KASTURBA GANDHI NURSING COLLEGE

SRI BALAJI VIDYAPEETH, SBV CAMPUS

Pillaiyarkuppam, Puducherry- 607 403

ADVANCED NURSING PRACTICE

SEMINAR ON
MORTALITY
AND
MORBIDITY

SUBMITTED TO SUBMITTED BY
[Link], [Link],

ASSOCIATE PROFESSOR, [Link] NURSING,

DEPT. OF COMMUNITY HEALTH NURSING 1ST YEAR,

KGNC. KGNC.

SUBMITTED ON:
 MORTALITY AND MORBIDITY
[Link] CONTENT [Link]
1 Introduction 1
2 Definition of Vital Statistics 1
3 Uses Of Vital And Health Statistics 2
4 Indicators of Health 2
5 Epidemiology 2
6 Basic measurements in epidemiology 3
7 Mortality
7.1 Definition Of Mortality 3
7.2 International and Indian Death Certificate 3
7.3 Uses Of Mortality Data 4
7.4 Limitation In Mortality Data 4
7.5 Mortality Indicators And Mortality Rates And Ratios 4
7.5.1 Crude Death Rate 5
7.5.2 Expectation Of Rate 5
7.5.3 Infant Mortality Rate 6
7.5.4 Neonatal Mortality Rate 6
7.5.5 Maternal Mortality Rate 6
7.5.6 Fetal Death Rate 7
7.5.7 Child Mortality Rate(Under 5) 7
7.5.8 Survival Index 8
7.5.9 Disease Specific Mortality 8
7.5.10 Proportional Mortality Rate 8
7.5.11 Case Fatality Rate 10
7.5.12 Survival Rate 10
7.5.13 Specific Mortality Rate 10
 8 Morbidity
8.1 Definition Of Morbidity 12
8.2 Value Of Morbidity Date 12
8.3 Morbidity Indicators 12
8.4 Incidence 13
8.4.1 Special Incidence Rate 14
9 Prevalence
9.1 Definition 15
9.2 Types 15
9.3 Relationship Between Prevalence And Incidence 16
9.4 Uses of Prevalence 17
10 Role of nurse in prevention of mortality and morbidity 18
11 Theory Application 19-20
12 Journal Abstract 21-22
13 Summary 22
14 Conclusion 23
15 Bibliography 24
 MORTALITY AND MORBIDITY
INTRODUCTION
Every nation is concerned with the health of its people must
know what its health problem are their nature, their size, and their distribution
among the various population group. Now these problems vary from place to
place and practitioner, these problems vary from place to place, and how they
changes in time and by external condition, economic and social. For any such
assessment, certain basic measurements are necessary, these are called Vital
Statistics.

DEFINITION OF VITAL STATISTICS:

“Vital Statistics may be defined as the facts, systematically
collected and compiled in numerical form, related to, or derived from records of
events”. These vital events legally registered, statistically recording and
reporting of the occurrence of and the collection, compilation, presentation to
vital events. For example; live birth, deaths, marriages and sickness that occur
in the community.

ORIGIN:
Vital statistics began with the studies of JOHN GRAUNT in
England (1620-1674) who studied the weekly bills of mortality and discovered
that urban death rates were higher than rural death rates and he founded that
male births were higher than the female births.

WILLIAM FARR (1807-1883) of England accurately compiled and analyzed,

the vital events serve as “YARD STICKS” for measuring the health status of a
population.

USES OF VITAL AND HEALTH STATISTICS:

 It measures the state of health of a community (Problem, nature, size,
resources)
 Comparing the present states with that of the past (country to another
country).
  For planning and administration of health services.
 To determine priorities for health programs.
 To discover solution for health problems.
 For prediction of health trends.
 Directs and maintain control during execution of programs.
 To promote health legislation.
 For evaluating the progress, success or failure of health programs and
services already in operation.
 Demand public support for health work.
 For research into community health problems

INDICATORS OF HEALTH:
The indicator of health may be classified as follows;

 Mortality Rate
 Morbidity Rate
 Disability Rate
 Nutritional Status Indicators
 Health Care Delivery Indicators
 Utilization Rates
 Indicators Of Social And Mental Health
 Environmental Indicators
 Socioeconomic Indicators
 Health Policy Indicators
 Indicators Of Quality Of Life
 Other Indicators

EPIDEMIOLOGY:
The study of the distribution and determinants of health related states or
events in specified populations and the application of this study to control of
health problems.
BASIC MEASUREMENTS IN EPIDEMIOLOGY:

 Measurements of mortality
 Measurements of morbidity
 Measurements of disability
 Measurements of natality
 Measurements of the presence, absence or distribution of the
characteristics or attributes of the disease
 Measurement of medical needs, health care facilities, utilization of health
services and other health related events
 Measurement of the presence, absence or distribution of the
environmental and other factors suspected of causing the disease
 Measurements of demographic variables

MEASUREMENT OF MORTALITY AND MORBIDITY:

Epidemiology focus on the measurement of mortality and
morbidity in human population and epidemiologists usually expresses
the disease magnitude, ratios and proportions, which are the basic
tools of measurements.

TOOLS OF MEASUREMENT:
1. RATE
2. RATIO
3. PROPORTIONS
RATE:
A rate is the occurrence of some particular event in a population
during a given time period. It comprises a numerator, denominator,
multiplier and time specifications. The rate is expressed per 1000 or
10,000 or 100,000 according to convenience to avoid fractions.
Various categories of rates are;

 Crude rates
 Standardized rates
 Specific rates
RATIO:
A ratio is a measure which expresses a relation between two
random quantities. It is obtained by dividing one quantity by another
and numerator is not the component of denominator. It is expressed as
a:b or a/b
PROPORTIONS:
A proportion indicates the relation in magnitude of a part of the
whole. The numerator include in the denominator. It is expressed in
percentage.
 MORTALITY
Mortality rate is inevitable for planning and carrying out interventions by
government to reduce mortality. It is considered as starting point for many
epidemiological studies. Most epidemiological studies begin with mortality
statistics, in the death certificate for ensuring national and international
comparability. It is very necessary to have a uniform and standardized system of
recording and classifying deaths.

DEFINITION OF MORTALITY:
Mortality is the condition of being mortal or susceptible to death; the
opposite of immortality.

INTERNATIONAL DEATH CERTIFICATE:

The basis of mortality data is the Death Certificate. So we first look at
death certification for ascertaining the frequency of disease in a population. For
ensuring national and international comparability, it is very necessary to have a
uniform and standardized system of recording and classifying deaths. The death
certificate recommended by WHO for international use is given

DEATH CERTIFICATE USED IN INDIA:

In order to improve the quality of maternal mortality and infant mortality
data and to provide alternative method of collecting data on deaths during
pregnancy and infancy, a set of questions are added to the basic structure of
international death certificate for use in India.
USES OF MORTALITY DATA:
 In explaining trends and differentials in overall mortality.
 Assessed and monitoring of public health problems.
 Indication priorities for health action and allocation of resources.
 In designing intervention programmed.
 Assessment and monitoring of public health problems and programmers
 Gives clues for epidemiological research

LIMITATIONS IN MORTALITY DATA:

 Incomplete reporting of death
 Lack of accuracy
 Lack of uniformity
 Choosing a single cause of death
 Changing coding system and changing fashion in diagnosis
 Disease with low vitality
MORTALITY INDICATORS AND MORTALITY RATES AND
RATIOS:
Each year the information on deaths is analysed and the results are
made available to government. Commonly used mortality rates are:
 CRUDE DEATH RATE:

The simplest measure of mortality is the 'crude death rate'. It is

defined as "the number of deaths (from all causes) per 1000 estimated mid-year
population in one year, in a given place". It measures the rate at which deaths
are occurring from various causes in a given population, during a specified
period. The crude death rate is calculated from the formula;

NO OF DEATH OCCURRED IN AN YEAR

CRUDE DEATH RATE= ×1000

ESTIMATED MID-YEAR POPULATION

It is important to recognize that the crude death rate summarizes

the effect of two factors:

a) Population composition
b) Age-specific death rates (which reflect the probability of
dying)

 EXPECTATION OF LIFE:

 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
rate persists.
 It is estimated for both sexes separately.
 Life expectancy is a good indicator of socioeconomic development in
general.
 As an indicator of long term survival, it can be considered as appositive
indicators.
 Help to identify what is happening to overall standard of living of people
in India.
 One of the broadest standard of living measures is,
 The life expectancy- the average expected lifespan
In India; total population: 69.89

 INFANT MORTALITY RATE:

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”.

NO OF DEATH UNDER 1YEAR AGE

INFANT MORTALITY RATE= ×1000

NO OF LIVE BIRTH DURING THAT YEAR

Infant’s mortality rate:

Total: 30.15death/1000live birth

 NEONATAL MORTALITY RATE:

Deaths occurring within 4 weeks or 28days of birth are
called neonatal deaths.
NO OF DEATH UNDER 28 DAYS OF AGE
OCCURRED DURING A YEAR

NEONATAL MOTLITY RATE= ×1000

NO OF LIVE BIRTH DURING THAT YEAR

 MATERNAL MORTALITY RATE:

Maternal Death is defined as the death of a woman while

pregnant or within 42days 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.

NUMBER OF DEATHS DIRECTLY DUE TO PREGNANCY OR

CHILDBIRTH AND OCCURS DURING PREGNANCY OR WITHIN
42DAYS OF DELIVERY
MMR= ×1000

TOTAL LIVE BIRTH- STILL BIRTH

 FETAL DEATH RATE:

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
The still birth rate (late fetal death rate) correspond to

NO OF FETAL DEATH, 28WKS OF GESTATION

OR MORE OCCURRED DURING A YEAR

STILL BIRTH RATE= ×1000

NO OF LIVE BIRTH PLUS LATE FETAL

DEATH DURING THAT YEAR

NO OF FETAL DEATH, 28 WEEK OF GESTATION

OR MORE OCCURRED DURING A YEAR

LATE FOETAL DEATH RATE= ×1000

NO OF LIVE BIRTH DURING THAT YEAR

 CHILD MORTALITY RATE (UNDER 5):

It is defined as the number as the number of death at age 1-4

year in a given year, per 1000 children in that age group at the midpoint
of the year concerned. It thus excludes infant mortality.

NUMBER OF DEATH AT THE AGE OF 1-4 YEARS

= × 1000
 TOTAL NO OF LIVE BIRTH DURING THAT YEAR

 SURVIVAL INDEX:

It is the proportion of survivors in a group, (e.g., of patients)

studied and followed over a period (e.g., a 5-year period). It is a method of
describing prognosis in certain disease conditions. Survival experience can be
used as a yardstick for the assessment of standards of therapy. The survival
period is usually reckoned from the date of diagnosis or start of the treatment.
Survival rates have received special attention in cancer studies.

TOTAL NUMBER OF PATIENTS ALIVE AFTER 5 YEARS

SURVIVAL RATE = ×100

TOTAL NUMBER OF PATIENTS DIAGNOSED OR TREATED

 DISEASE SPECIFIC MORTALITY:

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

It is sometimes useful to know what proportion of total deaths are

due to a particular cause (e.g., cancer) or what proportion of deaths are
occurring in a particular age group(e.g., above the age of 50 years). Proportional
mortality rate expresses the "number of deaths due to a particular cause (or in a
specific age group) per 100 (or 1000) total deaths". Thus we have:

(a) Proportional mortality from a specific disease

NUMBER OF DEATHS FROM THE SPECIFIC DISEASE IN A YEAR

= × 100

TOTAL DEATHS FROM ALL CAUSES IN THAT YEAR

(b) Under-5 proportionate mortality rate:

NUMBER OF DEATHS UNDER 5 YEARS OF AGE IN THE GIVEN YEAR

= x 100

TOTAL NUMBER OF DEATHS DURING THE SAME PERIOD

(c) Proportional mortality rate for aged 50 years and above:

NUMBER OF DEATHS OF PERSONS AGED 50 YEARS AND

ABOVE

= x 100

TOTAL DEATHS OF ALL AGE GROUPS IN THAT YEAR

Proportional mortality rate is computed usually for a broad disease

group (such as communicable diseases as a whole) and for a specific disease of
major public health importance, such as cancer or coronary heart disease in
industrialized countries.

Proportional rates are used when population data are not available.
Since proportional mortality rate depends upon two variables, both of which
may differ, it is of limited value in making comparison between population
groups or different time periods. However, proportional rates are useful
indicators within any population group of the relative importance of the specific
disease or disease group, as a cause of death. Mortality from communicable
diseases is especially important as it relates mostly to preventable conditions.
Since the prevailing causes of death vary according to age and sex, it is
desirable to compute proportionate mortality separately for each age and sex
group in order to determine measures directed.

 CASE FATALITY RATE:

TOTAL NO OF DEATH DUE TO A
PARTICULAR DISEASE

CASE FATALITY RATE= ×100

TOTAL NO OF CASES WITH SAME DISEASE

Case fatality rate represents the killing power of a disease. It is

simply the ratio of deaths to cases. The time interval is not specified. Case
fatality rate is typically used in acute infectious diseases (e.g., food poisoning,
cholera, and measles). Its usefulness for chronic diseases is limited, because the
period from onset to death is long and variable. The case fatality rate for the
same disease may vary in different epidemics because of changes in the agent,
host and environmental factors. Case fatality is closely related to virulence.

 CHILD SURVIVAL INDEX:

1000- UNDER 5 MORTALITY RATE

CHILD SURVIVAL RATE=
10
A child survival rate per 1000 birth can be simply calculated by
subtracting the less than 5 mortality rate from 1000 dividing this figure by
ten shows the percentage of those who survive to the age of 5 years.

 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
 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.

 AGE SPECIFIC DEATH RATE FOR GROUP A

NO OF DEATH OF AGE A IN A YEAR

= ×1000
ESTIMATED POPULATION OF AGE A MIDYEAR

 SEX SPECIFIC DEATH RATE FOR SEX M

NO OF DEATH OF SEX M IN A YEAR

= ×1000
ESTIMATED POPULATION OF SEX M MIDYEAR
 CAUSE SPECIFIC DEATH RATE FOR CAUSE C

NO OF DEATH DUETO CAUSE C OCCURRED IN A YEAR

= ×1000

ESTIMATED MIDYEAR POPULATION

MORBIDITY

DEFINITION OF MORBIDITY:
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.

The WHO Expert committee on Health Statistics noted in its 6 th

report that morbidity could be measured in terms of 3 units;

a) Person who ill

b) The illness that these persons experienced
c) The duration of these illnesses

VALUE AND IMPORTANCE OF MORBIDITY DATA:

 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 etiological studies, and thus play a crucial
role in disease prevention.
 They are needed for monitoring and evaluation of disease control
activities.

MEASUREMENT OF MORBIDITY:
Morbidity means deviation from normal state of physiological well-being.
Morbidity is measured in terms of a number of persons who are ill, spells of
illness experienced by persons and duration of days, the person have suffered
the illness.

 Frequency
 Duration
 severity

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 mortality indicators
are used to supplement mortality data to describe the health status of a
population.

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 centers, etc
 Admission readmission and discharge rates.
 Duration in hospital and spells of sickness or absence from work or
school.

INCIDENCE:

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.

NO OF NEW CASES OF SPECIFIC DISEASE DURING GIVEN

INCIDENCE= ×1000

POPULATION AT RISK DURING THAT PERIOD

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

NO OF SPELLS OF ILLNESS STARTING

IN A DEFINED PERIOD

INCUDENCE RATE (SPELL) = ×1000

MEAN NO OF PERSON EXPOSED

TO RISKIN THAT PERIOD

Special incidence rates:

Examples include: Attack rate (case rate), Secondary attack rate, Hospital
admission rate, etc.

a. Attack rate:

An attack rate is an incidence rate (usually expressed as a per cent), used

only when the population is exposed to risk for a limited period of time such as
during an epidemic. It relates the number of cases in the population at risk and
reflects the extent of the epidemic. Attack rate is given by the formula:

Attack rate

NUMBER OF NEW CASES OF A SPECIFIED

DISEASE DURING A SPECIFIED TIME INTERVAL

ATTACK RATE = × 100

TOTAL POPULATION AT RISK DURING THE

SAME INTERVAL

b. Secondary attack rate:

 It is defined as the number of exposed persons developing the disease
within the range of the incubation period following exposure to a primary case.

USES OF INCIDENCE RATE:

The incidence rate, as a health status indicator, is useful for taking action
(a) to control disease, and (b) for research into etiology and pathogenesis,
distribution of diseases, and efficacy of preventive and therapeutic measures.

Rising incidence rates might suggest the need for a new disease control or
preventive programme, or that reporting practices had improved. A change or
fluctuation in the incidence of disease may also mean a change in the etiology
of disease, e.g., change in the agent, host and environmental characteristics.
Analysis of differences in incidence rates reported from various socio-economic
groups and geographical areas may provide useful insights into the effectiveness
of the health services provided.

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.

DEFINITION:
“The total 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 attributed or disease at this point in time or midway through the
period”.

TYPES:

 Point prevalence
 Period prevalence

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 take to examine
the population sample. It is given by the formula;

NO OF ALLCURRENT CASES (OLD &NEW) OF A SPECIAL AT A GIVEN

POINT IN TIME
= ×1000
ESTIMATED POPULATION AT THE SAME POINT IN TIME

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.

RELATIONSHIP BETWEEN PREVALENCE AND INCIDENCE:

Prevalence depends upon 2 factors, the incidence and duration of

illness gives the assumption that the population is stable, and incidence and
duration are unchanging, the relationship between incidence and prevalence can
be expressed as;
P =I × D
= INCIDENCE X MEAN DURATION

Example;

 Incidence = 10 cases per 1000 population per year

 Mean duration of disease = 5 years

Prevalence = 10 x 5= 50 per 1000 population

Conversely, it is possible to derive incidence and duration as follows:

Incidence = P/D
 Duration = P/I

The above equation (P = Ix D) shows that the longer the duration of the disease,
the greater its prevalence

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 bed, manpower needs,
Rehabilitation etc.

ROLE OF NURSE IN PREVENTION OF MORTALITY AND

MORBIDITY:

 Identifies, investigates and take preventive measures to reduce the risk of

infectious disease outbreaks
 Reduction of risk factors to reduce morbidity and mortality rate
 Strengthening self-care activities to promote the health and prevent the
occurrence of diseases
 Maintain the quality of life to live productive life
 Improving standard of living to protect the health against diseases
 Apply epidemiological principles and knowledge of the disease process to
manage and control communicable diseases using preventive techniques,
infection control, behaviour change counseling, outbreak management,
surveillance, immunization, health education and case management.
 Motivates and guides communities, families and individuals to create
healthier environment.
THEORY APPLICATION
HEALTH BELIEF MODEL
 It was developed by Rosenstoch in1974 and Becker and Maiman in
[Link] Health Belief Model highlights how programs need to consider
individual beliefs about the problem being addressed, and the costs and barriers
associated with changing a behavior.

THIS MODEL HAS THREE COMPONENTS:

 Individual perception
 Individual’s perception of seriousness of the illness
 The likelihood of action

According to the Health Belief Model, a person is likely to change

behavior if he/she experiences:

 Perceived Susceptibility/Seriousness: believing he/she is at risk.

For example, the mother believes she is at risk of buying SSFFC medicines
or that her child will face severe consequences if treated with poor quality
medicine.

 Perceived Benefits: believing that the behavior change will reduce risk.

For example, a mother believes that she is more likely to get good quality
malaria medicine if she gets it from a government health facility, instead of
the local drug vendor.

 Perceived Barriers: how one interprets the costs/barriers of the desired

behavior.
For example, a mother is concerned about the time and transportation costs
involved in going to the government health facility when her child is sick
with fever, rather than simply buying malaria medicine from the local drug
vendor.

 Cues to Action: strategies to activate “readiness.”

 For example, a health provider recommends a quality medicine source when
telling the mother her child tested positive for malaria.

 Self-Efficacy: feeling confident in one’s ability to take action.

For example, a mother feels that she is able to purchase malaria medicines
from less risky, regulated sources.

NURSING IMPLICATIONS:
As health belief model explains the relationship between client’s
behaviour and beliefs. It helps the nurses to understand client’s belief and
perception about health which helps his/her in preventing diseases and
promoting health.

JOURNAL ABSTRACT
TOPIC: Dysnatremia is a Predictor for Morbidity and Mortality in
Hospitalized Patients with COVID-19

The Journal of Clinical Endocrinology & Metabolism, Volume 106, Issue 6,

June 2021, Pages 1637–1648, [Link]
Published: 23 February 2021
AUTHOR: Ploutarchos, Tzoulis, Julian A Waung, Emmanouil Bagkeris, Ziad
Hussein, Aiyappa Biddanda, John Cousins

ABSTRACT:

Context:
Dysnatremia is an independent predictor of mortality in patients with
bacterial pneumonia. There is paucity of data about the incidence and
prognostic impact of abnormal sodium concentration in patients with
coronavirus disease 2019 (COVID-19).
Objective:
This work aimed to examine the association of serum sodium during
hospitalization with key clinical outcomes, including mortality, need for
advanced respiratory support and acute kidney injury (AKI), and to explore the
role of serum sodium as a marker of inflammatory response in COVID-19.
Methods:
This retrospective longitudinal cohort study, including all adult patients
who presented with COVID-19 to 2 hospitals in London over an 8-week period,
evaluated the association of dysnatremia (serum sodium < 135 or > 145
mmol/L, hyponatremia, and hypernatremia, respectively) at several time points
with inpatient mortality, need for advanced ventilatory support, and AKI.
Results:
The study included 488 patients (median age, 68 years). At presentation,
24.6% of patients were hyponatremic, mainly due to hypovolemia, and 5.3%
hypernatremic. Hypernatremia 2 days after admission and exposure to
hypernatremia at any time point during hospitalization were associated with a
2.34-fold (95% CI, 1.08-5.05; P = .0014) and 3.05-fold (95% CI, 1.69-5.49; P 
< .0001) increased risk of death, respectively, compared to normonatremia.
Hyponatremia at admission was linked with a 2.18-fold increase in the
likelihood of needing ventilatory support (95% CI, 1.34-3.45, P = .0011).
Hyponatremia was not a risk factor for in-hospital mortality, except for the
subgroup of patients with hypovolemic hyponatremia. Sodium values were not
associated with the risk for AKI and length of hospital stay.
Conclusion:
Abnormal sodium levels during hospitalization are risk factors for poor
prognosis, with hypernatremia and hyponatremia being associated with a greater
risk of death and respiratory failure, respectively. Serum sodium values could
be used for risk stratification in patients with COVID-19.

SUMMARY:
Till now I have discussed about introduction of health, uses of vital and
health statistics, indicators of health, measurement of epidemiology, mortality
and morbidity in that briefly seen definition, limitation, uses, values and rates of
morbidity and mortality and also seen prevalence definition, types, uses, role of
nurse in prevention of mortality and morbidity, theory application, journal
abstract.

CONCLUSION:
Mother and child are one unit and most vulnerable to the morbidity and
mortality. Hence it is essential to protect them through appropriate action at
each level. MCH epidemiology programmer emphasizes the analytical skills to
address the health problems of the analytical skills to address the health
problems of the mothers and children through surveillance, assessment,
planning, implementation, monitoring and evaluation. Nurse as team member of
the health can contribute her skill for the promotion of health of mother and
children.

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Published by Banarasi Das Bhanot.
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 Gulani KK. Community Health Nursing Principles and Practices. 1 ST
Edition. Published by Kumar Publishing House
 Basavanthapa BT. Community health nursing. 1ST Edition. Published by
Jaypee Brothers; New delhi.
 [Link] Bhaskararaj. Text book of Advance nursing practice. 1st
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 Lakhwinder kaur and maninder kaur, a textbook of nursing foundation,
2017th edition, published by [Link] and company, [Link] – 781.
 Neelam kumara, a textbook of community health nursing -1, 5th edition,
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Journal Reference

 [Link]
ABSTRACT_1003__MORBIDITY_AND_MORTALITY_.[Link]

Net Reference

 [Link]
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