MODUL

PUBLIC HEALTH OF THE RESPIRATORY SYSTEM CODE : RESP 4

Contributors: Dr. Nani S!ti"o#ati$ M%!s Li&i 'u(ri)a($ S%M$ M !s Dr. Sri An*arini M%!s

INTRODUCTION
I+,ro-in. t(! /o++unit) (!a&t( /on*ition is not !as). Man) (!a&t( ,ro.ra+s in t(! ,r!/ious )!ars 0ai&!* b!/aus! o0 &a/ o0 /o++unit) ,arti/i,ation in !-!r) &!-!& o0 ,ro.ra+ ,&annin.. T(! !)s o0 su//!ss o0 /o++unit) *ia.nosis or /o++unit) ass!ss+!nt ,ro.ra+s ar! t(! in-o&-!+!nt o0 t(! /o++unit) 1*ir!/t&) t(rou.( /o++unit) (!a&t( n!!* sur-!) an* a//!,tabi&it) o0 a/tion ,ro.ra+s$ or in*ir!/t&) t(rou.( Fo/us 2rou, Dis/ussion b) t(! in-o&-!+!nt o0 Co++unit) &!a*!rs3 in t(! ass!ss+!nt o0 t(! ,ro.ra+. T(is ,art o0 +o*u&! assu+!s t(at t(! (!a&t( ass!ss+!nt t!a+4/o++itt!! 1)our t!a+3$ a0t!r in-o&-in. t(! /o++unit) ,arti/i,ation$ (as ,rioriti5!* Tub!r/u&osis as t(! +ost i+,ortant *is!as! to b! /ontro&&!* in t(! -i&&a.!. T(! n!6t !ss!ntia& st!, is to i*!nti0) a&& t(! ,ot!ntia& ris 0a/tors o0 Tub!r/u&osis in !a/( o0 t(! La Lon*! .rou,s o0 *!t!r+inants 1b!(a-ioura& 0a/tors$ !n-iron+!nt 0a/tors$ !n*uran/!4intrinsi/ 0a/tors an* H!a&t( S!r-i/! Fa/tors3. In or*!r to .!t a /o+,&!t! situation ana&)sis$ )ou s(ou&* i*!nti0) t(! +ost ,ot!ntia& ris 0a/tors .i-!n.

DETERMINING RISK FACTORS

A risk factor is a -ariab&! asso/iat!* #it( an in/r!as!* ris o0 *is!as! or in0!/tion. Ris 0a/tors ar! /orr!&ationa& an* not n!/!ssari&) /ausa&$ b!/aus! /orr!&ation *o!s not i+,&) /ausation. Ris 0a/tors ar! !-a&uat!* b) /o+,arin. t(! ris o0 t(os! !6,os!* to t(! ,ot!ntia& ris 0a/tor to t(os! not !6,os!*. I0 an asso/iation b!t#!!n !6,osur! to a 0a/tor an* *!-!&o,+!nt o0 a *is!as! !6ists$ (o# stron. is it7 8! /an a&so ,ut t(! 9u!stion anot(!r #a): :8(at is t(! ratio o0 t(! ris o0 *is!as! in !6,os!* in*i-i*ua&s to t(! ris o0 *is!as! in non;!6,os!* in*i-i*ua&s7< T(is ratio is /a&&!* t(! relative risk (RR)= Ratio Incidence (RI) in Cohort Study

R!&ati-! Ris =

Ho# *o #! int!r,r!t t(! -a&u! o0 a r!&ati-! ris 7 I0 t(! RR = >$ t(! nu+!rator !9ua&s to t(! *!no+inator$ an* t(! ris in !6,os!* ,!rsons !9ua&s t(! ris in non;!6,os!* ,!rsons. T(!r!0or!$ no !-i*!n/! !6ists 0or an) in/r!as!* ris in !6,os!* in*i-i*ua&s or 0or an) asso/iation o0 t(! *is!as! #it( t(! !6,osur! in 9u!stion. I0 t(! RR ? >$ t(! nu+!rator is .r!at!r t(an t(! *!no+inator$ an* t(! ris in !6,os!* ,!rsons is .r!at!r t(an t(! ris in non;!6,os!* ,!rsons. T(is is !-i*!n/! o0 a ,ositi-! asso/iation$ an* +a) b! /ausa&. I0 t(! RR @ >$ t(! nu+!rator is &!ss t(an t(! *!no+inator$ an* t(! ris in !6,os!* ,!rsons is &!ss t(an t(! ris in non;!6,os!* ,!rsons. T(is is !-i*!n/! o0 a n!.ati-! asso/iation$ an* it +a) b! in*i/ati-! o0 a ,rot!/ti-! !00!/t. Disease develop E!posed No " e!posed Disease does ot develop

Totals

a c

b d

a+b c+d

Fro+ t(! tab&! abo-!$ t(! in/i*!n/! in !6,os!* in*i-i*ua&s is

An* t(! in/i*!n/! in no;!6,os!* in*i-i*ua&s is

8! /a&/u&at! t(! r!&ati-! ris as 0o&&o#s

R!&ati-! Ris =

T(!r!0or!$ b) /a&/u&atin. RR 1usin. abo-! 0or+u&a3$ #! ar! a&so ab&! to *!t!r+in! #(!t(!r an !6,osur! or a /on*ition /an b! /onsi*!r!* as a ris 0a/tor o0 a *is!as! or (!a&t( ,rob&!+.
Case Control A case control study is an investigation into the extent to which persons selected because they have a specific disease (the cases) and comparable person who dont have the disease (the controls) have been exposed to the diseases possible risk factors in order to evaluate the hypothesis that one or more of these is a cause of the disease.

O**s Ratio =

T(! o**s o0 (a-in. t(! *is!as! #it( t(! ris 0a/tor ,r!s!nt = a4b T(! *is!as! #it( t(! ris 0a/tor abs!nt = /4* Ho# *o #! int!r,r!t t(! -a&u! o0 a r!&ati-! ris 7 I0 t(! OR = >$ no asso/iation b!t#!!n t(! *is!as! an* ris 0a/tor I0 t(! OR ? >$ ris 0a/tor in0&u!n/!* t(! *is!as! o//uran/!. I0 t(! OR @ >$ in*i/at! t(! ,robabi&it) t(at t(! ris 0a/tor +a) b! t(! ,rot!/ti-! on!.

Case E!posed No " e!posed Fro+ t(! tab&! abo-! is :

Co trol

a c

b d

CAS ! "uberculosis #revalence Survey was conducted to population of $%$ village& aged '( years and over who examined sputumnya. "he sample consisted of population)based study in a laboratory examination showed sputum smear results positive and smear negative. All patients who meet the criteria for microscopic examination of sputum morning of at least ' or more positive smear preparation included. *hile patients with negative smear taken at random. Sub+ects in this study amounted to ,- patient with

smear positive and ./0 smear negative patients. 1ata and some environmental factors taken from the sample population. "he result is shown in 2 table below.

"able '. "he relationship between the indoor environment with smear positive pulmonary tuberculosis incidence in the Adult #opulation in village 3%4

Aariab&! Li.(tin. roo+s &!ss !nou.( Roo# $e tilatio &!ss !nou.( T%pe of floor &an* not &an* Po,u&ation *!nsit) (i.( &o# Conta/t (ous!0u& ,r!s!nt abs!nt

BTA ,ositi-! n B >C GC >D$> HF$I

BTA n!.ati-! n B C> FDC >E$F HI$H

O**s Ratio

>4 GF >I JD

>H$4 H>$G FJ$E DJ$E

4E FG4 CC FD>

>C$F HG$H >E$I HI$>

FF J4 H GH

FH$I D>$> >E$J HI$J

>E4 FEE >E FI4

C4$F GJ$H C$C IG$D

"able 2. "he relationship between socio)economic factors with smear positive pulmonary tuberculosis incidence in the Adult #opulation in village 3%4

Aariab&! E*u/ation L!-!& Lo# M!*iu+ Hi.( O//u,ationa& #or no #or Marita& Status Not +arri!* +arri!* In/o+! ,!r/a,ita &o# (i.( E!ercise &

BTA ,ositi0 n B GC >> F FJ J> >E GG FH 4H HF$I >4$J F$G CF$I GD$> >C$F HG$H CG$H GC$F

BTA n!.ati0 n B FJH CF >4 >EJ >II GJ FCI GJ FCI H4$I >E$J 4$G C4$J GJ$J F>$4 DH$G F>$4 DH$G

O**s Ratio

>. Ca&/u&at! t(! C(i; S9uar! -a&u! 0or !a/( -ariab&! 7 (O E ) 2 Not! : X 2 = E O = OBSERAED AALUE E = EKPECTED AALUE KF = CHI SLUARE AALUE

E6 : 1In/o+! ,!r /a,ita3 In/o+! ,!r/a,ita &o# Cas! FH Obs 1IC6DG34CHE=>H$ G Exp 4H Obs 1FHD6DG34CHE=JD $4 Exp DG Contro& GJ Obs 1IC6CE434CHE=D4$4
Exp

Tota& IC

(i.(

FCI Obs 1FHD6CE434CHE=FF I$G Exp CE4

FHD

Tota&
X 2 =

CHE

(28 18,6) 2 (65 74,4) 2 (48 57,4) 2 (239 229,6) 2 + + + 18,6 74,4 57,4 229,6 F K = G$E4 M >$>I M>$J4 ME$4I

KF =I$FG As *0 = 1/;>3 1r;>3$ in t(is !6a+,&!$ *0 = 1F;>31F;>3=>. T(! /riti/a& K F at JB &!-!& 0or > *0 is C$H4. C= nu+b!r o0 /o&u+nN r= nu+b!r o0 ro# T(! r!su&tin. KF o0 I$FG is #it(in t(! /riti/a& r!.ionN t(!r!0or! #! r!"!/t t(! nu&& (),ot(!sis t(at t(!r! is no *i00!r!n/!s ,!r/!nta.! o0 /as! b!t#!!n &o# an* (i.( in/o+! .rou,. T(! /on/&usion is a&t!rnati-! (),ot(!sis is r!/!i-!* t(at t(!r! is *i00!r!n/!s ,!r/!nta.! o0 /as! b!t#!!n &o# an* (i.( in/o+! .rou,. F. C. 4. J. I*!nti0) t(! si.ni0i/ant -ariab&!s in t(! /as! abo-! O Ca&/u&at! t(! O**s Ratio o0 !a/( -ariab&! O 8(i/( o0 t(!s! -ariab&!s (a-! t(! stron.!st r!&ations(i,7 I0 )ou ar! in /(ar.! o0 +ana.in. t(! (!a&t( ,ro.ra+s 0or t(! .!n!ra& ,ub&i/ Bas!* on t(! /as!$ *!t!r+in! s!t .oa&s$ tar.!t .rou,$ ob"!/ti-!s an* +!t(o*s to o-!r/o+! !6istin. (!a&t( ,rob&!+s O G. D!t!r+in! in*i/ators o0 s!&!/t!* (!a&t( ,ro.ra+s an* !-a&uation +!t(o*s O