EPIDEMIOLOGICAL EXERCISES

VITAL STATISTICS
1. In a town with a mid – year population of 180000 the following events were recorded
during the year 2021.
LIVE BIRTH = 4800
FOETAL DEATHS (< 28 WEEKS) = 88
LATE FOETAL DEATHS (> 28 WEEKS) = 80
DEATHS IN THE AGE OF 0 - 7 DAYS = 75
DEATHS IN THE AGE OF 8 – 28 DAYS = 115
DEATHS IN THE AGE OF 29 – 365 DAYS = 170
DEATHS RELATED TO MATERNITY = 13
TOTAL DEATHS = 2400
Calculate MMR, IMR, Crude Birth Rate, Perinatal Mortality Rate and Crude Death Rate. Compare with
National statistics & Comment.
a. Maternal mortality rate (MMR) = Total maternal death x 1000 / live birth
=13 x 1000 /4800
=2.70/1000 live birth
b. Infant mortality rate = Total infant death x 1000 /live birth
= (Death 0-7 days+ deaths in 8 - 28 days+ deaths in 29-365 days) x 1000 / live birth
= (75+115+170) x 1000 /4800
=75/1000 livebirths
c. Crude birth rate = Total live birth x 1000 /Mid year population
=4800 x 1000 /180000
=26.66/1000 population
d. Perinatal mortality rate (PMR)
= (Late foetal death + death 0-7 days) x 1000 / (live birth +late foetal death)
= (80+75) x 1000 / (4800+80)
=31.7/1000 deliveries
e. Crude death rate = Total death x 1000 / mid year population
=2400 x 1000 /180000
=13.33/1000 population
2. In a town with a mid year population of 1,20,000 the following events were recorded in
2021. Total deaths – 996; Live births – 2499; deaths within 28 days of birth – 68; deaths
within 7 days – 35; deaths between 28 days to 1 Yr – 149; late foetal deaths – 30;
Calculate IMR, Crude Birth Rate, Early Neonatal mortality rate, Late Neonatal Mortality
rate, NMR, Post neonatal mortality rate, Still birth rate, Perinatal Mortality Rate and Crude
Death Rate. Compare with National statistics & Comment.
Answer:
a. Crude birth rate = Total births x 1000 /Mid year population
=2499 x 1000 /120000
=20.825/1000 population
b. Crude death rate = Total deaths x 1000 /mid year population
=996 x 1000 /120000
=8.3/1000 population
c. Early neonatal mortality rate = Death within 7 days x 1000 /live births
=35 x 1000 /2499
=14/1000 live births
d. Neonatal mortality rate = Death within 28 days x 1000 /live birth
=68 x 1000 /2499
=27.21/1000 live births
e. Late neonatal mortality rate = Deaths within7-28 days x 1000 /live birth
= (68-35) x 1000 /2499
=13.2/ 1000 live births
f. Post neonatal mortality rate = Deaths within 28 days to 1 year x 1000 /live birth
=149 x 1000 /2499
=59.62/1000 live births
g. Still birth rate = Late fetal death x 1000 / (live birth+still birth)
=30 x 1000 / (2499+30)
=30000/2529
= 11.86/ 1000 births
h. Perinatal mortality rate
= (Late fetal death +death within 7 days) x 1000 / (live birth + still birth)
= (30+35) x 1000 / (2499+30)
=25.7/ 1000 births
i. Infant mortality rate = No of infant death x 1000 /live birth
= (Deaths within 28 days + Deaths from 28 days to 1 year) x /live birth*(1000)
= (68+149) x 1000 /2499
=86.83/1000 live births

3. In a town with a mid year population of 1,80,000 the following events were recorded in the
year 2022.
Live births – 4406; early foetal deaths (<28 wks) – 65; late foetal deaths (>28 wks) – 80;
deaths in the age group 0-7 days – 72; Deaths in 8-28 days- 118; death in 29-365 days= 173;
Total deaths – 2402, Maternal deaths- 8. Women of child bearing age group formed 20% of
the population.

Calculate Crude Birth Rate, MMR, IMR, Early Neonatal mortality rate, Late Neonatal
Mortality rate, NMR, Post neonatal mortality rate, Still birth rate, Perinatal Mortality Rate,
Crude Death Rate, Abortion rate and general fertility rate. Compare with National statistics
& Comment.

a. Crude birth rate = Total live birth x 1000 /mid year population
= 4406 x 1000 /1,80,000
=24.47/ 1000 population
b. Crude death rate = Total deaths x 1000 /mid year population
=2402 x 1000 /1,80,000
=13.31/ 1000 population
c. Maternal mortality rate = Total maternal deaths x 1000 /live birth
=8 x 1000 /4406
=1.81/ 1000 live births
d. Early neonatal mortality rate = Death 0-7 days x 1000 /live birth
=72 x 1000 /4406
=16.34/ 1000 live birth
e. Late neonatal mortality rate = Death 8-28 days x 1000 /live birth
=118 x 1000 /4406
=26.78/ 1000 live birth
f. Post neonatal mortality rate = Deaths 29-365 days x 1000 /live birth
=173 x 1000 /4406
=39.26/ 1000 live births
g. Neonatal mortality rate = (Death 0-7 days+death8-28 days) x 1000 /live birth
= (72+118) x 1000 /4406
 =43.12/ 1000 live births
h. Infant mortality rate = Total infant death x 1000 /live birth
= (Death 0-7 days+ death in 8-28 days+ death in 29-365 days) x 1000 /live birth
= (72+118+173) x 1000 /4406
=82.39/1000 live births
i. General Fertility Rate
= No. of live births during the year x 1000
Mid year women population age 15-44(or 49) in the same year
= 4406 x 1000
20% of 180000
= 4406 x 1000
36000
= 122.38 per 1000 women population

4. The mid – year population of a district in Tamilnadu during the year 2005 was 13, 00, 000.
The data relating to the same year of the district is given. Calculate the following:

• General Fertility Rate – GFR

• Total fertility Rate – TFR

• Gross Reproduction Rate – GRR

• Net Reproduction Rate – NRR

Age No. of women No. of No. of Survival

Group Live Births Female Births Rate
(15-49 yrs)

15 – 19 16, 000 260 120 0.969

20 – 24 16, 400 2, 244 1, 037 0.967

25 – 29 15, 800 1, 894 875 0.963

30 – 34 15, 200 1, 320 610 0.958

35 – 39 14, 800 916 423 0.952

40 – 44 15, 000 280 129 0.942

45 – 49 14, 500 145 67 0.928

1, 07, 700 7, 059 3, 261

 Answer:
• General Fertility Rate
• Age – specific Fertility Rate for Live Births
• Total Fertility Rate
• Age – specific Fertility Rate for Female Live Births
• Gross Reproduction Rate and Net Reproduction Rate

General Fertility Rate – (GFR)

GFR = No. of live births which occurred among the population in a given year x 1000
Mid – year female population age 15 – 49 of same area & same year
GFR = 7, 059 x 1000 = 65.54 live births / 1000 women in reproductive age group
1, 07, 700
Age – Specific Fertility Rate for Live Births – (ASFR
ASFR = No. of live births in a particular age group x 1000
Mid – year female population of same age group
Age No. of No. of Live Age Specific Fertility Rates
Group Women Births
for Live Births

15 – 19 16, 000 260 16.25 live births / 1000 women in age group 15 – 19 yrs

20 – 24 16, 400 2, 244 136.83 live births / 1000 women in age group 20 – 24 yrs

25 – 29 15, 800 1, 894 119.87 live births / 1000 women in age group 25 – 29 yrs

30 – 34 15, 200 1, 320 86.84 live births / 1000 women in age group 30 – 34 yrs

35 – 39 14, 800 916 61.89 live births / 1000 women in age group 35 – 39 yrs

40 – 44 15, 000 280 18.67 live births / 1000 women in age group 40 – 44 yrs

45 – 49 14, 500 145 10.00 live births / 1000 women in age group 45 – 49 yrs

Total 1, 07, 700 7, 059 450.35 live births / 1000 women in reproductive age group

Total Fertility Rate – (TFR)

TFR = ( 45 – 49 Ʃ 15 – 19 Age – Specific Fertility Rate for live births) x Class Interval
1000
TFR = 450.35 x 5 = 2251.75 = 2.25
1000 1000
TFR = 2.25 children / woman through her reproductive period assuming current fertility and no
mortality
Age – Specific Fertility Rate for Female Live Births – (ASFFR

ASFFR = No. of female live births in a particular age group x 1000

Mid – year female population of same age group
Age No. of No. of Female ASFFR – Age Specific Fertility Rates
Group Women Live Births for Female Live Births

15 – 19 16, 000 120 7.5 female LB / 1000 women in age group 15 – 19 yrs

20 – 24 16, 400 1, 037 63.23 female LB / 1000 women in age group 20 – 24 yrs

25 – 29 15, 800 875 55.37 female LB / 1000 women in age group 25 – 29 yrs

30 – 34 15, 200 610 40.13 female LB / 1000 women in age group 30 – 34 yrs

35 – 39 14, 800 423 28.58 female LB / 1000 women in age group 35 – 39 yrs

40 – 44 15, 000 129 8.6 female LB / 1000 women in age group 40 – 44 yrs

45 – 49 14, 500 67 4.62 female LB / 1000 women in age group 45 – 49 yrs

Total 1, 07, 700 3, 261 208.03 female LB / 1000 women in reproductive age group

Gross Reproduction Rate – (GRR)

GRR = ( 45 – 49 Ʃ 15 – 19 Age – Specific Fertility Rate for female live births) x Class Interval
1000
GRR = 208.03 x 5 = 1040.15 = 1.04
1000 1000
GRR = 1.04 female child / woman through her reproductive period assuming the current fertility and
no mortality

Net Reproduction Rate – (NRR)

NRR = ( 45 – 49 Ʃ 15 – 19 ASFFR x Probability of Survival Rate) x Class Interval

1000
Age Group Age Specific Fertility Rate for Survival ASFFR x Survival
Female Live Births – ASFFR
Rate

15 – 19 7.5 0.969 7.28

20 – 24 63.23 0.967 61.15

25 – 29 55.37 0.963 53.33

30 – 34 40.13 0.958 38.45

35 – 39 28.58 0.952 27.21

40 – 44 8.6 0.942 8.10

45 – 49 4.62 0.928 4.29

Total 208.03 199.81

NRR = 199.81 x 5 = 999. 05 = 0.99905

1000 1000
NRR = 0.999 will be average number of daughters a newborn girl will bear through her
reproductive period assumed fixed age – specific fertility and mortality rates

Inference
• General Fertility Rate (GFR) – 65.54 live births / 1000 women in reproductive age
group.

• Total Fertility Rate (TFR) – 2.25 per women through her reproductive period assuming
current fertility and no mortality.

• Gross Reproduction Rate (GRR) – 1.04 female child per women through her
reproductive period assuming current fertility and no mortality.

• Net Reproduction Rate (NRR) – 0.99 will be average number of daughters a newborn
girl will bear through her reproductive period assumed fixed age – specific fertility and
mortality rates.
MORBIDITY INDICATORS
1. In a town with a midyear population of 245000, on 1.1.2022 there were 3100 cases of
coronary heart disease. During the year 1380 new cases of CHD were detected and
150 cases died. The total deaths due to all causes in the city during the year 2022 were
3200 calculate.
a. Incidence of CHD during 2022;
b. Period prevalence of CHD in 2022;
c. Point prevalence of CHD on 31.12.2022;
d. Case fatality rate for CHD;
e. Proportional mortality rate for CHD;
f. List the risk factors of CHD
Answers:
Mid year population = 2,45, 000
Incidence of CHD during 2022 = No of new cases x 1000 /population
=1380 x 1000 /245000
=5.63/1000 population
Period prevalence of CHD in 2022 = (3100+1380) x 1000 /245000
= 4480 x 1000 /245000
=18.28/1000 population
Point prevalence of CHD on 31.12.2010 = {(3100-150)} +1380 x 1000 /245000
=4330 x 1000 /245000
=17.67/1000 population
Case fatality rate for CHD = No of deaths due to CHD x100 /No of CHD cases
=150 x 100 / (3100+1380)
= 150 x 100 / 4480
=3.34%
Proportional mortality rate for CHD = No of deaths due to CHD x 100 /Total deaths
=150 x 100 /3200
=4.68%

2. In a town having a population of 80000 there were 24 cases of leprosy on 31.12.2018.

During 2019 – 8 new cases of leprosy were detected and 7 cases were released from
treatment. Calculate
1. Incidence of leprosy in 2019
2. Prevalence of leprosy on 31.12.2019
3. Compare with national figures and list actions to be taken.
Answer:
Population =20000
Incidence of leprosy in 2010 =No of new cases x 1000 /Population
= 8 x 1000 /80000
=0.1/1000 population
Prevalence of leprosy on 31.12.10 = (24-7)+8 x 1000 /80000
=25x 1000 /80000
=0.3125/1000 population

3. In a town with a population of 95000 on 31.12. 2021 there were 620 cases of diabetes.
During the year 2022 --- 420 new cases were detected and 96 died. The total no.of deaths in
the town due to all causes was 1200.
Calculate Incidence, Point prevalence as on 31.12.2022. case fatality rate, and proportional
mortality rate.
List measures required to control the problem.
Answer:
a. Incidence of the disease for 2022 = No of new cases x 1000 /population
=420/95000
= 4.42/1000 population
b. Period Prevalence = No of cases x 1000 /Estimated population
= (620+420) x 1000 /95000
=10.94/1000 population
c. Point prevalence as on 31.12.2022 = (620+420-96) x 1000 /95000
= 9.94 per 1000 population
d. Case fatality rate = No of deaths due to diabetes x 100 /No of persons affected by diabetes
= 96 x 100 / (420 + 620)
= 9.23%
e. Proportional mortality rate = No of death due to diabetes x 100 /Total no of death
=96 x 100 /1200= 8%
MALARIA FILARIA INDICES
1. The data relating to malaria surveillance activities of a PHC during
2022 are as follows:-
Mid year Population =45000
Blood smears collected:-
Active surveillance =4100
Passive surveillance =1200
Mass & contact =800
Total Positive cases detected =30
Total Pf cases detected =4
Deaths due to malaria =1
Calculate the malarial indices and list the actions to be taken.
Answers:
a. Annual blood smear examination rate (ABER) = (Active + Passive BS) x 100 / population
= (4100+1200) x 100 /45000
=5300 x 100 /45000
=11.77%
b. Annual Falciparum Incidence (AFI) = Total Pf x 1000 /population
=4 x 1000 /45000
=0.08/ 1000 population
c. Annual Parasite Incidence (API) = Total positive x 1000 / population
= 30 x1000 /45000
= 0.66 /1000 population
d. Slide Positivity Rate (SPR) = Total positive X 100 /Total BS examined
=30 x 100 / (4100+1200+800)
=30 x 100 /6100
=0.49%
e. Slide Falciparum Rate (SFR) = Total Pf x 100 / Total BS examined
=4 x 100 / (4100+1200+800)
=0.066%
f. Percentage of Pf = Total Pf x 100 / Total positive
 =4 x 100 /30
=13.3%
g. Case Fatality Rate = Total deaths due to malaria x 100 /Total positive
=1 x 100 /30
=3.33%

2. In a town with a population of 120000, filarial survey was conducted during the year 2010.
the survey findings were as follows:-
No. examined & night blood smear collected =11000
No. +ve for microfilaria = 850
No. +ve for external manifestations of filariasis =110
No. +ve for both Mf & External manifestations =8
Calculate the various indices and comment.
Answers:
a. Mf rate = No of night BS +ve for Mf x 100 /Total no of night BS taken examined
= (850+8) x 100 /11000
=7.8%
b. Filarial Disease rate (FDR)= No of persons +ve to external manifestation x100/No examined
= (110+8) x 100/11000
=1.07%
c. Filarial Endemicity Rate
= Positive for Mf only + positive for disease+ positive for both x 100 / No examined
= (850+110+8) x 100/11000
=8.8%
SCREENING TEST
1. The results of a screening programme using breast examination by physician and
confirmatory test by mammography for breast cancer are given below:-

Mammography
Breast Examination + - Total

+ 26 4 30

_ 20 50 70

Evaluate the screening test and comment.

Answers:
Breast examination Mammography
+ -
+ 26 a 4 b 30
- 20 c 50 d 70
46 54 100

Sensitivity = a/a+c*(100) = 26/46*(100) = 56.5%

Specificity = d/b+d*(100) =50/54 *(100) = 92.59%
Predictive value of +ve test = a/a+b*(100) = 26/46*(100) = 86.66%
Predictive value of –ve test = d/c+d*(100) =50/54*(100) = 71.42%
% of false +ve = b/b+d*(100)=4/54*(100) = 7.4%
% of false –ve = c/a+c*(100) = 20/46*(100) = 43.43%

2. A Pregnancy test was conducted among women with amenorrhoea and the results were as
follows:-
Out of 35 pregnant women the test was positive in 25 and negative in10 women. In contrast
the test was positive in 5 and negative in 60 non-pregnant women also.
a). Set up an appropriate 2/2 table.
b). Calculate the indices to evaluate the pregnancy test give your comment.
Answers:
Pregnancy
Pregnancy test
Yes No
+ve 25 a 5 b 30
-ve 10 c 60 d 70
35 65 100
Sensitivity = a/a+c *(100) = 25/35 *(100) = 71.4%
Specificity = d/b+d *(100) = 60/65*(100) = 92.3%
Predictive value of +ve test = a/a+b*(100) =25/30*(100) = 83.3%
Predictive value of –ve test = d/c+d*(100) =60/70*(100) =85.7%
% of false +ve = b/b+d*(100) = 5/65*(100) =7.69%
% of false –ve = c/a+c*(100) = 10/35*(100) = 28.57%

3. The uristix test was used for screening patients for diabetes in a community. The results
were as follows:-

Uristix test Diabetes Total

Present Absent

Positive 20 5 25

Negative 10 65 75

Evaluate the uristix test as a screening test.

Answer:
Uristix test Diabetes
Present Absent
Positive 20 a 5 b 25
Negative 10 c 65 d 75
30 70 100
Sensitivity = a/a+c*(100) = 20/30*(100) = 66.7%
Specificity = d/b+d*(100) = 65/70*(100) = 92.85%
Predictive value of +ve test = a/a+b*(100) = 20/25*(100) = 80%
Predictive value of –ve test = d/c+d*(100) = 65/75*(100) = 86.67%
% of false +ve = b/b+d*(100) = 5/70*(100) = 7.14%
% of false –ve = c/a+c*(100) = 10/30*(100) = 33.3%
MEASURES OF CENTRAL TENDENCY AND DISPERSION
1. Measures of central tendency & dispersion for ungrouped data.
The mid arm circumference of 11 male children aged 1 ½ years is given below.
Calculate the measure of central tendency and dispersion.
12, 12, 12, 14, 14, 13, 13, 12, 11, 15, 15
Answer:
S.No X x-x− (x-x−)2
1 11 -2 4
2 12 -1 1
3 12 -1 1
4 12 -1 1
5 12 -1 1
6 13 0 0
7 13 0 0
8 14 +1 1
9 14 +1 1
10 15 +2 4
11 15 +2 4
∑(x) = 143 ∑/(x-x−)/= 12 ∑(x-x)2 = 18

1. Mean = ∑x/n = 143/11 = 13

2. Median = 13
3. Mode = 12
4. Range = 11-15
5. Mean Deviation = ∑(x-x−)/n = 12/11 = 1.09
6. Standard deviation =√∑(x-x−)/n-1 = √18/10 = √1.8 = 1.34

2. The serum cholesterol of 10 subjects were as follows:

244, 254, 287, 273, 264, 277, 250, 320, 290, 280
Calculate the measures of central tendency and dispersion.
 The serum cholesterol of 10 subjects measures central tendency and dispersion.
S.No X x-x─ (x-x−)2
1 244 -28.9 894.01
2 250 -22.9 571.21
3 254 -18.9 396.01
4 254 -18.9 98.01
5 273 0.1 0.81
6 277 4.1 9.61
7 280 7.1 37.21
8 287 14.1 171.61
9 290 17.1 259.21
10 320 47.1 2125.21
∑(x) = 2729 ∑/(x-x−)/ = 179.2 ∑(x-x−)2 = 4850.9
1. Mean = ∑x/n = 2729/10 = 272.9
2. Median = 273+277/2 = 272
3. Mode = 254
4. Range = 244-320
5. Mean deviation = ∑/(x-x−)//n = 179.2/10 = 17.9
6. Standard deviation = √∑(x-x−)2/n-1 = √4850.9/9 = √538.98 = 23.21

3. The diastolic blood pressure in 10 patients in mm of Hg was as follows

90; 99; 94; 110; 116; 120; 130; 90; 110; 140.
Calculate the measures of central tendency and dispersion.
ANSWER:
Diastolic blood pressure in 10 patients.
S.No X x-x─ (x-x−)2
1 90 -19.9 396.01
2 90 -19.9 396.01
3 94 -15.9 252.81
4 99 -10.9 118.81
5 110 0.1 0.01
6 110 0.1 0.01
 7 116 6.1 37.21
8 120 -10.1 102.01
9 130 -20.1 404.01
10 140 -30.1 906.01
∑x = 1099 ∑x = /(x-x─)/ = 133.2 ∑(x-x─)2 = 2612.9
1. Mean = ∑x/n = 1099/10 = 109.9
2. Median = 110+110/2 = 110
3. Mode = 90,110
4. Range = 140-90 = 50
5. Mean derivation = ∑/(x-x─)//n = 133.2/10 = 13.2
6. Standard derivation = √∑(x-x─)2/n-1 = √2612.9/9 = √290.32 = 17.03

4. In a dietary survey conducted as per of nutrional assessment in semi urban area of

tamilnadu the protein in take of 400 families is as given below

Protien intake(gms per day) No of families

15-25 30

25-35 40

35-45 100

45-55 110

55-65 80

65-75 30

75-85 10

Find mean protein intake and also calculate median, mode, Variance and Standard deviation.
Answer:

CI(Class interval) F X Fx Cf(cumulative frequency)

15-25 30 20 600 30

25-35 40 30 1200 70

35-45 100 40 4000 170

45-55 110 50 5500 280

55-65 80 60 4800 360

65-75 30 70 2100 390

75-85 10 80 800 400

∑fx = 19,000

• Mean = ∑fx/n

=19000/400 = 47.5 gms/day

• Mode = L + d1 X CI
d1+d2
= 45 + 110-100 X 10
(110-100) + (110-80)
= 45+10/40 X 10
= 45+2.5
= 47.5 gms/day
Median = L + [n/2- cf] X CI
f
= 45 + (200-170) X 10
110
= 45+30/11 = 45+2.727
= 47.73 gms/day
TEST OF SIGNIFICANCE:
1. In a large city A 25 % of a random sample of 900 school boys had defective vision. In
another large city B 15.5 % of a random sample of 1600 school boys had defective vision.
Test to see if there is significant difference in the vision of school boys in the two cities.
Answers:
Defective Vision Total
Present Absent
City A 225 675 900
City B 248 1352 1600
Total 473 2027 2500
Null hypothesis: There is no significant difference between defective vision of school boys from
2 different cities.
Alternate hypothesis: There is significant difference between defective vision of school boys
from 2 different cities.
Expected value of Defective vision in City A= 473 x 900/ 2500 = 170.28
Expected value of Normal vision in city A= 2027 x 900 / 2500 = 729.72
Expected value of Defective vision in City B = 473 x 1600 /2500= 302.72
Expected value of Normal vision in City B = 2027 x 1600 /2500 = 1297.28
X2= ∑((0-E)2/E)
= (225-170.28)2/170.28+(675-729.72)2/729.72+(248-302.72)2/302.72+(1352-
1297.28)2/1297.28
=2994.27/170.28+2994.27/729.72+2994.27/302.72+2994.27/1297.28
= 17.58+4.10+9.89+2.30= 33.87
X2=33.87
df=(r-1) (c-1)=1
Observed X2 value (33.87) is greater than X2 table value at 0.05 level (3.84)
Hence null hypothesis is rejected and alternate hypothesis is accepted.
Chance of error p<0.05
Inference : There is significant difference in defective vision of schools boys from 2 different
cities. p<0.05
2. The mean values of birth weight and sample sizes are given below by socio economic status.
Is the mean birth weight statistically significant between socio economic groups?
t table value at 23 df for 0.05 level is 2.069
High Socio economic status:
Sample size- 15
Birth weight- 2.91 kg
Standard deviation- 0.27 kg
Low socioeconomic status:
Sample size- 10
Birth weight- 2.26 kg
Standard deviation- 0.22 kg

High socioeconomic Low socioeconomic

status status

N 15 10

Mean 2.91kg 2.26kg

SD 0.27kg 0.22kg

Answer:
CR = t = | X1 - X2 |
SD √ 1 + 1
n1 n2
SD = √ (n1-1)SD12 + (n2-1)SD22
√ n1 + n2- 2
SD = √14*0.272 + 9*0.222 = 0.25
√ 23
t = | 2.91-2.26| = 6.36
0.25 √ 1 + 1
15 10
DF = n1 + n2 – 2 = 23
Calculated t value > TABLE t value REJECT Ho
The mean birth weight is statistically significant between socio economic groups
3. A sample survey of 250 children revealed that 45% had nutritional deficiency.
Calculate the 95% and 99% confidence interval.
Answer:
Calculate the 95% and 99% confidence interval.
Prevalence(p) = 45%, q= 1-P = 55%, n= 250
Standard error of proportion= square root of (pq/n)
= square root of 45 X 55
250
= 3.15
95% CI = Mean +/- 1.96 S.E
= 45 +/- 1.96 X 3.15
= 45 +/- 6.174
= 38.83 % to 51.17%
99% CI = MEAN +/- 2.58 S.E
= 45 +/- 2.58 X 8.13
= 45 +/- 8.13
= 36.87% to 53.13%
 COHORT AND CASE CONTROL
1.An epidemiological study was conducted to find out the association between tobacco
chewing and oral cancer. 60 cases of oral cancer and 60 controls were selected, matched
and interviewed. History of tobacco chewing was reported among 40 cases and 20 controls.
Answer the following:
A) What was the study design?
B) Set up the appropriate 2 x 2 table
C) Estimate the risk of disease occurrence associated with the exposure.
Answer:
a) Case Control study
b)

Tobacco chewing Oral cancer Total

+ -
Yes 40 20 60
No 20 40 60
Total 60 60 120

c) Odd`s ratio:
= ad/ bc = 40 x 40/ 20 x 20 = 1600/400 = 4
Tobacco chewers have 4 times risk of developing oral cancer compared to non tobacco chewers.

2. The following data was obtained in a prospective study of smokers and lung cancer.

Smoking Developed lung Did not develop lung Total

Cancer cancer

Yes 30 6970 7000

No 3 2997 3000

Calculate incidence rates, RR, and AR.

ANSWER:
1. Incidence rate:
Incidence among exposed = 30 x 1000 / 7000 = 4.28
Incidence among non exposed = 3 x 1000 /3000 = 1
2. Relative risk = Incidence among exposed/Incidence among non exposed= 4.28/1 = 4.28
Smokers have 4.28 times higher risk for lung cancer compared to non smokers
3. Attributable risk = (IE-INE) x 100 /IE
= (4.28-1) x 100 /4.28= 76.6%
76.6% of lung cancer cases can be attributed to smoking

3. In a study of lung cancer, 50 patents of lung cancer were compared with 150 controls. It
was found that 39 of cases and 62 of controls were smokers.
a). What type of study is this?
b). Calculate relevant risk indicator.
Answer:
a. Case control study:
Smoking Lung cancer
Yes No
Yes 39 62 101
No 11 88 99
50 150 200

b. Odd`s ratio:
= ad/ bc = 39 x 88/ 11 x 62 = 3432/682 = 5.03
Smokers have 5.03 times risk of developing lung cancer compared to non smokers.

4. An epidemiological study was conducted as follows :- 7000 smokers and 3000 Non –
smokers were selected and followed for a period. Lung cancer was detected in 61 smokers
and 11 in non – smokers before the end of this period.
a). What type of study in this?
b). Calculate incidence rate among exposed and non-exposed.
c). Estimate relevant risk indicators
a. Cohort study:
Smokers Lung cancer Total
Yes No
Yes 61 6939 7000
No 11 2989 3000
Total 72 9928 10000

Incidence among exposed = 61 x 1000 /7000 = 8.71

Incidence among non exposed = 11 x 1000 /3000 = 3.66%
Relative risk = Incidence among exposed(IE)/ Incidence among non exposed(INE)
=8.71/3.66= 2.37
Smokers have 2.37 times more risk of developing lung cancer than non smokers.
Attributable risk = (IE-INE)x 100 /IE
= (8.71-3.66)*100 /8.71
57.9% of lung cancer occur because of smoking or can be attributed to smoking.

5. A group of male adults 20 to 60 years of age using pan masala under various trade names
were followed up for one year.50 of them were selected from a HSC area. A control group of
100 men comparable in other aspects were followed up for the same period. The outcome of
the study was development of leukoplakia. 19 of the pan chewers developed leukoplakia.
while 2 of the control developed leukoplakia. The reported prevalence of leukoplakia in
population is 10%.

a) What Is the type of study design.

b) Calculate the relative risk and comment.

c) Calculate the attributable risk and comment .

d) Calculate the population attributable risk and comment.

Pan Masala Leukoplakia Total

+ -

+ 19 31 50

- 2 98 100

Total 21 129 150

a) This is a cohort study

b) Relative risk

= Incidence among Exposed / Incidence among non exposed

= (19/50 x100)
(2/100 x 100)
= 38/2
= 19
Comment:
Those persons using pan masala are at 19 times greater risk of developing leukoplakia

Attributable risk
= Incidence among Exposed -Incidence among non exposed X 100
Incidence among Exposed
= 38- 2 X 100
38

= 94.74%
Comment:
94.74% of leukoplakia is attributed to the use of pan masala
Population attributable risk
= Incidence in the population -Incidence among non exposed X 100
Incidence in the population
= (10/100 x 100 ) - (2/100 x 100) X 100
(10/100 x 100)
= 10 – 2 X 100
10
= 80%

Comment
If the pan masala usage is eliminated, the incidence of leukoplakia will decrease by 80%
MID YEAR POPULATION
1. The population of a town was 2,49,000 as per 1991 census and 2,94,000 as per 2001 census.
The no. of vital events recorded in the town were as follows :-
In 1992 births = 5100 & deaths = 2500
In 2004 births = 5562 & deaths = 2657
Calculate birth and death rate and compare with national rates and comment.
Answer:
MYP for 1992 = P1+(P2-P1)/ N x (d+1/3)
=2,49,000+(294000-249000)/ (10) x (1+1/3)
=2,49,000+5985
=254985
Estimation of MYP for post censal year (2004)
MYP for 2004 = P2+(P2-P1) x (d+1/3)
=294000+(294000-249000)/10 x (3+1/3)
=2,94,000+14985
=308985
MYP of 1992 = 254985
MYP of 2004 = 308985
1992
CBR = No of births x 1000 /MYP = 5100 x 1000 /254985 =20 birth/1000 population
CDR = No of death x 1000 /MYP = 2500 x 1000 /254985=9.8 / 1000 population
2004
CBR = 5562 x 1000 /308985 = 18 birth / 1000 population
CDR = 2657 x 1000 /308985 = 8.59 deaths / 1000 population
CHLORINATION OF WELL
1. The diameter of a circular well was 1.5 metres and the height of the water column was 6
metres. Calculate the volume of water in the well. In the horrock’s test carried out, the 3rd
cup showed distinct blue colour. Calculate the amount of bleaching powder required to
chlorinate the water in the well.
Answer:
Volume of water in the well = 𝜋𝑟 2 h
= 3.14 x 1.5/2 x 1.5/2 x 6
=42.39/4 = 10.597 m3

1 cu. m = 1000 litres of water

For 10.597 m3 = 10598 litres
Volume of water in the well = 10598 litres

Free residual chlorine appears in 3 rd cup

Requirement of bleaching powder = 3 x 3= 6 g for 455 Liter of water
For 10598 Liters = 6 x 10598 /455 = 139.75 g

139.75 g of bleaching powder is required to chlorinate the well.

2. The diameter of a circular well is 5 metres. The height of water column in well is 5 metres.
Calculate the quantity of water in the well. In the Horrock’s Test carried out, the 2nd cup
showed a distinct blue colour. Calculate the quantity of bleaching powder required to
chlorinate the well water.
Answer:
Volume of water = 𝜋𝑟 2 h
=3.14 x 2.5 x 2.5 x 5 = 98.125 m3
1 cu. m = 1000 litre of water
3
For 98.125 m = 98125 litres
Volume of water in well = 98125 liters

Free residual chlorine appears in 2nd cup

Requirement of bleaching powder =2 x2
=4 g for 455 litres of water
For 62800 litres = 4 x 98125 / 455 =862.64 g

862.64 g of bleaching powder is required to chlorinate the well water.

3. 150 people per day visit swimming pool for their recreational purpose and sports activities.
Its dimensions are with length of 20 metres, breadth of 10 metres and depth of 6metres. In
order to maintain its sanitation, it needs to be chlorinated periodically.
Estimate the quantity of bleaching powder required to chlorinate the swimming pool to
attain the concentration of free chlorine of 2 ppm.
i) Volume of the swimming pool = l x b x h
= 20 x 10 x 6 m3
= 1200 m3
1 m3of pool contains 1000 liters so 1000 m3 of pool contains
=1200 x 1000
=12x105 litres of water

To attain the concentration of free chlorine of 2 ppm, 2 gm of chlorine present in 1000 L of water
Amount of chlorine required to disinfect this swimming pool is
= 12 x 105 x 2 / 103
= 2400 gms of chlorine

As bleaching powder is with 33% available chlorine. It means 33 gm of chlorine present in 100gm
of bleaching powder. So 2400 gms of chlorine is present in
=2400 x 100 / 33
=7272.72gms
So 7.27 kgs of bleaching powder is needed to disinfect this swimming pool.
VACCINE REQUIREMENT:
1. An outbreak of measles occurred in a CHC area. The measles immunization coverage of
the area as assessed by the coverage evaluation survey was 80% of the 10,000 eligible
children. Of the 250 cases of measles in the outbreak, 18% gave history of measles
immunization. Calculate the vaccine efficacy rate.
Given Data

• Total number of eligible children = 10000

• Number of children vaccinated (80% of the eligible children) = 8000
• Number of children NOT vaccinated (20% of the eligible children) = 2000
• Total number of cases with measles = 250
• Incidence of measles among those vaccinated = 45

Solution
Framework of the Data
Measles Present Measles Absent Total
Immunized 45 (a) 7955 (b) 8000 (a + b)
Non – immunized 205 (c) 1795 (d) 2000 (c + d)
Total 250 (a + c) 8750 (b + d) 10 000 (N)

Formula – I
Vaccine (Attack rate among unvaccinated – Attack rate among vaccinated) x 100
Efficacy = Attack rate among unvaccinated
Rate
c /c+d - a/a+b x 100
= c /c+d
205 45
Vaccine -
Efficacy = 2000 8000 x 100 = 0.9453 x 100 = 94.53%
Rate
205
2000
Formula – II
Vaccine Efficacy Rate = (1 – Relative Risk) x 100
Relative Risk – (RR)

RR = Incidence of disease among the vaccinated (IE) = (a / a + b)

Incidence of disease among the not vaccinated (INE) (c / c + d)

Relative Risk = IE = 45 / 8000 = 0.054

INE 205 /2000

Vaccine Efficacy Rate = (1 – RR) x 100

= (1 – 0.054) x 100

Vaccine Efficacy Rate = 94.6%

Inference
• Relative Risk = 0.054
Pre – school children who are vaccinated against measles are at 0.054 times at less risk
of contracting the disease as compared to those who are NOT vaccinated.

• Vaccine Efficacy Rate = 94.6%

The vaccine has the ability of preventing measles by 94.6% among the preschool
children.

2. In the area with the population of 50, 000, the birth rate is 30 per 1000 population and the
infant mortality rate is 100 per 1000 live births. Calculate the following:

• The expected number of pregnant women and infants

• Vaccine requirements for Td, BCG and OPV.
Given Data

• Total population = 50, 000

• Birth rate = 30 / 1000 population
 • Infant mortality rate = 100 / 1000 live births
Solution
Estimation of Eligibles

No. of Pregnant Women = Population x Birth Rate

= 50, 000 x 30
1000
= 1, 500 pregnant women

No. of Infants = Population x Birth Rate x (1 – IMR)

= 50, 000 x 30 x 1 – 100

1000 1000

= 1, 350 infants

Estimation of Requirement of Td

Total no. of Expected Number of Wastage

pregnant women x Coverage x doses x multiplication
factor
Vaccine Requirement
=

No. of sessions OR No. of doses

to be held per vial

= 1, 500 x 100 x 2 x 1.33 = 3, 990 doses ~ 4, 000 doses / year

100
Annual requirement of Td for pregnant women = 4, 000 doses / year

Monthly requirement of Td for pregnant women = 4, 000/12 = 333 doses / month

No. of vials of Td required for immunization = 333/10 = 34 vials

(Each vial contains 10 doses)

 Estimation of Requirement of BCG

Total no. of Expected Number of Wastage

infants x Coverage x doses x multiplication
factor
Vaccine
Requirement =

No. of sessions OR No. of doses

to be held per vial

= 1, 350 x 100 x 1 x 2 = 2, 700 doses / year

100
Annual requirement of BCG for infants = 2, 700 doses / year

Monthly requirement of BCG for infants = 2, 700 = 225 doses / month

12
Fortnightly requirement of BCG for infants = 112 doses / fortnight

No. of vials of BCG required per month = 225 = 23 vials

(Each vial contains 10 doses) 10
Estimation of Requirement of OPV

Total no. of Expected Number of Wastage

infants x Coverage x doses x multiplication
fact
Vaccine
Requirement =
No. of sessions OR No. of doses
to be held per vial

= 1, 350 x 100 x 4 x 1.33 = 7, 182 doses / year

100
Annual requirement of OPV for infants = 7, 182 doses / year

Monthly requirement of OPV for infants = 7, 182 = 600 doses / month

12
No. of vials of OPV required per month = 600 = 60 vials
(Each vial contains 10 doses) 10
Inference
Estimation of the Eligibles
No. of pregnant women = 1, 500 pregnant women
No. of infants = 1, 350 infants

Requirement of Td)
Annual requirement = 4, 000 doses / year
Monthly requirement = 333 doses / month
Number of vials = 34 vials

Requirement of BCG
Annual requirement = 2, 700 doses / year
Monthly requirement = 225 doses / month
Number of vials = 23 vials

Requirement of OPV
Annual requirement = 7, 182 doses / year
Monthly requirement = 600 doses / month
Number of vials = 60 vials