Methodology of Morbidity study

1. Methodology ofMethodology of
morbidity studymorbidity study
(general, with the(general, with the
temporal disability)temporal disability)

2. Morbidity of population
is a collapsible concept that includes values,
which are characterizing the level of
different diseases and their structure among
all population or its separate groups on the
given territory.

3. The main methods for studying the
morbidity are those one, which
foresee the use of such given:
• - appeals for medical help in medical
establishments;
• - medical examinations of separate groups of
population;
• - about the reasons of death;
• - questioning of population;
• - special selective researches.

4. Comparative description of basic methods of studying
the population morbidity
Name of
method
Advantages of method Disadvantages of method
1. Method of
registration
• availability for all layers
of population;
• aninterrapting and
dynamics of supervision the
state the health of
population;
• effectiveness of diseases
account;
• most complete account
of acute diseases;
• possibility of selection
of the diseases first
registered during the year;
• much more economy
• incomplete account of
chronically diseases:
• incomplete account of
initial symptomless stages and
forms of diseases;
• incomplete account of
diseases in cases: insufficient
availability of medicare,
insufficient plenitude of
diseases registration and degree
of specialization of medicare,
bad sanitary culture of
population; during service of
population in private medical
establishments

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6. Comparative description of basic methods of studying
the population morbidity
Name of
method
Advantages of
method
Disadvantages of method
2. Studying
of the
morbidity
according
the results of
medical
examinations
•almost a complete
account of chronical
diseases; “exposure of
diseases on initial
stages”;
• the independence
of examinations results
from availability of
medicare, sanitary
culture of population
etc.
• impossibility of
account of acute diseases;
• scope of only separate
groups of population:
children, young people,
workers of some
professions;
• high price

7. Plenitude of information, about the
morbidity of population after the
method of appeals can be limited:
• at insufficient availability of medicare (for
example, in rural locality);
• bad level of medical culture of population;
• insufficient authority among the population
of medical establishment on the whole or
separate doctors etc.

8. At the studying of morbidity from
data of medical examinations,
plenitude of information about
morbidity depends on:
• their systematic providing;
• participation of doctors of necessary
specialties;
• sufficient diagnostic providing;
• the control of timeliness and plenitude of
examinations.

9. International statistical classification of
diseases of the last Tenth revision
(ICD-10) was ratified by the forty-
third Assembly of WHCO January, 1,
1993. In obedience to the decision of
the Assembly the document has a new
name "International statistical
classification of diseases and close
problems of health protection", though
the comfortable abbreviation ICD is
preserved

10. International classification of diseases of the Tenth revision (ICD-10)
I Infectious and vermin diseases
II New formation
III Diseases of blood and blood producing organs and separate violations with bringing in of
immune mechanism
IV Endocrine diseases, disorders of feed and metabolic disturbances
V Disorders of psyche and behavior
VI Diseases of the nervous system
VII Diseases of eye and its additional vehicle
VIII Diseases of ear and papillary sprout
IX Diseases of the system of blood circulation
X Diseases of breathe organs
XI Diseases of digestion organs
XII Diseases of skin and hypodermic cellulose
XIII Diseases of the bone-muscle system and connecting tissue
XIV Diseases of the urogenital system
XV Pregnancy, births and post-natal period
XVI Separate conditions which arise up in a perinathal period
XVII Born defects of development, deformations and chromosomal anomalies
ХVIII Symptoms, signs and deviations from the norm, that appear at clinical and laboratory
researches, not classified in other headings
XIX Traumas, poisonings and some other results from action of external factors

11. Besides 19 classes of Diseases, two
additional headings are included into
ICD-10:
• ХХ External reasons of morbidity and
death rate
• ХХІ Factors which influence the state of
population health and appeal to
establishments of health protection

12. The basic principles of
construction of International
classification of diseases, traumas
and reasons of death are the
community of etiology or
pathogenesis of diseases or
combination of locally-etiologic and
local-pathogenetic principles.

13. There are such kinds of morbidity at its
study from the data of appeals
for medical help:
1. General morbidity - the account of all
diseases (sharp and chronic) which are
registered at the population of certain
territory for certain period of time;
2. Infectious morbidity - the special account
of acute diseases, connected with the
necessity of the operative conducting of
non-epidemical measures;

14. 3. Morbidity on the major non-epidemical diseases
falls due the special account as a result of their
epidemiology and social value (malignant new
formations, tuberculosis, venereal, psychical
diseases etc.);
4. Hospital or "hospitalized" morbidity enables to
learn composition of patients which were treated
in permanent establishment;
5. Morbidity with the temporal disability of
workers and employees is selected as a result of
its social and economic value.

15. Basic sources of information and values, which
characterize the separate types of morbidity
Methods of study, types of
morbidity
Basic information sources Basic values
From data of appeals for medical
help
General morbidity
Statistical coupon for registration of
final (specified) diagnoses
Coupon of ambulatory patient
The general morbidity (prevalence
of diseases) Primary morbidity
Structure of general and primary
morbidity
Infectious Urgent report Level and structure of infectious
morbidity
Nonepidemic Report about the important
nonepidemic diseases
Level and structure of nonepidemic
morbidity
Hospitalized patients Statistical card of patient. that left
permanent establishment
Level and structure of morbidity of
the hospitalized patients
With the temporal disability Bulletin Number of cases of temporal
disability (ТD) on 100 workers
Number of the calendar days ТD
on 100 workers
Medium duration of one case ТD
From data of medical examinations
(aimed, previous)
List of persons which are subject to
the medical examinations
From data about the reasons of
death
Medical certificate about death
Medical certificate about perynathal
death
Medical assistant’s certificate about
death
Values of level and structure of
morbidity, that led to death

16. The case of disease or trauma concerning
which the patient appealed to medical
establishment is taken for unit of supervision
at study of general morbidity.
Two documents are the source about
general morbidity: "Statistical coupon for
registration of final (specified) diagnoses" (f.
№ 025-2/о) and "Coupon of ambulatory
patient" (f. № 025-6/о, f. 025-7/о).

17. There are such basic values of general
morbidity:
• — primary morbidity (Іпсіdепсе) - the level of t
first registered diseases for a calendar year on
this territory; all sharp and first set for a year
chronic diseases are taken into account also:
• — general morbidity, or prevalence of diseases
(Рrеvаlепce) – the level of all registered diseases
for a calendar year: sharp and chronic (registered
at the first appeal in a current year, and exposed
both in current and in previous years);
• — structure primary and general morbidity of
population

18. The method of calculation of the values.
Name of values Method of calculation
Primary morbidity
Amount of diseases which are registered first at current year
(all acute + first exposed chronic diseases) х 1000
Average annual quantity of population
General morbidity
(prevalence of all
registered
diseases)
Amount of all registered during this year diseases (acute +
chronic, exposed both in current and in previous years) x 1000
Average annual quantity of population
Structure of primary,
general morbidity
(prevalence)
Amount of all diseases of this class, group, nosology form
registered for a year
(first registered) х 100
Amount of all (first) diseases registered for a year

19. Every case of disease or suspicion on
it is a unit of supervision at the study of
infectious morbidity. "Urgent report about
the infectious disease, food, acute
professional poisoning" (f. № 058/r) is
filled at the exposure of them, and it is a
basic document for the study of epidemic
morbidity.

20. The following values are used for the
analysis of infectious morbidity:
• frequency of the exposed diseases (correlation
of their number to the quantity of population of
this territory; values are calculated per 100
thousands of population);
• seasonality (data about the number of diseases
on months are taken as a basis. The indices of
seasonal vibrations are correlation of data
during month to average annuals);

21. • frequency of hospitalization and plenitude of it
embrace (in the first case it is correlation of
number of hospitalized persons to the quantity of
population, in the second — the correlation of
the number of hospitalized persons to the
number of exposed diseases in percents);
• frequency of diseases after age, sex, profession
(correlation of diseases number in the each group
to the quantity of population of this group):
• number of exposed bacillus carriers on 1000
inspected persons.

22. Morbidity on the major nonepidemic
diseases
Some nonepidemic diseases are the subject of the
special account:
• malignant new formations;
• psychical diseases;
• venereal diseases;
• active tuberculosis;
• difficult mycosis.

23. The necessity of the special account of the
indicated diseases is conditioned by:
• the high level of distribution;
• considerable frequency of death rate at
some of them;
• epidemiology meaningfulness;
• a social conditionality.

24. There are two basic documents for
registration of nonepidemic diseases:
• 1. The report about a patient, to which the
diagnosis of active tuberculosis, venereal
disease, tryhofitis, microsporias, favus,
scab, trachoma, and psychical disease is set
for the first time in life (f. № 089/r).
• 2.The report about a patient, with diagnosis
of cancer or other malignant new formation
set for the first time in life (f. № 089/r).

25. The unit of supervision during it’s
study is every case of hospitalization
of patient concerning the disease, and
information source is the "Statistical
card of patient, that left permanent
establishment".

26. Morbidity of the hospitalized patients is studied
on such values:
• frequency of hospitalization (the relation of
number of hospitalized concerning the certain
disease or all hospitalized in a calculation on the
quantity of population, that lives on this
territory);
• level of hospitalization after age, sex, the place of
residence (relation of number of the hospitalized
patients of this group in a calculation on the
quantity of population of this group);

27. • structure of hospitalization (specific case of
every disease among the common amount of
the hospitalized patients; it is possible to
calculate the structure of hospitalized after
age, sex, the place of residence);
• medium duration of treatment (relation of
number of the bed-days conveyed by patients
in permanent establishment, to the number of
the patients that left): this value is expedient
to connect with the age of patients, diagnoses,
the results of treatment and to analyze
separately for written out from permanent
establishment and deceased patients.

28. Morbidity with the temporal disability
• The case of disability is unit of
account.
• The registration document for
registration of each case of temporal
disability of a worker during the year
is a bulletin.

29. Morbidity of working persons with the temporal
disability is analyzed on such basic values:
Value of cases of temporal
disability on 100 working persons
=
Absolute number of cases at temporal
disability
• 100
Medium quantity of working persons
Value of calendar days
temporal disability on 100
working persons =
Absolute number of calendar days of temporal
disability - 100
Medium quantity of working persons
Medium duration of
case of temporal
disability
=
Number of calendar days of temporal disability
Number of cases of temporal disability
Value of structure of
morbidity with the
temporal disability
=
Number of cases (or calendar days) of disability from
this disease · 100
Number of cases (days) of disability at all diseases

30. A dynamics of the primary
morbidity in general prevalence
depending on the age
• Children (0-14 years) – 80 %
• Working age – 51 %
• Disabled age – 24 %

31. Diseases are most widespread at
the men and women
MansMans WomenWomen
Chronic bronchitis
Traumas and poisonings
Ulcerous illness of
stomach
Psychical disorders
Illnesses of the
peripheral nervous
system
Тhyrоtoxicosis
Diabetes
Hypertensive illness
Cholecystitis
Illnesses of the urinary
system
Cerebrovascular illness

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