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STATISTICS IN PUBLIC HEALTH

CHAPTER I
OBJECTIVES:
This report shall help the students to be able to:
1.
2.
3.
4.

Understand the definition of Public Health.


Understand the definition of Statistics and Biostatistics.
Determine the application of Biostatistics.
Discuss the significance of Statistics in Public Health.

STATISTICS IN PUBLIC HEALTH

CHAPTER II
INTRODUCTION TO PUBLIC HEALTH
Just as doctor monitors the health of a patient by taking vital signs like blood
pressure, heart rate, and so forth, public health workers monitor the health of the community
by collecting and analyzing health data. These data are called Health Statistics. Statistics are
a vital part of a public healths assessment function used to identify special risk groups,
detect new health threats, plan public health programs, and prepare government budgets.
Since, Public Health is concerned with population, it relies on Statistics to provide and
interpret data. The term Statistics of public health refers to both the numbers that describe
the health of population, and the science that helps to interpret these numbers. The science
of Statistics is a set of concepts and methods used to analyze data in order to extract
information. Statistics makes possible the translation of data into information about cases
and effects, health risks and cures.

Collection of data
Different agencies collect data which is used by Government in assessing the need
for public health programs and evaluating public health progress. The Statistics collected by
local, State and Central Governments are the raw materials for research on environmental
health, social and behavioral factors in health and the medical care system.
Information on public health includes collection data through vital statistics
(i.e. number of births, deaths, infant mortality and etc.) Vital Statistics and their analysis are
considered as the eye and ears of the public health administrator and serves as powerful
and valuable indicator. The data collected through Vital statistics system and other methods
must be converted into rates if they are to be useful for many public health purposes.

Department of Health
The Philippine Department of Health (abbreviated as DOH; Filipino: Kagawaran ng
Kalusugan) is the executive department of the Philippine government responsible for
ensuring access to basic public health services by all Filipinos through the provision of
quality health care and the regulation of all health services and products. It is the
government's over-all technical authority on health. It has its headquarters at the San Lazaro
Compound, along Rizal Avenue in Manila.
The department is led by the Secretary of Health, nominated by the President of the
Philippines and confirmed by the Commission on Appointments. The Secretary is a member
of the Cabinet. The current Secretary of Health is Paulyn Ubial.

STATISTICS IN PUBLIC HEALTH


The DOH is composed of bureaus, namely:

Epidemiology Bureau (formerly National Epidemiology Center)


Bureau of Health Devices and Technology
Bureau of Health Facilities and Services
Bureau of International Health Cooperation
Bureau of Local Health Systems Development
Bureau of Quarantine
Disease Prevention and Control Bureau (formerly National Center for Disease Prevention
and Control)
Food and Drug Administration
Health Emergency Management Bureau
Health Facility Development Bureau (formerly National Center For Health Facilities
Development)
Health Human Resources Development Bureau
Health Policy Development and Planning Bureau
Objectives of Bureaus:
1. Develops and evaluates surveillance and other health information systems.
2. Collects, analyzes and disseminates reliable and timely information on the health
status of the population.
3. Develops plans, policies, national objectives, programs, projects and strategies
for regulating health technologies, medical and health devices, radiation devices
and facilities and other health-related devices that may pose hazards to human
health.
4. Sets Standards for Regulation of health facilities and services.
5. Provide consultation and advisory services to stakeholders regarding health
facilities regulation.
6. Aims to improve the health management capacities at the sub-national and local
levels in order to ensure effective delivery of quality health services.

The following agencies and councils are attached to the DOH for policy and program
coordination:

Commission on Population (POPCOM)


Local Water Utilities Administration (LWUA)
National Nutrition Council (NNC)
Philippine Health Insurance Corporation (PHIC; PhilHealth)
Philippine Institute for Traditional and Alternative Health Care (PITAHC)
Philippine International Trading Corporation - Pharma (PITC - Pharma)
Philippine National AIDS Council (PNAC)
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Objectives of Agencies and Councils:
1. Coordinate planning, monitoring, and evaluation of the national nutrition
program;
2. It is responsible for ensuring access to basic public health services to all
Filipinos through the provision of quality health care and regulation of
providers of health goods and services.

CHAPTER III
STATISTICS- Is the science of conducting studies to collect, organize, summarize, analyze,
and draw conclusions from data.
TWO BRANCHES OF STATISTICS
DESCRIPTIVE STATISTICS - consists of the collection, organization, summarization, and
presentation of data.
INFERENTIAL STATISTICS - consists of generalizing from samples to populations, performing
estimations and hypothesis tests, determining relationships among variables, and making
predictions.
POPULATION AND SAMPLE
A POPULATION consists of all subjects (human or otherwise) that are being studied.
A SAMPLE is a group of subjects selected from a population.
FOUR BASIC METHODS USED TO OBTAIN SAMPLES:
RANDOM SAMPLING
Random samples are selected by using chance methods or random numbers.
SYSTEMATIC SAMPLING
Researchers obtain systematic samples by numbering each subject of the population and
then selecting every kth subject.
STRATIFIED SAMPLING
Researchers obtain stratified samples by dividing the population into groups (called strata)
according to some characteristic that is important to the study, then sampling from each
group.

STATISTICS IN PUBLIC HEALTH


CLUSTER SAMPLING
Researchers also use cluster samples. Here the population is divided into groups called
clusters by some means such as geographic area or schools in a large school district, etc.
TYPES OF DATA
QUALITATIVE DATA are variables that can be placed into distinct categories, according to
some characteristic or attribute.
QUANTITATIVE DATA are numerical and can be ordered or ranked.
DISCRETE DATA assume values that can be counted.
CONTINUOUS DATA can assume an infinite number of values between any two
specific values. They are obtained by measuring. They often include fractions and
decimals.

MEASUREMENT SCALES
The NOMINAL LEVEL OF MEASUREMENT classifies data into mutually exclusive (nonoverlapping), exhausting categories in which no order or ranking can be imposed on the data.
The ORDINAL LEVEL OF MEASUREMENT classifies data into categories that can be ranked;
however, precise differences between the ranks do not exist.
The INTERVAL LEVEL OF MEASUREMENT ranks data, and precise differences between units
of measure do exist; however, there is no meaningful zero.
The RATIO LEVEL OF MEASUREMENT possesses all the characteristics of interval
measurement, and there exists a true zero. In addition, true ratios exist when the same
variable is measured on two different members of the population.

FREQUENCY DISTRIBUTION
A FREQUENCY DISTRIBUTION is the organization of raw data in table form, using classes and
frequencies.

TYPES OF GRAPHS
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STATISTICS IN PUBLIC HEALTH


BAR GRAPH
represents the data by using vertical or horizontal
bars whose heights or
lengths represent the frequencies of the data.

PIE CHART OR CIRCLE GRAPH


A pie chart displays qualitative data in the form of a pie.
Each slice of pie represents a different category

SCATTERPLOTS
A scatterplot displays data that is paired by using a
horizontal axis (the x axis), and a vertical axis (the y axis).
The statistical tools of correlation and regression are
then used to show trends on the scatterplot.

TIME-SERIES GRAPHS
A time-series graph displays data at different points in time,
so it is another kind of graph to be used for certain kinds of
paired data. The horizontal axis shows the time and the vertical
axis is for the data values. These kinds of graphs can be used to
show trends as time progresses.

MEASURES OF CENTRAL TENDENCY


THE MEAN
The mean, also known as the arithmetic average, is found by adding the values of the
data and dividing by the total number of values.
THE MEDIAN
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The median is the midpoint of the data array. The symbol for the median is MD.
THE MODE
The third measure of average is called the mode. The mode is the value that occurs most
often in the data set. It is sometimes said to be the most typical case.
THE MIDRANGE
The midrange is defined as the sum of the lowest and highest values in the data set,
divided by 2. The symbol MR is used for the midrange.
=

+
2

MEASURES OF VARIATION
RANGE
The range is the highest value minus the lowest value. The symbol R is used for the range.
R =highest value - lowest value
VARIANCE
The variance is actually the average of the square of the distance that each value is from the
mean. Therefore, if the values are near the mean, the variance will be small. In contrast, if
the values are far from the mean, the variance will be large.
STANDARD DEVIATION
The standard deviation is the square root of the variance.

CORRELATION AND REGRESSION


CORRELATION is a statistical method used to determine whether a relationship between
variables exists.

A POSITIVE RELATIONSHIP exists when both variables increase or decrease at the


same time.
In a NEGATIVE RELATIONSHIP, as one variable increases, the other variable
decreases, and vice versa.

STATISTICS IN PUBLIC HEALTH


REGRESSION is a statistical method used to describe the nature of the relationship between
variables, that is, positive or negative, linear or nonlinear.

CHAPTER IV
BIOSTATISTICS is the application of statistics to a wide range of topics in biology. The science
of biostatistics encompasses the design of biological experiments, especially in medicine,
pharmacy, agriculture and fishery; the collection, summarization, and analysis of data from
those experiments; and the interpretation of, and inference from, the results. A major branch
of this is medical biostatistics, which is exclusively concerned with medicine and health.
VITAL STATISTICS
VITAL STATISTICS are statistics on live births, deaths, fetal deaths, marriages and divorces.
VITAL STATISTICS RATES
AGE-SPECIFIC BIRTH RATE is the number of resident live births to women in a specific age
group for a specified geographic area (country, state, county, etc.), divided by the total
population of women in the same age group for the same geographic area (for a specified
time period, usually a calendar year). This figure is multiplied by 1000 to give a rate per
1000 population.

AGE-SPECIFIC DEATH RATE is the total number of deaths to residents of a specified age or
age group in a specified geographic area (country, state, county, etc.) divided by the
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STATISTICS IN PUBLIC HEALTH


population of the same age or age group in the same geographic area (for a specified time
period, usually a calendar year) and multiplied by 100,000

CAUSE-SPECIFIC DEATH RATE is the number of deaths from a specified cause per 100,000
person-years at risk. The numerator is typically restricted to resident deaths in a specific
geographic area (country, state, county, etc.). Cause-specific death rates may be adjusted for
the age and sex composition, or other characteristics of the population. When that is done,
for instance, in the case of age adjustment, it is called an age-adjusted rate.

CRUDE BIRTH RATE refers to the number of live births, of a given geographic area in a given
year, per 1000 mid-year total population of the same geographic area in the same year.
Crude birth rate is expressed as the number of births per 1000 population.

CRUDE DEATH RATE is the total number of deaths to residents in a specified geographic area
(country, state, county, etc.) divided by the total population for the same geographic area (for
a specified time period, usually a calendar year) and multiplied by 1,000

FERTILITY RATE is the ratio of live births in an area to the population of that area; expressed
per 1000 population per year.

INFANT MORTALITY RATE (IMR) is the number of deaths of infants under one year old per
1,000 live births.
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STATISTICS IN PUBLIC HEALTH

LOW BIRTH WEIGHT RATE is defined as a ratio of birth weight of a liveborn infant of less than
2,500 g (5 pounds 8 ounces) regardless of gestational age to the total number of live births.

MATERNAL DEATH RATE: the ratio of the number of maternal deaths during a given time
period per 10,000 live births during the same time-period.

NEONATAL DEATH RATE is the number of neonatal deaths per 1000 live births. A neonatal
death is defined as a death during the first 28 days of life (0-27 days).

PERINATAL DEATH RATE is the number of perinatal deaths per 1000 total births. A perinatal
death is a fetal death (stillbirth) or an early neonatal death.
Stillbirth is typically defined as fetal death at or after 20 to 28 weeks of pregnancy.

Morbidity is a term used to describe how often a disease occurs in a specific area or is a
term used to describe a focus on death.

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CHAPTER V
PROCESS OF COLLECTING DATA
A. SOURCES OF DATA
Notifiable Disease Statistics Data on Notifiable Diseases is based on
information submitted by health personnel of different Rural Health Units (RHUs), City
Health Offices (CHOs) or Provincial Health Offices (PHOs) and Municipal Health
Offices (MHOs). The Law on Reporting of Notifiable Diseases (Act 3573) mandates
the immediate reporting of any Notifiable Disease to the nearest health officer. All
field health officers, by means of established reporting mechanism (Memorandum
Order No. 51-a.s. 1960) submit weekly morbidity reports (Forms W1-a and W1-b) to
the National Epidemiology Center (NEC) where such data received are then classified,
compiled, analyzed and interpreted. The complete report is presented in Field Health
Service Information System (FHSIS) Annual Report.
B. CLASSIFICATION OF DATA
1. Geographic Classification
Data on Notifiable Diseases have been classified by place of occurrence.
First by region which is a geographical division created as a result of the
reorganization of the Department of Health (DOH), then, by province and city that
were political divisions of the country. There are seventeen (17) regions, eighty
(80) provinces and one hundred twenty-one (121) cities. The National Capital
Region (NCR) has one (1) more municipality which is Pateros. There is no
classification as to whether it is rural or urban because of the lack of established
criteria.
2. Age
There is no valid information with regard to the accuracy of age of a reported
morbid case. Regarding the registered deaths, the age of deceased is fully
determined by the date of birth. However, some of the vital records are submitted
with the age not recorded or the date of birth not indicated. Thus, misstatement
of age on vital records may be assumed to some degree. The age classification or
age groupings used in this report are consistent with those recommended for
international use by the World Health Organization.
3. Diseases and Causes of Death
The Mortality statistics was tabulated based on the underlying cause of
death documented on the medical certificate of cause of death. The underlying
cause has been defined as the disease or injury which initiated the train of
morbid events leading directly to death; or the circumstances of the accident or
violence which produced the fatal injury. The selected cause of death does not
include symptoms and modes of dying, such as heart failure or respiratory failure.

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4. Sex
Classification by sex is made in relation to other factors such as age, and
geographical location. Thus, some tabulation presented in this report may be
considered as four-fold tables with sex as one of the attributes of classifications.

C. ANALYSIS AND INTERPRETATION OF DATA


Vital statistics are essential in planning, operating and evaluating programs
not only on health but also in some aspects too like, transport, agricultural
production, employment, housing, among others. They are very useful for a variety of
administrative and research purposes. However, they cannot correctly be interpreted
unless pertinent qualifying factors are taken into consideration.
Some of the factors limiting the use of statistical data emanate from
discrepancies in the original records or from the impracticability of tabulating these
data in very detailed items. While these defects do exist, nevertheless, the value of
these data for original purposes is indispensable. The exact evaluation of health
statistics or the analysis of small differences necessitates careful study of a variety of
related elements. However, the major trends and differences may not be altered
materially by finer analysis.

Case Fatality Ratio(CFR)


No. of registered deaths from a specifi
disease for a given year
CFR = ------------------------------------------------------------------ x 100
No. of registered cases from same specific
disease in same year

CHAPTER VI
EXAMPLES OF STATISTICAL ANALYSIS IN PUBLIC HEALTH
Dengue (pronounced DENgee) fever is a painful, debilitating mosquito-borne disease
caused by any one of four closely related dengue viruses. Dengue fever is transmitted by the
bite of an Aedes mosquito infected with a dengue virus. The mosquito becomes infected when it
bites a person with dengue virus in their blood. It cant be spread directly from one person to
another person.

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STATISTICS IN PUBLIC HEALTH


Symptoms of Dengue Fever
Symptoms, which usually begin four to six days after infection and last for up to 10 days, may include

Sudden, high fever


Severe headaches
Pain behind the eyes
Severe joint and muscle pain
Fatigue
Nausea
Vomiting
Skin rash, which appears two to five days after the onset of fever
Mild bleeding (such a nose bleed, bleeding gums, or easy bruising)

Treatment for Dengue Fever


There is no specific medicine to treat dengue infection. If you think you may have
dengue fever, you should use pain relievers with acetaminophen and avoid medicines
with aspirin, which could worsen bleeding. You should also rest, drink plenty of fluids, and see
your doctor. If you start to feel worse in the first 24 hours after your fever goes down, you
should get to a hospital immediately to be checked for complications.

Preventing Dengue Fever


There is no vaccine to prevent dengue fever. The best way to prevent the disease is to
prevent bites by infected mosquitoes, particularly if you are living in or traveling to a tropical area.
This involves protecting yourself and making efforts to keep the mosquito population down.
According to the archive of Department Of Health a total of 101,401 suspect dengue
cases were reported nationwide from January 1 to August 20, 2016. This is 16% higher
compared to the same time period last year (87,411).

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Geographic Distribution.

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Profile of Cases
Ages of cases ranged from less
than 1 month to 100 years old
(median = 13 years). Majority of
cases were male (52.4%). Most
(38.8%) of the cases belonged to
the 5 to 14 years age group.

There were 422 deaths (CFR = 0.42%). The age group that has the highest CFR is 1 to 4 years old
(0.82%).
Case Fatality Rate (CFR) - is the proportion of deaths within a designated population of "cases"
(people with a medical condition), over the course of the disease.

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CHAPTER VII
REVIEW QUESTIONS:
1.
2.
3.
4.

What are the different bureaus under DOH? What are their objectives?
What is the relationship of Biostatistics to Public Health?
What is the definition of statistics?
What is the difference between descriptive statistics and inferential
statistics?
5. In your own understanding why statistics is essential in public health?

CHAPTER VIII
SUMMARY:

Public health is the science of protecting and improving the health of families
and communities through promotion of healthy lifestyles, research for
disease and injury prevention and detection and control of infectious
diseases. Overall, public health is concerned with protecting the health of
entire populations.
Statistics is the science of conducting studies to collect, organizes,
summarize, analyze, and draw conclusions from data. The two major areas of
statistics are descriptive and inferential. Descriptive statistics includes the
collection, organization, summarization, and presentation of data. Inferential
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statistics includes making inferences from samples to populations,
estimations and hypothesis testing, determining relationships, and making
predictions. Inferential statistics is based on probability theory. Since in most
cases the populations under study are large, statisticians use subgroups
called samples to get the necessary data for their studies. There are four
basic methods used to obtain samples: random, systematic, stratified, and
cluster. Data can be classified as qualitative or quantitative. Quantitative
data can be either discrete or continuous, depending on the values they can
assume. Data can also be measured by various scales. The four basic levels
of measurement are nominal, ordinal, interval, and ratio. When data are
collected, they are called raw data. Since very little knowledge can be
obtained from raw data, they must be organized in some meaningful way. A
frequency distribution using classes is the solution. Once a frequency
distribution is constructed, the representation of the data by graphs is a
simple task. The most commonly used graphs in research statistics are the
bar graph, pie graph, scatterplots, and time-series graph. There are basic
ways of summarizing data. These include measures of central tendency, and
measures of variation or dispersion. The three most commonly used
measures of central tendency are the mean, median, and mode. The
midrange is also used occasionally to represent an average. The three most
commonly used measurements of variation are the range, variance, and
standard deviation. After learning the definitions presented above, you will
have a substantial knowledge of descriptive statistics. That is, you will be able
to collect, organize, summarize, and present data. Many relationships among
variables exist in the real world. One way to determine whether a relationship
exists is to use the statistical techniques known as correlation and
regression. The strength and direction of a linear relationship are measured
by the value of the correlation coefficient. It can assume values between and
including +1 and -1. The closer the value of the correlation coefficient is to +1
or -1, the stronger the linear relationship is between the variables. A value of
+1 or -1 indicates a perfect linear relationship. A positive relationship
between two variables means that for small values of the independent
variable, the values of the dependent variable will be small, and that for large
values of the independent variable, the values of the dependent variable will
be large. A negative relationship between two variables means that for small
values of the independent variable, the values of the dependent variable will
be large, and that for large values of the independent variable, the values of
the dependent variable will be small. The branch of statistics that covers all
the data about Biology and especially in health is called biostatics. Under
biostatistics it has vital statistics that specifically studies about the statistics
on live births, deaths, fetal deaths, marriages and divorces. Vital statistics
rates include Age-Specific Birth Rate, Age-Specific Death Rate, Cause-Specific
Death Rate, Crude Birth Rate, Crude Death Rate, Fertility Rate, Infant
Mortality Rate (IMR), Low Birth Weight Rate, Maternal Death Rate, Neonatal
Death Rate, and Perinatal Death Rate.
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CHAPTER IX
QUESTION AND ANSWER:
TEST I- IDENTIFICATION:

1. Is the science of conducting studies to collect, organize, summarize, analyze,


and draw conclusions from data. (STATISTICS)
2. Also known as the arithmetic average, it is found by adding the values of the
data and dividing by the total number of values. (MEAN)
3. Is the application of statistics to a wide range of topics in biology. The science
of biostatistics encompasses the design of biological experiments, especially
in medicine, pharmacy, agriculture and fishery; the collection, summarization,
and analysis of data from those experiments; and the interpretation of, and
inference from, the results. A major branch of this is medical biostatistics,
which is exclusively concerned with medicine and health. (BIOSTATISTICS)
4. Is the science of protecting and improving the health of families and
communities through promotion of healthy lifestyles, research for disease
and injury prevention and detection and control of infectious diseases.
(PUBLIC HEALTH)
5. Represents the data by using vertical or horizontal bars whose heights or
lengths represent the frequencies of the data.(BAR GRAPH)
6. _____________ are variables that can be placed into distinct categories,
according to some characteristics or attribute. (QUALITATIVE DATA)
7. _____________ are numerical and can be ordered or ranked. (QUANTITATIVE
DATA)
8. ___________ is a term used to describe how often a disease occurs in a
specific area or is a term used to describe a focus on death. (MORBIDITY)
9. A ____________ exists when both variables increase or decrease at the
same time. (POSITIVE RELATIONSHIP)
10. ______________ are essential in planning, operating and evaluating
programs not only on health but also in some aspects too like, transport,
agricultural production, employment, housing, among others. They are very
useful for a variety of administrative and research purposes. However, they
cannot correctly be interpreted unless pertinent qualifying factors are taken
into consideration. (VITAL STATISTICS)

TEST II- ENUMERATION


(1-3) Process of collecting data
1. Sources of data
2. Classification of data
3. Analysis and Interpretation of data
(4-7) Classification of data
4. Geographic classification
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5. Age
6. Diseases and causes of death
7. Sex
(8-14) Different Bureaus under DOH

Epidemiology Bureau (formerly National Epidemiology Center)


Bureau of Health Devices and Technology
Bureau of Health Facilities and Services
Bureau of International Health Cooperation
Bureau of Local Health Systems Development
Bureau of Quarantine
Disease Prevention and Control Bureau (formerly National Center for Disease
Prevention and Control)
Food and Drug Administration
Health Emergency Management Bureau
Health Facility Development Bureau (formerly National Center For Health
Facilities Development)
Health Human Resources Development Bureau
Health Policy Development and Planning Bureau
(15-20) Agencies and councils are attached to the DOH for policy and
program coordination:

Commission on Population (POPCOM)


Local Water Utilities Administration (LWUA)
National Nutrition Council (NNC)
Philippine Health Insurance Corporation (PHIC; Phil Health)
Philippine Institute for Traditional and Alternative Health Care (PITAHC)
Philippine International Trading Corporation - Pharma (PITC - Pharma)
Philippine National AIDS Council (PNAC)

TEST III- SOLVING PROBLEM


(Show solution)
Forlumas:
Percent change=

CFR=


100


100

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Leptospirosis Cases & Deaths by Region


Philippines, *2016 vs 2015

Region
I
II
III
IV-A
IV-B
V
VI
VII
VIII
IX
X
XI
XII
ARMM
CAR
CARAGA
NCR
Total

*2016
59
22
69
30
11
25
71
10
7
11
38
20
6
0
13
8
110
510

Cases
2015
% Change
61
-3.3
33
-33.3
119
-42.0
20
50.0
6
83.3
40
-37.5
86
-17.4
27
-63.0
37
-81.1
16
-31.3
29
31.0
35
-42.9
6
0.0
5
-100.0
9
44.4
12
-33.3
165
-33.3
706
-27.8

*2016
9
0
4
3
0
1
10
3
0
1
2
3
2
0
0
0
6
44

Deaths
CFR(%)
2015
15.25
3
0.00
3
5.80
7
10.00
2
0.00
0
4.00
6
14.08
7
30.00
2
0.00
3
9.09
1
5.26
5
15.00
3
33.33
1
0.00
1
0.00
1
0.00
2
5.45
21
8.63
68

CFR(%)
4.92
9.09
5.88
10.00
0.00
15.00
8.14
7.41
8.11
6.25
17.24
8.57
16.67
20.00
11.11
16.67
12.73
9.63

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