Prior to the plenary, the spokesperson of each group sits in front of the class Read carefully the learning tasks a to c below. Each group has to discuss all of the learning tasks below. Before the plenary start, every SGD has already put the file of the

2. Prior to the plenary, the spokesperson of each group sits in front of the class

3. Read carefully the learning tasks a to c below.

4. Each group has to discuss all of the learning tasks below.

5. Before the plenary start, every SGD has already put the file of the answer in the

class’ computerCPU LEARNING TASK a Discuss the natural history, primary, secondary and tertiary prevention of HIV-AIDS using a diagram. b Discuss the natural history, primary, secondary and tertiary prevention of denguehemorrhagic fever DHF using a chart. Please refer to: http:www.medscape.comviewarticle725639_2 SGD : DISEASES PREVENTION Guidelines: a During small group discussion SGD, each group has to select a spokesperson, who will be presenting the results of discussions at the plenary b Prior to the plenary, the spokesperson of each group sits in front of the class c Read carefully the learning tasks a to c below. d Each group has to discuss all of the learning tasks below. e Before the plenary start, every SGD has already put the file of the answer in the class’ computerCPU LEARNING TASK Please take a look this PDF file below before answering the following task: http:www.euro.who.int__dataassetspdf_file0004129532Ottawa_Charter.pdf All the answers for the following task must also referconsider to “Ottawa Charter” as explained on the above file. a Discuss the natural history, primary, secondary and tertiary prevention of tuberculosis. Please refer to the following website: http:www.uphs.upenn.edubugdrugantibiotic_manualiuatld_tb_manual_for_me dical_students.pdf b Discuss the natural history and primary, secondary and tertiary prevention of malnutrition in children age under 5 years. Udayana University Faculty of Medicine, DME 35 Please refer to the following website: http:www.jped.com.brconteudo00-76-s285ing.pdf c Please refer to the following website: http:depts.washington.eduepidemEpi583MockLancet.pdf Please discuss the natural history, primary, secondary and tertiary prevention of traffic accident Self assessment 1. Explain the determinant factor of diseases occurrence by using the Epidemiological Triangle, the Wheels and the Blum models 2. A part of the Blum model is the health care factor. If you use the Wheel model, into which factor that factor should be included? 3. The other part of the Blum model is behaviour factor. If you use the Wheel model, that factor should be included into which factor? And if you use the Epidemiological Triangle model, how should you place the behaviour factor? 4. What are the differences between the natural history of HIVAIDS, DHF, and coronary disease or stroke? 5. Why is it very important to understand the determinant and the natural history of certain diseases in a population? 6. The level of prevention consists of primary preventions, including health promotion behaviour change policyregulation and specific protection, secondary prevention early detection and prompt treatment, and tertiary prevention disability limitation and rehabilitation. Explain which prevention will be effective for the following diseasesincidents: DHF, HIVAIDS, diarrheal, traffic accident, coronary heart disease, stroke, tuberculosis TBC, and avian influenza. 7. The health promotion is actually “health education plus” which consists of health education or behaviour intervention and structural intervention or policyregulation. Give examples of behaviour intervention and policyregulation to reduce death due to traffic accident, to decrease deficiency of energy and protein under nutrition and certain diseases caused by smoking behaviour. 8. Explain the definition of the iceberg phenomena and its consequences regarding the disease prevention in the community and regarding the accuracy of data available at service statistic primary health services such as private midwives doctor, PHC, private clinics, secondary health care service such as district hospital, and tertiary health care service such as referral hospital. Udayana University Faculty of Medicine, DME 36 M O D U L E ~ 2 Reference Kirkwood and Sterne, chapter 2 Population, Sample, Data, and Variables dr. Putu Ayu Swandewi, MPH dr. Gede Artawan Eka Putra, M.Epid AIM: Demonstrate ability to search, collect, organize and interpret informationdata from different sources in order to assist in diagnostic, therapeutic and health. LEARNING OUTCOMES: a Describe the definitions of population and sample. b Explain the conditions required for a representative sample. c Explain several sampling methods. d Describe types of data and variables. e Describe several method of data collection CURRICULUM CONTENTS: Population, Sample, Data, and Variables ABSTRACT Population is a group in whom the result of certain study can be applied;while sample is part of the population that should represent its population. Two requirements for sample to be representative are concerning on samples size and sample selection. Sample size are determined by indicators of measurements mean, proportion study design, alphaα and power1-β, and tolerated deviation. Besides those above, sample selection also take important role. The recommended sample selection is non- random sampling simple, systematic, stratified, multistage, etc. In clinic setting, we frequently used consecutive sampling which is a non random sampling and assumed to be represented its population. Udayana University Faculty of Medicine, DME 37 Sample allocation can be used if we need more than one group of sample. The easiest way is block allocation. We can also use allocation of simple random sampling, stratified allocation, and systematic allocation. SCENARIO: Case 1. Study on Maternal and Child Health The study was conducted in two phase; 1 household survey to determine the under five years health status and 2 Quasi Experimental study to explore the effect of food supplementation program toward the improvement of nutritional status First Phase A household survey was conducted to explore under five years child’s health status at Desa Merdeka in 2011. The objective of the study was to determine several factors that associated with anemia and chronic malnutrition among children in the area. The area has two different characteristics which are easy to reach area easy and hard to reach area hard. The condition of both areaswas suggested to be considered since there might be different characteristics of the family; hence, the samples were randomly selected from both areas. The subjects of the study were all five under five years old children. Children from the family who are no longer residing in the area were excluded from the study and those with incomplete data were excluded during data analysis. List of the children were withdrawn from the register at the village leader office. Data collection was performed by interview using structured questionnaire with the mothers and measurement of the children. The characteristics that were explored and measured include: mothers’ and children’s demographic characteristic, haemoglobin level and body weight. More specifically, the variables in the study were ID, name, area, mothers’ age, education, occupation; history of exclusive breastfeeding, parity; and children’s weight, age, hemoglobin level, body weight and height. The hemoglobin level measured with HemoCue, and body weight measured with digital scale. Anemia status was determined when Hb level less than 11 mgdl and undernourished determined when BMI less than 11kgm 2 Second Phase After the above data collection was completed, the second phase of the study was started. This phase aims to evaluate the impact of food supplementation program to improve nutritional status among undernourished children. All undernourished children were involved in the study, expect those with severe illness. The children were allocated into two groups; first group received food supplementation and second groups continue with the prior daily consumption. The supplementation was provided up to 2 months and at the end of two month the nutritional status the body weightwere measured again. Udayana University Faculty of Medicine, DME 38 Learning Task 1: You are required to discuss the following questions, based on the study: 1. Explain the definition of population target population and sampled population and sample From each study phase of the case above describe: 1. Target population of the study 2. Sampled population of the study 3. Discuss what are the different between target and sampled population 2. Discuss the reason of taking sample rather than observed all population and the requirement of a good sample? 3. Discuss several conditions for samples to represent the population to be representative 4. Discuss the meanings and objective of inclusion criteria, exclusion criteria, and drop out criteria? Base on the case study above, for each phase, describe: 1. What are the inclusion criteria for the study 2. What are the exclusion criteria for the study 3. What are the drop out criteria for the study 5. Explain the indication and the technique for sampling methods below 1. Simple random, stratified random, systematic random, multi-stage random, cluster, 2. Quota, convenience, purposive, and “snow-balling technique” 3. Based on the case study above, what is the sampling method of the study? 6. Based on the case above phase 1, describe about sampling frame for the study. What is the importance of constructing a sampling frame and when it is not possible to be constructed? 7. Explain several important parts in sample size calculation including variability, design, power 1- , level of significance , effect size or precision or margin of error. a. Draw the relationship between variables above b. Classify the variables based on their function 8. a. Explain the classification of variables based on the level of measurement b. Among the variables on the study above, classify them based on the level of measurement 9. Describe method of data collection that have been applied on the case study above. Self Assessments: 1. Explain the definition of population and sample Udayana University Faculty of Medicine, DME 39 2. What are the conditions required for a representative sample? 3. Explain several sampling methods: simple random, proportional, multistage, stratified, systematic, cluster, quota, consecutive, incidental, purposive, and “snow- balling technique” 4. What is the meaning of exclusion criteria? What is the purpose of excluding some population characteristics? M O D U L E ~ 3 Reference Greenberg p. 15-28 Gordis, p. 37-83 Measurements of Morbidity and Mortality in a Population; Source of Error in Measurements dr. Ayu Kartika Sari, MPH dr. A.A.Sg. Sawitri, MPH AIMS To demonstrate ability to search, collect, organize and interpret informationdata from different sources in order to assist in diagnostic, therapeutic and health. LEARNING OUTCOMES: At the end of the module, students should be able to: 1. Explain measurements of morbidity and mortality in a population. 2. Differentiate proportion, ratio, rate, prevalence and incidence. 3. Explain four types of incidence based on their denominators. 4. Describe the source of numerators and denominators for prevalence and incidence. 5. Explain types of errors in rate calculation. 6. Explain the differences, application, interpretation, and weaknesses of slide crude, specific, and adjusted rate. 7. Analyze, and interpret crude, specific and adjusted rate. CURRICULUM CONTENTS: 1. Measurements of Morbidity and Mortality in a Population 2. Crude, Specific and Adjusted Rate SELF DIRECTING LEARNING: Udayana University Faculty of Medicine, DME 40 1. Read previous lectures regarding the natural history of diseases. 2. Read Handout 1, p. 62–68, Greenberg, p. 47-53, Gordis, p. 37-83, and power point slides. ABSTRACTS As a medical doctor, either in a clinic or in a public health setting, we will face many problems in a field work which relate to rate, ratio, and proportion. A clinician will certainly consider rate in diagnosing and predicting the fatality or prognosis of a certain disease, a clinician will certainly use rate. Meanwhile, a public health doctor will apply rate, ratio, and proportion to either diagnose a community problem or to evaluate a health program. Rate, ratio, and proportion, are measurements used to describe the situation, condition, or even a problem among population. Each measurement has specific characteristics and applications. Ratio which is a comparison between 2 independent numbers is usually used for management purpose. Proportion is a comparison between numerator and denominator in which the numerator is included in the denominator. Lastly, rate is a proportion which has population at risk as the denominator. The understanding on measurement characteristics is needed due to giving specific interpretation based on the situation and purpose of measurement. SCENARIO LEARNING TASK Case 1. The Jakarta Post, Jakarta | National | Tuesday, December 31 2013, 7:33 PM http:www.thejakartapost.comnews2013123136000-people-with-hivaids-receive-arv- therapy-throughout-2013.html 36,000 people with HIVAIDS receive ARV therapy throughout 2013 As many as 36,483 people living with HIVAIDS ODHA have received antiretroviral ARV treatment in 2013, up from 2,381 in 2005, a senior health official has said. “The development of HIVAIDS control in Indonesia has shown relatively good results. This can be seen from the increase in the number of people receiving antiretroviral therapy in 2013,” said the Health Ministry’s director general of disease control and environmental health, T, in Jakarta on Tuesday, as quoted by Antara news agency. Udayana University Faculty of Medicine, DME 41 However, he said, the ministry also found that the number of early detected HIV cases had continuously increased. In 2013, 20,397 people were recorded as having been infected with HIV, up from 895 in 2005. Meanwhile, the number of AIDS patients reached 2,763 as of September, down from 4,987 in 2005. “The Case Fatality Rate CFR has also dropped to 0.85 percent as of September from 13.65 percent in 2004,” said T. The Health Ministry has been intensively carrying out HIVAIDS control and prevention programs by, among other measures, putting together a national guideline and training modules for health workers such as Training of Trainers ToT on Voluntary Counseling and Testing VCT, which is followed up with VCT as well as Care and Support and Treatment CST training sessions. Learning Task 1 You are required to discuss the following questions, based on the study above. 1. What is the type of measurement underlined in the above case? 2. What is the weakness of that measurement when it is applied to diagnose community health problem? 3. Do you think that measurement is still important to be used in the above case? Please give a reason 4. Please interpret the data of case fatality rate mentioned in the above case What is the importance of this rate to clinician? 5. What are the differences between Case Fatality Rate and Cause Specific Death Rate? Case 2 . Mapping Injecting Drug Users Activity in Bali A study was conducted by team of NGOs Hatihati, Matahati, dan Yakeba and Udayana University staff on June-December 2009. The objective of study was to determine the types of HIV risk behaviors among injecting drug users IDUs in Bali. Structured interviewed was done to 125 IDUs who randomly selected from a total of 550 reported active IDUs in Denpasar and Badung district. The findings showed that the types of drugs were varied, including heroin 97; 77.6, buprenorphine 60; 48 and ATS 1; 0.8. Some were using both heroin and buprenorphine 35; 28. Number of injection per day were vary from 1-5 times mean 1.5. Instead of injecting, they were also using non injected drugs, such as marihuana 22; 17.6, ATS 23; 18.4, tranquilizer 39; 31.2 and ecstasy 15; 12.0. Study report of Mapping Injecting Drug Users Activity in Bali, 2010 Udayana University Faculty of Medicine, DME 42 Learning Task 2 You are required to discuss the following questions, based on the study above 1. What is the type of measurement presented in the case above?? 2. What is the weakness of that measurement when it is applied to diagnose community health problem? Explain your answer 3. If you want to present the data in the form of relative number, which type will be most appropriate: proportion, prevalence, or incidence? 4. What is the interpretation of 77.6 at above? 5. When there was a total of 550 reported active IDUs, how many of them were possibly using tranquilizer? 6. What are the possibilities of biases of your estimation at number 5? Provide your reasons Case 3 . Survey of Tuberculosis in Bali, 2010 Bellow is the result of TB survey in Bali in the end of 2009 Table 1 that was conducted by the team of Udayana University. The survey was conducted to total available public health centers 120 PHCs in Bali and 3 main hospitals RS Sanglah, RS Wangaya, and RS Buleleng. To complete the analysis of the study, researcher took data of population from the Bali Provincial Statistic Office Table 2. Table 1. Number of TB cases in Bali No Sub-province Frequency Proportion Rate 1. Buleleng 165 2. Jembrana 73 3. Tabanan 57 4. Badung 119 5. Denpasar 312 6. Gianyar 73 7. Bangli 28 8. Klungkung 57 9. Karangasem 116 Total 1000 Source: HIV prevalence among TB patients in Bali, 2009 Table 2 Number of population in Bali, Based on District and Nationality at 2010 Regencies Indonesian Foreigners Total China Others Male Female Male Female Male Female 1 2 3 4 5 6 7 8 Udayana University Faculty of Medicine, DME 43 1. Jembrana 136.063 136.757 4 1 2 1 272.828 2. Tabanan 214.260 216.884 19 9 431.172 3. Badung 197.167 195.619 1 161 72 393.020 4. Gianyar 199.973 199. 607 15 11 22 32 399.660 5. Klungkung 91.067 94.201 4 185.272 6. Bangli 107594 108.135 215.729 7. Karangasem 219.591 218.883 1 438.475 8. Buleleng 331.931 330.907 16 17 28 21 662.920 9. Denpasar 262.362 260.476 277 184 523.299 2010 1.760.008 1.761.469 35 31 513 319 3.522.375 Source: Bali Provincial Statistic Office, 2010 Learning Task 3 You are required to discuss the following questions, based on the study above 1. Fill in the proportion and the rate based on the above data. What is the interpretation? 2. What is the difference between the proportion and rate at the above? Which one is the appropriate to determine community health problem? 3. What is the rate you calculate: prevalence or incidence? Explain your answers 4. What are the differences between incidence and prevalence? 5. If you want to calculate incidence of TB, draw the figure of incidence measurement based on the above data take one sub-district as an example 6. With regard to the source of data, what could be biases regarding the above result? Case 4 Learning Task 4 Morbidity Cases on Newspaper 1. Read carefully the newspaper clipping provided at the annex with the title “Dipertanyakan, Pasien Kurang Mampu Masuk RSUP Denpasar”dan “Masalah Pasien Kurang Mampu, DPRD Pertanyakan Keluhan RSUP”. Questioned: “Poor patients in Provincial Central Hospital” and “Problem with poor patients, Parliament asks the hospital complaints”. Discuss in your group and give opinion or comments on that news. Write your comments on a paper and submit it to your lecturer by the next day. Udayana University Faculty of Medicine, DME 44 2. Read thoroughly the clipping with title “Korban Kanker Terbanyak Penduduk Pedesaan, Tingkat Sosek Rendah”. “Mostly cancer patients are from rural areas with low socio-economic status” Discuss in your group and give opinion or comments on that news. Write your comments on a paper and submit it to your lecturer by the next day. M O D U L E ~ 4 Greenbergp. 51-53 Crude, Specific and Adjusted Rate dr. Ayu Kartika Sari, MPH dr. A.A.Sg.Sawitri, MPH ___________________________________________________________________ ABSTRACTS The other principal topic of morbidity and mortality measurements is the terms of crude, specific, and adjustment. These measurements are often being applied to those rate, ratio, and proportion. Crude, specific and adjustment are relative measurements. Crude means, generally, if the numerator and the denominator use total incident in a population ex. CDR, CBR. While specific measurement is when the numerator and the denominator are comes from certain sub-populations. For instances the specific mortality on delivered women and the specific morbidity on tuberculosis. The adjustment is adjusting a certain incident among a group of population to a standard population for comparison purpose. Case 1 Sero prevalence of HIV among TB patients in Bali Study of HIV-TB was conducted in 2009 by research team of Udayana University to find out the HIV prevalence among TB patients who visit health services puskesmas, Sub- province and hospitals in Bali. Each newly TB diagnosed patients were having short counselling for examination for their HIV status in anonymously unlinked manner. One thousand TB patients 580 male and 420 female were visiting clinics on June to December 2008. HIV was found to be positive among 39 TB patients 30 male and 9 Udayana University Faculty of Medicine, DME 45 female, while the distribution based on sub-provinces is presented in the following table. Report of Sero-Survey of HIV Co Infection among TB patients in Bali, 2009 D istribution of TB and HIV Patients Based on Sex and Sub-province Number Disctric Freq. of TB patients m; f Freq of HIV patients m; f 1. Buleleng 165 101; 64 19 16; 3 2. Jembrana 73 45; 28 1 1; 0 3. Tabanan 57 31;26 1 1; 0 4. Badung 119 68; 51 5. Denpasar 312 171; 141 16 11; 5 6. Gianyar 73 43; 30 7. Bangli 28 18; 10 8. Klungkung 57 31; 26 9. Karangasem 116 75; 41 2 1; 1 Total 1000 580; 420 39 30; 9 Learning Task 1 1. What is the crude HIV infection among TB patients in Bali? What is the interpretation of that number? 2. What is the specific HIV infection among TB patients in Bali, based on sex? What is the interpretation of that number? Is the number confounded by area or sub- province? 3. What is the specific HIV infection among TB patients in Bali, based on sub- province? What is the interpretation of that number? Is the number confounded by sex? 4. What is the specific HIV infection among TB patients in Bali, based on sex and sub-province? What is the interpretation of that number? Is the number confounded by sex and sub-province? 5. Regarding the above results, explain the weaknesses of crude and specific rate. 6. If you are the Head of Bali Province, what will you do with regard to the above result number 1, 2, and 3? 7. If you are the Head of Puskesmas in Buleleng area, what will you do if you diagnose patient as a TB in Puskesmas? Case 2 The following graphic shows data of crude birth rate and crude death rate on two countries. Look at carefully, and discuss the following questions. Please be aware that now we are discussing crude, specific and adjusted rate; therefore your answers should be prompted to the concept of those measurements. Udayana University Faculty of Medicine, DME 46 Graphic Comparison of CBR and CDR at Canada and Alberta Learning Task 2 1. First summary: the health status at Canada is better than Alberta. Is that correct? Explain your answer 2. In order to make fair comparison between those states, what should you do? What data do you need? 3. Second summary: Number of deaths at Canada is greater than Alberta. Is that correct? Explain your answer 4. Third summary: If adjusted death rate for Canada is 7 per 1000 persons, when the total population of Canada is 33,476,688. The total number of death was 234,339. Is that correct? Explain your answer Self Assessment 1. How do you differentiate absolute, ratio, proportion and rate? 2. Incidence and prevalence are not similar in many ways. Explain that 3. In how many ways can you calculate incidence rate? 4. What are denominators that can be applied for calculating incidence? What is the most ideal enumerator? 5. Which measurement can be used to predict prognosis or trend of mortality for suffering from disease? Udayana University Faculty of Medicine, DME 47 M O D U L E ~ 5 SKILL LAB I Reference Skill Lab Manual, Kirkwood Sterne, Chapter 2 DATA ENTRY, DATA CLEANING AND DATA TRANSFORMATION dr. Putu Ayu Swandewi, MPH dr. Gede Artawan Eka Putra, M.Epid AIMS: To demonstrate ability to search,organize and interpret informationdata from different sources in order to assist in diagnostic, therapeutic and health. LEARNING OUTCOMES: 1. To make structure of data with SPSS application 2. To do data entry 3. To clean data before analysis and explain the use 4. To do data transformation and explain the use CURRICULUM CONTENTS: 1. Structure of data Udayana University Faculty of Medicine, DME 48 2. Data entry 3. Data cleaning 4. Data transformation SCENARIO LEARNING TASKS Case. A population study was done in two sub villages in Desa Merdeka. This study’s purpose was to determine several factors that associated with anaemia and chronic malnutrition among children in the area. The area has two different characteristics which are easy to reach area easy and hard to reach area hard. The condition of both areas was suggested to be considered since there might be different characteristics of the family; hence, the samples were randomly selected from both areas. First Phase Data collection was performed by interview using structured questionnaire with the mothers and measurement of the children see questionnaire in the skill lab guide. The characteristics that were explored and measured include: mothers’ and children’s demographic characteristic, haemoglobin level and body weight. More specifically, the variables in the study were ID, name, area, mothers’ age, education, occupation; parity; and children’s age, haemoglobin level, body weight and height. The haemoglobin level measured with HemoCue, and body weight measured with digital scale. Anaemia status was determined when Hb level less than 11 mgdl and undernourished determined when BMI less than 11kgm 2 Second Phase After the above data collection was completed, the second phase of the study was started. This phase aims to evaluate the impact of food supplementation program to improve nutritional status among undernourished children. All undernourished children were involved in the study, expect those with severe illness. The children were allocated into two groups; first group received food supplementation and second groups continue with the prior daily consumption. The supplementation was provided up to 2 months and at the end of two month the nutritional status the body weightwere measured again. Learning Tasks: See the sheet of data collection and raw data. The data were analysed by computer with software of SPSS. Discuss and analyse the tasks bellow: 1. Explain the types of variables in relation to construction of data entry: variable name name, type, width, decimal, labels, value labels, missing values

2. Number No consists of 3 numbers hundreds, name of its field is: number 5