HEALTH STATISTICS AND EPIDEMIOLOGY (CHN 2)

HEALTH STATISTICS AND
EPIDEMIOLOGY
By: ROMMEL LUIS C. ISRAEL III
By: Rommel Luis C Israel III 1

EPIDEMIOLOGY
Greek Words:
EPOS - which means “upon”
DEMOS - which means “people”
- It is the systematic, scientific study of the distribution patterns and
determinants of health, diseases and conditions in a population for the
purpose of promoting wellness and preventing diseases or conditions
Reference:
Jimenez, C. E. (2008). Community Organizing Participatory Action Research for Community Health Development. C & E Pub.

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 the people to
measure the distribution and dimension of illness in terms of incidence.
Prevalence, disability and mortality, to set problems in perspective and to
define their relative importance and to identify groups needing special
attention
3. Study the work of health services with a view of improving them.
Operational research shows how community expectations can result in the
actual provisions of service.
Reference:
National League of Philippine Government Nurses. (2007). Public Health Nursing in the Philippines (10th ed.). National League of Philippine Government Nurses.

USES OF EPIDEMIOLOGY
4. estimate the risk of disease, accident, defects, and the chances of
avoiding them
5. Identify syndromes of describing the distribution and association of
clinical phenomena in the population
6. Complete the clinical picture of chronic disease and describe their
natural history
7. Search for causes of health and disease by comparing the experience
of groups that are clearly defined by their composition, inheritance,
experience, behavior, and environments
Reference:

THE EPIDEMIOLOGIC
PROCESS
1. Determine the nature, extent and scope of the problem
2. Formulate a Tentative Hypothesis
3. Collect and Analyze data to test the hypothesis
4. Plan for control
5. Implement control plan
6. Make an appropriate report
7. Conduct research
Reference:

EPIDEMIOLOGIC PROCESS AND
THE NURSING PROCESS
The epidemiologic Process is related to the Nursing Process because it involves:
1. Assessing – data collection to determine the nature of client’s problems
2. Analyzing – Formulation of nursing diagnosis
3. Planning
4. Implementing
5. Evaluating
6. Revising or terminating, and
7. Research – to Improve the plan if needed
Reference:

DETERMINE THE NATURE,
EXTENT AND SCOPE OF THE
PROBLEM
1.Natural History of the condition
2.Determinants influencing the condition
3.Distribution Patterns
4.Condition Frequencies
Reference:

DETERMINANTS INFLUENCING
THE CONDITION
1. Primary Data (essential agent)
a. Parasite
b. Nutritional
c. Psychosocial
2. Contributing Data
a. Agent
b. Host
c. Environment
Reference:

THE EPIDEMIOLOGIC
TRIANGLE
HOST
AGENT
ENVIRON
MENT
HOST
• Any organism that harbors and provides
nourishment for another organism
• Any species (Human or other animals)
capable of being infected or affected
AGENT
• It is the intrinsic property
of microorganism to
survive and multiply in the
environment to produce
disease
• An animate or inanimate
factor that must be
present or lacking for a
disease or condition to
occur
ENVIRONMENT
It affects both the agent and
the host.
It is the sum-total of all
external condition and
influences that affects the
development of an organism
which can be:
a. Biological
b. Social
c. Physical
Reference:
National League of Philippine Government Nurses. (2007). Public Health Nursing in the Philippines (10th ed.). National League of Philippine Government
Nurses.

AGENTS OF DISEASE
AGENTS EXAMPLE OF ETIOLOGICAL FACTORS
NUTRITIVE ELEMENTS
Excess
Deficiencies
Cholesterol
Vitamins, Proteins
CHEMICAL AGENTS
Poisons
Allergens
Carbon Monoxide, Drugs
Ragweeds, Poison Ivy
PHYSICAL AGENTS Heat, Lights, Ionizing Radiation
INFECTIOUS AGENTS
Metazoa
Protozoa
Bacteria
Fungi
Rickettsia
Viruses
Hookworms, Schistosomiasis
Amoeba, Malaria
Pneumonia, Typhoid, Rheumatic Fever, Lobar
Histoplasmosis, Athlete’s Foot
Rocky Mountain, Spotted Fever
Measles, Mumps, Chicken pox, Poliomyelitis, Rabies
Reference:

HOST FACTORS (Intrinsic
Factors)
Influences exposure, susceptibility, or response to agent
Reference:
GENETIC Sickle Cell Disease
AGE
SEX
ETHNIC GROUP
PHYSIOLOGIC Fatigue, pregnancy, puberty, stress
IMMUNOLOGIC EXPERIENCE
Active
Passive
Hypersensitivity
Prior to infection, immunization
Maternal Antibodies, gammaglobulin
INTER-CURRENT OR PRE-
EXISTING DISEASE
HUMAN BEHAVIOR Personal Hygiene, Food Handling

ENVIRONMENTAL FACTORS (Extrinsic
Factors)
Influences existence of the agent, exposure, or susceptibility to
agent
PHYSICAL ENVIRONMENT Geology, Climate
BIOLOGIC ENVIRONMENT
Human Population
Flora
Density
Sources of food, influence on vertebrates and
anthropods as source of agent
SOCIO-ECONOMIC
ENVIRONMENT
Occupation
Urbanization
Disruption
Exposure to chemical agents
Urban crowding, tension and pressures
Wars, Disasters
Reference:

DISTRIBUTION PATTERNS IN
ANALYZING EPIDEMIOLOGY DATA
1.Person –refers to the characteristics of the individual who were exposed
and who contacted the infection or the disease in question
2.Place – refers to the features, factors, or conditions which existed in or
described the environment in which the disease occurred
3.Time – refers both to the period during which the cases of the disease being
studied were exposed to the source of infection and the period during which the illness
occurred
Reference:
National League of Philippine Government Nurses. (2007). Public Health Nursing in the Philippines (10th ed.). National League of Philippine Government
Nurses.

TIME
1. EPIDEMIC PERIOD
The Period during which the reported number of cases of a disease exceed the expected, or
usual number for that period
2. YEAR
For many diseases, the incidence (frequency r occurrence) is not uniform during each of 12
consecutive months. This seasonal variation is associated with variations in the risk of exposure
of susceptible to the source of infection
3. PERIOD OF CONSECUTIVE YEARS
Recording the reported cases of a disease over a period of years-by weeks, months, or year of
occurrence.
It is useful in predicting the probable future incidence of the disease and in planning appropriate
prevention and control program.
Reference:

PERSON CAN BE DESCRIBED IN TERMS OF:
TEIR INHERENT OR THEIR ACQUIRED
CHARACTERISTICS
Age, Race, Sex, immune status, and marital status
THEIR ACTIVITIES Form of work, play, religious practices, customs
CIRCUMSTANCES UNDER WHICH THEY LIVE Social, economic, and environmental conditions
AGE
- There is more variation in disease frequency by age than any other variable
- The single most useful variable associated in describing the occurrence and distribution of disease because of
the association between the person’s age and their:
a. potential for exposure to a source of infection
b. level of immunity or resistance
c. physiologic activity at the tissue level (which sets the manifestation of a disease subsequent to infection
SEX AND OCCUPATION
- Males experience higher mortality rate than females for a wide range of diseases
- Females have higher morbidity rates
- Rationale: Because of differing pattern of behavior between sexes or activities as recreation, travel,
occupation which results in different opportunities for exposure to source of infection
Reference:

PLACE
It is the geographic
area described in
terms of:
• Street
• Address
• City
• Municipality
• Province
• Region or
• Country
URBAN/RURAL
DIFFERENCES:
• Disease spreads more
rapidly in urban areas
because of greater
population density
where it provides more
opportunities for
susceptible individual to
come in contact with a
source of infection
SOCIO-ECONOMIC AREAS
• The incidence rate of many
diseases, both communicable
and chronic, varies inversely
with differences in large
geographic areas within a
country
• Geographic variations in the
incidence of infectious diseases
commonly results from
variations in the geographic
distribution of the reservoirs or
vectors of the disease or in the
ecological requirement of the
disease agent
Reference:

PATTERN OF OCCURRENCE AND
DISTRIBUTION
SPORADIC
ENDEMIC
EPIDEMIC
EPIDEMIC

SPORADIC OCCURRENCE
•Intermittent occurrence of a few isolated and
unrelated cases in a given locality
•The cases are few and scattered, so that there is
no apparent relationship between them
•They occur on and off intermittently through a
period of time
Reference:
EPIDEMIC

SPORADIC OCCURRENCE
Example:
RABIES
• In the Philippines, there are few
cases during certain weeks of the year
• Cases are scattered throughout the
country so that the cases are not related
at all to the cases in other area
Reference:
EPIDEMIC

ENDEMIC OCCURRENCE
•Continuous occurrence throughout a period of time, of
the usual number of cases in a given locality
•The disease is always occurring in the locality and the
level of occurrence is more or les constant through a
period of time.
•It is in a way identified in the locality itself, it may be
high endemic or low endemic when the given level is
continuously maintained.
Reference:

ENDEMIC OCCURRENCE
Example:
• SCHISTOSOMIASIS
is endemic in Leyte
and Samar
Reference:
National League of Philippine Government Nurses. (2007).
Public Health Nursing in the Philippines (10th ed.).
National League of Philippine Government Nurses.

ENDEMIC OCCURRENCE
Example:
• FILARIASIS is endemic
in Sorsogon
Reference:
National League of Philippine Government Nurses. (2007).
Public Health Nursing in the Philippines (10th ed.). National
League of Philippine Government Nurses.

EPIDEMIC OCCURRENCE
• Unusually large number of occurrences in a relatively short
period of time
• There is a disproportionate relationship between the number of
cases and the period of occurrence. The more the acute is the
disproportion, the more urgent and serious is the problem
• The number of cases is not in itself necessarily big or large, but
such number of cases when compared with the usual number
of cases may constitute an epidemic in a given locality, as long
as that number is so much more than the usual number in that
locality.
Reference:

EPIDEMIC OCCURRENCE
• Example
BIRD’S FLU
There has been no cases of
Bird’s Flu in any area of the
country, so that an occurrence
of few cases in a given area in
a given time would constitute
a bird’s flu epidemic.
Reference:

PANDEMIC OCCURENCE
• It is the simultaneous occurrence
of epidemic of the same disease
in several countries.
• It is another pattern of occurrence
from an international perspective
Example:
COVID-19
Reference:

WHAT MAKES EPIDEMIC AMONG THE MOST
INTERESTING AND MEANINGFUL AMONG THE
PATTERN OF OCCURRENCES OF DISEASE?
•It demands immediate effective action
•The immediate action includes
epidemiological investigation – emergency
epidemiology as well as control
Reference:

FACTORS CONTRIBUTORY TO
EPIDEMIC OCCURRENCE
AGENT FACTORS
• The result of the introduction of the new disease agent into the
population
• It may also result from changes in the number of living microorganisms
in the immediate environment or from their growth in some favorable
culture medium
HOST FACTORS
• They are related to lower resistance as a result of exposure to the
elements during flood or other disaster, to relaxed supervision of water
and milk supply or sewage disposal, or to changed habit of eating.
• It may be related to change in immunity and susceptibility to population
density and movement, crowding, to sexual habits, personal hygiene or
to changes in motivation as a result of health education
ENVIRONMENTAL FACTORS
• Changes in the physical environment: temperature, humidity, rainfall
may directly or indirectly influence equilibrium of agent and host
Reference:

PHILIPPINE HEALTH SITUATION

DEMOGRAPHIC PROFILE OF THE
PHILIPPINE
• Current population is 112,737,622 as of August
26, 2022
• Philippines ranks number 13th in the world by
population in the list of 235
countries/territories
• Philippines is ranked 7th among 51 countries in
Asia
Reference:
UN (World Population Prospects 2019). (2021, August 23). Philippines population 2021 - StatisticsTimes.com. Statisticstimes.com.
https://statisticstimes.com/demographics/country/philippines-population.php#:~:text=The%20population%20of%20Philippines%20is%20projected%20at%20111%2C046%2C913

PHILIPPINE
Reference:
Demographics of the Philippines. (2022, August 26). Wikipedia. https://en.wikipedia.org/wiki/Demographics_of_the_Philippines#Vital_statistics

PHILIPPINE

PHILIPPINE
The population density is high, but the distribution of the population is
uneven.
Parts of Metro Manila have a population density that is more than 100
times that of some outlying areas such as the mountainous area of
northern Luzon.
The birth rate remains significantly higher than the world average, as
well as the average for the Southeast Asian region.
Reference:
Britannica. (2019). Philippines - Resources and power | Britannica. In Encyclopædia Britannica. https://www.britannica.com/place/Philippines/Resources-and-power

PHILIPPINE
The Mortality rate in the early 21st century was considerably lower
than it had been a few decades earlier in the latter part of the 20th
century, particularly among infants, children under the age of five
years, and mothers.
There was also a generally steady increase in average life expectancy.
The improvement in health is credited to better prenatal care and the
services of more trained midwives, doctors, and nurses; improved
housing, sanitation, and social security benefits; the provision of
health services to government employees; the increasing number of
medical and nursing school graduates; and the requirement that a
medical graduate render rural service.
Reference:
Britannica. (2019). Philippines - Resources and power | Britannica. In Encyclopædia Britannica. https://www.britannica.com/place/Philippines/Resources-and-power

PHILIPPINE
The demand for health care continues to
outstrip available resources; a large number
of trained medical professionals emigrate,
particularly to the United States, and many
of the poorest people still rely on the
services of practitioners of traditional
medicine and unlicensed midwives.
Reference:

The Philippines has made significant investments and
advances in health in recent years. Rapid economic
growth and strong country capacity have contributed
to Filipinos living longer and healthier. However, not all
the benefits of this growth have reached the most
vulnerable groups, and the health system remains
fragmented.
Reference:
HEALTH SITUATION. (n.d.). Retrieved August 26, 2022, from https://apps.who.int/iris/bitstream/handle/10665/136828/ccsbrief_phl_en.pdf

Health insurance now covers 92% of the population.
Maternal and child health services have improved, with
more children living beyond infancy, a higher number of
women delivering at health facilities and more births being
attended by professional service providers than ever
before. Access to and provision of preventive, diagnostic
and treatment services for communicable diseases have
improved, while there are several initiatives to reduce
illness and death due to noncommunicable diseases
(NCDs).
Reference:

Despite substantial progress in improving the lives and
health of people in the Philippines, achievements have not
been uniform and challenges remain.
Deep inequities persist between regions, richand the poor,
and different population groups. Many Filipinos continue to
die or suffer from illnesses that have well-proven, cost-
effective interventions, such tuberculosis, HIV and dengue,
or diseases affecting mothers and children.
Reference:

Many people lack sufficient knowledge to make
informed decisions about their own health.
Rapid economic development, urbanization, escalating
climate change, and widening exposure to diseases
and pathogens in an increasingly global world increase
the risks associated with disasters, environmental
threats, and emerging and re-emerging infections
Reference:

COOPERATION FOR HEALTH
The global vision of the world in 2030, spelled out in
the Sustainable Development Goals, aligns with the
Philippines’ 25-year vision AmBisyon Natin 2040.
There is an ongoing process of integrating SDGs into
AmBisyon Natin 2040 and into national, sectoral and
subnational plans and frameworks
Reference:

WHO supportsthe Government of the Philippines to
foster well-being through action by the health sector
and across sectors.
WHO convenes platforms for health involving multiple
stakeholders and in addressing the social, economic
and environmental determinants of health.
Reference:

WHO also takes the lead in coordinating with
other health partners to ensure all stakeholders
are aware of health issues and activities in the
country.
Reference:

FUNCTIONS OF THE
EPIDEMIOLOGY NURSE
1. Implement public health surveillance
2. Monitor local health personnel conducting disease surveillance
3. Conduct and/or assist other health personnel in outbreak investigation
4. Assist in the conduct of rapid surveys and surveillance during disasters
5. Assist in the conduct of surveys, program evaluations, and other epidemiologic
studies
6. Assist in the conduct of training course in epidemiology
7. Assist the epidemiologist in preparing the annual report and financial plan
8. Responsible for inventory and maintenance of epidemiology and surveillance
unit (ESU) equipment
Reference:

SPECIFIC ROLE OF THE NURSE DURING
EPIDEMIOLOGICAL INVESTIGATIONS
1. Maintains surveillance of the occurrence of notifiable disease
2. Coordinates with other members of the health team during the disease outbreaks
3. Participates in case findings and collection of laboratory specimens
4. Isolates cases of communicable disease
5. Renders nursing care, teaches and supervises giving of care
6. Performs and teach household members method, concurrent and terminal disinfection
7. Gives health teaching to prevent further spreads of disease to individual and families
8. Follow up cases and contacts
9. Organizes, coordinates and conducts community health education campaign/meetings
10. Refers cases when necessary
11. Coordinates with other concerned community agencies
12. Accomplishes and keeps records and reports and submits to proper office/agency.
Reference:

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 deaths
• Statistics of disease (morbidity) and death (mortality) indicate the state of health
of a community and the success or failure of health work.
• Statistics on population and the characteristics such as age and sex, distribution
are obtained from the Philippine Statistics Authority (PSA)
• Births and Deaths are registered in the Office of The Local Civil Registrar of the
municipality or city. In cities, births and deaths are registered at the City Health
Department.
Reference:

USE OF VITAL STATISTICS
1.Indices of the health and illness status of the
community
2.Serves as basis for planning, implementing,
monitoring, and evaluating community health
nursing programs and services
Reference:

SOURCES OF DATA
1.Population Census
2.Registration of vital data
3.Health survey
4.Studies and researches
Reference:

HEALTH INDICATORS
CRUDE BIRTH RATE
- A measure of one characteristic of the natural growth or increase of a population
CBR = ______________________________________
Reference:
X 1000
Total number of live births registered in a
given calendar year
Estimated population as of July 1 of same
year

HEALTH INDICATORS
CRUDE DEATH RATE
- A measure of one mortality from all causes which may result in a decrease of
population
CDR = ______________________________________
Reference:
X 1000
Total number of live death registered in a
given calendar year
year

HEALTH INDICATORS
INFANT MORTALITY RATE
- Measures the risk of dying during the first year of life
IMR = ______________________________________
Reference:
X 1000
Total number of death under 1 year of age
registered in a given calendar year
Total number of registered live births of
same calendar year

HEALTH INDICATORS
MATERNAL MORTALITY RATE
- Measures the risk of dying from causes related to pregnancy, childbirth and
puerperium
MMR = ____________________________________
Reference:
X 1000
Total number of deaths from maternal
causes registered for a given calendar year
Total number of live births registered of
same year

HEALTH INDICATORS
FETAL DEATH RATE
- Measures the death of the product of conception prior to its complete expulsion,
irrespective of duration of pregnancy
FDR = ______________________________________
Reference:
X 1000
Total number of fetal deaths registered in a
given calendar year
Total number of live births registered on
same year

HEALTH INDICATORS
NEONATAL DEATH RATE
- Measures the risk of dying the 1st month of life
NDR = ______________________________________
Reference:
X 1000
Number of deaths under 28 days of age
Number of live births registered on
same year

HEALTH INDICATORS
SPECIFIC DEATH RATE
- Describes more accurately the risk of exposure of certain classes or groups to
particular diseases
SDR = ______________________________________
Reference:
X 1000
Deaths in specific class/group registered in
a given calendar year
Estimated population as of July 1 in same
specified clas/group of said year

HEALTH INDICATORS
Example of SPECIFIC DEATH RATE
particular diseases
Cause of SDR = ______________________________________
Reference:
X 1000
Number of deaths from specific cause
registered in a given year
year

HEALTH INDICATORS
particular diseases
Age SDR = ______________________________________
Reference:
X 1000
Number of deaths in a particular age
group registered in a given calendar year
age group of same year

HEALTH INDICATORS
particular diseases
Sex SDR = ______________________________________
Reference:
X 1000
Number of deaths of a certain sex
for same year

HEALTH INDICATORS
INCIDENCE RATE
- Measures the frequency of occurrence of the phenomenon during a given period
of time
IR = ______________________________________
Reference:
X 1000
Number of new cases of a particular
disease registered during a specified period
of time
Estimated population as of July of
same year

HEALTH INDICATORS
PREVALENCE RATE
- Measures the proportion of the population which exhibits a particular disease at
a particular time
PR = ______________________________________
Reference:
X 1000
Number of new and old of a certain disease
registered at a given time
Total number of persons examined at same
given time

HEALTH INDICATORS
ATTACK RATE
- A more accurate measure of the risk of exposure
AR = ______________________________________
Reference:
X 1000
Number of persons acquiring a disease
registered in a given year
Number of exposed to same disease in the
same year

HEALTH INDICATORS
PROPORTIONATE MORTALITY (Death Ratio)
- Shows the numerical relationship between deaths from all causes (or group of
causes), age (or group of age), etc. And the total number of deaths from all causes in all
ages taken together
PM = ______________________________________
Reference:
X 1000
Number of registered deaths from specific
cause or age for a given calendar year
Number of registered deaths from all
causes, all ages in same year

HEALTH INDICATORS
ADJUSTED OR STANDARDIZED RATE
- To render the rates of 2 communities comparable, adjustments for
the differences in age, sex, race, and any other factors which
influence vital events have to be made.
METHODS:
• By applying observed specific rates to some standard population
• By applying specific rates of standard population to corresponding
classes or groups of the local population
Reference:

HEALTH INDICATORS
CASE FATALITY RATION
- Index of a killing power of a disease and is influenced by incomplete reporting
and poor morbidity data
CFR = ______________________________________
Reference:
X 1000
Number of registered deaths from specific
disease for a given year
Number of registered cases from same
specific disease in same year

PRESENTATION OF DATA
LINE OR CURVED GRAPHS
Shows peaks, valleys, and seasonal trends. Also used to show the trends of birth
and death rates over a period of time
BAR GRAPHS
Represents or expresses a quantity in terms of rates or percentages of a particular
observation like causes of illness and deaths
AREA DIAGRAM (Pie Charts)
It shows the relative importance of parts to the whole
Reference:

FUNCTIONS OF THE NURSE
• Collects data
• Tabulates data
• Analyzes and interprets data
• Evaluates data
• Recommends redirection and /or strengthening of specific
areas of health programs as needed
Reference:

HEALTH STATISTICS AND EPIDEMIOLOGY (CHN 2)

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