CHN 2 Module3

Union Christian College
Widdoes St., Brgy. II, City of San Fernando, La Union

2500 Philippines
Email Address: president.ucc.2018@gmail.com
Website Address: www.ucc.edu.ph
Tel.#s. (63) 072 700-0282/242-4529, Tel. Fax (63) 072 888-3340, 072 687-2539
HEALTH STATISTICS AND EPIDEMIOLOGY
COURSE GUIDE
The key to successfully accomplish this online course lies in your hands. This module was prepared for you to learn intelligently,
wisely, diligently and independently. As would-be - nurse, doing these will greatly help and prepare you to become an efficient
and effective nurse. Aside from meeting the course content and performance standards of this course in accomplishing the
given activities, you will be able to learn other invaluable learning skills and attitudes which you will be very proud of as a
responsible learner. The following guides and house rules will help you further to be on track and at the end you can say “I did
my best”.
1. Schedule and manage your time to read and understand every part of the module. Read it repeatedly until you got the
idea. Due to the problems on internet connections and to be able to cooperate with our government in observing the ECQ
protocols, this online course will be delivered asynchronously.
2. In consideration of other modules from other courses, study how you can manage to do the activities of this course. By
being conscious of your study schedule, post it in a conspicuous place so that you can always see. Always remind
yourself of deadlines. Make appropriate adjustments with personal schedule to course schedule. Inform your respective
CI if you are unable to attend certain discussions online.
3. Read in advance. Devote your time to read any resources given to you. If you have questions or queries about the
content on which you find hard to understand, address the concerned Clinical Instructor.
LANI CAMAT-MUECA.RN,MAN,MAEDC 1
2500 Philippines
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4. During the online discussions, be polite and respectful not trying to argue and defend your opinions. Be courteous at all
times. Answer appropriately. Do not make any remarks considered as personal attacks. Focus on the idea and not the
person. The purpose of academic discussion is to develop your critical thinking.
5. Qoute the source by mentioning the author’s last name and year. Avoid any form of plagiarism.
LANI CAMAT – MUECA.RN, MANc, MAEDc
Clinical Instructor
Email Add.: lanimueca5@gmail.com

FB Account: lani cmueca
Philippians 4:13 “I can do all things through Christ who gives me strength.”
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“Investigation may be likened to the long months of pregnancy, and solving a problem to the day of birth. To investigate the
problem is, indeed, to solve it .”
—Mao Tse-Tung
MODULE III UNIT I
Health Statistics and Epidemiology
A. Tools
1. Definition
Demography
Population Size
Composition
Distribution
Sources of Data – Power point Presentation
2. Health Indicators
Crude Birth Rate
Crude Death Rate
Infant Mortality Rate
Maternal Mortality Rate
Specific Rates of Mortality
Leading Causes of Morbidity
Leading Causes of Mortality
ENGAGE
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The Greek physician Hippocrates is sometimes said to be the father of epidemiology. He is the first person known to have
examined the relationships between the occurrence of disease and environmental influences. • epi – means “on, upon, befall” •
demo – means “people, population, man” • logy – means study
EXPLORE
EPIDEMIOLGY
Key Words
Epidemic : ( Epi = upon : demos = people ) An outbreak of disease in a community in excess of “normal expectation ”
Endemic: (en = in; demos = people). The constant presence of disease within a geographic area or the usual prevalence of a
given disease in a particular area. malaria, tuberculosis, etc.
Pandemic: (pan = all: demos = people) An epidemic which spreads from country to country or over the whole world, as for
example, the recent epidemic of AIDS; COVID-19
DEFINITION OF EPIDEMIOLOGY
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The study of frequency, distribution and determinants of health-related diseases or events in specified populations, and the
application of this study to the prevention and control health problems. (International epidemiological association; Last, 1988)
Definition of Epidemiology
TERM EXPLANATION
Study Includes surveillance, observation, hypothesis testing, analytic research, and experiments
Distribution Refers to analysis by time, places, and classes of people affected
Determinants Include all the biological, chemical, physical, social, cultural, economic, genetic, and behavioral factors that
influence health
Health-related states or Refer to diseases, causes of death, behaviors such as the use of tobacco, positive health states, reactions
events to preventive regimens, and provision and use of health services
Specified populations Include those with identifiable characteristics such as occupational groups
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Application to prevention The aim of public health – to promote, protect, and restore good health
and control
Source: Adapted from Bonita et al.,2006
A. DEMOGRAPHY
The empirical, statistical and mathematical study of human population; derived from tow Greek words snyos, which
means people and ypagly which means to draw or write.
 Focuses on three common and observable human events:
a. Population composition or structure
b. Distribution of population in space
c. Population size – as affected by births, deaths, migration
 Sources of demographic data
B. COMPONENTS
1. Population composition – pertains to all measurable characteristics of the people who make up a given population
Common characteristics of interest:
 Age
 Sex
 Other characteristics: marital status, religious composition, educational attainment, occupation
a. Sex Ratio
Number of males
= X 100
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Number of females
Sex Structure – method of characterizing the sex composition of the population by computing the sex ratio of each
group
b. Age – dependency Ratio – used as an index of age – induced economic drain on human resources
Number of Persons 0-14 years old + number of persons aged 65 years and over
= X 100
Number of persons 15 -64 years old
The computed value represents the number of dependents that need to be supported by every 100 individuals
in the economically active group.
Assumptions:
 All children below 15 years and person above 65 are economically unproductive
 All persons aged 15 – 64 are economically productive
c. Age and Sex Composition – graphical presentation of the age and sex composition of a population through the
use of a POPULATION PYRAMID
d. Median Age – age below which 50% of the population fall. The lower the median age, the younger the
population (high fertility, high death rates).
e. Life Expectancy at Birth – average number of years an infant is expected to live under the mortality conditions
for a given year; mortality rates differ between sexes, thus, values of life expectancy at birth are calculated
separately for males and females.
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2. Population Distribution
a. Urban – Rural Distribution
- Shows the proportion of people living in urban compared to the rural areas
b. Crowding Index
- Indicates the ease by which a communicable disease can be transmitted from one host to another
susceptible host.
Total # of Persons in Household
Crowding Index =
Number of Rooms in the House
 The higher the index, the easier the disease transmission
c. Population Density
- Determines congestion of the place
 Number of people living in each square meter or square kilometer of a geographic unit
 The higher the population density, the more congested the area
3. Population Size
a. Natural Increase – difference between the number of births and the number of deaths that occurred in a
specific population within a specified period of time (usually one year)
b. Rate of Natural Increase – difference between Crude Birth Rate (CBR) and Crude Death Rate (CDR) of a
specific population within a specified time
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VITAL STATISTICS – the application of statistical measures to vital events (births, deaths and common illnesses) that is
utilized to gauge the levels of health, illness and health services of a community
HEALTH INDICATORS – a list of information which would determine the health of a particular community like population,
CBR, CDR, infant and maternal death rates, neonatal death rates and tuberculosis death rate
HEALTH INDICATORS
 Birth
 Death
 Marriages
 Migration
MORBIDITY
The occurrence of an illness or illnesses in a population.
Defined as any departure, subjective or objective, from a state of physiological well-being. The term is used
equivalent to such terms as sickness. Illness, disability etc. WHO Expert Committee on Health Statistics noted in
its 6th Report that morbidity could be measured in terms of 3 units (a) persons who were ill (b) the illnesses
(periods or spells of illness) that these persons experienced; and (c) the duration (days, weeks, etc.) of these
illnesses
MORTALITY
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The occurrence of death in a population.
Mortality data are relatively easy to obtain, and, in many countries, reasonably accurate. Many countries
have routine systems for collecting mortality data each year, information on deaths is analyzed and the resulting
tabulations are made available by each government.
COMMON VITAL STATISTICAL INDICATORS

 Fertility Rates
o Crude Birth Rate
Number of Live Births in a Year

= X 1000
Midyear Population, same year
Used often because of availability of data

a. Measure how fast people are added to the population through births. Affected by:
 Fertility/marriage practices of place
 Sex and age composition of a population
 Birth registration practice
o General Fertility Rate

Number of Livebirths
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= X 1000
Midyear Population of women 15 – 44 years of age
a. More specific than the CBR since births are related to the segment of the population deemed capable of
giving birth.
b. In some countries, reproductive age group is 15-49 years of age
o Age Specific Fertility Rate
Total births to women age X years

= X 1000
Midyear Population of Women age X years
a. Most accurate refinement in the study of fertility

b. Permits in depth study of the
 Impact of birth control measures on fertility and
 Differences in fertility at specific ages throughout the reproductive period
 Mortality Rates
 Crrude Death Rate
Number of Deaths
= X 1000
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a. Crude because death is affected by different factors

b. Factors that affect the level of this rate are:
- Age and sex composition of the population
- Adverse environmental and occupational conditions
- Peace and order situation
c. Widely used because of availability of data
d. Caution when comparing two or more populations with different structures
 Specific Mortality Rate

Number of Deaths in Specified Group
= X 1000
a. Made specific according to:
- Age
- Sex
- Occupation
- Education
- Exposureto risk factors
- Combination of the above
b. More valid than CDR when comparing mortality experiences between group
- High mortality rate among infants and elderly and among manales
- In developing countrieshowever, women of the reproductive age have higher death
rates than males of the same age
- Graph shows a J shaped or U shaped curve (age versus mortality rate)
2500 Philippines
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 Cause – of – death Rate
Number of deaths in Specified cause

= X 100,000
a. Crude rate since the denominator includes the whole population
b. Could be made specific by relating the deaths from a specific cause and group to the mid-
year population of that specific group
c. Factors that affect this include:
- Completeness of registation of deaths
- Composition of the population
- Disease ascertainment in the community
a. Ten leading causes of death are determined using this measure

b. May also be refined as to age and sex
 Infant Mortality Rate

No. Of deaths under 1 year of age
= X 1,000
Number of Livebirths, same year
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a. SENSITIVE INDEX of level of health in a community

b. HIGH IMR means LOW LEVELS of health standards secondary to poor maternal and child
health care, malnutrition, poor environmental sanitation or deficient health service delivery
c. May be artificially lowered by improving the registration of births
d. Infant Mortality Rate may be further subdivided into:
 Neonatal Mortality Rate:
Numbe rof deaths among those under 28 days of age

= X 1000
Number of Livebirths, same year
 Post – Neonatal Mortality Rate

Number of deaths due to pregnancy delivery and puerperium
= X 1000
a. Subdivision needed because
b. Neonatal deaths – due to prenatal or genetic factors
c. Post –neonatal deaths – due to environmental genetic, nutritional, and infectious diseases
 Maternal Mortality Rate

Number of deaths due to pregnancy, delivery and puerperium
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= X 1000
a. Measures risk of dying from causes associated with childbirth

b. Affected by:
- Maternal health practices
- Diagnostic ascertainment of maternal condition or cause of death
- Completeness of registration of birth
c. Ideal denominator should be number of pregnancies
 Perinatal Mortality Rate

Fetal deaths, 28 weeksand over of gestation + early neonatal deaths, 1 week of age in
calendar year
=
X 1000
Number of Livebirths in the same year
 Proportionate Mortality Rate

Number of deaths from a particular cause
= X 100
Total Deaths from all causes, same year
a. Used in ranking cause of death by magnitude of frequency (TEN LEADING CAUSE OF
MORTALITY)
b. Expressed in PERCENTAGE
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c. Does not show the probability of dying in a given population because denominator does
not show the population at risk
d. CAREFUL when making comparison between diseases, because the PMR of a disease
causing an epidemic may get a very high PMR while others would not, as result of
ARTIFICIAL LOWERING, and NOT of effective control
 SWAROOP’s Index
Number of deaths among those 50 years& over
= X 100
Total deaths, same year
a. Another Proportionate Mortality Rate measure
b. Directly proportional to the helth status of a population, where developed countries have
higher Swaroop’s index than developing ones
c. LOW INDEX implies that life expectancy is short
d. For example, an index of 20% means that only 80% die before age 50 years
 Case Fatality Rate

Number of deaths from a specified cause
= X 100
Number of cases of the same disease
a. Measures the killing power of a disease or injury

b. A HIGH CFR means a more fatal disease
c. Time element is NOT ANNUAL, but the usual duration of the prticular disease
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d. Follow – up of cases should be for a defined peiod only because deaths occurring beyond
usual period could not be reasonably directly related to the disease under study
e. Rate is useful in ACUTE infectious diseases, assuming that all new cases are reported
and most deaths occurred in a relatively short time after diagnosis
f. Rate depends on :
- Nature of the disease
- Diagnostic ascertainment
- Level of reporting in the population
g. CFR from hospitals HIGHER than from the community
 Morbidity Rates
 Incidence Rate
Number of NEW CASES of disease developing from a period of time

= X 100, 000
Population in the area during the same period of time
a. Measures the development of a disease in a group exposed to the risk of the disease in a
period of time
b. Can be made specific for age and sex
c. Tells of the speed of development of disease
d. Answers the question ‘how frequently does a disease occur within a given period of time,
for example, a year?
e. Appropriate to describe :
- Acute conditions – when it is usually higher than prevalence
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- Outbreaks or epidemics – study of causation or etiologic factors of a disease

- Secular trends – changes in disease pattern over short periods of time
 Attack Rate
Number of NEW CASES of disease developing from a period of time
= X 100
Population at risk of developing the disease during the same period of time
- Used for a limited population group and time period, usually during and outbreak or
epidemic
 Prevalence Rate
- Useful in describing the occurrence of chronic conditions and as basis for making
decisions in the administration of health services
- Useful also in computing for carrier rates and antibody levels
a. Point Prevalence
Number of existing (Old and New Cases) of a disease at a given time
= X
100
Population examined during that time
b. Period Prevalence
Number of Existing (OLD and NEW CASES) Of a disease at a given interval of
time
= X 100
Population examined during that interval of time
IMPLICATIONS OF VITAL STATISTICS TO THE INDIVIDUAL, FAMILY AND COMMUNITY
2500 Philippines
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1. It serves as an index of the health conditions of the people in a community

2. It provides valuable clues as to the nature of health services or actions needed and serve
as bases for determining the success or failure of such services/action
3. It is an indispensable tool in planning, implementation, and evaluation of any health
program
The 10 leading causes of mortality, morbidity, infant and maternal mortality in the Philippines.
Mortality Morbidity Infant Mortality Maternal Mortality
Disease of heart Acute respiratory Bacterial sepsis of newborn Complications related to
infection pregnancy occurring in the course
of labor, delivery and puerperium
Disease of the vascular Acute lower respiratory Pneumonia Hypertension complicating
system tract infection and pregnancy, childbirth and
pneumonia puerperium
Malignant neoplasm Bronchitis Respiratory distress of Postpartum hemorrhage
newborn
Pneumonia Hypertension Congenital malformation of the Pregnancy with abortion outcome
formation of the heart
Accidents Acute watery diarrhea Disorders related to short Hypertensive cardio vascular
gestation and low birth weight,
not elsewhere classified
Tuberculosis Influenza Congenital pneumonia Pneumonia
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Chronic lower respiratory Urinary tract infection Neonatal aspiration syndrome Kidney diseases
diseases
Diabetes mellitus TB respiratory Intrauterine hypoxia and birth Diabetes
asphyxia
Nephritis, nephrotic Injuries Other congenital malformations Accident
syndrome and nephrosis
Certain conditions Diseases of heart Diarrhea and gastroenteritis of Malignant neoplasm
originating in the perinatal presumed origin
period
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❂ APPLY
1. Choose one of the major causes of morbidity and mortality, such as cardiovascular disease.
a. On the basis of current epidemiological research evidence, outline the natural history, including known risk factors.
b. Based on the natural history, specify interventions for primary, secondary, and tertiary prevention of this disease
ASSESS
Summative Assessment
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REFERENCES:
Gesmundo, Monina H. 2009 .Nursing Board Exam Review Notes Volume 2.CENE Philippines, Manila.
Epidemiology.Retrieved October 1, 2021 https://www.slideshare.net/pateldharmendra4/epidemiology-for-nursing-student

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Union Christian College

Widdoes St., Brgy. II, City of San Fernando, La Union

HEALTH STATISTICS AND EPIDEMIOLOGY

LANI CAMAT – MUECA.RN, MANc, MAEDc

Email Add.: lanimueca5@gmail.com

MODULE III UNIT I

Health Statistics and Epidemiology

Distribution Refers to analysis by time, places, and classes of people affected

Source: Adapted from Bonita et al.,2006

Total # of Persons in Household

Number of Rooms in the House

 The higher the index, the easier the disease transmission

The occurrence of death in a population.

COMMON VITAL STATISTICAL INDICATORS

o Crude Birth Rate

Number of Live Births in a Year

Used often because of availability of data

o General Fertility Rate

o Age Specific Fertility Rate

Total births to women age X years

a. Most accurate refinement in the study of fertility

a. Crude because death is affected by different factors

 Specific Mortality Rate

 Cause – of – death Rate

Number of deaths in Specified cause

a. Ten leading causes of death are determined using this measure

 Infant Mortality Rate

a. SENSITIVE INDEX of level of health in a community

 Neonatal Mortality Rate:

Numbe rof deaths among those under 28 days of age

 Post – Neonatal Mortality Rate

 Maternal Mortality Rate

a. Measures risk of dying from causes associated with childbirth

 Perinatal Mortality Rate

 Proportionate Mortality Rate

 Case Fatality Rate

a. Measures the killing power of a disease or injury

Number of NEW CASES of disease developing from a period of time

- Outbreaks or epidemics – study of causation or etiologic factors of a disease

IMPLICATIONS OF VITAL STATISTICS TO THE INDIVIDUAL, FAMILY AND COMMUNITY

1. It serves as an index of the health conditions of the people in a community

Epidemiology.Retrieved October 1, 2021 https://www.slideshare.net/pateldharmendra4/epidemiology-for-nursing-student

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