Karpaga Vinayaga Institute of Medical Sciences and Research Centre

Department of Community Medicine

Epidemiology and Biostatistics exercises

Measures of central tendency and dispersion

1. The number of patients who visited Urban Health Training Centre for consultation for
10 consecutive days is given below. Calculate the mean, median, mode and standard
deviation for the following data.
75 100 84 100 80 90 100 75 90 85

Mean: 87.9; Median: 87.5; Mode: 100; SD: 9.81

2. The diastolic blood pressures of 10 individuals were:

84, 76, 80, 82, 78 , 94, 74, 90, 90, 106.
Calculate the arithmetic mean, median, mode, and standard deviation.

Mean: 85.4; Median: 83; Mode: 90 ; SD: 9.75

Screening test
3. A new diagnostic test for typhoid fever was validated using blood culture as the gold
standard. 200 culture positive typhoid cases and 200 cases with non-typhoid febrile
illness were subjected to this test. Totally, there were 210 who turned out to be test
positive; but 30 of these were culture negative.
Calculate, Sensitivity, Specificity, Positive predictive value, Negative predictive value,
percentage of false positives and false negatives.
Sensitivity- 90%
Specificity- 85%
PPV- 85.7%
NPV- 89.4%
% Of FP- 15%
% of FN- 10%

4. A rapid test which measures the presence of microfilarial antigen in the blood was
compared with the microscopic testing of the peripheral blood smear (which is
considered to be the gold standard). When a population of 2000 was screened 180 turned
out to be rapid test positive. Of the 150 smear positive samples, 138 were rapid test
positive too. What would be the sensitivity, specificity and predictive values of positive
and negative test, percentage of false positives and false negatives?
• Sensitivity- 92%
• Specificity- 97.7%
• PPV- 76.7%
• NPV- 99.34%
 • % Of FP- 2.27%
• % of FN- 8%

5. From the details given in the table below calculate the following to assess ECG as a
screening test to diagnose Myocardial infarction.
a. Sensitivity
b. Specificity
c. Positive predictive value.
d. Negative predictive value.
e. Percentage of false positives
f. Percentage of false negatives.
Disease Infarction No infarction
Abnormal ECG 50 91
Normal ECG 5 211

• Sensitivity- 90.9%
• Specificity- 69.8%
• PPV- 35.46%
• NPV- 97.68%
• % Of FP- 30.13%
• % of FN-9.09%

6. Among 149 migrants, the condition of HIV/AIDS was screened using ELISA test and the
disease was confirmed by Western Blot test. The ELISA test was positive for 37 people
and the Western Blot was positive for 62 people. Both tests were negative for 77 people.
Calculate the following for the screening test.
a. Sensitivity
b. Specificity
c. Predictive value of positive test
d. Predictive value of negative test
e. Percentage of false positives
f. Percentage of false negatives.
• Sensitivity- 43.55%
• Specificity- 88.5%
• PPV- 72.97%
• NPV- 68.75%
• % Of FP- 11.49%
• % of FN- 56.45%

Morbidity, Mortality & Vital statistics

7. In a city with population of 10,00,000 there were 30 new cases of Chronic myeloid
leukaemia (CML) reported in the year 2016. 25 previously diagnosed cases of CML were
 still alive at the end of 2015. A total of 15 cases of CML died during the year 2016.
Assuming no change in the population, calculate
a. Point prevalence of CML at the end of year 2015
b. Point prevalence of CML at the end of year 2016
c. Period prevalence of CML in 2016
d. Incidence of CML in 2016.

• Point prevalence of CML at the end of year 2015: 0.0025%

• Point prevalence of CML at the end of year 2016: 0.004%
• Period prevalence of CML in 2016: 0.0055%
• Incidence of CML in 2016: 0.03 per1000 per year

8. Mid-year population of a town in 2015 was 64550. There were 1500 births and 600
deaths in the year. In a morbidity survey, 221 old cases of Tuberculosis were identified
and 39 new cases were detected. Due to TB 2 deaths occurred during the year. Find out
a. Crude birth rate
b. Crude death rate
c. Growth rate
d. Case fatality rate
e. Proportional mortality rate
f. Specific death rate due to TB
g. Incidence rate of TB
h. Prevalence rate of TB

• Crude birth rate: 23.24/1000 population

• Crude death rate: 9.29 per 1000 population
• Growth rate: 1.39%
• Case fatality rate:0.77%
• Proportional mortality rate: 0.33%
• Specific death rate due to TB: 0.031 per 1000 population
• Incidence rate of TB: 0.6 per 1000 population per year
• Prevalence rate of TB: 0.4%

Epidemiological study designs

9. A group of 100 smokers were followed up for 10 years to study the incidence of COPD. A
comparison group of 200 non smokers were also followed up during this period. 30 of
the smokers and 20 of the non smokers developed COPD.

a. What is the type of study?

b. Put the study result into a properly labelled 2x2 table.
c. Calculate the incidence rates in the two groups
d. Calculate the relevant measure of association and explain what it means.
e. Calculate the Attributable risk
 • Cohort study
• Incidence among exposed: 300 per 1000 population
• Incidence among non-exposed: 100 per 1000 population
• Relative risk: 3
• Attributable risk: 66.67%

10. A study was done to evaluate the contribution of smoking on the causation of peripheral
vascular disease. 70 cases of thrombo-angitis-oblitrans were chosen as cases. 140 age-
matched controls were chosen. 40 cases and 40 controls were current smokers.
a. What type of design is used in this study?
b. Put the study result into a properly labelled 2x2 table.
c. Is there an association between smoking and TAO?
d. Interpret the result.

• Case control study

• Exposure rates among cases: 57.14
• Exposure rate among controls: 28.57
• Odds ratio: 3.33

11. All new cases of oral cancer appearing in a registry from a geographically defined area
were contacted to obtain history of pan chewing. A random sample of individuals
belonging to same age group as the cancer patients from the same area were also
contacted to get information on pan chewing. Of the 123 cases 82 gave history of pan
chewing. While of the 189 subjects from the general population 63 were pan chewers.
a. Name the study design
b. Put the study result into a properly labelled 2x2 table.
c. Calculate the relevant measure of association and interpret.

• Case control study

• Exposure rates among cases: 66.67
• Exposure rate among controls: 33.34
• Odds ratio: 4

12. A study was conducted to find out if chronic periodontitis is a risk factor for Coronary
Heart Disease (CHD). 188 patients with CHD and 180 patients without CHD were enrolled
in the study and were examined for evidence of chronic periodontitis. The data is given
below.
CHD present CHD not present
Chronic periodontitis present 152 110
Chronic periodontitis not present 36 70
Total 188 180
a. What is the study design?
b. Calculate the relevant measure and interpret.
 • Case control study
• Exposure rates among cases: 80.85
• Exposure rate among controls: 61.11
• Odds ratio: 2.69

13. In a study to find out the association between smoking and lung cancer, a group of 4000
people of whom 1600 were smokers and 2400 were non smokers, were enrolled. They
were followed for 20 years. 180 smokers and 20 non-smokers developed lung cancer.
Lung cancer No lung cancer Total
Smokers 180 1420 1600
Non-smokers 20 2380 2400
200 3800 4000
a. What is the type of study design?
b. Calculate incidence among exposed
c. Calculate incidence among non-exposed
d. Calculate relative risk and interpret.

• Cohort study
• Incidence among exposed: 112.5 per 1000 population
• Incidence among non-exposed: 8.33 per 1000 population
• Relative risk: 13.5
• Attributable risk: 92.59%

14. A study was conducted to find out the effect of tobacco chewing in onset of oral cancer.
A cohort of males aged 24 to 45 years with suitable control was followed up for a period
of 8 years. At the end of study period, 50 persons out of 6000 tobacco chewers and 9
persons out of 6000 non-users of tobacco developed oral cancer.
a. What is the type of study?
b. Calculate the Incidence rates.
c. Calculate Relative Risk and comment.
d. Calculate the Attributable risk. Comment.

• Cohort study
• Incidence among exposed: 8.33 per 1000 population
• Incidence among non-exposed: 1.5 per 1000 population
• Relative risk: 5.55
• Attributable risk: 82%

Demography & MCH

15. The following data relate to a town for the year 2013:

Midyear population 100,000

[Link] live births 2000
 No. of deaths 920
Of those who died, 600 were women of whom 2 died during delivery, 4 died during
delivery or between the 1st and 42nd day following delivery, 2 between the 60 to 90 days
following delivery and the rest were unrelated to delivery.
No. of foetal deaths (>1000 gms) -30
No. of deaths under 1 week -30
No. of deaths in first 4 weeks -50
No. of infant deaths (> 4 weeks to <52 weeks) -28

Calculate the following

a. Crude death rate
b. Perinatal mortality rate
c. Maternal mortality ratio
d. Neonatal mortality rate
e. Infant mortality rate.

• CBR: 20 per 1000 population

• CDR: 9.2 per 1000 population
• IMR: 39 per 1000 live births
• PNMR: 30 per 1000 live births
• NMR: 25 per 1000 live births (E-NMR: 15; L-NMR: 10)
• MMR: 3 per 1000 live births

16. In a town with an estimated mid-year population of 120,000 in 2013, there were 2,500
live births and 1000 deaths during the same year.
No. of abortions reported 300
[Link] foetal deaths (>1000gms) 50
Deaths 0 - 7 days 70
Deaths 8 - 28 days 40
Deaths 1 month - 1 year 20
Calculate the following:
a. Crude birth rate
b. Crude death rate
c. Infant mortality rate
d. Perinatal mortality rate
e. Neonatal mortality rate

• CBR: 20.83 per 1000 population

• CDR: 8.33 per 1000 population
• IMR: 52 per 1000 live births
• PNMR: 48 per 1000 live births
• NMR: 44 per 1000 live births (E-NMR: 28; L-NMR: 16)
Malarial and Filarial indices

17. The following are the data available for Kanchepuram district with population 10,00,000,
regarding Anti malaria activities during the year 2015. Blood smear examined = 80000
positive cases detected PV = 2592, PF = 308. Calculate ABER, API, AFI, SPR and
Percentage of falciparum. Interpret the results and mention remedial measures.

• API: 2.9 per 1000 population

• ABER: 8%
• AFI: 0.308 per 1000 population
• SPR: 3.625%
• SFR: 0.385%
• % of Pf: 10.62%

18. A filarial survey was conducted in a P.H.C area with a population of 25, 000. The results
of the survey were as follows
Number of persons showing only clinical manifestations of filariasis - 400
Number of persons showing microfilaria in blood smears without any clinical
manifestations of filariasis -900
Number of persons having both positive blood smear for microfilaria & clinical
manifestations of filarial disease - 100

Calculate the various filarial indices and suggest appropriate control measures for
filariasis in the said P.H.C area.

• Microfilaria rate: 4%
• Filarial disease rate: 2%
• Filarial endemicity rate: 5.6%

Estimation of Bleaching powder requirement for well disinfection

19. Enumerate steps in well disinfection and calculate amount of bleaching powder required
to disinfect a circular well of diameter 10 meters, Height of water column 8 meters when
second cup of Horrocks shows blue color.

• Volume of water column in the well: 628000 lit

• Bleaching powder required: 5520.8g
20. Calculate the amount of Bleaching Powder required to disinfect a rectangular tank with
a length of 8 metres, breadth of 4 metres and height of water column being 10 metres.
When the 3rd cup in the Horrocks apparatus shows blue colour. Write a note on steps in
well disinfection.

• Volume of water column in the well: 320000 lit

• Bleaching powder required: 4219.78 g