Epidemiology in Health Planning

Epidemiology in Health Planning: 

Epidemiology in Health Planning State Institute of Health & Family Welfare, Jaipur

Epidemiology : 

Epidemiology “ Study of distribution and determinants of health related state or events & disease in human population” “Science of rates expressed as probability” 2 SIHFW-an ISO 9001:2008 certified Institution

Epidemiology: Basic approach: 

Epidemiology: Basic approach Counts cases (events). Defines involved population. Determines rates/proportions Compares rates. Makes inferences 3 SIHFW-an ISO 9001:2008 certified Institution

Epidemiology vis-à-vis Management: 

Epidemiology vis-à-vis Management Identify Problems – Descriptive Epidemiology Setting Priorities - Impact, Cost and Feasibility Identify Causes - Analytic Epidemiology: Case Control Studies Cohort Studies Interventions - Experimental Studies M & E – Using Epidemiologic Measures 4 SIHFW-an ISO 9001:2008 certified Institution

: 

Why Health Managers should Know Epidemiologic Concepts and Methods ? 5 SIHFW-an ISO 9001:2008 certified Institution

Why………………: 

Why … …………… Increasing size of populations served by the providers, Understand the characteristics and health status of population, Understand the consequences of health care problems, Evidence of impact of health system on health status, The necessity of monitoring performance – programs and system, The continuous need for restructuring health system/program and process, and The development and evaluation of public policy 6 SIHFW-an ISO 9001:2008 certified Institution

Epidemiology can Answer such questions:: 

Epidemiology can Answer such questions: Quantification by counting Order of priorities based on Incidence/ Prevalence What are the High risk groups in population Value of early case finding( Lives saved, cost) What Resources needed Whether Screening programs be established Utilization Impact- Reduction in Mortality/ Morbidity Do the Health benefits justify the Cost (Cost effectiveness) 7 SIHFW-an ISO 9001:2008 certified Institution

To answer, one needs to Epidemiological Skills: 

To answer, one needs to Epidemiological Skills 8 SIHFW-an ISO 9001:2008 certified Institution

Health related State or events: 

Health related State or events Epidemics / outbreaks Endemic levels Chronic diseases Birth defects Injuries Reproductive health Occupational Health Environmental health 9 SIHFW-an ISO 9001:2008 certified Institution

Descriptive Epidemiology: 

Descriptive Epidemiology Descriptive epidemiological approach attempts to describe the disease in terms of its attributes & variables and answers the questions like- Who (Person) Where (Place) When (Time) 10 SIHFW-an ISO 9001:2008 certified Institution

Descriptive Epidemiology: Objectives: 

Descriptive Epidemiology: Objectives To evaluate trends in health & disease and allow comparison among different population groups To provide basis for planning , provision and evaluation of services To identify problems to be studied by analytical methods 11 SIHFW-an ISO 9001:2008 certified Institution

A. Distribution (Where, Who, When): 

A. Distribution (Where, Who, When) Frequency Rate Pattern Time Place Person 12 SIHFW-an ISO 9001:2008 certified Institution

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Person: Place: Time: Who? Where? When? Descriptive Epidemiology 13 SIHFW-an ISO 9001:2008 certified Institution

Who (Person) ? Is getting the disease: 

Who (Person) ? Is getting the disease Attributes & Variables Age Sex Ethnicity Marital status Occupation Education Income group………… 14 SIHFW-an ISO 9001:2008 certified Institution

Age: 

Age Malnutrition Measles STI Arthritis / Cancer 15 SIHFW-an ISO 9001:2008 certified Institution

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Gap starts narrowing after 54 (menopause), suggests protective effect of estrogen Sex 16 SIHFW-an ISO 9001:2008 certified Institution

Where (Place) ? Where Rates are highest and lowest: 

Where (Place) ? Where Rates are highest and lowest Residence Occupation/ Work place At specific events Geographic sites 17 SIHFW-an ISO 9001:2008 certified Institution

Time (When) ? Reflects on trend: 

Time (When) ? Reflects on trend Year Season Day Date of Onset Duration 18 SIHFW-an ISO 9001:2008 certified Institution

Time trends : 

Time trends Secular (Changes that occur over long periods of time) Periodic (short term) Cyclic (Seasonal) Epidemic 19 SIHFW-an ISO 9001:2008 certified Institution

Secular trend is influenced by:: 

Secular trend is influenced by: Changes in completeness of source of data Changes in diagnostic ability Experience Techniques Changes in data classification approach (ICD-9 to ICD-10) Demographic changes in population Changes in environment other than that which is related to disease Changes in clinical concepts, Diagnosis, Terminology 20 SIHFW-an ISO 9001:2008 certified Institution

Cyclic (Seasonal) trends: 

Cyclic (Seasonal) trends Changes in frequency over: Days Weeks Months Years 21 SIHFW-an ISO 9001:2008 certified Institution

Periodic (short term): 

Periodic (short term) Changes that occur in hours/ days / weeks Simultaneous exposure to single source (Point source) John Snow- Cholera 22 SIHFW-an ISO 9001:2008 certified Institution

Endemic vs. Epidemic: 

Endemic vs. Epidemic No. of Cases of a Disease Time Endemic Epidemic 23 SIHFW-an ISO 9001:2008 certified Institution

B. Determinants ( What. Why & How): 

B. Determinants ( What. Why & How) Demographic feature Risk Factors Genetic predisposition Life style & behavior Environmental exposures 24 SIHFW-an ISO 9001:2008 certified Institution

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Let us see, if we know the terms like : 25 SIHFW-an ISO 9001:2008 certified Institution

Program: 

Program “a strategy with defined Objectives” 26 SIHFW-an ISO 9001:2008 certified Institution

Policy: 

Policy “ a written statement of objectives and expected outcomes” 27 SIHFW-an ISO 9001:2008 certified Institution

Planning: 

Planning “an act or process of choosing between alternatives to accomplish preset goals”. denotes a blue print of action. The planning prerequisites are- Base line of standards and performance Additional resources Reallocation of resources. “an act or process of choosing between alternatives to accomplish preset goals”. 28 SIHFW-an ISO 9001:2008 certified Institution

Goal:: 

Goal: “The proposed long-range benefits of the program for a specified area, defined in general terms. A goal is the ultimate objective; for example, “reducing the incidence of HIV in (a country).” 29 SIHFW-an ISO 9001:2008 certified Institution

Purpose: : 

Purpose: “The overall objective (also called strategic objective) of the program, for example, “to increase the accessibility to and use of palliative care facilities in (a particular geographic area).” Ultimate measure of the program’s effectiveness. 30 SIHFW-an ISO 9001:2008 certified Institution

Objectives: : 

Objectives: The anticipated outcomes or benefits that are the expected results of implementing a strategy. They are described in measurable terms and indicate a specific period of time during which these results will be achieved. should be SMART S pecific , M easurable , A ppropriate , R ealistic , and T ime -bound 31 SIHFW-an ISO 9001:2008 certified Institution

Strategy: 

Strategy “a plan (to choose) to achieve a particular goal or result; and reveals the logic of your choices”. 32 SIHFW-an ISO 9001:2008 certified Institution

Approach: : 

Approach: A statement that describes how the program will achieve its objective, in terms of activities, most effectively and feasibly. 33 SIHFW-an ISO 9001:2008 certified Institution

Monitoring : 

Monitoring tracks the program’s incremental steps to its effect and informs the final evaluation report. A continual, routine effort requiring data gathering, analysis, and reporting on results at periodic intervals Periodic, regular Focuses on inputs, outputs, process outcomes, work plans Basic purpose is improve efficiency and adjust work plan 34 SIHFW-an ISO 9001:2008 certified Institution

Evaluation : 

Evaluation A technical activity that measures the program’s impact and effectiveness as a whole. Evaluation is not about assigning a “grade” of success or failure at the end of a project. Episodic Focuses on effectiveness, relevance, impact, cost-effectiveness Basic purpose is to improve effectiveness, impact, and future programming 35 SIHFW-an ISO 9001:2008 certified Institution

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Environment Constraints- Human resource Financial Legal Ethical Expectations Value system Situational analysis Appraisal of interaction between system & its environment Objectives: Formulation of alternate policies Goals, objectives & Priority decisions Strategies: Alternative programs, Evaluation of likely outcomes Feasibility, Operational choice Operational plan: Allocation of resources & Authority, Scheduling activities, Designing monitoring system Implementation: Execution of Plan Collection of monitoring data Environment Effect upon clients and adjacent systems Evaluation: Monitoring & Evaluation in relation to objectives Cybernetic Planning Cycle 36 SIHFW-an ISO 9001:2008 certified Institution

Planning steps : 

Planning steps Situational analysis Deciding objectives Defining strategies Laying an Operational Plan Implementation Evaluation- Criteria, Frequency and Process 37 SIHFW-an ISO 9001:2008 certified Institution

The Research-to-Policy Gap: 

The Research-to-Policy Gap Large investments have been made in policy-relevant data collection and research. Yet, opportunities for increasing knowledge and putting data to use are often lost. Researchers and decision makers work in different spheres. 38 SIHFW-an ISO 9001:2008 certified Institution

Researchers' Stereotypes of Policymakers: 

Researchers' Stereotypes of Policymakers Uninterested or too busy to read Reach hasty conclusions Actions unsubstantiated by data Distrust survey and research findings Limited perspective Should be responsible for drawing implications from the data 39 SIHFW-an ISO 9001:2008 certified Institution

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Avoid policy implications of findings Prone to professional "faddism" Excessive use of technical jargon Inconclusive generalities about broad theoretical matters Little appreciation of real problems and data needs 40 SIHFW-an ISO 9001:2008 certified Institution

Assumptions about Decision-making: 

Assumptions about Decision-making Researchers may assume that policymakers: Practice rational decision-making Prioritize goals and objectives Examine alternative solutions systematically Choose alternatives that maximize goals 41 SIHFW-an ISO 9001:2008 certified Institution

Policymaking is Not Linear: 

Policymaking is Not Linear Problems Solutions Politics 42 SIHFW-an ISO 9001:2008 certified Institution

A Window of Opportunity for Policy Change: 

A Window of Opportunity for Policy Change Window of opportunity Politics Problems Solutions 43 SIHFW-an ISO 9001:2008 certified Institution

Using opportunity: 

Using opportunity Window of opportunity exploited by HIV/AIDS Politics Problems Solutions Rabies: Convince with data Rabies: TCV safety, cost, compliance 44 SIHFW-an ISO 9001:2008 certified Institution

Moving the Spheres Together: 

Moving the Spheres Together Problems Solutions Politics Coalition Building Policy Learning Agenda Setting 45 SIHFW-an ISO 9001:2008 certified Institution

Characteristics of Issues that Get on the Policy Agenda: 

Characteristics of Issues that Get on the Policy Agenda Clear, measurable indicators Policy champions Feasible policy or program alternatives Attention-focusing events 46 SIHFW-an ISO 9001:2008 certified Institution

Crafting the Policy Message: 

Crafting the Policy Message Policy communication messages derive directly from the data help decision makers to understand policy implications and to make grounded policy recommendations. 47 SIHFW-an ISO 9001:2008 certified Institution

Research to Recommendations : 

Research to Recommendations Research Key Findings Implications Policy Environment Other Research Recommendations 48 SIHFW-an ISO 9001:2008 certified Institution

Health Programs:: 

Health Programs: P Epidemiology Program P Planning Policy P P 49 SIHFW-an ISO 9001:2008 certified Institution

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Population (Morbidity/Mortality) Epidemiology Services & performance Records/Reports Quantifiable public Health priority Problem Machines (Diagnostics) Manpower (Doctors) Medicines (Drugs) Money (Dollars) Program Planning Policy Provisions Political Commitment Pressure (Donor initiative) 50 SIHFW-an ISO 9001:2008 certified Institution

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NO Health Policy for 36 years Health left to Committees and Commissions Each Committee addressed to a single specific issue. Comprehension missing Majority of recommendations of every committee were reiterations of Bhore Committee. Individual “Health” Programs developed in isolation based on situational exigency . Uni -purpose workers later baptized as Multi-purpose. Some Programs worked in complete isolation till 1980 (e.g. NTCP). Fragmented approach to Health 51 SIHFW-an ISO 9001:2008 certified Institution

Health Planning: 

Health Planning “ The orderly process of defining community health problems, identifying unmet needs and surveying the resources to meet them, establishing priority goals that are realistic and feasible and projecting administrative action to accomplish the purpose of the proposed programme.” 52 SIHFW: an ISO 9001: 2008 certified institution

Health Planning: 

Health Planning Measurement or assessment of burden of illness Identification of cause of illness Measurement of effectiveness of different community interventions Assessment of efficiency of interventions in terms of resources used Implementation of interventions Monitoring of activities Reassessment of burden of Disease to see if there is any change 53 SIHFW-an ISO 9001:2008 certified Institution

The planning process in health: 

The planning process in health Where are we? Situational analysis Where do we want to reach? Goals, Objectives, priorities, Targets, and strategic decisions How will we get there? Organizational constraints, resources & organizational structure, functions & management How well we have done? Monitoring evaluation & feedback What new problems do we have? Re-planning 54 SIHFW: an ISO 9001: 2008 certified institution

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55 SIHFW: an ISO 9001: 2008 certified institution

Health planning in India: 

Health planning in India Bhore , 1946 FYPs Mudaliar , 1962 Chadhah , 1963 Mukerji , 1965 Mukherji , 1966 Jungalwalla , 1967 Kartar Singh, 1973 Srivastava , 1975 Rural Health Scheme, 1977 NHP, 1983, 2002 NPP, 2000 SIHFW: an ISO 9001: 2008 certified institution 56 56 SIHFW-an ISO 9001:2008 certified Institution

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Epidemiological Profile of Malaria NMCP NMEP (Vector Surveillance) (1953) (1958) Insecticides resistance Drugs resistance Complacency& Shift in Priority Cases-50000(1961) to 6.4 M (1976) Resurgence (1994) Malaria Action Plan Malaria Plan of Operation (1977) (Case Management (Surveillance Reducing Mortality & Morbidity FTD Falciparum containment DDC Epidemic control UMS High risk groups) Spray in areas with API > 2) 57 SIHFW-an ISO 9001:2008 certified Institution

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Global concern for High prevalence of VPDs Evolution of EPI (1978) UIP (1985) Un-reached areas Low coverage High U 5 Mortality Risk age group (Reshuffling of priority) Policy & Goals (Available Time frame) Uniformity of Efforts Prioritized component isolation -Increased Coverage -Increased Demand Sustainability Integration Comprehension MCH RCH (1997) CSSM (1992) (Gender sensitive-Adolescent Rep. Health (ORT, ARI, Newborn Responsive-Demand driven care Client satisfaction Essential Obstetric Convergence of VIII Plan initiatives) Care) NRHM (2005) 58 SIHFW-an ISO 9001:2008 certified Institution

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Mile stones NRHM-2005 NHP-2002 NPP-2000 RCH-1996 UIP-1985 NHP-1983 Alma Ata-1978 Small pox eradicated-July 5, 1975 NFPP-1952 India Joins WHO-1948 HSDC-1946 59 SIHFW-an ISO 9001:2008 certified Institution

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Programs NRHM-2005 NVBDCP-2004 NHP-2002 NPP-2000 NSPCD-1997- (IDSP-2004) RCH-1996 CSSM-1992 NACP-1987 UIP-1985 NGCP-1962 NIDDCP-1992 NFWP-1977 NPPVICB-1976 NCCP-75-76 NTCP-1962 RNTCP-1993 NFCP-1955 NLCP-1955 NMEP-1953 NFPP-1952 60 SIHFW-an ISO 9001:2008 certified Institution

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In the process, we need Data, based on descriptive epidemiology generated during- Service delivery Surveys Studies 61 SIHFW-an ISO 9001:2008 certified Institution

From where do I do get Data: 

From where do I do get Data Census Civil Registration System Vital Registration System Sample survey Demographic Health Surveys Epidemiological investigations Service delivery- SDR C-E register EC register 62 SIHFW-an ISO 9001:2008 certified Institution

Common data used in Planning: 

Common data used in Planning Demographic profile Health system Infrastructure Human Resource Financing Morbidity/ Mortality Performance Indicators 63 SIHFW-an ISO 9001:2008 certified Institution

Counting Tools: How are data expressed: 

Counting Tools: How are data expressed Rate Ratio Proportion 64 SIHFW-an ISO 9001:2008 certified Institution

What is a rate?: 

What is a rate? “a measure of speed with which events are occurring in a population in a specified time period .” A numerator A denominator that “appropriately” relates the numerator to population at risk A “unit” such as per 1000, per 100,000 or per million 65 SIHFW-an ISO 9001:2008 certified Institution

Why a rate?: 

Why a rate? To ensure comparing apples with apples 66 SIHFW-an ISO 9001:2008 certified Institution

Ratio: “a fraction (a/b) of two mutually exclusive groups with elements “a” & “b”. : 

Ratio: “a fraction (a/b) of two mutually exclusive groups with elements “a” & “b”. 67 SIHFW-an ISO 9001:2008 certified Institution

Proportion: “a fraction (a /a + b) of two mutually exclusive groups with elements “a”& “b” : 

Proportion: “a fraction (a /a + b) of two mutually exclusive groups with elements “a”& “b” + 68 SIHFW-an ISO 9001:2008 certified Institution

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Index Numerator Denominator Proportion People with disease All people with & without disease Ratio People with disease People without disease Rate People with disease in a given period All people with & without disease 69 SIHFW-an ISO 9001:2008 certified Institution

Counting diseases: 

Counting diseases Mortality Tools Crude Mortality Case fatality Proportional Mortality Standardized Mortality Age specific Mortality Morbidity Tools Prevalence Incidence 70 SIHFW-an ISO 9001:2008 certified Institution

Morbidity Measuring: Prevalence-: 

Morbidity Measuring: Prevalence- Prevalence - Total no. of cases ( new + old) ----------------- x 100 Total population over specified period Point prevalence Period prevalence Prevalence rate- a Ratio, reflects status 71 SIHFW-an ISO 9001:2008 certified Institution

Population at Risk- in a study of Cancer cervix: 

Population at Risk- in a study of Cancer cervix All Men All Women 0-25 Yrs 25-69 Yrs. 70+ 25-69 Yrs. All Women Pop. At Risk Total Population Only Pop. At risk should go into denominator of Prevalence rate but at times it is the total population that is considered 72 SIHFW-an ISO 9001:2008 certified Institution

Prevalence:: 

Prevalence: Prevalence can be expressed either as a proportion or as a rate Expressed as a proportion, prevalence is a number between 0 and 1 As a rate, prevalence can be expressed as per 1000, per 100,000, or per whatever 73 SIHFW-an ISO 9001:2008 certified Institution

Prevalence-Types: 

Prevalence-Types Point Period So far as prevalence is concerned it generally refers to point prevalence. However when the period of observation is large it is referred as period prevalence where the numerator will have all existing cases plus all new cases occurring during period of observation an denominator will be mid year population 74 SIHFW-an ISO 9001:2008 certified Institution

Prevalence: Example: 

Prevalence: Example In a sample of 1,038 women (70-74 years), 70 were found to have rheumatoid arthritis. The prevalence of arthritis is: 70 P= ------------------ =0.07 per women ( 70-74) 1,038 Or P= 70 per thousand women age 70-74 Or P= 7 percent for women age 70-74 Or………. 75 SIHFW-an ISO 9001:2008 certified Institution

Prevalence:: 

Prevalence: Choice of scale of rate usually depends on the ubiquity of the disease. Thus, more common disease prevalence may be presented as percentage Rare disease prevalence may be presented as per 100,000 or per million 76 SIHFW-an ISO 9001:2008 certified Institution

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In 2004 there were 1076 cases of Tuberculosis in District X among 50000 men in age group of 40-44 years. The Prevalence rate will be: 1076 p = ________ =0.0215 per year 50000 = 21.5 per thousand per year = 215 per 10 thousand per year = 2150 per million per year 77 SIHFW-an ISO 9001:2008 certified Institution

Change in Prevalence reflects: 

Change in Prevalence reflects Change in incidence or duration of disease Introduction or impact of an intervention Selective attrition Change in disease definition or classification Significant migration 78 SIHFW-an ISO 9001:2008 certified Institution

Prevalence has its use in – : 

Prevalence has its use in – Determination of the sickness load Planning of health services in relation to Infrastructure Manpower Facilities, and Finances In making community diagnosis 79 SIHFW-an ISO 9001:2008 certified Institution

Incidence Rate: 

Incidence Rate number of new cases occurring during a period of time I = x 100 “total person time” at risk What is “person time”: The duration of time a person is at risk Usually expressed as person years but can be expressed as anything, e.g., person months, person weeks, etc. 80 SIHFW-an ISO 9001:2008 certified Institution

Incidence Rate-Types: 

Incidence Rate-Types Cumulative Incidence (CI)= New cases --------------------------------------- X 100 Population at risk (PAR) during a specified period Incidence Density (ID)/ Incidence rate= New cases ------------------------------------------- X 100 Total Person time of observation in PAR, over a specified period 81 SIHFW-an ISO 9001:2008 certified Institution

“Total Person Time”: 

“Total Person Time” Sum of person time of all individuals who were at risk and were available for observation. Equivalence of “total person time” 50,000 person years = 5,000 persons observed for 10 years = 1,000 persons observed for 50 years = 10,000 persons observed for 5 years 82 SIHFW-an ISO 9001:2008 certified Institution

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In 2004 there were 1139 cases of Measles in Jaipur (Pop.-2500000, children- 15%) among children 0-5 years. The number of person years was 375000. The incidence rate will be: 1139 I = _____ =0.00317 per person per year, 375000 or = 3.17466 per thousand per year, or = 31.7066 per 10 thousand per year, or = 3170.666 per million per year To be more accurate, we must add another qualifier, namely, “for children 0-5 years of age” 83 SIHFW-an ISO 9001:2008 certified Institution

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This would mean exclusion of people currently having disease people who had had the disease people who are protected on account of-immunization, habits and earlier intervention; from the population at risk 84 SIHFW-an ISO 9001:2008 certified Institution

Incidence Rate: Expressed as-: 

Incidence Rate: Expressed as- Morbidity rate- New cases\total population at risk Mortality rate- No. Of deaths due to a disease\total population Case fatality rate- No. Of deaths due to a disease\total no. Of cases of that disease Attack rate- No. Of cases of a disease, not persons / total population at risk for a very short period 85 SIHFW-an ISO 9001:2008 certified Institution

Change in Incidence reflects: 

Change in Incidence reflects Introduction of a new risk factor Changes in habits Change in virulence Change in intervention strategy Selective migration 86 SIHFW-an ISO 9001:2008 certified Institution

Incidence useful in : 

Incidence useful in surveillance understanding etiology & pathogenesis, & planning of new services 87 SIHFW-an ISO 9001:2008 certified Institution

Prevalence V/S Incidence: 

Prevalence V/S Incidence Prevalence: A “snapshot” of disease at a point in time in a population Incidence: A description of how new cases of disease are occurring. “force of morbidity” “rate of flow” of cases from non disease to disease state 88 SIHFW-an ISO 9001:2008 certified Institution

Prevalence (P) and Incidence (I): 

Prevalence (P) and Incidence (I) P= I x d d=duration If the disease is stable, that is, if the incidence and duration remains constant over time. 89 SIHFW-an ISO 9001:2008 certified Institution

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Died Migrated out Migrated out Died Pop. On Jan 1, 2004= 25000 July 1, Mid Year Dec. 31 =100 Cases 90 SIHFW-an ISO 9001:2008 certified Institution

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Point prevalence on Jan.1, 2004 = 400 / 25000 x 100 = 1.6 % Point prevalence on July, 1, 2004 = 600/ 24800 (i.e. 25000-200) x 100 = 2.41 % Point prevalence on December 31, 2004 = 400/ 24600 (i.e25000-400) x 100 = 1.62 Period prevalence in one year = 400+1100 / 25000-200 x 100 = 6.51% Cumulative Incidence for the year (Jan.1, 2004-December 31, 2003) =1100/ 25000-400x 100= 4.47 91 SIHFW-an ISO 9001:2008 certified Institution

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Date of Onset of disease Date of Termination or death R Case no . 1 2 3 4 5 R Date of recurrence R = July 30, 2003 June30, 2004 N= 300 Point prevalence on July 30, 2003= 4 cases( 1, 2, 3, 6)/ 300 Incidence rate on July 30, 2003= 2 cases (4, 5) /296 Period prevalence between July 30, 2003 to June 30, 2004= 6 /300 6 92 SIHFW-an ISO 9001:2008 certified Institution

Prevalence V/s Incidence: 

Prevalence V/s Incidence Prevalence: Relevant for planning of health services Incidence: Relevant for exploring causal theories 93 SIHFW-an ISO 9001:2008 certified Institution

Incidence & Prevalence: 

Incidence & Prevalence Rate Type Numerator Denominator Morbidity Incidence New cases Total PAR * Mortality Incidence Deaths due Total population a disease or all causes Case fatality Incidence Deaths due to a No. of case of disease that disease Attack rate Incidence No. of cases of Total PAR for disease limited period Period Prevalence No. of Cases Total population prevalence New + Old * population at risk 94 SIHFW-an ISO 9001:2008 certified Institution

Incidence increasing but prevalence decreasing: 

Akhilesh Bhargava 95 Incidence increasing but prevalence decreasing 95 SIHFW-an ISO 9001:2008 certified Institution

Interpretation:: 

Interpretation: # Disease duration is reduced and it is becoming acute, or # Disease becoming more fatal 96 SIHFW-an ISO 9001:2008 certified Institution

Incidence stable but prevalence increasing indicates:- : 

Akhilesh Bhargava 97 Incidence stable but prevalence increasing indicates:- 97 SIHFW-an ISO 9001:2008 certified Institution

Slide 98: 

1.Slow recovery (disease becoming chronic, drugs less effective) or, 2.Fatality reduced (potent drugs available, new drugs effective) or, 3.Immigration of cases from other area (for better facility available). Interpretation 98 SIHFW-an ISO 9001:2008 certified Institution

Incidence maintained but prevalence declining means:- : 

Akhilesh Bhargava 99 Incidence maintained but prevalence declining means:- 99 SIHFW-an ISO 9001:2008 certified Institution

Slide 100: 

# Recovery is becoming rapid, (may be a new drug identified is more effective) # Disease turns into a more fatal one (because of treatment failure, change in virulence, drug resistance) or, # Selective emigration of cases (to seek treatment elsewhere) 100 SIHFW-an ISO 9001:2008 certified Institution

When I plan, I need: 

When I plan, I need Knowledge Data Resources 101 SIHFW-an ISO 9001:2008 certified Institution

Slide 102: 

Knowledge: Whom I am planning for What am I planning for What do I need to know 102 SIHFW-an ISO 9001:2008 certified Institution

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I need Data on- Demographic profile Morbidity Mortality profile Performance –Rates and Ratios from past 103 SIHFW-an ISO 9001:2008 certified Institution

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Resources- What is available Can it be generated How can I use it How much is available for an activity 104 SIHFW-an ISO 9001:2008 certified Institution

Thank You: 

Thank You 105 SIHFW-an ISO 9001:2008 certified Institution For more details log on to www. Sihfwrajasthan.com or contact : Director-SIHFW on sihfwraj@yahoo.co.in