Putting Data to WorkEvidence-based health programming and management

Sustainable Management Development Program

Learning ObjectivesDescribe how data are used in health

organizations and programsIdentify methods for summarizing dataExplain how data analysis and

interpretation can improve decisionsPrepare and apply tables, graphs, and

charts such as line graphs, bar charts, pie charts, and spot (dot) maps

How do you use data?Simple vs. complicated decisions

Decisions can significantly impact a community

Use of timely & accurate

data analysis

Scenario Imagine that you are a medical

superintendent of a district hospital and part of your job is to manage resources.

Each month your employees submit a receipt for their fuel usage. Instead of just approving the bills, you can study the data they provide.

Collecting and analyzing these simple data will allow you to better track and understand trends in fuel usage.

Consider the following graph.

Exercise 1: Is there a problem?

Janua

ry

Febru

aryMarc

hAp

ril May June Jul

yAu

gust

Septe

mber

Octobe

r

Novem

ber

Decembe

r0200400600800

100012001400

District Hospital monthly fuel usage, 2007

Month

Fuel

(Li

ters

)

Why use data?Data provides evidence and guidance for

successful programming and resource management

Collecting data is only one step

Accurate data analysis, interpretation and application is also an important step

As the medical director of this hospital, what else would you want to keep track of besides fuel usage?

Kinds of DataIndividual - focus on one person’s health

issues, e.g. patient’s medical record

Population - focus on communities, districts, etc. ,to obtain an overall picture of health

Management- focus on tracking, monitoring and evaluating the use and distribution of resources

Types of DataQuantitative

◦Who◦What◦When ◦Where

Qualitative◦Why◦How

Can you think of data that crosses your path? What data are available to you?

Data Collection- Counts

Actual number of events (in a specific population, place and time)

Used for:◦Program planning and monitoring:

Describe the magnitude of the problemLimitations

◦No indication of problem in relation to size of population

◦No information on risks

Exercise 2: Using a check sheet

Exercise 2: Using a check sheet

Interpreting DataMost commonly used measures of

frequency◦Counts ◦Ratios 1:2◦Proportions 1/2◦Percents 15%◦Rates

33.3 per 100,000

RatiosA ratio is a

comparison of two dissimilar things

8:16 or 1:2

Two types of ratios:Proportion and PercentsA proportion or a

percentage = special kind of ratio◦ A part is compared to the

whole◦ Multiply by 100, 1,000 or

100,000◦ Proportions and

percentages are essentially the same measure

854 =

0.15Proportion: 15 per 100Percent: 15%

PercentsStandardize data and make

comparableRemember to report numbers or

counts to put the percentage in contextClinic

% pregnant women whose partner gets tested

# of pregnant women whose partner gets tested

A 50% 3 out of 6B 21% 38 out of 181C 17% 121 out of 712

Rates

Rate: often a proportion, with an added dimension of time

Measures the frequency at which a health event occurs over a period of time

Risk and Persons at RiskRisk = the probability or

likelihood that an event will occur

All people to whom the event could have happened

Everyone in the geographic area during the time period of interest

Rates compare the risk of health events across different groups of people, places, and time periods

Rates

K = A standard unit of the population (per100, 1,000, or 100,000)

Remember both numerator and denominator must represent the same time and place

Number of personsexperiencing the event

Number of persons “at risk” ofexperiencing the event over

a specified time periodx K

Rates Example

K = 100,000

Cases Total population

# cases Total pop.

Rate

20 ÷ 1,000 0.02 2,000 per

100,000

20 ÷ 1,000,000 0.00002 2 per

100,000

Rates Exercise

What is the mortality rate from HIV/AIDS per 100,000 women in Panama?

What is the mortality rate from HIV/AIDS per 100,000 women in Guatemala?

Based on the rates we have calculated which country has a higher rate of women dying from the disease?

Which country has the higher number of women dying from HIV/AIDS?

Country HIV/AIDS Deaths

Female Population

Panama 114 1,573,289

Guatemala 167 6,342,703

Why Use Rates?Describe the frequency of a

health event or health status relative to the size of a population

To target interventionsTo manage resources

◦Employee turnover rate◦Vaccination coverage rate◦Hospital admissions

Exercise 3: Calculate Ratios and RatesUse the counts from the check sheet on

page 7  to answer the questions below.1. What is the ratio of total missed

appointments between Clinic C and Clinic D?

2. What is the proportion of missed appointments in Week 5 for Clinic E?

3. What is the rate of missed appointments over the 7 week period?

Summarizing DataTo analyze data

To explore patterns and trends, and identify variations from trends

To provide a useful way of communicating information to others

Basic Methods for Organizing and Presenting DataData can be organized through

creation of:◦Tables

◦Graphs

◦Charts

◦Maps

Tables

Deceased Living Total

Diabetics 100 89 189

Non diabetics

811 2,340 3,151

Total 911 2,429 3,340

Follow-up status of a group of men with and without diabetes, Medical examination survey

follow-up study, 2005-2010

Clear, concise labels

Totals to accompan

y rows

Quantitative data Column (vertical)

Row (horizontal)

Totals to accompany columns

Footnote: Used to explain codes, abbreviations, symbols, exclusions or data sources used.

Continuous vs. Discrete DataContinuous data can be assigned an infinite number of values between whole numbers

- weight, height, time

Discrete data is data that can be counted.- gender, race

Graphs

1950

1951

1952

1953

1954

1955

1956

1957

1958

1959

1960

1961

1962

1963

1964

1965

1966

1967

1968

1969

1970

1971

1972

1973

1974

1975

1976

1977

1978

1979

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

0100200300400500600700800900

Measles by year of notification, 1950-1990

YearRepo

rted

cas

es (

per

1,00

0)

Y-ax

is

Freq

uenc

y mea

sure

A set of coordinates (i.e. year, # of cases) make up a data point

Method of classification

X-axis

Creating Line GraphsShow patterns or trends over some

variable, usually time

Good for comparing 2 or more sets of data

Example:◦Number of staff members hired to worked at district health facilities from 1975 to 2010

Tip 1Mark off each axis at equal intervals

Y-axis

X-axis

(vertical)

(horizontal)

Tip 2Match x-axis scale to intervals used

during data collection

Time period shown on X-axis

1975 1980 1985 1990 1995 2000 2005 2010

YEAR

1975 1980 1985 1990 1995 2000 2005 2010

Tip 3Make the x-axis longer than the y-axisAlways start y-axis with 0

X-axis longer than Y-axis

YEAR

0 cases

1975 1980 1985 1990 1995 2000 2005 2010

Tip 4Select interval size for y-axis that will provide

enough intervals to illustrate data in adequate detail

Determine range of values on y-axis by identifying the largest value

Number of staff members shown on Y-axis

Time period shown on X-axis

YEAR

9000

STAF

F M

EMBE

RS

8000

7000

6000

5000

4000

3000

2000

1000

Completed Line Graph

Bar ChartsMethod of organizing and illustrating

data using only one coordinate

Quick way to show big differences in dataBar charts are used to compare data and

show relationshipsBest used for comparing data with

discrete categories◦ Gender, race, marital status and trained and

untrained

Example: Horizontal Bar Chart

Warangal

Kadapa

Chittoor

Adilabad

Nalgonda

0 10 20 30 40 50 60 70

Average clinic wait times per District, 2008

Minutes

Dis

tric

t

Creating a Simple Bar ChartBar Characteristics:

◦May be horizontal or vertical◦Bars are all equal width and are

separated◦Each bar represents one value of the

variable◦Length or height of each bar is

proportional to frequency of the event in that category

Example: Vertical Bar Chart

Number of Reported Polio Cases, Worldwide

0

5,000

10,000

15,000

20,000

25,000

1990 1991 1992 1993 1994 1995

Year

Case

s

Exercise 4: which method for displaying data would you use?

Sub districts Number of tripsDodowa 5Prampram 3Osudoku 2Ningo 1

Number of Mobile Clinic Trips

0

1

2

3

4

5

6

Dodowa Prampram Osudoku Ningo

Sub-districts

Num

ber o

f trip

s

Pie ChartsPie charts show how part of

something relates to the whole. A circle with slices that represent

percentages of the different categories of the variable.

Pie charts are a way to effectively present percentages in which the “slices” of the pie add up to 100%.

Pie Chart

Traffic ac-cident50%

Burn30%

Fall9%

Drowning8%

Poisoning2%

Other1%

Distribution of accidental deaths for children aged 1–19 years, 2005-2010

MapsA visual display of geographical

or spatial patternsPowerful tool for looking at

clusters of disease or eventsCan be used for management

purposes Types include

◦Spot or dot maps◦Area maps◦Geographic information systems

Creating a Spot MapUse dots or other symbols

to show geographic distribution of an event or a disease/condition

Famous spot map- John Snow tracking cholera deaths in London

Spot maps can be used to track operations information

Example: Spot Map

DO NOT take into account size of population at risk

Example: Dot Maps

Key:Dengue fever -Malaria -Chagas -

Source: http://www.worldmapsonline.com/images/OutlineMaps/Guatemala.jpg

Example: Area MapCountries at risk of yellow fever and countries that have reported at least one outbreak of yellow fever, 1985-1999

http://www.who.int/csr/resources/publications/yellowfev/CSR_ISR_2000_1/en/

StratificationBreakdown results into smaller

groups◦Age◦Gender◦Place◦Time◦Geographic location

Stratification

Stratification

1 2 3 4 5 6 70

5

10

15

20

25

Percent of people who missed ap-pointments by clinic

Clinic AClinic BClinic CClinic DClinic E

Week

Perc

ent (

%)

SummaryThe purpose of organizing and presenting

data is to analyze it, to explore patterns and trends, and to communicate information to others.

Data can be organized through the creation of tables, graphs, charts, and maps.

Tables can illustrate the number of people who share a certain

SummaryLine graphs are useful for showing patterns or

trends over some variable, usually time.

Bar charts are used to display countable or discrete data, such as race or gender, and make it easy to see differences among the categories.

Pie charts are useful for showing the component parts of a single group or variable.

SummaryMaps are an excellent way to

display geographic information, and make it easier to identify geographical patterns in data.

Spot (dot) maps use dots or other symbols to show geographic distribution of an event or a disease/condition.

Exercise 5: Summarizing Data

What method would you use?

ConclusionKnow how to read, understand and interpret

data

These processes can help with decision making for health programming and management

Frequent data analysis helps to detect problems

Data can be organized through tables, graphs, charts, and maps.

What’s next?Think about how data can help

you make stronger management and public health policy decisions

Practice data analysis and presentation and share your reports with colleagues.