POSTGRADUATE PUBLIC HEALTH PROGRAM

CASE STUDIES IN APPLIED EPIDEMIOLOGY

No. M1.U2

Nama : Husni Mubarak

NIM : 21/485020/PKU/19607
Minat : PPK

Measuring And Comparing Disease Frequency

Student’s Tutorial

Overview
Epidemiological principles and methods are used to describe the frequency and the determinants
of disease, injury and death occurrence. In this chapter you will learn about the epidemiological
measures that are used to quantify the frequency of morbidity and mortality in a population.

Objective
After this session, students were expected to better able to:
1. Define the basic measurement including proportion, rate and ratio
2. Define and calculate define and calculate a range of measures of frequency of disease,
including prevalence, risk, odds and rates
3. Define and calculate crude and specific mortality rates
4. Explain the limitations of comparing crude rates between populations and the methods to
overcome these limitations.

Activity 1.
Determine whether each of the following statements is ratio, proportion or rate

Tabel 1. Questions of statements is ratio, proportion or rate

No Statements Answer
A. The incidence of dengue is 40/100.000 population per year Rasio
Occurrence of typhoid cases in a elementary school for class 4
B. to class 5 is 1: 5 Rasio

Person who had active smokers has 30-40% higher risk (1,3 -
C. 1,4) to diabetes mellitus of type 2 than nonsmokers. Rate

80% of measles cases in Magelang have history of measles

D. Proporsi
vaccination
Patient who had surgery procedure at room A has 4.3 higher
E. risk to develop post-surgery infection compared to those who Rate
had surgery procedure at room C in the Y Hospital

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Activity 2.

On May 2017, Creak factory was reported a number of their employee suffering from symptoms of
nausea, vomiting, diarrhea and abdominal pain after lunch. A total of 218 employees reported had same
symptoms after lunch and 4 of them were hospitalized.
The menu of lunch such as nasi kuning, ayam bumbu bali, kering tempe dan telur iris.
The result of investigation found 306 cases were ate same menu in lunch. Employee were ate Ayam
bumbu bali 243 dan 212 were ill, 255 were ate nasi kuning and 218 were ill, 237 ate kering tempe and
201 were ill, 227 ate telur iris and 192 ill.

No Jenis Jumlah Jumlah Jumlah Bergejalah Status tidak Di rawat

Makanan Kasus Sehat Sakit mual,muntah,dia diketahui di RS
re,
sakit perut
1 Nasi Kuning 255 37 218
2 Ayam 243 31 212
bumbu Bali
3 Kering 237 36 201
Tempe
4 Telur iris 227 35 192
Total 962 139 823 218 84 4

1. Calculate and interpret crude attack rate!

CDR =Jumlah total kasus x 1000
Jumlah yang sakit
= 962
823
= 1.16

2. Calculate food-specific attack rate!

a. Kelompok makanan Nasi kuning
ASDRx =Dx x 1000
Px
= 255
218
= 1.16

b. Kelompok makanan Ayam Bumbu Bali

ASDRx =Dx x 1000
Px
= 243
212
= 1.14

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 c. Kelompok makanan Kering tempe
ASDRx =Dx x 1000
Px
= 237
201
= 1.17
d. Kelompok makanan Telur iris
ASDRx =Dx x 1000
Px
= 227
192
= 1.18

3. Interpret your finding! And Help DHO to find which responsible for this outbreak?
Dari 306 kasus yang ditemukan pada karyawan pabrik Creak karena memakan makanan yang
sama pada saat makan siang ditemukan 823 orang yang sakit,dan 139lainnya tetap sehat, yang
memiliki gejalah mual, muntah, diare dan sakit perut sebesar 218 orang, dan yang dirawat di rs 4
orang, dan 84 lainnya status tidak diketahui.
Dari kasus ditemukan bahwa menu makanan yang dimakan pada saat makan siang merupakan
penyebab utamanya, yang dapt dilihat dari adanya keluhan seperti yang dialami oleh para
karyawan pabrik Creak sehingga besar kemungkinan keracunan makanan adalah penyebab
utamanya, hal ini terjadi karena :
- Bahan atau makanan yang dikonsumsi mengandung bakteri, virus, atau parasit yang
merugikan
- Kurangnya menjaga kebersihan makanan yang dikonsumsi, orang yang mengolah
makanan,dan lingkungan / peralatan yang digunakan
- Yang bertanggung jawab dalam hal ini adalah penyedia makanan/ pihak catering.

4. Why not all the employees were sick?

Alasan tidak semua karyawan sakit itu karena dipengaruhi oleh beberapa factor salah satunya
system kekebalan tubuh yang kuat, bukan kelompok rentan, tidak memiliki penyakit kronis, usia
yang masih relatif muda lebih beresiko pada usia tuah.

Activity 3.
Five hundred men who were working in Factory A were screened for HIV on 31 January 2005 for the
first time, and 30 of them were found to be positive for HIV antibodies. These 30 employees were than
referred to HIV clinic for further examination and treatment. The screening was a part of health
reproductive program in the factory and establish on yearly basis. The yearly HIV screening program
for employee was than repeated again on 31 January 2006 in the same 500 men and found that 50
employees were positive, including 30 men who were positive on the 2005 screening (no one had died
or lost to follow-up).
1. What is the prevalence of HIV in men working in factory A on 31 January 2005, and on 31 January
2006?

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 Diketahui :
Jumlah karyawan yang bekerja di pabrik A yang diskrining pertama kali adalah 500 orang,
prevalensi HIV pada tahun 2005 adalah 30 kasus, sedangkan pada tahun 2006 jumlah prevalensi
HIV ada 20 kasus, sehingga jumlah kasus menjadi 50.
Dimana prevalensi = Jumlah penderita
Jumlah karyawan yang diskrining

Pada tahun 2005 = 30 = 0,6 %

500

Pada tahun 2006 = 20 = 0,4 %

500

Jadi prevalensi HIV pada laki -laki yang bekerja dipabrik A pada tanggal 31 januari 2005 sampai
31 januari 2006 adalah sebanyak 50 kasus

2. What is the annual risk of developin g HIV infection in men working in factory A in 2005?
Dari kasus diatas, dapat disimpulkan bahwa resiko tahunan terkena infeksi HIV pada pria yang
bekerja dipabrik A pada tahun 2005 adalah 1,5 kali lebih tinggi dibandingkan pada tahun 2006.

2000 men from factory Hun were screened for HIV on 1 January 2012 and 60 men were found to be
HIV positive. For those who are positive, the factory clinic referred them to HIV clinic at the district
level for further exam and treatment. All the men were tested for HIV once a month until 31
December 2012 and all test carried out at the end of the month. 20 men became HIV positive during
these 12 months. Figure below shows when these 20 men become HIV positive. The remaining
1920 men were still HIV negative by December 2012. No one died or was lost to follow up during
this period.

Figure 1. Cases-Time of Illness HIV From January – December

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 3. What were the odds of becoming infected with HIV in the first 6 months of 2012 in the 20 men
who became HIV-positive that year?
Jumlah peluang terinfeksi HIV dalam 6 bulan pertama tahun 2012 pada pria yang menjadi
positif tahun ini adalah 12 orang.

4. What is the total number of person-months at risk of HIV infection observed in this study?
20 orang selama 12 bulan

5. What is the incidence rate of HIV infection in men working in factory Hun?
Jumlah kejadian 80 orang positif HIV
Dari 2000 karyawan laki -laki dari pabrik Hun yang diskrining terdapat 60 kasus HIV pada
awal januari 2012, setelah dilakukan skrining berkala sampai akhir tahun 2012 jumlah kasus
HIV bertambah total menjadi 80 orang, ini berarti dalam satu tahun berjalan terjadi
penambahan kasus sebanyak 20 orang.

Activity 4.
Definitions:
 Infant Mortality Rate: The rate of death for children less than one year of age during a specified year.
The denominator is the total number of live births during the same year.
 Neonatal Mortality rate: The rate of death of children less than 28 days of age during a specified
year. The denominator is the total number of live births during the same year.
 Post-neonatal Mortality rate: The rate of death of children aged 28-364 days during a specified year.
The denominator is the total number of live births during the same year.
 Neonatal Mortality + Post neonatal Mortality = Infant Mortality

In 2019, the number of births In Indonesia were 900.000 live births and 26.395 were infant deaths (21%
of these infants death were neonatal).
(Resource: Ditjen Kesehatan Masyarakat, Kemenkes RI, 2020).
1. Calculate and interpret the infant mortality rate!

IMR = Jumlah kematian bayi umur < 1 tahun x 1.000

Jumlah kelahiran bayi hidup

= 26.395
900.000
= 0,0293

2. Calculate and interpret the neonatal mortality rate!

IMR = Jumlah kematian neonatus x 1.000

Jumlah kelahiran bayi hidup

= 0,21 x 26.395 = 5.542,95

= 5.542,95
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 900.000
= 0,00615

3. Calculate and interpret the post-neonatal mortality rate

IMR = Jumlah kematian post neonatus x 1.000

Jumlah kelahiran bayi hidup

= 26.395 – 5.542= 20.853

= 20.853
900.000
= 0,0231

In country U during the same year, there were 155.030.700 male population and the number of deaths of
male were 1.439.111 Among male death from 347.879 were caused by heart disease and 315.147
Malignant neoplasms disease.
4. Calculate and interpret the crude death rate from all causes for male!

CDR = M x 1000
P
= 1.439.111
155.030.70
= 92,82

CDR = Angka kematian kasar

M = Jumlah kematian selama satu tahun
P = jumlah penduduk pertengahan tahun
1.000 = Jumlah kelahiran perpenduduk

5. Calculate and interpret the death rate from heart disease among male!

ASDR = Mi/Pi x 1.000

= 1.439.11 x 1.000
155.030.700
=9,28
Artinya, setiap 1.000 penduduk yang bejenis kelamin laki-laki memiliki resiko kematian
akibat penyakit jantung sebesar 9,28%

ASDR = Angka kematian khusus

Mi = Jumlah kematian pada kelompok tertentu
Pi = Jumlah penduduk laki-laki

6. Calculate and interpret the proportion of all death among male due to heart disease and malignat

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 neoplasmas

Case Fatality rate menunjukkan seberapa fatalkah suatu penyakit dapat menimbulkan kematian
CFR = Jumlah kematian akibat penyakit x
Jumlah kasus yang terdiagnosa sebagai sebagai penyakit x pada waktu yang sama

CFR = 347.879 x 100

1.439.111
= 24,17
Artinya setiap 100 jumlah kasus yang terdiagnosa sebagai penyakit jantung terdapat 24,17 kasus
kematian pada waktu yang sama

CFR = 315.147 x 100

1.439.111
= 21,89
Artinya setiap 100 jumlah kasus yang terdiagnosa sebagai penyakit neo plasma ganas terdapat 24,17
kasus kematian pada waktu yang sama

Activity 5
A total of 1,176,453 deaths (all causes in the whole population) were reported in country X in 2003.
The mid-year population in 2003 was estimated to be 198,812,000. HIV-related deaths and mid-year
population by age group are given in below table. Calculate the crude death rate (from all causes) in
country X in 2003.

Table 2. HIV-related Deaths and Mid-years Population by Age Group in Country

X in 2003

1,1

1,4

5,7

1. Calculate the crude HIV-related death rate in country X in 2003 in the whole population on table
2.
CDR =M x 1000
P
= 11.406
198.812.000
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 = 5,73

2. Calculate the age-specific HIV-related death rate among 5–14-year-olds and among 35–44-year-
olds on table 2.

e. Kelompok usia 5-14 tahun

ASDRx =Dx x 1000
Px
= 30
28.146.000
= 1,1
Artinya setiap 1000 penduduk yang berumur 5-14 tahun yang meninggal sebanyak 1,1
dalam satu tahun

ASDR = angka kematian kelompok umur x tahun

Dx = Jumlah kematian penduduk kelompok umur x tahun
Px = Jumlah penduduk yang termasuk dalam kelompok umur x tahun

f. Kelompok usia 35-44 tahun

ASDR =D x 1000
Px
= 4096
29.305.000
= 1,4
Artinya setiap 1000 penduduk yang berumur 35-44 tahun yang meninggal sebanyak 1,4
dalam satu tahun

ASDR = angka kematian kelompok umur x tahun

Dx = Jumlah kematian penduduk kelompok umur x tahun
Px = Jumlah penduduk yang termasuk dalam kelompok umur x tahun

HIV-related deaths and mid-year population by age group in Country Y in 2003 are given in table 3 below.

Table 3. HIV-related Deaths and Mid-years Population by Age Group in Country Y in

2003

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 3. Calculate the age-specific HIV-related death rates for country Y in 2003, and complete table
above on table 3.
a. Kelompok usia 0-4 tahun
ASDRx =Dx x 1000
Px
= 336
33.600.000
= 0,01

b. Kelompok usia 5-14 tahun

ASDRx =Dx x 1000
Px
= 87
62.400.000
= 1,4

c. Kelompok usia 15-24 tahun

ASDRx =Dx x 1000
Px
= 499
38.400.000
= 1,3

d. Kelompok usia 25-34 tahun

ASDRx =Dx x 1000
Px
= 4454
38.400.000
= 0,11

e. Kelompok usia 35-44 tahun

ASDRx =Dx x 1000
Px
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 = 3360
24.000.000
= 0,14

f. Kelompok usia 45-54 tahun

ASDRx =Dx x 1000
Px
= 1516
19.200.000
= 7,9

g. Kelompok usia 55+ tahun

ASDRx =Dx x 1000
Px
= 504
24.000.000
= 2,1

The HIV-specific death rate for country Y in 2003 was 4.5 per 100,000 populations. Your calculation for
Question 2 should have given you the HIV-specific death rate in country X in 2002 as 5.5 per 100,000
populations.
4.Can you conclude that a person living in country X has a risk of dying from HIV that is 1.2 times
(5.73/4.5 = 1.27) as high as a person living in country Y?
Tingkat kematian terkait HIV dinegara X lebih tinggi daripada negara Y sedangkan jumlah
populasi pertengahan tahun menurut kelompok umur di negara X lebih kecil/sedikit bila
dibandingkan dengan negara Y pada tahun yang sama, dengan demikian dapat disimpulkan
bahwa hai ini dipengaruhi oleh factor jumlah populasi dan jumlah kasus yang terjadi.

5.Discuss the limitations of the comparison in Question b above and outline two ways to
overcome them.
Rate x = Jumlah kasus = 11.406 =5,7
Jumlah populasi 198.812.000

Rate y = Jumlah kasus = 10.756 =4,5

Jumlah populasi 240.000.000

Artinya negara x memiliki resiko kematian akibat HIV 1,2 kali lebih tinggi daripada negara y.

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Ver.2021/IKM_IKT