HEALTH STATISTICS FOR MEDICAL BOARD REVIEW By DR. THERESITA R. LARIOSA
SOURCES OF DATA FOR HEALTH STATISTICS • REGISTRATION DATA • CENSUS DATA • SURVEY • HEALTH CENTER DATA • IN PATIENT HOSPITAL RECORDS • PRIVATE DOCTORS’ OFFICE RECORDS • COMMERCIAL AGENCY RECORDS ex. INSURANCE • GOVERNMENT AGENCY DATA ex. NEDA, DepEd, DSWD
REGISTRATION • ..is the legal recording with the authorized officials of the occurrence of an event together with certain identifying or descriptive characteristics of the event. • … is a continuous, permanent and compulsory recording of vital events and their characteristics in accordance with the legal requirements in each country.
REGISTRATION • …In the Philippines, the Civil Registry Law (RA 3753) mandates the registration in appropriate civil registry books of all facts concerning the civil status of persons from birth to death including the changes taking place therein.
Laws or regulations governing registration of births and deaths • Civil Registry Law (R.A. 3753) passed in Nov 1929 .. Defines-events to be registered, civil registrar, responsible persons… 2. Presidential decree 651 of Jan 1975
RESPONSIBILITIES • National Statistics Office ( headed by the Civil Registrar-General) is the agency responsible in maintaining an efficient and effective civil registration system in the Philippines. • Each city or municipality has a local civil registrar
Accomplishment of Forms • Municipal Form 102-Certificate of live birth Municipal Form 103- Certificate of death Municipal Form 103A- Certificate of fetal death • The accomplishment of the civil registry documents requires extra care since erroneous entries cannot be corrected without proper court order.
Accomplishment of forms • Accomplish all forms in quadruplicate • Type or write legibly • Never sign an incompletely filled up form • Data should be reckoned at the time of occurrence, not at the time of the preparation. • Source of information on personal data should be supplied by the closest/next of kin.
Attendant to the registrable event • It is the responsibility of the attendant at death to certify to the medical facts pertinent to the case. • In the absence of an attendant at death, the local health officer is duty bound to complete the medical certification portion of the death certificate and effect the registration of the event. He is also required to review the entries in all certificates of death in his jurisdiction.
Circumstance - Foreigner, resident of the Phil - Foreigner, non-resident - If place can’t be ascertained - Unrecovered body Place of Registration - Habitual residence - Manila - Place of burial -Last known address PLACE OF REGISTRATIONRule: Place of occurrence and within 30 days of the event
Events requiring registration • Livebirth -Marriage • Death -Separation/Divorce • Fetal death -Adoption Livebirth: The complete expulsion from the mother’s womb of a product of conception, irrespective of the duration of pregnancy, which after such separation, breathes or shows other evidence of life such as beating of the heart, pulsation of the umbilical cord or definite movement of voluntary muscles whether or not the umbilical cord has been cut off or the placenta is attached.
Death and fetal death • Death The permanent disappearance of all evidence of life anytime after live birth has taken place • Fetal death Death prior to the complete expulsion of the product of conception, irrespective of the period of pregnancy
CERTIFICATE OF LIVE BIRTH • INFORMATION ON • THE CHILD • Name (first, middle and last) • Sex • Date of birth • Place of birth • Type of birth (single, twin, triplet) • Birth Order • Weight at birth • THE MOTHER • THE FATHER
CERTIFICATE OF LIVE BIRTH • Information on the mother • Maiden Name • Citizenship • Religion • Total number of children born alive • No. of children living including this birth • No of children born alive but are now dead • Occupation • Age at the time of this birth • Residence
CERTIFICATE OF LIVE BIRTH • Information on the Father • Name • Citizenship • Religion • Occupation • Age at the time of this birth 18. Date and Place of Marriage of Parents (If not married, accomplish Affidavit of Acknowledgement/Admission of Paternity at the back)
CERTIFICATE OF LIVE BIRTH • Attendant: (Physician, Nurse, Midwife, Hilot, Others [specify] ) • Certification of birth: I hereby certify that I attended the birth of the child who was born alive at -------- o’clock am/pm on the date stated above: Signature Address Name in print Date: Title or position
CERTIFICATE OF LIVE BIRTH • Informant • Signature, Name in print, Address, Relationship to the child, Date • Prepared by • Signature, Name in print, Title or position, Date • Received at the Office of the Civil Registrar • Signature, Name in print, Title or position, Date
CERTIFICATE OF DEATH • Information • Name • Sex • Religion • Age • Place of death • Date of death • Citizenship • Residence • Civil Status • Occupation • Medical certificate portion: • A. • Immediate • Antecedent • Underlying (Include intervals) B. • Other Significant Conditions
Certificate of Death • Immediate cause: the disease or morbid condition that directly led to death. • Antecedent cause: the condition that gave rise to the immediate cause of death. • Underlying cause: that which initiated the train of morbid events leading to the direct cause of death, or the circumstance of the accident or violence which produced the fatal injury. • -ENTRIES MUST BE CONSONANT TO THE LIST FOUND IN THE “INTERNATIONAL CLASSIFICATION OF DISEASES, INJURIES AND CAUSE OF DEATH” 10TH EDITION, WHO
EXAMPLES… • I. A. Acute myocardial infection---2 days • B. Congestive heart disease----6 mos. • C. Hypertension-------------------15 years • II Carcinoma of the colon • ------------------------------------------------------- • I. A. Pneumocystis carinii pneumonia—2 wks • B. AIDS----------------------------------- 10 yrs • C. HIV Infection------------------------- 15 yrs • II. Diabetes mellitus
FERTILITY RATE • Measures the capability of the population to reproduce • Crude birth rate • General fertility rate • Age specific birth rate • Total fertility rate • Child-woman ratio • Total completed family size
Fertility rate…. CBR • Crude Birth Rate=Registered live birth/ Total midyear population X 1000 CBR=4.8/1000 • Most common • Easily computed • Indicates trend
Fertility rate… • GFR General Fertility Rate= Registered livebirths Midyear population of 15-49 y.o.women X 1000 • Considers population exposed to the risk. • Accuracy depends on satisfactory registration and enumeration of population.
Fertility rate.. • AGE SPECIFIC BIRTH RATE (ASBR)= Registered live births from women in the specified 5 yr age interval (15-19;20-24, 25-29;30-34;35-39.. etc)/ Corresponding population of women in the same age intervals x 1000 • Consist of 7 rates:15-19; 20-24; 25-29; 30-34; 35-39; 40-44; 45-49.
Fertility rate… • Total fertility rate=the average number of babies born to WRA TFR= 3.5 • Child-Woman Ratio= Number of children under 6 y.o. Population of women 15-49 y.o. x 1000 *Based on survivors of previous births *Used only when birth statistics is not available
Fertility rate… • Total Completed Family Size= Mean number of children ever born to the families.
Mortality rate… • This rate measures the occurrence of deaths in the community/country • Types: • Crude death rate • Specific death rate (ex: by cause, age, sex.. etc) • Proportional mortality ratio (ex: cause, age..etc) • Swaroops index • Infant mortality rate • Perinatal mortality rate • Maternal mortality rate • Fetal death rate • Case fatality rate
Mortality rate… • Crude deathrate=Total# of deaths Total population x 1000 CDR=23.1/1000 • Specific death rate, by sex= # of male (or female) deaths Total population of males (or females) x 1000 or 100,000
Mortality rate… • Proportionate mortality rate (by cause) Example: = # of deaths from Tuberculosis Total # of deaths from all causes x 100 • Swaroop’s Index= # of deaths among 50y.o.+ Total # of deaths x 100
Mortality rate… • Infant Mortality Rate (IMR)= # of deaths of babies (newborn to one year old) Total live births x 1000 IMR= 29/1000 • Neonatal Mortality Rate= # of deaths of babies (=/< 28 days old) Total live births x 1000
Mortality rate… • Post neonatal Mortality rate= # of deaths of babies (>28 days - 1 year old) Total livebirths x 1000 • Perinatal Mortality Rate= # of late fetal deaths (> 28 wks gestation) and postnatal deaths (< 1 week) Total livebirths x 1000
Mortality rate… • Maternal Mortality Rate= # of deaths in women due to pregnancy, labor, delivery and postpartum conditions Total livebirths x 100 or 1000 Philippines: 138/100,000
Mortality rate… • Case Fatality rate= # of deaths from a specific disease # of diagnosed cases of the same disease x 100 Ex: CFR PTB= 4% 4 deaths 100 cases x100
MORBIDITY RATES • Morbidity is a measure of illness burden in a community/country. Two types: PREVALENCE RATE INCIDENCE RATE
MORBIDITY RATES • PREVALENCE RATE • Total # of existing cases (old and new cases)/ Total # of population X 100,000 ( or any multiples of 10) • Answers the question: what proportion of the population is ill of this disease during the time specified? • Useful for health management and administration.
Morbidity rate • Variants of Prevalence rate: • Point prevalence-is reckoned for a specific day. For example, point prevalence rate of URTI today among UPEC board reviewers. (5/43=.116x100=11.6%) • Period prevalence-is reckoned for a duration of time, like one week or one month etc. For example, period prevalence of URTI (Nov. 15-Jan. 30) among UPEC board reviewers (12/43=.279x100=27.9%)
MORBIDITY RATE • Incidence rate • Total # of new cases of a specific disease/ Total # of people at risk of the same disease x 100,000 ( or any multiples of 10) • Requires knowledge of onset of disease • Requires data on “people at risk” • Answers the question: what is the probability of getting sick from this disease?
MORBIDITY RATE • Variants of Incidence rate • Secondary attack rate # of secondary* cases of a disease diagnosed within the incubation period/ # of persons at risk X 100 (* After an index case) Ex: Incubation period of typhoid fever is 14 days. An index case was diagnosed in a community of 100 people. On day 3, two cases; day 5-seven cases; day 8- five cases; day 11, two cases; day 14, one case; day 17, one case. SAR= (17/100= .17 x100=17%)
Morbidity rate • Person- years incidence rate In a 5- year prospective morbidity study N=1000 persons 1 yr-1000=1000 2 yr-800= 1600 3yr- 550= 1650 4yr- 300= 1200 5 yr- 220= 1100 Total= 6550 person-years 23 CASES OF DISEASE X PYIR= 23/6550
MORBIDITY RATES.. • REPORTING OF NOTIFIABLE DISEASES Immediate purposes: - To secure prompt action for preventing the spread of infectious disease, ascertaining its source and inhibiting action of the infecting cause. - To disseminate news, warning the health authorities of the affected area and adjoining areas of the progress of the disease.
NOTIFIABLE DISEASES • Cholera Filariasis Syphilis • Plaque Gonorrhea Tetanus • Smallpox Hepatitis TB • Yellow fever Influenza Typhoid • Accidents Leprosy Salmonella • AIDS Malaria Whooping cough • Bronchitis Malignant neoplasm • Dengue Pneumonia • Diphtheria Poliomyelitis • Diseases of the Heart Schistosomiasis
Board exam questions.. Registration of births, deaths and illnesses are incomplete because of • Ignorance of parents • Difficulty of communication and transportation • Non-cooperation with health personnel • All of the above The following are the uses of rates, EXCEPT • Basis for planning health programs and priorities • Indicators for disease occurrence • Disease surveillance • None of the above
Which of the following diseases is more likely to have greater frequency among the lower social class • Cancer of the lungs • Pneumonia • Ischemic heart disease • Diabetes The following are among the 10 leading causes of infant deaths in the Philippines, EXCEPT • Pneumonia • Accidents • Measles • Diarrhea
The following is/are reportable diseases in the Philippines • Malignant neoplasm • Malaria • Dengue hemorrhagic fever • Yellow fever • All of the above A 28 day old dead infant is classified as • Neonatal mortality • Fetal mortality • Post-neonatal mortality • Perinatal mortality
As a general rule, the registration of death in the Philippines is by: • Place of burial • Place of residence • Place of occurrence • Place of choice The most important entry in the medical certificate of death from the public health viewpoint • Underlying cause • Immediate cause • Intervening antecedent cause • A and B
The prime yardstick of childhealth in the community is • Number of live births • Number of pre school children • Number of well child centers • Infant and child mortality rate Post neonatal mortality is closely linked to • Maternal health prior to pregnancy • Events during pregnancy • Maternal health during pregnancy • Environmental factors
The rate that measures the probability of a person dying in a year regardless of age, sex. race, etc is • Case fatality rate • Neonatal mortality rate • Crude death rate • Specific death rate The case fatality rate of communicable diseases is primarily affected by • Virulence of offending organism • Immunity status of the population • Promptness and adequacy of medical care given • Social status of the patient
The ideal denominator for IMR is • The number of live births • Population of infants • Number of infants followed up • Total deaths from all causes. The leading cause of maternal mortality in the Philippines • Toxemia • Hemorrhage • Sepsis • Eclampsia