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

1.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.

PLACE OF REGISTRATIONRule: Place of occurrence and within 30 days of

the event

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

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 birth18. 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 1000CBR=4.8/1000• Most common• Easily computed• Indicates trend

Fertility rate…

• GFRGeneral Fertility Rate=

Registered livebirthsMidyear 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 intervalsx 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 death rate=Total # of deaths Total population x 1000CDR=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 1000IMR= 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 100Ex: 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 rateIn 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 XPYIR= 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

A. Ignorance of parentsB. Difficulty of communication and transportationC. Non-cooperation with health personnelD. All of the aboveThe following are the uses of rates, EXCEPTA. Basis for planning health programs and prioritiesB. Indicators for disease occurrenceC. Disease surveillanceD. None of the above

Which of the following diseases is more likely to have greater frequency among the lower social class

A. Cancer of the lungsB. PneumoniaC. Ischemic heart diseaseD. DiabetesThe following are among the 10 leading causes of infant deaths in

the Philippines, EXCEPTA. PneumoniaB. AccidentsC. MeaslesD. Diarrhea

The following is/are reportable diseases in the Philippines

A. Malignant neoplasmB. MalariaC. Dengue hemorrhagic feverD. Yellow feverE. All of the aboveA 28 day old dead infant is classified asA. Neonatal mortalityB. Fetal mortalityC. Post-neonatal mortalityD. Perinatal mortality

As a general rule, the registration of death in the Philippines is by:

A. Place of burialB. Place of residenceC. Place of occurrenceD. Place of choiceThe most important entry in the medical certificate of

death from the public health viewpoint A. Underlying causeB. Immediate causeC. Intervening antecedent causeD. A and B

The prime yardstick of child health in the community isA. Number of live birthsB. Number of pre school childrenC. Number of well child centersD. Infant and child mortality ratePost neonatal mortality is closely linked to A. Maternal health prior to pregnancyB. Events during pregnancyC. Maternal health during pregnancyD. Environmental factors

The rate that measures the probability of a person dying in a year regardless of age, sex. race, etc is

A. Case fatality rateB. Neonatal mortality rateC. Crude death rateD. Specific death rateThe case fatality rate of communicable diseases is

primarily affected byA. Virulence of offending organismB. Immunity status of the populationC. Promptness and adequacy of medical care givenD. Social status of the patient

The ideal denominator for IMR isA. The number of live birthsB. Population of infantsC. Number of infants followed upD. Total deaths from all causes.The leading cause of maternal mortality in the

PhilippinesA. ToxemiaB. HemorrhageC. SepsisD. Eclampsia