ACTIVITY

• Situation :
Arlene, a public health nurse
assigned in barangay Mabolo. She is
to submit a report on the data
gathered from this barangay during
the mid year of July 2016. Data
included are the following:
• What is the total population of the barangay?
• What’s the crude birth rate of the barangay?
• Compute for the specific death rate for tuberculosis.
• What’s the maternity mortality rate?
• What’s the early neonatal mortality rate?
• What’s the neonatal mortality rate?
• Compute for the infant mortality rate.
• Compute for the perinatal mortality rate.
• Compute for attack rate of tuberculosis.
• What’s the crude death rate of this barangay?
• What’s the Swaroop’s index of this
community?
Philippines Health Situation and
Epidemiology and the Nurse

Prepared By:
Ms. Elena Tierra RN MN
Ms. Ruth Enriquez RN MAN
Ms. Shohadaa B. Mandangan RN MAN
 Epidemiology is the study of the
occurrence and distribution of
disease in the community,
population, including determinants
of factors

*Epidemiology is the backbone of the

prevention of the disease
Studying the Etiology and distribution of
disease and conditions in humans should
positively confirm the health of the
populations.
The data obtained and analyzed in
EPIDEMIOLOGY is used to rank the level of
Health a given population in relation to
another segment at an identified time.
 EPIDEMIOLOGY
TWO MAIN AREAS OF INVESTIGATION

1.Study of the distribution of disease

2. Search for the determinants(cause) of
the disease and its distribution
 Cont…area of epidemiological
investigation
• The first area is the Distribution of health
status in terms of age , gender, race,
geography, time,etc. or might be an expansion
of the discipline of DEMOGRAPHY to health
and diseases.
• The second area is the explanation of patterns
of disease distribution interms of causative
factors.
 USES OF EPIDEMIOLOGY

1.Study the history of the health population and the rise and
fall of diseases and changes in their character.
2. Diagnose the health of the community and the condition
of people to measure the distribution and dimension of
illness in terms of incidence,prevalence, disability,
mortality, needing special attention.
 Uses of Epidemiology

3. Study the work services for improvement

4. Estimate the risk of disease, accident,
defects and the chances of avoiding them
5. Identify syndromes by describing the
distribution and association of clinical
phenomena in the population
6. Complete the clinical picture of chronic illness
and distribution of their natural history
7. Search for the causes of health and disease-
compare the experience of groups clearly
defined by their composition, inheritance,
experience, behavior and improvements
STATISTICAL MEASURES IN EPIDEMIOLOGY
1.RATE
2.RATIO
3.MORBIDITY
4.MORTALITY
5.CRUDE
6.INCIDENCE
7.PREVALENCE
8.SPECIFIC RATE
 The Epidemiological Triangle
HOST

AGENT E ENVIRONMENT
 AGENT
INTRINSIC FACTOR OF MICROORGANISM
TO SURVIVE IN THE ENVIRONMENT TO
PRODUCE DISEASE

HOST
THE STATE OF THE HOST AT ANY GIVEN
TIME IS THE RESULT OF THE INTERACTION
OF GENETIC ENDOWMENT WITH THE
ENVIRONMENT OVER THE ENTIRE
LIFESPAN
 ENVIRONMENT
IS THE SUM TOTAL OF ALL EXTERNAL
CONDITION AND INFLUENCES THAT AFFECTS
THE DEVELOPMENT OF AN ORGANISM WHICH
CAN BE BIOLOGICAL, SOCIAL AND PHYSICAL.

ENVIRONMENT AFFECTS BOTH AGENTS AND

HOST
• The model suggests that the agent and the
susceptible human host are interacting freely
in common environment.
– For as long as the balance is maintained or is tilted
in favor of the host (because of good nutritional
status and high levels of immunity), disease does
not occur.
– However, when the balance is tilted in favor of the
agent, disease occurs.
PATTERN OF OCCURRENCE OF DISEASE OR
FREQUENCY OR N0. OF CASES

1.SPORADIC (ISOLATED CASE)- ON AND OFF

OCCURRENCE OF DISEASE, OCCURRENCE OF
ONE OR SEVERAL UNRELATED
CASES(DIFFERENT SOURCES) OF DISEASE IN
THE COMMUNITY
Examples: In US -Tetanus, rabies and plague
2. ENDEMIC- Cases of the disease are
PERSISTENTLY/CONSTANTLY present in the
community (eg : Malaria )

3. EPIDEMIC- an unexpected increase in the

number of cases of a disease in the country.
*DOH is the only one that can declare the presence of epidemic by the
National Epidemiology center

Examples: Obesity rates, smoking

4. PANDEMIC- epidemic of worldwide or
continental proportion of the same disease
in several countries. It is another pattern of
occurrence from international perspective
* PANDEMIC is declared by WHO
( Examples: Spanish Flu (1918-1920)
 TIME-RELATED PATTERNS OF
OCCURRENCE
1. SHORT TIME FLUCTUATION OF AN EPIDEMIC
2. CYCLICAL VARIATIONS-Recurrent fluctuations
of disease that may exhibit cycles lasting for
certain period. Ex. Seasonal disease like
Dengue fever- 3 cyclical patterns-2008
increase incidence of dengue expected to
increase incidence by 2011 then by 2013
expect an increase in the incidence of dengue
again….
3. SECULAR VARIATIONS- change in disease
frequency over a period of many years.
ex. Poliomyelitis- decrease now, in
frequency…
In the Philippines, it has been declared
polio-free in the year 2000 and expected to
be eradicated by year 2005 up to present.
Epidemic
is the most interesting and meaningful of the
occurrence of disease as it demands immediate
effective action which includes epidemiological
investigation- emergency epidemiology as well
as control
 BRANCHES OF EPIDEMIOLOGY
1. DESCRIPTIVE EPIDEMIOLOGY- concern with disease
frequency and distribution.
ex.1. DOH declared an epidemic in Laguna in
2008- Dengue fever
ex.2. N0. 1 cause of death is heart disease.
make a study on the correlation in the diet
and heart disease
2. ANALYTICAL EPIDEMIOLOGY-
Analysis of the causes or determinants of disease
( this can be use for Community Evaluation)
3. INTERVENTION/EXPERIMENTAL – study of
effectiveness of new methods of prevention/
treatment of disease.
ex. Effectiveness of garlic in hypertension
 Branches of Epidemiology

*Descriptive and Analytical Epidemiology are

used in Community diagnosis/community
assessment
*Intervention and Evaluation Epidemiology
are best approach in Evaluation of Nursing
actions
 Branches of EpidemiologY
4. EVALUATION EPIDEMIOLOGY – measurement of the
effectiveness of study of the different diseases

HERD IMMUNITY
General level of immunity of a Population against a
particular disease
Ex. SARS
 EPIDEMIOLOGICAL INVESTIGATION
IS TO IDENTIFY THE SOURCE /DELINEATE ETIOLOGY OF AN EPIDEMIC (this is done if there is an epidemic)
STEPS
1.ESTABLISH THE FACT OF THE PRESENCE OF EPIDEMIC :
present number of cases compare to the usual no. of cases in the past at this time of the year.
If less than then we can conclude –(proving that there is NO epidemic) however, if there are more cases, refer to the DOH to know if your data is
valid

-.
 If data is valid then DOH can declare
“hot spot”- surveillance.
2. APPRAISAL OF FACTS- describing the epidemic
according to:
person- age, sex, occupation, etc..
distribution: place-can help make con-
conclusion and spot map should be included
to be able to see geographical distribution
pattern
time-on set of the epidemic…was there sudden
onset?
Types of epidemic according to onset
A. point/common source of epidemic- common
vehicle, sudden onset - ex. Food poisoning after
eating spaghetti in the party

B. Propagated epidemic-
1. person-to-person propagated- person contact
needed, slow onset. Ex. SARS
2. Vector propagate
ex. Dengue
vector population site is the single important
factor in determining n0. of cases
Strategy use here is ERADICATION OF VECTORS
Ex. of vector: Anopheles – slow moving water in
mountain streams. From 9am to 3pm,
breeds in shaded water strategy use here is
STREAM CLEARING
DOH can put an area in quarantine if the area
has 0% HERD IMMUNITY.
polio infant eradication year 2000
Last casual polio in the PHIL. 1943
Small pox 0% (worldwide) 1980 Phil. Has no
more case of small pox
CONT.. Steps in epidemiological investigation
3. FORMULATING THE HYPOTHESIS
-making an educated guess
resources of epidemic
- relation of cases to age, group, sex, color, occupation, school
attendance, past immunization
- relation of sanitary facilities, environmental health and
sanitation
 -relation to milk and food supply and food
sanitation
-relation of animal or insect vectors
-relation f cases and known carriers if any
4. TESTING THE HYPOTHESIS
-performing diagnostic test to determine
actual source:
ex. Food poisoning- culture food sample,
examine food handlers- It’s a proof that it
came from specific source
Drinking water- COLIFORM test
Coliform is a normal bacteria of human colon
In PHC the use of this coliform test is to know /
detect presence of Coliform in the water, this is
an indicator for water potability.
COLIFORM TEST
70% ethyl alcohol to mixed in the water.This
should not be exposed to sunlight. 3 days after
the color of the water becomes/turns to black
and this will indicate positive result for coliform
5. CONCLUSSION AND RECOMMENDATION
-Document findings
-Recommendation
 NATIONAL EPIDEMIC SENTINEL
SURVEILLANCE SYSTEM
(NESSS)
This is a Hospital-based information system to
provide the DOH supplemental information on
occurence of diseases with outbreak potential.
- early warning system for outbreak of: polio,
measles, HIV/AIDS, diptheria, hepatitis A, B …,
rabies, Dengue, malaria, leptospirosis, paralytic
shellfish poisoning- red tide, force able firecracker
• Injuries during new year, etc…
FUNCTIONS OF THE EPIDEMIOLOGY NURSE
1.Implement public health surveillance
2. Monitor local health personnel
conducting disease surveillance
3. Assist in the conduct of rapid
surveillance during disasters.
4. Assist in the conduct of surveys,
programs evaluations, and other
epidemiologic studies
5. Conduct and assist other health personnel in
outbreak investigation
6. Assist in the training course of epidemiology
7. Assist in the epidemiologist in preparing the
annual report and financial plan
8. Responsible for inventory and maintenance
of epidemiology and surveillance unit (ESU)
equipment
 Community Diagnosis
It is the identification of health needs and problems
of the community

Types of Data according to Source

1.Primary or First hand information –data collected by
the investigator himself/herself
a.Census
b.survey/sample
 Cont… of data

c. experiment
CENSUS- data gathering about 100% of the
population, an official and periodic enumeration
*gather information from the whole
population. Conducted by middle of the year
(starts in May and ends in August) Mid year
population cesnsus
Census is usually conducted every 10 years but
depending on the President’s command.
- done by the NSO (National Statistics Office)
unit- Local civil Registrar

WAYS OF ASSISTING PEOPLE IN THE CENSUS

1.De Jure- place of usual residence, use by the
NSO
2. De Facto- actual physical location at the time
of the census
Survey /Sample Survey
-collecting data about a sample of the
population
- use of sampling techniques depend-
ing on the type of community
diagnosis
 TYPES OF COMMUNITY
DIAGNOSIS
Types of Community Diagnosis
1.Comprehensive – data gather from all source of factors
that may be affected.
2.Random- or known as Convenience sampling
3.Problem-oriented – done after the comprehensive
diagnosis because we need the data from previous survey-
ex. Nutritional survey
we do purposeful sampling (detecting families who are
susceptible)
Cont… of the TYPES OF DATA
2. SECONDARY DATA
-data collected by somebody else, which
the investigator is using for his own purpose.
a. Registry of Vital events
b. Records and reports
c. Publications
d. informal source- this ia according to the person
who gave you an information
 TYPES OF GRAPH
1. LINE or Curve graphs – Trends over time and age.
Shows peaks, valleys.and seasonal trends of birth and
death rates over aperiod of time.
2. BAR – comparisson of values.each represents
or expresses quantity in terms of rates or % of a
particular observation like causes of illness and death.
3. AREA DIAGRAM /COMPONENT BAR GRAPH/(Pie
graph) impt.part to the whole
4. SCATTER DIAGRAM – CORRELATION OF 2 VARIABLES

x
 DEMOGRAPHY
STUDY OF A POPULATION

DEMOGRAPHIC DATA
1.Population size and population growth rate-
depends on population census
2.Population composition
3.Population distribution
MEASURING POPULATION GROWTH
I.Rate of natural increase:
-Crude Birth Rate – Crude Death Rate
II.Population Composition
A. Age Composition
1. median age- is tha age that devides a population
into 2 equal parts, a younger half and an older half
 III. Sex composition
ex. Male proportion=n0.of males/total
population x 100
Sex Ratio = n0. of males/n0.of females
x 100
how many men are there in 100F?
= (m:100f)
 IV . Age and sex composition- population
pyramid- it’s a double bar graph:
males at left
Females at right
V- POPULATION DISTRIBUTION
1. Urban- Rural disribution
2. Population density
- n0. of people living in a given area
 VITAL STATISTICS

STATISTICS refers to a systematic approach of

obtaining organizing and analyzing numerical facts
so that conclusion may be drawn from them.

VITAL STATISTICS
Refers to the systematic study of vital events such
as births, illnesses, marriages, divorce, separation
and death.s
USES OF VITAL STATISTICS
1.Indices of the health and illness status of a
community
2.Serves as bases for planning, implementing,
monitoring and evaluating community
health
nursing programs and services.
In statistics :
“CRUDE” means “TOTAL”
N is the numerator (crude)
D is the denominator- population susceptible
to the event
Total population – average population mid
year, estimated population
PREVALENCE- percent of the population affected.
100,000- as a factor – incidence rate and
specific mortality rate.
“Natality” means” Birth”
FERTILITY RATES
MWRA- married woman of reproductive age-
15-49 y.o
MCRA – married couple of reproductive age
Rate – shows the relationship between a vital
event and those persons exposed to the
occurrence of said event, within a given area and
during a specified unit of time..

Ratio – is used to describe the relationship

between two (2) numerical quantities or measures
of events without taking particular considerations
to the time and place.
Crude Rates- e or General referred to the total living
population. It must be presumed that the total
population was exposed to the risk of the occurrence
of the event.

Specific Rate – the relationship is for a specific

population class or group. It limits the occurrence of
the events to the portion of the population definitely
exposed to it.
CRUDE BIRTH RATE – a measure of one
characteristic of the natural growth or increase
of a population.
REGISTRY OF VITAL STATISTICS
NSO
R.A. 3753- Civil Registry Law
3 Types
1. Birth 2. Marriage
3. Death
PD 651 – Birth Registry Law
1. Cerficate of Livebirth- signed by the
birth attendant must be final with-
in 30 days.
 - can be done by midwife/mother or anyone
present during delivery or knows the circumstances of
the birth.
2. DEATH CERTIFICATE (COLOR BLUE)
- IUFD / STILL BIRTH only the PHYSICIAN can
sign the death cerficate (legal authority). IN A
DOCTORLESS COMMUNITY, THE MAYOR WILL SIGN IT.
PD 856 SAYS THAT THE STILL BIRTH BABY WILL BE
BURRIED IN THE CEMETERY.
6
 ILL
DEFINED AS UNKNOWN CAUSE OF DEATH
The death will be included if the Mayor was the
one who signed it the death death certificate.

To determine if STILLBIRTH or an ABORTUS,

we should see the appearance if it is like a baby,
should be burried in the cemetery.
Death certificate must be filled up and
accomplished within 48 hours from the
occurrence of death.

*MORTALITY RATE –is the most accurate data

and the best indicator /reflection of health
status of a population.
How to compute for the following:
1. CRUDE BIRTH RATE – NATALITY RATE
Total n0. of Livebirth x 1000
Total population

2. How fertile th community is? Reproductive

Age = 13-49 y.o ave.menopausal 50 y.o

Total n0. of livebirths x 1000

number of female of reproductive age
MORBIDITY RATES
1.Prevalence rate ( pre-old and new)
(Inc- new /acute)
-Include everyone who are sick regardless of time of
diagnosis.
Total N0. of cases of a Disease x 100
Total population or population examined
Total n0. of cases old an new
Old cases-diagnosed before the time period.
New cases – cases diagnosed within the given time.
ex. PTB 2010
old case – diagnosed before 2010 but
still positive in 2010

New case- diagnosed in Jan to Dec 2010

2. INCIDENCE RATE-DO NOT include here the old cases.
N0. of New cases of a disease
total population X100,000
Population at risk of developing the disease
*Prevalance – incidence, unless the disease is
acute where the total no. of cases may be equal to the no. of new cases.
*for Chronic Disease, the difference between
prevalance and incidence may reflect the
effectiveness of management.
* Community Diagnosis is use for the basis of
planning.
ex. PTB- 15 old cases (failure)
AIDS- 15 old cases (survivor)
Difference PTB and AIDS-( curable or not)
3. ATTACK RATE- a more accurate measure of
the risk exposure.
- use during epidemic
- use in epidemiologic investigation

No. of persons acquiring a disease

during a specific period x100
N0. expected to same disease in the period
 MORTALITY RATE
1. CRUDE DEATH RAT
- Not to compare population
- useful when considered as a series in a
trend
TOTAL N0.of deaths x 1000
Total population
*If total death rate is decrease= good health
3. CRUDE- SPECIFIC DEATH RATE

N0.of Deaths fromSpecific cause x 100,000

Total population

* Basis for leading cause of death

3. AGE- SPECIFIC DEATH RATE

N0. of death in an age group x 100,000

population aged 1-4 y.o

* Nutritional and immunization status of the

population.
-multiplication factor:
ex. 1-2 per 100,000 aged 1-4 y.o died
*Attack, Swaroop’s, Prevalence x 100

4. Proportionate Mortality rate x 100

Total n0. of deaths
Ex. Teacher proportionate mortality rate
Cancer proportionate mortality rate
Infant proportionate mortality rate
5. SWAROOP’S RATES
N0. of Deaths age > 50 y.o x 100
Total no. of Deaths
*The most sensitive indicator of health status
of a population ( the most accurate)
-100% Swarop’s index ( all who died are 50
y,o and above.
6. Case fatality rate
- To know if the disease is Fatal
- reflects the killing power of a disease

N0. of Deaths from a specific disease x 100

No. of Cases of the disease
ex. SARS case is 12 death is 2
2 x 100 = 16.6
12
7. MATERNAL MORTALITY RATE
-To know from those who are pregnant, how
many died due to pregnancy-
No. of Deaths due to pregnancy, labor or
puerperium (Maternal Deaths) x 1000
Total no. of livebirths (n0. of women
who got pregnant)
*NOTE- no. of IUFD (still birth) may be added to the denominator
8. INFANT MORTALITY RATE ( Death in the First
year)
- No. 2 best indicator of health status of a popu-
lation
- The lesser the healthier
No. of Deaths aged 0-11 mons (or 0-1 yr) x 1000
Total No. of Livebirths (n0. of infants)
Note: DO NOT add stillbirth
Neonatal Mortality rate
- age is 0- 28 days (Death in first month)

No. of Deaths aged 0-28 days x 1000

Total n0. of Liveborths
9. EARLY NEONATAL (hobdomadol) mortality
rate ( death in the first week) 0-7 days old

No. deaths aged 0-7 days x 1000

Total n0. of Liveboirths
10. PERINATAL MORTALITY RATE
No. of Deaths aged 0-28 days +
no. of IUFD’s (stillbirths) x 1000
Total No. of Livebirths + No. of
IUFD’s (Stillbirth)
Ex. Neonatal death = 5 IUFD=3 livebirth= 145
=5+3 x 1000 = 8 x 1000 = 8,000= 54.05
145+3 148 148