Objectives Introduction Concepts of Health Information and Health Statistics 5.2.1 Health Information 5.2.2 Health Statistics 5.2.3 Difference between Data and Information System 5.2.4 Criteria for Health ~nformation
5.2.5 5.2.6





Sources of Health Information Statistical Methods and Presentation of Data 5.4.1 Compilation 5.4.2 Tabulation 5.4.3 Charts and Diagrams 5.4.4 Statistical Maps 5.4.5 Statistical Averages Reporting System 5.5.1 Reporting at Peripheral, National and International Level Surveillance Let Us Sum Up Keywords Answers to Check Your Progress




5.10 Further Readings

After going through this unit, you should be able to:


acquire knowledge about health information system in India;
explain the sources of various data; discus the various methods of presentation of data; and explain the reporting system National as well as international level.



Health information is important aspect of a national health system. A good health information system is necessary for effective 'management in the health sector. It is important for planning, implementation, and administratio~l of health services in the community an,d at the national level. In earlier time the health informalion system in our country was in a very rudimentary term. The statistics related to health (mainly death and births) were collected and recorded by the lowest ranked government





The data will show the general pesformance of the health services and help the plannel-s in shidying their current functioning and trends of various disease conditions in the country. the Government of India set up the office of the Registrar General at New Delhi. health statistics can be defined as "study of facts indicating the state of health..have seen that while defining vital ar health statistics we have used the term data which means the discrete presentation of observation in the numerical term which really has a little meaning unless transformed and explained. housing and sanitation. On these ~~ecommendations. death.1 Health Information ION AND Health Information system is defined as "a mechanism for the collection. health survey and development committee popularly known as Bhore Committee gave its final report which showed many loopholes in the maintenance of the records. 5. There are still lot of lacunae in our system of collection of data at the grass root level. morbidity and mortality". processing.2 Health Statistics Before we learn the definition of health statistics let us define vital statistics because health statistics is a broader term and includes few more informations than that of vital statistics. Since then there is lot of improvement in collection of data and as a whole the health information system in this country. In this chapter.2. promotive. adequate and relevant infonnation to the health managers. mortality and state of health. Health ~nformation and Healtli Statistics CONCEPTS OF HEALTH INFO STATISTICS 5. Vital Statistics is defined as "a systematically collected and compiled data relating to vital events of life such as birth. * So you can see from above elaboration that health statistics has a wider coverage t11an vital statistics. marriage. So now we will differentiate the data and the information: . The primary objective or health information is to provide up-to-date.3 Difference between Data and Information You. nutrition.g. we will be studying about various sources of data collection and methods of data presentation. So. National Sample Survey Units. But health statistics does include the data on factors influencing health. 2) Study of factors which influence the state of health for individuals or the community at large for e. as well as the Central Statistical Organisation. Bureau of Health Intellegence and Medical Records in the hospitals were established.2. Vital statistics depict the trend and leading causes of mortality over a period of time but do not consider factors influencing heath status.In 1946. socio-economic status. analysis and transmission of information required for organizing and operating health services and also for research and training". 5. Health statistics includes following aspects: 1) Study of the health status in terms of morbidity. 3) Evaluating the scope of preventive.2. divorce and adoption etc". curative and rehabilitative healrh services. There were various recommendations by the committee.

Environmental health statistics. Utilization and non-utilization of health services. medical and health care needs. and health manpower. 0 Demography and health statistics. e e For evaIuation of health services. disability and quality of life. Financial statistics.2. The comprehensive system should have information and indicators about. 5.4 Criteria for Health Illformation System WHO expert committee states that the health information system should be population hased.Principles and Practice of Community Health Nursing 5. It is important for an effective system to nlalte a provision for feedback. national and international comparisons. should avoid unnecessary information. should imply functional and operational terms. For research into particular problem regarding health and diseases. should be problem oriented. For local. Health status of the people which includes mortality. The system should be expresses information briefly in tables charts and percentages.6 Uses Now we will be discussing about the uses of health information. morbidity. For plai~ning. For assessing the attitudes and satisfaction among the beneficiaries.5 Components The health infonnation system has various sub-systems. The important uses are: * e 0 To measure the health StahIS of the people. implementation and effective management of health services and programmes.2. a a e @ a 5.2. their health problems. a . Health resource facilities like beds in the hospital.

communicable diseases etc. In India the system has many drawbacks like lack of completeness. A sample survey is generally carried out. family planning. lack of accuracy. The time limit for registering the death is 7 days and birth is 14 days failing which a fine upto Rs. religion. influenza. are gathered. The information is compiled and published by Registrar General and Census Commission of India. relation to the head of family. At international level the notifiable disease to WI-I0 in Geneva under International Health Regulation are Cholera. / In order to improve the births and death registration system the Government of India has pro~nulgatedthe "Central Births and Deaths Act". 3 05 . typhoid fever. mother tongue. polio. education. caste. a sample registration system was initiated in 1960. The list of notifiable disease vary from country to country and also within some country from state to state. During census every family is contacted and information regarding age. A few others like louse borne fever. reporting by the illiterate and ignorant person. The SRS is a dual record system consisting of continuous enumeration of birth's deaths by an enumerator and an independent survey every 6 months by an investigator. In 1969. relapsing fever.- 5. lack of uniformity and irregular transmission of data. 4) Health Surveys Health survey is a currently developed system. as it is expensive and time consuming to carry out a survey of the whole population 5) Records of Hospitals and Health Centres It is easier to get the relevant data on the prevalence. 2) Registration of Births and Deaths The births and deaths registration also provides an important and useful data during intercensal period. malaria and salmonellas are subject to international surveillance. Census is taken in all countries every ten years. sex. Health surveys are widely used in cornmudity health practice. / 6 ) Sample Registration System (SRS) Since civil registration is deficient in India. occupation. 3) Notification and Diseases Certain coinmunicable diseases which are a menace of the public health are notifiable LO health officer. while the health center have a variety of records and registers of MCH.The hospital has outdoor and indoor records.can be imposed..501. the act makes it compulsory to register every death and birth. The SRS now covers the whole country. incidence of disease in a coinmunity through hospital records. It is a major source of health information in our country. Plague and Yellow Fever.3 SOURCES OF HEALTH INFO ION Health Information and Health Statistics In our country there are various sources of health information which are listed and discussed: 1) Census ~t is an important source of liealth statistics. income etc.

These programmes have fielded a considerable morbidity and mortality data for specific diseases. 9) Other Health Service Records A lot of infotmation is also found in the records of hospital out patients department. surveillance system are often setup. . It is maintained by various councils like Indian Nursing Council. air and noise pollution. industrial toxicants are helpful in identification of quantification of factors causing of disease. The problem with the system is it relates to only a part of the community. the record originating in different times or places. these association may have etiological significance. 13) Non Quantifiable Information These information are also important for health planners and decision makers like health policies. 12) Other routine statistics related to health are demographic data. Record linkage is particularly suitable method of studying association between diseases. private clinics and nursing homes. special controlleradication programmes have been initiated. Government of India also publish an annual manual on "Health Information of India" which states the various categories of health personnel in our country. public attitudes and prograinmes in particular country. 8) Epidemiological surveillance In many countries where particular diseases are endemic. The main problem of record linkage is the volume of data which get collected. pliinary health centers. Medical Council and Phannacy Council of India. Collection of environmental data remains a major problem in our country. 10) Environmental Health Data Environmental data regarding water. As part of these programmes. health legislation.Principles and Practicc of Community Wealth Nursing 7 ) Record Linkage The term record linkage is used to describe the process of bringing together records relating to one individual. 11) Health Manpower Statistics Information related to health manpower is also very important. economic data and social security schemes.

analysed and tested for accuracy by statistical methods. You can see from the figures below the various forms of bar graph: ~al& f em ales I Fig.1: Distributionof male and femaleas per intensity of pain .4. In this part of the unit we will be reading about the various statistical methods and how to present these data. When a data is obtained directly through individual it is known as primary data. The length of bar is proportional to the magnitude to be represented.5. 1 1 t 5. a) Bar Charts Bar charts are merely a way of presenting a set of members by the length of bar. After the data is collected its presented in various methods.2 Tabulation Tabulation denotes the recording of the classified material in accurate mathematical terms. classified. analysed and tested for accuracy. for example. They have powerful impact on imagination of people. Therefore. 5. first data is collected which is then classified. they are popular media of expressing statistical data.4:3 Charts and Diagrams Charts and Diagrams are useful methods of presenting simple statistical data. Some times the data is also collected from another source it is known as secondary data.4 STATISTIGALMl3TWODS AND PRESENTATION OF DATA In order to study a problem or subject. Tabulating machines and now-a-days use of computers is coming in use. The entire data should be tested on the basis of the purpose of which they are gathered and only the useful and usable data should be tabulated.4. The first step after collection of data includes compilation till the reporting is done. making and counting frequency tallies for different items on which information is gathered. 5. 5.1 Compilation The data or health information is collected.

60 ' Population Land Cd + 0 4- 50-40-- 2 s 3 Asia -'Europe Africa Latin Americal USSR North Oceania America Pig. Each part representing a certain item and proportional to the magnitude of that particular item as shown in figure 5.Principles and Practice of Community Health Nursing b) Multiple Bar Chart The Figure 5. It is obtained by joining the mid points of histogram blocks as shown in Fig 5.6. 5.3: Census Decades d) Histogram It is a pictorial diagram of frequency distribution. It consists of series of blocks.3 E . 5. 300 Fig.2 gives an example of a multiple bar chart or a compound bar chart.3 3 % r n 400 P . e) Frequency Polygon 108 A frequency may also be represented diagrammatically by the frequency polygon. Two or more bars can be graphed together. The class interval is given along the horizontal axis and frequencies along the vertical axis as it is shown in Fig. . 5.4.2: Population' and Land distribution in world c) Compound Bar Chart The bars may be divided into two or more parts.

Health Information and Health Statistics 10 20 30 40 50 60 ' Histogram and frequency polygon showing painresponse of 14cancer patients Fig.7. It is shown in Fig 5. The shaded maps are used to present data of varying size.6 f) Lipe Diagram Line diagrams are used to show the trend of the events in the massage of time.7: Pie graph showing pain levels of a group of cancer patients 5. 5. *" Rg 5.5 Statistical Averages The word average implies a value in distribution around which the other values are distributed.4: Scores on a pain scale Fig. 5. There are several kinds of averages of which commonly used are: . It gives a mental picture of central value.4 Statistical Maps When statistical data refer to geographic or administrative areas it is presented either as "shaded maps" or "dot Maps" according to suitability. 5.4. ' Scatter diagram shows the relationship between variables which shows a positive correlation between the intakes of fats and sugars in average data of 41 countries.4.

81. the data is first arranged in -an ascending or descending order of magnitude. To obtain median. and then divided by the number of observations. 5.95.45. If there are even number of observation the median is worked out by taking the average of two middle values. 48. The process of adding together is called summation and denoted by sign.60. P You can understand this by the following example: The income of 7 people per day in rupees are as follows: 102.Principles and Practice of Community Health Nursing a) Arithmatic mean.20.20. Mean a) ~rithmatic' It is widely used for statistical calculation. c ) Mode Mode is the commonly occurring value in a distribution of data.75.75. the number 60 is repeated most frequently and this is the mode. Hence the arithmetic mean can be calculated as follows: Hence mean = 724 = 72. b) Median.4 xx . It may sometime look rediculous.84 and 90.5. the individual observations are added a observation for example the weight of 10 patients are given below: 60. To obtain the mean.58.7.5. It is the most frequent item occurring.79. You can understand the arithmetic mean by following example.7.60. 102 Hence the middle value is 7 which is the median.- N 10 The mean average of arilhrnatic mean is that they are easy to calculate and understand.77. C) Mode. . Hence. The individual observation is denoted by the sign n and the mean is denoted by (called X bar). and then value of the middle observation is located. Hence it is the median value. cases fall. .80.52. The diastolic blood pressure of 10 individualwere 83.71. The disadvantage is that sometime it may be unduly influenced by abnormal values in distribution.5 Now we will organize this data in ascending order. b) Median The median is that point in a distribution above which and below which 50% of all .49.

5. the notifiable diseases should be reported within 72 hours.1 Reporting at Peripheral. For example. All these reports are compiled at state levels and sent to center at ministry of health and family welfare deptt. and a national report if required may be prepared for international reporting. f . b) Timely Reports: The reports should be sent to higher authority within the frame work of time. All subcenter. The reports can be verbal and written. Good surveillance system allows a proper. It also suggests solution for specific problems at each health level. implementation and monitoring and have a direct impact on the health of a nation. 5. WHO is the apex body to collect the report from various countries and compilation is done.5. The written reports is a must even after a verbal reporting.Health Information and Health Statistics 5. There are two types of surveillance: a) Active surveillance: Peripheral staff invest additional efforts to collect data on cases and deaths. At state level these are compiled together. c) Mandatory Reports: There are mandatory reports for example all cases of poliomyelitics has to be sent or it can 6e of neonatal tetanus is a must to be sent then and there and cannot wait for monthly or annual reports. effective surveillance system allows affective planning. NationaI and International Levd At any level the reports can be of following types: a) Regular Reports: These are the reports which are sent regularly like weekly. The incidents of emergency nature need to be explained verbally but must be followed by a written report.5 REPORTING SYSTEM Any occu~ience in the community need to be-reported to the appropriate authority for proper management. primary health centers and hospitals must send a monthly report to the higher authority. At WHO the international comparison is done and periodically the international reports are published by WHO.6 SURVEILLANCE Surveillance is a regular cbllection of data and its analysis. monthly or annual reports. complete'data collection and analysis.

112 e For evaluation of health services. In the community health nursing practice you need to report various diseases which can pose to be epidemic. Data : Discrete presentation of o b s e r v a h in the numerical form. The couritries require to notify these diseases under international health regulations in order to take proper quarantine precautions. You have also learnt about the various sources of health information in India. malaha and viral influenza. There are lot of lacunae in present system our country. cholera. national and international comparisons. There are diseases which are notifiable to WHO immediately like. paralytic poliomyelitis. : When the data is collected from other source than the individual. yellow fever and small pox. WHO is having a close scrutiny over many disease and it is known as surveillance. 2) Cholera. 2) Problem oriented. relapsing fever. You also learnt about the various ways of representation of data in mathematical form and in the form of charts and diagrams. 3) Avoid unnecessary information. No extra effort is used to collect the data. : The continuous scrutiny of the factors that determine the occurrence and distribution of disease and other condition of ill health. The census being the major sources and other source include hospital records and sample registration system.9 ANSWERS TO CHECK YOUR PROGRESS Check Your Progress 1 1) a) Birth in 14 days.7 LET US SUM UP In this unit we have discussed about the data which can be interpreted which properly. : When the data is collected directly from the Primary Data Secondary Data Surveillance individuals. Death in 7 days. 3) e To measure the health status of the people. 5. Yellow fever. These diseases are notified to WHO. For local. b) c) 10 years 1) Population based. Plague. In addition there are disease which are under surveillance by WHO like louse borne. We know that existing system is not the perfect one. . plague. 5. typhus fever.Principles and Practice of Community Health Nurslng b) Passive surveillance: Hospital and other health facilities data on patients seeking medical aid is analysed is passive surveillance.

e e For planning. Vara Medicd Publications. lst.K. Health Information and Health Statistics Check Your Progress 2 1) a) Bar Charts b) c) Multiple Bar Charts Component Bar Charts d) Histograms e) Frequency Polygon f) Line Diagrams g) Pie Chart h) Pictograms. 2nd. 1981. W. Essential Preventive Medicine. Gupta Piyush (1999). Mumbai. New Delhi. To assess the attitude and satisfaction among beneficiaries. . 1997. Ltd.P.. Mode is the coinrnonly occurring value in a distribution of data. Philadelphia. Manelken R. Park K. 5. Preventive and Social Medicine. 1997.. 322-336.B. 1st Edition.. New Delhi. 2) The median is that point in a distribution above which and below which 50% of all cases fall. implementation and management of health services of programmes. 123-140. Samders Camp. A Text Book o f Commutzity Health for Nurses.. Community Health Nursing Practice. 574-585. Banarsidas Bhanot Publishers. Heinrich Janet. lst.. Vikas Publisher Home Pvt. .10 FURTHER READINGS Freeinan Ruth B. Ghai O. 743-772.