Federal State Autonomous Educational Institution of Higher Education

I.M.Sechenov First Moscow State Medical University

of the Ministry of Health Care of the Russian Federation
(Sechenov University)

Public Health Institution

N.A.Semashko Public Health and Healthcare Department

COURSE TASK

Public Health and the Methods of its Study

Variant 1

Student : ABDUL RAHMAN BIN SOHAILUR

REHMAN

Faculty :General Medicine

Course: 3
Group : 78

  Group instructor :
Prof. Ekkert N.V.
 Moscow – 2020
Authors:

Professor Ekkert N.V.

Associate professor Mikerova M.S.

Guidelines for the implementation of the course task:

On the basis of self-training tutorial, learned topics in practical classes and tutorial
materials and lectures, as well as using additional literature, including materials on the
Internet, a student must:

Part 1.
Define the problem in public health, choose a topic, formulate the goal and objectives
of the study, propose a plan (the object of study, the type and method of observation)
and the program of statistical research (unit of observation, data collection and
program development program material (models of statistical tables) .

Part 2.
In the complex task to assess the situation in the city K. and to analyze the state of
health of the population of this city at the moment and in the dynamics (if in the
problem presented material), determine the possibility of graphic and submit it, to
make a brief summary of the analyzed material.

2
 Information

City K. is an industrial center in the Middle Volga in Russia. The city operates a
major river port, ship repair, and there are cement plants, agricultural machinery plant,
chemical fiber plant, a cannery, a textile mill. Industrial enterprises working at full
capacity and often complicate environmental conditions in the city. Housing
construction is slow pace. Green space in the city is not enough. There are no
opportunities for the development of physical culture and sports in this city.
Conducting cultural activities is difficult. City Department of Health, with the
participation of experts and specialists studied health. The results are shown below.
There are 100, 000 people in the city K., including the age group until 15 years –
23 000 children and teenagers, from 15 to 49 years – 50 000 citizens (including
women – 26 000), 50 years and older – 27 000 people.
Task: evaluate structure of the population of the city by the age, imagine the
results graphically, write a conclusion.

Answers:

0-15 15-49 50 and older

27% 23%

50%

Percentage of each age group of population of City K.

3
 Conclusions:
1.The structure of population by age is regressive.
2.23% of the population consist of age 0-15
3.27% of the population consist of age 50 and older
4.50% of the population consist of age 15-49

In this year born 1100 alive children (previous year – 1050 children), all of
women aged 15 - 49 years. 1750 people died during the year, including 12 children
until 1 year. The dynamic of demographic indicators in city K. is shown in Table 1.

Table 1
Dynamic of Demographic Indicators of the city K. (per 1 000)

Estimation
Indicators 1999 2004 2009 2014 2019 of parameter

Birth rate 6.8 7.9 8.4 8.7 11 Low

Death rate 16.3 15.7 15.3 14.8 17.5 High
Population
growth rate -9.5 -7.8 -6.9 -6.1 -6.5 High Negative

Fertility rate 43.3 43.1 41.7 40.9 42.3 /

Infant mortality Middle

15.8 14.9 13.8 13.1 11.8
rate

Task: Assess the level and dynamics of demographic indices in city K., show
them graphically, make conclusion about the possible causes of demographic
situation.

Answers:
4
Birth rate: 1100*1000/100000=11
Death rate:1750*1000/100000=17.5
Population growth rate:11-17.5=-6.5
Fertility rate:1100*1000/26000=42.3
Infant mortality rate: （12*1000）/（2/3*1100+1/3*1050）=11.8

Birth rate Death rate

Population growth rate
23.63

15.75

7.88

-7.88

-15.75
1999 2004 2009 2014 2019
The Birth rate and Population Growth rate of City K per 1,000 people.

Infant Infant mortality rate

Mortality
rate of city 20
K per 1,000
infants. 16
12
8
4
0

5
 Fertility rate

44

43

42

41

40

39
1999 2004 2009 2014 2019
Fertility rate of City K per 1,000 woman in reproductive age

Conclusion:
The population is naturally decreasing in city K, because of Low birth rate and high
death rate, from 1999 till 2019, but the population structure is still regressive type. K city is
industrial city and is located at the middle and lower end of the industrial chain. Poor air
quality, lack of sports for citizens, low salaries will decrease, it will reduce citizens'
expectation of life and birth rate, increase citizens' mortality rate.

Materials of study the causes of general mortality and infant mortality rates are
presented in Table 2.

Table 2
Leading causes of death of the population in city K.
(abs. number and % of total)

6
 Number of deaths
Causes of death in the city K.
abs. number % of total

678 38.7
Diseases of the circulatory system

203 11.6
Accidents, injuries, poisoning

188 10.7
Malignant tumors

124 7.1
Diseases of the digestive system

356 20.3
Respiratory diseases

201 11.5
Other reasons

1 750 100.0
Total

Task: Analyze the main causes of death of the population of city K., provide
information graphically, write a conclusion.
Cause of death in population of city K

Answers:

7
 Diseases of the
circulatory system 12%

Accidents, injuries,
poisoning 39%
20%
Malignant tumors
Diseases of the
digestive system 7%
Respiratory 11% 12%
diseases
Other reasons
Percentage of diseases cause death of population in City K

Conclusion:
The most common disease cause of death are Diseases of the circulatory system(39%),
second is Respiratory diseases (12%) .

Analysis of morbidity of adults and children residing in the city K. showed the
following. In the city K. 58 430 cases of diseases were registered among the
children aged 0 to 18 years in this year (including the first-ever diagnosis of 42 680
cases). The number of children aged 0 to 18 years is 30 000 (Table 3).

Table 3
Indicators of general morbidity of the population in different age groups
and places of residence (1000 population of corresponding age)

8
 Children Adults
Indicators
city K. region city K. region
Primary morbidity 1422.6 1 370 687 595

Prevalence 1947.7 1 846 1 409 1 378

Task: analyze the incidence of child and adult population of city K., provide
information graphically, write a conclusion.

Answers:

Indic
atros of
Children City K Children Region
general Adults City K Adults Region
2500

2000

1500

1000

500

0
Primary Morbidity Prevalence
morbidity of the popluation of City K in different age groups and places of residence, per 1,000
people.

Conclusions:
Primary morbidity of children City K is greater than the region. Prevalence of
Children City K is greater than region. Primary Morbidity of Adults City K is greater than
Region. Prevalence of Adults in City K is greater than Region. Residents of City K are more
likely to get sick. This has to do with the poor living environment of City K

9
The dynamic of the indicators of the incidence and prevalence of respiratory
diseases of the population of city K. is presented in Table 4.

Table 4
Dynamics of indicators of general morbidity and primary morbidity
of the population of city K. (per 1 000 population)

Indicators 1999 2004 2009 2014 2019

Primary morbidity 1 025 986 930 891 844

Prevalence 1 491 1 570 1 602 1 634 1 759

Task: analyze dynamics of morbidity of population of city K., provide

information graphically, write a conclusion.
Answers:

10
 Primary morbidity Prevalence

2250

1800

1350

900

450

0
1999 2004 2009 2014 2019
Dynamic of indicators of general and primary morbidity of the population of City K, Per
1,000 people

Conclusions:
The Primary Morbidity has been decreasing, from 1025 till 844. But the prevalence has
been increasing from 1491 till 1759. New cases are decreasing, but more people still have
diseases, potentially chronic. Which means City K is getting better prevention. Increasing
the Expected life.

The structure of the prevalence of the population of city K. presented in Table 5.

Table 5
Structure of the primary morbidity and prevalence of the population of city K.
(% of total)

Primary Prevalence
Name classes and diseases morbidity
11
 % of % of
rank rank
total total

Certain infectious and parasitic diseases 4.9 6 3.2 11

Neoplasms 1.3 13 2.8 13
Endocrine , nutritional and metabolic
1.6 12 3.1 12
disorders
Mental and behavioral disorders 3.4 10 7.4 5
Diseases of the nervous system 2.6 11 4.0 10
Diseases of the eye and adnexa 5.0 5 6.9 6
Diseases of the ear and mastoid process 2.6 11 2.1 14
Diseases of the circulatory system 4.6 7 12.2 2
Respiratory diseases 40.8 1 24.0 1
Diseases of the digestive system 4.5 8 7.7 3
Diseases of the skin subcutaneous tissue 6.1 3 5.0 9
Diseases of the musculoskeletal system and
5.2 4 7.6 4
connective tissue
Diseases of the genitourinary system 4.4 9 6.1 8
Injury, poisoning and certain other
11.9 2 6.3 7
consequences of external causes
Other 1.1 14 1.6 15

Total 100.0 14 100.0 15

Task: analyze the structure of morbidity of population of city K., provide

information graphically, write a conclusion.
Answers

12
 Certain infectious and parasitic diseases
Endocrine, nutritional and metabolic disorders
Diseases of nervous system
Diseases of the ear and mastoid process
Respiratory diseases
Neoplasms
Mental and behavioral disorders
Disease of the eye and adnexa
Diseases of the circulatory system
Disease of the digestive system

1%5%1%
12% 2%
3%
3%
4% 5%
5% 3%
5%
6%

5%

41%

Structure of Primary Morbidity of the population of City K, per 1,000 people

Prevalence of the population of City K, per 1,000

13
 6% 2% 3% 3%
3%
6%
7%

8% 4%

5% 7%

2%
8%

12%

24%
Certain infectious and parasitic diseases
Endocrine, nutritional and metabolic disorders
Diseases of nervous system
Diseases of the ear and mastoid process
Respiratory diseases
Diseases of the subcutaneous tissue
Diseases if the genitourinary system
Other
Neoplasms
Mental and behavioral disorders
Disease of the eye and adnexa
Diseases of the circulatory system
Disease of the digestive system
Diseases of the musculoskeletal system and
Injury, poisoning, and certain other

14
Conclusion:
Top of the causes disease in primary morbidity:
1.Respiratory disease (40.8%)
2.Injury, poisoning, and certain other consequences of external cause(11.9%)
3.Diseases of the subcutaneous tissue (6.1%)
Top of cause disease in prevalence in City K:
1. Respiratory diseases (24%)
1. Diseases of the circulatory system (12.2%)
2. Diseases of the digestive system (7.7%)

In this year dentists of the Moscow Central Research Institute of Dentistry were held
continuous epidemiological study of the prevalence of periodontal disease of
residents of the city K. and town M. Frequency of periodontitis (per 1,000
inhabitants) in K. was noticeably higher. There are the differences in the age structure
of the population of city K. and town M. (Table 6).

Table 6
Distribution of urban residents of the city K. and town M.
and periodontitis patients by age groups

The city K. The town M.

Age the number of the number of the number of the number of

residents patients with residents patients with
periodontitis periodontitis
up to 15 25,000 500 30,000 660
years

15
15-49 years 50,000 3,000 50,000 3,200

50 years and 25,000 8,500 20,000 7,000

older
Total 100,000 12,000 100,000 10,860

Task: using an appropriate statistical method analyze the influence the age
structure of the population of the city K. and the town M. on the incidence of
periodontal disease, write a conclusion.

Answers:

Step1: City K(12000*1000)/100000=120per 1000 people

Town M: (10860*1000)/100000=108.6per 1000people

Age City K per 1000 Town M per 1000

Up to 15 years old 500*1000/25000=20 660*1000/30000=22

15-49 years old 3000*1000/50000=60 3200*1000-50000=64

50 and older 8500*1000/25000=340 7000*1000/20000=350

Step II: Sum it up

Up to 15 years old 25000+30000=55000

15-49 years old 50000+50000=100000
50 years old and more 25000+20000=45000
Total 10000+100000=200000

Step III: determind

Up to 15 years old:
City K: 1,000 – 20 Town M : 1,000 -22
55,000 - X 55,000 - X
15 - 49 years old:
City K: 1,000 – 60 Town M : 1,000 - 64
100,000 - X 100,000 - X
50 years and older:
City K: 1,000 – 340 Town M : 1,000 - 350
45,000 - X 45,000 - X
To compute the expected number of patient with periodontitis :
16
In city K: (1,100+6000+15,300) = 22,400
In town M: (1,210+6,400+15,750) = 23,360.
Step IV: Common Standardization
City K: 22,400 – 200,000 Town M: 23,360 - 200,000
X - 1000 X - 1000
Step V: comparing

Indicators: City K Town M Comparing City K and town M

Intensice Rate 120 108.6 K is greater than M
Standarized Rates 112 116.8 K is smaller than M

Conclusion:
1. The number of patients with periodontitis by age in city K is more than in town
M.
2. There are more patients with periodontitis less than 1 year with high frequency
rate in city K while there are more patients with periodontitis more than 5 years
with low frequency rate in town M.

Doctors of the maternity home in the city K. analyzed the rates of physical
development of children born by the women of different age groups (Table 7).

Table 7
The results of measuring the body weight of children
born by the women the age over 35 years

Body Weight (in kg.) Number of Children

2.2 2
2.5 1
2.8 2
3.1 4
17
 3.4 9
3.7 12
4.0 9
4.3 3

more columns with calculations in table!

d
V р Vp d2 d2p
(V-M)

………………………………………………………..

Task: calculate the average weight of babies born by women the age over
35 years, indicators of the variety, make a conclusion.
Answers:
N=42
The average weights of babies born by women aged over 354 years old:
M= ∑V∙P / N = 148.8/42 = 3.5kg
Variation coefficient : Cv=СV = (/M)x100 = 14.57%
• Standard deviation is computed by the formula
 = (d2p)/n
= +0.51kg

Conclusion:
The mean weight of newborn by women over 35 years old is 3.5kg
Standard deviation is +0.51kg, the variation coefficient is 14.57%

Children born by women aged 20-29 years had an average body weight of 3.2 kg
( = 0.3 кг, СV = 9.1 %, m = 0.03 кг).

Task: Compare a diversity of body mass index of children born by women of

different age groups, write conclusions. Assess the impact of women's age on body
weight at birth and write conclusions.
Answers:

18
Weight age over 35 age 20-29
M 3.5kg 3.2kg
 +-3.5 +- 0.3
m +- 0.08 +- 0.03
Cv 14.6% 9.1 %

Conclusion:
the Cv of children born by women aged over 35 years is medium , but the Cv of children
born by women aged over 20-29 years is weak. The age of mother can influences the
newborn babies

Doctors conducted a research of state of health of students (n=360) from the college
to identify myopia. Myopia was diagnosed by 80 students.

Task: calculate a frequency of myopia among students using an appropriate

statistical method to make a prediction about the frequency of myopia for the total
population of students of colleges in the city K.
Answers:

N=360-100
80-x

P=22.2%
G=1-22.2%=77.8%
Confidence interval – from 15.6% to 28.8%

Conclusion:
the prediction of the frequency of myopia for the total population of students of colleges in
the city K is from 15.6% to 28.8.

Doctors conducted a study of influence of length of service on hearing loss in riveters

in order to reduce the occupational morbidity of shipyard workers and to develop
preventive measures (Table 8).

Table 8
Influence of length of service on hearing loss among dockyard workers

The number of people with hearing

Length of service (years)
loss (per 100 workers)
Less than 5 years 2.0

19
 5-9 19.2
10-14 48.0
15-19 81.4
20-24 98.1
25 and more 95.5

Task: using an appropriate statistical method, analyze the influence of work

experience on hearing loss at the shipyard riveters, write a conclusion
Answers:

The length The number Rank The The square

of Service,. of people differences of
years with of ranks difference
hearing loss of ranks
per 100
X Y d d^2

Less than 5 2.0 1 1 0 0

5-9 19.2 2 2 0 0

10-14 48.0 3 3 0 0

15-19 81.4 4 4 0 0

20-24 97.1 5 5 -1 1

25 and more 96.5 6 6 1 1

Rxy=+0.94
m rxy= +0.17 t= 5.53
Criteria t=5.53 corresponds to probability p≥99.9% (the results is significant when t≥3 ; p≥99.9%)

Conclusion:
the The correlation between length of service (years) and the number of people with hearing
loss (per 100 workers) is positive, strong and significant (rху= +0.94 , ; p≥99.9%) .
Gastroenterologist of the student polyclinic of The Medical University conducted a
study of risk factors for diseases of the digestive system of the students and
20
established the power of their influence on the occurrence, course and outcome of the
diseases (Table 9).
Table 9
Incidence of diseases of the digestive system of the students of The Medical
University of the city K. depending on the presence of risk factors
(per 100 students)
The incidence
Risk Factors of diseases of the digestive Relative Risk (RR)
system
Irregular meals
+ 28.0 2.8

- 10.0
Unbalanced diet
+ 35.0 2.3

- 15.0
Constant use
of fast food
+ 40.0 3.3

- 12.0
Smoking
+ 25.0 1.8

- 12.0

Task: evaluate the index of the relative risk of gastrointestinal diseases for each
factor and write conclusions.
Answers:

Conclusion:
Constant use of fast food has 3.3 relative risk while smoking has 1.8 relative risk, means fast
food is stronger than smoking in being a risk factor, fast food consumed has the highest
relative risk while smoking has the lowest relative risk.

21
The program of the prevention of gastrointestinal diseases was developed by health
department specialists to reduce morbidity of this group of diseases among students
of the city K.

Task: develop a plan of measures for the city administration, medical and
preventive health care organizations, educational institutions to prevent morbidity of
gastro-intestinal diseases among students (depending on the stage of prevention).
Answers:
Prevention plan:
According to epidemiology, gastrointestinal diseases that are more easily obtained among teenagers
are esophageal reflux, Helicobacter pylori gastritis. Obesity, overeating, and poor lifestyle are risk
factors for esophageal reflux.
Therefore, the measures to be taken are as follows "
1. Perform weight statistics on adolescents, and educational institutions increase the proportion of
physical activity in school life according to the adolescent obesity rate and educate students on
healthy eating.
2. Conduct a census of the young people's living habits to determine whether the young people's
behaviors such as staying up late during holidays and weekends are reversed. Educate young people
about the importance of time for good work and rest. At the same time, the government should
actively manage matters that potentially affect the sleep quality of citizens, such as light pollution
and noise pollution that industrial cities may bring.

457 physicians of all specialties and 846 nurses work in the medical
organizations of the city K. There are 957 beds at the hospital and the maternity
hospital (Table 10).

Table 10
Dynamic of the availability of doctors, nurses and hospital beds
in the medical organizations of the city K. (per 10 000 population)

Indicators 2009 2014 2019

Ratio of physicians 37.8 41.4 45.7

Ratio of nurses 92.5 87.2 84.5

Ratio of beds 97.3 96.6 95.5

Task: evaluate the providing of the population of the city K. with doctors, nurses,
beds at medical organizations, draw a graphs, write conclusions.

22
 Answers:

availability of doctors, nurses,beds in the medical organization of City K.

Ratio of physicians Ratio of nurses Ratio of beds

97.3

96.6

95.5
92.5

87.2

84.5
45.7
41.4
37.8

2009 2014 2019

Conclusion:
The availability of doctors in medical organizations of the city K increases during 2009-2019
The availability of nurses in medical organizations of the city K decreases during 2009-2019
The availability of beds in medical organizations of the city K decreases during 2009-2019

Task: Make a general conclusion about the state of health of the population
of the city K.
Answers:

General conclusions:
The population growth rate in city K is meager, but the death rate is higher, the population is
decreasing.
The significant causes of death of the population in city K are diseases of the circulatory system
The primary morbidity and prevalence of the child population are higher than an adult.
The highest rank of primary morbidity and the prevalence are respiratory diseases
The number of patient with periodontitis by age in City K is more than Town M
the More length of the year the more number of people with hearing loss among dockyard workers

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