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CROSS-SECTIONAL STUDY & SAMPLING METHOD
AP. DR. MOHD HASNI JAAFAR (ENVIRONMENTAL PHYSICIAN &
TOXICOLOGIST)Dept. Of Community Health
UKMMC.
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Classification of Study Design
Observational – Case study– Case series– Cross-sectional – Case-control– Cohort
Experimental– Clinical trial– Laboratory
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Cross-sectional study
Observational / Prevalence study.Cut across the study population only
one time.– Examine sample only at one time.– To answer: what is happening now?
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What is happening?
What is the male: female ratio in this hall?
How many participants had hepatitis B vaccination in this hall?
How many participants felt into sleep now?
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Definition
A study design that examines the relationship / association between ONE disease or other health –related characteristics and other MANY variables in ONE defined population at ONE particular time.
NOT for cause-effect or risk factors!
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Condition
Study a disease or health problem– Description of affected population.– Associated causal and protective factors
present.– Magnitude or severity for control and
prevention program evaluation (may change health policy).
Randomization in sampling method.
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Population Description
Disease distribution– Who (age, gender, ethnic group,
social class, occupation)?– When?– Where?
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Age
Age or certain age groups.– Extreme age: morbidity mortality– Age: cumulative exposure (diet,
smoking, occupation, behaviour).– Extreme age: immune / hormone
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E.g.: Malaria according to age
StateNumber of Malaria according to age group (year)
Total< 1 1 – 4 5 – 9 10 - 14 > 15
Perlis
Kedah
Pulau Pinang
Perak
Selangor
Negeri Sembilan
Melaka
Johor
Pahang
Terengganu
Kelantan
0
2
0
43
13
10
0
1
11
35
59
0
83
0
377
88
56
16
17
139
398
561
1
137
1
561
73
45
18
30
186
542
665
5
151
1
485
70
47
17
16
117
312
499
25
384
99
1534
217
249
204
304
692
914
1901
31
757
101
3000
461
407
205
368
1145
2201
3685
Pen. Malaysia 174
(1.4%)1735
(13.9%)2259
(18.2%)1720
(13.9%)6523
(52.6%)12 411 (100%)
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Gender
Male female.– Physical and hormonal differences.– Occupation, leisure activity, daily
tasks.– Different exposure leads to different
health risks.
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E.g.: Malaria according to gender
StateMalaria cases according to gender
TotalMale Female
Perlis
Kedah
Pulau Pinang
Perak
Kelantan
Terengganu
Pahang
Selangor
Negeri Sembilan
Melaka
Johor
27
158
29
1305
1897
780
1228
415
531
28
465
10
90
7
741
1185
300
590
209
314
3
57
37
248
36
2046
3082
1080
1818
624
845
31
522
Pen. Malaysia 6863 (66.2%) 3506 (33.8%) 10 369 (100%)
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Ethnic
Ethnicity.– Different exposure (occupation,
homes, culture).– Body immune system (genetic).– Behaviour and socioeconomic
status.
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E.g.: Malaria according to groups of people
State
Case of malaria
TotalArmy Police Orang Asli
Rancangan Tanah Kampung
Perlis
Kedah
Pulau Pinang
Perak
Selangor
Negeri Sembilan
Melaka
Johor
Pahang
Terengganu
Kelantan
8
22
40
329
18
13
124
28
80
15
199
2
17
4
269
0
67
1
55
148
66
74
0
0
0
210
232
167
61
18
206
0
7
1
14
0
259
2
12
0
85
155
417
1313
20
704
57
1933
209
148
69
182
556
1703
2092
31
757
101
3000
461
407
255
368
1145
2201
3685
Semenanjung Malaysia 876
(7.1%)703
(5.7%)901
(7.2%)
2258
(18.2%)
7673 (61.8%)
12 411 (100%)
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E.g.: Ethnicity according to health problems (row %)
Health problemsNumber of cases according to ethnicity
Malay (%) Chinese (%) India (%) Total (%)
Caries
Pediculosis capitis
Low body weight
Obesity
Skin infection
Blindness
99 (29.5)
36 (16.6)
24 (24.0)
17 (31.5)
13 (22.4)
10 (19.2)
76 (22.6)
37 (17.0)
6 (6.0)
4 (7.4)
7 (12.1)
11 (21.2)
161 (47.9)
144 (66.4)
70 (70.0)
33 (61.1)
38 (65.5)
31 (59.6)
336 (100.0)
217 (100.0)
100 (100.0)
54 (100.0)
58 (100.0)
52 (100.0)
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E.g.: Health problems, according to ethnicity (column %)
Health problemsNumber of cases according to ethnicity
Malay (%) Chinese (%) India (%)
Caries
Pediculosis capitis
Low body weight
Obesity
Skin infection
Blindness
Total
99 (49.8)
36 (18.1)
24 (12.1)
17 (8.5)
13 (6.5)
10 (5.0)
199 (100.0)
76 (53.9)
37 (26.2)
6 (4.3)
4 (2.8)
7 (5.0)
11 (7.8)
141 (100.0)
161 (33.7)
144 (30.2)
70 (14.7)
33 (6.9)
38 (8.0)
31 (6.5)
477 (100.0)
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Description
When?– Air pollution (haze episodes).– Industrial accidents (explosion, chemical
spill).– Disaster (earth quake, drought, flood).– Recession (infrastructure, budget,
programme).
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Description
Where?– Housing area (urban / rural / hostel).– Local area (district / mukim / kampung).– Topography (mountain, river).– Political geography (nation / state
/mukim / kampung)
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What data are available?
Questionnaire (demography, associated factors, severity) – need validation.
Medical records.Physical examination.Laboratory investigation (blood, urine,
ultrasound, rapid test kits, X-ray, ECG).
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What related factors - confounders?
Predisposing factors– Premorbid health problem.
Enabling factors– Poor nutrition, income, medical care.
Precipitating factors– Excess exposure to other risks.
Reinforcing factors– Repeated exposure to the agents.
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How?
Sampling methods and techniques– Multi stage.– Stratified random sampling.– Simple random sampling.– Purposive.– Convenience.
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Statistical output
Descriptive result– Percentages, ratio, population rate.– Prevalence rate (cross-sectional study output) = P.
Analytical result– Chi-square.– t-test.– ANOVA.– Correlation.– Linear regression.
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Prevalence Rate
Rate / percentage of the disease in a population at a point of time.
Prevalence rate =
No. of all cases
at a period in timeX 100
Total population during that time
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Factors influence the prevalence rate
Increase – Addition of new events (+)– Immigration of cases (+)– Emigration of healthy persons (-)– Longer life span among cases (+)– Less death among cases (+)
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Chi-square test
Observed valueObserved value Expected valueExpected value
Infection M F Total
tve
-ve
29
67
24
80
53
147
Total 96 104 200
Infection M F Total
tve
-ve
25.44
70.56
27.56
76.44
53
147
Total 96 104 200
2 = (29 – 25.44)2/25.44 + (24 – 27.56)2/27.56 + (67 – 70.56)2/70.56 + (80 – 76.44)2/76.44
= 1.303 (p > 0.05); the Nul Hipotesis not rejected.
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SAMPLING METHOD
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A STUDY ON PREVALENCE OF SECONDARY HYPERTENSION AND ITS ASSOCIATED FACTORS AMONG ADOLESCENCE IN MALAYSIA
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Target population – all HPT pts
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Sample Population
Multistage random sampling
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Sample Frame
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Sample Unit
Stratified random
Simple random
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SamplingRandom
Multistage / cluster sampling
– States
Stratified random– Departments / wards
Simple random– Patient list
Non random
Quota sampling– Gender balance
Purposive sampling. Convenience sampling. Matched samples.