1. MORBIDITYANDMORTALITY

2. To review about health indicators To understand meaning of mortality To explain the limitations of mortalityindicators To list out the uses of mortalityindicators To define the mortality indicators 3. To explain the meaning ofmorbidity To enumerate the types ofmorbidity rates To explain the meaning ofprevalence and incidence rate To compare the relationshipbetween prevalence and incidence To define compression of morbidityrate 4. INDICATORS OF HEALTH :- 5. The indicators of health may be classified as follows:Mortality indicatorsMorbidity indicatorsDisability ratesNutritional status indicatorsHealth care delivery indicators 6. Utilization ratesIndicators of social and mental healthEnvironmental indicatorsSocioeconomic indicatorsHealth policy indicatorsIndicators of quality of lifeOther indicators 7. MORTALITY :- 8. Mortality is the condition of being mortal, or susceptible to death; theopposite of immortality 9. Limitation inmortality data 10. Incomplete reporting of deathLack of accuracyLack of uniformityChoosing a single cause of deathChanging coding system and changing fashion in diagnosisDiseases with low vitality 11. USES OFMORTALITYDATA 12. In explaining trends and differentialsin overall mortality Indicating priorities for health actionand allocation of resources In designing intervention programmeand Assessment and monitoring of publichealth problems and programmes Givesclues for epidemiologicalresearch 13. MORTALITYINDICATORS andMORTALITY RATESAND RATIOS 14. It is defined as the number ofdeath per 1000 estimatedmidyear population per yearin a given community. Itindicates the rate at whichpeople are dying. 15. Crude Death rate =no: of death occurred in an year 1000 Estimated mid - year population 16. The crude death rate summarizes the effect of two factors;Population compositionAge specific death ratesDeath rate of India : 6.23 deaths/1,000 population (July 2009 est.) 17. Life expectancy at birth is the average number of years that will be lived by those born alive into a population if the current age specific mortality rates persist 18. It is estimated for both sex separately. Life expectancy is a good indicator ofsocioeconomic development in general. As an indicator of long term survival ,it can be considered as a positiveindicator. Help to identify what is happening tooverall standard of living of people inIndia. 19. One of the broadest standard of livingmeasure is the life expectancy - the averageexpected lifespan of an Indian is ; Total population: 69.89yearsmale : 67.46yearsfemale : 72.61 years (2009 est.) 20. Infant mortality rate is defined as the ratio of infant deaths registeredin a given year to the total numberof live birth registered in the sameyear; usually expressed as a rate per1000 live births 21. IMR=no: of death under 1yr age in 11000No: of live birth during that year 22. Infantmortalityrate: total: 30.15deaths/1,000livebtmale: 34.61deaths/1,000livebirthsfemale: 25.17 deaths/1,000 livebirths (2009 est.) 23. NEONATALMORTALITY RATE 24. Neonatal mortality rate:= no of death ,under 28 days of age occurred during a y1000. no of live birth during that year 25. i 26. MATERNALMORTALITY RATE; 27. Maternal death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy irrespective of the duration ,and the site of pregnancy from any cause related to or aggravated to by the pregnancy or its management but not from accidental or incidental causes. 28. MMR =no of female death from pregnancy,child birth,orPuerperial causes in an year1000 no of live birth in same area during that year 29. Journal studyChanging trends in maternalmortality over a decade study the change in trend in maternal mortality over the last decade and to find out specific causes of death. Method: A retrospective study was carried out. The admission ledgers of patients admitted over two 3-year periods (19791981 and 1989 1991) were studied to ascertain the total number of maternal deaths and the specific causes of death 30. FETAL DEATH RATES 31. The WHO subdivided the fetal death based on gestation as follows : Early : under 20 weeks Intermediate : 20 to 27 weeks Late: 28 weeks and over 32. The still birth rate (late fetal death rate) correspond toStill birth rate = no of fetal death, 28wks of gestation or more occurred during a y1000 no of live birth plus late fetal death during that year 33. Late foetal death rate =no of foetal death,28 week of gestation Or more occurred during a yr 1000No of live births during that year 34. It is defined as the number asthe number of death at age 1-4 yrs in a given year ,per 1000children in that age group atthe midpoint of the yearconcerned. It thus excludesinfant mortality. 35. CHILD SURVIVALINDEX:- 36. A child survival rate per 1000 birthcan be simply calculated bysubtracting the under 5 mortalityrate from 1000 dividing this figureby ten shows the percentage ofthose who survive to the age of 5yrs 37. Child survival rate =1000 under 5 mortality rate 10 38. Disease specific mortality 39. Mortality rates can be computedfor specific diseases. As countriesbegin to extricate themselves fromburden of communicable disease, anumber of other indicatorsemerged as measures of specificdisease problem. 40. PROPOTIONAL MORTALITY RATE 41. It is useful to know what proportion of total death are due to particular disease.(eg cancer)The simplest measure of estimating the burden of a disease in the community is proportional mortality rate.. ie, the proportion of all death currently attributed to it.Proportional mortality rate for a specific disease; is 42. = No ofdeaths from the specificdisease inyear x 100/Total death from all causes inthat year 43. CASE FATALITY RATE:- 44. = total no of death due to a particular diseasx100 total no of cases with same disease 45. It determines the killing power of adisease It is simply the ratio of death to case It is typically used in acute infectiousdiseases( eg: food poisoning, choleraetc) 46. Specific mortality rate:- This rate can be made specific withregard to any subgroup of thepopulation such as age specific death rate for group A sex specific death rate for sex M or cause specific death rate for cause C. A refers to a specific age; C refers tospecific cause of death; M and F refersto their gender . 47. Age specific death rate for A = no of death of age A in an year 1000Estimated population of age A midyearsex specific death rate for group M =no of death of sex M in an year 1000estimated population of sex M midyear Cause specific rate=no of death due to cause C occurred in a year1000 estimated midyear population 48. Adjusted or standardized rates: If we want to compare the death rates oftwo populations with different age-composition, we can use age adjustmentor age Standardization. There are two ways of computingstandardized death rates direct and indirect standardization. 49. Direct Standardization (SDR1) calculatesa weightedaverageof the regions age-specific mortality rates 50. Indirect Standardization (SDR2) usesage-specific mortality rates from the standard population to derive expected deaths in the regions population 51. Direct Standardization: SDR1 = [ age groups (Mar Pas)]/Ps x 1000 Mar is the age-specific mortality rate for the region. Pas is the number of people in the age group in the standard population. Ps is the total standard population. 52. INDIRECT STANDARDISATION SDR2 = Dr/[ age groups (Mas Par)] x CDRs Mas is the age-specific mortality rate for the standard population. Par is the number of people in the age group in the regions population. Dr is the number of deaths in the region. CDRs is the crude death rate for the standard population. 53. MORBIDITY 54. Morbidity has been defined as any departure, subjective or objective, from a state of physiological well being .The problem is equivalent to such terms as sickness , illness, disability etc. 55. The WHO Expert committee on HealthStatistics noted in its 6th report thatmorbidity could be measured in termsof 3 units- a. person who ill ; b. theillness that these personsexperienced and c. the duration of these illness. 56. The value of morbidity data is summarized as; They describe the nature and extend of the diseaseload in the community and thus assist in theestablishment of priorities They usually provide more comprehensive andmore accurate and clinically relevant informationon patient characteristic. They act as starting points for aetiological studies,and thus play a crucial role in disease prevention They are needed for monitoring and evaluation ofdisease control activities 57. Morbidity indicators:- To describe health in terms of mortality is misleading. This is because the mortality indicators do not reveal the burden of ill health in a community , as for example mental illness and rheumatoid arthritis. Therefore morbidity indicators are used to supplement mortality data to describe the health status of a population. 58. Morbidity statistics have also their own drawback; they tend to overlook a large number of condition which are subclinical or inapparent , that is , the hidden part of the iceburg of disease 59. The following morbidity rates areused for assessing the ill health in the community. Incidence and prevalence Notification rates Attendance rate at outpatient department,health centres ,etc Admission readmission and discharge rates Duration in hospital and Spells of sicknessor absence from work or school 60. Incidence 61. Incidence rate is defined as : the number of NEW cases occurring in a defined population during a specified period of time. It is given by the formula . Incidence= no of new case of specific disease during given time period/ 1000Population at risk during that period 62. incidence rate refers Only to new cases During a given period(usually one year) In a specified population or population at risk ,unlessother denominators are chosen It can also refer new spells or episodes of diseasearising in a given period of time , per 1000 population.For example , a person may suffer from common coldmore than once a year . If he had suffered twice , hewould contribute two spell of sickness in the year. Theformula in this case would be 63. Incidence rate(spell) = no ofspells of illness starting in adefined period 1000mean no of person exposed to riskin that period 64. PREVALENCE The term disease prevalence refers specifically to all current cases( old and new) existing at a given point of time , or over a period of time in a given population 65. DEFINITION thetotal number of all individuals who have an attribute or disease at a particular time ( or during a particular period) divided by the population at risk of having the attribute or disease at this point in time or midway through the period . 66. Prevalence is of two type;Point prevalencePeriod prevalence 67. Point prevalence:- Point prevalence of a disease is defined asthe number of all current cases ( old andnew) existing at a given point of time inrelation to a defined population. The point in point prevalence, may for allpractical purpose consist of a day ,severaldays or even few weeks depending uponthe time it takes to examine the populationsample. It is given by the formula; 68. = No of all current cases (old & new)of a specified disease at a given point in time / 100 Estimated population at the same point in time 69. Period prevalence:-A less commonly used measure ofprevalence is period prevalence. It measuresthe frequency of all current cases (old andnew) existing during a defined period oftime ( eg:- annual prevalence) expressed inrelation to a defined population . It includes cases arising before butextending into or through to the year as wellas those cases arising during the year .period prevalence is given by the formula : 70. = no of existing cases(new& old) of a specificdisease during a given period of time interval /100estimated mid interval population at risk 71. Relationship between prevalence and incidence:- 72. Prevalence depends upon 2 factors , the incidence and duration of illness . given the assumption that the population is stable , and incidence and duration are unchanging , the relationship between incidence and prevalence can be expressed as: 73. P= I D=incidence mean duration 74. Uses of prevalence:_- Helps to estimate the magnitude of health/disease problems in the community andidentify potential high risk population Prevalence rates are especially useful foradministrative and planning purpose , eg:hospital beds , manpower needs ,rehabilitation facilities ,etc . 75. THANK YOU