MB4002 Assignment: Public Health Analysis and Needs Assessment

This assignment presents a comprehensive analysis of malignant melanoma incidence in Preston, UK, and maternal morbidity in Mombasa, Kenya. The first part of the assignment critically examines the increasing trends of malignant melanoma, its risk factors, and provides recommendations for the P...Read More

Running head: ADVANCED NEEDS ASSESSMENT
ADVANCED NEEDS ASSESSMENT
Name of the Student:
Name of the University:
Author’

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Response to Question 1.
Answer a. Report
Introduction
Malignant melanoma is a type of cancer that develops from the melanocytes,
pigment-containing cells. It is a typical skin disease; however, it may occur in mouth, eyes
and intestine (Bronswijk, Sagaert & Bechter, 2019). The incidence of cancer is increasing in
Preston; as a result, the local councillor has contacted the public health department. The
report aims to analyse the trends of cancer critically.
Trends in incidence of Malignant Melanoma
According to Jeannette, Olazagasti and Janice (2016), previously it was a rare disease;
however, in the last 50 years, its trend has risen at a fast rate than any other cancer.
Melanoma is stated to be an aggressive malignancy that spread from its primary sites and in
case of advanced melanoma, it becomes challenging to treat (Kurebayashi et al., 2019). The
incidence of malignant melanoma is at a rise, and as per the survey conducted by the
International Classification of Disease, the disease is found to be prevalent in different parts
of England. In 2006, the disease affected 14.6% of the people where the percentage of female
was found to be higher than men. Matthews et al. (2016) opined that in the Northwestern and
South Western part of England, the percentage of affected people was higher. The incidence
was slowly and steadily increasing over time in 2009, 2012 and 2015, as found in graph 1.

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England North East North West Yorkshire East
Midlands
West
Midlands
East London South East South West
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
2015 Male 2015 Female 2012 Male 2012 Female 2009 Male 2009 Female 2006 Male 2006 Female
Graph 1: European age-standardised rates per 100,000
According to Gupta and Tsao (2017), the reason that has been identified for such
trending medical condition is the white-skinned people. The people in European do not have
much melanin in their skin due to the cold weather; as a result, they are found to be more
prone to skin disease and skin cancer. The most prominent area that has been affected
overtime was a southern part; however, the northern parts of England are also affected at a
high rate. Moreover, it can be confirmed that initially, the disease affected more female than
male, however, with time, the trend had reversed and from the data found in 2015, it was
found to be more trending among men.

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20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+
0.0
20.0
40.0
60.0
80.0
100.0
120.0
2015 Male 2015 Female 2012 Male 2012 Female
2009 Male 2009 Female 2006 Male 2006 Female
Graph 2: Age-specific rates per 100,000 of malignant melanoma in the English
Population
From graph 2, it is evident that with age, malignant melanoma increased from the
period of 2006 to 2015. Kyrgidis (2017) opined that the reason for increasing disease
incidence is not fully diagnosed as old age is an independent and poor prognostic factor that
affects the survival rate from melanoma. Various underreported and undetected cases that
affect the epidemiological studies in understanding the frequency and characteristics of
cancer in older people, both men and women (Murali et al., 2018). For a period ten years, the
frequency of melanoma has increased in Preston not only in older people but also among
young and middle-aged people. Thus, it is a grave concern for the people of Preston and the
government needs to understand the scenario and combat it.
Conclusion
From the report, it can be concluded that malignant melanoma is a type of skin cancer
whose incidence is drastically increasing in England. The trend analysis critically stated that

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over time, it is stated to be a public health issue and require an immediate response from the
council of Preston.

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Answer 1b
The exact reason for malignant melanoma is not recognised in nature; however,
exposure to ultraviolet radiation from the sunlight or tanning lamps may increase the risk of
developing the disorder. The risk of the disease is more prevalent among people that are
white-skinned people and among people that are above the age of 40 years. According to the
study of Sacchetto et al. (2018), the risk of developing melanoma is ten times higher among
whites, especially people with fair skin, red or blond hair and freckles. In addition to this, the
presence of mole, which is a benign pigmented tumour, have a high risk of acquiring the
disease at later stages of life. The risk of melanoma is found to be higher due to genetic
contributing to 10% of the cases having a family history. The high risk of the disease may
include shared lifestyle, frequent exposure to the sun, family history and mutation or
combination of these factors that have an impact of developing the condition. People who
have a weak immune system are likely to develop cancer more readily than others are.
Specific medical disease such as AIDS, being aged and having xeroderma pigmentosum. In
another study conducted by Herbert et al. (2018), it was observed that men are more affected
by the disease than women are; however, the reason is under investigation.
The recommendations that can be given to the council of Preston in order to limit the
trending incidence of malignant melanoma require investigation by the public health
department and understanding its characteristic in an in-depth manner (Brooks, 2017). This
will help in gaining more in-depth knowledge of the disease allowing in formulating the best
possible strategies. An awareness program offering vivid understanding and knowledge of the
disease to the public is an important step that will support in broadening the perceptions of
the people with respect to melanoma. Due to their skin types, people need to undertake
strategies that will help in reducing the risk of melanoma. These include wearing sunscreen
that has high SPF content, protecting the body by wearing protecting clothing such as

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sunglasses and hats (Jørgensen, 2017). It is vital that people need to avoid the peak ray at
mid-day when the rays of the sun are intense in nature. Moreover, people should not use any
tanning beds that increase the incidence of malignant melanoma by 25 to 75%. According to
Yas et al. (2018), it is vital to protect the children, older adults and people having weakened
immune system from the intense ultraviolet rays of the sun. This is because these populations
are considered to be vulnerable to the disease; as a result, they have a higher possibility of
acquiring cancer than other people. Mulcahy, Mulligan and Shumack (2018) opined that one
of the critical aspects of treating the melanoma is early diagnosis. Therefore, people need to
be aware of the early signs and symptoms of malignant melanoma in order to consult with the
healthcare professionals in a timely manner, as it will increase the possibility of survival,
which is mostly not possible in the advanced stages (Melanoma Research Alliance, 2020).

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Response to Question 2.
Answer 2a
The method used in the article for collecting the information related to the needs of
the women in this particular study is a cross-sectional survey that included 500 women who
had attended a child-health clinic at a provincial hospital in Mombasa in Kenya. The data
collection tool used for gathering data from the selected population was a structured
questionnaire and data from clinical examination, results of blood, urine, cervical swabs and
Pap smear (Chersich et al., 2009). The comparison of the healthcare need of women based on
three periods, early that is four weeks to two months, the middle from two to six months and
late period from six to twelve months after the birth of the child. Aschenbeck et al. (2017)
opined that the use of a cross-sectional survey that helps in collecting data in order to make
an inference about the selected population at one point in time. It is used for describing a
particular scenario or issue related to the sample. It can be repeated in nature; thus, the project
was conducted from 2002 to 2005 and it focused on the services of antenatal and intrapartum.
According to Von Kobyletzki et al. (2017), in this case, the data on exposure as well as
outcomes are gathered on a simultaneous manner that includes both inclusion and exclusion
criteria that were initially developed during the design stage. This is done in order to ensure
that the outcomes are identified in a correct manner. The use of the data collection method
will be dependent on the outcome, exposure and study setting.
There are certain strengths and limitations of using the cross-sectional survey that will
be discussed. The method is comparatively fast, easy to conduct and cheap as it does not
require any extended period of follow-ups; thus, it helps in gaining appropriate outcomes
from the research. In case, many variables need to be evaluated, and this method can be used
for collecting the data at once. Otiashvili et al. (2019) opined that it offers the ability to

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measure the incidence of the factors under investigation. The most beneficial aspect of using
this method is that it allows studying multiple outcomes and exposures. The variables that
were collected in this particular research include demographic characteristics, sexual and
reproduction health services, sexual health need and family planning needs. Therefore, it can
be seen that it is appropriate for the descriptive analysis that involves an analysis of the
generation of hypotheses. It simultaneously allow evaluation of various factors, thus,
expanding the scope of the study and broadening the viewpoint based on the research topic.
In this case, the maternal morbidity in the first year of childbirth was evaluated, taking into
consideration various aspects related to it.
On the other hand, there are various limitations in using a cross-sectional survey that
needs to be taken into account. Health Knowledge (2020) opined the method have certain
challenges in determining the nature of the exposure that is whether the exposure is on time
or has resulted from the outcomes. Moreover, it is not suitable for understanding and
assessing rare diseases and those that exist for a short duration of time. This is because of the
fact that it requires thorough evaluation for a period of time; thus, the duration becomes a
factor of concern. As per the opinion of Setia (2016), the use of cross-section survey is used
for measure the prevalent case studies rather than incident; therefore, the data is found to be
related to reflect the determinant of survival and aetiology. However, it is unable to measure
the incidence of the disease or issue at hand. This is one of the most predominant limitations
of the study and thus, it is not applicable in all the studies in the healthcare sector. According
to Christie et al. (2019), it can be seen that the relationship that is being studied in the
particular research is difficult to interpret; as a result, it has an impact on the discussion and
conclusion section as it becomes vague in nature. The last limitation of this kind of study
involves the possibility of bias, where the aspect of non-response is an issue that affects the
study and thus, results in biasness while measuring the outcome. Christie et al. (2019) opined

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that this particular issue occurs when the characteristics of the non-responders are different
from the responders. This lead to a low response rate and misclassification within the context
of the study.
Answer 2b
Due to the issues identified in the case of a cross-sectional study used in the study
selected, it is important to use an alternative method. Datu, King and Valdez (2018) opined
that the study design depends on the nature of the questions in the research; thus, the types of
information that needs to be collected is one of the criteria based on which the study type is
selected. The alternative that can be used instead of the cross-sectional survey is a
longitudinal study where the researcher does not interfere with the subjects and several
observations of the participants are collected over a period that includes several years. As per
the opinion of Higuchi et al. (2016), this is advantageous because it allows in detecting any
changes or development in the features of the target population at not only individual level
but also group level. Thus, it creates a sequence of events that offer a better understanding of
the relationship between the two variables at an extended phase rather than assessing it at a
single point. Therefore, it is not timesaving or economic in nature however; it can be stated
that for conducting an in-depth manner. On a general term, a study or research is usually
driven by its design; however, in some cases, the progress of study is useful in assessing the
design is most apt in that case. The use of cross-sectional studies are faster and cheaper as
compared to longitudinal studies; thus, in most of the cases, the researcher opts for it at the
initial phase. This is done for establishing the association or link between the variables;
however, in order to assess the cause and effect on a particular subject, it is vital for using
longitudinal study (Iwh.on.ca, 2020). In addition to this, the medical assessment used in the
study was to assess the medical conditions of the participants could be used for improving the
scope of the research.

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