[kuliah 18 a] ukuran kesakitan_1april2012
DESCRIPTION
Ukuran angka kesakitan 2012 menurut sumberTRANSCRIPT
MEASUREMENTS OF MEASUREMENTS OF MORBIDITY AND MORTALITY MORBIDITY AND MORTALITY IN A POPULATION & SOURCE IN A POPULATION & SOURCE
OF ERROROF ERROR
AA. SAGUNG. SAWITRI
KOMANG AYU KARTIKA SARI
Demonstrate ability to search, collect, organize and
interpret information/data from different sources in
order to assist in diagnostic, therapeutic and health
OBJECTIVESOBJECTIVES• Differentiate proportion, ratio, rate, prevalence and incidence.
• Explain four types of incidence based on their denominators.
• Describe the source of numerators and denominators for prevalence and incidence.
• Explain types of errors in rate calculation.
GOALGOAL
CONTENT
• Introduction
• Types of measurement
• More on Incidence and Prevalence
• Specific measurements
• Summary
Doctor and Patient
http://www.google.co.id/imgres?imgurl=http://carolynandersonmd.com/wp-content/uploads/2010/05/doctor-connecting-patient.jpg
http://www.google.co.id/imgres?imgurl=http://us.123rf.com/400wm/400/400/justmeyo/justmeyo1010/justmeyo101000384/8042129-doctor-woman-having-conversation-with-elderly-patient-in-office-and-preparing-to-write-prescription.jpg
Diagnose Treat/therapyDetermine the prognosis
Total Population
Illness
Seeking treatment
Hospitalized
Death
Development from healthy in to illness based on severity of illness in the population setting
Natural History and Source of Data
Outcome:
Cure
Control
Disability
Death
Healthy
TreatmentDiagnosisSeek careDiseaseOnset
Symptoms
Data Sources
Survey & Interview in community setting
Doctor/Clinic Record
Hospital Record
Absolute Number
FSWs are classified mostly as direct (those who work in brothels and street‐based sex workers) or indirect (such as women working in karaoke bars or massage parlors). It is estimated that there are 95,000-157,000 direct sex workers and 85,000-107,000 indirect sex workers as of 2009. In 2006, the figure was put at 221,000 women working in the sex industry, serving an estimated 4 million clients per year [Sex Work and HIV in Indonesia, 2011].
NUMERATOR
DISTRIBUTION OF PERSONS BITEN BY DOGS PER SUB-VILLAGES AT UNGASAN
No Name of Sub-villages Total Description
1. Giri Darma 15 Death = 2 persons
2. Santi Karya 2
3. Bakung Sari 4 Death = 1 person
4. Sari Karya 7
5. Wijaya Kesuma 2 Death = 1 person
6. Wana Giri 1
7. Dusun Kauh 1
8. Dusun Kelod 8
9. Dusun Kangin 10
10 Santi Karya 3
11. Jaba Pura 0
12 Kaja Jati 0
13 Petangan 0
Jumlah 53 Total deaths 4 persons
Cumulative HIV Cases Per DistrictIn Bali, 1987 - 2011
Bali Provincial Health Dept, Sept 2011
301
732
2179
52
81
138
1059
213
78
Cumulative HIV Cases Per DistrictIn Bali, 1987 - 2011
Bali Provincial Health Dept, Sept 2011
301
732
2179
52
81
138
1059
213
78 15%
1%
22%
45%
4%2%3%
2%6%
Badung
Bangli
Buleleng
Denpasar
Gianyar
Jembrana
Karangasem
Klungkung
Tabanan
• Proportion of population that not having illness previously and then become ill during the certain period among observed at risk population
• NEW CASES
• RISK OF BEING ILL
INCIDENCE
Numerator / Denominator, Constant, Period 1 2 5 4 3
1. Similar characteristics of N & D
2. Denominator is a “population at risk”
3. During a period of time [time frame]
4. Constant of round number of 10 fold
5. Denominator is a population of certain geographic area
CONDITION
Cumulative Rabies Cases Per DistrictIn Bali, 2008 - 2011
Bali Provincial Health Dept, 2011
18
8
36
26 0
11
21
7
6
# of new cases 2012 = 51 in Denpasar2 in Karangasem2 in Badung
Incidence rate Bali (2012)
= (N/pop at risk)*Constant
= ……..?
Total Population: 3,891,428 persons
1
2
2
RABIES IN BALI, 2008-12 Kabupaten Frek Total Population Proportion Incidence Rate
Jembrana 0 272.828 0
Buleleng 26 662.920 19.5
Tabanan 18 431.172 13.5
Badung 21 (+ 2) 393.020 15.8
Denpasar 11 (+ 1) 523.299 8.3
Gianyar 7 399.660 5.3
Klungkung 8 185.272 6.0
Bangli 6 215.729 4.5
Karangasem 36 (+ 2) 438.475 27.1
Total 133 3.522.375 100.0
Bali Provincial Health Dept, 2011
Natural History of Diseases and Source of Data
Outcome:
Cure
Control
Disability
Death
Healthy
TreatmentDiagnosisSeek careDiseaseOnset
Symptoms
Source of Data
Survey and Interview
Record of doctor/clinic
Hospital Medical Record
Calculating Incidence
• Direct method Primary Data– Interview – Measurement/Assessment
• From Secondary Data– Numerator records (GP/Clinics/hospital/public
health center– Statistic office, estimation from census, census
• Estimating from prevalence
Important Notes!!• Incidence of persons or events?
• Denominator of Incidence?
– “population at risk?” (death, drop out, immune, lost to follow up)
– Availability of data, particularly for the denominator (mid-year, average, beginning plus end divide by 2, etc)
– Person years (person time) Incidence density, cumulative incidence
• Proportion of population who suffer for illness at the time of measurement among the observed at risk population.
• NEW and OLD CASES
• NOT DESCRIBE AT RISK
PREVALENCE
Type of prevalence
• Point prevalence– New and old cases at the point of time
measurement
• Period prevalen– New and old cases at the beginning of
measurement added by new cases on the whole period of measurement
Cumulative Rabies Cases Per DistrictBali, 2008 - 2011
Bali Provincial Health Dept, 2011
18
8
36
26 0
11
21
7
6
# of new cases 2012 = 51 in Denpasar2 in Karangasem2 in Badung
Total Population: 3,891,428 persons
1
2
2Prevalence at 2008-2011?
RABIES IN BALI, 2008-11 Kabupaten Frek Total Population Proportion Prevalence Rate
Jembrana 0 272.828 0
Buleleng 26 662.920 19.5
Tabanan 18 431.172 13.5
Badung 21 393.020 15.8
Denpasar 11 523.299 8.3
Gianyar 7 399.660 5.3
Klungkung 8 185.272 6.0
Bangli 6 215.729 4.5
Karangasem 36 438.475 27.1
Total 133 3.522.375 100.0
Bali Provincial Health Dept, 2011
Relationship between prevalence and incidence
WHEN (the steady state is in effect):
a) Incidence rate (I) has been constant over time
b) The duration of disease (D) has been constant over time:
ID = P / (1 – P)
P = ID / (1 + ID)c) If the prevalence of disease is low (i.e. < 0.10):
P = ID.
Discuss in your group!Discuss in your group!
How is the relationship between
incidence and prevalence?
Case Fatality Rate # of Deaths from a Disease # of Cases from that Disease
Survival Rate # of survivors from a Disease # of Cases from that Disease
Attack Rate # of Cases of a Disease Total Population at Risk for a Limited Period of Time
Infant Mortality Ratio?
Maternal Mortality Ratio?
Maternal Mortality Rate?
Crude Death Rate?
Crude Birth Rate?
Incidence Prevalence
Risk to suffer for disease (period of time)
Proportion of suffering disease (point of time)
For acute/chronic For chronic
Application:- Etiology- Management
Application:- Management
COMPARISON BETWEEN INCIDENCE AND PREVALENCE