Inferential Statistics I:

Introduction

Mr. Shital Bhandary

Assistant Professor
Department of Community
Health Sciences
Shital Bhandary
PAHS 1
Review

Entity, Variable and Data

Categorical and quantitative variables
Scaling of variables
Descriptive statistics
Central Tendency, dispersion, skewness,
kurtosis
Correlation / Association
Sample size / Sampling Techniques
Shital Bhandary 2
Preview

Inferential / Applied biostitistics

Samples and populations (Sample size)
Estimation
Hypothesis testing
Critical value
P-value
Standard error and standard deviation
Confidence internal (95% CI)
Shital Bhandary 3
Inferential statistics
 It is the applied statistics where we want to make
inferences on the population based on the
sample(s) we collect
 The basic idea is to test the research hypothesis
e.g. height of female MBBS students is lower
than the height of the male MBBS students
 Research hypothesis are known as “alternative
hypothesis” in inferential statistics
 The “null hypothesis” is always stated as “no
difference” between two (or more) variables of
interest (under consideration)
Shital Bhandary 4
The hypothesis can be presented as:
H0: Height of female MBBS students =
Height of male MBBS students

H1: Height of female MBBS students < or

> or ≠ Height of male MBBS students

Which statistical measure do we use

here? Why?
How many samples do we need?
Shital Bhandary 5
Possibilities (Why?):

H0: F = M
H1: F < M

OR

H0: MdF = MdM

H1: MdF < MdM

Shital Bhandary 6
NB

This course will enable you to use the

appropriate biostatistical techniques for
various type of study designs (which you
have already learned in Epidemiology)

This course will not teach you about the

study design per se as you are expected
to have this competency by now.
Shital Bhandary 7
 Let’ begin with

SOME EXAMPLES

Shital Bhandary 8
Research
(S Bhandary and A Shrestha 2011)
Subject: Representative Nepalese women
of reproductive age (15 – 49) (NDHS
2006)

Hypothesis: None
But we used Chi-square test to find if the
prevalence of anemia is difference across
13 eco-development regions.
Shital Bhandary 9
Shital Bhandary 10
JGPEM Vol 2
What type of study design it this?

What will be minimum sample size

required for this?

Shital Bhandary 11
Research
(Shrijana Shrestha et al 2012)
Subjects: Healthy Nepal children (age 2 –
14 years) living permanently at high
altitude.

Research Hypothesis: Children residing at

higher altitude will have oxygen saturation
of hemoglobin different to those living at
lower altitude.
Shital Bhandary 12
Shital Bhandary 13
What type of study design it this?

What will be minimum sample size

required for this?

Shital Bhandary 14
Research (Babu Raja et al 2010)

Subjects: Two ethic groups (Jyapus and

Brahmin) of Kavre and Kathmandu
districts with Diabetes Mellitus Type 2
(matched with age and sex)
Research Hypothesis: Prevalence of
albuminuria is higher among Jyapus than
Brahmin DM Type 2 patients
Inclusion criteria:
Exclusion criteria:
Shital Bhandary 15
 [JNHRC 2010, Oct; 8 (17): 110 – 15]

Shital Bhandary 16
What type of study design it this?

What will be minimum sample size

required for this?

Shital Bhandary 17
Research (Uma Chhetry et al 2011)

Subject: Women who had previous history

of abortion and had delivered at Patan
Hospital in 2066 BS were followed.

Hypothesis: Sex Ratio at Birth is higher

than normal and it is related with the
prenatal sex determination and female
fecticides.
Shital Bhandary 18
Shital Bhandary 19
What type of study design it this?

What will be minimum sample size

required for this?

Shital Bhandary 20
Research (Ira Shreshta et al 2010)
Subject: Women delivering a full term
single baby at Patan Hospital within 60-
days of study period

Hypothesis: Maternal weight gain heavily

influences the birth weight of infants.

Other hypothesis: Demographic and socio-

economic characteristics also influences
the birth weight of the infants.
Shital Bhandary 21
Shital Bhandary 22
What type of study design it this?

What will be minimum sample size

required for this?

Shital Bhandary 23
Research (A Shah et al 2009)

Subject: Selected diabetes and non-

diabetes population of Kavre district

Hypothesis: Waist-Hip Ratio, Waist

Circumference and Body Mass Index
among diabetes population are lower than
the standard prescribed by WHO.

Shital Bhandary 24
Shital Bhandary 25
What type of study design it this?

What will be minimum sample size

required for this?

Shital Bhandary 26
Shital Bhandary 27
Quick Think: Research
(Shih-Chen Chang et al 2003)
Subject:

Hypothesis:

Shital Bhandary 28
What type of study design is this?

What will be minimum sample size

required for this?

Shital Bhandary 29
Summary: Process for performing
an Inferential statistical test
 Start with a theory
 Make a research hypothesis
 Operationalize the variable
 Identify the target population
 Form a null hypothesis for this population
 Collect a sample from the population and run the
study
 Perform statistical test to see if the obtained
samples are statistically different
 Dissiminate the findings
Shital Bhandary 30
Course Books

Fundamentals of Biostatistics: BERNARD

ROSNER (Seventh Edition and above)
(Duxbury Press).

Elementary Statistics: Step-by-step

Approach. Bluman (Eighth Edition and
above) (McGrawHill).

They are in your dropbox folder.

Shital Bhandary 31
 Recommended Books:
1. Statistics at Square One: TDV Swinscow and
MJ CAMPBELL (BMJ Books, Tenth Edition)
2. Statistics at Square Two: MJ CAMPBELL (BMJ
Books, First Edition, Second Impression)
(These two books can be downloaded free from
BMJ website from Nepal)
1. Basic and Clinical Biostatistics: LANGE (Third
Edition and above)
2. Teaching Health Statistics: Lesson and
Seminars Outlines (Second Edition): WHO
(These books are in our library?)
Shital Bhandary 32
 Break!!!

Shital Bhandary 33
 Inferential Statistics II:
Probability

Mr. Shital Bhandary

Assistant Professor
Department of Community
Health Sciences
Shital Bhandary
PAHS 34
Review Preview
 Experiment  Probability
 Sample space Classical definition
 Simple or  Laws of probability
experimental event Additive
 Exhaustive event Multiplicative

 Mutually exclusive  Probability based on:

event Binomial distribution
Poisson distribution
 Equally likely event
Normal distribution
 Independent event
Shital Bhandary 35
 Basic concepts
Experiment: An experiment gives rise to
a set of possible outcomes which can
occur, but there is an uncertainty as to
which one of them will actually occurs.
Example: Outcome of a normal
pregnancy.
Sample space: {Boy, Girl}
Thus, a sample space is the set of all
possible outcomes.
Shital Bhandary 36
 Example 1
If a couple wants to have two children,
then the sample space would be:
First Child Second Child Outcome
B B BB
G BG
G B GB
G GG
So, the sample space is: {BB, BG, GB, GG}
Shital Bhandary 37
Exercise 1
A surgeon performs three operations in a
day. What is the sample space of this
experiment? Illustrate your result using
tree-diagram.

At PAHS, Basic Science students can

have end year and two make up exams in
annual exam. Show the sample space of
this experiment using tree-diagram.
Shital Bhandary 38
Basic concepts (continued)

The outcomes of an experiment are the

elementary events or simple events.
For example, the experiment of tossing a
fair coin has two simple events which are
denoted by H (Head) and T (Tail).
An event of an experiment is a subset of
simple events of the sample space.

Shital Bhandary 39
 Examples of an event
 Suppose the throw of a dice results in the
number 3 on the top face. Then this
outcome may be regarded as the
occurrence of following events:
i) The number shown at the dice is an odd
number, which is the event, {1,3,5}
ii) The number is greater than 2, which is
the event {3,4,5,6}
iii) The number is less than 5, which is the
event {1,2,3,4}
Shital Bhandary 40
 On the other hand,

We may also say that the following events

have not occurred:
i) The number shown at the throw of a dice
is even, which is the event {2,4,6}
ii) The number shown at the throw of a dice
is less than 3, which is the event {1, 2}
iii) The number shown at the throw of a
dice is more than 4, which is the event {5,6}
Shital Bhandary 41
 Types of event

Exhaustive Events: The total number

of possible outcomes in any trail
(experiment) is known as exhaustive
events. For instance,
i) in tossing of a coin there are two
exhaustive events, viz., head and tail.
ii) in throwing a dice there are 6
exhaustive events since any of the
faces 1,2,…..,6 may come uppermost.
Shital Bhandary 42
Types of events (contd.)
 Mutually Exclusive Events: Events are said to
be mutually exclusive if the happening of any
one of them precludes the happening of all
others, i.e., if no two or more of them can
happen simultaneously. For example,
i) in tossing a coin the events head and tail are
mutually exclusive.
ii) in first pregnancy the events boy and girl are
mutually exclusive.

Shital Bhandary 43
 Types of events (contd.)

Equally Likely Events: Outcomes of a

trail are said to be equally likely if taking
into consideration all the relevant
evidences, there is no reason to expect
one in preference to other.
For instance, while tossing a fair coin,
head and tail are equally likely.
Similarly, in throwing an unbiased dice,
all the six faces are equally likely to
come.
Shital Bhandary 44
 Types of events (contd.)
Sure event
Unsure (impossible) event
Independent events: Several events are
said to be independent if the happening (or
non-happening) of an event is not affected
by the supplementary knowledge concerning
the occurrence of any number of remaining
events.
For instance, getting a boy in first pregnancy
is independent of getting another boy in the
second pregnancy.
Shital Bhandary 45
Probability

The probability is the numerical value to

the degree of uncertainty involved for the
occurrence of some future event
associated with an experiment.
Probability is usually denoted by “p”, thus,
the value associated with probability is
also known as p-value. It can take any
value between 0 and 1.

Shital Bhandary 46
 Probability (Range)

When p = 0, it means there is no chance

of an event happening or its occurrence is
impossible. For example, chances of
survival after rabies are zero or nil.
If p = 1, it means the chance of an event
happening are 100%, i.e., it is inevitable
(like death for any living body). Similarly,
probability of survival after sandfly fever is
100%
Shital Bhandary 47
Note before:

If the probability of an event happening in

a sample is p and that of not happening is
q, then,
q = 1 – p
p + q = 1

Shital Bhandary 48
 Calculation
If E is an event, then its probability (or
relative frequency) is defined as the ratio of
the number of times the event E occurs to
the total number of trial, that is,
P(E) = number of times event E occurring
total number of trails (experiments)

It may also be expressed as the ratio of

favorable number of cases to the
exhaustive number of cases.
Shital Bhandary 49
 Example 2
 If a surgeon at Martyr Gangalal Memorial Heart
Center performs open-heart surgery in 150
cases and succeeds in 138 cases in a year then
find the probability of survival after operation.
Also find the probability of dying after operation.

Solution: If event E is the survival after operation

then,

P (E) = Number of survivals after the surgery

Total number of patients operated
= 138/150 = 0.92
Shital Bhandary 50
Exercise 2
If a surgeon performs three operations in a
day, then find the probability that:
a. One of the patient will die
b. Two of the patients will survive
c. None of the patients will die
If a Basic Science student has two make
up exams to pass annual exam then find
the probability that he/she will fail in the
second make up exam.
Shital Bhandary 51
 Laws of probability
Addition law of probability
Multiplication law of probability
Binomial law of probability distribution
Probability from shape of Normal
distribution
Probability of calculated values from
tables.

NB: “or” means addition and “and”

mean multiplication in probability.
Shital Bhandary 52
 Addition law
If A and B are two mutually exclusive (or
independent) events then:
P (A or B) or P (A + B) = P(A) + P(B)
If A and B are not mutually exclusive (or
dependent) events then:
P (A or B) = P(A) + P(B) – P (A and B)

Literally, P (A or B) means “at least A or

B occurs” in the experiment.
Shital Bhandary 53
Example 3

The probability of getting a male or a

female baby in the single pregnancy will
be:
P(B) + P(G) = ½ + ½ = 1
The probability of getting an ace or a
spade from a well shuffled deck of card
will be:
= P(A) + P(S) – P (A and S)
= 1/4 + 1/13 – (1/4 * 1/13) = 16/52 = 4/13
Shital Bhandary 54
Multiplicative law

If A and B are two independent events

then:
P (A and B) = P (A) x P (B)
If A and B are not independent events then:
P (A and B) = P (A | B) x P (B)
= P (B | A) x P (A)
These expression are known as
“conditional probability”.
Shital Bhandary 55
 Example 4
The probability of a child being male and
Rh negative is:
P (B and Rh-ve) = P (B) x P(Rh-ve)
= 1/2 x 1/10 = 1/20
The probability of a child being female, Rh
positive and single birth will be:
P (G and Rh+ve and SB) = P (G) x P
(Rh+ve) x P (SB) = 1/2 x 9/10 x 79/80 =
711/1600
Shital Bhandary 56
 Example 5 (Student Research)

Among MBBS students 43 still takes

alcohol, 35 still smoke and 25 take alcohol
as well as smoke. If a student is chosen at
random then:
i) find the probability that this student is a
smoker
ii) If the student is found to be take alcohol,
find the probability that he/she is also a
smoker.
Shital Bhandary 57
Solution:

i) P (S) = 43/173 = 0.2485

ii) P (S | A) = P (S and A) / P (A)
= 25 / 43 = 0.5814
iii) P (A | S) = ???

Shital Bhandary 58
 Exercise 3
 Find the probability of getting two boys
and one girl in a family with three
children.
 A study on the probability that a randomly
selected person smokes cigarettes
divided the Nepalese population into
three age groups: Under 30 (<30),
between 30 and 50 (30 – 50) and over 50
(> 50). Half of those under 30 were found
to smoke.
Shital Bhandary 59
Exercise 3 (Contd.)
a. If P (< 30) = ½, find the probability that a
randomly selected person is under 30 and
smokes.
b. If P (Smoke or < 30) = ½, P (Smoke or 30-50)
= ¼, and P (Smoke or > 50) = ½, does this
indicate independence or dependence
between age and smoking?
c. If P (30-50) = ¼ and P (>50) = ¼, find P
(Smokes).
d. Find P (Smoke or > 50).
e. You have to write a small discussion on each
of these calculations.
Shital Bhandary 60
 Thank you!!!

Shital Bhandary 61