Public Health Assignment: Melanoma Incidence and Maternal Morbidity

This public health assignment analyzes data on malignant melanoma incidence in England, examining age-standardized rates and age-specific rates to identify trends and risk factors. The analysis reveals an increasing incidence of melanoma, particularly among the elderly, highlighting the need for targeted interventions like improved screening, educational campaigns, and tailored public health strategies. The assignment also reviews a study by Chersich et al. (2009) on maternal morbidity in Mombasa, Kenya, evaluating data collection methods, including interviews and laboratory tests, and suggesting the need for qualitative research approaches to understand women's perceptions and needs during the postpartum period. The assignment explores the significance of these findings for public health planning and the implementation of effective interventions to reduce the burden of disease and improve maternal health outcomes.

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Answer 1 a.
The table 1 and 2 describes the incidence of malignant melanoma in different regions of
England. The first data gives the statistics for age standardised rates of malignant melanoma
detected in overall England and other local regions of England such as North East, North West,
Yorkshire, East Midlands, West Midlands, East, London, South East and South West. The
gender wise rates have been displayed for the year 2006, 2009, 2012, 2015. The review of the
age-standardised rate since 2006 revealed that the incidence of malignant has been increasing
with increase in year both in male and female gender. This is an indication of no change in
prevalent rate despite implementation of preventive programs. Hence, the potential of
educational campaigns like sun safety must be considered. The data for the local counties are
also shows the same trend with the South West region showing the highest rate and York Shire
showing the lowest rate of the disease. The most recent statistics for 2015 in Yorkshire show
incidence rate of 20.1% for males in Yorkshire and 38.5% for males in South West region.
Comparing the average increase every three years, it can be said that the rate of increase has been
relatively lower for Yorkshire compared to other region as increase in only 4% was seen in the
past 9 years. Hence, Table 1 gave an overview of the incidence of melanoma based on standard
age structure and based on this data, it can be said that the inform
The significance of the data given in table 2 is that it gives data on age specific rates for
malignant melanoma per 100, 000 individuals in England. The significance of this rate is that it
will to examine the seriousness of the disease and number of individuals who develop the
disease. It is an indication of the frequency of the disease in different age group. From the
analysis of the data in the same year interval of 2006, 2009, 2012 and 2015, it has been found
that people aged 60 to 85+ years are at high risk of malignant melanoma compared to other age

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group. The trends related to age specific rates in the past 10 years revealed that age has revealed
that although the prevalence rate has decreased for people aged 20-54 years from the year 2006
to 2016, the trend towards an increase in rate is seen for people aged 55 years and above. This
statistics show that there is a need to pay greater attention to people aged above 55 years as they
are potentially at high risk of mortality due to the condition. The comparison of the age specific
rates for male and females further show that melanoma in males is more common compared to
females in elderly patient above 65 years. However, the difference is for some years. Hence,
attention should be paid to prioritize interventions based on age of at-risk individuals. One of the
alarming data is the rate per 100, 000 for people aged 65 years and above. The rate of the disease
in 2006 was 30% for females and in the year 2015, it rose to 58.1%. Such rise in rate of
melanoma is alarming and it is recommended that greater attention be paid to treatment and care
of malignant melanoma in elderly patients above 60 years.
Answer 1b
Based on the analysis of the incidence of malignant melanoma in England, the most
significant trend was an increase in incidence of melanoma in people above 65 years and
increase in overall incidence of disease from the year 2006 to 2015. The main rationale for the
high incidence of malignant melanoma in elderly individual is because of the effect of age.
Research evidence shows that age is a poor prognostic factor in melanoma patient due to which
the mortality rate increase in elderly patient compared to the younger population. It is more
common in men and often discovered late in elderly patient (Macdonald et al., 2011). This
difference in prevalence of skin cancer in elderly people is seen because of lack of systematic
skin assessment during geriatric assessment. In addition, diagnosis of skin cancer depends on
dermoscopy, however institutionalized elderly people have poor access to dermoscopy

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consultation. This indicates a need for taking oncogeriatric approach in clinical management
(Garcovich et al., 2017). It is also recommended that the public health department of Preston
should discuss about the trends with surgeons and clinicians make better plans for risk
stratification of the disease in elderly. Investment in proper screening of the disease in elderly
and active follow-up with patients who are already diagnosed with the disease is crucial too. This
would help to address the issue of longer delays in diagnosing melanoma in elderly patient.
(Ciocan et al., 2013). Many elderly patient lack awareness about sign and symptoms of skin
cancer, improving educational awareness related to risk factors and signs and symptoms of
melanoma in this group is critical (Rosengren, 2013, December).. Hence, active screening and
surveillance along with educational campaigns for elderly is the key to address the issue of poor
prognosis of the disease in older adults.
Based on the analysis of standardized rate of Melanoma in England, the trend towards an
increase in the rate of the disease in each local region at every three years interval suggest the
need for implementing population based strategies to prevent melanoma. As economic and
health related burden due to melanoma is likely to rise with increase in rates, segregating high
risk regions and implementing preventive strategies are necessary. As skin exposure is the main
cause behind malignant melanoma, community based interventions like promoting sunscreen
use, stricter sun protection policy and tailored counselling can further reduce UV exposure. This
is part of primary prevention strategy. Some examples of sun-protective behaviours include
‘SunSmart’ style advice, covering up with clothing, using sunscreens and advising fair skinned
to avoid sunbed (Flynn et al., 2016). The NICE guideline has issued key messages in public
resource for primary prevention of skin cancer (NICE, 2012). A UK based case control study
investigating about the effectiveness of sun-protective behaviours in populations at high risk for

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cancer revealed that increasing knowledge alone do not translate into behavioural changes (Diao
& Lee, 2014). Thus, as behaviour may differ based on different beliefs and perception of risk,
tailoring any intervention as per the population targeted is a cost-effective strategy that England
should adapt too.
Answer 2a
The main aim of the study by Chersich et al. (2009) was to conduct a needs assessment
regarding maternal morbidity in the first year after childbirth in Mombasa, Kenya. The study was
conducted with 500 women attending immunization and acute care clinic. Data collection was
done using a pre-tested structured questionnaire administered in local language, Swahili. The
main information collected during the interview included demographic characteristics, access to
sexual and reproductive health services, family planning needs and sexual health status. During
this stage, screening for risk of depression and harmful alcohol use was done using ICD-10
definitions and the AUDIT tool respectively. The data collection was not restricted to interview
questionnaire only. Instead, clinical test like blood test, Pap smear, urine test and a cervical swab
was done too. Urine dipstick was done to rule out urinary infection by detecting nitrites and
leucocytes in the urine samples. Screening for risk of sexually transmitted disease like HIV and
syphilis was done too. In case of screening positive for syphilis, malaria and severe anemia
results, participants were asked to return back to the clinics. In addition, those tested HIV
positive were enrolled in HIV care and treatment at the research site.
There are many strength of the data collection method. This is said because the
researchers used a rigorous method to collect as many details about factors that could increase
risk of maternal mortality. The focus was to collect not only subjective information about the

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topic but also many objective informations linked to various laboratory test. The strength of this
form of data collection is that it favoured collecting both mental and physical health data. This
data ensured that all possible disease that results in poor maternal morbidity was collected. The
pros and cons of each type of data collection method will be done separately. In case of interview
method, one of the major drawback was that appropriate source of interview questionnaire was
not provided. Although the authors mentioned regarding the use of pre-tested questionnaire,
however no such links for further detail was provided. This is an indication of reporting bias in
the data collection method. In addition, as interview response was based on self-reported
symptoms, there is a likelihood of recall bias too. According to Althubaiti (2016), recall bias is
mostly caused by social desirability factor and this kind of bias may lead to underestimation or
overestimation of the association between key research variables. Hence, appropriate analysis
must be done before coming to any conclusion with the use of interview based responses.
The data collection using laboratory testing is the most useful method of data collection
used in this study. There is a need to asses each of the test and identify the clinical significance
of collecting those information with respect to the research aim. Proper diagnostic testing was
done to detect depression and anemia in participants. The ICD-10 criteria were used to screen for
depression. Considering depression screening was essential because postpartum depression is
common in mothers and this is one of the causes behind maternal morbidity like mood swings,
sleep disorders, lack of interest in activities and sadness. Extreme symptoms lead to suicide too
which is a cause behind 20% of maternal deaths (Ghaedrahmati et al., 2017). Thus, screenings
patients for depression was important considering the above evidence. Pap smear and cervical
swab test was done too. Pap smear is a test to detect cervical cancer in women. The main rational
for collection results of this test was that there is a high chance of abnormal pap smear results

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following child birth. The laboratory testing results collected data on HIV testing too. This is
particularly important in the context of evaluating needs of maternal women as women with HIV
have poor morbidity in the post partum period. For women with HIV, ongoing HIV care is most
crucial for women in the post partum period. However, many women reports lower retention in
HIV care thus leading to poor outcomes (Meade et al., 2019). Hence, this signifies the
importance of HIV testing results in the study. However, still there were many other needs which
were ignored. For example, the study did not considered the needs of women who cannot access
maternity services. However, as such group can have many diverse needs, alternative method of
data collection was needed to reach out to this group too.
Answer 2b
The study by Chersich et al. (2009) used cross-sectional survey method to assess needs of
women in the first year of birth by collecting subjective data and lab testing results of various
diagnostic test. Although the use of semi-structured questionnaire method using mixed method
study design was appropriate, however articulating needs directly from the women in the post
partum period was important. Thus, another research approach that was needed to inform the
development of services for this population group includes conducting the study using qualitative
approach. This will help to identify health needs by evaluating women’s perception regarding
challenges and issues faced during the post partum period. The significance of qualitative
research approach is that it is a suitable research design when the purpose of any research is to
evaluate perceptions of participants related to a research phenomenon (Hennink, Hutter &
Bailey, 2020). Thus, when appropriate question is prepared, it can be possible to identify needs
of women in the postpartum period too.

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A multi-stage qualitative interview can be undertaken involving individual and focus
group interviews with mothers and health care professionals respectively. An interview guide
with detailed questions can be asked regarding their lives after pregnancy, any incidence of baby
blues and any feelings of specialised needs post the birth of their child. The interview can also
inquire about feelings of support in the form of information, clinical service or leisure by the
participants. This can be followed by focused group interview using the same question with
health care professional. The significance of focus group interview is that it will help to get
broader information and seek clarification regarding the validity of the expressed needs of the
mother (Silverman, 2016). This helps to compared ideas of post partum needs from the
perspective of health care professionals and mothers. However, as women with access related
barriers may not come, it will be necessary to reach out to this group by offering them financial
incentives to participate. The data obtained in this way will help to conduct appropriate needs
assessment and identify new services which must be included as part of post partum care.

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(2009). Maternal morbidity in the first year after childbirth in Mombasa Kenya; a needs
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Ciocan, D., Barbe, C., Aubin, F., Granel-Brocard, F., Lipsker, D., Velten, M., ... & Arnoult, G.
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