 Section One: Individuals and Groups with

Special Health Needs.

Section Two: Disaster Management.
Section Three: School Health Programmes.
Section Four: Occupational Health Services.
 By the end of this unit you will be able
to:
 Identify individuals/groups who need special
health services in the community and take
appropriate action
 Mobilise and sensitise the community to
respond appropriately in emergencies and
disease outbreaks
 Manage school health programmes
 Identify occupational health hazards in the
community and take appropriate action
 In this section you will look at:
 individuals and groups with special
health needs.
 You will also look at the needs of
people with hearing and visual
impairment, children in need, the
elderly, chronically ill patients,
displaced persons, widows and
widowers.
 Define the term disability
 Identify and manage

individuals and groups in

need of special health
services
 Describe services available

for people with special

health needs
 Def: A disability is a physical, emotional or
mental injury or illness that is severe or
permanent, that interferes with an individual’s
normal growth, development or ability to learn
or work.
 Types:
 Physical Disabilities: Motor defects due to
congenital causes such as missing limbs,
trauma.
 Sensory defects such as blindness and
deafness.
 Chronic illness, for example, epilepsy
 Mental Disability:
- bipolar
 - schizophrenia
 -others?
 Def: The inability to hear or
interpret/perceive sound waves. It is when
your hearing is affected by a disease,
disorder or injury.
1. Conductive hearing loss usually results
from an external ear disorder, such as
impacted cerumen, or a middle ear
disorder, such as otitis media or
otosclerosis. In such instances, the efficient
transmission of sound by air to the inner
ear is interrupted.
2. Sensorineural loss involves damage to
the cochlea or vestibulocochlear nerve.
3. Mixed hearing loss has conductive loss
and sensorineural loss, resulting from
dysfunction of air and bone conduction.
4. Functional (or psychogenic) hearing
loss is
nonorganic and unrelated to detectable
structural changes in the hearing
mechanisms; it is usually a manifestation of
an emotional disturbance.
 tinnitus
 increasing inability to hear in groups
 a need to turn up the volume of the

television.
 Hearing impairment can also trigger

changes in attitude, the ability to

communicate, the awareness of
surroundings, and even the ability to
protect oneself (crossing the road),
affecting the person’s quality of life
 In a classroom, a student with impaired
hearing may be disinterested and
inattentive and have failing grades.
 A person at home may feel isolated
because of an inability to hear the
refrigerator hum, the birds sing, or the
traffic pass.
 A hearing-impaired pedestrian may
attempt to cross the street and fail to
hear an approaching car.
 Hearing-impaired people may miss parts
of a conversation.
 They tend to shout when communicating.
 Many people are unaware of their gradual

hearing impairment. Often, it is not the

person with the hearing loss, but the people
with whom he or she is communicating who
recognize the impairment first.
 Surgery: This can be performed if
the hearing loss is not congenital.
Operations can be performed on the
tympanic membrane and the
ossicles (malleus, incus and stapes).
 Ear Syringing: Ear syringing may
be done in cases where the hearing
problem is due to excessive wax
and there is no ear infection. This is
mainly in the external ear.
 Hearing Aid; These appliances are used to
correct the hearing defect in cases of mild
and moderate hearing.
 Alternative Communication Skills
◦Lip reading to help in
communication
◦Gestures or actions of the
body to express issues
◦Sign language
◦Integration and rehabilitation
◦Writing
 Community teachers, family,
institutions, special schools and
associations are some available
resources for the hearing impaired.
 People who have hearing
impairment can be requested to
mentor and train a child with
hearing impairment.
 REMEMBER: IEBC sign language
interpreter- they did a good job.
 Families with children who have hearing
impairment in the same community can
come together and form a support group
where they share experiences. This serves
as group therapy and they learn very well
as a group. As a community nurse you can
again motivate these families to come
together and support each other, as well as
support them with information and ideas
about prevention, and the different services
available for their children.
 There are a number of institutions where
special education and programmes for the
persons with hearing loss take place. E.g.
Thika school for the deaf.
 Persons with hearing impairment need

special training in special schools where

they can learn.
 Early diagnosis and treatment of
infections and trauma such as otitis media.
 The community should be educated on

the importance of identifying these signs

and seeking prompt medical advice.
 Avoid drugs which may cause ototoxicity

E.G.?
 Avoid excessive noise, which may result

to temporally or permanent hearing loss.

 Visual impairment is the lack or inability to see,
which may be caused by diseases or injuries to
the eye.
 Causes
 Trachoma.
 Vitamin A deficiency.
 Cataract.
 Some types of cancer such as retinoblastoma
 Glaucoma.
 Childhood blindness, for example, congenital
cataract
 Diabetic retinopathy.
 Accidents which cause injury to the eye.
 Family Level: The family trains the child to
recognise common domestic objects by
touching.
 Education Institutions: Schools for the
Blind
These are special schools that provide special
services to the visually impaired.
 Educational Assessment and Resources
Centres (EARCs)These are centres which
were created countrywide to offer assessment
and referral, as well as placement of children
in schools which are nearest to their homes.
 Prenatal Stage : Advise pregnant mothers to
avoid taking any medicines unless prescribed
by the doctor
 Administration of the following measures:
 All primary immunisations should be
completed
 Application of tetracycline eye ointments to
newborns at birth
 Giving vitamin A capsules to children suffering
from measles
 Control of diabetes and the blood pressure
Def:A child in need is one
who has been
abandoned, orphaned,
or one whose parents are
incapable of looking
after them properly.
 Parental love.
 Lack of education.
 Lack of access to health care
 Nutritional needs. Most of these children are
malnourished.
 Security and protection from harmful practices
like female genital mutilation, child labour, forced
marriage.
 Stigma and discrimination such as those orphaned
by AIDS.
 Social burden such as care for the other children
or for a terminally
ill parent.
 Poverty due to lack of a source of income to care
for themselves and the family.
 Inadequate or lack of shelter.

These homes are
Children’s Homes:
owned and run by individuals
with the help of donors and well
wishers. They provide the
children with their basic needs
and education. These homes
are supervised by the
department of children under
the ministry of social services.
 Hospitals: Most of the abandoned children are
brought to the hospitals.
Here they are cared for and then handed over
to the children’s department for adoption, or
are later taken to homes or institutions.
 Integration and Rehabilitation : When these
children grow and attend school or acquire
some skills they are able to be independent by
getting employment or by becoming self-
employed. In this way they become useful
members
of the community.
 Strengthening family relationships
in the community, so that such children
are taken care of by their immediate
family members, especially orphans.
 Providing family life education to

the youth on consequences of pre-

marital sex, as many of the abandoned
children are as a result of unwanted
pregnancies.
 Implementing safe motherhood initiatives in
order to prevent maternal deaths.
 Providing family planning services, so
that families get the number of children they can
manage.
 Providing information to the community
members on the services available for
adoption. This would help those members in the
community who have no children of their own, as
well as those with unwanted pregnancies E.G.
Njoki Ndungu, Caroline Mutuko
 Theageing process is often
defined in terms of physical
changes that negatively affect
the body’s function and
appearance. Old age is
associated with poor health,
poverty and dependency.
 JAPAN-Oprah show
 Poverty
 Loneliness
 Poor nutrition
 Physical handicap
 Dental problems
 Mental problems
 Lack of energy to provide activities of daily
living
 Inadequate housing
 Chronic illnesses
 Age related changes such as immobility
 Lack of care in sickness
 At the Family Level: As a community health
nurse, it is your responsibility to encourage families
to care for their elderly persons. You need to
educate them on the needs of the elderly, equip
them with the necessary knowledge, skills and
attitudes to provide effective care. You also need to
educate members of the community on the
importance of planning for retirement
 At the Community Level: Encourage them to join
recreation facilities to improve their mobility and
to join peer groups to help them psychologically.
 Institutions for the Elderly: In Kenya,
there are a number of homes for the elderly
and day
care centres.
 They provide:
 Nutrition
 Activities of daily living such as personal hygiene
 Treatment of any sickness
 Recreational activities
 Safety and comfort
 Hospitals: Geriatric hospitals
are well established in developed
countries. In Kenya the elderly
do not have any special health
services targeting them.
 Butwith the digital age we will get
there
 An illness is said to be chronic if it meets
one or more of the following criteria:
 Permanent
 Leaves a residual disability
 Caused by non-reversible pathological
conditions
 Requires special rehabilitative training of the
patient
 Requires long term supervision and care
 Examples of chronic illnesses include:
 Diabetes mellitus
 Arthritis
 Hypertension
 Sickle cell disease
 Renal disease
 Heart disease
 Family: chronically ill patients are taken
care of at home by family members. This is
known as home-based care.
 Institutions: Institutions that provide

services to the chronically ill include

hospitals, hospices, and support groups
depending on the type of chronic illness.
 Provision of good prenatal, intrapartum and
delivery care congenital malformations
 Genetic counselling is done in cases where there
is a genetic risk, e.g. in DM and sickle cell disease.
 Discouraging risky habits, such as smoking and
over consumption of alcohol, in order to reduce
chances of lung conditions, liver cirrhosis and
mental disorders.
 Early diagnosis and treatment of these
conditions.
 Regular exercises.
 A healthy diet low in calories and animal fat, to
prevent obesity, heart and blood vessel diseases.
 These are people who have been displaced
from their communities or even countries
caused by natural disasters, famine,
political reasons and economic changes.
 Internally Displaced Persons: These are
people who have been displaced within
their country
 Externally Displaced Persons: These are
people who have run away from their
country
 Housing
 Sanitation
 Water supply
 Lack of inadequate nutrition which may result
in malnutrition
 Security risk and human rights violation
 Overcrowding which may cause rapid spread of
diseases
 Lack of education opportunities
 Lack of health services
 Emotional needs
 Poverty
 The services available for
displaced persons tend to be those
provided by relief agencies,
NGOs, the government through
the provincial and district
administration, the church, and
institutions such as UNCHR which
take care of external refugees.
 Screening and first aid to all new arrivals.
 Food assistance, especially to infants and
children, as food is a basic need. Temporary
shelter so that individuals can sleep and rest.
 Reproductive health services; antenatal, labour,
delivery and post natal, family planning services
are also provided.
 Medical care services, where curative care for
common diseases and injuries will be provided.
 Immunisation programmes for children and
pregnant mothers.
 Health education and community
mobilisation.
 Identification and the use of the community
health workers in the area is necessary.
 Death of a spouse.
 The leading causes of death today in Kenya

include diseases and road traffic accidents.

 Needs of Widows/ widowers
 Psychological effects following the death

of the husband, such as loneliness

 Basic needs such as food and shelter
 Support to care for the left children
vulnerable to violence, sexual abuse and
rape.
 Exploitation at work place due to
homelessness, illiteracy and poverty.
 Love and belonging. Some may be rejected
by the family.
 Health needs for the whole family or the left
spouse. This is especially so if she was sick,
as in the case of AIDS.
 The Extended Family
Members
 Clan
 Support Groups