INTRODUCTION TO

BIOSTATISTICS
Ayenew Molla (Ass’t Professor)

Department of Epidemiology and Biostatistics

Institute of Public Health
University of Gondar

mayenew15(@[Link]

February 2021 1
 Introduction to Biostatistics
 Objectives of the chapter
 After completion of this chapter, the student will be able
to:
– Understand the rationale of Biostatistics
– Enumerate the importance and limitations of
biostatistics
– Define and Identify the different types of data and
understand why we need to classify variables
– Identify the different methods of medical and biological
data collection, organization and presentation

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Statistics/Biostatistics
 Statistics/Biostatistics?

 Classes of statistics?

 Statistical inference?

3
 Statistics/Biostatistics…
In most of the empirical research, but definitely in medical
research, scientific conclusions need to be supported by a
‘significant result’ using the classical P-value.

 Views/paradigms to draw statistical inference:

the Frequentist approach and
the Bayesian approach

 In-between these two paradigms is the (pure) likelihood

approach.

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 Thoughts in Biostatistics

 Common schools of thoughts of statistics

Frequentist

Bayesian

Likelihood

 Likelihood is a unifying aspect of the remaining two schools of

thoughts

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 Thoughts in Biostatistics cont’d…
Frequentist (The classical school of thought)

 Sir Ronald Fisher (1890-1962)

 Gave us the null hypothesis and p-values as evidence against
the null
 Neyman/ Pearson (1928)
 Gave us Type I and II errors, power, alternative hypotheses,
deciding to reject or not reject based on an alpha level
 Fisher and Neyman/Pearson had different views on statistics and,

 Today’s typical "statistics for scientists" course is a jumbled

combination of both, which can lead to much confusion
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 Thoughts in Biostatistics cont’d…
Bayesian
 It is arguably the oldest method (Thomas Bayes; 1702-1761)
 It combines the results of an experiment with some prior information
to get what is called a posterior probability

 Established a mathematical basis for the probability an event will occur in

the future from the frequency that it has occurred in the past.

 The controversial part of Bayesian thought is the prior information because

two people may have different prior knowledge or information and thus end
up with a different result

 The advantage of Bayesian methods is that they can include other relevant
information and are therefore useful for integrating the results of many
experiments. 7
 Thoughts in Biostatistics cont’d…
Likelihood

 Likelihood is a common (and perhaps unifying) aspect of the

previous methods.

 The term was coined by Fisher which underpins much of

classical statistics.

 It is also the uncontroversial part of Bayesian statistics, and

 The higher the likelihood, the better the fit.

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 Statistics/Biostatistics
 The term statistics is used to mean either statistical data or
estimates or statistical methods.

1. Statistical data: it refers to numerical descriptions of things.

These may take the form of counts or measurements.

 Estimates (the plural form of statistic): two or more

descriptive measures computed from the data of a
sample/samples (e.g. sample mean or proportion)

E.g., statistics of malaria cases include fever cases

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 Statistics/Biostatistics…
 NB : Even though statistical data always denote figures
(numerical descriptions), it must be remembered that all
'numerical descriptions' are not statistical data.
1. They must be in aggregates,
2. They must be enumerated or estimated according to a
reasonable standard of accuracy,
3. They must have been collected in a systematic manner for a
predetermined purpose
4. They must be placed in relation to each other.
 Statistics/Biostatistics…

2. Statistical methods: it refers to a body of methods used for

collecting, organising, analyzing and interpreting numerical data for
understanding a phenomenon or
making wise decisions.

 In this sense it is a branch of scientific method and helps us to

know in a better way the object under study.

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 Statistics/Biostatistics…

 Statistics is the science of gaining information from data

through

 collecting data,

 Organizing,

 analysing and drawing conclusion (inferences) from data.

statistics

Information
Data
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Biostatistics?
 Biostatistics…
 The tools of statistics are employed in many fields (e.g.
health, agriculture, business, economics, social, education,
psychology etc.)

 When the data being analyzed are derived from the

biological sciences, medicine or public health, we use
the term biostatistics to distinguish this particular
application of statistical tools and concepts from the others

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 What Do Biostatisticians Do?
 Identify and develop treatments for disease and estimate
their effects.
 Identify risk factors for diseases.
 Design, monitor, analyze, interpret, and report results of
clinical studies.
 Develop statistical methodologies to address questions
arising from medical/public health data.

 Whether you apply statistics to biological or other processes, it

is the art of decision making in the face of uncertainty.

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Classification of Biostatistics
Descriptive statistics

Inferential statistics

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 Descriptive Statistics
• Statistical procedures used to summarise, organise, and simplify data. This
process should be carried out in such a way that reflects overall findings
Raw data is made more manageable
Raw data is presented in a logical form
Patterns can be seen from organised data
Some statistical summaries which are especially common in descriptive
analyses are:
Measures of central tendency
Measures of dispersion
Cross-tabulation, contingency table
Bar charts
Histogram
Quantile, Q-Q plot
Scatter plot
Box plot
 Statistical Inferences
 This branch of statistics deals with techniques of making
conclusions about the population

 Inferential statistics builds upon descriptive statistics

 The inferences are drawn from particular properties of sample to
particular properties of population

 Inferential statistics are used to make generalizations from a

sample to a population
generalize

sample
Population

Select sample
 Statistical inference:.....
 They encompasses a variety of procedures to ensure that the
inferences are sound and rational, even though they may not
always be correct

 In short, inferential statistics enables us to make confident

decisions in the face of uncertainty

– E.g. Antibiotics reduce the duration of viral throat infections

by 1-2 days

– Five percent of women aged 30-49 consult their GP each

year with heavy menstrual bleeding

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 Statistical Methods
Biostatistics

Descriptive Statistics Inferential Statistics

collection making inferences

organizing hypothesis testing
summarizing determining relationship
presenting of data making the prediction

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 What does biostatistics cover?

Research Planning

Design The best way to

Biostatistical learn about
thinking biostatistics is to
Execution (Data collection)
contribute in follow the flow of a
every step in a research from
Data Processing
research inception to the
final publication
Data Analysis

Presentation

Interpretation
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Publication 21
 Definition of some basic terms
 Target Population:. the population about which you want
information, that you wish to make conclusions about from the
results of the study.

 Study(sampled) Population: is a part of target population

and actually accessible and legitimate for data
collection

 Sample: A subset of a study population, about which

information is actually obtained. It is a part of a population

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Sample, study population, target population

STUDY POPULATION

Sample

TARGET POPULATION
 Population vs. Sample

2/6/2021 24
 Definition cont’d…
• For example, suppose you want to estimate the
prevalence of flu-like symptoms in a country and you
conduct telephone interviews;
Target population  the total population in the country
Study population all people with telephones

• If you want to conduct a research on institutional delivery

mothers who gave birth in the last one year in Amhara
Region and a take a sample of Zones;
Target population  ?
Sampled population ? 25
 Definition cont’d…

 Census: Complete enumeration of the population

 Sample survey: A statistical study based on samples

 Parameter: A descriptive measure computed from the data of

a population: eg., population proportion (π)

 Statistic: A descriptive measure computed from the data of a

sample: eg., sample proportion (P)

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Parameter and statistic

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 Definition cont…

 Sampling: The technique of selecting representative

portion of the entire population

 Variable: A characteristic which takes different values

in different persons, places, or things/objects.
(e.g., BP, age, sex, birth weight, etc)

Data: observation collected from the source

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 Types of variables
 In broad terms we have two types of variables: (quantitative and
qualitative)
1. Quantitative variable (Discrete & continuous)
– Numerical variables,
– Information is measured by assigning numbers (eg. Age, BP, wt, etc),

2. Qualitative variable (a.k.a categorical variables):

No-numerical variables,
Information is measured by assigning names to items (events)
according to a set of rules, which result on different types of
data.
Eg. Eye color, blood group, Marital status
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 categories of Variables

Variables

Category Quantity

Continuous
Ordinal Discrete
Nominal (counting) (measuring)

Ordered
categories Ranks.

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 Levels of Measurement
The level of measurement determines which statistical calculations are
meaningful.

The four levels of measurement are: nominal, ordinal, interval, and

ratio.

Nominal
Lowest to
Levels of Ordinal highest
Measurement Interval
Ratio
 Nominal Level of Measurement
Data at the nominal level of measurement are qualitative
only.
Nominal
Calculated using names, labels, or
Levels of qualities. No mathematical
Measurement computations can be made at this
level.

Colors in the
Blood type Religion
Ethiopian flag
 Ordinal Level of Measurement
Data at the ordinal level of measurement are qualitative or
quantitative.

Levels of
Measurement Ordinal
Arranged in order, but differences
between data entries are not
meaningful.

Class standings: Severity of disease as: Top 10 songs

freshman, sophomore, healthy, mild, moderate, played by
junior, senior sever Ethiopian idol
 Interval Level of Measurement
Data at the interval level of measurement are quantitative. A zero entry
simply represents a position on a scale; the entry is not an inherent zero.

Levels of Interval
Measurement
Arranged in order, the differences between
data entries can be calculated.

Temperatures Years on a timeline IQ level

 Ratio Level of Measurement
Data at the ratio level of measurement are similar to the interval level,
but a zero entry is meaningful.

A ratio of two data values can be formed so

Levels of one data value can be expressed as a ratio.
Measurement

Ratio

Grade point
Ages Weights
averages
 Summary of Levels of Measurement

Determine if one
Arrange
Level of Put data in Subtract data value is a
data in
measurement categories data values multiple of
order
another

Nominal Yes No No No
Ordinal Yes Yes No No
Interval Yes Yes Yes No
Ratio Yes Yes Yes Yes
 Exercises
Give the correct scales of measurement for each variable
1. Blood group ...............................
2. Temperature (Celsius) ...............
3. Hair colour ................................
4. Job satisfaction index (1-5).........
5. Number of heart attacks .............
6. Calendar year ...........................
7. Serum uric acid (mg/100ml)..........
8. Number of accidents in a 3 - year period....
9. Number of cases of each reportable disease
reported by a health worker.......
10. The average weight gain of a 1-year old dogs with
a special diet supplement was 950 grams last month...

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 Rationale of studying statistics
• Public health & medicine are becoming increasingly quantitative;
and
• statistics is the language of assembling and handling quantitative
issues

• i.e. the planning, conduct, and interpretation of much of medical

research are becoming increasingly reliant on statistical
technology.
Example:-
 Is the new drug better than the one commonly in use? How
much better?
 In testing a new drug how many patients must be treated, and in
what manner, in order to demonstrate its worth?
 Which group of the population is more affected by
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malaria/Fistula ? Etc…
 Uses of statistics:
The main function of statistics is to enlarge our knowledge of complex
phenomena. The following are some uses of statistics:

 It presents facts in a definite and precise form

 Data reduction

 Measuring the magnitude of variations in data

 Furnishes a technique of comparison

 Estimating unknown population characteristics

 Testing and formulating of hypothesis

 Studying the relationship between two or more variable

 Forecasting future events

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 Limitations of statistics

1. It deals with only those subjects of inquiry that are capable of

being quantitatively measured and numerically expressed
2. It deals on aggregates of facts and no importance is attached to
individual items
– suited only if the group characteristics are desired to be
studied
3. Statistical data are only approximation and not mathematically
correct 40
 Misuse of statistics

 The vast majority of errors in research arise from a poor

planning (e.g., data collection)

 Fancy statistical methods cannot rescue garbage data

 Collect exact values whenever possible

 Data Collection Methods/ Techniques
Sources of Data

Primary data
 Data generated for the first time primarily/originally for
the study in question

 it needs the involvement of the researcher himself

 Census and sample survey are sources of primary types of

data

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Secondary data
• The data needed to answer a question may already exist in the
form of published reports, commercially available data banks, or
the research literature

• In this case data were obtained from already collected sources

like newspaper, magazines, DHS, hospital records and existing
data like;
 Mortality reports
 Morbidity reports
 Epidemic reports
 Reports of laboratory utilization (including laboratory test
results)
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Methods of data collection
We distinguish three basic different methods of collecting
data. These are:

• Extraction of data from records

• Self-administered questionnaire

• Direct investigation-measurement (observation) of the

subject and interviewing (face-to-face, telephone) our
first step is to decide on which of these three methods to
use.
 Factors influencing choice of data
collection methods
• Type of data
• Availability of data
• Money
• Time
• Quality needed
• Characteristics of study participants
 Extraction of data from records

A mass of information about the population studied by social

surveys is available in

 historical documents,

 statistical reports,

 records of institutions and

 other sources …
 Self-administered questionnaire

• Mail and Self-administered questionnaire is a method of data

collection in which researchers can give questionnaires with
instructions directly to respondents,

• or mail them to respondents who read instructions and questions,

• then record their answers and give it back or return it by mail

again to data collecting agency.
Advantages
• It is the cheapest and can be conducted by a single researcher.

• A researcher can send questioners to a wide geographical

area.

• The respondent can complete the questionnaire when it is

convenient and check personnel records if necessary.

• Mail questionnaire offer anonymity and avoid interviewer

bias.
Disadvantages
• A low response rate is the biggest problem

• A researcher cannot control the conditions under which a

mail questionnaire is completed

• Researcher cannot visually observe the respondent’s

reactions to questions, physical characteristics, or settings

• Mail questionnaire is not suitable for illiterate community

Direct investigation- measurement
These are

 Observation and
 Interviewing (face-to-face, telephone)
Measurement or Observations
• Information on a topic can be gathered by measurement if it
is physically measurable or observable.
Common types of data collected by observation and
measurement include:
• Anthropometrics measurements
• Weight, height
• Direct observations of work
• The observation of people engaged in an activity
Cont’d…
• Face-to-face interview is a social process that involves the
interviewer and respondent.

• It is the process in which the interviewer meets the

respondents, explains the purpose of the study, forwards a set
of questions and records the answers.

• It is widely used in economic and social surveys.

 Advantage of face-to-face interviews
• Have the highest response rate,

• Interviewers control the sequence of questions and use some

probes,

• Respondent is likely to answer all the questions alone,

• Interviewers also can observe the surroundings and can use

nonverbal communication and visual aids,

• Well-trained interviewers can ask all types of questions

including complex questions.
 Disadvantages
• Cost is high- that is , recruiting, training, travel, supervisor,
and personnel costs for interviewers can be high.

• Interviewer bias is also high in this method.

• The appearance, tone of voice, question wording, and so forth

of the interview may affect the respondent.
 Data collection tools/Instruments

 One of the most important components of a research design

is a set of research instruments because they are the tools we
use to collect the data

 Some of them are questionnaires, measuring instruments

(e.g anthropometric measuring instruments like meter, tape,
balance scale), etc for quantitative study, and

 interview guideline (check list), tape recorder , etc. for

qualitative study

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 Research Tools cont’d…

 Questionnaires are the most frequently used data collection

tools in quantitative research.

 If there are standard questionnaires already designed by

other organizations, use it as one should not re-invent the
wheel.

 Otherwise, developing a valid and reliable questionnaire is a

must to reduce measurement error which is the "discrepancy
between respondents' actual attributes and their survey
responses

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 Types of Questions
 Depending on how questions are asked and recorded we can
distinguish two major possibilities - Open–ended questions, and
closed questions.

 Open-ended questions
Open-ended questions permit free responses that should be
recorded in the respondent’s own words. The respondent is not
given any possible answers to choose from.
Such questions are useful to obtain information on:
 Facts with which the researcher is not very familiar,
 Opinions, attitudes, and suggestions of informants, or
 Sensitive issues.

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 Open-ended questions cont’d…

For example
 Can you describe exactly what the traditional birth attendant
did when your labor started?

 What would you do if you noticed that your daughter (school

girl) had a relationship with a teacher?

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 Closed Questions
 Closed questions offer a list of possible options or answers from
which the respondents must choose.

 When designing closed questions one should try to:

 Offer a list of options that are exhaustive and mutually
exclusive

 Keep the number of options as few as possible.

 Closed questions are useful if the range of possible responses

is known.

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 Closed Questions cont’d…
For example
 What is your marital status?
1. Single
2. Married/living together
3. Separated
4. divorced
5. widowed
 Have you ever gone to the local village health worker for
treatment?
1. Yes
2. No
Closed questions may also be used if one does not want to
waste the time of the respondent and interviewer by obtaining
more information than one needs. 59
60