DEPARTMENT OF COMMUNITY MEDICINE

Sree Balaji Medical College & Hospital

STATISTICAL EXERCISES
DESCRIPTIVE STATISTICS
1. Mid arm circumference of 11 male children aged 18 months are given below.
12, 14, 11, 12, 13, 15, 12, 13, 15, 14, 12
Calculate
i. Measures of Central tendency (mean, median, mode)
ii. Measures of Dispersion (range, mean deviation, standard deviation)

x = 11, 12, 12, 12, 12, 13, 13, 14, 14, 15 and 15

(I) Measures of Central Tendency

-

x
a) ()
Mean x =
n

143
= = 13 cm
11

()
Mean x = 13 cm

𝑛+1 𝑡ℎ
b) Median = ( ) value
2

11 + 1 12
= =
2 2

= 6th value

Median = 13 cm

c) Mode = frequently recurring number in the series

= 12 cm.

(II). Measures of Dispersion:

(a) Range = maximum value – minimum value

= 15 – 11

Range = 4 cm
(b) Mean Deviation

[Link]. x x 𝑥-xI I𝑥 - x I (𝑥 - x )2
1. 11 13 -2 2 4
2. 12 13 -1 1 1
3. 12 13 -1 1 1
4. 12 13 -1 1 1
5. 12 13 -1 1 1
6. 13 13 0 0 0
7. 13 13 0 0 0
8. 14 13 1 1 1
9. 14 13 1 1 1
10. 15 13 2 2 4
11. 15 13 2 2 4
TOTAL 12 18

Mean Deviation = ∑ I𝑥 - x I / n

= 12 / 11

Mean Deviation = 1.09 cm

 ( x − x)2
c) Standard deviation: =
n −1

18 18
= =
11 − 1 10

= 1.8 =1.34

Standard deviation = 1.34 cm.

2. The serum cholesterol levels (in mg/dl) of 10 persons are given below.
260, 200, 240, 260, 150, 220, 190, 210, 240, 240.
Calculate
i. Measures of Central tendency (mean, median, mode)
ii. Measures of Dispersion (range, mean deviation, standard deviation)
 x= 150, 190, 200, 210, 220, 240, 240, 240, 260, 260.

(I) Measures of Central Tendency

x
a) Mean =
n
150 + 190 + 200 + 210 + 220 + 240 + 240 + 240 + 260 + 260
=
10
2210
= = 221
10
()
Mean x = 221 mg/dl

th th
n n 
  value +  + 1 value
Median =   2 
2
b)
2
 10   10 
  +  + 1 5th + 6th
=    =
2 2
2 2
220 + 240
=
2
= 230
Median = 230 mg/dl

c) Mode = frequently recurring number in the series

= 240
Mode = 240 mg/dl

(II). Measures of Dispersion:

(a) Range = maximum value – minimum value

= 260 – 150

Range = 110 mg/dl

(b) Mean Deviation

S. No. x x 𝑥-x I𝑥 - x I (𝑥 - x )2
1. 150 221 -17 71 5041
2. 190 221 -31 31 961
3. 200 221 -21 21 441
4. 210 221 -11 11 121
5. 220 221 -1 1 1
6. 240 221 19 19 361
7. 240 221 19 19 361
8. 240 221 19 19 361
9. 260 221 39 39 1521
10. 260 221 39 39 1521
TOTAL 270 10690

Mean Deviation = ∑ I𝑥 - x I / n

= 270 / 10

Mean Deviation = 27 mg/dl

 ( x − x)2
c) Standard deviation =
n −1

10690 10690
= =
10 − 1 9

= 1187.7 = 34.46

Standard deviation = 34.46 mg/dl

Answers:

a) Mean = 221 mg/dl

b) Median = 230 mg/dl
c) Mode = 248 mg/dl
d) Range = 110 mg/dl
e) Mean Deviation = 27 mg/dl
f) Standard deviation = 34.46 mg/dl
3. Weight in kg of 10 children aged 2 years are 9, 11, 10, 9, 12, 8, 9, 11, 9, 12

Calculate

i. Measures of Central tendency (mean, median, mode)

ii. Measures of Dispersion (range, mean deviation, standard deviation)

x = 8, 9, 9, 9, 9, 10, 11, 11, 12 and 12

(I) Measures of Central Tendency

x
a) Mean =
n

8 + 9 + 9 + 9 + 9 + 10 + 11 + 11 + 12 + 12
=
10

100
= = 10
10

Mean = 10 Kg.
th th
n n 
  value +  + 1 value
Median =   2 
2
b)
2
th
 10 
th
10
value +  + 1
=
2 2 
2

5th + 6th
=
2

9 + 10 19
= = = 9.5 Kg.
2 2

Median = 9.5 Kg.

c) Mode = Frequently recurring value in the series.

Mode = 9 Kg.

(II). Measures of Dispersion:

(a) Range = maximum value – minimum value

= 12 – 8
 Range = 4 Kg

(b) Mean Deviation

S. No. x x 𝑥-x I𝑥 - x I (𝑥 - x )2
1. 8 10 -2 2 4
2. 9 10 -1 1 1
3. 9 10 -1 1 1
4. 9 10 -1 1 1
5. 9 10 -1 1 1
6. 10 10 0 0 0
7. 11 10 1 1 1
8. 11 10 1 1 1
9. 12 10 2 2 4
10. 12 10 2 2 4
TOTAL 12 18

Mean Deviation = ∑ I𝑥 - x I / n

= 12 / 10

Mean Deviation = 1.2 Kg

 ( x − x)2
c) Standard deviation =
n −1

18 18
= = = 2
10 − 1 9

Standard deviation = 1.414 kg

Answers:

a) Mean = 10 Kg
b) Median = 9.5 Kg
c) Mode = 9 Kg
d) Range = 4 Kg
e) Mean Deviation = 1.2 Kg
f) Standard deviation = 1.414 kg
 ANALYTICAL STATISTICS

4. A study was conducted to know the effects of forceps delivery on the development of
mental retardation. The obstetric records of 100 normal and 50 mentally retarded
children were and analyzed. It was found that outlet forceps was applied on 4 of
normal and 10 mentally retarded groups.

a) Name the type of study

b) Calculate odd’s ratio and give your inference
c) Calculate exposure rates.

a) Case control study.

aXd
b) Odd’s Ratio =
bXc

Forceps Mental Retardation Mental Retardation Total

present absent
Applied 10 (a) 4 (b) 14 (a+b)
Not applied 40 (c) 96 (d) 136 ( c+d)
50 ( a+c ) 100 ( b+d )

ad 10 X 96
Odd’s ratio = =
bc 4 x 40

Odd’s ratio = 6

a
c) Exposure Rate among cases = a+c x 100

10
= x 100= 20 percent
50

Exposure Rate among controls = b/b+d

= 4/100 x 100 = 4 percent

 a) Case control study
b) Odds ratio = 6 i.e., Children born by forceps delivery have a risk of mental
retardation 6 times more than those born by non-forceps delivery
c) Exposure rate among cases = 20 percent
Exposure rate among controls = 4 percent.

5) 2000 smokers and 4000 non smokers were followed for 10 years. 65 smokers & 20 non-
smokers developed CHD. Find out casual association of smoking with CHD. Comment of results
obtained by you.

a) Name the Type of study

b) Calculate the Incidence
c) Estimate the Relative risk
d) Calculate the Attributable risk.

CHD present CHD absent Total

Smokers 65 (a) 1935 (b) 2000 (a+b)
Non smokers 20 (c) 3980 (d) 4000 ( c+d)
85 ( a+c ) 5915 ( b+d )

a) Cohort study

a) Incidence:

Incidence among (exposed)

a
Smokers = a+b x 1000

65
= x 1000
2000

= 32.5 per 1000

c
Incidence among non - smokers = c+d x 1000

20
= 4000 x 1000

= 5 per 1000
 a
a+b
b) Relative Risk = c
C+d

32.5
= = 6.5
5

Incidence of CHD is 6.5 times more among smokers than non-smokers.

a c
−
a+b c+d
c) Attributable risk = a x 100
a+b

32.5−5
= x 100
32.5

= 0.8461 x 100

= 84.61%

84.61% of CHD in smokers was due to their smoking.

INFERENTIAL STATISTICS

6. 300 surgeries were carried under local and general anesthesia. The number of success
and failures of surgeries are tabulated below. Test whether there is any statistically
significant difference between the two anesthesia in terms of success rates.

Success Failure Total

Local anesthesia 211 14 225
General anesthesia 60 15 75
Total 271 29 300

ANSWER:

Null Hypothesis: There is no difference in the success rates between local and general
anaesthesia

χ² = ∑ (O – E) ² / E O - Observed Frequency; E - Expected Frequency

Expected Frequency (E): = (Column Total x Row Total) / Ground Total (N)

E211= 225 x 271 / 300 = 203.25 E60 = 75 x 271 / 300 = 67.75

E14= 225 x 29 / 300 = 21.75 E15 = 75 x 29 / 300 = 7.25

Degrees of freedom: = (Number of Columns – 1) x (Number of Rows - 1)
= (2 – 1) x (2 – 1) = 1

O E

Observed Expected (O – E) (O – E)² (O – E)2 / E

Frequency Frequency

211 203.25 7.75 60.06 0.29

14 21.75 7.75 60.06 2.76

60 67.75 7.75 60.06 0.89

15 7.25 7.75 60.06 8.28

Total [∑ (O – E) ² / E] 12.22

Find Table value: For df of 1, the table value for χ² is 3.841 at p<0.05

Comparing the calculated χ² value with table values, we find 12.22 > 3.841

Conclusion:

Since the calculated χ² value is > the table value, we REJECT the Null hypothesis

Hence there is a statistically significant difference in the success rates between surgeries done
under general anaesthesia and local anaesthesia

7. In a health survey of school children it is found that the mean haemoglobin level of 55
boys is 10.2g/dL with a SD is 2.1. Can we consider this group as taken from a
population with mean of 11.0g/dL?

ANSWER: If n is > 30, Apply “Z “test.

Null Hypothesis: There is no difference between the sample mean and population mean

Sample Size (n) = 55

Sample Mean (x) = 10.2 g/dL

Sample SD (S) = 2.1 g/dL

Population Mean (µ) = 11.0 g/dL

Standard Error (SE) = S / √ n

= 2.1 / √ 55

= 2.1 / 7.42

SE = 0.28

Z = |µ - x| / SE

= 11 - 10.2 / 0.28

= 0.8 / 0.28

Z = 2.86

Comparing the calculated Z value with table values, we find 2.83 > 1.96

Conclusion:

Since the calculated Z value is > the table value, we REJECT the Null Hypothesis

The observed difference between the sample mean and the population mean is statistically
significant with P< 0.05. Since the sample mean is significantly different from the population
mean, the sample is unlikely to have been drawn from the same universe

[Link] mean weight gain among 10 patients is 4 kg and SD is 3.33 kg. The mean weight
gain among the population is 8 kg. Find whether the difference in the weight gain is
statistically significant.

ANSWER:

(a) Null Hypothesis:

There is no difference between the mean weight gain among population and patient group

(b) Given:

Sample size (n) = 10

Sample mean (x) = 4 kg

 Sample SD (S) = 3.33 kg

Population Mean (µ) = 8 kg

(c) Formula:

i. Standard Error (S.E) = S/√n

= 3.33 / √ 10

SE = 1.05

ii. Critical Ratio (t) = Difference in the two Means / S.E

= |µ - x| / SE

= 4 - 8 / 1.05

t = 3.81

(d) Find the Degrees of freedom (d.f)

When n < 30, d.f = n - 1 = 10 – 1 = 9

(e) Compare calculated t value with table value at the given d.f

For 9 d.f, table value of t is 2.262 (at p < 0.05) and the calculated t value is 3.81

3.81 > 2.262 →calculated value > table value → REJECT null hypothesis
 EPIDEMIOLOGICAL EXERCISES

9) See the data of PHC area for the year 2020.

Population = 32165

Total blood smears collected = 2812

Blood smear examined = 2500 (312 were kept as back log)

Positive for plasmodium Falciparum = 12

Positive for plasmodium Vivax = 59

Positive for Mixed = 3.

Calculate annual blood smear examination rate, annual parasite incidence, annual
falciparum incidence, slide positivity rate, slide falciparum rate. Comment on the API and
enumerate the control measures.
𝑁𝑜. 𝑜𝑓 𝑠𝑙𝑖𝑑𝑒 𝑒𝑥𝑎𝑚𝑖𝑛𝑒𝑑
a) Annual blood smear = x 100
𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛
Examination Rate
2500
= x 100 = 7.77
32165

ABER = 7.77%

b) Annual Parasite incidence = confirmed cases during

1 𝑦𝑒𝑎𝑟
𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑢𝑛𝑑𝑒𝑟 x 1000
𝑠𝑢𝑟𝑣𝑖𝑒𝑙𝑙𝑎𝑛𝑐𝑒
74
= x 1000 = 2.30
32165

API = 2.3 / 1000 population per year

c) Annual Falciparum incidence = No. of falciparum

𝑃𝑜𝑠𝑖𝑡𝑖𝑣𝑒 𝐶𝑎𝑠𝑒𝑠
x 1000
𝑃𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑢𝑛𝑑𝑒𝑟 𝑠𝑢𝑟𝑣𝑒𝑖𝑙𝑙𝑎𝑛𝑐𝑒
15
= x 1000 = 0.466
32165
AFI = 0.466/ 1000 population per year

d) Slide positivity rate = Total no. of slides

𝑃𝑜𝑠𝑖𝑡𝑖𝑣𝑒
𝑇𝑜𝑡𝑎𝑙 𝑁𝑜. 𝑜𝑓 𝑠𝑙𝑖𝑑𝑒𝑠 x 100
𝑒𝑥𝑎𝑚𝑖𝑛𝑒𝑑
 74
= x 100 = 2.96
2500
SPR = 2.96%

e) Slide falciparum rate = Total slides positive

𝑓𝑜𝑟 𝑓𝑎𝑙𝑐𝑖𝑝𝑎𝑟𝑢𝑚
𝑇𝑜𝑡𝑎𝑙 𝑁𝑜. 𝑜𝑓 𝑠𝑙𝑖𝑑𝑒𝑠 x 100
𝑒𝑥𝑎𝑚𝑖𝑛𝑒𝑑
12+3 15
= x 100 =
2500 25
SFR = 0.6%

Answers:
a) Annual blood smear examination = 7.77%
b) Annual Parasite incidence = 2.30 / 1000 population per year
c) Annual falciparum Incidence = 0.466/1000 population per year
d) Slide positivity rate = 2.96%
e) Slide falciparum rate = 0.6%

API of the PHC is 2.3/1000 per year, which can be stratified as Category 3 and hence
needs Intensified control measures as per National Framework for Malaria Elimination in
India (2016-30) which includes:
• Massive scaling up of existing disease management and preventive approaches
and tools
• Screening of all fever cases suspected of malaria
• Classify areas as per risk of transmission and implement tailored interventions
• Strengthening intersectoral collaboration
• Timely referral and treatment of severe malaria cases to reduce mortality
• One stop centres or Mobile clinics on fixed days in tribal areas
• Establishment of robust supply chain management system
• Maintenance of optimum level of surveillance

10. See the results of a filarial survey done in a PHC in the population of 45,000.
❖ Population examined = 3700
❖ Positive for M.F alone (without symptoms) = 300
❖ Patients with clinical symptoms only without mf = 400
❖ Patients with both clinical symptoms and mf positive = 100

Calculate MFR, FDR, FER and comment on the size of population surveyed.

a) Microfilarial rate = No. of mf positive

𝑐𝑎𝑠𝑒𝑠
x 100
𝑆𝑎𝑚𝑝𝑙𝑒 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛
 400
= x 100
3700

MFR = 10.81%

b) Filarial disease Rate = No. of patients with

𝑐𝑙𝑖𝑛𝑖𝑐𝑎𝑙 𝑠𝑦𝑚𝑝𝑡𝑜𝑚𝑠
x 100
𝑆𝑎𝑚𝑝𝑙𝑒 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛

400+100
= x 100
3700

500
=
37

FDR = 13.5%

c) Filarial endemicity rate = No. of patients

Showing Mf in blood,
Disease manifestation
𝑜𝑟 𝑏𝑜𝑡ℎ
= x 100
𝑆𝑎𝑚𝑝𝑙𝑒 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛

400+100+300
= x 100
3700

800
=
37

FER = 21.6%
d) ABER = population examined x 100
total population

3700
= x 100
45000

ABER = 8.22 %

Sample size:

• For routine filarial survey, sample size recommended is 5-7%.

• In this survey, 8.22% sample is examined.
• Hence the size of the population surveyed is adequate and
acceptable.

Answers:
 a) Microfilaria rate = 10.81%
b) Filarial disease rate = 13.5%
c) Filarial endemicity rate = 21.6%
d) Size of the population surveyed is adequate and acceptable.

11. In a population of 20,000 there was 200 cases of TB on Jan 1st 2019. There were 100
new cases of TB during that year. 10 died due to TB, 15 were cured and 5 of them
migrated to other community. The crude death rate for this community was 8 per
1000 population. Calculate.
a) Period prevalence for 2019
b) Point prevalence on dec 31st 2019
c) Incidence in 2019
d) Case fatality rate.
e) Proportional mortality rate.

a) Period prevalence = No. of existing cases ( old + new )

of a disease during
a period of time
Estimated mid−interval x 1000
Population at risk
300
= x 1000
20,000
= 15 per 1000 Population

b) Point prevalence = No. of all current cases

of disease at a
given point of time
Estimated Population x 1000
at same point in time

270
= x 1000
20,000
= 13.5 per 1000 population.

c) Incidence = No. of new cases

 of disease at a given time
Population at risk during x 1000
that period
100
= x 1000
20,000

= 5/ 1000 population.
d) Case fatality rate = Total No. of deaths
due to disease
No. of cases in x 100
same disease
10
= x 100
300
= 3.33%

e) Proportional mortality rate = No. of death from

specific disease
in a year
Total death from all x 100
causes in a year.

Given that Crude death rate = 8/1000 pop.

No. of deaths
during a year
Crude death Rate = x 1000
Midyear population

𝒳
8 = x 1000
20,000
𝒳 = 8x 20 = 160

10
Proportional mortality rate = x 100
160
= 6.25%
Answer:
a) Period prevalence = 15 / 1000 Population
b) Point prevalence = 13.5/ 1000 Population
c) Incidence = 5/ 1000 population
d) Case fatality rate = 3.33%
e) Proportional mortality rate = 6.25%

12. A morbidity survey was conducted in subcentre of PHC to know the extent of TB in
this centre in the year 2019.
Total population = 8000
Total TB cases on Jan 2019 = 70
No. of new TB cases during 2019 - 60
No. of TB cases cured in 2019 = 90
Calculate Incidence, point prevalence of TB on January 2019, cure rate of TB.

[Link] new TB cases

a) Incidence = x 1000
Total Population

60
= x 1000
8000
= 7.5 / 1000 population

b) Point prevalence = No. of all current case

of disease at a
period of time
Estimated population at x 1000
same point in given time
70
= x 1000
8000
= 8.75/1000 Population

c) Cure rate of TB
(survival rate) = Total No. of patients
 alive after 5 years
Total No. of patients x 100
disease / treated
90
= x 100
70+60
90
= x 100
130
=69.23%

Answers:

a) Incidence = 7.5 / 1000 population

b) Point prevalence = 8.75 / 1000 population
c) Cure rate = 69.23%

DEMOGRAPHY AND MCH

13. A city has recorded 20,000 live births in the year 2019. 200 die within 28 days of
birth. 90 died before 1 year of age. 12 Mother died due to pregnancy causes.
Calculate all possible vital indices from the above data.

a) Maternal mortality Ratio = Total No. of Maternal deaths

due to pregnancy
Total No. of live x 100000
births

12
= x 100000
20,000

MMR = 60/ 100000 live births

b) Infant mortality Rate = No. of deaths in

Children less than
1 year age
x 1000
Total No. of live births

90+200
= X 1000
20,000
 IMR = 14.5 / 1000 live births

c) Neonatal Mortality Rate = No. of children died

before 28 days
x 1000
Total No. of live births

200
= X 1000
20,000

NMR = 10/1000 live births

d) Post neonatal mortality rate = No. of children died
Between 28 days
to 1 year age
x 1000
No. of live births

90
= X 1000
20,000
PNMR = 4.5 / 1000 live births.

Answers:
a) MMR = 60/100000 live births
b) IMR = 14.5/1000 live births
c) NMR = 10/1000 live births
d) PNMR = 4.5/1000 live births

[Link] population of Chennai as per 1st march 2001 was 62,20,000 and as per 1st march
2011 was 94,21,000. Calculate the midyear population for 2016.

Census population of 1991 (P1) = 62,20,000

Census population of 2001 (P2) = 94,21,000

Midyear population of 2006.

𝑃2 − 𝑃1 4
PIC (MYP) = P2 + ( ) x (𝑑 + 12 )
𝑛

= 94,21,000+ (9421000−6220000
4
) X (5 + )
10 12
 32,01,000
= 94,21,000+ ( ) (5+10.3)
10

= 94,21,000+ 1707200

= 11,128,200

Midyear population of 2006 = 11,128,200

15) In a town with a mid year population of 1,00,000 there were 2000 births and 38 infant
deaths in year 2016. Of these 26 infants died in first 28 days of life and of them 15 died in
1st week of life. There were 30 still births in same year calculate all possible vital indices
for the data given and Write 2 causes for each of the following.

a) Infant mortality Rate = No. of deaths of age

less than 1 year
x 1000
Total No. of live births

38
= X 1000
2000
IMR = 19/1000 live births.

still birth+Early NMR

b) Perinatal mortality Rate = x 1000
Live births +still birth
30+15
= X 1000
2000+30
45
= X 1000
2030
= 22.17
PMR = 22.17/1000 births.

c) Post neonatal mortality rate = No. of deaths

Between 28 days - 1 year
of age
x 1000
Total No. of live births
38 − 26
= X 1000
2000
PNMR = 6/1000 live births.

d) Neonatal Mortality Rate = No. of death of children

aged under
 28 days
x 1000
Total [Link] births

26
= x 1000
2000
NMR = 13/1000 live births.

e) Early Neonatal Mortality Rate = No. of death of children under

7 days
x 1000
Total [Link] births

= 15/2000X1000
ENMR= 7.5/1000 live births

No. of live births during a year

f)Crude birth Rate = x 1000
Midyear population
2000
= x 1000
1,00,000
CBR =20 /1000 Population.
g) Still birth Rate =
Fetal deaths weighing over 1000 grams or > 28 𝑤𝑒𝑒𝑘𝑠 𝑜𝑓 𝑔𝑒𝑠𝑡𝑎𝑡𝑖𝑜𝑛 𝑑𝑢𝑟𝑖𝑛𝑔 𝑡ℎ𝑒 𝑦𝑒𝑎𝑟
x 1000
Total live +still birth weighing over 1000 grams or > 28 𝑤𝑒𝑒𝑘𝑠 𝑜𝑓 𝑔𝑒𝑠𝑡𝑎𝑡𝑖𝑜𝑛 𝑑𝑢𝑟𝑖𝑛𝑔 𝑡ℎ𝑒 𝑦𝑒𝑎𝑟

30 30
= x 1000 = x 1000
2000+30 2030
SBR = 14.77 / 1000 births

Causes:
Infant mortality Rate - Anemia, low birth weight
Perinatal mortality Rate - Preterm birth & Respiratory distress syndrome
Neonatal Mortality - Birth defects, preterm birth

Answers:
a) IMR - 19/ 1000 Live births
b) PMR – 22.17 / 1000 births
c) PNMR - 6/ 1000 Live births
 d) NMR -13/ 1000 Live births
e) ENMR- 7.5/1000 live births
f) CBR =20 /1000 Population
g) SBR = 14.77 / 1000 births

16) A town has midyear population of 40,000 in 2011. During the year, 550 live births
and 340 Deaths. Calculate the possible vital indices.
No. of live births during a year
a) Crude birth Rate = x 1000
Midyear population
550
= x 1000
40,000
= 13.5/1000 Population.

No. of deaths
during a year
b) Crude death Rate = x 1000
Midyear population

340
= x 1000
40,000
= 8.5/1000 Population.

c) Growth Rate = Crude birth - Crude death

Rate Rate
x 100
1000

13.5−8.5 20
= x 100 =
1000 10
= 0.525%.

Answers:
a) CBR = 13.5 / 1000 Population
b) CDR = 8.5 / 1000 Population
c) Growth Rate – 0.525%
17) In a town with midyear population of 3 lakhs there were 6050 live births, 110 still
births, 121 deaths in 1st year of life,; of these 80 deaths occurred in 1st month of life and
52 deaths within 1 week after birth .Calculate possible vital indices for the given data and
Write 2 causes for each of the following

a) Still birth Rate =

Fetal deaths weighing over 1000 grams or > 28 𝑤𝑒𝑒𝑘𝑠 𝑜𝑓 𝑔𝑒𝑠𝑡𝑎𝑡𝑖𝑜𝑛 𝑑𝑢𝑟𝑖𝑛𝑔 𝑡ℎ𝑒 𝑦𝑒𝑎𝑟
x 1000
Total live +still birth weighing over 1000 grams or > 28 𝑤𝑒𝑒𝑘𝑠 𝑜𝑓 𝑔𝑒𝑠𝑡𝑎𝑡𝑖𝑜𝑛 𝑑𝑢𝑟𝑖𝑛𝑔 𝑡ℎ𝑒 𝑦𝑒𝑎𝑟

110 110
= x 1000 = x 1000
6050+110 6160
SBR = 17.85 / 1000 births

Still births+Early NMR

b) Perinatal mortality Rate = x 1000
Live births +still births

110+52
= x 1000
6050+110

162
= x 1000 = 26.3
6160
PMR = 26.3 / 1000 Births

c) Infant mortality Rate = No. of deaths

within 1year age
x 1000
Total [Link] live births
121
= x 1000
6050

IMR = 20 / 1000 live births

d) Post neonatal mortality rate = No. of deaths

Between 28 days - 1 year
 of age
x 1000
Total No. of live births
121 − 80
= X 1000
6050
PNMR = 6.78/1000 live births.

e) Neonatal Mortality Rate = No. of death of children

aged under
28 days
x 1000
Total [Link] births

80
= x 1000
6050
NMR = 13.22/1000 live births.

f) Early Neonatal Mortality Rate = No. of death of children under

7 days
x 1000
Total [Link] births

= 52/6050X1000
ENMR= 8.6/1000 live births

No. of live births during a year

g)Crude birth Rate = x 1000
Midyear population
6050
= x 1000
3,00,000
CBR =20.17 /1000 Population.

Answers:
a) Still birth Rate = 17.85 / 1000 Births
b) PMR = 26.3 / 1000 Births
c) IMR = 20 / 1000 live births
d) PNMR = 6.78/1000 live births.
e) NMR = 13.22/1000 live births.
f) ENMR= 8.6/1000 live births
g) CBR =20.17 /1000 Population.
Causes:
Infant mortality Rate - Anemia, low birth weight
Perinatal mortality Rate - Preterm birth & Respiratory distress syndrome
Neonatal Mortality - Birth defects, preterm birth

18) India’s 2001 census population was 846 million. 2011 census population was 1020
million calculate the population and midyear population of India for 2007.

Population of India in 2007

𝑃2 − 𝑃1
PIC = P1 + ( )xd
𝑛

P1 = 846 million : P2 = 1020 million

1020−846
PIC = 846 + ( )x6
10

174
= 846 + ( )x6
10

= 846 + 17.4 x6
= 846 + 104.4
= 950.4
Population of India in 2007 is 950.4 million

Midyear population of India in 2007,

𝑃2 − 𝑃1
PIC = P1 + ( ) x (𝑑 + 124 )
𝑛

1020−846 4
PIC = 846 + ( ) x 6+
10 12

174
= 846 + ( ) x 6+ 0.3
10
 = 846 + 17.4 x 6.33

= 846 + 110. 142

= 956. 142.

Midyear population of India in 2007 is 956.14 million.

19) Calculate the vital indices from the following data.

❖ Midyear population 2018 = 30,000

❖ Birth during Jan - Dec 2018 = 600
❖ Total death = 300
❖ Death due to pregnancy and puerperal causes = 21
❖ Infant deaths = 13

a) Birth rate = No. of births

in a year
x 1000
Mid year population

600
= x 1000
30,000
Birth Rate = 20 / 1000 Population
b) Death Rate = No. of deaths during
a year
x 1000
Mid year population

300
= x 1000
30,000
Death Rate = 10 / 1000 Population
No. of infant deaths
c) Infant Mortality Rate = x 1000
Total [Link] live births
13
= x 1000
600
IMR = 21.6 / 1000 Live births

d) Maternal mortality Ratio = No. of deaths due

to pregnancy
x 1000
[Link] live birth
 21
= x 1000
600
MMR = 35 / 1000 Live births

Answers:
a) Birth Rate = 20 / 1000 Population
b) Death Rate = 10 / 1000 Population
c) IMR = 21.6 / 1000 Live births
d) MMR = 35 / 1000 Live births

ENVIRONMENT
20. The diameter of a circular well = 1m
Depth of water column in well = 5m
While doing the Horrock’s test the blue colour appeared from 2 nd cup onwards.
Estimate.
a) The volume of water in the well
b) The quantity of bleaching powder required for chlorinating the
above well.
c) Write the steps of Chlorination.
Solution:
Diameter = 1m
Radius, r = 0.5m
Depth of water column, h = 5m
Volume = 𝜋𝑟 2 ℎ
= 3.14 x 0.5 x 0.5 x5
= 3.925m3
1𝑐𝑢. 𝑚 = 1000 L
= 3.925 x 1000
Volume = 3925 L
Blue colour appears on the 2nd cup in Horrock’s test.
1 cup = 2gms.
4 gms = 455 ℓ
 3925
For 3925 ℓ = x4
455
= 34.5 gms.

Answer:
a) Volume of water in well = 3925 ℓ
b) Amount of bleaching powder required for chlorinating = 34.5gms.
c) Steps of chlorination

i. Dissolve the Calculated Amount of Bleaching Powder in Water

The calculated amount is drawn and placed in a bucket .Make it into a thin paste. Add more
water till the bucket is nearly ¾ full. The contents are stirred well. Allow to sediment for 5 –
10 min. Lime settles down. The supernatant solution is the chlorine solution. This
supernatant chlorine solution is transferred to another bucket. The chalk or lime which
settles at the bottom is discarded DO NOT POUR the SEDIMENT into the well, this is lime
which will increase the hardness of water.
ii) Delivery of the Chlorine Solution into the Well
The bucket containing the chlorine solution is lowered some distance below the water
surface. Then the well water is agitated by moving the bucket violently vertically and
laterally. This is repeated several times to ensure thorough mixing of the chlorine solution
into all of the well water
iii) Allow a Contact Period between the Chlorine and Water
Contact period of one hour is allowed before anyone is permitted to draw water from the
well
iV) Perform Orthotolidine Arsenite (OTA)Test
Orthotolidine Arsenite Test is then performed at the end of one hour contact period. This is
done to check the level of free residual chlorine
If the free residual chlorine is < 0.5 mg/L, the entire procedure is repeated before any water
is drawn

21) Calculate the amount of bleaching powder required to chlorinate a square well of
sides 2m and depth 3m. The horrocks test showed blue color from 2nd cup
onwards. Write the steps of Chlorination of well.
Volume of square well = 𝑎2 ℎ
 =2x2x3
= 12cu.m
1 cu.m = 1000 ℓ
= 12 x 1000
= 12000 ℓ
Blue colour appears on the 2nd cup onwards in horrock’s test.
1 cup = 2gms
4gms = 455 ℓ
12000
For 12,000 ℓ = x4
455

= 105.4gms.
Answer:
a) Volume of square well = 12000 ℓ
b) Quantity of bleaching powder required for chlorinating = 105.4gms.
c) Steps of chlorination
i)Dissolve the Calculated Amount of Bleaching Powder in Water
The calculated amount is drawn and placed in a bucket .Make it into a thin paste. Add more
water till the bucket is nearly ¾ full. The contents are stirred well. Allow to sediment for 5 –
10 min. Lime settles down. The supernatant solution is the chlorine solution. This
supernatant chlorine solution is transferred to another bucket. The chalk or lime which
settles at the bottom is discarded DO NOT POUR the SEDIMENT into the well, this is lime
which will increase the hardness of water.
ii) Delivery of the Chlorine Solution into the Well
The bucket containing the chlorine solution is lowered some distance below the water
surface. Then the well water is agitated by moving the bucket violently vertically and
laterally. This is repeated several times to ensure thorough mixing of the chlorine solution
into all of the well water
iii) Allow a Contact Period between the Chlorine and Water
Contact period of one hour is allowed before anyone is permitted to draw water from the
well
iV) Perform Orthotolidine Arsenite (OTA)Test
Orthotolidine Arsenite Test is then performed at the end of one hour contact period. This is
done to check the level of free residual chlorine
If the free residual chlorine is < 0.5 mg/L, the entire procedure is repeated before any water
is drawn

22) Calculate the amount of bleaching powder required for disinfecting a well with a
diameter 3m and depth 15m. Horrock’s test shows blue colour on 3rd cup. Write
the steps of Chlorination of well.

Diameter of circular well = 3m

Radius (r) = 1.5m
Depth of well (h) = 15m
Volume = 𝜋𝑟 2 h
= 3.14 x 1.5 x 1.5 x 15
= 105.975 cum.
1 cu.m = 1000 ℓ
= 105. 975 x 1000
= 105975 ℓ

Blue color appears from 3rd cup on doing horrock’s test.

1 cup = 2gms
6gms = 455 ℓ
105 975
For 105 975 ℓ = x6
455
= 1397.4gms.

Answer:

a) Volume of square well = 105975 ℓ

b) Quantity of bleaching powder = 1397.4gms
c) Steps of chlorination
i) Dissolve the Calculated Amount of Bleaching Powder in Water
The calculated amount is drawn and placed in a bucket .Make it into a thin paste. Add more
water till the bucket is nearly ¾ full. The contents are stirred well. Allow to sediment for 5 –
10 min. Lime settles down. The supernatant solution is the chlorine solution. This
supernatant chlorine solution is transferred to another bucket. The chalk or lime which
settles at the bottom is discarded DO NOT POUR the SEDIMENT into the well, this is lime
which will increase the hardness of water.
ii) Delivery of the Chlorine Solution into the Well
The bucket containing the chlorine solution is lowered some distance below the water
surface. Then the well water is agitated by moving the bucket violently vertically and
laterally. This is repeated several times to ensure thorough mixing of the chlorine solution
into all of the well water
iii) Allow a Contact Period between the Chlorine and Water
Contact period of one hour is allowed before anyone is permitted to draw water from the
well
iV) Perform Orthotolidine Arsenite (OTA)Test
Orthotolidine Arsenite Test is then performed at the end of one hour contact period. This is
done to check the level of free residual chlorine
If the free residual chlorine is < 0.5 mg/L, the entire procedure is repeated before any water
is drawn

23. Calculate the amount of bleaching powder required to disinfect a circular well of
diameter 6m and depth 12m. Horrock’s test shows blue colour on 4 th cup onwards.
Write the steps of Chlorination of well.

Diameter of well = 6m

Radius (r) = 3m

Depth, h = 12m

Volume = 𝜋𝑟 2 h
 = 3.14 x 3 x 3 x 6

= 3.14 x 9 x 6

= 339.12 cum.

1 cum = 1000 ℓ

= 339.12 x 1000

= 339120 ℓ

Blue colour appears from 4th cup in Horrock’s test.

1 cup = 2gms

8gms = 455 ℓ

339120
For 339120 ℓ = x8
455

= 5962.54gm

= 5.9 Kg.

Answer:

a) volume of circular well = 339120 ℓ

b) Amount of bleaching powder required to chlorinate = 5.9Kg.
c) Steps of chlorination

i)Dissolve the Calculated Amount of Bleaching Powder in Water

The calculated amount is drawn and placed in a bucket .Make it into a thin paste. Add more
water till the bucket is nearly ¾ full. The contents are stirred well. Allow to sediment for 5 –
10 min. Lime settles down. The supernatant solution is the chlorine solution. This
supernatant chlorine solution is transferred to another bucket. The chalk or lime which
settles at the bottom is discarded DO NOT POUR the SEDIMENT into the well, this is lime
which will increase the hardness of water.
ii) Delivery of the Chlorine Solution into the Well
The bucket containing the chlorine solution is lowered some distance below the water
surface. Then the well water is agitated by moving the bucket violently vertically and
laterally. This is repeated several times to ensure thorough mixing of the chlorine solution
into all of the well water
iii) Allow a Contact Period between the Chlorine and Water
Contact period of one hour is allowed before anyone is permitted to draw water from the
well
iV) Perform Orthotolidine Arsenite (OTA)Test
Orthotolidine Arsenite Test is then performed at the end of one hour contact period. This is
done to check the level of free residual chlorine
If the free residual chlorine is < 0.5 mg/L, the entire procedure is repeated before any water
is drawn

SCREENING TESTS

24) The screening (widal test) conducted and the results are follows.

Out of 200 diseased typhoid patient test was positive in 180 and negative in 20. In
contrast out of 200 non diseased test was +ve in 60 and negative in 140. To the given data
set up a 2 x 2 contingency table. Calculate the screening parameters.

Widal test Typhoid present Typhoid absent Total

Positive 180 (a) 60 (b) 240 (a+b)
Negative 20 (c) 140 (d) 160 ( c+d)
200 ( a+c ) 200 ( b+d )

a
a) Sensitivity = a+c x 100

180
= 200 x 100

= 90%

d
b)Specificity = b+d x 100
 = 140 / 200 x 100
= 70%

a
c) +ve predictive value = (a+b) x 100

180
= 240 x 100

= 75%

d
d) -ve predictive value = (c+d) x 100

140
= 160 x 100

= 87.5%

Answers:

a) Sensitivity = 90%
b) Specificity - 70%
c) Positive predictive value - 75%
d) Negative predictive value - 87.5%

25) 1000 people were screened for TB in PHC. Sputum +ve for AFB in 140 persons.
Mass miniature radiography shows 60 as positive. Both MMR and sputum for AFB
showed negative in 848 persons. Calculate various screening parameters.

X-Ray Sputum positive for Sputum Negative for Total

AFB AFB
Positive for TB 48 (a) 12 (b) 60 (a+b)
Negative for TB 92 (c) 848 (d) 940 ( c+d)
140 ( a+c ) 860 ( b+d ) 1000
a
a) Sensitivity = a+c x 100

48
= 140 x 100

= 34.2%
 d
b) Specificity = b+d x 100

848
= x 100 = 98.6%
860

a
c) Positive predictive value = a+b x100

= 48/60 x 100 = 80%

d
d) Negative predictive value = c+d x 100

848
= 940 x 100

= 90.2%

Answers:

a) Sensitivity - 34.2%
b) Specificity - 98.6%
c) Positive predictive value - 80%
d) Negative predictive value - 90.2%

26) A new screening test for disease with a prevalence of 16% and was positive in 20%
of 600 population. There were 12 False negative. Calculate the screening parameters.

Screening test Disease present Disease absent Total

Positive 84 (a) 36 (b) 120 (a+b)
Negative 12 (c) 468 (d) 480( c+d)
96 ( a+c ) 504 ( b+d ) 600

Disease prevalence = 16%

16
For 600 population = x 600
100

= 96.
 20
Screening test +ve in 20% = 100 x 600

= 120

a
a) Sensitivity = a+c x 100

84
= 96 x 100

= 87.5%

d
b) Specificity = b+d x 100

468
= 504 x 100

= 92.8 %

a
c) Positive predictive value = a +b x 100

84
= 120 x 100

= 70%

d
d) Negative predictive value = c+d x 100

468
= 480 x 100

= 97.5%

Answers:

a) Sensitivity = 87.5%
b) Specificity = 92.8%
c) Positive predictive value = 70%
d) Negative predictive value = 97.5%
 NUTRITION

27. Sita is a house wife and her weight is 50Kg and does moderate work. Calculate her
daily nutritional requirement for energy & protein.

a) During normal time

b) If she is a pregnant mother
c) If she is a lactating mother.

For Adult= Per Kg body weight requires 0.8g - 1gm protein/day

1CU = 2400 kcal.

Moderate work = 0.9 CU is required

= 2400 x 0.9

= 2160 kcal

Protein intake = 46 - 50gms.

a) Normal time = 2160 kcal.

b) Pregnant Mother = 2160 Kcal + 350

= 2510 k cal.

c) Lactating Mother = 2160 kcal + 600

= 2760 Kcal.

28) Calculate the energy & protein requirement of a child 7 years old weighing 20Kg.
Suggest a diet to meet the requirements. Mention some sources of carbohydrates
and protein to improve the diet.

7 year child requires = 0.7 CU

1cu =2400 kcal

Energy requirement = 0.7 x 2400

 = 1680 kcal

Protein requirement = 1 g/ kg

For 20 Kg child = 20 g / day

Amount of protein required = 10% of 1680

1680 x 10
=
100

= 168 kcal = 168/4 = 42 g

In a balanced diet

Protein = 10 - 15%

Fat = 20%

Carbohydrate = 65 - 70%

Carbohydrate required = 70% of 1680

1680 x 70
= = 1176 kcal = 1176/4 = 294 g
100

Amount of fat required = 20% of 1680

1680 x 20
= = 336 kcal = 336/9 = 37.3 g
100

The diet should contain 42 g proteins,

294 g Carbohydrates

37.3 g fats

Prescribed diet:

Milk 1 cup + 2 tsp sugar = 180

Idly 2 nos. = 150

Chutney 2 tsp =20

Banana (1) = 90

Rice 1 cup = 170

Vegetable 1 cup =150

Sambar 1 cup = 110

Milk 1 cup + 2 tspn. sugar = 180

Dosa 2 nos. = 220

Chutney 2 stspn. = 20

Milk 1 cup + sugar 2 tsp = 180

Banana (1) = 90

Totally 1560 Kcal.