BASICS OF BIOSTATISTICS

AND EPIDEMIOLOGY
•TOPIC: TESTING AND
SCREENING
Learning Tasks
•At the end of this session a learner is expected to be
able:
 To define screening and testing
 To explain the four types of screening
 To outline principles of screening
 To explain the WHO criteria for screening test
 To explain the advantages and disadvantages of
screening
Definition of Screening and Testing
(10 Minutes)
• Activity: Brainstorming (5 minutes)
• ASK students to brainstorm answers to the following question:
• What is a screening?
• What is testing?
• What is screening test?
• ALLOW time for them to respond
• WRITE their answers on a flip chart/board.
• PROVIDE possible answers as indicated in the notes below
•Screening is defined as the
presumptive identification of
unrecognized disease in an
apparently healthy, asymptomatic
population by means of tests,
examinations or other procedures
that can be applied rapidly and
easily to the target population.
•Testing is a process or system which is
used to identify characteristics or
problems.
•The screening test is a test used to
confirm a diagnosis is evaluated in terms
of its ability to assess correctly the
presence or absence of a disease or
condition as compared with a gold
standard.
Types of Screening (15Minutes)
•There are four main types of screening:
 Mass screening
o Screening a whole population or organized periodic procedures performed on
large groups or population of people for the purpose of detecting disease.
o It is offered to all irrespective of a particular risk of individual contracting the
disease in question e.g. Tuberculosis
o Mass screening is not useful for preventive measures but it is useful for a
suitable treatment that will reduce the duration of illness or alter its final
outcome.
 Multiple or multiphase screening
o Involves the use of a variety of tests on the same
occasion for the same condition or is the application
of two or more screening tests to a large population at
one time instead of carrying out separate.
• The procedure may also include health questionnaire,
clinical examination and a range of measurements and
investigations e.g. diabetes screening
•Targeted screening
•Screening of groups with specific
exposures.
• It is applied selectively group to a high risk
group is defined on the basis of
epidemiological research e.g. cervical
cancer in a low social economic group,
foetus for Down’ syndrome in a woman who
already had a baby with Down’ syndrome
 Case-finding or opportunistic screening
oThere is no accurate or precise diagnostic test for
the disease where the frequency of its occurrence in
the population is small
oScreening of patients visiting a healthcare delivery
point for some other purpose
oThe main objective is to detect disease and bring
patients to treatment. Example rheumatic heart
disease in children
Outline Principles of Screening (05 Minutes)
 
 The principles of screening test adopted by the World
Health Organization
oThe condition should be an important health problem
oThere should be a recognizable latent or early
symptomatic stage
oThe natural history of the condition, including
development from latent to declared disease, should be
adequately understood.
• There should be an accepted treatment
for patients with recognized disease
• There should be a suitable test or
examination that has a high level of
accuracy
• The test should be acceptable to the
population
• There should be an agreed policy on
whom to treat as patients
• Facilities for diagnosis and treatment
should be available
• The cost of screening (including diagnosis
and treatment of patients diagnosed)
should be economically balanced in
relation to possible expenditure on
medical care as a whole, and
• Screening should be a continuing process
and not a ‘once and for all’ project.
WHO Criteria for Screening Test (10
Minutes)
• The screening test should meet the following
criteria:
• The condition screened for should be an
important one
• There should be an acceptable treatment for
patients with the disease
• The facilities for diagnosis and treatment should
be available
•There should be a recognised
latent or early symptomatic
stage
•There should be a suitable test
or examination which has few
false positives - specificity - and
few false negatives - sensitivity
•The test or examination should
be acceptable to the population
•The cost, including diagnosis and
subsequent treatment, should
be economically balanced in
relation to expenditure on
medical care as a whole
 These criteria can also be summarised as
follows
oPatient/Community/Population Considerations
Acceptability/desirability by patient and
community
Historical precedent for screening
Sufficient burden of disease
oEpidemiological/Medical Considerations
 Different populations have a distinct and different
distribution of disease
 Natural history of disease supports early detection
 Availability of ‘adequate’ screening tests
 Availability of and compliance with ‘effective’
treatment and follow up
 Acceptability by provider and health care system
•Resource Considerations
•Will of the political and health
care system
•Availability of resources - funds,
services, transportation,
•Cost-effectiveness of screening
The Advantages and
Disadvantages of Screening (05
Minutes)
 Advantages
o Early detection of disease, therefore benefits for early
treatment
o Reduction of mortality due to early treatment
o Screening is a “preventive” measure especially if it aims
to determine and influence risk factors, or detect and treat
abnormal changes that could later develop into a disease
•Disadvantages
•Screening does not set a 'gold
standard' as an examination
method; in addition, the ideal
screening method is far from
discovered yet.
•A positive screening test can also
often be a false alarm
•Screening and health checkups may give
a feeling, consciously or unconsciously,
of being well taken care of and thereby
reduce motivation to take responsibility
for ones’ own health e.g. (continue
smoking, too little exercise or an
unhealthy diet).
•Screening involves, as a rule, only one
disease
 Key Points (05 minutes)
• Screening is the presumptive identification
of unrecognized disease in an apparently
healthy, asymptomatic population
by means of tests, examinations or other
procedures that can be applied rapidly and
easily to the target population.
• Four types of screening are: Mass screening,
multiple or multiphase screening, targeted
screening and opportunistic screening
Session Evaluation (05
minutes)
•What are the principles of
screening?
•What are the advantages and
disadvantages of screening?
• References
• Bonita, R., Beaglehole, R., Kjellstrom, T.
(2006). Basic Epidemiology (Second).
Geneva, Switzerland:
• WHO.
• Greenberg, R.S., et al. (1993). Medical
epidemiology. East Norwalk, CT: Appleton
Lange.