Introduction to BIOSTATISTICS, VITAL AND

HEALTH STATISTICS (EVM 217)

OUTLINE
 Definition
 Derivation and Application of various statistics and
Health status indicators and indices
 Indices and indicators of wellness as well as those of
Morbidity and mortality patterns.

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 UNIT ONE
INTRODUCTION
Biostatistics is an important tool in the challenge to enhance health outcomes in the
face of stretched health care resources. The use of statistics in health care dates back
more than a century to the earliest application of the scientific method in medical
research. Many health care decisions are based in small or large part on the results of
biostatistical research. The application of statistics to biological and medical data
have a tremendous impact on the provision of health care and prevention of disease.
The accurate interpretation of biostatistical data can serve as the foundation for
efforts to improve public health and the quality of patient care.
Vital and health statistics on the other hand are essential components of health
information systems. Immediate birth registration is a human right, provides identity,
and facilitates access to such essential services as health, education, and social
benefits. Registration of deaths ensures inheritance rights for the population, allows
voter rolls to be purged, reveals a society’s true epidemiological profile, and allows
the health systems to adjust their public policies to help reduce avoidable deaths. This
registration process yields vital and health statistics, which are essential for decision-
making, distribution of resources, policy-making, and interventions on behalf of the
different populations of the countries and territories of the Region. These data are an
important component of health statistics. They are essential for the planning and
implementation of public health programs, including measuring and monitoring
progress toward achieving the Sustainable Development Goals (SDGs). For example,
birth data by locality can help improve vaccination campaigns, while birthweight data
can help identify high-risk areas.
DEFINITION
Biostatistics is defined as the science of collecting and analyzing biological or health
data using statistical method. It simply means the application of statistics to the study
and analysis of biological and medical data. Biostatistics involves the development
and application of statistical science to human health and disease.
Vital and health statistics on the other hand may be defined as conventionally
numerical records of marriage, births, sickness, and death by which the health and
growth of a community may be studied. The data are usually collected by
governmental bodies, detailing the rates of birth, death, disease, marriage, and
divorce in a population.

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Vital and health statistics may also be defined as figures of births, marriages,
separations and deaths in a population, from which the rate of natural increase or
decrease in a population can be calculated.
TYPES OF VITAL AND HEALTH STATISTICS
• Birth Statistics: It includes an absolute number of births, crude birth rates, and
sex ratio at birth. It also comprises fertility rates in terms of adolescent birth rate,
age-specific fertility rate, and total fertility rates as well as low birth weight and
preterm live births.
• Marriage Statistics: It consists of an absolute number of marriages, age-specific
distributions and rates, the median age at marriage.
• Divorce Statistics: It involves an absolute number of divorces, age-specific
distributions and rates, the median age at divorce and cause of divorce.
• Death Statistics: It covers an absolute number of deaths, crude death rates, age-,
sex-, and cause-specific death rates. Moreover, death statistics include: infant
mortality, under-five mortality and maternal mortality ratio. etc

SOURCES OF BIOSTISTICS, VITAL AND HEALTH STATISTICS

• Population census
• Civil registration system
• Demographic/ National sample survey
• Hospital records etc.

USES OF BIOSTATISTICS, VITAL AND HEALTH STATISTICS

Biostatistics
• To fix priorities in public health programs.
• To help promote health legislation and create administrative standards for health.
• To evaluate the achievement of public health programs.
• To measure mortality and morbidity rates.
Vital and health statistics
• For the individual; Vital statistics have much of use for the individuals, for
example, a child’s birth certificate, that is being issued by the registering
authority, is a crucial document that has the data of date, time, place, and
parentage of the child, also it authorized child’s identity as the citizen of the
respective country. A birth certificate is a legal document that is deployed in
various tasks such as for taking admission in school, for obtaining a passport, to

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 migrate in another country, etc. Likewise, a marriage certificate keeps the record
of the marital status of a couple, death certificate records the no more existence
of a person in the world, etc.
• For legal usage; Vital statistics are legally extremely beneficiary, such as issued
certificates related to birth, death, marriage, divorce, etc are legally important. For
example, a death certificate is necessary and an important legal document for the
settlement of property of the expired person, for claiming his/her insurance policy,
etc.
• Health and family planning programs; Related to births and deaths records,
vital statistics are used in health and planning programs under the government
system. The causes behind deaths, and the mortality rates of several categories aid
in capturing the health conditions of the people. In accordance with this data, the
state authority can design health programs such as malaria eradication, polio,
tuberculosis, etc. Also, the government can launch hospitals, maternity and child
welfare centers, etc. according to the requirement of the population.
• For the study of social circumstances; In order to study the birth and death rate,
divorce rate, widow remarriage, widowhood etc, vital statistics are of much use,
it reflects the current situation/circumstances of the society as well as its customs
and traditions.
• For administrators and planners; Related to trend and population growth under
the various age group and as a whole, vital statistics provide data and information
that help planners and administrators for proposing and preparing policies for
health, education, housing, transporting and communications, food supplies, etc.

IMPORTANCE OF BIOSTATISTICS, VITAL AND HEALTH STATISTICS

• Community health; assist in describing the level of community health, diagnose
community illness and discover solutions to health problems.
• Administrative purpose; they provide clues for administrative standards of
health activities.
• Health programmed organization; they assist various health authorities
determine success or failure of specific health programs or undertake overall
evaluation of public health work
• Legislation purpose; they help in promoting health legislation at local, state, and
national levels.
• Government levels; statistics help government develop policies, procedure at
various levels (federal, state and local).

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 UNIT TWO
DERIVATION AND APPLICATION OF VARIOUS STATISTICS AND
HEALTH STATUS INDICATORS AND INDICES
INTRODUCTION
Having known the importance of biostatistics, vital and health statistics, we shall be
looking at the derivations and application of different statistics used in
nursing/medicine such as measures of central tendency (mean, median, mode), tabular
presentation of data (frequency distribution data), graphical presentation of data (bar
chart, pie chart etc) and vital and health statistics such as birth rates, fertility rates,
death rates etc.

Statistics simply means information in numerical form. Statistics can be defined as a

mathematical science concerned with data collection, presentation, analysis, and
interpretation. E.g include mean, median, mode, bar chart, pie chart, frequency
distribution table, histogram etc
Statistics can also be defined as a systematic collection and analysis of data on
measurements or observations, often related to demographic information such as
population counts at different ages, incomes, etc.
MEASURES OF CENTRAL TENDENCY
Measures of central tendency otherwise known as measure of location is the
statistical information that gives the middle or center of a set of data. There are three
common measures of central tendency which are mean, median and mode.
1. THE MEAN OR ARITHMETIC MEAN
The mean or arithmetic mean is the most important and common type. It is the sum
of all the items in a set of data divided by the number of items in the set of data. Mean
can be calculated for ungrouped and grouped data.
Mean of grouped data
The mean of ungrouped data can be calculated thus;
Mean = sum of the numbers in the set
N

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Example 1
Find the arithmetic mean of the following respiratory rates (c/m) of ten patients as
recorded in a hospital somewhere in Lagos.14, 16, 16, 16, 18, 18, 18, 20, 20, 20
Solution
Add all the numbers and divide by 10. Hence,
the arithmetic mean is got as follows;

x = 14+ 16+16+16+18+18+18+20+20+20

10
= 17.6
= 18 approximately
Sometimes when the number of items is large, there will be need to form a frequency
table. The frequency table will have three columns; the items column, the frequency
column and the column for the product of the item and its respective frequency.
Example 2
The following are the pulse rates (b/m) of 36 200L biological students of WAUU as
recorded in the sickbay.
60 66 68 70 80 64 76 68 76
76 68 64 66 80 60 64 76 80
68 70 64 76 64 76 72 80 76
80 76 80 76 76 68 66 60 64
Calculate the mean of the students’ pulse rates
1. Solution

Pulse rate x Frequency f fx

60 3 180

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 64 6 384
66 3 198
68 5 340
70 2 140
72 1 72
76 10 760
80 6 480
∑f = 36 ∑fx = 2, 554

First, we prepare the frequency table showing the three columns as follows;
The first column denoted x is for the pulse, the second column is the number
of times or frequency each of the pulse rates appear while the third column is the
product of the first and the second column denoted fx
Therefore the mean x is calculated thus as;

x = ∑fx
∑f
= 2,554
36
= 70.9
= 71 approximately
Mean of grouped data
The mean can also be calculated for grouped data as follows;
Example 3
The following are ages of 50 people diagnosed with diabetes at a hospital in Oyo
64 72 23 35 58 60 43 44 22 24
47 25 57 48 41 36 19 36 15 32
31 21 35 37 46 44 10 24 36 30

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22 45 29 41 37 38 54 38 26 62
43 14 17 33 51 26 51 52 19 41
Using a class interval 10-19, 20 – 29….. Prepare a frequency table and use it to calculate
the mean age.
Solution
Age Classmark Frequency fx
(x) (f)
10 - 19 14.5 6 87
20 - 29 24.5 10 245
30 - 39 34.5 13 488.5
40 - 49 44.5 11 489.5
50 -59 54.5 6 327
60 - 69 64.5 3 193.5
70 - 79 74.5 1 74.5
∑f = 50 ∑fx = 1,865

Mean x= ∑fx
∑f
= 1865
50
= 37.3
2. THE MEDIAN
The median is one other type of measures of location. If a set of numbers is arranged
in order size, the middle term is called median. If there is an even number of terms,
the median is the arithmetic mean of the two middle terms.
Example 1
Find the median of the following weights (kg)
50, 30, 40, 35, 60, 54, 48, 65, 52

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Solution
The first step is to arrange the items in order of magnitude (either ascending or
descending order)
30, 35, 40, 48, 50, 52, 54, 60, 65
There are nine items altogether, the median is the 5th and thus 50.
Therefore the median = 50
When the items are large, it may be necessary to use other methods to calculate the
median. This will require that a frequency table be prepared. Hence from the
frequency distribution table the median will be calculated as thus
Median = (N+1)th member for odd number of the items i.e N is odd.
2
For even number median is calculated as thus
Median = (N)th +( N +1)th
2 2
2
Where N is the summation of all the frequency and this is the terminal frequency
Example 2

The table below shows the weight of patients admitted at child and adolescent clinic.
Weight(kg) 22 24 36 42 45 48 56 60
frequency 11 2 7 13 10 3 9 5

Solution
A cumulative frequency is prepared as thus
Weight 22 24 36 42 45 48 56 60
(kg)
frequency 11 2 7 13 10 3 9 5

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Cum. 11 13 20 33 43 46 55 60
frequency

From the table, there 60 patients admitted at the clinic as indicated by the terminal
(last) cumulative frequency. Since 60 is an even number, the median mark will be
= ( N)th + (N+1)th
2 2
2
= (60)th + (60 +1)
2 2
2
= (30th + 31st)
2
The 30th member is 42kg
31st member is 42kg
Median = 42 + 42 = 42
2

3. THE MODE
The mode of a given data is the item or number that occurs or appears most in the
distribution. It is the value with the highest number of frequency. The mode may not
exist if no items repeats itself, and the mode may not be unique if more than one item
repeat itself, and such items have the same highest frequency.
The easiest way of calculating the mode of any distribution is to form a frequency table
for it.

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Example 1
The following are the weight (kg) of some group of pregnant women who attended
antenatal clinic at an undisclosed hospital at Abuja. 60, 55, 60, 48, 57, 55, 60, 58,
78, 60, 55, 60, 58, 60. Find the modal weight.
Solution
The frequency distribution table is prepared as thus;
Weight 48 55 57 58 60 78
(kg)
Frequency 1 3 1 2 6 1

From the table above, the highest frequency is 6 and this corresponds to the weight of
60
Therefore the mode is 60.
Example 2
The following are the ages of 25 patients who were diagnosed with malaria at the
laboratory of Queen Amina Hospital, Yola yesterday.
45 45 50 35 80 70 50 65 58 50
70 48 60 80 60 70 50 60 60 70
45 35 65 70 58
What is the modal age of the above data?
Solution
A frequency distribution table is prepared as thus;
Age(x) Frequency(f)
35 2
45 3
48 1
50 4
58 2
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 60 4
65 2
70 5
80 2

From the table, the highest frequency is 5 and the corresponding score is 70. Therefore
the mode is 70.

TABULAR PRESENTATION OF DATA

1. FREQUENCY DISTRIBUTION TABLE
For ungrouped data
The frequency table shows the number of times particular event occurs in a given data
or information. It shows at a glance the number of time each event appear.
The frequency table usually consists of three columns. The first column contains each
of the events given in the data. These are normally arranged in ascending order. The
second column is used to make strokes which represent the number of times a
particular event occurs or appears. After the fourth stroke, the fifth one is written
across the fourth to give a bundle of five strokes. The reason for this is to make
counting easy. The third column is obtained by adding the number of strokes in the
second (tally) column together. This is the frequency column.
Example 1
The record below shows the scores obtained by some students in a community health
nursing test (30%)
12 18 25 14 18 18 12 28 10 12
18 10 25 28 18 18 10 25 14 18

14 25 18 12 10 25 18 28 28 25
10 25 11 18 28 28 12 14 11 11
Using the data above prepare a frequency table

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Solution
Scores Tally Frequency
10 |||| 5
11 ||| 3
12 |||| 5
14 |||| 4
18 |||| |||| 10
25 |||| || 7
28 |||| | 6

For grouped data

When the number of entries in a given data is large, the construction of a frequency
distribution may be difficult, hence, there will be need to group the data. In grouping
data, class interval should be considered, which means the number of groups that a
particular data is classified. Each interval will contain equal units of data that is being
analyzed.
For example 2
The following are the weights (kg) of a number of students of law department given as
80 64 80 66 84 74 80 70 83
65 75 70 72 83 66 80 64 82
70 84 80 65 66 75 72 84 64
68 68 72 68 75 70 70 76 80
Suppose, we want to classify the data into 7 equal interval, the process is as follows;
The least weight = 64
The greatest weight = 84
The range which is the difference between the least and the greatest is given as 84 –
64 = 20 therefore the width of each class which is the number of units in each
grouping shall be 20/7 = 2.9 = 3 approximately
Therefore in order to get 7 equal intervals, each grouping must contain 3 units as such
below
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 Class intervals Tally Frequency
64 - 66 |||| ||| 8
67 - 69 ||| 3
70 - 72 |||| ||| 8
76 - 78 | 1
79 - 81 |||| | 6
82 - 84 |||| | 6

2. CUMULATIVE FREQUENCY TABLE

The cumulative frequency of a particular class is gotten by adding the frequency of
the particular class to the frequencies of the class before it. So the cumulative
frequency table is the table that shows the cumulative frequency of each of the
classes.
The cumulative frequency table can be obtained as follows;
Class Tally Frequency Cumulative
Interval Frequency
64 – 66 |||| ||| 8 8
67 – 69 ||| 3 11
70 – 72 |||| ||| 8 19
73 – 75 |||| 4 23
76 – 78 | 1 24
79 – 81 |||| | 6 30
82 – 84 |||| | 6 36

Example 2
The following weights (kg) were recorded at the outpatient department of 50 people
who came to see the Doctor on 11th October, 2021 at Cephas Hospital and Maternity,
Ibadan.

71 65 45 45 59 82 61 79 72 89
57 36 67 87 91 73 61 67 37 60

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76 73 39 42 64 67 59 59 39 43
33 56 70 52 35 46 54 72 95 43
46 63 61 71 74 82 64 37 58 86
Using the class intervals 31- 40, 41-50, 51- 60. Construct; a. A frequency table for
the above data, b. a cumulative frequency table of the data.

Solution

• Frequency table

Class interval Tally Frequency

31 - 40 |||| || 7
41 - 50 |||| || 7
51 - 60 |||| |||| 9
61 - 70 |||| |||| | 11
71 - 80 |||| |||| 10
81 - 90 |||| 5
91 -100 || 2

• Cumulative frequency table

Class interval Cumulative frequency
31 - 40 7
41 - 50 14
51 - 60 22
61 - 70 33
71 - 80 43
81 - 90 48
91 - 100 50

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 GRAPHICAL PRESENTATION OF DATA
(Bar chart, pie chart, histogram etc)
Having known the organization of data by the use of frequency distribution table or
cumulative frequency table, it was discovered that data is better appreciated from a
frequency table than in a raw form. However, apart frequency or cumulative
frequency table, a clearer method of presenting data is the graphical method. This
method is done by the use of mathematical diagrams e.g include; bar chart, pie chart,
histogram etc.
1. BAR CHART/ BAR GRAPH
This is one of the most popular types of diagram used to show statistical information.
Bar cart consists of rectangular bars of equal width whose heights or lengths are
proportional to the quantities or sizes of the items that are being represented. Each
bar is however separated by equal gaps.
Example 1
The table shows the number of pregnant women who came for antenatal clinic over a
six year period (from 2015 to 2020) at St. Paul’s medical Centre, Addis Ababa.
Year 2015 2016 2017 2018 2019 2020
No. of 2000 1000 4000 8000 5000 3000
women
Prepare a bar chart for the above distribution
Solution

9000
8000
7000
6000
5000
4000
3000
2000
1000
0
2015 2016 2017 2018 2019
Year

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EXAMPLE 2
The following are the number of babies admitted in the nursery at Greenfield Medical
Center, Doha with the diagnosis of neonatal jaundice in five years (2010 to 2014).
Years 2010 2011 2012 2013 2014
Number of 50 100 30 80 70
babies

Represent the above data on a bar chart

Solution
120

100

80

60

40

20

0
2010 2011 2012 2013 2014
Years

2. PIE CHART
The pie chart is also known as the divided chart or circle chart is a circular statistical
graphic which is divided into sectors to illustrate numerical proportion. The angle of
each sector is proportional to the frequency of the item that is being represented. The
process is by finding the sum of all the frequencies. This sum is used to divide 360
degree which is the total degree in a complete circle. Therefore each of the
frequencies is used to multiply this result to arrive at the sectoral angle for each item.

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Example 1

The following data are the number of workforce at Saint’s group companies.
 Production managers = 10
 Accountants = 20
 Doctors = 5
 Nurses = 20
 Cleaners = 40
 Security men = 30
 Drivers = 25
 Factory workers = 50
Represent the above information on a pie chart

Solution

o Production managers = 10
o Accountants = 20
o Doctors = 5
o Nurses = 20
o Cleaners = 40
o Security men = 30
o Drivers = 25
o Factory workers = 50

200
o Production managers =18⸰
o Accountants = 36⸰
o Doctor = 9⸰
o Nurses = 36⸰
o Cleaners = 72⸰
o Security men = 54⸰

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 o Drivers =45⸰
o Factory workers = 90⸰

3. HISTOGRAM
Histogram is the graphical representation of data where data is grouped into
continuous number ranges and each range corresponds to a vertical bar. It is
similar to a bar chart, but a histogram groups numbers into ranges. They are
rectangular bars placed side by side. The vertical axis represents the frequency
while the horizontal axis represents the variable being represented. The
histogram is different from bar chart because no gaps between the bars and the
histogram can be used for grouped data.

Example 1
The following is the record of number of 300L students of WAUU from different
departments
Biological science 50
Psychology 20
Computer science 30
Microbiology 10
Medical lab science 20
Law 60

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Construct a histogram for the distribution;

Solution
Histogram showing the different departments distribution

Example 2
The following are the weight (kg) of 50 patients diagnosed with Covid-19 at
Pyramid Hospitals, Cairo.
64 21 17 37 51 60 51 52 15 41
47 14 35 48 46 36 54 24 22 62
31 72 23 33 58 26 19 44 36 30
43 45 57 41 41 38 10 36 26 24
22 25 29 35 37 44 43 38 19 32

i. Prepare a frequency table with class intervals 10 – 19,

20 – 29 …..
ii. Draw a histogram to display the above data.

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Solution i.

Weight (kg) Frequency

10 - 19 6
20 - 29 10
30 - 39 13
40 - 49 11
50 - 59 6
60 - 69 3
70 - 69 1

30 -39 40 – 49 20 – 29 20 – 29 50 – 59 60 - 69 70 -79

MEASURES OF DISPERSION
This is also referred to as measure of variation. It is concerned with the degree
of spread of the numerical value of a distribution. It measures the variation that
occurs in a given data. Eg include range, variance, standard deviation etc.

1. THE RANGE
The range is the simplest and most straight forward measure of dispersion. It is
the difference between the largest and minimum values in a data.
Example 1
The following are the pulse rates (b/m) of some patients 60, 45, 80, 96, 70, 90, 55,
100, 50, 40, find the range.

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 Solution
The maximum value is 100
The minimum value is 40
Therefore the range = 100 – 40 = 60

For a grouped data, the range is calculated as;

Example 2
Find the range in the table below
Marks (30%) Frequency
6 - 10 4
11 - 15 2
16 - 20 5
21 - 25 6
26 - 30 30

Solution
The maximum score is 30
The minimum score is 2
Therefore the range = 30 – 2 = 28

2. VARIANCE AND STANDARD DEVIATION

Variance is a measure of dispersion or variability i.e. it is a measure of how far a set
of numbers is spread out from their average value. When the variance of data in a set
is large, the data is widely scattered. Conversely when the variance is small, the data
in the set is clustered. It is calculated by taking the average of squared deviations
from the mean. It is called the mean squared deviation.
Standard deviation on the other hand is the square root of the variance.it is also referred
to as root mean squared deviation.

i. Variance

ii. Standard deviation =

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Example 1
Calculate the variance and standard deviation of the following data 5, 12, 3, 18, 6, 8, 2,
10
Solution
Arrange the data in ascending order as thus
2, 3, 5, 6, 8, 10, 12, 18
Next is to find the mean
2 + 3 + 5 + 6 + 8 + 10 + 12 +18
8
= 64 = 8
8
Then take each value in data set, subtract the mean and square the difference
= (2-8)2 + (3-8)2 + (5-8)2 + (6-8)2 + (8-8)2 + (10 -8)2 + (12-8)2 + (18-8)2
8
The squared differences for all values are added
= 36 + 25 + 9 + 4 + 0 + 4 + 16 + 100
8
The sum is then divided by the number of data
= 194
8
= 24.25
To get the standard deviation, you calculate the square root of the variance

Using the formula √ ∑(x-x)2

N
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= 4.9 approximately

Example 2
x x (mean) x-x (x – x)2
2 8 -6 36
3 8 -5 25
5 8 -3 9
6 8 -2 4
8 8 0 0
10 8 2 4
12 8 4 16
18 8 10 100
∑(x – x)2 = 194

∑(x – x)2
N
= 194 /8
= 24.25

Standard deviation = √∑(x –x)2

N

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 Population and sample variance and standard deviation
Population variance refers to the value of variance that is calculated from population
data, and sample variance is the variance calculated from sample data. Due to this,
value of denominator in the formula for variance in case of sample data is ‘n-1’, and
it is ‘n’ for population data.

Population variance

When you have collected data from every member of the population that you’re
interested in, you can get an exact value for population variance.
The population variance formula include:
Formula Meaning
i. σ2 = population variance
ii. Σ = sum of…
iii. Χ = each value
iv. μ = population mean
v. N = number of values in the population
Population variance (σ2) tells us how data points in a specific population are spread
out. It is the average of the distances from each data point in the population to the
mean, squared.
Example 1
Find the population variance of the age of children in a family of five children aged 16,
11, 9, 8, and 1.
Step1: Find the mean, μ = 9.
Step 2: Subtract each data point from the mean, then square the result:
(16-9)2 =49
(11-9)2 =4
(9-9)2 =0
(8-9)2 =1
(1-9)2 = 64.

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Step 3: Add up all of the squared differences from Step 2:
(16-9)2 + (11-9)2 + (9-9)2 + (8-9)2+ (1-9)2 = 118.
Step 4: Divide Step 3 by the number of items. 118/5 gives a population variance of 23.6.
Sample variance
When you collect data from a sample, the sample variance is used to make estimates
about the population variance.
The sample variance formula include:
Formula Meaning

i. s2 = sample variance
ii. Σ = sum of…
iii. Χ = each value
iv. x̄ = sample mean
v. n = number of values in the sample
The sample variance, s2, is used to calculate how varied a sample is. A sample is a
select number of items taken from a population. For example, if you are measuring
the weights of the Nigerian populace, it wouldn’t be feasible (from either a time or a
monetary standpoint) for you to measure the weights of every person in the
population. The solution is to take a sample of the population, say 1000 people, and
use that sample size to estimate the actual weights of the whole population. The
variance helps you to figure out how spread out your weights are.
Example 2
The following data represent the weekly earnings of Lagosians (Naira) 600, 470, 430,
300 and 170.
a. find the variance
b. calculate the standard deviation.

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Solution

x x (mean) x-x (x – x)2

170 394 -224 50,176
300 394 -94 8,836
430 394 36 1,296
470 394 76 5,776
600 394 206 42,436
∑(x –x)2 =
108,520

Mean = sum total of all the values

Number of values
= 170 + 300 + 430 + 470 + 600
5
= 394

Sample variance
= 108,520/5 – 1
=27,130
Standard deviation = √∑(x x)2
n–1
=164.7

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 HEALTH STATUS INDICATORS / INDICES
Health Indicators or indices are variables, susceptible to direct measurement that reflects
the state of health of persons in a community. Health status indicators measures different
aspects of the health of a population. Examples include life expectancy, mortality rates,
morbidity rate etc. Indicators help to measure the extent to which the objectives and
targets of a programs are being attained.
CHARACTERISTICS
• Valid; they should actually measure what they are supposed to measure.
• Reliable; the results should be the same when measured by different people in
similar circumstances.
• Specific; they should reflect changes only in the situation concerned.
• Feasible; they should have the ability to obtain data when needed.
• Relevant; they should contribute to the understanding of the phenomenon of
interest.
CLASSIFICATION OF HEALTH STATUS INDICATORS
i. Mortality Indicators; These are set of indicators measuring the rate of mortality
related to: age, sex, infectious disease, injury etc.
ii. Morbidity Indicators; Morbidity Indicators reveal the burden of ill health in a
community.
iii. Nutritional Indicators; The nutritional status indicators include obesity,
overweight, underweight, and short stature.
iv. Health Care Delivery Indicators; These indicators reflect the equity of distribution
of health resources in different parts of the country and of the provision of health care.
v. Indicators of Social And Mental Health; These include rates of suicide, homicide,
other crime, road traffic accident, juvenile delinquency, alcohol and substance abuse,
domestic violence, battered-baby syndrome, etc.
vi. Environmental Indicators; These reflect the quality of physical and biological
environment in which diseases occur and people live.
vii. Socio-economic Indicators; These do not directly measure health but are important
in interpreting health indicators.
viii. Health Policy Indicators; The single most important indicator of political
commitment is allocation of adequate resources.
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 MORTALITY INDICATORS
These are set of indicators measuring the rate of mortality related to: age, sex, infectious
disease, injury etc.
A. Crude Death Rate (CDR); is considered a fair indicator of the comparative health
of the people. It is defined as the number of deaths per 1000 population per year in a
given community, usually the mid-year population. The CDR are determined by
taking the total deaths in a population and dividing the values by a number to obtain
the rate per 1,000.
CDR = Total number of deaths /Total population x 1000.
Example 1
Calculate the CDR of the following data: Country; USA, year; 2005, number of Deaths:
2,448,017, Total population: 295,895,897.
Solution
Using the formula CDR = total number of deaths/ total population × 1000
= 2,448,017/ 295,895,897 × 1,000
= 8.27
Therefore CDR = 8.27 per 1,000
Example 2
In a certain country with a population of 6 million, 85,000 deaths occurred during the
year ending December 31, 2005.
Solution
Using the formula
85,000 ÷ 6,000,000 = 0.0142 × 1,000 = 14.2 per 1,000
B. Infant mortality rate (IMR); The ratio of deaths under 1yr of age in a given year to
the total number of live births in the same year, usually expressed as a rate per 1000 live
births. Indicator of health status of not only infants but also whole population &
socioeconomic conditions. Sensitive indicator of availability, utilization &effectiveness
of health care, particularly perinatal and postnatal care. It is given by;

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IMR = Number of children who died before their first birthday (0−11 months of age)
÷ Number of live births (years of exposure) × 1,000 or the Number of deaths of
children less than one year of age in a year ÷ Number of live births in the same year
× 1,000
Example;
75 infants (less than one year) died out of 4, 000 infants born in the year 2015 in Nigeria.
Calculate the IMR.
Solution
Using the formula IMR = # of deaths of children less than one year ÷ # of live births
x 1, 000
75/4, 000 = 0187 x 1, 000 = 18. 7 19 infants died per 1, 000 live births
C. Under 5 mortality rate; defined as number of deaths occurring in the under-5 age
group per 1000 live births.
U5MR = Number of deaths below age 5 during a given period × 1,000
Number of live births during a given period
Example;
The following are the data of children in Ghana as recorded in their civil registration
and vital statistics system in the year 2012. Number of live births (0 – 11months =
60,000), (12 – 59months = 45,000) number of deaths below age five = 5,000.
Calculate the mortality rate.
Solution
Using the formula
U5MR = number of death below age 5 /number of live births x 1,000
= 5,000/105,000 x 1,000
= 47.61
= 48 approximately per 1,000 live births
D. Stillbirth rate(SBR); is defined as the number of babies born with no sign of life
at 28 weeks or more of gestation, per 1,000 total births.

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SBR = Number of stillbirths. × 1000
Number of live births and no. of stillbirth during the year
Example;
The total number of babies born dead at 28th week and more of gestation recorded in
the year 2011 in Kenya is given as 1,000 while the number of babies born alive in the
same year is 100,000. Calculate the stillbirth rate the country using the above data.
Solution
SBR = number of stillbirth ÷ number of live birth and stillbirth x 1,000
= 1,000 ÷ 100,000 + 1,000 x 1,000
= 2,000 ÷ 101,000 x 1,000
= 9.9
= 10 per 1,000 approximately
E. Neonatal mortality rate (NMR); is the number of newborns in a specified
geographic area (country, state, county, etc.) dying at less than 28 days of age divided
by the number of live births for the same geographic area (for a specified time period,
usually a calendar year) and multiplied by 1,000.
NMR = (Number of neonatal deaths/Number of live births) x 1,000
Example;
The number of death of neonates in Kaduna state is 700 in 2008 while the live births
is 150,000. Calculate the neonatal mortality rate.
Solution
700 = neonatal deaths in 2008 among state residents
150,000 = live births in 2008 to state residents
(700/150,000) x 1,000 = 4.7 neonatal deaths per 1,000 live births in 2008 among state
residents
F. Perinatal mortality rate (PMR); the Perinatal mortality is defined as the number
of fetal deaths past 22 (or 28) completed weeks of pregnancy plus the number of
deaths among live-born children up to 7 completed days of life, per 1000 total births
(live births and stillbirths).

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PMR = number of perinatal deaths/ total number of births (still births + live birth) x
1,000. A perinatal death is a fetal death (stillbirth) or an early neonatal death (first 7
days).
Example 1
In Cuba, there were 39 neonatal deaths (0 – 7 days) and late fetal death occurred in 42
fetuses with total births 0f 4057. Calculate the perinatal mortality rate.
Solution
Perinatal deaths = 42 + 39 =81
= 81/4057 + 42 x 1,000
= 81/4099 x 1,000
= 19.8
= 20 per 1,000 approximately
Examples 2
700 fetal deaths of 28 or more weeks’ gestation in 2008 among state residents
300 newborns dying under 7 days of age in 2008 among state residents
150,000 live births in 2005 among state residents
Solution
[(700 + 300) / (150,000 + 700)] x 1,000 = 6.6 perinatal deaths per 1,000 live births and
fetal deaths of 28 or more weeks gestation in 2008 among state residents.
G. Maternal mortality rate (MMR); is the number of maternal deaths within 42 days
of pregnancy termination due to complications of pregnancy, childbirth, and the
puerperium in a specified geographic area (country, state, county, etc.) divided by total
live births for the same geographic area for a specified time period, usually a calendar
year, multiplied by 100,000.
MMR = (Number of maternal deaths/Number of live births) x 100,000
A maternal death is defined by the World Health Organization as: The death of a
woman while pregnant or within 42 days of termination of pregnancy, irrespective of
the duration and the site of the pregnancy, from any cause related to or aggravated

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by the pregnancy or its management, but not from accidental or incidental causes. A
maternal mortality rate is considered a primary and important indicator of a
geographic area’s (country, state, county) overall health status or quality of life.
Example 1
In the state of Borno, 84 maternal deaths occurred in the year 2010 among the state
residents of 130,000 live births. What is the maternal mortality rate?
Solution
= 84/130,000 x 100,000 = 64.6 maternal deaths per 100,000 live births in 2010 among
state resident.
G. Adult mortality rate between 15 and 60 years of age; Probability that a 15year-
old person will die before reaching his or her 60th birthday. The probability of dying
between the ages of 15 and 60years (per 1000 population)
= Number of deaths at ages 15 to 59 years. X 1,000
Number of years of exposure to the risk of death between ages 15 and 59 years
H. An age-specific mortality (death) rate; is a mortality rate limited to a particular
age group. The numerator is the number of deaths in that age group; the denominator
is the number of persons in that age group in the population. The formula is given as
thus;
Age specific death rate = number of deaths in a particular age group/mid-year
population of same age group x 1,000

Example 1
In the United States in 2003, a total of 130,761 deaths occurred among persons aged
25–44 years with the population of 1,000,000 calculate the age-specific mortality
rate.

Solution
Using the formula
Age specific death rate = number of death in a particular age group/number of
population of same age group x 1,000 = 130,761/ 1,000,000 x 1,000

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= 130.7 or 131 per 1000 25-44 years old

MORBIDITY INDICATORS
Morbidity Indicators reveal the burden of ill health in a community, but do not
measure the subclinical or inapparent disease states. Incidence and Prevalence are the
most common morbidity indicators.
A. Incidence/ incidence rate; incidence refers to the number of new events or new
cases of a disease in a defined population, within a specified period of time. The
incidence rate represents the rate of new cases of a condition observed within a given
period (affected population) in relation to the total population within which these
cases have arisen (in the same period).
Incidence rate is generally expressed in number of persons affected per 1,000 or 100,000
of the population, per year. The formula is given as;
Incidence rate = total number of new cases of an event ÷ total population at risk x 1,000
or 100,000
Example 1
In the year 2020 the total number of new cases of hypertension was 500,000 in Nigeria
with the population of 200,000,000. Calculate the incidence rate.
Solution
Using the formula
Incidence rate = total number of new cases/total population at risk x 100,000
= 500,000 ÷ 200,000,000 x 100,000
= 0.0025 x 100,000
= 250 per 100,000
This means that there will be on average 250 hypertension cases in 100,000 people in
Nigeria for one year.

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Example 2
In 2003, 44,232 new cases of acquired immunodeficiency syndrome (AIDS) were
reported in the United States. The estimated mid-year population of the U.S in 2003
was approximately 290, 809,777. Calculate the incidence rate of AIDS in 2003.
Solution
Using the formula
Incidence = number of new cases/ total population at risk x 1,000
= 44,232/ 290,809,777 x 1,000
= 0.15 per 1,000 population
B. Prevalence/ prevalence rate; prevalence, sometimes referred to as prevalence
rate is the proportion of persons who have a particular disease at a specified point in
time or over a specific period. It differs from incidence in that prevalence includes
all cases, both new and preexisting, in the population at the specified time, whereas
incidence is limited to new cases only. The formula is given as;
Prevalence rate = the total number of all individuals who have a disease (both new
and preexisting cases) during a given time ÷ by population during the same time
period x 1,000 or 100,000 or even 1,000,000.
Example
The table below shows the number of pregnant women who were diagnosed with
urinary tract infection (UTI) during antenatal visit as recorded at Zenith Medical
Centre, Kampala from 2001 to 2004.

Year Number of cases Number of women who

attended antenatal clinic
2001 50 1,000
2002 40 2,000
2003 100 5,000
2004 80 4,000
Calculate the prevalence rate of the above data.

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Solution
Total number of pregnant women diagnosed with UTI = 270
Total number of women who attended antenatal = 12,000
Using the formula
Prevalence rate = total number of people who have a disease at a given period of time
÷ population during the same period x 1,000
= 270 ÷ 12,000 x 1,000
= 22.5 per 1,000 pregnant women
Other morbidity indicators include;
C. Attendance rates at OPDs and at health centers.
D. Admission, Re-admission and discharge rates.
F. Duration of stay in hospital.

FERTILITY INDICATORS
A. The crude birth rate (CBR); is the number of live births per 1,000 people in a
population (where the population is the total population: men, women and children).
The formula is given as thus;
CBR = total birth ÷ total population x 1,000
Example
In 2013 the total number of births recorded in Zambia was 100,000 in a population of
6 million. Calculate the crude birth rate of the country.
Solution
CBR = total birth ÷ total population x 1,000
= 100,000 ÷ 6,000,000 x 1,000
= 16.6 per 1,000 or approximately 17 per 1,000 people

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This means that in every group of 1,000 people there are an average of 17 babies born
every year.
B. Fertility rate or the General Fertility Rate (GFR); is the number of live births
per 1,000 women of child-bearing age in a year (for the purpose of calculating the
rate, ‘child-bearing age’ is taken as ages 15-49, inclusive).
The formula is given as thus;
GFR = total birth ÷ total women aged 15 to 49 x 1,000
C. The Age Specific Fertility Rate (ASFR); is the number of live births per 1,000
women of a specific age in a specified period - e.g., the age-specific fertility rate for
25-29 year old women in 2008 is calculated by dividing the number of births in 2008
to women aged 25-29 by the estimated population of women of that age in that year.
The formula is given as;
ASFR = number of live births by women of a specific age group ÷ total number of
women in that age group x 1,000
D. The adolescent fertility rate; measures the annual number of births to women 15
to 19 years of age per 1,000 women in that age group. It is also referred to as the age-
specific fertility rate for women aged 15-19.
E. Total fertility rate (TFR); The total fertility rate of a population is the average
number of children that would be born to a woman over her lifetime if: she was to
experience the exact current age-specific fertility rates through her lifetime she was
to live from birth until the end of her reproductive life.

NUTRITIONAL STATUS INDICATORS

Nutritional Status is a positive health indicator. Newborns are measured for their
Birth weight, Length, Head circumference etc. They reflect the maternal nutrition
status.
Anthropometric measurements of pre-school children include;
i. Weight (measures acute malnutrition)

ii. Height (measures chronic malnutrition)

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iii. Mid-arm circumference (measures chronic malnutrition)
Growth Monitoring of children is done by measuring weight-for-age, height-for-age,
weight-for- height, head & chest circumference and mid-arm circumference.
In adults body mass index (Underweight, Obesity) is generally considered reliable
nutritional indicators. Body mass index (BMI) is a measure for indicating nutritional
status in adults. It is defined as a person’s weight in kilometers divided by the square
of the person’s height in meters (Kg/m2)
BMI Nutritional status
Below 18.5 Underweight
18.5 to 24.9 Healthy
25.0 to 29.9 Overweight
30.0 and above Obesity

Example
Height = 160 cm, Weight = 50kg calculate the BMI.
Solution
Height = 160 cm = 1.6 m
Weight = 50kg
Using the formula BMI = weight ÷ square of the height
= 50 ÷1.6 x 1.6
= 50 ÷ 2.56
= 19.5 Kg/m2
SOCIAL AND MENTAL HEALTH INDICATORS
These include rates of suicide, homicide, other crime, road traffic accident, juvenile
delinquency, alcohol and substance abuse, domestic violence, battered-baby
syndrome, etc. These indicators provide a guide to social action for improving the
health of people.

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 SOCIOECONOMIC INDICATORS
These do not directly measure health but are important in interpreting health indicators.
These are
• Rate of growth of population per capita GNI (gross national income); GNI
calculates the total income earned by a nation’s people and businesses,
including investment income regardless of where it was earned.
• Dependency ratio; this is a measure of the number of dependents aged zero
to 14 and over the age of 65, compared with the total population aged 15 to 65.
This demographic indicator gives insight into the number of people of non-
working age, compared with the number of those of working age.
• Literacy rates; this is the proportion of the population aged 15 years and
above that is literate.
• Housing – the number of persons per room.
Countries with favorable socioeconomic indicators have reported less health related
problems.

USES/ IMPORTANCE OF INDICATORS OF HEALTH

i. Measurement of the health of the community.
ii. Comparison of the health of different communities.
iii. Identification of health needs and prioritizing them.
iv. Evaluation of health services.
v. Planning and allocation of health resources.
vi. Measurement of health successes.

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 UNIT THREE
INDICES AND INDICATORS OF WELLNESS
INTRODUCTION
Wellness or well-being simply means state of being in good health. Wellness is the
act of practicing healthy habits on a daily basis to attain better physical and mental
health outcomes. The condition of good physical and mental health, especially when
actively maintained by proper diet, exercise, and avoidance of risky behavior.

Well-being is a positive outcome that is meaningful for people and for many sectors
of society, because it tells us that people perceive that their lives are going well. Good
living conditions (e.g., housing, employment) are fundamental to well-being.

Well-being is associated with numerous health, job, family, and economically related
benefits. For example, higher levels of well-being are associated with decreased risk
of disease, illness, and injury; better immune functioning; speedier recovery; and
increased longevity. Individuals with high levels of well-being are more productive
at work and are more likely to contribute to their communities.

Indices and indicators of wellness include;

i. Physical indicators
a. Exercise
b. Nutrition
c. Sleep
d. Self-care
ii. Mental indicators
a. Stress management
b. A positive attitude towards self
c. Autonomy
d. Growth, development and the ability for self-actualization
iii. Emotional indicators
a. Sense of belonging
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b. Sense of purpose
c. Feeling contented
d. Managing emotions in a constructive way
iv. Spiritual indicators
a. Understanding the values, beliefs, and morals that guide your actions.
b. Spending quiet time alone pondering the meaning of life.
c. Having a clear sense of right and wrong, and acting accordingly etc.
v. Social indicators
a. Friendship
b. Love
c. Gender identity
d. Good Relationships
e. Education
f. Income
g. Employment etc.
vi. Environmental indicators
a. Good governance
b. Infrastructure
c. Justice, fairness and equality
d. Free from crime and social vices etc.

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