Manish Chaudhary MPH( BPKIHS) manish264@gmail.com Sources of Data Manish Chaudhary MPH( BPKIHS) manish264@gmail.com

Different sources of data Census Registration of vital events Notification of diseases Hospital records Disease registers Epidemiological surveillance Environmental health data Health manpower statistics Population surveys Other health service records

Census A census is defined by the UN as “ the total process of collecting, compiling and publishing demographic, economic and social data pertaining at a specific time or times, to all persons in the country or delimited territory.” It is usually done once in every 10 years at regular intervals by every country. Recent census in Nepal is conducted in 2011.

Census A census contains information on subjects not only demographic but also social and economic characteristics, conditions under which they live, how they work, their income and basic information. Census provide basic data needed to compute vital statistical rates and other health, demographic and socio economic indicators.

Limitations of Census It needs considerable organization, a vast preparation and long time to analyze the results Full results are not available quickly.

Registration of vital events Registration of vital events( birth, deaths, marriage) keeps a continuous check on demographic changes. If registration of vital events is complete and accurate it can serve as a reliable source of health information. Vital events: births, foetal deaths, marriages, divorces, adoptions etc

Registration of vital events Limitations Registration system in Nepal is unreliable, the data being grossly deficient in regard to accuracy, timeliness, completeness and coverage because of illiteracy, ignorance and lack of concern and motivation.

Notification of Diseases Reporting of certain diseases or other health related conditions by a specific group, as specified by law, regulation, or agreement

Notification of Diseases Disease or hazard-specific notifications Communicable diseases World Health Organization: International health regulations require reporting of cholera, plague, and yellow fever Nepal: Polio, Measles, Hepatitis B, Malaria, Kala-azar, Japanese Encephalitis

Notification of Diseases Chemical and physical hazards in the environment Childhood lead poisoning Occupational hazards Firearm-related injury Consumer product-related injury Notifications related to treatment administration Adverse effect of drugs or medical products Adverse effect from vaccines

Notification of Diseases Notifications related to persons at risk Elevated blood lead among adults Elevated blood lead among children Limitations: Notification covers only part of total sickness in the community. System suffers good deal of under reporting. Many atypical and subclinical cases escape notification due to non recognition.

Hospital Records A hospital record serves as Geographic sources of patients Age and sex distribution of disease and duration of hospital stay Association between different diseases The period between onset of disease and hospital admission Cost of hospital care

Hospital Records Hospital data constitute a basic and primary source of information about diseases prevalent in the community. Limitations: They constitute only the tip of an iceberg, population at risk can not be defined.

Disease Registers A register requires that permanent record be established, that cases be followed up, and that basic statistical tabulations be prepared both on frequency and on survival. Patients on registers should be frequently be subjects of special studies. Morbidity registers exists only for certain diseases stroke, myocardial infarction, cancer, congenital defects, tuberculosis and leprosy. Limitation: Coverage is not national or representative basis

Epidemiological surveillance Special disease control/elimination program have been instituted for particular endemic diseases e.g malaria, JE, kala-azar etc. Surveillance system are set up to report on the occurrence of new cases and on efforts to control the disease. Limitations: Surveillance system does not cover all diseases.

Environmental Health data Environmental data can be helpful in the identification and quantification of factors causative of disease. Multiple qualitative and quantitative approaches are used to monitor the environment, depending on the problem, setting, and planned use of the monitoring data. Monitor air pollutants Cities and towns monitor public water supplies for bacterial and chemical contaminants

Environmental Health data Health agencies monitor animal and insect vectors for the presence of viruses and parasites that are harmful to humans Departments of transportation monitor roads, highways, and bridges to ensure that they are safe for traffic; they also monitor traffic to ensure that speed limits and other traffic laws are observed Occupational health authorities monitor noise levels in the workplace to prevent hearing loss among employees Limitations Environmental data are not aggregated

Health manpower Data Health manpower data are available from their respective councils Nepal Medical Council Nepal Nursing Council Nepal Health Professional Council Nepal Pharmacy Council Limitation: Not all kinds of health manpower are registered All health manpower are not registered

Population Surveys Structured and systematic gathering of information Probably the most common method used for gathering information about populations Designed to obtain specific information Can be conducted once or on a periodic basis Nepal Demographic and Health Survey Nepal Micronutrient Status Survey

Other health service records Demographic: Population density, movement, educational level Economic: consumption of tobacco, dietary fats, sales of drugs and remedies, per capita income, employment and unemployment data Social security: Medical insurance, disability benefit rate

Organizations as primary source of epidemiological data Central Bureau of Statistics – Census Ministry of Local Development and Ministry of Health and population- Health related data and vital statistics Department of health services: annual report WHO- notifiable disease Epidemiology and Disease Control Division Department of Drug Administration Ministry of housing and physical planning NHIECC, NGOs and INGOs

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