Health Statistics and

Epidemiology
Rationale

Individual Community
Demography
• Science which deals with the study of population sizes, composition
and distribution in space.

Population
• Refers to the number of people in a given place or areas a given time.
Household
• Is a person or group of related or unrelated persons who live together
in the same dwelling unit, who acknowledge one adult male or female
as the head of the household, who share the same housekeeping
arrangements and who are considered a single unit
Sources of Demographic Information

1. Census
Assign People During Census
• De jure – when people are assigned to the place where they
usually live regardless of where they are at the time of the census
• De facto – people usually present during time of the census
2. Sample surveys
3. Registration
Population
Size?

• Information on population changes

• Prioritize & strategize health
programs or interventions for the
community
• Assess possible health related factors
2 Methods of Measuring Population Changes
1. Comparing the CBR and CDR
2. Comparison by Census
Natural Increase (NI)
• Difference between the number of births and the number of Deaths
occurring in a population in a specific period of time.

NI = Births - Deaths
(Specified Year) (Specified Year) (Specified Year)
Rate of Natural Increase
• Difference Between the Crude Birth Rate (CBR) and Crude Death Rate
(CDR) in a specific period of time.
CBR
In Kidapawan City, North Cotabato, there were 4567 births. The total
population was 125,447. The CBR is
Rate of Natural Increase
• Difference Between the Crude Birth Rate (CBR) and Crude Death Rate
(CDR) in a specific period of time.
CBR
In Kidapawan City, North Cotabato, there were 4567 births. The total
population was 125,447. The CBR is

36.4 per 1000 population

 CDR
In the municipality of Balo-i, Lanao Del Norte, there were 5634 deaths. The
total population was 192,310. The CDR is
 CDR
In the municipality of Balo-i, Lanao Del Norte, there were 5634 deaths. The
total population was 192,310. The CDR is

29.3 per 1000 population

Rate of Natural Increase
• Difference Between the Crude Birth Rate (CBR) and Crude Death Rate
(CDR) in a specific period of time.

NRI= CBR - CRD

Calculate the Rate of Natural Increase
Leyte Southern Biliran Samar Eastern Northern
Leyte Samar Samar

Population 1,724,679 421,750 780,481 467,160 632,379

171,612
Deaths 12,345 8,034 5,489 7,609 4,679 5,543

Births 15,745 15,023 3,456 11,234 6,987 12,342

RNI
Calculate the Rate of Natural Increase
Leyte Southern Biliran Samar Eastern Northern
Leyte Samar Samar
Population 1,724,679 421,750 171,612 780,481 467,160 632,379
Deaths 12,345 8,034 5,489 7,609 4,679 5,543
Births 15,745 15,023 3,456 11,234 6,987 12,342
RNI 2.0 16.6 -11.8 4.6 4.9 10.8
Demographic Indicators
• Population Statistics
• Sex ratio
• Dependency ratio
• Density
• Population size
• Vital Statistics
• BR
• DR
Comparison by Census

1.Absolute increase per year

2.Relative increase
1. Absolute Increase per year
• Number of people added to the population per year.

AI = Pt - Po
t
Pt =Population size at a later time
Po=Population size at an earlier time
t =Number of years between 0 and time t
San Jose de Buan
Year Population

2010 6,563 Calculate the absolute

2011 6,989 increase per year of San
2012 7,220 Jose de Buan from 2010
2013
7,456 to 2015
2014
7,692
2015
7,769
San Jose de Buan
Year Population

2010 6,563
AI/year = 7769 - 6563
2011 6,989
2012 7,220 5
2013
7,456 AI/year. = 241 per year
2014
7,692
2015 Absolute Increase = 1206 increase
7,769
of population in San Jose De Buan
for 2010 to 2015
2. Relative Increase
• It is the actual difference between two census counts expressed in
percentage

RI = P t - Po

Po
San Jose de Buan
Year Population

2010 6,563 Calculate the Relative

2011 6,989 Increase of San Jose de
2012 7,220 Buan Population in 2010
2013
7,456 & 2015
2014
7,692
2015
7,769
San Jose de Buan -
Year Population RI = 7,769 6,536
2010

2011
6,563
6,989
6,536
2012 7,220
= 0.18
= 18%
2013
7,456
2014
7,692
2015
7,769
 Population Composition
• Sex Composition
• Age Composition
• Age and Sex Composition
I. Sex Ratio
• Number of females to the number of males in the population.
• Number of female per 1000 male population

Number of Females x 1000

Number of Males
Calculate Sex Ratio

Males 1,996,355
Females 1,930,234
Calculate Sex Ratio

Males 1,996,355
967 Females
Females 1,930,234 per 1000
males
Age Composition
Median = arrange age from smallest to the
highest, divide population into 2 equal equal
parts & identify number in between

Ex.
you are trying to decide an activity for a
suitable for the majority group of people.
Age of the group are as follows.
12, 8, 13, 65, 10, 10, 9
Median Mean/Average
8+9+10+10+12+13+65 = 127
8 7
9
10 18 Years
10 Old
12
13
65
Dependency Ratio
• The number of economically dependent with the economically
productive group in the population.

Economically Independent = 0-14 years old & 65

years old above
Economically Productive = 15- 64 years old
EI
X 100
EP
Age and Sex Composition
Population Distribution
• Urban Rural Distribution = illustrates the proportion of the people
living urban and rural areas
• Crowding Index = describes the ease by which a communicable
disease will be transmitted from one host to another. Divide number
of persons in a house hold to the number of rooms
• Population Density = will determine how congested a place is and has
implications in terms of adequacy of basic health services. It describes
how crowded a place is.
Population Density
1.Convert to Square Mile
(.5 mil) x (.4 mil) = .2mil2
2. Divide the number of People
4 people = 20 People
.4 mil .2mil2 mi2

.5 mil
20 People / mil2

1 mil

1 mil
Population Density

.5 mil

.8 mil
Population Density
1.Convert to Square Mile
(.8 mil) x (.5mil) = .4mil2
2. Divide the number of People
4 people = 10 People
.5 mil .4mil2 mi2

.8 mil
VITAL HEALTH STATISTICS
Nurse Function

• Collects data
• Tabulates data
• Analyses data and interprets data
• Evaluates data
• Recommends redirection and /or
strengthening of specific areas of
health program
Rates and Ratio
• RATE = shows the relationship bet. a vital event and those persons
exposed to the occurrence to the said event with in a given area and
specific period of time
• RATIO = describe relationship between 2 numerical quantities or
measures of events without taking particular considerations to the
time or place.
• CRUDE or GENERAL RATES = rates are referred to the total living
population.
• SPECIFIC RATE = the relationship is for a specific population class or
group.
Vital Statistics
• Refers to the systematic study of vital events such as births, illness,
marriages, divorces/separations and deaths.
USES OF VITAL STATISTICS
• Planning human development
• Dynamics of reproduction
• Life-tables
• Risks of dying
• Population growth dynamics
• Population projections
• Monitoring & evaluating interventions
Can facilitate information for:
• Provision of services for vulnerable populations (i.e. single mothers &
children)

• Regional & urban/rural comparisons

• Allocation of resources (i.e. health care, education, & social security)

• Crude Birth Rate =Natural growth and increase of Population.
CBR = # OF Registered livebirth in a year X 1000
estimated population as of July 1 same year
• Crude Death Rate =mortality from all causes of Population
CDR = # OF Registered deaths in a year X 1000
estimated population as of July 1 same year
• Infant Mortality Rate =risk of dying during the first year of life
IMR = # OF Registered livebirth in a year X 1000
estimated population as of July 1 same year
• Maternal Mortality Rate=measures the risk o dying for causes related to
pregnancy, childbirth and puerperium.
MMR =# number of deaths from maternal causes registered given year X 1000
Total number of livebirths registered in the same year
• Fetal Death Rate = measures pregnancy wastage. Death of the product of
conception occurs prior to its complete expulsion, irrespective of duration of
pregnancy
FDR = # feotal deaths registered in a given calendar year X 100
Total Number of Live births registered in a same year
• Neonatal Death Rate= risk of dying the 1st month of life.
NDR =# of deaths under 28 days of age registered X 100
number of livebirths reg. in the same year
ATTACK RATE
Measures the risk of exposure. Useful in epidemiological investigation

AR = number of person acquiring the disease x 100

number of exposed to the same disease in same year
Scenario
Person who Ate Food Person who did not Ate Food
Food
Sick Not Sick Total ATTACK RATE Sick Not Sick Total ATTACK RATE

HUMBA 29 17 46 17 12 29

LECHON BABOY 26 17 43   20 12 32  

PANCIT BIHON 23 14 37   23 14 37  

CHOP SUEY 18 10 28   28 19 47  

FRIED CHICKEN 16 7 23   30 22 52  

GRILLED PORK 21 16 37   25 13 38  

VEGETABLE SALAD 43 11 54   3 18 21  

SPAGHETTI 25 22 47   20 7 27  
Scenario
Person who Ate Food Person who did not Ate Food
Food
Sick Not Sick Total ATTACK RATE Sick Not Sick Total ATTACK RATE

HUMBA 29 17 46 63.0 17 12 29 58.6

LECHON BABOY 26 17 43 60.5 20 12 32 62.5

PANCIT BIHON 23 14 37 62.2 23 14 37 62.2

CHOP SUEY 18 10 28 64.3 28 19 47 59.6

FRIED CHICKEN 16 7 23 69.6 30 22 52 57.7

GRILLED PORK 21 16 37 56.8 25 13 38 65.8

VEGETABLE SALAD 43 11 54 79.6 3 18 21 14.3

SPAGHETTI 25 22 47 53.2 20 7 27 74.1

ATTACK RATIO
Food AR1 AR2 ATTACK RATIO
HUMBA 63.0 58.6 1.08
LECHON BABOY 60.5 62.5 0.97
PANCIT BIHON 62.2 62.2 1.00
CHOP SUEY 64.3 59.6 1.08
FRIED CHICKEN 69.6 57.7 1.21
GRILLED PORK 56.8 65.8 0.86
VEGETABLE SALAD 79.6 14.3 5.57
SPAGHETTI 53.2 74.1 0.72
Case Fatality Rate
• Killing power of the disease

CFR = No. of registered Deaths from aspecific disease

for a given year
No. of registered cases from specific disease X 100
in same year
INCIDENCE and Prevalence
IINCIDENCE RATE = Measures the frequency of occurrence of the
phenomenon during a given period of time. Deals of only wit New
Cases
No. of New Cases of particular disease
Registered during a specific period of time
IR = Population at risk of developing the diseasex 100 (F)
INCIDENCE and PREVALENCE
PREVALENCE RATE = Measures the proportion of th population which
exhibits a particular disease at a particular time.

No. of New and old cases of a certain disease

registered at a given time
IR = Number of persons examined at same time
x 100 (F)
INCIDENCE and PREVALENCE
PREVELENCE
 In the study of diabetics, 100 of the 189 diabetic men died during the
13-year follow-up period. Calculate the risk of death for these men.

Numerator = 100 deaths among the diabetic men

Denominator = 189 diabetic men
Risk = (100 ⁄ 189) × 100 = 52.9%
In a survey of 1,150 women who gave birth in Maine in 2000, a total of
468 reported taking a multivitamin at least 4 times a week during the
month before becoming pregnant.(7) Calculate the prevalence of
frequent multivitamin use in this group.
In a survey of 1,150 women who gave birth in Maine in 2000, a total of
468 reported taking a multivitamin at least 4 times a week during the
month before becoming pregnant.(7) Calculate the prevalence of
frequent multivitamin use in this group.
• Numerator = 468 multivitamin users
Denominator = 1,150 women
• Prevalence = (468 ⁄ 1,150) × 100 = 0.407 × 100 = 40.7%
Introduction to Basic Epidemiology
Learning Objectives
• Define Epidemiology.
• Define Field Epidemiology.
• Identify the different core epidemiology functions.
• Describe primary applications of epidemiology in public health
practice.
• Describe epidemiology as to Time, Place and Person.
Epidemiology originated from the Greek words “epi”- meaning on or
upon, “demos” meaning people and “ logos” meaning study of.
Epidemiology
is the study of the distribution and determinants
of health-related states or events in specified
populations, and the application of this study to
the control of health problems.
Study

• scientific discipline
• data driven and relies on systematic approach
• basic science of public health
• provide foundation for practical and appropriate public health action
• basis for causal reasoning in public health
Distribution

• frequency
• pattern
Determinants

• Factors that influence disease or health events

• assumption: Disease does not occur RANDOMLY
• analytic epidemiology provide “why” and “how” to provide evidence
to direct, prompt and effective
Application

• applying the knowledge gained by the studies to community-based

practice
• An outbreak, needs epidemiologic judgment of local conditions
Objectives of Epidemiology

• To identify the etiology or the cause of the disease and the risk
factors.
• To determine extent of disease found in the community.
• To study the natural history and prognosis of disease.
• To evaluate existing and new preventive and therapeutic measures
and modes of health care delivery.
• To provide foundation for developing public policy and regulatory
decisions relating to environmental problems.
Uses of Epidemiology
• Study the health History of the population
• Assessing the community’s health
• Relevant sources of data:
• What are actual and potential health problems?
• Where are they occurring?
• Which populations are at risk?
• Which problems are increasing or decreasing over time?
• How do these patterns relate to public health services available?
• Diagnose the Community and the condition of the people
• Assess evaluate the effectivity of heatlh services
Uses of Epidemiology
• Completing a clinical picture
Epidemiologists rely on clinicians and laboratorians for proper diagnosis
but also contribute to physicians’ understanding of clinical picture and
natural history of disease
Core Epidemiologic Functions
1. Public Health Surveillance
2. Field Investigation
3. Analytic Studies
4. Evaluation
5. Linkages
6. Policy Development
1. Public Health Surveillance
• refers to the ongoing, systematic collection, analysis, interpretation
and timely dissemination of health data for the planning,
implementation and evaluation of public health program. The use of
information based from these data to disease prevention and health
promotion program completes the surveillance cycle in public health.
• “The essence of public health surveillance is the use of data to
monitor health problems to facilitate their prevention or control
Public Health Surveillance Cycle
2. Field Investigation

• A phone call to confirm or clarify circumstances of reported case

• Coordinated efforts of people to characterize extent of an epidemic or
• identify cause
• Objectives for investigations may vary
3. Analytic Studies

• Rigorous methods than surveillance and outbreak investigation

• Hallmark of analytic study is use of a comparison group
4. Evaluation

• process of determining, as systematically and objectively as possible,

the relevance, effectiveness, efficiency, and impact of activities with
respect to established goals.
• Effectiveness refers to the ability of a program to produce the
intended or expected results in the field; effectiveness differs from
efficacy, which is the ability to produce results under ideal conditions.
• Efficiency refers to the ability of the program to produce the intended
results with a minimum expenditure of time and resources.
5. Linkages

• During an investigation an epidemiologist usually participates as

either a member or the leader of a multidisciplinary team. Other
team members may be laboratorians, sanitarians, infection control
personnel, nurses or other clinical staff, and, computer information
specialists
6. Policy Development
• Public health workers regularly provide input, testimony, and
recommendations regarding disease control strategies, reportable
disease regulations, and health-care policy.
Descriptive Epidemiology
• Descriptive epidemiology characterizes as to time, place, person
through comprehensive characterization. It identifies population at
risk for the disease and provide clues about etiology, source and
modes of transmission. This will be used to begin intervention and
prevention measures.
The Ws of descriptive epidemiology:
• What: Health issue of concern
• Who: Person
• Where: Place
• When: Time
 TIME
• Analysis of occurrence of disease over time is useful in formulating
hypothesis about environmental change, presence of the agent and
source of transmission associated with any disease. Changes in time
occurrence can be regular or unpredictable.
• Example are Influenza common during rainy and colder seasons and
foodborne disease that can occur anytime.
Epidemic Curve
• Variability in disease occurrence can also be analyzed from different
points of view. These observations are organized and illustrated as an
Epidemic Curve.
 PLACE
• Disease pattern by place can be analyzed by place-related difference
based on geographic localities or characteristics common in a locality.
Examples are urbanicity, economic development and climate type.
Early clues about many diseases have come from comparing
geographic-specific mortality rates.
PLACE
PERSON
 PERSON
Variation in disease rates by person variables suggests differences in
the opportunity for exposure to the agent or differences in their
susceptibility once exposed. This element pertains to personal
characteristics which may affect illness .
Concepts of Public Health Surveillance
 SURVEILLANCE
• Surveillance came from “sur” meaning over and “veller” meaning to
watch.
• “close and continuous observation of one or more persons for the
purpose of direction, supervision, or control
• Continued watchfulness over the distribution and trends of incidence
[of a disease] through the systematic collection, consolidation, and
evaluation of morbidity and mortality reports and other relevant
data.” – by Alexander Langmuir, 1963
• General application of surveillance to public health problems
ROLES OF A NURSE IN SURVEILLANCE
1. Identify, define and measure the health problem of interest
2. Collect and compile data about the problem
3. Analyze and interpret these data
4. Provide these data and their interpretation stakeholders/ program
managers
5. Monitor and periodically evaluate the usefulness and quality of
surveillance
CORE PROCESS OF PUBLIC HEALTH
SURVEILLANCE
CORE PROCESS OF PUBLIC HEALTH
SURVEILLANCE
CORE PROCESS OF PUBLIC HEALTH
SURVEILLANCE
Identifying and Selecting a Health Problem
for Surveillance
• a. Public health importance
– Incidence, prevalence, severity, disabilities, mortality,
socioeconomic impact,
• community, outbreak potential,
• Ability to prevent, control, or treat
• Capacity of health systems
• Speed and response, economics, availability of response,
NATIONAL SURVEILLANCE SYSTEM
Nurse Function in Epidemiology

• Maintains surveillance of the occurrence of

notifiable disease
• Coordinates with other members of the
health team during outbreaks
• Participates in case finding and collection of
laboratory specimen.
• Isolates cases or communicable diseases
• Nursing care teaching & supervises care
Nurse Function in Epidemiology

• Teaches household concurrent and terminat

disinfection
• Follow up cases and contacts
• Education campaign
• Referral of cases
• Coordinates with other concerned
community agencies
• Accomplishes reports and keeps records
submits it to proper office.
Epidemiological Investigation
OUTBREAK OR AN EPIDEMIC
is the occurrence of more cases of disease than expected in a given
area or among a specific group of people over a particular period of
time.

EPIDEMIC to situations involving larger numbers of people over a wide

geographic area.

OUTBREAK as an epidemic limited to localized increase in the incidence

of disease, e.g., village, town, or closed institution.
 SPORADIC

• refers to a disease that occurs infrequently and

irregularly.
 ENDEMIC

• refers to the constant presence and/or usual

prevalence of a disease or infectious agent in a
population within a geographic area.
 CLUSTERING
• is an aggregation of cases in a given area over a particular period
without regard to whether the number of cases is more than
expected.
Even if the current number of reported cases exceeds the expected
number, the excess may not necessarily indicate an outbreak

Increase in cases may be due to the following:

• changes in local reporting procedures
• changes in the case definition
• increased interest because of local or national awareness,
improvements in diagnostic procedures
• A new physician, infection control nurse, or healthcare facility may
more consistently report cases
• result of misdiagnosis or laboratory error
• sudden changes in population size
Outline of Plan for Epidemiological
Investigation
1. Establish fact of presence of Epidemic
 Verify Diagnosis
1. Is the disease that which it is reported to be?
2. Are all the cases due to the same disease
Reporting
1. Is it reasonably complete?
2. Is the data accurate
Unusual prevalence of the disease
1. Past experience of the disease
2. Relation to nature of the disease
2. Establish time and space relationship of the disease
• Are cases limited or concentrated by place
• Relationship by onset of time
3. Relations to characteristic of the group community
• Relation of case by person (age, sex, occupation etc.)
• Relation to vital health facilities
• Relation to food and water
• Relation to other cases
4. Correlation of all data obtained
Build final case and conclusion
Provision of control measures
Steps In outbreak Investigation
1. Prepare for field work
2. Establish the existence of an outbreak
3. Verify the diagnosis
4. Construct a working case definition
5. Find cases systematically and record information
6. Perform descriptive epidemiology
7. Develop hypotheses
8. Evaluate hypotheses epidemiologically
9. As necessary, reconsider, refine, and re-evaluate hypotheses
10. Compare and reconcile with laboratory and/or environmental studies
11. Implement control and prevention measures
12. Initiate or maintain surveillance
13. Communicate finding
Epidemiological Triad
• A model that describes the causation of a disease
Agent (WHAT)
• infectious microorganism or pathogen: a virus, bacterium, parasite, or other
microbe.
• Bacteria- Tuberculosis, Salmonellosis, Stryptococcal infections
• Viruses - Ex. Viral hepatitis A, influenza, viral meningitis
• Mycoses- diseases caused by fungi (Ex. Ringworm, athlete’s
foot,
• candidiasis)
• Protozoa- Malaria, Amoebiasis
• Helminths- Schistosomiasis
Characteristics of Infectious Disease Agents:

• INFECTIVITY - capacity of the agent to enter and multiply in a susceptible host

to produce infection or disease. Poliomyelitis and measles are diseases with high
infectivity.
• PATHOGENICITY- capacity of the agent to cause disease in the infected
host
• VIRULENCE- refers to the severity of the disease
• TOXIGENICITY- capacity of the agent to produce toxin or poison
• RESISTANCE- ability of the agent to survive adverse environmental conditions
• ANTIGENICITY- ability of the agent to induce antibody production in the host.
Host
• refers to the human who can get the disease.
Example of host factors are: age, race, sex,
socioeconomic status, and behaviors
(smoking, drug abuse, lifestyle, sexual
practices and contraception, eating habits),
genetic composition, nutritional and
immunologic status, anatomic structure,
presence of disease or medications, and
psychological makeup are some of the host
factors which affect a person’s susceptibility
and response to an agent.
Environment refers to the extrinsic factors that affect the agent and the
opportunity for exposure.

• refers to the extrinsic factors that affect the agent and the
opportunity for exposure.
• Environmental factors include physical factors such as geology and
climate, biologic factors such as insects that transmit the agent, and
socioeconomic factors such as crowding, sanitation, and the
availability of health services.