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MEASURES OF DISEASE FREQUENC

TOOLS OF MEASUREMENT

Counting the number

Rates, proportions & rates

Utilities a) most readily available data b) monitoring occurrence of important infectious disease and outbreaks c) administrative purposes i) indicate load of illness ii) estimate resources needed

Limitation Cannot be used to COMPARE disease load

Ratio

Proportion

Rates

Used to : a) Characterize population b) Describe morbidity morbidity, mortality & fertility c) Measures occurrence of an event Value of NUMERATOR Ratio in whic in a population over time NOT INCLUDED in NUMERATOR INCLUDED Cases x 10n denominator IN DENOMINATOR Population at risk

MEASUREMENT OF

Morbidity

Mortality

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MEASURE OF MORBIDITTY

Definition of morbidity Departure from a state of physical or psychological well-being, resulting from disease, illness, injury or sickness, specially where the affected individual is aware of his or her condition

Terms of measurement

Uses a) describe disease load in the community to assist establishment of priorities b) provide more comprehensive & accurate & clinically relevant information for basic research c) starting point for etiological study for disease prevention d) monitoring & evaluation of disease control activkities

Commonly used

Number of persons

Illness experienced

Duration

Incidence rate

Attack rate

Secondary attack rate

Prevalence rate

Recovery rate

Point prevalence

Period prevalence

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MEASURE OF MORTALITY

Definition of mortality rate Measure of frequency of occurrence of death in a defined population during a specified interval.

deaths population

x 10n

Uses a) explaining trends in overall mortality b) indicating priorities for health action & allocation of resources c) designing intervention programmes d) assessment & monitoring of public health problems & programmes

Commonly used

Crude death rate -Not a sensitive indicator -from all cases of deaths

Age specific death rate Infant mortality rate (0-1 year)

Sex specific death rate Maternal mortality ratio Mortality associated with pregnancy, delivery & puerperium

Cause specific death rate

Proportionate mortality rate

Case fatality rate

Neonatal mortality rate (0 <28 days) Indicator for maternity care

Post-neonatal mortality rate (>28days-1 year) Reflex environmental condition of infants

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EPIDEMIOLOGICAL STUDY DESIGN

DESCRIPTIVE STUDIES

ANALYTICAL STUDIES

INTERVENTION STUDIES Cohort

Population-based Correlation Case report

Individual-based

Case-control

Case series

Cross-sectional

Prospective

Retrospective

Descriptive Studies on frequency& distribution of known& possible of known& posible causes of disease in populations 1)provide information on the frequency of health states&possible causes 2)planning health promotion 3)planning health services & preventions Population Correlation Case report Individual-based Case Cross sectional series

Analytical strength of association between diseases& other factors with particular emphasis or whether such associations are causal

uses

types

Cohort studies Case control Propspective Retrospective

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DESCRIPTIVE EPIDEMIOLOGY

USES

Information answered

Helps in formulation of etiological hypothesis

Provides data for planning, evaluating preventive & curative services

PERSON

PLACE

TIME

Age

Sex

Marital status

Occupation

Social class

Behaviour

Religion

Ethnic group

International variations Eg: Breast cancer -Highest rate, Western countries -Lowest rate, Japan

National variations Eg: endemic goiter, fluorosis, goiter

Rural / urban variations Common in urban -chronic bronchitis, accidents, lung cancer, CVS disease, mental illness Common in rural -zoonotic diseases, snail transmitted helminths, bilharziasis -fertility&death rates esp infant&maternal mortality May be due to differences in: -population density -social class -quality of medical care -levels of sanitation -education & environmental factors

Local variations Eg: filth diseases, rheumatic fever, tb, scabies, nutritional deficiency diseases is higher in slummy areas of city

SHORT TERM FLUCTUATION S Pointsource

PERIODIC / CYCLIC FLUCTUATIONS

LONG TERM/ SECULAR TRENDS

Propagated/ contagious

Upward trend Chronic non communicable

Downward trend infectious

General characteristics peculiar to place 1) high frequency rates observed in all ethnics groups in the area 2) high frequency rates not observed in persons of similar background who not living in this area 3)healthy persons entering the area become ill with similar frequency those living there 4) inhabitants who leave the area do not show high rates of disease

Daily variations Hay fever

Weekly variations Automobile accuidents

Seasonal variations -URT infections in winter -GIT infections in summer dt i) warm wather ii) rapid multification of flies

Yearly variations Measles

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KEY WORD DEFINITION

The study of distribution and determinants of diseases and health-related states or events in specified populations, and the application of this study to the prevention & control of diseases & other health problems

INTRODUCTION TO EPIDEMIOLOGY

SOURCES

study

distribution DESCRIPTIVE EPIDEMIOLOGY

determinants ANALYTIC EPIDEMIOLOGY

Health related states or events

specified population

Application to prevention & control USES

Health Care Management


-assessment of community health needs -planning,implementation evaluantion of health service & setting priorities -delevoping Health Policies

Understanding the disease process


-search causes&risk factors -study natural history -study historic rise&fall -establishing clinical diagnose

Public Health Practice


-investigations of epidemics -surveillance for disease -making projections -assessing Programmes for Mass Screening for Disease -assisting in formulating medical teaching curricula

Clinical & preventive practice


-assessing effectiveness of preventive & treatment modalities -study prognostic factors -study effectiveness of diagnostic modalities -assisting in clinical decision making

Population statitistics

Vital records

Notification of infectious disease

Disease Register

Morbidity surveys

Record Linkage

Population census

Population estimates

Birth registration

Death registration

International

National

Special subgroups records

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