MEASUREMENT OF
HEALTH & DISEASE
Dr Ugo Enebeli
MBBS, MPH, FRSPH, MASTMH, MWACP, PhD
Senior Lecturer, Department of Community Medicine
Disease...
Health… Death…
Outline
• What is Measurement of Health and Disease?
• Rates: Crude, Specific, Standardized.
• Ratios.
• Proportions.
• Mortality indicators.
• Morbidity indicators.
• Uses of measurements of health and disease.
• Summary
What is measurement, health,
disease?
• Measurement of health and disease can be carried out with
Mortality and Morbidity indicators.
• Health is “a state of complete physical, mental &social well-
being, and not merely the absence of disease” (WHO, 1948).
• Disease is a spectrum of physiological/psychological
dysfunction ranging from inapparent (subclinical) to severe
manifest illness.
Tools of Measurement
The basic tools of measurement are:
• Rate.
• Ratio.
• Proportion.
Rate
• Rate measures the occurrence of a particular event (e.g. disease, health status, death) in a
population during a given time period. It’s the most common.
• Rate has a numerator, denominator, time specification and multiplier, and numerator is
related to denominator. E.g. Death Rate:
Death Rate = No of deaths in one year x 1000
Mid-year population
Categories of Rates:
• Crude rates
• Specific rates
• Standardized rates.
crude rates
• These are the actual observed rates in the total population
• Total population or mid-year population is the denominator.
• They are known as “Unstandardized rates”.
• E.g.: Birth rates and death rates.
Crude birth rate = No of live-births in a year x 1000
Total population
Crude death rate = No of deaths in a year x 1000
Total population
specific rates
• These are the actual observed rates due to specific causes (e.g. tuberculosis), or in
specific groups (e.g. age-sex groups) or during specific periods (e.g. weekly, annual
etc.).
• The particular population at risk is the denominator.
• E.gs. Age/sex-specific death rates; Specific birth rate (GFR)
Specific Birth Rate = Number of live-births in a year x 1000
No women aged 15-44 years
Age/Sex-Specific Death Rate= No of deaths in people of specified age/sex x 1000
Population of people in specified age/sex grp
standardized rates
• They are called “Adjusted rates”.
• They are used when we want to compare between two populations.
• We use a standard population to adjust/standardize ( a population in which the
age and sex group are known).
• They are obtained by direct and indirect methods of standardization.
• Direct Standardization: Compare with an expected total no. of deaths.
• Indirect Standardization: E.g. Standardized Mortality Ratio (SMR) wherein
regions with higher mortality also have higher morbidity and this is used as a
basis for allocating resources.
• SMR = Observed deaths x 100
Expected deaths
….assessment:
Decide if the following is crude, specific or standardized? Give
reason/s:
• Crude mortality rate
• Specific death rate due to tuberculosis
• Specific death rate in age group 15-20 years
• Weekly death rate
• Crude birth rate
• Standardized mortality ratio
Lecture 2
Recall:
• The basic tools of measurement are:
• Rate.
• Ratio.
• Proportion.
• After Rates, Let’s look at Ratio and Proportion.
Ratio
• Ratio is one number expressed in relation to another.
• Ratio = A/B where A and B are separate un-related quantities.
• E.g. Sex Ratio
Sex Ratio = Males
Females
Proportion
• Proportion is a special kind of ratio in which the numerator (A) is included in
the denominator (B)
• Proportion is usually a percentage (i.e. multiplier usually 100).
• E.g. Percentage of children with scabies in Abayi
Percentage of children with scabies in Abayi
= No children with scabies in Abayi in 2021 x 100
Total no of children with in Abayi in 2021
Mortality Indicators
Mortality Indicators
Commonly sourced from Death Certificates.
Information on DCs include:
• Name of deceased,
• Sex of deceased,
• Age at death,
• Cause of death – immediate and underlying.
Morbidity Indicators
• Crude mortality rate.
• Age-specific mortality rate.
• Infant mortality rate = No. deaths in a year of infants (<1yr) x 1000
No. of live births during the year
• Under-five mortality rate = No. deaths of children under 5 years of age x 1000
No. of live births during the year
• Neonatal mortality rate =
No. of deaths in a year of neonates (infants <1month) x 1000
No. of live births during the year
Morbidity Indicators
Morbidity Indicators
• Morbidity is any departure from physiological well-
being i.e. sickness, illness, disability etc.
• It gives a measure of health of the community.
• E.g. Incidence Rate = No new cases of a disease x 1000
Population at risk at a given time
• Prevalence rate = No new & old cases at a given time x 1000
Population at risk at a given time
Morbidity Indicators
• Fatality Rate = No of deaths from a specific disease x 1000
No of cases from the specific disease
• Attack ‘Rate’ = No of new cases of a disease x 100
Population at risk
NB: Attack rate is a special type of Incidence rate, and is a Percentage.
Importance of Measuring Health
& Disease
• Used in explaining trends and differentials in
overall mortality.
• Used in indicating priorities for health action.
• Used in indicating priorities for allocation of
resources.
• In designing intervention programmes.
• They give important clues for research.
In Summary:
• Measurement of health and disease can be carried out with Mortality and
Morbidity indicators.
• It involves the use of 3 basic tools of epidemiology: Rates (x1000, 10000
etc.); Ratios (un-related) and Proportions (x100).
• Mortality indicators include: crude death rate and Morbidity indicators
include Incidence rate, prevalence rate etc.
• It’s used in explaining trends and differentials in overall mortality; prioritizing
for health action & allocation; designing intervention programmes; and
research.
