Health Information & Basic

Medical Statistics
Definition

• A mechanism for the collection, processing, analysis

and transmission of information required for
organizing and operation health services, and also for
research and training.
Primary objective
• Provide Reliable, relevant, up-to-date, adequate , timely and
reasonable complete information for health managers at all levels
• and to the sharing of technical and scientific information by all the
health personnel participating in the health service of a country;
• also to provide at periodic intervals,
• data that will show the general performance of the health services
• and to assist the planners in studying their current functioning and trends
in demand and work load
Distinction between data and information

Information is a processed, organized data presented in a

given context and is useful to humans. Data is an individual
unit that contains raw material which does not carry any
specific meaning. Information is a group of data that
collectively carry a logical meaning.
 DATA
• It is a piece of information, discrete observations of attributes or events, especially those
that are apart of a collection to be analysed.
 INFORMATION
• Data that is accurate and timely, specific and organized for a purpose, presented
within a context that gives it meaning and relevance, and can lead to an increase
in understanding and decrease in uncertainty.
 called

• The manipulated and processed form of data is information.

• More meaningful than data.
• Used for making valuable decisions.

Data is used as input for processing and information

is output of this processing
 INTELLIGENCE
• It is the transformation of information through integration and processing with
experience and perceptions based on social and political values.

DATAINFORMATIONINTELLIGENCE
Requirements of HIMS
• Population based
• Avoid unnecessary agglomeration of data (mass or collection of things)
• Problem oriented
• Employ functional and operational terms (episodes of illness, treatment
regimen, lab tests)
• Express information briefly and imaginatively (tables, charts)
• Provision for feedback of data
Components of HIMS
• Demography and vital events
• Environment health statistics
• Health status : morbidity, mortality, disability and quality of life
• Health resources : facilities, beds, manpower
• Utilization and non-utilization of health services : attendance, admission,
waiting lists
• Indices of outcome of medical care
• Financial statistics (Cost, Expenditure)
Uses of HIMS
• Measure the health status of the people and quantify their
health problems and medical and health care needs
• Local, national & international comparisons of health status
– standardization
• For planning, administration and effective management of health
services and programmes
• For assessing whether health services are accomplishing their objective
in terms of their effectiveness and efficiency
• For assessing attitude and degree of satisfaction of their beneficiaries
with the health system
• For research into particular problem of health and disease
 Why is it Important?
• Good management is a prerequisite for increasing the
• efficiency
Improved ofhealth information
health services. system is clearly linked to good management.
• Information is crucial at all management levels of the health services from
periphery to the centre.
• It is required by policymakers, health care providers, managers,
community health workers.
• “Changing the way information is gathered, processed, and used for decision-
making implies changing the way an organization
• The ultimate objective of health information system is not “to
gain information” but “to improve action”
Sources
1. Census
2. Registration of vital events
3. Sample registration systems
(SRS)
4. Notification of diseases
5. Hospital records
6. Disease registers
7. Record linkages
8. Epidemiological surveillance
9. Other health record services
10. Environmental health data
11. Health manpower statistics
12. Population surveys
13. Other routine statistics related
to health
14. Non-quantifiable information
CENSUS
• Census is an important source of health information.

• It is the complete count of a country population.

• Taken in most countries of the world at regular intervals, usually of 10

years.
• Census means “to enumerate”.
• It consists of a sequence of activities concerned with collection, collation and
factual presentation of data pertaining to social, demographic and health related
factors, in respect of a nation (or large population group), undertaken periodically,
and having some sort of statutory back - up for it to be undertaken.
• The periodicity of census is generally kept as once in ten years, and it is generally
undertaken during the first quarter of the first year of the decade. It was started in
1881.
• A legal authority constituted by the government is generally made responsible for
the collection, collation and publication of census data.
methods of collection of data in a census
 facto method : Persons are enumerated according to their location at the time of
enumeration.
 Extended de-facto method used in india since 1941.
• The primary function of census is to provide demographic information such as total
count of population and its breakdown into groups and subgroups such as age and
sex distribution, it represents only a small part of the total information collected.
• Census contains information which are not only demographic, but also social and
economic characteristics of the people, the conditions under which they live, how
they work, their income and other basic information.
• These data provide a frame of reference and base line for planning, action and
research not only in the field of medicine, human ecology and social sciences but in
the entire governmental system.
 STRENGTHS
• Covers the whole population; small geographic units

• Equity information

• Data and fertility for different levels of geographic areas

for mortality

• Important source for planning and implementation of various activities and

programs at smallest geographic unit
 Activities
• Reading the message on the Census and its importance during the
School Assembly.
• Census Awareness Quiz .

• Display of Maps and Data Sheets.

• Poster Making Competition on the topic ‘Population

• Census Week

7th to 12th February 2011

 2. Registration of Vital Events
• It keeps a continuous check on demographic changes.

• If registration of vital events is complete and accurate, it can serve as a reliable

source of health information.
• Importance is therefore given to the registration of vital events in all countries.

• It is the precursor of health statistics and it has dominated the health information
system.
 Definition
• “Legal registration, statistical recording and reporting of the occurrence of, and the
collection, compilation, presentation, analysis and distribution of statistics pertaining
to vital events, i.e., live births, deaths, foetal deaths, marriages, divorces, adoptions,
legitimations, recognitions, annulments and legal separations"
-- UNITED NATIONS

• The origin of vital registration begins as early as 1869 and death by social class was
recorded in England beginning in 1921.
• Vital events are

 Live births

 Deaths

 Foetal deaths

 Marriages

 Divorces

 Adoptions
• In 1873, the Govt, of India had passed the Births, Deaths and Marriages Registration
Act, but the Act provided only for voluntary registration.
• Registration system in India tended to be very unreliable, the data being grossly
deficient in regard to accuracy, timeliness, completeness and coverage.
 Reasons
• Lack of uniformity in collection, compilation and transmission
of data which is different for rural and urban areas.
• Most importantly multiple registration agencies (e.g., health agency,
panchayat agency, police agency and revenue agency).
The Central Birth & Registration Act 1969
 It came in force on 1st April 1970.

 Act provides for compulsory registration of birth & deaths & other Vital events
throughout the country.
 The time limit for registration of birth is 14 days & that of death is 7 days.
 In default a fine of Rs. 50/- can be imposed.
 Still there is lack of registration of birth (38-97%) & in death
(3-83%).
 It is because of illiteracy, ignorance, lack of concern & motivation.

 The Act also fixes the responsibility for reporting births and deaths. While the public
are to report events occurring in their households, the heads of hospitals, nursing
homes, hotels, jails or dharmashalas are to report events occurring in such
institutions to the concerning Registrar.
 LAY REPORTING

• Lay Reporting is the collection of information , its use, and its transmission to other
levels of the health system by non- professional health workers.
• Due to slow progress in the development of a comprehensive vital registration
system, some countries have attempted to employ first-line health workers (e.g.,
village health guides) to record births and deaths in the community.
• Important functions of a primary health worker is to collect and record data on vital
events and other health information in his or her community.
 Sample Registration System (SRS)
• One of the largest continuous demographic household sample
survey in the world.
• The Government of India, in the late 1960s, initiated the Sample Registration
System that is based on a Dual Recording System as Civil Registration is deficient
in India.
• In the Sample Registration System, there is a continuous enumeration of births and
deaths in a sample of villages/urban blocks by a resident part‐time enumerator and
then, an independent six monthly retrospective survey by a full time supervisor.
 Objectives:
• To provide annual reliable estimates of birth and death rates at the state and national
levels for rural and urban areas separately.
• To provide other measures like fertility and mortality(TFR,
IMR, CMR, etc).
• To study risk factors and household determinants through
causes of deaths.
The main components of Sample Registration System are:
• Base-line survey of the sample unit

• Continuous of
(longitudinal) enumeration vital events
pertaining to usual resident population by the enumerator
• Independent retrospective half- yearly surveys

• Matching of events

• Field verification of unmatched and partially matched events.

• The SRS in India now covers most of the country. It is a major
source of health information.
• Since the introduction of this system, more reliable information on birth and death
rates, age-specific fertility and mortality rates, infant and adult mortality, etc. have
become available.
 4.Notification of Diseases
• Historically notification of infectious diseases was the first health, information sub-
system to be established. The primary purpose of notification is to effect prevention
and/or control of the disease.
• Notification is also a valuable source of morbidity data i.e., the incidence and
distribution of certain specified diseases which are notifiable.
• Usually diseases which are considered to be serious menaces
to public health are included in the list of notifiable diseases.
• Lists of notifiable diseases vary from country to country, and also within the same
country between the States and between urban and rural areas.
• As per International Health Regulation , Cholera, Plague , Yellow Fever are to be
notified to WHO, Geneva.
• The primary purpose of notification is to effect prevention &
control of disease.
• Mainly Health workers at grass-root level report the disease.

• International Surveillance is required for Louse borne Typhus, relapsing Fever,

Polio, Influenza, Malaria, Rabies, Salmonellosis.
• The notification system is linked up with the vital statistics machinery and the
reporter is often the village chowkidar or headman.
• With the introduction of village Health Guides and multipurpose workers, the
reporting responsibility is now shifted from the village chowkidar to the health
workers.
• Notification is an important source of health information,

• Limitations :

(a) notification covers only a small part of the total sickness in the community

(b) the system suffers from a good deal of under-reporting

(c) many cases especially atypical and subclinical cases escape notification due to
non-recognition, e.g., rubella, non- paralytic polio, etc
• Notification provides valuable information about fluctuations
in disease frequency.
• It also provides early warning about new occurrences or outbreaks of disease.

• The concept of notification has been extended to many non- communicable diseases
and conditions notably cancer, congenital malformations, mental illness, stroke and
handicapped persons.
 5.Hospital Records
• The eighth report of the WHO Expert Committee on Statistics recommended that
hospital statistics be regarded in all countries as an integral and basic part of the
national statistical programme.
• In India, where registration of vital events is defective and notification of infectious
diseases extremely inadequate, hospital data constitute a basic and primary source of
information about diseases prevalent in the community.
 USEFULNESS
• Geographic sources of patients

• Age and sex distribution of different diseases and duration of hospital stay

• Distribution of diagnosis

• Association between different diseases

• The period between disease and hospital admission

• The distribution of patients according to different social and biological

characteristics,

• The cost of hospital care.

 Drawbacks

1. They consitute the “tip of the ICE-BERG.”(they provide information on only those
patients who seek medical care, but not on a representative sample of the
population. )

2. Admission policy varies from hospital to hospital.

3. There are no precise bondaries to the catchment area of the hospital.

4. Population served by a hospital.

 6.Disease Registers
• "Registration" implies something more than "notification".

• Permanent records are established, those cases are followed up, and that basic
statistical tabulations be prepared both on frequency and on survival.
• Patients on a register should frequently be the subjects of special studies
• Morbidity registers exist only for Stroke, MI, TB, Leprosy,
Congenital Rubella & congenital defects.
• If the reporting system is effective, & the coverage is on national basis, than register
can provide useful data on disease specific morbidity & mortality.
• Disease registers allow follow-up of patients and provide a continuous account of
the frequency of disease in the community.
• In the absence of a defined population base, useful information may be obtained
from registers on the natural course of disease, especially chronic disease in
different parts of the world.
 Disease Registry in India:

National Centre for Disease Informatics and Research, ICMR

operates following disease registries in the country:
• National Cancer Registry Programme
• Registry of people with diabetes in India with young age at the

onset
• National stroke registry program
 National Cancer Registry Programme
• History of the registries in India can be traced long back since
1963 with the establishment of Bombay Cancer Registry.
• The National Cancer Registry Programme (NCRP) was commenced by the Indian
Council of Medical Research (ICMR) with a network of cancer registries across the
country in December 1981.
• Three Population Based Cancer Registries (PBCRs) at Bangalore, Chennai and
Mumbai and three Hospital Based Cancer Registries (HBCRs) at Chandigarh,
Dibrugarh and Thiruvananthapuram were commenced from 1 January 1982
• The PBCRs have gradually expanded over the years and as of now there are 23
PBCRs under the NCRP network.
 7. Record Linkage
• It is the process of bringing together records relating to one
individual.
• “Medical Record Linkage” is the assembly & maintenance for each individual in a
population , of a file of the more important records relating to his health.
• The main drawback is the volume of data it can accumulate.
• The events commonly recorded are birth, marriage, death,
hospital admission and discharge.
• Other useful data might also be included such as sickness absence from work,
prophylactic procedures, use of social services, etc.
• It is used only on limited scale e.g. in twin studies & genetic diseases, morbidity,
chronic disease epidemiology and family.
 Epidemiological Surveillance

• Surveillance systems are often set-up in case where a disease

is endemic e.g., Malaria, tuberculosis, leprosy, filariasis, etc.
• To report New cases.

• To know the result of efforts to control the diseases.

• These programmes have yielded considerable morbidity and mortality data

for the specific diseases.
 9.Other health service records
• A lot of information is found in the records of hospital out- patient departments,
primary health centres and subcentres, polyclinics, private practitioners, mother and
child health centres, school health records, diabetic and hypertensive clinics, etc.
 10.Environmental Health Data
• It may be the data of air water & noise pollution, industrial intoxicants, inadequate
waste disposal and other aspects of the combination of population explosion with
increased production and consumption of material goods.
• Environmental data can be helpful in the identification and quantification of factors
causative of disease.
 Health Manpower Statistics

• Information related to the number of physicians (by age, sex,

speciality and place of work), dentists (classified in the same way),
pharmacists, veterenarians, hospital nurses, medical technicians, etc.
by the State the
Directorates
• Their records are maintained medical/dental/nursing councils of
and Medical
Education.
• The Institute of Applied Manpower Research attempts estimates of manpower,
taking into account different sources of data, mortality and out-turn of qualified
persons from the different institutions.
• Regarding medical education, statistics of numbers admitted, numbers qualified, are
given every year in "Health Information of India", published by the Govt, of India,
in the Ministry of Health & Family Welfare.
 12.POPULATION SURVEY
• A health information system should be population-based.

• The routine statistics collected from the above sources do not provide all the
information about health and disease in the community.
• The term "health surveys" is used for surveys relating to any aspect of health -
morbidity, mortality, nutritional status, etc.
• Surveys, where information is collected on sample basis are used to provide variety
of information with fair degree of precision.
• Using a scientifically adopted sample design the sampling
error can be controlled to a large extent.
• Also careful planning, elaborate training of investigators and supervisors and
effective monitoring and supervision can help in controlling non-sampling error.
Following types of surveys would be covered under health
survey:
• Surveys for evaluating the health status of a population, that is community diagnosis
of problems of health and disease.
• Surveys for
investigation of factors affecting health and
disease (environment, occupation, income, circumstances associated with the onset
of illness, etc.)
• These surveys are helpful for studying the natural history of disease, and obtaining
more information about disease aetiology and risk factors
• Surveys relating to administration of health services, e.g., use
of health services, expenditure on health, population health evaluation of needs and
unmet needs, evaluation of medical care, etc.
Health surveys can be broadly classified into 4 types :

a. Health interview (face-to-face) survey

b.Health examination survey (here treatment is also provided to the people suffering
from the disease.)

c. Health records survey (cheapest method)

d. Mailed questionnaire survey (Has a high rate of non-response.)

 13.Other routine statistics related to health
• Demographic : In addition to routine census data, statistics on such other
demographic phenomena as population density, movement and educational level.
• Economic : consumption of such consumer goods as tobacco, dietary fats and
domestic coal; sales of drugs and remedies; information concerning per capita
income; employment and unemployment data.
• Social security schemes : medical insurance schemes make it possible to study the
occurrence of illnesses in the insured population. Other useful data comprise
sickness absence, sickness and disability benefit rates.
 14.Non-quantifiable information
• Information on health policies, health legislation, public
attitudes, programme costs, procedures and technology.
• Health information system has multi-disciplinary inputs.

• There should be proper storage, processing and dissemination of information as

health planners and decision makers require a lot of non-quantifiable information.