UERM COLLEGE OF MEDICINE A.Y.

2015 2016 (2ND SEMESTER)

EPIDEMIOLOGY

Exercise 2: Sources of Morbidity and Mortality Data

(Preceptors) Nov. 24, 2015

PART I
CASE 3
CASE 1
Certificate of Live Birth
Certificate of Death CHILD
Province NCR Province NCR
City/Municipality Quezon City City/Municipality Quezon City
Name Gene Bulago Name Maine Olivar Mendoza
Sex Male Sex Female
Age 54 y/o Date of Birth October 29, 2015
Place of Death UERM Hospital Place of Birth Brgy. Dona Imelda, QC
Death Date October 28, 2015 Type of Birth Twin
Citizenship Filipino If Multiple Birth, First (1st)
Residence Guirayan St., Brgy. Doa Imelda, Child was
Quezon City Birth Order Second (2nd)
Civil Status Married Weight at Birth 2, 000 grams
Occupation Unemployed MOTHER
Medical Certificate Name Leah Olivar
CAUSES of DEATH Citizenship Filipino
Immediate Cause Hepatic Encephalopathy (K72.9) Religion Protestant
Antecedent Cause Alcoholic Liver Disease (K70) Total number of 1
Underlying Cause children born alive
Other Significant Hepatitis B Infection (B15-B19) Number of children 1
Conditions still living including
contributing to this birth
death: Number of children 0
born alive but are
Attendant Private Physician now dead
Occupation Saleslady
Age at the time of 21 y/o
CASE 2
delivery
Residence Brgy. Dona Imelda, Quezon City
Certificate of Death FATHER
Province Bukidnon Name Clark Medina
Name OA Citizenship Filipino
Sex Male Religion Born Again Christian
Age 36 y/o Occupation Street Food Vendor
Place of Death Bukidnon Age at the time of 24 y/o
Citizenship Filipino delivery
Residence Bukidnon OTHER
Civil Status Unknown Date and Place of August 25, 2013;
Occupation Farmer Marriage of Parents Quezon City Mayors Office
Medical Certificate Attendant Hilot (Traditional Midwife)
CAUSES of DEATH Prepared by Title/Position: City Health Officer
Immediate Cause Ventricular Fibrillation (I49) Date: October 30, 2015
Antecedent Cause Exposure to Electric Transmission
Lines (W85) Certificate of Fetal Death
Underlying Cause Ankle Strain/Sprain (S93.4) CHILD
Province NCR
DEATH BY NON-NATURAL CAUSE City/Municipality Quezon City
Manner of Death Accident Name Alden Olivar Mendoza
Place of Occurrence Bukidnon Health Facility Sex Male
Attendant Public Health Officer Date of Delivery October 29 2015
Place of Delivery Brgy. Dona Imelda, QC
Type of Delivery Twin
If Multiple Delivery, Second (2nd)
Fetus was

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Malana, Marcelino, Martinez, Mendoza, E., Mendoza, G., Mendoza, K.
 Method of Delivery Normal Spontaneous Vertex Religion Born Again Christian
Birth Order Third (3rd) Occupation Street Food Vendor
Weight at Birth 1, 400 grams Age at the time of 24 y/o
MOTHER delivery
Name Leah Olivar
Citizenship Filipino MEDICAL CERTIFICATE
Religion Protestant Cause of Fetal Death Main disease/ condition of fetus:
Occupation Sales lady Prematurity
Age at the time of 21 y/o Other diseases/ conditions of
delivery fetus: Hyaline Membrane Disease,
Total number of 1 Premature Rupture Syndrome
children born alive Fetus Died Before labor
Number of children 1 Length of > 37 weeks
still living including Pregnancy
this birth Attendant Hilot (Traditional Midwife)
Number of children 0 CERTIFICATION
born alive but are Prepared by Title or Position: City Health Officer
now dead Date: October 30, 2015
Residence Brgy. Dona Imelda, Quezon City
FATHER
Name Clark Medina
Citizenship Filipino

PART II

Task 1 recall, infant mortality rate, soil-transmitted helminthes

incidence rate)
You are recently appointed project officer of a non-
government organization concerned with the health aspect of 2. Enumerate possible sources of the above information or
urban-depressed barangays. Your first task as the health officer is data.
to define and to make a report about the state of nutrition among
infants and children in the barangays. 24-hr Food Recall
Anthropometric Measurements
1. List down the information or data that will allow you to In-depth Interviews
estimate the state of nutrition among identified target Existing Clinical Records / Health Records
population. Publications / Journals / Researches

Demographics: Age, gender, socioeconomic status 3. Can you recommend some methods by which you will be
Anthropometric Measurements: Height, weight, arm able to collect the above information? Explain these
circumference, scapular fold, acute vs. chronic methods and briefly discuss their strengths and
malnutrition (Waterlows Classification) weaknesses.
Acute: compute for weight for height
Chronic: compute for height for age Primary Data: obtained first hand by investigator
Biochemical Data: For vitamin deficiency, iodine Secondary Data: obtained from existing information,
deficiency, anemia, etc. data, or research by other researchers
Clinical Aspect: Clinical manifestations (signs &
symptoms), medical history, vaccination status Method Advantages Disadvantages
Existing health/clinical records: Infant mortality rate, Survey Can be Respondents
Questionnaire administered should be literate
infant cause-specific mortality, maternal mortality rate,
to a large group
under 5 mortality rate, prevalence & incidence rates of (Respondents read a simultaneously Low completion
malnutrition, fetal mortality rate set of questions and rates on follow
Surveys: Dietary Intake answer accordingly) Anonymity up questions

* May be DIRECT (Anthropometric measurements, i.e., Cheaper Questionnaire

Middle upper arm, chest, abdominal, head circumference, may have been
Less pressure on answered by
and fat soluble assays) or INDIRECT measurements (diet
respondent different people

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Malana, Marcelino, Martinez, Mendoza, E., Mendoza, G., Mendoza, K.
Interview Venue for Time- consuming
clarifications Malnutrition incidence rate = increase in the # of new
(One-to-one regarding survey Some cases of malnourishment among infants and children in a
encounter between answers respondents community
the interviewer and may be shy or
the respondent; may Can obtain a lot of uncooperative
be facilitated by a list information Cause-Specific Death Rate:
of questions called Subjects may not An increase in cause-specific death rate due to
an interview Can ask follow-up be certain on their measles may indicate high malnutrition incidence and
schedule) questions perceptions about prevalence. Thus an increase or a high number of
health problems measles cases (secondary to weak immune system).
Can obtain data or concepts
about behavior,
emotion, and Fetal Mortality Rate: Malnutrition has caused
attitude of an increase in deaths due to extreme weakened immune
respondent system

Both verbal and

non-verbal cues
can be obtained
and used Task 2
Records Review Easy to obtain data Data may be
as they are pre- inaccurate, Make a summary of the following information using the table below:
(Use of existing collected incomplete, or
records and reports outdated See table on page 4 (This was not discussed in class.
pertinent to the Saves time,
Contents of the table were lifted from 2018A)
client; energy, money, No control over
can be laboratory and efforts how data was
records, reports collected REFERENCES
about environmental
conditions) Zulueta, JL., M.D. (2015, November). Sources of Morbidity
Physical First-hand Respondent may and Mortality Data (PDF copy). Epidemiology class.
Examination information be uncooperative Lecture conducted in UERMMMCI
2018 A&B Trans
(Direct examination Objective
through: inspection;
palpation; Quantifiable
percussion, Data
auscultation;
measurement of Easily interpretable
specific body parts; data
and reviewing of
body systems)

4. What indicators or indices reflect the state of nutrition in a

given community?

- Incidence and prevalence of malnutrition

- Cause-specific death rate due to measles or other
diseases
- Incidence and prevalence of iron deficiency, anemia,
iodine deficiency disorder, vitamin A deficiency, etc.
- Fetal mortality rate

5. Using hypothetical data, how will these above indicators

(#4) be interpreted?

Malnutrition prevalence rate = Prevalence of

Malnutrition = number of existing cases of malnutrition
in a community

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Malana, Marcelino, Martinez, Mendoza, E., Mendoza, G., Mendoza, K.
 Nutrition Indicators and Other Methods of Data Advantages of the Methods Disadvantages of the
Related Data Collection Used Methods Used
Anthropometric Measurements (Weight, Primary Data: - Updated - Subjects may be
Height, Arm Circumference, Physical - Easily interpretable data uncooperative
Subscapular Fold) Examination - Objective, quantifiable data - Time-consuming
- Universally applicable - Expensive
- First hand information

Biochemical Data (For: Vitamin Primary Data: - Updated - Expensive

deficiency, Iodine deficiency, etc.) Laboratory Tests - Accurate - Time-consuming
- Standardized
- First hand information

Clinical Aspects (Clinical Primary Data: - Updated - Time consuming

Manifestations: Signs and Symptoms, Physical - First hand information - Respondents may be
Medical History, Vaccination status) Examination, uncooperative
Interview - Recall bias

Dietary Intake Primary Data: 24- - Updated - Time-consuming

hour Food Recall - First hand information - Respondents may be
uncooperative
- Recall bias

Environmental Factors Primary data: - Updated (primary data) - Time consuming (primary
Observation, - Data are pre-collected, saving data)
Interview time (secondary data) - Second-hand information, so
reliability can be questioned or
Secondary Data: the objectives of the records
Records of may be different from yours
Community (secondary data)
Sanitation, Records
on Incidence and
Prevalence Rates of
Soil Transmitted
Diseases and Water
Borne Diseases

Mortality Rates (Infant Mortality, Cause- Secondary data: - Saves time - Reliability of data can be
specific) Prevalence and Incidence Health/Clinical questionable
Rates of Malnutrition Records - Under reporting/estimation
and/or over
reporting/estimation can be
present

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Malana, Marcelino, Martinez, Mendoza, E., Mendoza, G., Mendoza, K.