Ratios, proportions,

and rates

Ratio : A ratio quantifies the magnitude of

one occurrence or condition to another x/y X k
The ratio of male malaria patients to female
malaria patients
Proportion : It is a specific type of ratio in
which the numerator is included in the
denominator and the result is expressed as a
percentage.
The proportion of all births that was male :
Male births/ Male + Female births X 100

Rate : the most important epidemiological

tool used for measuring diseases.

Rate = Number of events in a specific period/
xk
Population at risk of these events in a specified
number
of
events
in
a
specified
time
period
Rate

xk

population at risk in a specified time

The number of newly diagnosed

pneumonia cases in 2010 per 1000

Measurements of
morbidity
Incidence rate : the number of new cases of a
disease that occur during a specified period of
time in a population at risk for developing the
disease.
number of new cases of a disease over a period of time

incidence rate

total population at risk during the period of time

Incidence rate important for etiologic studies of

diseases since it is a direct measure of risk. If the
incidence rate is significantly higher in one area,
then the cause of that disease can be
systematically searched.

xk

Prevalence rate
Number of people in a population who have a

disease at a given time. It includes both new

and old cases.
The major type of prevalence is point
prevalence rate.
Point prevalence rate

all person with spesific condition at one time

Total population

xk

The total number of students in that school was

200. The health extension worker examined all

the 200 students for trachoma. Hundred
students were found to have trachoma.

100
Point prevalence rate
0,5 50%
200
Uses of prevalence rate :
1. Planning health facilities and human resource
2. Monitoring chronic disease control programs like
tuberculosis control program

Measurements of
Mortality
Crude Death rate (CDR)
CDR

total number ofdeath during a period of time

x1000
total population the same time

CDR in X tahun 2012 is 12.6 per 1000 population. That means

out of 1000 total population about 13 people die each year.

Age- specific mortality

rate
ASMR

number of death in a specific age group during a given time

total population specific age group

x 1000

Sex- specific mortality

rate
Sex specific mortality rate

number of death in a spesific sex

x 1000
total population of same sex

Sex- specific mortality

rate
Example: The average total population of Y
in 2010 was 6000 (3500 female & 2500 male).
In the same year 300 people died (100 female
& 200 male). Calculate the mortality rate
(Crude death rate) for females

100
CDR for female
x 1000 29 per 1000
3500

Case Fatality Rate

(CFR)
number of death from a spesific disease in a given time
CDR
x100
number of cases of that disease at the same time

In 2010 there were 1000 tuberculosis patients in one

region. Out of the 1000 patients 100 died in the same year.

100
CFR
x100 10%
1000

Neonatal Mortality
Rate
Neonatal mortality rate

number of death under 28 days during a given time

number of live birth during the same time

x1000

In 2010 there were a total of 5000 live births in X. Two hundred of

them died before 28 days after birth).
200
NMR
x1000 40 per1000 kelahiran hidup
5000

Infant Mortality Rate

(IMR)

IMR

number of death under1 year of age during spesific time

x1000
number of live birth the same time

Infant mortality rate reflects the health of the

community in which the child is being brought up.

Maternal Mortality Rate

(MMR)
MMR

number of pregnancy associated death of mothers given period time

number of live births in the same time

x1000

Kehamilan,kelahiran dan komplikasinya , masa nifas

Maternal Mortality Rate reflects the standards of all aspects
of maternal care (antenatal, delivery and postnatal).
MMR 871 per 100,000 live births. That means in 100,000
live births, around 871 mothers die each year due to
pregnancy related causes.

The following information is kelurhan X th 2011

Total average population = 40,000
Total number of live births = 4000
Total number of deaths = 400
Total number of deaths before the age of 28 days =50
Total number of infant deaths = 200
Number of women who died from pregnancy related causes =

160
New cases of tuberculosis = 100
All cases of tuberculosis = 300
Deaths from tuberculosis = 60

Based on the above information calculate the following.

1. The incidence rate of tuberculosis.
2. The period prevalence rate of tuberculosis.
3. The case fatality rate of tuberculosis.
4. The Neonatal mortality rate.
5. The infant mortality rate.
6. The maternal mortality ratio

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.
Types of surveillance:The two common
types of surveillance are passive and active
surveillance.

Passive surveillance
Mechanism for routine surveillance based on

passive case detection and on the routine

recording and reporting system.
The information provider comes to the health
institutions for help, be it medical or other
preventive and promotive health services. It
involves collection of data as part of routine
provision of health services.

Advantages of passive
surveillance
covers a wide range of problems
does not require special arrangement
relatively cheap
covers a wider area

Disadvantages of passive
surveillance
Information unreliable, incomplete and

inaccurate is not available on time

You may not get the kind of information you
desire
Lacks representativeness of the whole
population since passive surveillance is mainly
based on health institution reports

Active surveillance
method of data collection usually on a specific

disease, for relatively limited period of time.

collection of data from communities such as
in house-to-house surveys or mobilizing
communities to some central point where data
can be collected.

Advantages of active surveillance :

the collected data is complete and accurate
information collected is timely.
The disadvantages of active surveillance
it requires good organization,
it is expensive
it requires skilled human power
it is directed towards specific disease

conditions

MEASURES OF EFFECT
In epidemiologic studies, compare disease

frequencies of two or more groups using a

measure of effect.
The measure described in the case control
study is called an odds ratio.
The measure described in the cohort study is
called a risk ratio/relative risk

A cohort of 156 heart attack patients was studied, all of whom

were regular smokers up to the time of their heart attack. Seventyfive of these patients continued to smoke after their attack. The
other 81 patients quit smoking during their recovery period. Of the
75 patients that continued smoking, 27 died, so the proportion of
these patients that died is 0.36. Of the 81 patients who quit
smoking, 14 died, so the corresponding proportion is 0.17.

estimated risk for continuing smokers 0.36

Risk ratio

2,1
estimated risk for smokers who quit
0,17

Risk ratio of 2.1 tells us that continuing smokers are about twice
as likely to die as smokers who quit.
For heart attack patients the five-year risk for continuing smokers
is about twice the corresponding risk for smokers who quit.

Subjek yang makan hamburger risiko mengalami diare

3,2 kali dibandingkan mereka yang tidak makan
hamburger