DEPARTMENT OF COMMUNITY MEDICINE

PRACTICAL PROBLEMS & KEYS

Bio – Statistics - Questions

Measures of central tendency

1. The following data relate to respiration rates per minute for 10 patients,
Find mean, median and mode for the given data.
22, 21, 23, 21, 18, 20, 17, 18, 20, 20

2. The following data give weight in kilogram of 9 children aged 5 years.

10, 14, 16, 13, 14, 13, 11, 13, 13

Calculate the mean, median and mode.

 Key
Q. No: 1

Mean:
n

=∑
xi 22+ 21+ 23+21+18+20+17+ 18+20+20
i=1 = 10
n

Mean = 200/10 = 20

Median: Median is the middle value after arranging the ascending or

descending order. In this example the no. of observation are 10 (even) so, we
get two middle values taking the arithmetic mean.
17 18 18 20 20 20 21 21 22 23

Median = 20+20/2 = 20

Mode: Mode is maximum no. of frequency repeated. In this example 20 is 3

times occurs so, mode is 20

Mode = 20

Q. No: 2

Mean:

=∑
xi 10+14+16+ 13+14+13+ 11+13+13
i=1 = 9
n

Mean = 117/9 = 13

Median: Median is the middle value after arranging the ascending or

descending order.

10 11 13 13 13 13 14 14 16

Median = 13

Mode: Mode is maximum no. of frequency repeated. In this example 13 is 4

times occurs so, mode is 13
Mode = 13
 DEPARTMENT OF COMMUNITY MEDICINE
PRACTICAL PROBLEMS & KEYS

Bio – Statistics- Questions

Measures of central tendency & Measures of Variation

1. Tuberculin test readings (in mm) of 12 boys, find the mean, median, mode and
standard deviation for the following data. 7 8 12 3 7 11 8 5 9 8 10
and 8.

2. The haemoglobin values (%) of 9 pregnant women are given below: 10.1 12.5
10.8 12.4 11.2 12.6 13.5 12.6 12.9 calculate the mean, median, mode
and standard deviation.
 Keys
Q. No: 1
Mean:

=
n

=
∑ xi 7+8+12+3+7 +11+8+5+ 9+8+10+ 8 96
=
i=1
12 12
n
Mean= 8

Median: Median is the middle value after arranging the ascending or descending
order. In this example the no. of observation are 12 (even) so, we get two middle
values taking the arithmetic mean.
3 5 7 7 8 8 8 8 9 10 11 12
Median = 8+8/2 = 8

Mode: Mode is maximum no. of frequency repeated. In this example 8 is 4 times

occurs so, mode is 8
Mode = 8
Standard Deviation:

√
n

∑ ( xi −x )2
i =1
¿ =2.34
n

Q. No: 2
Mean:

= i=1
∑ xi = 10.1+ 12.5+10.8+12.4+11.2+13.5+12.6+12.6+ 12.9
n

= 108.6/9 = 12.06
n

Mean = 12.06

Median: Median is the middle value after arranging the ascending or descending
order.
10.1 10.8 11.2 12.4 12.5 12.6 12.6 12.9 13.5
Median = 12.5

Mode: Mode is maximum no. of frequency repeated. In this example 12.6 is 2

times occurs so, mode is 12.6
Mode = 12.6

Standard Deviation:
 √
n

∑ ( xi −x )2 SD = 1.04
i =1
¿ =1.04
n
 DEPARTMENT OF COMMUNITY MEDICINE
PRACTICAL PROBLEMS & KEYS

Bio – Statistics- Questions

Chi – Square test

1. In a clinical treatment, 100 patients were tested to see the effect of a
potential anti-hypertensive drug. 50 patients were assigned to receive
active drug and other 50 were assigned to receive placebo at random.
Their response to treatment was categorized as favourable or
unfavourable. The data is given in the table below:

Response
Treatment Favorabl Unfavorabl
e e
Active
34 16
Drug
Placebo 9 41

Test the hypothesis that the drug has a positive effect.

2. A trial of 2 whooping cough vaccines was carried out. The results of the
field trial were as follows

Vaccin Attacke Not

e d attacked
A 22 68
B 14 72

Test whether the vaccine B was superior to vaccine A

 Keys
Q. No: 1
Ho: There is no association difference between the two drugs.
H1: There is some association difference between the two drugs.

Response
Treatment Total
Favorable Unfavorable
34 16 50
Active Drug
21.5 28.5
9 41 50
Placebo
21.5 28.5
Total 43 57 100

χ 2=
∑ ( Oi −Ei )2
Ei
Where,
Expected value = row total * column total/Grand total (for each values)
Chi square value = 25.50
DF = (r-1)*(c-1) = (2-1)*(2-1) =1
DF = 3.841(chi square table value)
Chi square value is greater than the Chi square table value. So, we reject our null
hypothesis. Inference: Hence, there is some relationship between the two drugs.
Q. No: 2
Ho: Vaccine B is not superior to Vaccine A
H1: Vaccine B is superior to Vaccine A.
Vaccine Attacked Not attacked Row total
A 22 68 90
18.41 71.59
B 14 72 86
17.59 68.41
Column total 36 140 176

χ=
∑2( Oi −Ei )
2

Ei
Where,
Expected value = row total * column total/Grand total (for each values)
Chi square value = 1.80
DF = (r-1)*(c-1) = (2-1)*(2-1) =1
DF = 3.841(chi square table value)
Chi square value is less than Chi square table value. So, we accept our null hypothesis.
Inference: Hence, the vaccine B is not superior to vaccine A.
Chi square value is Less than table value – accept null hypothesis – Independent.
Greater than – reject null hypothesis (accept alternate hypothesis) – Dependent.
DEPARTMENT OF COMMUNITY MEDICINE
PRACTICAL PROBLEMS & KEYS

Bio – Statistics- Questions

Screening test
1. A study was conducted to evaluate the dextromethaxone suppression test (DST) as a
diagnostic test for major depression. The study compared the results of the DST to
those obtained using the gold standard procedure in 368 patients.

MAJOR DEPRESSION
DST RESULTS TOTAL
YES NO
POSITIVE 84 5 89
NEGATIVE 131 148 279
TOTAL 215 153 368

Calculate sensitivity, specificity, positive predictive value and negative predictive value.

2. Calculate sensitivity, specificity, % of false positives and % of false negatives.

TEST DIABETIC NON-DIABETIC TOTAL

URINE SUGAR + 900 600 1500
URINE SUGAR -VE 100 8400 8500
TOTAL 1000 9000 10000
 Keys
Q. No: 1

DST Major Depression

Total
Results Yes No
Positive 84 a 5b 89 a+b
Negative 131 c 148 d 279
c+d
Total 215 153 b+d 368
a+c
a. Sensitivity:
= a/a+c χ 100
= 84/215 χ 100
= 39.06%

b. Specificity:
= d/b+d χ 100
= 148/153 χ 100
= 96.73%

c. Percentage of false positive:

= b/b+d x 100
= 5/153 x 100
= 3.26%

d. Positive predictive value:

= a/a+b χ 100
= 84/89 χ 100
= 94.38%

e. Negative predictive value:

= d/c+d χ 100
= 148/279 χ 100
= 53.04%

Q. No: 2

Test Diabetic Non- Total

diabetic
Urine sugar 900 a 600 b 1500
+ a+b
Urine sugar - 100 c 8400 d 8500
c+d
Total 1000 a+c 9000 b+d 10000

a. Sensitivity:
= a/a+c χ 100
= 900/1000 χ 100
 = 90%

b. Specificity:
= d/b+d χ 100
= 8400/9000 χ 100
= 93.33%

c. Percentage of false positive:

= b/b+d χ 100
= 600/9000 χ 100
= 6.66%

d. Percentage of false negative:

= c/a+c χ 100
= 100/1000 χ 100
= 10%
 DEPARTMENT OF COMMUNITY MEDICINE
PRACTICAL PROBLEMS & KEYS

Bio – Statistics- Questions

1. In a primary health centre with a population 50, 000; 3000 smears were collected by
health workers in the field and another 800 smears collected from patients with fever
attending PHC in 2014 of these, 120 slides were positive for malarial parasites. Calculate
the following,
Annual parasite incidence (API)
Annual blood examination rate by active surveillance (ABER by AS) and
Annual blood examination rate by passive surveillance (ABER by PS)

2. In a community health centre with a population of 1, 00, 000 health workers collected
3725 blood slides from fever cases during their home visits. In the same year 3275 blood
slides were collected from the OPD. On examination 185 slides were positive for
Plasmodium vivax and 15 were positive for Plasmodium falciparum.
Calculate the following,
ABER
ABER by active surveillance
ABER by passive surveillance
Slide positivity rate

Slide Positivity Rate:

Total no . of positive slides ∈an particular year
¿ × 100
Total no . of blood slides collected
during a particular year
 Key

Q. No: 1

Population : 50, 000

Smears : 3000 (health workers)
Smears : 800 (Fever attending)
Slide positive : 120

Total No . of blood slides positive for malaria∈an area

during particular year
API= × 1000
Total no . of population under survey
= 120/50000 χ 1000
= 2.4/1000 population

Total no . of blood slides taken by active surveillance

¿ an area during a particular year
ABER by AS= × 100
Total no . of population under survey

= 3000/50000 χ 100
= 6%

Total no . of blood slides taken by passive surveillance

¿ an area during a particular year
ABER by PS= ×100
Total no . of population under survey
= 800/50000 χ 100
= 1.6 %
Q. No: 2
Population : 1, 00, 000
Blood slides during home visit : 3725
Blood slides during OPD : 3275
Slide positive : 185/ Plasmodium vivax
Slide positive : 15/ Plasmodium falciparum
Total no . of blood slides takenby active∧ passive surveillance
¿ an area during a particular year
ABER= × 100
Total no . of population under survey
= 3725+3275/100000 χ 100
= 7%
Total no . of blood slides taken by active surveillance
¿ an area during a particular year
ABER by AS= × 100
Total no . of population under survey

= 3725/100000 χ 100
= 3.7%
Total no . of blood slides taken by passive surveillance
¿ an area during a particular year
ABER by PS= ×100
Total no . of population under survey
= 3275/100000 χ 100
= 3.3%
SPR = 185+15/3725+3275 χ 100 = 2.9%

DEPARTMENT OF COMMUNITY MEDICINE

 PRACTICAL PROBLEMS & KEYS

Bio – Statistics- Questions

Cohort study

1. 50 people working in a chemical factory, followed up for 3 months. 40 develop dermatitis;

another 50 had not worked in a chemical factory followed up for 3 months of whom 10
develops dermatitis.
Chemical Disease
Total
factory Present Absent
Working 40 a 10 b 50 a+b
Not working10 c 40 d 50 c+d
T0tal 50 a+c 50 b+d 100

a. What type of study is this?

b. Calculate the Relative risk and its inference.
c. Calculate Attributable risk and Give your inference on the result.

2. During 2002 a rural community in sholavaram block was surveyed and several of their
characteristic features like age, sex blood pressure, smoking habit etc., were documented.
All cases of coronary artery disease were excluded from the study. The population was
followed up for the incidence of coronary artery disease and deaths due to Myocardial
infarction for the next 3 years. The following results pertain to the incidence of disease
according to smoking status.
Myocardial infarction
Smoking
status Total
status
Present Absent
Present 95 a 3905 b 4000 a+b
Absent 45 c 4455 d 4500 c+d
T0tal 140 a+c 8360 b+d 8500

a. What type of study design is this?

b. Calculate the relative risk and give your inference
c. Calculate the attributable risk and give your inference

Key
Q. No: 1

Chemical Disease
Total
factory Present Absent
Working 40 a 10 b 50 a+b
Not working10 c 40 d 50 c+d
T0tal 50 a+c 50 b+d 100

Name of the study design: Cohort study

Incidence of disease among exposed
Relative risk =
Incidence of disease among non−exposed

Incidence of disease among exposed = a/a+b = 40/50 = 0.80

Incidence of disease among non- exposed = c/c+d = 10/50 = 0.20
Relative risk = 0.80/0.20 = 4

Inference: There is 4 times risk for those who are working in chemical factory other
than normal people.

Incidence of disease among exposed−among non−exposed

Attributable risk = ×100
Incidence of disease among exposed

= 0.80 – 0.20/0.80 χ 100

= 75%
Inference: Among the people who are all affected 75% are attributed due to chemical
causes.

Q. No: 2

Myocardial infarction
Smoking status Total
status Present Absent
Present 95 a 3905 b 4000 a+b
Absent 45 c 4455 d 4500 c+d
T0tal 140 a+c 8360 b+d 8500

Name of the study design: Cohort study

Incidence of disease among exposed
Relative risk =
Incidence of disease among non−exposed

Incidence of disease among exposed = a/a+b = 95/4000 = 23.75

Incidence of disease among non- exposed = c/c+d = 45/4500 = 10
Relative risk = 23.75/10 = 2.375
Inference: So, smokers were 2.4 times more risk of developing myocardial infarction
than non-smokers.
 DEPARTMENT OF COMMUNITY MEDICINE
PRACTICAL PROBLEMS & KEYS

Bio – Statistics- Questions

Case- control study

1. In a study to measure the protective effect of Haemophilus influenza B vaccine, 60

children were diagnosed with pneumonia during a calendar year. In the same year,
another 120 cases of childhood pneumonia other than HiB origin was chosen as the
comparison group.

HiB Vaccination Cases Controls

Present 6a 72 b
Absent 54 c 48 d

a. Name the study design with justification

b. Calculate the relevant measure of association
c. Calculate odds ratio and give your inference.

2. A study was conducted to measure the protective effect of BCG against tuberculosis
meningitis. 60 cases of tuberculosis meningitis were diagnosed in 5 hospitals. An equal
number of controls matched for age, sex from the neighbourhood were selected and
looked for ‘BCG’ scar in both the groups.

Tuberculosis Meningitis
BCG Scar
Present Absent
Present 15a 45 b
Absent 30 c 30 d

a. What is the type of study?

b. What is the exposure factor being studied?
c. Calculate the odd’s ratio and comment

Key
Q. No: 1
HiB Vaccination Cases Controls
Present 6a 72 b
Absent 54 c 48 d

Name of the study design: Case – control study

Justification: retrospective study, case and control were selected, HiB vaccination
coverage
status was compared between case and control
Exposure factor of cases = a/a+c χ 100
= 54/60 χ 100
= 90%
Exposure factor of controls = b/b+d χ 100
= 48/120 χ 100
= 40%
Odd’s ratio = ad/bc
= 54χ72/48χ6
= 13.5
Inference: Those who were not vaccinated against HiB were 13.5 times at risk of
developing HiB meningitis than who received HiB Vaccination

Q. No: 2
Tuberculosis Meningitis
BCG Scar Total
Present Absent
Present 15a 45 b 60
Absent 30 c 30 d 60
Total 45 a+c 75 b+d 120

Name of the study design: Case – control study

Exposure factor of cases = a/a+c χ 100

= 30/45 χ 100

= 66.67%

Exposure factor of controls = b/b+d χ 100

= 30/75 χ 100
= 40%

Odd’s ratio = ad/bc

= 30 χ45/30 χ15
=3
Comment: Those who were not immunized with BCG were 3 times at risk of developing
TB meningitis than those who received BCG.
 DEPARTMENT OF COMMUNITY MEDICINE
PRACTICAL PROBLEMS & KEYS

Bio – Statistics- Questions

MATERNAL AND CHILD HEALTH INDICATORS

1. The following data were obtained from Zone-5 of Chennai Corporation records.
Mid-year population 100000
No. of live births 5000
No. of foetal deaths (>28 weeks gestation) 200
No. of deaths within 7 days of birth 200
No. of deaths between 8th day-28 days 100
No. of deaths below 1 year of age 500
No. of deaths due to all causes 3000
Calculate the following,
a. Perinatal mortality rate
b. Early neonatal mortality rate
c. Late neonatal mortality rate
d. Post neonatal mortality rate and
e. Infant mortality rate

2. In an estimated midyear population of 100000 there were 2500 live births and 850 deaths
in year 2014.
No of foetal deaths 50
Deaths 0 – 7 days 50
Deaths 8-28 days 25
Deaths 1 month- 1 year 50
Calculate the following,
a. Crude birth rate
b. Crude death rate
c. Still birth rate
d. Infant mortality rate
e. Annual growth rate
 Key
Q. No: 1
a. Perinatal mortality rate:
Late foetaldeaths ( 28 wks gestation∨more ) +0−7 days deaths
¿ ×1000
Total live birth∈the same year
= 200+200/2500 × 1000 = 80/1000 LB
b. Early neonatal mortality rate
No . of deaths of children below 7 days inaaspecific population ∈a year
¿ ¿ × 1000 ¿
Total live birth∈the same year
= 200/2500 × 1000 = 40/ 1000 LB
c. Late neonatal mortality rate
No . of deaths of children 8−28 days∈a specific population ∈a year
¿ × 1000
Total live birth∈the same year
= 100/2500 × 1000 = 20/1000 LB
d. Post neonatal mortality rate

¿ No . of deaths of children28 days ¿1 year ∈a specific population∈a year ¿

Total live birth∈the same yea
= 500-300/2500 × 1000 = 40/1000 LB
e. Infant mortality rate
No . of deaths of children<1 year of age ∈a specific po pulation∈a year
¿ ×1000
Total live birth∈the same year
= 500/2500 ×1000 = 100/1000 LB
Q. No: 2
Total live birth
a. Crude birth rate ¿ × 1000
Mid year population
= 2500/100000 × 1000 = 25/1000 Population

b. Crude death rate ¿ Mid year population × 1000

Total death

= 850/100000 × 1000 = 8.5/1000 Population

c. Still birth rate
weighing
Foetat deaths gms at birth
1000
¿ ×1000
weighing
Total live+ still birth gms at birth
1000
= 50/2500+50 × 1000 = 19.6/1000 LB
d. Infant mortality rate
No . of deaths of children<1 year of age ∈a specific population∈a year
¿ ×1000
Total live birth∈the same year
= 50+25+50/2500 × 1000 = 50/1000 LB
e. Annual growth rate = CBR-CDR/10
= 25-8.5/10
 = 1.65%

DEPARTMENT OF COMMUNITY MEDICINE

PRACTICAL PROBLEMS & KEYS

Bio – Statistics- Questions

FAMILY WELFARE
1. In an estimated midyear population of 1 lakh there were 4000 live births. The number of
women in the reproductive age group was 20,000. Distribution of women and births in the
different age groups is given below.
Age No. of Live
Group Women births
15-19 3500 400
20-24 3000 1200
25-29 4500 1500
30-34 3750 400
35-39 2750 200
40-44 2500 300
Total 20000 4000
Calculate the following:
a. Birth rate
b. General fertility rate
c. Age specific fertility rate
d. Total fertility rate.
 Key
Q. No: 1
Total no . of live birth
Birthrate= ×1000
mid year population

= 4000/100000 × 1000
= 40/1000 Population

No. of live birth

General fertility rate= ×1000
MYP of women ∈age group of 15−45 year

= 4000/2000 × 1000
= 200/1000 Population

No . of live birth women ∈specific age group

Age Specific fertility rate= ×1000
Total no . of women

ASFR (15-19) = 400/3500 × 1000

= 114.29/1000 Population
ASFR (20-24) = 1200/3000× 1000
= 400/1000 Population
ASFR (25-29) = 1500/4500 × 1000
= 333.33/1000 Population
ASFR (30-34) = 400/3750 × 1000
=106.67/ 1000 Population
ASFR (35-39) = 200/2750 × 1000
= 72.73/1000 Population
ASFR (40-44) = 300/2500 × 1000
= 120/ 1000 Population

40−44

∑ ASFR × Age interval

15−19
Total fertility rate (TFR )=
1000
= 1147.02 × 5/1000
= 5.74
 DEPARTMENT OF COMMUNITY MEDICINE
PRACTICAL PROBLEMS & KEYS

Bio – Statistics- Questions

1. In a district of 10, 00,000 population, there were 4000 cases of TB, as on 1st
Jan 2009. During the year, 500 new TB cases were detected. 1000 persons
completed their full treatment and were declared as cured. There were 8000
deaths in the district, of which 100 cases were due to TB.

Calculate the following,

a. Prevalence of TB for the year 2009

b. Point prevalence of the disease as on 31st December, 2009
c. Proportional mortality rate of TB
d. Incidence rate
e. Case fertility rate

2. A small town consists of 50,000 populations in 2007. 600 total deaths were
recorded. 50 children suffered from Japanese encephalitis. During the same
year of these, 20 Children died of JE.

Calculate the following,

a. Proportional mortality rate of JE
b. Case fatality rate and
c. Prevalence rate due to JE.
 Key

Q. No: 1

a. Prevalence of TB for the year 2009

Total no . of old + new cases of TB∈an area during a particular year

¿ × 100
Mid year population
= 4000+500/100000 × 100 = 0.45%
b. Point prevalence of the disease as on 31st December, 2009
No . of all current cases ( old ∧new ) of a specifeid disease exisiting at a given point∈time
¿ × 100
Estimated population at the same point ∈time
= 4000+500-1000-100/100000 × 100 = 0.34%
c. Proportional mortality rate of TB

¿ Total no . of deathe due ¿ TB∈an area during a particular year ¿ all causes ¿× 100
Total no . of death due ¿
= 100/8000 × 100 = 1.25%
d. Case fertility rate of TB

¿ Total no . of deathdue ¿TB ¿ TB ¿ ×100

Total no . of case due ¿
= 100/4500 × 100 = 2.23%
e. Incidence rate of TB
Total no . of new cases∈an areaduring a particular time period
¿ ×1000
Poupulation at risk
= 500/100000 × 1000 = 0.5/1000 Population
Q. No: 2

a. Proportional mortality rate:

¿ Total no . of deathe due ¿ JE ∈an area during a particular year ¿ all causes ¿× 100
Total no . of deathdue ¿
= 20/600 × 100

= 3.33%

b. Case fertility rate

¿ Total no . of deathdue ¿ JE ¿ JE ¿ × 100
Total no . of case due ¿

= 20/50 × 100
= 40%
c. Prevalence rate due to JE

¿ Total no . of cases due ¿ JE ∈an area during a particular year ¿ ×100

Mid year population
= 50/50000 × 100
= 0.1%
 DEPARTMENT OF COMMUNITY MEDICINE
PRACTICAL PROBLEMS & KEYS

Bio – Statistics- Questions

1. In a town of 50, 000 population. 20, 000 population were clinically examined blood
exam done, it was found that microfilaria 400. 200 people show clinically
manifestation of filarial disease. Calculate the following,

a. Microfilaria rate
b. Filarial disease rate
c. Filarial endemicity rate

2. Filarial survey was conducted for a population of 50,000 in a town. Of this, 100
persons showed clinical manifestation for filariasis. 50 persons showed microfilaria
in peripheral blood. Calculate the following

a. Microfilaria rate
b. Filarial disease rate
c. Filarial endemicity rate
Key

Q. No: 1

a. Microfilaria rate
Total no . of person showing microfilarial ∈their peripheral blood
¿ an area during a particular year
¿ ×100
Total no . of person examined
= 400/20000 × 100
= 2%
b. Filarial disease rate
Total no . of person showing clinical manifestation for filaria
¿ an area during a particular year
¿ ×100
Total no . of person examined
= 200/20000 × 100
= 1%
c. Filarial endemicity rate
Total no . of person showing microfilarial ∈their peripheral blood∧¿ clinical manifestation∈an area durin
¿
Total no . of person examined
= 400+200/20000 × 100
=3%
Q. No: 2
a. Microfilaria rate
Total no . of person showing microfilarial ∈their peripheral blood
¿ an area during a particular year
¿ ×100
Total no . of person examined
= 50/50000× 100
= 0.1%
b. Filarial disease rate
Total no . of person showing clinical manifestation for filaria
¿ an area during a particular year
¿ ×100
Total no . of person examined
= 100/50000 × 100
= 0.2%
c. Filarial endemicity rate
Total no . of person showing microfilarial ∈their peripheral blood∧¿ clinical manifestation∈an area durin
¿
Total no . of person examined
= 50+100/50000× 100
= 0.3%