PHS11- UNIT TEST 1 SEMESTER 1 2015 MARKING SHEET:

Section A: Multiple choices (10 marks)

1. C 6. D
2. B 7. A
3. D 8. D
4. B 9. A
5. C 10. B

Section B: True and False (15 marks)

1. True 9. False
2. False 10. True
3. False 11. True
4. True 12. True
5. False 13. True
6. True 14. True
7. False 15. True
8. False

Section C: Short answer & problem solving questions: (36 marks)

Question 1: Define the following terms:

a. Epidemiology is the study of the distribution and determinants of health – related events in specified
populations and the application of this study to control of health problems.

b. Population at risk is the population made up of people who are healthy and unhealthy but who have the
potential to develop the health event of interest. Reference population from where the cases are taken

c. Confounding factor is another factor other than the ‘exposure’ of interest that can also lead to the same
outcome of interest.

Question 2: List 3 broad uses of epidemiology and give an appropriate example for each?

a. Determine disease causation - Diseases can be caused by the interaction of genetic and environmental
factors. E.g. Malaria and the environmental factors that causes the elevated incidence of cases.
b. Natural History - The natural history of disease is the course of disease overtime unaffected by treatment.
E.g. examining the natural history of diabetics from the stage of susceptibility → stage of pre- symptomatic
disease → stage of clinical disease →stage of disability/ recovery.
c. Description of Health Status of Populations – e.g. identifying the proportion of people with malaria in
village x and allocating the needed resources for interventions.
d. Evaluation of Intervention – e.g. Evaluating the HIV/AIDS implementation programs at village x to know if
the intervention was successful and if not then what has to be done next.

PHS 11 –Test 1 Answer sheet  Semester 1 2015 Page 1

 Question 3: Describe two major differences between a case-control and a cohort study design.

Ans: Check for the following correct answers.

Case Control Study Cohort Study

1. Proceeds from effect to cause
2. Starts with the disease
3. Tests whether the suspected cause occurs more
frequently in those with the diseases than among
those without the disease.
4. Usually the first approach to the testing of a
hypothesis but also useful for exploratory studies
5. Involves fewer number of subjects
6. Yields relatively quick results
7. Suitable for the study of rare diseases
8. Generally yields only estimate of relative risk (
odds ratio)
9. Cannot yield information about diseases other
than that selected for study
10. Relatively inexpensive
1. Proceeds from cause to effect
2. Starts with people exposed to risk factor or
suspected cause
3. Tests whether disease occurs more frequently in
those exposed, than in those not similarly exposed
4. Reserved for testing of precisely formulated
hypothesis
5. Involves large number of subjects
6. Long follow – up period often needed, involving
delayed results.
7. Inappropriate when the disease or exposure under
investigation is rare
8. Yields incidence rates, relative risk as well as
attributable risk
9. Can yield information about more than one disease
outcome
10. Expensive

Question 4:

Compute:

i. The proportion of the elderly (aged 65+) in the population: 31,078/248,710 = 0.125 or 12.5%
ii. The proportion of the young (aged 0-14) in the population: (3,946+14,812+35,095)/248,710 = 0.217 or
21.7%
iii. The sex ratio in age group 0-14 expressed as 100 males: 100 males: 95.3 females
iv. The sex ratio in age group 65+ expressed as 67.2 males: 100 females

During the year, 4,158,212 babies were born alive and 2,148,463 people died of whom 38,351 were infants under the age of
one.

Compute

v. The crude birth rate: 4,158,212/248,710,000 = 0.0167 or 16.7 per 1,000 population
vi. The crude death rate: 2,148,463 / 248,709,000 = 0.0086 or 8.6 per 1,000 population

PHS 11 –Test 1 Answer sheet  Semester 1 2015 Page 2

Question 5:
i) What kind of study is this investigation of exercise and blood pressure?

Ans: Case-control study

ii) Present the result of the investigation in a 2 x 2 table.

Outcome
Exposure
(High Blood Pressure)
(Exercise)
Cases Control Total
Yes 96 175 271
No 144 75 219
Total 240 250 490

iii) Calculate the appropriate measure of association.

Odds Ratio: = a x d
b x c
= 96 x 75
175 x 144
= 0.29

iv) Interpret the result in words.

Ans: There is an association between the exposure and the outcome and that the exposure is protective.
Regular exercise among exposure will reduce or remove high blood pressure.

Question 6:

i) Construct a 2x2 table.

Outcome
Exposure
Disease (MI)
(O C use)
Yes No Total
Yes 8 192 200
No 2 598 600
Total 10 790 800

ii) Calculate the appropriate measure of association and interpret it.

Relative Risk: = IE or [a/(a+b)]/[c/(c+d)]

INE
= 8 /200
2/600
= 12

Interpretation: There is an association between the exposure and the outcome. Women with oral
contraceptive use are 12 times at risk of developing myocardial infarction heart attack.

PHS 11 –Test 1 Answer sheet  Semester 1 2015 Page 3