation date of diagnosis(1)51[Q]Symptoms of TB551[Q]optional: Documentation TB symptoms(x)52[Q]Tested for TB(1)52[Q]Test outcome(1)53[Q]optional: Documentation TB tests(x)537Reproductive Health algorithm25[Q]Attitude on contraception128[Q]Sexual activity128[Q]Current contraception useF 1028[Q]Reasons for not using contraception currentlyF 129[Q]History (children, pregnancies)F 229[Q]PregnancyF 130[Q]ANC attendanceF (1)31[Q]EDDF (1)31[Q]Intention of pregnancyF 131[Q]Previous contraception use(F {10})31[Q]Reasons for not using contraception previously(F {9})32[Q]Intention of TOPF (1)32[Q]Previous complicationsF (1)33[Q]Documentation promptF (5)33[Q]Duration of trying to becoming pregnant(F {1})34[Q]Knowledge of emergency contraception134[Q]Condom usage135[Q]Reasons for not using condoms F 135[Q]STI screen135[Q]CircumcisionM 136[Q]“Men’s health”M 5378HIV algorithm39[Q]Ever tested142[Q]Outcome142[Q]Age of test / ART142[Q]Last CD4(1)42[Q]CD4 value(1)42[S/Q]PMTCTF 1429Cancer70Breast cancer70[Q]Diagnosis and CareF 1(-2)70[Q]Risk/preventionF 2(-3)71Cervix cancer 72[Q]Diagnosis and CareF 1(-2)72[Q]Pap screenF 3(-4)7210Violence/sexual assault/accidents/injury74[Q]Experience/Exposure to violence/sexual assault174[Q]Experience and exposure to accidents/injury116[C]Documentation prompt(5)1711Indigent information76[Q]Skills39+3976[Q]Driver’s licence178[Q]Availability178Individual registration - Individual information[applicable to persons: ≥15 years – compulsory schooling]ItemComment/RationaleReferenceS: [System displays surname, name, DOB, ID/RN/PP, gender, DOB etc. which was captured already when HH is registered]Mezzanine to adviseS: [Prompt to edit/complete information if any fields are blank] Mezzanine to adviseCommunicationC: Do you (CHW) and the person have difficulty understanding and/or communicating with each other?A: No difficulty, Some difficulty, A lot of difficulty, Unable to understand and/or communicate with each otherProper communication is a prerequisite to conduct the interview. Communication is understood as the ability to speak and the mental abilities required to follow and/or keep up a conversation. There needs tobe sufficent abiity to communicate in order to complete the interview. Should this not be possible, th CHW will have to establish who the primary carer of the individual is and interview him or her. Reason for communication difficultiesIf: “Some difficulty, A lot of Difficulty, Unable to understand and/or communicate”: C: Please specify the reasons (multiple choice):ReasonoLanguageoSpeakingoHearingoUnderstanding/Mental issuesoOtherFLAG: Communication difficulty if Reason Speaking, Hearing or Understanding/Mental issuesConduct of the interview[only asked if Some difficulty, A lot of difficulty, Unable to understand and/or communicate”]C: Is the interview conducted with assistance?A: Yes, NoIf yes:ContinueIf no and “some difficulty”:ContinueIf no and “a lot of difficulty” or “unable to understand...]:Show prompt: Please get assistance to conduct the health status assessment.A: Continue with assistance, ExitIf Exit, exit (to be defined)If Continue with assistance, repeat questionTraining issue! Ethcially, the interview can only be conducted if CHW and the person can communicate properly/understand each other. Otherwise, what value would the consent have? If language is the communication hurdle a translator should be assisting or the interview should be conducted by a person who is knowledgeable in the language of the interviewee. If hearing/speaking ability is a problem the CHW should explore appropriate ways for communication and seek assistance accordingly (e.g. hearing aid, pen and paper, family member who can better understand the person and can “translate” etc.)If the person is mentally unable to communicate a primary carer or family member who is familiar with the person should assist with the interview. S: [Prompt consent, part 1: I have been told about the purpose of the HSA...{data storage}]Mezzanine to adviseS: [Prompt consent, part 2: {research}]Mezzanine to adviseResidency statusQ: In South Africa everybody is entitled to access public health care services. However your access to social services is conditional on your nationality or residency status. What is your residency status?A: South African citizen, Non-South African - Permanent resident, Non-South African - Temporary resident, Non-South African – Refugee, Non-South African – Unknown/undetermined residency status, Refuse to answerAim 1) to get residency status clarified to allow for access of social services, 2) condition for Indigent labour programme, 3) conditional for grant qualificationEducational statusQ: What is your highest level of education?A: [system displays table]Educational status enables us to distinguish between illiteracy and the degrees of functional literacy. It is a useful indicator for both descriptive and analytical purposes in respect of health and social status. Furthermore the level of qualification informs service delivery iro the indigent programme.Level/ FETDesignationGeneral and Further Education and Training Qualifications Sub-FrameworkOccupational Qualifications Sub-Frameworko-No schooling--o-Grade 1 – 6 (Incomplete primary)--o-Grade 7 - 8--o1Grade 9General CertificateOcc. certificate (level 1)o2Grade 10 and National (vocational) certificate level 2Elementary CertificateOcc. certificate (level 2)o3Grade 11 and N(V)C level 3Intermediate CertificateOcc. certificate (level 3)o4Grade 12 (National Senior Certificate) and N(V)C level 4National CertificateOcc. certificate (level 4)o5Higher Certificates and Advanced N(V)CHigher CertificateOcc. certificate (level 5)o6Diploma and Advanced CertificatesDiploma, Advanced CertificateOcc. certificate (level 6)o7Bachelor’s degree and Advanced DiplomaBachelor’s degree,Advanced Diploma-O8Honours degree, Post-graduate Diploma and Professional QualificationsHonours degree,Post-graduate Diploma-O9Master’s degreeMaster’s degree-O10Doctor’s degreeDoctor’s degree-StudyingQ: Are you currently enrolled at a school, college or university?A:StudyingoYes, SchooloYes, CollegeoYes, UniversityoNoSchool nameIf “Studying – school”:Q: Please provide the name of the schoolA: [enter school name]Requirement by NDOHOccupational statusQ: Are you currently working?A: Occupation/workoYes - Self employedoYes - full timeoYes - part timeoNo - Unable to work because of illness or disabilityoNo - Unemployed – looking for workoNo - Staying at home – not looking for workoNo - Retired/PensionerWorking categories focus on the class of activity as they relate to livelihood/occupation rather than the sector (as in the census). The question is useful for descriptive (informing strategy, how to reach people who are working) and analytical purposes (attributed risks).Definition “working” (census): work for pay (in cash or kind), profit or family gain“studying” – enrolled at an educational institution or in an educaitonal programme (school, college, university, course)Individual incomeQ: How much money do you earn from work (income only)A: [week]A: [month]Refuse to answerThe individual needs to provide either monthly or weekly earnings, but should be allowed to provide both (monthly and weekly).GrantsQ: Do you receive any of the following grants?A: [table, system displays only what is applicable according to age]GrantYNDKROld age grantooooDisability GrantooooWar Veteran’s GrantooooCare Dependency GrantooooFoster Child GrantooooChild Support GrantooooThis provides information on individual grant income, with the exception of grants for children, who are the indirect beneficiaries of such awards. Grants in South Africa:GrantNationalAgeCriteriaSingle incomeCouple incomeOld ageSA/PR≥60 years<47.400<94.800DisabilitySA/PR18-59Disability (medical) report<47.400<94.800War VeteranSA/PR(≥60 years)WWI+II, Korean war<47.400<94.800Care DependencySA/PRno age restriction (can also apply to adults who depend on care)Disability(medical)report<144.000<288.000Foster ChildSA/PR/Ref<18 yearsCourt order foster parent--Child SupportSA/PRChild DOB <01.01.1993Primary care giver<33.600<67.000Eample:<18: does not show anything18-59 years shows: Disability, Care Dependency, Foster child, Child >=60 shows: War veteran, care dependency, Foster child, child supportGrant application[If not receiving any grant]:Q: Do you want to apply for a grant?A: Yes, NoIf Yes: FLAG: Grant applicationIndividual “triage”:ItemComment/RationaleReferenceTriageQ: Now I am going to ask you about your health. Is there anything you want to tell me about your health? A: Yes, No, DK, RIf No, DK, R: [Skip documentation questions]If Yes: Q: Please provide detailsA: [freetext] This question is meant to identify any condition that requires immediate action (“triage”), whatever it is. The question is intentionally open ended to allow the person to mention any health issue that he/she wants to address, be it an acute problem, any health worry, a known diseases, or relevant medical history.With regards to interview strategy the question invites the respondent to verbalise any health concerns they have immediately and it supports the building of rapport between the CHW and the respondent.In taking this approach we are aware that the CHW will not be able to make a clinical judgement from information provided by the person. However, acting within scope of practice, a CHW will be able to identify and “triage” a person who presents an acute problem and send for referral or seek advice on how to proceed.The CHW should be taught how to document a case:What problem was reported?How long does the problem exist?/When last did the problem occur?How severe is the problem? (mild, moderate, severe)What has been done so far about it?If Yes: FLAG: Health problemIndividual assessment - LifestyleBody massC: Please assess the person’s body shape using the Stunkard cardA: [enter number]Example:Body mass is an important health measure. Underweight can be a sign of a consuming disease (e.g. cancer, TB, worm infestation) as well as under-nutrition and malnutrition. Overweight is important risk factor for cardiovascular and skeletal diseases. CHWs can act on all these issues through referrals or health education.In data analyses weight can be used as a predictor for certain health and social conditions.Assessing BMI is a bit more challenging to operationalise in a COPC context both in terms of getting the measurement itself (scale/height) as well as regarding the interpretation of results. Other measures (such as waist circumference, or waist to height ratios) have been found to be unacceptaple at community or not validated for adults or to assess obesity (MUAC). The comparison of the person against Stunkard cards aims to eliminate investigator bias regarding what is considered as under-/normal-/overweight/obesity. The mobile device only displays shapes and not their interpretation like “obesity” etc. Based on observations, the CHW assesss readiness for change and/or refers to person observed for nutritional assessment and can support dietary changes.HeightC: Please measure the person’s heightA: [enter number], refused, skipAfter discussions we decided to add this question in order to be able to assess BMI. The question should be understood as optional, conditional to the availability of a leangth measurement tool.WeightC: Please measure the person’s weightA: [enter number], refused, skipSee comment to previous questions.The system should display the BMI based on the following calculation:BMI = weight in kg / (heigth in meter)2 The display should prompt the following statements depending on the BMI<18.518.5 - 24.9925 - 29.99≥ 30“The BMI indicates that the person is underweight”“The weight of the person is normal”“The BMI indicates that the person is overweight”“The BMI indicates that the person is obese”Referral prompt(no action)Assess readiness for change (see next questions)FLAG If Stunkard <=2, or BMI <18.5: UnderweightIf obese (Stunkard >=7 or BMI >=25):Assess readiness for changeQ: How important is it for you to reduce your weight?A: important, unsure, not important, R, DKIf important:suggest referral for nutritional assessment[referral prompt]FLAG If important: Obese - ready to changeThere should be a nutritional support programm available!If unsure: provide more information but don’t necessarily prompt for actionPhysical activityQ: Do you do physical activity (walk fast, run, do sport or physical labour) for at least half an hour on five days a week or for at least two and a half hours per week?A: Yes, No, DK, RPhysical activity contributes to physical health and mental wellbeing. Its absence is a risk factor for cardiovascular disease. It is recommended that an individual should be involved in sustained physical activity for 150 minutes in a week If No to physical activity:Assess readiness for changeQ: How important is it for you to become more physically active?A: Important, unsure, No, R, DKIf important:provide further information/schedule follow-up visist/referTobacco exposureActive smokingQ: How many cigarettes, cigars or pipes do you usually smoke a day?A: [enter number], Refuse to answerIdentifying active smokers and quantifying the health hazard of active smoking. Will also support CHWs to engage actively in health promotion and disease prevention.The fagerstr?m test was suggested. The test includes about 6 questions assessing nicotine dependency and heaviness of smoking. We believe that the screening here should just identify smokers and assess whether they are prepared for change with as few questions as possible and then go into more detail with an assessment test separately.The short fagerstrom test for nicotine dependence might be worth a look in the ichange4health material?If >= 10 cigarettes per day:Assess readiness for changeQ: How important is it for you to reduce smoking?A: Important, unsure, not important, R, DK There should be a special programme for smokers, otherwise this question may not be asked FLAG: Smoker - ready for changeQ: Do you use snuff?A: Yes/No/RPassive smokingQ: How many cigarettes do people smoke in your presence a day (in your home or personal car, at work/school/college or during recreation/leisure outside your home)? A: [enter number], R, DKThis questions aims to identifying people exposed to tobacco smoke (passive smoker) It is especially important in respect of managing environmental pollution in the home, reducing health problems in children, the aged, pregnant women as well as limiting generational reproduction of high risk lifestyle habits. A review of recent literature highlights general difficulties in assessing secondhand smoking. However, asking about the the number of cigarettes smoked per day (CPD) in the presence of the exposed individual was found to be most reliable reliable. Avila-Tang et al. Assessing secondhand smoke exposure with reported measures. Tobaccor Control, 2013; 22: 156-163AlcoholIdentify risky drinking (abuse/dependency)Q: How often do you drink alcohol? (F Frequency)A: Never or less than once a month, once a month, once a week, several days of the week, daily If Never or less than once a month:Skip following questions and continue with next complex of questions (drugs)Alcohol has major implications on individual health. Drinkers are at risk of liver damage, brain damage, depression, nerve damage, accidents, and financial/work place consequences. Drinkers also affect the health of others e.g. birth defects, aggression, violence, injury, accidents. It is therefore both an individual and a public health concern to identify hazardous drinking in order to get individuals to reduce or stop alcohol consumption. The ICD-10 distinguished between Alcohol abuse and Alcohol dependency.Alcohol abuse is defined as drinking related trouble with friends, police, work, physical health or psychological health. Alcohol dependency is defined as being positive in three or more of the following domains: (i) craving, (ii) impaired capacity to control use, (iii) withdrawal, (iv) tolerance, (v) neglect of interests, (vi) continued use despite problems, (vii) spending a great deal of time in drinking activities. The difficulty of controlling alcohol consumption through behaviour change is that alcohol consumption is socially acceptable, individuals are rarely socially sanctioned for excessive alcohol consumption and their sequelae, and equally, they are reluctant to acknowledge their responsibility in regulating their own drinking. In respect of alcohol dependency various drinking patterns each carry specific hazards and challenges (e.g. routine drinking, binge drinking, social drinking etc...). The questions support the CHW scope of practice. Regarding the control and reduction of hazardous alcohol consumption their role ito identify and refer alcohol dependency;to promote safe practices around alcohol consumption (drink driving, pedestrian safety, drinking in pregnancy, children and alcohol, to sensitize individuals, families and the community about the problem of hazardous drinkingto support treatment.Detailed alcohol drinking history, quantities and dependency (through screening tools such as CAGE or RAPS) are subsequent steps linked to individuals initially screened as “at risk”. Cherpitel, 2002. Alc Clin Exp Res; 26 (11): 1686Canagasaby, 2005. Alcohol Alcoholism; 40 (3): 208Kelly, 2009. Addictive Behaviour; 34: 668Newton, 2011. Pediatrics; 28 (1): e180Vinson, 2007. Alc Clin Exp Res; 31 (8): 1392Q: On one single occasion during the past month, have you had 5 or more drinks containing alcohol. (Q Quantity)A: Yes, No, Cannot remember, Refuse to answerIdentify people with a dangerous drinking pattern regarding quantity. All those who had 5 or more drinks on one occasion must be considered as possible abusing alcohol or being even alcohol dependent and should be referred for further assessment. How much?How often do you drink?5 drinks or moreless than 5 drinksnever (<1/month)--1/monthsalcohol abuse/dep. possible => refer or RAPSalcohol abuse/dep. unlikely=> no further action1/weekalcohol abuse/dep. possible => refer or RAPSalcohol abuse/dep. unlikely=> no further action>1/weekalcohol abuse/dep. possible => refer or RAPSalcohol abuse/dep. unlikely=> no further actiondailyalcohol abuse/dep. possible => refer or RAPSalcohol abuse/dep. unlikely=> no further actionDefinition “drink”: Equivalent doses: 350ml beer 5%, 125ml wine 12-14%, 25ml shots 40%, 350ml cider 5%, 1 cocktailIf 5 or more drinks ask the following 4 questions (RAPS): Q: Have you had a feeling of guilt or remorse after drinking? (R Remorse)A: Yes, No, Refuse to answer The four RAPS question assess people with possible alcohol abuse/dependency for probable alcohol abuse/dependency among those identified as with possible alcohol abuse/dependency. Any of the following four questions answered with Yes indicates probable alcohol abuse/dependency and the individual should definitively be referred. This question enquires a person’s ability to control alcohol and the consequences of drinking.RAPS is similar to CAGE (no, see Cherpitel, 2002 and other publications) and I suspect will identify alcohol dependency more than harmful alcohol use. See below. AUDIT-C as per the ichange4health manual is another option which you are lready covering 2 out of the 3 questions and may be more sensitive to harmful drinking. The only questions in the AUDIT-C that addresses consequences is: Have people annoyed you by criticizing your drinkning? R and S are similar, the 4th AUDIT-C question is Have you ever felt you should cut down on your drinking (see ichange4health manual) See Cerpitel, 2002. Screening for Alcohol problems..., Alcohol Clin Exp Res; 26 (11): 1686-1691Q: Has a friend or family member told you about things you said or did when you were drunk that you could not remember? (A Amnesia/Blackouts)A: Yes, No, Refuse to answerThe question addresses a person’s ability to control alcohol intakeQ: Have you failed to do what was expected from you because of drinking? (P Performance)A; Yes, No, Refuse to answerThe question addresses the impact of drinking interests/performanceQ: Do you sometimes take a drink in the morning when you first get up or sneak out from work to have a drink? (S Starter) A; Yes, No, Refuse to answerThe question taddresses craving and withdrawal Analysis:QF only: frequency analysis according to frequency of drinking and quantity (5 or more drinks). RAPS4: allows to analyse deeper for probable alcohol abuse/dependency.If any of the 4 RAPS questions positive:Assess readiness for changeQ: How important is it for you to reduce drinking alcohol?A: Important, unsure, not important, R, DK FLAG if any of RAPS positive and readiness for change: Probable Alcohol abuse ([score 1-4]) ready for changeDrug useQ: Have you ever used any of the following drugs or medicines?A: (table)Drug abuse is common in SA. Drug abuse has individual and social impacts similar to alcoholism. The characteristics of dependency/ abuse vary according to the drug class. In COPC, the primary aim is to identify people who regularly consume drugs. A further assessment if the criteria of abuse or dependency apply wouldbe linked to interventions. Several CHWs have requested that drug abuse be assessed in the HSA. SubstanceYNRCannabis (dagga, marijuana, grass, hash etc.)Street drugs (nyaope, whoonga, heroin, opium etc.)Cocaine (crack, coke etc.)Methamphetamines (tic, crystal meth, speed, ecstasy, XTC, etc.)Inhalants (glue, paint thinner, nitrous oxide etc.)Sedatives/sleeping pills (Mandrax, Valium, Rohypnol, GHB etc.)Hallucinogens (LSD, mushrooms, Efavirenz/Sustiva etc.)Prescription opioids (Fentanyl, Tramal, Hydrocodone, Buprenorphine etc.)Prescription stimulants (Ritalin, diet pills etc.)Prescription sedatives/sleeping pills (Valium, Rohypnol etc.)OtherQ: In the past 3 months, how often have you used the drug?A: (table [system only displays relevant rows])Split action between “illegal” and “prescription” drugs:The CHW should offer any patient to seek for professional assistance for Rehab. Street drugs: Heroin and heroin containing drugSubstanceNot used1-2 times≥1/ month≥1/ weekdailyCannabis (dagga, marijuana, grass, hash etc.)Street drugs (nyaope, whoonga, heroin, opium etc.)Cocaine (crack, coke etc.)Methamphetamines (tic, crystal meth, speed, ecstasy, XTC, etc.)Inhalants (glue, paint thinner, nitrous oxide etc.)Sedatives/sleeping pills (Mandrax, Valium, Rohypnol, GHB etc.)Hallucinogens (LSD, mushrooms, Efavirenz/Sustiva etc.)Prescription opioids (Fentanyl, Tramal, Hydrocodone, Buprenorphine etc.)Prescription stimulants (Ritalin, diet pills etc.)Prescription sedatives/sleeping pills (Valium,Diazepam, Rohypnol etc.)OtherIf ≥1/month:Assess readiness for changeQ: How important is it for you to reduce taking drugs?A: Important, unsure, not important, R, DK FLAG if >+1/months and ready for change: Drug use redy for change Nutrition[may come here...]Aim is to make people eating healthy (behavioural change/practice).General health (sensory and performance) The following section assesses a person’s level of activity and performance. It strives to identify people who have difficulties in full participation in life activities. It informs interventions that can optimize individual participation in daily activities and social life. Biomedical ApproachDisability is associated with illness or impairment emphasising correction or cure of disability. Philanthropic ApproachDisability is regarded as a tragedy or subject that solicits sympathy and charity.Sociological ApproachThis approach construed disability as a form of human difference that results in inequality, inequity and discrimination.Economic ApproachDisability is examined in terms of the cost of impaired biophysical and mental functioning to individuals, families and society. Functionality and Socio-Political Approaches ( International Classification of Functionality and the Integrated National Disability Framework)The Integrated National Disability Framework regards disability as a socio-political construct that disadvantage people with disabilities through exclusionsThe WHO International Classification of Functionality (e.g. the 12 item WHO-ICF (WHODAS 2.0) assessment) assesses all aspects of health along a continuum of function. Since “function” more often involves more than one “ability”, a review of the ICF found that the traditional way of assessing “disability” in terms of singular “abilities” does not allow for the complex interplay of “abilities” as “functions”.Census 2011 comments on disability: “In Census 2011, disability was defined as difficulties encountered in functioning due to body impairments or activity limitation, with or without the use of assistive devices.” The Census assesses sight, hearing, communication, physical actiity (walking or climbing stairs), remembering and concentrating, self care. Census 2011 questions were asked in the form of: “Does the person has difficulties in…”. Response options were: No difficulty, Some difficulty, A lot of difficulty, Cannot do at all. According to StatsSA these questions were drawn from the Washington Group of the Round of Population Censuses. After extensive discussions we adopted the Census 2011 strategy to assess activity/performance. ItemComment/RationalReferenceEye sight/visionQ: Do you have any difficulty with your eye sight (without glasses) [prompt: consider difficulty reading small letters, blurred vision, blind spots, inability to focus on close or distant objects, limited visual field, lost eye etc.]?A: Blind (unable to count fingers at a distance of 30 cm), Yes (low vision), No (able to read small letters in a book or newspaper without effort), DK, RColenbander, 2001, Chapter 51 in Volume 5 of Duane’s Clinical OphthalmologyWHO, 2012 Global data on visual impairmentSchulze-Bonsel, 2006, Investigative Ophthalmology and Visual ScienceIf Blind/Yes:Q: Have you had your eye sight checked?A: Yes, No, DK, RIf No, DK:[Refer to clinic/optometrist]FLAG If No: Sight difficulties, not checkedHearingQ: Do you have difficulty hearing?A: Yes, No, DK, RIf Yes (to Q: Do you have difficulty hearing?):Q: Have you had your hearing checked? A: Yes, No, DK RFLAG If No: Hearing difficulties, not checkedIf No (to Q: Do you have difficulty hearing?):EITHERQ: May I please perform a brief hearing test with you? [Hearing screening test (whispered voice test) A: no hearing impairment (3/3 or 3/6), hearing impairment (<3/6)ORLink to HEARING APPWhispered voice test:Examiner stands at arms length behind the seated person. The examiner exhales quietly. She/he whispers a combination of 3 numbers and letters (e.g. K – 6 – 5). S/he asks the seated person to repeat what she said (the sequence). If person repeats the whispered sequence correctly: no hearing impairmen. If incorrect the test is repeated once. If, after doing the test twice, the patient repeats the sequence no hearing impariment. If after two tests the response is incorrect hearing impairment is very likely.]FLAG if Hearing difficulties as: Hearing difficulties, not checked Pirozzo, 2003, BMJQ: Do you have difficulty communicating?A: No difficulty, Some difficulty, A lot difficulty, Unable to doThis question is now dealt with clarified prior to the consent proceduresQ: Do you have difficulty walking or climbing steps or stairs?A: No difficulty, Some difficulty, A lot difficulty, Unable to doQ: Do you have difficulty caring for yourself?A: No difficulty, Some difficulty, A lot difficulty, Unable to care for him/herselfQ: Are you bedridden? A: Yes, No, DK, RHow to process the information from above?If any of the following answer options was ticked please continue with the questions on HBC/ DisabilityQuestionVisionHearingHearing testCommunicationbut not language!!Walking/ Steps/ StairsCaringBedriddenRemembering & ConcentratingAnswer optionsBlindLowYespositiveSomeA lotUnableSomeA lotunableSomeA lotUnableSomeA lotUnableQ: HBCxx---xx-xx-xxx-xxIf any of the questions indicated limited activity/performance (see table above) the person should be assessed further: Home based careQ: Do you receive HBC?A: Yes –HBC adequate, Yes - HBC not adequate, No If the person is not receiving HBC or inadequate HBC: [Refer/Assess for HBC & Disability][Referral prompt]Definition: HBC is directed to people who need basic support services to continue to live and/or die in their community and without which they would have been either prematurely, inappropriately or unavoidably moved to institutional care.If “disability” is understood as a status that is linked to social benefits (e.g. grant, indigent programme) then COPC may work towards getting all who qualify for this status to be recognised as “disabled” in order for them to receive the social benefits. The difficulty though is that classifying a person as “disabled” is not clearly outlined. The assessment may hence utilise the results of the activity/performance assessment to assess if the person may qualify to be recognised as “disabled”.The strategy of this questionnaire is to assess for known/recognised disability (indirectly through the grant question) and for HBC directly by asking about HBC. The HBC question though is conditional on reduced performance/activity. If the person does not receive HBC but otherwise meets the criteria that should prompt HBC) the CHW should refer him/her to social/HBC services. Social services will then assess the need for HBC and/or disability. This strategy circumvents directly asking about disability (unclear definition/how to proof?), assessing for it (unclear criteria??) as well as the problem of raising (false/unrealistic) expectations in the WBOT programme.This said, CHWs should be well trained in HBC and Disability. FLAG If not receiving HBC: may need HBC healthRational:“Oral health is essential to general health and quality of life. It is a state of being free from mouth and facial pain, oral and throat cancer, oral infection and sores, periodontal (gum) disease, tooth decay, tooth loss, and other diseases and disorders that limit an individual’s capacity in biting, chewing, smiling, speaking, and psychosocial wellbeing.” (WHO, 2012).There are many documents about the OH in SA which show that there is aneed for urgent action.The most suitable tool for oral health is the 9-item Keyser-Jones BOHSE screening tool (applied also in a modified version as 8-item OHAT oral health assessment tool). The BOHSE tool has been validated and proven to provide reliable results (e.g. elderly population). It includes an assessment of the (natural) teeth, dentures, gums and dental pain as well as an assessment of the lips, tongue, buccal/palatinal mucosa (oral cavity), saliva and oral cleanliness.It is proposed that the HSA focuses on the 4 most relevant questions as these can be assessed without physical examination. The remaining 4/5 questions can be asked as one general question.Further it is proposed that a question about the burden of oral disease on society not be included. (e.g. In the past 4 weeks of work (consider school times only) how many days did you stay away from work because of toothache or problems with the mouth? A: [enter number between 00 and 20].) As much as such aquestion is useful from a public health perspective it is regarded as not relevant for this screening tool. Q: How often do you brush your teeth using a toothbrush and a toothpasteA: At least two times per day, One time per day, Less than one time per day, DK, RThe NdoH CHW 10 day training manual suggests that saltwater or bicarbonate of soda is used to rub teeth if a person cannot afford a toothbrush or toothpaste. This is a valid recommendation. However just as important, CHWs should encourage individuals to reduce or even stop drinking sweetened drinks (except if sweetened with non-natural sweetener). Education for CHW! Singh, 2010, SA J Epidemiological InfectionThema, 2013, PHCFMNDOH, 2005, South African National oral Health StrategyVan Wyk, 2004, Int Dental JournalTaub, 2012, College of NursingKeyser-Jones, 1995, Special Care in Dentistry, 19(2), 64-71Q [1]: Do you have a toothache or do your teeth ache when chewing/eating/drinkingA: Yes, No, DK, R Q [2]: Do you have any rotten or broken (natural) teeth?A: NA (I do not have any natural teeth anymore), Yes, No, DK, , RQ [3]: Do you have any problems with your gums (e.g. swelling, bleeding, wounds, redness/soreness)A: Yes, No, DK, RQ [4]: If you have dentures, do you have any problems with your dentures (e.g. broken, partially broken, discomfort)A: NA (I do not have dentures), Yes, No, DK, , RQ [5]: Do you have any other problems with your mouth (e.g. lips, tongue, the skin inside your mouth, taste, saliva etc.)A; Yes, No, DK, RFLAG If any of the last 5 screening questions is answered with yes or DK: Dental problem Chronic non-communicable diseasesComment:In principle, the strategy is threefold.Diseases screening: to identify people who already know that they have the disease in order to support their treatment (secondary prophylaxis)Diagnostic screening: to identify people who have the disease but do not know about it (early diagnosis, secondary prevention) Risk assessment. Identify people who are at risk of developing the disease (primary (prophylaxis)Not all three principles are equally suitable for the diseases and it is eventually to decide what may work (evidence, reasonable) and what may be cost efficient (resources). However, the disease screening is obligatory.ItemComment/RationalReferenceArterial HypertensionDisease screeningQ: Have you been diagnosed with high blood pressure?A: Yes, No, DK, R[entry to chronic care module]If Yes:Q: Are you taking treatment for high blood pressure? A: Yes, No, DK, RMeasuring BPC: Please measure the person’s BPA: [enter systolic/diastolic value], unclear, skip, refused, DKIf skip or refused continue next questionIf BP measured, skip next question and continue with Diabetes screeningDefinition:High: systolic ≥140, diastolic ≥90Normal systolic <140, diastolic <90Q: Have you had your BP measured in the past year A: Yes – BP was normal, Yes – BP was high, No, DK, RIf Yes – BP was high, No, DK:[Check BP and, if necessary refer and schedule f/up][Referral prompt]If Yes – BP was normal:[Remember to use opportunities to check BP at least once in two years] The US guidelines recommend measuring BP every 2 years abover 18 yearsFLAGS:Diabetes mellitusDisease screeningQ: Have you been diagnosed with Diabetes mellitus?A: Yes, No, DK, R[entry to chronic care module]FLAG: if Diabetes mellitus: Diabetes mellitusIf Yes: Q: Are you taking treatment for Diabetes mellitus?A: Yes, No, DK, RQuestions regarding the management of diabetes are addressed in the follow-up module. Q: I am now going to ask you a few questions to find out if you could have diabetes mellitus. [[1] S : Age – system generated, demographicsA: <45 (0), 45-54 (2), 55-64 (3), >64 (4)]Diabetes risk assessmentRationale:Generally, the aim of the assessment is 2-fold, firstly to reduce the risk factors for D.m. and to prevent or delay the onset of D.m. (primary prevention), and secondly to identify undiagnosed patients early before the onset of irreversible damage (secondary prevention – go for further D.m. diagnostic). The evidence base regarding efficacy and efficiency of community based screening for undiagnosed (asymptomatic) Diabetes mellitus is moderate to poor. Depending on the screening system PPV of about 10% are achieved if a person is identified as “at risk”. That means that about 90% of individuals are unnecessarily screened for diabetes.There is extensive literature on screening tools for D.m. (reviewed in: Nobel, BMJ, 2011). The FIN Score is the most promising tool that does not include invasive measures. It however requires a brief nutritional assessment (an argument for nutritional assessment?) and (categorical) waist measurement (can relatively easy be done with a colour coded string).It is estimates that 3% in the population have diagnosed D.m. and another 3% are undiagnosed. That would mean for a population of 10,000 that about 300 people have undiagnosed diabetes. The sensitivity/specificity of the FIN score is about 0.8/0.75, that would mean that about 225 - 240 could potentially be found, but about 2025 – 2160 would be screened unnecessarily.Even if it is not ideal, the sensitivity is pretty encouraging.[[2] S: Body mass – system generated, general healthA: normal weight (0), overweight (1), obese (3)][3] Q: Could you please measure your waist circumference?A: <94/80 (0), 94-102/80-88 (3), >102/>88 (4)Colour coded measureSee concerns about this above[[4] S: physical activity – asked aboveA: Yes (at least 30 min daily) (0), No (2)][5] Q: How often do you eat vegetables and fruits? A: Every day (0), Not every day (1)[[6.1] S If above Q: Are you taking treatment for high blood pressure? was ansered with: yes, skip this question and count the question as 2, otherwise ask:][6.2] Q: Have you ever taken medication for high blood pressure?A: Yes (2), No (0)][7] Q: Have you ever been found to have high blood glucose (e.g. during an illness, pregnancy etc.)?A: Yes (5), No (0)[8] Q: Has anyone in your immediate family been diagnosed with diabetes (type 1 or type 2)?A: Yes - parent, sibling, own child (5), Yes – grandparent, aunt/uncle, cousin (3), No (0)[System calculates sore]The FIN score recommends routine screening intervals of 3 years. Individuals with risk factors but ruled out Dm may be screened more frequently. SEMDSA guidelines for frequency of screening are every 3 years if screen normal but to consider annual screening in those with multiple RF’s or IGT. We actually should have the opportunity to repeat screening every 1-2 years because of the assessment cycles in COPC/WBOT. Any who is found to have risk factors is supposed to go for either FPG/OGT or both to the clinic. POC testing or testing at the health post are welcome options, if they become available. We should seriously consider doing FPG or A1C for diagnosis. Unless we want to do a two- step approach: fingerstick at health post followed by FPG. If Bob’s current study evaluating POC A1C is shown to be cost-effective, that could be considered.If risk score is >12 ORIf BMI >25 ORIf age >45Glucose measurementQ: When last did you eat or drink (not water)?A: within the last 2 hours, between 2 and 8 hoursago, more than 8 hours ago, DK C: Please measure blood glucose (finger pricktest)A: [enter value] mg/dL, [enter value] mmol/L, refused, skip, DKFLAG as following depending on Glucose testing:mg/dlmmol/L<2 hours2-8 hours>8 hours and DK<100<5.6[don’t flag][don’t flag][don’t flag]>100>5.6[don’t flag][don’t flag]elevated Glucose >125>6.9[don’t flag]elevated Glucose high glucose suggestive of Diabetes>140>7.8elevated Glucose high glucose suggestive of Diabeteshigh glucose suggestive of Diabetes>200>11high glucose suggestive of Diabeteshigh glucose suggestive of Diabeteshigh glucose suggestive of Diabetes(Possible in future:HbA1c measurementC: Please measure HbA1c (finger pricktest)A: [enter value] mg/dL, [enter value]mmol/L, refused, skip, DK)FLAG if score >12 and NO HbA1c testing was done: Possible diabetes FLAG if HbA1c ≥6.5%: Possible daibetesCoronary heart disease (CHD)Disease screeningQ: Have you ever had a heart attack or been diagnosed with coronary heart disease?A: Yes, No, DK, R[entry to chronic care module]FLAG if yes: Coronary heart diseaseQ: Are you taking treatment for coronary heart disease?A: Yes, No, DK, RDiagnostic screeningIf >= 40 yearsQ: In the past 12 months have you had any of the following?A: SymptomYNDRSqueezing chest pain, especially on activityooooChest pain radiating into the arm(s), jaws, stomach or backooooDiagnostic screening is useful for two reasons. It sensitises the person to the symptoms of heart attacks and coronary heart disease (health promotion). It also is a condiiton with a long enough lead time to make screening useful for early discovery and preventative action.FLAG if one is Yes: Symptoms of coronary heart diseaseCHD risk assessmentIf >=40 years of ageS: Based on the information you have given us so far, your risk to suffer from a heart attack in the coming year is low (<10%) /moderate (10-20%)/ high (>20%)/ unknown[system calculates the rsik score based on Diabetes status, Gender, Age, BMI/Stunckard and systolic BP - source document see below] We have discussed the CDIA risk score that requires a BP but would otherwise enable you to detect those at high risk who should be targeted further. The intervention would be based on the person’s total risk rather than individual components such as BP (only, smoking only etc.). Could one use this as the level 3 screen:DiagnosedSymptoms of the disease / undiagnosed diseaseCVD risk score to target health promotion( It might not be necessary to do this for people with DM already or diagnosed here because their risk will be high)Diabetes? Yes => high riskDiabetes? No => assess risk score based on the following criteria:BP (only if measured, otherwise risk score not computable)Age (see picture)Gender (see picture)BMI (attribute Stunckard according to BMI):<20: Stunckard 1, 2, 3>=20 <25: Stuckard 4, 5>=25 <30: Stunckard 6, 7>=30: Stuckard 8 and aboveSource: National Dept. of Health - PC[Primary care ]101 Guideline v2 2013Non-Diabetic Man, Non SmokerNon-Diabetic Man, SmokerNon-Diabetic Woman, Non SmokerNon-Diabetic Woman, SmokerPeripheral arterial vascular disease (pAVK)If >=40 years of age:Q: Have you bee diagnosed with a disorder of the arterial blood circulation of your legs?A: Yes, No, DK FLAF if yes: Periheral arterial vascular diseaseTeaching: Distringuish from diseases of the veins (deep vein thrombosis, varicosis)If >=40 years of ageQ: In the past 12 months have you had any of the following symptoms?SymptomYNDRSqueezing/Cramping lower leg pain when walkingooooFLAG if above question NO and YES to this question: Symptoms of peripheral arterial vascular diseaseCerebro-vascular disease (CVD)Disease screeningIf >=40 yearsQ: Have you ever had a stroke?A: Yes, No, DK, R[entry to chronic care module]FLAG if Yes: History of StrokeProvide Definition of STROKE, TIA and PRINDDiagnostic screeningIf >=40 yearsQ: In the past 12 months have you had any of the following symtoms, even if only for some time?A: (please tick what applies]SymptomYNDRAn uneven or dropped face, or an inability to move your face or numbness of your faceooooWeakness in an arm or legooooDifficulty in speakingooooSudden trouble with eye sightooooSudden confusionooooFLAG if any Yes: Warning symptoms for StrokeReasoning - See CHD Chronic lung diseaseDisease screening Q: Have you been diagnosed with a chronic lung disease (e.g. COPD, Asthma, Emphysema)?A: Yes, No, DK, R[entry to chronic care module]Prevention of complications (relapse/exacerbation, infections), i.e. the patient should take his/her medication and adhere to a healthy life style (e.g. quit smoking etc.)FLAG if Yes: Chronic lung diseaseIf Yes: Q: Are you taking treatment for chronic lung disease?A: Yes, No, DK, RThe conflation of asthma with all chronic ling diseases is a problem i.e. blurring of COPD, asthma and postTB damage. It is however more to identify those with chronic lung disease in an unspecified way. Diagnostic screeningIf question about chronic lung disease was answered with No:Q: In the past 12 months have you had any of the following, even if only for some time?A: (please tick what applies]SymptomYNDRTight chest, especially when exercisingooooShortness of breath when excercisingooooNoisy breathing/wheezingooooA typical symptom is cough. However, chronic lung disease is an exclusion diagnosis (after having ruled out TB), that’s why chronic cough is considered as TB until ruled out. That’s why we don’t ask for chronic cough here. Patients with cough are send to the clinic with the suggestion of TB, and will be diagnosed with chronic lung disease byu the clinic/doctor. FLAG if any YES: Symptoms of chronic lung diseaseEpilepsy/cerebral fitsDisease screeningQ: Have you been diagnosed with epilepsy?A: Yes, No, DK, R[entry to chronic care module] If Yes: Q: Are you taking treatment for epilepsy?A: Yes, No, DK, RFLAG if NO: Epilepsy/cereral fits not on treatmentPrevention of relapseDiagnostic screeningIf Not been diagnosed with epilepsy/cerebral fit:Q: In the past year, have you ever had an epileptic fit (the whole body involuntarily shaking)?A: Yes, No, DK, RIf Yes:Assess if patient needs further diagnosticsRationale:Workup of fits/diagnosis and treatment of epilepsyFLAG if YES: Symptoms of cerebral fitChronic Joint diseaseAny ageQ: Have you been diagnosed with chronic joint disease?A: Yes, No, R, DKTeaching: Rheumatoid arthritis, Osteoarthritis, ArthrosisIf Yes:Q: Are you taking treatment for chronic joint disease?A: Yes, No, DK, RChronic painAny ageQ: Do you have ongoing pain in your body for more than 3 months? A: Yes, No, R, DKFLAG if Yes: Chronic PainIf yes: Q: In which part(s) of your body do you have ongoing pain for more than 3 months (multiple choice)oHeadoBackoupper limb joints (shoulder, elbow, wrist, hand)olowere limb Joints (hip, knee, ankle, foot)oChestoUpper abdomenoLower abdomen/genitalsoOtherSleeping problemsNot at allSeveral daysMore than half the daysNearly every day3Q: Do you have problems falling or staying asleep?0123This question is used in a slightly modified bersion in the Depression screening tool. Do avoid duplication we will use this question so that it can be used for the Depression screening as well.Mental healthAspects covered:DepressionDementiaDepression - as primarily psychiatric diseases. The screening tool may help to identify psychiatric diseases (screening). Depression is a common condition/disease that may become life threatening (suicide). Often there are psychological and social barriers to health seeking and addressing depression (or mental illness in general). If a person is identified as likely to be depressed he or she should be referred for a full clinical assessment – ultimately assessing the need for treatment of the disorder (depression/bipolar disorder etc.). The available tool(s) (PHQ-2/-9) are able to accurately identify depression. The PHQ is a very widely used tool for depression screening / monitoring. It is actually more useful to monitor the severity of symptoms over time, but is acceptable as a screening tool.? Dementia – as a primarily neurological disease. - has to be screened in relation to performance screening (functionality), which also covers mental capability. Although there is an argument for separate dementia screening, as people with mental disturbances (including dementia) should have been identified already, early forms of dementia must not necessarily be overtly disabling. The Cognitive Screen questions were limited to people >=50 years, because this screen is specifically for Alzheimer's dementia and that leaves a window to pick up early onset cases. The other causes for dementia in younger individuals (e.g. HIV and head injuries), will probably not be picked up by these questions, because of the different clinical presentation. ?The reference article can be found at:? ItemComment/RationalReferenceDepression screening (PHQ-2/-9 tool)Q: Over the last month, how often have you been bothered by any of the following problems?Not at allSeveral daysMore than half the daysNearly every day1Little interest or pleasure in doing things01232Feeling down, depressed or hopeless0123If score of the first 2 questions is 3 or more continue:Not at allSeveral daysMore than half the daysNearly every day3Trouble falling or staying asleep, or Sleeping too much*01234Feeling tired or having little energy01235Poor appetite or overeating01236Feeling bad about yourself – or that you are a failure or have let yourself or your family down01237Trouble concentrating on things, such as reading, or watching TV or listening to the radio01238Moving or speaking so slowly that other people could have noticed. Or the opposite – being so fidgety or restless that you have been moving a lot more than usual01239Thoughts that you would be better off dead, or of hurting yourself01*23Evaluation:If 2-4 shaded boxes (Q1 – Q9) ticked: consider depressive disorderIf ≥ 5 shaded boxes (Q1 – Q9) ticked: consider major depression* Consider answer to sleeping problem question above and count the higher score of either of the two questions.FLAG if 2-4: Possible depressionFLAG if >=5: Probable major depressionOptional:If 10If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other peopleNo difficult at allSomewhat difficultVery difficultExtremely difficultDiagnostic for depression is that it has caused functional impairment (Q10)Dementia/Cognitive disorder (CSI-D)If age >=50 yearsQ: Do you have difficulty remembering or concentrating?A: No difficulty, Some difficulty, A lot difficulty, Unable to remember or concentrateThis question is a screening for dementia/cognitive disordes in people 50 years and older. If the question is answered with “some difficulty” or higher, an informant based 4-item questionnaire should follow.The ability to identify cogntive symptoms through informant-based information may provide some clinical utility in accurately identifying individuals at risk for developing Major Neurocognitive Disorder (Alzheimer’s Dementia).Just 4 questions may help to distinguish between normal age-related memory loss and those at risk for developing Alzheimer’s disease. Items pertaining to repetition of statements, orientation, ability to manage finances and visuospatial disorientation has high discriminatory power.This screen should be done for any individual >=50 years of age with subjective / objective reported memory problems. When ≥3 questions are answered ‘Yes”, referral for further investigation is required.Prince, 2010, Int J Geriatric PsychiatryIf “Some difficulty” or more:C: The following four questions should be answered by a member of this household who knows the person well. Is a member of this household available?A: Yes, NoIf No: skip the following four questionsIf Yes:4-item Cognitive Screen (informant reported)[1] Q to household member: The person indicated that he/she has difficulty remembering or concentrating. Does the person repeat questions or statements or stories in the same day?A: Yes, NoMalek-Ahmadi M, Infromant-reported cognitive symptoms that predict amnestic mild cognitve impairmnet, 2012, BMC Geriatrics[2] Q to household member: Does the person frequently have trouble knowing the day, date, month, year and time or does the person need to reference a newspaper or calender for the date more than once a day?A: Yes, No[3] Q to household member: Excluding physical limitations (e.g. tremor / weakness) does the person have trouble paying bills, doing finances, doing shopping or similar daily activities that he/she could previously perform independently?A; Yes, No[4] Q to household member: Does the person have a decreased sense of direction (e.g. gets lost in the home / local area)?A: Yes, NoFLAG if 3 or more Yes answers in the 4 item cognitive screening score: Probable cognitive disorderOther chronic conditionsAll agesQ: Have you been diagnosed with any other chronic condition that requires you to regularly take medicine or to regularly go for follow-ups (*exclude: arterial hypertension, Diabetes mellitus, coronary heart disease/heart attack, cerebrovascular disease/stroke, peripheral arteriovascular disease, chronic lung disease/asthma, epilepsia, joint disease, dementia, depression, HIV, TB, cancer). A: Yes, No, DK, RIf Yes:Q: Please provide details:A: [freetext]This question is asked to identify people who require adherence support for any (other) chronic condition.FALG if Yes: Chronic condition, otherHealth status assessment – Categories of TB patientsCourseAsymptomaticOnset/ SuspectFor diagnosisDiagnosedTreatmentFollow-upPast TBAlternativeScenarioABCDEFXGDescriptionNo symptomsSymptomsTestingDiagnosed with TB but not yet startedOn treatmentCompleted TB treatment past 12 monthsHistory of TBComplete TB treatment > 12 monthsTB symptoms but TB ruled outCategories...if no sympt.A (Definition)(B [Definition])(C [Definition])(D [Definition])E (Definition)F (Definition)A (Definition)=> A**if symptoms=> BB (Definition)C (Definition)D (Definition)E (Definition)= > B*=> BG (Definition) => B* primary symptomatic, i.e. already having symptoms at the time treatment ends (but not considered as failure), will immediately become B again and processed as such, secondary symptomatic patients, i.e. patients who become symptomatic during the 12 months post treatment after having been asymptomatic at the end of the treatment also will become B and processed as such** a patient stays G for up to one year. If he becomes asymptomatic before he will be re-categorised as A. If he continues to have symptoms for more than a year he requires to be re-assed as BItemComment/RationalReferenceQ: Are you currently taking TB treatment?A: Yes, No, DK, RFLAG if yes: On TB treatment[E]If Yes:Q: Could you please show me your green card?A: GC available, GC not available, DK, R Q: When did you start taking your current TB treatment?A: [enter date][System offers treatment documentation module]TB treatment documentationQ: Please provide details on the TB treatment... [see TB follow-up module]Q: Have you ever take TB treatment for more than one month before?A: Yes, No, DK, RDefinition: Taken TB treatment for more than 1 monthIf Yes:[System offers TB history doumentation module][End of TB assessment - System classifies patient as TBEx][Entry to TB f/up module]TB history documentationQ: Please provide details on previous TB treatmentA: [table] TB course start dateTB course stop dateDiagnostic categoryTreatment outcome[dd/mm/yyyy][dd/mm/yyyy][drop down][drop down]...Example:TB course start dateTB course stop dateDiagnostic categoryTreatment outcomedd/05/2010dd/11/2010pTBcompleteddd/mm/1999dd/mm/1999pTBcompletedIf No:[End of TB assessment – System classifies patient as TBEo][Entry to TB f/up module]If No (to Q: Are you currently taking TB treatment?)Q: Did you ever take TB treatment before?A: Yes, No, DK, RIf Yes[system offers TB history documentation module][see above]If Yes and TB history documentation not yet done:Q: Did you take TB treatment in the past 12 months? A: Yes, No, DK, R Q: Have you been told that you currently have TB?A: Yes, No, DK, RFLAG if Yes: Diagnosed with TB bt not on treatment[D]If Yes:Q: When were you told that you currently have TB?A: [enter date manually][End of module – System classifies patient as Do/x][Entry to TB f/up module]If No (to Q: Have you been told that you currently have TB?)Q: Do you have any of the following:YNDRCough for more than 2 weeksooooNight sweatsooooWeight lossooooLoss of appetiteooooFever/chillsooooIf No to all and No treatment in the past 12 months (taken from above):[End of module – System classifies patient as Ao/x]If No to all but (Yes) to treatment in the past 12 months (taken from above):[System offers TB treatment documentation module][see above][End of module – System classifies patient as Fo/x][Entry to TB f/up module]If Yes in any of the symptom question:[system offers symptom documentation module, displaying a list/table of present symptoms to enter date of onset or duration]TB symptom documentationQ: Please provide details on the onset of TB symptoms A: [table]Symptom [system]Duration in weeksDate of Onset[Cough]xxxdd/mm/yyyy[Loss of weight]xxxdd/mm/yyyy[Neightsweats]xxxdd/mm/yyyy...Traditional HealerQ: Have you been to a traditional healer for these symptoms?Yes, No, DK, RQ: Did you have tests done at a clinic to check you for TB?Yes, No, DK, RIf No:[Refer person to clinic for testing] [End of module – System classifies patient as Bo/x][Entry to TB f/up module]FLAG if any TB symptom and if not been checked: TB symptoms, no TB tests done yet[B]If Yes:Q: What was the outcome of the tests? A: Still waiting for the results, The results were inconclusive, I was told that I do not have TB, DK, R [system offers test documentation module]TB testing documentationQ: Please provide details on the TB testsA: [table]TestDate(sample was taken)Outcome[drop down]dd/mm/yyyy[drop down]...Tests: Sputum unspecificed, Sputum smear, Sputum culture, Sputum GenXpert, Other, DK,Outcome: TB positive, TB negative, Result pending, DK, R[only ask to people who went for testing]Q: Who realised you could have TB and made you to test for TB?A: Myself, my family, a friend/colleague, a CHW, a health professional in a clinic, Other, DK, R If: I was told that I do not have TB[End of module – System classifies patient as Go/x]If: (other options)[End of module – System classifies patient as Co/x][Entry to TB f/up module]Tests prior to treatment only. There are also tests done while the person is on treatment – these are recorded elsewhere (TB treatment documentation)FLAG if TB symptoms Yes and according to outcome:TB symptoms, awaiting test result [C]TB symptoms, inconclusive results [C]TB symptoms, TB excluded [G]Reproductive HealthSexual activity & condom useFamily planning/fertility intentionSTI/chronic genital problemRationale:Promotion of family planning/assess for contraceptionIdentify pregnant women or fertility intentionPromotion of safe sex for the prevention of sexually transmitted diseases Identify people with genital infections/diseases Family planningAttitude to fertility regulationQ: Some people say: “If a man and a woman have sex, it is the woman who must make sure she doesn’t get pregnant unintentionally.” Please say how strongly you agree or disagree with this statementA: Strongly agree, mostly agree, mostly disagree, strongly disagree The question provides an insight into an individual’s understanding of where gender responsibility for fertility regulation lies. It helps inform primary care strategies around safe sex and fertility regulation.Promoting shared responsibility!Sexual activityQ: In the last 12 months, have you had sex?A: Yes, No, DK, RIdentify people who are currently sexually active. Relevant for following questions, which should only be asked to people who are sexually activeDefinition of “sex”: penetrating vaginal, anal or oral sexIf No (not sexually active)Pregnancy and birth history [women only]Q: How many times have you been pregnant?A: [type in number], DK, R [women only]Q: How many children have you given birth to? A: [type in number], DK, RWHO refers to childbearing age as the age between 15 to 49... cont. STIIf Yes (sexually active)Q: Do you and your partner use any method of contraception (e.g. condoms, “the pill”, intrauterine contraception device, hormone injections etc.)A: Yes, No, DK, RThe question is asked to men and womenIf YES (using contraception) - Track AIf Yes, DK:Q: Which method(s) do you currently use for contraception?MethodYNDRThe loop (Intrauterine contraceptive device [IUCD])ooooThe pill (hormone tablets)ooooThe injection (hormone depot)ooooMale condomooooFemale condomooooMale sterilisation (vasectomy)ooooFemale sterilisation (tubal ligation)ooooVaginal spermicidesooooOtherooooMultiple choice questionEmergency contraception. Q: Have you heard about the “morning after pill”?A: Yes, I’m not sure, No, DK, RIn an opportunistic screening approach it is difficult to screen for the actual need for emergency contraception. We have chosen to approach the challenge through a knowledge question, targeting women’s awarness of the existence of “emergency contraception”/”morning after pill”Pregnancy[women only]Q: Are you currently pregnant?A: Yes, No, DK, RIF YES (If currently pregnant) - Track A1ANC attendanceQ: Have you been to the antenatal care (ANC) clinic for this pregnancy?A: Yes, No, DK, RIf No, DK, R:The CHW/team leader should refer the women for ANC [referral prompt opens]If Yes:Presence of Maternal Clinic Record/ANC cardQ: Please request the maternal clinic record/ANC card A: Present, Not present, DK, RExpected Date of DeliveryQ: What is the due date (expected date of delivery)?A: [type date], DK, RIf unknown (e.g. if the woman has not yet been to the clinic):Q: When was the first day of your last period (FDLMP)?A: [type date], DK, R[system shows something like:“Given that your first day of you last menstrual period was [date], you are in the [...]th week of your pregnancy. The estimated expected date of delivery is [date]. Please note that this information is an estimation and needs to be confirmed by your ANC”[Naegele’s rule: 280 days after FDLMP][Age of pregnancy: (Integer(date today - FDLMP)/7)+1)Intention of pregnancy (retrospective)Q: Did you want to become pregnant now? A: Yes, No, DK, RIf YES (want to become pregnant) - Track A1APregnancy and birth history [women only]Q: How many times have you been pregnant (if currently pregnant only count previous pregnancies)?A: [type in number], DK, RIf the woman is currently pregnant, only count the previous pregnancies.Example: A pregnant women has been three times pregnant before this pregnancy. The answere to this question “How many times have you been pregnant?” would then be 3. Pregnancy complications[women only, only if above answer is >=1)Q: Have you had any complications in any previous pregnancies?A: Yes, No, DK, RIf Yes:C: Please document what complication(s) the women reported[Freetext][women only]Q: How many children have you given birth to? A: [type in number], DK, RWHO refers to childbearing age as the age between 15 to 49If NO (no intention to become pregnant) - Track A1BIntention to TOPQ: Do you plan to keep this baby?A: Yes, No, DK, RIf No, DK, R:[Refer the women for TOP][Referral prompt]If Yes:[System labels woman as “pregnant”/ANC][Entry to the pregnancy follow-up module] If Yes (to Q: Did you want to become pregnant now?)[System labels woman as “pregnant”/ANC][Entry to the pregnancy follow-up module] TOP is allowed until a gestational age of 13 weeks. The TOP Act (1996) allows TOP after the 20th week of gestation, under certain conditions. We therefore have decided against asking this question conditional on gestational age. May the gynaecologist/ obstetrician decide upon the (legal) options available in case the pregnancy is older than 13 weeks.Cont. With Pregnacy and birth history(see above)If NOT pregnant (NO to: “Are you currently pregnant?” - Track A2Cont. withPregnancy and birth history(see above)If NO to contraception use - Track BPregnancy[women only]Q: Are you currently pregnant?A: Yes, No, DK, RIF YES (If currently pregnant) - Track B1, continue as A1IF NO (not pregnant) - Track B2Intention of pregnancy (prospective)Q: Do you want to become pregnant now?A: Yes, No, DK,RIf YES (want to become pregnant) - Track B2ACont. withPregnancy and birth history(see above)If age ≥25Q: For how long have you tried to become pregnant?A: <12 months, ≥12 months, DK, RIf ≥12 months:[Consider referral to GP/gynaecologist for fertility assessment][Referral prompt]IF NOT want to become pregnant - Track B2BIf No:Q: Why are you not using any contraceptionA: [table]oI do not know whether I can use contraception (knowledge)oI do not really think about contraception (indifference)oI do not expect to have sex (expectation)oI think I cannot get pregnant (misconception)oMy partner does not want me/us to use any contraception (power)oMy parents/family do/does not want me to use any contraception (power) oMy beliefs do not allow the use of contraception (culture) oI am worried about the side effects e.g. weight gain etc. (fear)oI could not get contraception at the clinic/doctoroOtherEmergency contraception. Q: Have you heard about the “morning after pill”?A: Yes, I’m not sure, No, DK, RIn an opportunistic screening approach it is difficult to screen for the actual need for emergency contraception. We have chosen to approach the challenge through a knowledge question, targeting women’s awarness of the existence of “emergency contraception”/”morning after pill”Cont. withPregnancy and birth history(see above)Sexual transmitted diseasesCondom use[sexually active only]Q: When you last had sex, did you use a condom?A: Yes, No, DK, RDefinition of (correct) condom use: using a condom throughout the entire sexual intercourseBear in mind that this is an epidemiological question which does not allow conclusions on the (regular?) individual use of condoms. It’s just an epidemiological measure for how frequent condoms are used in a population.CHW should remind the regular and correct use of condoms in any case of answer.If No: Q: Why did you not use a condom?A: [table]oI/we did not know we should have used a condom (knowledge/misconception)oI/we did not know how to put a condom on (knowledge)oI/we did not have or could not get a condom (expectation/preparedness)oMy partner did not want to use a condom (power)oCondoms are uncomfortableoCondoms put me/us out of moodocondoms make sex less enjoyableoMy partner and I love and trust each otheroI/my partner am/are allergic to latexoI/my partner want/s to get pregnantoOtherSTI screening[all]Q: Do you currently have any itch, discharge, ulcers, wounds, lower abdominal pain or pain in your genital area?Y: Yes, No, DK, RIf Yes:Q: Have you been to the clinic/doctor for the problem(s)? A: Yes, No, DK, RQ: Have you been to a traditional healer for the problem(s)A: Yes, No, DK, R[Documentation prompt opens]C: Please document what you were told[Freetext]The CHW should consider reportingWhat problem was reportedHow long does the problem exist or when last did the problem occurHow severe is the problem is (mild, moderate, severe)What action(s) has the person taken so far (treatment?“Men’s health”[Men only]Q: Do you have any of the following?SymptomYNDRErection difficultyooooLumps in your testiclesooooFrequent need to pass urineooooDifficulty controlling the start/stoop of urine flowooooSlow urine stream or dribbling at the endooooBlood with urine or semenooooA men’s health question is included to screen for erectile and urological symptoms. Responses can support primary prevention early detection and treatment of sexual, cardiovascular , urinary and reproductive health in men. [refer if any is answered with yes]If Yes:Q: Have you been to the clinic/doctor for the problem(s)? A: Yes, No, DK, RQ: Have you been to a traditional healer for the problem(s)A: Yes, No, DK, R[Documentation prompt opens]C: Please document what you were told[Freetext]Circumcision[Men only]Q: Circumcision is one among several measures to reduce the risk of transmission of sexually transmitted infections (STI) and HIV. Are you circumcised?A: Yes - I am medically circumcised, Yes – I am traditionally circumcised, No – no intention to circumcise, No – but intention to medically circumcise, No - but intention to traditionally circumcise, DK, RThe government is promoting medical circumcision of men. Promote circumcision, assess prevalence of circumcision, suggest f/up for those with intention PLEASE NOTE that traditional circumcision does not always remove the entire foreskin. Therefore, men who have been traditionally circumcised can still be candidates for medical circumcision! HIV In HIV it is about the individual and public health. The aim is to prevent new infections and to prevent people who are HIV positive from delayed treatment. CHW should strive to towards the following aims:Annual HCTPrompt assessment of immune status/indication for ART in HIV positive peoplePrompt ART initiationPrompt assessment of pregnancy/breastfeeding status in HIV positive peoplePrompt PMTCT initiationCategorize people according to the following criteriaTest status (tested, not tested …)HIV status (positive, negative …)ART status (on, not on …)Immune status (CD4 counts …)In women: pregnancy/breastfeeding status PMTCT status (on, not on …)This allows to determine:Indication to testIndication to ARTIndication to PMTCTHIV (men)HIV womenItemComment/RationalReferenceHIVQ: Have you ever have an HIV test?A: Yes, No, DK, RGating question and promotion of HCTIf Yes:Q: What was the most recent text result)?A: HIV positive, HIV negative, DK, R[System labels person as HIV positive]If HIV positive:Q: Are you taking ART?A: Yes, No, DK, RIf Yes: [Entry to the HIV/ART module]If No:Q: When last did you check your CD4 count?A: [enter date], never, DK, RQ: What was the outcome of the CD4 test?A: [enter value], DK, R[Entry to HIV/ART module][Refer if necessary {see algorithm}][Referral prompt]If HIV negative:Q: When did you do the test?A: [enter date][Refer if necessary {see algorithm}][Referral prompt]Further constellations, including DK or R answers, see algorithm belowAssessing PMTCTS: Is the woman currently pregnant?A: Yes, No, DK, RIf Yes:Skip next question on breastfeeding and continue with PMTCT questionIf pregnant and If HIV negative and If HIV test older than 3 months:Refer for HCTHIV positive women in childbearing age who are not on ART should be asked if they are pregnant or breastfeeding and if they are taking PMTCT. It should be carefully distinguished whether the woman is taking ARVs because she herself qualifies for ART (=ART) or whether the women takes or should take ARVs because of her child (=PMTCT). In the last case she would not need to take ARVs (because her immune status is still well) if she was not pregnant. Presently (September 2013), ARVs taken for (maternal) PMTCT are most often identical to the ARVs taken for ART (triple combination). This means that generally it is not possible to conclude from the kind of ARVs the woman takes on the indication. This is an important training issue! Pregnancy or breastfeeding HIV negative women should be tested every 3 months while pregnant or breastfeeding.Q: Are you currently breastfeeding?A: Yes, No, DK, RGating question for next questionPMTCTQ: Are you on PMTCT?A: Yes, No, DK, R See algorithm applicable to women belowIf breastfeeding and If HIV negative and If HIV test older than 3 months:Refer for HCT[see algorithm with outcomes]TuberculosisComment:The HSA aims to identify people with/without/suspect for TB according to the following categories:COPC categories (defined upon the action required “what to do”/for community management):Current TB diagnosisPost-treatment (12 months)=> F - f/up outcome & recurrence?On treatment => E - f/up for DOTSPre-treatment=> D - f/up for treatment startTB suspect (symptoms)In care=> C - f/up for resultsPre-care=> B - f/up for diagnostic TB not suspectSymptoms but TB excluded=> G - f/up for persistence of symptomsNo symptoms=> A - no f/upThe TB Modulekicks in once a person is identified as B-G. It is skipped only for category A individuals. Background:Evaluating the impact of COPC provides the evidence of efficacy and efficiency. It is a purpose of our work to show how COPC can be evaluated in terms of its impact at a population level. We propose to use TB to evaluate the impact of COPC. We aim to demonstrate that a significant reduction in the period of de-facto or possible infectiousness can be achieved through COPC. Assessing the management of TB provides us with a unique opportunity to assess (at least some) impact-related aspects of COPC using primary data. This too is novel, as impact is usually assessed using secondary data sources. A key driver of the TB epidemic in SA is the fact that one infected person still infects too many others. This transmission risk is a function of the time between the onset of symptoms and treatment (infectious period). If it could be demonstrated that the period of infectiousness can be significantly reduced through COPC we may expect the epidemic to go down. The ultimate proof of the epidemic coming down is the decrease in the incidence of TB, i.e. the number of new cases diagnosed per annum. The baseline assessment will allow us to estimate the number of new cases for the 12 month period prior to the interview (How many [%] of the people interviewed have been diagnosed with TB in the past 12 months). We may be able to estimate retrospectively, how many people [%] actually had TB (TB suspects with onset of symptoms in the past 12 months who turned out to have TB).The incidence based on newly diagnosed cases can be expected to increase during the first year and only then start to decrease. This is because the aim is to screen everyonel during the first year and to identify all those with TB. This will inevitably result in an increase in TB diagnosisin the first year. If there is no “backlog” of longstanding (still undiagnosed) cases from the first year, then from year 2 onwards the number of cases with new onset of symptoms and the number of newly diagnosed TB should parallel again and progressively decrease if COPC is practised consequently. Each TB case as well as each TB suspect case should be characterised by a set of items characterising the course (biology) and the management (health system response). This is outlined in more detail in the TB follow-up module (separate paper)IntroductionHealth Status AssessmentFollow-up moduleInformation FileResearchPurposeidentify TB suspects/patientsCategorise for ease of operational procedures into:Non suspectSuspect (symptoms)For diagnosisTB not on treatmentOn treatmentFollow-upSymptomatic no TBHistory of TBA person may be characterised as: Non suspect with TB historyFor diagnosis with no TB historyOn treatment with no TB historyPurposeF/up on TB suspects/patientsDepending in the HSA category different f/up pathways B, C, D, E, F, G applyThe pathways:Lead the CHWAssure relevant information for community based (clinical) assessment obtainedAssure relevant information for M&E obtainedPurposeCollection of individual info required for community based clinical managementthat can be shared with HCPs etc.required for M&Erequired for researchThe file collects all relevant information that is needed for community based (clinical) management, M&E and research. Research overlaps widely with M&E.As the info becomes available throughout the course, it is collected or fed into an electronic form. PurposeDescription (cross-sectional) of the (local) TB epidemic(s) COPC allows for significant reduction of the time of (possible) infectiosity in TB suspects/patientsCOPC leads to a decrease in the (local) TB epidemic To prove these hypotheses an assessment of the outcome, the timing of the interventions and diagnostic and therapeutic procedures is required. This requires to assess timing of events (onset of symptoms, TB diagnosed/ruled out, treatmnent start etc.) CancerBreast cancerRationale:The incidence is about 15-25/100 000 in SA. If detected early the chances of cure are good. The strategy for breast cancer prevention/early detection is to proactively support breast health literacy and enable prevention and early detection through widespread health team supported self- and clinical breast cancer examinaton (Marcus TS, Lunda S, Fernandez L. Delayed?Breast Cancer Presentation: hospital data should inform proactive primary care. Afr J Prm Health Care Fam Med. 2013;5(1), Art. #503, 7 pages. phcfm.v5i1.503). This approach makes screening is a community activity The knowledge about BSE is moderate and BSE practice is low (Krombein, 2006). COPC can assess for knowledge/practice of BSE in order to promote BSE and clinical exam.There is an expert opinion published following UK recommendations that low risk (no PH or FH) women between 50 and 70 years of age might be the appropriate population of regular mammograms every two to three years. The expert, however, also recognises that this UK strategy has been under scrutiny because of a high number of false positive results and the consequences thereof. High risk women (i.e. personal or family history) may need to go for regular mammograms earlier than the age of 40 (US National Cancer Institute)/(50?). US data suggests that the down staging of breast cancer is strongly lnked to improved breast health literacy especially among older and younger women.Disease screeningQ: Have you ever been diagnosed with breast cancer?A: Yes, No, DK, RIdentification of breast cancer exposed women, and possibly women of high risk Q: I will read some statements. Please say which one best describes your current status?A: I had treatment (operation, radiation, chemotherapy) and do not need to go for follow-up anymore, I had treatment (operation, radiation, chemotherapy) and am still going for follow-ups, I had treatment but did not go for the follow-ups, I am currently under treatment for breast cancer (operation, radiation, chemotherapy), I did not go for treatment, Other, DK, RIdentification if need for referral (for further management/re-assessment), book follow-upQ: In your immediate family has anyone been diagnosed with breast or ovarian cancer?A: Yes, No, DK, RIdentification of high risk/breast cancer exposed individualsIf Yes: - Q: Have you been to a clinic/doctor about your breast health?- A: Yes, No, DK, R [act accordingly, book follow-up]Q: Do you examine your breast for breast cancer once a month?A: Yes, No, DK, RIf No [what did you {CHW} do?]:Provided leaflet/informationDemonstrated BSEScheduled follow-upCervical cancer Rationale:Cancer of the cervix is the second most common cancer in women in SA. Given the long lead time of the pre-cancerous period, cervical cancer is suitable for screening. Screening tools and follow up are available (Pap). The strategy for cervical cancer prevention/early detection is to proactively support cervical cancer literacy and to enable prevention and early detection according to CC screening guidelines. There is still some confusion about the screening intervals and the onset of screening and new technologies and systems are becoming available at community level.. Asat September 2013, according to the SA ARV treatment guidelines women with HIV should be screened every 3 years, onset for screening at diagnosis of HIVFor non-HIV positive women the current guidelines suggest a Pap smear every 10 years, onset for screening 30 years of age Q: Have you been diagnosed with cervix cancer?A; Yes, No, DK, RQ: I will read some statements. Please say which one best describes your current status?A: I had treatment (operation, radiation, chemotherapy) and do not need to go for follow-up anymore, I had treatment (operation, radiation, chemotherapy) and am still going for follow-ups, I had treatment but did not go for the follow-ups, I am currently under treatment for cervix cancer.Identification if need for referral (for further management/re-assessment), book follow-upQ: When next do you need go for a cervical screening test (e.g. Pap smear)?A: I don’t need to go anymore, in 3-10 years, in 1-3 years, within one year, DK, RAdvise: you should go every 3-10 years or if you are HIV positive every year unless advised otherwiseQ: When did you last go for a pap smear or other cervical cancer test?A: Never, >10 years ago, 3-10 years ago, 1-3 years ago, within the last year, DK, RQ: What was the test result/outcome?A: No abnormalities, Abnormalities, DK, R If No abnormalities:[prompt showing what to do according to the rules in the right column]< 30 years of age≥ 30 years of ageHIV neg.HIV pos./unk.HIV neg.HIV pos./unk.Never/>10y ago - educate! – refer! - refer! – refer3-10 y ago - educate! – refer - educate! – refer<3 y - educate - educate - educate - educateDK - educate! - refer! - refer! – referIf Abnormalities/DK and Cervix screening with last year:Q: Do you have an appointment booked at the clinic?A: Yes, No, DK, RIf No:[referral prompt]If Abnormalities/DK and Cervix screening more than 1 year back:[referral prompt]Prostate cancerRationale:Prostate cancer predominantly affects men above 50 years of age. Prostate cancer is slow growing and has little impact on life expectancy amongst men over 75 years of age. Screening should target 50-75 year old, should it be undertaken. However, PSA measurement results in a high proportion of men being unnecessarily treated (radical prostatectomy, radiation etc.) and/or remaining incontinent or impotent. Moreover PSA is not routinely used in the public sector in SA. Recent literature argues for diagnostic screening (i.e. at onset of symptoms. Therefore we will not screen for asymtomatic screening but rather will promote symptomatic screening for (secondary) prevention as part of men’s health (see men’s health question in the sexual health section).ItemComment/RationalReferenceOther cancers conditionsAny ageQ: Have you been diagnosed with any other cancer that requires you to regularly take medicine or to regularly go for treatment or follow-ups (*exclude: cervix cancer, breast cancer). A: Yes, No, DK, RIf Yes:Q: Please provide details:A: [freetext]Physical/sexual assault (P/SA)ItemComment/RationalReferenceWe know that physical and sexual assault is common in South Africa. I would like to ask you some questions Violence (Physical and sexual assault) and Injury are one of the four health epidemics in South Africa. Engaging the issues of physical and sexual assault with individuals through COPC is considered to be important for a number of reasons:To raise awareness of the problem and to create the space for victims to voice their experience The question pro-actively addresses this topic To support Break the vicious cycle. The question also aims to assist people who experienced P/SA in identifying strategies to cope with trauma (if necessary), and to identify people who still experience P/SA in preventing further assault.Assess for the magnitude of the epidemic in the community and over time. Address P/SA at a community levelQ: Have been hurt, beaten, kicked, threatened, or sexually assaulted by anybody in the past year?A: Yes/No/Not applicable/Refuse to answerAddress p/SA at an individual levelIf Yes:[Documentation and action prompt opens]C: Please write down what you are told. In case of a health problem, did you record any of the following?YesNoNAType of assaultoooWhere it happenoooHow long does the problem exist or when last did the problem occuroooIs it still ongoingoooWhat has been done so faroooQ: What did you (CHW) do about it? A: Logged emergency call, Reported the assault, Consulted team leader, Scheduled follow-up visit, Provided advice/health education, No action required[Progress as following]Injury/accidentsQ: In the past year, have you had an injury [not assault!]?YNDRIn your homeooooIn your place of workooooAt school/collegeooooOn the roadooooDuring recreation/ leisure time (sports, partying etc.)ooooIf YES to any:Q: Please provide details: A: [freetext]Injuries/Accidents are one of the four major epidemics in South Africa. The reason for asking about accidents/injury is to understand the frequency and kind of accidents in a specific community (e.g. more home/work/road related?). This may assist in identifying specific hazards in a community and should prompt educational or advocacy campaigns at a community level. Although on an individual level not much can be done once an accident has happened (maybe: claim from RAF?), the information can be used to raise public awareness about community specific hazardsFor training: The definition in the footnote of what is considered an “injury” is insufficient: Suggestion, any injury that required medical intervention (e.g. fractures and suggestions of fractures, sprains/strains that require casts, wounds that need surgical care, concussion) or impacted significantly on functionalityRoad Accident FundIf Yes “On the road”Q: Do you want to make a claim at the RAF?A: Yes, No, DK, R CHW need to know when an application to the RAF may be successful. is entitled to make a claim?The following are entitled to make a claimA person who?sustained a bodily injury in the accident?(except a driver who was the sole cause of the accident);A dependent of a deceased?breadwinner;A close relative of the deceased?who paid for the funeral; andA claimant under the age of 18 years must be assisted by a parent,?legal guardian?or curator?ad litem.FLAG if Yes: Want to claim from RAFIndigent dataComment:The following questions will be asked by social development workers to support the indigent programme they are beyond the scope of CHWs at present. It is proposed that the module be made available on the hand held for use by and in support of the ILP. Applies to people fulfilling the following criteria:Living in a household that is classified as indigent or possibly indigent householdAge: ≥14 yearsItemComment/RationalReferenceRegistrationQ: Do you want to be registered on the Indigent Labour Support Programme of the City of Tshwane? A: Yes, No, DK, RIf Yes:If Yes:[Residency status][system][Category - vulnerability][system][Disability][system/grant receipients][Education/Qualification][system]Skills/ExperienceQ: Please describe your skills and/or work experience?Type of skill/experienceSkills availableAccreditedCurrently usedYesNoYesNoYesNoBoiler MakerooooooBraidingooooooBuilderooooooCabinet MakingooooooCarpenterooooooCashierooooooChefooooooCleanerooooooComputer skillsooooooConstruction WorkerooooooCooking/BakingooooooCounsellingooooooDomestic WorkerooooooDress MakingooooooDriverooooooDriving InstructionooooooElectricianooooooFarm WorkerooooooFitting & TurningooooooGeneral WorkerooooooGranite WorkerooooooHeavy Equipment OperatorooooooLeather worksooooooMechanicooooooMillwrightooooooNurseooooooPainterooooooPetrol AttendantooooooPlastererooooooPlumbingooooooSales PersonooooooSewingooooooSports assistantooooooStock PackerooooooToolmakerooooooTractor operatorooooooUpholsteryooooooWeldingooooooOther: [specify]ooooooDriver’s licenceQ: What driving licence do you have?A: A1 (motor cycle <125ccm), A (motor cycle ≥125ccm), B (motor vehicle < 3500 kg), C1 (motor vehicle ≥ 3?500 kg and <16 000 kg), C (motor vehicle ≥ 16?000 kg), EB (articulated/trailer motor vehicle < 3500 kg), C1 (articulated/trailer motor vehicle ≥ 3?500 kg and <16 000 kg), C (articulated/trailer motor vehicle ≥ 16?000 kg), None, DK, RAvailabilityQ: Please indicate the period when you are avaiable to work?[enter start date, calendar function][enter end date, calendar function]/opne endComment:This information should be used to identify people fulfilling certain criteria. A search function needs to apply here.Managing Health Status AssessmentThe application guides through the assessment and records (in the background) all issues that may require action.Once the HSA is done the application leads to a summary list/table with all the findings that may require actionAs in the HHR, the CHW needs to work through the findings and and actionsThen the CHW needs to schedule a follow-up visitFLAGSCommunication difficulty (hearing, speaking, understanding/mental issues)Health problemSight difficulty - not checkedHearing difficulty - not checkedMay need HBCWants to apply for GrantHistory of accidentUnderweight / Overweight - ready for changeSmoker - ready for changeProbable alcohol abuse - ready for changeDrug use - ready for changeDental problemArterial HypertensionElevated BP (if measured)Check BP (if not measured)Diabetes mellitusProbable Diabetes mellitus (if No Glucose measurement)Elevated Glucose / Highly glucose suggestive for Diabetes mellitus (if Glucose measured; according to outcome)Coronary heart diseaseSymptoms of Coronary heart diseasePeripheral arterial vascular disease (pAVD)Symptoms of perioheral arterial vascular disease (pAVD)History of StrokeWarning symptoms of strokeChronic lung diseaseSymptoms of chronic lung diseaseEpilepsy/cerebral fits on treatmentEpilepsy/cerebral fits not on treatmentSymptoms of Epilepsy/cerebral fitsChronic PainSleeping problem Possible depressionProbable depressionProbable cognitive disorder ................
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