Habib OS, Ajeel NAH, Yacoub AAH. Household surveys as a tool for training medical students in measuring population health. The Iraqi Journal of Community Medicine 2002; 15: 5-8.

1. Household survey as a tool for training
medical students in measuring population health
Omran S Habib (PhD)
Narjis A Ajeel (PhD)
Alim A Yacoub (PhD, MPHM)
Department of Community Medicine, College of Medicine, University of Basrah
ABSTRACT
This paper reports part of the results of a household survey carried out in Al-Jumhorryah
Quarter in Basrah during March-May 2001.
The study aimed at measuring health and health service utilization using epidemiological
population based approach thus providing both staff and medical students with an opportunity to
apply theoretical concepts and methods of community medicine into real practical experiments. A
questionnaire form was filled for 682 households and the data analyzed in the computer unit in the
College of Medicine.
The results indicate a reasonable service utilization by the population which is characterized
by high fertility and mortality rates, crowded houses and low socioeconomic status.
The feedback by the participating students was very encouraging as they were able to
recognize health in its broad social and ecological contexts.
Key Words: Household Survey, Utilization, Student Opinion.
INTRODUCTION
The competence of health care providers to deal with prevailing health problems at population level
depends, in part, on a realistic imagination of these problems, such imagination must be based on
evidence derived from data and intellectual judgment within the context of the ecosocial system and
its constraints.
The solution of health problems needs:
a. Ability to predict changes in the foreseeable future.
b. Ability to plan strategic programmes to deal with these changes.
c. Planning based on problem identification, definition and prioritization.
d. Ability to acquire, compile and use relevant information for planning, management and
evaluation of activities.
e. Ability to mobilize resources both human and non human and use them effectively, efficiently
and adequately from technical and social point of view.
All these abilities, in our view, are constrained by the quality and variety of information available to
decision makers. Doctors are important partners in decision making related to population health.
Also, epidemiology as a basic discipline, is crucial in the generation, analysis and interpretation of
information required for decision making. (1,2,3)

2. 1
With this background in mind, the Department of Community Medicine, Basrah College of
Medicine, adopted an annual programme to strengthen the theoretically taught principles and
methods of epidemiology. The programme encompasses a learner-participatory exercise in which
medical students play an active role in planning, execution and analysis of a household survey
carried out on a defined population.
This paper report some results of the household survey carried out during the spring of 2001.
Setting and methods:
The household survey was carried out in Al Jumhorryia; A densely populated urban quarter in
Basrah city during the period, March – May 2001. This quarter is considered as an intermediate
residential area from socioeconomic point of view.
It is served by two primary health care centres which are located within walking distance from
almost all houses. Almost all other services are available in the area including markets, police and
schools .
The sample consists of a randomly selected clusters of residential blocks covering 30% of
households. The final number of households studied was 682 with 5216 persons. Each household
was visited and a questionnaire form was filled covering sociodemographic and health variables. The
survey was conducted by well instructed fourth year medical students under close supervision of
experienced teaching staff. Data on births and deaths are related to the year 2000. All other data are
related to the year 2001. No routine records were used.
RESULTS
General characteristics
Table –1- shows selected sociodemographic and health indicators of the study population. The
average household size is 7.7 persons with nearly 61% of households having a family size around or
greater than the average.
The population has an intermediate fertility as indicated by crude birth rate of 27.4/1000 population
but has a relatively high infant mortality rate (35/1000 live birth). The crude death rate is relatively
low (4.8/1000).
Table –2- shows the age distribution of the population. Children aged less than 15 years constitute
about 36.4%. Adults in the economically active age 15-64 years account for 59.8% while elderly
people constitute only 3.7%. Such figures suggest that the population experience relatively high
fertility and mortality rates.
Use of Maternal and Child Care
Table –3- summarizes selected aspects of maternal and child care utilization. Of the 110 pregnant
women identified during the study 74 (67.3%) were using antenatal care whereas 36 (32.7%) of them
were not. The main source for antenatal care used was the local primary health care centres where
89.2% reported to be using such centres compared to only 10.8% who were using other sources.
With respect to place of and attendant at delivery, of the 143 deliveries occurred during the year
2000, 67.8% took place at hospitals, further 16.8% took place at homes under medically qualified
midwives and only 15.4% of deliveries were supervised by traditional birth attendants.

3. 2
Student’s opinion
To get direct feedback from the participating students on the survey, some of the results pertaining to
their opinion are given in Table –4-. Poor physical environment, low service utilization, big family
size and low educational level were the main observations identified and reported by the students.
Regarding important areas in which they gained significant knowledge and skills, the students
specified communication with people, health measurements and understanding people behaviour in
response to illness as the main areas of interest.
DISCUSSION
Planning health care services for any population requires a health information system supported by
ad hoc surveys for specific or general purposes. Previous experience indicates that household
interview surveys provide very useful population and health related information.(5)
Such information
may be used as a guide to improve the conduct of primary health care at planning, management,
and evaluation levels. In addition these surveys may be used as a field demonstration areas for
applying the theoretical concepts of community medicine and epidemiology by both the faculty
members and medical students . That is what has been intended in the present survey which
represents the subject of this paper. Added to the classical indicators of population health and
services utilization, the reflection on other aspects of medical education was also assessed. We
requested each student to state clearly and freely their important observations and the important
areas in which they gained knowledge and skills. The results were remarkable because students, in
view of what they witnessed, were able to pinpoint areas which are significant to the philosophy of
Community Medicine (see table 4). They understood, at least partially, population health in broad
ecological context when they related indirectly, health to environment, education, crowding and use
of services . The results of this survey supported our long standing view about the relevance of
household surveys both to the health care system and medical education. (3,4,5)
The results of previous surveys were accepted by the health authorities in Basrah as a useful
contribution to the monitoring and improvement of health and health care services. We are also
convinced of the role of such surveys in improving students familiarity and performance in
Community Medicine.
Table 1: Selected sociodemographic variables, Al- Jumhorryah, Basrah 2001.
Variable Value
Family size:
1-6 39.0%
7-10 45.1%
11-24 15.9%
Mean 7.7
Total households studies 682
Total persons in studied household 5216
Crude birth rate for the year 2000 27.4/1000
Crude death rate for the year 2000 4.8/1000
Infant mortality rate for the year 2000 35/1000L.B

4. 3
Table 2: Age distribution of population, Al-Jumhorryah Basrah 2001.
Age in years Number %
<1 166 3.2
1-4 429 8.2
5-14 1306 25.0
15-44 2539 48.7
45-64 581 11.1
65 and over 195 3.7
Total 5216 100.0
Table 3: Utilization of Maternal and Child Care: Al- Jumhorryah, Basrah 2001.
Variable Number %
- Utilization of antenatal care by pregnant women:
Use ANC 74 67.3
Did not use ANC 36 32.7
Total 110 100.0
- Source of ANC:
PHC Center 66 89.2
Others 8 10.8
Total 74 100.0
- Place of delivery
Hospital under medical supervision 97 67.8
Home under qualified health staff 24 16.8
Home under TBAS care 22 15.4
Total 143 100.0
ANC = Antenatal care, PHC = primary health care centre, TBA = traditional birth attendant.
Table 4: Views of participating students regarding A. Main observations B. Main areas of gained
knowledge and skill.
A- Main Observations No. of
answers
%
- Poor physical environment 140 80.0
- Low service utilization 79 45.0
- Big family size relative to house capacity 79 45.0
- Low level of education among people 79 45.0
B. Main areas of gained knowledge and skill:
- Communication with people at community level 105 60.0
- Practical aspects of measuring population health 88 50.3
- People behaviour in response to illness 96 54.9

5. 4
REFERENCES
1. Mausner JS, Kramer S. epidemiology: An introductory text . W.B Saunders Company
London 1985, Chapter I.
2. Greenberg RS, Eley JW, Daniels SR et al. Medical epidemiology. Lange Medical book,
New York 2001, chapter I.
3. Habib OS, Al-Azzawi HK, Ajeel NAH. Household surveys as source of information. The
Medical Journal of Basrah University 2000, 18:13-18.
4. Yacoub AAH, Habib OS. AL-Sadoon IA et al. College of Medicine experience in
community – wide Services. Dar Al-Kutub for printing and publication, University of
Basrah 1997. P3.
5. Yacoub AAH, Habib OS, Ajeel NAH et al. The university and the community: Health
indicators of the Shatt Al Arab district population. Report of the seventh field practice study.
College of Medicine, University of Basrah 1999.
Paper Citation
Habib OS, Ajeel NAH, Yacoub AAH. Household surveys as a tool for training medical students in
measuring population health. The Iraqi Journal of Community Medicine 2002; 15: 5-8.