Study Guide CBP Semester 2 Tayang 12 Maret 2015

Study Guide
Community-Based
Practice
Department of Community
and Preventive Medicine
Study Program of Medicine
Faculty of Medicine Udayana
University
2015
Study Guide Communitybased Practice
Udayana University Faculty of Medicine, DME
LIST
0F CONTENT
List of Module
Curriculum of Community Based Practice
Planners Team
Facilitators
Skill Lab Facilitators
Reserve Facilitators
Time Table
10
Skill Lab Time Table
22
Assessment Method
22
Introduction
23
Module 1 18
24
References
98
Annex 1 Film Summary And the band played on
99
Annex 2 Artikel Koran Bali Post
104
Annex 3 Artikel jurnal
109
Skill Lab (1-3)
110
Student Project: Searching, analysis, and interpreting study result
129
LIST
OF MODULE
MODULE ~ 1 (Mausner & Bahn, p. 1-42)

Determinants of Health/Diseases, Natural; History of Diseases
and Diseases Prevention
p. 26
MODULE ~ 2 (Kirkwood and Sterne, chapter 2)

Population, Sample, Data, and Variables
p.32
MODULE ~ 3 (Greenberg p. 15-28)

Measurements of Morbidity and Mortality in a Population;
Source of Error in Measurements
p.35
MODULE ~ 4 (Greenbergp. 51-53)

Crude, Specific and Adjusted Rate
p.40
MODULE ~ 5 (Skill Lab Manual, Kirkwood & Sterne, Chapter 2)

Skill Lab: Data entry, Data Cleaning, and Data Transformation
p. 43
MODULE ~ 6 (Greenberg, p. 29-43)

Analysis and Interpretation of Descriptive Data
p.45
MODULE ~ 7 (Kirkwood & Sterne, Chap 3 &4)

Data Presentation and Data Description
p.49
MODULE ~ 8 (Skill Lab Manual, Kirkwood & Sterne)

Skill Lab Data Presentation and Data Interpretation
p.54
MODULE ~ 9 (Kirkwood & Sterne, Chap. 5-8, 10, 14, 15)

Inferential Analysis and Interpretation of Analysis Results
(Hypothesis Test)
p.55
MODULE ~ 10 (Kirkwood & Sterne, Chap. 7, 9, 11, 16, 18, 19)

Significance Test for Categorical and Interval Data
p.59
MODULE ~ 11 (Skill Lab Manual, Kirkwood & Sterne)

Correlation-Regression, Significance Test
For Categorical and Interval Data
p. 64
MODULE ~ 12 (Greenberg, p. 45 73)

Definition, Requirements, Types, and Applications of
Surveillance and Outbreaks
p. 65
MODULE ~ 13 (Greenberg)
Epidemiology Study to Determine Risk Factor of Disease
p. 72

Epidemiology Study Design: Cohort Study
p.79

Epidemiology Study Design: Case Control Study
p.83
MODULE ~ 16 (Greenberg, p.91-113)

Epidemiology Study Design: Clinical Trial
p. 87

Epidemiology Study Design: Diagnostic Test
p. 92

MODULE ~ 18 (Mausner & Bahn, p. 91-110, Greenberg 141-153)
Variability and Biases
p. 95
CURRICULUM
Community Based Practice
Competency
Statement
Instructional
Goals
Learning Objectives
Topics
Use community
based-practices to
conduct studies
that improve
diseases
prevention in the
community
Demonstrate
ability to apply
health prevention
principles based
on risks and
determinant
factors of health
problem
a) Describe several
determinants (models) of
diseases and death
occurring in the
population
Determinants of
Morbidity and
Mortality in a
Population,
Natural History
and Diseases
Prevention
b) Explain the applications

of understanding
diseases and death
determinants (models).
c) Identify the strengths and
weaknesses of diseases
models.
d) Draw figures of the
natural history of a certain
disease.
e) Explain the applications
of the natural history of a
disease for prevention.
f)
Explain the severity of

diseases in a population
and its implication to
prevention.
g) Explain the Ice Berg

phenomena and its
implication in diseases
prevention.
h) Describe the level of
disease prevention based
on determinants and
natural history.
Competency
Statement
Instructional Goals
Learning Objectives
Topics
Demonstrate ability
to search, organize
and interpret
information/data
from different
sources in order to
assist in diagnostic,
therapeutic and
health
a) Explain
measurements of
morbidity and
mortality in a
population.
Measurements
of Morbidity and
Mortality in a
Population
b) Describe the
definitions of
population and
sample.
c) Explain the conditions
required for a
representative
sample.
d) Explain several
sampling methods.
e) Describe types of data
and variables.
f)
Be able to prepare
software for data
entry.
g) Differentiate
proportion, ratio, rate,
prevalence and
incidence.
h) Explain four types of
incidence based on
their denominators.
i)
Describe the source

of numerators and
denominators for
prevalence and
incidence.
j)
Explain types of errors

in rate calculation.
k) Explain the
differences,
application,
interpretation, and
weaknesses of (slide)
crude, specific, and
adjusted rate.
Pattern of
Morbidity and
Mortality Based
on Person,
Place, and Time
l)
Competency
Statement
Instructional Goals
Be able to analyze,
and interpret crude,
specific and adjusted
rate.
Learning Objectives
Topics
m) Be able to analyze,
present, and interpret
descriptive categorical
and interval data.
n) Be able to analyze
and present data
using computers. Be
able to interpret the
measurements of
morbidity and
mortality on samples
descriptively.
o) Explain the method to
determine disease
prognosis from the
population (survival
analysis).
Demonstrate ability
to apply methods to
determine risk
factors of a disease
and effectiveness of
diseases
intervention/
treatment/
prevention
p) Be able to manage,
analyze and interpret
data inferentially.
q) Describe the
definition,
requirements, types,
and applications of
surveillance.
r) Be able to conduct an
epidemiologic
investigation of an
outbreak.
Surveillance and
Disease
Outbreak
a. Describe
epidemiological
design, e.g.: crosssection, case-control,
and cohort, to
determine risk factors
of diseases.
b. Explain the
advantages and
disadvantages of
cross-sectional, casecontrol and cohort
design.
c. Describe the
Methods to
determine risk
factors,
effectiveness of
treatment,
prevention, and
intervention of
diseases in the
community

application of clinical
trials to determine the
effectiveness of
intervention,
prevention, and
treatment of diseases.
Competency
Statement
Instructional Goals
Learning Objectives
Topics
d. Be able to describe
the differences
between descriptive,
cross-sectional, casecontrol, and clinical
study design.
e. Describe the concept
of patient variability,
variability in medical
research, variability of
measurement, both in
individual and
population level.
f. Explain internal
validity, external
validity, selection bias,
information bias, and
confounding factors.
g. Describe sources of
bias in descriptive
research design,
cross-sectional, casecontrol, cohort, and
clinical trials and
describe how to
minimize those
biases.
Analyze and
interpret data of
diseases screening
in the community
a. Be able to apply the

concept of sensitivity,
specificity, and
predictive value
Screening of
diseases in the
community
b. Describe the concept

of cut off points.
~ PLANNERS TEAM ~
No
Name
Department
Phone
Prof. dr. D.N. Wirawan, MPH

(Coordinator)
Community/Preventive
0811394306
dr. A.A.Sg. Sawitri (Secretary)
0817340145
dr. I.B. Wirakusuma, MOH
08124696647
dr. Ayu Swandewi, MPH
Public Health
088113677930
dr. Komang Ayu Kartika Sari, MPH
082147092348
dr. Nyoman Sutarsa, MPH
087860380028
dr. Ni Wayan Septarini, MPH
Public Health
081353342409
dr. Putu Aryani, S. Ked
081805664963
dr. Ni Luh Putu Ariastuti, MPH
0818560008
10
dr. Gede Artawan Eka Putra, M. Epid
Public Health
087860118004
11
Dr. Putu Cintya Denny Yuliatni
081353380666
~ FACILITATORS ~
Regular Class (Class A)
No
Department
Phone
Group
Room
Number
Dr.rer.Nat. dr. Ni N. Ayu Dewi, M.Si

dr. Ni Luh Putu Eka Diarthini,
S.Ked
Dr. I Gusti Nyoman Sri Wiryawan,
M.Repro
Biochemistry
081337141506
A-1
A.3.09
Parasitology
081353077733
A-2
A.3.10
Histology
082341768888
A-3
A.3.11
I.B. Putra Dwija, S.Si, M.Biotech
Microbiology
08179747502
A-4
A.3.12
Drs. I Gede Made Adioka, Apt,

M.Kes
A-5
A.3.13
A-6
A.3.14
A-7
A.3.15
A-8
A.3.16
A-9
A.3.17
A-10
A.3.19
1
2
3
Name
Pharmacy
081999418471
dr. I Wayan Eka Sutyawan, Sp.M
Opthalmology
081338538499
dr. I B Rangga Wibhuti, M.Biomed,

Sp.JP
Cardiovascular
081237287888
dr. I Putu Kurniyanta, Sp.An
Anaesthesiology
081805755222
DR. Luh Seri Ani, SKM, M.Kes
Community/
Preventive
08123924326
Radiology
08164745561
Department
Phone
Grou
p
Room
Number
Phisiology
081999636899
B-1
A.3.09
10 dr. Sri Laksminingsih, Sp.Rad

English Class (Class B)
No
Name
Dr. I Putu Adiartha Griadi, M.Fis
Dr. Komang Ayu Kartika Sari, MPH
Community/ Preventive
082147092348
B-2
A.3.10
dr. I Nyoman Sutarsa, MPH
Community/ Preventive
087860380028
B-3
A.3.11
dr. I Nyoman Arcana, Sp.Biok
Biochemistry
0811397960
B-4
A.3.12
dr. I Made Susila Utama, Sp.PD-KPTI
Internal Med
08123815025
B-5
A.3.13
dr. I Made Suka Adnyana, Sp.BP
Plastic Surgery
081236288975
B-6
A.3.14
dr. I Made Sudipta, Sp. THT-KL
ENT
08123937063
B-7
A.3.15
dr. I Wayan Aryabiantara, Sp.An
Anaesthesiology
08123822009
B-8
A.3.16
085339644145
B-9
A.3.17
dr. I G Kamasan N. Arijana, M.Si.Med
Histology
10
10
dr. I Made Oka Negara, S.Ked
Andrology
08123979397
B-10
A.3.19
Skill Lab Facilitators

No
Name
Department
Phone
dr. G.N. Indraguna Pinatih, MSc.
Com/Prev
08123816424
dr. Wayan Weta, MSc.
Com/Prev
081337005360
dr. A.A.Sg. Sawitri, MPH
Com/Prev
0817340145
dr.Putu Ayu Swandewi, MPH
Public Health
081338996006
Com/Prev
0818560008
dr.I Wayan Gede Artawan EP, M.Epid
Public Health
03617848123
dr. Komang Ayu Kartika Sari, MPH
Com/Prev
082147092348
dr. Nyoman Sutarsa, MPH
Com/Prev
087860380028
Public Health
081353342409
10
dr. Wulan Citra Sucipta, S.Ked
Com/Prev
081805570772
Department
Phone
Reserve Facilitators
No
Name
dr. A.A.Sg. Sawitri, MPH
Com/Prev
0817340145
dr. I.B Wirakusuma, MOH
Com/Prev
08124696647
dr. Putu Cintya Denny Yuliatni
Com/Prev
081353380666
Public Health
081353342409
dr. Wulan Citra Sucipta, S.Ked
Com/Prev
081805570772
Com/Prev
0818560008
11
~ TIME TABLE ~
English Class (B)
Days/date
1
Thursday
12th of March
Time
Activity
08.00 09.00
Introductory
09.00 10.30
Movie
10.30 12.00
Discussion
12.00 13.00
Break/lunch
13.00 15.00
Independent learning/Student
Project (SP)
Venue
Conveyer
dr. A.A.Sg. Sawitri,
MPH
Theatre 4th Floor
Introductory lecture 1
08.00 09.00
09.00 10.00
10.00 10.30
2
Friday
th
13 of March
10.30 11.30
11.30 12.30
Determinants of morbidity and

mortality in a population
Natural history of diseases
Break
Class Room (CR)

3.01
dr. Ni Wayan
Septarini, MPH
Diseases prevention
Break/lunch
SGD : Determinants of morbidity
and mortality in a population
12.30 15.30
Prof. dr. D.N.

Wirawan, MPH
SGD : Natural history of

diseases
Discussion Room
(DR)
SGD : Diseases prevention
3
Monday
16th of March
08.00 09.00
Student presentation and feedback

: Determinants of morbidity and
09.00 10.00

: Natural history of diseases
10.00 10.30
Break
10.30 11.30

: Diseases prevention
11.30 12.30
Break/Lunch
12.30 15.00
Independent Learning/SP
Prof. dr. D.N.

Wirawan, MPH
CR 3.01
dr. Ni Wayan
Septarini, MPH
12
Introductory Lecture
08.00 09.00
dr. Putu Ayu

Swandewi, MPH
Population, Sample, Data, and

Variables
dr. Gd Artawan,
M.Epid
09.00 10.00
4
Tuesday
17th of March
10.00 10.30
Measurements of Morbidity and

Mortality in A Population;
Source of Error
CR 3.01
dr. Ayu Kartika
Sari, MPH
Break
dr. Sawitri, MPH
10.30 11.30
Crude, Specific and Adjusted

Rate
11.30 12.30
Break/Lunch
DR
SGD : Population, Sample, Data,

and Variables
12.30 15.30
SGD : Measurements of
Morbidity and Mortality in A
Population; Source of Error
SGD : Crude, Specific and
Adjusted Rate
08.00 09.00

: Population, Sample, Data, and
Variables
09.00 10.00
Wednesday18th
of March

: Measurements of Morbidity and
Source of Error
10.00 10.30
Break
10.30 11.30

: Crude, Specific and Adjusted
Rate
11.30 12.30
Break/Lunch
12.30 15.30
Skill lab
Schedule
Skill Lab
6
Thursday
th
19 of March
7
Monday
23th of March
10.00 11.00
dr. P. Swandewi,
MPH
dr. Gede Artawan
Eka Putra, M. Epid
dr. Ayu Kartika
Sari, MPH
dr. Sawitri, MPH
CR 3.01
Skill Lab Team
CR 3.01
dr. Wirakusuma,
MOH
Data Entry, Data Cleaning, and

Data Transformation
09.00 10.00
CR 3.01
Analysis and Interpretation of

Descriptive Data
Data Presentation and Data
Description
dr. Ariastuti, MPH

dr. Putu Ayu
Swandewi, MPH
dr. Gede Artawan
13
11.00 12.00
12.00 13.00
Break/Lunch
13.00 15.00
SGD : Analysis and

Interpretation of Descriptive
Data
Eka Putra, M.
Epid
DR
SGD : Data Presentation and

Data Description
09.00 10.00
8
Tuesday
10.00 11.00
th
24 of March
9
Wednesday
25th of March

Descriptive Data
: Data Presentation and Data
Description
11.00 12.00
12.00 13.00
Break/Lunch
13.00 15.00
Independent Learning
Skill lab
Schedule
Skill Lab
Thursday
26th of March
Significance Test for
Categorical and Interval Data
11.00 12.00
12.00 13.00
Break/Lunch
13.00 15.00
11
Friday
27th of March
09.00 10.00
CR 3.01
SGD : Inferential Analysis and

Interpretation of Analysis
Results (Hypothesis Test)
dr. Putu Ayu

Swandewi, MPH
dr. Gede Artawan
Eka Putra, M.
Epid
CR 3.01
CR 3.01
Inferential Analysis and

10.00 11.00
10
dr. Ariastuti, MPH

Interpretation
09.00 10.00
dr. Wirakusuma,
MOH
Skill lab
Schedule
dr. Putu Ayu
Swandewi, MPH
dr. Gede Artawan
Eka Putra, M.
Epid
DR
SGD :
: Inferential Analysis and
10.00 11.00

: Significance Test for
11.00 12.00
12.00 13.00
Break/Lunch
CR 3.01
dr. Putu Ayu

Swandewi, MPH
dr. Gede Artawan
Eka Putra, M.
Epid
14
13.00 15.00
Days/date
12
Monday
30th of March
Independent Learning/ SP
Time
Skill lab
Schedule
Activity
Skill Lab
Categorical & Interval Data
09.00 10.00
Venue
CR 3.01
Team Skill Lab
CR 3.01
dr. Ayu Kartika Sari,

MPH
dr. Ariastuti, MPH
Definition, Requirements, Types,

and Applications of Surveillance
and Outbreaks

MPH
Dr. dr. Gede
Indraguna, SpGK
13
Tuesday
31st of March
10.00 11.00
Epidemiologic studies to
determine risk factors of
diseases
11.00 12.00
12.00 13.00
Break/Lunch
SGD :
13.00 15.00
Lecturers
DR

and Outbreaks
SGD:
Epidemiologic studies to determine
risk factors of diseases
09.00 10.00
14
Wednesday
1st of April

and Outbreaks
10.00 11.00

11.00 12.00
12.00 13.00
Break/Lunch
13.00 15.00
15
Thursday
2nd of April
09.00 10.00
CR 3.01
dr. Ariastuti, MPH

CR 3.01

MPH
Dr. dr. Gd.
Indraguna, Sp.GK
CR 3.01
dr. Nyoman
Sutarsa, MPH
dr. Ariastuti, MPH
CR 3.01
dr. Nyoman
Sutarsa, MPH
dr. Ariastuti, MPH
Epidemiology Study Design:

Cohort Study
10.00 11.00

Case Control Study
11.00 12.00
12.00 13.00
Break/Lunch
13.00 15.00
SGD :
Cohort Study
dr. Ayu Kartika

Sari, MPH
DR
15
SGD :
Case Control Study
16
Monday
6th of April
CR 3.01
09.00 10.00

Cohort Study
CR 3.01
10.00 11.00

: Epidemiology Study Design:
Case Control Study
11.00 12.00
12.00 13.00
Break/Lunch
13.00 15.00
17
Tuesday
7th of April
09.00 10.00
10.00 11.00
Screening and Diagnostic

Testing
11.00 12.00
12.00 13.00
Break/Lunch
13.00 15.00
CR 3.01

MPH
Dr. dr. Gd
Indraguna, SpGK
CR 3.01
dr. Gede Artawan

Eka Putra, M.
Epid
dr. Sawitri, MPH
Applications of Clinical Trials to

Determine the Effectiveness of
Intervention, Prevention, and
Treatment of Diseases
SGD:
Epidemiology Study Design: Case
Control Study
SGD
Testing
dr. Nyoman
Sutarsa, MPH,
dr. Ariastuti, MPH
DR
DR
CR 3.01
09.00 10.00
Student presentation and

feedback: Applications of Clinical
Trials to Determine the
Effectiveness of Intervention,
Prevention, and Treatment of
Diseases

MPH
Dr. dr. Indraguna,
SpGK

: Screening and Diagnostic
Testing
CR 3.01
10.00 11.00
dr. Gede Artawan

Eka Putra, M.
Epid
11.00 12.00
12.00 13.00
Break/Lunch
13.00 15.00
18
Wednesday
8th of April

MPH
16
CR 3.01
19
Thursday
9th of April
20
Friday
10th of April
09.00 10.00
Variability and bias
10.00 11.00
SGD: Variability and bias
11.00 12.00
12.00 13.00
Break/Lunch
14.00 15.00
09.00 10.00

10.00 13.00
Presentation of student project and

feed back
13.00 14.00
Break/Lunch
14.00 15.00
21
Saturday
11th of April
22
Monday
13th of April

MPH
Dr. dr. Indraguna,
SpGK
DR
CR 3.01

MPH
Dr. dr. Indraguna,
SpGK
Team
Preparation for Final Test
09.00 11.00
Assessment
Will be arranged
later
Team Resource
Person
And Facilitators
17
~ TIME TABLE ~
Regular Class (A)
Days/date
1
Thursday
12th of March
Time
Activity
08.00 09.00
Introductory
09.00 10.30
Movie
10.30 12.00
Independent learning / Student

Project (SP)
12.00 13.00
Break/lunch
13.00 15.00
Discussion
08.00 11.30
Independent learning /SP
11.30 12.30
Break/lunch
Venue

MPH
Theatre Room 4th
Floor
2
Friday
13th of March
12.30 13.30
13.30 14.30
14.30 15.30
Determinants of morbidity and

Conveyer
Class Room (CR)

3.01
Prof. dr. D.N.

Wirawan, MPH
dr. Ni Wayan
Septarini, MPH
Natural history of diseases

Diseases prevention
SGD : Determinants of morbidity
and mortality in a population
08.00 11.00
SGD : Natural history of

diseases
Discussion Room
(DR)
SGD : Diseases prevention

3
11.00 12.00
Monday
16th of March
Break/Lunch
: Determinants of morbidity and
12.00 15.00

: Natural history of diseases
Prof. dr. D.N.

Wirawan, MPH
CR 3.01
dr. Ni Wayan
Septarini, MPH
CR 3.01
dr. Putu Ayu

Swandewi, MPH

: Diseases prevention
4
08.00 11.30
Tuesday
17th of March
11.30 12.30
Break/lunch
12.30 13.30
Population, Sample, Data, and
Variables
dr. G.Artawan,
M.Epid
18
13.30 14.30
14.30 15.30
Measurements of Morbidity and

Source of Error
dr. Ayu Kartika

Sari, MPH
dr. Sawitri, MPH
Crude, Specific and Adjusted

Rate
SGD : Population, Sample, Data,
and Variables
08.00 11.00
DR
SGD : Measurements of
Morbidity and Mortality in A
Population; Source of Error
SGD : Crude, Specific and
Adjusted Rate
5
Wednesday18t
h
of March
6
Thursday
11.00 12.00
Break/lunch
12.00 13.00

: Population, Sample, Data, and
Variables
13.00 14.00

: Measurements of Morbidity and
Source of Error
14.00 15.00

: Crude, Specific and Adjusted
Rate
Skill lab
Schedule
Skill Lab
09.00 12.00
12.00 13.00
Break/lunch
19th of March
13.00 14.00
Monday
23th of March
dr. Artawan, MEpid
dr. Ayu Kartika

Sari, MPH
dr. Sawitri, MPH
CR 3.01
Skill Lab Team
CR 3.01
dr. Wirakusuma,
MOH

Descriptive Data
dr. Ariastuti, MPH

dr. Putu Ayu
Swandewi, MPH
14.00 15.00
8
Tuesday
24th of March
09.00 11.00
dr. Putu Ayu

Swandewi, MPH
Data Entry, Data Cleaning, and

Data Transformation
7
CR 3.01

Description
SGD : Analysis and
Interpretation of Descriptive
Data
dr. Gede Artawan

Eka Putra, M. Epid
DR
SGD : Data Presentation and

Data Description
11.00 12.00
12.00 13.00
Break/Lunch
19
13.00 14.00
14.00 15.00
9
Wednesday
25th of March
Student presentation & feedback:

Description
Skill lab
Schedule
Skill Lab
09.00 12.00
12.00 13.00
Break/Lunch
13.00 14.00
14.00 15.00
09.00 11.00
CR 3.01
Skill lab Schedule
CR 3.01
dr. Putu Ayu

Swandewi, MPH
dr. Gede Artawan
Eka Putra, M. Epid
SGD : Inferential Analysis and
Friday
27 of March
12.00 13.00
Break/Lunch
13.00 14.00

: : Inferential Analysis and
14.00 15.00

: Significance Test for
Skill lab
Schedule
Skill Lab
Categorical & Interval Data
09.00 12.00
12.00 13.00
Break/Lunch
13.00 14.00
DR
SGD :
th
dr. Putu Ayu

Swandewi, MPH
dr. Gede Artawan
Eka Putra, M. Epid
Inferential Analysis and

11.00 12.00
13
Tuesday
31st of March
CR 3.01

Interpretation
11
12
Monday
30th of March
dr. Ariastuti, MPH
10
Thursday
26th of March
dr. Wirakusuma,
MOH
Student presentation & feedback:

Descriptive Data

and Outbreaks
CR 3.01
dr. Putu Ayu

Swandewi, MPH
dr. Gede Artawan
Eka Putra, M. Epid
CR 3.01
Team Skill Lab
CR 3.01
dr. Ayu Kartika

Sari, MPH
dr. Sawitri, MPH
20

MPH
Dr. dr. Indraguna,
SpGK
14.00 15.00
Epidemiologic studies to
determine risk factors of
diseases
SGD :
09.00 11.00
DR

and Outbreaks
SGD:
14
Wednesday
1st of April
15
Thursday
2nd of April
11.00 12.00
Independent Learning /SP
12.00 13.00
Break/Lunch
CR 3.01
13.00 14.00

: Definition, Requirements, Types,
and Outbreaks
: Epidemiologic studies to
determine risk factors of diseases
CR 3.01
14.00 15.00
09.00 12.00

MPH
Dr. dr. Indraguna,
SpGK
12.00 13.00
Break/Lunch
CR 3.01
dr. Nyoman
Sutarsa, MPH
dr. Ariastuti, MPH
13.00 14.00
dr. Ayu Kartika

Sari, MPH
MPH

Cohort Study
14.00 15.00
09.00 11.00
16
Monday
6th of April

Case Control Study
SGD :
Cohort Study
DR
SGD :
Case Control Study
11.00 12.00
12.00 13.00
Break/Lunch
Cohort Study
CR 3.01
13.00 14.00

Case Control Study
CR 3.01
14.00 15.00
09.00 12.00
12.00 13.00
Break/Lunch
dr. Nyoman
Sutarsa, MPH
dr. Ariastuti, MPH
21
17
Tuesday
7th of April
13.00 14.00
18
Wednesday
8th of April
19
Thursday
9th of April
20
Friday
10th of April
09.00 11.00
CR 3.01
dr. Artawan Eka

Putra, M. Epid

Testing
SGD:
SGD
Testing
dr. Sawitri, MPH

DR
DR
11.00 12.00
12.00 13.00
Break/Lunch
13.00 14.00
Student presentation and feedback:

14.00 15.00

: Screening and Diagnostic
Testing
09.00 12.00
12.00 13.00
Break/Lunch
13.00 14.00
14.00 15.00
SGD: Variability and bias
DR
09.00 12.00
CR 3.01
12.00 13.00
Break/Lunch
13.00 14.00
Student presentation (SP) and

feedback : Variability and bias
14.00 16.00
Presentation of student project and

feed back
21
Saturday
11th of April
22
Monday
13th of April
dr. Sawitri, MPH

Dr. dr. Indraguna,
SpGK

14.00 15.00
CR 3.01
CR 3.01

MPH
Dr. dr. Indraguna P
CR 3.01
dr. Artawan Eka

Putra, M. Epid
MPH
CR 3.01

MPH
Dr. dr. Indraguna P

MPH
Dr. dr. Indraguna P
Preparation for Final Test
09.00 11.00
Assessment
Will be arranged
later
Team Resource
Person
And Facilitators
22
SKILL LAB TIME TABLE (Regular and English Class)

Date:
1. Thursday
19th March 2015
2. Wednesday
25th March 2015
3. Monday
30th March 2015
No
Class
Group SGD
Activity
English
I, II, III, IV, V
Skill Lab/ pleno
08.00 09.30 / Class room
English
VI, VII, VIII, IX, X
Skill Lab/ pleno
09.30 11.00 / Class room
Break/Lunch
Time/Place
11.00 12.00 WITA
Regular I, II, III, IV, V
Skill Lab/ pleno
12.00 13.30 / Class room
Regular VI, VII, VIII, IX, X
Skill Lab/ pleno
13.30 15.00 / Class room
Guidance:
1. Each student is required to bring their own lap-top and has installed the SPSS
program in to their laptop.
2. Data for practising will be provided before the first skill lab. Each head of the
SGD have to contact dr. Putuariastuti or dr. Citra to ask for those files.
3. Skill Lab Guide is provided on the Anexes. Remember to bring your study guide
every day.
ASSESSMENT METHOD
Student assessment of this block consists of:
1. a paper test with multiple choice questions at the end of block with proportion
80% of total score
2. a student project with proportion 15% of total score
3. evaluation of activity during the small group discussion with proportion 5% of total
score
23
INTRODUCTION
A movie And the Band Played On will be played after introduction session in theatre
room 4th floor. Every student should pay attention and carefully watch the movie because
proper understanding of the movie is needed to answer learning task question below.
The summary of this movie can be seen in the Annex 1 of the Study Guide.
Learning task
Based on the movie And The Band Played On, you are required to discuss in
your group the following questions:
1. Please explain about steps to discover the cause of AIDS based on this movie.
Which one was started first, the lab investigation or epidemiology investigation to
find out the cause of AIDS?
2. How were the roles of the following fields shown in the movie
a. Statistic
b. Clinical
c. Social
d. Epidemiology
e. Virology
3. Please explain which part of the movie explained the types of social and political
threats that influenced the investigation to find out the cause of that mysterious
disease
4. Please explain which part of the movie showed ethics and professional aspects
5. Please explain which part of the movie that presented the threats/difficulties in
controlling and preventing that disease
24
MODULE~1
(Reference Maussner & Bahn, p. 1-42)
Determinants of Health/Diseases, Natural History of

Diseases and Diseases Prevention
Prof. dr. Dewa Nyoman Wirawan, MPH & dr. Ni Wayan Septarini, MPH
AIMS:
To be able to describe determinants, the natural history of diseases and death occurring
in the population and diseases prevention
LEARNING OUTCOMES:
1.
Describe several determinants (models) of diseases and death occurring in the

population.
2.
Explain the applications of understanding diseases and death determinants

(models).
3.
Identify the strengths and weaknesses of diseases models.
4.
Draw figures of the natural history of a certain disease.
5.
Explain the applications of the natural history of a disease for prevention.
6.
Explain the severity of diseases in a population and its implication to prevention.
7.
Explain the Ice Berg phenomena and its implication in diseases prevention.
8.
Describe the level of disease prevention based on determinants and natural history
CURRICULUM CONTENTS:
1. Determinants (models) of diseases and death occurring in the population.
2. Natural history of certain disease and applications for prevention.
3. Level of disease prevention based on determinants and natural history.
25
ABSTRACTS
In this lecture the difference approaches of community medicine and clinical
medicine are discussed. In clinical medicine, concern is to individual patients who are
visit health providers. In community or population medicine concern is to whole
population, either sick or healthy in certain geographical area. Community medicine or
public health focuses on prevention of diseasesin the population, whereas clinical
medicine focuses on treating sick individual patients who come to health providers.
In order to provide appropriate treatments to individual patients, the diagnosis of
her/his disease must be established. Similar approach must be established in
community medicine. In order to provide appropriate preventions, determinants of
health problems in the community must be understood.
To understand determinants or factors which influence the occurrence of
diseases in the population, some epidemiological models or theories are discussed in
this lecture. Each model has its strengths and weaknesses. There is no single model
which is appropriate to explain determinants of all diseases occurrence. Triangle model
which was first introduced, explained that the occurrence of diseases in the population is
determine by agent, host and environments. Wheel model focused on intrinsic (host
factors) and extrinsic (environments factors). Model which was introduced by Blum
explained that the occurrence of diseases in the population determine by genetic,
behaviour, health programs and environments. Web model explained that a determinant
of diseases occurrence in the population is not simple but interrelated of many factors.
There are many other models which explain determinants of diseases but not discussed
in this lecture.
Beside determinants of diseases occurrence, appropriate prevention also
depends on the natural history of the disease. For example, disease where the cause is
well established such as HIV/AIDS, has long incubation period and fatal, the focus of
prevention are primary prevention such as behavior change educations, secondary
prevention such as voluntary HIV testing (VCT) and tertiary prevention such as care
support and treatments of secondary (opportunistic) infections. On the other hand, if the
cause of disease is not known such as cancers, focus of preventions is secondary and
tertiary preventions. Other disease such as dengue fever, which is acute, no vaccine
available and no treatments to kill the virus, the focus of prevention is on primary
preventions.
SELF DIRECTING LEARNING:

Basic knowledge and its application that students must know, include:
1. Diseases model
2. Natural history of disease
3. Level of prevention
26
SCENARIO& LEARNING TASKS

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 (1)and(2) below.
d) Each group have to discuss at least 4 (four) learning tasks below which are learning
task (1) and three learning task(2) from (a) to (e)
e) Each group must present three learning tasks in the plenary.
f) Before the plenary start, every SGD has already put the file of the answer in the
class computer/CPU
g) Learning task (3) is additional task, however, all of the students MUST watch the
movie carefully in order to be able to answer learning task in day 2.
SGD : DETERMINANTS OF HEALTH/ DISEASES

Case 1.
Please watch carefully a short video clip on: (you can watch it at your home before the
lecture)
http://www.youtube.com/watch?v=5Lul6KNIw_8
Learning Tasks 1:
After you carefully watch the video, please discuss the following questions:
1. What factors that influence health mentioned in this video clip?
2. Which model/s of disease morbidity is/are being use?
3. What interventions are being conducted in the two examples given on the clip?
What are the focuses of the interventions for each case?
Case 2
Please watch carefully as well:
http://www.youtube.com/watch?v=mMDUv2R6tHQ
Learning Tasks 2
1. What is the main topic of the conversation?
2. Please draw in a diagram about what make the guy become a beggar!
27
Learning Tasks 3
Discuss the following in your group:
a) The high morbidity and mortality due to dengue hemorrhagic fever (DHF) is
influenced by many factors (determinants). Discuss these factorsusing Wheels
Model. Explain also the most dominant factor.
b) 1. The high incidence of morbidity (morbidity rate) due to traffic accidents are
influenced by many factors (determinants). Discuss in groups these factors using
Web Model. Explain the most dominant factor.
2.The high mortality rate due to traffic accidents are also influenced by many factors
(determinants). Discuss in groups these factors using Blum Model. Explain also
the most dominant factor.
c) The high morbidity and mortality due to tuberculosis (TB) are influenced by many
factors (determinants). Discuss in groups these factors using Triangle Model.
Explain also the most dominant factor.
d) The high morbidity and mortality caused by HIV-AIDS are influenced by many factors
(determinants). Discuss in groups these factors usingBlum and Triangle Model.
Explain also the most dominant factor.
e) The high morbidity and mortality of children under 5 year olds in the community is
influenced by many factors (determinants). Discuss these factors by using Mosley
Model. Explain also the mechanisms between these factors by considering the
direction of the lines in the Mosley Model.
Learning Tasks 4:
1. At the end of the lecture, each SGD group should give the lecturer a USB with
capacity minimum 8 gb.
2. A movie The Contagion will be transfered to the USB and the USB will be returned
during plenary. This movie will be discussed on the surveillance and diseases
outbreak topic
SGD : NATURAL HISTORY OF DISEASES

Guidelines:
1.
During small group discussion (SGD), each group has to select a spokesperson,
who will be presenting the results of discussions at the plenary
2.
Prior to the plenary, the spokesperson of each group sits in front of the class
28

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 computer/CPU
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.com/viewarticle/725639_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 computer/CPU
LEARNING TASK
Please take a look this PDF file below before answering the following task:
http://www.euro.who.int/__data/assets/pdf_file/0004/129532/Ottawa_Charter.pdf
All the answers for the following task must also refer/consider 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.edu/bugdrug/antibiotic_manual/iuatld_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.
Please refer to the following website:
29

http://www.jped.com.br/conteudo/00-76-s285/ing.pdf
c) Please refer to the following website:
http://depts.washington.edu/epidem/Epi583/MockLancet.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 HIV/AIDS, 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 & policy/regulation) 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
diseases/incidents: DHF, HIV/AIDS, 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
policy/regulation). Give examples of behaviour intervention and policy/regulation 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).
30
MODULE~2
(Reference Kirkwood and Sterne, chapter 2)

dr. Putu Ayu Swandewi, MPH & dr. Gede Artawan Eka Putra, M.Epid
AIM:
Demonstrate ability to search, collect, organize and interpret information/data 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
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, alpha() and power(1-), and tolerated deviation. Besides those above,
sample selection also take important role. The recommended sample selection is nonrandom 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.
31

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 childs 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 childrens 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
childrens 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 mg/dl and undernourished determined when
BMI less than 11kg/m2
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 weight)were measured again.
32
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!
33
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 snowballing technique!
4. What is the meaning of exclusion criteria? What is the purpose of excluding some
population characteristics?
MODULE~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 information/data from
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.
1.
2.
Measurements of Morbidity and Mortality in a Population


34

1. Read previous lectures regarding the natural history of diseases.
2. Read Handout 1, p. 6268, 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.com/news/2013/12/31/36000-people-with-hivaids-receive-arvtherapy-throughout-2013.html
36,000 people with HIV/AIDS receive ARV therapy throughout 2013
As many as 36,483 people living with HIV/AIDS (ODHA) have received antiretroviral
(ARV) treatment in 2013, up from 2,381 in 2005, a senior health official has said.
The development of HIV/AIDS 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 Ministrys director general of disease control and
environmental health, T, in Jakarta on Tuesday, as quoted by Antara news agency.
35

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 HIV/AIDS 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)
36
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
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
Proportion
Rate
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
China
(1)
Total
Others
Male
Female
Male
Female
Male
Female
(2)
(3)
(4)
(5)
(6)
(7)
(8)
37
1.
Jembrana
136.063
136.757
272.828
2.
Tabanan
214.260
216.884
19
431.172
3.
Badung
197.167
195.619
161
72
393.020
4.
Gianyar
199.973
199. 607
15
11
22
32
399.660
5.
Klungkung
91.067
94.201
185.272
6.
Bangli
107594
108.135
215.729
7.
Karangasem
219.591
218.883
438.475
8.
Buleleng
331.931
330.907
16
17
28
21
662.920
9.
Denpasar
262.362
260.476
277
184
523.299
1.760.008
1.761.469
35
31
513
319
3.522.375
2010
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 Denpasardan 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.
38

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.
MODULE~4
(Greenbergp. 51-53)

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, Subprovince 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
39

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)
Distribution of TB and HIV Patients Based on Sex and Sub-province
Number
Disctric
1.
Buleleng
2.
Jembrana
3.
Tabanan
4.
Badung
5.
Denpasar
6.
Freq. of TB patients (m; f)
Freq of HIV patients (m; f)
165 (101; 64)
19 (16; 3)
73 (45; 28)
1 (1; 0)
57 (31;26)
1 (1; 0)
119 (68; 51)
312 (171; 141)
16 (11; 5)
Gianyar
73 (43; 30)
7.
Bangli
28 (18; 10)
8.
Klungkung
57 (31; 26)
9.
Karangasem
116 (75; 41)
2 (1; 1)
1000 (580; 420)
39 (30; 9)
Total
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 subprovince?
3. What is the specific HIV infection among TB patients in Bali, based on subprovince? 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.
40

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?
41
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
AIMS:
To demonstrate ability to search,organize and interpret information/data from different
sources in order to assist in diagnostic, therapeutic and health.
LEARNING OUTCOMES:
1.
2.
3.
4.
To make structure of data with SPSS application

To do data entry
To clean data before analysis and explain the use
To do data transformation and explain the use
1. Structure of data
42

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 studys 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 childrens
demographic characteristic, haemoglobin level and body weight. More specifically, the
variables in the study were ID, name, area, mothers age, education, occupation; parity;
and childrens 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 mg/dl and undernourished determined when
BMI less than 11kg/m2
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 weight)were 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
characters, not more than 8 characters for SPSS V.12 or bellow). Fill in the following
field structure: type of field: . . . . . . . . . . . . ; Width: . . . . . ; Decimal: . . . . . . . . ,
Labels: . . . . . . . . . . . . . . . . . . . . . . . . . . , Value labels: . . . . . . . . . . . . . . . . . . . . . ;
Missing values: . . .
3. Generally, how can you determine errors in data entry?
4. Explain how you can search and fix the errors!
43

5. Explain the methods of classifying interval and categorical data!
6. Explain how to calculate composite index of Mass Body Index based on body height
and body weight.
Self Evaluation
1.
2.
3.
A haemoglobin value consists of 2 numbers and 1 decimal (example: 13.6 gr%).

What is its field width?
Explain the limits of values that can be used as indicators of error in data entry.
Explain the types of variables based on their functions. Give an example of each
variable.
4.
Explain the types of variables based on measurements scale. Give an example of

each.
5. Explain with an example, what is the meaning of ratio variable?
6. Explain some methods to control a variable!
7. Explain the differences between formal education and IQ variables!
MODULE~6
(Reference Greenberg, p. 29-43)
Analysis and Interpretation of Descriptive Data

dr. Ida Bagus Wirakusuma, MOH & dr. Putu Ariastuti, MPH
AIMS:
LEARNING OUTCOMES:
1. To analyse, present, and interpret descriptive data.
2. To interpret the measurements of morbidity and mortality on samples
descriptively
1. Variable of person, place, and time
44

2. Rate comparison
3. Data interpretation
ABSTRACT
Descriptive in epidemiology begins with the assumption that disease do not occur in
random. Typically three standard questions are posed to characterize the non random
distribution of disease: Who get the disease? Where does the disease occur? and
When does the disease occur? These questions concern the element of person, place
and time, respectively.
At the minimum, the personal attributes examined in relation to disease
occurrence are the distribution by age, race and sex. The place of occurrence of the
disease may be studied at international, regional and local level. Temporal pattern can
be examined across year, month, or days, depending on the time course of the disease
in question.

Basic knowledge and its application that students must know include:
1. Variables of person, place and time
2. Rate comparison and interpretation

Case 1.
Look at the following figure carefully:
Fig 1 Total deaths by broad cause group, by WHO Region,
World Bank income group and by sex, 2008
45
(Source: Global status report on non communicable diseases 2010)
Learning Tasks 1:
Carefully look at the figure above, and discuss the following questions:
1. What are the interpretations of the figure? How many conclusions could you drawn
from the figure?
2. When you are living at Indonesia on 2008, what is your risk of death by injuries?
Case 2.
Carefully look at the figure below, and discuss the following questions:
Fig. 2 Most frequently diagnosed cancers world wide
46
(Source: Global status report on non communicable diseases 2010)
Learning Tasks 2:
1. The figures are data of cancer worldwide based on 1) ; 2) .; 3)
2. Could we conclude that risk of lung cancer among male is higher than liver cancer
among female?
3. Could we conclude that risk of breast ca among female is higher than cervix ca?
4. Could we conclude that risk of lung cancer in Indonesia is higher than in India?
Case 3:
Figure 3. Age-standardized incidence of all cancers (excluding non-melanoma skin
cancer), by type, per 100 000 population for both sexes, by WHO Region, 2008
47
Learning Tasks 3:
Based on the above figure, please answer the following questions:
1.
The figures are data of cancer worldwide based on 1) .; 2) ..
2.
Could we conclude that highest risk of lung cancer was in AMR and EUR?
3.
Could we conclude that risk of breast ca among female is higher than cervix ca?
4.
Could we conclude that risk of cervix uteri cancer in SEAR is higher than in
AFRICA?
5.
What are the difference between data provided at figure 2 and 3?
Self Assessments:
1.
What is the definition of specific rate?
2.
What are the differences between specific and crude rate?
3.
Which variables are usually used as a base for specific rate

calculation?
4.
What is the use/benefit of calculating specific rate?
5.
Describe the method to diagnose an undernourish problem

among under-five- year old children in one area?
6.
A clinician needs to understand the variation (pattern) of diseases

based on Who, Where, and When. Why?
48
MODULE~7
(Reference Kirkwood & Sterne, Chap 3 &4)
Data Presentation and Data Description

AIM:
LEARNING OUTCOME:
Be able to perform data presentation and data description.
Data presentation and data description
ABSTRACT
Presenting and describing data are closely related with data classification based on their
function, which are: interval (numeric or quantitative), discrete, continue, categorical
(qualitative), and ordinal data.
Qualitative data is divided into two categories (dichotomies) and more than two
categories (multi-chotomies). Important aspect of qualitative data is the number for each
category. The analysis can be made is, either frequency distribution or cross-tab
frequency distribution. In the table of frequency distribution, we can calculate incidence,
prevalence, and ratio, both for crude and specific measurements based on place, time
and person. To summarize the data we can use highest and lowest frequencies and or
mode. While for cross-tab frequency distribution, we can make percentage based on
column, row, dan total percentages. For specific cross-tab 2x2 (four-fold table), we can
calculate some important indicators such as Odds Ratio (OR), Risk Ratio (RR),
Specificity (Sp), and Sensitivity (Se). Besides table, we can present this data by graphic,
which is most appropriate, is bar chart
Presenting numeric/quantitative data looks more simple than presenting
categorical/nominal data. The important aspect to be understood is how to determine
appropriate data presentation, either as a single variable or in relation with other
variable. Measurements which are used is central tendency (Average) and dispersion.
49

Including in average are mean, mode, median, strength and weakness of average. While
including in dispersion are range, variance, SD; strength and weakness of dispersion.
This data can be displayed in graphic such as line chart, hystogram, and box plot.
SCENARIO:
Case 1. Data Presentation of Categorical Data
Look at the skill lab Data (appendix) Data which have been collected, include several
variables: area, age, education level, occupation, exclusive breastfeeding, parity,
children age, Hb level , body weight and height. In the previous session, weve discuss
variables based on their scale of measurement. Understanding the measurement scale
of data is important for selecting the way to present the data. .
For categorical data, the presentation mainly using three different mode which are table,
graph/chart and statistics. Table for categorical data are single frequency table, and
cross table. Presentation of categorical data in graph can used either bar or pie chart;
and statistics that is used are percentage or ratio.
Learning Task 1
Discuss the following:
1. Discuss data presentation in a table and/or chart; and explain the components of
table and chart.
2. Discuss the appropriate chart for categorical data based on the variable available in
skill lab data
3. Discuss about absolute, relative ad cumulative frequency
4. Below is draft of single frequency distribution table
Table-1. The frequency distribution of parity among mothers at Ds. Merdeka, 2011
Parity
Frequency
15
25
30
15
10
5 or more
Cumulative frequency
Relative
frequency
Cumulative relative
frequency
Total
100
- Please fill the blank cells and Interpret the information on the table above!
5. Discuss the presentation of data in a cross tabs frequency distribution table and when
we use this type of table. Give example based on the skill lab data
50

6. Below is cross tabulation between area and type of school and nutritional status
among teenager in Province Sentosa
Table 2. Distribution of teenage nutritional status based on type of school
Province Sentosa in 2012
Type of school
Undernourished
Normal
Obese
Total
Public
20
(a)
50
(b)
15
(c)
85
Private
10
(d)
50
(e)
(f)
65
Total
30
100
in
20
150
Based on table 2 above,

-
calculate, the row and column percentages for each cells
Interpret the meaning of row percentage in cell a
Interpret the meaning of column percentage in cell d
Discuss about chart for presenting data in table 2, please provide an illustration.
7. Specific for 2 by 2 cross tabulation (four-fold table), we can calculate several numbers
that useful for describing another method for presenting categorical data, which is
ratio. The ratio such as: OR (Odds Ratio), PR (Prevalence Ratio), RR (Relative
Risk/risk ratio). Discuss and give example (based on the skill lab data if possible, or
your own example)
-
The Indication of each ratio
How to calculate each ratio
How to interpret the meaning of each ratio
8. There was a cohort study that observed the impact of physical inactivity toward
obesity among people age above 40 years old in Province Asri. Underneath is the
result after 2 years follow up
Table 3. Cross table between physical activity level and the obesity among people
age above 40 years old
Physical activity
Obese
Normal
Total
Less active
30
25
55
Active
10
35
45
Total
40
60
100
From table 3,
-
Determine the type of ratio that appropriate for comparing the risk of obesity
based on degree of physical activity?
Calculate and interpret the meaning of the ratio
51
Case 2.
Data Description/Interpretation of Continuous data
Re-open the Skill lab data (appendix). Previously, you have discussed about data
presentation of categorical data.
Similar to categorical data, the mode of presentation for continuous data divides into
three ways namely; 1) Table, 2) Graphs and 3) Statistics. The tables that can be used
are single frequency tables when the range of the data is narrow; on the other hand,
using grouped frequency table when the range of data is wide. Several types of graph
can be used for presenting continuous data include histogram, box plot, steam and Leaf
plot, polygon and scatter plot. Meanwhile, statistics for continuous data comprise
measure of central tendency and Measure of dispersion.
The measure of central tendency is the value where the data are concentrated. It
includes mean, median and modus. Meanwhile, measure of dispersion show the spread
of the data includes range, variance, standard deviation, and inter quartile range. It is
also important to understand the distribution of data which can be seen by plotting them
on a histogram. The distribution will guide us to select the appropriate statistics to
represent the data.
Learning Task 2
Discuss the following
1. Discuss and explain the definition, of central tendency (mean, modus, median).
2. Discuss the distribution of data which can be determine by the value of mean,
median and modus of the data
3. Case 1; If from 100 samples, we found mean Hb level is 12.8 mg/dl, the median is
11.0 mg/dl and the mode is 11.0 mg/dl.
- Is the data tend to distribute normally or skewed?
- Which measure of central tendency is appropriate for describing the data?
4.
Discuss and explain the definition of measure of dispersion/spread (range,

variance, SD, percentile, quartile and inter quartile range)
- Based on case 1 above, what measure of spread is appropriate for describe the
data?
5.
Based on continuous variables on skill lab data, discuss the appropriate chart that
can be used for data presentation and provide illustration
6.
In the skill lab data, we have data on childrens age and body weight. Suppose we
wish to show both data in a graphto show the relationship between both variables,
what type of graph can be used and make an illustration
Self Assessments:
52

1. Explain the components of a one-way frequency distribution table!
2. How can you conclude the content of a frequency distribution table?
3. Explain the application of cumulative percentage!
4. Cumulative percentage is applied to which kind of data? What is it for?
5. Explain how to conclude the content of a cross tabulation table!
6. Explain briefly the definition of: column, row, and total percentages!
7. Explain some indicators to show the relationship regarding to various categories of
variables!
8. Explain the understanding and application of central tendency (average): mean,
median, and mode.
9. Explain the understanding and application of dispersion (spread): range, variance,
and SD.
10. Explain the advantages and disadvantages of central tendency (average): mean,
median, and mode.
11. Explain the advantages and disadvantages of dispersion: range, variance, SD.
12. Explain the differences of data presentation and data description of age and formal
education, before and after the categorization.
13. Explain the differences of data presentation and data description of body height,
body weight, and Body Mass Index (BMI).
53
M O D U L E ~ 8 (SKILL LAB II)

(Skill Lab Manual, Kirkwood & Sterne)
Data Presentation and Data Interpretation

AIMS:
To demonstrate ability to search, organize and interpret information/data from different
sources in order to assist in diagnostic, therapeutic and health.
LEARNING OUTCOMES:
1. To present data into some forms for categorical and continues data
2. To interpret data accurately
1. Data presentation for categorical data
2. Data presentation for continues data

Refer to Cases of Data presentation and Data Description (DAY 9).
54
MODULE~9
(Reference Kirkwood & Sterne, Chap. 5-8, 10, 14, 15)
Inferential Analysis and Interpretation of Analysis

Putu Ayu Swandewi, MD, MPH & Gede Artawan Eka Putra, MD, M.Epid
AIM:
LEARNING OUTCOME:
Be able to interpret inferential and interpretation of result analysis
Inferential Analysis and Interpretation of Analysis Results (Hypothesis Test)
ABSTRACT
THEORETICAL DISTRIBUTIONS, CONFIDENCE INTERVAL, AREA UNDER
NORMAL DISTRIBUTION, AND HYPOTESIS TEST
For statistical test purpose, we must have basic understanding on theoritical
distribution, confidence interval (CI), one-tail and two-tail test.
In a theoritical distribution there are several topics need to be understood, are the
probability distribution, characteristics of normal distribution, area under normal
distribution curve, definition of Standard Normal Deviate, and also definition and the
application of CI. The important point is the understanding on whether a certain data
is normally distributed or not. Parametric test require normal data distribution.
Related with normality of data, extreme value outliers may influence data normality.
By deleting those values (if the sample size is sufficient), we may produce data with
normal distribution. We also can replace those values with the median to gain normal
distribution data. If those efforts are not succeed, we may use transformation
55

methods based on power of transformation in the Explore. If the data still not
normally distributed, we may choose non parametric test.
In a hypothetic test, we must know the asumptions used, definition of nul and
alternative hyphotesis, relation between hyphotesis test with probability (p),
confidence interval (CI), the errors in hyphotetis test, and the application of one and
two tail tests.
SCENARIO:
Case 1.
Theoretical Distributions, Confidence Interval, Area under Normal Distribution
For statistical tests, it is important to understand probability theory, theoretical
distributions, confidence intervals (CI), one-tail and two-tail statistical tests, and error in
interpreting hypothesis tests.
Learning Task 1
Discuss the following
1.
Explain the definition of probability, marginal probability, conditional probability and

joint probability
2.
Explain the definition of the addition rule and multiplication rule
3.
Table 1. Cross tabulation between economic status and nutritional status of children
under 5 years in Desa Amerta 2012
Economic status
Under nourish
Normal
Obese
Total
poor
30
35
70
affluent
10
55
15
80
Total
30
80
20
150
Based on table above, calculate the probability:
a. What is the probability if we selected one child randomly from Desa Amerta,
will be an under nourish kids in? What type of probability it is?
b. What is the probability of under-nourish, if the kids from poor family? What
type of probability it is?
c. Probability of a child who is randomly selected from this group will be from
poor family or an obese kid?
d. Probability of a child who is randomly selected from this group will be from
affluent family and is obese
4. Describe the type of probability distribution of a random variable. Give examples!

5.
Describe the characteristic of normal distribution and the use of normal distribution?
56

6.
Distinguish the difference between normal distribution/Gaussian distribution and

standard normal distribution
7. Describe about z score and its use?

8.
If from a study we found the mean of Hb level from 200 samples of children is 11.8
mg/dl, and the standard deviation is 0.5mg/dl. It is assumed that data was normally
distributed.
Based on the used of normal distribution and the area under normal curve (z score)
a. What is the probability of children in the population has Hb level > 12mg/dl
b. What is the probability of children in the population has Hb level <11 mg/dl
9.
Describe about sampling distribution, standar error of the mean and confidence
interval (CI) of the mean
10. Based on case 2 above:

- Calculate the standard error of the mean
- Calculate the 95% CI of the mean
- Interpret the 95% CI of the mean
Case 2
Hypothesis Testing and Linear Correlation
Re-open skill lab data (appendix).
Recall that the type of data presentation is based on scale measurement and also the
type of hypothesis testing will be based on the scale of measurement and purpose of the
analysis. Basically, there are two types of hypothesis testing; namely: testing the
difference and testing the association. The basic concept of hypothesis testing should be
understood before performing the test. In hypothesis testing we are testing the possibility
of the difference or the association is likely to be true in the population. There two type of
hypothesis, null hypothesis (Ho) and alternative hypothesis (Ha)
For testing the association between two continuous variables we can use correlation test
with correlation coefficient from Pearson (r). In the correlation test, we can determine the
strength and direction of the association.
Correlation may be a linear and non-linear, symmetric and non-symmetric, straight and
reverse correlation, and relational and causal. In this case, we will only discuss linear
correlation.
Learning Task 2
1. Discuss the indication of linear correlation analysis.
2. From the variables in skill lab data, discuss example of possible correlation analysis
3. Discuss the two ways that we can use for determining correlation between two
variables?
4. Discuss the use of coefficient correlation?
5. Discuss the meaning of negative and positive correlation, provide example!
57

6. Discuss the strength of the association, when it is considered low, moderate, high and
perfect, describe with example!
Self Assessments:
1. Draw figure of t-distribution, chi-square (2) distribution, F-distribution, Poisson
distribution, Log normal distribution, Binomial distribution. What are the differences
of those six distributions?
2.
Explain the probability distribution of a random variable!
3.
Explain the definition of Normal distribution (Gaussian distribution).
4.
Explain the characteristics of Normal distribution.
5.
What is the total area under the normal curve between: (-) and (+), (-1.96)
and (+1.96), (-2.58) and (+2.58).
6.
Describe the definition of SND (Standard Normal Deviate).
7.
Explain one-tail and two-tail statistical tests and when they can be applied.
8.
Describe the strength and direction of quantitative variables correlation.
9.
What does it mean if two quantitative variables have correlation coefficients (r)
which are negative or positive?
10. What does it mean if two quantitative variables have correlation coefficients (r) of (0)
or (1)?
58
M O D U L E ~ 10
(Reference Kirkwood & Sterne, Chap. 7, 9, 11, 16, 18, 19)

AIM:
LEARNING OUTCOME:
Understand the significance test for categorical and interval data
ABSTRACT
1. CATEGORICAL DATA
For analytical test, we must remind classification of variables based on their function
to determine which variable act as dependent or independent variable.
In a sample taken from certain population, we can calculate proportion, rate, or ratio.
Those numbers are used to estimate the parameters in a population. To know
whether those numbers are accurate to estimate population parameters, we need to
conduct hypothesis test. When conducting the hypothesis test, we need to state
statistic hypothesis. There are two types of statistic hypothesis, are null hypothesis
(H0) which shows no difference (similar) in a population, and alternative hypothesis
(Ha) which shows there is/are difference(s) (not similar) in a population. The way to
write those hypothesis are depending on the study direction and indicator to be
measured.
59

Statistical tests for categorical data include test for 1 proportion (binomial test), two
proportions (Chi-square, Mc Nemar, Fisher exact), and three proportions or more
(Chi-square). Each of those has requirements to be fulfilled before the test being
conducted. In some tests, if the requirement is failed to be fulfilled, there are available
the alternative test.
2. INTERVAL DATA
For interval data, the indicators to be calculated in statistical test are mean or
median. Statistical hypothesis also stated in H0 andHa in a ways depend study
direction and the indicator measured. Requirements for statistical test on interval
data are data must be normally distributed and the variance between the groups
tested are similar.
Statistical tests for interval data include test for mean of 1 sample (One-sample Ttest), Independent-Sample T Test for unmatched 2 samples and Paired-Sample T
Test for matched 2 samples if the analysis is conducted for one dependent interval
variable with one dichotomous categorical variable. If the data is not normally
distributed, we may choose parametric test such as Mann Whitney U Test, Wilcoxon
(Wilcoxon Sign Rank)
While for analysis of one dependent interval variable with one multicotomous (more
than 2 categories) variable, the choice are One-Way ANOVA (if normally distributed),
comparative group test Bonferroni, LSD, Scheffe etc (if variance is similar),
Tamhanes T2/T3 etc (if variance is not similar), and non parametric test KruskalWallis if the data is not normally distributed.
SCENARIO:
Case 1.
Significancy Test for Categorical Data
Re-open skill lab data (annex).
Data available in the data set include: area, age, education level, occupation, exclusive
breastfeeding, parity, children age, Hb level, and body weight. Lets recall that
understanding the measurement scale of data is important for selecting the way to
present the data. Beside for purpose of data presentation, measurement scale of data is
important on determining the appropriate type of statistical testing (hypothesis testing).
Moreover, the classification of data based on the function in the relationship is also
important issue to be considered.
We have discussed that there are mainly two type of hypothesis testing which are testing
the association and testing the difference (comparison). In the previous section, we
learned about correlation test which is one type of test for testing association between
variables. In this section, we will discuss hypothesis test for the difference (comparison).
The testing will be differentiating based on the type of data (categorical or continuous
data).
60

From a sample taken from a population, we can calculate proportion, rate, and ratio.
These numbers are parameter estimations of a population. Whether a number gained
from sample may or may not represent its population, it needs to be verified by statistical
methods towards the hypothetical test. There are two kinds ofhypothetical statistic
statements: Null Hypothesis (H0) and Alternative Hypothesis (Ha). The Null
Hypothesis (H0) assumes that there is no difference (similarity) in a population, while
the Alternative Hypothesis (Ha) assumes the opposite.
Learning Task 1
1. Discuss about null hypothesis and alternate hypothesis, and provide example of
hypothetical testing based on the skill lab data
2. Discuss two type of error in making decision on statistical analysis
3. Discuss about the p value and its use in statistical testing?
4. Discuss
a. If the p value of a test is 0.01, what does it means?
b. if the p value of a test is 0.1, what does it means?
5. If from the study we found that the prevalence of malnutrition in Desa Merdeka is
12%. Can we conclude that the proportion is different from national data which is
at 10. %? (=0.05)
Discuss:
a. The statistical hypothesis of case 1
b. The statistical test should we apply for the analysis of case 1
c. How we determine the statistical decision
d. If the p value for the study is 0.1, what is your decision and interpretation
6. We want to compare the proportion of undernourished children from hard area
(1) and easy area (2). (=0.05). The proportion of undernourished children in
hard area and easy area is 18% and 15%, respectively.
Discuss:
a. The statistical hypothesis for testing there is a different between both area!
b. The statistical hypothesis for testing that the proportion of undernourished
children is higher in the hard area compare to the easy area
c. The test should we apply for the analysis!
d. Create the 2x2 table for this case
e. If p value from the study is 0.005, what is the statistical decision and
conclusion of the analysis
7. We want to determine wether obesitas is a predictor of diabetes millitus (DM)
among men age above 40 years olds. A cross-sectional study was conducted;
61

among 100 men above 40 years old; 40 of them are obese. Among those 40 with
obese 20 of them are diagnosed with DM; meanwhile among the remaining 60
men, 15 of them are diagnosed with DM.
Discuss:
a. The statistical hypothesis for testing for determining that obesitas is predictor
of DM
b. The test should we apply for the analysis!
c. Create the 2x2 table for this case
d. Calculate the ratio of risk/odd that appropriate based on the study design
e. If the 95% CI of the above ratio is between 0.8- 3.5, what is the statistical
decision and conclusion of the analysis
Case 2
Significancy Test for Interval Data
Open again skill lab data file (annex). Classification of variables has been discussed in
previous lesson. Remember about interval variables! For statistical analysis, we also
need to remember variable classification based on its function. Variables may act as
dependent or independent variables.
The statistical analysis is classify into two group which a parametric test and non
parametric test. Parametric test based on the assumption of the distribution of the data.
For continuous data that are normally distributed, the statistical analysis includes t test
and ANOVA. The tests principally based on comparison of mean between groups.
Learning task 2
Discuss the following:
1. Discuss the statistical method to be applied for testing of a sample mean.
We want to compare the mean Hb level of pregnant women in the study, with the
normal Hb level for pregnant women which is 11mg/dl. Can we conclude that the
mean of Hb level of samples is higher than 11 mg/dl?
a. Write down the statistical hypothesis!
b. Discuss, the test that should be applied for the analysis!
c. How we determine the statistical decision
2. Discuss about when two groups of samples/ data considered as two independent
or two dependent samples?
3. Discuss about homogeneity of variance and when we should determine it?
4. What type of test is used for testing homogeneity of variance, provide an
illustration!
5. We want to compare the mean body mass index (BMI) among children from hard
area and children from easy area. We wish to conclude that the mean BMI of
children in hard are is higher than the children in easy area. Let =0.05
62

a. Write down the statistical hypothesis for case 2!
b. Explain what test should be applied for the analysis of case 2!
c. If the p value from the study is 0.09, what is the statistical decision and
conclusion of the analysis?
6. We want to evaluate the impact of nutrition program on the body weight among
the children in the study. Can we conclude that the intervention is effective to
increase the childrens body weight? Let =0.05
a. Write down the statistical hypothesis for case 3!
b. Discuss the test should be applied for the analysis for case 3!
d. If the 95% confidence interval of body weight mean difference is 1.2 to 2.8 kg,
what is the statistical decision and conclusion of the analysis?
7. We want to compare the mean Hb level pre intervention (Hbpre) of children
based on the nutritional status pre intervention (stgizi_pre). Can we conclude
that the mean body weight differ based on nutritional status?
Discuss:
a. What test should we apply for the analysis?
b. Is the analysis one tail or two tails?
c. Write down the statistical hypothesis!
d. If the p value from the test is 0.2, discuss about the statistical decision and
the conclusion.
8. Explain the conditions for applying those statistical tests above!
If the conditions cannot be met, what statistical method should be applied for
testing the hypothesis?
Self Assessments:
Significance Test for Categorical Data
1. Explain the statistical method for 2x2 tables and its requirements.
2. Explain the statistical methods if those requirements are not fulfilled!
3. Explain the statistical method for pair 2x2 tables.
4. Describe the statistics that can be calculated in 2x2 tables for cross-sectional, casecontrol, and cohort study.
5. Write down the statistical hypothesis statement!
6. Explain the statistics for correlation of two variables: interval-interval, ordinal-ordinal,
nominal-interval, nominal-nominal, and similar number of categories.
7. Explain the condition for 2 test of the 2x3 tables or more. Explain how to deal with
that if those conditions are not provided.
8. Write down the statistical hypothesis statement for proportion, prevalence, RR, PR,
and OR for one-way and two-way tests.
9. What is the meaning of type 1 and type 2 sampling error?
63
Significance Test for Interval Data

1. Explain the application and requirements for one sample T-test!
2. Which T-test should be applied for independent and pair samples?
3. Write down the statistical hypothesis statement used above!
4. Regarding the tests above, which tests should be used if the condition required for Ttest is not met?
5. Explain the non-parametric test to be applied if the condition required for the
independent One-Way ANOVA is not met.
6. Write down the statistical hypothesis statement for the above question!
M O D U L E ~ 11 (SKILL LAB III)

(Skill Lab Manual, Kirkwood & Sterne)
Correlation-Regressi, Significance Test for

AIMS:
LEARNING OUTCOMES:
1. To conduct data analysis correctly for categorical and interval data
2. To interpret data accurately
1. Data analysis for categorical and interval data
2. Data interpretation for categorical and interval data

Refer to Cases of Data analysis and data interpretation for categorical &
continues data (DAY 12).
64
M O D U L E ~ 12
(Reference Greenberg, p. 45 73)
Definition, Requirements, Types, and Applications

of Surveillance and Outbreaks
dr. Ayu Kartika Sari, MPH & dr. Putu Ariastuti, MPH
AIM:
LEARNING OUTCOMES:
At the end of the module, students should be able to:
a) Manage, analyze and interpret data inferentially.
b) Describe the definition, requirements, types, and applications of surveillance.
c) Describe how to conduct an epidemiologic investigation of an outbreak.
Surveillance and Disease Outbreak
ABSTRACT
65

SURVEILLANCE
Surveillance was defined as the detection of the occurrence of health-related events or
exposures in a target population. Successful surveillance activities require continuity
over time; standardize methodology, and timelines of data collection and dissemination.
Surveillance data can be used in different ways, depending on the type of
information collected. Persons newly diagnosed with a disease can yield information on
incidence rate, death from a disease can be used to describe mortality rate, indices of
premature death can be used to assess the impact of a disease of longevity, and
prevalence of risk factors can be used to predict future disease occurrence or to assess
the status of prevention initiatives.
OUTBREAKS
The investigation of disease outbreaks (sudden and geographically limited epidemics) is
an essential role epidemiology. The primary goals of an outbreak investigation are the
identification of the causal agent (the pathogen) and prevention for further cases. The
propagation of a disease outbreak requires a pathogen, a viable mode of transmission,
and an adequate poll of susceptible persons. Elimination of one or more of these three
components will terminate the outbreak. Two basic modes of transmission are person-toperson spread and common-source exposure. Infection illnesses can be transmitted by
either mode, whereas non-infectious environmental pathogens usually produce disease
outbreaks through a common-source transmission.
Not all disease outbreaks warrant investigation. The decision to investigate an
outbreak typically is based on the severity of illness, the number of affected persons,
uncertainty about the pathogen, and the perceived need to control further spread of the
disease. Investigations usually are conducted by local, state or federal public health
officials.
A measure of the risk of developing an illness over specified period of time is the
attack rate (AR). The traditional epidemiology of food-borne outbreaks-high attack rates,
short incubation periods, and clustering of affected individuals in time and place-is
changing for a number of reasons. The composition of the topical diet has shifted, with
decreased consumption of red meat and increased consumption of poultry, fresh fruits,
and vegetables.
Emerging infections can be defined as infections that are appearing in a
population for the first time or that have existed in a population but rapidly increasing in
incidence or geographic range. A number of factors contribute to the emergence of
certain infections:
1) Man-made or natural changes in the environment
2) Demographic shift in population
3) Increased international travel and commerce
4) Technologic and industrial changes.
5) Adaptation of microbes
6) Lapses of the public health system.
66

Self Directing Learning
1. Read previous lectures
2. Read Greenberg pp. 45-73and power point slides
3. Watch the Contagion movie

Case 1 & Learning Task 1
Interpretation of Surveillance Results
The following chart contains results of surveillance of dengue hemorrhagic fever in Bali
Province, provided by the Bali Provincial Health Department.
Discuss the following questions:

1. The surveillance is conducted to assess morbidity, mortality, or risk factor of dengue?
Explain your answer.
2. What is the interpretation of the figure?
3. What is the benefit of conducting surveillance of dengue cases?
4. Think of the natural history and the determinant of DHF and also consider the types
of surveillance. What other surveillance might needed for the success of the dengue
prevention program?
67
Case 2. Watch the movie Contagion and read the synopsis below
Synopsis of the movie: Contagion
1. This movie is a fiction which inspired by the incidence of SARS in several countries
around the world.
2. The story is about an outbreak of an unknown disease occurred initially in China

and spread to other places including the USA, Japan and England.
3. The movie shows how a disease can be transmitted very fast to cause an outbreak
all over the world, how the mode of transmission and the causing agent can be
identified, and how the transmission can be finally prevented.
4. The story is started with a woman named Beth Emhoff (Gwyneth Paltrow) departing
to Minnesota from her Chicago layover. She had a short term visit to Macao (near
Hong Kong) beforehand. She seemed to cough several times at the airport when
she talked to her old boyfriend on the phone.
5. The story was continued with the occurrence of a severe flu-like disease in a young
man in Hong Kong who then died because of a traffic accident, in a young model in
London who then found dead in her bathroom and in a man in Tokyo who had a
seizure and died on a bus.
6. The same symptoms that happened to Beth got worsened once she arrived in
Minnesota and met her husband and son. She died in a hospital 2 dayslater with
severe seizures and the doctor decided to make an autopsy to her body. Soon after
her death, her son died after having the same symptoms.
68
7. Beths husband, Mitch (Matt Damon), was then put in isolation but turned out to be
immune to the disease.
8. In Switzerland, a briefing led by Dr. Leonora Orantes (Marion Cotillard) was

conducted at the WHO office. She emphasized the need to investigate the cases of
infection thoroughly and thought that Beth is the potential start of the infection. She
then went to Hong Kong to investigate the movements Beth made while there.
9. Dr. Ellis Cheever (Laurence Fishburne), who works at the Atlanta-based Centers for
Disease Control and Prevention (CDC), asked Dr. Erin Mears (Kate Winslet) to do
an investigation in Minnesota. She gave a briefing at the nearby CDC office about
the potential mode of transmission of the disease. She said that the virus is a
contagion of touch and the problem is the number of people will be potentially
infected (R-naught number), which is very high for this novel disease. She was then
unfortunately infected and died during the investigation.
10. There was an issue released by a blogger journalist, Allen (Jude Law), that the virus
is being manufactured by drug companies to get profit. Another issue said by
Homeland Security agents was that the virus might be a terrorist action to kill
people.
11. Two doctors, Ally Hextal (Jennifer Ehle) and David Eisenberg (Demetri Martin)
looked at the samples taken from Beths body in a secure CDC bio laboratory. They
found a virus that taking over the host cell completely, and noticed there were traces
of bat and pig in the virus DNA code.
12. Dr. Sussman (Eliott Gould) ran some further tests on the virus samples and he was
able to make a stable cultured version of the virus using a particular bat cell line.
This finding made them able to develop and test vaccines. The news reported on
the virus, now called MEV-1 (Meningoencephalitis virus type 1), and credited
Sussman for the discovery.
13. The story continues with the situation of the quarantine and vaccines delivery
process to prevent the transmission of the disease. Finally the movie shows the
process of how Beth was initially infected by the virus.
Learning Task 2
Based on the story of the movie, please answer the following questions:
1. What is the type of the disease outbreak in the movie? Is it a person to person
outbreak or a common source outbreak? Please explain your answer.
2. Why is it important to find the first person being infected? Describe how the
process of identifying the mode of transmission was conducted in the movie.
3. What efforts need to be taken to prevent the disease transmission before the
vaccines are available?
4. Describe how the process of finding the virus was conducted in the movie.
5. What is the importance of many stakeholders involvement (WHO, CDC,
government, military staff and journalists) in the outbreak investigation and
transmission prevention process?
69
Self Assessment
Interpretation of Surveillance Results
1.
The government continuously collects data for smoking behavior among men
and patterns of meat consumption among both men and women. In this case, what
the government does is:
A. New infections surveillance
B. Outbreaks surveillance
C. Death surveillance
D. Risk factors surveillance
E. Epidemiologic surveillance
2.
3.
A group of Lung Cancer patients who died were identified for their age of
death. The difference between the age of death and their average life expectancy
was then accumulated. That will produce:
A.
PYL (Person-years of Life lost).
B.
MR (Mortality rate).
C.
YPLL (years of potential life lost).
D.
YPM (Years of mortality)
60% of lung Cancer patients in stage 2 have the possibility of survival for five
years following diagnosis of the cancer. The measurement of 60% follows the criteria
as below:
A. It is a case fatality rate of Lung Cancer patients
B. Can be used to predict the prognosis of Lung cancer patients in a similar stage.
C. It was measured from the lung cancer patients in one periode of time into Lung
cancer patients stage 1 3.
D. One person with Lung cancer stage 2 having possibility to live in the first five
years as of 0.06.
E. All Lung cancer patients stage 2 may live five years after diagnosed.
4. When compared to the corresponding rate for non-migrants in a low risk country, the
incidence rate for a genetically determined disease among offspring in a high-risk
country is:
A. Greater
B. Smaller
C. About the same
D. Cannot be determined from the information provided
E. All possible
70
Outbreak Investigation
1. Which steps of those above are parts of descriptive methods? Which are parts of
analytic methods?
2. Not all outbreaks need epidemiologic investigation. Several factors to be considered
for an investigation are:
1. Number of apparent cases prevalent
2. Public concern
3. Aetiology of the outbreak is obviously unclear
4. Need for intervention to be stopped
3. The following are parts of the outbreak investigation steps:
1. Distribute cases based on person, place and time
2. Calculate prevalence rate based on person, place and time
3. Assume temporary hypothesis on transmissions source
4. Analyse aetiology by cross sectional study
4. Due to the outbreak investigation, the analysis of cases based on person, place, and
time is done. Its main purpose is:
1. Find out the most common group affected by the disease
2. Find out the area which was mostly affected by the disease
3. Determine the time of outbreak
4. Predict the possibility of exposure
5. A result of outbreak investigation is as follows:
Risk Estimate
Value
95% Confidence Interval

Lower
Upper
Odds Ratio for Stall B (Yes / No)
0.048
0.016
0.145
For cohort Sick/healthy = Yes
0.231
0.130
0.410
For cohort Sick/healthy = No
4.846
2.307
10.181
Its interpretation is:

a.
Risk of diarrhea if having meals at B stall is a half lower than not

having meals at the other stall.
b.
Risk of diarrhea if having meals at B stall is higher than not having

meals at B stall.
c.
The OR only affects sample, but not a population.
d.
The B stall is proven not to be source of transmission.
6. If an OR of eating es campur at the B stall is 1.3 with the CI from 0.61.9, what is
the significance of the data? What conclusions can you draw about the es campur
71

eating within the whole population? Give an example of a more significant OR and
CI.
7. A doctor at puskesmas was function as program coordinator for transmitted disease
at district with the total population was 500.000 persons. The result of surveillance for
several infectious diseases for 5 years was as follows: (source UKDI)
Diseases
Malaria
DHF
Typhoid
Hepatitis C
Influenza
Year I (%)
30
0,6
5,1
2,1
50
Year II (%)
35
0,5
5,4
2,2
45
Year III (%)

32
0,4
4,8
1,8
52
Year IV (%) Year V (%)

34
31
0,9
2,1
6,2
5,8
1,7
1,6
53
53
Which one of the above has become an outbreak?
a. Malaria
b. DHF
c. Typhoid
d. Hepatitis C
e. Influenza
M O D U L E ~ 13
(Greenberg)
72
Epidemiology Study to Determine

Risk Factor of Disease
dr. Anak Agung Sagung Sawitri, MPH & Dr. dr. Gd Indraguna Pinatih, MSc., Sp.GK
AIMS:
1. To describe the types and application of epidemiology study designs to determine risk
factors of the disease of interest
2. To describe cross sectional & longitudinal study design and to explain the advantages
and disadvantages of cross sectional & longitudinal study to determine risk factors of
diseases.
LEARNING OUTCOMES:
1.
2.
3.
4.
5.
6.
7.
8.
To describe and to draw types of epidemiology study designs and their applications
To describe advantages and weaknesses of epidemiology study designs
To describe and to draw cross sectional and longitudinal study design
To explain the advantages and disadvantages of cross sectional and longitudinal
study to determine risk factors of diseases
To explain what is prevalence ratio and how to calculate prevalence ratio in cross
sectional study
To explain the interpretation of prevalence ratio in cross sectional studies
To explain the incidence rate and how to calculate incidence in longitudinal study
To explain the interpretation of incidence rate in longitudinal studies
1.
2.
3.
4.
5.
6.
Type, application and advantages/weaknesses of epidemiology study designs

The cross sectional and longitudinal study design and theirs attributes
Timing of measurements: cross sectional and longitudinal design
Data collection in cross sectional and longitudinal studies
Data analysis in cross sectional studies: prevalence ratio (PR)
Data analysis in longitudinal studies: incidence rate
ABSTRACTS
To prevent the disease, determinants or risk factors of the disease must be
understood. To understand determinants or risk factors, epidemiological studies are
used. There are several epidemiological study designs those can be grouped into
73

several ways. Based on the availability of intervention or not, the study designs can be
divided into intervention or experimental study and observational study. Intervention
study is used to test the efficacy of treatment or prevention of certain disease in a
population. Observational studies can be grouped into two groups based on whether
there are comparison groups or not. Descriptive study is an observational study without
comparison group to study the distribution of the diseases occurrences in a population.
Analytic studies have comparison groups to study risk factors of diseases. Analytic
studies can be defined into three based on the direction of the observation or the
measurement of the outcome. Cross-sectional is when the measurement or the
observation of the disease under study (outcome) is at the same time with the
measurement of risk factors. Cohort design is prospective or effect to cause while case
control design when the direction of the observation is retrospective or cause to effect.
Descriptive studies describe diseases occurrences (how much or how many) in
the community based on who, when and where attributes. There are two major
purposes of this study, are for program planning and evaluation and for foundation of
hypothesis testing of analytical studies (experimental, cross-sectional, case-control and
cohort).
Each type of analytical study has advantages and disadvantages. Experimental
study is not possible to be implemented in human when the aim is to study risk factors
(cause) of certain disease but It can be used to study treatment and prevention of certain
disease. It is also the strongest design to test the hypotheses. Major disadvantage of
cross-sectional design is lack of temporal association since outcome (disease) and risk
factors are measured at the same time. Major disadvantages of cohort design are
expensive and take long time especially when the disease incidence is low and the time
between exposure and disease occurrence is long. Case-control design is less
expensive and faster than Cohort, however it has major weakness of information bias
and difficult to match between case group and control group.

1. Study design of cross sectional and longitudinal studies and their attributes
2. The procedures of cross sectional and longitudinal studies
3. Findings and its interpretation (including crude PR, adjusted PR) as well as
confounding factors in a cross sectional study
4. Findings and its interpretation (including Crude and Specific Incidence Rate)

Case 1.
Please carefully study the article entitles: Dengue and Other Common Causes of
Acute Febrile Illness in Asia: An Active Surveillance Study in Children
74
Learning Tasks 1:
After you carefully read through the article above, please discuss the
following questions:
1.
Draw a figure and explain the design of the study. Provide reasons for your
answer.
2.
What is the purpose of the study?
3.
What are the uses of this study?
4.
Does the study use primary or secondary data?

a.
What is the source of the numerator?
b.
What is the source of the denominator?
5.
Explain how researcher determines and selects the sample!
6.
Explain how researcher measures the incidence of acute fever!
7.
What are the three most common cause of fever in Asia? And what are the three
most common cause of fever in Indonesia? What is the rank of Indonesia among
Asean countries in term of dengue?
8.
Explain the interpretation of incidence of dengue, chikungunya, and typhoid fever

obtained from the study in Indonesia? The denominator is PY, what is the definition
and the strength of PY?
9.
Carefully observed Table 3. What measurements explained in the Table? Why

researcher presenting that table?
10.
How you interpret the 95% CI in the below data?
Case 2.
Please carefully study the article entitles:Bacterial vaginosis in female facility
workers in north-western Tanzania: prevalence and risk factors
75
Learning Tasks 2:
1. What is the design of the study which investigated 1305 HSV-2 seropositive women
aged 16-35 years and acyclovir 400mg? What is the dependent variable and
independent variable? Note: HSV: herpes simplex virus
2. What is the design of the study which investigated prevalence and risk factors for
bacterial vaginosis (BV) among HSV-2 seropositive women? What is/are the
dependent variable and independents variable?
3. Draw figures (bagan) of study designs. Firstly a figure of study to understand the
outcome of acyclovir treatment toward HSV-2. Secondly a figure of study to find out
the association between BV and sex in the last week and other risk factors. Note:
See Widagdo page 99 and page 148.
4. Calculate the 95% Confidence Interval of BV prevalence using the below formula
and explain the interpretation.
Penghitungan CI untuk proporsi (angka prevalens, angka insiden dan

proporsi)
CONTOH:
P (proporsi) kurang gizi = 23.2%
N (jumlah sampel) = 400
RUMUS CI:
CI p z(1 / 2 )
p (1 p ) / n
95%CI 0.232 Z (1 0.05 / 2 0.232(1 0.232) / 400

95%CI 0.232 1.96 0.232(0.768) / 400
95%CI 0.232 1.96 0.00044544
95%CI 0.232 1.96 X 0.021
95%CI 0.232 0.041
95%CI (19.1% 27.3%)
CATATAN:
(Untuk nilai Z- nya yang dibagi 2 adalah alpha-nya.
Jadi untuk 95% CI, alpha nya berarti 5% di Table Z dicari nilai Z dari (1-/2) yaitu
(1-0.025) atau nilai Z ( 0.975) yaitu 1.96
76

Kalau yang dicari adalah 99% CI dilihat di Tabel Z adalah nilai Z (0.995) yaitu 2.57
5. a) List significant risk factors and their adjusted OR of BV which were found in this
study b) List not significant risk factors of BV which were found in this study.
6. a) Why the researcher calculate that adjusted OR?
b) Which one is correct term, OR (odds ratio) or prevalence ratio? Note: See
Widagdo page 102.
7. a) What is the main weakness of this study?
b) List other weakness of this design. c) List advantageous of this design. Note: See
Widagdo page 107.
8. NOTE: Below are the advantageous and weakness of epidemiological study
design
KEUNGGULAN & KELEMAHAN RANCANGAN/DISAIN

PENELITIAN
RANCANGAN
KEUNGGULAN
EKSPERIMENTAL
MURNI
1. Merupakan rancangan yang

paling kuat/meyakinkan untuk
membuktikan hipotesis, karena
peneliti sepenuhnya bisa
memanipulasi/melakukan
kontrol terhadap variabelvariabel yang diteliti, baik
variabel pengacau/confounding
maupun terhadap variabel
independent
1. Pemakaiannya terbatas hanya

pada binatang dan tumbuhtumbuhan saja
EKSPERIMENTAL
KUASI
(Clinical dan
Community Trials)
1. Lebih kuat/meyakinkan
dibandingkan penelitian
observasional.
2. Bisa dilakukan pada manusia
1. Tidak semua variabel pengacau

bisa dihilangkan efeknya
2. Pemakaian pada manusia terbatas
hanya untuk meneliti percobaan
penyembuhan dan pencegahan
penyakit saja, dan tidak bisa
dipakai untuk meneliti penyebab
penyakit.
COHORT
PROSPEKTIF
1. Angka insiden penyakit bisa

diperoleh
2. Seringkali secara kebetulan
dijumpai hubungan antara
exposure/pemaparan yang
diteliti dengan penyakit yang
sebelumnya tidak terpikirkan
oleh peneliti
3. Karena pemaparannya terjadi
1. Pada penyakit-penyakit yang

angka insidennya rendah, maka
jumlah subyek (penduduk sehat)
yang harus diamati/diperiksa
secara berkala akan sangat
banyak, ini memerlukan biaya,
tenaga dan ketekunan yang amat
tinggi.
2. Pada penyakit-penyakit yang
waktu antara mulainya pemaparan
KELEMAHAN
77
pada saat sekarang maka

bias dalam menetapkan
exposure akan lebih kecil
dibandingkan rancangan
case-control
dan timbulnya penyakit panjang,

maka akan memerlukan waktu
pengamatan yang amat lama.
Akibatnya: juga memerlukan
biaya, tenaga dan ketekunan yang
tinggi.
3. Pada pengamatan yang lama:
attrition/lost to follow upakan
menjadi tinggi. Ini juga amat
dipengaruhi oleh tingkat mobilitas
penduduk
4. Ada kemungkinan bias pada saat
menentukan pembilang angka
insiden, karena kemungkinan
adanya kesalahan pada saat
menentukan sakit/tidaknya subyek
yang diamati.
5. Pada pengamatan yang panjang,
bisa jadi KRITERIA atau CARA
DIAGNOSIS penyakit telah
berubah terutama pada dekade ini
dimana teknologi kedokteran
berkembang dengan sangat pesat.
COHORT
RETROSPEKTIF
1. Relatif lebih murah bila

dibandingkan cohort
prospektif
2. Waktu penelitian lebih pendek
sehingga hasilnya cepat
diperoleh
3. Sama halnya dengan cohort
prospektif: angka insiden bisa
dihitung sehingga RR
(relative risk) bisa diperoleh.
1. Rancangan ini 100% tergantung

dari kelengkapan pencatatan di
masa lalu, baik pencatatan
tentang exposure (independent
variable), kejadian penyakit
(dependent variable), dan
variabel-variabel pengacau
lainnya. BILA PENCATATAN
TIDAK LENGKAP, MAKA BIAS
NYA AKAN TINGGI. Karena
rancangan ini 100% tergantung
dari data sekunder, maka tidak
semua variabel confounding mesti
tersedia pada catatan pasien.
78
CASE CONTROL
ANALITIK CROSSSECTIONAL
1. Relatif lebih rendah biayanya
1. Karena menelusuri exposure di
dibandingkan cohort
prospektif.
2. Jumlah subyek yang
dilibatkan dalam penelitian
lebih kecil dibandingkan
cohort.
3. Waktu pengamatan/penelitian
lebih pendek dibandingkan
cohort prospektif, sehingga
hasilnya lebih cepat
diperoleh.
4. Lebih tepat untuk penyakitpenyakit yang angka
insidennya rendah atau yang
masa inkubasi-nya panjang.
masa lalu, maka lebih besar

kemungkinannya, data tentang
exposure yang tersedia DARI
CATATAN-CATATAN YANG ADA
tidak komplit.
2. Bila exposure ditelusuri melalui
wawancara/interview, karena
responden harus mengingat
kejadian-kejadian di masa lalu,
maka lebih besar kemungkinannya
mereka lupa (BIAS RECALL)
3. Sering kali dijumpai adanya
kesulitan ketika memilih
CONTROL yang betul-betul
serupa dengan kelompok CASES,
terutama pada rancangan
mathcing.
4. Tidak bisa diperoleh RELATIVE
RISK (tetapi hanya estimasi/
perkiraan relative risk saja).
Perkiraan RR ini disebut ODDS
RATIO.
1. Karena baik faktor penyebab

maupun akibat (dependent
dan independent variable)
dan demikian pula
confounding variable diamati
pada satu titik waktu saja,
maka pelaksanaan penelitian
relatif lebih cepat dibanding
case-control dan cohort.
1. Rancangan ini PALING LEMAH

dalam hal pembuktian HUBUNGAN
KAUSAL. Kriteria hungnan temporal
tidak bisa dipenuhi, karena tidak
bisa diketahui, mana yang terjadi
terlebih dahulu apakah independent
atau independent variabelnya.
Angka insiden dan RR tidak bisa
diperoleh. Yang dipakai hanya OR.
Self assessment
1. What are the roles of descriptive epidemiologic study designs?
2. What are the types of descriptive epidemiologic study designs?
3. Draw the figure of cross-sectional analytic study design.
4. What is the basic definition of cross-sectional and what is the procedure of the
study?
5. Make one example of results analysis for analytic cross sectional design.
6. What are the advantages and disadvantages of analytic cross sectional design?
7. Can analytic cross-sectional design be applied as a basic study to find out aetiology of
a disease?
79
M O D U L E ~ 14
(Greenberg, p. 113-123)
Epidemiology Study Design: Cohort Study

dr. I Nyoman Sutarsa, MPH & dr. Putu Ariastuti, MPH
AIMS:
To describe cohort study design and to explain the advantages and disadvantages of
cohort study to determine risk factors of diseases.
LEARNING OUTCOMES:
1.
2.
To describe and to draw prospective and retrospective cohort study design

To explain the advantages and disadvantages of cohort study to determine risk
factors of diseases
3. To explain what is relative risk and how to calculate relative risk
4. To explain the interpretation of relative risk in cohort studies
1.
2.
3.
4.
5.
The cohort study design and its attributes

Timing of measurements: prospective and retrospective design
Subject selection in cohort studies: exposed and un-exposed groups
Data collection incohort studies
Data analysis in cohort studies: risk ratio (RR) and attributable risk (AR)
ABSTRACTS
A cohort study is a type of observational investigation in which subjects are classified on
the basis of level of exposure to a risk factor and followed to determine subsequent
disease outcome. Prospective cohort studies are conducted by making all observations
on exposure and disease status after the onset of the investigation. Retrospective
cohort studies involved observations on exposure and disease status prior to the onset
of the study. The retrospective approach offers several pragmatic advantages, but may
result in less accurate and complete information on exposure and disease status.
Cohort studies are statistically efficient for the study of rare exposures because
the exposed individuals can be selectively included in the study. On the other hand,
cohort studies are inefficient for the investigation of slowly developing or rare diseases.
The evaluation of chronic diseases through the cohort approach requires a long followup period and increases the chances that subjects will be lost from the study. The
evaluation of rare diseases with the cohort study approach requires a large sample size
and therefore is expensive and labour intensive.
There are several basic strategies to analyse cohort studies. If data are collected
on the risk of developing an outcome during a specified period, the summary measure of
80

effect typically is the risk ratio. An alternative approach to contrasting risks is risk
difference, which is the risk among exposed persons minus the risks among unexposed
persons. If the risk difference is divided by the risk among exposed persons, a measure
term the attributable risk percent is derived. The attributable risk percent is an indicator
of the proportion of risk that may be attributable to the exposure. When data in a cohort
study are based on the rate of disease outcome, the standard measure of effect is the
rate ratio.

1. Study design of cohort studies and its attributes
2. The procedures of cohort studies
3. Findings and its interpretation (including crude RR, adjusted RR and attributable
risk) as well as confounding factors in a cohort study

Case 1.
Please carefully study the article entitles: Tobacco smoking as a risk factor for
depression: A 26-year population-based follow up study
Learning Tasks 2:
1.
2.
3.
4.
5.
6.
Draw a figure of the study design with its attributes.

What are the dependent and independent variables of that study?
What are the confounding variables of that study?
Describe two major conditions of study group and control group in a cohort study!
How did the researcher choose the control group?
How did the researcher control the effect of confounding variables? Is that the way
by design or by analysis?
7. Explain how the researcher did that (no 6)!
8. Why do the researchers choose this study design? Describe two reasons.
9. What is its CRUDE RR of the study? Provide the interpretation!
10. What is its SPECIFIC RR after being controlled for its tobacco consumption level?
Provide the interpretation!
81
Case 2.
Carefully examine the following table.
Social
Non-Smokers
Class
Alcohol Intake
Smokers
All
Alcohol Intake
Heavy
Moderate Light
Total
Heavy
Moderate Light
Total
I and II
11/84
5/79
11/169
27/332
6/28
3/13
1/26
10/67
37/399
III
4/22
3/25
12/162
19/209
4/17
2/7
6/38
12/62
31/271
IV and 0/14
V
1/18
12/91
13/123
7/19
2/18
8/70
17/107
30/230
9/122
35/422
59/664
17/64
7/38
15/134
39/236
98/900
15/120
Learning Tasks 2:
After you examined the above table, please calculate the following:
1.
2.
3.
4.
5.
What is the CRUDE RR?

What is the SPECIFIC RR after being controlled for its social class variable?
What is the SPECIFIC RR after its smoking variable is controlled for?
What is the SPECIFIC RR after both smoking and social class variables are
controlled for?
Provide the interpretation of thoseRR!
Case 3:
A study at Stockholm had observed 216 children who received BCG immunization when
they were aged below 6 years and 358 children who did not have BCG immunization
since 1989-1992. The study was set up in 1994. In 1995-1996, all children were
examined to find out atopic disease incidence (atopic: a type of allergic disease). The
study result shows that 36% who had BCG immunization and 41% who did not have
BCG immunization are suffering from atopic disease (2 = 2.6; p > 0,05).
Learning Tasks 3:
Based on the above case, please answer the following questions:
1.
2.
3.
4.
5.
What is the study design of the case above?

Draw figure of the study with its attributes?
What is the main requirement if we want to choose that design?
What is the RR?
Does the RR in this study also occur in a population? Describe your reasons!
Case 4.
Carefully read the article entitles: Risk of herpes zoster among patients with chronic
obstructive pulmonary disease: a population-based study
82
Learning Tasks 4:
1.
2.
3.
4.
5.
Please draw the study profile/design with its attributes

Where the exposure and the outcome data were obtained from?
What is the dependent and independent variables?
Identify the confounding variables in this study!
What is the crude RR and what does it mean?
Self Assessments:
1.
2.
What are the advantages and disadvantages of prospective and retrospective

cohort studies?
Explain the limitation of cohort studies to determine risk factors of diseases?
83
M O D U L E ~ 15
(Greenberg, p. 127-136)
Epidemiology Study Design: Case Control Study

dr. I Nyoman Sutarsa, MPH & dr. Putu Ariastuti, MPH
AIMS:
At the end of this module, students are expected to be able to describe case-control
study and to explain the advantages and disadvantages of case-control study to
determine risk factors of diseases.
LEARNING OUTCOMES:
1. To describe and to draw case-control study design
2. To explain the advantages and disadvantages of case-control study to determine
3. To explain what is odd ratio (OR) and how to calculate OR
4. To explain the interpretation of OR in a case control study
1.
2.
3.
4.
5.
6.
The case-control study design and its attributes

Case and control definition
Determination of exposure
Selection bias in case-control study
Matching strategy in case-control study
Data analysis in case control: OR and its interpretation
ABSTRACTS
A case-control study is a type of observational investigation in which subjects are
enrolled on the basis of the presence or absence of a particular disease and are then
evaluated to determine their history of prior exposure to risk factors of interest.
The advantages of this design are primarily logistical. In particular, rare disease
and those with long latency periods can be studied efficiently. The sample size required
for a case control study tends to be smaller than would be needed for an alternative
design, such as a cohort study. As a result, the expense of conducting a case-control
study may be substantially less than the cost of conducting a cohort study. Furthermore,
reliance on historical information allows rapid completion of case-control study. The
ability to reach a prompt conclusion is particularly important if the disease of interest is
potentially life-threatening.
84

The disadvantages of case-control studies relate primarily to their susceptibility to
systematic errors. Because cases and controls are sampled separately, it is possible that
these groups may not arise from the same source population. Bias can be introduced
into the study results if exposure status is associated with the likelihood of including
cases or controls into the study. Reliance on subject recall of earlier exposures or the
use of historical records can lead to imprecise or inaccurate classification of exposure.
The decision to conduct a case control study typically is motivated by a desire to
exposure the relationship between prior exposure to a specific risk factor and the
likelihood of developing a particular disease. Ideally, the cases and the controls should
derive from a single well-defined source population, such as a state or metropolitan area
(population-based sampling scheme). An attempt may be made to identify all newly
diagnosed cases (incident cases) within the source population, particularly when the
disease is rare or the source population is modest in size. Cases may be identified from
hospital record, surveillance system, death certificates, or other sources. Careful criteria
for the presence of disease must be established to minimize false inclusions or
exclusions.
Controls typically are sampled from the population that gave rise to the cases.
Occasionally, for purposes of convenience, hospital based samples of cases and control
are selected. The hospital based approach tends to have the advantages of accessibility
to the subjects and cooperative study participants. On the other hand, cases and
controls may derive from dissimilar source populations in a hospital-based study and
prior exposure status might influence the likelihood of inclusion in this type of
investigation.
Matching of controls of cases on the basis of known risk factors for the disease of
interest is a common practice in case-control studies. The intent of matching is usually to
decrease the possibility of confounding, or mixing of the effectof exposure to the risk
factors. Matching can increase the statistical precision of estimates and thereby allow a
smaller sample size. On the other hand, matching can be time consuming, and subjects
who are not successfully matched must be discarded from the analysis.
The process of selection of subjects in a case-control study precludes the
estimation of risk (or rates), and the risk ratio therefore cannot be calculated directly from
case-control data. An indirect estimate of the risk ratio, however, can be calculated in a
case-control study. This measure is referred to as the odds ratio and is defined as the
odds of exposure among cases divided by the odds of exposure among cases divided
the odds of exposure among controls. The approach to calculating the odds ratio
depends on whether cases and controls were sampled in an unmatched or matched
fashion. In instance, a point estimate and 95% confidence interval for the odds ratio can
be calculated as a measure of association between prior exposure to the risk factor and
occurrence of disease.

1. Case-control study design and its attributes
2. The procedures of a case control study
3. Findings and its interpretation (including crude OR, adjusted OR) as well as
confounding factors in case-control study
85

Case 1.
Please carefully study the article entitlesProlonged breastfeeding reduces risk of
breast cancer in Sri Lankan women: a case-control study
Learning Tasks 1:
1.
2.
3.
4.
5.
6.
Draw a figure of the study with its attributes.

Was this study hospital based or population based or combination?
Explain its dependent and independent variables!
Explain its case definition!
Explain the source and methods of selecting control from the study!
Is the above study part of a match-paired design? Why or why not? Describe three
reasons.
7. Do the cases represent their population? Do the controls represent their population?
8. Are cases and controls comparable? If not, which part is not comparable?
9. How does the researcher control the effect of confounding variables?
10. What is its CRUDE OR? Provide an interpretation!
Case 2.
Carefully examine the following table.
Table 2.1 Use of IUD in sometime pregnant and never pregnant patients and controls in
different age groups
Age
Patients
Control
group Sometime
Never Pregnant
Total
Sometime
Never Pregnant
Total
(year) Pregnant
Pregnant
IUD
No
IUD
IUD
No
IUD
IUD
No
IUD
IUD
No
IUD
15
16-20
13
44
27
93
177
19
196
227
21-25
26
74
28
87
215
25
131
163
326
26-30
20
50
19
92
21
86
49
159
31-35
12
23
21
26
Total
66
181
59
209
515
55
257
17
412
741
Learning Tasks 2:
After you examined the above table, please calculate the following:
86

1.
2.
What is the CRUDE OR? Please provide an interpretation!

Calculate 95% CI (confidence interval) of the CRUDE OR using below formula:
95% CI = (OR) exp [+ 1.961/a+1/b+1/c+1/d]

3.
4.
After it is controlled for age variable, what is its SPECIFIC OR? What is the
interpretation?
What is the SPECIFIC OR after being controlled for obstetric history variable? What
is the interpretation?
Case 3:
Carefully read the article entitles: Risk factors for psoriasis: a case control study
Learning Tasks 3:
Based on the above case, please answer the following questions:
1.
2.
3.
4.
5.
6.
7.
What is the dependent (or response) variable of this study?

What are the objectives of this study?
What are risk factors investigated or what are independent variables of this study?
Was this study hospital based or population based?
How long the cases were collected?
Who was the control group?
Regarding which variables cases and control was comparable?
(a) Regarding which variables cases and control was not comparable?
(b)What must be done to control these confounding variables?
8. See Table-3. How do you determine the most dominant risk factors?
9. See Table-3. Which risk factor had the highest OR? What was the 95% CI for this
risk factor?
10. What were the OR and 95% CI of variable place of recidence? Explain, what does
it mean?
Self Assessments:
1.
2.
What are the advantages and disadvantages of case-control study in determining

risk factors of diseases?
Explain what is mean by control by design and control by analysis in a case-control
study!
87
M O D U L E ~ 16
(Reference Greenberg, p.91-113 & Gordis, 131-163)
Epidemiology Study Design: Clinical Trial

AIMS:
To be able to describe the application of clinical trials to determine the effectiveness of
intervention, prevention, and treatment of diseases.
LEARNING OUTCOMES:
1. To describe and to draw clinical & communitytrial design
2. To explain the advantages and disadvantages of clinical & community trial to
determine the effectiveness of intervention, prevention, and treatment of
diseases
3. To explain the definition, aims, subject determination (enrolment,
inclusion/exclusion criteria, and randomization of intervention and control group)
4. To explain statistical calculation and consideration in clinical trial
5. To explain outcome evaluation strategy (blinding) and how to calculate outcome
6. To explain the interpretation of study outcome
7. To explain ethical consideration in certain clinical trial
8. To explain the differentiation between clinical and community trial
1.
2.
3.
4.
5.
6.
7.
8.
The clinical trial design and its attributes

Definition of intervention and control group
Enrolment, Inclusion and exclusion criteria and randomization strategy
Blinding strategy in clinical trial
Statistical calculation and its parameters
Data analysis in clinical trial and its interpretation
Ethical consideration
Differentiation of clinical and community trial
88
ABSTRACTS
Evidence-based medicine can be defined as the integration of current best evidence with
clinical expertise, pathophysiological knowledge and patient preferences to make health
care decisions. Although there are barriers to the practice of evidence-based medicine,
such as the skills and time required in appraising the literature, this approach
encourages effective management of diseases. It can serve to optimize health outcomes
and promote cost-effective management.
Fundamental practice of evidence-based medicine is the ability to critically
assess the design, conduct and analysis of clinical studies. For the purpose of assessing
the comparative benefits of alternative treatment, the randomized controlled clinical trial
is the gold standard approach. The evidence-based practitioner, therefore, must be
thoroughly familiar with this research method.
The principal strength of this approach derives from assigning treatment to
patients by randomization, thereby tending to balance the study groups with respect to
both known and unknown prognostic factors.
Before enrolling patient in a clinical trial, the investigation can determine the
baseline and follow-up information that will be required to all subjects. Procedures can
then be put in place to enable the researches to collect data in a fairly complete and
accurate manner. The investigator can also allocate subjects to desire dose level rather
than relying on physicians or patients preference. When blinding of the evaluation or
patients is feasible, the assessment of clinical outcomes is less likely to be influenced by
knowing which treatment was used.
Randomized controlled clinical trial is subject to certain constraints, however.
Restrictive criteria for inclusion of subjects may produce a very homogenous study
population, which may restrict the ability to extrapolate results to patients with other
characteristics. Clinical trialparticularly those involving chronic processesmay
require years of follow-up to determine the outcome of the treatment. A prolonged
observation period leads to higher costs, increases the likelihood that patient will be lost
to follow-up, and delays the time at which a treatment recommendation can be made.
The use of intermediate end points, such as measurement blood glucose levels
glycosylated hemoglobin in the diabetes therapy trial, can help limit the length of
required follow-up. Nevertheless, a definitive conclusion about treatment benefit often
requires years of observation.
Large sample sizes typically are required in clinical trial when the magnitude of
differences in responses between study groups is small. Furthermore, large numbers of
subjects are likely to be required to demonstrate differences between study groups when
there is wide variability in responses to treatment. Increasing the size of the study
population not only raises the cost of a trial but may also lead to pragmatic difficulties in
locating a sufficiently large pool of eligible patients.
Ethical concern may arise in clinical trial if one or more of the treatment options
has serious potential effects or if early suggest-but do not establish- a therapeutic
advantage for one of the treatments. In this situation, a decision must be made about
89

whether the trial should be continued until a definitive conclusion is reached or should be
terminated early so that all patients have the opportunity to receive the apparently
superior treatment. To minimize the possible influence of real or perceive conflicts of
interests, and external advisory group should review these ethical questions.
An investigator cannot control the behaviour of subjects enrolled in clinical trial.
Even after initial informed consent has been given to participate in clinical trial, a subject
has the right withdraw at any time. Some subject may elect to remain in the trial but not
comply with the assigned regimen. Noncompliance can reduce the statistical power of
clinical trial and thereby lead to a false-negative conclusion. Accordingly, every effort
must be made to achieve maximal compliance with assigned treatment without infringing
on the patients right to refuse therapy. Ultimately, treatment decisions should be best on
the best evidence available concerning therapeutic benefit. The standard approach to
gathering this evidence is the randomized controlled clinical trial. Although this type of
investigation labour intensive, time consuming, and expensive it can provide the most
convincing evidence of the superiority of one treatment over another. Through the use of
randomized control clinical trial such as the diabetes therapy study, decisions concerning
patient treatment and care can be based on rigorous scientific information.

1. Clinical trial design and its attributes
2. The procedures of a clinical trial
3. The concept of subject selection, restriction and randomization
4. Statistical calculation and its parameters
5. Findings and its interpretation

Case 1.
Please carefully study the article entitles Clinical efficacy and safety of a
novel tetravalent dengue vaccine in healthy children in Asia: a phase 3,
randomised, observer-masked, placebo-controlled trial
Learning Tasks 1:
1. What is the study intervention?
2. What is the expected outcome (its dependent variable)?
3. Why did the researcher consider to do this study, or in other words, what is the
problem in the community?
4. Based on clinical trials definition, describe the purpose of this trial.
90
5. Describe how researchers design the study, the period, and selected the sites for
study. What considerations were put in place when selected the sites?
6. Describe how the researcher selected the subjects of this study. What are the
inclusion and exclusion criteria? What are the purposes of defining these criteria?
7. Which type of randomization has been done? What is the purpose in doing this?
8. See the Figure 1. Trial Profile. What is the purpose to describe this figure?
9. Describe how the method of intervention was performed?
10.
What are the outcomes (dependent variables)? Describe the operational

definitions.
11.
Based on measurement scale, that dependent variable is part of which type?
12.
Is this study using a blind design? What is the purpose to use blind design?
13.
What is one limitation for this longitudinal study with regard to study subjects?
14.
Look at Table 1. Baseline Characteristics of the Participants. What is the

purpose of researchers for showing the table?
15.
What is the main result of this study? Which intervention was more effective?
16.
What other outcomes were also resulting from this study?
17.
How you interpret the vaccine efficacy of primary analysis (per protocol?)
18. How you compare the vaccine efficacy for the dengue serotype?
19. What are ethical aspects you see from the study?
Case 2.
91

Family planning services throughout all villages are needed to decrease birth rate in
Indonesia. In Ayodya Province, almost all reproductive couples chose the vasectomy
method. Since the users were high in demand while the doctors in that province were
limited, dr. Nyoman Abimanyu, a surgeon who was also the head of the Provincial Health
Department, trained a group of nurses to be able to conduct vasectomies. With his
authorization for the nurses to do vasectomies, dr. Abimanyu got a lot of criticisms from
other surgeons. Therefore, he thought that it was important to have empiric data from a
research.
In his study, a number of candidate acceptors (candidate users) were vasectomised by
trained nurses, while the other users underwent vasectomies by doctors. Previously, all
candidates were informed whether they would be operated by doctors or trained nurses.
The number of samples was already sufficient and was already sampled randomly to
ensure representatives for their population. The results are as follows: vasectomy failure
on the group operated by nurses was 2% while by doctors was 1.25%. Hematoma
(subcutaneous bleeding) in the nurses group was 8% and in the doctors group was 5%.
Learning Tasks 2:
1. What are dependent and independent variables in that study?

2. Is the study above an observational or experimental study?
3. What is the intervention?
4. Is that possible to randomize?
5. What randomization can be done?
6. What are the advantages and disadvantages of each randomization method?
7. Is it possible to do cross-over design? If not, why?
8. Is it possible to do blind design?
9. Which blind design can be done?
10. From the result above, what is the conclusion? Which is more effective?
11. If the result is as follows, what is the conclusion? Which one is more effective? The
vasectomy failure in the group operated by nurses is 2% while on the doctor is
1.25% (p > 0.01). Hematoma (subcutaneous bleeding) in the nurses group is 8%
and in the doctors group is 5% (p > 0.01).
Self Assessments:
1. Describe the application of clinical trials in diagnosis and patient treatment?
2.
Describe the design of parallel clinical trials and cross-over trials
4.
Explain the purpose and application of parallel clinical trials and cross-over trials
5.
Describe the definition and purpose of single blind and double blind study.
6.
Describe the definition of informed consent.
92

7. On the British Medical Journal 2002, the study was conducted to know the effect of
ice consumption to headache with the design study was prospective randomized trial
(Source: UKDI)
Headache (+)
Headache (-)
Total
Accelerated eating group
20
53
73
Cautious eating group
63
72
Total
29
116
145
What is the role of the risk factor?

A. 2,9
B. 2,2
C. 4,4
D. 4,6
E. 6,8
13. On the study of medication that will be use to suppress cholesterol level; the study
procedure was dividing the study group in to two: control and intervention group.
Then, the outcome will be compared for both groups. What is the design of the
study? (Source: UKDI)
A.
B.
C.
D.
E.
True experimental
Quasi experimental
Cross sectional
Cohort
Descriptive
93
M O D U L E ~ 17
(Reference Greenberg, p. 127-136)
Epidemiology Study Design: Diagnostic Test

dr. Gede Artawan Eka Putra, M. Epid & dr. Anak Agung Sagung Sawitri, MPH
AIMS:
To be able to describe validity and reliability of certain test to apply in the individual and
or community context
LEARNING OUTCOMES:
1.
2.
3.
4.
To describe definition of accuracy, validity and reliability

To explain parameters used to indicate validity and reliability
To describe concept of test validity of the continues or multilevel outcome result
To choose ideal diagnostic test in certain situations related to individual and
community context
1. Definition of diagnostic test and screening program
2. Accuracy, validity (sensitivity, specificity, predictive value, and likely hood ratio) and
reliability
3. Screening program
ABSTRACTS
All clinical information is subject to error. Accounting for the various errors that can arise
in diagnostic testing allows the physician to select tests and interpret the result of those
tests appropriately. The errors are false- negative, false-positive.
Sensitivity and specificity are characteristics of a diagnostic test. It is useful to
consider two other measures, positive predictive value (PV+) and negative predictive
value (PV-), which are use to interpret the results of a diagnostic test.
94

For multilevel or continuous outcome test results, a dividing line or cut off point
can be chosen to separate findings considered to be positive or negative. The
performance of diagnostic tests also can be assessed by use of likelihood ratios.
SELF DIRECTING LEARNING

1. Accuracy
2. Sensitivity, specificity, predictive value, likelihood ratio
3. Cut off point
4. Screening program

Case 1
The result of screening test was as bellow;
Diabetic retinopathy
S
Sakit
Positif
Negatif
Total
Tidak Sakit
Total
3.200
1.400
4.600
150
29.000
29.150
3.350
30.400
33.750
Learning Tasks 1
1. Calculate the sensitivity, specificity, and predictive value of diabetic retinopathy and
Interpret each of your calculation
2. What is the prevalence of diabetic retinopathy among the population?
3. What is the relation between prevalence and predictive value? What is the relation
with the target group for screening program?
4. When you conduct screening test among elderly population, which prevention you
have done: primary, secondary, or tertiary?
Case 2
A detailer has come to dr. Arjuna for offering cheap rapid test for anemia. Dr. Arjuna
asked 3 tests for trial. Fortunately, Mrs. Drupadi came for consultation of malaise and
continuing dizziness. Dr. Arjuna asked permission from mrs. Drupadi to take the blood
sample for checking anemia. At the same time, he also told her that he wanted to check
the rapid test for anemia.
Using cyan-met HB, the result of hemoglobin was 12.5mg%, while the result of rapid test
respectively was 10.5 mg%; 10.2mg%; and 12.0mg%.
Learning Task 2
If the criteria of anemia was <11 mg%, how you conclude the result of the rapid test for
anemia that just being tried by dr. Arjuna?
95
Self Assessments:
1.
What is the definition of sensitivity?
2.
What is the definition of specificity?
3.
If the prevalence increases, what other value will also increase?
4.
If the prevalence of a certain disease is high, while the sensitivity and specificity
are stable, than ................... will be low.
M O D U L E ~ 18
(Reference Mausner & Bahn, p. 91-110, Greenberg 141-153)
Variability and Biases

AIMS:
Be able to describe variability and biases those might occurred in certain studies
LEARNING OUTCOMES:
1.
2.
3.
To describe the concept of patient variability, variability in medical research,

variability of measurement, both in individual and population level.
To explain internal validity, external validity, selection bias, information bias, and
confounding factors.
To describe sources of bias in descriptive research design, cross-sectional, casecontrol, cohort, and clinical trials and describe how to minimize those biases
1.
2.
3.
Variability (individual, measurement, and population)

Validity (internal and external)
Biases (selection bias, information bias, and confounding bias)
ABSTRACTS
In this lecture, the topics of variability and bias (systematic errors) in
epidemiologic measurements are discussed. A distinction is drawn between random
96

variation which is inversely related to precision in measurement, and non random or
systematic error, which is related to distortion in measurement.
Variability can arise from (1) the subject under study, (2) differences between
individuals, (3) the approach used to sample subjects, or (4) the measurement process
itself. Variability related to sampling is likely to diminish as the sample size increases.
With extremely large sample size, a very small difference in outcome between study
groups can be statistically significant. Whether the magnitude of this difference is
sufficient to warrant a change in clinical practice is separate, but equally important
question.
Validity concerns the extent to which the findings of a study reflect truth. Internal
validity relates to the accuracy of study findings for the persons who are investigated.
External validity concerns the extent to which study findings accurately apply to
persons who are not studied.
Bias is defined as lack of validity. Conventionally, bias is classified into three
major types: selection bias, information (misclassification) bias, and confounding.
Selection bias refers to the introduction of systematic errors into study results through
the manner in which study subjects are selected. Information bias results in systematic
errors in study findings that originate in the approach to collecting information. Two kinds
of information bias can exist. Non-differential misclassification occurs when errors in the
information about one variable unrelated to the status of another variable. Differential
misclassification, on the other hand, occurs when errors in the information about one
variable are affected by the status of another variable.
Confounding is concerned with the mixing of the primary effect of interest with
the effects of one or more extraneous factors. In experimental studies, the problem of
confounding is reduced by randomization, which tends to balance the study groups with
respect to both known and unknown determinants of the outcome. In observational
research, however, study groups may differ appreciably in factors that are (1) related to
the risk of disease among unexposed persons and (2) are also associated with the
exposure of interest, but not as a result of being exposed. The influence of these
potential confounders can be addressed in the study design (e.g., through matching or
restrictive inclusion criteria) or in the analysis (e.g., through stratification or regression
techniques). Only known confounders can be addressed in observational research.
No study is immune from the possibility of bias. The investigator must therefore
consider potential sources of bias when sampling subjects, collecting information,
analyzing results, and interpreting findings. With planning and forethought, it is possible
to anticipate and avoid certain types of error and thus conduct a study that leads to a
convincing and valid conclusion
SELF DIRECTING LEARNING

1. Variability
2. Validity
3. Bias
4. Confounding
97

1.
Carefully look at Patient Profile in Greenberg page 141. What possibilities may
cause the differences in the patients cholesterol level?
2.
Explain the differences between random and systematic variation (bias) by drawing
a figure as shown in Greenberg page 142 (Figure 10.1)
3.
Draw a copy of Figure 10-2 in Greenberg page 143 into your work-paper, and then
explain with your own words about the definition of sampling variability in research
studies. From that example it can be concluded that a smaller sample size in a
research study, will cause the variability to be ...
4.
Draw a copy of Figure 10-3 in Greenberg page 143 into your work-paper.
a. What is demonstrated in A and the B of the study figure?
b. From that example, it can be concluded that the consequence of a bigger
sample size in a research study is .
c. In a research study like the one above, despite sample size or differences
which statistically give significant results, what other things are very important
in biological or clinical meaning?
5.
Explain with examples, the differences between internal and external validity.
6.
Give examples of selection bias.
7.
Information bias may be presented in two forms, which are nondifferential

misclassification and differential misclassification. Explain those differences using
examples.
8.
Draw a copy of figure 10-7 in Greenberg page 148 into your work-paper. Ex-plain,
with the above examples, nondifferential misclassification which causes
underestimated OR and differential misclassification which causes overestimated
OR.
9.
a. Explain the definition of confounding variable

b. Two methods to control the effect of confounding variables are &
c. Carefully see Figure 10-9 in Greenberg page 150. Calculate the OR for all
subjects, OR for the obese group, and OR for the non-obese group. What is
your conclusion after calculating those three ORs?
d.
The method used above (no. c) controls the effect of confounding variables by
Self Assessments:
1. Explain the concept of variability in one patient and in medical research.
2. Explain individual & population variability, &variability related to measurement,
3. Explain the definition of validity and bias.
4. Explain the difference between internal validity and external validity.
98

5. What is the difference between selection bias, information bias, and confounding
bias?
6. A teenager wanted to be a study subject related with lung cancer. His father was
death due to lung cancer. Even though he was not selected as sample, what could
be most possible bias if he was join the study? (source: UKDI)
Recall bias? or Berkson bias? or Misclasification bias? or Ney man bias? or
Volunteer bias?
REFERENCES
Mausner and Bahn, Epidemiology an Introductory text
Kirkwood B.R & Sterne, A.C. (2008), Medical Statistics, Blackwell Publishing Company
Greenberg, R.S. (2004), Medical Epidemiology, 3rded, McGraw-Hill, New York, USA
SPSS V.11.5 Manual
Sastroasmoro, S. dan Ismael, S. (2014), Dasar-Dasar Metodologi Penelitian Klinis, edisi
ke-2, CV Sagung Seto, Jakarta.
Bahan SGD (jurnal, hasil penelitian)
99
ANNEX-1
FILM SUMMARY
And The Band
Played On
100
SINOPSIS DAN PENJELASAN TAMBAHAN

FILM AND THE BAND PLAYED ON
Film ini merupakan kisah nyata yang menceritakan tentang terjadinya wabah suatu
penyakit yang tidak diketahui penyebabnya pada awal tahun 1980.
Kisah yang mirip dengan film juga diuraikan di Buku Greenberg halaman 1 7
(lihat buku reference yang telah dibagikan).
Dikisahkan dalam film ini bahwa untuk meneliti atau mengungkapkan penyebab
suatu penyakit banyak bidang ilmu yang terlibat, yaitu: ilmu klinik, statistik,
epidemilogi, ilmu sosial, imunologi, virologi, etika dan profesionalime. Juga
banyak aspek yang berperan, yaitu aspek sosial, politik, dan ekonomi.
Demikian pula dalam pencegahan dan penanggulangannya dikisahkan bahwa

suatu penyakit baru bisa dicegah setelah diketahui determinannya, cara
penularannya, teknologi untuk diagnosanya (alat test), dan banyak aspek yang
berperan antara lain: aspek sosial (stigma pada kelompok gay), politik (rezim yang
berkuasa di pemerintahan), ekonomi (pembiayaan).
Film dimulai dengan Dr. Don Francis (seorang dokter yang menekuni Bidang
Epidemiologi dan pencegahan)yang diminta oleh Badan Kesehatan Dunia
(WHO)untuk meneliti wabah Ebola di Sungai Ebola (Afrika). Ebola adalah suatu
penyakit yang tingkat kematiannya hampir 100% dan dijumpai pertama kali di Sungai
Ebola.
Setelah itu, ditunjukkan bahwa dokter dan rumah sakit di Kopenhagen, Denmark
menemukan seorang pasien yang sakit lalu meninggal dimana penyebab penyakit
dan kematiannya tidak diketahui. Yang dijumpai oleh dokter rumah sakit tersebut
hanya T-sel (suatu sel yang membentuk kekebalan tubuh manusia) hampir nol
dalam pemeriksaan lab-nya.
Selanjutnya bermunculan kasus-kasus serupa yang dijumpai oleh dokter di sejumlah

rumah sakit di Amerika, pasien dengan T-sel amat rendah, dan secara klinis dijumpai
ada semacam tumor kulit (Kaposi Sarcoma), infeksi oleh jamur di mulut pasien,
101

radang pada otaknya oleh kuman toksoplasmosis. Bakteri ini biasanya dijumpai
pada kucing atau anjing.
Hampir semua kasus-kasus tersebut diumpai pada kalangan gay di Amerika

terutama Negara Bagian California dan New York. Karena itu, pada saat itu penyakit
misterius tsb disebut saja dengan penyakit gay.
Kemudian pihak Communicable Diseases Control (CDC) atau lembaga Kementrian

Kesehatan Amerika yang bertanggung jawab terhadap penyakit menular (yang
kantor pusatnya di Atlanta, Negara Bagian Georgia) minta bantuan Dr. Don Francis
ikut dalam Tim untuk meneliti penyakit ini lebih lanjut. Dia dipilih oleh CDC karena Dr.
Don Francis pernah meneliti penularan Hepatitis B dan Wabah Ebola. CDC sama
dengan Dirjen P2M (Penanggulangan Penyakit Menular) di Kementrian Kesehatan
RI.
Dr. Don Francis bergabung dalam Tim CDC bersama-sama dengan pakar ilmu
sosial, statistik, parasitologi, dokter ahli penyakit menular seksual, dll.
Saat itu kegiatan CDC banyak menemui hambatan karena tidak didukung
pendanannya oleh Pemerintah Pusat Amerika karena penyakit tersebut banyak
dijumpai pada kalangan gay. Partai yang berkuasa saat itu adalah Partai Republik
(dengan Reagan sebagai presidennya) yang ideologi politiknya tidak menyetujui atau
tidak menyukai homosek-sualitas. Sedangkan Partai Demokrat (partai oposisi) tidak
menentang keberadaan komunitas gay. Permintaan CDC untuk meningkatkan
laboratoriumnya termasuk untuk membeli mikroskop elektron juga menemui
hambatan.
Penelitian yang pertama kali dilakukan oleh CDC adalah menentukan apakah ini
penyakit menular dan bagaimana cara menularnya.
Dari data deskriptif dimana hampir semua kasus dijumpai pada kalangan gay dan
dengan penelitian contact tracing, kemudian CDC mendapat petunjuk bahwa
penyakit ini menular melalui hubungan seksual. Contact tracingatau penelusuran
kontak adalah salah satu cara untuk mencari sumber penularan suatu penyakit
yang ditularkan melalui kontak langsung termasuk kontak seksual. Catatan: cara
penularan penyakit SARS diketahui dengan cara penelitian contact tracing. Catatan:
Wabah SARS terjadi tahun 2003 yang bermula di Hongkong kemudian menyebar ke
berbagai negara di dunia.
Namun selanjutnya CDC menerima laporan bahwa kasus-kasus yang sama juga
dijumpai pada perempuan (migran dari Haiti). Dengan demikian maka penyakit ini
bukan lagi penyakit pada gay.
Juga ada laporan bahwa dijumpai pada anak-anak penderita hemofilia (penyakit
genetik dimana terjadi kelainan pada sistem pembekuan darah), pasien operasi
yang mendapat transfusi darah. Catatan: penderita hemofilia harus rutin mendapat
transfusi darah.
102
Tim CDC semakin bingung karena penyakit ini ternyata bukan saja menular melalui
seksual tetapi juga melalui darah atau produk darah.
Karena bukan lagi pada gay saja, kemudian tercetus istilah bahwa penyakit ini
adalah suatu Acquired Immunodeficiency Syndrome(AIDS), yaitu suatu
syndrome (kumpulan gejala) yang didapat karena terganggunya kekebalan
tubuh..
Secara kebetulan Dr. Don Francis melihat temannya yang main game di suatu
kantin, dan dia terinspirasi dari game tersebut bahwa ada virus yang
menghancurkan T-sel pasien. Tim CDC kemudian mencurigai bahwa penyebab
penyakit ini kemungkinan suatu virus yang termasuk dalam famili rotavirus. Pada
tahap ini, kemudian penelitian difokuskan untuk bisa menemukan virus tersebut
pada pasien. Pada saat itu pakar yang sedang meneliti rotavirus adalah Robert
Gallo (seorang ahli virology ternama di Amerika Serikat). Saat itu Robert Gallo
meneliti rotavirus pada pasien-pasien leukemia.
Robert Gallo mengklaim bahwa rotavirus yang dia jumpai adalah penyebab pasienpasien Acquired Immunodeficiency Syndrome pada saat itu.
Karena fasilitas penelitian virus yang saat itu masih terbatas di Amerika, kemudian
Dr. Don Francis (CDC) juga minta bantuan kepada Dr. Luc Montagnier (ilmuwan
dan peneliti di Lembaga Pasteur di Perancis) untuk menemukan virus yang
menyebabkan pasien-pasien AIDS. Saat itu fasilitas di Lembaga Pasteur di Perancis
lebih lengkap dibanding di Amerika.
Dalam hal inilah terjadi moral hazard (pelanggaran etika dan kelakuan yang tidak
professional) dimana Robert Gallo mengklaim bahwa dirinyalah penemu HIV,
padahal yang menemukan pertama kali adalah Tim dari Lembaga Pasteur di
Perancis. Menemukan suatu virus baru dalam suatu sampel yang diambil dari
pasien tidaklah mudah karena virus harus bisa dibiakkan (dibuat kultur sehingga
tidak mati) agar kemudian bisa dilihat dengan elektron mikroskop.
Perselisihan antara Robert Gallo dan Lembaga Pasteur hampir dibawa ke

pengadilan (tetapi batal) dan terus berkepanjangan. Karena itu, Panitia Hadiah
Nobel dalam waktu lama tidak memutuskan pemberian hadiah Nobel kepada pihak
manapun, tetapi akhirnya baru diberikan pada tahun 2008 kepada Tim
dariLembaga Pasteur di Perancis setelah HIV dijumpai pada tahun 1984 (setelah
24 tahun).
Test antibodi pertama untuk mengetahui seseorang tertular HIV dijumpai pertama
kali pada tahun 1984.
Hal-hal lain yang dikemukakan dalam film ini:
Pencegahan penyakit bisa dilaksanakan ketika cara penularannya telah bisa

dipastikan walaupun kuman penyebabnya (HIV) belum diketemukan secara pasti.
Hal yang sama juga terjadi pada penyakit-penyakit lainnya. Kejadian kolera dengan
penelitian epidemiologi diumpai pada tahun 1854 dan sudah mulai bisa dilakukan
103

pencegahannya saat itu (dengan konsumsi air bersih), sedangkan kuman kolera
baru dijumpai 30 tahun kemudian. Demikian pula dengan penyakit-penyakit lain
(TBC, polio, dll).
Upaya pencegahan AIDS yang diusulkan oleh Dr. Don Francis saat itu banyak
menemukan hambatan, baik hambatan politik (partai republik tidak mau memberikan
biaya), hambatan ekonomi (PMI-nya Amerika menolak test pada donor darah karena
biayanya akan amat mahal), hambatan sosial (stigma pada komunitas gay dan
penolakan penutupan tempat sauna/bathhouse yang biasa dipergunakan oleh
komunitas gay untuk berkumpul).
Dalam film juga ditunjukkan bahwa hambatan yang dijumpai bukan saja dalam hal
pencegahan tetapi juga dalam hal perawatan pasien AIDS. Dokter di salah satu
negara di Eropa dipanggil dan ditegur oleh direkturnya karena banyak merawat
pasien AIDS. Direktur RS mengatakan citra RS-nya tercoreng. Si dokter
menjawab: Saya tetap akan merawat mereka, dimanapun saya mendapat
tempat.
Sampai saat ini Dr. Don Francis berdomisili di California dan banyak melaksanakan
program-program pencegahan.
Catatan: Dr. MervynSilverman yang dalam film ditunjukan sebagai Kepala Dinas
Kesehatan San Franscisco (Public Health Director) saat itu yang terlambat datang
satu jam dalam pertemuan di bathhouse dan bersusah payah menengahi upaya
penutupan bathhouse komunitas gay, sampai saat ini sering berkunjung ke Bali
karena putrinya menikah dengan seorang pemuda dari suatu desa di
Kabupaten Gianyar.
=====================
104
ANNEX -2
ARTIKEL KORAN
BALI POST
105
Bali Post, Senin, 19-6-1995
Dipertanyakan, Pasien Kurang Mampu

Masuk RSUP Denpasar
Denpasar, (Bali Post)
Pihak RSUP Denpasar mempertanyakan pasien kurang mampu masuk RSUP Denpasar
yang jumlahnya cenderung terus meningkat.Munculnya pertanyaan itu, karena dari data
yang ada jumlah pasien yang kurang mampu masuk RSUP justru paling banyak dari
Kabupaten Badung (179 orang), Gianyar (171 orang), dan Tabanan (150 orang).Padahal
ketiga daerah ini dinilai sebagai daerah yang memiliki pendapatan perkapita lebih tinggi
dari daerah lainnya di Bali.
Hal tersebut diungkapkan Humas
RSUP Denpasar, Y.H.L., ketika
ditemui Jumat (16/6).Dia menilai
tidak masuk akal ketiga daerah
yang pendapatan perkapitanya
cukup tinggi justru warganya
paling
banyak
menyatakan
kurang mampu. Padahal Daerah
Bali yang perekonomiannya dinilai
semakin maju, sebagai dampak
pariwisata, jumlah masyarakatnya
yang kurang mampu makin sedikit
Apakah mungkin mereka sengaja
mengaku kurang mampu dan
gampang mendapatkan surat
keterangan kurang mampu dari

aparat desanya, kata Y.
Ketika ditanya apakah hal itu
merugikan RSUP yang kini
menjadi swadana, Y tidak berani
menjawab.Namun direktur RSUP,
dr. IGLMR, ketika dikonfirmasi
megatakan hal itu sebenarnya
tidak
terlalu
berpengaruh
terhadap
keberadaan
RSUP.Meskipun kini menjadi
swadana,
RSUP
tetap
mempertahankan
fungsi
sosialnya.
Jangan
hanya
mengejar
keuntungan belaka, fungsi sosial
harus
tetap
diperhatikan.
Ujarnya.
Menurut R, asalkan tempat tidur
berkelas
penuh,
sebenarnya
pasien kurang mampu tidak
masalah bagi RSUP. Sebab kalau
tempat tidur berkelas itu penuh,
keuntungan dari sana yang akan
dipakai membantu para pasien
kurang mampu yang masuk
membludak, tentu hal ini akan
menjadi masalah, paparnya.
106

Seleksi Surat Keterangan
Baik R dan Y mengharapkan
pihak aparat terkait lainnya,
benar-benar menyeleksi dalam
memberikan surat keterangan
kurang mampu. Sebab, tidak
mungkin pihak RSUP akan
mengecek apakah orang itu benar
benar kurang mampu sampai ke
desanya. Demikian pula pihak
terkait, seperti camat, Depsos,
dan lain-lain, tidak akan mungkin
tahu dengan persis dan detai
keadaan
pemohon
surat
keteragan kurang mampu. Untuk
itu seleksi aparat desa diharapkan
lebih
ketat
lagi
dalam
mengeluarkan surat keterangan
kurang mampu. ujar Y.
Sejak Januari sampai Juni 1995,

tercatat 271 pasien kurang
mampu telah dibantu biaya
perawatannya oleh pihak RSUP.
Sedangkan
sebelumnya
dari
Januari-Desember 1994 tercatat
606 pasien kurang mampu yang
telah ditolong. Itu berarti 877
pasien kurang mampu ditolong
keringanan biaya perawatannya
oleh RSUP. Dari jumlah tersebut,
Kabupaten Badung menempati
posisi paling tinggi sebanyak 179
orang, menyusul Gianyar 171
orang , Tabanan 150 orang,
Karangasem 97 orang, Kodya
Denpasar 75 orang, Klungkung
52 orang, Singaraja 50 oarang,
Jembrana 43 orang, Bangli 42
orang, Banyuwangi 9 orang,

Timtim 4 orang, NTB 3 orang, dan
NTT 1 orang.
Sementara jumlah tempat tidur
yang tersedia di RSUP sebanyak
752 buah, masing-masing VIP A
17 buah, VIP B 18 buah, VIP C 15
Buah, dan sisanya tempat tidur
kelas I, II, III, dan biasa.
Sedangkan tarif yang diberikan
untuk tempat tidur berkelas VIP A
Rp 100.000, VIP B Rp 70.000,
VIP C Rp 55.000, kelas I Rp
30.000, kelas II Rp 15.000, dan
kelas III Rp 4.000 per hari. Dari
sinilah
keuntungan
yang
diharapkan dapat membantu para
penderita kurang mampu yang
masuk RSUP.
Bali Post, Selasa, 20-6-1995
Masalah Pasien Kurang Mampu

DPRD Pertanyakan Keluhan RSUP
Denpasar (Bali Post)
Keluhan RSUP Denpasar tentang terus
meningkatnya jumlah pasien kurang mampu
yang datang berobat (Bali Post, 19/6))
durasakan sebagai hal yang mengherankan
oleh Komisi E DPRD Bali. Karena dalam
kunjungan terakhir Komisi E ke RSUP sekitar
dua bulan lalu, didapat masukan jumlah pasien
yang menggunakan kartu miskin menurun,
bahkan banyak orang yang kurang mampu
tidak menunjukkan surat keterangan miskin
karena malu.
Mungkin awal Juli nanti sebagai bagian dari

acara rapat koordinasi dengan berbagai
instansi yang merupakan mitra kerja Komisi E.
tegasnya.
Berkenaan dengan jumlah pasien kurang
mampu yang lebih banyak datang dari daerah
yang memiliki pendapatan per kapita tinggi
seperti Badung, Tabanan, dan Gianyar,
anggota Komisi E lainnya, S berpendapat,
masalah ini harus dikaji lebih mendalam.
Demikian keterangan yang dihimpun Bali Post

dari beberapa anggota Komisi E DPRD Bali,
Senin (19/6) kemarin. Ketua Komisi E APN
mempertanyakan, apakah hanya dalam waktu
singkat sudah terjadi perubahan. Kami akan
mengadakan pertemuan dengan pihak RSUP
untuk mendapatkan masukan lebih rinci.
107

Bisa saja suatu daerah pendapatan per
kapitanya tinggi tetapi banyak masyarakat yang
tergolong kurang mampu. Mungkin ada
kesenjangan pendapatan di mana sebagian
kecil masyarakat pendapatannya sangat tinggi
dan sebagian lainnya rendah. Kemudian
setelah
dirata-ratakan
pendapatan
per
kapitanya tinggi, ujarnya.
APN kemudian menambahkan sama saja
dengan desa tertinggal. Belum tentu penduduk
di desa tertinggal tergolong kurang mampu.
Misalnya
Kintamani,
di
sana
banyak
penduduknya kaya-kaya, tandasnya.
Dia menambahkan, Kami sebagai wakil rakyat

juga menghimbau agar pihak RSUP tetap
mengutamakan fungsi sosialnya dibandingkan
masalah
administrasi.
Bagaimanapun
masyarakat miskin tetap harus dibantu. Kalau
ada masyarakat miskin terlanjur datang ke
rumah sakit, apakah harus ditolak? Saya kira
tidak. RSUP perlu mementingkan aspek sosial
daripada urusan administrasi. ujarnya.
Direktur RSUP dr. IGLMR menegaskan,

peningkatan jumlah pasien tidak mampu
sebenarnya tidak berpengaruh terhadap
keberadaan RSUP asalkan tempat tidur
berkelas penuh. RSUP yang kini memiliki
Baik APN maupun S juga melihat ada hal lain status
swadana,
lanjut
dia,
tetap
yang perlu dipertimbangkan. Menurut mereka, mengutamakan aspek sosialnya. (jas)
kesadaran penduduk di Badung, Tabanan, dan
Gianyar mungkin lebih tinggi daripada
kabupaten lain. Meski tergolong tidak mampu,
tetapi karena daerahnya relatif lebih maju,
penduduk di tiga kabupaten itu memiliki
kesadaran untuk berobat ke rumah sakit
dibanding tempat lain seperti ke dukun.
Sebaliknya, penduduk tak mampu di kabupaten
lain lebih memilih ke dukun. Jadi kelihatannya
jumlah penduduk miskinnya lebih sedikit, tutur
S.
Kriteria harus jelas

Sebelumnya pihak RSUP juga meminta agar
aparat desa melakukan seleksi yang lebih ketat
dalam memberikan surat keterangan miskin.
Karena, menurut Y, tidak masuk akal daerah
yang pendapatan per kapitanya tinggi memiliki
banyak masyarakat miskin.
Terhadap hal ini APN, yang juga Ketua FKP
menegaskan, pemberian surat keterangan
miskin harus mengikuti kriteria yang ada.
Berdasarkan kriteria itulah kemudian ditetapkan
apakah seseorang tergolong miskin atau tidak.
Saya kira kriteria ini perlu diikuti dalam
mengeluarkan surat keterangan miskin. Jangan
sampai masyarakat merasa aparat desa pilih
kasih. Kalau sudah begitu masyarakat bisa
ribut. ujarnya.
108
Study Guide Community-Based Practice
2015
Bali Post, Jumat, 23 September 1983
KORBAN KANKER TERBANYAK PENDUDUK

PEDESAAN, TINGKAT SOSEK RENDAH Perlu
Penyebarluasan Pencegahan Lewat PKK dan Media Massa
Denpasar (Bali Post). Korban
kanker terbanyak penduduk
pedesaan, kaum Ibu dan anakanak. Data di RSUP Sanglah
menunjukkan dari 296 kasus
yang diteliti, ternyata 87,50
persen penderita dari golongan
petani, 5,07 persen pegawai,
4,73
persen
pedagang.
Sisanya 2,7 persen tidak
diketahui
profesinya.
Data
tersebut memberi petunjuk
golongan masyarakat yang
tingkat
sosial
ekonominya
rendah paling banyak diancam
jiwanya oleh penyakit ganas
itu.
Data tersebut terungkap dalam
seminar di auditorium unud,
Kamis,
22/9
yang
diselenggarakan dalam rangka
dies natalis Unud ke-21.
Tindakan pencegahan lebih
baik daripada pengobatan yang
sampai saat ini belum berhasil
diselesaikan secara tuntas.
Pengobatan
hanya
untuk
memperpanjang
penundaan
kematian.
Dalam hubungan tersebut,
rektor Unud, dr. IBO dalam
sambutannya
pada
acara
pembukaan
seminar
menyarankan
pengetahuan
tentang kanker dan cara
pencegahannya
disebarluaskan
kepada
masyarakat, misalnya melalui
kaum
Ibu
sebagai
juru
penerangnya di masing-masing
rumah tangga. Penyebarluasan
ini juga penting disalurkan
lewat PKK dan media massa.
Masalah
pemberantasan
penyakit kanker yang semakin
tumbuh,
menjadi
semakin
penting. Lebih-lebih dikaitkan
dengan upaya meningkatkan
kesejahteraan umum. ujar
rektor.
Rektor IBO juga menghimbau
dilakukan pengawasan yang
baik
lewat
pelayanan
wisatawan,
seperti
pengawasan
kesehatan,
kebersihan lingkungan dan
kebersihan
makanan
dan
minuman di bar dan restauran.
Tempe Bosok
Dr. DNS mengungkapkan salah
satu
penyebab
timbulnya
kanker adalah virus cendawan
kuning beracun yang terdapat
dalam oncom, tempe bosok,
kecap, kacang, kool, kelapa,
ketela, dll. Juga disebabkan
oleh faktor keturunan, ujar dr.
AH, disamping zat-zat kimia,
zat warna merah, perekat,
iradiasi.
Pengobatan dilakukan dalam
berbagai tingkat, yakni antara
lain
dengan
pembedahan,
radiasi,
kombinasi
bedah,
diikuti radiasi dan kemoterapi
yang
lazimnya
dilakukan
sebagai tindakan paliatif.
Prof. Dr. IGPA menyinggung
terdapatnya
pengobatan
kanker
secara
tradisional
seperti menggunakan ketela
gendruwo di salah satu rumah
sakit di Jakarta Barat. Di
beberapa
daerah
lainnya
seperti Sulsel, cara pengobatan
dilakukan dengan memakai
ramuan dedaunan pada kanker
payudara, seperti daun siput
kuning
dicampur
kumis
kucing dan kapur sirih
ditambah air digunakan untuk
mengompres payudara yang
diserang oleh tumor. Di Sulsel
juga dilakukan pengobatan
dengan menggunakan besi
pijar disertai mantra-mantra,
pengobatan
dengan
pijat,
dengan
kekuatan
batin,
mediasi dll.
Seminar
yang
menarik
perhatian
besar
itu
menampilkan
delapan
pembicara yakni Prof. Dr. IGPA
mengenai Kanker Masalah
Kita:, dr. IBCM Beberapa
informasi kanker buah dada,
dr. IGPS Kanker rahim, dr.
WS Beberapa aspek Kanker
Nasofaring di RSUP Sanglah,
dr. DSN Kanker Hati, dr. AH
Kanker Darah pada Anakanak, dr. GRT Kanker Mata
yang
Ganas.
Seminar
dikoordinasikan oleh panitia
penyelenggara diketuai dr. IBT
ANNEX -3
ARTIKEL
JURNAL
1. Dengue and other common causes of
acute febrile illness in Asia: an active
surveillance study in children (Day 14)
2.Bacterial Vaginosis in Female Fascility
Workers in North-Western Tanzania:
Prevalence and Risk Factors (Day 14)
3.Tobacco Smoking as a Risk Factor for
Depression. A 26-year population-based
follow up study (Day 16)
4.Risk of Herpes Zoster among Patients
with Chronic Obstructive Pulmonary
Disease: a population-based study (Day
16)
5.Prolonged breastfeeding reduces risk of
breast cancer in Sri Lankan women: A
case-control study (Day 17)
6.Risk factors for psoriasis: a case control
study (Day 17)
7. Clinical efficacy and safety of a novel tetravalent
dengue vaccine in healthy children in Asia: a phase 3,
randomized, observer-masked, placebo-controlled trial
(Day 18)
Skill Lab
DATA
ANALYSIS
USING COMPUTER
TOPICS:
- Skill Lab 1: Data Entry Structure, Data Entry,
Data Cleaning, DataTransformation
- Skill Lab 2: Presenting and Describing Data
(Table and Graph)
- Skill Lab 3: Correlation and Regression,
Hypothesis Testing of Categorical and
Interval Data, Survival Analysis
SKILL LAB MANUAL

BLOCK COMMUNITY-BASED PRACTICE
Skill Lab 1
Preparing Data Entry Structure
Before preparing structure of data entry, please recall types and classification
of data and variables, and structure of variables regarding to data entry.
1. To make data entry structure consisting of number, variable name, variable type,
width, decimal, variable labels, value labels, and missing values
a. Use the variables in Annex 1 (Data collection form) to make data entry structure and
Annex 2 (Data skill lab) for data entry practice.
b. Open SPSS program, click Variable View. Make the variables structure
(name, type, width, decimal, variable labels, value labels, and missing values),
beginning with variable: nomor, nama, area . . . . . . . . etc. (Refer to variable
structure for data entry).
c. Save the file you just made, make your own folder and give the name of this file.
d. Notice the variables BBpre (BB before intervention) and BBpost (Bb after
intervention)! These variables are a pair (two) of variables of one individual
(examination of body weight level before and after intervention). It is important to
remember in-paired or dependent tests such as paired test e.g.: paired-sample test,
matched-pair test.
2. Data entry. To practice, use the data Annex 2 . Type the data of variables for ten
recods only.
3. Data cleaning. A very important step that must be done before data analysis.
Think of the errors which might occur during data entry. It can be shown by looking
for the minimum, maximum, or extreme values, and the average values of the
variables.
What should the minimum, maximum, and the mean values of numeric variables be,
and what the normal values of the variables are. Just think about it!
a. Open skill lab raw.sav file, look at the value labels of every variable. Numeric
variable doesnt have value labels, Write the minimum and maximum values of all
categorical variables and the anticipated mean for numerical variables.
b. In this case, to some extent data analysis will be done.
Method: Open skill lab raw.sav file (if it hasnt so). For numeric variable, use the
menu Analyze, Descriptive Statistics, choose and click
Descriptives..., click and move variables to be analyzed to the
[Variable(s)] box. Click [Options...] box, leave [Descriptives:
Options] window (mean, minimum, and maximun had been marked),
click [Continue] box and [OK] box to finish the process.
Watch the results . Note if there is any extreme values that might
be incorrect (below the minimum or above the maximum values), or
whether the mean is in between or out of the range of normal value (eg.
the mean of BB above 150 cm).
c. For categorical variable look for frequencies of the categories
Method: Open skill lab raw.sav file (if it hasnt so).
Use and click the menu: Analyze, Descriptive Statistics, choose and
click Frequencies, click and move variables to be analyzed to the
[Variable(s)] box. Click [Statistics] box Click minimum and
maximum in the [Dispersion] box, click [Continue] box and [OK] box
to finish the process See the results . Take note if there are any
values beyond the value labels.
Of point b and c, take note of the variables that have incorrect values and the values
supposed to be incorrect.
d. To display the incorrect data
Method: Open Skill Lab Raw.sav file (if it has not be opened yet).
Use the menu: Data, choose Select Cases, click if condition is
satisfied in the [Select] box, click if and type the condition of the
incorrect data to be looked for in the blank box in the [Select cases]
window.
To display the incorrect data use and click the menu: Analyze,
Reports, choose and click Case Summaries, type the specification of
data to be displayed in the [Variables] box of the [Summarized cases]
window, e.g. variables name, record number, etc. Click [OK] box to
finish the process. Specifications of the data will make easier to find the
incorrect data to be corrected.
e. Data correction
Method: Open skill lab raw.sav file (if it hasnt so).
Use and click the menu: Data View . place cursor on the variable
column of the incorrect data. Use the menu: Edit, Finds, type the
incorrect value of the data in the [Find what] box, click Find next, ..
cursor will move to the incorrect data, . replace the incorrect data
with the correct value.
f. Save this corrected file for further analysis!
4. Data Transformation (Grouping)

In some cases, its very important to transform numeric variable to catego-rical
variable, even categorical variable to other categorical variable of difference
categories.
For instance: age can be grouped into several categories of five-year inter-vals,
formal educational level to three categories, e.g. high, middle, and low level of
education.
Another example, to make an indicator (composite index) based on two or more
variables, e.g. BMI (body mass index) based on BW (body weight) and H (height).
A new variable must be made based on some existing variables. This new variable can be
numeric or categorical. BMI is a numeric variable and can be trasformed to categorical
variable.
a. To make a new categorical variable from quantitative/interval data or numeric/interval variable. Make a note of categorical value. ....... Use the menu:
Transform, Recode, Into Different Variables. (Use Skill Lab Raw.sav file).
Method: Open skill lab.sav file.
Use and click the menu: Transform, choose Recode, choose and
click Into Different Variables, choose and move the variable to be
recoded to [Input Variabel:] box, .... type the new variable name in the
[Output Variabel:] box, .... click Change, .... click Old and New
Values, . give a new code/value (must be integer) for every new
category.
To practice: transform variables pendidikan to tk_pendidikan, umur to
Klp_umur, hb to anemia, based on the following classi-fication!
- pendidikan to tk_pendidikan (two categories): 1. Low education (tdk
pernah sekolah-SMP); 2. High Education (SMA PT)
- umurAnak to Klp_umur (three categories): 1. Bayi (0-11 months); 2.
Batita (12-35 months); 3. Balita (36-59 months).
- hb to anemia (two categories): 1. Anemia ( 11 g/dL); 2. Normal (>

11 g/dL).
Edit these new variable structures (type, width, decimal, label, and
values).
b. To make composite index
To make an indicator of obesity using BMI (Body Mass Index) based on tb (tinggi
badan, height) and bb (berat badan, body weight). From data we can compute
BMIpre dan BMIpost.
Furthermore, BMI can be transformed to categorical variable as described before (1.
< 17,0: kurang BB tingkat berat, severe underweight, 2. 17,0-18,5: kurang BB
tingkat ringan, mild underweight, 3. 18,5-25,0: normal, 4. >25-27,0: kelebihan BB
tingkat ringan, mild obesity, 5. >27,0: kelebihan BB tingkat berat, severe obesity).
Formula: BMI = BB (kg)2/TB (m)2.
Remember that BMI formula for TB is in metre; therefore you need to
compute the TB in cm into m.
Use and click the menu: Transform, click Compute..., Compute
Variable window will appear, .... type TBmetre (new variable name) in
the [Target Variable:] box, .... type the equation (TB/100) in the
[Numeric Expression] box click [OK] box
Then continue to compute BMI variable:
Use and click the menu: Transform, click Compute..., Compute
Variable window will appear, .... type bmipre (new variable name) in
the [Target Variable:] box, .... type the equation to compute bmi in
[Numeric Espression] box (BBpre/TBmetre2), .... click and move
variable BBpre to the [Numeric Expression:] box, .... click (/)
(devide symbol), .... click (() (left bracket), .... click and move
variable tbmetre to the [Numeric Expression:] box, .... click (*) (star
symbol), .... click and move variable tbmetre to the [Numeric
Expression:] box, .... click ()) (right bracket), then .... click [OK]
box to finish the process. .... A new variable (imt) has been created
containing the results of the calculation of the equation just made. .....
Edit the new variable structure, imt (type, width, decimal, label, and
values).
Skill Lab 2
a.
Presenting and Describing Data

Frequency Distribution Tables and Graph
Tables and graphs can be used to present data/variables. Use narration to describe
the conclusion of the table and graph. One-way tables can be used to present
categorical variables. While association of two or more categorical variables can be
presented using cross-tables.
Graph/chart presentation can be used for either categorical or numeric variables,
single or associations of two or more variables.
Narration is used to describe the conclusion as depicted by the table or graph, e.g.
frequencies, mean, minimum and maximum values, modus, etc.
For those purposes, tables or cross-tables and graphs are needed to be made.
Conclusions of the tables and graphs are presented narratively such as some values
depicted by the tables and graph (average and spread).
1. Presentation of discrete quantitative data is the same as categorical data (qualitative
variable)
a. To make frequency distribution tables, to calculate average and spread, e.g.: mean,
minimum and maximum values, SD, modus, percentiles, etc., use the menu:
Analyze, Descriptive Statistics, Frequencies.
Method: Open skill lab.sav file (if it hasnt so).
Use and click the menu: Analyze, choose Descriptive Statistics,
choose and click Frequencies..., chose and move the variable(s) to be
analysed (paritas) to the [Variable(s):] box in the Frequencies window.
- Leave Display frequency tables (had been marked)
- For statistics option, .... click [Statistics...] box, .. choose the
appopriate statistics in the [Percentile Values, Central Tendency,
Dispersion] box in the [Frequencies: Statistics window].
- For graph options, .... click [Charts...] box, .. choose the
appopriate chart options in the [Chart Type] box, e.g.: bar, pie, or
histogram (with normal distribution) in the [Frequencies: Charts]
window.
click [Continue] and [OK] box to finish the process.
b. For quantitative data (continuous), calculate the mean, minimum, and maxi-mum
values, SD; use the menu: Analyze, Descriptive Statistics, ... choose and
click Descriptives
Method:
Open skill lab.sav file (if it hasnt so).

Use and click the menu: Analyze, choose Descriptive Statis-tics,
choose and click Descriptives, choose and move the variable(s)
(hbpre) to be analysed to the [Variable(s):] box.
- For descriptive statistics, click [Options] box, .. choose and
marked () the appropriate statistics in the [Dispersion] box, e.g.:
mean, minimum, maximum, and SD) in the [Descriptive: Option]
window. ..... Click [Continue] and [OK] box to finish the process.
c. For more statistics options, including trimmed mean, outliers, CI (Confidence

Interval), percentiles, normality test, plot, etc.: .. use the menu: Analyze,
Descriptive Statistics, Explore
Method:
Open Skill Lab.sav file (if it hasnt so).

choose and click Explore..., [Explore] window will be displayed.
Choose, click and move the variable(s) will be analysed (hbpre) to the
[Dependent List:] box, .. Leave [Display] box (Both had been
marked), ..... click [Statistics...] box for statistic options (e.g.
descriptives, outliers), .. click [Conti-nue] box. .... Click [Plots...]
box (for graph options: Boxplots, Descriptive, Normality Plots with
Test) ..... click [Continue] box. ..... Click [OK] box to finish the
process.
Normality test of data is required in hypothesis test, e.g.: T-test, Analysis
of Variance, Correlation, and Multiple Regression.
2. Cross tabulation is used to analyze the association of two categorical variables

(dicotomous or multicotomous). It can be descriptive or analytic analysis. If the
variables can be classified as dependent or independent variables, the depen-dent
variable should be placed as column variable and the independent variable as row
variable. Row, column, and total percentages should be considered according to the
methodological design. .. use the menu: Analyze, Descriptive Statistics,
Crosstabs
choose and click Crosstabs..., [Crosstabs] window will be displayed,
..... choose and move the variables to be analysed (choose kab as row
variable and BBpre as column variable), ..... choose and move the
variable kab to Row(s): box, and the variable BBpre to Column(s): box,
.. click the [Statis-tics...] box (for statistic options: statistic test,
association), click [Continue] box (Return to [Crosstabs] window),
.. click the [Cells...] box (for persentage options: row, column, and
total percentages). To display the chart, ..... click Display clustered
bar charts. ..... click [OK] box to finish the process.
B. Presenting and Describing Data

Continued: Frequency Distribution Tables and Charts
1. To Make Several Types of Charts
Other software such as Microsoft Office (Microsoft Word) can be used to make charts.
It is more variative and practical, easier, and yields better results.
The type of charts to be used to present the data depends on the type of
data/variables and the number of variables. Based on these, the appropriate type of
charts should be thought about.
a. One categorical or numeric (discrete) variable: use bar, pie, line chart,
histogram. (Bar, pie chart, and histogram, can be made in the chart options of
frequency distribution analysis).
Use and click the menu: Graphs, choose and click the type of graphs
(Bar..., Line..., Pie..., Area..., Histogram..., etc.), .... Bar... for
example. [Bar Charts] window will be displayed. ..... Click the type
of chart ( click Simple), .... click Summaries for groups of cases in
[Data in Chart Are] box, .... click the [Define] box, .... [Define Simple
Bar: Summaries for group of cases] window will be displayed click N
of cases or % of cases options in the [Bar Represent] box to display
value labels, .... choose and move the variable (choose paritas) for the
chart to the [Category Axis:] box, click OK to finish the process.
b. Two or more variables:
- Two categorical variables .. choose bar chart (clustered or stacked),
type: Summaries for groups of cases for displaying data in Persentage;
You need make two categorical variabels (if it hasnt so). For example
transform the paritas variable and categorized it into <3 and >3.
Transform hemoglobin variable into anaemia (<11 g/dl) and not anaemia
(11 g/dl and above)
Use and click the menu: Graphs, choose and click Bar [Bar
Charts] window will be displayed. ..... Click the type of chart ( click
Clustered or Stacked,), .... click Summaries for groups of cases in
[Data in Chart Are] box, .... click the [Define] box, .... [Define Simple
Bar: Summaries for group of cases] window will be displayed click N
of cases or % of cases options in the [Bar Represent] box to display
value labels, .... choose and move grouping variable (parity= <3 & >3)
for the chart to the [Category Axis:] box, .... choose and move
anemipre to [Define Clusters by:] box), .... click OK to finish the
process.
. . . . . . Follow this procedure to practice making the other charts. Other
example is graph of age (year) with Hb (anemia/not anemia). First, you need
to transform the continuous variabel in to categorical
The process is almost similar . . . . . . . . .
- More than two variables (one categorical variable for X axis, and two numeric
variables for Y axis) .. choose bar chart (Clustered or Stacked), type:
Summaries of separate variables to display Mean);

Use the menu: Graphs, choose Bar..., and click Clustered or
Stacked click Define, choose variables for the graph, ..
(choose and move age (categorical variable) into Category Axis:
box, and BBpre and BBpos into Bar Represent Box. .... click [OK]
box to finish the process.
- Two continuous or ordinal variables for X and Y axis respectively ..
choose scatter diagram (type: simple).
Use the menu: Graphs, choose Scatter/Dot..., [Scatter/ Dot]
window will be displayed, and click Simple, ..... click [Define] box,
[Simple Sacatterplot] window will be displayed, ..... choose the
variable for the graph, .. (choose BBpre for X axis and BBpos for
Y axis). ..... click [OK] box to finish the process.
- Two variables, one categorical variable for X axis and one quantita-tive
(continuous/discrete) variable for Y axis. choose boxplot (type:
simple, choose and click Summaries for groups of cases for Data in Chart
Are options).
*) If two numeric variable will be displayed separately, choose Clustered, and
click Summaries of separate variables in the [Data in Chart Area] box.
Use the menu: Graphs, choose and click boxplot..., [Boxplot]
window will be displayed, ..... click Simple for chart option, and click
Summaries for groups of cases in the [Data in Chart Are] box, .....
klik Define, choose variable for the chart, .. (choose and
move BBpre or BBpos into [Variable:] box, and age (first: recode
age into year) into Category Axis: box). .... Click [OK] box to finish
the process.
Method*): Open Skill Lab.sav file (if it hasnt so).
Use the menu: Graphs, choose and click boxplot..., ..... [Boxplot]
window will be displayed, ..... click Clustered for chart option, and
click Summaries of separate variables in the [Data in Chart Are]
box, ..... klik [Define] box, choose variable for the chart, ..
(choose and move BBpre and BBpos into [Variable:] box, and
age (year) into [Category Axis:] box). .... Click [OK] box to finish
the process.
- One numeric variable for Y Axis, one categorical variable as grouping variable
for Y Axis, and one categorical variable for X Axis . choose boxplot (type:
clustered, and click Summaries for groups of cases for Data in Chart Area
options).
Method: Open Skill Lab.sav file (if it hasnt so).
Use the menu: Graphs, choose boxplot..., [Boxplot] window will

be displayed, ..... click Clustered for chart type, click Summaries
for groups of cases options in [Data in Chart Are] box, ..... click
Define, choose the variable for the chart to be made, (choose
and move age (year) into [Category Axsis:] box, ..... choose and
move kab into [Define Clusters by:] box, and BBpre or BBpos into
Variable box). .... Click [OK] box to finish the process.
- Two numeric variables for Y Axis, and one categorical variable for X Axis,
choose boxplot (type: clustered, and Summaries of separate variables for
Data in Chart Area options). (Choose parity for X Axis, and BBpre and BBpos
for Y Axis).
Method: Open Skill Lab.sav file (if it hasnt so).
Use the menu: Graphs, choose boxplot..., [Boxplot] window will
be displayed, ..... click Clustered for type of chart, ..... click
Summaries of separate variables options in [Data in Chart Are] box,
..... click Define, choose the variables for the chart to be made,
.. choose and move paritas into [Category Axis:] box, and
BBpre and BBpos into [Boxes Represent:] box. ..... Click [OK]
box to finish the process.
2. Graph Editing for Better Presentation
Method: Double-click the chart will be edited, click the part/component of chart to
be edited, chose the appropriate menu to edit the com-ponent of the
chart. Just do the same process for the other component .. (Trial and
Error, patient ....... are absolutely required).
For black and white printing, using pattern will be better than using color for
fill color, and dash style will be better than line color.
Skill Lab 3
A. Correlation and Regression
Linear Correlation
Coefficient correlation (r) is an indicator of association of two numeric or interval
variables. The values ranged between -1 and +1. The number depics the strength of
the association, while the or + values depict the direction of the association. The
data should be normally distributed. If it isnt so, non-parametric analysis should be
choosen (Remember Pearson coefficient correlation and Spearman rho).
1. Coefficient correlation. It doesnt show the causal-effect association or classify the
variables to neither dependent nor independent variables. To com-pute coefficient
correlation, choose the menu: Analyze, Correlate, Bivariate
Method:
Open skill lab.sav file.
Choose the menu: Analyze, Correlate, choose and click Bivariate...,

choose and move the variables will be analysed into [Variables:] box,
(paritas, Hb, BBpre, and BBpos), ..... in the [Correlation Coefficients]
box, choose and click Pearson (if the data are normally distributed), or
Kendalls tau-b or Spearman (if the data are not normally distributed), ..
click Options for statistic options, ..... [Bivariate Correlation Options]
window will be displayed, ..... click the appropriate statistics in the
[Statistics] box. .... Click [OK] box to finish the process.
2. Regression, is used to predict the value of one dependent variable (Y) based on one
or more independent variables (X or X 1, X2, X3.......). The variables must be numeric or
ordinal. The term Multiple Regression is used if the independent variables are more
than one. To predict the value of Y variable based on the change in value of one or
more X variables, choose the menu: Analyze, Regression, Linear
. . . . Not to be discussed in this lecture . . . . Only for who is intrested in.
Method: Open skill lab.sav.sav file (if it hasnt so).
Choose the menu: Analyze, choose Regression, choose and click
Linear..., [Linear Regression] window will appear. ..... Choose and
move the dependent variable into [Dependent:] box, and the independent
variable(s) into [Independent(s):] box (more than one variables for multiple
regression) .. click [Statistics:] box for statistic options, ..... choose
and click the appropriate statistic options in the [Linear Regression:
Statistics] window .. click [Plots:] box, ..... click the appropriate
options, .. Then click [OK] box to finish the process.
Equation: Y = a + b1X1 + b2X2 + b3X3.........
a = intercept
b = slope (regression coefficient)
B. Significancy Test for Categorical Data

There are three types of Significancy Tests for Categorical Data: single proportion for one
dicotomous variable, two proportions of two dicotomous variables, and more than two
proportions. Two proportions of two dicotomous variables in the form of 2 by 2 table (fourfold table), the larger contingency tables if the categories are more than two.
1. Significancy Test for Single Proportion (Nonparametrik: Binomial test). This
significancy test is used to test a single proportion of one dicotomous vari-able (can be
multicotomous and specify the cut point; cut point must be one of the categories).
Use the menu: Analyze, Nonparametric Test, Binomial
Use menu Analyze, choose Nonparametric Tests, choose and click
Binomial..., choose and move the variabel to be analyzed (choose
anemia) to the [Test Variable Lists:] box, .. type the specified test
proportion in the [Test Proportion:] box, ..... in the [Define Dichotomy:]

box, ..... choose and click Cut Point (misal=12) type the specified
category as cut point in the box. ..... Then click [OK] box to finish the
process.
2. Significancy Test for Two Proportion (independent and paired test): four-fold table
and larger contingency table
Remember the condition required for Chi-square test:
Significancy test for 2 by 2 table, if the condition does not meet
the require-ment. If it is so, what should be done for a larger contingency table.
The significancy test for 2 by 2 table for dependent sample or
paired sam-ple.
Remember the expected frequency less than 5, 2-test,
McNemar test, Fishers Exact Test, regroup of column or row.
Recall the placement of dependent and independent variables,
row and column percentages related to the methodology design.
-
a. Independent significancy test for two proportions (two dicotomous vari-ables).

Use menu: Analyze, Descriptive Statistics, Crosstabs
Use menu: Analyze, choose Descriptive Statistics, ..... choose
and click Crosstabs..., [Crosstabs] window will be displayed, .....
choose and move area (independent variable) to [Row(s):] box, and
anemia (dependent variable) to [Column(s):] box, ..... click
[Statistics] box, ..... [Crosstabs: Statistics] window will be displayed,
choose and click Chi-square (for statistical test) and Risk (for:
RR and OR), ..... click [Continue] box (Return to [Crosstabs]
window), ..... click [Cells] box, .. [Crosstabs: Cell Display]
window will be displayed, .. click Row and Column to display Row
and Column Percentages. ..... Then click [Continue] and [OK] box to
finish the process.
- Output: Chi-Square Test, .. See p (Asymp Sig.) of Chi-Square
or Yates Continuity Correction (for less than 20 sam-ples).
- See Expected Frequency that less than 5. If more than 20% of the
total cells, . use p (Exact Sig.) of Fishers Exact Test.
- Risk Estimate, . use Odds Ratio for case-control design
(OR), or for Cohort (RR) of risk factor and not risk factor for Cohort
design.
b. Dependent significancy test for two proportions (two dicotomous vari-ables,
paired sample test). Use menu: Analyze, Descriptive Statistics, Crosstabs
Use menu: Analyze, use Descriptive Statistics, ..... choose and
click Crosstabs..., [Crosstabs] window will be displayed, .. choose
and move the paired variables, one variable to [Row(s):] box, and the
other variable to [Column(s):] box, .. click [Statistics:] box, .....

[Crosstabs: Statistics] window will be displayed, .. click McNemar
(for statistical test), . click [Continue] box (Return to [Crosstabs]
window), ..... click [Cells:] box, .. click Row or Column (to display
Row or Column Percentages). ..... Then click [Continue] and [OK] box
to finish the process.
SPSS Program doesnt provide facility to compute OR for depen-dent
sample or paired-sample test. OR can be easily computed manually using
the equation: OR = b/c.
C. Significancy Test for Interval Data

Statistical test for two samples mean, independent and dependent or pairedsample test
1. Remember the condition required for the test (normality distribution of the
data).
2. Use non-parametric test if the condition does not meet the requirement.
3. For independent-samples T test, read the Levene test to make conclu-sion of
the results.
Variable consideration: dependent or test variable should be numeric or interval, and
the independent variable should be dicotomous variable.
Recall normality test of data, 1-Sample K-S and Explore
a. Test the normality of BBpre using non-paramtric Kolmogorov-Smirnov test, Use
menu: Analyze, Nonparametric Tests, 1-Sample K-S.
Use and click menu: Analyze, choose Nonparametric Tests, choose
and click 1-Sample K-S..., [One-Sample Kolmogorov-Smirnov Test]
window will be displayed, ..... choose and move the test variable (choose
BBpre) to [Test Variable List:] box, .. click Normal in the [Test
Distribution] box. ..... Then click [OK] box to finish the process.
b. Normality test based on grouping variable, ..... Use and click menu: Analyse,
Descriptive Statistics, Explore...
Method: Open skill lab.sav file (if it hasnt so)
Use and click menu: Analyze, choose Descriptive Statistics, .....
choose and click Explore..., [Explore] window will be displayed, .....
choose and move the test variable (BBpre) to the [Dependent List:] box,
and grouping variable (area) to the [Factor List:] box, .. leave the
Display box, .... click the [Statistics] box, ..... [Explore: Statistics]
window will be displayed, ..... click the appropriate statistics options, ....
click [Continue] box, ..... click the Plots box, ..... [Explore: Plots]
window will be displayed, .. click the appropriate options (the most
important is Normality plots with test, and Power estimation), .... click
[Continue] box, and [OK] box to finish the process.
c. Use Levene test for equality of variances testing. It doesnt need to do this separately,
because it has been included in T test.
d. Whatever the result was, normal or not, assume that the data is normally distri-buted
and it is not normally distributed), .. go further to T-test. Assume that the
distribution of the data is normal 1) Use and click menu: Analyze, Compare
Means, One-Sample T Test (for a single mean test), 2) Use and click menu:
Analyze, Compare Means, Independent-Samples T Test .. (for independentsamples), and 3) Paired-Samples T Test (for dependent/pair-ed-samples).
1. Statistical Test for One-Sample T Test

This significancy test is used to test the mean of a sample compared with a specified
value (standard or determined by the investigator).
Method: - One-Sample T Test
Open skill lab.sav file (if it hasnt so).
Use and click menu: Analyze, choose Compare Means, ..... choose
and click One-Samples T Test..., [One-Sample T Test] window will be
displayed. ..... click and move the test variable (BBpre) to the [Test
Variable(s):] box, ..... type the standard value (or determined by the
investigator; example=15kg ) in the [Test Value] box, leave the
Options box, and ..... click [OK] box to finish the process.
2. Statistical test for two-samples mean, independent and paired-sample test

- If the data is normally distributed
Method: - Independent-Sample T-Test.
Open skill lab.sav file (if it is not already open).
and click Independent-Samples T Test..., [Independent-Samples T
Test] window will be displayed, ..... choose and move the test
variable (BBpre) to the [Test Varible(s):] box, and the grouping variable
(area) to the [Grouping Variabel:] box, .. click [Define Group...]
box, ..... [Define Groups] window will be displayed, ..... type code
of categories (must be integer) of the grouping variable in Group 1 and
Group 2 box respectively, ...... click [Continue] box, ..... and then, .....
click [OK] box to finish the process.
Method: - Paired-Samples T Test.

Use and click menu: Analyze, choose Compare Means, ..... click
Paired-Samples T Test..., [Paired-Samples T Test] window will be
displayed,.. choose and move the paired-variables (BBpre and
BBpost) to [Paired Variables:] box, ..... and click OK to finish the
process.
- If the data is not normally distributed, use nonparametric test
Use and click menu: Analyze, Nonparametric Tests, choose [2 Inde-pendent
Samples] (for 2 independent samples) or [2 Related Sam-ples] (for 2
dependent samples or paired-samples).
Method: - Nonparametric Test for 2 Independent Samples.
Open
skill
lab.sav
file
(if
it
is
not
already
open).
Use and click menu: Analyze, choose Nonparametric Tests, ....
choose and click 2 Independent Samples..., choose and move the
test variable (BBpre) to the [Test Varible(s):] box, and grouping
variable (area) to the [Grouping Variable:] box, ... click Define
Group, and type the code of categories of grouping variable in Group 1
and Group 2 box respectively, click Continue, choose and click
Mann-Whitney U in Test type: box, click OK to finish the process.
Method: - Nonparametric Test for 2 Related Samples.
Open
skill
lab.sav
file
(if
it
is
not
already
open).
choose and click 2 Related Samples..., choose and move the pairedvariables to be tested (BBpre and BBpost) to [Test Pair(s) List:] box, ..
choose and click Wilcoxon in [Test type:] box, click OK to
finish the process.
3. Statistical test for three or more samples mean, independent and paired sample
test (NOT TO BE DISCUSSED), ....... just for who are interested in.
- If the data is normally distributed
Method: - One-Way ANOVA.
Open skill lab.sav file (if it is not already open).
and click One-Way ANOVA..., [One-Way ANOVA] window will be
displayed, ..... choose and move the test variable (Hb) to the
[Dependent List:] box, and the factor variable (klp_umur) to the
[Factor:] box, .. click [Post Hoc...] box, ..... [One-Way ANOVA:
Post Hoc Multiple Comparisons] window will be displayed, ..... click
Bonferoni or other options in the [Equal Variances Assumed] box, and
Tamhanes T2 or other options in the [Equal Variances Not Assumed]
box, ...... click [Continue] box (Return to [One-Way ANOVA] window.

..... Click [Options] box, ..... [One-Way ANOVA: Options] window
will be displayed, ..... click Descriptive and Homogeneity of
Variance Test in the [Statistics] box, Then, ..... click [Continue] and
[OK] box to finish the process.
- If the data is not normally distributed, use nonparametric test
Use and click menu: Analyze, Nonparametric Tests, choose [K Independent
Samples] (for 2 independent samples) or [2 Related Samples] (for 2
dependent samples or paired-samples).
Method: - Nonparametric Test for 3 or more Independent Samples.
Open
skill
lab.sav
file
(if
it
is
not
already
open).
choose and click K Independent Samples..., [Test for Several
Independent Samples] window will be displayed, ..... choose and
move the test variable (Hbpre) to the [Test Varible(s):] box, and
grouping variable (klp_umur) to the [Grouping Variable:] box, ...
click [Define Range...] box, ..... [Several Independent Samples:
Define Range] will be displayed, ..... and type the minimum and
maximun range of grouping variable in the [Minimum] and [Maximum]
box respectively, ..... click Continue (Return to the [Test for Several
Independent Samples] window, ... click [Options...] box, .....
[Several Independent Samples: Options] will be displayed, .....
click Descriptive and Quartile in the [Statistics] box, ..... click
Continue (Return to the [Test for Several Independent Samples]
window, choose and click Kruskal-Wallis H in Test type: box,
click OK to finish the process.
Annex 1.
Data Collection Questionnaire and Data Entry Structure
DATA COLLECTIONS QUESTIONNAIRE

KUESIONER PENELITIAN KESEHATAN ANAK PROPINSI MERDEKA
1. Nomor
Identitas:
I. IDENTITAS RESPONDEN
1. Nama
:.........................
2. Area
:.........................
3. Pendidikan Ibu
: .
4. Pekerjaan Ibu
: .
5. Berapa jumlah anak yang pernah Ibu lahirkan? . . . . . . . orang.
II. HASIL PEMERIKSAAN LABORATORIUM ANAK
6. Hasil pemeriksaan Hb : . . . . . . . . mg%

7. Hasil pemeriksaan TB : . cm
8. Hasil pemeriksaan BB sebelum intervensi : . . . . . . .kg
8. Hasil pemeriksaan BB setelah intervensi
st . . . . . . . . . . . . . . .
: . . . . . . . kg
DATA ENTRY STRUCTURE

Format variabel
Name
Typ
e
Widt
h
Deci
mal
s
Label
ID
No. urut
Area
Area
tempat
tinggal
nama
Nama
umur
Umur ibu
Pendidika
n
Tingkat
pendidik
an formal
terakhir
Values
Missin
g
1 = Mudah dijangkau,
2 = sulit dijangkau.
1=Tidak Pernah sekolah,

2=Tidak tamat SD
3= SD
4= SMP
5=SMA
6=PT
Pekerjaan
Pekerjaa
n ibu
1= Tidak Bekerja
2=Bertani/berkebun/bert
ernak
3= lainnya
Hb
Kadar Hb
anak
BBpre
BB
sebelum
intervens
i
TB
Tinggi
badan
BBpost
BB
setelah
intervens
i
Pengisian:
- Name (nama variabel), satu kata maksimal 8 huruf jika SPSS versi 12 atau di
bawahnya, tidak boleh ada tanda baca, kecuali tanda (_).
- Type (ingat jenis variabel: numeric/string atau teks, date).
- Width (jumlah digit atau angka yang diperlukan termasuk tanda baca,
koma/titik).
- Decimals (jumlah desimal atau jumlah digit di belakang koma, untuk variabel
numerik).
- Label (jelas).
- Values (jelas).
- Missing (biasa dipergunakan angka 9, sesuaikan dengan jumlah digit).
Annex 2. Skill lab data
S
EARCHING, ANALYSIS, AND
INTERPRETING STUDY RESULT
TOPICS:
Descriptive longitudinal, cross sectional
Analitic cross sectional
Case Control
Cohort
Clinical & Community Trial
Diagnostic Test
STUDENT PROJECT
Abstract
Epidemiologic approaches are utilised to understand the distribution and risk factor of
disease, also to know the effectiveness of an intervention. The understanding of these
concepts assist doctors in diagnosing, developing evidence based therapy and determining
the prognosis of the disease. In community, a doctor is expected to utilise these concepts to
tackle health problems.
This student project aims to help student to gain better understanding about epidemiologic
approaches and the specific attributes in each approach.
Learning task:
1. Each group need to conduct search on scientific publication that using one of the
epidemiology approach (see assignment table for each group).
2. Pay attention on the timeline of this student project
3. Each group need to consult and get approval from the planners on the topic
4. Pay attention on the specific tasks for each approach. Discuss it with your group.
5. Develop short report, maximum 10 A4 pages
6. Make 8 copies of your group reports and submit them to dr. Citra timely
7. Presentation of the student project will be conducted randomly on day 20 th of CBP
block, at the PLENARY SESSION (See the presentation guide)
8. Assessment will be conducted based on several criteria (See evaluation guide)
a. Appropriateness of the answer to the task
b. Participation in group work will be proved by clear job description for each
group member. (dominated work will receive negative mark)
c. Student project will contribute 15% of total CBP block mark.
Table 1. Group assign and epidemiologic approach
No
SGD
Class
Approach
Planners
I, II
Regular
English
Study Descriptive Cross

Sectional
Dr. AyuKartika/dr. Citra
III
Regular
English
Study Descriptive Longitudinal
Dr.AyuKartika/dr. Citra
IV
Regular
English
Study Analytic Cross Sectional
Dr.Septarini
Regular
English
Study Case Control
Dr.Sutarsa
VI
Regular
Study Case Control (Matched
Dr.Sutarsa
English
Pair)
VII
Regular
English
Study Cohort Prospective
Dr.Ariastuti
VIII
Regular
English
Study Cohort Retrospective
Dr.Ariastuti
IX
Regular
English
Study Clinical Trial
Dr.Sawitri
Regular
English
Study Community Trial
Dr.Sawitri
10
XI
Regular
English
Uji Diagnostik
Dr.Artawan
Table 2. Student Project Timeline

No
Date/week Activities
Penanggungjawab
Week II
Searching and consultation with Planners
Planners
Week II
Discussion with group
The chief of SGD
Week III
Report writing
The chief of SGD
Week IV
Report submission to IKK-IKP
The chief of SGD & dr.

Ariastuti
Week IV
Develop presentation slide
The chief of SGD
Week IV
Presentation
The chief of CBP block
Table 3. Task for each approach

No
1
Design
Task
Observational study: cross sectional, case control, cohort (source: STROBE Statement)
Introduction
Explains the study background

Explains the specific objective of the study
Explains the study hypothesis (if available)
Method
Explains the study design and describe important element of the study
Develops study profile
explains the setting, location, relevant date include recruitment period,
exposure, follow up and data collection method
Participant:
(a) Cohort studydescribes eligibility criteria, sources, and selection
method. Explain the follow up method
(b) Case-control studydescribes eligibility criteria, sources and
method to select case and control. Explain the rational in selecting
case and control.
Cross-sectional study describes eligibility criteria, sources, and
selection method
(d)Cohort study For matched studies, explains the matching criteria,
the number of exposed and unexposed group.
(e) Case-control studyFor matched studies, explains the matching
criteriaand number of control per case
Explains the definition of outcome, exposure, predictor, potential
confounder and effect modifier. Explain the diagnostic criteria (if
available)
Explains how to determine sample size
Explains all statistical methods including methods to control
confounding variables
Cohort studyif available, explains how to resolve loss to follow-up
Case-control studyif available, explains how to match between case
and control that was done
Cross-sectional studyif available, explains analytical method that
have done related to sample selection
Result
2
Explains main result of the study
Clinical Trial : (source: CONSORT Statement)

Introduction
Explains the background of the study

Explains the specific purpose of the study
Explains the hypothesis
Methods
Result &
Discussion
Describe the trial design and the attributes including ration allocation
Developa study profile completely including the attributes
Explains the criteria of eligibility for the participant
Explains the settings and location where data collected
Explains the intervention given to each group, including the possibility
of repetition and real of the intervention
Explains specific measurement from primary and secondary outcome
Explains how to determine sample size
If available, explains about analytical interim that was done
Explains the randomization methods
Explains the randomization type and details of the restrictions if
available
Described the procedure that was done until intervention given
Explains who did the randomization, who did the subject inclusion and
and who determine subject allocation for intervention/placebo? Was it
done blinded?
Explains the statistical method used to compare the primary and
secondary outcome
For every primary and secondary outcome, explains the result and
significance
Explains the study limitation, how to resolve bias source, whether any
precision problems
Explains about generalisability (external validity, applicability) of the
result; if available
Diagnostic Test
Introduction
Explains the background of the study

Explains about the special purpose of the study
Explains the hypothesis (if available)
Method
Explains the study design and important part related to the study
design
Develop the study profile
Explains about the relevant setting, location, and date including
recruitment period, exposure, follow up and data collection
Participant: explains the eligibility criteria, source and selection method
Explains the definition of gold standard and diagnostic test. Please
explains the diagnostic criteria if available.
Explains how to determine the sample size
Presentation guideline:
1. Presentation slides:
Maximum 10 slides
Maximum 12 sentences/point per slide, minimum font size 20, font type
ARIAL/TIMES NEW ROMAN/CALIBRI
Minimum animation, simple background
2. Presentation time maximum 12 minutes, followed by 10 minutes discussion

3. Each group will have chance to present their SP as planners will chose presenters
randomly.
4. Please ensure to input all group slides to the computer before the presentation session
begin, and name them as SGD 1, SGD 2 and so on, and put them in to one folder
namely: Student Project Community Based Practice English/Regular Class
Assesment guideline
No
Assesment items
Maximum mark
Appropriate answer
60
Group work
20
The ability to answer questions
20
Total mark
100
The mark for study project is an average of marks from planners who assess every SGD
groups. The study project mark contribute 15% of total CBP evaluation.

Study Guide CBP Semester 2 Tayang 12 Maret 2015

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Study Guide

Study Guide Communitybased Practice

Udayana University Faculty of Medicine, DME

Study Guide Communitybased Practice

Curriculum of Community Based Practice

Skill Lab Facilitators

Skill Lab Time Table

Annex 1 Film Summary And the band played on

Annex 2 Artikel Koran Bali Post

Annex 3 Artikel jurnal

Skill Lab (1-3)

Student Project: Searching, analysis, and interpreting study result

Udayana University Faculty of Medicine, DME

Study Guide Communitybased Practice

MODULE ~ 1 (Mausner & Bahn, p. 1-42)

MODULE ~ 2 (Kirkwood and Sterne, chapter 2)

MODULE ~ 3 (Greenberg p. 15-28)

MODULE ~ 4 (Greenbergp. 51-53)

MODULE ~ 5 (Skill Lab Manual, Kirkwood & Sterne, Chapter 2)

MODULE ~ 6 (Greenberg, p. 29-43)

MODULE ~ 7 (Kirkwood & Sterne, Chap 3 &4)

MODULE ~ 8 (Skill Lab Manual, Kirkwood & Sterne)

MODULE ~ 9 (Kirkwood & Sterne, Chap. 5-8, 10, 14, 15)

MODULE ~ 10 (Kirkwood & Sterne, Chap. 7, 9, 11, 16, 18, 19)

MODULE ~ 11 (Skill Lab Manual, Kirkwood & Sterne)

MODULE ~ 12 (Greenberg, p. 45 73)

MODULE ~ 14 (Greenberg, p. 113-123)

MODULE ~ 15 (Greenberg, p. 127-136)

MODULE ~ 16 (Greenberg, p.91-113)

MODULE ~ 17 (Greenberg, p. 127-136)

Udayana University Faculty of Medicine, DME

Study Guide Communitybased Practice

b) Explain the applications

Explain the severity of

g) Explain the Ice Berg

Udayana University Faculty of Medicine, DME

Study Guide Communitybased Practice

Describe the source

Explain types of errors

Udayana University Faculty of Medicine, DME

Study Guide Communitybased Practice

Udayana University Faculty of Medicine, DME

Study Guide Communitybased Practice

a. Be able to apply the

b. Describe the concept

Udayana University Faculty of Medicine, DME

Study Guide Communitybased Practice

Prof. dr. D.N. Wirawan, MPH

dr. A.A.Sg. Sawitri (Secretary)

dr. I.B. Wirakusuma, MOH

dr. Ayu Swandewi, MPH

dr. Komang Ayu Kartika Sari, MPH

dr. Nyoman Sutarsa, MPH

dr. Ni Wayan Septarini, MPH

dr. Putu Aryani, S. Ked

dr. Ni Luh Putu Ariastuti, MPH

dr. Gede Artawan Eka Putra, M. Epid

Dr. Putu Cintya Denny Yuliatni

Udayana University Faculty of Medicine, DME

Study Guide Communitybased Practice

Dr.rer.Nat. dr. Ni N. Ayu Dewi, M.Si

I.B. Putra Dwija, S.Si, M.Biotech

Drs. I Gede Made Adioka, Apt,