RATES, RATIOS, AND VITAL STATISTICS

RATIO
•also called a proportion if the quotient of the sum of the two numbers. A good example is
number of deaths per population
RATE
•ratio involving a time period
•count or measurement is observed over a period and then divided by its base or
population of observation.
Incidence Rate
•measures the frequency of occurrence of the phenomenon during a given period of time.
Deals only with NEW cases.
Prevalence rate
•Measures the proportion of the population which exhibits a particular disease at a
particular time.
•This can only be determined following a survey of the population concerned. •Deals with
total (OLD and NEW) number of cases

Concepts of Incidence and Prevalence

INCIDENCE
•Also known as attack rate, case, sickness rate morbidity rate
•It refers to newly discovered cases of a particular disease
•It answers the question “how frequent do cases of a particular disease occur during a
given period of time”
•Used when dealing with acute conditions and accidents
PREVALENCE
•It refers to the newly discovered and old cases of a particular disease over a population
•Used when dealing with chronic conditions and disabilities
•It answers the question “what proportion of the group or population is actually ill with a
particular disease at a point in time.
•Usually determined by means of survey
CRUDE BIRTH RATE (CBR)
•This is a measure of fertility of the population
•The rate is called crude for the following reasons
–Only live births are counted
–The denominator is the total population which includes children, old people and
males
–The rate is expressed in population unit of 1000 to make the figures meaningful
CRUDES DEATH RATE (CDR)
•This is a measure of the risk of dying from all causes in a population.
•The Crude Birth Rate (CBR) and Crude Death Rate (CBR)
–statistical values that can be utilized to measure the growth or decline of a
population.
–measured by the rate of births or deaths respectively among a population of 1000.
 –determined by taking the total number of births or deaths in a population and
dividing both values by a number to obtain the rate per 1000.
MATERNAL MORTALITY RATE (MMR)
•Measure the risk of dying due to the process of pregnancy, childbirth and puerperium.
•It also measures the adequacy of maternal health services
INFANT MORTALITY RATE (IMR)
•Measures the risk of dying due to infancy (under 1 year of age)
•deaths under 1 year of age/ number of live births x 1000
NEONATAL MORTALITY RATE
•Measures the risk of dying in the first four weeks of life of the infant (newborn)
•The number of children dying under 28 days of age divided by the number of live births
that year
• (Number of infant death / number of life birth) X 1000
FETAL DEATH RATE
•Measures the risk of dying before birth
PERI-NATAL MORTALITY RATE
•The word means around the period of birth (a month or more before births and one month
after birth)
•Measures the loss of life in later pregnancy and early infancy.
COMMON VITAL STATISTICS
Fertility Rates
•Crude Birth rate = number of live births
x 1000
Midyear population
•General Fertility Rate = Number of live births
x1000
Midyear population of women (15-44 years of age)
COMMON VITAL STATISTICAL INDICATOR
Mortality Rate
•Crude Death rate= number of deaths
x 1000
Midyear population
•Specific Mortality rate= number of death in a specified group
x 1000
Midyear population of the same specified group
•Cause-of-Death Rate= number of deaths from a specified cause
x 1000
Midyear population
•Infant Mortality Rate= deaths under one year of age
x 1000
Number of live births

•Maternal Mortality rate= number of deaths due to pregnancy, delivery and puerperium
x 1000
Number of live births
•Proportionate Mortality rate= number of deaths from a particular cause
x 100
Total Deaths
•Swaroop’sIndex= Number of deaths among those 50 years and over
_ x 100
Total Deaths
•Case Fatality rate= number of Deaths from a specified cause
x 100
Number of Cases of the same disease
Rates
•Incidence Rate= number of new cases of disease developing from a period of time
x 100
Population at risk of developing the disease
•Prevalence Rate= number of Old and new cases of a disease
x 100
Population examined
COMMON VITAL
Morbidity Rates
•Incidence Rate= number of new cases of disease developing from a period of time
x 100
Population at risk of developing the disease
•Prevalence Rate= number of Old and new cases of a disease
____________________________________ x 100
Population examine

INTRODUCTION TO EPIDEMIOLOGY
EPIDEMIOLOGY

• Study the occurrence and distribution of diseases as well as distribution of determinants of health state or
events in specified population and the application of this study to control health problems
• Field of science dealing with the relationship of the various factors which determine the frequencies and
distribution of an infectious process. A disease or a physiological state in human community.
• Study of the behavior of disease in the community rather than in individual patients and includes the study of
reservoirs and sources of human disease.
• Studies the patterns of disease occurrence in human populations and the factors that influence this pattern.
The term obviously is related to epidemic (derived form the Greek word” upon the people” meaning leading
the people)

C-E. A. Winslow, the great public health leader of the early 20th century, called epidemiology “the
diagnostic discipline of public health.”

EPIDEMIC

It is an increase in the frequency (incidence) of a disease above the usual and expected rate, which is called the
endemic rate., thus epidemiology count cases of a disease, and when they detect the sign of epidemic, they ask
who, when and where questions.

• Who is getting the disease

• Where and when the disease is occurring
• From this information, they can often make informed guesses as to why it is occurring.
 Notifiable disease - surveillance made by the government before many people start dying.
 The timely reporting of cases of notifiable disease allows public health authorities to detect an emerging
epidemic at an early stage.
 A typical Epidemiologic Investigation- Outbreak of hepatitis and Food poisoning

WHAT IS THE GOAL OF EPIDEMIOLOGY?

 The ultimate goal is to use this knowledge to control and prevent the spread of disease.

John Snow

 father of modern epidemiology - Study about cholera.

Two main areas of investigation

1. Describes the distribution of health status in terms of age, gender, race, geography, and time. 2. Patterns of disease
distribution in terms of causal factor

 In epidemiology of any disease or event, one studies the factor which contribute to its causation and behavior-
AGENT, HOST, ENVIRONMENT
 Epidemiology concept maintains that there can be no single cause of disease

Uses of Epidemiology
  1. Study the history of the health population and the rise and fall of diseases and changes in their character
 2. Diagnose the health of the community and the condition of the people.
 3. Study the work of health services with a view of improving them
 4. Estimate the risk of diseases, accidents, detects and the changes avoiding them
 5. Complete the clinical feature of chronic disease and describe their natural history
 6. Search for cause of health and disease

THE AGENT FACTORS OF DISEASE

 Agent is any element, substance or force whether living or non-living thing; the presence or absence can
initiate or perpetuate a disease process.

Types of Agent

 1. This could be living or non-living things, physical or mechanical in nature such as extremes of temperature,
light electricity.
 2. They could be chemicals- endogenous (within the body) or exogenous (poison)

Characteristics of Agent of disease

 1. Inherent characteristics- physical feature, biological requirement, chemical composition, resistance

 2. Characteristic in relation to the environment- refers to the reservoir and source of infection and modes of
transmission.
 3. Characteristic directly related to man
o a. Infectivity- ability to gain access and adapt to the human host to the extent of finding of finding
lodgement and multiplication
o b. Pathogenicity- measures the ability of agent when lodged in the body set up a specific reaction
o c. Virulence- refers to the severity of the reaction produce and is usually measured in terms of fatality.
o d. Antigenicity- ability to stimulate the host to produce antibody

Modes of Transmission

1. Direct transmission- immediate transfer of infectious agent a receptive portal of entry

2. Indirect transmission

a. Vehicle borne- contaminated inanimate objects or materials

b. Vector-borne- from other living organism (ex. Insects)

c. Mechanical vector

d. Biological vector

3. Airborne- dissemination of microbial aerosols to a suitable portal of entry usually the respiratory tract

a. Droplet nuclei- usually small residues which result from evaporation of fluid from droplets emitted by an
infected host b. Dust

THE HOST FACTOR OF DISEASE

 1. Age
 2. Sex
 3. Race
 4. Habits, Customs and religions
 5. Exposure to agent
 6. Defense mechanism of the host

1. Humoral defense- these are cells in our body like plasma cells and lymphocytes that produce antibodies to neutralize
harmful effects of the infectious agents and body fluids in our body that possess substance that have antimicrobial
properties

2. Cellular defense- there are cells in our body like macrophages and neutrophils involve in the process of phagocytocis.

THE ENVIRONMENTAL FACTORS OF DISEASE

Environment- sum total of an organism’s external surrounding conditions and influences that affect its life and
development
 • Physical Environment
• climate- certain disease have seasonal distribution
• Geography and location
• Biologic Environment- living environment of man consist of plants, animals and fellow human beings.

Incubation Period

Time between exposure to infectious agent up to the time of appearance of the earliest signs and symptoms

 Clinical incubation period- the time between exposure to a pathogenic organism and the onset of
symptoms of a disease.
 Biological Incubation Period- The time taken by the parasite to complete its development in the
definite host (from the time of entry of the infective larvae to the presence of microfilariae) is called
the Intrinsic incubation period (Biological incubation).

ISOLATION AND QUARANTINE

ISOLATION

 As applied to patient, separation for the period of communicability, of infected persons or animals
from others in such places and under such conditions as to prevent or limit the effect of the direct or
indirect transmission of the infectious agent from those infected to those who are susceptible or who
may spread the disease agent.

Categories of Isolation

 1. Strict isolation- this category is designed to prevent transmission of highly contagious or virulent
infectious that may spread by direct contact or droplet.
 2. Contact isolation- for less highly transmissible or serious infections, for disease or conditions which
are spread primarily by close or direct contact.
 3. Respiratory isolation- to prevent transmission of infectious diseases over short distance through
the air
 4. Tuberculosis isolation (AFB isolation)- for patient with pulmonary tuberculosis who have a positive
sputum smear or chest x-rays which strongly suggest active tuberculosis

Categories of Precautions

 Enteric Precautions- for infectious transmitted by direct or indirect contact with feces purulent
material or drainage from an infected body site
 Drainage/secretion Precautions- to prevent infections transmitted by direct or indirect contact with
purulent material or drainage from an infected body site.
 Blood/body fluid Precautions- to prevent infections that are transmitted by direct or indirect contact
with infected blood or body fluids.

 QUARANTINE- restriction of the activities of a well persons or animals who have been exposed to a
case of communicable diseases during its period of communicability to prevent disease transmission
during incubation of infection should occur.

Categories of Quarantine

 1. Absolute or Complete Quarantine Limitation of movement of those exposed to a communicable

disease for a period of time not longer than the longest usual incubation period of that disease.
 2. Modified Quarantine Selective, partial limitation of freedom of movements of contacts

Phases

 1. Pre-pathogenesis
 - This is the phase before man is involved. Through the interaction of the agent, the host
and environmental factors, the agent finally reaches man.
 - It maybe said that everyone is in the period of pre- pathogenesis of many diseases
because agents are present in the environment where man lives
 2. Pathogenesis
 - This phases includes the successful invasion and establishment of the agent in the hos
The process of infection

There are six requirements for the successful invasion of the host by an infectious agent.

1. Condition in the environment must be favorable to the agent or the agent must be able to adapt in the
environment

2. Suitable reservoirs must be present

3. A susceptible host must be present

4. Satisfactory portal of entry into the host

5. Accessible portal of exit from the host

6. Appropriate means of dissemination and transmission to a new host