1. MORBIDITY
AND
MORTALITY

2.  To review about health indicators
 To understand meaning of mortality
 To explain the limitations of mortality
indicators
 To list out the uses of mortality
indicators
 To define the mortality indicators

3.  To explain the meaning of
morbidity
 To enumerate the types of
morbidity rates
 To explain the meaning of
prevalence and incidence rate
 To compare the relationship
between prevalence and incidence
 To define compression of morbidity
rate

4. INDICATORS
OF HEALTH
:-

5. The indicators of health may be
classified as follows:
Mortality indicators
Morbidity indicators
Disability rates
Nutritional status indicators
Health care delivery indicators

6. Utilization rates
Indicators of social and mental
health
Environmental indicators
Socioeconomic indicators
Health policy indicators
Indicators of quality of life
Other indicators

7. MORTALITY :-

8. Mortality is the condition of
being mortal, or susceptible to
death; the opposite of
immortality

9. Limitation in
mortality data

10. Incomplete reporting of death
Lack of accuracy
Lack of uniformity
Choosing a single cause of death
Changing coding system and
changing fashion in diagnosis
Diseases with low vitality

11. USES OF
MORTALITY
DATA

12.  In explaining trends and differentials
in overall mortality
 Indicating priorities for health action
and allocation of resources
 In designing intervention programme
and
 Assessment and monitoring of public
health problems and programmes
 Gives clues for epidemiological
research

13. MORTALITY
INDICATORS and
MORTALITY RATES
AND RATIOS

15. It is defined as the number of
death per 1000 estimated
midyear population per year
in a given community. It
indicates the rate at which
people are dying.

16. Crude Death rate =
no: of death occurred in an year х 1000
Estimated mid - year population

17. The crude death rate summarizes the effect of two
factors;
Population composition
Age – specific death rates
Death rate of India : 6.23
deaths/1,000 population (July 2009
est.)

19. 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”

20.  It is estimated for both sex separately.
 Life expectancy is a good indicator of
socioeconomic development in general.
 As an indicator of long term survival ,
it can be considered as a positive
indicator.
 Help to identify what is happening to
overall standard of living of people in
India.

21. One of the broadest standard of living
measure is the life expectancy - the average
expected lifespan of an Indian is ;
 Total population: 69.89years
male : 67.46years
female : 72.61 years (2009 est.)

23. Infant mortality rate is defined as “
the ratio of infant deaths registered
in a given year to the total number
of live birth registered in the same
year; usually expressed as a rate per
1000 live births”

24. IMR=
no: of death under 1yr age in 1х1000
No: of live birth during that year

25. Infantmortalityrate:
 total: 30.15deaths/1,000livebt
male: 34.61deaths/1,000livebirt
hs
female: 25.17 deaths/1,000 live
births (2009 est.)

26. NEONATAL
MORTALITY RATE

27.  Neonatal mortality rate:

= no of death ,under 28 days of age occurred during a yх1000
. no of live birth during that year

30. i

31. MATERNAL
MORTALITY RATE;

33. 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.

34. MMR =
no of female death from pregnancy,child birth,or
Puerperial causes in an year х1000
no of live birth in same area during that year

35. Journal study
Changing trends in maternal
mortality 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 (1979–1981 and 1989–
1991) were studied to ascertain the total
number of maternal deaths and the specific
causes of death

36. FETAL DEATH
RATES

37. 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

38. The still birth rate (late fetal death rate) correspond to
Still birth rate = no of fetal death, 28wks of
gestation or more occurred during a yх1000
no of live birth plus late fetal death during
that year

39.  Late foetal death rate =
no of foetal death,28 week of
gestation Or more occurred during
a yr х1000
No of live births during that year

41. It is defined as the number as
the number of death at age 1-
4 yrs in a given year ,per 1000
children in that age group at
the midpoint of the year
concerned. It thus excludes
infant mortality.

42. CHILD SURVIVAL
INDEX:-

43. A child survival rate per 1000 birth
can be simply calculated by
subtracting the under 5 mortality
rate from 1000 dividing this figure
by ten shows the percentage of
those who survive to the age of 5yrs

44. Child survival rate =
1000 – under 5 mortality rate
10

45. Disease specific
mortality

46. Mortality rates can be computed
for specific diseases. As countries
begin to extricate themselves from
burden of communicable disease, a
number of other indicators
emerged as measures of specific
disease problem.

47. PROPOTIONAL
MORTALITY
RATE

48. 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

49. = No of
deaths from the specific
disease inyear x 100/
Total death from all causes in
that year

50. CASE FATALITY
RATE:-

51. = total no of death due to a particular diseasx100
total no of cases with same disease

52.  It determines the killing power of a
disease
 It is simply the ratio of death to case
 It is typically used in acute infectious
diseases( eg: food poisoning, cholera
etc)

53. Specific mortality rate:-
 This rate can be made specific with
regard to any subgroup of the
population 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 to
specific cause of death; M and F refers
to their gender .

54. Age specific death rate for A
 = no of death of age A in an year х1000
Estimated population of age A midyear
sex specific death rate for group M
=no of death of sex M in an year х1000
estimated population of sex M midyear
 Cause specific rate=
no of death due to cause C occurred in a yearх1000
estimated midyear population

55. Adjusted or standardized rates:
 If we want to compare the death rates of
two populations with different age-
composition, we can use ‘age adjustment
“or “age Standardization’”.
 There are two ways of computing
standardized death rates – direct and
indirect standardization.

56.  Direct Standardization (SDR1)
calculates a weighted average of
the region’s age-specific mortality rates

57.  Indirect Standardization (SDR2)
uses age-specific mortality
rates from the standard population to
derive expected deaths in
the region’s population

58. 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.

59. 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 region’s population.
Dr is the number of deaths in the region.
CDRs is the crude death rate for the
standard population.

60. MORBIDITY

61. 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.

62.  The WHO Expert committee on Health
Statistics noted in its 6th report that
morbidity could be measured in terms
of 3 units-
 a. person who ill ;
 b. the illness that these persons
experienced and
 c. the duration of these illness.

64. The value of morbidity data is
summarized as;
 They describe the nature and extend of the disease
load in the community and thus assist in the
establishment of priorities
 They usually provide more comprehensive and
more accurate and clinically relevant information
on 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 of
disease control activities

66. 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.

67. 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

68. The following morbidity rates are
used 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 sickness
or absence from work or school

69. Incidence

70.  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/ х1000
Population at risk during that period

71. incidence rate refers
 Only to new cases
 During a given period(usually one year)
 In a specified population or “population at risk” ,unless
other denominators are chosen
 It can also refer new spells or episodes of disease
arising in a given period of time , per 1000 population.
For example , a person may suffer from common cold
more than once a year . If he had suffered twice , he
would contribute two spell of sickness in the year. The
formula in this case would be

72.  Incidence rate(spell) = no of
spells of illness starting in a
defined period х1000
mean no of person exposed to risk
in that period

73. 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

74. 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”
.

75. Prevalence is of two type;
Point prevalence
Period prevalence

76. Point prevalence:-
 Point prevalence of a disease is defined as
the number of all current cases ( old and
new) existing at a given point of time in
relation to a defined population.
 The “point” in point prevalence, may for all
practical purpose consist of a day ,several
days or even few weeks depending upon
the time it takes to examine the population
sample. It is given by the formula;
•

77.  = No of all current cases (old &
new)of a specified disease at a
given point in time / х100
Estimated population at the same
point in time

78.  Period prevalence:-
A less commonly used measure of
prevalence is period prevalence. It measures
the frequency of all current cases (old and
new) existing during a defined period of
time ( eg:- annual prevalence) expressed in
relation to a defined population .
 It includes cases arising before but
extending into or through to the year as well
as those cases arising during the year .
period prevalence is given by the formula :

79. =
no of existing cases(new& old) of a specific
disease during a given period of time interval /
х100
estimated mid interval population at risk

80. Relationship between
prevalence and
incidence:-

81.  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:

82.  P= I х D=incidence х mean duration

83. Uses of prevalence:_-
 Helps to estimate the magnitude of health/
disease problems in the community and
identify potential high risk population
 Prevalence rates are especially useful for
administrative and planning purpose , eg:
hospital beds , manpower needs ,
rehabilitation facilities ,etc .

84. THANK YOU