Vital Statistics – refers to the data gathered from the systematic study of statistical measures to vital events like

births, deaths, marriages, adoptions, separations, annulment patterns and common illnesses. This is utilized to
gauge the levels of health, illness and health services of a community and the country.
 Statistics of disease and death indicate the state of health of community and the success or failure of health
work.
 Births and deaths are registered in the office of the Local Civil Registrar of the municipality.

Health Indicators refers to a list of information that would determine the health of a particular community or
country. This includes population size, crude birth rate, crude death rate, infant and maternal death rates,
neonatal death rates, and even tuberculosis death rate.

Common health indicators used in public health and community health nursing are the following:
1. Birth
2. Death
3. Marriages
4. Migration

The common vital statistical indicators could be grouped into the following:
1. Fertility rates
2. Mortality rates
3. Morbidity rates

Definition of terms
 Crude rates – have for its denominator the total population of a specified geographic unit
 Specific rates – the events occurring to a specific group are related only to the affected segment of the
population; specific rates could be considered more valuable when comparing populations because one
could zero in on groups possessing particular characteristics like age, sex, educational attainment,
marital status, occupation, race, and even exposure to disease or risk factors of diseases.
 Midyear population – refers to the estimated population as of July 1 of a specified year; assuming that
births, deaths, and migration are equally distributed throughout the year; the midyear population
maybe considered a representative of the population for the whole year.
 Birth – the complete expulsion or extraction from the mother of a fetus irrespective of whether the
umbilical cord has been cut of the placenta is attached.
 Live birth – the condition wherein the infant at or sometime after birth breaths spontaneously, or shows
any other sign of life such as heartbeat, pulsation of the umbilical cord or definite movement of
voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached.
 Death – the World Medical Assembly as early as 1968 identified the following guidelines for physicians
as indications of death; total lack of response to external stimuli; no reflexes; and flat encephalogram
(brain waves).
 Maternal death – refers to the death of any woman, for whatsoever cause; while pregnant or within 90
days of termination of pregnancy, irrespective of the duration of the pregnancy at the time of
termination or method by which it was terminated.

Uses of Vital and Health Statistics

1. Vital and health statistics are used as indicators of the health status for a group or a whole community.
2. Statistics of disease (morbidity) or death (mortality) indicate the state of health of community and how
successful or unsuccessful are its health services.
3. It is an indispensable tool in planning, implementation, and evaluation of any health program.
 These statistics are collected by the Department of Health Units (RHUs) in the municipalities are
responsible for collecting and reporting data of vital statistics dealing with births, deaths, and all reportable
diseases.
Statistics on population and its characteristics like age, sex and distribution can be obtained from the
Philippine Statistics Authority (Filipino: Pangasiwaan ng Estadistika ng Pilipinas), abbreviated as PSA where
vital facts are registered.
Registration of births and deaths and correction of errors in names, dated are done in the office of the
Local Civil Registrar of the Municipality (usually the Municipal Treasurer of Municipal Health Officer) or at
the City Health department.

COMMON VITAL STATISTICAL INDICATORS

Below are the common statistical indicators used in community health nursing and public health.
MEMORY AID:

In interpreting answers to computations, the answer will always be read as

“the number of the numerator for every factor of the denominator

In example 1 on crude birth rate, since the numerator is the number of the registered live births in a
year, the factor is 1,000 and the denominator is the midyear population in the same year. Additionally, the
answer of 21 live births will be interpreted as “There are 21 livebirths for every 1,000 population in the
Philippines in 2013.”

Fertility Rates

1. Crude Birth Rate (CBR) = Total # of registered live births in a given calendar year      X 1000
  Midyear population, same given year

 Measures how fast people are added to the population through births
 Used often because of the availability of data
 CBR is affected by:
a. Fertility/marriage practices of place,
b. Sex and age composition of a population, and
c. Birth registration practice.
 Crude since it is related to the population including men, children and elderly who are not capable
of giving birth

Example: The Philippines registered a total of 1,669,442 live births in 2013. If in 2013 population
was 81,081,000, what was its CBR?

CBR = (1,669,442 ÷ 81,081,000) X 1000 = 20.59 or 21 live births per 1,000 population

Interpretation: There were 21 live births for 1,000 population in the Philippines in 2013.

2. General Fertility Rate (GFR) = Total # of registered livebirths in a given calendar year   X 1000
               Total number of reproductive age
  More specific than the CBR since births are related to the segment of the population that are
capable of giving birth
 Reproductive age group for women in the Philippines is 15-44 years of age
 In some countries, reproductive age group is 15-49 years of age

Example: In 1990, the Philippines’ female population of 15-44 age group numbered 9,670,200
while the total live births registered 1,344,836. What was its GFR?

GFR = (1,344,836 ÷ 9,670,200) X 1,000 = 139.07 or 139 live births per 1,000 population

Interpretation: There were 139 live births for every 1,000 population of women aged 15-44 years in
the Philippines in 1990.

Mortality Rates

1. Crude Death Rate (CDR) = _Total # of death in a given calendar year_     X 1000
   Midyear population, same year

 The term crude because death is affected by different factors and the denominator is the population
 Factors that affect the level of this rate are:
a. Age and sex composition of the population,
b. Adverse environmental and occupational conditions in an area, and
c. Peace and order situation in a geographic unit.
 Widely used because of availability of data
 Health workers should be cautious when comparing two or more populations with different age and
sex compositions or structures because these factors affected the CDR itself.

Example: A total of 396, 331 deaths were registered in the Philippines when it had a population of
81,081,000 in 2013.

CDR = (396, 331 ÷ 81,081,000) X 1,000 = 4.89 or around 5 deaths every population

Interpretation: There were 5 deaths for every 1,000 population in the Philippines in 2013.

2. Specific Mortality Rate (SMR) = Total # of death in a specified group in a year X 1000
   Midyear population of the same specified group, same year

 Shows rates of deaths in groups with specific characteristics according to:

a. Age
b. Sex
c. Occupation
d. Education
e. Exposure to risks factors
f. Combination of the above
  More valid than CDR when comparing mortality experiences between groups
 In age-specific mortality rates, there is high mortality rate among infants and elderly and its graph
shows J-shaped or U-shaped curve (age versus mortality rate)
 In sex- and age-specific mortality rates, there is generally, a high mortality rate among males, except
in developing countries where women of the reproductive age have higher death rates than males
of the same age.
 Deaths among women in the reproductive age in developing countries are due to complications of
pregnancy, childbirth, and puerperium.

Example: The male population for the 1 to 4 years of age group is 1,251,987 and the total number of
deaths in the same sex and age group is 7,214. Compute for the sex and age specific death rate.

SMR = (7,214 ÷ 1,251,987) X 1,000 = 5.76 or 6 deaths for every 1,000 population of 1 to 4-year-old
males

Interpretation: There were 6 deaths for every 1,000 population of 1 to 4-year-old males.

3. Cause-of-Death Rate (C-DR) = Total # of deaths from specified cause X 1,000

Midyear population, same year
 The term crude is used since the denominator includes the whole population
 Could be made specific by relating the deaths from a specific cause and group to the mid-year
population of that specific group (example, according to age, and sex)
 Factors that affect this rate include:
a. Completeness of registration of deaths,
b. Composition of the population, and
c. Disease ascertainment level in the community.

TEN LEADING CAUSES OF MORTALITY NUMBER AND RATE

PER 100,000 POPULATION, PHILIPPINES (2002)

MALE FEMALE BOTH SEXES

CAUSES
Number Number Number Rate Percent
1. Heart disease 39,502 30,636 70,138 88.2 17.2
2. Vascular system diseases 27, 536 21,983 49,519 62.3 12.5
3. Malignant neoplasm 20,440 18,381 38,821 48.8 9.8
4. Pneumonia 16,729 17,489 34,218 43.0 8.6
5. Accident 27,448 6,169 33,317 42.3 8.5
6. Tuberculosis, all forms 19,293 9,214 28,507 35.9 7.2
7. COPD and allied conditions 13,007 6,313 19,320 24.3 4.9
8. Certain conditions originating 8,520 5,689 14,209 17.9 3.6
in the perinatal period
9. Diabetes mellitus 6,524 7,398 13,922 17.5 3.5
10. Nephritis, nephritic syndrome, 5,358 3,834 9,192 11.6 2.3
and nephrosis

Source: 2002 Philippine Health Statistics (Last update January 18, 2006)
 Example: In 2000, there were 60,417 reported deaths from heart diseases in the Philippines. The
midyear population in the country for that year is 76, 348,000. Using the given data, compute for the
specific Cause-of-death rate.

C-DR = (60,417 ÷ 76, 348,000) X 1,000 = 0.79 per 1000 population or 79 per 100,000
population

Interpretation: Seventy-nine for every 100,000 population in the Philippines died due to
diseases of the heart in 2000.

4. Infant Mortality Rate = Total # of death below 1 yr in a given calendar year       X 1000
Number of registered livebirths, same year

 Sensitive index of level of health in a community

 High IMR means low levels of health standards due:
a. Poor maternal and child health care,
b. Poor environmental sanitation, and
c. Poor or deficient health service delivery.
 This may be artificially lowered by improving the registration of births
 Infant mortality rate may be further subdivided into:

Neonatal Mortality Rate (NMR) = Total # of death under 28 days old in a given year       X 1000
Number of registered livebirths, same year
Post-Neonatal Mortality Rate
= Total # of death under 28 days old to less than 1 year in a given year     X 1,000
   Number of registered livebirths, same year

 The subdivision is noteworthy because:

a. Neonatal deaths are primarily due to prenatal or genetic factors
b. Post-neonatal deaths are often caused by environmental, genetic, nutritional, and infectious
diseases

Example: There were 22,844 infant deaths reported for the Philippines in 2003. Using the total number
of live births for that year, which is 1,669,442, compute for the infant mortality rate.

IMR = (22,844 ÷ 1,669,442) X 1000 = 13.68 or 14 infant deaths for every 1,000 live births

Interpretation: There are 14 infant deaths for every 1,000 livebirths in the Philippines in 2003.

5. Maternal Mortality Rate = Total # of death among all maternal cases in a given year     X 1000
Midyear population, same year

 Measures the risk of death from causes associated with pregnancy and childbirth
 This value is affected by:
a. Maternal health practices,
b. Diagnostic ascertainment of maternal condition or cause of death, and
c. Completeness of registration of birth.
  The ideal denominator is the number of pregnancies because all pregnancies will lead to deliveries
but not all pregnancies will lead to live births.

Example: Maternal deaths for the Philippines totaled 1,698 in 2000. Using the total number of live births
for that year, which is 1,766,440, compute for the MMR.

MMR = (1,698 ÷ 1,766,440) X 1,000 = 0.96 or 1 maternal death for every 1,000 births.

Interpretation: There was 1 maternal death for every 1,000 live births in the Philippines in 2000.

TEN LEADING CAUSES OF INFANT MORTALITY NUMBER AND RATE PER 1,000 LIVE BIRTHS AND
PERCENTAGE DISTRIBUTION, PHILIPPINES (2003)

CAUSES NUMBER RATE* PERCENT

1. Other perinatal conditions 9,695 5.8 42.4
2. Pneumonia 2,314 1.4 10.1
3. Bacterial sepsis of newborn 1,439 0.9 6.3
4. Congenital malformation of the heart 1,127 0.7 4.3
5. Diarrhea and gastroenteritis of
984 0.6 3.4
presumed infectious origin
6. Congenital pneumonia 783 0.5 3.4
7. Other congenital malformation 550 0.3 2.0
8. Respiratory distress of newborn 462 0.3 2.0
9. Neonatal aspiration syndrome 440 0.3 1.9
10. Disorders related to short gestation and
433 0.3 1.9
low birth weight

MATERNAL MORTALITY BY MAIN CAUSE

NUMBER RATE PER 1000 LIVE BIRTHS AND PERCENTAGE DISTRIBUTION,
PHILIPPINES (2002)

CAUSE NUMBER RATE PERCENT

1. Other complications related to
pregnancy occurring in the course of 779 0.5 43.3
labor, delivery and puerperium
2. Hypertension complicating pregnancy,
533 0.3 29.6
childbirth, and puerperium
3. Postpartum hemorrhage 327 0.2 18.2
4. Pregnancy with abortive outcome 161 0.1 8.9
5. Hemorrhage related to pregnancy 1 0.0 0.1

6. Proportionate Mortality (PMR) = Total # of death from a particular cause in a given year     X 100
Total deaths from all cases, same year

 Expressed in percentage
  Does not show the probability of death in a given population because the denominator does not
show the population at risk of acquiring the disease
 Health workers must be careful when making comparisons between diseases, because the PMR of a
disease causing an epidemic may get a very high PMR while other do not, as a result of artificial
lowering, and not of effective control

Example: If the reported deaths from Pneumonia in 2000 were 32,637 and the total number of death
was 366,931, what is the PMR for Pneumonia?
PMR = (32,637 ÷ 366,931) X 100 = 8.89% died due to pneumonia

Interpretation: Pneumonia cause 8.89% of all the deaths in the Philippines.

7. Swaroop’s Index (SI) = Total # of death 50 years and above in a given year     X 100
Total deaths from all cases, same year

 Special type of proportionate mortality rate measure which is also considered a sensitive index of
the standards of health care in a country
 This measure is directly proportional to the death status of a population, where developed countries
have higher Swaroop’s index, the more developed a country is, the better the health services, the
better health status of the people, the longer the lifespan, and the more people would reach up 50
years and above
 A low index implies that life expectancy is short; for example, an index of 15% means that 15% died
at the age of 50 years and above, and 85% died before they reached the age of 50 years and above.

Example: If the number of deaths in the Philippines in 1977 for the age group 50 years old and
above is 57,260; and the total number of deaths is 308,904, what was the Swaroop’s index in 1977?

SI = (57,260 ÷ 308,904) X 100 = 18.54% or 19 %

Interpretation: Eighteen percent of the Filipinos in 1977 died at the age of 50 years and above.

8. Case Fatality Rate (CFR) = Total # of death from specified cause     X 100
Total # of cases of the same disease

 Measures the killing power of a disease or injury and a high CFR means a more fatal disease.
 CFR is useful in ACUTE infectious diseases given that all new cases are reported, and most deaths
occurred in a relatively short time after diagnosis.
 Since the measure is useful for acute cases, the time element is the usual duration of a particular
disease and not annual.
 CFR depends on:
a. The nature of the disease
b. Diagnostic ascertainment and
c. The level of reporting in the population
d. With well-documented cases and the level of diagnostic ascertainment in hospitals, expect that
the CFR from the hospitals will be higher that from the community.

Example: If there were 450 cases of diarrhea reported in Calauan for a six-month period and 277 of
these causes subsequently led to death, what would the CFR be?
 CFR = (277 ÷ 450 X 100 = 61.56% or 62%
Interpretation: Sixty-two percent of all Diarrhea cases in Calauan died.

Morbidity Rates

1. Incidence Rate (IR) = Total # of new cases of disease developing from a period of time X 1000
Population in the area during the same period of time
 Measures the development of a disease in a group exposed to the risk of such in a given period of time
 Tells of the speed of the development of disease and is best in determining the etiologic factors of a
disease
 Rate can be made specific for age and sex
 IR is the measure of choice to describe:
a. Acute conditions – when incidence is usually higher than prevalence
b. Outbreaks or epidemics – in the study of causation or etiologic factors of the identified disease

Example: The highest number of cases reported for the influenza was 9,887 occurring on the 33 rd week.
If the population, was 77,926,000, what would be the incidence rate for week 33 be?

IR = (9,887 ÷ 77,926,000) X 1000= 0.13 case for every 1,000 or 13 for every 100,000 population

Interpretation: there were 13 cases of influenza on the 33 rd week for every 100,000 population.

Attack Rate (AR) = Number of persons acquiring a disease new cases registered in a given year X 1000
Number of persons exposed to the same disease in the same year

 A refinement of the IR which is used for limited population group and time period, usually during an
outbreak or epidemic.

2. Prevalence Rate (PR)

 Measures the proportion of old and new cases (or existing case) of a disease in the population
 PR is a measure of choice to describe:
a. The occurrence of chronic conditions, and
b. Carrier rated and antibody levels.
 PR may be used as basis for making decisions in the administration of health services

PR = Total # of new & old cases in a given calendar year   X 1000

Estimated population of the same year

Example: The total number of TB cases reported in the Philippines in2001 was 110,841. If the population
was 77,926,000, what would the PR for 2001 be?

PR = (110,841 ÷ 77,926,000) X 1000 = 1.42 or 1 case for every 1000 population

Interpretation: There was 1 case of TB for every 1,000 population in the Philippines in 2001.

Sources of Date
1) Vital Registration Records
The Civil Registry Law or RA no. 3753 required of all births and deaths through the PSA requires the
registration of all births and deaths.
 Presidential Decree 651 require all health workers to register births with 30 days following delivery.
2) Weekly reports from Field Health Personnel
Republic Act (RA) 11332 (An Act Providing Policies and Prescribing Procedures on Surveillance and
Response to Notifiable Diseases, Epidemics, and Health Events of Public Health Concern, and Appropriating
Funds Therefor, repealing for the Purpose Act No. 3573, Otherwise Known as the “Law on Reporting of
Communicable Diseases”).

This Act shall be known as the “Mandatory Reporting of Notifiable Diseases and Health Events of Public
Health Concern Act”. Mandatory Reporting of Notifiable Diseases and Health Events of Public Concern. -The
DoH (Department of Health), through the Epidemiology Bureau, shall issue the official list of institutionalized
public health information system, disease surveillance and response systems for mandatory reporting of
notifiable diseases and health events of public concern.
All public and private physicians, allied medical personnel, professional societies, hospitals, clinics,
health facilities, laboratories, institutions, workplaces, schools, prisons, ports, airports, establishments,
communities, other government agencies, and NGOs (nongovernment organizations) are required to
accurately and immediately report notifiable diseases and health events of public health concern as issued
by the DOH.
3) Population Census
Population census are typically done every 5 to 10 years and population estimates are computed by the PSA.
In the Philippines, census is done every 5 years.

Presidential Decree 651

Requires all workers to register births within 30 days following delivery.

B. Philippine Health Situation

 There were 1,731,289 live births registered in 2016 which was equivalent to a crude birth rate (CBR) of
16.7 or 17 livebirths per 1000 population. This was 3.5 percent decrease in last year’s CBR or a decrease of
13,478 livebirths in number. About three babies were born alive per minute, which corresponded to a daily
average of 4,743 livebirths. (Table 1)

GENERAL MORTALITY

In the Philippines, there were 582,183 deaths registered in 2016. This is equivalent to five or six deaths
for every one thousand population. Of these deaths, 57.5 percent or 334,678 deaths were males and 42.5
percent or 247,505 deaths were females. For every 100 female deaths, there correspond 135 male deaths and
which constituted to a death sex ratio of 1.35.

The 2016 Crude Death Rate (CDR) per thousand population was computed at 5.6 deaths. The two-
decade trend of CDR from 1996 to 2016 is slowly but steadily increases, from 4.9 deaths to 5.6 deaths per one
thousand population. (Table 1)

INFANT MORTALITY

The 2016 infant death rate increased by six percent from 11.9 infant deaths per 1000 live births in 2015
to 12.6 infant deaths per 1000 live births in 2016. The 21,874 infant deaths comprised 3.7 percent of the total
deaths (582,183) reported during the year. This represented a daily average of 60 infant deaths or two infant
deaths every hour

MATERNAL MORTALITY
 Maternal health refers to the health of women during pregnancy, childhood and postpartum period.
While motherhood is often a positive and fulfilling experience, for too many women it is associated with
suffering, ill-health and even death. (WHO) On the other hand, maternal mortality is a mirror of a woman’s
health and nutritional status during pregnancy, at childbirth, or in the period after childbirth. It also highlights
her access to professional medical services before, during and even after childbirth. Statistics for this vital event
are based on information obtained from the Death Certificates (Municipal Form No. 103) transmitted by the
City/Municipal Civil Registrars to the Philippine Statistics Authority for processing and archiving. Included in this
report are registered maternal deaths that occurred in 2016. No adjustments for under registration were done
in the presentation.

In 2016, the number of registered maternal deaths reached a total of 1,483. The Maternal Mortality
Ratio (MMR) is 0.9 per one thousand live birth. There was a decrease of ten percent from last year’s MMR of
1.0. (Table 4)

FETAL DEATHS

The information presented herein was obtained from the fetal death certificates (Municipal Form No.
103A) submitted by the City/Municipal Registrars from all over the country to the Office of the Civil Registrar
General for processing and archiving purposes. There was no adjustment for under registration in the
presentation.

The total numbers of registered fetal deaths were 8,020 which was equivalent to a fetal death ratio
(FDR) of 4.6 per one thousand live birth. There was an increase in FDR of about 4.5 percent from previous year’s
FDR. This was translated to an average of 22 fetal deaths per day for the year 2016. (Table 1)
 The 2016 PHS presented the ten (10) leading causes of morbidity. The number one leading cause of
morbidity was acute respiratory infection with a total of 3,080,343 cases or a rate of 2,971.1 per 100,000
population. This was a 45.6 percent and 41.8 percent increase in number of cases and rate, respectively. (the
2015 rate was 2,094.5 per 100,000 population and 2,115,018 cases). The number of cases was already doubled
when compared to the number of cases in the past two years (2014) which was only 1.4 million.

Hypertension was second on the list with 886,203 cases and a rate of 854.5 cases per 100,000
population. It is followed by acute lower respiratory tract infection (ALRTI) and Pneumonia (786,085; 758.0),
Urinary tract infection (288,588; 278.3) and Influenza (216,074; 208.3). The same top four diseases were
recorded last year, however, Bronchitis was replaced by Influenza in the fifth rank. Bronchitis is the sixth leading
cause of morbidity in 2016.

The ten leading causes of morbidity separately for male and female. The same morbid conditions had
been recorded for both sexes, which only differ in rates and consequently a slight difference in ranks. A higher
number of cases were reported among females than males to seven out of ten leading causes of morbidity.
C. Epidemiology

Epidemiology is the study of the distribution of disease or physiologic conditions, such as deformities or
disability and even death, and the factors affecting such distribution among human populations.

Its primary objective is to identify factors of causation as bases for determining preventive and control
measures.

Uses of Epidemiology
 According to Morris, as stated in Cuevas et al. (2007), epidemiology is used:

1) To study the health history of a population and emergence of disease and the changes in its character
2) To diagnose the health of the community and the condition of the people in terms of distribution,
incidence and prevalence of disease and disability, including mortality
3) To help improve the delivery of health services in the community
4) To estimate the risk of disease, accidents, and physical defects
5) To identify syndromes by describing the distribution and association of clinical phenomena in the
population.
6) To complete the clinical picture of chronic disease and describe their natural history
7) To search for the causes of health and disease by comparing groups based on their composition, genetic
traits, experience, behavior, and environment

The Epidemiologic Triad

Leavell & Clark’s Agent-Host-Environment Model or Ecologic Model

This model has three interactive elements:

1) Agent – Any environmental factor or stressor (biologic, chemical, mechanical, physical, and
psychological) whose presence or absence can lead to illness or disease.
 2) Host – Person (s) who may or may not be at risk of acquiring a disease based on family history of disease,
lifestyle habits and age; the state of health of a host at any given time is a result of the interaction of
genetic endowment with the environment over his/her entire lifespan.
3) Environment – All factors external to the host that may or may not predispose the person to the
development of a disease. The components of the environment include:
a) Physical environment – includes inanimate objects and geophysical condition such as the climate
b) Biological environment – includes all the living things around the host.
c) Socio-economic environment – includes economic conditions. Level of economic development,
presence of social problems and the like.

Accordingly, a change in any of the interactive elements alters the existing equilibrium; thus, either
increasing or decreasing the frequency of disease.

Phases of an Epidemiologic Investigation

According to Dones, as cited in Maglaya, 2004, the following are the phases of the epidemiology
approach:

I. Descriptive Epidemiology
A. Verification of the Diagnosis
B. Description of the Disease Condition
C. Analysis of the Disease Pattern
II. Analytical Epidemiology
III. Intervention or Experimental Epidemiology
IV. Evaluation Epidemiology

Descriptive Epidemiology deals with the collection, organization, and analysis of data regarding the occurrence
of disease and other health conditions.

A. Verification of a Diagnosis – involves stating one’s definition of a disease or diagnosis based on the existing
signs and symptoms

Consider these 2 factors:

1. Sensitivity – measures the proportion or percentage of those with the disease who are correctly identified by the
sign; indicates the strength of association between a sign/symptom & the disease. A sensitive test picks up most
cases & has few false negatives.

2. Specificity – measures the proportion or percentage of those without the disease who are correctly called free of
the disease through the absence of symptoms; it shows the uniqueness of the association between a sign &
symptoms and the disease. A specific test excludes non-cases & yield few false positives.

To determine which clinical manifestation should be present to consider a person a disease case, consider 4
possibilities:
1. True positive – a sign/symptom manifested is correctly identified
2. False negative – a sign/symptom NOT manifested is not correctly identified
3. True negative – a sign/symptom NOT manifested is correctly identified
4. False positive – a sign/symptom manifested not is correctly identified

DISEAS CLINICAL MANIFESTATION

E Present Absent
 Present True positive False negative
Absent False positive True negative

Sensitivity = True positives

True positives + False negatives

Specificity = True negatives

True negatives + False positives

B. DESCRIPTION OF THE DISEASE OR CONDITION – concerned with describing the disease process in terms of place,
person & time
Factors to consider:
1. Place – refers to the factors external to the person
a. Natural characteristics of a place – consider geography & topography because these may give a clue as to the
types of vectors that thrive in those areas
b. Social factors – consider economic, political & social activities including availability of transportation & medical
facilities because the absence of these resources may result to complications in the health conditions of the
people due to the delay in health services.
2. Person – intrinsic characteristics such as age, sex, genetic endowment & other social factors such as occupation,
place of residence & income are analyzed to identify susceptible groups in a certain locality.

Community’s reaction to disease agent invasion is the expression term used to describe the sum total of the reaction of
individuals who compose the population group

Factors affecting the Community’s Reaction to Disease Agent Invasion:

a. Herd Immunity – state of resistance of a population group to a particular disease at a given time

Normal Body defenses

1. Non-specific defense – protection against all types of microorganisms, regardless of exposure
2. Specific defense
Immune response – response of the immune system to an antigen (immunogen) that leads to a condition of
induced sensitivity; deals with the recognition of foreign substances to neutralize, eliminate or metabolize
them with or without injury to the body’s own tissues.

Functions of the Immune Response:

a) Defense
b) Homeostasis or state of balance
c) Immunosurveillance to eliminate tumor cells that are arise spontaneously

Immunity – Specific resistance of the body to infection

a) Active immunity – host produces own antibodies in response to natural antigens (infections) or artificial
antigens (vaccines)
b) Passive immunity – host receives natural (from nursing mothers) or artificial (from an injection of an
immune serum) antibodies produced by another source

TYPES OF IMMUNITY

TYPE ANTIGEN OR ANTIBODY SOURCES DURATION

A C T I V E LONG
- Antibodies formed in the presence of active infection
A. Natural Lifelong
 - Antigen (vaccines/toxoids) administered to stimulate Antibodies Many years,
B. Artificial formation reinforced by boost
P A S S I V E SHORT
- Antibodies from immune mother to baby through placenta or colostrum
A. Natural 6 mos – 1 yr
- Immune serum (antibody) from animal to human is injected.
B. Artificial 2-3 weeks

CLASSES OF IMMUNOGLOBULINS (Ig)

CLAS % CHARACTERISTICS
S
- Present in majority of B cells
- Contains antiviral antitoxin & antibacterial Ab
Ig G 75% - The only Ig that crosses the placenta
- Responsible for the protection of newborn
- Activates complement & binds to macrophages
- Predominant Ig in body secretions such as saliva, nasal & respiratory secretions and in
Ig A 15% breastmilk
- Protects mucus membranes
- Forms natural Ab such as ABO blood antigens
Ig M 10%
- Prominent in early immune responses
- Action not known
Ig D 0.2%
- May affect B cell maturation
- Binds to mast cells & basophils
Ig E 0.004%
- Involved in allergic & hypersensitivity reactions

b. Exposure or Contact Rate -represents the opportunities for progressive transfer or transmission of an infectious
agent to a new host

Factors Affecting the Transfer of Infectious Agents:

1) Size of the reservoir
2) Facility of transmission
 Population density in a specific area
 Standard of hygiene in a specific area
 Vector density in a specific area

c. Chance – represents the probability of contact between the source of infection & the susceptible individual; it
depends on:
1) The number of sources of infection, which means that the higher the number of sources of infection, the
greater the chances of exposure;
2) The location of the source of infection, which means that the nearer the source to the susceptible population,
the greater the chances of exposure; &
3) The number of immunes which means that the lower the number of immunes, the greater the chances of
exposure

3. Time – refers to the temporal patterns expressed in a daily, weekly, monthly, or yearly basis & is reckoned by the time
of onset of the disease.
a. Short-time fluctuations (epidemic)
1) Common source epidemic is due to exposure of a group of persons to a common vehicle such as water or
food
 Point or common source (food poisoning during a birthday party)
  Epidemic due to prolonged exposure to source (diarrhea due to continuous use of water collected from a
contaminated pipe)
2) Propagated epidemic may be due to direct or indirect transmission of an infectious agent from an infected to
a susceptible person; this is characterized by a gradual onset with an increasing number of cases in successive
time periods; may be radially spread from an index case
 Person to person (Measles)
 Through arthropod vector Dengue due to bites of Aedes aegypti
 Animal reservoir (leptospirosis due to contact with flood water contaminated with rat urine/feces.
b. Cyclic Variations – refers to the recurrent fluctuations of disease frequency exhibiting cycles for certain periods;
this may include seasonal fluctuations of diseases:

Factors affecting Seasonal Fluctuations:

1. Characteristics of the infectious agent
2. Life pattern of vector or animal host
3. Changes in likelihood of person to person-to-contact

c. Secular Variations – refers to long-term (decades) changes in disease frequency; characterized by an

epidemiologic shift, hence the increasing importance of preventing non-communicable diseases side-by-
side with preventing and controlling communicable diseases. It is affected by:
1) Major changes in population patterns and
2) Changes in lifestyle.
Ex. Increased in prevalence of lung cancer nowadays because of the rampant smoking practices of
both males and females.

Pattern of Disease Occurrence

 Epidemic – a situation wherein the proportion of the susceptible are high compared to the proportion of the immunes;
also characterized by a situation where there is a high incidence of new cases of a specific disease in excess of the
expected.
I
>
S

Several factors such as climate change, ecologic shift, changes, or even economic crisis may make an area
susceptible to a disease upsurge, thus resulting in a high epidemic potential.

 Endemic – a situation wherein there is a habitual presence of a disease in a given geographic location
accounting for the low number of both immunes and susceptible, in such cases, the causative factor of the
disease is constantly available or present in the area

S = I

 Sporadic – a situation wherein a disease occurs every now and then, affecting only small number of people
relative to the total population

S
>
I

 Pandemic – global or worldwide occurrence of a disease

Analysis of the Disease Pattern – the epidemiologist tries to find out if there is a statistical relationship between
a disease and biological or social factors.

 Causal relationship – when there is evidence that show that certain factors increase the probability of the
occurrence of a disease and a change in one or more of these factors produces a change in the occurrence of
the disease
 Non-causal relationship
1) Spurious – the relationship or association may only be due to chance or bias caused by certain
procedures/aspects involved in the study (bias in selecting study subjects, collecting information, or
recording information, etc.)
2) Indirect – when a factor and a disease are associated only because both are related to some common
underlying condition

I. Analytical Epidemiology deals with hypothesis-testing and concerned with analyzing the causes or
factors affecting disease occurrence
II. Intervention or Experimental Epidemiology determines the effectiveness of new methods for
controlling the spread of disease
III. Evaluation Epidemiology measures the effectiveness of different health services and health programs in
addressing health problems

Functions of the Epidemiology Nurse

The functions of the epidemiology nurse according to Cuevas et al. (2007) are the following:

1) Implement public health surveillance

2) Monitor local health personnel conducting disease surveillance
3) Conduct and assist other health personnel in outbreak investigations
4) Assist in the conduct of rapid surveys and surveillance during disasters
5) Assist in the conduct of surveys, program evaluations, and other epidemiologic studies
6) Assist in the conduct of training course in epidemiology
7) Assist the epidemiologist in preparing the annual report and financial plan.
8) Conduct inventory and ensure maintenance of epidemiology and surveillance unit (ESU)

PLANNING FOR AN EPIDEMIOLOGICAL INVESTIGATION

Below is an outline of the plan of an epidemiological investigation during an epidemic outbreak, as cited
in Cuevas et al. (2007):

1) Establish the presence of an epidemic

a) Verify the diagnosis.
 Clinical confirmation of the disease
 Laboratory confirmation of the disease
b) Report the cases of disease.
 Should be prompt
 Should be complete
 Establish the presence of an unusual prevalence of disease
c) Past experiences of the community with regard, to the disease
 Relation between the prevalence of the disease and its nature
  Cues to be considered as being epidemic and endemic
2) Establish the time and space relationship of the disease
a) Cases found in a particular geographical subdivision of the community or scattered all over the
community
b) Relation of cases by days of onset to onset of the first known cases.
3) Establish the relationship between the cases to the characteristics of the group community:
a) Consider age, ethnicity, sex, occupation, educational attainment, past immunization etc.
b) Consider the presence of sanitary facilities, especially water supply, sewage disposal, general
sanitation of the homes, presence of animal or insect vectors, etc.
c) Consider milk and food supply.
d) Consider the types of cases and the presence of known carriers in the community.
4) Correlate all date obtained; summarize the data with the aid of table and charts:
a) Build up the case for the final, conclusion.
b) Establish the source of epidemic and the manner of spread.
c) Suggest control measures and measures to prevent future outbreak.

https://www.doh.gov.ph/publication/serials/2016_PHILIPPINE-HEALTH-STATISTICS