1. III. Measures of Morbidity: Morbid means disease. Morbidity is an important part of community health. It gives an idea about disease status in that community. The most important measures of morbidity are incidence, prevalence & attack rate. Incidence: is the most important measure of morbidity. It is the occurrence of an event or a characteristic over a period of time.

2. No. of new events occurring during a period of time Incidence rate = ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ x 1000 Total population at risk of getting that event Notes:. Population should be free of disease at beginning of study.. The population at risk should be susceptible and exposed to the disease, (everyone in denominator must have the potential to be part of the numerator).. It is a measure of new events therefore it’s a measure of risk of disease but must be for a specific time period.. Time is an integral part of incidence. If it is not mentioned it will not be a rate, it will be a proportion.

3. Uses of incidence: 1.Describe the rate of diseases occurrence overtime. 2.Assess patient survival from diseases. 3.Compare the risk of disease between two or more populations (relative risk). 4.Since the incidence rates are affected by any factor that affects the development of a disease, they can be used to detect the etiologic factors. But note that, the incidence rate is obtained from cohort studies (follow up studies).

4. E.g. a study examined the occurrence of TB in a district. A total of 10000 persons who have no TB were followed for the year 2010. It was seen that 15 persons developed the disease in that year. No. of new cases of TB in year 2010 Incidence rate of TB = ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ x 1000 in the village Total persons at risk of having TB during 2010 15 Incidence rate = ـــــــــــــــ x 1000 = 1.5 cases of TB /1000 10000 population in that year

5. Prevalence: is the presence of the disease in the community whether old or new cases in a well defined population. No. of new and old events occurring at a point of time Prevalence rate = ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ x k Total population at risk of getting that event Uses of prevalence: 1. Describes the burden of a disease in a community, thus it's important for health care planner to put and implement the effective health programs for the control and prevention of any disease. 2. Define the rate of clinical characteristics in subjects with specified diseases. 3. Estimates the probability of having a disease given the result of a diagnostic test result. But note that, prevalence rate is obtained from cross-sectional studies (community studies).

6. There are two types of prevalence: 1.Point prevalence: is the no. of events that are present at a point in time whether old or new cases. This is the most used form of prevalence. No. of new and old events occurring at a point in time Point Prevalence rate= ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ x1000 Total population at risk of getting that event 2. Period prevalence: is the no. of cases of disease whether old or new that are present within a period of time (usually a calendar year). No. of new and old events occurring during a period of time Period Prevalence rate= ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ x 1000 Total population at risk of getting that event

7. 1 2 3 4 5 P1 p2 Incidence : cases 1, 2 & 4 Point prevalence p1 : cases 1,2, 3 & 5, p2 : cases 2, 4 & 5 Period prevalence : cases 1, 2, 3, 4 & 5 Period of time 1 year

8. Relation between incidence & prevalence: Prevalence rate is influenced by both the incidence of disease and its duration. It sometimes approximates the incidence rate if the course of disease is short. Prevalence = Incidence × Duration of disease (P = I×D) Example: There were 120 cases of typhoid fever in a small city (50000 pop.) at 1 st Jan.2002. At the end of this year there were 30 added cases of that disease. At April of that year 60 cases (old and recently diagnosed). Calculate the point prevalence (at April,2002) and period prevalence for the year 2002.

9. No. of new and old cases of typhoid fever at April Point Prevalence = ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــx 1000 rate Total population at risk of getting that event 60 Point Prevalence = ـــــــــــــــــــــــ x 1000 = 1.2 cases of typhoid fever rate 50000 per 1000 pop at April, 2002. No. of cases present at the beginning of 2002 + new events occurring during that period of time Period Prevalence= ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ x1000 rate Total population at risk of getting that disease 120 + 30 Period Prevalence = ـــــــــــــــــــــــــــ x 1000 = 3 cases of typhoid fever/1000 rate 50000 population during 2002

10. Attack Rate: is an incidence rate during a limited time period. For infectious diseases, the attack rate is the number of secondary cases occurring within the accepted incubation period divided by the number of susceptible individuals in a closed group exposed to the primary (index) case. No. of new events occurring during a limited time period Attack rate = ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ x 1000 Total population at risk of getting that event

11. Example A study was done to assess the health status of a community with a total population of 50000. It was seen that in 1 year: Live births = 2000 Total deaths = 500 Stillbirths = 90 Neonatal deaths = 300 Deaths due to leukemia = 15 Cases of leukemia = 45 Calculate the main fertility, morbidity, and mortality measures of this community.

12. Answer Fertility measures: No. of live births during one year *Crude Birth Rate = ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ x 1000 Midyear population 2000 Crude Birth Rate = ــــــــــــــ x1000 = 40/1000 pop. 50000 Mortality measures: No. of stillbirths during one year *Stillbirth rate = ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ x 1000 Total births (stillbirths + live births) 90 Stillbirth rate = ـــــــــــــــــــــــــــــ x1000 = 43.1/1000 total births. 90+2000

13. Deaths among neonates(<4 weeks of age) during one year *Neonatal Mortality Rate = ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ x1000 Total live births 300 Neonatal Mortality Rate = ــــــــــــ x 1000 = 150/1000 live births. 2000 Deaths due to leukemia during one year *Cause specific = ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ x1000 mortality rate Total population at risk of getting the disease 15 Cause specific = ــــــــــــــــــــــــ x 1000 = 0.3/1000 pop. died due to leukemia. mortality rate 50000

14. Deaths due to leukemia during one year *Case fatality rate = ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ x 100 Total no. of leukemia cases in that year 15 Case fatality rate =ـــــــــــــــ x 100 = 33.4% of leukemia cases died in that year. 45 No. of deaths from leukemia During one year *Proportional mortality = ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــx100 Total no. of deaths in that year 15 Proportional mortality = ــــــــــــــــx 100 = 3% of all deaths were due to leukemia. 500

15. Total deaths (all ages, both sexes, all causes) *Crude Death Rate = ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ x1000 Midyear population 500 Crude Death Rate = ــــــــــــــــــــ x 1000 = 10/1000 pop. 50000 Morbidity measures: No. of new cases of leukemia occurring during a period of time *Incidence rate= ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــx1000 Total population at risk of getting the disease 45 Incidence rate= ــــــــــــــx1000 = 0.9/1000 pop. is the incidence of leukemia. 50000