The goal of this introductory text is to assist the reader in identifying causes of ill health in communities, so as to provide more effective and less costly health interventions. Topics explored include basic demographics, water and sanitation, food preparation and nutrition, community resources, health and endemic diseases, and an introduction to the growing field of Rapid Epidemiological Assessment.

Preface vii
Chapter 1 Introduction 1
Chapter 2 First steps to community assessment 5
The need for assessment 5
Working with community leaders 7
Where to start 8
Observation methods 10
Chapter 3 Basic demographics 13
Population density 14
Fertility rate and family composition 15
Socioeconomic indicators 19
Chapter 4 Water and sanitation 25
Water quality 25
Water quantity 27
Human waste disposal 28
Disease transmission by water contact 29
Water-related diseases 30
Chapter 5 Food - preparation and nutrition 35
Maternal effects on child nutrition 35
Child nutrition 37
Food availability - family level 39
The cooking facility and cooking methods 40
Food selection 43
Chapter 6 Food - agriculture 49
Food source and food availability 49
Factors limiting crop yield 51
1. Seed variety 51
2. Irrigation 52
3. Fertilizer use 53
4. Land management 57
5. Harvesting and storage 58
Chapter 7 Identification of community resources 63
People
Raw Materials
Transportation
Leaders
Skilled workers
Literate people
Community members
Traditional healers
Building materials
methods
Cars and trucks
Human-powered transportation
Animal-powered transportation
Water transportation
Alternative energy sources
1. Humans and animals
2. Electricity and fossil fuels
3. Natural energy sources
Monetary and material resources
Outside resources
1. Money
2. Personnel
3. Books and educational materials
Chapter 8 Health, health care and endemic diseases 79
Health care availability 79
1. Barriers to health care 81
2. Health facility services 84
3. Essential medicines 85
4. Vertical programmes 87
At-risk groups 88
1. Women 88
2. Children 91
3. The elderly 100
4. Other at-risk groups 101
Common and endemic diseases 103
1. Disease prevalence and identification 104
2. Detection of onchocerciasis 107
3. Nightblindness - a screening tool for
xerophthalmia 109
4. Haematuria and proteinuria as an indicator
of schistosomiasis 110
5. Estimating malaria prevalence 111
Chapter 9 Rapid epidemiological assessment 123
Cluster sampling 123
Verbal autopsy 125
Estimating maternal mortality by the sisterhood method 127
Questionnaires aimed at key informants 130
RE A summary 133
Appendices
1. International agricultural research centres 135
2. REA equations 136
3. Health survey guidelines 137
4. Sources for published materials pertaining
to international health 138
Index 139

Douglas Stockman
Douglas Stockman has spent most of his career working in Africa where he founded the Organization for West African Health (OWAH), a non-profit organization designed to support small grassroots health programmes in West Africa. He is currently a faculty member in the Department of Family Medicine at the University of Rochester USA where he has created an International Health Education Track and has made care of refugees a priority.