Shri Sathya Sai Medical College and Research Institute

Department of Community Medicine

Practical Problems and Answers

1. The duration of illness in days in a group of patients suffering from upper

respiratory infection is given below:

Duration of illness in days: 9,7,11,9,8,4,6,12,6,8,8,5

Calculate the Mean, Median, Mode, Mean deviation, and Standard deviation.

X x |x i−x| (x- x ¿2

4 7.75 3.75 14.06

5 7.75 2.75 7.56
6 7.75 1.75 3.06
6 7.75 1.75 3.06
7 7.75 0.75 0.56
8 7.75 0.25 0.06
8 7.75 0.25 0.06
8 7.75 0.25 0.06
9 7.75 1.25 1.56
9 7.75 1.25 1.56
11 7.75 3.25 10.56
12 7.75 4.25 18.06
∑ x =93 ∑|xi −x|=21.5 ∑ ( x −x ) 2=60.22

Mean =
∑ xi = 93 =7 . 75 days
n 12

n+1
Median = size of the value = 12+1/2 = 6.5th value
2

= 8+8/2 = 8 days

Mode = 8 days
n

Mean deviation
∑ |x i−x| 21.5 days
i=1
¿ = =1. 79
n 12

Standard deviation¿
√ n−1 √
∑ ( xi −x ) 2 = 60.22
11
=√ 5.475=2.34 days
2. A new screening test was done for disease "X" with a prevalence of 16%.Test was
found to be positive in 20% of 600 people. There were12 false negatives.
Calculate the Sensitivity, Specificity, Positive predictive value, Negative
predictive value, Percentage of false positives and Percentage of false negatives.

16
Prevalence= ×600=96
100

20
Test positive=20%= ×600=120
100

Disease Disease
Screening test Total
positive negative
Positive 84(a) 36(b) 120(a+b)
Negative 12(c) 468(d) 480(c+d)
Total 96(a+c) 504(b+d) 600
a 84
Sensitivity = × 100= ×100=87.5 %
a+c 96

d 468
Specificity= × 100= ×100=92.85 %
b+d 504

a 84
Positive predictive value = ×100= ×100=70 %
a+b 120

d 468
Negative predictive value = ×100= × 100=97.5 %
c+ d 480

b 36
Percentage of false positive = × 100= ×100=7.14%
b+d 504

c 12
Percentage of false negative = × 100= ×100=12.5 %
a+c 96

3. A study was conducted to find the effect of forceps delivery on the mentally
retarded children. On analysis of obstetrics records, it was found that at the time
of delivery, outlet forceps was applied in 10 out of 50 children in the mentally
retarded group and 4 out of 100 children in the normal group.
Calculate: a) Exposure rate among cases
b) Exposure rate among controls
c) Odds ratio
d) Comment on the calculated Odds ratio.

Mental Mental
Forceps
Retardation Retardation
delivery
present absent
 Positive 10(a) 4(b)
Negative 40(c) 96(d)
Total 50(a+c) 100(b+d)

a) Exposure rate among cases

No. of cases with history of exposure
= X 100
no . of cases withexposure +no . of cases without exposure
a 10
= X 100= X 100 =20%
a+c 50
b) Exposure rate among controls
No . of controls with history of exposure
= X 100
No . of controls with exposure+ no . of controls withlout exposure
b 4
= X 100 = X 100 =4%
b+d 100
c) Odd’s ratio
aXd 10 X 96 960
= = = =6
bXc 4 X 40 160
d)Children delivered by forceps have 6 times more risk of developing mental
retardation than normal delivery children.

4. A study was conducted to find the effect of tobacco chewing in oral cancer. A
cohort of males aged 24-45 years with suitable controls were followed upto a
period of 8 years. The study showed 50 cases of oral cancer out of 6000 tobacco
chewers and 9 cases out of 6000 people not using tobacco.

a) Calculate the incidence rate

b) Calculate the relative and give your command
c) Calculate the attributable risk and give your command

Oral
Tobacco Oral cancer
cancer Total
chewing negative
positive
Positive 50(a) 5950(b) 6000(a+b)
Negative 9(c) 5991(d) 6000(c+d)

a) Incidence rate among exposed:

=
no . of persons developing disease after exposure
X 100
no . of persons developing disease after exposure +¿ no . of persons not developingdisease after exposure
a 50
= X1000 = X 1000=8.33 per 1000 population
a+b 6000
Incidence rate among non-exposed
 =
no . of persons developing disease without exposure
no . of persons developing disease without exposure +¿ no . of persons not developing disease without exposure
c 9
= X 1000= X 1000 =1.5 per 1000 population
c+ d 6000
b) Relative risk
incidence among expected 8.33
= = = 5.55
incidence among non expected 1.5
Incidence of oral cancer is 5.5 times higher among tobacco users than non users
of tobacco.

c) Attributed risk:

incidence among exposed−incidece amongnon exposed

= X 100
incidence among exposed
8.33−1.5 6.83
= X 100= X 100 = 81.99%
8.33 8.33
81.99% of oral cancer is attributed to the use of tobacco, so 81.99% of oral
cancer can be prevented by reducing the tobacco use.

5. In a PHC area with a population of 50000, total blood smears collected during
active surveillance was 6000. On examination, P.vivax was found to be positive in
60 blood smears, 5 blood smears were positive for P.falciparum and 4 for both
P.vivax and P.falciparum. Calculate the Annual Parasite Incidence, Annual Blood
Examination Rate, Annual Falciparum Incidence and Slide Positivity Rate.

Annual Parasite Incidence (API)

No . of confirmed cases during one year
= X 1000
population under surveillence
69
= X 1000 =1.38 per 1000 population
50000
Annual Blood Examination Rate (ABER)
no . of slides examined ∈a year
= X 100
population under suveillance
6000
= X100 = 12%
50000
Annual Falciparum Incidence (AFI)
Total no . of falciparum positive cases∈a year
= X 1000
population under surveillance
9
= X 1000 ¿ 0.18 per 1000 population
50000
Slide Positivity Rate (SPR)
total no . of slides positive
= X 100
total no . of slides examined
 69
= X 100=1.15 %
6000

6. In a town with population of 150000, a routine filarial survey was conducted and
2750 blood smears were collected for examination. In the slides collected,
disease was reported in 317 individuals, 472 slides were positive for microfilaria
and 90 were reported with both the disease and slide positive.
Calculate:
a) Microfilaria rate b) Filarial endemicity rate c) Comment on the sample size

a) Microfilaria rate

Total no . of person showing microfilarial ∈their peripheral blood

¿ an area during a particular year
¿ ×100
Total no . of person examined

472+90 562
= x100= x100=20.44%
2750 2750

b) Filarial endemicity rate

Total no . of person showing microfilarial ∈their peripheral blood∧¿ clinical manifestation∈an area d
¿
Total no . of person examined

472+317+ 90 879
= x100= x100=31.96%
2750 2750

No. of slides examined

c) Sample size = x100
population under study
2750
= x100=1.83%
150000
Sample size is 1.83% which is inadequate. For routine survey sample size needed
is 5 to 7%

7. Population of a town on 1st January 2010 was 64550. There were 1500 births
and 600 deaths for the year of which 20 deaths occurred due to TB. Total
number of TB cases for the year is 260. Calculate the vital rates:
a) Crude birth rate
b) Crude death rate
c) Specific death rate due to TB
d) Proportional mortality rate for TB

a) Crude birth rate

 total no . of live births ∈a given year
= X1000
midyear population
1500
= X 1000 ¿ 23.24 per 1000 population
64650
b) Crude death rate
no . of deaths∈a given year
= X 1000
mid year population
600
= X 1000 ¿9.29 per 1000 population
64550
c) Specific death rate for TB
¿
= total no . of deaths due ¿ TB∈a year mid year population X 1000
20
= X 1000 = 0.3 per 1000 population
64550
d) Proportional mortality rate TB
=
no . of death∈a year due ¿ TB ¿ all causes∈same year ¿ X 100
total no . of deaths ¿
20
= X 100 ¿ 3.33 %
600
8. The following data relate to a town:
Midyear population : 1 lakh
No. of live births : 2400
No. of deaths : 1040
Maternal deaths :5
No. of late fetal deaths (more than 1000 grams) : 35
Early neonatal deaths : 25
No. of late neonatal deaths : 20
No. of infant deaths : 115
Calculate: a) Maternal mortality ratio b) Perinatal mortality rate
c) Post neonatal mortality rate d) Infant mortality rate
a) Maternal mortality rate
=
total no . of female death due ¿ complications of ¿ pregnancy childbirth∨within 42 ¿ days of delive ry ¿ ¿
¿
X1000
5
= X 1000
2400
¿ 2.08 per 1000 live births or 208 / 100000 population
b) Perinatal mortality rate
late fetal deaths+early neonatal deaths∈a year
= X 1000
live births ∈sa me year
35+25 60
= X 1000= X 1000
2400 2400
¿ 25 per 1000 live births
 c) Post neonatal mortality rate
=
no of deathof children aged 28 days ¿ 1 year ∈a given year ¿ X 1000
live births∈ same yea
115−45 70
= X 1000= X 1000
2400 2400
= 29.16 per 1000 live births
d) Infant mortality rate
no . of deaths of children
= ¿1 of age ∈a year
X 1000
no . of live births∈ same year
115
= X 1000=47.91 per 1000 live births
2400

9. 500 elementary school boys and girls are asked which their favourite colour is:
blue, green, or pink. Results are shown below:

Blue Green Pink

Boys 100 150 20
Girls 20 30 180

Using alpha = 0.05, would you conclude that there is a relationship between
gender and favourite colour?

Step: 1
Ho: For the population of elementary school students, gender
and favourite colours are not related.
H1: For the population of elementary school students, gender
and favourite colours are related.

Step: 2 Alpha = 0.05

Step: 3 DF = (rows – 1) (columns – 1)

DF = (2 – 1) (3 – 1)
DF = (1) (2) = 2

Step: 4 State decision rules

Using our alpha and our degrees of freedom, who look up a critical
value in the Chi-Square Table. We find our critical value to be
5.99.
Step: 5 Calculate Test Statistic
 First, we need to calculate our expected values; we find the
expected values by multiplying each row total by each column
total, and then diving by the total number of subjects.

O E 2 2
(O-E) ∑(O-E) /E
100 64.80 1239.04 19.12
150 97.20 2787.84 28.68
20 108 7744.00 71.70
20 55.20 1239.04 22.45
30 82.80 2787.84 33.67
180 92 7744 84.17
Total 259.79

Step: 5 State result

Calculated value of chi square is = 259.79
Table value of chi square is = 5.991
Calculated value is greater than table value, so we reject our null
hypothesis.
Step: 6 Conclusions or Inference
In the population, there is a association relationship between gender and
favourite colour