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validity
:
reliability
:
accuracy
:
sensitivity :
specificity :
The purpose of quality control in measurement is to reduce errors as much as possible.
However, measurement of psycho-social aspects have not been covered.
Tools of Measurement
Three basic tools of measurement in Epidemiology are Rates, Ratios and Proportions.
- crude rate : are the actual observed rates such as birth and death rates (unstandard)
- specific rate : these are actual observed rates due to specific causes. eg. TB
occurring in
specific groups or sex annually or monthly, etc.
- standardised rate: obtained by direct or indirect method of standardisation. eg age
and sex standardised
rates.
Proportion is a ratio which indicates the relation in magnitude of a part of the whole.
It is expressed as percentage.
Example:
no. of children with scabies at a particular time
---------------------------------------------------------total no. of children in the village at the same time.
* 100
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PREVALENCE:
INCIDENCE:
Observational studies:investigator does not intervene; but only observes the extent of exposure of a person to a
disease or the causative factors related to occurrence of the disease.
I.
DescriptiveEpidemiological Studies:
Study of frequency of health events by asking questions like:
Who is getting the disease? (person distribution )
Where is it occurring
(place distribution) and
When is the disease occurring (time distribution).
Describing the Disease:The occurrence and distribution of disease by time, place and person:
o Short term fluctuations/trends: are occurrences of diseases which may appear in the form of
epidemics, which are generally of 3 types:
Common source epidemics- which may be single or continuous exposure:
- Common source with singleepidemic:
- these are known as point source epidemics and exposure to disease agent is brief;
- the epidemic curve rises and falls rapidly;
- clustering of cases occur resulting in development of all within one incubation
period.
- these epidemics may due to exposure to infectious agent, contamination of
environment,(air, water, soil) by industrial pollutants etc.
- Common source with Continuous/ repeated exposure:
-Repeated / prolonged exposure of disease takes place with same / multiplesources.
e.g. a well of contaminated water may infect people for a prolonged period with
repeated exposures to the contaminated water resulting in disease outbreaks.
Propagated epidemics- which may be transmitted fromperson to person, anthropod
vector or animal reservoir.
- This epidemic is of infectious origin resulting from person-person transmissioneg:spread of hepatitis and polio.
- the epidemic curve rises gradually and falls over a much longer period of time.
- Spread of infection depends upon period of exposure to the infected persons.
o Periodic trends/ fluctuations: may be of seasonal trend or cyclic trend.
- Seasonal trend-disease occurrence due to variation in environmental conditions;
e.g:(i) measles occur in early spring; upper respiratory infections occur in winters while,
bacterial infections are prominent in summer months
(ii)Seasonal variation/trend of Dengue can be seen in Table given below:
Table-Seasonal Variation- Dengue
Months
January
Februar
y
March
April
May
June
July
Nov
Dec
2005
151
80
2006
281
193
2007
83
64
50
68
130
172
742
1500
800
181
175
185
279
478
1900
910
46
50
175
186
487
802
201
From the above Table, it is clear that each year, rise of dengue is from May- Nov. However,
there is decrease in the occurrence of the disease in winter month of Dec.
Cyclic trend- Some diseases occurin cyclic periods; eg: influenza is seen to occur after
every 7-10 years; accidents in US is witnessed more during weekends etc.
o Long term trends/secular trends: when changes in occurrence of disease happens over a
long period of time.eg: lifestyle diseases like diabetes, lung cancer, heart diseases have
shown upward trend in developed countries while there is decline in Tuberculosis, typhoid
etc. in these countries.
(ii)Place distribution:
i.
-This is distribution of disease in different population not only between different countries but
also within countries (geographic variation in disease occurrence).
- These variations in mortality and morbidity are classified as international variations, national
variations, rural-urban variation and local distributions:
Eg. cancer of stomach is common in Japan but unusual in US. Cancer of oral cavity and
uterine cervix are common in India, etc.These variations lead to study of cause-effect
relationships between environmental factors and disease for prevention of disease.
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ii.
iii.
-
e.gDistribution of malaria, leprosy, nutritional deficiency diseases vary within different parts
of India. Such information helps to demarcate the affected areas for providing appropriate
health care services.
e.gThe variations in death rates (infant and maternal mortality rates) are higher in rural than
urban areas in India, which may be due to differences in social class, lack of medical care,
sanitation, education, etc.
All diseases showdefinite patterns of geographic distribution which may provide evidence of
source of disease and mode of spread.
By relating these variations to agent, host and environmental factors, the cause of the disease
and its frequency can be found out.
Diseases are also classified by geographic occurrence as:
Endemic: habitual presence of a disease in a given geographical area.
Epidemic: occurrence of group of diseases in a community in excess of normal expectancy or an
outbreak.
o Pandemic: world-wide epidemic is known as pandemic.
o
o
(iii)
Person distribution:
- The disease is characterised by defining the persons who develop the disease by age, sex,
occupation, marital status, social class (host factors in epidemiological studies), etc.
- Some of the host factors are :
i.
age: certain diseases are more frequent in certain age groups than in others. Eg.
measles in childhood and arthritis in old age however, communicable disease is
common to all age groups.
ii.
Sex: certain chronic disease such as diabetes etc. are common in women than men
while lung cancer and heart diseases are less frequent in women.
iii.
Marital status: some studies indicate that mortality rates were lower in married males
and females than the unmarried ones of the same age and sex. (K.Park)
iv.
Occupation: while workers in coal mines suffer from silicosis, those in sedentary jobs
suffer from heart diseases.
v.
Social class: certain diseases like hypertension, diabetes, etc. are common in upper
classes than in lower class.
Measurement of Disease:
The information on disease load in a population is available in terms of mortality, morbidity,
disability, etc. the magnitude of health and disease problems in human population is obtained
bycross-sectional studies and longitudinal studies in descriptive epidemiology.
-
i.