Harar health science collage

Applying basic Heath statistics and Survey For TVET

level III Students

By – OUMER D.
 Chapter one
Preparing for the application of
health survey
 Learning objectives

After completing this chapter, the student will be able to:

• 1.1. Concepts of statics
• 1.2. Health statics
• 1.3. Characteristics of health statistics
• 1.4. Health service statistics
• 1.5. Variable and scales of measurement
• 1.6. Basic principles of health statistics
• 1.7. Basic principles of health survey
• 1.8. Measures of fertility
• 1.9. Basic concept of epidemiology
• 1.10. Epidemiological surveillance
• 1.11. Measurement of morbidity and mortality
 Definitions

 Statistics is the science of conducting studies by collect,

organize, summarize, analyze, and draw conclusions from data.

 The word “Statistics” is both a plural as well as a singular

A. Statistics in Plural sense= Statistical Data

• An aggregate, a summary or a collection of numerical
(quantitative) information (facts, values, measures, records,
figures) of things ,or numerical description.

 Statistical data: When it means statistical data it refers to

numerical descriptions of things.
These descriptions may take the form of counts or
measurements.
e.g.

a) The average starting salary of college graduates in Ethiopia is

birr 4,234.

b) The number of deaths due to alcoholism last year in three

towns of Oromia: Adama, Jimma and Asella, was respectively
12, 4 and 6.

c) 10 % of students who join Haramaya University is found

studying Health Sciences.
 Statistics in singular sense:-
Refers to statistical methods.

Putting it differently, it means a methodological science, a scientific

method or

a branch of applied research which is concerned with the

development and application of methods and techniques for
collecting, organizing, presenting, analyzing, and interpreting
quantitative (numerical) data for understanding a phenomenon
 Characteristics of statistical data

In order that numerical descriptions may be called statistics

they must possess the following characteristics:
i) They must be in aggregates
 This means that statistics are 'number of facts.'
 A single fact, even though numerically stated,
cannot be called statistics.
 Single and isolated numerical expressions are not
called statistics as such facts cannot be put in
comparison or in relation to others. For eg., ‘abdi
marks in Management are 80’ is not a statistics. But
marksof 10 students in Management
35,60,54,87,67,90,55,43,77,60 are statistics. So a
set or an aggregate of observations form statistics.
ii) They must be affected to a marked extent by a multiplicity
of causes.
• This means that statistics are aggregates of such facts only
as grow out of a ' variety of circumstances'.
 E.g. the explosion of outbreak is attributable to a number of
factors, Viz., Human factors, parasite factors, mosquito and
environmental factors.
 All these factors acting jointly determine the severity of the
outbreak
iii) They must be enumerated or estimated according to a
reasonable standard of accuracy
 Statistics must be enumerated or estimated according to
reasonable standards of accuracy.
 This means that if aggregates of numerical facts are to be
called 'statistics' they must be reasonably accurate.
 This is necessary because statistical data are to serve as a
basis for statistical investigations.
 If the basis happens to be incorrect the results are bound to be
misleading.
iv)They must have been collected in a systematic manner for a
predetermined purpose.

 Numerical data can be called statistics only if they

have been compiled in a properly planned manner
and for a purpose about which the enumerator had a
definite idea.
 Facts collected in an unsystematic manner and
without a complete awareness of the object, will be
confusing and cannot be made the basis of valid
conclusions.
V) They must be placed in relation to each other.
 They must be comparable.

 Numerical facts may be placed in relation to each other

either in point of time, space or condition.
 The phrase, ‘placed in relation to each other' suggests
that the facts should be comparable.
 Health statistics
• Definition: When the different statistical methods
are applied in biological, medical and public health
data they constitute the discipline of health
statistics.

• An application of statistical method applied to life

and health sciences.

• statistics could be Descriptive or Inferential.

 Types of health statistics
1. Descriptive statistical methods
• Consists of the collection, organization, classification,
summarization, and presentation of data obtain from the sample.
• Concerned with describing the sampled data

Descriptive statistics includes:

Tables
Graphs (Figures)
• Bar graph, Pie chart, Scatter plot, line graph etc.
Numerical summary measures
• Measure of central tendency (mean, median, mode, etc)
• Measure of variation (range, variance, etc.)
 2. Inferential statistical methods,

 usually referred to by “statistical analysis”

 deal with using the sample to make statement about a wider

population

 Used when we want to draw a conclusion for the data obtain

from the sample i.e. The basic aim of all statistical inference is
to employ sampled data to infer to a population from which the
sample was obtained.

 In statistical inference sample statistics are used to make

statements about population values.
 Health service statistics

• Health care statistics involves collection, organization ,

summarizing , analyzing , and draw conclusions from health
service data

• And using of this data to make effective decision

Health care data comes from hospitals ,clinics ,health centers, health
post etc
 VARIABLE and scale of measurement
• A characteristics that when observed or measured takes on different
values in different individuals (elements) persons, places, or things..

• Any aspect of an individual or object that is measured (BP) or

recorded (sex)and takes any value

• For example: heart rate, the heights of adult males, the weights of
preschool children
 Types of variables
1. Qualitative variable:

A variable or characteristic which cannot be measured in

quantitative form but can only be identified by name or

categories.

Non-numerical

The notion of magnitude is absent

e.g.
-place of birth,
-ethnic group,
-Blood group,
-stages of breast cancer (I, II, III, or IV)
2. Quantitative variable:

• A quantitative variable is one that can be measured and

expressed numerically

• Variables measured by assigning numbers to the items

• It is either discrete or continues

• E.g.
- weight in gr.
-height in cm
-temperature in F/C
-CBC cell/ml etc…
- Episodes of pneumonia in under 5 yrs. children
 Types of quantitative variables

1. Discrete
• The values of a discrete variable are usually whole
numbers,
 Examples .
 Number of episodes of diarrhea in the first five
years of life,
 Number of new AIDS cases reported during one
year period,
 Number of students in the class
2. Continuous

Can assume any value within a specified relevant interval of

values assumed by the variable.

A continuous variable is a measurement on a continuous scale.

E.g. weight, height, blood pressure, age, etc.

No matter how close together the observed heights of two

people, we can find another person whose height falls
somewhere in between.
 Dependent Vs independent variables
• Dependent variable:- is measured as the outcome of interest or

response variable. It is the variable which is determined by the

presence or absence of other variables.

• Independent variable:- is the variable which influence the outcome

variable. Called explanatory variable.

• E.g. study conducted on a female fertility and associated factors

among Haramaya University Workers.

• Dependent-----

• Independent------
 MEASUREMENT SCALES

• Measurements:- is the procedure where qualities or

quantities are assigned to the characteristics of object,
subject or events
It is procedure where the objects are assigned by number
Ex
Measuring of height of person
Scales of measurement is how variables are defined and
categorized.
 Continued…

• Properties of Scale of Measurement

• Identity-each value on the measurement scale has a unique
meaning.
• Magnitude-values have an ordered r/n ship to another value
(one is larger and others are smaller)
• Equal interval-scale unit along the scale are equal one to
other. E.g. difference between 1 and 2 and 10 and 11 are the
same
• Absolute zero- scale has a true zero point below which value
is not exist.
• Depending on these properties there are four measurement
scales that are commonly used in statistics
• Nominal
• Ordinal
• Interval
• Ratio
 1. Nominal scale

• Satisfy identity property of the measurement

• Values assigned to variables represent a descriptive category

but have no inherent numerical value with respect to
magnitude.

• Naming or categorization of possible values of the variables

• Categories are non ordered and mutually exclusive

• E.g. Gender (male, female), blood type, religion, race, cause of

illness, cause of death…
 2. Ordinal scale
• Have properties of magnitude and identity

• Values are ordered (one is less than the other)

• The spaces or intervals between the categories (order) are not

necessarily equal.

• E.g. level of education

• E.g. the Likert scales on agreeness

• 1. strongly agree 2. agree 3. no opinion

4. disagree 5. strongly disagree

In the above situation, we only know that the data are ordered
 Continued…
• BUT, intervals are no longer equivalent.

• For instance, the differences in performance between the

1st and 2nd ranked in class isn’t necessary equivalent to the
differences between the 2nd and 3rd ranked students.

• The ranking only implies that 1st is better than 2nd, 2nd is
better than 3rd, and so on . . .
 3. Interval Data
• Have properties of identity, magnitude, and equal interval

• In interval data the intervals between values are the same.

• Has no true zero point

E.g., in the Fahrenheit temperature scale,

• the difference between 70 degrees and 71 degrees is the same as
the difference between 32 and 33 degrees.
• E.g. Intelligence Quotient (IQ)

• Date
 4. Ratio scale

• Satisfies all properties of scales of measurement

• The highest scale of measurement

• Measurement begins at true zero point and the scale has equal
space..

• E.g. weight, height, age, dose, , follow up time

Class activity
• Form 4 groups and discuss on those data and
identify their scale of measurement
• 1 marital status 7 . car championship
• 2 distance measurement in KM 8.age measure
• 3 birth day
• 4 country
• 5 hair color
• 6 date
Principle of statistics
• Statistics is the science and art of making decisions based on
quantitative evidence.
• The objective of descriptive statistics methods is to
summarize a set of observations
• the objective of inferential statistics methods is to make
inferences (predictions, decisions) about population based
on information contained in a sample,
Key concept in statistics
• Observations
• Population
• Sample
• Parameter
• Statistic
• variables
Cont. …….
Observational units are entities whose characteristics we
measure.
• Population: the entire collection of units about which we
would like information.
• Sample: the portion from population
• Parameter: the true value we hope to obtain
• Statistic: an estimate of the parameter based on observed
information in the sample
Basic concept of
epidemiology
• What is epidemiology ?
Epidemiology is the study of The frequency, distribution and
determinants of health-related states or events in specified
populations, and the application of this study to the control of
health problems
Key terms in the defn
• Study: Epidemiology is a scientific discipline with sound
methods of scientific inquiry
• Frequency Refers to the number of health events
It also looks at the relationship of that number to the size of
the population
Cont.…….
• Distribution: Describes the occurrence of health-related
events by time, place, and person
• Determinants: factors that influence the occurrence of
disease and other health related events
Epidemiologists assume that illness does not occur randomly
in a population
Health-related states or events:
• Include communicable diseases and non-communicable
diseases, injuries, birth defects etc
Cont.…
• Specified populations: The population defined in
geographical or other terms ]
• Application: As a discipline within public health,
epidemiology provides data for directing public
health action
Types of epidemiology
• Descriptive Epidemiology
Defines the magnitude and distribution of health
problems in relation to person, place and time
It answers the questions who, where and when
• Analytic Epidemiology
Involves comparison of groups of individuals to
identify determinants of health and diseases
It answers the questions why and how
Uses of epidemiology
1. Elucidate the natural history of disease
2. Describe the health status of the population
3. Provide understanding of what causes or sustains disease
4. Define standards and ranges for normal values
5. Guide health and healthcare policy and planning
6. Assist in the management and care of health and disease
7. Evaluate the effectiveness of intervention
Basic Epidemiologic
Assumptions
1. Human disease does not occur at random There are
patterns of occurrence
Exposures increase the risk of acquiring a disease
2. Human disease has causal and preventive factors
• causal factors can be identified through systematic
investigations
• prevention mechanism can be sought for that specific
problem
Natural history of
disease
• The natural history of disease: refers to the progression of a
disease process in an individual over time, in the absence of
intervention
Without medical intervention, the process ends with
recovery, disability, or death
• the time frame and specific manifestations of disease may
vary from individual to individual
Cont.
Stages in the natural history of diseases
Cont.
1. Stage of susceptibility - this is a stage in which disease has
not developed but the ground work has been laid
Susceptible person is lacking sufficient resistance to
particular pathogenic agent
Example: a person practicing casual or unprotected sex has
high risk of getting STI‟
Cont.
• 2. Stage of pre symptomatic disease or sub clinical stage
no signs and symptoms are detected
The disease can only be detected through special tests
The sub clinical stage of disease may lead to the clinical stage
or the individual may recover
• Example: ova of intestinal parasite in the stool of apparently
health individual
Cont.
• 3. The clinical stage- the person has symptoms and signs of
disease The clinical stage of different diseases differs in
duration, severity and outcome
The outcome of this stage may be recovery, disability or death
4. Stage of disability or death- some diseases run their course
and then resolve completely either spontaneously or under
the influence of therapy others leave residual defects of short
or long term duration
Levels of disease
prevention
• There are three important levels of disease prevention:
primary, secondary and tertiary
1. Primary prevention- is preventing healthy people
from becoming sick.
Primary prevention works to eliminate causes of disease
or increase resistance to disease

• It includes health promotion, prevention of exposure

and
prevention of disease occurrence
Cont.
• Some of primary prevention are:
- Immunization
- Provision of safe water supply
- Health related behavioral change through health
education
- Safe disposal of human excreta
- Control of vectors of diseases
- Protection against accidents and occupational hazards
Good nutrition
Cont.
2. Secondary prevention- involves detecting people who
already have the disease and those in subclinical stage
 Early detection depends on the clinical stage and
availability of investigation facilities.
 The aim is to limit severity and spread of disease
Cont.
• 3.Tertiary prevention: is targeted towards people with chronic
diseases and disabilities that can not be cured
• The aim of tertiary prevention is rehabilitation
• prevent severe disability and early death
• limit the impact of disability and thereby improving the quality of life
Example: Thus the goal of tertiary prevention in diabetes mellitus is:
• Control the level of blood sugar
• Treat complications
• Prevent permanent damage
• Prevent early death
Basic concept of health
survey
• According to Webster’s dictionary, the word survey
derived from Anglo – French word “surveer‟ which means
to look over.
• A survey is the collection of information from all
individuals, or a sample of individuals chosen to be
representative of the population from which they are
drawn.
• Its A systematic method for gathering information from
sample for the purposes of describing the attributes of
the larger population of which the individuals are
members.
Characteristics or Features of a
survey
• It requires experts imaginative planning.
• It requires careful analysis and interpretation of the
gathered.
• It requires logical and skillful reporting of the
findings.
• It provides information useful to solution of local
problems.
• It suggests the course of future and solves current
problems.
Types of survey

The surveys are broadly categorized based on

 Purposes of survey
 Time to conduct survey
• Based on the time taken, survey research can be
classified into two methods:
• 1. Longitudinal survey research
• 2. Cross-sectional survey research
 Cross sectional Survey

• Cross-sectional surveys involve the collection of data at a

single point in time from a sample drawn from a specified
population.
• quick and helps researchers collected information in a brief
period.
• This type of survey is less time consuming and economical
as well
;
Longitudinal survey

 involves conducting survey research over a continuum of

time and spread across years and decades.
 provide the required data at more than one point
in time unlike cross- sectional surveys
It analyses events at more than one point in time
When to Conduct a
Survey
• To estimate prevalence of a health condition or
prevalence of a behavior or risk factor
• To learn about characteristics such as knowledge,
attitude and practices of individuals in a population
• To monitor trends over time with serial cross-
sectional studies (National demographic and health
survey (DHS)).
Epidemiologic
surveillance
• It is derived from a French word ‘SURVEILLER’ meaning ‘to
watch over’ which encompasses careful observation and
timely intervention.
• Epidemiologic surveillance is an ongoing systematic
collection, analysis, interpretation and dissemination of
health related data essential to the planning,
implementation, and evaluation of public health practice.
• The essential characteristic of surveillance is that it should
be continuous.
cont.
• Surveillance provides ‘information for action’ which can be
used to investigate, prevent and control disease in a
community.
• Public health surveillance main function is to serve as an
“early warning system” providing timely information
needed for action
• Surveillance can be conducted globally, regionally, nationally
or locally.
Survey vs surveillance

surveillance
• Continuous
• It is relatively cheap
• Allows monitoring of trends of disease over time
• In-depth data may not be collected
• Prevalence or incidence may not be assessed well
• May not provide representative data
Survey
• It is a single time collection of data
• It is costly, needs to use by hiring a trained once
• Represents only single point in time
• More in-depth data could be collected
• More accurate assessment of true incidence or prevalence
 Components of surveillance
and resulting public
health action
Surveillance
•Collection
•Analysais
•Interprétation
•Dissémination
Public Health Action
• Priority Setting
• Planning, implementing and evaluating disease
• Investigation
• Control
• Prevention
Basic measurements in epidemiology
(morbidity and mortality measures)

• Measurements of disease frequency are basic tools in

epidemiologic approach
• Health status of a community is assessed by collection,
compilation, analysis and interpretation of data on
 Illness, Death, Disability and
 Utilization of health services
Cont.…….
• Number of cases in a given community can give more
epidemiological sense if they are related to the size of the
population
• Relating the number of cases with the population size can
be done by calculating ratios, rates and proportions
Cont.…

1. Absolute numbers- are simple count of occurrences like

sickness (morbidity), death (mortality) etc.
Example 1: In 2012, there were 150 reported deaths of
patients admitted to medical ward of hospital A and only
100 deaths were reported in the medical ward of hospital B.
In which hospital did the reported death was higher?
Cont.…..
2 . Ratio- quantifies the magnitude of one occurrence or
condition in relation to another in the form of X:Y.
Ex The number of male to female in the class
3. Proportion: is a specific type of ratio in which the
numerator is included in the denominator and the
• resultant value is expressed as percentages
Ex The number of male to the whole class
4. Rate- can be seen as a proportion with time element,
i.e occurrences are quantified over a specific period of
time
Cont.….

Rates must include:

1) Persons in the denominator who reflect the population
from which the cases in the numerator arose
2) Counts in the numerator which are for the same time
period as those from the denominator; and,
3) Only persons in the denominator who are "at risk" for the
event
Rate= Number of events in a specific period x K
_________________________________________
Popn at risk of these events in a specified period
Measurements of morbidity
Measures of morbidity are rates used to quantify the
occurrence of disease
Measures of morbidity include incidence and
prevalence rate
• Incidence rate measures the occurrence of new
cases of disease in a population at risk
• Prevalence measures both new occurrences and
old cases in a given population
Cont.…
A. Incidence rate:
• Measures the number of new occurrences of
disease during a specified period of time in
population at risk for developing the disease
• Incidence rate= number of new cases
over a period of time /population at risk
during the given period of time
Cont. …..
• The appropriate denominator for incidence rate is
population at risk
• Any individual who is included in the denominator must
have the potential to be counted in the numerator
• For instance, every one is at risk of HIV infection except
those who are already infected
• For measles, the population at risk includes all those
without a current or prior history of measles, or not
immunized
Prevalence rate

• measures the proportion of a populationwho have the

disease at a given time
• It includes both new and old cases
• There are two types of prevalence rates
1. period prevalence
2. point prevalence
Cont.

1. Period prevalence: measures the proportion of a

population who have the event of interest during a specified
period of time
• Period prevalence rate = number of people with a certain
condition during a specified period of time/ Total population
• Period prevalence rate counts all cases during the time
interval
• The denominator for period prevalence is the total
population rather than the population at risk
cont.
2. Point prevalence: measures the proportion of a population
with a certain condition at a given point in time
• Point prevalence rate= all persons with a certain condition
at one point in time /Total population
• Cross sectional studies are important in determining point
prevalence
• In incidence and period prevalence rates, the population is
followed overtime to count the number of cases arising
Count
• Example 1 in Somali village A cross sectional study was
conducted to determine prevalence of measles in village A
50 new case of measles were reported at time of study in
pervious the clinic data showed that their was about 200
measles case in that village what is the prevalence of
measles in village A
Measurements of mortality:
⚫ Mortality rates and ratios measure the occurrence of
deaths
in a population

⚫ Rates whose denominators are the total population

commonly
are using either the mid-interval
calculated
average population
population or the
population size because of
fluctuates
Basic measurements …cont‟d
1. CDR= total no. of deaths reported during
a given time period x
Estimated mid-year 1000
population
2. ASMR= no. of deaths in a specific age
group x
during a given time 1000
Estimated
of thatmid-year population
specific age
group
Basic measurements …cont‟d
3. Sex specific = no. of deaths in a specific sex
mortality rate during a given time x
Estimated mid-year population 1000
of same sex

4. Cause specific = no. of deaths from a specific

mortality rate cause x
during
Estimated a given time
mid-interval 100,000
population
Basic measurements …cont‟d
5. Proportionate = no. of deaths from a specific
cause mortality ratio during a given time x
total no. of deaths from all 100
causes
during the same time
6. Case fatality rate (CFR)= no. of deaths from a specific
cause x
during a given time 100
Number of cases
during of that disease
the same
time
Basic measurements …cont‟d
7. Fetal death rate= no. of fetal deaths of 28 wks or
more gestation reported during a given time

x 1000
no. of fetal deaths of 28 wks or more gestation
and live births during the same time

8. Perinatal mortality = no. of fetal deaths of 28 wks or more gestation

rate plus no. of infant deaths under 7 days
x 1000 no. of fetal deaths of 28 wks or
more gestation
plus the no. of live births during the same time
Basic measurements …cont‟d
9. Neonatal mortality rate= no. of deaths under 28 days of
age x
no.reported during
of live births a given time
reported 1000
during
the same time period
10. Infant mortality rate= no. of deaths under 1 year of age
during a given time x
no. of live births reported 1000
during the same
period
Basic measurements …cont‟d
11. Child mortality rate= no. of deaths of 1-4 yrs of
age x
during
mid-year a given time
population of children 1000
of same age during the same
time
12. Under-five mortality rate= no. of deaths of 0-4 yrs of
age x
during
mid-year a given time
population of children 1000
of same age during the same
time
Basic measurements …cont‟d
13. Maternal mortality ratio= no. of pregnancy associated deaths of
mothers in a given time

x 100,000
no. of live births in the same time
.
Measure of Fertility
• Fertility is the reproductive performance of an individual, a
couple, a group or a population
-- fertility leads to increase of population. It differs from
fecundity – which refers to the physiological capability of a
woman to reproduce. A woman’s reproductive period is
roughly 15 – 49 years of age.
- The most important measures of fertility include
Cont.…
1.the crude birth rate indicates the number of live
births (children born alive) per 1000 mid – year
population in a given year.
CBR = Number of live births in a year/ X 1000

total mid – year population

Cont..
• the General Fertility Rate is the number of live births per
1000 females aged 15-49 years (fertile age group) in a given
year. The GFR in more sensitive measure of fertility than the
CBR, since it refers to the age and sex group capable of
giving birth (females 15-49 years of age
• GFR = Number of live births in a year/ Number of females
15-49 years of age X 1000
Cont.…
Age specific fertility rates (ASFR)
• The Age specific fertility rate is defined as the number of children
born alive to females in a specific age group per 1000 females in
that specific age group, example (15-19), (20-24),….. (45-49) years
of age

• ASFR = No. of live births to females in a specific age group in a year

/ Mid-year population of females of the same age group x 1000
For example, ASFR for women 20 – 24 years of age is
expressed as ASFR (20-24) = Live births to women 20- 24 years of
age / Total No. of females 20 – 24 years of age x1000
Cont.…
• the total Fertility Rate is the average number of children
that would be born to a woman throughout her life time or
her child bearing age (15-49 years), if she were to pass
through all her child bearing years at the same rates as the
women now in each age group.
Cont.…
• The TFR sums up in a single number the Age Specific
Fertility Rates of all women at a given point in time. If 5 –
year age groups are used, the sum of the rates is multiplied
by 5. This measure gives the approximate magnitude of
“completed family size”.
TFR = Sum of all Age specific fertility rates
multiplied by age interval
Cont..
Gross Reproduction Rate (GRR)
• The Gross Reproduction Rate is the average number of
daughters that would be born to a woman throughout her
lifetime or child bearing age (15-49 years), if she were to
pass through all her child bearing age.
• This rate is like the TFR except that it counts only daughters
and literally measures “reproduction”; a woman
reproducing herself by having a daughter.
• GRR = TFR X Female births /Male births+ female
birth
Cont..
. Child – Woman Ratio (CWR)
• Child woman ratio is defined as the number of children 0 – 4
years of age per 1000 women of child bearing age, (15 -49
years). This ratio is used where birth registration statistics
do not exist or are inadequate. It is estimated through data
derived from censuses.
• CWR = No of children 0 – 4 years of age / x1000
Total No of women 15 – 49 years age
Exercise

Suppose hypothetical data of Somali region in 2014

Total number of live birth = 100,000
Total number of population 3,000,000
Total number of female aged between 15-49 = 500,000
total number of children 0-4 years = 10,000
If total fertility rate 3.8 birth per women
Male birth 50,000
Calculate
1 CBR 3. GFR
2. Cwr 4.GRR