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UKURAN DAN INDIKATOR EPIDEMIOLOGI PENYAKIT KRONIS . Oleh : Dr. Edison, MPH Bagian Ilmu Kesehatan Masyarakat dan ILmu Kedokteran Komunitas Fakultas Kedokteran Universitas Andalas. Parameter epidemiologi ;

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Ukuran dan indikator epidemiologi penyakit kronis

UKURAN DAN INDIKATOR EPIDEMIOLOGI PENYAKIT KRONIS

Oleh :

Dr. Edison, MPH

BagianIlmuKesehatanMasyarakat

danILmuKedokteranKomunitas

FakultasKedokteranUniversitasAndalas


  • Parameter epidemiologi ;

    adalah ukuran-ukuran yang dipergunakan untuk mengukur masalah kesehatan yang terjadi pada sekelompok penduduk, meliputi :

    - ukuran penyakit

    - ukuran kematian

    - ukuran status kesehatan


  • Ukuran Frekuensi Penyakit

    Dalam mengukur frekuensi penyakit ada beberapa hal yang harus diperhatikan yaitu :

    1. Frekuensi penyakit yang dimaksud saja

    2. Semuanya masuk dalam pengukuran

    3. Penyajiannya harus optimal dalam bentuk ;

    a. angka mutlak

    b. rate

    c. ratio


* Populasi Beresiko ( Population at Risk )

Dalam mengukur frekuensi penyakit, populasi beresiko perlu diperhitungkan.

Populasi beresiko : populasi yang susceptible / yang beresiko untuk terkena suatu panyakit.

Population at risk in a study of Ca-cervix uteri

Total population All women Pop. at risk

0 -25 years

All men All women 25 – 69 years 25 – 69 years

70 + years


  • Ukuran Frekuensi Penyakit

    1. Incidence rate: jumlah even / kasus baru yang terjadi dlm suatu periode waktu tertentu ( bulan, tahun ) dibagi dengan populasi beresiko dalam periode waktu yang sama.

    a. Person-time incidence rate

    Number of people who get a disease in

    specified period

    I = X ( 100, 1000 )

    Sum of the length of time during which

    person in the population in at risk


  • Relationship between cigarette smoking and incidence rate of stroke in a cohort of 118539 women

    Smoking No.of cases Person-years Stroke IR

    category of stroke of observation per 100.000

    ( over 8 years ) person-years

    Never smoked 70 395 594 17.7

    Ex-smoker 65 232 712 27.9

    Smoker 139 280 141 49.6

    Total 274 908 447 30.2

    Souce : Colditz et al.., 1988. Reproduced by kind permission of the publisher


  • b. Cumulative incidence rate ( Risk ) stroke in a cohort of 118539 women

    Merupakan pengukuran yang simpel untuk kejadian penyakit atau status kesehatan. Denominatornya adalah populasi beresiko pada permulaan studi.

    Number of people who get a disease during

    a specified period

    CI = X (100, 1000)

    Number of people free of the disease in the

    population at risk at the beginning of the period


  • 2. Case Fatality Rate ( CFR ) stroke in a cohort of 118539 women

    Merupakan ukuran untuk menyatakan keganasan (severity) dari suatu penyakit.

    Number of deaths from a disease in the

    specified period

    CFR = X 100 %

    Number of diagnosed cases of the disease

    In the same period


  • Kesulitan dalam menghitung Insidens stroke in a cohort of 118539 women

    1. Menentukan penderita / kasus baru

    2. Menentukan populasi beresiko

  • Manfaat Insidens

    1. Diketahuinya masalah kesehatan yang sdg dihadapi

    2. Diketahuinya populasi yang beresiko

    3. Dikethuinya beban kerja pelayanan kesehatan


  • 3. Prevalence rate ( P ) stroke in a cohort of 118539 women

    Ada 2 macam :

    a. Point Prevalence rate

    Number of people with the disease at

    one point in time

    = X (100, 1000)

    Number of people in the population at

    risk at the same time

    Data populasi beresiko sering tidak tersedia, untuk itu dipakai jumlah seluruh populasi pada waktu yang sama.


  • b. Period Prevalence Rate stroke in a cohort of 118539 women

    Number of people with the disease in

    a specified period

    = X ( 100, 1000 )

    Number of people in the population at

    risk in the mid of a specified period

    Angka prevalens dapat menunjukan mutu pelayanan kesehatan yang dilaksanakan.

    P tinggi mutu yankes rendah

    P rendah mutu yankes baik / rendah sekali


  • Faktor-faktor yang mempengaruhi Nilai Prevalence. stroke in a cohort of 118539 women

    1. the severity of illness

    2. the duration of illness

    3. the number of new cases

  • Hubungan Prevalence dengan Incidence

    P = I x d P = prevalence

    I = incidence

    d = duration of disease


  • Factors influencing observed prevalence rate stroke in a cohort of 118539 women

    Increased by : Decreased by :

    - Longer duration of the disease - Shorter duration of the disease

    - Prolongation of life of patients - High case-fatality rate from

    without cure desease

    - Increase in new cases - Decrease in new cases

    ( increase in incidence ) ( decrease in incidence )

    - In-migration of cases - In-migration of healthy people

    - Out-migration of healthy people - Out-migration of cases

    - In-migration of susceptible - Improved cure rate of cases

    - Improved diagnostics facilities

    ( better reporting )


  • Example of calculation of disesase occurrence stroke in a cohort of 118539 women

    Total time under

    observation and in

    Individualshealth ( years )

    1 ________________________________________ 7

    2 ________________________________________ 7

    3 _______...............................d 2

    4 ________________________________________ 7

    5 _____________--------------------------------------------- 3

    6 _______.................................................................. 2

    7 ________________________.......................... 5

    ________________________________________

    1 2 3 4 5 6 7

    Years of follow-up

    ___ healthy period ….. disease period

    ----- lost to follow-up d = death


  • 1. The incidence rate of the disease during the seven-year period is the number of new cases ( 3 ) divided by the sum of the lengths of time at risk of getting the disease for the population ( 33 person-years ), i.e. 9.1 cases per 100 person-years.

  • 2. The cumulative incidence rate is the number of new cases ( 3 ) divided by the number of people at risk free of the disease at the beginning of the period ( 7 ), i.e. 43 cases per 100 persons during the seven years.

  • 3. The average duration of disease is the total number of years of disease divided by the number of cases, i.e. 10 / 3 = 3.3 years.

  • 4. The prevalence rate at the start of year 4 = 2 / 6 = 33 cases per 100 persons.


Ukuran risiko penyakit
Ukuran period is the number of new cases ( 3 ) divided by the sum of the lengths of time at risk of getting the disease for the population ( 33 person-years ), i.e. 9.1 cases per 100 person-years.RisikoPenyakit

  • Relative risk (RR)

  • Odd’s ratio

  • Adalahukuran yang menunjukkankekuatanhubunganterjadinyapenyakitdenganfaktorrisiko.


  • Pengertian period is the number of new cases ( 3 ) divided by the sum of the lengths of time at risk of getting the disease for the population ( 33 person-years ), i.e. 9.1 cases per 100 person-years.Indikator :

    Variabel-variabel yang dapatdigunakanuntukmembantudalammengukurperuba-han yang terjadi.

    langsung

    Indikator

    tidaklangsung

    Ciri-ciriindikator

    1. Validbenar-benarmengukur yang

    seharusnyadiukur


  • 2. Reliable period is the number of new cases ( 3 ) divided by the sum of the lengths of time at risk of getting the disease for the population ( 33 person-years ), i.e. 9.1 cases per 100 person-years.

    Dipergunakanpadawaktudankeadaan yang berbedahasilnyasama.

    3. Spesifik

    Mengalamiperubahanhanyapadafenomena yang ingindiukur.

    4. Sensitif

    Pekaterhadapperubahan yang terjadi.


5. period is the number of new cases ( 3 ) divided by the sum of the lengths of time at risk of getting the disease for the population ( 33 person-years ), i.e. 9.1 cases per 100 person-years.Dapatmemberikanartidanmakna

suatukeadaan.

6. Mudahdioperasionalkan

7. Logisdanrasional

Contoh :

Surveillans AFP ; AFP rate padapopulasi

< 15 thn, batasannya < 2 / 100.000.


  • Kegunaan period is the number of new cases ( 3 ) divided by the sum of the lengths of time at risk of getting the disease for the population ( 33 person-years ), i.e. 9.1 cases per 100 person-years.Indikator

    1. Menentukanbatasansuatumasalah

    2. Menentukankeseriusanmasalah

    3. Alatuntukmengevaluasikegiatan

    * Jenis-jenisIndikator

    1. Indikator morbidity, mortality, disability.

    2. Indikatorfaktorresiko ; RR dan OR

    3. Indikatorhasillaboratorium

    4. Indikator program ; input, proses, output

    dan outcome.


Ukuran period is the number of new cases ( 3 ) divided by the sum of the lengths of time at risk of getting the disease for the population ( 33 person-years ), i.e. 9.1 cases per 100 person-years.kematian

Masalah :

* Pencatatanseringtidaklengkap

* Akurasipencatatankurang

Number of deaths in a specified period

Crude mort. rate = x 1000

Average total pop. during that period

Nilainyadipengaruhioleh : umur, seks, ras, kelassosio-ekonomi, dll

Death rate can be usefully for specific groups in a population which are defined by age, race, sex, occupation, geographical location, or for specific causes of death.


Case fatality rate cfr
Case Fatality Rate (CFR) period is the number of new cases ( 3 ) divided by the sum of the lengths of time at risk of getting the disease for the population ( 33 person-years ), i.e. 9.1 cases per 100 person-years.

  • Adalahjumlahkematiansuatupenyakitdalamwaktutertentudibagidenganjumlahkeseluruhanpenyakittersebutdalamwaktu yang sama x 100%

    A

    CFR = ------ x 100%

    B

    A = Jumlahkematiansuatupenyakit

    B = Jumlahkeseluruhanpenyakit


TERIMA KASIH period is the number of new cases ( 3 ) divided by the sum of the lengths of time at risk of getting the disease for the population ( 33 person-years ), i.e. 9.1 cases per 100 person-years.


  • Infant Mortality Rate ( IMR ) period is the number of new cases ( 3 ) divided by the sum of the lengths of time at risk of getting the disease for the population ( 33 person-years ), i.e. 9.1 cases per 100 person-years.

    * Indicator of the level of health in a community

    * Sensitive to socioeconomic changes and to health- care intervention

    Number of deaths in a year of children

    less than 1 year of age

    IMR = x 1000

    Number of live births in the same year

    Angka kematian anak ( 1 – 4 th ) penting karena berhubungan dengan kecelakaan / rudapaksa, malnutrisi dan penyakit infeksi.

    Ukuran lain yaitu Maternal mortality rate, life expectancy.


  • Comparing disease occurrence period is the number of new cases ( 3 ) divided by the sum of the lengths of time at risk of getting the disease for the population ( 33 person-years ), i.e. 9.1 cases per 100 person-years.

    1. Absolute comparison

    a. Risk difference ( Attributable risk )

    ( 49.6 – 17.7 ) = 31.9 per 100.000

    b. Attributable fraction ( exposed )

    ( 49.6 – 17.7 ) / 49.6 = 64 %

    c. Population attributable risk ( PAR )

    ( 49.6 – 17.7 ) x 0.51 = 16.3 per 100.000

    2. Relative comparison

    Risk ratio ( Relative risk ) yaitu rasio kejadian penyakit pada kelompok terekspos dengan kelompok tidak terekspos ( 49.6 / 17.7 = 2.8 )


Strategi epidemiologi
STRATEGI EPIDEMIOLOGI period is the number of new cases ( 3 ) divided by the sum of the lengths of time at risk of getting the disease for the population ( 33 person-years ), i.e. 9.1 cases per 100 person-years.

  • Suatu pola pendekatan berupa suatu rangkaian kegiatan tertentu yang akan diterapkan dalam mengkaji masalah-masalah kesehatan sedemikian rupa sehingga diperoleh berbagai kejelasan tentang masalah kesehatan tersebut.

  • Unsur pokok : 1. merumuskan hipotesa

    2. menguji hipotesa

    3. menarik kesimpulan


  • Hipotesa : period is the number of new cases ( 3 ) divided by the sum of the lengths of time at risk of getting the disease for the population ( 33 person-years ), i.e. 9.1 cases per 100 person-years.

    * Adalah kesimpulan atau jawaban sementara dari suatu

    masalah yang sedang dihadapi.

    * Dirumuskan berdasarkan data frekuensi dan distribusi

    masalah kesehatan.

    * Unsur pokok hipotesa : manusia, agen, akibat, dosis-

    sebab dan waktu.

    * Disusun berdasarkan :

    - Method of difference

    - Method of agreement

    - Method of concomitant variation

    - Method of analogy


  • Types of epidemiological study period is the number of new cases ( 3 ) divided by the sum of the lengths of time at risk of getting the disease for the population ( 33 person-years ), i.e. 9.1 cases per 100 person-years.

    I. Observational studies

    1. Descriptve study

    2. Analytical study a. Cohort study

    b. Case-control study

    c. Cross-sectional

    d. Ecological study

    II. Experimental studies

    1. Randomized control trials

    2. Field trials

    3. Community trials


Thank you
THANK YOU period is the number of new cases ( 3 ) divided by the sum of the lengths of time at risk of getting the disease for the population ( 33 person-years ), i.e. 9.1 cases per 100 person-years.


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