L L EG E BA H I R D A R

HIGHLAND CO
E N T O F N U RS I N G
CAMPUS DEPARTM
Applying Basic Health
Statistics and survey

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 Learning Outcomes
LO1:Prepare for the application of health
survey
LO2:Undertake data collection
LO3:Compile, interpret and utilize health data
LO4:Prepare and submit reports
LO5:Take intervention measures accordingly

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LO1:Prepare for the Application of Health Survey
Learning objectives
o At the end of the learning outcome students will
be able to:-
 Identify the characteristics of health statistics
 Explain scales of measurement in health
statistics
 Apply basic principles of health statistics
 Calculate rates and ratios
 Apply basic principles of health survey

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 Concepts of statistics
What is statistics?
Statistics is a field of study concerned with
1. collection, organization, summarization and
analysis of data.
2. drawing of inferences about a body of data when
only a part of the data is observed.
 help us to use numbers to communicate ideas
 Is the science of designing studies, gathering data
then classifying, summarizing, interpreting and
presenting these data to support the decisions that
are needed.
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 Concepts of statistics cont…

• Biostatistics is a growing field with applications

in many areas of biology including epidemiology,
medical sciences, health sciences, educational
research and environmental sciences.
• When the data analyzed are derived from the
biological science and medicine, we use the term
biostatistics to distinguish this particular
application of statistical tools and concepts.
• It is the scientific treatment given to the medical
data derived from group of individuals or
patients
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 Types of Statistics
1. Descriptive statistics:
 A statistical method that is concerned with the collection,
organization, summarization, and analysis of data from a sample
of population.
 Statistical procedures used to summaries, organize, and simplify
data.
 Helps to identify the general features and trends in a set of data
and extracting useful information
 Also very important in conveying the final results of a study

10-Jan-24
Example: tables, graphs,Bynumerical summary measures
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 Types of Statistics cont…
2. Inferential statistics:
 A statistical method that is concerned with the drawing
conclusions/infering about a particular population by selecting and
measuring a random sample from the population.
 This branch of statistics deals with techniques of making conclusions
about the population.
 Inferential statistics builds upon descriptive statistics

 Example:

– Principles of probability, estimation, CI,

– comparison of two or more means or proportions, hypothesis
testing, etc.
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 Why we study statistics?
1. Roles in Public Health Functions
Assessment: Identify problems related to the
public’s health, and measure their extent
Policy Setting: Prioritize problems, find
possible solutions, set regulations to achieve
change, and predict effect on the population.
Assurance: Provide services as determined by
policy, and monitor compliance
– Evaluation is a theme that cuts across all these
functions, i.e., how well are they performed?
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 Role of statistics in Assessment
Decide which information to gather,
– find patterns in collected data, and
– make the best summary description of the population
and associated problems
It may be necessary to
– design general surveys of the population needs,
– plan experiments to supplement these surveys, and
– assist scientists in estimating the extent of health
problems and associated risk factors.

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 Role of statistics in Policy Setting
develop mathematical tools to:
measure the problems,
prioritize the problems,
quantify associations of risk factors with disease,
quantify associations of risk factors with disease,
predict the effect of policy changes, and
estimate costs, including monetary and undesirable
side effects of preventive and curative measures.
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Role of statistics in Assurance and Evaluation
use sampling and estimation methods to study the
factors related to compliance and outcome.
decide if improvement is due to compliance or
something else, how best to measure compliance, and
how to increase the compliance level in the target
population.
take into account possible inaccuracy in responses and
measurements, both intentional and unintentional.
Survey instruments should be designed to make it
possible to check for inaccuracies, and to correct for
non-response and missing values
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 2. Role of Statistics in Clinical Medicine
 The main theory of statistics lies in the term variability.
 No two individuals are same.
 For example, blood pressure of person may vary from
time to time as well as from person to person.
 We can also have instrumental variability as well as
observers variability.
 Methods of statistical inference provide largely
objective means for drawing conclusions from the data
about the issue under study.
 Medical science is full of uncertainties and statistics
deals with uncertainties.

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Role of Statistics in Clinical Medicine cont..
 Statistical methods try to quantify the
uncertainties present in medical science.
 It helps the researcher to arrive at a scientific
judgment about a hypothesis.
 It has been argued that decision making is an
integral part of a physician’s work.
 Frequently, decision making is probability
based!

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 Definition of Some basic terms
 Population: is the complete set of possible measurements for
which inferences are to be made.
 Census: a complete enumeration of the population. But in most
real problems it cannot be realized, hence we take sample.
 Sample: A sample from a population is the set of measurements
that are actually collected in the course of an investigation.
• The individuals who are actually measured and comprise the
actual data.
 Parameter: Characteristic or measure obtained from a
population

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 Definition of Some basic terms
 Statistic: A statistic refers to a numerical quantity
computed from sample data (e.g. the mean, the median,
the maximum...).
 Data: Refers to a collection of facts, values, observations,
or measurements that the variables can assume.
 Sampling: The process or method of sample selection
from the population.
 Sample Size: The number of elements or observation to
be included in the sample.
 Variable: It is an item of interest that can take on many
different numerical values.

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 Definition of Some basic terms
 Sampling unit: The unit of selection in the sampling
process. For example, in a sample of districts, the
sampling unit is a district; in a sample of persons, a
person, etc.
 Study unit: The unit on which the observations will
be collected. For example, persons in a study of
disease prevalence, or households, in a study of
family size.
 N.B. The sampling unit is not necessarily the same as
the study unit.

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 Uses of biostatistics
 The main function of statistics is to enlarge our
knowledge of complex phenomena.
 The following are some uses of statistics:
i. To test whether the difference between two populations is
real or by chance occurrence.
ii. To study the correlation between attributes in the same
population.
iii. To evaluate the efficacy of vaccines.
iv. To measure mortality and morbidity.
v. To evaluate the achievements of public health programs
vi. To fix priorities in public health programs
vii. To help promote health legislation and create administrative
standards for oral health.
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 Limitations of statistics
 As a science statistics has its own limitations.
The following are some of the limitations:
i. Deals with only quantitative information.
ii. Deals with only aggregate of facts and not with
individual data items.
iii. Statistical data are only approximately and not
mathematical correct.
iv. Statistics can be easily misused and therefore
should be used be experts

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 Types of Variables and Measurement Scales
 Variable- A variable is a characteristic or attribute that can
assume different values in different persons, places, or
things.
• Example:
 Age,
 Diastolic blood pressure,
 Heart rate,
 The height of adult males,
 The weights of preschool children,
 Gender of Biostatistics students,
 Marital status of instructors at highland college,
 Ethnic group of patients

 Variables are categorized into two they are quantitative and

qualitative variable
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 Types of Variables (1)

1. Quantitative (numerical variable): it is one

that can be measured in the usual sense.
• it can be expressed in numerical values , counts
and measurements.
• Quantitative variables are subdivided into TWO
A. Discrete variable:
• a variable whose values are countable.
• there is no decimal number
• e.g. the number of daily admission of hospital,
number of live births/1000 women, number of
motor vehicle accident in Bahir dar town
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 Types …..
B. Continuous variable: the one that does
not poccess gaps or interruption.
• A variable that can assume any numerical value
over a certain interval or intervals.
• e.g.
– serum cholesterol level of a patient,
– weight,
– age,
– laboratory result,
– time, arm circumference
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 Types …..
2. Qualitative (categorical) variable: it can not be
quantified or measured in usual sence because it
lost magnitude but can describe attributes or
quality of something.
e.g. sex, marital status, race or ethnic group,
occupational status, eye color etc.

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 Types …..
A. Nominal variables: variables with no inherent
order or ranking sequence
e.g. gender, race, marital status etc.
B. Ordinal variables: variables with an ordered
series
e.g. greatly dislike, moderately dislike, indifferent,
moderately like, greatly like.
• Numbers assigned to such variables indicate rank order
only
• the distance between the numbers has no meaning

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 Types of Variables (2)
Independent variable: a variable that you
believe might influence your outcome measure.
• An independent variable is a hypothesized
cause or influence on a dependent variable
Dependent variable: in a research study , the
variable that you believe might be influenced or
modified by some treatment or exposure.
• It may also represent the variable you are trying
to predict.
• Some times called as out come variable
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 SCALES OF MEASUREMENT

 Measurement: These are usual terms given to values

resulting from measurement procedures of a given
variable.
 More scientifically, measurement is defined as the
assignment of numbers, symbols and/or names to objects
or events according to a set of rules.
 Depending on the nature of variable, variables can be
measured in four different levels of scales.
 Each scale of measurement has certain properties which
in turn determine the appropriateness for use of certain
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 Scale…..

 The four scales of measurement are nominal, ordinal, interval and

ratio
1. Nominal scale:
• It is the lowest level of measurement scale
• it simply consists of "naming" observations or classifying them
into various mutually exclusive and collectively exhaustive
categories.
• Nominal measurements have no meaningful rank order among
values. e.g. :-Sex of a person (M, F),
» eye color (e.g. brown, blue),
» religion (Muslim, Christian),
» place of residence (urban, rural),
» race (e.g. black, white).
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 Scale….
2. Ordinal scale:
• observations can be categorizerd and ranked according to some
criteria,
• Here, we can talk of greater than, less than and it conveys meaning
to the value.
• Still it is impossible to express the real difference between
measurements in numerical terms.
Example-
– Socio-economic status (very low, low, medium, high, very high)
– patient status (unimproved, improved, much improved),
– height of patients (very short, short, tall, very tall),
– blood pressure (very low, low, high, very high),
– job satisfaction index (highly dissatisfied, dissatisfied, satisfied, highly
satisfied), etc.
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 Scale…..

3. Interval Scale:
• In this type of scale, it is possible to categorize, rank and tell the
real distance between any two measurements.
• It is meaningful to say the difference between 30 oC & 40oC and
60oC & 70oC is equal (i.e. 10oC)
• In this scale however, the zero point (whenever present) is arbitrary.
• The selected zero point is not necessarily a true zero in that it
doesn't have to indicate a total absence of the quantity being
measured.
– Not that zero degree Celsius is arbitrary so it does not make sence to say that 20
degree Celsius is twice hot as 10 degree Celsius
Examples:
– Body temperature in OF or OC, time of the day, days of the year
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 Scale…..
4. Ratio scale:
• Is the highest level of measurement
• characterized by equality of ratios as well as equality of
intervals may be determined.
• There is always a true zero point.
• In this case zero shows the absence of quantity measured
• provide the greatest flexibility in statistical methods that
can be used for analyzing data.
Example: volume, height, weight, length, number of items,
etc.
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Summary of characteristics of level of measurement

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 Summary of Levels of Measurement

Arrange Determine if one data

Level of Put data in Subtract data
data in value is a multiple of
measurement categories values
order another

Nominal Yes No No No
Ordinal Yes Yes No No
Interval Yes Yes Yes No
Ratio Yes Yes Yes Yes
Summary of Levels of Measurement
 Basic concept of epidemiology
o Epidemiology
• It is the study of frequency, distribution, and
determinants of diseases and other health-
related conditions in a human population
and
• the application of this study to the prevention
of disease and promotion of health

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 Basic concept of epidemiology cont…
Components of the definition
1. Study: Systematic collection, analysis and
interpretation of data
• Epidemiology involves collection, analysis and
interpretation of health related data
• Epidemiology is a science
2. Frequency: the number of times an event occurs
• Epidemiology studies the number of times a disease
occurs
• It answers the question How many?
• Epidemiology is a quantitative science
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 Basic concept of epidemiology cont…
3. Distribution: Distribution of an event by person,
place and time
• Epidemiology studies distribution of diseases
• It answers the question who, where and when?
• Epidemiology describes health events
4. Determinants: Factors the presence/absence of
which affect the occurrence and level of an event
• Epidemiology studies what determines health
events
• It answers the question how and why?
• Epidemiology analyzes health events
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 Basic concept of epidemiology cont…

5. Diseases & other health related events

• Epidemiology is not only the study of diseases
• The focus of Epidemiology are not only patients
• It studies all health related conditions
• Epidemiology is a broader science
6. Human population
• Epidemiology diagnoses and treats communities/
populations
• Clinical medicine diagnoses and treats patients
• Epidemiology is a basic science of public health
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 Basic concept of epidemiology cont…

7. Application
• Epidemiological studies have direct and
practical applications for prevention of
diseases & promotion of health
• Epidemiology is a science and practice
• Epidemiology is an applied science

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 Basic concept of epidemiology cont…
Scope of Epidemiology
• Originally, Epidemiology was concerned with
investigation & management of epidemics of
communicable diseases
• Lately, Epidemiology was extended to endemic
communicable diseases and non-communicable
infectious diseases
• Recently, Epidemiology can be applied to all
diseases and other health related events

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 Basic concept of epidemiology cont…
Purpose/use of Epidemiology
• The ultimate purpose of Epidemiology is
prevention of diseases and promotion of health
• How?
1. Elucidation of natural history of diseases
2. Description of health status of population
3. Establishing determinants of diseases
4. Evaluation of intervention effectiveness

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 Basic concept of epidemiology cont…
 Types of Epidemiology
• Two major categories of Epidemiology
I. Descriptive Epidemiology
• Defines frequency and distribution of diseases and other
health related events
• Answers the four major questions: how many, who,
where, and when?
II. Analytic Epidemiology
• Analyses determinants of health problems
• Answers two other major questions: how? and why?
• Generally, Epidemiology answers six major questions:
how many, who, where, when, how and why?
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 Basic concept of epidemiology cont…
Basic Epidemiological assumptions
1) Human diseases doesn’t occur at random or by
chance
2) Human diseases have causal and preventive factors
Basic features of Epidemiology
1. Studies are conducted on human population
2. It examines patterns of events in people
3. Can establish cause-effect relationship without the
knowledge of biological mechanism
4. It covers a wide range of conditions
5. It is an advancing science
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 Epidemiological Surveillance
• Surveillance is defined as the continuous
(ongoing) scrutiny of the factors that determine
the occurrence and distribution of diseases and
other health related events through a systematic
collection of data.
o Surveillance – data provides
• “Information for action”
• Surveillance also determines the distributions of
disease and another health related events.

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 Epidemiological Surveillance cont…
Purpose of surveillance
o To identify, detect and predicate the occurrence of
disease and other health related factors, as early as
possible.
o To prove a scientific and factual baseline date and
information’s
 This helps in priority setting, planning, implementing,
monitoring and evaluation of disease control programs.
o To determine the magnitude and distribution of disease
by time, person, and place dimensions
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 Epidemiological Surveillance cont…
 Types of surveillance
• There are three types of surveillance
1. passive surveillance
2. active surveillance
3. sentinel surveillance
 Passive surveillance
• it is mechanism for routine survey based on passive case
detection and on the routine recording and reporting system
• it involves collection of data as part of routine provision of
health services.
• No intervention to the community
• The information provider comes to health facility
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 Epidemiological Surveillance cont…
o Advantages
• Cover a wide range of problems
• No special arrangement is required Cheap
• Cover wide area
o Disadvantage
• Information could be unreliable, incomplete, and
inaccurate.
• Data may not available in time
• The required type of information may not be found
• It is not representative
• No feed back system
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 Epidemiological Surveillance cont…
 Active surveillance
• It involves a data collection method
– On specific disease
– For limited period time
– From the community
• Example: house – to house
• It indicate the presence and absence of new case of a
particular at regular time intervals
• Information collected through
– Conducting survey
– Creating community awareness to wards a specific disease, and
alerts the public to visit health facility.
– Asking patients of subjects disease
– Asking reports from health facilities
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 Epidemiological Surveillance cont…
o The advantages of active surveillance
• Data is completed and accurate
• The information reaches timely
o The disadvantages of active surveillance
• Expensive
• Needs organization
• Needs skilled man power
• Directed towards a specific disease

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 Epidemiological Surveillance cont…
• Active surveillance is used to
• For periodic evaluation of outgoing program
• For program with limited time of operation
– Example: eradication program
• In unusual situations
– Example – new disease discovery
– new mode of transmission
– when previously eradicated disease reappears
– When a disease found to affect a new subgroup.

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 Epidemiological Surveillance cont…
Sentinel surveillance
• It uses a pre-arranging sample of reporting
source to report all cases of one or more
condition.
• In this strategy
Homogeneous population sub group is selected
Institution are also selected
• It is a population based surveillance
o The selection population may not be
representative of the whole population.
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 Epidemiological Surveillance cont…
o Activities in Surveillance
• The different activities carried out under surveillance are:
1. Data collection and recording
2. Data compilation, analysis and interpretation
3. Reporting and notification
4. Dissemination of information
o Features of a good surveillance system
• ƒUsing a combination of both active and passive
surveillance techniques
• ƒTimely notification
• ƒTimely and comprehensive action taken in response to
notification
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 Exercises
For each of the following variable indicate whether it is quantitative or
qualitative and specify the measurement scale for each variable :
1. Blood Pressure (mmHg)
2. Cholesterol (mmol/l)
3. Diabetes (Yes/No)
4. Body Mass Index (Kg/m2)
5. Age (years)
6. Sex (female/male)
7. Employment (paid work/retired/housewife)
8. Smoking Status (smokers/non-smokers, ex-smokers)
9. Exercise (hours per week)
10. Drink alcohol (units per week)
11. Level of pain (mild/moderate/severe)
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