Adal Medical University

March 16, 2024

Faculty of Public Health &
Human Nutrition

Instructor: Ahmed M B Ph.D (C)

Measurement of Diseases
Chapter Two

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Email: [email protected]
CHAPTER TWO

March 16, 2024

Instructor: Ahmed M B Ph.D (C)
Measurements
of Morbidity and
Mortality

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 LEARNING OBJECTIVES:

March 16, 2024

 At the end of this unit the student is expected to:

Instructor: Ahmed M B Ph.D (C)

 Describe the differences between ratio, proportion and rate
 Calculate the most important morbidity and mortality measures

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 2.1 INTRODUCTION:

March 16, 2024

 Epidemiology is mainly a quantitative science.

Instructor: Ahmed M B Ph.D (C)

 Measures of disease frequency are the basic tools of the
epidemiological approach.
 Health status of a community is assessed by the
collection, analysis and interpretation of data on illness
(morbidity), death (mortality), disability and
utilization of health services. 4
CONT…

March 16, 2024

 Suchinformation is useful for public health planners
and administrators for proper allocation of health care

Instructor: Ahmed M B Ph.D (C)

resources in a particular community.

 However, to investigate distributions and

determinants of disease, it is also necessary to know
the size of the source population from which affected
individuals were counted.

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 2.2 RATIOS, PROPORTIONS, AND
RATES

March 16, 2024

 Tools of Measurement:
 Rates: comprises the numerator, denominator, time specification and
multiplier.

Instructor: Ahmed M B Ph.D (C)

 Ratio: relation in size between two random quantities (x : y )
 The ratio of males to females (M:F) in Somaliland.
 The ratio of male malaria patients to female malaria patients.
 Proportion: numerator is always part of denominator and the result is
expressed as a percentage.
Example: The proportion of all births that was male
Male births x 100
Male + Female births 6
2.3 MEASUREMENTS OF MORBIDITY

March 16, 2024

 Morbidity rates are rates used to quantify the occurrence of
disease.

Instructor: Ahmed M B Ph.D (C)

 Measures of morbidity include incidence, period prevalence, and
point prevalence rates.

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 INCIDENCE RISK

March 16, 2024

 The incidence of a disease is defined as the number of new cases
of a disease that occur during a specified period of time in a

Instructor: Ahmed M B Ph.D (C)

population at risk for developing the disease.
 IR = Number of new cases of a disease over a period of time X K
Total Population during the given period of time

 Numerator = number of new cases

 Denominator = population at risk of becoming a new case
 Specified over a specific time period 8
Disease occurrence in a sample of Farrlandia over time

Year 1, 5 individuals

March 16, 2024

developed the outcome

Instructor: Ahmed M B Ph.D (C)

Year 2, an additional 7
people developed the
outcome

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Year 3, an additional 4
people developed the
outcome
 WHAT IS THE INCIDENCE OF DISEASE IN
YEAR 2? EX.1

March 16, 2024

 What is the numerator?
7 new cases in Year 2

Instructor: Ahmed M B Ph.D (C)

 What is the denominator?
25 people at risk (5 people already developed the
disease in Year 1 and are thus not at risk)
 Incidence = 7/25 = 0.28
The incidence (risk) of disease in Year 2 is 28%
 That means out of every 100 people living in “X”, 28 of them
acquired disease in year 2. 10
EXAMPLE 2

March 16, 2024

 In May1995 there were 50 new cases of relapsing fever in “Dilla”.

Instructor: Ahmed M B Ph.D (C)

The average total population of “Dilla” was 5000. Calculate the

incidence rate of relapsing fever in “Dilla” in May1995.

 Answer- Incidence risk = 50/5000 X 1000

= 10 new cases per 1000 population

 That means out of every 1000 people living in “Dilla”, 10 of them

acquired relapsing fever in May 1995. 11
ATTACK RATES

March 16, 2024

 A population may be at risk of a disease for limited

Instructor: Ahmed M B Ph.D (C)

period of time only

Number of individuals who became sick

after a particular exposure
xb
Attack rate =
Total population at risk during the same time

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 EXAMPLE:

March 16, 2024

 On June 7, 1995, 100 people were invited by X Restaurant for
dinner. All of them ate the food that was served for dinner. The
next day (June 8, 1995) 90 of the 100 people who ate that food

Instructor: Ahmed M B Ph.D (C)

developed diarrhea. Calculate the attack rate of diarrhea which
occurred on June 8, 1995.
 Attack rate = 90/100 X 100 = 90 cases of diarrhea per 100 people

 That means out of 100 people who ate the food served by X
Restaurant , 90 of them developed diarrhea on June 8, 1995.

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USES INCIDENCE RISK

March 16, 2024

 Incidence risk is important as a fundamental tool for etiologic
studies of diseases. If the incidence rate is significantly higher in

Instructor: Ahmed M B Ph.D (C)

one area, then the cause of that disease can be systematically
searched.

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 PREVALENCE RATE

March 16, 2024

 ALL cases (new + old)
 Types: period, point, life-time prevalence

Instructor: Ahmed M B Ph.D (C)

 Period prevalence: #of cases over a period of time;
months, years
 Point prevalence: #of cases at a specific point in time

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POINT PREVALENCE:

March 16, 2024

 measures the proportion of a population with a

Instructor: Ahmed M B Ph.D (C)

certain condition at a given point in time.

All persons with a specific

Conditional one point in time
x 1000
Point Prevalence =
Total population

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 EXAMPLE:

March 16, 2024

 One health extension worker conducted a survey in one of the
nearby elementary schools on May 10, 2018 to know the
prevalence of trachoma in that school. The total number of

Instructor: Ahmed M B Ph.D (C)

students in that school was 200. The health extension worker
examined all the 200 students for trachoma. Hundred students
were found to have trachoma.
 Calculate the point prevalence rate of trachoma for that school.

 Point prevalence rate= 100/200 X 100 = 50 trachoma patients

per 100 students on May,2018

 That means 50 % of the students in that elementary school were

affected by trachoma on May 10, 2018.

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USES OF PREVALENCE RATE

March 16, 2024

 Planning health facilities and human resource

Instructor: Ahmed M B Ph.D (C)

 Monitoring chronic disease control programs like tuberculosis
control program

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 2.4 MEASUREMENTS OF MORTALITY

March 16, 2024

 Mortality rates and ratios measure the occurrence of

Instructor: Ahmed M B Ph.D (C)

deaths in a population using different ways. Rates
whose denominators are the total population are
commonly calculated using either the mid - interval
population or the average population.

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1. CRUDE DEATH RATE (CDR)

March 16, 2024

Total no. of deaths reported

Instructor: Ahmed M B Ph.D (C)

during a given time interval X 1000
 CDR=
Estimated mid interval population

 The Crude Death Rate measures the proportion of the population

dying every year.

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2. AGE- SPECIFIC MORTALITY RATE

March 16, 2024

No. of deaths in a specific age group
during a given time X1000

Instructor: Ahmed M B Ph.D (C)

ASMR=
Estimated mid interval population of specific age group

 One example of age specific mortality rate is Infant Mortality

Rate.

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EXAMPLE

March 16, 2024

 Location: Dilla  Location: Dilla
 Year: 2022  Year: 2022

Instructor: Ahmed M B Ph.D (C)

 Population of dilla:  Number of deaty in
20000 dilla: 3000
 age:  age:

 <10 : 7000  <10 : <1100

 11-20: 3000  10-20: 300

 21-30: 2500  21-30: 600

 >30: 7500  >30: 1000

300/3000 x1000
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1000/7500 x 1000
 3. SEX- SPECIFIC MORTALITY RATE

March 16, 2024

Sex- specific mortality rate =

Instructor: Ahmed M B Ph.D (C)

No. of deaths in a specific sex
during a given time X 1000

Estimated mid interval population of same sex

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 EXAMPLE:

March 16, 2024

 The average total population of “District Y” in 2005 was 6000
(3500 female & 2500 male). In the same year 300 people died
(100 female & 200 male). Calculate the mortality rate (Crude

Instructor: Ahmed M B Ph.D (C)

death rate) for females.
 CDR for females = 100/3500 X 1000 = 29 per 1000 female
population
 That means out of 1000 female population living in “District Y”,
29 females died in 2005.

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4. PROPORTIONATE MORTALITY
RATIO

March 16, 2024

 Proportionate mortality ratio =

Instructor: Ahmed M B Ph.D (C)

No. of deaths from a specific cause
during a given time x 100

Total no. of deaths from all causes in the same time

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 March 16, 2024
 Location: Baki
 Year: 2009

Instructor: Ahmed M B Ph.D (C)

 Population living: 4000

 Number of death: 80

 1. TB: 35 : 44%

 2. MALARIA: 20 : 25%

 3. OTHER: 25: 31%

 35/80X100=

 20/80X100=

 25/80X100=
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EXAMPLE:

March 16, 2024

 The proportionate mortality ratio asks the question: What
proportion of deaths are due to a certain cause?

Instructor: Ahmed M B Ph.D (C)

 For example : when we say the proportionate mortality ratio for
HIV/AIDS is 30 %, this means out of 100 total (of all) deaths 30
of them died from HIV/AIDS.

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5. CASE FATALITY RATE (CFR)

March 16, 2024

 Case Fatality Rate (CFR) =

Instructor: Ahmed M B Ph.D (C)

No. of deaths from a specific disease
during a given time x 100

No. of cases of that disease during the same time

 Case fatality rate represents the probability of death among

diagnosed cases or the killing power of a disease.

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EXAMPLE:

March 16, 2024

 In 2005 there were 1000 tuberculosis patients in one region. Out
of the 1000 patients 100 died in the same year. Calculate the case

Instructor: Ahmed M B Ph.D (C)

fatality rate of tuberculosis.
 CFR = 100 /1000 x 100 = 10 %
 That means 10% of tuberculosis patients will die once they
develop the disease.

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6. NEONATAL MORTALITY RATE

March 16, 2024

 Neonatal Mortality Rate =

Instructor: Ahmed M B Ph.D (C)

No. of deaths under 28 days of age reported
during a given time X 1000

No. of live births reported during the same time

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EXAMPLE:

March 16, 2024

 In 2005 there were a total of 5000 live births in “Zone B”. Two
hundred of them died before 28 days after birth. Calculate the

Instructor: Ahmed M B Ph.D (C)

Neonatal Mortality Rate (NMR).
 NMR = 200 / 5000 X 1000 = 40 per 1000 live births
 That means out of 1000 live births in 2005, 40 of them died
before 28 days after birth.

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7. INFANT MORTALITY RATE (IMR)

March 16, 2024

 Infant Mortality Rate (IMR) =

Instructor: Ahmed M B Ph.D (C)

No. of deaths under 1 year of age
during a given time X 1000

No. of live births reported during the

same time interval

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8. UNDER- FIVE MORTALITY RATE

March 16, 2024

 Under- five mortality rate =

Instructor: Ahmed M B Ph.D (C)

No. of deaths of 0-4 years of age
during a given time X 1000

Average (mid-year) population of

the same age at the same time

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 EXAMPLE:

March 16, 2024

 In 2005 the total number of children under 5 years of age was
10,000 in “Zone C”. In the same year 200 children under five
years of age died. Calculate the under five-mortality rate

Instructor: Ahmed M B Ph.D (C)

(U5MR).
 U5MR = 200 /10000 x 1000 = 20 per 1000 under five children

 That means in “Zone C”, out of 1000 under five children, 20 died
in 2005.

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 9. MATERNAL MORTALITY RATE

March 16, 2024

. Maternal Mortality Rate =

Instructor: Ahmed M B Ph.D (C)

No. of pregnancy associated deaths of
mothers in a given time X 100,000

No. of live births in the same time

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March 16, 2024 Instructor: Ahmed M B Ph.D (C)
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