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Health Statistics including Medical Statistics

Health Statistics including Medical Statistics. Outline of the Presentation. Introduction Applications of Statistics in Public Health Tools for measurement Measurement of Mortality Problems of Mortality data Standardization of Rates Measurement of Morbidity Measurement of Fertility

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Health Statistics including Medical Statistics

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  1. Health Statistics including Medical Statistics Contributed by National Academy of Statistical Administration, India

  2. Outline of the Presentation • Introduction • Applications of Statistics in Public Health • Tools for measurement • Measurement of Mortality • Problems of Mortality data • Standardization of Rates • Measurement of Morbidity • Measurement of Fertility • Official Health Statistics • Health under the Indian constitution • Role of Central Bureau of Health Intelligence (CBHI) • Limitations of CBHI Publications • Achievements of Family Welfare Program Contributed by National Academy of Statistical Administration, India

  3. Introduction At the time of the creation of the World Health Organization (WHO), in 1948, health was defined as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity“. But now it is defined as Health is the general condition of a person in all aspects. It is also a level of functional and/or metabolic efficiency of an organism, often implicitly human. Contributed by National Academy of Statistical Administration, India

  4. Applications of statistics in public health: Population estimation and forecasting Surveys of population characteristics, health needs and problems Analysis of health trends Health education Evaluation of Health Programs Research & Development Contributed by National Academy of Statistical Administration, India

  5. Tools for measurement Three tools: Rates Ratio Proportion Contributed by National Academy of Statistical Administration, India

  6. Rate Rates of a vital event is defined as the total number of occurrence of the event to the total number of persons exposed. A rate consists of (a) numerator (b) denominator (c) time specification (d) multiplier e.g. Number of births in 2001 Birth rate= _________________________x 1000 Mid year population in 2001 Contributed by National Academy of Statistical Administration, India

  7. Rate (contd..) Three types: Crude rates Specific rates Standardized Rates Contributed by National Academy of Statistical Administration, India

  8. Rate (Contd..) Crude Rates- Simplest of all the indices and is defined as the no. of a event (e.g. death from all causes) per k persons in the population of any given region or community during the given period. called crude because here denominator used is entire mid year population and we are not including specific information in numerator, e.g. in crude birth rate we include all births whether live or still births Contributed by National Academy of Statistical Administration, India

  9. Rate (Contd..) Specific Rates- These are the actual observed rates due to specific causes e.g. AIDS, Cancer or occurring in specific groups e.g. under five children, women from 15 to 44 years, or during specific time periods e.g. week, month or year Contributed by National Academy of Statistical Administration, India

  10. Rate (Contd..) Standardized Rates- To make two populations and their rates comparable Adjustment either by direct or indirect method for age, sex, religion etc. is made. This way we get age or sex standardized rates. Multivariate analysis, regression techniques can help us in standardization. Contributed by National Academy of Statistical Administration, India

  11. Ratio express relation between two unrelated quantities. no time frame and multiplier. e.g. Sex ratio i.e. number of females per 1000 males. In 2001 it was 933: 1000. Contributed by National Academy of Statistical Administration, India

  12. Dependency Ratio (Population aged 0 to 14 years)+(population aged 65 years and above ) Dependency ratio = ______________________________________x 100 Population aged 15 to 64 years (population aged 0 to 14 years) Childdependency ratio= _________________________x 100 Population aged 15 to 64 years (population aged 65 years & above) Old age dependency ratio= ________________________________x 100 Population aged 15 to 64 years Contributed by National Academy of Statistical Administration, India

  13. Proportion A proportion is a ratio in which numerator is always included in the denominator. usually expressed as percentage. Example- (Marks obtained/ Total Marks) x 100 Proportional morality due to AIDS= (No. of deaths due to AIDS/ No. of deaths due to all causes )x 100 Contributed by National Academy of Statistical Administration, India

  14. Measurement of Mortality Only data available in many of the developing countries Useful for Epidemiologic research Health trends Planning Execution Evaluation of various Health Programmes Contributed by National Academy of Statistical Administration, India

  15. Problems of Mortality data a) All deaths may not be reported. b) The age of deceased and cause of death may not be recorded accurately. c) National and international comparabilitypoor due to lack of uniform and standardized methods of collection. d) If a single cause of death is recorded, then information regarding associated conditions and risk factors may not be available. e) Coding systems and diagnosing practices changes over time affecting validity/ comparability of the data. Contributed by National Academy of Statistical Administration, India

  16. Measurement of Mortality (contd..) Mainly following type of mortality rates are available 1. Crude death rates 2. Specific death rate 3. Standardized death rates Contributed by National Academy of Statistical Administration, India

  17. Crude Rates Crude death rate= No. of deaths in year x 1000 Mid year population of that year) Natural Increase rate= No. of births - No. of deaths x 1000 Mid year population of that year) Contributed by National Academy of Statistical Administration, India

  18. Specific Death Rates Death rates computed for a particular specified section of the population is termed as specific death rate (SDR). SDR= {Total no. of deaths in the specified section of the population in the given period/Total population of the specified section in the same period}x k Where k= 1000 usually. Usually S.D.R is computed specific to (i) age and (ii) sex Contributed by National Academy of Statistical Administration, India

  19. Specific Rates: Infant mortality rate= No. of infant deaths in a year x 1000 No. of live births in that year Neonatal mortality rate= No. of deaths within First 28 days of life in a yearX1000 No. of live births in that year Child death rate= Annual No. of deaths between 1st & 4thYr. of life x 1000 No. of live births in that year Contributed by National Academy of Statistical Administration, India

  20. Standardization of Rates: Two methods : direct indirect Contributed by National Academy of Statistical Administration, India

  21. Direct Standardization In this method given values are evaluated against some standard values. Suppose a city has following parameters with CDR 10 per 1000.. Contributed by National Academy of Statistical Administration, India

  22. Contd…. Now lets us take a standard population with 50000 males 50000 females. Apply sex specific death rates of above population to the standard population Contributed by National Academy of Statistical Administration, India

  23. Contd…. Standardized death rate per 1000 =(750+392.5/100000) x 1000 = 11.42 per 1000 Standardization for sex has increased death rate from 10 per 1000 to 11.42 per 1000 Contributed by National Academy of Statistical Administration, India

  24. Indirect standardization It requires: 1. Age or sex distribution of each group to be standardized 2. Total events in each group to be standardized 3. Age or sex specific rates for a standard population. Contributed by National Academy of Statistical Administration, India

  25. Contd…… In the study population of 1,00,000 there are 60,000 Coal miners, 20,000 Farmers, 10,000 laborers and 10,000 others. Contributed by National Academy of Statistical Administration, India

  26. Contd…… Total expected deaths= 1070 Actual deaths = 900 Crude death rate for study population= 900/100000x1000=9 per 1000 =observed deaths/expected deaths X 100 =900/1070x100 =84.11 Contributed by National Academy of Statistical Administration, India

  27. Measurement of Morbidity Three units- I) Persons affected. II) spells of illness III) duration of illness Contributed by National Academy of Statistical Administration, India

  28. Contd….. Utility of rates and ratios : A) help in deciding priorities. B) help in monitoring and evaluation of various activities aimed at control and C) Prevention of the disease D) Research activities. Contributed by National Academy of Statistical Administration, India

  29. Contd….. Limitations of rates and ratios : A) Illness occur in spells. B) illness has various grades of severity. C) illness exists over a period of time. D) illness cannot be defined precisely. Contributed by National Academy of Statistical Administration, India

  30. Measurement of disease frequency Commonly used rates are- Incidence rate: It is defined as number of new cases occurring a defined population during a specified period of time a) Incidence rate (persons) =(No. of persons starting an episode of illness in a defined period ) X 1000 Average no. of persons exposed to risk during that period b) Incidence rate (spells)= No. of spellsof illness starting during the defined period x 1000 Average no. of persons exposed to risk during that period Contributed by National Academy of Statistical Administration, India

  31. Measurement of duration of illness Avg. duration of illness= Sum of duration of illness of cases in a sample No. of cases in the sample Days of illness per spell= Sum of days of illness of all sick persons No. of spells of illness Contributed by National Academy of Statistical Administration, India

  32. Measurement of fertility: Birth rate = (No. of live births during the year/ Estimated mid year population of that year) x 1000 General fertility rate= (No. of live births in an area during the year/ Midyear female population of age 15 to 44 (or 49) in the same area in that year) x 1000 General martial fertility rate= (No. of live births in an area during the year /Midyear female population of age 15 to 44 (or 49) and who are married, in the same area in that year)x 1000 Contributed by National Academy of Statistical Administration, India

  33. Official Health Statistics Two broad categories: a) Existing Health Situation b) Response of Official Machinery to Improve the Health Situation preventive curative and rehabilitative Contributed by National Academy of Statistical Administration, India

  34. Existing Health Situation include Population information Vital Statistics Burden of Disease and Disability Cause of death information Reproductive and child health Contributed by National Academy of Statistical Administration, India

  35. Existing Health Situation (contd..) Environmental pollution Availability of basic amenities like safe drinking water, availability of sanitation facilities, source of lighting, housing facility Socio economic condition of family like average family size, level of poverty, literacy level of head of household 9 International comparative information Contributed by National Academy of Statistical Administration, India

  36. Response of Official Machinery to Improve the Health Situation include Health and population policies Health and medical educationinfrastructure Availability and deployment of health and medical personnel Health expenditure Health and medical research Checking food adulteration Preparedness to tackle epidemics and aftermath of natural calamities Contributed by National Academy of Statistical Administration, India

  37. Health under the Indian constitution Union List: Port Quarantine Administration Post graduate Medical Education International Health Medical Research etc. State List: Public Health Sanitation and medical care Hospitals and dispensaries Contributed by National Academy of Statistical Administration, India

  38. Health under the Indian constitution (Contd..) Concurrent List: Vital Statistics (including registration of births and deaths) Food Adulteration Drug Control etc. Contributed by National Academy of Statistical Administration, India

  39. MINISTRY OF HEALTH & FAMILY WELFARE Organizational setup Department of Health and Family Welfare Department of AYUSH Department of Health Research Department of AIDS Control Central Bureau of Health Intelligence (CBHI) Contributed by National Academy of Statistical Administration, India

  40. Health Care Delivery System – Government Sub Centre (5000 population) Primary Health Centre (6 Sub Centers) Central Health Centre (for 4 PHC’s) Hospital: Municipal, District Level, Teaching Hospital, Non Teaching Hospital etc. Contributed by National Academy of Statistical Administration, India

  41. Information flow to central authorities Sub Center Primary Health Center Primary Health Center District Health Office State Center Community Health Center Contributed by National Academy of Statistical Administration, India

  42. Statistical set up at the centre and States/ UTs Centre: CBHI, National AIDS Control Organization States: SBHI or State demographer or State AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy ) officer. Contributed by National Academy of Statistical Administration, India

  43. Central Bureau of Health Intelligence (CBHI) • CBHI collects information on • Education: • Allopathic Medical/ Dental Education from MCI/ DCI recognized Medical and Dental Colleges through annual proforma • Paramedical education from Dental Health Services/ DME of states/ UTs to annual proforma • Physiotherapy • Occupational Therapy • Prosthetics & Orthotics • Speech & Hearing Therapy • Medical Laboratory Technology Contributed by National Academy of Statistical Administration, India

  44. Manpowers Registered number of allopathic doctors dental surgeons general nurses Pharmacists from the respective all India councils such as medical council, dental council and pharmacy council annually. Registered number of AYUSH practitioners from Department of AYUSH annually Number of allopathic doctors/dental surgeons working in Govt. establishments in States/ UTs from the DHS of States/ UTs through annual proforma. Number of paramedical personnel from States/UT’s Contributed by National Academy of Statistical Administration, India

  45. CBHI (Contd..) Treatment infrastructure : Allopathic treatment infrastructure in Govt. Sector on annual basis from DHS of States/ UTs. Rural health facilities information from infrastructure division of department of family welfare annually Information on treatment infrastructure from Department of Ayush Contributed by National Academy of Statistical Administration, India

  46. CBHI (Contd..) Annually Public Health Information : Reported cases and deaths due to Cholera (weekly), communicable (monthly) and non communicable diseases (monthly) through prescribed formats Information on Malaria, Filaria, Kala Azar, Dengue from National Vector Borne Disease Control Programme – annually Contributed by National Academy of Statistical Administration, India

  47. CBHI (Contd..) Causes of death information From RGI annually All information is published in an annual publication titled “Health Information of India” Contributed by National Academy of Statistical Administration, India

  48. Health Information of India Population & Vital statistics, Per capita Income, Percent of population below poverty line, Medical & Dental Education, Registered Personnel Information, Number of Govt. Allpathic Hospitals, No. of ISM&H facility (both Educational & treatment), Production of certain Essential drugs, Public Health Statistics for Cholera & major communicable disease, Causes of Death Statistics, International Comparative Statistics etc. Contributed by National Academy of Statistical Administration, India

  49. Limitations of CBHI Publications: Data below States/UT level are not available in central health statistical publications. Private sector health data are not included. There is no Statutory provision to collect Health Data from Private Health establishment. Age & Gender specific data are not done. Action is being taken to capture morbidity data, gender wise for the publication Morbidity surveys are not done regularly and hence, there is a dearth of data on prevalence/incidence rates of disease. Contributed by National Academy of Statistical Administration, India

  50. Limitations of CBHI Publications (Contd..) There is no systematic generation of health data and scientific methods of recording at grass root levels. There are no data on cost of Health Care, availability of specialty treatments in the various Hospitals. Hospital inpatient & Out patient Medical Records are not computerized. There is no data on registered Para Medical Professional. The registered Health Personnel data are not corrected for death etc. There is no District Health Facilities Directory in many of the States/UTs. Contributed by National Academy of Statistical Administration, India

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