CHN – Lecture Formula:

Module 3
Health Statistics and Epidemiology Natural Increase = No. of Birth − No. of Birth

TOOLS IN IDENTIFYING COMMUNITY (specified year) (specified year) (specified year)

HEALTH NEEDS
1. Demography
2. Vital Statistics 2. RATE OF NATURAL INCREASE
3. Epidemiology  the difference between the Crude Birth Rate and
the Crude Death Rate occurring in a population
Tools in Public Health: Demography in a specified period of time

DEMOGRAPHY Formula:
 science which deals with the study of human
population’s size, composition & distribution in Rate of Natural Increase = Crude Birth Rate – Crude Death Rate
space.
 helps the nurse find reasons or rationale on a (specified year) (specified year) (specified year)
particular population group is influenced by a
variety of factors resulting to vulnerability to
certain diseases (Maglaya, 2009). 3. Relative Increase
 the actual difference between the two census
COMPONENTS OF DEMOGRAPHY counts expressed in percent relative to the
A. Population Size population size made during the earlier census.
B. Population Composition
C. Population Distribution Formula:

A. POPULATION SIZE Relative increase = Pt - Po

 Refers to the number of people in a given place Po
or area at a given time.
 It involves analysis of three observable Where: Pt = population size at a later time
phenomena: changes in population size, the
composition of the population and the Po = population size at an earlier time
distribution of populations in space.
Demographers study five processes: fertility, B. POPULATION COMPOSITION
mortality, marriage, migration and social  population is characterized by its relation to
mobility. These processes determine variables such:
populations’ size, composition and distribution 1. Age
 Not only know how large or small the 2. Sex
population is but to make comparisons between 3. Occupation
4. Educational level
population changes in time
 The nurse uses this data to decide who among the
 Helps rationalize types of health programs or
population group merits attention in terms of
interventions that will be provided in the health services and programs.
community
CALCULATIONS:
METHODS OF CALCULATING POPULATION 1. SEX COMPOSITION – computes for sex ratio
SIZE (compares # of males to # of females in the
population).
1. NATURAL INCREASE
 the difference between the number of births Formula:
and the number of deaths occurring in a
population in a specified period of time. Sex ratio = # of males x 100
# of females
sex ratio represents the # of males for every 100
females in the population
1
2. AGE COMPOSITION 3. POPULATION DENSITY
a. MEDIAN AGE – divides the population into  determines how congested a place is and
two equal parts provides implications in terms of the adequacy
 ex: if median age is said to be 19 years of basic health services present in the
old, it means half of the population community.
belongs to 19 years and above, while the  how congested the place is and has implications
other half belongs to ages below 19 in terms of the adequacy of basic health services
years old present in the community
b. DEPENDENCY RATIO – compares the
number of economically dependent with the Formula:
economically productive group in the population
 Dependency ratio represents the number Population Density = number of people
of economically dependent for every Land area in terms of sq meter or kilometer
100 economically productive
 Economically dependent – 0-14 & 65 Dividing the number of people living in a given land
and above age groups area
 Economically independent – 15 to 64
years old Tools in Public Health: Vital Statistics
1. Births
Formula: 2. Infant Deaths
3. Population
4. Deaths
5. Maternal Deaths

3. AGE AND SEX COMPOSITION VITAL STATISTICS

 can be described using a population pyramid. (A  Refers to the systematic study of vital events
graphical presentation of the age and sex such as births, illnesses, marriages,
composition of the population) divorces/separations and deaths.
 A helpful tool in estimating the extent or
C. POPULATION DISTRIBUTION magnitude of health needs and problems in the
 can be described in terms of urban-rural community
distribution, population density & crowding
index. USES OF VITAL STATISTICS IN THE CARE OF
 These measures help the nurse decide how I, F, C
resources can be allocated based on 1. Serves as index of the health condition of the
concentration of population in a certain place. people in a community
2. Provides valuable clues to nature of health
1. URBAN-RURAL DISTRIBUTION services
 illustrates proportion of the people living in 3. Indispensable tool in planning, implementation,
urban compared to rural areas evaluation of any health program

2. CROWDING INDEX Statistics of disease (morbidity) and death (mortality)

 describes the ease by which a communicable indicate the state of health of a community and the
disease will be transmitted from one host to success or failure of health work.
another susceptible host.
Statistics on population (demography) and the
Formula: characteristics such as age and sex, distribution are
obtained from the NSO, the office charged with
Crowding Index = number of persons in a household registering vital facts in the country.
number of rooms used for sleeping

Dividing the # of persons in a household with the

number of rooms used by the family for sleeping

2
BIRTHS AND DEATHS COMMON VITAL STATISTICAL INDICATORS
 are registered in the office of the Local Civil
Registrar of the municipality and is usually 1. FERTILITY RATES
headed by the Municipality Local Registrar or  Crude Birth Rate (CBR)
Municipal Health Officer.  A measure of one characteristic of the
 In the city, these records are registered in the natural growth or increase of a population
City Local/Local Civil Registrar (LCR) Office
and data is forwarded to the National Statistics
Office (NSO)

REPUBLIC ACT NO. 3753 - "CIVIL REGISTRY

LAW"
 requires that all birth and deaths, including fetal  General Fertility Rate (GFR)
deaths are registered with the National Statistics  more specific than CBR
Office (NSO).  segment of the population deemed capable
of giving birth
PRESIDENTIAL DECREE 651
 requires all health workers to register births
within 30 days following delivery.

SOURCES OF DATA:
1. Population Census - An official and periodic
enumeration of population which includes the 2. MORBIDITY RATES
demographic, economic, and social data  Rates measure the number of cases of a disease
2. Registration of vital data occurring within a given population during a
3. Health Surveys specified amount of time.
4. Studies and researches  The population can be small and specific.
 eg. demographic group within a
Types of Data neighborhood, or large like the entire
population of a country
1. Primary Data  Incidence Rate (IR)
 data which have not been collected before  measures the development of a disease in a
 through observation (ocular/windshield), group exposed to the risk of such in a given
informant interview, focused group discussions period of time.
(FGD) o deals only with new cases (newly
diagnosed)
2. Secondary Data o used during epidemics or acute
 data from existing sources conditions
 vital registries, publications  best indicator of whether a condition is
 health records and reports decreasing, increasing or static
o measure of the effectivity of
HEALTH INDICATORS interventions
 a list of information which would determine the
health of a particular community like population,
crude birth rate, crude death rate, infant &
maternal death rates & etc.

COMMON HEALTH INDICATORS

1. Birth
2. Death
3. Marriages
4. Migration

3
  Prevalence Rate (PR)  Infant Mortality Rate (IFR)
 Measures the proportion of the population which  Measures the risk of dying during the 1st
exhibits a particular disease at a particular time. year of life.
 This can only be determined following a survey  It is good index of the general health
of the population concerned. condition of a community since it reflects
 Deals with total (old and new) number cases. the changes in the environmental and
 Used in the administration of health services medical conditions of a community.
 10 Leading Causes of Morbidity.  High IMF means low level of health

 Maternal Mortality Rate (MMR)

 It measures the risk of dying from causes
related to pregnancy, childbirth and
puerperium.
 It is an index of the obstetrical care needed
and received by the women in a community

 Proportionate Mortality Rate (PMR)

 shows the numerical relationship between
deaths from a cause (or group of causes),
age (groups of age etc.) and the total
number of deaths from all causes in all ages
taken together.
 Used in ranking cause of death by
frequency
 expressed in percentage

3. MORTALITY RATES
 Crude Death Rate (CDR)
 A measure of one mortality from all causes
which may result in a decrease of
 Swaroop's Index (SI)
population.
 a sensitive index of the standards of health
 expressed as “no. of deaths per 1000
care in a country
persons”
 Directly proportional to the health status of a
population, where developed countries have
higher Swaroop’s Index than developing
ones
 High index implies the better health
services, better health status, longer life
span and more people would reach up to
 Cause of Death Rate (C-DR)
50 years old.
 determines the 10 Leading cause of death
 Low index implies that life expectancy is
 Considered as crude since denominator
short
includes the whole population
Puerperium - may last up to 6 weeks or 42 days

Maternal death- refers to the death if any woman while

pregnant or with 90 days of termination of the pregnancy
4
Additional Notes of SWAROOP'S INDEX (SI): 3. National Epidemiology Sentinel Surveillance
 a sensitive index of the standards of health care System (NESSS)
in a country 4. Expanded Program on Immunization (EPI)
 the higher the SI, the better health services, Surveillance System
better health status, longer life span and more 5. HIV-AIDS Registry
people would reach up to 50 years old.
R.A. 11332 - "Mandatory Reporting of Notifiable
Better interpretation of the Swaroop's Index in an Diseases and Health Events in Public Health Concern
example: Act"
 Section 7 of RA 11332 provides that the
If the number of deaths in the Philippines among 50 President of the Republic of the Philippines shall
years old and above is 45,650 in 2016 and the total declare a State of Public Health Emergency in
population is 275,260, what is the Swaroop's Index in the event of an epidemic of national and/or
2016? international concern which threatens national
security in order to mobilize governmental and
SI = 45, 650 x 100 nongovernmental agencies to respond to the
275, 260 threat.
= 16.58 or 17%
DISEASE OUTBREAK (WHO)
Interpretations:  The occurrence of disease in excess of what
a. 17% of the Filipinos in 2016 died at the age of would normally be expected in a defined
50 years and above. community geographical area or season
b. 83% of the Filipinos in 2016 died before the age  also considered in a previously unknown disease
of 50 years old.

PRACTICAL APPLICATION OF
Tools in Public Health : Epidemiology EPIDEMIOLOGY
 Assessment of the health system of the
EPIDEMIOLOGY community
 The study of the distribution and determinants of  Elucidation of the natural history of disease
health-related states of events in specified  Determination of disease causation
populations and the application of this study to  Prevention and control of disease
the prevention and control of health problems  Monitoring and evaluation of health intervention
(Last, 1988)  Provision of evidence for policy formulation
 The study utilizes concepts and methods form
other fields of study such as biology, sociology, CONCEPTS IN EPIDEMIOLOGY
demography and environmental science and
statistics. 1. MULTIPLE CAUSATION THEORY
 Disease development does not rest on a single
cause but rather results from multiple factors
EPIDEMIOLOGIST - person who studies
epidemiology. ECOLOGIC TRIAD (Triad of Epidemiology)
 most helpful to the nurse because it highlights
PUBLIC HEALTH SURVEILLANCE - the ongoing not only the host’s and agent’s roles in disease
systematic collection, analysis and interpretation of development but also regards the role of
health of health related-data needed for the planning, environment as important in disease causation.
implementation and evaluation of public health practice
1. Agent – is any element, substance, force animate or
inanimate which serve as a stimulus to initiate or
PHILIPPINE INTEGRATED DISEASE perpetuate a disease process.
SURVEILLANCE AND RESPONSE  Biological
1. Notifiable Disease Reporting System (NDRS)
 Physical
2. Field Health Service Information System
 Chemical
(FHSIS)
 Mechanical
 Nutritive
5
  anatomical or functional changes have produced
2. Host – is any organism that harbors and provide recognizable signs & symptoms.
nourishment for another organism
 Demographic characteristics
 General health status 3. LEVELS OF PREVENTION OF HEALTH
 Body defenses PROBLEMS
 State of immunity & immunological response  Prevention refers to identification of potential
 Human behavior problems so that the nurse can minimize or
eradicate possible disability or deformity in a
3. Environment – the sum total of all external population at risk.
conditions and influences that affect the life and
development of an organism 1. Primary Prevention
 Physical – inanimate surroundings such as the  activities directed to the healthy population,
geophysical conditions and climate focusing on prevention of emergence of risk
 Biological – living things such as plants and factors and removal or reduction of risk
animal life (vectors) factors
 strengthen host resistance; interrupt the chain of
 Socio-economic – economic development,
infection
social disruptions
 surveillance, quarantine, segregation, isolation

2. Secondary Prevention
2. NATURAL HISTORY OF DISEASE
 aims to identify and treat existing health
 Seeks to identify factors related to the course of
problems at the earliest possible time.
a disease once established in order to determine
 control or eradication of the health problem
its duration and the probability of recovery,
 screening, case finding, disease surveillance
death or specific complications.
 prompt and appropriate treatment
 Help the nurse and other people to implement
measures to prevent pathologic processes to
3. Tertiary Prevention
progress.
 limits disability progression
 the nurse attempts to reduce the magnitude or
STAGES OF NATURAL HISTORY OF DISEASE
severity of the residual effects of infectious
(Leavall and Clark, 1968 )
diseases and non-infectious diseases.
PRE-PATHOGENESIS
4. CONCEPT OF CAUSALITY AND
 the disease has not developed but factors that
ASSOCIATION
favor its occurrence are present.
2 Premises:
PATHOGENESIS
 Disease does not occur at random.
 disease has developed
 Disease has identifiable CAUSAL and
PREVENTIVE factors
a. Cause Of A Disease
3 SUBSTAGES OF PATHOGENESIS  any event, condition, characteristic or
combination of these factors that play an
1. Pre-Symptomatic Disease Or Early Pathogenesis important role in producing the disease.
 individual has no symptoms that indicate the  a cause must precede a disease and the cause of
presence of illness but in fact, pathogenic a disease must be necessary and sufficient for
changes have begun. the occurrence of disease.

2. Discernible Lesions b. Necessary Cause

 changes may be detectable through  refers to the fact that the factor must be present
sophisticated laboratory tests, during this for the disease to occur.
period, the early signs & symptoms of diseases
are developing. C. Sufficient Cause

3. Advanced Disease
6
  indicates that if a factor is present, the disease 6. An epidemic curve is merely a graphic display
can occur, but the factor’s presence does not of disease onsets overtime, hours, days or
always result in the disease occurrence. weeks.

d. Risk FUNCTIONS OF THE NURSE IN

 probability of an unfavorable event, disease, EPIDEMIOLOGY
disability, defect or even death. 1. Maintain surveillance of the occurrence of
 must be identified and dealt with to prevent notifiable diseases.
diseases. 2. Coordinate with other team members during an
outbreak.
e. Association 3. Participate in case finding and collection of lab
 concurrence of 2 variables under investigation specimen.
and are often associated with each other 4. Isolate cases of communicable diseases.
5. Render or supervise nursing care.
6. Perform and teach household members methods
FACTORS ASSOCIATED WITH INCREASED of disinfection.
RISK OF DISEASE 7. Conduct health teachings.
A. Predisposing factor – any characteristic of an 8. Follow-up cases.
individual, a community or an environment that 9. Organize, coordinate, and conduct community
predisposes behavior or other conditions related to health education campaign.
health. 10. Refer cases when necessary.
11. Coordinate with other concerned community
B. Enabling Factor - any characteristic of an agencies.
individual, group or the environment that facilitates or 12. Accomplish and keep records and reports and
make possible a certain health behavior or other submit to proper office/agency.
conditions affecting health.
PHASES OF EPIDEMIOLOGICAL APPROACH
C. Reinforcing factor – any reward or punishment or
any feedback following or anticipated as a consequence A. DESCRIPTIVE EPIDEMIOLOGY
of health behavior.  aims to describe the occurrence of health
conditions in the community in terms of the
attributes of the people, pattern of disease and
characteristics of the place when the disease
appeared
 concerned with disease distribution and
frequency
 Case finding and screening activities

PRINCIPLES IN EPIDEMIOLOGY
1. No disease occurs by chance alone because each DETERMINING CHARACTERISTICS OF THE
follows its own recognizable pattern of COMMUNITY AND POPULATION:
occurrence.
2. Health is a state of equilibrium, a delicate 1. Herd Immunity
balance of many factors.  represents the immunity and susceptibility levels
3. Disease causation is complex. of the population
4. Infection is not synonymous with disease  occurs when a high percentage of the
5. Knowledge of the distribution of disease community is immune to a disease (through
overtime is valuable to the nurse in the vaccination and/or prior illness), making the
community spread of this disease from person to person
unlikely.

7
  Epidemic
o occurs when the proportion of
susceptible are high compared
to the immunes; increase in
disease incidence
 Endemic
o occurrence of disease that
implies habitual presence of
disease in a given geographic
location
 Sporadic
o disease occur every now and
then affecting a small number of
people relative to the population
 Pandemic
o global occurrence of a disease

2. Exposure or Contact Rate

 represents opportunities for progressive transfer
or transmission of an infectious agent to a
susceptible host
 depends on the frequency of contact and facility
of transmission.

3. Chance
 is the probability pf contact between the source
of infection and the susceptible host

B. ANALYTICAL EPIDEMIOLOGY
 Attempts to identify the possible factors
associated with disease occurrence.

C. INTERVENTIONAL OR EXPERIMENTAL
EPIDEMIOLOGY
 aims to test effectiveness of intervention
programs designed to prevent and control
disease utilizing randomized controlled or
clinical trials and field or community trials.

D. EVALUATION EPIDEMIOLOGY
 attempts to measure effectiveness of different
health services and intervention programs