CASE-CONTROL STUDY

1. A study was conducted to find the association between consuming oral contraceptive pills
(OCPs) and development of cervical cancer. In total, 312 women with cervical cancer and
464 women without cervical cancer were selected for the study. Details about a history of
long-term OCP uses were enquire from both the groups. Among the cases, 109 were found
to use OCPs while 75 gave a positive history of OCP usage in the other group.
(a) Identify the study design. Justify your answer.
(b) Represent the data in a 2 x 2 table form.
(c) Calculate the appropriate measure of risk and interpret.
Ans:
a) It is a case-control study cases and controls were selected and details of the history
of exposure were enquire.
b)
History of Exposure Gold standard + Gold standard - Total
OCP Use +ve 109 (a) 75 (b) 184
OCP Use -ve 230 (c) 389 (d) 592
Total 312 464 776

𝑎𝑑 109 𝑋 389
c) 𝑂𝑑𝑑𝑠 𝑅𝑎𝑡𝑖𝑜 = = = 2.8
𝑏𝑐 75 𝑋 203

OR= 2.8
Interpretation: Odds of OCP use was 2.8 times among cervical cancer cases compared with
controls. We can interpret this in a simpler way if the cervical cancer is rare and controls are
representative of the same population from where the cases are taken; we can say that the
risk of getting cervical cancer in OCP users is 2.8 times as compared with OCP nonusers.

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2. A recent study by Shankar et al looked at the various risk factors of myocardial infarction
in India. 200 cases with acute myocardial infarction & 200 age & sex matched controls
without acute MI was evaluated for several risk factors including diabetes. The results are
as follows:
● Patients with DM among the acute MI cases 36
● Patients with DM among the control 18
a. What type of study design it is? Give reasons.
b. Find out the possible measures of association and interpret
Ans:
a. Case-control study
b. Odds ratio
MI+ MI-

DM+ 36 18

DM- 164 182

Total 200 200

𝑎𝑑 36 𝑋 182
𝑂𝑑𝑑𝑠 𝑅𝑎𝑡𝑖𝑜 = = = 2.22
𝑏𝑐 164 𝑋 18

OR= 2.22

Interpretation: Patients with DM have 2.2 times risk of developing MI compared to people
without DM.

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COHORT STUDY
3. In a study, 5400 smokers and 2000 nonsmokers were followed up for 10 years and
observed for the development of lung cancer. Among smokers, 50 persons developed lung
cancer while among nonsmokers three persons developed lung cancer.
(a) Identify the study design. Justify your answer.
(b) Represent the data in a 2 X 2 table form.
(c) Calculate the appropriate measure of risk and interpret.
(d) Calculate AR% and PAR% and interpret.
Ans:
(a) It is a cohort study, as two groups (exposure and non-exposure) were followed up
for the development of the disease for 10 years.
(b) Table: Cohort Study (2 x 2 Table)
 Group Developed Lung Cancer Did Not Develop Lung Total
(After Follow-up) Cancer (After Follow-up)

Smokers 50 (a) 5350 (b) 5400(a+b)

Nonsmokers 3 (c) 1997 (d) 2000(c+d)
Total 53 (a+c) 7347 7400(a+b+c+d)

(c)
a
incidence of lung cancer among smokers(𝐼𝑒 ) a+b
∗1000
Relative Risk = = c
incidence of lung cancer among non−smokers (𝐼𝑜 ) ∗1000
c+d

50
∗ 1000 9.3
𝑅𝑅 = 5400 = = 6.2
3 1.5
∗ 1000
2000
Interpretation: A relative risk of 6.2 means that the risk of lung cancer is 6.2 times among
smokers compared with the risk among nonsmokers.
(d)
incidence of lung cancer among smokers(𝐼𝑒 ) − 𝑖ncidence of lung cancer among nonsmokers (𝐼𝑜 )
𝐀𝐑% = 𝑋100
incidence of lung cancer among smokers (𝐼𝑒 )

9.3 − 1.5
AR% = 𝑋100 = 83.9%
9.3
Interpretation: An AR of 83.9% means that 83.9% of the lung cancer cases among the
smokers can be attributed to (due to) their smoking habit while remaining 16.1% of lung
cancer cases among smokers are due to some other reason (cannot be due to smoking).

incidence of lung cancer in the total population(𝐼𝑡 ) − 𝑖ncidence of lung cancer among nonsmokers (𝐼𝑜 )
𝐏𝐀𝐑% = 𝑋100
incidence of lung cancerin the total population (𝐼𝑡 )

𝑇𝑜𝑡𝑎𝑙 𝑐𝑎𝑠𝑒𝑠 𝑜𝑓 𝑙𝑢𝑛𝑔 𝑐𝑎𝑛𝑐𝑒𝑟 𝑎+𝑐 53

𝐼𝑡 = 𝑋1000 = 𝑋1000 = 𝑋1000 = 7.16
𝑇𝑜𝑡𝑎𝑙 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑎+𝑏+𝑐+𝑑 7400

𝐼𝑡 = 7.16 𝑝𝑒𝑟 1000 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛

7.16−1.5
𝑃𝐴𝑅% = 𝑋100 = 79.05%
7.16
Interpretation: In total, 79% of lung cancer cases in the total population (exposed and
nonexposed) can be attributed to (due to) smoking behaviour. So, if smoking is stopped, it can
prevent 79% of lung cancer cases in the total population.

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4. In a study to find out the effect of PIH on low birth weight; 100 antenatal women with
PIH and 200 normal antenatal women, age and parity matched were followed up till
delivery. 24 of the mothers with PIH and 42 of the normal antenatal mothers had babies
with birth weight less than 2 kg.
Find out the possible measures of association and interpret
Ans:
a. Cohort study & reason
b. Relative risk, Attributable Risk
c.
LBW + LBW - Total
PIH + 24 (a) 76 (b) 100

PIH - 42 (c) 158 (d) 200

incidence among exposed

Relative Risk =
incidence among unexposed
a 24
𝑅𝑅 = a + b 100
c = 42 = 1.14
c+d 200

incidence among exposed − incidence among unexposed

AR = 𝑋100
incidence among exposed
a c
− 0.24−0.21
a+b c+d
𝐴𝑅 = a = 𝑋100 = 12.5%
0.24
a+b

Interpretation …………….

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SCREENING TEST
5. In a community, 930 people were administered a new screening test for a disease. Of a
total of 160 persons who were actually having the disease, the test was found to be
positive in 130 persons. The screening test was also positive in 170 persons who were
actually healthy.
(a) Calculate the following: Sensitivity, specificity, PPV, and NPV
(b) Comment on the usefulness of this screening test.
Ans:
Diagnostic Test/ Disease
Screening Test Total
Yes (+ve) No (-ve)
Positive 130 (a) 170 (b) 300
Negative 30 (c) 600 (d) 630
Total 160 770 930

a 130
𝐒𝐞𝐧𝐬𝐢𝐭𝐢𝐯𝐢𝐭𝐲 = 𝑋100 = 𝑋100 = 81.25%
a+c 160
d 600
𝐒𝐩𝐞𝐜𝐢𝐟𝐢𝐜𝐢𝐭𝐲 = 𝑋100 = 𝑋100 = 77.92%
b+d 770
a 130
𝐏𝐨𝐬𝐢𝐭𝐢𝐯𝐞 𝐩𝐫𝐞𝐝𝐢𝐜𝐭𝐢𝐯𝐞 𝐯𝐚𝐥𝐮𝐞 = 𝑋100 = 𝑋100 = 43.33%
a+b 300
d 600
𝐍𝐞𝐠𝐚𝐭𝐢𝐯𝐞 𝐩𝐫𝐞𝐝𝐢𝐜𝐭𝐢𝐯𝐞 𝐯𝐚𝐥𝐮𝐞 = 𝑋100 = 𝑋100 = 95.24%
c+d 630

Interpretation: As we do not want to miss any case in the community, a screening test should
be highly sensitive. This screening test is highly sensitive (81.25%), so it can be used as a
screening test in the community for the given disease.

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6. A new test has been developed for the rapid diagnosis of malaria. The test was applied
on 150 fever cases. All cases were tested by peripheral smear examination also. 12
patients were positive for Malaria parasite by peripheral smear examination out of which
8 were positive for the new test. 120 patients were negative for both the tests.
Find out the measures of validity in the given situation and interpret
Ans:
 PS + PS - Total
RDT + 8 (a) 18 (b)
26
(TP) (FP)
RDT - 4 (c) 120 (d)
124
(FN) (TN)
Total 12 138

a 8
𝐒𝐞𝐧𝐬𝐢𝐭𝐢𝐯𝐢𝐭𝐲 = 𝑋100 = 𝑋100 = 66.6%
a+c 12
d 120
𝐒𝐩𝐞𝐜𝐢𝐟𝐢𝐜𝐢𝐭𝐲 = 𝑋100 = 𝑋100 = 86.95%
b+d 138
a 8
𝐏𝐨𝐬𝐢𝐭𝐢𝐯𝐞 𝐩𝐫𝐞𝐝𝐢𝐜𝐭𝐢𝐯𝐞 𝐯𝐚𝐥𝐮𝐞 = 𝑋100 = 𝑋100 = 30.76%
a+b 26
d 120
𝐍𝐞𝐠𝐚𝐭𝐢𝐯𝐞 𝐩𝐫𝐞𝐝𝐢𝐜𝐭𝐢𝐯𝐞 𝐯𝐚𝐥𝐮𝐞 = 𝑋100 = 𝑋100 = 96.77%
c+d 124

Interpretation …………….

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MALARIA INDICES
7. In a Primary Health Centre (PHC) area, with a population of 33,000 in year 2016,
surveillance for malaria revealed the following information:
● No. of blood slides examined for malaria parasite = 1640
● No. of total slides positive for malaria = 98
● No. of slides positive for Plasmodium vivax = 60
● No. of slides positive for Plasmodium falciparum 31
● No. of slides positive for mixed infection (P. vivax + P. falciparum) = 7
Calculate the various indicators related to malaria and comment.
Ans:
(a) Annual blood examination rate
No. of slides examined in a year 1640
𝑨𝑩𝑬𝑹 = 𝑋100 = 𝑋100 = 4.97%
Total population under surveillance 33000
(b) Annual parasite incidence
No. of slides positive for malaria in a year 98
𝑨𝑷𝑰 = 𝑋1000 = 𝑋1000 = 2.97%
Total population under surveillance 33000
API = 2.97% per 1000 population
(c) Slide positivity rate
No. of slides positive for malaria in a year 98
𝑺𝑷𝑹 = 𝑋100 = 𝑋100 = 5.98%
No. of blood slides examined 1640

(d) Slide falciparum rate

No. of slides positive for P. falciparum including mixed infection
𝑺𝑭𝑹 = 𝑋100
No. of slides examined
31 + 7
𝑆𝐹𝑅 = 𝑋100 = 2.32%
1640

(e) Slide falciparum percentage

No. of slides positive for P. falciparum including mixed infection
𝑺𝑭𝑷 = 𝑋100
No. of slides positive for malaria
31 + 7
𝑆𝐹𝑃 = 𝑋100 = 38.78%
98

𝑨𝑩𝑬𝑹 = 𝟒. 𝟗𝟕%
𝑨𝑷𝑰 = 𝟐. 𝟗𝟕 𝒑𝒆𝒓 𝟏𝟎𝟎𝟎 𝒑𝒐𝒑𝒖𝒍𝒂𝒕𝒊𝒐𝒏
𝑺𝑷𝑹 = 𝟓. 𝟗𝟖%
𝑺𝑭𝑹 = 𝟐. 𝟑𝟐%
𝑺𝑭𝑷 = 𝟑𝟖. 𝟕𝟖%
Comments: Under National Framework for Malaria Elimination (NFME), the objective is to
sustain malaria surveillance with a minimum of 10% ABER. In the given area, ABER is only
4.97%. To improve the ABER, the number of slides examined should be doubled from the
current number. The validity of API depends upon ABER, so a minimum of 10% ABER is
required. SPR is considered as a better indicator than API when ABER is less than 10%.

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 8. A malaria survey was conducted in a panchayath covering a population of 10,000.
Following are the results of the survey.
● No. of smears collected and examined - 1200
● No. of slides positive for MP - 80
● No. of slides positive for [Link] - 36
● No. of slides positive mixed infection - 20
Calculate various malaria indices and comment
Ans:
No. of confirmed cases during 1 yr 80
𝑨𝑷𝑰 = 𝑋1000 = 𝑋1000 = 8
population under surveillance 10000

No. of slides examined 1200

𝑨𝑩𝑬𝑹 = 𝑋100 = 𝑋100 = 12%
population under surveillance 10000

No. of slides positive for MP irrespective of the species 80

𝑺𝑷𝑹 = 𝑋100 = 𝑋100 = 6.66%
Total no of smears examined 1200

No. of slides positive for falciparum 36 + 20

𝑨𝑭𝑰 = 𝑋100 = 𝑋1000 = 5.6%
Population 10000

No. of slides positive for falciparum 56

𝑺𝑭𝑹 = 𝑋100 = 𝑋1000 = 4.66%
Total no. of slides examined 1200

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MORTALITY INDICATORS
9. In a community with a mid-year population of 30,000, the total number of males was
15,500 and that of females was 14,500. There were 2900 children in the under-five age
group. In total 206 deaths were reported in the same year; of these, 100 were males and
106 were females. There were 42 deaths in children younger than 5 years.
Calculate CDR and ASMR for the under-five age group and specific mortality rates for males
and females.

Ans:
Total no. of deaths in a defined area in a year
𝐂𝐫𝐮𝐝𝐞 𝐝𝐞𝐚𝐭𝐡 𝐫𝐚𝐭𝐞 = 𝑋1000
Mid − year population of the area
206
𝐶𝐷𝑅 = 𝑋1000 = 6.9 deaths per 1000 population
30000
𝐀𝐒𝐌𝐑 𝐟𝐨𝐫 𝐭𝐡𝐞 𝐮𝐧𝐝𝐞𝐫 − 𝐟𝐢𝐯𝐞 𝐚𝐠𝐞 𝐠𝐫𝐨𝐮𝐩
No. of deaths among the under − five age group in a defined area in a year
= 𝑋1000
Mid − year population of the under − five age group
42
= 𝑋1000 = 14.5 per 1000 children in the under − five age group
2900

𝐌𝐚𝐥𝐞 − 𝐒𝐩𝐞𝐜𝐢𝐟𝐢𝐜 𝐌𝐨𝐫𝐭𝐚𝐥𝐢𝐭𝐲 𝐑𝐚𝐭𝐞 (𝐒𝐒𝐌𝐑 − 𝐦𝐚𝐥𝐞)

No. of male deaths in a defined area in a year
= 𝑋1000
Mid − year population of males of the area
100
= 𝑋1000 = 6.5 per 1000 male population
15500

𝐅𝐞𝐦𝐚𝐥𝐞 − 𝐒𝐩𝐞𝐜𝐢𝐟𝐢𝐜 𝐌𝐨𝐫𝐭𝐚𝐥𝐢𝐭𝐲 𝐑𝐚𝐭𝐞 (𝐒𝐒𝐌𝐑 − 𝐟𝐞𝐦𝐚𝐥𝐞)

No. of female deaths in a defined area in a year
= 𝑋1000
Mid − year population of females of the area
106
= 𝑋1000 = 7.3 per 1000 female population
14500

CDR = 6.9 deaths per 1000 population,

ASMR (under five) = 14.5 per 1000 children in the under-five age group,
SSMR-male = 6.5 per 1000 male population,
SSMR-female = 7.3 per 1000 female population

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10. In a community, with a mid-year population of 136,000, there were 3576 live births in
the year 2016. Following was the number of deaths:
● No. of fatal deaths (≥28 weeks gestation) = 24
● Deaths in less than 7 days of birth = 39
● Deaths during 7-28 days of birth = 34
● Deaths during 29 days to less than 1 year of age = 58
● Maternal deaths = 7
● Deaths in the under-five age group = 170
Calculate MMR, SBR, PMR, NMR, PNMR, IMR, and U5MR.
Ans:
a)
No. of maternal deaths 7
𝐌𝐌𝐑 = 𝑋100000 = 𝑋100000 = 196 per 100,000 live births
No. of live births 3576
(b)
No. of stillbirths (late fetal deaths) 24
𝐒𝐁𝐑 = 𝑋1000 = 𝑋1000 = 6.7 per 1000 total births
No. of live births and stillbirths 3576 + 24
(c)
No. of perinatal deaths (late fetal deaths + deaths in less than 7 days of births)
𝐏𝐌𝐑 = 𝑋1000
No. of live births + stillbirths
24 + 39
= 𝑋1000 = 17.5 deaths per 1000 total births
3576 + 24
(d)
No. of neonatal deaths (within 28 days of birth)
𝐍𝐌𝐑 = 𝑋1000
No. of live births
39 + 34
= 𝑋1000 = 20.4 deaths per 1000 live births
3576
(e)
No. of post neonatal deaths (after 28 days and less than 1 year)
𝐏𝐍𝐌𝐑 = 𝑋1000
No. of live births
58
= 𝑋1000 = 16.2 deaths per 1000 live births
3576
(f)
No. of infant deaths (less than 1 year)
𝐈𝐌𝐑 = 𝑋1000
No. of live births
39 + 34 + 58
= 𝑋1000 = 36.7 deaths per 1000 live births
3576
(g)
No. of deaths among children younger than 5 years
𝐔𝐒𝐌𝐑 = 𝑋1000
No. of live births
170
= 𝑋1000 = 47.5 deaths per 1000 live births
3576

MMR = 196 per 100,000 live births; SBR = 6.7 deaths per 1000 total births; PMR 175 deaths
per 1000 total births; NMR = 20.4 deaths per 1000 live births; PNMR = 16.2 deaths per 1000
live births; IMR 36.7 deaths per 1000 live births and USMR = 47.5 deaths per 1000 live births.

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MORBIDITY INDICATORS
11. In a town with 20,000 population, the following statistics were reported related to
pulmonary TB in year 2016:
● Total no. of pulmonary TB cases 500 =
● No. of newly detected cases of pulmonary TB = 90
● Total no. of cases on 31 December 2016 = 380
Calculate the incidence, period prevalence for the year 2016, and point prevalence on 31
December 2016.
Ans:
[Link] new TB cases during 2016
a) 𝐈𝐧𝐜𝐢𝐝𝐞𝐧𝐜𝐞 𝐨𝐟 𝐩𝐮𝐥𝐦𝐨𝐧𝐚𝐫𝐲 𝐓𝐁 = Population at risk,at the start of the study 𝑋100

90
= 𝑋100 = 0.45% 𝑜𝑟 4.5 𝑝𝑒𝑟 1000
20000

[Link] new and old TB cases in 2016

(b) 𝐏𝐞𝐫𝐢𝐨𝐝 𝐩𝐫𝐞𝐯𝐚𝐥𝐞𝐧𝐜𝐞 𝐨𝐟 𝐩𝐮𝐥𝐦𝐨𝐧𝐚𝐫𝐲 𝐓𝐁 = Total population at the start of the study 𝑋100

500
= 𝑋100 = 2.5%
20000

(c) 𝐏𝐨𝐢𝐧𝐭 𝐩𝐫𝐞𝐯𝐚𝐥𝐞𝐧𝐜𝐞 𝐨𝐟 𝐩𝐮𝐥𝐦𝐨𝐧𝐚𝐫𝐲 𝐓𝐁 𝐨𝐧 𝟑𝟏 𝐃𝐞𝐜𝐞𝐦𝐛𝐞𝐫 =

No. of new and old cases on 31 December 2016
𝑋100
Total population on 31 December 2016
380
= 𝑋100 = 1.9%
20000

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12. The given figure depicts the occurrence of tuberculosis (TB) cases at different times in
a population of 300. Assuming that the population is the same at any point of time,
calculate the following rates for TB:
(1) Point prevalence on 1 January 2015
(2) Point prevalence on 31 December 2015
(3) Period prevalence in year 2015
(4) Incidence in year 2015
Ans:
[Link] TB cases on 1 January
a) 𝐏𝐨𝐢𝐧𝐭 𝐩𝐫𝐞𝐯𝐚𝐥𝐞𝐧𝐜𝐞 𝐨𝐧 𝟏 𝐉𝐚𝐧𝐮𝐚𝐫𝐲 𝟐𝟎𝟏𝟓 = 𝑋100
Population on 1 January

No. of cases on 1 January = Cases no. 1, 3 and 9 (three cases)

Population on 1 January = 300 (as per the question, population is 300 at any given
point of time)
No. of TB cases on 1 January
𝐏𝐨𝐢𝐧𝐭 𝐩𝐫𝐞𝐯𝐚𝐥𝐞𝐧𝐜𝐞 𝐨𝐧 𝟏 𝐉𝐚𝐧𝐮𝐚𝐫𝐲 𝟐𝟎𝟏𝟓 = 𝑋100
Population on 1 January
3
Thus, point prevalence = 𝑋100 = 1%
300

[Link] TB cases on 31 December

(b) 𝐏𝐨𝐢𝐧𝐭 𝐩𝐫𝐞𝐯𝐚𝐥𝐞𝐧𝐜𝐞 𝐨𝐧 𝟑𝟏 𝐃𝐞𝐜𝐞𝐦𝐛𝐞𝐫𝟐𝟎𝟏𝟓 = 𝑋100
Population on 31 December

No. of cases on 31 December = Cases no. 1, 4, 5 and 7 (four cases)

Population on 31 December = 300
Thus, point prevalence on 31 December = (4/300) x 100 = 1.33%.

[Link] new and old cases of TB in year 2015

(c) 𝐏𝐞𝐫𝐢𝐨𝐝 𝐩𝐫𝐞𝐯𝐚𝐥𝐞𝐧𝐜𝐞 𝐢𝐧 𝐲𝐞𝐚𝐫 𝟐𝟎𝟏𝟓 = 𝑋100
Total population at the start in 2015

New cases are case nos. 2, 4, 5, 6, 7 and 8 (six cases) and old cases are case nos. 1, 3,
9(three cases).
6+3
Thus, period prevalence in year 2015 = 𝑋100 = 3%
300
[Link] new cases of TB in year 2015
(d) 𝐈𝐧𝐜𝐢𝐝𝐞𝐧𝐜𝐞 𝐢𝐧 𝐲𝐞𝐚𝐫 𝟐𝟎𝟏𝟓 = Population at risk at the start in year 2015 𝑋100

Population at risk of development of disease on 1 January =

(𝑇𝑜𝑡𝑎𝑙 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑜𝑛 1 𝐽𝑎𝑛𝑢𝑎𝑟𝑦 − 𝑃𝑒𝑜𝑝𝑙𝑒 𝑤ℎ𝑜 𝑎𝑙𝑟𝑒𝑎𝑑𝑦 ℎ𝑎𝑑 𝑡ℎ𝑒 𝑑𝑖𝑠𝑒𝑎𝑠𝑒 𝑜𝑛 1 𝐽𝑎𝑛𝑢𝑎𝑟𝑦)
 = 300 − 3 = 297
6
Thus, incidence in year 2015 = 𝑋100 = 2.02%
297

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13. In a hostel having 160 children, four cases of measles were detected. Within 10 days,
another 40 cases were identified. On enquiry, it was found that of the healthy children,
42 were immunized against measles. Assuming 100% protection by measles vaccine,
calculate the Secondary Attack Rate (SAR).
Ans:

No. of susceptible contacts exposed to the primary case, developing the disease,
within maximum incubation period of the disease
𝑺𝑨𝑹 = 𝑋100
Total no. of susceptible contacts exposed to the primary case
Here,
𝑡ℎ𝑒 𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑠𝑢𝑠𝑐𝑒𝑝𝑡𝑖𝑏𝑙𝑒 𝑐ℎ𝑖𝑙𝑑𝑟𝑒𝑛 𝑒𝑥𝑝𝑜𝑠𝑒𝑑 𝑎𝑓𝑡𝑒𝑟 𝑖𝑛𝑖𝑡𝑖𝑎𝑙 𝑐𝑎𝑠𝑒𝑠
= 𝑇𝑜𝑡𝑎𝑙 𝑛𝑜. 𝑜𝑓 𝑐ℎ𝑖𝑙𝑑𝑟𝑒𝑛 − 𝐼𝑛𝑖𝑡𝑖𝑎𝑙 𝑐𝑎𝑠𝑒𝑠 𝐼𝑚𝑚𝑢𝑛𝑖𝑧𝑒𝑑 𝑐ℎ𝑖𝑙𝑑𝑟𝑒𝑛)
= 160 − (4 + 42) = 114
No. of susceptible contacts exposed to the primary case, who developed the disease in
maximum incubation period (IP) (secondary cases) = 40
Thus,
40
𝑺𝑨𝑹 = 𝑋100 = 35.1%
114

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WATER PROBLEMS
14. A cylindrical well used for drinking purpose has water column height 11m and diameter
3m. Calculate the amount of bleaching powder required to disinfect this well if Horrock's
test shows blue colour from the third cup onwards. Write the procedure of well
disinfection.
Ans:
Step I: Find the volume of the water to be disinfected.
Volume of water (Liters) = 𝜋𝑟² ℎ × 1000
 𝑑𝑖𝑎𝑚𝑒𝑡𝑒𝑟 3
where π = 3.14, 𝑟 = = = 1.5𝑚, h = 11 m.
2 2

= 3.14 𝑋 1.5 𝑋 1.5 𝑋 11 𝑋 1000 = 77715

Step II: Find the bleaching powder requirement by Horrock's test.
Horrock's test showed blue colour earliest in the third cup.
Hence, 3 x 2= 6 g of bleaching powder is required to disinfect 455 L of water.
𝑉𝑜𝑙𝑢𝑚𝑒 𝑜𝑓 𝑤𝑎𝑡𝑒𝑟 𝑖𝑛 𝐿𝑖𝑡𝑒𝑟𝑠 𝑋 𝑛 𝑋2
𝑅𝑒𝑞𝑢𝑖𝑟𝑒𝑑 𝑏𝑙𝑒𝑎𝑐ℎ𝑖𝑛𝑔 𝑝𝑜𝑤𝑑𝑒𝑟 𝑖𝑛 𝑔𝑟𝑎𝑚𝑠 =
455
77715 ∗ 3 ∗ 2
= = 1025𝑔
455
Thus, 1.025 kg of bleaching powder will be required to disinfect the water of this well.
Step III: Procedure for well water disinfection.

PROCEDURE FOR WELL WATER DISINFECTION

● Mix the required amount of bleaching powder in fractions of 100 g at one time with
some water in a bucket to make a thin paste.
● Add water further to fill the bucket up to three-fourths level and stir well. Allow to
sediment for 10 minutes.
● Pour the supernatant water, which contains chlorine, in another bucket and discard the
sediment, which contains lime. (If poured, it will result in an increase in hardness of
water.)
● Lower down the bucket containing supernatant water into the well below the water level.
● Move the bucket violently both vertically and laterally several times to mix the chlorine
with water.
● Similarly add remaining required amount of bleaching powder into the well.
● Do a test for residual chlorine of well water after a minimum of half an hour by ortho-
tolidine test.
● This free residual chlorine should be minimum 0.5 mg/L. (If not, disinfection procedure
is repeated.)
● It is better to disinfect the well during night-time so that people can use the water in the
morning.

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15. Calculate the quantity of bleaching powder required to disinfect a rectangular well
having 5-m length, 3-m breadth and 7-m depth of the water column. Horrock's test
done on water sample from this well shows blue colour from the fourth cup onwards.
Explain the practical procedure of disinfecting the well.
Ans:
Step I: Find the volume of the water to be disinfected.
Volume of water (Liters) = (𝑙 × 𝑏 × ℎ) ∗ 1000
= (5 𝑋 3 𝑋 7) 𝑋 1000 = 105000
Step II: Find the bleaching powder requirement by Horrock's test.
Horrock's test showed blue colour earliest in the fourth cup.
Hence, 4 x 2= 8 g of bleaching powder is required to disinfect 455 L of water.

𝑉𝑜𝑙𝑢𝑚𝑒 𝑜𝑓 𝑤𝑎𝑡𝑒𝑟 𝑖𝑛 𝐿𝑖𝑡𝑒𝑟𝑠 𝑋 𝑛 𝑋 2

𝑅𝑒𝑞𝑢𝑖𝑟𝑒𝑑 𝑏𝑙𝑒𝑎𝑐ℎ𝑖𝑛𝑔 𝑝𝑜𝑤𝑑𝑒𝑟 𝑖𝑛 𝑔𝑟𝑎𝑚𝑠 =
455
105000 ∗ 4 ∗ 2
= = 1846 𝑔
455

Thus, 1.846 kg of bleaching powder will be required to disinfect the water of this
well.
Step III: Procedure for well water disinfection
same as above