Fundamentals of Epidemilogy

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(Fundamentals of Epidemiology)

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ljifo ;'rL Table of Contents

PsfO Ps (Unit One) ............................................................................................... 1 \/f]u cWoog lj1fgsf] kl/ro (Introduction to Epidemiology) ........................................... 1 !=! PsfO kl/ro (Unit Introduction) ....................................................................... 1 !=@ klxnf] PsfOsf] ljlzi6 p2]Zox? (Specific objectives of unit one)..............................1 !=# ljifoj:t'x? (Content Presentation) .................................................................... 2 !=#=! /f]u cWoog lj1fgsf] cjwf/0ff (Concept of Epidemiology) ..................................... 2 !=#=@ /f]u cWoog lj1fgsf] If]q (Fields of Epidemiology) ............................................. 5 !=#=# /f]u cWoog lj1fgsf] kIfx¿ (Components of Epidemiology) .................................. 8 !=#=# /f]u cWoog lj1fgsf] cfwf/e"t dfkgx¿ (Basic Measurements in Epidemiology) ...... 11 !=#=$ PsfO Pssf] cEof; nflu k|Zgx? .................................................................................... 25 PsfO{ b'O{ .................................................................................................................................. 29 /f]u cWoog lj1fgsf cWoog 9frfx¿.......................................................................... 29 (Epidemiology Study Designs) .............................................................................. 29 @=! PsfO kl/ro (Unit Introduction) ...................................................................... 29 @=@ ljlzi6 p2]Zox? (Specific objectives) ............................................................... 29 PsfO{ tLg ............................................................................................................ 64 ;?jf tyf ;ª\qmfds /f]u cWoog lj1fg ....................................................................... 64 (Communicable/infestious disease epidemiology) .................................................... 64 #=! PsfO kl/ro (Unit Introduction)...................................................................... 64 #=@ PsfOsf] p2]Zo (Unit objectives) ....................................................................... 64 #=# ;?jf /f]usf] tTj tyf l;4fGt (Elements and theory of communicable disease) ........ 66 #=$ ;?jf /f]usf] l;4fGt (Theory of communicable disease) ....................................... 69 #=% ;?jf /f]usf] juL{s/0f(Classification of communicable diseases) ............................ 71 #=^ /f]u k|;f/0fsf] ultlzntf (Dynamic of disease transmisstion) ................................... 77 #=& ;?jf/f]usf] k|fs[lts Oltxf; (Natural History of Disease) ...................................... 85 #=* 5gf]6 g]kfnsf] k|d'v ;?jf /f]ux?M dn]/Lof, Ifo/f]u, ?3fvf]sL tyf PrcfOeL P8;sf]

Olk8]ldof]nf]hL (Epidemiology of Major Communicable Diseases: Malaria, TB, Influenza, HIV and AIDS) ............................................................................ 89

#=( /f]u k|sf]ksf] cGj]if0f ug]{ rn0fx? (Steps in disease outbreak investigation) .............. 97 #=!) /f]u lgu/fgLsf] cjwf/0f / k|sf/ (Concept and types of disease surveillance) .............. 99 #=!! ;?jf /f]u lgoGq0f tyf /f]syfd ug{] ;fdfGo l;4fGt tyf pkfox¿ ............................. 102 (Disease control methods and principles) ............................................................... 102 $=! kl/ro (Introduction) ................................................................................... 109 $=@ ljlzi6 p2]Zox¿ (Specific Objectives and Contents) .................................................. 109

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$=@ h}ljs tYofª\szf:qsf] cjwf/0ff (Concept of Biostatistics) .................................... 110 $=# rn /kl/jTo{sf] dfkgsf] tx cjwf/0ff agfpg] / To;sf] lqmofTds kl/efifLt ug]{

(Conceptualization and operationalization of variables, and level of measurement ) 112

$=$ dxfdf/Llj1fgdf q'l6x?, kIfkft / ;Gb]xhgs -clgl:rt_ (Concept of Error, bias and confounding in Epidemiology ) ..................................................................... 122

$=% dxfdf/L lj1fgdf ljZj;gLotf / j}Btf (Concept and types of reliability and validity in epidemiology) .......................................................................................................... 130

$=^ Ps rnLo, bLrnLo / ax'rnLo a0f{gfTds ljZn]if0fsf] cjwf/0ff -Concept and techniques of univariate and bivariate descriptive analysis (frequency tables, cross tables and figures) ..................................................................................................... 135

$=& kl/sNkgf k/LIf0f / ;}4flGts tYofª\ssf] cjwf/0ff / ljlw (Concept and techniques of hypothesis testing and inferential statistics (t-test, correlation, coefficient and chi-squire test) in epidemiology) ........................................................................ 139

$=* sf/0f / ;DaGwsf] cjwf/0ff (Concept of Causation and Association) ................... 148 $=( j0f{gfTds cWoog, 36gf lgoGq0f cWoog tyf ;fd'lxs cWoogsf] k'g/fjnf]sg (Review of

some descriptive studies, case-control studies and cohort studies, randomized control trial and field trials conducted in Nepal and other countries) ............................. 151

;Gbe{u|Gy (References) ........................................................................................ 164

1

PsfO Ps (Unit One)

/f]u cWoog lj1fgsf] kl/ro (Introduction to Epidemiology)

!=! PsfO kl/ro (Unit Introduction)

o; klxnf] PsfOdf /f]u cWoog lj1fg cyf{t\ Olk8]ldof]nf]hLnfO{ kl/ro lbg] ljifo j:t'x?

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af/]df hfgsf/L u/fpg] ljifo j:t'x? ;dfj]z ul/Psf] 5 . of] PsfO cWoog u/]kl5

ljBfyL{x? Olk8]ldof]nf]hLsf] kl/efiff, If]q, kIf, dfkgsf ;fwg tyf dfkg ug]{ ;"qx?af/]df

kl/lrt x'g] 5g\ .

!=@ PsfOsf] ljlzi6 p2]Zo x¿ (Specific objectives)

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!=# ljifoj:t'x? k|:t'tLs/0f (Content Presentation)

!=#=! /f]u cWoog lj1fgsf] cjwf/0ff (Concept of Epidemiology)

Olk8]ldof]nf]hL u|Ls zAb Epi, demos / Logos ldn]/ ag]sf] xf] . Epi sf] cy{ df, dfly,

aLrdf (on, upon, among), demos sf] cy{ hgtf÷hg;d'bfo (People) / Logos

sf] cy{ cWoog (Study) x'G5 . o;y{ Olk8]ldof]nf]hL eGgfn] hgtf jf hg;d'bfodf ul/g]

/f]u tyf :jf:Yo ;DaGwL 36gfsf] cWoognfO{ hgfpF5 . k|flrg u|Ls hg;d'bfodf dxfdf/Lsf]

?kdf km}lng] /f]unfO{ Epidemic elgGYof] . /f]usf] j}1flgs sf/0f ;f]Rg] klxnf] JolQm

Hippocrates (460 – 375 BC) x'g\ . pgn] xfjfkfgL, df};d, 7fpF tyf dflg;sf] hLjg z}nL

cg';f/ ;d'bfodf /f]u km}lnG5 eg]/ JofVof u/]sf lyP . pgn] /f]usf] cWoog ug]{ tl/sf k"0f{

j}1flgs geP klg Hippocrates sf] /f]u ;DaGwL cWoog tyf n]vn] cfw'lgs

Olk8]ldof]nf]hLsf] nflu cfwf/ tof/ kf/]sf] lyof] .

John Graunt n] ;g\ !^&@ df hg;ª\Vof tyf hg:jf:Yo;Fu ;DalGwt kIf h:t} hg;ª\Vof

j[l4, /f]u tyf d[To'nfO{ tYofÍzf:qLo ljZn]if0f u/]/ k':ts n]v]kl5 / James Lind n] ;g\

!&($ df ;fdfGo Clinical trial vfnsf] cWoog u/]/ Scurvy /f]usf] sf/0f kQf nufPkl5

dxfdf/L /f]u cWoog ljlwn] lj1fg tyf j}1flgs ljlwsf] dfGotf kfPsf] xf] . ;g\ !&(^ df

Edward Jenner n] Cowpox sf] Virus ;Fu ;Dks{df cfPsf / gcfPsf] dflg;x?sf]

;d"xdf Olk8]ldof]nf]lhsn cWoog u/]/ ljkm/sf] vf]k kQf nufPsf lyP . John Snow n]

;g\ !*%# df n08gdf km}lnPsf] x}hfsf] cjnf]sgfTds Olk8]ldof]nf]lhsn cWoog u/]/ b"lift

kfgLsf] ;]jgaf6 x}hf km}lnG5 eGg] s'/f kQf nufPsf lyP . of] Jojl:yt / j}1flgs tl/sfn]

3

cWoog ul/Psf] klxnf] rlr{t Epidemiological study lyof] . To;}u/L ;g\ !(%) df

cfOk'Ubf csf]{ rlr{t 36gf lgoGq0f (Case–control) 9fFrfdf cfwfl/t eP/ w'd|kfg /

kmf]S;f]sf] SofG;/lar ;DaGwsf] af/]df Doll / Hill (1954) n] cWoog u/]sf lyP . of]

cWoogaf6 w'd|kfg ug]{ afgLn] kmf]S;f]df SofG;/ pTkGg x'gdf of]ubfg k'¥ofpF5 eGg] s'/f

kQf nfUof] . o;kl5 d'6' tyf g;g]{ /f]ux¿sf] Olk8]ldof]nf]lhs cWoog ePsf] kfO{G5 . o;/L

/f]u cWoog lj1fgsf] If]q . ;ª\qmfds/f]ux¿sf] cWoogaf6 g;g]{ tyf :jf:Yo;Fu ;DalGwt

36gfx¿sf] cWoogdf lj:tf/ ePsf] kfOG5 . /f]u cWoog lj1fgsf] ljsf;sf] Oltxf;nfO{

lgDg qmddf JoQm ug{ ;lsG5 .

• ;'?df dxfdf/L /f]usf] cWoog (Study of epidemic of infectious disease)

• dfgj hg;ª\Vofdf . ;ª\qmfds/f]usf] cWoog (Study of infectious disease in

human population)

• ;a} k|sf/sf] /f]usf] cWoog (Study of all disease)

• /f]u tyf :jf:Yo;Fu ;DalGwt 36gfx¿sf] cWoog (Study of diseases and health

related events)

• /f]u, :jf:Yo;Fu ;DalGwt 36gf tyf k|0ffnLsf] cWoog (Study of diseases, health

related events and system)

c7f/f}F ztfAbL eGbf cufl8 Epidemiology eGgfn] dxfdf/L /f]u cWoogsf] cy{ nfUbYof]

eg] lj;f}F ztfAbLsf] cGTodf cfOk'Ubf Epidemiology eGgfn] /f]u tyf :jf:Yo;Fu

;DalGwt 36gf tyf :jf:Yo k|0ffnLsf] j}1flgs cWoog ug'{nfO{ hgfpF5 . lgDg kl/efiffn]

klg of] s'/fnfO{ ;+s]t ub{5 .

kfls{g (Parkin, 1876) sf cg';f/– Olk8]ldof]nf]hL eg]sf] dxfdf/L /f]usf] ;/f]sf/ /fVg]

lrlsT;fzf:qsf] zfvf xf] . (Epidemiology is the branch of medical science

which treats of epidemics.)

k|mf]:6 (Frost, 1927) sf cg';f/– ;?jf/f]usf] cfd 36gfsf] cWoog ug]{ lj1fg xf] .

(Epidemiology is the science of the mass phenomenon of infectious

disease.)

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lu|gp8 (Green Wood, 1934) sf cg';f/– cfd 36gfsf] ?kdf b]vf kg]{ s'g} klg

/f]usf] cWoognfO{ Olk8]ldof]nf]hL elgG5 . (Epidemiology is the study of disease,

any disease as mass phenomenon.)

Dofs df]xg (Mac Mohan, 1960) sf cg';f/– dflg;df /f]usf] ljt/0f tyf

af/Daf/tfsf] lgwf{/s tTjx?sf] j}1flgs cWoognfO{ Olk8]ldof]nf]hL elgG5 .

(Epidemiology is scientific study of distribution and determinants of

diseases frequency in man.)

hf]g Pd=nf:6 (John M. Last 2000) sf cg';f/– s'g} ljz]if hg;ª\Vofdf :jf:Yo;Fu

;DalGwt cj:yf jf 36gfsf] ljt/0f / lgwf{/s tTjx¿sf] cWoog / ;f] cWoognfO{ :jf:Yo

;d:ofx¿sf] lgoGq0fdf k|of]u ug'{nfO{ Olk8]ldof]nf]hL elgG5 . (Epidemiology is the

study of the distribution and determinants of health related states or

events in specified population and the application of this study to

control of health problems.)

dflysf] kl/efiffx¿af6 :ki6 x'G5 ls k/Dk/fut cjwf/0ff cg';f/– Olk8]ldof]nf]hL eGgfn]

dxfdf/L /f]u jf /f]ux¿sf] ljt/0f / lgwf{/sx¿sf] af/]df cWoog ug]{ lj1fg jf j}1flgs

k4ltnfO{ hgfpFYof] eg] cfw'lgs cjwf/0ff cg';f/ /f]u, :jf:Yo / :jf:Yo;Fu ;DaGwL cj:yf

tyf 36gfx¿sf] cWoog ug]{ / o;af6 k|fKt 1fgnfO{ :jf:Yo ;d:of lgoGq0f tyf ;dfwfg

ug{df k|of]u ug]{ k4ltnfO{ ;d]t Olk8]ldof]nf]hL elgG5 . cfw'lgs Olk8]ldof]nf]hLn] /f]u tyf

:jf:Yo cj:yf ;Fu;Fu} cf}ifwL tyf /f]u lgbfg ug]{ ;fwg÷tl/sfsf] pkof]lutf tyf

k|efjsfl/tf :jf:Yo ;]jfsf] ljt/0f, kx'Fr tyf k|of]u cflbsf] cWoog tyf d"NofÍg ub{5 .

5

tkfO{n] s] a'‰g' eof]

!= lxkf]qm]6;\sf] Olk8]ldof]lnof]hLsf] cjwf/0ff / Olk8]ldof]lnof]hLsf cfw'lgs cjwf/0ff

lar s] ;DaGw 5 <

@= Olk8]ldof]lnof]hLn] s] s] af/]df cWoog ub{5 <

#= Olk8]ldof]lnof]hLsf] af/]df tkfO{n] s] a'e\mg' eof] < 5f]6s/Ldf j0f{g ug'{xf];\.

$= Olk8]ldof]lnof]hLsf] If]q lj:tfl/t x'Fb} hfg'sf] sf/0f s] xf]nf <

!=#=@ /f]u cWoog lj1fgsf] If]q (Fields of Epidemiology)

/f]u cWoog lj1fgsf] If]q dxfdf/L /f]usf] cWoogaf6 ;'? eP/ :jf:Yo;Fu ;DalGwt

36gfsf] cWoog ug]{ lj1fgsf] ?kdf ;DalGwt ePsf] kfOG5 . o;/L o;sf] If]q w]/} km/flsnf]

ePsf] x'gfn] /f]u cWoog lj1fgsf] xfFufx¿ klg ylkFb} cfPsf] 5 . /f]u cWoog lj1fgn] sfd

ug]{ If]qsf] cfwf/df o;nfO{ lgDg xfFufsf If]qdf ljefhg ul/Psf] kfOG5 .

!= ;ª\qmd0f /f]u cWoog lj1fg (Infections disease epidemiology)

@= lSnlgsn /f]u cWoog lj1fg (Clinical Epidemiology)

#= If]q /f]u cWoog lj1fg (Field Epidemiology)

$= jftfj/0fLo /f]u cWoog lj1fg (Environmental Epidemiology)

%= ;dfh /f]u cWoog lj1fg (Social Epidemiology)

^= kf]if0f /f]u cWoog lj1fg (Nutritional epidemiology)

&= ca'{b /f]u cWoog lj1fg (Cancer Epidemiology)

s_ ;ª\qmd0f /f]u cWoog lj1fg (Infections disease epidemiology)

;?jf tyf ;ª\qmd0f /f]usf] cWoog ug]{ lj1fgnfO{ ;ª\qmds /f]u cWoog lj1fg elgG5

. cyf{t\ /f]usf hLjf0f' h:t} efO/;, JofS6]l/of, k|f]6f]hf]jf, 9';L, h'sf cflbsf] ;+qmd0faf6

x'g] /f]ux¿sf] cfwf/e"t sf/0f lj:tf/, /f]syfd lgoGq0f tyf pkrf/;DaGwL cWoog of]

/f]u cWoog lj1fg;Fu ;DalGwt 5 . o;n] gofF tyf k'/fgf] ;ª\qmfds tyf ;?jf /f]usf]

sf/0f klxrfg ug]{, /f]u km}lng] dfWod, dxfdf/L km}lng] ;|f]t, ;ª\qmd0fsf] lgu/fgL ug]{

6

hg;+/rgfdf 36gf b/, /f]u k|an b/, dg{ ;Sg] Ifdtf b/,d[To'sf b/ ;fy} /f]u lgoGq0f

/f]syfd tyf pkrf/sf] gofF x:tIf]k u/L sfo{qmd klxrfg cflbsf] cWoog ub{5 .

v_ lSnlgsn Olk8]ldyf]nf]hL (Clinical epidemiology)

;fdfGtof Olk8]ldyf]nf]hLn] dfgj ;d'bfo tyf hg;+/rgfdf /f]u tyf :jf:Yo ;DaGwL

36gfsf] cWoog ub{5 . lSnlgsn] Olk8]ldof]nf]hL eGgfn] /f]u cWoog lj1fg

(Epidemiology) sf] ljlwnfO{ /f]usf] lgbfg tyf pkrf/ ug]{ If]q h:t} c:ktfn tyf

:jf:Yo x]/rfx / ;+:yfdf k|of]u ug'{nfO{ hgfpF5 . of] Olk8]ldof]nf]hLn] lj/fdLx¿sf]

JolQm tyf ;d"xdf /f]usf] lgbfg, pkrf/ tfy pkrf/ k|ult (Prognosis) sf] af/]df

/f]u cWoog lj1fgsf] cjwf/0ff tyf ljlwaf6 cWoog ub{5 . Clinical epidemiology

eGg] zAb ;j{ k|yd John Paul n] ;g\ !($) df k|of]u u/]sf lyP . pgsf cg';f/

/f]usf] cWoog hg;+Vofdf dfq xf]Og lj/fdLx¿sf] ;d"xdf klg cWoog ug{ ;lsG5 /

/f]unfO{ kl/l:ylt;Fu ;DalGwt ug{ ;lsG5 . of] /f]u cWoog lj1fgn] /f]u lgbfg ug]{

k|ljlw tyf tl/sf, /f]u pkrf/ ug]{ tl/sf tyf gofF cf}ifwLsf] pkof]lutf tyf

k|efjsfl/tfsf] cWoog u/L hg:jf:Yo ;'wf/df of]ubfg k'¥ofpF5 .

u_ If]q /f]u cWoog lj1fg (Field Epidemiology)

Olk8]ldof]nf]hLsf] cjwf/0ff / ljlw cg';f/ /f]u tyf :jf:Yo ;d:ofsf] af/]df ;d'bfo

If]qdf cWoog ug]{ lj1fgnfO{ If]q /f]u cWoog lj1fg elgG5 . o;n] ;d'bfo tyf s'g}

If]qdf dxfdf/L /f]usf] cWoog ub{5 . cyf{t\ cfsl:ds ?kdf km}lng] /f]u tyf tTsfn

;d:ofsf] ;dfwfg ug'{kg]{ /f]usf] af/]df t'?Gt cWoog ug{sf] nflu (Field

epidemiology) sf] k|of]u ul/G5 . o;n] dflg;x¿nfO{ /f]u tyf ;d:ofaf6 arfpg

/ :jf:Yo ;+/If0f ug{sf] nflu of]hgf agfpg, sfof{Gjog cg'udg tyf sfo{qmdx¿

d"Nofª\sg ug{ klg d2t ub{5 . o;n] ;?jf /f]u cWoog lj1fgsf] l;4fGt tyf ljlw

cg';f/ dxfdf/L /f]u tyf cfsl:ds :jf:Yo ;d:ofsf] sf/0f klxrfg, /f]usf] k|fs[lts

Oltxf;, /f]usf] cfj[lQ, dfg{ ;Sg] Ifdtf /f]u km}lng] ;|f]t, ;g]{ dfWod /f]usf] k|j[lQ,

:jf:Yo sfo{qmdsf] k|efjsfl/tf d"Nofª\sg ug]{ sfd ub{5 .

3_ jftfj/0fLo /f]u cWoog lj1fg (Environmental Epidemiology)

jftfj/0fLo /f]u cWoog lj1fg Olk8]ldyf]nf]hLsf] Pp6f xfFuf xf] h:n] ef}lts, /f;folgs,

h}ljs tyf ;fdflhs tTjx¿df ;Dks{df cfP/ jf ;fdflhs, cfly{s, ;fF:s[lts tyf

7

ef}lts tTjx¿sf] k|efjn] dfgj :jf:Yodf kfg]{ c;/sf] af/]df Olk8]ldof]nf]hLsf]

cjwf/0ff tyf ljlw cg';f/ cWoog ub{5 . cfy{t o;n] jftfj/0f / :jf:Yosf] ljrsf]

;DaGw, tyf dflg;sf] jl/kl/sf] jftfj/0fsf] k|efjn] b]vf kg]{ /f]usf] sf/0f tyf l:yltsf]

af/]df cWoog ub{5 . o;n] JolQmsf] ljz]iftf eGbf klg dflg;sf] jl/kl/sf] jftfj/0fsf]

cj:yf tyf ljz]iftfn] h:t}M ;/;kmf{, vfg] kfgL, kmf]xf]/d}nfsf] Joj:yfkg, jfo' k|b"if0f

vfB k|b"if0f jftfj/0fLo sfg'g cflbsf] cj:yfn] dflg;sf] :jf:Yodf s] slt k|efj kf/]sf]

5, s'g ;d"xsf dflg;nfO{ k|efj kf/]sf] 5 / c;/ dfqf s:tf] kb{5 cflb af/]df cWoog

ub{5 . jftfj/0fdf x'g] ljelGg vfnsf] ;fdflhs tTjx¿n] dflg;sf] :jf:Yodf s] s:tf]

c;/ kf/]sf] eGg] af/]df cWoog ub{5 . o;n] jftjf/0fLo k|b"if0fsf] :jf:Yo vt/f tyf

kl/l:yltsf] lj36g, /f]usf lj:tf/ cflbsf] klxrfg ug{ d2t ub{5 .

ª+_ ;fdflhs /f]u cWoog lj1fg (Social epidemiology)

of] lj1fgn] :jf:Yo ;d:ofsf] d"n sf/0f ;fdflhs cfly{s cj:yf xf] eGg] s'/fdf hf]8

lbG5 . ;fdflhs /f]u cWoog lj1fg klg Olk8]ldof]nf]hLsf] Pp6f xfFuf xf] h;n] dfgj

hg;+Vofdf ;fdflhs cfly{s, ljz]iftfn] s;/L :jf:Yodf k|efj kf/]sf] 5 eGg] af/]df

cWoog ub{5 . ;fdflhs?kn] lk5l8Psf] JolQmx¿df k/]sf, cfly{s ?kn] sdhf]/ tyf

ul/j dflg;x¿ ljleGg /f]u tyf :jf:Yo ;d:ofx¿ cGo ;d'bfosf dflg;x¿nfO{ eGbf

a9L b]vfk/]sf] s'['/f ljleGg cWoogn] k'li6 u/]sf] 5 . ;dfhdf ePsf] c;dfgtf klg

:jf:Yodf k|s6 x'G5 . ljleGg cWoogn] ;fdflhs, cfly{s c;dfgtf / :jf:Yodf k|lts"n

c;/sf] aLrdf ;DaGw 5 eGg] s'/f k'li6 u/]sf] 5 . o;/L ;fdflhs, cfly{s ljz]iftfn]

/f]u / :jf:Yodf kfg]{ k|efjsf] af/]df Olk8]ldof]nf]hLsf] ljlw cg';f/ cWoog ug'{nfO{

;fdflhs /f]u cWoog lj1fg elgG5 . ;fdflhs Gofo tyf ;dtfsf] af/]df cGt/fli6«o

If]qdf Aofks rrf{ x'Fb} uPkl5 ;fdflhs /f]u cWoog lj1fgsf] klg a9L rrf{ x'g yfn]sf]

5 .

r_ kf]if0f /f]u cWoog lj1fg (Nutritional epidemiology)

dflg;df b]vfkg]{ /f]u tyf :jf:Yo ;d:of vfBfGg / kf]if0f ;Fu ;DalGwt 5 . a9L jf

sd kf]if0f ePdf :jf:Yo ;d:of pTkGg x'G5 . vfBfGgsf] cj:yf vfg] afgL, zf/Ll/s

kl/>d cflb kf]if0f / :jf:Yosf] larsf] ;DaGwsf] af/]df cWoog ug]{ /f]u cWog

lj1fgnfO{ Nutritional epidemiology elgG5 . cyf{t\ Olk8]ldof]nf]hLsf ljlw cg';f/

kf]if0fsf] sdLaf6 x'g] /f]usf] sf/0f tyf hf]lvd tTjx¿sf] klxrfg ug]{ s'g ;d"x, pd]/

8

lnª\u, ju{ tyf If]qsf dflg;x¿nfO{ s'g s'g k|sf/sf] kf]if0f ;DalGwt :jf:Yo ;d:of

tyf /f]un] c;/ kf/]sf] 5, o;sf] cfj[lQ b/ s] slt 5, o:tf ;d:ofx¿nfO{ s;/L

;dfwfg ug{ ;lsG5 egL cWoog ug]{ lj1fgnfO{ Nutritional epidemiology elgG5 .

5_ cj'b{/f]u cWoog lj1fg (Cancer epidemiology)

cfw'lgs o'udf SofG;/ /f]u Jofks¿kdf ljleGg pd]/ ;d"xsf JolQmnfO{ b]vf kg{ yfn]sf]

5 . ljleGg k|sf/sf] SofG;/ /f]u pTkGg ug]{ tTjx¿ / dfgj ;d'bfodf SofG;/sf]

ljt/0f tyf 36gf b/, d[To'b/, SofG;/ nfu]kl5 afFRg] jf dg]{ b/ cflbsf] af/]df cWoog

ug]{ lj1fgnfO{ cj'b{ /f]u cWoog lj1fg elgG5 . of] Environmental tyf Occupational epidemiology ;Fu klg ;DalGwt 5 . o;n] ;a} k|sf/sf] SofG;/sf]

sf/s tTjx¿, ljt/0f tyf cfj[lQ b/sf] af/]df cWoog ub{5 .

tkfOn] s] a'‰g' eof] <

!= Olk8]ldof]lnof]hLsf] If]q slt Jofks 5 <

@= jftfj/0fLo /f]u cWoog lj1fg (Environmental epidemiology) n] s]sf] af/]df

cWoog ub{5 <

#= ;fdflhs /f]u cWoog lj1fgn] s] sf] af/]df cWoog ub{5 <

$= tkfO{sf] ljrf/df Olk8]ldof]lnof]hLsf] dfly lbPsf] afx]s cGo If]q klg x'g ;S5 <

olb ;S5 eg] s] x'g ;S5 <

!=#=# /f]u cWoog lj1fgsf kIfx¿ (Components of Epidemiology)

/f]u cWoog lj1fgsf] rf/ kIfx¿ x'G5g\ .

s= /f]usf] cfj[lQ (Disease frequency): /f]usf] cfj[lQ eGgfn] s'g} dfgj hg;ª\Vofdf

s'g} /f]u jf :jf:Yo;Fu ;DalGwt 36gfx¿ sltk6s, sltdfqfdf b]vf kb{5 eGg] s'/fnfO{

hgfpF5 . :jf:Yo ;+:yf, c:ktfn tyf ;DalGwt lgsfox¿df /f]u, pkrf/, hGd, d[To',

b'3{6gf, rf]6k6s cflbsf] clen]vaf6 / ;fd'bflos ;j]{If0faf6k|fKt ;"rgf tyf

tYofÍx¿nfO{ ;+Vofdf kl/jt{g u/L u0fgf ug]{ / cfj[lQ dfkg ug{ ;lsG5 . /f]usf]

cfj[lQsf] ÷ af/Daf/tfsf] dfkg b/ (Rate) / cg'kft (Ratio) df ug{ ;lsG5 .

Olk8]ldof]nf]hLsf] klxnf] kIf /f]u jf :jf:Yo ;Fu ;DalGwt 36gfsf] 36gf b/

(Incidental rate), k|fefljt b/ (Prevalence rate), d[To' b/ (Mortality rate),

9

afFRg] b/ (Survival rate) cflbsf] lx;fa ug'{ xf] . /f]usf] cfj[lQ dfkgn] ;d'bfodf

/f]u cj:yf, :jf:Yo ;d:of klxrfg tyf k|fyldsLs/0f ug{ / /f]u /f]syfd jf

lgoGq0fsf] nflu of]hgf /0fgLlt agfpg dbt ub{5 .

v= /f]usf] ljt/0f (Disease distribution): JolQm,7fpF / ;do cflb ljz]iftfx¿sf]

cfwf/df /f]usf] 9fFrf tyf ljt/0fsf] ljZn]if0f ug'{nfO{ /f]usf] ljt/0f elgG5 . cyf{t\

s;nfO{ s'g ;d"xnfO{ /f]u nfU5, sxfF s'g 7fpFdf nfU5 / s'g s'g ;dodf /f]u b]vf

kb{5 eGg] s'/fsf] ljZn]if0f / j0f{g ug'{ g} /f]usf] ljt/0f xf] . /f]u cWoog lj1fgn] klxnf]

rn0fdf ;d'bfodf ;do, :yfg / JolQmsf] ljz]iftfsf] cfwf/df s;/L lj/0f ePsf] 5

eg]/ cWoog ub{5 . cyf{t\ /f]u cWoog lj1fgn] lgDg tLg kIfnfO{ cfwf/ agfP/ /f]u jf

;d:ofsf] ljt/0f tyf km}nfj6sf] af/]df a0f{g ub{5 .

-c_ ;do ljt/0f (Time distribution)

-cf_ :yfg ljt/0f (Place distribution)

-O_ JolQm ljt/0f (Person distribution)

-c_ ;do ljt/0f (Time distribution): o; 36scGtu{t s'g} klg /f]u s'g s'g

lbg, s'g s'g dlxgf, s'g s'g Ct', s'g s'g jif{, s'gs'g df};ddf s;/L km}ln/x]sf]

5 h:tf s'/fsf] cWoog ul/G5 .;do ljt/0faf6 /f]u slxn] km}lnG5 (When is

the disease occurring) kQf nufOG5 .

-cf_ :yfg ljt/0f (Place distribution): o;cGtu{t s'g} /f]u k|b]z, b]z, If]q,

lhNnf, c~rn, ;x/, ufpF, ul/aa:tL, Onfsf, t/fO{, kxf8, lxdfn, pkTosf, vf]r

cflbdf slt Jofks ¿kn] km}lnPsf] 5 eGg] cWoog ul/G5 . o;af6 s'g} lglZrt

If]qdf a9L jf sd km}lnPsf] tYo k'li6 x'G5 .

-O_ JolQm ljt/0f (Person distribution): dxfdf/L lj1fg cWoogsf] j0f{gfTds

cWoogcGtu{t JolQm ljt/0fnfO{ Ps k|d'v ¿kdf lnOG5 . s'g} klg /f]u s'g

k|s[ltsf] JolQm ljz]ifnfO{ a9L jf sd nfUb5 elg Jofks cWoog ul/G5 .

o;cGtu{t pd]/, lnª\u, hft, wd{, k];f, lzIffsf] :t/, ;fdflhs÷cfly{s cj:yf,

;'Ts]/L÷ue{jtL ;do, cfbt, j}jflxs l:ylt, kfl/jfl/s ;DaGw h:tf s'/fx¿nfO{

Wofg lbFb} cWoog cg';Gwfg ug]{ ul/G5 .

10

u= /f]usf] lgwf{/s tTj (Disease determinants)

lgwf{/s tTj eGgfn] sf/s tTj / k|ltsf/fTds tTj b'j} ;dfj]z x'G5 . o;n] JolQm -

j+zf0f', pd]/, lnË, Jojxf/, kf]if0f_, jftfj/0fLo -xfjf, kfgL, jf;:yfg, ;/;kmfO{ cflb_ /

;fdflhs -hft–hflt, wgL ul/j, wd{, ;+:s[lt cflb_ ljz]iftfx¿nfO{ ;d]6\b5 . /f]usf]

lgwf{/s tTjx¿sf] klxrfg tyf JofVof ug{sf] nflu ljZn]if0ffTds cWoog (Analytical

study) jf k|of]ufTds cWoog ug'{kb{5 . o; k|sf/sf] cWoog ubf{ j0f{gfTds cWoogaf6

k|fKt glthf h:t} /f]usf] 36gf jf k|faNo -k|efljt_ b/, dft[ b/, hfthflt ;d"x, 7fpF /

;do cfwf/df /f]u jf ;d:ofsf] cj:yf cflbnfO{ cfwf/ agfP/ /f]usf] lgwf{/s

tTjx¿sf] af/]df kl/sNkgf agfpg'kb{5 . cWoogdf pko'Qm vfnsf] b'O{ jf b'O{ eGbf a9L

;d"x ;dfj]z u/]/ lglZrt ;do;Dd cjnf]sg u/L tYofÍ ;Íng u/L /f]usf] cfj[lQ

dfkg ul/G5 . b'O{ ;d"xdf b]vf k/]sf] /f]usf] b/ t'ngf ug]{ / /f]u nfUg] ;dfGo cg'kft

jf ;fk]lIfs hf]lvd cg'kft cflb lx;fj ubf{ kl/sNkgf k/LIf0f ul/G5 .

3= /f]u lgoGq0f (Disease Control)

s'g} ;d'bfodf s'g} /f]usf] af/]df glhsaf6 cg'udg ug]{, lgu/fgL /fVg], ;"rgf ;Íng ug]{ /

/f]usf] ptf/r9fjsf] ljZn]if0f u/L t'?Gt} k|efjsf/L /f]syfdsf pkfox¿ cjnDag u/L /f]u

lgoGq0f ug]{ k|of; ug{ dbt ug'{ klg Olk8]ldof]nf]hLsf] kIf xf] . cWoogaf6 k|fKt tYo tyf

1fgnfO{ cfwf/ agfP/ /f]u lgoGq0f pkfox¿ klxrfg ug]{, gLlt tyf /0fgLlt agfP/ sfo{qmd

;~rfng ug{ cfwf/ tof/ kfb{5 . sfo{qmd ;~rfng u/]kl5 klg lg/Gt/ cg'udg tyf

d"NofÍg ug]{ sfo{ klg Olk8]ldof]nf]lhsn ljwLaf6 ug{ ;lsG5 . /f]u cWoog lj1fgsf] clGtd

/ dxTjk"0f{ kIf /f]u lgoGq0f tyf :jf:Yo ;d:ofdf ;dfwfg ug{ of]ubfg k'¥ofpg' xf] .

lqmofsnfk

!= glhssf] :jf:Yo ;++:yfdf uP/ Ps jif{ d'lgsf vf]k nufpg cfPsf lzz'x?sf] hDdf

;FVofsf] ;'rL tof/ kf/L ToxL ;dodf emf8fkvfnf tyf Pcf/cfO{÷:jf;k|Zjf; gnLdf

;+qmd0f eP/ pkrf/ u/fpg cfPsf lzz'x?sf] ;'rL tof/ kfg'{xf];\ .

@= :jf:o ;+:yfaf6 ;ª\sng u/]sf] lz'z'sf] hg;+Vof / /f]uL lz'z'sf] ;+Vofsf] cfwf/df

emf8fkvfnf / Pcf/cfO, lgdf]lgofsf] b/ tyf k|ltzt lgsfNg'xf];\ . To;}u/L ufpF,

lnª\u,hfthfltsf] cfwf/sf] /f]usf] ljt/0f b]vfpg'xf];\ .

11

tkfOn] s] a'‰g' eof] .

!= Olk8]ldof]lnof]hLsf slt kIf 5g\<

@= Olk8]ldof]lnof]hLdf /f]usf] cfj[lQ eGgfn] s] snfO{ hgfpF5 < pbfx/0f ;lxt rrf{

ug'{xf];\ .

#= /f]usf] ljt/0f / lgwf{/ssf] af/]df s] a'e\mg' eof] <

$= /f]u tyf :jf:Yosf] lgwf/stTj klxrfg ug{ s'g k|sf/sf] cWoog ug'{ kb{5 <

!=#=# /f]u cWoog lj1fgsf cfwf/e"t dfkgx¿ (Basic Measurements in Epidemiology)

s_ ?U0ftf÷/f]u k|sf]k b/sf] u0fgf (Measurements of morbidity)

dflg;x? ljeGgsf/0fn] c:j:y / /f]uL eO/xG5g\ . /f]u, ljdf/, c:j:y tyf czQm ePsf]

cj:yfnfO{ ?U0ftf elgG5 . ;fd'bflos tyf hg:Jff:Yo If]qdf o;nfO{ lg/Gt/?kdf dfkg ug'{

kb{5 . /f]u cWoog lj1fgsf] d'Vo sfd g} dflg;x?sf] ?U0ftf cj:yf dfkg / cWoog ug'{ xf]

. /f]u k|sf]k jf ?Ugtf (Morbidity) sf] dfkg ug{ vf;u/L b'O{ lsl;dsf b/ (Rate) sf]

k|of]u ul/G5 M–

c= 36gf b/ (Incidence rate)

lglZrt ;dofjlwdf lglZrt :yfgsf] gofF la/fdLsf] ;ª\VofnfO{ ;f]lx:yfgsf] hf]lvddf

kg{ ;Sg] ;ª\Vofn] efu u/L k|lt xhf/df u0fgf u/L cfpg] k|ltkmnnfO{ 36gf b/

elgG5 .

The number of new cases occurring in a defined population during a specific

period of time or a measure of morbidity based on the number of new

episodes of illness arising in a population over an estimated period.

36gf b/ dfkg ug{ lgDglnlvt ;"q k|of]u ul/G5 M–

36gf b/ Ö lglZrt ;dodf b]vfk/]sf gofF la/fdL ;ª̖Vof

dWo jif{sf] hf]lvddf k/]sf] hg;ª̖Vof × !)))

12

IR =

No. of new cases of disease duringgiven time period

Mid year population at risk × 1000

pbfx/0f, tf}lnxjf gu/kflnsfdf @)^! ;fndf %)) hgf cf}nf]sf gofF la/fdLx¿ b]vfk/]

pQm gu/kflnsfsf] @)^! ;fnsf] dWo jif{sf] hf]lvddf k/]sf] hg;ª\Vof %),))) lyof]

eg] cf}nf]sf] 36gf b/ slt xf]nf <

gofF la/fdLsf] ;ª\Vof Ö %))

dWo jif{sf] hf]lvddf k/]sf] hg;ª\Vof Ö %))))

36gf b/ Ö gofF la/fdL ;ª̖Vof


Ö 500

50000 × !)))

36gf b/ Ö k|lt xhf/df !) hgf k|lt jif{

lqmofsnfk

s'g} dlxgfsf] ! ut]nfO{ cfwf/ agfP/ tkfO{ ufpF÷j8fdf kfFr aif{ d'lgsf afnaflnsfx? slt

5g\ < hg;ªVoff kQf nufpg'xf];\ . lg/f]uL afnaflnsfx?sf] ;"rL tof/ kfg'{xf];\ / Ps dlxgf

;Dd nuftf/ ;f]wk'5 tyf cjnf]sg u/L slt hgfnfO{ ?3fvf]sL ;d:of b]vf kb{5 kQf

nufO{ To;sf cfwf/df ?3fvf]sLsf] 36gf b/ kQf nufpg'xf];\.

cf= k|efljt÷k|faNo b/ (Prevalence rate)

/f]u k|efljt b/ eGgfn] s'g} lglZrt ;dodfjlw jf ;do ljGb'df s'g} /f]uaf6 u|l;t

ePsf ;a} la/fdLx¿ -gofF tyf k'/fgf]_ ;ª\VofnfO{ Tolx ;dodf hf]lvddf k/]sf

hg;Vofn] efu u/]/ cfPsf] efukmnnfO{ /f]u Jofkstf jf k|faNo b/ elgG5 . of] b/

dfkg ubf{ s'g} /f]usf lj/fdL ;ª\VofnfO hf]lvddf k/]sf hg;Vofn] efu u/L cfPsf]

efukmnfO dfkg OsfO{ ;Vof h:t} !)) jf !))) jf !)))) n] u'0fg u/L k|efljt b/

lgsflnG5 (Prevalence rate is defined as the total number of all current cases

13

(old and new) of a particular disease or event at a particular time point or

period divided by the population at risk of the same diseases at same time

point or midway through period) .

k|efljt b/ dfkg ug{ lgDglnlvt ;"q k|of]u ul/G5 M–

k|efljt b/ Ö

s'g} lglZrt ;d'bfo Pj+ ;do jf cjlwdf /f]u nfu]sf hDdf -gofF ± k'/fgf]_ /f]uLsf] ;ª ̖Vof

pQm cjlwsf] pQm /f]u nfUg ;Sg] hDdf hg;ª ̖Vof × !))

PR =

Total No. of Patients or cases (new + old) ofa particular disease/period/time/communityPopulation at risk at the same time & place × 100

k|efljt b/ (Prevalence Rate) b'O{ tl/sfaf6 dfkg ul/G5 M–

i) ljGb' k|efljt b/ (Point prevalence rate)

ii) cfjlws k|efljt b/ (Period prevalence rate)

i) ljGb' k|efljt b/ (Point prevalence rate)

ljGb' k|efljt eGgfn] s'g} lglZrt hg;ª\Vofdf lglZrt ;dosf] ljGb'df s'g} /f]usf]

xfnsf gofF / k'/fgf la/fdLx¿sf] ;ª\Vof xf] cyf{t\ s'g} klg /f]usf] ljGb' k|efljt eg]sf]

s'g} vf; ;dodf vf; ;d'bfodf ePsf] s'g} /f]usf] gofF / k'/fgf] /f]uLsf] ;ª\Vof xf] .

tf]lsPsf] ;do cjlw leq s'g} lglZr 7fpFdf km]nf k/]sf gofF tyf k'/fgf lj/fdLsf]

;ª\Vof / To; 7fpFdf hf]lvddf k/]sf hg;ª\Vofn] efu u/L !))) n] u'0fg ubf{ cfpg]

k|ltkmnnfO{ ljGb' k|efljt b/ elgG5 . o;df vf;u/L 5f]6f] ;do h:t} M lbg xKtf jf

dlxgfleqsf 36gfqmdx¿sf] cWoog ul/G5 .

The number of all current cases (old and new) of a particular disease at one

point in time in relation to a defined population. Here point may take a day,

several days, or a few week.

ljGb' k|efljt b/ dfkg ug{ lgDglnlvt ;"q k|of]u ul/G5 M–

14

ljGb' k|efljt b/ Ö

s'g} lglZrt ;dodf lglZrt 7fpFdf ePsfhDdf -gofF ± k'/fgf]_ la/fdL ;ª̖Vof

To; ;dosf] laGb'df cg'dflgt hg;ª̖Vof × !)))

Point prevalence rate =

No. of all current cases (old and new) of a specifieddisease existing at a given point in time

Estimated population at the same point in time

×1000

pbfx/0f M– dfgf}+{ afUn'Ë lhNnfsf] a'lt{afË uf=la=;= df #))) hg;ª\Vofdf lj=;+= @)^* ;fn

dª\l;/ dlxgfsf] !% ut] ;j]{If0f ubf gofF / k'/fgf u/L #)) hgf ?3fvf]sLsf lj/fdL

lyP eg] pQm 7fpFdf ?3f vf]sLsf] ljGb' k|efljt b/ slt lyof] <

Point prevalence rate = 3003000 × 100

?3fvf]sLsf] laGb' k|eflat b/ !) k|ltzt lyof] jf k|lt xhf/ !)) lyof] .

ii) cfjlws k|efljt b/ (Period prevalence rate) M o;n] s'n hg;ª\Vofdf

lglZrt ;dofjlwdf nuftf/ ePsf ;Dk"0f{ la/fdLx¿ -gofF÷k'/fgf]_ sf] /f]usf] k6s jf

cfj[lQnfO{ dfkg ub{5 . o; leq ;dofjlw klxn]b]lv hf] nuftf/ u|l;t 5g\, tL klg

kb{5g\ / xfnsf ;dofjlwdf ePsf la/fdLx¿ klg kg{ hfG5g\ . Period prevalence

measures the frequency of all current cases (old and new) existing during

defined period of time (eg. monthly or annualy prevalence) expressed in

relation to a defined population period.

cfjlws k|efljt b/ dfkg ug{ lgDglnlvt ;"q k|of]u ul/G5 M–

cfjlws k|efljt b/ Ö


pQm ;dofjlwsf] cg'dflgt hg;ª ̖Vof × !)))

Period prevalence rate =

No. of existing cases (old and new) of a specifieddisease during a given period of time interval

Estimated mid interval population at risk during the given period of time

×

100 or 1000

15

pbfx/0f M–dfgf}+ lj=;+= @)^& ;fndf afUn'Ë lhNnfsf] a'lt{afË uf=la=;= df d+l;/ / k';

dlxgfsf] cljlw leq #))) hg;ª\Vofdf gofF / k'/fgf u/L #%) hgf ?3fvf]lssf lj/fdL lyP

eg] pQm 7fpFdf ?3f vf]sLsf] cfjlws k|efljt b/ slt lyof] <

Period prevalence rate = 250

15000 × 100 or 1000

d+l;/ dlxgfdf ?3fvf]sLsf] cfjlws k|efljt jf k|faNo b/ !!=^^ k|ltzt jf k|ltxhf/

!!^=^ lyof] eGg] x'G5 .

/f]u k|efljt b/ k|fo kltztdf dfkg ul/G5 . sd dfqfdf b]vf kg]{ /f]u 5 eg] k|ltxhf/df

klg dfkg ug]{ ul/G5 . ;/sf/n] Ps aif{ ;Ddsf] tYofª\s ;+sng u/]/ aflif{s /f]u k|efljt

b/ lgsfNg] ub{5 . of] b/ of]hgf agfpbf pkof]uL x'g ;Sb5 .

lqmofsnfk

tkfOsf] uf=lj=;=df %) aif{ eGbf dfly pd]/sf hg;ª\Vof slt 5g\ < kQf nufpg'xf]';\ / tL

dWo] slt hgfnfO{ bdsf] ;d:of 5 Tof] klg kQfnufO /f]u k|efljt b/ lgsNg'xf];\ .

v_ d[To'b/sf] dfkg (Measurement of Mortality)

ljZj:jf:Yo ;+u7g (WHO) n] d[To'nfO{ o;k|sf/ kl/eflift u/]sf] kfOG5 æd[To' eg]sf]

hLljt hGd kl5 s'g} klg j]nfdf hLjgsf] ;Dk"0f{ nIf0fx¿sf] :yfoL ?kdf ;dfKt x'g' xf] .Æ

(Death is the permanent disappearance of all evidence of life at any time after

birth has taken place.)

d[To'nfO{ ljleGg tl/sfn] dfkg ug{ ;lsG5 h'g o;k|sf/ 5 M–

!= sf]/f÷ckl/kSj d[[To'b/ (Crude death rate)

sf]/f d[To' eGgfn] h'g;'s} pd]/ / lnËsf dflg;x?sf] d[To'nfO{ hgfpFb 5 . d[To'nfO{

ul0ftLo cfwf/df dfkg ug]{ ;a}eGbf ;fdfGo ljlwsf] ¿kdf sf]/f d'To'b/nfO{ lng ;lsG5

. s'g} lglZrt If]qdf Ps jif{ leqdf k|lt xhf/ hg;ª\Vofdf dg]{ JolQmx¿sf] ;ª\VofnfO{

sf]/f d[To'b/ elgG5 . o;n] ;a} pd]/ / lnËsf] d[To'b/ nfO{ ;d]6\5 . s'g} lglZrt If]qdf

Ps jif{ leqdf d[To' x'g] JolQmx¿sf] ;ª\VofnfO{ pQm If]qsf] cg'dflgt dWo jif{sf]

16

hg;ª\Vofn] efuu/L Ps xhf/n] u'0fg u/L sf]/f d[To' b/ lgsflnG5 . (The numbers

of death from all causes per thousand of estimated mid -year

population in one year in given place.)

o;nfO{ lgDg ;"qaf6 lgsfNg ;lsG5 M–

sf]/f d[To'b/ Ö

s'g} lglZrt If]qdf Ps jif{ leqdfd/]sf hDdf dflg;x?sf] ;ª̖Vof

pQm If]qsf] cg'dflgt dWo jif{sf] hg;ª̖Vof × !)))

CDR=

The number all deaths during the yearin particular place(D)

Estumated Mid year population of the place(P) × 1000

pbfx/0f M– dfgf}+ h'Dnf lhNnfsf] rGbggfydf lj=;+= @)^& ;fndf !%) hgf JolQmsf]

d[To' eof] / To; jif{ rGbggfysf] dWo jif{sf] hg;ª\Vof !),))) lyof] eg] sf]/f d[To' b/

slt lyof] <

CDR= 150

10000 × 1000

sf]/f d[To'b/ k|ltxhf/ !% lyof] .

pd]/ ljlzi6 d[To'b/ (Age specific mortality rate)

s'g} vf; jif{sf] dWo;Dddf s'g} lglZrt pd]/ jf pd]/ ;d"xdf d[To' x'g] dflg;x¿sf]

hg;ª\VofnfO{ To;} pd/ jf pd]/ ;d"xsf] dWo jif{sf] hg;ª\Vofn] efu u/L cfPsf]

kl/0ffdnfO{ Ps xhf/ n] u'0fg u/L pd]/ ljlzi6 d[To'b/ (ASMR) lgsflnG5 . o;nfO{

lgDg ;"qaf6 lgsfNg ;lsG5 M–

ljlzi6 d[To'b/ Ö

lglZrt jif{ Pj+ 7fpFdf ePsf vf; pd]/;d"xsf] s'n d[To'

dWo jif{df To; pd]/ ;d"xsf] hg;ª ̖Vof × !)))

17

pbfx/0f M– dfgf}+ lj=;+= @)^& ;fndf pbok'/ lhNnfsf] s6f/Ldf @)–@$ jif{ pd]/ ;d"xsf]

hg;ª\Vof !,%)) lyof] tL dWo] !) hgf dflg;x¿ d/]5g\ eg] pd]/ ljlzi6 d[To' b/ slt

lyof] <

ASMR= 10

1500 × 1000

ljlzi6 d[To'b/ k|lt xhf/ ^=^^ lyof] .

lzz' d[To'b/ (Infant mortality rate)

lzz' s'g} lglZrt 7fpFdf Ps jif{el/df cfˆgf] Ps jif{ pd]/ gk'Ub} dg]{ lzz'x¿sf] s'n

;ª\VofnfO{ ToxL jif{el/df hLljt hGd ePsf s'n lzz'x¿sf ;ª\Vofn] efu u/L cfPsf]

kl/0ffdnfO{ !))) n] u'0fg u/L lzz' d[To'b/ lgsflnG5 (It is the number of death

under one year of age per thousand live birth in a given place in a

year.)

lzz' d[To'b/Ö

s'g} jif{df Ps lglZrt 7fpFdf jif{ pd]/ leqsf d/]sf aRrfx¿sf] ;ª̖Vof

hDdf hLljt hGd]sf aRrfx¿sf] ;ª ̖Vof × !)))

IMR= No. of death of infants under age 1 yearTotal no. of live birth in the same year × 1000

pbfx/0f M– dfgf}+ k;f{ lhNnfsf] jL/u~h gu/kflnsfdf lj=;+= @)^& ;fndf @%)) hgf

afnaflnsfx¿ hLljt hGd]sf] lyP h; dWo] To; jif{ pQm gu/kflnsfdf %) hgf

lzz'x¿sf] Ps jif{ gk'Ub} d[To' ePsf] lyof] eg] To; 7fpFsf] lzz' d[To'b/ slt lyof] <

IMR= 50

2500 × 1000

lzz' d[To' b/ k|ltxhf/ @) lyof] .

18

afn d[To'b/ (Child mortality rate)

Ps jif{ pd]/ b]lv kfFr jif{ d'lgsf -!–$ jif{_ k|ltxhf/ afnaflnsfx¿ dWo] s'g} Ps

jif{ leq d[To' x'g] afnaflnsfsf] ;ª\VofnfO{ afnd[To' b/ elgG5 . o;sf] u0fgf ubf{ s'g}

lglZrt 7fpFsf] s'g} Ps jif{ leq Ps jif{ k'/f u/L kfFr jif{ ggf3]sf afnaflnsfx¿sf]

d[To' x'g] ;ª\VofnfO{ ToxL 7fpFsf] ToxL jif{ leqdf !–$ jif{ pd]/sf s'n hLljt

afnaflnsfx¿sf] ;ª\Vofn] efu u/L cfPsf] kl/0ffdnfO{ Ps xhf/n] u'0fg u/L lgsflnG5

. o;nfO{ lgDg ;"qcg';f/ lgsfNg ;lsG5 M–

afnd[To'b/Ö

s'g} jif{df !–$ jif{sf] pd]/ leq d[To' x'g] aRrfx¿sf] ;ª̖Vof (No. of death children 1-4 year)

pQm jif{df ToxL pd]/ ;d"xsf] dWo jif{sf] hDdf hLljt hGd]sf

aRrfx¿sf] ;ª̖Vof (Total mid year population aged 1-4 year in the year)

× !)))

pbfx/0f M– dfgf}+ s}nfnL lhNnfsf] wgu9L gu/kflnsfdf lj=;+= @)^& ;fndf !–$

jif{sf afnaflnsfx¿sf] ;ª\Vof %))) lyof] To;} jif{ pQm gu/kflnsfdf !–$ jif{ pd]/

;d"xsfdWo] !%) hgf afnaflnsfx¿sf] d[To' ePsf] lyof] eg] To; 7pFsf] afn d[To'b/

slt lyof] <

CMR= 1505000 × 1000

afn d[To'b/ k|lt xhf/ #) lyof] .

kfFr jif{d'lgsf afnaflnsfsf] d[To'b/ (Under five mortality rate)

s'g} Ps jif{ leq kfFr jif{ d'lgsf k|ltxhf/ afnaflnsfx¿ dWo] To;} jif{ leq kfFr jif{ gk'Ub}

d[To' x'g] afnaflnsfsf] ;ª\VofnfO{ kfFr jif{d'lgsf afnaflnsfsf] d[To' b/ elgG5 . lzz'

d[To' b/ / afn d[To' b/sf] of]u g} kfFr jif{d'lgsf] d[To' b/ xf] . o;sf] u0fgf ubf{ s'g}

lglZrt 7fpFsf] s'g} Ps jif{ leq kfFr jif{ ggf3]sf afnaflnsfx¿sf] d[To' x'g] ;ª\VofnfO{

ToxL 7fpFsf] ToxL jif{ leqdf pQm pd]/sf s'n hLljt afnaflnsfx¿sf] ;ª\Vofn] efu u/L

cfPsf] kl/0ffdnfO{ Ps xhf/n] u'0fg u/L lgsflnG5 . o;nfO{ lgDg ;"qcg';f/ lgsfNg

;lsG5 M–

19

kfFr jif{ d'lgsf afn d[To'b/ Ö kfFr jif{ pd]/ gk'Ub} d[To' x'g]aRrfx¿sf] ;ª ̖Vof

pQm jif{df kfFr jif{ d'lgsf hDdf hLljt hGd]sf

aRrfx¿sf] ;ª ̖Vof

×!)))

pbfx/0f M– dfgf}+ afFs] lhNnfsf] g]kfnu~h gu/kflnsfdf lj=;+= @)^& ;fndf &)))

afnaflnsfx¿ % jif{ pd]/ ggf3]sf lyP / To;} jif{ pQm gu/kflnsfdf ToxL pd]/ ;d"xsf

dWo]af6 #)! hgf afnaflnsfx¿sf] d[To' ePsf] lyof] eg] To; 7pFsf] kfFr jif{d'lgsf] afn

d[To'b/ slt x'G5 <

U5MR= 3017000 × 1000

kfFr jif{ d'lgsf afn d[To'b/ k|ltxhf/ $# lyof] .

dft[ d[To'b/ jf cg'kft (Maternal mortality rate/ratio)

uef{j:yfdf b]v.k/]sf ;d:of, k|;j j]bgf, ;'Ts]/L kl5 klg $@ lbg leq ;f]xL ;d:ofn]

ubf{ k|lt Psnfv hLljt lzz' hGdbf dg]{ dlxnfx¿sf] ;ª\VofnfO{ dft[ d[To' cg'kft

elgG5 . Ps jif{ leq k|;'lt jf k|hgg;+u ;DalGwt hl6ntfsf] sf/0fn] d[To' x'g] cfdfsf]

;ª\VofnfO{ To;} jif{ leq hLljt hgd]sf lzz'x¿sf] ;ª\Vofn] efu u/L cfPsf]

kl/0ffdnfO{ Psnfvn] u'0fg u/L dft[ d[To' cg'kft lgsflnG5 . o;nfO{ vf;u/L k|lt !

nfvdf hLljt hGd]sf aRrf;Fu t'ngf u/]/ d[To' b/ lgsfNg] ePsf]n] o;nfO{ ;xL cy{df

dft[ d[To' cg'kft elgG5 . cfly{s jif{ @)^^÷)^& sf] cg';f/ g]kfnsf] dft[d[To'

cg'kft÷b/ @@( lyof] .

dft[ d[To'b/ Ö

ue{jtL jf ;'Ts]/L cj:yfdf ;'Ts]/L ePsf] ^ xKtf -$@ lbg_ leq k|ToIf ¿kn] ue{jtL jf ;'Ts]/L;Fu

;DalGwt sf/0fn] ePsf] cfdfx¿sf] dft[ d[To' ;ª ̖VofTo; jif{df hGd]sf hLljt lzz'sf] s'n ;ª ̖Vof

× !,)),)))

/f]u ljz]if d[To'b/ ÷ /f]u d[To' Ifdtf b/ (Case fatality rate)

/f]u d[To'b/n] s'g} /f]u nfu]sf dflg;nfO{ dfg{ ;Sg] (Killing power) zlQmnfO{

hgfpF5 . of] d[To'b/ s8f vfnsf] ;¿jf /f]ux¿ h:t} x}hf, emf8fkvfnf, OGk'mNhf, cflb

/f]ux¿sf] dfg]{ Ifdtf dfkg ug{ k|of]u ul/G5 . s'g} If]qsf] Ps jif{df s'g} ljz]if /f]u

20

af6 lkl8t eO{ dg]{x¿sf] ;ª\VofnfO{ pQm 7fpFsf ToxL jif{ / ToxL /f]uaf6 kLl8t

dflg;x¿sf] ;ª\Vofn] efu u/L cfPsf] efukmnnfO{ Ps xhf/n] u'0fg u/L /f]u ljz]if

d[To'b/ lgsflnG5 .

/f]u d[To' Ifdtf b/ Ö s'g} Pp6f jif{df lglZrt /f]uaf6 ePsf] d[To'sf] s'n ;ª̖Vof

pQm ;dodf ToxL /f]u nfu]sf ;Dk"0f{ la/fdLsf] ;ª̖Vof ×!)))

pbfx/0f M– dfgf}+ hfh/sf]6 lhNnfdf lj=;+= @)^& ;fndf x}hf /f]u nfu]sf sf/0faf6

la/fdL ePsf @%) hgf JolQmx¿ dWo] !% hgfsf] d[To' ePsf] lyof] eg] /f]u d[To' Ifdtf

b/÷/f]u ljz]if d[To'b/ slt lyof] xf]nf <

CFR = 15250 ×1000

/f]u d[To' Ifdtf b/ k|ltxhf/ ^) lyof] .

lqmofsnfk

tkfO{sf] uf=lj=;=df Ps aif{ leq slt lzz' / kfFr aif{ d'lgsf afnafnlnsf] d[To' eof]

kQf nufO{ lzz / afn d[To'b/ kQf nufpg'xf];\ .

u_ k|hgg\sf] dfkg (Measurement of Fertility)

k|hgg cyf{t\ fertility nfO{ csf]{ zAbdf birth jf Natality klg elgG5 . k|hgg eGgfn] aRrf hGdfpg] jf:tljs k|lqmof xf] h;nfO{ aRrf hGdfpg ;Sg] zf/Ll/s Ifdtf;Fu t'ngf

ug{ ;lsG5 . k|hggnfO{ afFemf]kg (Infertility) sf] 7Ls ljk/Lt ¿kdf lnOG5 . s'g} klg JolQmsf] k|hgg p;sf] aRrf hGdfpg] zf/Ll/s Ifdtfdf e/k5{ . k|hggnfO{ Pp6f dlxnf jf dlxnfx¿sf] ;d"xsf] jf:tljs k|hggsf] dxŒjk"0f{ pknlAwsf] ¿kdf lnOG5 . sf]/f hGdb/ g} hGdsf] dfkg ug{ Ps cfwf/ xf] . k|hggnfO{ lgDg tl/sfn] dfkg ug{ ;lsG5 h'g o;k|sf/ 5 M–

!= sf]/f hGdb/ (Crude birth rate)

sf]/f hGdb/ eGgfn] s'g} lglZrt :yfgsf] s'Gf} lglZrt jif{sf] dWo;Dddf /x]sf] s'n hGf;ª\Vofn] pQm vf; jif{el/df g} hLljt hlGdPsf] s'n aRrfx¿sf] ;ª\VofnfO{ efu u/L cfPsf] kl/0ffdnfO{ !))) n] u'0fg ubf{ cfpg] kl/0ffdnfO{ hgfpF5 . o;nfO{ ;"qaf6 o;k|sf/ lgsfNg ;lsG5 M–

21

CBR = Total live birth

Total Mid year population × 1000

OR

CBR = BP × k

B = Total number of live birth in a given year

p = Total mid year population

K = Constant number (1000)

@= ;fwf/0f k|hggb/ (General fertility rate)

;fdfGo k|hggb/ eGgfn] k|ltxhf/ k|Hfggof]Uo dlxnf -h;n] aRrf kfpg ;S5_ af6 Ps jif{df hLljt hGd]sf] lzz'x¿sf] ;ª\Vof kQf nfUb5 . o;/L ;fdfGo k|hggb/ eGgfn] aRrf hGdfpg] Ifdtf ePsf] k|ltxhf/ dlxnfåf/f Ps jif{leq hGd]sf hLljt lzz'x¿sf] ;ª\VofnfO{ a'emfpFb5 .

;fDffGo k|hggb/ lgsfNg s'g} 7fpFdf lbOPsf] jif{sf] dWolt/ hGd]sf] hLljt lzz'sf] ;ª\VofnfO{ To; jif{ ToxfF ePsf !% b]lv $( jif{ pd]/ leqsf dlxnfsf] ;ª\Vofn] efu u/L !))) n] u'0ffg ul/G5 .

o;nfO{ lgDg ;"q k|of]u u/L lgsfNg ;lsG5 M–

GFR = B

P(15- 49 years) × 1000

B = Total number of live birth in a given year

P(15-49 years) = Female population of age 15 to 49 years

#= s'n k|hggb/ (Total fertility rate)

s'g} dlxnf jf dlxnf ;d"xn] !% b]lv $( jif{sf] cjlwdf ;/b/ slt aRrf hGdfpF5g\ eGg] s'/f s'n k|hggb/n] atfpF5 . s'n k|hggb/ pd]/ ljlzi6 k|hggb/af6 lgsflnG5 . To;}n] pd]/ ljlzi6 k|hggb/sf] of]u g} s"n k|hggb/ xf] . o;sf nflu pd]/ cg';f/sf k|hggb/x¿ hDdf ug{'k5{ . To;kl5 %–% jif{sf] cGt/fnsf] pd]/cg';f/sf] k|hggb/xnfO{ % n] u'0fg u/L !))) n] efu ug'{k5{ . s'n k|hggb/ k|ltdlxnf JoQm ul/G5 . k|ltdlxnf Jotm ug{sf] nflu u'0fg kmnnfO{ !))) n] efu ug'{k5{ .

o;sf/0f k|To]s pd]/ ;d"xsf dlxnfsf] pd]/ ljlzi6 k|hggb/ lgsfln;s]kl5 of] ;a} ;d"xsf k|hggb/nfO{ hf]8]/ k|fKt x'g] k|hggb/nfO{ s'n k|hggb/ elgG5 . g]kfnsf] s'n

22

k|hggb/ lj=;+= @)$* / lj=;+= @)%* sf] hgu0fgfcg';f/ qmdzM @=!@ / #=* k|ltJolQm /x]sf] 5 .

TFR = ∑ 49 ASFR

1000 × 5

TFR lgsfNg'eGbf klxnf ASFR lgsfNg' k5{ . g]kfn hg;fª\lVosLo tyf :jf:Yo

;j]{If0f ;g\ @))& sf cg';f/ g]kfnsf] s'n k|hggb/ #=! /x]sf] 5 .

3_ hf]lvd cg'kft tyf ;DaGwsf] dfkg (Measures of Risk Ratio and Association)

/f]u cWoog lj1fgsf] d'Vo sfo{ ;d'bfosf s'g} b'O{ ;d"xdf /f]u tyf :jf:Yo ;d:of 36gf jf

k|fjNo b/ kQf nfupg] / b'O{ ;d"xsf lar t'ngf u/L hf]lvdsf] cg'kft lardf /f]u /

/f]unfUg] hf]lvd cj:yfdf k|s6 lar;DaGwnfO{ ;+Vofdf kl/jt{g u/L ;DaGwsf] dfkg u/L

;DefJo sf/s tTjsf] klxrfg ug'{ xf]

hf]lvd eGgfn] ;d'bfodf /f]u nfUg] jf s'g} 36gf x'g] ;Defjgf (Probability) nfO{ Risk

jf hf]lvd elgG5 . /f]u cWoog lj1fgn] vt/feGbf klg hf]lvdsf] ;Defjgf cyf{t\ s'g} /f]u

nfUg] ;Defjgf slt 5 eg]/ lx;fj ug{÷cg'dfg ug]{ ub{5 . hf]lvdsf] dfkg tyf ;DaGwsf]

dfkg cg'kft h:t} Risk ratio, Odds ratio, Rate ratio df ul/G5 .

!_ hf]lvd cg'kft (Risk Ratio)

hf]lvd cg'kftnfO{ ;fk]lIfs hf]lvd klg elgG5 . Pp6f ;d"xdf ePsf] :jf:Yo ;DaGwL 36gf

h:t} /f]u, czSttf, b'3{6gf cflbsf] hf]lvdnfO{ csf]{ ;d"xdf ePsf] ToxL hf]lvdnfO{ t'ngf

u/L hf]lvd cg'kft lgsflnG5 . (It is the probability of a particular disease or

event occurring among persons exposed to a given risk factor divided

by the corresponding probability among unexposed group) . ;d"xdf

Psdf ePsf] hf]lvd cyf{t\36gf b/, cfqmd0f b/ (Incidence rate, attack rate) nfO{

;d"x b'O{df ePsf] hf]lvd b/n] efu u¥of] eg] hf]lvd cg'kft kQf nfUb5 .

hf]lvd cg'kft efu ug]{ ljlw (Method for calculating risk ratio)

lgDg ;"q k|of]u u/]/ hf]lvd cg'kft kQf nufOG5 .

23

Risk Ratio =

Risk of disease (incidence rate) in primary group with exposureRisk of disease (incidence rate)

in comparison group without exposure

;Defjgf cGt/ cg'kft (Odds ratio): ;Defjgf cGt/ cg'kft klg sf/0f / c;/sf]

lar;DaGw :yfkgf dfkg ug]{ hf]lvd cg'kft h:t} xf] . hf]lvd cg'kftdf 36gf b/

cfjZostf kb{5 eg] o;df ;Defjgf cGt/ (Odds) klxrfg ug'{kb{5 . s'g} /f]u jf 36gf

x'g] ;DefjgfnfO{ ToxL /f]u ÷ 36gf gx'g] ;Defjgfn] efu u/]/ cfPsf] glthfnfO{ Odds

ratio elgG5 . h:t} !)) hgf w'dkfg ug]{ JolQmdf ^) hgfnfO{ lb3{vf]sLsf] ;d:of b]vf

k¥of] eg] !)) hgf Smoker df ^) nfO{ vf]sL /f]u nfUg] ;Defjgf 5 eg] !)) hgf dWo]

$) hgfnfO{ ;Defjgf 5}g . ^)÷$)Ö!=% nfO{ Exposure odds elgG5 .

/f]u nfUg ;Sg] sf/s tTjx¿sf] ;Dks{df cfP/ /f]u nfu]sf] / ;DefJo sf/s tTjsf]

;Dks{df gcfP/ klg /f]u nfu]sf] aLrsf] cg'kfnfO{ Odds of case exposure elgG5 .

;DefJo sf/s tTj;Fu Exposed eP/ klg /f]u gnfu]sf] / unexposed eP/ /f]u gnfu]sf]

aLrsf] cg'kftnfO{ Odds of control exposure elgG5 . oL b'O{ k|sf/ Odds sf] Ratio

nfO{ Odds ratio elgG5 . cyf{t\ s'g} vf; ;DefJo sf/s tTjsf] ;Dks{df cfP/ ÷ gcfP/

/f]u nfu]sf] JolQmx¿ Case exposure sf] Odds nfO{ /f]u gnfu]sf] JolQmx¿ (Control)

Exposure sf] Odds n] efu u/]/ cfPsf] cg'kftnfO{ Odds ratio elgG5 . (It is the odds

of a particular exposure among persons with a specific disease divided by the

corresponding odds of exposure among persons without the disease of interest)

o;nfO{ Cross product ratio klg elgG5 . o;sf] nflu b'O{ x b'O{ sf] Table agfpg' kb{5 .

Exposed Unexposed Total

Case (disease) A = 100 B = 80 A + B = 180

Control (without

disease)

C = 1900 D = 7100 C + D = 8000

Total A + C B + D A + B + C + D

24

Odds of case exposure = Exposed cases

All cases ÷ Unexposed cases

All cases

= A

A + B ÷ B

A + B = AB

Odds of control exposure = CD

OR

Odds Ratio lx;fa ug]{ Formula

OR = Disease exposed

Disease no exposed ÷ Non diseae expose

Non-disease no - exposed

dflysf] tflnsf cg';f/,

c8;\ cg'kft (OR) = AB ÷

CD =

A × DB × C

100 × 7‚10080 ×1‚900 =

710‚000191‚000 = 4.7

c8\; cg'kft (OR = 4.6)

/f]usf] ;Dej sf/s tTjx¿sf] ;Dks{df gcfPsf (Unexposed) JolQmnfO{ eGbf ;Dks{df

cfPsf (Exposed) JolQmnfO{ /f]u nfUg] ;Defjgf % u'0fn] a9L x'G5 . o;n] /f]usf] sf/s

tTj / /f]usf] aLrsf] ;DaGw 5 eGg] b]vfpF5 . o;/L Odds ratio n] /f]u nfUg] ;Defjgf /

/f]u / ;Defjgf sf/s tTjx¿sf] lar;DaGwsf] dfkg ub{5 .

lqmofnfk

tkfO{sf] j8fdf ;fa'g kfgLn] xft wf]P/ vfg vfg] / ;fa'g kfgLn] xft gwf]P/ vfgfvfg]

cfwf/df emf8fkvfnsf] hf]lvd cg'kft / c8\; cg'kft kQfnufpg'xf];\ .

25


!= Olk8]ldof]lnof]hLdf 36gf / k|efljt eGgfn] s] s] hgfp5 <

@= 36gf b/ eg]sf] s] xf] < of] s;/L lgsflnG5 <

#= k|efjlt jf k|fjNo b/ eg]sf] s] xf] < of] s;/L lgsflnG5 <

$= lzz' / dft[d[To' b/ s;/L lgsflnG5 <

%= /f]un] dfg{ ;Sg] Ifdtf s;/L jf /f]u b/ s;/L kQf nufOG5 .

^= hf]lvd cg'kft / ;Defjgf cg'kft eg]sf] s] xf] <

&= tkfO{sf] lhNnfdf emf8fkvfnfsf] hf]lvd cg'kft / ;Defjgf cg'kft b/ lgsfNg'

k¥of] eg] s;/L lgsfNg' x'G5 <

;f/f+z

o; PsfOdf Olk8]ldof]lnof]hLsf]] If]q, kl/efiff, cjwf/0ff, Oltxf; cflb ;dfj]z ul/Psf] 5 .

;fy} Olk8]ldof]nf]hLsf] kIf, dfkg ug]{ ;fwg, /f]u tyf d[To' cflbsf] dfkg ug]{ tl/sf cflbsf]

af/]df hfgsf/L u/fpg] ljifo j:t'x? ;dfj]z ul/Psf] 5 .

26

!=#=$ PsfO Pssf] cEof; nflu k|Zgx?

s_ ljifout k|Zgx?

5f]6f] pQ/ cfpg] k|Zgx?

!= Olk8]ldof]nf]hL eg]sf] s] xf] < cfw'lgs Olk8]ldof]nf]hLn] s'g s'g kIfnfO ;d]6\b5 <

@= :jf:Yo lzIffdf s'g rfFlx Olk8]ldof]nf]hL a9L pkof]uL xG5 < pbfx/0f ;lxt rrf{

ug'{xf];\.

#= 36gf b/ / /f]u k|efljt b/ s;/L lgsflnG5 <

$= dft[ dTo' cg'kft lx;fa ug]{ ;"qsf]af/]df JofVof ug'{xf];\ .

%= Olk8]ldof]nf]hLdf hf]lvd / vt/fsf] cy{ s] x'G5 <

nfdf] pQ/ cfpg] k|Zgx?

!= Olk8]ldof]nf]hLsf kIfx? pbfx/0f ;lxt JofVof ug'{xf];\ .

@= 36gf b/ / /f]u k|efljt b/ lgsfNg tl/sfsf] af/]df JofVof ug'{xf]; \.

#= dft[ dTo'b/ / /fun] dfg]{ Ifdtf s;/L lgwf/0f{ ul/G5 < pbfx/0f ;lxt JofVof

ug'{xf];\.

$= hf]lvd cg'kft lgsfNg] tl/sfsf] af/]df JofVof ug'{xf];\.

%= Odds Ratio eg]sf] s] xf] < of] cg'kft lgsfNg] tl/sfsf] af/]df JofVof ug'{xf];\ .

v_ j:t'ut k|Zgx?

!= h]D; lnG8n] slt hgf gfljsx?df Olk8]dLof]lnhs cWoog u/L :seL{ /f]usf] sf/0f kQf

nufPsf lyP <

s_ $ hgf v_ ^ hgf u_ !@ hgf 3_ !* hgf

@= w'd|kfgaf6 SofG;/ /f]u nfU5 eGg] s'/f s'g k|sf/ cWoogaf6 kQf nfu]sf] lyof] <

s_ cGj]ifgfTds cWoog v_ s]; sG6«fn cWoog

u_ sf]x6{ cWoog u_ k|of]ufTds cWoog

27

#= 36gf b/ Olk8]ldof]nf]hLsf] s'g kIf;Fu ;DalGwt 5 <

s_ cfj[lQ v_ ljt/0f

u_ lgwf{/s 3_ /f]u lgoGq0f

$= /f]u tyf :jf:YonfO{ lgwf{/0f ug]{ tTj kQf nufpg s'g k|sf/sf] cWoog ug'{ kb{5 <

s_ cGj]if0ffTds cWoog v_ j0f{gfTds cWoog

u_ ljZn]if0ffTds cWoog 3_ s]; cWoog

%= 36gf b/ lgsfNg tnsf dWo s'g ;"q k|of]u ul/G5 <

s_ 36gf b/ Ö



v_ 36gf b/ Ö lglZrt ;dodf b]vfk/]sf gofF la/fdL ;ª̖Vof


u_ 36gf b/ Ö


To; ;dosf] laGb'df cg'dflgt hg;ª ̖Vof × !)))

3_ 36gf b/ Ö


pQm ;dofjlwsf] cg'dflgt hg;ª ̖Vof × !)))

^= cfjlws k|eflt b/ (Period Prevalence) lgsfNg tnsfdWo] s'g ;"q k|of]u ul/G5 <

s_ cfjlws k|efljt b/ Ö


pQm ;dofjlwsf] cg'dflgt hg;ª̖Vof × !)))

v_ 36gf b/ Ö



u_ 36gf b/ Ö lglZrt ;dodf b]vfk/]sf gofF la/fdL ;ª̖Vof


28

3_ 36gf b/ Ö


To; ;dosf] laGb'df cg'dflgt hg;ª ̖Vof × !)))

&= ;d"xdf Psdf ePsf] hf]lvd cyf{t\36gf b/ (Incidence rate) nfO{ ;d"x b'O{df ePsf]

hf]lvd b/n] efu u¥of] s] kQf nfUb5 <

s_ /f]un] dfg{ ;Sg] b/ v_ dft[ d[To' cg'kft

u_ hf]lvd cg'kft 3_ c8\; cg'kft

*= /f]u nfUg ;Sg] sf/s tTjx¿sf]df ;Dks{df cfP/ /f]u nfu]sf] / ;Dks{df gcfP/ klg

/f]u nfu]sf] aLrsf] cg'kftnfO{ s] elgG5 <

s_ s]; PSkf]h/ c8\; v_ sG6«f\n PS;kf]h/ c8\;


29

PsfO b'O{

/f]u cWoog lj1fgsf cWoog 9fFrfx¿

(Epidemiologic Study Designs)

@=! PsfO kl/ro (Unit Introduction)

/f]u cWoog lj1fgsf] d'Vo sfd dfgj ;d'bfodf b]vf kg]{ /f]u tyf :jf:Yo ;d:ofsf]

cWoog ug'{ xf] . /f]u cWoog ug]{ ljleGg ljlw tyf cWoog 9fFrfx¿ 5g\ . o; PsfO{df

/f]u tyf :jf:Yo ;d:of cWoog ug{ pkof]uL x'g] ljlw tyf 9fFrfx¿ ;DalGwt ljifoj:t'

;dfj]z ul/Psf] 5 .

@=@ ljlzi6 p2]Zox? (Specific objectives)

o; PsfOsf] cGTodf ljBfyL{x? lgDg sfo{ ug{ ;Ifd x'g] 5g\ .


/f]u cWoog lj1fg ljlw tyf

9fFrfx?sf] cjwf/0ff JoQm ug{

j0{fgfTds cWoog ljlwsf] rn0fx?

j0f{g ug{

36gf lgoGq0f / ;d"x cWoog

9fFrfx?sf] JofVof ug{

36gf lgoGq0f / ;d"x cWoog

9fFrfx¿af6 k|fKt x'g] tYofª\sx?sf]

ljZn]if0f ug{

/f08f]dfOh sG6«f]n 6«fon, If]qut

6«fon / ;fd'bflos 6«fon cWoog

9fFrf JofVof ug{

!= /f]u cWoog lj1fg ljlw tyf 9fFrfx?

@= Olk8]ldof]nf]lhs ljlwsf] k|sf/

cjnf]sgfTds ljlw

k|of]ufTds ljlw

#= j0f{gfTds cWoog 9rfM s]; l/kf]{6, s];

l;l/h / qm;]S;gn ljlw

$= ljZn]ifgfTds 9frfM s]; sG6«f]n cWoog /

sf]x6{ cWoog

%= k|of]ufTds cWoog 9frf

¥ofG8dfOh sG6«f]n k/LIf0f 9frf

lkmN8 k/LIf0f 9frf

;d'bflos k/LIf0f 9frf

30

@=# /f]u cWoog ljlw tyf 9fFrfx?sf] cjwf/0ff (Concept of epidemiologic methods

and designs)

/f]u tyf :jf:Yo;Fu ;DalGwt 36gfsf] cWoog ug{ ljeGg ljlwx? ckgfpg' kb{5 . /f]u tyf

:jf:Yo;Fu ;DalGwt 36gfx? cWoog ug{ ckfOg] tl/sf tyf k|lqmofnfO{ /f]u cWoog lj1fg

ljlw elgG5 . h:t} ;j]{If0f ljlw, j0f{gfTds, cjf]nsg ljlw, x:tIf]k tyf k|of]ufTds ljlw

clb . s'g} /f]u tyf :jf:Yo ;d:of cWoog s'g s'g ;d"xdf, slxn], sxfF, s'g ljlw tyf

k|lqmof ckgfP/ cWoog ug]{ egL agfOPsf] lj:t[t vfsf tyf k|lqmofTds of]hgf

(procedural plan) nfO{ /f]u cWoog lj1fgsf] 9frf (epidemiologic study

design) elgG5 . 36gf lgoGq0f 9frf cg'';f/ cWoog ubf{ 36gf / lgoGq0f ;d"x 5gf}6

u/L hf]lvd tTj tyf Jojxf/sf] af/]df tYofª\s ;ª\sng ug'{ kb{5 . 36gf lgoGq0f 9fFrf

cg'';f/ cWoog ubf{ ckgfOg] k|lqmof tyf tl/sf cGo cWoog ljlw tyf 9fFrf;Fu d]n vfFb}g .

To;}n] ljleGg cWoog 9fFrfx?sf] cfkm\g} ljz]if k|lqmof tyf tl/sf x'g] ePsf]n] k|To]ssf]

cfkm\g} 9fFrf x'G5 .

dxfdf/L lj1fg jf /f]u cWoog lj1fgnfO{ ljlwsf] cfwf/df d'Vo b'O{ efudf ljefhg ug{

;lsG5 .

s_ cjnf]sgfTds O{lk8]ldof]nf]hL (Observational epidemiology)

v_ k|of]ufTds O{lk8]ldof]nf]hL (Experimental epidemiology)

s_ cjnf]sfTds O{lk8]ldof]nf]hL (Observational epidemiology)

k|s[ltdf xfd|f] :jf:Yo tyf /f]unfO{ k|efj kfg]{ lqmofsnfk jf 36gfx? eO/x]sf] x'G5g\ . h:t}

ef]sd/L, b}jL k|sf]k, cf0fljs b'3{6\gf, afo' k|b"if0f, kfgLsf] k|b"if0f, vfBfGgdf ljifflbsf] k|of]u,

v}gLsf] ;]jg, w'|d|kfgsf] ;]jg, s'g} ljif]z vfgf tyf h8La'6Lsf] k|of]u cflb . o:tf

36gfx?nfO{ k|s[ltdf :jfefljs ?kdf eO/x]sf] cj:yfdf cjnf]sg u/L cfjZos tYofª\s

;ª\sng tyf ljZn]if0f u/L :jf:Yo tyf /f]usf] sf/s jf lgwf{/s tTj jf /f]u lgjf/0f tyf

pkrf/df pkof]uL x'g] tTjx? Klxrfg ug]{ ljlwnfO{ cjnf]sfTds O{lk8]ldof]nf]hL

31

(Observational epidemiology) . o;k|sf/sf] cWoogdf cWoogstf{n] hfgLhfgL s'g}

k|sf/sf] x:tIf]k ug]{ jf s'g} cf}ifwL, vf]k jf s'g} /f]u pTkGg ug]{ hLjf0f' jf /;fog tTj

dflg;x?df k|of]u ul/b}g . /f]u pTkGg ug]{ tTj h:t} hLjf0f' jf dlbf/ jf ;'tL{sf] ;]jg jf

b'lift kfgL jf vfBfGgx? Dfflg;x?df k|of]u ug{ ;lsb}g . To;}n] :jf:Yodf w]/} cWoogx?

k|s[ltdf eO/x]sf 36gf jf Jojxf/x? cjnf]sg ul/G5 . hf]xg :gf]xn] klg nG8df ePsf]

x}hfsf] cWoog cjnf]sgfTds O{lk8]ldof]nf]hL k4lt ckgfP/ u/]sf lyP . o; cGt/ut s];

sG6«f]n / sf]x6{ cWoog kb{5g\ . o;sf] cltl/Qm qm;;]s;gn, Osf]nf]hLsn, ;j]{If0f jf

j0f{gfTds cWoog cjnf]sgfTds O{lk8]ldof]nf]hL cGt/ut kb{5 .

v_ k|of]ufTds O{lk8]ldof]nf]hL (Experimental epidemiology)

cWoog ug{ rfx]sf] tTj jf rn dfyL lgoGq0f tyf x:tIf]k u/L /f]u, :jf:Yosf] lgwf{/s tTj

jf /f]usf] pkrf/ tyf /f]syfd ;DaGwL cWoog u/L 1fg cfh{g ug]{ lj1fgnfO{ k|of]ufTds

O{lk8]ldof]nf]hL elgG5 . o;k|sf/sf] cWoogdf hfgLhfgL of]hga4 tl/sfn] cWoog ;d"xddf

k/]sf dflg;x?df cWoog ug{ rfx]sf] cf}ifwL jf vf]k jf /f]u lgoGq0f ug]{ pkfo jf kf}li6s

tTj jf :jf:Yo k|a4{g ug]{ pkfox?nfO k|of]u jf x:tIf]k (Intervention) jf kl/rfng u/L

cWoog u/LG5 / sf/s / c;/ jf pknlAwsf] larsf] ;DaGw kl/sNkgf k/LIf0f u/L ;xL

tYo jf 1fg k|fKt ug{ dbt ub{5 . o; cGt/ut /fG8dfOh 6«fOn, lkmN8 6«fOn / ;d'bfo

6«fOn cWoog 9fFrf kb{5g\ .

cWoog 9fFrfsf] dxfdf/L jf /f]u cWoog lj1fgsf] 9fFrfx?nfO{ d'Vo tLg ;d"xdf ljefhg ug{

;lsG5 .

!= j0ff{Tds ljlw tyf 9fFrf (Descriptive study design)

@= ljZn]ifgfTds ljlw tyf 9fFrf (Analytic study design)

#= k|of]ufTds÷x:tIf]k 9frf (Experimental/interventional study design)

@=$ j0f{gfTds cWoog (Descriptive Study)

Old8]ldof]nf]lhs cWoog tyf cGj]if0fsf] klxnf] rn0fdf ul/g] cWoognfO{ j0f{gfTds cWoog

elgG5 . o;n] dfgj hg;ª\Vof /f]usf] pkl:yt tyf :jf:Yo;Fu ;DalGwt ljz]iftfx¿sf]

j0f{g ub{5 . o;n] /f]u tyf 36gf / o;sf ljz]iftfnfO{ s'g} kl/jt{g jf k|of]u gu/L

k|fs[lts÷:jfefljs cj:yfdf cjnf]sg tyf ;"rgf ;Íng u/]/ ljBdfg kl/l:ylt /

cj:yfsf] JofVof ub{5 . s'g} ;d'bfodf :jf:Yo ;d:of / :jf:Yo cj:yf lgwf{/0f ug{ ul/g]

32

;fd'bflos :jf:Yo ;j]{If0fnfO{ j0f{gfTds cWoog eGg ;lsG5 . j0f{gfTds cWoog 9fFrf

cGtu{t, s]z l/kf]6{ (Case–report), s]z cWoog (Case study) / s]z >[ª\vnf

(Case series) cWoog kb{5g\ .

j0f{gfTds cWoog (Descriptive Study) sf] k|sf/

36gf l/kf]6{ (Case – report): ;d'bfodf ;do ;dodf b]vf kg]{ /f]u tyf 36gf

sxfF, slxn] / slt ;+Vofdf eof] eg]/ l6kf]6 u/L clen]v /fVg] / ;DalGwt lgsfodf

clen]v ;+k|]zg ug]{ tl/sfnfO{ 36gf l/kf]{6 elgG5 .

36gf cWoog (Case study): s'g} /f]u tyf 36gf sxfF, slxn], s;/L eof] eGg]

af/]df Ps jf Psf eGbf a9L 36gfsf] lj:t[t?kdf j0f{g ug]{ tl/sfnfO{ 36gf cWoog

elgG5 .

;fd'bflos lgbfg jf n]vfhf]vf (Community assessment/community

survey): ;d'bfosf] hg;Vofaf/]df ;j]{If0f u/L dflg;x?sf] hg;Vof, k]zf, lzIff,

vfg]kfgL, /f]u, ;d:ofsf] lgbfg tyf cfjZostfsf] klxrfg ug]{ ljlwnfO{ ;fd'bflosf

lgbfg tyf ;j]{If0f elgG5 .

j0f{gfTds qm;]S;gn cWoog (Cross sectional descriptive study): o;

k|sf/sf] cWoog s'g} ;do ljGb' (Time point) df Psk6s tYofÍ ;Íng u/]/

cWoog ul/g] ePsf]n] o;nfO{ Cross sectional study klg elgG5 .

j0f{gfTds cWoogsf] p2]Zo (Objective of Descriptive Study Design)

– ;d'bfosf] ;j]{If0f u/]/ /f]u, d[To' tyf :jf:Yo cj:yfsf] dfkg tyf k|fjNo b/

(Prevalence rate) kQf nufpg' .

– /f]u tyf :jf:Yo ;d:ofsf] k|j[lQ, ;d"x / 7fpF cg';f/ ljt/0f lj:tf/ jf lgoGq0fsf]

cg'udg tyf d"NofÍg ug'{ .

– :jf:Yo ;DaGwL of]hgf agfpg / ;~rflnt :jf:Yo ;]jfsf] d"NofÍsg ug{ cfjZos kg]{

tYofÍ tyf tYo k|bfg ug'{ .

– ljZn]if0ffTds cWoogsf] nflu ;d:of tyf kl/sNkgf klxrfg ug'{ .

33

j0f{gfTds cWoogsf sfo{ljlw tyf rn0fx¿ (Steps or Procedure in Descriptive

Study)

!_ cWoog ul/g] hg;+VofnfO{ kl/eflift ug]{ (Defining the population to be

studied)

j0f{gfTds cWoogn] s'g} ;d'bfo jf s'g} 7fpF jf If]qsf] hg;+Vofdf /f]u tyf :jf:Yo

;d:ofsf] j0f{g ug]{ ePsf]n] klxnf] rn0fdf cWoog ;d'bfo tyf hg;ª\Vofsf] kl/eflift ug]{

/ kl/ro n]Vg' kb{5 . s'g} ;d'bfo jf If]qsf] ;a} hg;+VofnfO{ ;dfj]z ug{ ;lsG5 jf s'g}

;d'bfo jf 7fpFsf] ljz]if ;d"x h:t} ue{jtL dlxnf, kfFr jif{ d'lgsf afnaflnsf jf :s'n

hfg] ljBfyL{x¿ jf lszf]/ lszf]/L jf j[4j[4fx¿dWo] s'g} ;d"xnfO{ dfq ;dfj]z u/L

pgLx¿sf] ljz]iftfsf] cfwf/df kl/eflift ug'{ kb{5 .

@_ cWoog ul/g] /f]u jf :jf:Yo ;d:ofnfO{ kl/eflift ug]{ (Defining the disease or

health problem under study)

s'g} hg;ª\Vof tyf ;d'bfodf w]/} k|sf/sf :jf:Yo ;d:ofx¿ x'g ;Sb5 . ;a} /f]u tyf

;d:ofnfO{ Pp6f cWoogdf ;dfj]z ug{ ;lsb}g . s'g} ljz]if /f]u jf ;d:ofnfO{ rog u/L

To;sf] ljz]iftf h:t} gofF k'/fgf], ;g]{, g;g]{, :yfgLo, dxfdf/L, l56km'6 ?kdf b]vf kg]{, s'g}

df};d jf s'g} ;dosf] cGt/fndf b]vf kg]{ s:tf] vfnsf] /f]u xf] To;sf] ;+lIfKt hfgsf/L lbg'

kb{5 .

#_ /f]u jf ;d:ofsf] af/]df tYofÍ ;Íng ug]{ (Collecting data about disease

or health problem)

cWoogsf] nflu 5gf}6 ul/Psf] /f]u jf ;d:ofsf] af/]df k|ZgfjnL cGtjftf{, cjnf]sg,

clen]v cflbaf6 cfjZos ;"rgf tYofÍ tyf tYox¿ ;Íng ug'{kb{5 .

$_ ;do, :yfg / JolQmsf] cfwf/df /f]usf] JofVof ug]{ (Describing the disease by

time, place and persons)

cWoogsf] nflu cfjZos tYofÍ ;Íng u/]kl5 To;nfO{ ;do, :yfg / JolQmsf] cfwf/df

ljZn]if0f u/]/ /f]u jf ;d:ofsf] JofVof ug'{kb{5 . s'g} ;?jf /f]usf] af/]df cWoog ub}{5fF} eg]

s'g} ;do /f]u b]vf k¥of], sxfFaf6 km}lnof] ;do cg';f/ /f]u a9\b} uPsf] 5 ls 36]sf] 5 jf

34

36\g] a9\g] u/]sf] To;sf] af/]df j0f{g ug'{kb{5 . 7fpF cg';f/ ;x/ / u|fdL0f If]q, hËnsf]

glhs, v]tsf] glhs, pkTosf, vf]r jf 8fF8f kfvf s'g} 7fpFdf a:g]nfO{ a9L /f]u nfu]sf] 5

eGg] af/]df klg JofVof ug'{kb{5 . To;}u/L /f]uaf6 k|efljt JolQmnfO{ hft hflt, k]zf, lzIff,

:jf:Yo, Jojxf/, lnË tyf pd]/sf] cfwf/df JofVof ug'{kb{5 .

%_ /f]u jf ;d:ofsf] hf]lvdsf] dfkg ug]{ (Measuring disease risk)

/f]u jf ;d:ofsf] pkl:ylt / ljt/0fsf] JofVof u/]kl5 /f]u jf ;d:ofsf] hf]lvdsf] dfkg

ug'{kb5{ . 36gf b/, k|fjNo b/, ?U0ftf b/, ckfË jf czQmttf b/, d[To' b/ cflbsf] lx;fa

u/]/ hf]lvd dfkg ug{ ;lsG5 . ;d'bfodf qm; ;]S;g vfnsf] ;j]{If0f u/]/ cWoog ul/Psf]

5 o;af6 /f]u k|fjNo b/ (Prevalence rate), d[To' b/, jf /f]un] dfg{ ;Sg] b/sf] dfkg

ug{ ;lsG5 .

^_ hfgsf/L ePsf ;Gbe{ ;"rL;Fu t'ngf ug]{ (Comparing with known indices)

/f]u cWoog lj1fgsf] ;f/tTj eg]sf] k|Zg ;f]Wg] u0fgf ug]{ dfkg ug]{ / Pp6f tYonfO{

csf]{;Fu t'ngf ug'{ xf] . hg;ª\VofnfO{ pk;d"x ljefhg u/]/ Prevalence, Incidence

or Mortality rate sf] t'ngf ug{ ;lsG5 . Pp6f vfnsf] ;d"x 5 eg] klg p:t} vfnsf]

cWoog tyf ;j]{If0fn] b]vfPsf] glthf jf /fli6«o ;"rL tyf tYofÍ;Fu t'ngf u/L j0f{gnfO{

cy{k"0f{ agfpg ;lsG5 .

&_ kl/sNkgfsf] lgdf{0f (Formulation of hypothesis)

j0f{gfTds cWoogsf] clGtd p2]Zo /f]usf] sf/s tTj kQf nufpg' eGbf klg /f]usf] jf

:jf:Yo ;d:ofsf] ;DefJo sf/s÷lgwf{/s tTjsf] af/]df kl/sNkgf lgdf{0f ug'{ xf] . To;}n]

j0f{gfTds cWoogsf] clGtd rn0fdf kl/sNkgf (Hypothesis lgdf{0f ul/G5 . h:t} olb

r'/f]6 vfg] ;d"xdf a|f]ª\sfOl6; COPD (Chronic Obstructive Pulmonary

Disease) b/ a9L 5 gvfg]df sd 5 eg] o;sf] cfwf/df o:tf] kl/sNkgf agfpg ;lsG5

lg/Gt/ r'/f]6 ;]jgn] COPD ;d:of pTkGg ub{5 . j0f{gfTds cWoogsf] cfwf/df

kl/sNkgf aGg] ePsf]n] o;nfO{ kl/sNkgf lgdf{0f ug]{ (Hypothesis generating

study) elgG5 . o;n] j0f{gfTds cWoogn] Analytical study sf] nflu cfwf/ tof/

kfb{5 .

35

tkfOn] s] q‰g' eof] <

!= ;fd'bflos ;j]{If0f / j0f{gfTds cWoog lars]f ;DaGw 5 <

@= j0f{gfTds Olk8]ldof]nf]hLs cWoog ug{ s] s] ug'{ kb{5 <

# j0f{gfTds cWoogsf lsl;dx? pbfx/0f lbP/ n]Vg;xf];\ .

lqmofsnfk

!= tkfO{sf] ufpFDff s'g} Ps hgf /f]uL JolQmnfO{ cGt/jftf{ lnP/ s]; l/kf]6{ tof/ kfg'{xf];\ .

@= tkfO{sf] ufpsf] glhs :jf:Yo rf}sLdf uP/ kfraif{ d'lgsf afnaflnsfx?sf] vf]k tyf

/f]usf]af/]df tYofª\s ;ªsng u/L j0f{gfTds cWoog 9frfsf] ;fgf] k|ltj]bg tof/ kfg'{xf];\ .

@=% ljZn]if0ffTds cWoog 9fFrf (Analytical Study Design)

/f]u cWoog lj1fg cWoog rn0fdf ul/g] bf];|f] d'Vo cWoog 9fFrfx¿sf] ;d"x g}

ljZn]if0ffTds cWoog xf] . /f]u / sf/s tTjsf] aLrdf sf/so'Qm ;daGw b]vfP/

agfPsf] kl/sNkgf k/LIf0f ug]{ cWoog 9fFrfnfO{ ljZn]if0ffTds cWoog 9fFrf elgG5 .

(Analytical study is designed to examine the hypothesis that

indicates causal relationship between cause and effect of disease)

cyf{t\s'g} k|of]u (Experiment) lagf kl/sNkgf k/LIf0f ug]{ / :jtGq / cfl>t

rnx¿ aLrdf ;DaGw :yfkgf ug]{ cWoognfO{ ljZn]if0ffTds cWoog 9fFrf elgG5 . of]

cWoog 9fFrf cGtu{t d'Vo Case control / Cohort study designs kb{5 . oL

b'O{ cWoog 9fFrfsf] af/] lj:t[t?kdf rrf{ ul/g] 5 . t/ klg ljZn]if0ffTds cWoog

eGgfn] lgDg cWoog 9fFrfnfO{ ;d]6\b5 .

c= s]; sG6«f]n cWoog (Case control study)

cf= sf]x6{ cWoog (Cohort study)

36

@=%=! s]; sG6«f]n cWoog (Case control study):

of] cWoogdf /f]u nfu]sf / gnfu]sf JolQmx¿nfO{ b'O{ ;d"xdf ljefhg u/L oL b'O{;d"xdf

JolQmx¿ hf]lvd tTj jf ;DefJo sf/s tTjx¿df slt ;Dks{df cfPsf] 5 eGg] s'/fsf]

dfkg / ljZn]if0f u/]/ /f]u / hf]lvd tTjx¿sf] lar;DaGw :yfkg ug]{, kl/sNkgf

k/LIf0f ug]{ / /f]usf] ;DefJo sf/s tTj jf hf]lvd tTj klxrfg ul/G5 . of] cWoog

/f]u nfu]kl5 jf 36gf 36]kl5 klxn]sf] j0f{gfTds cWoogn] lgdf{0f u/]sf] kl/sNkgf

(Hypothesis) sf] cfwf/df ul/G5 . of] cWoog ;fgf] ;d"x / 5f]6f] ;dodf

;fdfGob]lv SofG;/ h:tf /f]usf] sd nufgLdf ug{ ;lsG5 .

o; cWoogcGtu{t /f]usf sf/0fx¿sf] kl/sNkgf k/LIf0fsf] nflu ug]{ ul/G5 . of]

cWoog ug{sf] nflu b'O{ ;d"x M /f]u nfu]sf] ;d"x Case / /f]u gnfu]sf] ;d"x Control

x'g'kb{5 . of] cWoog ljlwnfO{ a'‰g]sf] nflu tn lrqdf b]vfPsf] rf6{nfO{ a'e\mg cfjZos

5 M–

37

Design of a case-control study

s];nfO{ lgoGq0f ubf{ ;a}eGbf ;'?df Pp6f lglZrt If]qsf] hg;ª\Vofdf Case sf]

klxrfg ug'{kb{5 . Case eGgfn] xfdLn] cWoog ug{ rfx]sf] /f]u nfu]sf]

JolQmx¿nfO{ hgfpF5 . olb xfdLn] d'vsf] SofG;/sf] sf/0f kQf nufpg jf

k|dfl0ft ug{ vf]h]sf] xf] eg] d'vsf] SofG;/ ePsf] JolQmx¿nfO{ Case elgG5 /

ToxL pd]/ ;d"xsf d'vsf] SofG;/ gnfu]sf JolQmx¿nfO{ Control elgG5 .

o;/L cWoog hg;ª\VofnfO{ Case / Control u/L b'O{ efudf ljefhg ul/G5 .

v}gL vfg]nfO{ d'vsf] SofG;/ x'G5 eGg] kl/sNkgf agfPsf 5f}F eg] v}gL vfg]nfO{

Exposed ePsf] / gvfg] JolQmnfO{ Not Exposed elgG5 . /f]u nfu]sf

JolQmx¿df / gnfu]sf] JolQmx¿df b'j}df v}gL vfg] / gvfg] x'g ;Sb5g\ .

SofG;/ /f]u nfu]sf] Case ;d"xdf v}gL nfdf] ;do;Dd vfg] w]/} / gvfg] ;ª\Vof

sd 5 / /f]u gnfu]sf] Control ;d"xdf v}gL vfg] yf]/} / gvfg] w]/} 5 eg]

v}gLsf] ;]jgn] SofG;/ x'G5 eg]/ eGg ;S5f}F . o;/L Case / Control ;d"xsf]

t'ngf ubf{ /f]u nfUg] sf/s tTjx¿sf] dfqf (Exposed Rate) /f]uLx¿sf] ;d"x

(Cases) a9L ePdf cWoogsf] kl/sNkgf k|dfl0ft x'G5 / /f]usf] sf/s tTj kQf

nfU5 . of] cWoogaf6 emf8fkvfnf, lgdf]lgof cflbsf] sf/0f klg kQf nufpg

;lsG5 .

38

s];–sG6«f]n cWoogsf] ljz]iftf (Distinct feature of case control study)

– of] cWoogdf /f]u nfu]sf] Case / gnfu]sf] Control ;d"xx¿ ;dfj]; x'G5 .

(This study includes two groups of people, one with disease case

and another without disease control)

– cWoog ;'? ug'{eGbf cl3 hf]lvd / /f]u b'j} pTkGg ePsf x'G5g\ . (Both

exposure and outcome (disease) have occurred before the start of

the study.)

– c;/÷/f]u b]lvP kl5 cWoog ;'? x'G5 . (The study proceeds backward

from effect to cause)

– sf/0f / c;/sf] cg'dfgnfO{ ;xL jf unt k|dfl0ft ug{ cWoogdf lgoGq0f jf t'ngf

;d"xsf] k|of]u ub{5 . (It uses control or comparison group to support

or refute an inference between cause and effect.)

s];–sG6«f]n cWoogsf] cfwf/e"t tTj ÷ rn0fx¿ (Basic steps /elements of

case control study)

s];–sG6«f]n cWoog 9fFrf cg';f/ /f]u tyf :j:Yo;Fu ;DalGwt 36gfsf] cWoog ubf{

lgDg rf/ rn0f ckgfpg kb{5 .

!= s]; / sG6«f]nx¿sf] 5gf}6 (Selection of cases and controls)

i) s];sf] 5gf}6 (Selection of cases): s];–sG6«f]n cWoogsf] l8hfOg ubf{

;a}eGbf ;'?df cWoog ug]{ s]; jf 36gfsf] klxrfg u/L 5gf}6 ug'{kb{5 . s]; 5gf}6

ubf{ s];sf] kl/efiff agfpg] / ;|f]t lgZro ug'{kb{5 .

36gf jf s];sf] kl/efiff (Definition of a case)

cWoog ug{ rfx]sf] /f]u jf ljlzi6 :jf:Yo ;d:of ePsf] JolQmnfO{ s]; jf 36gf elgG5

. Ifo/f]usf cWoog ug]{ xf] of] /f]usf] nIf0f b]vf k/]sf] vsf/ hfFr ubf{ ;sf/fTds

(Positive) e]l6Psf] / kmf]S;f]df bfu b]lvPsf cflb Criteria agfpg ;lsG5 . /f]u

nfu]sf] JolQm cWoogsf] nflu of]Uo ePsf] x'g'kb{5 .

39

s];sf] ;|f]t klxrfg (Sources of cases): cWoogsf] nflu 5gf}6 ul/g] s];sf] ;|f]t

c:ktfn (Hospital) / ;fdfGo hg;ª\Vof x'g ;Sb5 . c:kfnaf6 s]; 5gf]6 ;lhnf]

x'G5 . c:ktfnaf6 s]; 5gf]6 ubf{ 7"nf] c:ktfn 5 eg] Pp6f c:ktfnaf6 ug{ ;lsG5 .

cfjZostfcg';f/ PseGbf a9L c:ktfnaf6 s];sf] 5gf]6 ug{ ;lsG5 .

;fdfGo hg;ª\Vof cfwfl/t eP/ s]; 5gf]6 ubf{ Pp6f lglZrt If]qdf a;f]af; ug]{

;d'bfonfO{ 5gf]6 ug'{ kb{5 . dn]l/of /f]usf] af/]df cWoog ug]{ xf] t/fO{sf] dn]l/of /f]u

nfUg] If]q / hg;ª\Vof 5gf}6 ug'{ kb{5 .

ii) sG6«f]n jf t'ngf ;d"xsf] 5gf]6 (Selection of control or comparison group)

s]; 5gf]6 u/]kl5 o;;Fu ldNbf] h'Nbf] JolQmx¿ jf t'ngf ;d"x 5gf]6 ug'{kb{5 . sG6«f]n

jf t'ngf ug]{ JolQmx¿ /f]u / /f]usf] hf]lvd afx]s c? ljz]iftfx¿ h:t} pd]/, k]zf,

cfly{s, ;fdflhs cj:Yff cflb ldNbf] h'Nbf] x'g' kb{5 . cWoog ug{ rfx]sf] /f]u gnfu]sf]

JolQmnfO{ lgoGq0f jf sG6«f]n elgG5 . sG6«f]n jf lg/f]uL JolQmx? s]; 5gf]6 ubf{ /f]uL

JolQmx¿ 5gf]6 ul/Psf] If]qaf6 5gf]6 ug'{kb{5 . 5gf]6 ubf{ ;DalGwt hg;ª\Vofaf6

Randomly 5gf]6 ug'{kb{5 . s];sf] ;f] c:ktfnsf] xf] eg] sG6«f]n jf lg/f]uL JolQm klg

;f]xL c:ktfnaf6 5gf]6 ug'{kb{5 . olb s]; ;d'bfoaf6 5gf]6 ul/Psf] 5 eg] sG6«f]n klg

ToxL ;d'bfodf a;f]af; ug]{ /f]u gnfu]sf JolQmnfO{ 5gf]6 ug'{kb{5 .

@= hf]8f ldng (Matching)

/f]u nfu]sf] JolQm s]; / lg/f]uL JolQm sG6«f]nx¿sf] hf]lvdsf] cj:yf nufot w]/}

ljz]iftfx¿ ;dfg x'g'kb{5 . pd]/sf] lx;fan] s]; ;d"xdf ;dfj]; ul/Psf JolQmx¿ $)

jif{ dflysf 5g\ eg] sG6«f]n ;d"xsf JolQmx¿ klg $) jif{ dflysf x'g'kb{5 . /f]uL JolQm

s];df k]zf s[lif xf] eg] lg/f]uL JolQmsf] hflt tyf cfly{s cj:yf / sG6«f]n ;d"xsf

JolQmsf] p:t} x'g'kb{5 . o;/L s]; / sG6«f]naLrdf hf]8f ldnfg u/]/ cWoog ubf{

/f]unfO{ k|efj kfg{ ;Gb]xhgs tTj (Confounding) nfO{ lgoGq0f u/L cWoog ubf{

olx lgisif{df k'Ug ;lsG5 .

#= /f]usf] hf]lvdsf] dfkg (Measurement of exposure)

/f]u nfu]sf] s]; / gnfu]sf] sG6«f]n ;d"xsf JolQmx¿ sd jf j]zL ?kdf hf]lvddf

k/]sf jf hf]lvdsf] ;Dks{df cfPsf x'g ;Sb5g\ . kmf]S;f] SofG;/ ePdf JolQmnfO{ s];

dfg]/ cWoog ubf{ w'd|kfgnfO{ hf]lvd dflgPsf] x'G5 t/ ;a} /f]uL JolQmsf] w'dkfg ug]{

40

afgL gx'g ;Sb5 . To:t} lgoGq0f ;d"xsf lg/f]uL JolQmx¿ dWo sltkon] w'dkfg ug]{

klg x'G5 . /f]usf] hf]lvdsf] af/]df k|Zg ;f]w]/ tYofÍ ;Íng u/L b'j} ;d"xdf hf]lvdsf]

dfkg ug'{kb{5 . k|ZgfjnL jf cGtjf{tf{ JolQmut clen]vaf6 b'j} ;d"xsf JolQmx¿ s]

slt dfqfdf hf]lvddf k|s6 ePsf 5g\ eGg] af/]df ;'rgf÷cfFs8f ;Íng u/L hf]lvd

dfkg ug'{kb{5 .

$= ljZn]if0f (Analysis)

s];–sG6«f]n cWoog clGtd rn0fdf lgDg b'O{ s'/fx? kQf nfupg hf]lvd

(Exposure) ;Fu ;DalGwt tYofÍ tyf dfkgnfO{ ljZn]if0f ug'{kb{5 M

• b'j} ;d"xdf hf]lvd b/ (Exposure rate)

• cGt/÷c8;\ cg'kft (Odds ratio)

of] cWoogdf ljZn]if0f ubf{ s]; ;d"xdf k/]sf /f]uL JolQmx?nfO{ ;DefJo sf/s tTjsf]

;Dks{df cfP/ hf]lvddf (Exposure) df k/]sf] / hf]lvddf gk/]sf] cfwf/df b'O{

;d"xdf ljefhg ug'{kb{5 . To;}u/L t'ngf ug]{ sG6«f]n ;d"xdf k/]sf JolQmx?nfO{

klg hf]lvd k/]sf] / gk/]sf] cfwf/df b'O{efudf ljefhg ug'{kb{5 . oL ;d"xnfO{ @ @ sf] 6]andf k|:t't ug'{kb{5 .

A = hf]lvddf k/]sf -r'/f]6 lkpg]_ s]; -SofG;/_ ePsf] (Cases who were

exposed to risk factors)

B = /f]u nfu]sf] t/ hf]lvddf gk/]sf -r'/f]6 glkpg]_ s]; (Cases who were not

exposed)

C = hf]lvddf k/]sf -r'/f]6 lkpg] t/ /f]u gnfu]sf] -SofG;/_ gePsf] sG6«f]n ;d"x

(Control who were exposed)

D = hf]lvddf gk/]sf -r'/f]6 glkpg]_ / /f]u klg gnfu]sf sG6«f]n ;d"x (Controls

who were not exposed) ljZn]if0fsf] nflu lgDg cg';f/sf] 6]ansf] 9fFrf

agfP/ ;Ílnt tYofÍnfO{ ;+If]kdf k|:t't ug'{kb{5 .

Summary of data collected in a case control study of smoking and lung

cancer

41

Exposed Unexposed Total

Case (Lung

cancer)

A (74) B (16) A + B = 90

Controls (without

cancer)

C (62) D (148) C + D = 210

Total A + C =

136

B + D =

164

A + B + C + D

= 300

hf]lvd b/sf] cg'dfg (Estimation of exposure rate)

s]; ;d"xdf hf]lvd b/ (Exposure rate in cases) = Exposed cases

All cases

= A

A + B

= 7490 = 82.2%

sG6«f]n ;d"xdf hf]lvd b/ (Exposure rate in control) = Exposed cases

All controls

= C

C + D

= 62210 = 29.5

cGt/÷c8\; cg'kftsf] lgwf{/0f (Calculation of odds ratio)

c8\; cg'kft eg]sf] s]; hf]lvdsf] Odds / sG6«f]n hf]lvdsf] Odds sf] cg'kft xf] .

c8\; eGgfn] Pp6f ;d"xdf hf]lvddf k/]sf Exposure / gk/]sf Unexposure

aLrsf] cg'kftnfO{ hgfpF5 .

s]; ;d"xdf hf]lvddf k/]sf / gk/]sf cg'kft c8\;

42

(Odds of case exposure) = exposed cases

unexposed cases = AB

sG6«f]n ;d"xdf hf]lvddf k/]sf / gk/]sf c8\; (Odds of control exposure) = CD

Odds Ratio Formula = Exposed cases

Unexposed cases ÷Exposed control

Unexposed control

= AB ÷

CD =

A×DB×C

dflysf tflnsf lbPsf] tYofÍ cg';f/ = 74 × 14816 × 62

Odds Ratio = 10952992 = 11

Odds Ratio sf] JofVof (Interpretation) s]; ;d"xsf dflg;x¿n] hf]lvd Jojxf/

ug]{ cyf{t\ w'dkfg ug]{ k|ltzt *@ k|ltzt 5 eg] lgoGq0f ;d"xdf hf]lvd b/ #)

k|ltzt 5 . c8\; c'gkft (Odds ratio) !! 5 . o;sf] cy{ w'dkfg gug]{ JolQmnfO{

eGbf w'dkfg ug]{nfO{ kmf]S;f]sf] SofG;/ x'g] ;Defjgf !! u'0ff a9L 5 . o;af6 :ki6 x'G5

ls w'dkfg / kmf]S;f]sf] Sofg;/ larsf/s ;DaGw 5 .


!= s]; eGgfn] s] nfO{ hgfp5<

@= s]; sG6«f]N8 cWoog ug{ s'g s'g ;t{ cfjZos kb{5 <

#= s]; sG6«f]N8 cWoog pbfx/0f lbP/ n]Vg'xf];\ .

@=%=@ sf]x6{ cWoog (Cohort study):

sf]x6{ eGgfn] ldNbf] :jefj, cg'ej tyf rl/q ePsf] JolQmx¿sf] Pp6f ;d"xnfO{ hgfpF5

. h:t} pd]/, lnË, ue{, hGd, vf]k nufPsf], cf}ifwL vfPsf], ef]sd/L, b}jLk|sf]k, cf0fljs

e§L, b'3{6gf cflb dWo s'g} ljz]iftf cg'ej s'g} ;dofjwLdf ;dfg?kn] u|x0f ug]{ ;d"x .

Pp6f sf/vfgfdf sfd ug]{ dhb'/, Pp6f ljBfnodf k9\g] ljBfyL{x¿ jf Pp6} vfnsf]

43

jftfj/0f a:g] dflg;x¿nfO{ klg sf]x6{ eGg ;lsG5 . o; k|sf/sf] s'g} sf]x6{ ;d"xnfO{

/f]u nfUg eGbf cufl8 :j:y cj:yfaf6 nfdf] ;do;Dd hf]lvdsf ;Dks{df cfP

gcfPsf] / /f]usf] pkl:ylt cg'udg ÷ km\nf]ck u/L 36gf b/ (Incidence rate)

klxrfg ul/G5 . /f]usf] ;DefJo sf/s tTjsf] hf]lvd k/]sf] / gk/]sf] cfwf/df b'O{ ;d"x

Exposed / Unexposed ;d"x agfP/ 36gf b/ t'ngf u/L cWoog ul/G5 . To;}n]

o;nfO{ Incidence study klg elgG5 .

sf]x6{ cWoogsf ljz]iftfx¿ (Features of Cohort Study)

!= cWoog cg';Gwfg ug{ rfx]sf] /f]u b]vf kg'{eGbf cufl8 g} cWoog sf]x6{ klxrfg ul/G5

(The Cohorts are identified prior to the appearance of the disease under

investigation.)

@= cWoog ;'? ug]{ ;dodf sf]x6{df ;dfj]z ul/Psf JolQmx¿ ;DalGwt /f]uaf6 d'Qm x'G5g\

(Cohorts are free from the disease under investigation at the onset

of the study.)

#= kl/eflift ul/Psf] lglZrt ;dofjlw leq cWoog ;d"xx¿nfO{ cjnf]sg u/]/ pgLx¿df

/f]usf] cfj[lQ÷36gfb/ lgwf{/0f ul/G5 . (The study groups exposed or non-

exposed to the risk factor) are observable. A defined period of time to

determine frequency or incidence of disease among them.)

$= sf/0faf6 c;/ kQf nufpg] u/L cWoog cl3 a9\5 (The study process forward

from cause to effects.)

%= sf]x6{df ;dfj]z ul/Psf b'j};d"x hf]lvdsf] cj:yf afx]s ;a} k|sf/n] ldNbf] h'Nbf] /

t'ngf of]Uo x'g'kb{5 (Both group should be comparable in respect to all possible

variables except the exposure to the particular risk.)

44

sf]x6{ cWoogsf] k|sf/ (Types of Cohort Study)

sf]x6{ cWoognfO{ d'Vo tLg efudf ljefhg ug{ ;lsG5 M

!= k|Toflzt sf]x6{ cWoog (Prospective Cohort Study)

cWoog ;'? ug]{ ;dodf sf]x6{ ;d"xdf /f]u b]vf k/]sf] x'Fb}g . lg/f]uL sf]x6{sf] ;d"xnfO{

jt{dfgaf6 eljiolt/ cjnf]sg tyf kmnf]ck ub}{ hf]lvd tTj;Fu ;Dks{ eP gePsf] /

/f]usf] pkl:ylt u0fgf tyf 36gfb/, d[To'b/ kQf nufpFb} ul/g] cWoognfO{ k|Toflzt

sf]x6{ cWoog elgG5 . k|foh;f] sf]x6{ cWoog o; k|sf/sf] x'G5 . o;nfO{ jt{dfg sf]x6{

klg elgG5 .

@= ctLt k|efjL÷P]ltxfl;s sf]x6{ cWoog (Retrospective/historical Cohort Study)

ljutdf ePsf :jf:Yodf kfg]{ 36gf h:t}M ef]sd/L, o'4, cf0fljs el§ b'36{gf cflbn]

jt{dfg cj:yfdf jf s'g} ;dosf] cGt/fndf :jf:Yodf s] slt c;/ kf/]sf] 5 eGg]

hf]lvdsf] cg'dfg ug{sf] nflu ul/g] cWoognfO{ ctLt k|efjL cWoog elgG5 . !)–!$

jif{ cl3sf 36gf hf]lvd k/] jf gk/]sf] tYox? sfof{no, c:ktfn tyf cGo /]s8{sf]

k'g/fjnf]sg u/L cwoog ul/g] ePsf]n] o;nfO{ P]ltxfl;s sf]x6{ cWoog elgG5 .

cWoog z'4 ug'{ eGbf culf8 g} c;/ jf /f]u (Outcome) b]vf kl/;s]sf] x'G5 .

o;k|sf/ cWoogdf k|s[ltn] l;h{gf u/]sf] k|of]ufTds cj:yfnfO{ cfwf/ agfP/ ul/G5 .

o;k|sf/sf] cWoogsf] nflu ;/sf/L jf u}/;sf/L jf s'g} lgsfon] ;DalGwt kIfsf] len]v

/fv]sf] x'g] kb{5 .

#= ctLt k|efjL / k|TofzL sf]x6{ cWoog ;ld>0f (A combination of retrospective

and perspective study)

ctLt k|efjL / k|TofzL sf]x6{ cWoog sf] tTjx¿ ;dfj]z u/L ul/Psf] cWoognfO{ oL

b'j}sf] ;+of]hg jf ldng cWoog elgG5 . o; k|sf/sf] cWoogdf sf]x6{ / c;/ b]vf

k/]sf] ldlt klg ljutsf] /]s8{af6 lgwf{/0f ul/G5 . s'g} 36gfsf] c;/ s]xL dfqfdf b]vf

k/]sf] 5 klxn] ctLt k|efjL cWoog ul/G5 . o;sf] c? c;/ s] 5 eg] eljiodf klg

ug{ ;lsG5 . Court Brown / Doll (1957) n] ljs/0f c;/ af/]df b'j} k|sf/sf]

sf]x6{sf] tTj ;dfj]z u/]/ Olk8]ldof]nf]lhsn cWoog u/]sf lyP .

45

sf]x6{ cWoogsf] 9fFrf (Framework of Cohort study)

sf]x6{ cWoog /f]u gnfu]sf] ;dfg ljz]iftf ePsf JolQmx¿nfO{ hf]lvddf k|s6 eP jf

gePsf] cfwf/df b'O{ ;d"xdf ljefhg u/L sf/s tTjsf] c;/ slt ;dodf b]vfk5{ eg]/

cg'udg tyf kmnf]ck ul/G5 . of] cWoog ubf{ c;/ (Effect) sf /f]u b]vf k/]sf] x'Fb}g t/

hf]lvd tTjx? k|s6 ePsf] x'G5 . To;}n] of] cWoogsf sf/0faf6 c;/ (Cause to

effect) cGj]if0f ug]{ k|of; ul/G5 . of] cwoogsf] 9fFrfnfO{ tn lrqdf k|:t't ul/Psf] 5 M

Design of a cohort study

g]kfnsf] t/fO{ / leqL dw];df udL{ ;dodf dn]l/of /f]u nfU5 . e'mn k|of]u gu/]/ ;'Tg]

JolQmnfO{ dn]l/of /f]u nfU5 eGg] kl/sNkgf agfP/ cWoog ub}{5f}F eg] udL{ ;do ;'?

x'g'eGbf cufl8 cyf{t\ /f]u nfUg'eGbf cufl8 t/fO{sf] dn]l/of k|efljt ;d'bfodf hfg'kb{5

. /f]u gnfu]sf t/ /f]u nfUg ;Sg] ;Defjgf ePsf 3/w'/L 5gf}6 ug'{kb{5 . To;kl5 xfdL

r}qb]]lv c;f]h;Ddsf] cjlwdf e'mn nufP/ ;'Tg] / e'mn gnufP/ ;'Tg] kl/jf/÷JolQmx¿

u/L b'O{ ;d"xdf ljefhg ul/G5 . cyf{t\ e'mn gnufpg] Exposed ;d"x / e'mn nufpg]

Not Exposed ;d"x u/L b'O{ ;d"xdf ljefhg ul/G5 . Exposed ;d"xdf slt hgtfnfO{

dn]l/of eof] / Not exposed ;d"xsf slt hgfnfO{ dn];Lof /f]u nfUof] /]s8{ /flvG5 /

b'j} ;d"xdf /f]un] cfqmd0f ug]{ b/ Incidence Rate lgsflnG5 . olb Malaria

Incidence Rate em'n gnufP/ ;'Tg] exposed ;d"xdf w]/} 5 / Not-exposed e''mn

nufpg] ;d"xdf sd 5 eGg] cWoogsf] kl/sNkgf k|dfl0ft x'G5 . cyf{t\ em'n gnufP/

;'Tg] ubf{ dn]l/of /f]u nfU5 eGg ;Sb5f}F .

46

o;/L ljleGg /f]usf] sf/s tTj cyf{t\ Risk Factor kQf nufpg]sf] nflu of] cWoog

ljlw /fd||f] dflgG5 . t/ of] cWoog ug{ ;do a9L nfUg] x'gfn] Case-Control af6 klg ToxL s'/f kQf nufpg ;lsG5 eg] of] cWoog ul/Fb}g . c¿ cWoog ljlwaf6 /f]usf]

sf/s tTj kQf nufpg ;lsPg eg] of] Cohort Study k|of]u ul/G5 .

sf]x6{ cWoogsf] k|lqmof÷rn0f -tTj_ (Process/Steps (Elements) of a cohort study)

sf]x6{ cWoog 9fFrf cg';f/ Olk8]ldof]nLlhs cWoog ubf{ lgDg k|lqmof ckgfpg' kb{5 .

!= cWoog sf]x6{ ;d"xsf] 5gf]6 (Selection of the study cohort/subjects)

@= hf]lvdsf] af/]df tYofÍ lng] (Obtaining data on exposure)

#= t'ngf ;d"xsf] 5gf]6 (Selection of comparison group)

$= kmnf]ck / c;/sf] clen]v /fVg] (Follow up and keeping records about

effects)

%= ljZn]if0f (Analysis)

!= cWoog sf]x6{ ;d"xsf] af/]df 5gf]6 (Selection of the study cohort/subject)

sf]x6{ cWoog 9fFrf cg';f/ cWoog ubf{ ;j{k|yd sf]x6{ ;d"xsf] 5gf]6 ug'{ kb{5 .

cWoog sf]x6{ /f]u gnfu]sf ;dfg ljz]iftf ePsf] x'g' kb{5 . cWoog sf]x6{ ;fdfGo

hg;ª\Vof jf ljlzi6 ;d"xaf6 5gf]6 ug{ ;lsG5 .

i) ;fdfGo hg;ª\Vofaf6 sf]x6{ 5gf]6 (General population): ;fdfGo hg;+Vofdf

/f]usf] hf]lvd jf sf/s tTjx¿ af/Daf/ ?kdf b]lvG5 eg] ;fwf/0f hg;ª\Vofaf6

cWoog sf]x6{ 5gf]6 ug{ ;lsG5 .

ii) ljz]if ;d"xaf6 sf]x6{ 5gf]6 (Special group): olb ;fwf/0f hg;+Vofdf hf]lvd

tTjx¿ lj/n} dfqfdf b]lvG5 s'g} ljz]if ;dodf hGd]sf dflg;x¿ (Birth cohort),

s'g} k]zfdf ;+nUg JolQmx¿ h:t}M ljiffbL k|of]u u/]/ v]tL ug]{ ls;fg, s'g} snsf/vfgf

sfd ug]{ dflg;x¿, ljls/0fsf] ;Dks{df cfPsf JolQm, /]l8of] y]/fkL u/fpg] JolQmx¿,

nfu' cf}ifwL ;]jg ug]{ JolQmx¿ cflbnfO{ cWoog ug{ rfx]sf] hf]lvd / c;/sf] cfwf/df

pko'Qm sf]x6{ 5gf]6 ug{ ;lsG5 . o;/L sf]x6{ 5gf]6 ug{ ;lhnf] / sd vlr{nf] x'G5 .

47

@= hf]lvdsf] af/]df tYofÍ lng] (Obtaining data on exposure)

cWoog ;d"xnfO b'O{ ;d"xdf ljefhg ug'{ kg]{ ePsf]n] bf];|f] rn0fdf hf]lvdsf] ;Dks{

cfP gcfPsf] cfwf/df b'O{ efudf ljefhg ug{sf nflu cGtjf{tf{, k|ZgfjnL eGg nufP/,

;j]{If0f u/]/ hf]lvdsf] af/]df tYofÍ lng ;lsG5 . o;/L k|fKt u/]sf] tYofÍn] cWoog

;d"xnfO{ hf]lvddf k|s6 ePsf] Exposed / gePsf] Non-exposed ;d"xdf ljefhg

ug{ d2t ub{5 .

#= t'ngfTds ;d"xsf] 5gf]6 (Selection of comparison groups)

sf]x6{ cWoog ubf{ b'O{ j6f ;d"x cfjZos kb{5 . Pp6f cWoog ug{ rfx]sf] hf]lvd

tTjsf] ;Dks{df cfPsf] / csf]{ hf]lvdf gk/]sf] x'g' kb{5 . olb ;fwf/0f hg;+Vofaf6

sf]x6{ 5gf]6 u/]sf] cj:yfdf pQm sf]x6{ ;d"x leqaf6 cfGtl/s t'ngf (Internal

comparison) ;d"x 5gf]6 ul/G5 . o:tf] cj:yf sf]x6{ ;d"xnfO{ hf]lvdsf] af/]df

tYofÍ lnPkl5 Exposed / Unexpected ;d"xdf ljefhg ul/G5 . hf]lvdsf]

;Dks{df gcfPsf] Unexposed group nfO{ cfGtl/s t'ngf ;d"x eGg ;lsG5 . olb

ljz]if hf]lvddf k/]sf ;d"xnfO{ sf]x6{df 5gf]6 u/]sf 5fF} eg] of] ;d"x;Fu ldNbf] h'Nbf]

hf]lvddf gk/]sf] To; ;d"x eGbf aflx/af6 t'ngf 5gf]6 ug'{ kb{5 o;nfO{ External

comparison ;d"x elgG5 .

$= kmnf]ck / c;/sf] clen]v /fVg] (Follow-up and keeping records of

effect/outcomes)

cWoog ;d"xnfO{ b'O{ ;d"xM Exposed / Unexposed ;d"xdf ljefhg u/]kl5 nfdf]

;od;Dd cjnf]sg / cg'udg ub}{ hfg' kb{5 . olb v}gL vfg] / gvfg] ;d"xdf ljefhg

u/]/ v}gLsf] d'vdf c;/ x]g{ rfx]sf 5f} eg] b'j} ;d"xdf d'vsf] 3fp tyf SofG;/sf]

cjnf]sg, hfFr u/]/ /f]u jf SofG;/ b]vf k/]df ;do cg';f/ clen]v /fVb} hfg' kb{5 .

hf]lvd c;/ x]g{sf] nflu b'j} ;d"xdf ;DalGwt /f]u b]vf kg]{ljlQs} lrlsT;f k/LIf0f u/]/

/f]u jf c;/sf] lgbfg ug'{ kb{5 .

48

%= ljZn]if0f (Analysis)

sf]x6{ cWoogsf] nflu cfjZos tYofÍ k|fKt u/]kl5 clGtd rn0fdf /f]usf] 36gf b/,

d[To' b/ / hf]lvd cg'dfg ug'{ kb{5 . sf]x6{ cWoogsf ljZn]if0f ubf{ lgDg cg';f/sf] 2 ×

2 sf] tflnsf agfpg' kb{5 .

A = hf]lvd tTjsf] ;dks{ -v}gL ;]jg÷cfPsf] / /f]u -d'vsf]_ SofG;/ ePsf]

(Exposed person who developed disease)

B= hf]lvdsf] ;Dks{df cfPsf] -v}gL ;]jg_ t/ kl5 /f]u gnfu]sf] (Exposed person

who did not developed disease)

C = hf]lvddf gk/]sf] -v}gL gvfg]_ t/ kl5 /f]u -SofG;/_ nfu]sf] (Unexposed

person who developed disease)

D = hf]lvddf gk/]sf] / /f]u klg gnfu]sf] (Unexposed person who did not

developed disease)

;'lt{ vfg] afgL / d'vsf] SofG;/ larsf] sf]x6{ cWoogsf] gd"gf

Expoure Developed disease

(oral cancer)

Did not develop

disease

Total

Exposed (chewing

tobacco)

A = 70 B = 6930 A + B = 7000

Unexposed (not chewing

tobacco)

C = 3 D = 2997 C + D = 3000

Total A + C = 73 B + D = 9927 A + B + C +

D = 10000

49

36gf b/sf] lgwf{/0f (Calculation of incidence rate)

;Dk"0f{ hg;+Vofdf 36gf b/

Incidence rate in total population

= A + C

A + B + C + D + = 73

10‚000 × 1000 = 7.3

= 7.3/1000

hf]lvddf ePsf (Exposed group) ;d"xdf /f]usf] 36gf b/

Incidence rate among exposed group = A

A + B = 70

1‚000 × 1‚000

= 10/1,000 population

hf]lvddf gePsf (Unexposed) v}gL gvfg] ;d"xdf /f]usf] 36gf b/

Incidence rate among unexposed = C

C + D = 3

3‚000 × 1‚000

= 1/1,000 population

;fk]lIfs hf]lvd cg'kftsf] lgwf{/0f (Estimation of relative risk or risk ratio)

hf]lvddf k/]sf ;d"xdf b]vf k/]sf] /f]usf] 36gf b/ / hf]lvddf gk/]sf] ;d"xdf b]vf

k/]sf /f]usf] 36gf b/sf] cg'kftnfO{ ;fk]lIfs hf]lvd jf hf]lvd tTjsf] ;Dks{df cfPsf

;d"xdf /f]u nfUg] ;+efjgf -36gfb/_ nfO{ hf]lvdsf] tTjx?sf] ;Dks{df gcfPsf ;d"xdf

/f]u nfUg] ;+efjgfn] efu ubf{ cfpg] kl/0ffdnfO{ ;fk]lIfs hf]lvd elgG5 .

Relative risk = Incidence ofdisease among exposed group

Dinidence ofdiseas among non-exposed group

dflysf] tflnsf cg';f/,

RR = A/A + B C/C + D =

101 = 10

dflysf] sfNklgs tYofª\s cg';f/ ;'tL{ ;]jgaf6 d'vsf] SofG;/ x'g] ;fk]lIfs hf]lvd jf

hf]lvd cg'kft !) kfOof] . o;sf] cy{ x'G5 v}gL ;]jg gug]{nfO{ eGbf v}gL ;]jg ug]{

cfbt ePsf JolQmnfO{ d'vsf] SofG;/ x'g] ;+efjgf !) u'0ff a9L x'G5 .

50

lqmofsnfk

tkfOFsf] uf=lj=;=df Ps dlxgfd leq blnt / cGo hfthfltx?sf] afnaflnsfx?df b]vf

k/]sf] emf8fkvfnfsf gofF /f]uLsf] ;Vof kQf nufO{ b'j}} hft ;d"xsf afnaflnsfx?df

emf8fkvnfsf] 36gfb/ kQf nufO hf]lvd b/ lgwf/{0f ug'{xf];\ .


!= sf]x6{ eGgfn] s]nfO{ hgfp5 <

@= sf]x6{ cWoogsf] ljz]iftfx? s] s] 5g\ <

@=^ k|of]uffTds cWoog 9fFrf (Experimental/Intervention Study Design)

k|of]ufTds /f]u cWoog lj1fg (Experimental epidemiology) sf] k4lt cg';f/

cWoog ubf{ cGo cWoog 9fFrfx¿n] eGbf a9L e/kbf]{ / j}w 1fg k|bfg ub{5 . o;n] /f]u

jf :jf:Yo ;d:of jf :jf:Yo ;'wf/df k|ToIf k|efj kfg]{ sf/s tTjx¿ kQf nufpg d2t

ub{5 . sf]x6{ tyf s];–s]G6«f]n cWoog sf/0f / c;/ ;DaGw dfq b]vfpF5 eg] o;n]

c;/sf] jf:tljs sf/0f jf sf/0fsf] c;/ / k|efj dfkg tyf ljZn]if0f ub{5 .

k|of]ufTds cWoogdf cWoog ug{ rfx]sf] sf/s tTj÷:jtGq rndf yk36 u/L

kl/rfng÷kl/jt{g u/L To;sf] c;/ cWoog ul/g] ePsf]n] o;nfO{ x:tIf]k

(Intervention) cWoog klg elgG5 . /f]u pkrf/ tyf lgoGq0f ug]{ cf}ifwL tyf

vf]k÷pkfox?nfO{ dflg;x?df k|of]u u/]/ cWoog ug{ ;lsG5 . o;k|sf/sf] cWoogdf

s'g} s'/fsf] k/LIf0f (Trial) ul/g] ePsf]n] Clinic trial jf Community trial eGg]

ul/G5 .

w]/}nfO{ s] e|d 5 eg] k|of]uzfnfdf ul/g] cWoogx¿ g} k|of]ufTds cWoog xf] . t/

k|of]uzfnfdf cWoog ub}{df k|of]ufTds cWoog x'Fb}g . h:t} Hj/f] cfPsf] dflg;sf]

/utdf Typhoid sf] Bacteria 5 5}g eg]/ k|of]uzfnfdf Blood culture u/]/

x]l/G5 . o;n] /utdf ls6f0f' eP gePsf] kl/0ffd lbOG5 . o;sf] cfwf/df ;fdfGo

j0ff{gfTds cWoog h:t} c:ktfndf s'g dlxgfdf slt Hj/f]sf la/fdL / slt /utdf

51

6fOkmfO8sf] ls6f0f' kfOof] eg]/ j0f{g ub{5 . k|of]uzfnfdf /ut, lb;f, lk;fa k/LIf0f

tyf ljZn]if0f u/]/ cWoog ub}{df k|of]ufTds cWoog x'b}g .

k|of]ufTds cWoog ug{sf nlfu sDtLdf b'O{ jf b'O{ eGbf a9L ;d"x cfjZos kb{5 /

cWoog ug{ rfx]sf] ;d"xnfO{ sf/s tTj;Fu hfgfhfgL ;Dk{sdf Nofpg] jf v'jfpg jf

nufpg] u/L kl/jt{g ug'{ kb{5 . o; k|sf/sf] cWoog James Lind n] ;g\ !&$& df

;fdfGo tl/sfn] kfgL hxfhdf sfd ug]{ !@ hgf gfljsx¿ klxnf] k6s k|of]ufTds

Olk8]ldof]nf]lhs cWoog u/]sf lyP . James lind la|l6; gf};]gfsf 8fS6/ lyP . kfgL

hxfhsf gfljs÷ gf};]gfx¿df Scurvy /f]u b]vf kb{Yof] . of] g;g]{ /f]u xf] t/ s]

sf/0fn] nfU5 / o;sf] pkrf/ s] xf] eGg] hfgsf/L lyPg . gfljs÷gf};]gfx?sf] vfgfdf

kmnkm"n ;dfj]z gul/Psfn] of] Scurvy /f]u x'g ;Sb5 eGg] kl/sNkgf agfP / !@

hgf :seL{ ePsf JolQmx?nfO{ 5gf}6 u/] . !@ hgfnfO{ @ hgfsf] ;d"x agfP/ ^ ;d"xdf

ljefhg u/] . To;dWo] Pp6f ;d"xnfO{ ;fdfGo vfgfsf] cltl/Qm b}lgs b'O{j6f ;'Gtnf /

Pp6f sfutL vfg lbP . bf];|f] ;d"xnfO{ :ofpsf] /;, t];|f]nfO{ r'ssf] ;j{t, rf}yf]nfO{

;d'b|sf] kfgL (Sea water), kfFrf}nfO{ h'g;'s} /f]u lgsf] kf5{ eGg] uGws ldl;Psf]

cDnLo /; / 5}+7f}}nfO{ df5f df;' ;lxtsf] ;fdfGo vfgf v'jfOPsf] lyof] . klxnf] b'O{

hgfsf] ;d"x h;n] ;fdfGo vfgfsf] cltl/Qm b'O{ j6f ;'Gtnf / Pp6f sfutL /; vfgf

kfPsf lyP, Ps xKtf pgLx? :seL{sf] ;d:of 7Ls eof] . cGo ;d"xdf s'g} ;'wf/ ePg .

Citrus fruits ;'Gtnf tyf sfutLsf] ;]jgn] :seL{ 7Ls x'G5 / :seL{af6 arfpF5 eGg]

lgisif{ lgsfn]sf lyP . James Lind nfO{ k|of]ufTds cWoogsf] af/]df hfgsf/L geP/

klg ;fgf] ;d"xdf k|of]u u/]/ j}1flgs 1fg kQf nufPsf lyP . o;n] k|of]ufTds /f]u

lj1fgsf] nflu dxTjk"0f{ cfwf/ tof/ kf¥of] .

dfly pNn]v u/]sf] James Lind sf] ;fdfGo P]ltxfl;s k|of]ufTds cWoogaf6 :ki6

x'G5 ls k|of]ufTds cWoog ug{sf] nflu sf/0f / c;/sf] kl/sNkgf agfP/ c;/ kfg]{

tTjnfO{ cWoog ;d"xx¿sf] k|of]u tyf kl/rfng ug'{ kb{5 . s'g} sfo{ jf tTjsf] c;/

ljZn]if0f ug{ / kl/sNkgf k/LIf0f ug{ cWoogstf{n] hfgL hfgL Pp6f k|of]ufTds ;d"xdf

Ps jf Ps eGbf a9L sf/s tTjx? kl/rfng÷kl/jt{g ug{ / csf]{ ;d"xnfO{ lgoGq0f

u/L ul/g] cWoognfO{ k|of]uffTds cWoog 9fFrf elgG5 .

52

k|of]ufTds cWoogsf nIox¿ (Aims of experimental study)

!= /f]usf] sf/s tTjx¿ jf hf]lvd tTjx¿sf] j}1flgs k'li6 ug]{ h;n] tL /f]ux¿nfO{

lgoGq0f tyf kl/jt{g ug{ cg'dlt lbG5 . (To provide scientific proof of

aetiological/risk factors which may permit modification or control of those

diseases.)

@= /f]usf] /f]syfd, lgoGq0f tyf pkrf/ / ;d'bfosf] :jf:Yo ;'wf/sf nflu :jf:Yo

;]jfx¿sf] k|efjsfl/tf / bIftf dfkg ug]{ j}1flgs ljlw k|bfg ug]{ . (To provide a

scientific method of measuring the effectiveness and effeiciency of health

services for the prevention, control and treatment of disease and improve the

health of the community.)

k|of]ufTds cWoog 9fFrfsf] k|sf/ (Types of experimental study design in

epidemiology)

k|of]ufTds /f]u cWoog lj1fg 9fFrfx?nfO{ d'Vo tLg efudf ljefhg ug{ ;lsG5 M–

c_ /]G8f]dfOh sG6«f]n k/LIf0f (Randomized controlled trial, RCT)

cf_ ;fd'bflos k/LIf0f (Community trial)

O_ lkmN8÷sfo{If]q k/LIf0f (Field trial)

@=^=! /]G8f]dfOh sG6«f]n k/LIf0f (Randomized controlled trial, RCT)

k|of]ufTds cWoog ljlwåf/f gofF cf}ifwL tyf k|ltsf/fTds pkfox¿sf] af/]df cWoog

cg';Gwfg ug]{ ljlwnfO{ /f]u cWoog lj1fgdf Randomized Control Trial

(RTC) jf Randomized clinical trial elgG5 . o;nfO{ ;Rrf k|of]ufTds cWoog

9fFrf klg elgG5 . o;df cWoog ;d"xnfO{ slDtdf b'O{ ;d"x k|of]ufTds ;d"x

(Experimental group) / lgoGq0f ;d"x (Control group) df ljefhg ug'{ kb{5

. cWoogdf ;xefuL ePdf JolQmx¿ dWo] b'O{ ;d"x dWo] s'g} klg ;d"xdf kg]{ u/L lagf

e]befj ;fdfGotofsf] l;4fGt cg';f/ Randomly ljefhg ug'{ nfO{

Randomization elgG5 . cWoogdf Randomization / Control b'j} k|lqmof

53

;dfj]z x'g] ePsf]n] cWoogsf] gfd Randomized controlled trial (RCT)

/flvPsf] xf] . tn pNn]v ul/Psf] kl/efiffn] RCT nfO{ a'‰g d2t ug]{ 5 .

RCT eg]sf] Ps Olk8]ldof]nf]lhsn k|of]ufTds cWoog xf] h;df cWoog hg;+VofnfO{

k|foM cWoog / lgoGq0f ;d"xdf /]08dnL ljefhg ul/G5 / klxnf] ;d"xn] dfq

pkrf/fTds jf k|ltsf/fTds cf}ifwL jf pkfo k|fKt ub{5 . o;kl5 glthf, :jf:Yo nfe,

/f]u, d[To' cflbsf] b/nfO{ b'O{ ;d"xdf t'ngf u/L kl/sNkgf k/LIf0f ug]{ / lgisif{

lgsflnG5 .

RCT 9fFrf k|of]u u/]/ klxnf] k6s ;g\ !($) sf] bzsdf la|l6; lrlsT;f cg';Gwfg

kl/ifb\n] Ifo/f]usf] cf}ifwL Streptomycin sf] af/]df Ifo/f]u ePsf] !)& hgfnfO{

cWoogdf ;dfj]z ul/Psf] lyof] / logLx¿nfO{ Randomization k|lqmofåf/f %%

hgfnfO{ cWoog ;d"x / %@ hgfnfO{ lgoGq0f ;d"xdf ljefhg ul/Psf] lyof] . cWoog

;d"xsf] %% hgf /f]uLnfO{ Streptomycin v'jfpg] / cf]5\ofgdf cf/fd ug{ nufOof]

eg] lgoGq0f ;d"xdf %@ hgfnfO{ Bed rest dfq k|bfg ul/of] . nuftf/ ^ dlxgf ;Dd

Streptomycin v'jfpg] / cjnf]sg ul/of] . of] cjlwdf cWog ;d"xsf] &Ü lgoGq0f

;d"xsf] @&Ü d[To' eof] . ^ dlxgf ;Dd cf}ifwL v'jfPkl5 cWoog ;d"xsf ax';+Vosdf

/f]usf] ;'wf/ eof] eg] lgoGq0f ;d"xdf *Ü dfq ;fdfGo ;'wf/ cfPsf] lyof] . o;af6

Streptomycin n] Ifo/f]usf] pkrf/ ug{ ;S5 eGg] lgisif{ lgsflnof] .

/]G8f]dfOh sG6«f]n k/LIf0fsf] 9fFrfnfO{ tn 8fou|fddf k|:t't ul/Psf] 5 . of] cWoog ug{sf]

nflu cWoog ug{ rfx]sf] /f]u tyf pkrf/sf] cfjZostf cg';f/ pko'Qm cWoog hg;+Vof

klxrfg ul/G5 / lglZrt dfkb08 cg';f/ cWoog ;xefuL x'g ;Sg] k|an ;+efjgf ePdf

dflg;x? klxrfg ul/G5 . To;kl5 pgLx¿nfO{ cWoogsf] p2]Zo, :jefj, ;do, kmfObf tyf

j]kmfObfx?sf] hfgsf/L u/fP/ cWoogdf ;xefuL x'g cfdGq0f ul/G5 . To; dWo] s]xL

cWoog ;xefuL x'Fb}g . dfgf}F s'i7/f]usf] gofF cf}ifwLsf] k|efjsfl/tf af/]df cWoog ug{

rfx]sf 5f}F eg] cWoog hg;+Vof s'i7/f]u c:ktfndf x'G5g\ . pQm c:ktfndf !^) s'i7

/f]uLx? 5g\ eg] To;nfO{ cWoog hg;+Vof elgG5 . To;dWo !$) dfq cWoogdf ;xefuL

x'g of]Uo 5g\ eg] tL !$) hgfnfO{ ;xefuL x'g cg'/f]w ubf{ !@) hgfn] dfq d~h'/L eP klg

tL !@) nfO{ dfq cWoogdf ;xefuL u/fpg ;lsG5 .

54

!@) hgf ;xefuLnfO{ klg cWoog / lgoGq0f ;d"xdf ljefhg ug'{ kb{5 . o;sf] nflu !@)

hgfsf] ;"rL agfP/ Randomization ljlwåf/f ljgf e]befj b'O{ ;d"xdf k/]sf /f]uLnfO{

s'i7/f]usf] gofF cf}ifwLn] pkrf/ ul/G5 / lgoGq0f ;d"xdf k/]sf /f]uLnfO{ k'/fgf] cf}ifwLn]

pkrf/ ul/G5 . o;/L gofF cf}ifwL v'jfpg] sfo{nfO{ x:tIf]k tyf kl/jt{g (Manipulation)

elgG5 . o;/L cf}ifwL v'jfpg] cjlw;Dd Manipulation ub}{ kmnf] ck÷cg'udg ug]{ /

clen]v /fVg] sfo{ ul/G5 . Manipulation sf] glthf tyf c;/ b'j} ;d"xdf s:tf] kfOof]

dfkg ul/G5 . gofF cf}ifwL v'jfpg] ;d"xsf /f]uLx¿ slt hgfsf] ;kmn pkrf/ eof] / sltsf]

pkrf/ ;kmn ePg dfkg ug'{ kb{5 . To;}u/L k'/fgf cf}ifwL vfPsf] lgoGq0f ;d"xsf /f]uLx¿

sltsf] ;kmn pkrf/ eof] slt ePg dfkg ug'{ kb{5 . b'j} ;d"xdf pkrf/ ;kmntf b/ t''ngf

ul/G5 . olb gofF cf}ifwL ;]jg ug]{ ;d"xdf pkrf/ ;kmn b/ &)Ü 5 / k'/fgf cf}ifwL vfg]

lgoGq0f ;d"xdf $*Ü 5 eg] gofF cf}ifwL a9L k|efjsf/L 5 eGg] kQf nfUb5 . olb b'j}

;d"xdf pkrf/ b/ p:t} 5 eg] k'/fgf] / gofF cf}ifwL k|efjsfl/tf ;dfg 5 eGg] lgod

agfOG5 .

RCT cg';f/ cWoog ubf{ Treatment ;d"xnfO{ gofF cf}iflw jf ljlw lbOG5 eg] lgoGq0f

;d"x (Control group) nfO{ s]xL klg lbOb}g jf k'/fgf] cf}iflw jf Placebo lbOG5 .

cf}iflw h:t} b]lvg] rLhnfO{ Placebo elgG5 . la/fdL JolQm cWoog ubf{ lgoGq0f ;d"xnfO{

cf}iflw h:t} b]lvg] lrgLsf] rSsL jf SofK;"n jf ;nfOgdfqsf] ;'O lbOG5 . o;sf] s]xL

dfqfdf ;sf/fTds c;/ kg{ ;S5 . o:tf] c;/nfO{ Placebo effect elgG5 .

55

Design of randomized controlled trial

Study population

Select potential sample participants

Select real partionparts

Randomization

Study treatment group

Control group

Yes

No

Internation / manipulation & follow up

Yes

No

Outcomes

Analysis

56

/]G8f]dfOh sG6«f]N8 k/LIf0fsf rn0f tyf tTjx¿ (Steps/Elements of randomized

controlled trial)

RCT sf] 9fFrf cg';f/ k|of]uffTds cWoog ug{sf nflu lgDg tTjx¿ ;dfj]z u/]/

rn0fj4¿kdf cWoognfO{ ;~rfng ug'{ kb{5M–

!= cWoog k|f¿k÷k|f]6f]sn tof/ kfg]{ (Drawing up a study protocol)

RCT cg';f/ cWoog ubf{ ;j{k|yd cWoogsf] k|f]6f]sn– lj:t[t ¿k/]vf tof/ kfg'{ kb{5 .

cWoognfO{ s;/L ;~rfng ug]{ eGg] af/]df ;a} kIfnfO{ lj:t[t ¿kf JofVof ul/Psf] lnlvt

b:tfa]hnfO{ k|f]6f]sn elgG5 . (Protocol is a written document describing all

the important details of how a study will be conducted) of] cWoog k|:tfjgf

(Proposal) sf] lj:t[t ¿k xf] . o;df cWoogsf] zLif{s, nIo, p2]Zo kl/sNkgf jf

cg';Gwfg k|Zg, RCT sf] 9fFrf, cWoog hg;ª\Vof, ;xefuL 5gf]6 ug]{ dfkb08, gd"gf

cfsf/ (Sample size), /]G8f]dfOh]zg ug]{ tl/sf, cf}iflw jf ljlw k|lqmof lj:t[t ljj/0f

(Intervention detail) tYofÍ ;+sng, n]vfhf]vf tyf ljZn]if0f ug]{ tl/sf / g}lts

cfrf/;lxt (Ethical issue) cflbsf af/]df lj:t[t ¿kdf pNn]v ug'{ kb{5 . :ki6 /

lj:t[t cWoog k|f]6f]sn agfPkl5 dfq cWoog k|lqmof cl3 a9fpg ;lsG5 .

@= ;Gbe{÷nlIft tyf cWoog÷k|of]ufTds hg;ª\Vofsf] 5gf]6 (Selecting reference/

target and study/ experimental: population)

;Gbe{ hg;ª\Vofdf w]/} k|sf/sf dflg;x¿ x'g] ePsfn] ;a} cWoogdf ;xefuL x'g of]Uo

x'Fb}gg\ . ;Gb{e hg;ª\Vofaf6 cWoogdf ;xefuL x'g ;Sg] of]Uo dflg;x¿nfO{ cWoog jf

k|of]uffTds hg;ª\Vof elgG5 . ARI sf] af/]df cWoog ug{ rfx]sf cj:yfdf % jif{ d'lgsf

c:ktfndf cfPsf afnaflnsfx¿ ;Gbe{ hg;ª\Vof x'g eg] ARI eP/ pkrf/ u/fpg

cfPsf c:ktfn kl/;/ leq e]l6Psf afnaflnsfx¿ cWoog ug]{ ljBfyL{x¿ ;Gbe{ hg;ª\Vof

x'G5g eg] !) jif{ d'lgsf ljBfyL{x¿ cWoog ug]{ xf] eg] k|fylds txdf k9\g] ljBfyL{x¿

k|of]ufTds hg;ª\Vof x'G5g\ . o;/L cwoog ug{ rfx]sf] ;d"x klxrfg u/L cWoog

hg;ª\Vof ;"rL agfpg' kb{5 / pgLx¿nfO{ cWoogdf ;xefuL x'g cfdGq0f ug'{ kb{5 .

57

#= gd"gf ;xefuL 5gf]6 ug]{ (Selecting sample participants)

cWoog hg;ª\Vofaf6 cfjZos kg]]{ ;xof]uL 5gf]6 ug'{ kb{5 . /]G8f]dfOh s]G6«f]N8 k/LIf0f

cg';f/ cWoog ubf{ ;xefuL 5gf]6 ug{sf nflu ;dfj];L dfkb08 (Inclusion

criteria) / x6fpg] dfkb08 (Exclusion criteria) agfpg' kb{5 . ;dfj];L dfkb08

eGgfn] cWoog ug{ pko'Qm x'g] ljz]iftfx¿ h:t} s'g} /f]u jf la/fdLsf] af/]df cWoog

ubf{ /f]usf] nIf0f b]vfk/]sf], lglZrt pd]/ ;d"xleq kg]{, /f]usf] lgbfg ePsf, ;DalGwt

cf}iflw gvfPsf cflb x'g ;S5 . ;dfj]z gug]{ dfkb08df /f]usf] lgbfg ePklg lzlsit

la/fdL ePsf] ;DalGwt cf}iflw pkrf/ ;'? eO;s]sf] / cWoogdf ;xefuL x'g grfxg]

cflb x'G5 . oL s'/fx¿ k|f]6f]sndf pNn]v ug'{ kb{5 . o;/L :ki6 ¿kdf ;dfj]; ug]{ /

gug]{ dfkb08 agfP/ k|f]6f]sndf pNn]v ePsf] gd"gf cfsf/ cg';f/ ;xefuL 5gf]6 ug]{

/ cWoogdf egf{ (Enrollment) ug'{ kb{5 .

$= /]G8f]dfOh]zgsf] ;d"x ljefhg (Randomization of group division)

cWoog ;xefuL / egf{ ePsf JolQmnfO{ sDtLdf b'O{ ;d"xdf ljefhg ug'{ kb{5 . ;d"x

ljefhg ubf{ kIfkft gxf];\ eGgsf nflu Randomization ljlw ckgfpg' kb{5 .

/]G8f]dfOh]zg eGgfn] ;xefuLx¿ cWoog / lgoGq0f b'j} ;d"xdf 5gf]6 x'g] ;Defjgf

a/fa/L x'g] uf]nf k|yf÷lr¶f (Lottery), /]08d 6]an, sDKo'6/n] lgsfNg] Random

number cflb k|of]u u/]/ egf{ ePsf ;xefuLx¿nfO{ cWoog / lgoGq0f ;d"xdf

ljefhg ug'{ kb{5 . of] /]G8f]dfOh]zg kIfkft x6fpg]] dxŒjk"0f{ tl/sf xf] .

%= kl/rfng÷x:tIf]k (Manipulation or Intervention)

cWoog ug{ rfx]sf] :jtGq rnnfO{ kl/rfng ug'{ jf s]xL lqmofsnfknfO{ kl/rfng jf

x:tIf]k elgG5 . s'g} cf}iflw, vf]k, kf]if0f, jfgL Jojxf/, :jf:Yo lzIff sfo{qmdsf] k|efj /

pknlAw kQf nufpg] p2]Zo 5 eg] ;DalGwt cf}iflw jf vf]k jf ljlw cWoog ;d"xdf

k|of]u ug'{ kb{5 . olb gofF cf}iflwsf] af/]df cWoog ug{ rfx]sf] cj:yfdf cWoog

;d"xnfO{ gofF cf}iflw lbOG5 eg] lgoGq0fdf /x]sf t'ngf ;d"xnfO{ s]xL klg lbOFbg jf

klxn] g} k|of]u eO/x]sf cf}iflw lbOG5 . t/ k|foM h;f] cWoogdf cf}iflw h:t} b]lvg] t/

cf}iflw gePsf] lrgL jf vfg] s'/f jf ;nfOgsf] ;'O{ lbOG5 . o;nfO{ Placebo elgG5 .

t/ lgoGq0f ;d"xdf la/fdLnfO{ Placebo v'jfPsf] jf k|of]u u/]sf] eg]/ hfgsf/L

u/fpg' x'Fb}g .

58

^= ˆnf]kck tyf tYofÍ ;ª\sng (Follow up and data collection)

kl/rfng tyf x:tIf]k lqmofsnfk ;'? ePb]lv cGt geP ;Ddsf]] ;dofjwL ;Dd lg/Gt/

¿kdf cg'udg ug]{, :jf:Yo hfFr ug]{, /f]u ljdf/df ;'wf/ cfPsf] jf gcfPsf] :jf:Yonfe

jf d[To' tyf x:tIf]ksf] k|efjn] b]vf kg]{ kl/jt{gx¿sf] af/]df clen]v /fVg] / cfjZos

tYofÍ ;ª\sngug'{ kb{5 . b'j} ;d"xnfO{ a/fa/ lgu/fgLdf /fVg' kb{5 . s'g} JolQm aLr}df

5f]8g ;Sb5 . cWoogsf] aLrdf ;s];Dd x6fpg / 5f]8\g lbg' x'Fb}g .

&= pknAwLsf] n]vfhf]vf (Assessment of outcomes)

b'j} ;d"xdf kl/rfng tyf x:tIf]ksf] ;sf/fTds / gsf/fTds k|efj kg{ ;Sb5 . cWoog ;d"xdf gofF cf}iflw jf ljlw k|of]u u/]kl5 sltnfO{ ;sf/fTds k|efj k¥of], /f]u lgsf] eof], kmnbfoL eof], d[To' 36\of] / slt hgfdf ;'wf/ cfPg jf gsf/fTds c;/ k¥of] n]vfhf]vf ug'{ kb{5 . To;} u/L lgoGq0f ;d"xdf slt hgfsf] :jf:Yo ;'wf/ eof] / slt hgfsf] :jf:Yodf gsf/fTds c;/ k¥of], d[To' eof] cflbsf] k/LIf0f u/]/ n]vfhf]vf ug'{ kb{5 .

*= ljZn]if0f (Analysis)

cWoogsf] cGtdf k|fKt tYofÍsf] cfwf/df tYofÍzf:qLo ;fwgsf] d2tn] ljZn]if0f ug'{ kb{5 . lglZrt ;do ;Dd u/]sf] kl/rfng÷pkrf/af6 b'j} ;d"xdf ;sf/fTds tyf gsf/fTds k/]sf] x'G5 cyf{t\ kl/rfngsf] pknlAw k|fKt x'G5 . b'j} ;d"xdf ;kmn pkrf/ b/ dfkg ug'{ kb{5 . b'j} ;d"xsf] aLrdf t'ngf ug'{ kb{5 . pkrf/ dxŒjk"0f{ 5 ls 5}g ljZn]if0f ug'{ kb{5 . b'j} ;d"xdf ePsf] pkrf/ b/sf] Rate ratio lgsfNg' kb{5 . olb cWoog ;d"xdf pkrf/ b/ ()Ü 5 / lgoGq0f ;d"xdf #)Ü dfq 5 eg] oL b'O{ aLrsf] Rate ratio ()–#) Ö # x'G5 . o;sf] cy{ k'/fgf] ljlw jf Placebo eGbf gofF cf}iflw # u'0ff a9L k|efjsf/L 5 eGg] x'G5 . o;sf] cltl/Qm cGo tYofÍzf:qLo ;fwg ;"qk|of]u u/L pRr txsf] ljZn]if0f ug{ ;lsG5 .

lqmofsnfk

!= c+u|]hLdf n]lvPsf Olk8]ldof]nLhLsf k':tsx? cWoog u/L ¥ofG8dfOh sG6«f]n k/LIf0fsf] Oltxf; tyf cWoog ug]{ tl/sf]af/]df gf]6 tof/ kfg'{xf]; \.

@= ¥ofG8dfOh sG6«f]n k/LIf0fsf] 9frfdf cfwfl/t ePsf cg';Gwfgd'ns n]v tyf k|ltj]bg OG6/g]6df vf]h]/ ;dLIff u/L cWoog ;d"xsf] lardf ;s{'n/ ug'{xf];\ .

59

@=^=@ lkmN8 k/LIf0f (Field trial)

lkmN8 k/LIf0f klg Ps k|sf/sf] /]G8f]dfOh s]G6«f]N8 k/LIf0f xf] . lrlsT;f If]qdf /f]u tyf pkrf/fTd ljlw ;DaGwL ul/g] /]G8f]dfOh sG6«f]N8 jf lSnlgsn k/LIf0f (Clinical trial) c:ktfn, k|of]uzfnf tyf lSnlgsn If]qdf /f]uL JolQmx¿df cWoog ul/G5 . t/ lkmN8 k/LIf0f /f]u gnfu]sf t/ /f]usf] hf]lvddf k/]sf dflg;x¿nfO{ s'g} lglZrt ;+:yf eGbf aflx/ ;fdfGo hg;ª\Vofdf ul/G5 . lkmN8 k/LIf0f cWoogn] vf]k, zf/Ll/s Jofofd tyf cGo /f]syfdsf pkfox¿sf] k|efjsfl/tf k|dfl0ft ug{ d2t ub{5 . o; k|sf/sf] cWoogsf] k|aGw ug{ a9L vr{, ;f3g, ;|f]t / d]xgt nfUb5 .

Design of a field trial

lkmN8 6«fon cWoog 9fFrf RCT ;Fu ldNbf] 5 . o;nfO{ tn lrqdf b]vfOPsf] 5 .

pbfx/0fsf vf]k tyf k|ltsf/fTds pkfon] lgoGq0f ug{ ;Sg] /f]uaf6 k|efljt hg;ª\Vof

klxrfg ug'{ . sfnhf/ vf]ksf] k/LIf0f ug]{ xf] eg] pQm /f]uaf6 k|efljt If]q / hg;ª\Vof

kQf nufpg' kb{5 . To;kl5 slt hg;ª\VofnfO{ cWoogdf ;xefuL agfpg] xf]

pgLx¿sf] ;"rL agfpg' kb{5 .

bf];|f] rn0fdf cWoog ;d"xnfO{ cWoog / lgoGq0f ;d"xdf Randomization tl/sfn]

ljefhg ug'{ kb{5 . To;kl5 cWoog ;d"xdf 5gf]6 ePsfnfO{ gofF vf]k jf k|ltsf/fTds

pkfox¿ k|of]u u/L kl/rfng jf x:tIf]k ug'{ kb{5 . lgoGq0f ;d"xsf dflg;nfO{ s]xL

glbg] jf Vaccine h:t} b]lvg] Saline kfgL cyf{t\ Placebo lbg' kb{5 . vf]k

lbPkl5 /f]u b]vf kg]{ ;do tyf df};d;Dd lg/Gt/ cg'udg tyf lgu/fgL ug'{ kb{5 .

Target population

Study population

Randomization

Treatment group (preventive

intervention)

Disease

No Dis.

Control group (no intervention)

Disease

No Dis.

60

cGtdf b'a} ;d"xdf ;DalGwt /f]u nfu]sf] / gnfu]sf] x]g'{ kb{5 . vf]k nufPsf] ;d"xdf

/f]usf] 36gf b/ sd / vf]k gnfuPsf] lgoGq0f ;d"xdf /f]usf] b/ a9L 5 eg] vf]k

k|efjsf/L ePsf] lgisif{ lgsflnG5 .

@=^=# ;fd'bflos k/LIf0f (Community Trial)

o;/L Pp6f ;d'bfonfO{ cWoog ;d"x 5gf]6 dfg]/ kl/rfng÷x:tIf]k ug]{ / csf]{ 7fpFsf]

;d'bfonfO{ lgoGq0f ;d"x dfg]/ ul/g] k|of]ufTds cWoognfO{ Community trial

elgG5 . o; k|sf/sf] cWoogdf /f]usf] /f]syfd ug]{ pkfo tyf :jf:Yo k|a4{g sfo{sf]

k|efjsfl/tf lgwf{/0f ug{ o; k|sf/sf] cWoog ul/G5 . of] cGo cWoog eGbf sd vr{ /

;fgf] ;d'bfodf klg ug{ ;lsG5 . ;/sf/n] rnfPsf] gofF sfo{qmdnfO{ Community

intervention dfg]/ ug{ ;lsG5 . ;fd'bflos lzIff tyf k|a4{g sfo{sf] k|efjsfl/tf

dfkg ug{ klg ;fd'bflos k/LIf0f pkof]uL x'G5 .

ljifflbo'Qm em'n (Insecticide treated nets/ITN) ;fdfGo em'n eGbf dn]l/of

lgoGq0f ug{sf nlfu Community trial ug{ ;lsG5 . o;sf] nflu klg t/fOsf] plQs}

¿kdf dn]l/ofaf6 k|efljt ;d'bfo÷ufpF 5gf]6 ug'{ kb{5 . Pp6f ufpFnfO{ cWoog ;d"x

dfg]/ k|To]s 3/df ljifflbo'Qm em'n ljt/0f u/L k|of]u ug{ nufpg' kb{5 eg] csf]{

ufpF÷;d'bfodf k/Dk/fut ;fdfGo em'n k|of]u ug{ ;Nnfx lbg ;lsG5 . To;kl5 dn]l/of

km}lng] dlxgf c;f]h, sflQs ;Dd cg'udg tyf lgu/fgL /fvL Hj/f]sf] la/fdL e]l6Pdf

/ut hfFr u/L dn]l/ofsf] lgbfg ug'{ kb{5 . cGtdf b'j} ;d'bfodf dn]l/of /f]usf]

Selection of study comunity

Community intervention (Treatment community)

No community intervention (Controlled community)

Follow up

Intervention Yes

No

Follow up

Yes

No

Outcomes

61

36gfb/ dfkg ug]{ / b'O{ ;d'bfolart'ngf ug'{ kb{5 . olb cWoog jf Intervention

community dn]l/of 36gf b/ Go"g 5 / Non-intervention community df

a9L 5 eg] o;sf] cfwf/df ljiffbLo'Qm e'mn dn]l/of /f]syfd ug{ k|efjsf/L 5 eGg

;lsG5 .

;fd'bflos k/LIf0f 9fFrfaf6 cWoog ug{ ;lhnf] 5 . lkmN8 k/LIf0fdf eGbf sd ;fwg

;|f]t / d]xtdf o; k|sf/sf] cWoog ug{ ;lsG5 . w]/} ;d'bfodf cWoog ubf{ ;d'bfonfO{

klg Randomization ug{ ;lsG5 . t/ JolQmnfO{ ubf{ h:tf] Jojxfl/s k|efjsf/L

x'Fb}g . x:tIf]k ug]{ ;d'bfo / lgoGq0f ;d'bfo cnu cnu 7fpFsf] x'g] ePsfn] b'j}

;d'bfosf] ljz]iftf ;dfg gx'g ;Sb5 . sfo{qmd tyf x:tIf]k klg b'O{ ;d'bfodf b]vf

k/]sf] leGgtf gofF sfo{qmdn] xf] of ;d'bflos cfGtl/s ljz]iftf leGg ePsf]n] xf] jf

;do / jftfj/0fdf cfPsf] kl/jt{gsf k|efjn] xf] eGg] s'/f lgZrodf ug{ sl7g x'G5 .

t/ klg ;fd'bflos txdf x'g] Interventions sf] cfwf/ tyf k|efj dfkg g{ of] 9fFrf

pkof]uL x'G5 .


!= /fG8dfOh sG6«f]N8 k/LIf0fsf] 9fFrf cg';Gwfg cWoog ug{ s] s] ;t{ cfjZos kb{5 <

@= lkmN8 k/LIf0f 9fFrf :jf:Yo lzIffdf a9L pkof]uL x'G5 eGg] s'/fsf] k'li6 ug'{xf];\ .

;f/f+z

o; PsfO{df /f]u tyf :jf:Yo ;d:of cWoog ug{ pkof]uL x'g] ljlw tyf 9fFrfx¿

;DalGwt ljifoa:t', /f]ucWoog lj1fg ljlw tyf 9frfx?sf] cjwf/0ff, j0{fgfTds

cWoog ljlwsf] rn0fx?, 36gf lgoGq0f / ;d"x cWoog 9fFrfx?], 36gf lgoGq0f / ;d"x

cWoog 9fFrfx¿af6 k|fKt x'g] tYofª\sx?sf] ljZn]if0f ug{ ¥ofG8f]dfOh sG6«f]n 6«fon,

If]qut 6«fon / ;fd'bflos 6«fon cWoog 9fFrf ;dfj]z ul/Psf] 5

62

PsfO b'Osf] cEof;sf nflu k|Zgx?

s_ ljifout k|Zgx?


!= a0f{ggfTds cWoog cy{ pbfx/0f ;lxt n]Vg'xf]; <

@= a0f{ggfTds cWoogsf] d'Vo cfzo s] xf] <

#= s]; sG6«f]n cWoog ubf{ sxfFaf6 ;'? ul/G5 <

$= sf]x6{ eg]sf] s] xf] < sf]x6{ cWoog slt k|sf/sf x'G5g\ <

%= jt{dfgaf6 eljiolt/ cufl8 a9\g] sf]x6{ cWoogn] s'g vfnsf] hg;+Vofdf

cWoog ub{5 / s'g k|sf/sf] b/ lgsfN5 <


!= a0f{gfTds cWoog ubf{ ckgfOg] rn0fx? j0f{g ug'xf];\ .

@= s]; sG6«f]N8 cWoog 9fFrf ;lrq JofVof ug'{xf];\.

#= /fG8dfOh sG6«f]N8 k/LIf0fsf] 9fFrf cg';f/ cWoog ubf{ s] s] sfo{ ug'{ kb{5 <

;lj:tf/ j0f{g ug'{xf];\ .

$= ;fd'bflos k/LIf0f 9fFrf cg';f/ :jf:Yo lzIffsf] k|efjsfl/tf kQf nufpg s] s]

ug'{ kb{5 <

v_ j:t'ut k|Zgx?

!= j0f{gfTds cWoogsf] clGtd rn0fdf s] ul/G5 <

s_ tYofª\sf ljZn]if0f v_ kl/sNkgfsf] lgdf0f{

u_ lgisif{ lgsfNg] 3_ glthf cGo ;"rs;Fu t'ngf ug]{

63

@= tnsfdWo s'g cWoogåf/f /f]u k|efljt b/ lgsfNg ;lsG5 <

s_ qm;;]S;gn ;j]{If0f u_ sf]x6{ cWoog

u_ s]; sG6«f]N8 cWoog 3_ ;fd'bflos k/LIf0f

#= tnsfdWo s'g cWoognfO{ 36gf cWoog (Incidence Study) klg elgG5 <

s_ qm;;]S;gn ;j]{If0f u_ sf]x6{ cWoog

u_ s]; sG6«f]N8 cWoog 3_ ;fd'bflos k/LIf0f

$= s]; sG6«f]N8 cWoogaf6 s'g cg'kft jf b/ lgsflnG5 <

s_ 36gf b/ v_ /f]u k|efljt b/


%= sf]x6{ cWoogsf] bf];|f] rn0f df s] ul/G5 <

s_ kmnf]ck v_ t'ngf ;d"xsf] 5gf}6

u_ PSkf]h/sf] af/df ;"rgf ;ª\sng u_ tYofª\s ljZn]if0f

^= /fG8dfOh sG6«f]N8 k/LIf0fsf] 9fFrf cg';f/ cWoog ubf{ tnsf dWo s'g s'/f cfjZos

kb}{g <

s_ kl/jt{g v_ sG6«f]n

u_ /fG8dfOh]zg 3_ sf]x6{

&= ;d'bfodf :jf:Yo lzIffsf] k|efjsfl/tf kQf nufpg s'g cWoog 9fFrf a9L pkof]uL

x'G5 <

s_ ;fd'bflos k/LIf0f 9fFrf v_ /fG8dfOh sG6«f]N8 k/LIf0f 9fFrf

v_ j0f{gfTds cWoog u_ sf]x6{ cWoog

64

PsfO{ tLg

;?jf tyf ;ª\qmfds /f]u cWoog lj1fg

(Communicable/Infestious Disease Epidemiology)

#=! PsfO kl/ro (Unit Introduction)

o; PsfOdf ;?jf /f]u cWoog;Fu ;DalGwt ;}¢flGts tyf Jojxfl/s kIfsf]af/]df 1fg

tyf l;k lbg cfjZos kg]{ ljifoj:t'x? ;dfj]z ul/Psf] 5 . ;?jf /f]usf] l;¢fGt,

;?jf /f]usf] jlu{s/0f, /f]u k|;f/0f x'g] tl/sf, dxfdf/L /f]usf] cGj]if0f, /f]usf] lgu/fgL

tyf g]kfndf b]vf kg]{ d'Vo ;?jf/f]usf Olk8]ldof]nf]hLaf/]df rrf{ ul/g]5 .

#=@ PsfOsf] p2]Zo (Unit objectives)

of] PsfOsf] cGTodf ljBfyL{x? lgDg sfo{ ug{ ;Ifd x'g]5 .


;?jf /f]usf] tTj tyf l;¢fGt

JofVof ug{

;?jf /f]ux?nfO{ pko'Qm

;d"xdf juL{s/0fug{

;?jf /f]usf] k|fs[lts Oltxf;

tyf /f]u k|;f/0f ultlzntfsf]

af/]df j0f{g

g]kfndf b]vf kg]{ dn]l/of,

Ifo/f]u, ?3fvf]sL, PrcfOeL

ty P8\;sf] Olk8]ldof]nf]hLsf]

af/]df 5nkmn ug{ ;Ifd x'g]

5g\

/f]u k|sf]k cGj]if0f ug]{ rn0fsf]

!= ;?jf /f]usf] tTj tyf l;¢fGt

@= ;?jf /f]uxsf] juL{s/0f / k'g/fjnf]sg

kgLn] kvflng] /f]u -Water-washed diseases): Scabies, Trachoma, Conjunctivitis, Tropical ulcer etc

lb;fhGo jf ck|ToIf?kdf lb;f d'vdf k/L nfUg] /f]u (Fecal-Oral Diseases): Cholera, Diarrhea, Gastro-Enteritis, Bacillary Dysentery, Giardiasis, Amoebiasis, Typhoid, Hepatitis A & E, Poliomyelitis etc

vfgfhGo /f]u (Food-Borne Diseases): Food poisoning, The Sheep Liver Fluke, The Beef and Pork Tapeworms

ls6hGo /f]u (Vector-Borne Diseases): Malaria, Dengue, Kala-azar, Japanese encephalitis, Filariasis, Yellow fever, Chaga's

65

af/]df j0f{g ug{

/f]u lgu/fgLsf] cjwf/0ff /

k|sf/ a0f{g ug{

;?jf/f]u lgoGq0fsf] l;¢fGt /

ljlw a0f{g ug{

diseases jfo'hGo Zjf;k|Zjf; /f]u (Airborne

Respiratory Diseases): TB, ARI, Pneumonia, Influenza, Diphtheria, Whooping cough

of}g k|;fl/t /f]u tyf ;ªqmd0f (Sexually transmitted diseases and infections): Gonorrhea, Syphilis, Chancroid, Genital herpes, Hepatitis B, HIV, HPV (human papilloma virus)

df6f] ;Dks{sf] /f]u (Diseases of soil contact): Tetanus, Hook Worm, Round Worm, Whip Worm

kfgLsf ;Dks{af6 nfUg] /f]u (Diseases of water contact): Schistosomiasis, Guinea Worm

5fnf ;ª\qmd0f /f]u (Skin infecious diseases): Measles, Chicken-pox, Mumps, Leprosy

afXok/hLjLsf] dfWodaf6 k|f0fLaf6 ;g]{ /f]u (Ectoparasite zooneses): Plague, Typhus fever, Louse-borne relapsing fever, Lyme disease

3/kfn'jf hgfj/af6 ;g]{ /f]u (Domestic zoonotic diseases): Rabies, Hydatid disease, Anthrax, Brucellosis, Leptospirosis

#= /f]u k|;f/0f ultlzntfsf

$= ;?jf /f]usf] k|fs[lts Oltxf; tyf /f]usf]

5gf]6 k/LIf0f

%=g]kfndf b]vf kg]{ dn]l/of, Ifo/f]u, ?3fvf]sL,

PrcfOeL ty P8\;sf] Olk8]ldof]nf]hL

^= /f]u k|sf]k cGj]if0f ug]{ rn0fx?

&= /f]u lgu/fgLsf] cjwf/0ff / k|sf/

*= ;?jf/f]u lgoGq0fsf] l;¢fGt / ljlw

66

#=# ;?jf /f]usf] tTj tyf l;4fGt (Elements and theory of communicable

disease)

;ª\qmds clestf{ jf hLjf0f'x¿ dflg;x¿sf] z/L/leq k|j]z u/L j[l4 / ljsf; ePdf

To;nfO{ ;ª\qmd0f elgG5 . /f]usf hLjf0f'x¿sf] ;ª\qmd0fn] ubf{ ;?jf /f]u nfUb5 . t/ ;a}

k|sf/sf] ;ª\qmd0fn] /f]u nfUb}g / ;a} k|sf/sf] ;ª\qmds /f]u ;?jf /f]u x'Fb}g . 5fnf tyf

;fdfGo rf]6k6s nfUbf klg ls6f0f'x¿sf] ;ª\qmd0f x'G5 t/ ;fdfGo ljdf/sf] cj:yfdf

k'¥ofpFb}g . lkgf;, sfg kfSg] tyf wg'i6ª\sf/ /f]u cflb ;ª\qmds /f]u x'g t/ Pp6f

JolQmaf6 csf]{ JolQmdf g;g]{ ePsf]n] oL /f]ux¿nfO{ ;?jf /f]u elgb}g .

;ª\qmds /f]u Pp6f JolQmaf6 csf]{ JolQm jf k|f0fLaf6 dflg;df /f]u ;g]{ s'g} dfWodaf6 ;5{

eg] To; k|sf/sf] /f]unfO{ ;?jf /f]u elgG5 . cyf{t\s'g} lglZrt clestf{ jf o;sf ljifhGo

pTkfbgsf] sf/0f k|ToIf jf ck|ToIf ¿kdf dflg;sf cyjf jftfj/0f -xfjf, w'nf], df6f], kfgL,

vfgf_ cflbaf6 dflg; jf hgfj/df km}lng] /f]unfO{ ;?jf /f]u elgG5 . (A communicable

disease is an illness due to a specific infections agent or its toxic products

capable of being directly or indirectly transmitted from man to man, from animal

to man, from animal to animal or from the environment (through air, water, food

etc) to man) . ;?jf /f]u dxfdf/L, ljZjJofkL, :yflgs tyf l56km'6 ¿kdf dfgj ;d'bfodf

km}lnG5 .

#=$ ;?jf /f]usf] tTjx¿ (Elements of communicable disease)

;?jf /f]u nfUgsf] d'Vo tLg j6f tTjx¿ h:t}M /f]usf] sf/s tTj (Agent), /f]u u|x0f ug{

nfos JolQm (Host) jftfj/0f (Environment) sf] cfjZostf kb{5 . o;nfO{

Epidemiological triad sf ;?jf /f]usf] 9fFrf (Communicable disease

model) klg elgG5 . o; cltl/Qm /f]u ;g]{ dfWod klg cfjZos kb{5 . jftfj/0fdf /f]usf

ls6f0f'x¿ 5g\ t/ /f]u u|x0f ug]{ nfos JolQm (Host) 5}gg jf dflg;x¿df /f]u lj?4 n8\g]

Ifdtf alnof] 5 eGg] ;?jf /f]un] cfqmd0f ug{ ;Sb}g . /f]u u|x0f ug]{ nfos JolQm 5g\ t/

jftfj/0fdf /f]usf ls6f0f' 5}g eg] klg /f]usf] ;|f]t / /f]u ;fg{] dfWod 5 t/ jftfj/0f

pko'Qm 5}g eg] klg /f]u km}lnb}g . h:t} sf7df08f}+df dn]l/of ;fg]{ nfdv'§] 5 / t/fOaf6

dn]l/of /f]u lnP/ cfPdf JolQmx¿ klg kmf6km'6 ¿kdf sf7df08f}+ x'G5g\ . t/ nfdv'§]n] /f]uL

67

JolQmaf6 /ut r';]/ p;sf] z/L/df /f]u hLjf0f'x¿ j[l4 x'gsf] nflu cfjZos kg]{ /fltsf]

tfkqmd gk'Ug] ePsf]n] nfdv'§]n] /f]u ;fg]{ ;Sb}g . To;}n] ;?jf /f]u km}lngsf] nflu /f]usf]

sf/s tTj (Agent) /f]u u|x0f ug{ nfos JolQm (Host), jftfj/0f (Environment) /

/f]u ;g]{ dfWodx¿sf] aLrdf x'g] cGt/;DaGwsf] kl/0ffdn] ;?jf /f]u pTkGg x'G5 . oL rf/

kIfnfO{ ;?jf /f]usf tTjx¿ elgG5 .

– /f]u pTkGg ug]{ tTj (Agent or causative factors of communicable

disease)

– /f]u u|x0f ug{ nfos JolQm (Host)

– jftfj/0f (Environment)

– /f]u ;fg]{ dfWodx¿ (Mode of transmission)

!_ /f]u pTkGg ug]{ tTj (Agent or causative factors of communicable

disease)

/f]uhGo clestf{ eGgfn] ljleGg lsl;dsf cj;/jfbL hLjx¿ (Opportunistic

Organism) h:t}M– Bacteria, virus, protozoa, fungi and Helminths x¿

kb{5g\ lsgls logLx¿n] ha JolQm sdhf]/ ePsf] x'G5 / jftfj/0f klg p;sf] k|lts"n

5 eg] To;} a]nfdf cfqmd0f u/L /f]uL t'NofpF5g\ . ;?jf tyf ;+qmfds/f]u nfUg] d'Vo

sf/s tTj /f]usf hLjf0f'x? xf] . w}/} h;f] ;?jf tyf ;ª\qmfds /f]u Bacteria, virus,

protozoa sf/] ;ª\qmd0fsf] sf/0fn] nfUb5 .

@_ /f]u u|x0f ug{ nfos JolQm (Host)

/f]usf hLjf0fx?nfO{ a:g, afRg / a[l¢ x'g cj;/ lbg] dflg; jf cGo hLj hGt'nfO{

Host elgG5 . /f]u k|lt/f]w Ifdtf sdhf]/ ePsf] / /f]usf hLjf0f'x?nfO{ z/L/df k|j]z

x'g / a[l¢ tyf ljsf; x'g lbg] JolQmnfO{ /f]u u|x0f ug{ nfos JolQm elgG5 . rf]6k6s

nfu]sf] cj:yf, s'kf]if0f ePsf], k|lt/Iff k|0ffnL sdhf]/ ePsf], ue{jtL cj:Yff tyf a[¢

cj:yfdf JolQm ;?jf /f]u u|x0f nfosf] x'G5 . JolQmsf] lnª\u -dlxnf–k'?if_ pd]/ cj:yf

-afns, o'jf, / j[4_ :jf:Yo;DaGwL afgL Jojxf/, JolQmut :jR5tf, kl/>d, cf/fd,

Jofofd, j+zf0f'ut u'0f tyf k|lt/Iff k|0ffnL, :jf:Yo r]tgfsf] cj:yf cflb s'/fx¿n]

JolQmnfO{ /f]u nfUg] jf gnfUg] s'/fsf] lgwf{/0f ub{5 . ;?jf /f]u nfUgsf nflu /f]usf

68

hLjf0f' s'g} dfWofdaf6 JolQmsf] zl/df k|j]z ug'{ kb{5 . JolQm /f]u u|x0f ug{ nfossf]

ePdf /f]u nfU5 . jl/k/L jftj/0fdf /f]usf ls6f0f'x? eP klg /f]u u|x0f ug{ nfossf

JolQmx? 5}g eg] /f]u nfUb}g .

#_ jftfj/0f (Environment)

/f]u tyf :jf:YonfO{ k|efj kfg]{ aflx/L jf cfGtl/s, d"t{ jf cd"t{, ;hLj jf lghL{j ;a}

kIfnfO{ jftfj/0f elgG5 . ;?jf/f]usf hLjf0f'x? Ps JolQm jf ;|f]taf6 csf]{ JolQmdf

k'Ug] k|lqmof klg jftfj/0fdf x'G5 . jftfj/0f eGgfn] ef}lts, h}ljs jf ;fdflhs, cfly{s

tyf ;f+:s[lts jftfj/0fnfO{ hgfpF5 . jftfj/0f ef}lts, h}ljs jf ;fdflhs tyf

;f+:s[lts h'g;'s} vfnsf] eP tfklg k|lts"n ePdf JolQmnfO{ /f]u nfUg] ;Defjgf clws

x'G5 t/ o; cj:yfdf klg JolQmsf] JolQmut cj:yf ;Gt'lnt /lx/xg] tyf cj;/jfbL

hLjx¿n] cfqmd0f gug]{ xf] eg] JolQmdf s'g} klg /f]u b]vfkb}{g . /f]usf ls6f0f'x? a[l¢

x'g, km}lng / /f]u pTkGg ug{sf nflu pk'Qm jftf/j/0f rflxG5 .

$_ /f]u ;fg]{ dfWodx¿ (Mode of transmission)

;?jf /f]u dflg;df ;g{ / km}lngsf nflu /f]u ;g]{ dfWod rflxG5 . /f]u ;g]{ dfWodx?

k|ToIf tyf ck|ToIf x'G5 . s'g} /f]u nfdv'§], le+muf, ls/f tyf hgjf/sf] dfWodaf6

dflg;df ;b{5 . s'g} /f]u b'lift kfgL, xfjf tyf df6f]af6 klg ;b{5 . s'g} ;?jf /f]u

hgfj/sf] 6f]sfOaf6 ;b{5 . slto /f]usf ls6f0f'x? c? k|f0fL tyf ls/fsf] z/L/df

hLjgsf] Pp6f rqm k'/f u/]/ dfq dflg;sf] z/L/df k|j]z ub{5 . dn]l/ofsf] ls6f0f'

nfdv'§]n] /f]uL dflg;sf] /ut r':g] qmddf nfDv'§]sf] z/L/df k|j]z ub{5 / p;sf] z/L/df

a[l¢ ePkl5 csf]{ lg/f]uL JolQmsf] /ut r':g] qmddf dn]/Lofsf] ls6f0f' ;fb{5 . olb

/f]usf sf/s tTjx¿ 5fnfb]lv 5fnf, Do'sf];fb]lv Do'sf];f (Mucosa to Mucosa),

Do'sf];fb]lv 5fnf, 5fnfb]lv Do'sf];f, d'vb]lv d'v;Dd jf cGo af6f]af6 /utdf k|ToIf

¿kn] hfG5g\ eg] To;nfO{ k|ToIf ¿kn] ;g]{ elgG5 . sltko sf/s tTjx¿ 5Fs jf

Food, Fluid, Fomites, Fly, Finger sf] dfWod xF'b} Ps /f]uLaf6 csf]{ lg/f]uLdf

;g]{ ub{5 . o;/L ;g]{ tl/sfnfO{ ck|ToIf ;/fO (Indirect Transmission) elgG5 .

;?jf /f]u dfgj ;d'bfodf b]vf kg{sf nflu /f]usf hLjf0f'x? k|ToIf jf ck|ToIf ?kdf

;g]{ dfWod rflxG5 . /f]usf] k|;f'0f tyf /f]u ;g]{ dfWod ;?jf /f]usf] dxTjk"0f{ tTj xf] .

69

cEof;÷lqmofsnfk

!= ;?jf /f]u / . ;ª\qmfds/f]u ljr s] ;dfgtf 5 / s] leGgtf 5 <

@= ;?jf/f]u cfqmd0f ug{sf] nflu s] s] tTjx? cfjZos kb{5 <

# ;a} k|sf/sf] ;ª\qmd0fn] /f]u nfUb}g / ;a} k|sf/sf] ;ª\qmds /f]u ;?jf /f]u x'Fb}g

JofVof u/ .

#=% ;?jf /f]usf] l;4fGt (Theory of communicable disease)

l;4fGt eg]sf] cfwf/e"t dfGotfsf] k|;"tLs/0f xf] h;n] s'g} 36gfsf] af/]df JofVof

ug{sf] nflu cfwf/ tof/ kfb{5 . s'g} 36gf s;/L 36\5 eg]/ ;DaGwL To;;Fu ;DalGwt

kIfx¿nfO{ cfwf/ agfP/ Jojl:yt ljrf/ lbOG5 eg] To;nfO{ l;4fGt elgG5 . ;?jf

/f]unfO{ JofVof ug{] ljlzi6 l;4fGtx¿ 5}g t/ ;?jf /f]u s;/L x'G5, o;;Fu s'g s'g

tTjx¿ ;dfj]z x'G5g\, s;/L km}lnG5 eGg] af/]df Jojl:yt ljrf/ :yflkt eO;s]sf] 5 .

;?jf /f]unfO{ JofVof ug{] Jojl:yt ljrf/ tyf cjwf/0ffx¿nfO{ g} ;?jf /f]usf] l;4fGt

elgG5 . cyf{t\ ;?jf /f]usf] tTjx¿sf] aLrsf] cGt/;DaGw JofVof ug]{ / Jojl:yt

ljrf/ k|bfg ug'{ g} ;?jf /f]usf] l;4fGt xf] .

c_ hLjf0f' l;4fGt (Germ theory)

n'O; kf:rn (Louis Pasteur) n] /f]u nfUg'sf] d'Vo sf/0f hLjf0f' xf] eGg] s'/f

kQf nfu] kl5 hLjf0f' l;4fGt :yflkt ePsf] xf] . of] l;4fGt cg';f/ ;?jf /f]u

nfUg'sf] sf/0f /f]usf hLjf0f'x¿ s'g} klg dfWodaf6 dflg;sf] z/L/df k|j]z u/]/

j[l4 / ljsf; ePkl5 z/L/df gsf/fTds c;/ kb{5 / /f]usf] nIf0f b]vf kb{5 .

cf_ dxfdf/L /f]usf] l;4fGt (Epidemic theory)

;fdfGo cfzf ul/Psf] eGbf clws dfqfdf /f]usf] 36gfx¿ b]vf kg'{nfO{ dxfdf/L

elgG5 . s'g} /f]u af/Daf/ ¿kdf s'g} :yfgdf b]vf kb{5 eg] dflg;x¿n] To;sf]

lj?4 n8\g] Ifdtf ljsf; u/]sf x'gfn] :yflgs ¿kdf b]vf kg]{ /f]ux¿ ;fdfGo

cj:yfdf dxfdf/Lsf] ¿kdf b]vf kb}{g . s'g} gofF /f]usf] ls6f0f' ;d'bfodf k|j]z u¥of]

eg] ;?jf /f]u dxfdf/Lsf] ¿kdf km}lnG5 . j8{ˆn' , :jfOgˆn', Kn]u /f]u ;d'bfodf

b]vf k¥of] eg] dxfdf/Lsf] ¿kdf km}lnG5 . 8]ª\u' /f]u g]kfnsf] nflu gofF /f]u xf] . of]

/f]u @)^% ;fnsf] efb|÷c;f]h dlxgfdf /f]usf] ¿kdf km}lnPsf] lyof] . s]xL jif{ cl3

70

?s'd, hfh/sf]6df x}hf dxfdf/L klg dWoo'udf o'/f]kdf dxfdf/L ¿kdf km}lnPsf]

lyof] . xfn of] /f]u k'/fgf] ePsf] 5 . g]kfnsf] $%Ü hg;ª\Vof Ifo/f]u (TB) sf]

hLjf0f'af6 ;ª\qmldt x'G5g\ t/ w]/} dflg;x¿sf] z/L/df Ifo/f]u lj?4 n8\g] Ifdtf

ePsf]n] Ifo/f]u dxfdf/Lsf] ¿kdf km}lnPsf] 5}g . gofF /f]usf] hLjf0f'df ;d'bfodf

k|j]z u/]sf] v08df o;n] ;a} dflg;nfO{ c;/ kfg{ ;Sb5 lsg eg] dflg;x¿sf]

z/L/df gofF /f]u lj?4 n8\g] Ifdtf x'Fb}g .

O_ ;~hfnsf] l;4fGt (Network theory)

;~hfnsf] l;4fGtnfO{ ;?jf jf ;ª\qmds /f]usf] ul0ftLo l;4fGt elgG5 . o;n]

;?jf /f]u Ps JolQm / csf]{ JolQmsf] aLrdf x'g] ;Dks{sf] ;~hfnaf5 s;/L km}lnG5

/ /f]usf ls6f0f'x¿ s'g b/df j[l4 / k|;f/0f x'G5 eGg] s'/fsf] JofVof ub{5 .

o; l;4fGt cg';f/ ;d'bfodf dflg;x¿sf] ;Dks{sf] hfnf] tyf ;~hfn x'G5 .

;d'bfosf] ljleGg 7fpFdf /x]sf dflg;x¿ ;~hfnsf] ufF7f] (Nodes) sf] k|ltlglwTj

ub{5 eg] / Pp6f JolQm / csf]{ JolQmsf] aLrdf x'g] ;Dks{nfO{ /]vf÷lsgf/ (Edge)

elgG5 . tn lrqdf b]vfP h:t} dflg;sf] ;~hfn x'G5 . dflg;x¿ k|To]s lbg Ps

csf]{df ;Dks{ tyf e]63f6 eO/x]sf] x'G5 . ;a} dflg;sf] ;a};Fu a/fa/L ;Dks{ x'Fb}g .

s]xL dflg;sf] ;Dks{ s]xL ;d'bfodf a9L x'G5 . ;dfg k]zf tyf ljrf/ ePsff

dflg;x¿sf] aLrdf a9L ;Dk{s x'G5 . h:t} lzIffsf] ;Dks{ ljBfyL{ / lzIfs;Fu a9L

x'G5 . b'w ljqmL dflg;sf] ;Dks{ b'w ;ª\sng ug]{ :yfgdf cfPdf c? b'w ljqmL ug]{

dflg;;Fu a9L ;Dks{ x'G5 . Hofnf, dhb'/ ug]{ dflg;x¿sf] o:t} k]zf ePdf

dflg;x¿;Fu a9L ;Dks{ x'G5 .

;d'bfodf x'g] dflg;x¿sf] ;Dks{ tyf e]63f6sf] ;~hfn;Fu} ;?jf /f]u km}lnG5 .

;~hfnsf] Pp6f JolQm ufF7f] (Node) df ;?jf /f]u nfUof] eg] /f]usf] nIf0f b]vf

k/]kl5 cfˆgf] ;Dks{df glhssf] JolQmnfO{ ;fb{5 . To;kl5 ;ª\\qmldt JolQmn] /f]uL

JolQm;Fusf] ;Dks{df cfPdf /f]u u|x0f nfossf] JolQmnfO{ /f]u ;fb{5 . /f]u ;f/]kl5

/f]uL JolQmsf] z/L/df ljsf; ePsf] /f]u k|lt/f]w Ifdtfn] lhTg ;Sof] eg] /f]u lgsf]

x'G5 ePg eg] d'To' x'G5 . gofF /f]usf] ls6f0f' ePdf ;d'bfodf ;a} JolQmx¿ /f]u

u|x0f nfos ePdf dflg;sf] ;Dks{sf] ;~hfn dfkm{t tLj| ult /f]u km}lnG5 .

cyf{t\/f]un] dxfdf/Lsf] ¿k lnG5 . :yflgs /f]u ePdf ;Dks{df cfPdf ;a}nfO{ /f]u

;b}{g . /f]uL JolQmsf] ;Dk{sdf cfPdf /f]u u|x0f ug{ nfos JolQmnfO{ dfq /f]u nfU5

71

. of] ;~hfnsf] l;4fGtn] ;d'bfodf s'g ;d"xdf s'g ultdf s;/L km}lnG5 eGg]

s'/fsf] JofVof / cg'dfg ug{ d2t ub{5 .

lqmofsnfk

!= ;?jf/f]u ;DaGwL k':tsx? / OG6/g]6df ;?jf/f]usf] l;4fGtx? ;DaGwL n]vx?

vf]hL u/L ;?jf/f]usf] ;j}kIfsf] JofVof ug]{ l;4fGtsf] gf]6 tof/ cWoog ;d"xdf

ljt/0f ug'{xf];\/ ;fyLx?af6 klg ;'emfj lng'xf];\.


!= ;?jf/f]usf] l;4fGtsf] af/]df s] l;Sg' eof] <

@= dxfdf/L /f]usf] l;4fGt cg';f/ ;?jf/f]u s;/L km}lnG5 <

#=^ ;?jf /f]usf] juL{s/0f(Classification of communicable diseases)

;?jf /f]ux?nfO{ ljleGg tl/sfn] juL{s/0fug{ ;lsG5 . /f]u pkrf/ tyf lrlsT;f lj1fgdf

;?jf /f]unfO{ ls6f0fx?sf] k|sf/ h:t} efO/;, JofS6]l/of, k|f]6f]hf]jf, cflbsf] cfwf/df

juL{s/0fu/]sf] kfOG5 . /f]usf] pkrf/ ug]{ JolQmn] /f]usf ls6f0f'x? klxrfg u/L To;nfO{

lgl:qmo agfpg] cf}ifwL k|of]u ug'{ kb{5 . t/ :jf:Yo lzIff tyf /f]u lgjf/0f ug]{ JolQmn] /f]u

;g]{ dfWod klxrfg u/L /f]u ;g]{ k|lqmofnfO{ ca?¢ kfg'{ kb{5 . To;}n] :jf:Yo lzIffdf

;?jfnfO{ /f]u ;g]{ dfWofdsf] cfwf/df ljefhg ug{ pko'Qm xG5 . /f]h/ j]a/ (Roger

Weber, 2005) n] ;?jf/f]unfO{ lgDgfg';f/ juL{s/0fu/]sf 5g\ .

!= kfgLn] kvflng] /fux? (Water Borne Diseases):

;/;kmfOsf] sdLn] 5fnf, cg'xf/, cfFvfdf hLjf0f'x? ;+qmd0f eO /f]u nfUb5 . o:tf /f]ux?

sf ls6f0f'x? ;fa'g kfgLn] klg kvflng] jf x6fpg ;lsG5 . cyf{t\ 5fnf, cfvf, gfs,

cg'xf/,xftuf]8f tyf 5fnf lgoldt ?kdf ;kmf /fVbf o:tf /f]ux? nfUg ;Sb}g . kfgLn]

kfvflng] /f]u cGt/ut n'tf], 6«sf]df, cfFvf kfSg] /f]u, 5fnfsf] 3fp vl6/f cflb kb{5 .

@= kfgLhGo /f]u (Water Borne Diseases)

72

kmf]x/ tyf /f]usf hLjf0f'x? ldl;P/ b'lift ePsf] kfgLaf6 ;g]{ ;?jf /f]ux?nfO{ kfgLhGo

;?jf /f]u elgG5 . kfgLhGo /f]usf] sf/s tTj jf /f]u hGo clestf{ cGt/ut efO/;,

AofS6]/Lof, k/hLjL tyf ls6f0f'x?n] pTkfbg u/]sf ljif kb{5g\ . efO/; cGt/ut kf]lnof]

efO/; / x]k6fOl6; efO/; kb{5g\ . kfgLhGo AofS6]l/of cGt/ut O{sf]nfO{ (Esherichia

coli) Salmonell typhi, vibrio cholera kb{5g\ . kfgLhGo kl/hLlj cGt/ut

Girdia, entamoebia histolytiaca, Cryptosporidium parvum kb{5g\ . vfg]

kfgL crfgs b'lift ePdf kfgL hGo /f]u h:t} x}hf, 6fO{kmfO8, cfpF dfxfdf/L /f]udf km}lnG5

. vfg]kfgLsf] j/Lk/L kmf]x/ ug]{ / v'nf 7fpFdf lb;f ubf{ kfgL b'lift x'G5 / kfgLsf]

dfWodaf6 ;?jf /f]u km}lnG5 . kfgLhGo /f]u cGt/ut x]k6fOl6; P, kf]lnof], 6fOkmfO8, x}hf,

cfpF, lhof{l8ofl;; cflb /f]ux? kb{5g\ .

Waterborne Diseases

Germs Agent Disease

Viruses Poliomyelitis virus

Hepatitis A virus

Polio

Infectious hepatitis

Bacteria Vibrio cholerae

Salmonella typhi

Shigella spp.

Leptospira spp.

Cholera

Typhoid fever

Bacillary dysentery

Leptospirosis

Protozoans

(parasites)

Entamoeba histolytica

Giardia lamblia

Cryptosporidium parvum

Amoebic dysentery

Giardiasis

Cryptosporidiosis

#= lb;fhGo jf ck|ToIf?kdf lb;f d'vdf k/L nfUg] /f]u (Fecal-Oral Diseases)

v'nf 7fpFdf lb;f ubf{,lb;fhGo kbfy{x? jftfj/0fdf km}lnG5 / kfgL, vfgf tyf dflg;x?sf]

xftdf ;Dk{sdf cfP/ ck|ToIf ?kdf lb;f d'vaf6 z/L/df k|j]z u/L x'g] /f]unfO{ lb;fhGo

73

/f]u elgG5 . v'nf 7fpFdf lb;f ug]{, kmf]x/d}nf hxfF ToxL ˆofSg], 3/]n' tyf JolQmut

;/;kmfOdf Wofg glbg] ubf{ lb;fhGo tTjx? Dfflg;sf] d'vdf kg{ hfG5 / Pp6f JolQmaf6

csf]{ JolQmdf /f]u km}lnG5 . Ps u|fd Dfflg;sf] lb;fdf Ps s/f]8 efO/;, b; nfv

AofS6]/Lof, Ps xhf/ k/hLjLsf l;:6 tyf k/hLjLsf Ps ;o k'mnx? X'G5g . lb;fsf] Psbd}

;fgf] c+z ck|ToIf?kdf d'vdf kbf{ jf vfgf tyf kfgLsf] dfWodaf6 d'vdf kbf{ /f]usf

ls6f0f'x? klg d'vleq k|j]z ub{5 / /f]u nfU5 . d"Vo % j6f dfWodaf6 h:t} kmf]x/ xftaf6,

kmf]x/ vfgf / kfgLaf6, kmf]x/ ;fu;AhLaf6, lemFufaf6, kz'k+IfL -s's'/, ;F'u'/, s'v'/f, xfF;

cflb_ af6 lb;f lk;fa dflg;sf] d'vdf kg{ hfG5 . lb;fhGo /f]u cGt/ut x]k6fOl6; P,

kf]lnof], emf8fkvfnf, 6fOkmfO8, x}hf, cfpF, lhof{l8ofl;;, h'sf, r'gf{ cflb /f]ux? kb{5g\ .

$= vfgfhGo /f]u (Food-Borne Diseases)

/f]usf hLjf0f'x? vfgfdf ldl;P/ b'lift ePsf] vfgfsf] dfWodaf6 ;g]{ /f]unfO{ vfgfhGo /f]u

elgG5 . b'O;o eGbf a9L /f]ux? vfgfsf] dfWodaf6 ;g]{ ub{5 . v'nf 7fpFdf lb;f ug]{,

cJojl:yt kmf]x/d}nf, ;/;kmfOsf] sdL tyf vfBfGg :jR5tfsf] sdL cflbn] vfgf b'lift x'G5

/ o:tf] vfgf ;]jg ubf{ /f]u km}lnG5 . b'lift vfgfn] /f]usf hLjf0f'x?sf] afxssf]?kdf sfd

ub{5 . vfgfhGo /f]usf ls6f0f'x? cGt/ut efO/;, AofS6]l/of / k/hLjL kb{5g\ . oL

hLjf0f'x? af;L vfgfdf a[l¢ x'g] / laiffQm klg pTkGg ub{5 . ef]hg ljiffQmtf Ps d'Vo

vfgfhGo /f]u xf] . ef]hg ljiffQmtf, df5f ljiffQmtf, k|b'lift df;', ;8]sf] df;', af;L vfgf

vfFbf vfgf hGo /f]u nfUb5 . b"lift jftfj/0fdf kflnPsf aª\u'/sf df;'df gfDn]h'sfsf] l;:6

x'G5 . o:tf] b"lift df;' vfFbf dflg;df klg gfDn] h'sf kb{5 / of] dflg;sf] dl:tisdf k'uL

bL3{sfnLg c;/ ub{5 . b"lift kfgLdf x'g] df5fdf klg sn]hf]df a:g] h'sf x'G5 o;nfO{

df5faf6 ;g]{ Liver flukes elgG5 . d/]sf] hgfj/sf] df;' jf ;8]sf df;'df x}hfsf

ls6f0f'x¿ x'G5g\ . o:tf] ;8]sf] df;' vfFbf x}hf tyf cGo /f]u km}lnG5 . vfgfhGo /f]u

cGt/ut ef]hg ljiffQmtf, df5fdf x'g] h'sf, ufO{ tyf aª\u'/sf] df;'df x'g] gfDn] h'sf,

e]8fsf] sn]hf]df kfOg] h'sf, vfgf ljiffQmtf eP/ x'g] emf8f jfGtf, kvfnf, 6fO{kmfO8 cflb

kb{5 .

%= ls6hGo /f]u (Vector-Borne Diseases)

74

/f]usf ls6f0f'x? /f]usf] ;|f]taf6 cfkm\gf] z/L/df lnP/ jf cf>o lbP/ Pp6f JolQm jf

jftfj/0faf6 csf]{ JolQmdf ;fg]{ ls/f jf hLjnfO{ e]S6/ elgG5 . o; k|sf/sf] e]S6/ jf

nfDv'§], le+muf, e';'gf, plkof, h'd|f cflbn] ;fg]{ /f]ux?nfO{ ls6hGo /f]u elgG5 . ls6hGo

/f]usf] pbfx/0f h:t}M nfdv'§]sf] 6f]sfOaf6 nfUg] /f]ux¿ OG;]ˆnfOl6;, dn]l/of, kmfOn]l/of,

8]ª\u', e'';'gfsf] 6f]sfOaf6 sfnfhf/, plkofFsf]] 6f]sfOaf6 Kn]u tyf 6fOkm; Hj/f] cflb km}lnG5

. o; cGt/ut kg]{ /f]ux? tn tflnsfdf k|:t't ul/Psf] 5 .

Vectorborne Diseases

Germs Agent Vector Disease

Virus JE virus Mosquito Japanese

encephalitis

LaCrosse Mosquito LaCrosse encephalitis

Rickettsia Rickettsia typhi Flea Murine typhus

Rickettsia

prowazekii

Human Louse Epdemic typhus

Louse borne relapsing

fever

Rickettsia rickettsii Tick Rocky Mountain

spotted fever

Ehrlichia chaffeensis Tick Ehrlichiosis

Bacteria Yersinia pestis Flea Bubonic plague

Borrelia burgdorferi Tick Lyme disease

Protozoa Plasmodium vivax,

falciparum, ovale,

malaria

Mosquito Malaria

Leishmania

donovani,

Sand fly Kala-azar or visceral

leishmaniasis

75

Leishmania

braziliensis

Nematodes Wuchereria

bancrofti

Mosquito Filariasis

(elephantiasis)

^= jfo'hGo Zjf;k|Zjf; /f]u (Airborne Respiratory Diseases)

xfjfsf] dfWod tyf ljGb' ;ª\qmd0faf6 Ps JolQmaf6 csf]{ JolQmdf ;g]{ /f]unfO{ jfo'hGo

Zjf;k|Zjf; /f]u elgG5 . /f]uL JolQmn] vf]Sbf, xflR5o' ubf{ /f]usf ls6f0f'x? xfjfdf km}lnG5

/ glhssf] JolQmn] Zjf;km]bf{ lg/f]uL JolQmsf] z/L/ leq k|j]z ub{5 / /f]u nfUb5 . o;

cGt/ut ?3fvf]sL, OGˆn'oGhf, s8f Zjf;k|Zjf; /f]u, Ifo/f]u, nx/]vf]sL, Eofu't]/f]u,

lgdf]lgof o; cGt/ut kb{5 .

%= of}g k|;fl/t /f]u tyf ;ªqmd0f (Sexually transmitted diseases and

infections)

of}g ;DaGw jf zf/L/s n;k;sf] dfWodaf6 Ps JolQmaf6 csf]{ JolQmdf ;g]{ /f]u tyf

;ª\qmd0fnfO{ of}g k|;fl/t /f]u elgG5 . of] /f]u k|ToIf?kdf ljo{, of]gL/;, /ut tyf ¥ofnsf]

dfWodaf6 / ck|ToIf?kdf /f]uLn] k|of]u u/]sf] sk8f tyf of}gfª\udf k|of]u ug]{ a:t'af6

;b{5 . of] /f]u efO/;, AofS6]/Lof tyf 9';Lsf] ;+qmd0faf6 ;b{5 . of}g k|;fl/t hLjf0f'x?

Gofgf] / cf]l;nf] 7fpFdf afRg] x'gfn] dflg;sf] of}g cª\u tyf u'åf/df a:g] / a[l¢ x'g] ub{5 .

o; cGt/ut ;'hfs, le/ª\uL, ;'hfsaGw'/f]u, hg} vl6/f, hg]lGb|o d'';f, PrcfOeL P8\; cflb

kb{5 .

^= df6f] ;Dks{sf] /f]u (Diseases of soil contact)

Dff6f]df w]/} /f]ux?sf hLjf0f' tyf c08f hLljt x/g] ePsf]n] df6f] klg ;?jf/f]usf] ;|f]t x'G5

. df6f]sf] ;Dk{saf6 ;g]{ /f]ux?nfO{ df6f] ;Dks{sf] /f]u elgG5 . b'lift df6f]df 3fp rf]6k6s

;Dks{df cfpFbf wg'i6ª\sf/ /f]usf] ls6f0f' ;ª\qmd0f x'G5 . v'nf7fpFdf lb;f ubf{ v]taf/L tyf

v'nf 7fpFsf df6f]df h'sfsf c08f tyf nfef{x? x'G5 . o; k|sf/sf] b'lift df6f]df sfd u/]/

76

/fd|/L xft gwf]P/ vfgf vfFbf h'sfsf] km'n d'v leq k|j]z x'G5 . b'lift hldg tyf df6f]df

vfnL v'§f lx8\of] eg] c+s'z] h'sfsf] nfef{ 5fnf 5]8]/ dflg;sf] z/L/ leq k|j]z ub{5 . df6f]

;Dks{sf] /f]ux? cGt/ut wg'i6ª\sf/, c+s'z] h'sf, 8f]nf] h'sf, r'gf{ cflb kb{5 .

&= 5fnf ;ª\qmd0f /f]u (Skin infecious diseases)

5fnfdf ;ª\qmd0f tyf ljld/f eP/ ljeGg ;?jf /f]ux? dflg;df ;g]{ ug]{ ub{5 . s'g}

5fnfsf] ;ª\qmd0f x'bf 3fp x'g] kfSg] ub{5 eg] s'g} ;ª\qmd0fdf kmf]sf, ljld/f b]vf kg]{ /

/ftf] jf v;|f] bfu b]vf kb{5 . 6fOkmfO8 /f]u nfUbf klg 5fnfdf ljld/f b]vf kg{ ;Sb5 / t/

of] /f]u 5fnfsf] ;Dks{af6 ;b}{g . 5fnfdf x'g] ;ª\qmds /f]u cGt/ut n'tf], bfb, 7]pnf,

bfb'/f, xf8], s'i7/f]u cflb kb{5 .

*= afXok/hLjLsf] dfWodaf6 k|f0fLaf6 ;g]{ /f]u (Ectoparasite zooneses)

sltko ;ª\qmfd/f]ux? cGo k|f0fL jf hgjf/sf] z/L/df a:g] afXo k/hLjLaf6 dflg;df

;b{5 . Kn]u/f]u hª\unL d';fdf b]vf kb{5 . of] /f]u nfu] kl5 hª\unL d';f wdfwd dg]{ ub{5

. 3/df x'g] d'';f hª\undf hfFbf hª\unL d';fdf x'g] plkof d';fsf] z/L/df cfp5 / p;sf]

/ut r':g] qmddf 3/df cfpg] d';fdf ;b{5 . 3/sf] d';f klg d¥of] eg] hª\unL plkof

dflg;sf] ;Dks{df cfpF5 / /ut r':bf Kn]u /f]u ;fb{5 . To;} u/L hgfj/df x'g] Ps

k|sf/sf] lsgf{af6 6fOkm; /f]u dflg;df ;b{5 . dflg;df 6fOkm; ;/]kl5 dflg;sf] h'd|fsf]

dfWodaf6 klg /f]u ;b{5 . dflg;sf] h'd|fsf] dfWodaf6 Relapsing fever km}lnG5 .

JolQmut ;/;kmfOsf] sdL x'g] / dflg;x? ;d"xdf a:g] ;'Tg] ubf{ plkof tyf h'd|faf6 /f]u

km}lnG5 .

(= 3/kfn'jf hgjf/af6 ;g]{ /f]u (Domestic zoonotic diseases)

d]?80bo'Qm hgfj/ dflg;sf] lardf ;g]{ / ;ª\qmd0f x'g] /f]unfO{ zoonotic /f]u elgG5 .

o:tf /f]ux? hgjf/sf] 6f]sfO jf hgjf/sf] ;Dk{saf6 dflg;df ;g]{ ub{5 . h:t} /]lah

ax'nf s's'/sf] 6f]sfOaf6 dflg;df ;g]{ ub{5 . s's'/ tyf e]8faf6 Hydatid /f]u ;5{ .

s's'/ tyf lj/fnfsf] h'sf tyf r'gf{ klg dflg;df ;g]{ ub{5 . ufO{ e};Ldff nfUg] Anthrax,

bovin TB /f]u hgjf/;Fu k|ToIf ;Dks{af6 / b'waf6 klg ;g]{ ub{5 .

77


!= ;?jf/f]unfO{ s] s] cfwf/df juL{s/0f ubf{ :jf:Yo lzIff sfo{qmdsf] nflu pkof]uL

x'G5 <

@= g]kfndf b]vf kg]{ kfgLhGo, vfgfhGo, ls6hGo, xfjf hGo / df6fsf] ;Dks{af6

nfUg] /f]ux? s] s] x'g\ <

lqmofsnfk

!= tkfO{sf] If]qdf b]vf kg]{ ;?jf /f]ux?sf] ;'rL tof/ kf/L /f]u ;g]{ dfWodsf] cfwf/df l7s

tl/sfn] juL{s/0fug'{xf];\.

@= Roger Webber (2004) åf/f lnlvt communicable disease

epidemiology: A global perspective gfds k':ts cWoog u/L ljleGg dfWofdaf6

;g]{ /f]ux?sf] sf/0f, nIf0f, k|;f/0f, ljt/0f, /f]syfd tyf lgoGq0f ljlw ;DaGwL gf]6

agfpg'xf];\ .

#= g]kfndf ;?jf /f]u lgjf/0f ug{ s] s] JolQm, kl/jf/, ;d'bfo tyf /fHon] s] s] ug'{ kb{5 .

cfˆgf ts{ k|:t't ub}{ 5nkmn rnfpg'xf];\ .

#=& /f]u k|;f/0fsf] ultlzntf (Dynamic of disease transmisstion)

/f]uhGo clestf{ jf /f]usf hLjf0f'x?, dflg; jf hLjf0f'nfO{ cf>o lbg] k|f0fLx? / /f]u ;g]{

dfWofdx?sf] ljrdf jftf/j/0fdf lg/Gt/ cGt/lqmofaf6 ;?jf /f]u b]vf kb{5 . cyf{t\ /f]usf

hLjf0f'x?, /f]u u|x0f ug]{ dflg; / /f]u ;g]{ dfWodsf] ljrfdf x'g] cGt/lqmofn] ;?jf /f]usf]

lgwf{/0f ub{5 . ;?jf /f]u /f]usf] sf/s tTjx?sf] >f]t tyf e08f/af6 /f]u ;g]{ dfWodaf6

/f]u u|x0f ug{ nfossf] JolQmdf ;+qmd0f ePkl5 /f]u nfUb5 . o;nfO{ ;+qmd0fsf] >[ª\vnf klg

elgG5 . /f]usf] ;|f]taf6 dflg;df /f]u ;g]{ k|lqmofnfO{ /f]u k|;f/0fsf] ultzLntf elgG5 . o;

cGt/ut lgDg tLg kIfx? kb{5 .

78

!= sf/s tTj jf hLjf0f'sf] ;|f]t jf e08f/ (Source or reservoir of disease

agents)

s'g} JolQm, hgjf/ jf j:t' hxFfaf6 /f]usf ls6f0f'x? afXo jftfj/0f lg:sG5 jf ˆofFSg ;S5

To;nfO{ /f]usf] ;|f]t elgG5 . s'g} JolQm, hgjf/ jf j:t', ag:klt, df6f] cflb hxfF /f]usf

hLjf0f'x? afRg, x's{g, a9\g, a[l4 x'g ;Sb5g\ To;nfO{ sf/s tTjsf] e08f/ (Reservoir of

Agent) elgG5 . /f]usf] ;|f]t e08f/nfO{ d'Vo tLg efudf ljefhg ug{ ;lsG5 .

c_ dfgj e08f/ (Human Reservoir)

cf_ hgfj/ e08f/ (Animal Reservoir)

p_ lghL{j e08f/ (Reservoir in Non-Living Thing)

c_ dfgj e08f/ (Human Reservoir): dflg;nfO{ /f]usf sf/stTjsf] k|d'v e08f/

jf ;|f]tsf] ¿kdf lnOG5 . dflg; :jo+ la/fdL jf jfxs b'j} x'g ;Sb5 cyf{t\ dfgj

e08f/cGtu{t /f]uL / jfxs kb{5g\ . To;}n] eGg] ul/G5 "Man himself is a great

reservior of causative agent."

a) /f]uL (Case): /f]uL eGg] lalQs} s'g} klg sf/s tTjn] cfqmd0f u/L k|efljt

u/fPsf] JolQm xf] . o;df s'g} /f]usf] :ki6 nIf0f gb]lvg klg ;Sb5 . /f]uLn] ljleGg

cj:yfdf sf/s tTjx¿nfO{ e08f/ u/L /fVg ;Sb5g\ . tL cj:yfx¿ lgDg 5g\ M

i) /f]usf] :ki6 nIf0f b]vfk/]sf la/fdL (Clinical Cases): o; cj:yfdf

/f]uLn] ;Dk"0f{ lrXgx¿ tyf nIf0fx¿ b]vfPsf] x'G5, /f]uLsf] b}lgs sfo{ k|efljt

ePsf] x'G5 . /f]uLsf] ;Dks{df cfPsf dflg;x¿nfO{ sf/stTj ;fg]{ jf /f]uLn]

cfˆgf] z/L/af6 sf/stTj lg/Gt/ ¿kdf aflx/ ˆofFSg] ub{5g\ .

ii) /f]usf] nIf0f :ki6 ¿kdf b]vf gk/]sf la/fdL (Sub-Clinical Cases): s'g}

klg JolQmsf] z/L/df /f]usf ls6f0f'x¿ ePsf] tyf ls6f0f'x¿ a[l4 ljsf;

eO/x]sf] t/ JolQmdf /f]usf] :ki6 nIf0fx¿ b]vf gk/]sf] cj:yfnfO{ (Sub-

Clinical Case) elgG5 . o:tf] cj:yfdf JolQmn] /f]usf hLjf0f'x¿

79

ˆofFls/x]sf] x'G5 ;fy} o:tf] cj:yfdf emg\ a9L c¿nfO{ /f]u ;fg]{ ;Defjgf x'G5

lsgeg] JolQm lxF88'n u/L w]/} JolQmsf] ;Dks{df x'g ;Sb5 . h:t} – kf]lnof]

iii) n'Kt ;ª\qmd0f (Latent Infection): s'g} klg JolQmsf] z/L/df /f]usf

sf/s tTjx¿ /x]sf x'G5g\ t/ /ut, cGt>fj jf tGt'x¿sf] k/LIf0fdf sf/s

tTjx¿ b]lvFb}gg\ t/ df}sf kfPdf crfgs j[l4 eO{ /f]u nufpFb5g\ h:t} – xf8]

(Mumps)

b) jfxs (Carrier): dflg; tyf hgfj/ h;n] /f]usf sf/s tTjx¿nfO{ s'g} nIf0f

gb]vfO{ kfln/x]sf] x'G5 t/ pQm ls6f0f'nfO{ cGodf ;fg{ ;Sb5 eg] To:tf] JolQm jf

hgfj/nfO{ jfxs (Carrier) elgG5 . ;fg]{ tl/sfsf] cfwf/df o;nfO{ tLg efudf

afFl8Psf] 5 M

i) cj:yf (Period) sf] cfwf/df

OGSo'j]6/L jfxs (Incubatory Carrier): /f]usf] nIf0f ;'? x'g'eGbf

cufl8 g} ;fg]{, h:t}M Measles, Mumps, Polio

sGeN;]G; jfxs (Convalescence Carrier): ;'wf/fTds cj:yfdf

k'u]kl5 ;fg]{, h:t}M Typhoid, Dysentry, Cholera

:j:yjfxs (Healthy Carrier): :j:y eP/ klg c¿nfO{ /f]usf sf/s

tTj ;fg]{, ub{5 eg] To;nfO{ :jf:yjfxs elgG5 . o;df dflg;df /f]usf

ls6f0f'x¿ x'G5g\ t/ ;'if'Kt cj:yfdf x'G5g\ . oL ;'if'Kt cj:yfdf /x]sf ls6f0f'

csf]{ JolQmsf] z/L/df k|j]z u/]kl5 ;lqmo x'G5g\ . h:t}M Polio, Cholera,

Meningococial Infection, HIV Positive

ii) cjlw (Duration) sf] cfwf/df

• c:yfoLjfxs (Temporary Carrier): s'g} ls6f0f'x¿ 5f]6f] cjlw jf

c:yfoL ¿kdf dfq ;fg]{ jfxsnfO{ c:yfoLjfxs elgG5 . h:t} M bfb'/f, xf8],

kf]lnof] .

• :yfoLjfxs (Chronic Carrier): /f]usf ls6f0f'x¿nfO{ nfdf] cjlw;Dd

;fg]{ jfxsnfO{ :yfoL jfxs elgG5 . h:t} – 6fOkmfO8

80

cf_ hgfj/ e08f/ (Animal Reservoir): dflg;h:t} hgfj/ jf kz'k+IfL klg

;ª\qmd0fsf] e08f/ x'g ;Sb5g\ . oL hgfj/ jf kz'k++IfL /f]uL jf jfxs b'j} x'g ;Sb5g\ .

olb 9f8 ePsf hgfj/ jf kz'k+IfLaf6 dflg;df /f]u ;b{5 eg] To;nfO{ hf]gf]l6s /f]u

(Zoonotic Disease) elgG5 . h:t} M /]lah (Rabies), j8{ ˆn' (Bird Flu)

p_ lghL{j e08f/ (Reservoir in Non-Living Things): dflg; tyf hgfj/dfh:t}

sf/s tTjx¿ lghL{j j:t'df klg afFRg, x's{g jf a[l4 ljsf; x'g ;Sb5g\ . df6f],

sf7h:tf lghL{j j:t'df sltko /f]usf sf/s tTjx¿ /f]u ;fg]{ df}sf kv]{/ e08f/sf]

¿kdf /xG5g\ cyf{t\ plrt cj:yf kfPdf dflg;nfO{ /f]uaf6 u|l;t agfpg ;Sb5g\,

h:t} M wg'i6ª\sf/ (Tetanus) sf sf/s tTjx¿ df6f] tyf uf]a/df e08f/sf] ¿kdf

/x]sf x'G5g\ .

@= /f]u ;g]{ dfWofd÷tl/sf (Mode of disease transmission)

;+qmd0f tyf /f]u k|;f/0f ultlzntfsf] bf];|f] kIf /f]u ;g]{ dfWofd jf ;g]{ tl/sf xf] . Ps

k|sf/sf] ;?jf /f]u ;a} dfWofdaf6 ;b}{g . 6fOkmfO8 /f]u b'lift vfgf tyf kfgLaf6 ;b{5 eg]

Ifo/f]u xfjf jf laGb' ;+qmd0faf6 ;b{5 . /f]usf tTjx¿ ;g]{ tl/sfnfO{ d'Vo u/L b'O{ efudf

afF8\g ;lsG5 M—

s_ k|ToIf ¿kn] ;g]{ (Direct Transmission)

1. Dirct contact

2. Droplet infection

3. Contact with soild

4. Inoculation into skin or mucosa

5. Vertical/Tranplacental

v= ck|ToIf ¿kaf6 ;g]{ (Indirect Transmission)

1. Vehicle borne

2. Vector-borne

3. Air-borne

4. Fomite borne

81

5. Unclean hands and fingers

s_ k|ToIf ¿kn] ;g]{ (Direct Transmission)

/f]usf sf/s tTj jf ls6f0fx¿ k|ToIf?kdf 5fnfb]lv 5fnf, Do'sf];fb]lv Do'sf];f

(Mucosa to Mucosa), Do'sf];fb]lv 5fnf, 5fnfb]lv Do'sf];f, d'vb]lv d'v;Dd jf

cGo af6f]af6 /utdf k|ToIf ¿kn] hfG5g\ eg] To;nfO{ k|ToIf ¿kn] ;g]{ elgG5 . k|ToIf

¿kn] ;g]{ tl/sfnfO{ lgDgfg';f/ ljefhg ug{ ;lsG5 M

c_ k|ToIf ;Dks{ (Direct Contact): k|ToIf ;Dks{ jf ;+;u{ ubf{ s'g} /f]usf sf/s

tTjx¿ Psaf6 csf]{df ;b{5 eg] To;nfO{ k|ToIf ;Dks{af6 ;g]{ elgG5 . h:t}M

Kissing, Sexual Contact, Skin Contact cflb . o;af6 ;g]{ /f]ux¿df HIV

and AIDS, Leprosy, Gonorrhoea, Scabies, Ring Worm cflbnfO{ lng

;lsG5 .

cf_ ljGb' ;ª\qmd0f (Droplet Infection): /f]uL JolQmn] vf]Sbf, xf5\o'F ubf{, af]Nbf sf/s

tTjx¿ Zjf;k|Zjf;;Fu} s0fsf] ¿kdf aflx/ lg:sG5g\ / /f]uLsf] glhs} 30cm ;Ddsf]

b'/Ldf a;]sf] JolQmdf Zjf; lnFbf ;b{5 eg] To;/L ;g]{ tl/sfnfO{ ljGb' ;ª\qmd0f

elgG5 . o;/L ;g]{ /f]ux¿df ?3fvf]sL, Ifo/f]u, nx/]vf]sL, bfb'/f, Eofu't] /f]u

(Common Cold, TB, Pertusis, Measles, Diptheria) cflbnfO{ lng ;lsG5 .

O_ df6f]sf] ;Dks{af6 ;g]{ (Contact with Soil): sltko sf/s tTjx¿ df6f]df a:g,

x's{g jf j[l4 ljsf; x'g ;Sb5 / dflg;;Fu (Host) ;Dks{ x'g uPdf / logLx¿

z/L/leq hfg] / cg's"n cj:yf kfPdf /f]u nfUg] ub{5 . df6f]sf] ;Dks{af6 x'g ;Sg]

/f]ux¿df wg'i6ª\sf/, cs'z]h'sf, kmª\un ;ª\qmd0f (Tetanus, Hook Worm,

Fungal Infection) cflb k|d'v x'g\ .

O{_ hgfj/sf] 6f]sfOaf6 jf 5fnf 5]8]/ (Bite of an animal or Inocutation into

Skin): /f]uaf6 u|l;t hgfj/n] dflg;df 6f]s]df jf ;ª\qmldt wfl/nf cf}hf/n] 5fnf

5]8]df sf/s tTjx¿ z/L/leq k|j]z u/L /f]u nufpg ;Sb5g\ . h:t}M /]ljh (Rabies)

nfu]sf] s's'/n] dflg;nfO{ 6f]s]df /]ljh nfUg ;Sb5 To:t} Pr=cfO{=eL= / P8\;

(HIV/AIDS), x]kf6fOl6; B h:tf /f]u ;ª\qmldt ;'O{sf] k|of]usf] sf/0f ubf{ ;g{

;Sb5 . nfdv'§]sf] 6f]sfOaf6 dn]l/of nfUg ;S5 .

82

p_ ;fngfnsf] dfWodaf6 ;g]{ (Vertical or Transplacental Transmission):

cfdf /f]uL ePdf sltko /f]usf sf/s tTjx¿ ;fngfnsf] dfWodaf6 e|"0f jf k]6df /x]sf]

aRrfdf ;g{ ;Sb5 . o;/L ;g]{ tl/sfnfO{ ;fngfnsf] dfWodaf6 ;g]{ elgG5, h:t} M–

x]kf6fOl6; …aLÚ, lel/ª\uL, Pr=cfO{=eL= / P8\; (Hepatitis 'B', Syphilis, HIV and

AIDS).

v= ck|ToIf ¿kaf6 ;g]{ (Indirect Transmission)

/f]usf sf/s tTjx¿ jf /f]usf ls6f0f'x¿ 5Fs jf Food, Fluid, Fomites, Fly,

Finger sf] dfWod xF'b} Ps /f]uLaf6 csf]{ lg/f]uLdf ;g]{ ub{5 . o;/L ;g]{ tl/sfnfO{

ck|ToIf ;/fO (Indirect Transmission) elgG5 . ck|ToIf ¿kdf sf/s tTjx¿

lgDg tl/sfaf6 ;g]{ ub{5 M–

c_ vfB tyf k]o kbfy{af6 ;g]{ (Vehicle Borne Transmission): vfB tyf k]o

kbfy{af6 ;g]{ /f]u vfB tyf k]ohGo /f]u (Vehicle borne disease) vfB tyf

k]ohGo eGgfn] kfgL, vfgf, tyf k]okbfy{x¿af6 ;g]{ /f]ux¿ kb{5g\ . oLdWo] vfB tyf

k]o kbfy{ d'Vo ¿kdf cfpF5g\ . sltko /f]usf sf/s tTjx¿sf] o:tf dfWoddf a;]/

j[l4 ljsf;;d]t x'g] ub{5 . o;/L ;g]{ /f]ux¿df 6fOkmfO8, kf]lnof], x]kf6fOl6; …PÚ,

emf8fkvfnf, cfpF, x}hf (Typhoid, Polio, Hepatitis 'A', Diarrhoea,

Dysentery, Cholera) cflb kb{5g\ .

cf_ ls/faf6 ;g]{ (Vector Borne Transmission): ls/f le+mufaf6 ;g]{ /f]ux¿nfO{

ls/faf6 pTkGg /f]u (Vector Borne Disease) / o;/L ;g]{ tl/sfnfO{ ls/faf6 ;g]{

elgG5 . ls/fx¿n] vf; u/L b'O{ lsl;daf6 /f]u ;fg]{ ub{5g\ M–

i) h}ljs ljlw (Biological Method): o;df ls/fn] cfˆgf] z/L/sf] leqL efudf

/f]usf ls6f0f'x¿ af]s]/ a[l4 ljsf; u/fO{ cGodf ;fb{5 eg] To;nfO{ h}ljs ljlw

elgG5, h:t} M nfdv'§]n] cf}nf] ;fbf{ cf}nf]sf k/hLjLx¿sf] Ps cj:yf nfdv'§]sf]

z/L/leq k"/f x'G5 o;}cGtu{t cGo /f]ux¿ klg kb{5g\ h:t} M plkofFaf6 Kn]u,

:ofG8ˆnfO{af6 sfnfhf/ cflb .

ii) oflGqs ljlw (Mechanical Method): le+muf tyf ;fª\nf ls/fn] cfˆgf]

z/L/sf] afXo efudf ls6f0f'x¿nfO{ af]s]/ jf z/L/df 6fF;]/ Ps JolQmaf6 csf]{df

83

n}hfG5 eg] To; ljlwnfO{ oflGqs ljlw elgG5 . o;/L ;fg]{ ls/fdWo] lem+ufnfO{ k|d'v

¿kdf lng ;lsG5, h:t} M o;/L ;fg]{ /f]ux¿df emf8fkvfnf, cfpF, x}hf cflbnfO{

lng ;lsG5 .

O_ xfjfsf] dfWodaf6 ;g]{ (Air Borne Transmission): /f]uLn] Zjf;k|Zjf;sf]

dfWodaf6 vf; u/L ;f; km]bf{, vf]Sbf, xfR5\o'F ubf{, ls6f0f'x¿ xfjfdf km}lnG5g\ / h'g

JolQmn] pQm b"lift xfjfdf Zjf; lnG5, pQm JolQmsf] z/L/df tL ls6f0f'x¿ k|j]z u/L

/f]u nfUb5 . o;/L ;g]{ tl/sfnfO{ b'O{ efudf afF8\g ;lsG5 M–

i) 8«Kn]6 Go'lSn (Droplet Nuclei): Zjf;k|Zjf;;DaGwL /f]u nfu]sf JolQmx¿n]

vf]Sbf, xfR5\o'F ubf{, s'/fsfgL ubf{ sf/s tTjx¿ ;fgf s0fx¿sf] ;'Svf 5f]l8Psf]

yf]kfsf] ¿kdf xfjfdf /x]sf x'G5g\ . tLgLx¿sf] gfk 0.1mm cyf{t\ 1 -

10micron ;Dd x'G5 . oL k|b"lift s0fx¿ xfjfsf] dfWodaf6 lg/f]uL JolQmsf]

z/L/leq hfg ;Sb5g\ / /f]u nfUg ;Sb5 . o;/L ;g]{ /f]ux¿df bfb'/f, 7]pnf,

OGˆn'PGhf, Ifo/f]u (Measles, Chickenpox, Influenza, Tuberculosis)

cflb kb{5g\ .

ii) ;ª\qmldt w'nf] (Infected Dust): /f]uL JolQmn] vf]Sbf, xfR5\o'F ubf{, s'/fsfgL ubf{

y'ssf 7"nf l56fx¿sf ¿kdf ls6f0f'x¿ aflx/ lgl:sP/ e'OFdf, kmlg{rnx¿df,

efF8fs'8f, nQfsk8f cflbdf pko'Qm jftfj/0f kfPdf afFRg jf al;/xg ;Sb5g\ . tL

j:t'x¿sf] ;/;kmfO ubf{ sf/s tTjx¿ k'gM xfjfdf ldl;g hfG5g\ / lg/f]uL JolQmn]

Zjf; lnbf tL sf/s tTjx¿ z/L/leq k|j]z ug{ ;Sb5g\ / /f]u nfUg ;Sb5 . o;/L

nfUg] /f]ux¿df lgdf]lgof, Ifo/f]u (Pneumonia, Tuberculosis) cflbnfO{ lng

;lsG5 .

O{_ nQfsk8faf6 ;g]{ (Fomite Borne): nQfsk8faf6 ;g]{ /f]u (Fomite borne

disease) eGgfn] nQfsk8f h:t}M ¿dfn, sk8f, snd, sfkL, lunf;, rDrf, v]nf}gf,

tlsof cflbaf6 ;g]{ /f]ux¿nfO{ a'lemG5 . nQfsk8fdf klg sltko sf/stTjx¿nfO{

afFRgsf] nflu cg's"n jftfj/0f ldNb5 . o:tf ;fdu|Lx¿ ;ª\qmldt ePkl5 /f]u km}lng

;xof]u k'Ub5 . oL ;fdu|Lx¿af6 nfUg] /f]ux¿dWo] cfpF, x]kf6fOl6; …PÚ, 5fnf;DaGwL

/f]u, n'tf], 6fOkmfO8, Eofu'Q] /f]u (Dysentry, Hepatitis A, Skin diseases,

Scabies, Typhoid, Diphtheria) cflb d'Vo x'g\ .

84

p_ kmf]xf]/ xft tyf cf}nfx¿af6 ;g]{ (Unclean hands and finger

Transmission): dflg;sf] xftn] w]/} k|sf/ sfd ug]{ x'bf xft tyf cf}nf t'Gt} kmf]x/

x'G5 . lb;f u/]kl5 xftdf lb;fhGo kmf]x/ 6fFl;Psf] x'G5, v]taf/Ldf sfd ubf{ df6f]df

ePsf] ls6f0f' 6fFl;Psf] x'G5, /f]uL JolQmn] k|of]u u/]sf ;fdfg tyf sk8f rnfpbf klg

ls6f0f'x? xftdf cfp5 jf ljleGg a:t' ;dfpbf jf k|of]u ubf{ kmf]/ tyf hLjf0f'x?

xftdf 6fF;Psf] x'G5 . xft ;fa'g kfgLn] wf]P/ ;kmf u/]g eg] vfgf vfbfF ls6f0f'x?

d'vaf6 z/L/leq k|j]z ub{5 . b'lift xft tyf cf}nfn] gfs tyf cfFvf rfnpbf, sfg

sf]6\ofpbf jf aRrfx?n] cf}Fnf r':bf k|b"lift xft jf cf}Fnfsf] dfWodaf6 /f]usf sf/s

tTjx¿ d'v, gfs jf 5fnf;Dd k'Ub5g\ / /f]u nfUb5 . k|b"lift xft jf cf}+nfaf6 ;g{

;Sg] /f]ux¿df x}hf, cfpF, x]kf6fOl6; …PÚ, cfGb|fdf nfUg] k/hLjLx¿ (Cholera,

Dysentery, Hepatitis 'A', Intestinal Parasites) cflbnfO{ lng ;lsG5 .

#= /f]u u|x0f nfos JolQm (Susceptible host)

/f]usf hLjf0f'x? ;|f]t jf e08f/af6 ljleGg dfWodaf6 JolQmsf] z/L/df k|j]z ub{5 . /f]usf

ls6f0f'x? z/L/df k|]jz ub}{df /f]u nfU5 eGg ;lsb}g . olb dfg;sf] z/L/df /f]usf

ls6f0f'x? lj?¢ n8\g] Ifdtf 5 eg] /f]usf ls6f0f'x?nfO{ gi6 ul/lbG5 / /f]un] cfqmd0f ug{

;Sb}g . xfd|f] jl/kl/ jftfj/0fdf Ifo/f]usf ls6f0f'x? 5g\ / g]kfndf emG8} cfwf hg;ª\Vofsf]

z/L/df Ifo/f]usf ls6f0f'x? ;'if'Kt ?kdf ;+qmd0f u/]sf] x'G5 . Ifo/f]u lj?¢ n8\g] Ifdtf

ePsf JolQmx?df /f]usf ls6f0f' z/L/ leq k|j]z u/] klg Ifo/f]usf] nIf0f b]vf kb}{g . JolQm

sdhf]/, s'kf]lift eP/ /f]usf] lj?¢ n8\g] Ifdtf gePsf] cj:yfdf dfq /f]un] cfqmd0f ub{5 .

s'g} JolQm h;df s'g} vf; /f]u lj?4 k|lt/f]w Ifdtf sd 5 jf ljsf; ePsf] 5}g / s'g}

/f]uhGo clestf{n] cfqmd0f u/L Antibody nfO{ k/f:t ubf{;fy /f]u nfUb5 eg] To:tf]

JolQmnfO{ Susceptible Host elgG5 . /f]u ls6f0f'x?sf] ;Dks{df cfP/ /f]un] cfqmd0f ug{

;Sg] cj:yfdf ePsf JolQmnfO{ /f]u u|x0f ug{ nfossf] JolQm elgG5 .

;d'bfodf /f]u u|x0f ug{ nfossf JolQmx? 5g\ / /f]usf] ;|f]t e08f/ klg 5 / /f]u ;fg]{

dfWodx? klg 5 eg] /f]u nfUb5 . a8{ˆn', :jfOgˆn', ;f;{ h:tf gof /f]u b]vf k/]sf] v08df

k|fo ;a} JolQmx?sf] z/L/df /f]ulj?¢ n8\g] Ifdtf x'b}g / o:tf] cj:yfdf ;?jf /f]u

dxfdf/Lsf] ?kdf km}lnG5 / w]/} dflg;x?sf] Hofg lnG5 . /f]un] cfqmd0f u/]kl5 /f]usf] hLjf0f'

lj?¢ n8\g] qmddf /f]uk|lt/f]w Ifdtfsf] ljsf; x'G5 . /f]usf lj?¢ vf]k nufPsf JolQmx? 5g\

eg] klg dflg;x?df /f]usf] lj?¢ n8\g] Ifdtf ljsf; ePsf] x'G5 / o:tf] cj:yf /f]u km}lng

85

kfpb}g . o;nfO{ cem ;/n 9Ën] eGg] xf] eg] xfd|f] zl//df /f]uhGo clestf{ k|j]z

ul/;s]kl5 PG6LhLg (Antigen) pTkGg ub{5g\ / z/L/n] To:tf P06LhLg lj?5 PG6La8L

(Antibody) tof/ kfb{5 / k|lt/f]w ug{ nufpF5 . To; n8fOdf P06L a8Lsf] hLt

ePdf /f]uhGo clestf{ k/f:t eO{ JolQm :j:y /xG5 / PG6LhLgsf] lht ePdf z/L/df

/f]usf nIf0f b]lvg yfN5g\ . To;}n] ;?jf/f]u b]vf kg{sf] nflu /f]usf ls6f0f'x? eP/

dfq x'b}g /f]u u|x0f ug{ nfos JolQm x'g' kb{5 . ;d'bfodf /f]u u|x0f ug{ nfossf

JolQmx? 5g\ / /f]usf] ;|f ]t jf e08f/af6 dflg;df k'Ug] dfWod jf af6fx? 5g\ eg]

;?jf /f]u b]vf kb{5 .

cEof;÷lqmofsnfk

!= ;?jf/f]usf] dfgj, hgjf/ lghL{j e08f/sf] af/]df s] a'e\mg' eof] <

@= ;?jf /f]u ;g]{ k|ToIf / ck|ToIf tl/sfsfaf/]df 5f]6s/Ldf JofVof ug'{xf];\<

#= "Man himself is a great reservior of causative agent." JofVof

ug'{xf];\ .

#=* ;?jf/f]usf] k|fs[lts Oltxf; (Natural History of Disease)

/f]usf] sf/s tTj / jftfj/0fsf] aLrdf x'g] hl6n cGtlq{mofaf6 dflg;df /f]u nfUb5 .

/f]usf] k|fs[lts Oltxf; /f]u cWoog lj1fg (Epidemiology) df dxŒjk"0f{ cjwf/0ff xf] .

s'g} klg /f]u PSsfl; nfUg] / x6\g] x'Fb}g . s'g} klg ;¿jf /f]un] dflg;nfO{ cfqmd0f ug{ /

c;Ifd jf d[To'sf] d'vdf k'¥ofpg lglZrt rn0fx¿ kf/ ub{5 . o;/L Pp6f /f]usf] sf/0f

tTj cyf{t\ ;?jf /f]usf] sL6f0f' Pp6f JolQmdf s;/L k'Ub5, c;/ kfg]{ nIf0f b]vfkg]{, lgsf]

x'g] jf d[To' x'g] cj:yf rn0fa4 x'g] k|lqmofsf] ljj/0fnfO{ /f]usf] k|fs[lts Oltxf; elgG5 .

(The natural history of disease refers to a description of the uninterrupted

progression of a disease in on individual from the moment of exposure to causal

agent until recovery or death) . ;?jf /f]usf] k|fs[lts Oltxf;df Pp6f /f]u lgDg

rn0fdf qmda4 ¿kdf cufl8 a9\5 M–

86

!= /f]usf] k"j{ cj:yf (Prepathogenesis phase)

/f]usf] cfqmd0f ug{'eGbf cufl8sf] cj:yfnfO{ Prepathogenesis elgG5 . of]

cj:yfdf /f]usf] sL6f0f' jftfj/0f x'G5 t/ Pp6f JolQmsf] z/L/ leq k|j]z u/]sf x'Fb}g .

cyf{t\ Ifo/f]u sL6f0f' ePsf] 7fpFdf Pp6f JolQm 5 eg] p;sf] z/L/df s'g} klg ;do

z/L/leq sL6f0f' k|j]z ug{ ;Sb5 . g]kfndf 3]/} dflg;x¿ TB sf] sL6f0f' ePsf]

jftfj/0fdf a;]sf 5g\ .

@= /f]usf] sL6f0f' k|j]z ug]{/f]un] cfqmd0f ug]{ rn0f (Pathogenesis Phase)

of] rn0fdf cfpFbf Pp6f JolQmsf] z/L/ ;?jf /f]u sL6f0f' k|j]z ub{5 / z/L/nfO{

cfqmd0f ug{ yfNb5 . TB /f]usf] sL6f0f' z/L/ leq k|j]z u/]kl5 la:tf/} a[l4 eP/ s'g}

cª\u vf;u/L kmf]S;f]sf] tGt'nfO{ cfqmd0f ug{ yfNb5 . olb BCG vf]k nufPsf] 5}g /

/f]uLsf] /f]u lj¿4 n8\g] Ifdtf 5}g eg] /f]u l5§} cfqmd0f ug{ ;Sb5 t/ /f]u lj¿4

n8\g] Ifdtf 5 eg] /f]u of]eGbf cufl8 a9\b}g cyf{t\ /f]u nfUb}g . TB sf] sL6f0f' k|j]z

x'g]lalQs} ;a}nfO{ TB nfUb}g u/La s'kf]if0f ePsf] / sdhf]/ JolQmsf] z/L/df TB sf]

sL6f0f' k|j]z u¥of] eg] sL6f0f'x¿ l5§} j[l4 eP/ /f]usf] nIf0f b]vfk5{ .

#= /f]u nIf0f b]vfkg]{ rn0f (Clinical phase)

of] rn0fdf ;'?df /f]usf] nIf0f b]vfk5{ . cyf{t\ Ifo/f]usf] sL6f0f'n] cfqmd0f u/]df vf]sL

nfdf] ;do;Dd nfUg], vsf/df /ut b]vfkg]{ / xNsf Hj/f] cfpg yfN5 . nIf0f

b]vfk/]kl5 klg /f]usf] lgbfg ePg / pkrf/ ePg eg] JolQm sdhf]/ / /f]uL÷la/fdL x'G5

. of] cj:yfdf klg pkrf/ ePg eg] /f]un] lg/Gt/ cfqmd0f ub{5 / c;Ifd x'g] / Zjf;

km]g{ ufx|f] x'g] kmf]S;f]n] /fd|f];Fu sfd gug]{ x'G5 . olb pkrf/ ePg eg] cGtdf d[To' x'G5

.

$= /f]uaf6 lgsf] jf d[To' x'g' (Recovery or death)

/f]usf] nIf0f b]vfkg]{ lalQs} (Early Diagnosis) ug{sf nflu vsf/ hrfpg] PS;–/]

u/fpg u/]/ /f]usf] lgbfg u/]/ k'/f dfqfdf cf}ifwL vfPdf /f]u lgsf] x'G5 . t/ /f]usf]

87

lgbfg eP/ klg 8fS6/sf] ;Nnfx cg';f/ cf}ifwL vfPg eg] k]ml/ /f]u alNemG5 / /f]usf]

s8f nIf0f b]vfk5{ . km]l/ /fd|f] :jf:Yo ;+:yf cyf{t\ c:ktfndf uP/ /f]usf] lgbfg

u/]/ 8fS6/sf] ;Nnfx cg';f/ cf}ifwL ;]jg u/]df /f]u lgsf] x'G5 . cGoyf /f]u km]l/

alNemg] / /f]u lgsf] geP/ d[To' x'G5 . o;/L Pp6f JolQm /f]u k|lt/f]w Ifdtf 5 eg]

/f]u sL6f0f' z/L/ leq k|j]z u/] klg /f]u nfUb}g . /f]u k|lt/f]w Ifdtf 5}g eg] /f]un]

cfqmd0f ub{5 / /f]usf] nIf0f b]vfk5{ . ;oddf /f]usf] lgbfg / pkrf/ ePdf /f]u

lgsf] x'G5 . ;dodf pko'Qm pkrf/, ;]jf k|fKt ug{ ;s]gf}F eg] /f]un] dflg;nfO{

d[To'sf] d'vdf k'¥ofpF5 . o;/L dflg;nfO{ /f]u nfUg ;Sg] cj:yfb]lv /f]u nfu]/ /f]u

lgsf] x'g] jf d[To' x'g] ;Ddsf] rn0fx¿sf] ljj/0fnfO{ /f]u cWoogdf /f]usf] k|fs[lts

Oltxf; eGg] ul/G5 .

s'g} gofF /f]u ;d'bfodf aflx/af6 cfPdf Ps}rf]l6 w]/} JolQmnfO{ cfqmd0f ub{5 .

dflg;x¿df gofF /f]u;Fu n8\g] Ifdtf gePsf]n] /f]usf sL6f0f'x¿ z/L/ leq k|j]z

ug]{lalQs} tLj| ultdf j[l4 x'G5 / z/L/nfO{ sdhf]/ agfpF5 . Ifo/f]u klg ;'¿df

km}lng] ;dodf o'/f]knufot ljZjsf] ljleGg b]z / If]qsf] dflg;x¿df dxfdf/Lsf]

¿kdf km}lnP/ nfvf}F dfG5]sf] Hofg uPsf] lyof] . la:tf/} dflg;x¿ k|fs[lts /f]u

k|lt/f]w Ifdtf a9\g yfNof] . cfly{s ljsf; / pGgltn] ubf{ hLjg:t/ tyf kf]if0fsf]

:t/df ;'wf/ eof] . lxhf]cfh ljsl;t b]zdf Ifo/f]u ;d:of guGo dfqfdf 5 .

cfhsn b]vfkg{ yfn]sf] a8{ˆn', :jfOg ˆn' / SARS h:tf /f]uaf6 8/fpg'kg]{ ePsf]

5 . oL gofF /f]u hg;d'bfodf km}lnPdf nfvf}F dfG5]sf] Hofg hfg ;S5 . lsgeg] gofF

/f]u lj?4 n8\g] dflg;x¿sf] Immunity Power 5}g . /f]usf] k|fs[lts Oltxf;cg';f/

Psk6s /f]u gkm}lnP;Dd dflg;x¿df /f]u k|lt/f]w Ifdtf ljsf; x'Fb}g . /f]usf]

Oltxf;cg';f/ ;d'bfodf /f]u km}lnP/ w]/} dflg;sf] Hofg uPkl5 dfq la:tf/} k|s[ltsf]

;dfof]hgsf] lgodcg';f/ /f]u k|lt/f]w Ifdtf j[l4 x'G5 / /f]usf] c;/ sd x'g hfG5 .

#=% /f]usf] 5gf]6 (Screening of disease)

;d'bfodf :j:y yflgPsf t/ /f]u tyf :jf:Yo ;d:of x'g ;S5 egL cg'dfg ul/Psf

hg;Vofdf zL3| ?kdf k/LIf0f, hfFr tyf cGo k|lqmof ljlw zL3|?kdf k|of]u u/]/

;'if'Kt?kdf /x]sf], klxrfg gePsf] /f]u, bf]if tyf ;d:of klxrfg ug]{ tl/sfnfO{ /f]usf]

5gf]6 elgG5 . o;n] :j:y yflgPsf JolQmx?af6 /f]uePsf JolQm klxrfg ug]{ sfd

ub{5 . t/ /f]u 5gf]6 ug'{ eg]sf] /f]u lgbfg ug'{ xf]Og . /f]u 5gf}6 k|lqmofaf6 klxrfg

88

ul/Psf JolQmnfO{ /f]usf] jf:tljs sf/0f kQf nufP/ pkrf/ ug{sf nflu c:ktfndf

/f]u lgbfg ug'{ kb{5 . /f]u 5gf]6sf] d'Vo nIo lgDgfg'';f/ 5 .

/f]u tyf /f]usf] hf]lvddf k/]sf JolQmx?sf] zL3| klxrfg ug'{

/f]usf] /f]syfd tyf pkrf/ lqmofsnfk zL3|?kdf ;~rfng ug{ cfwf/ tof/ kfg'{

/f]u 5gf]6 tLg k|sf/sf] x'G5 .

cfd 5gf]6 (Mass Screening): s'g} 7fp jf If]qdf a;f]af; ug]{ ;a} hg;ª\Vofdf

s'g} /f]usf] 5gf]6 ug'{nfO{ cfd 5gf]6 elgG5 .

rogo'Qm 5gf]6 (Selective Screening): s'g} 7fp jf If]qdf a;f]af; ug]{ dflg;x?

dWo pRr hf]lvddf k/]sf ;d"xdf dfq 5gf]6 sfo{ ug'nfO{ rogo'Qm 5gf]6 elgG5 .

h:t} $) jif{ dflysf dlxnfx?df :tg tyf kf7]3/sf] 5gf]6 k/LIf0f, dw'd]x ePsf

kl/jf/sf ;b:ox?df dw'd]x/f]usf] 5gf]6 k/LIf0f, kfFr jif{ d'lgsf afnaflnsfx?xdf

SARS sf] k/LIf0f ug{ ;lsG5 .

ax'rn0fLo 5gf]6 (Multiphasic Screening): s'g} 7fpFsf] 7'nf] hg;+Vofdf b'O{ jf b'O{

eGbf a9L 5gf]6 k/LIf0f ljlw ckgfP/ Ps eGbf a9L /f]u jf ;d:of klxrfg ug{ ug{

;Sg] 5gf]6 k/LIf0fnfO{ ax'rn0fLo 5gf]6 elgG5 . h:t}: k|ZgfjnL, /ut k/LIf0f, vsf/

k/LIf0f, zf/Ll/s k/LIf0f cflb u/]/ ul/g] k/LIf0f .

5gf]6 k/LIf0fsf] k|of]u (Uses of Screening)

5gf]6 k/LIf0fsf] d'Vo rf/ k|of]hg 5g\ .

36gf jf /f]u kQf nufpg (Case detection)

/f]usf] lgoGq0f tyf /f]syfd ug{ (Control and preventio of diseases)

cWoog cg';Gwfg ug{ (Research/investigation)

hgtfdf ;r]tgf hufpg] z}lIfs sfo{qmd ;~rfng ug]{ cj;/ l;h{gf ug{

(Educational opportunities)


!= /f]usf] k|fs[lts Oltxf;sf] af/]df s] a'e\mg' eof] <

89

@= /f]usf] 5gf}6 eg]sf] s] xf] < of] s;/L ul/G5 < #=( 5gf]6 g]kfnsf] k|d'v ;?jf /f]ux?M dn]/Lof, Ifo/f]u, ?3fvf]sL tyf PrcfOeL P8\;sf] Olk8]ldof]nf]hL (Epidemiology of Major Communicable Diseases: Malaria, TB, Influenza, HIV and AIDS)

g]kfndf k|d'v ;?jf /f]ux¿sf] Olk8]ldof]nf]hL eGgfn] lt /f]usf] 36gf b/, s'g ;d"x, ju{ jf

hflt k|jflxt ePsf 5g\ / s] sf/0fn] s'g} ;d"x ljz]ifnfO{ c;/ kf/]sf] 5 eGg] af/]df rrf{

ug'{nfO{ hgfpF5 . s]xL d'Vo /f]usf] 36gf b/, d[To' b/, sf/s tTj / JolQm, ;do tyf

ef}uf]lns If]q cg';f/ ljt/0fsf] 5f]6s/Ldf j0f{g ul/Psf] 5 .

#=&=! cf}nf]/f]usf] Olk8]ldof]nf]hL (Epidemiology of Malaria)

xfjfkfgL nfdv'§], k/hLjL / dflg;sf] aLrdf x'g] ;Dks{n] cf}+nf] /f]usf] ljt/0f /

lj:tf/nfO{ lgwf{/0f ub{5 . of] /f]usf] k/hLjL (Malaria Parasite) ;g\ !**) df

k|mfG;sf lrlsT;s Charles L.A. Laveran n] ;'Id bz{s oGqsf] d2tn] kQf

nufPsf lyP . of] /f]u nfdv'§]sf] dfWodaf6 dflg;df ;5{ eGg] s'/f ;g\ !*(& df

Ronald Ross / Giovanni Grassi n] kQf nufPsf lyP . of] /f]u pi0f tyf pkf]i0f

sl6a+wLo If]qdf kg]{ b]zx¿df b]vf kg]{ k'/fgf] /f]u xf] . cf}nf]/f]u ljZjJofkL ¿kdf

;d:of ePsf] /f]u xf] .

g]kfndf cf}nf]/f]usf] cfj[lQ÷b/ (Frequency/Rate): g]kfndf cf}nf]/f]u pGd'ng

sfo{qmdsf] yfngL x'g'eGbf cl3 lj=;+= @))* ;fndf sl/a @ nfv dflg;x¿ of] /f]uaf6

k|efljt ePsf] cg'dfg ul/Psf] lyof] . Jofks¿kdf DDT 5ls{Pkl5 @)@) ;fndf

cfOk'Ubf of] /f]u pGd"ng x'g] cj:yfdf k'u]sf] / !%( cf}nf]/f]uLsf] lj/fdL klxrfg ePsf]

lyof] . @)@% ;fn ;Dddf pGd"ng x'g' kg]{ lyof] t/ @)@) ;fn kl5 k'g j[l4 x'g yfNof]

. @)#$ ;fndf cfOk'Ubf !$,^)) cf}nf]/f]uLsf lj/fdL e]l6P . lj=;+= @)$) ;fndf

cfOk'Ubf cf}nf]/f]uLsf] ;ª\Vof $@,#*! k'Uof] . lj= ;+= @)%! ;fn b]vL k'g 36\g yfn]sf]

lyof] . @)^^ ;fndf #,%)& cf}nf]/f]uLx¿ ePsf] s'/f /Qm k/LIf0faf6 k'li6 eof] .

@)^^÷^& df @,(@) JolQm cf}nf]/f]u jf ;+qmldt ePsf] s'/f /Qmk/LIf0faf6 klxrfg

ePsf] lyof] . of] /f]usf] jflif{s hLjf0f' cfqmd0f b/ (Annual Parasite incidence

Rate, API) )=!$ k|lt6 xhf/ 5 . cyf{t\ Ps nfv hg;ª\Vofdf !$ hgfnfO{ jflif{s

90

¿kdf cf}nf]/f]u nfUb5 . tLg jif{ cl3 k|ltnfv @@ hgf lyof] . o;/L g]kfndf cf}nf]

/f]usf] k|sf]k 36]sf] b]lvP klg /f]usf] nIf0fsf] cfwf/df cf}ifwL vfg], clinical malaria

sf] ;ª\Vof *#,@)& lyof] eg] @)^^÷^& df of] ;ª\Vof !)*,!&( k'u]sf] 5 . cf}nf] /f]usf]

;ª\Vof 36]sf] b]vfOPklg oyfy{df of] /f]u ;d:of k|jn 5 eGg] s'/f clinical malaria

sf] ;ª\Vofn] b]vfpF5 .

cf}nf]/f]usf] ljt/0f (Distribution of malaria in Nepal)

g]kfnsf] lxdfnL If]qdf kg]{ cf7 lhNnf / sf7df8f}F tyf eQmk'/ u/L !) lhNnf dfq

cf}nf]/f]u d'Qm lhNnf xf] . cGo ^% lhNnfdf cf}nf]/f]u ;+qmd0f x'g] ;Defjgf 5 . of] /f]u

t/fO, leqL dw]z, vf]r, tyf dWo kxf8L If]qsf pkTosfdf a9L b]vfkb{5 . sf7df8f}F tyf

eQmk'/df nfdv'§] ePklg /f]u ;fg{sf] nflu /ftsf] tfkqmd gk'Ug] ePsf]n] cfh;Dd

sf7df8f}F pkTosfsf] b'O{ lhNnfdf :yflgo ¿kdf cf}nf] k|;f/0f ePsf] tYo e]l6Psf] 5}g .

g]kfnsf] !# lhNnf h:t} sGrgk'/, s}nfnL, alb{of, afFs], gjnk/f;L, wg'iff, df]/ª\u,

emfkf, Onfd, l;Gw'nL / 88]nw'/f / sfe|]knfGrf]s lhNnfnfO{ pRr hf]lvd ePsf] lhNnf

cyf{t\ High malaria endemic districts elgG5 . cyf{t\ oL lhNnfx¿df

cf}nf]/f]usf] ;+qmd0f a9L x'G5 . @)^^÷^& df dn]l/of k/hLjL 36gf b/ (API) ;a}

eGbf a9L ef]hk'/ lhNnfdf !=*@ k|lt xhf/, s}nfnLdf !=)#÷!=))), emfkfdf

)=&(÷!))) / sGrgk'/df )=$^÷!))) hg;ª\Vof lyof] . /ut :nfO8 hfFr u/]sf]df

;a}eGbf a9L positive cases ;'b'/ klZrdf~rn ljsf; If]qdf !# k|ltzt / sd

klZrdf~rn ljsf; If]qdf &=@( k|ltzt lyof] . sl/a () k|ltzt /f]u !% jif{eGbf

dfyLsf dflg;x¿df /x]sf] b]lvG5 .

cf}nf] dn]l/ofsf] lgwf{/s tyf hf]lvd tTjx¿ (Determinants and Risk factors)

cf}nf]/f]u nfUg'sf] sf/0f o; /f]usf] k/hLjLsf] ;+qmd0f xf] . Plasmodium vivax,

P.falciparum, P.ovale / P. malarie sf] ;+|qmd0faf6 nfUb5 . g]kfndf P.vivax

/ P.falciparum sf] ;+qmd0fsf] sf/0fn] dfq cf}nf] Hjf]/f] nfUb5 . of] /f]u

Anopheles hfltsf] nfdv'§]sf] 6f]sfOaf6 ;b{5 . ;+;f/df $)) k|hfltsf

Anopheles nfdv'§] kfOG5 . To;dWo ^) k|hflt dfq cf}nf] ;fg{ ;Sb5 . t/ $)

k|hfltsf Anopheles n] cf}nf]/f]u ;fg]{ dxTjk"0f{ e"ldsf v]Nb5g\ . g]kfndf d'Vo rf/

91

k|sf/sf] Pgf]lkmlnh nfdv'§] h:t}M Anopheles fluvialitis, A. annularis, A.

maculate tyf willmori n] cf}nf]/f]u ;fg]{ ub{5 .

g]kfndf Pgf]lkmlnh nfdv'§]sf] 3gTj j}zfvaf6 a9g\ yfN5 / c;f/df cTolws j[l4 x'G5

. cf}nf]/f]u lj/fdL a9L dfqfdf j}zfv / ;fpgsf] aLrdf b]vf kb{5 . of] /f]u c;f]h

sflQ{s;Dd klg km}lnG5 . t/fO{sf] sltko lhNnfdf lxpFbdf klg b]vf kb{5 . of] /f]u

nfUg'sf] d'Vo sf/0f udL{ df};d nfdv'§] j[l4 x'g' / nfdv'§]sf] 6f]sfOaf6 aRg g;Sg' xf] .

of] /f]u ;fg]{ nfdv'§] hª\un / l;d;f/sf] 5]p5fpdf a9L kfOg] ePsf]n] g]kfnsf] t/fO

tyf leqL dw]zsf hª\unsf] glhs j:g]nfO{ a9L nfUb5 . u/Lj kl/jf/sf dflg;x¿n]

em'n lsGg g;Sg] / nfdv'§]sf] 6f]OsfOaf6 aRg ljleGg pkfox¿ ckgfpg g;Sg] x'Fbf

pgLx¿df of] /f]un] ;tfpg] ub{5 . To;}n] o;nfO{ klg u/LjLsf] /f]u eGg] ul/G5 . em'n

k|of]u gug]{ jf /fd|f];Fu em'n k|of]u ug{ g;Sg] dflg;x¿ g} of] /f]usf] ;+qmd0faf6 lkl8t

x'G5g . xfjfkfgL nfdv'§]sf] 3gTj tyf u/LjLn] cf}nf]/f]usf] ;+qmd0fnfO{ lgwf{/0f ub{5 .

#=&=@ Ifo/f]usf] Olk8]ldof]nf]hL (Epidemiology of Tuberculosis)

Ifo/f]u klg g]kfnsf] Ps k|d'v ;?jf /f]u xf] . ljZjdf of] /f]unfO{ dfG5] dfg]{ bf];|f]

;+qmd0f /f]u dflgG5 . ljZj :jf:Yo ;ª\u7gsf] cg';f/ k|To]s jif{ sl/a !^ nfv

dflg;x¿ Ifo/f]usf] sf/0fn] db{5g\ . cyf{t\ k|To]s lbg ljZjdf sl/a $$))) dflg;sf]

d[To', Ifo/f]usf] sf/0fn] x'G5 . ljZjsf] sl/a Ps ltxfO{ hg;ª\Vof Ifo/f]uaf6 ;+qmldt

ePsf] cg'dfg 5 -ljZj :jf:Yo ;+3, @))&_

Ifo/f]usf] ljt/0f (Distribution of TB)

g]kfnsf] s"n hg;ª\Vofsf] $% k|ltzt dflg;x¿ Ifo/f]usf] ls6f0f'af6 ;+qmldt ePsf /

z'if'Kt Ifo/f]u ePsf] c'gdfg 5 . t/ ;+qmldt ;a} AolQmdf Ifo/f]usf] nIf0f b]vf kb}{g /

;qmLo Ifo/f]u cj:yfdf k'Ub}g . To;}n] g]kfndf k|To]s jif{ $) xhf/nfO{ Ifo/f]u nfUg] /

To; dWo] @),))) nfO{ kmf]S;f]sf] Ifo/f]u b]vf kb{5 . g]kfndf of] /f]usf] 36gfb/ @$)

k|lt nfv hg;ª\Vof 5 eGg] cg'dfg 5 .

Ifo/f]usf] ljt/0f (Distribution of TB): g]kfndf Ifo/;f]udf ljt/0fsf] af/]df

cWoog ePsf] kfOb}g . of] /f]u a9L dfqfdf a'9fkfsf / jo:snfO{ nfUb5 . dlxnfnfO{

eGbf k'?ifnfO{ a9L nfUb5 . k'?ifx¿n] a9L r'/f]6 tyf dlb/f ;]jg ug]{ / 3/aflx/ a9L

92

kl/>dsf] sfd ug'{kg]{ ePsf]n] ubf{ dlxnfnfO{eGbf k'?ifnfO{ a9L dfqfdf Ifo/f]un]

;tfpF5 .

Ifo/f]usf] lgwf{/s tTj (Determinants of TB)

Ifo/f]usf] sf/s tTj dfOqmf]JofS6]/Lod 6\o"a/s'nf]l;; JofS6]/Lofsf] ;+qmd0f eP klg

o;sf] lgwf{/s tTjx¿ u/LjL tyf sdh/f] cfly{s cj:yfnfO{ dflgG5 . ul/j kl/jf/sf

dflg;x¿n] a9L zf/Ll/s kl/>d ug{ kg]{ t/ k]6e/L kf]if0fo'Qm vfgf vfg gkfpg]

ePsf]n] ul/j hg;ª\Vofdf s'kf]if0f x'G5 . s'kf]if0f ePdf JolQmsf] /f]u k|lt/f]w Ifdtf klg

sd x'g] ePsfn] Ifo/f]usf] ls6f0f'n] cfqmd0f u/]kl5 ;+lqm0f Ifo/f]u pTkGg x'G5 . u/Lj

tyf cfly{s cj:yf sdhf]/ ePdf, em'k8L, w'jf, w'nf]df a:g] / sfd ug]{, dhb'/ tyf

>dhLjL ju{sf] dflg;x¿nfO{ of] /f]un] a9L cfqmd0f ug]{ ePsf]n] u/LjL tyf s'kf]if0fnfO{

Ifo/f]usf] lgwf{/s tTj dflgG5 . /f]u k|lt/Iff sdhf]/ ePsf] tyf Pr=cfO=eL= ;+qmd0f

ePdf JolQmx¿df klg Ifo/f]u nfUb5 . cGo JolQmx¿nfO{ eGbf Pr=cfO=eL= ePsf

JolQmnfO{ Ifo/f]u nfUg] ;Defjgf %–& u'0ff a9L x'G5 .

#=&=# Pr= cfO=eL=÷P8\;sf] Olk8]dLkf]nf]hL (Epidemiology of HIV/AID)

;g\ !(*! df ;+o'Qm /fHo cd]l/sfsf] n; PGhn; zx/df hjfgL ;dlnª\uL k'?ifdf

cfGtl/s /IffTds k|0ffnL cefj ePsf] lgdf]lgof ePsf] / Kaposi sarcoma 3fp

ePsf] cj:yf cg';Gwfg ubf{ klxnf] k6s Pr=cfO=eL= P8\; kQf nfu]sf] lyof] . of]

/f]usf] ls6f0f' HIV virus ;g\ !(*# df k]l/;sf] kf:rn cWoog ;+:yfdf sfd ug]{

j}1flgs Luc Montagnier / ;fyLx¿n] kQf nufPsf lyP . of] /f]u ;+qmd0fsf]

;?jft ;g\ !(&) sf] bzsdf ePsf] x'g'kb{5 . Pr=cfO{=eL= sf] efO/;sf] ;+qmd0f

ePkl5 k|lt/f]wfTds zlQm gi6 eO{ /f]u lj?4 nfUg] cfGtl/s ;'/IffTds Ifdtf sdhf]/

eO{ cj;/hGo /f]ux¿sf] cfqmd0f ug]{ cj:yf P8\; x'gsf]nflu s]xL jif{ nfUb5 . ;'?df

of] /f]u ;ldlnª\L k'?ifx¿df a9L b]vf k/]sf] x'gfn] P8\; ;dlnª\uLnfO{ nfUg] /f]u elgGYof]

. t/ kl5 o;sf] efO/; kQf nfu]kl5 nfu' cf}ifwL ;]jg ug]{, of}gsdL{ dlxnf , k'?if, lzz'

tyf afnaflnsfx¿df klg kQf nfUof] . of] /f]uaf6 u|l;t ePsf JolQmx¿ ljleGg b]zx¿

df b]vf k¥of] . o;/L P8\; ljZjJofkL dxfdf/L /f]usf] ¿kdf km}lnof] . ut lt; jif{sf]

cjlwdf ljZjdf nfvf}F k'?if, dlxnf tyf afnaflnsfx¿ P8\;sf] sf/0fn] d[To' eO;s]sf]

5 . ;g\ !((^ df # s/f]8 dflg;x¿ HIV sf] ;+qmd0f ePsf] / () nfvsf] d[To' ePsf]

93

lyof] . ;g @))^ df sl/a $ s/f]8 (39.5 million) dflg;x¿nfO{ HIV ePsf]

cg'dfg ul/Psf] lyof] (UNAIDS, 2006) . ;g\ @)!) sf] cGTo;Dd ljZjdf #

s/f]8 $) nfv dflg;x? HIV ;+qmd0f kL8f ;lxt afFr]sf 5g\ eGg] cg'dfg ul/Psf]

lyof] . ;g\ @)!) df dfq ;+;f/ e/df @& nfv dflg;x¿ HIV af6 ;+qmldt ePsf]

cg'dfg 5 . of] /f]u lgoGq0f ug{ ljZjJofkL cleofg ;~rfng eP klg HIV/AIDS sf]

;+qmd0fdf pNn]vgLo ¿kdf sdL ePsf] 5}g . P8\; lgoGq0f sfo{qmdsf] k|efjn] ubf{ ;g\

@))^ df sl/a $ s/f]8 af6 ;g\ @)!) df sl/a #!@ s/f]8 cfPsf] 5 . g]kfndf klg of]

;+qmd0f s]xL 36]sf] 5 .

cfj[lQ b/ (Frequency/Rates of HIV/AIDS): g]kfndf klxnf] k6s Pshgf ljb]zL /

b]xJofkf/sf] lzsf/ eO{ ef/tsf] j]Zofnoaf6 kms]{sf # hgf dlxnfnfO{ ;g\ !(** df

Pr=cfO=eL= b]vf k/]sf] lyof] . /fli6«o P8\; tyf of}g /f]u lgoGq0f s]Gb|sf] cg';f/ ;g\

@))& df &) xhf/ dflg;x¿nfO{ PrcfOeL ;+qmd0f ePsf] cg'dfg ul/Psf] lyof] .

@))( df ^#,%@* JolQmdf ;+qmldt ePsf] cg'dfg ul/of] . ;g\ @)!! gf]e]Da/df

%%,^@& JolQm PrcfOeLaf6 ;+qmldt ePsf] cg'dfg 5 . ;g\ @))( of] of] /f]usf] k|fjNo

b/ jo:s hg;ª\Vofdf )=#( k|ltzt lyof] . ;g\ @)!! df PrfcfOeL ;+qmd0fsf] k|fjNo

b/ (Prevalence Rate) jo:s hg;ª\Vof )=## k|ltzt 5 eGg] cg'dfg ul/Psf] 5 .

g]kfndf of] ;d;ofnfO{ s]xL ;d"xdf s]lGb|t ePsf] concentrated epidemic elgG5

. ;'Oaf6 nfu' cf}ifwL ;]jg ug{ dflg;x¿df o;sf] k|fjNo b/ (Prevalence Rate) %

k|ltzt eGbf a9L 5 .

Pr= cfO=eL=÷P8\;sf] ljt/0f (Distribution of HIV/AIDS in Nepal)

;g\ @)!! df cg'dflgt ;+qmldt %%,^@& hg;ª\Vof dWo $,&!^ JolQm !% jif{ d'lgsf /

$&,^$% JolQm !%–$( jif{sf / afFsL %) jif{ eGbf dflysf 5g\ . ;g\ @))( sf] cg'dfg

cg';f/ %(,(*$ JolQm HIV af6 ;+qmldt ePsf] / ;+qmldtdWo] ;a}eGbf a9L

a;fOF;/fO ug]{ dhb'/x¿df @(=$ k|ltzt / 3/df a:g] sd hf]lvd ePsf dlxnfx¿df

@*=)% k|ltzt / k'?ifx¿df @^=@ ePsf] cg'dfg 5 . ^ k|ltzt k'?if / k'?ifsf] aLrdf

of}g ;Dks{ ug]{xdf / $=@ k|ltzt ;'Oaf6 nfu' kbfy{ ;]jg ug]{x¿df ;+qmd0f ePsf]

cg'dfg 5 . o;/L ljt/0fsf] ljZn]if0f ubf{ ;a}eGbf a9L !%–$( jif{sf hjfg dflg;x¿

/ sfdsf] vf]hLdf a;fOF;g]{x¿df s]Gb|lt ePsf] b]lvG5 .

94

lgwf{/s tyf hf]lvd tTjx¿ (Determinants and Risk factors)

PrcfOeL k|;f/0f x'g] tl/sf / hf]lvdsf] tTjx¿n] g} PrcfOeLsf] Olk8]ldof]nf]hLnfO{

lgwf{/0f ub{5 . of] /f]usf] d'Vo sf/s tTj HIV efO/; xf] . of] efO/; ;+qmldt

JolQmsf /ut, of}g /;÷ljo{ df k|r'/dfqfdf kfOG5 . of}g hf]lvd Jojxf/ ug]{ JolQmx¿df

HIV efO;/sf] ;+qmd0f x'G5 . ;+;f/e/df ljkl/t lnª\uL of}g ;Dks{sf] dfWodaf6

HIV ;+qmd0fsf] &%–*% k|ltzt x'g] ePsf]n] o;sf] k|d'v sf/0f of}g k|zf/0f (Sexual

transmission) xf] . HIV2 eGbf HIV1 a9L ;+qmd0f x'G5 . of]gLåf/df Psk6s of}g

;Dks{ ubf{ HIV ;g]{ ;Defjgf )=))!! x'G5 eg] u'åf/df ;Dks{ ubf{ ;g]{ ;Defjgf

)=))*@ k|lt ;Dks{ x'G5 . ue{lg/f]w rSsL vfP/ of}g ;Dks{ ug]{, d'vdf, u'åf/df of}g

;Dks{ ug]{, nfu'kbfy{ ;]jg ug]{ dlxgfjf/Lsf] ;dodf of}g ;Dks{ ug]{ tyf anfTsf/sf]

36gfdf kg]{ JolQmnfO{ HIV ;+qmd0f x'g] ;Defjgf a9L x'G5 . ;'Oaf6 nfu' kbfy{ ;]jg

ug]{ / c;'/lIft of}g ;Dks{ ug]{ JolQmnfO{ a9L HIV ;+qmd0f x'G5 . ;fdflhs cfly{s

cj:yfn] klg HIV sf] ;+qmd0fsf] lgwf{/0f ub{5 . u/Lj k/jf/sf dflg;x¿ sfdsf]

vf]hLdf ljb]zdf hfg] / 3/af6 nfdf] ;do;Dd 6f9f /xg] JolQmx¿ j]Zofj[lQdf ;+nUg

;Defjgf a9L x'G5 . u/LjLsf] sf/0fn] ubf{ sltko dlxnf tyf s]6Lx¿ zx/ahf/df

cfP/ of}g k]zfdf ;+nUg x'g] ub{5g\ . kl/0ffd:j¿k sfdsf] vf]hLdf a;fO ;g]{ / of}g

k]zfdf ;+nUg x'g] JolQmx¿df HIV/AIDs nfUg] ;Defjgf a9L x'G5 . sltko

;d'bfosf] dflg;x¿ h:t} jfbL ;d'bfodf dlxnfx¿ k/Dk/fut ¿kdf of}g Joj;fo ug]{

ub{5g\ . o;k|sf/sf] ;fdflhs k|rngn] klg HIV ;+qmd0fdf 6]jf k'/fpFb5 . o;/L

;fdflhs–cfly{s cj:yfn] klg HIV/AIDs sf] Olk8]ldof]nf]hLnfO{ lgwf{/0f ub{5 .

#=&=$ OGˆn"oGhf tyf s8f Zjf;k|Zjf; /f]usf] Olk8]ldof]nf]hL (Epidemiology of

Influenza and ARI)

ljleGg 7fp tyf If]qdf df};d cg';f/ b]vf kg]{ ?3fvf]sL tyf Zjf; k|Zjf; ;DaGwL

;+qmd0fsf] /f]unfO{ OGˆn"oGhf elgG5 . of] /f]u :yflgs, dxfdf/L tyf ljZjJofkL?kdf

klg b]vf kb{5 . OGˆn"oGhf Nofl6g zAb Coeli influenzaaf6 cfPsf] xf] h;sf] cy{

x'G5 cfsfzLo k|efj jf hnjfo' k|efj eGg] x'G5 . kl5 lr;f] tyf ;bL{sf] sf/0faf6

OGˆn"oGhf x'G5 eGg] ljZjf; ug{ yflnPsf] xf] . OGˆn"oGhf jf ?3fvf]sL RNA efO/; P

95

aL / ;L sf] Zjf;k|Zjf; gnLdf ;+qmd0f eP/ nfUb5 . OGˆNo'PGhf efO/;

cf]/yf]ldShf]dfOl/8f (Orthomyxomiridae) ju{df kb{5 . o;}sf] cfwf/df OGˆn"oGhf

P aL / ;L eGg] ul/G5 . efO/;sf] ;txdf kfOg] z'Id tTj PlG6h]gsf] cfw/df H / N

sf] cfwf/df ljleGg pk;d"xdf ljefhg u/]sf] kfOG5 . of] H / N sf] ;+of]hgaf6

OGˆNo'PGhfsf] pk;d"xdf ljefhg u/]sf] kfOG5 . a8{ˆn" OGˆNo'PGhf P sf] pk;d"x

H5N1 sf] gfdn] kl/lrt 5 . aª\u'/dfaf6 dflg;df ;g]{ OGˆNo'PGhfnfO{ :jfOgˆn"

elgG5 / o;nfO{ H1N1 efO/;sf] sf/0fn] ePsf] elgG5 . efO/;sf] c0f'j+zdf l56f]

pTkl/jt{g eP/ o;sf] PlG6h]gdf klg kl/jt{g eO/G5 . Psk6s ?3fvf]sL nfu]kl5

dflg;df /f]u k|lt/f]w Ifdtf k|fKt x'G5 t/ Ps df};ddf cfqmd0f u/]sf] efO/; csf]{

df};ddf cfOk'Ubf gof PlG6h]g ePsf] efO/; aGg] ePsf]n] dflg;nfO{ km]/L ?3fvf]sL

nfU5 . o;/L pTk/jt{g eP/ gof pk;d"xsf] efO/;sf] ljsf; x'bf s'g} ;dodf

OGˆn"oGhf dxfdf/Lsf] ?kdf km}lng] / dflg;x?sf] d[To' x'G5 . vf;u/L s'kf]lift

afnaflnsfx?, cGo/f]unfu]/ sdhf]/ ePsf, a'9fkfsf, u/La, le8, 9'nf], w'Fjfdf a:g]

JolQmx?df o;n] s8f cfqmd0f ub{5 . of] /f]u !) b]vL %) aif{sf] cGt/fndf ljZjsf]

ljeGg 7fpFdf dxfdf/L jf ljZjJofkL /f]usf] ?kdf km}lng] u/]sf]5 . la;f}+ ;tfAbLdf ;g

!(!*÷!( df :k]gdf ˆn" km}lnPsf] lyof] . ;g !(%& df Plzog ˆn" km}lnPsf] lyof] . ;g

!(^* df xª\sª\u ˆn" km}lnPsf] lyof] . ;g !((& b]vL @))@ ;Dd xª\sª\udf Pleog jf

a8{ˆn" OGˆNo'PGhf P sf] pk;d"x H5N1 sf] sf/0fn] km}lnPsf] lyof] . ;g @))( df

ljZjsf] ljleGg b]zx?df :jfOg OGˆNo'PGhf H5N1 km}lnP/ g]kfndf klg cfPsf] lyof] .

t/ g]kfndf dxfdf/Lsf] ?kdf eg] km}lng ;s]g .

lgdf]lgof tyf Zjf;k|Zjf; gnLdf x'g] ;+qmd0f g]kfnsf] k|d'v ;d:of xf] . o;n] kfFr jif{

d'lgsf afnaflnsfx¿nfO{ ;tfpg] ub{5 . o'lg;]km -@))^_ sf] cg';f/ kfFr jif{ d'lgsf

afnaflnsfx¿df !% s/f]8 lgdf]lgofsf 36gfx¿ b]vf kb{5 . ARI tyf lgdf]lgofsf]

sf/0fn] k|To]s jif{ ljZjf; $) nfv afnsflnsfx¿sf] d[To' x'G5 . To; dWo sl/a !^

nfv -$)%_ blIf0f Plzofsf] afnaflnsfx¿ kb{5g\ .

cfj[lQ÷b/ (Frequency/Rate or ARI/Pneumonia): :jf:Yo ;]jf ljefu

jflif{s k|ltj]bg @)^&÷^* sf] cg';f/ @(,((,**$ kfFr jif{ d'lgsf afnaflnsfx¿

ARI af6 u|l;t ePsf lyP . cyf{t\ k|To]s jif{ sl/a #), nfv afnaflnsfx¿ ARI

96

af6 u|l;t x'G5g\ . of] ;ª\Vof emf8fkvfnf eGbf !) nfv a9L 5 . o;af6 :ki6 x'G5 ls

kfFr jif{ d'lgsf afnaflnsfx¿nfO{ emf8fkvfnfn] eGbf ARI/Pneumonia n] a9L

;tfpF5 . /fli6«o txdf 36gf b/ (Incidence Rate) k|lt xhf/ **@ afnaflnsfx¿

5 . ARI ePsf dWo sl/a #) k|ltzt (28.97) nfO{ lgdf]lgof x'G5 .

ljt/0f (Distribution of ARI):

sf] ARI sf] ;d:of dWoklZrd ljsf; If]qdf ;a} eGbf a9L (!,)$(÷!)))_, To;kl5

;'b'/klZrd

-!,)*&÷!)))_, k"jL{ ljsf; If]q -!,)@$_ / dWo ljsf; If]qdf sd -&)$÷!)))_ 5 .

k"jL{o, dWo / ;'b"/klZrd ljsf; If]qdf ARI sf] 36gf b/ k|ltxhf/ ! xhf/ eGbf a9L

5 . o;af6 s] :ki6 x'G5 eg] To; If]qsf k|foM ;a} afnaflnsfx¿nfO{ ARI x'g] /

sltkonfO{ PseGbf a9L k6s ARI x'G5 . To;} u/L lgdf]lgof 36gf ;a} eGbf a9L

dWoljsf; If]q -#!=&%_ a9L To;kl5 k"jL{ If]q -#!=#%_ / klZrd ljsf; If]qdf sd -

@^=%_ 5 . ARI tyf lgdf]lgofsf ;d:of a9L dfqfdf u/Lj, em'k8L, w'nf], w'Fjf j:g]

afnaflnsfx¿nfO{ x'G5 .

lgwf{/s tTj (Determinants)

o;sf] d'Vo sf/s tTj JofS6]/Lof / efO/;sf] ;ª\qmd0f xf] . of] /f]un] a9L dfqfdf u/Lj

kl/jf/df hGd]sf s'kf]lift, aflnsfnfO{ ;tfpF5 . w'nf], w'Fjf tyf lr;f] sf]7fdf a:g]

u/Ljsf afnaflnsf a9L ;tfpg] ePsf]n] u/LjL, s'kf]if0f / w'nf], w'jfo'Qm 3/sf] jftfj/0f

g} d'Vo lgwf{/s xf] .


!= ;?jf/f]usf] Olk8]ldof]nf]hLaf/]df j0f{g ug'{ kbf{ s'g s'g kIfnfO{ Wofg lbg' kb{5 <

@= g]kfnsf] Ifo/f]u, :jf; k|Zjf; /f]u / cf}nf] /f]usf]x?sf] 36gf b/, ljt/0f / sf/s

tTjx?sf] af/]df s] l;Sg' eof] <

#= Pr= cfO=eL=÷P8\;sf] k|sf]k b/ / g]kfndf o;sf] cj:yf s] 5 <

97

lqmofsnfk

:jf:Yo ljefuaf6 k|sfzg x'g] Annual Report of Department of Health Services af6 ut kfFr aif{sf] tYofª\s ;ª\sng u/L g]kfnsf] d'Vo ;?jf/f]u h:t} emf8fkvfnf, Pcf/cfO, Ifo/f]usf] sf/0f, ljt/0f tyf 36gf b/sf] k|j[lt sf] AofVof ljZn]z0f u/L hg{ndf k|sfzg of]Uo sl/a tLg xhf/ zAbsf] Ps n]v tof/ kfg'{xf];\ .

#=!) /f]u k|sf]ksf] cGj]zif0f ug]{ rn0fx? (Steps in disease outbreak investigation)

s'g} /f]u s'g} ;d'bfo jf ef}uf]lns If]qdf ;w}F x'g] ck]lIft 36gfsf] dfqf÷;+Vof a9]/ c;fdfGo

?kdf b]vf k¥of] eg] dxfdf/L elgG5 . s'g} ;d'bfo tyf If]qdf ck|Toflzt ?kdf /f]u

km}ng'nfO{ dxfdf/L elgG5 . s'g} ;Lldt If]qdf /f]u cfsl:ds / ck|Toflzt ?kdf a9\g'nfO{

/f]u k|sf]k (Disease outbreak) elgG5 . (Disease outbreak refers to a

sudden, unexpected increase in the occurrence of disease or health

related event within a relatively limited geographic area) /f]u cfsl:ds /

ck|Toflzt ?kdf b]vfkg]{ / km}lnPsf] a]nfdf /f]uk|sf]ksf] af/]df cGj]if0f ug'{ kb{5 . ck|Toflzt

?kdf b]vfk/] /f]usf] af/]df pknAw tYonfO{ d"Nofª\sg u/L To;sf] af/]df kl/sNkgf agfP/

tYofª\s ;ª\sng u/L kl/sNkgf k/LIf0f ug]{ Jojl:yt k|lqmofnfO{ /f]u k|sf]ksf] cGj]zif0f

elgG5 . o; k|sf/sf] cGj]if0f ubf{ lgDg !) rn0f ckgfpg' kb{5 .

!= /f]u k|sf]k cGj]if0fsf] tof/L ug]{ (Prepare to investigate): s'g} 7fpFdf /f]u k|sf]k

ePsf] ;"rgf cfpg] lalQs} cWoog cGj]if0f ug]{ ;d"x agfpg], ;DalGwt ;flxTosf]

k'g/fjnf]sg ug]{, ;DalGwt :jf:Yo lgsfodf va/ ug]{ / /f]u lgoGq0fsf] nflu tof/L ug]{,

;DalGwt If]qdf k|j]zsf] nflu tof/L ug'{ kb{5 .

@= /f]u k|sf]k eP gePsf] lgwf{/0f ug]{ (Determine the existence of an

outbreak): lg/Gt/ :jf:Yo lgu/fgLaf6 k|fKt tYofª\ssf] k|j[lt x/]/ ;dfGo cg'dflgt

eGbf a9L b]vf k/]sf] 5 5}g Ct', dlxgf, xKtf cflbsf] cfwf/df /f]usf] 36gfx?sf] u|fkm

agfP/ x]g'{ kb{5 . olb /f]uLsf] ;Vof ck|Toflzt?kdf a9L b]vf k/]sf] 5 eg] /f]u k|sf]k tyf

dxfdf/L cj:yf 5 eg]/ lgZro ug'{ kb{5 .

98

#= /f]u lgbfg k|df0fLs/0f ug]{ (Verify diagnosis): s'g} If]qdf s'g} /f]u km}lnof] k|sf]k

eof] eg]/ ;drf/ ;Dk|]z0f ePsf] 5 eg] ToxL /f]u xf] jf cGo /f]u eg]/ /f]usf] lgbfg u/]/

lgZro ug'{ kb{5 . h:t} x}hfsf] k|sf]k xf] eGg] xNnf 5 eg] lb;fsf] gd'gf ;ª\sng u/]/

lgbfg ug'{ kb{5 . dn]/Lofsf] k|sf]k ePsf] 5 eg] Hj/f] cfPsf] lj/fdLaf6 /ut ;ª\sng u/L

k/LIf0f u/L lgZro tyf k|dfl0fs/0f ug'{ kb{5 .

$= 36gfsf] kl/eflift ug]{ / 36gfsf] cg'dfg ug]{ (Define case and estimate the

number of cases): s'g s'g nIf0f tyf ;d:of ePsf JolQmnfO{ /f]u nfu]sf] xf] eg]/

lgZro ug{sf nflu :t/Lo dfkb08 agfP/ /f]usf] 36gfsf] kl/eflift ug'{ kb{5 . 36gfsf]

kl/eflift u/]kl5 36gfsf] vf]hL ug]{, kQf nufpg] / 36gfsf] uGtL u/L ;Vof cg'dfg ug'{

kb{5 .

%= j0f{gfTds Olk8]ldof]nf]hLsf] sfo{ ug]{ (Perform descriptive epidemiology):

/f]usf] 36gfsf] af/]df tYofª\s ;ª\sng u/] kl5 JolQm, 7fpF tyf ;dosf] cfwf/df tflnsf

agfpg], af/Djf/tf uGtL ug]{, k|ltzt lgsfNg], 36gf b/ tyf /f]un] dfg{ ;Sg] b/ klxrfg

ug]{, lrq, jqm/]vf agfP/ tYofª\snfO{ k|:t't\ ug'{ kb{5 .

^= /f]u k|sf]ksf] af/]df kl/sNkgf agfpg] (Generate hypothesis): j0f{gfTds

ljZn]if0fsf] cfwf/df sxfF, s:nfO{ / s] sf/0fn] ubf{ /f]u k|sf]k ePsf] eGg] af/]df kl/sNkgf

agfpg' kb{5 .

&= a9L Jojl:ylt ljZn]ifgfTds cWoo 9frf k|of]u u/L kl/sNkgfsf] d"Nofª\sg ug]{

(Evaluate the hypothesis by conducting more systematic study):

kl/sNkgf k/LIf0f ug{sf nflu pknAw cGo tYofª\s ;Fu t'ngf ug]{ jf t'ngfTds cWoog

jf 36gf cWoog jf sf]x6{ cWoog 5gf]6 u/L hf]lvd ;DalGwt ;"rgf;+sng u/L ljZn]if0f

u/L kl/sNkgfsf] d"Nofª\sg ug'{ kb{5 .

*= cltl/Qm jftfj/0fLo cWoog ug]{ (Conduct additional envrionmental

studies): . vfgf, kfgL, ;/;kmfOsf] cj:yf, dflg;x?dsf] afgL Jojxf/ ;DaGwL tYofª\s

;+sng u/L /f]u k|sf]kdf jftfj/0fLo tyf Jojxfl/s tTjsf] e'ldsf klxrfg ug'{ kb{5 .

(= cGj]if0fsf] k|ltj]bg tof/ kfg]{ (Prepare report): Jojl:yt ?kdf tYofª\s ;+sng,

ljZn]if0f tyf kl/sNkgfsf] k/LIf0f u/] /f]u k|sf]k x'g'sf] sf/0f tyf hf]lvd tTjsf]af/]df

99

glthf kQf nfufP kl5 cWoog cGj]if0fsf] kltj]bg tof/ kfg'{ kb{5 / ;DalGwt lgsfo tyf

;/f]sf/jfnfnfO{ cWoogaf6 k|fKt glthf ;+k|if0f ug'{ kb{5 .

!)= /f]u k|sf]k lgoGq0f tyf /f]syfdsf pkfox? sfof{Gjog ug]{ (Execute control and

preventive measures): /f]u k|sf]ksf] sf/0f, hf]lvd tTj tyf jftfj/0fLo cj:yfsf]

klxrfgsf] cfwf/df pko'Qm lgoGq0f tyf /f]syfdsf pkfox? sfof{Gjog ug]{ sfo{qmd

zL3|?kdf ;~rfng u/L /f]uk|sf]ksf] lgoGq0f ug'{ kb{5 .

#=!! /f]u lgu/fgLsf] cjwf/0f / k|sf/ (Concept and types of disease surveillance)

;le{n]G; zAb k|m]Gr zAb Sur (Over) / Veiller (to watch) ldn] ag]sf] xf], h;sf]

cy{ x'G5 kx/]bf/÷lgu/fgL ug'{ (To watch over) eGg] x'G5 . /f]usf]lgu/fgL jf

;le{n]G; eGgfn] /f]u jf /f]u ;DalGwt 36gfsf] pTklQ, pkl:ylt÷36gf, ljt/0f tyf

lj:t/;+u ;DalGwt ;a} kIfsf] af/]df glhsaf6 lg/Gt/ ¿kdf cjnf]sg, cg'udg,

;'kl/j]If0f tyf hfFrk8tfn ug]{ / ;d:ofnfO{ ;dodf lgoGq0f tyf ;dfwfg ug{ d2t

ug'{nfO{ hgfpF5 . o; k|sf/sf] ;t{stf / lgu/fgLn] ;?jf /f]u nfu]sf] JolQmnfO{ ;d:of

klxrfg, lgbfg tyf pkrf/ u/L ;d'bfodf /f]u km}lng] / dxfdf/L x'g] 36gfnfO{ lgoGq0f

ug{ ;+ej x'G5 . o;sf] cjwf/0ffnfO{ lj:tf/ u/L of]hgf agfpg / ;d:of ;dodf

;dfwfg ug{sf] nflu /f]u 36gfsf] af/]df lg/Gt/ cjnf]sg tYofÍ ;+sng, ljZn]if0f tyf

JofVof g]{ sfo{nfO{ Surveillance elgG5 .

u|Lg ju{ / ;fyLx¿sf] cg';f/, æs'g} /f]usf] 36gfdf x'g] kl/jt{gnfO{ zL3| / ;]l6s

klxrfg ug{sf] nflu hg;d'bfonfO{ lg/Gt/ ¿kdf cjnf]sg ug'{nfO{ lgu/fgL elgG5

(Surveillance is the ongoing observation of a population for rapid

and accurate detection of change in the occurrence of particular

disease) .

Surveillance eGgfn] lgDg s'/fnfO{ hgfpF5 M–

– s'g} /f]u jf :jf:Yo ;d:ofsf] hf]lvddf k/]df hg;ª\Vofsf] lg/Gt/ cjnf]sg

– Jojl:yt ¿kn] /f]u ;DalGwt 36gfsf] lg/Gt/ tYofÍ ;+sng, ljZn]if0f / JofVof ug'{,

– lg/Gt/ ¿kdf ;+slnt tYofÍsf] cfwf/df /f]u tyf 36gfsf] pkl:ylt 36gf b/, ljt/0f

lgwf{/ssf] zL3|klxrfg,

100

– ;ª\slnt ;"rgfaf6 k|fKt glthf zL3| lj:tf/ tyf ;~rf/

– /f]u tyf 36gf ;dodf lgoGq0f ug{sf] nflu cGo ;"rgf tyf cfsF8fsf] k|of]u

/f]u lgu/fgLsf] k|sf/ (Types of disease surveillance)

lgu/fgLnfO{ tLg efudf ljefhg ug{ ;lsG5 M–

s= ;lqmo lgu/fgL (Active surveillance)

hf]lvddf k/]sf hg;d'bfo tyf If]qsf dflg;x¿sf] 3/ 3/df uP/ :jf:Yo sfo{stf{n]

/f]u;Fu ;DalGwt 36gfsf] af/]df lg/Gt/ tYofÍ÷;"rfgf ;+sng, ljZ]nif0f tyf JofVof

ug'{nfO{ ;lqmo lgu/fgL elgG5 . ;?jf /f]u jf dxfdf/L km}lng] If]q jf /f]u pGd"ng

sfo{qmd ;~rfng u/]sf] ;dodf ;lqmo lgu/fgL pkof]uL x'G5 . g]kfndf lj=;+=@)!%

;fndf cf}nf] pGd"ng sfo{qmd ;~rfng eP kl5 cf}nf]af6 k|efljt If]qsf k|To]s 3/df

uP/ 3/ kl/jf/df s;}nfO{ Hj/f] cfPsf] 5 eg]/ ;f]Wg] / Hj/f] cfPsf] JolQmaf6 /utsf]

gd"gf ;ª\sngug]{, cf}nf] /f]usf] lgbfg tyf pkrf/ ug]{ ul/GYof] . o;k|sf/ lgu/fgL

k|efjsf/L x'G5 t/ w]/} hgzlQm tyf vr{ nfUg] ePsf]n] ;w} ;~rfng ug{ ;lsFb}g .

v= lgliqmo lgu/fgL (Passive surveillance)

:jf:Yo ;+:yf tyf c:ktfnaf6 dfl;s jf q}dfl;s ¿kdf /f]u;Fu ;DalGwt 36gfsf]

tYofÍ ;ª\sng ljZn]if0f, JofVof tyf /f]u tyf 36gfdf cfPsf kl/jt{gsf] klxrfg

ug'{nfO{ lgliqmo lgu/fgL elgG5 . g]kfndf k|To]s :jf:Yo ;+:yf h:t} :jf:Yo rf}sL,

pkrf}sL, :jf:Yo s]Gb|n] dfl;s ¿kdf lhNnf :jf:Yo sfof{nodf /f]u, pkrf/ tyf vf]ksf]

k|ltj]bg k7fpF5 . o;/L :jf:Yo ;+:yfaf6 k|fKt x'g] lgoldt tYofÍnfO{ ljZn]if0f /

JofVof u/L hg;d'bfosf] :jf:Yo ;d:of tyf ultljlwnfO{ lgu/fgL /fVg ;lsG5 .

u= ;]lG6g]n lgu/fgL (Sentinel surveillance)

s'g} /f]u af/]df 5gf]6 ul/Psf] ljleGg :yfgsf :jf:Yo ;+:yf tyf k|of]uzfnfaf6 lgoldt

¿kdf tYofÍ, ;ª\sngug]{, gofF 36gfx¿sf] klxrfg ug]{, 36gfx¿ tyf d[To'b/ kQf

nufpg], tYofÍ zf:qLo ljZn]if0f u/L ;Dk"0f{ hg;ª\Vofdf /f]usf] b/ tyf k|j[lQ

(Trends) lgwf{/0f ug{] tl/sfnfO{ ;]lG6n]g lgu/fgL elgG5 . g]kfndf

Pr=cfO=eL÷P8\;sf] ;ª\Vof tyf b/ oxL ljlwsf] cfwf/df cg'dfg ul/G5 . Pr=cfO=eL

P8\;sf] tYofÍ ;a} :jf:Yo ;+:Yfaf6 ;lhn} k|fKt x'Fb}g . o;sf] nflu b]zsf] ljleGg

101

7fpFsf] 5gf]6 ul/Psf lglZrt s]xL :jf:Yo ;+:yf tyf k|of]zfnfaf6 lg/Gt/ ¿kdf HIV

positive tyf Negative sf] ;ª\Vof k|fKt x'G5 . To;sf] cfwf/df b]zsf] hg;ª\Vofdf

HIV/AIDS sf] cj:yfsf] cg'dfg ul/G5 .

/f]u lgu/fgL ubf{ ckgfOg] rn0fx¿ (Steps in disease Surveillance)

– /f]u lgu/fgLsf] nIo tyf p2]Zo lgwf{/0f ug]{ (Establish the goals and

objectives of disease surveillance)

– lgu/fgL ug{ rfx]sf] /f]u jf :jf:Yo ;d:ofsf] klxrfg tyf kl/eflift ug]{ (Identify

and define the disease of interest)

– tYofÍ ;ª\sng ;fwg tyf ljlw klxrfg ug]{ (Identify data collection tool and

techniques)

– /f]usf] ljleGg kIfsf] af/]df tYofÍ ;ª\sng tyf ;+u|x ug'{ (Collect and compile

data on different aspect of a disease)

– tYofÍsf] ljZn]if0f / JofVof ug]{ (Analyze and interpret data)

– ;+slnt tyf ljZn]if0f ul/Psf] tYofÍ÷glthf /f]u lgoGq0f ;+nUg lhDd]jf/ JolQmnfO{

k|bfg ug]{ (Provide these data and findings to those responsible for

controlling the disease) .


!= /f]uk|sf]ksf] cGj]if0f s;/L ul/G5 >

@= ;?jf/f]usf] lgu/fgL ubf{ s] s] s'/fnfO{ Wofg lbg' kb{5 <

102

lqmofsnfk != tkfO{sf] lhNnfd ;?jf /f]usf] lgu/fgL ug{ s] s] k|of;x? ul/Psf 5g\ < o;sf] af/]df lhNnf hg:jf:Yoaf6 ;"rgf;ª\sng u/L Ps n]v tof/ kfg'{xf];\ .

#=!@ ;?jf /f]u lgoGq0f tyf /f]syfd ug{] ;fdfGo l;4fGt tyf pkfox¿

(Disease control methods and principles)

;?jf /f]u tyf dxfdf/L /f]u lgoGq0f ug{ ;}l¢lGts?kdf lgDg pkfox¿ ckgfpg kb{5M–

!= /f]usf e08f/ tyf ;|f]tsf] lgoGq0f

(Control of the reservoir and source of disease)

/f]usf hLjf0f'x¿ a:g], afFRg] / j[l4 x'g] 7fpF, dflg;, k|f0fL jf lghL{j j:t'x¿nfO{ /f]usf]

e08f/ elgG5 . lg/f]uL JolQmsf] z/L/df /f]usf hLjf0f'x¿ cfpg] 7fpF h:t}M /f]uL JolQm,

k|f0fL tyf lghL{j j:t' g} /f]usf ;|f]t x'g\ . w]/} k|sf/sf /f]usf] e08f/ /f]uL dflg; g} xf] .

s'g} /f]usf] e08f/ k|f0fL klg x'G5 . ;?jf /f]unfO{ lgoGq0f tyf /f]syfd ug{sf] nflu

/f]usf] e08f/ / ;|f]t klxrfg u/L lgoGq0f tyf pGd"ng ug]{ k|of; ug'{ kb{5 . /f]usf]

dfgj e08f/ lgoGq0f ug{ lgDg lnlvt pkfox¿ ckgfpg' kb{5 .

s_ zL3| lgbfg (Early diagnosis)

s'g} klg /f]u nfUg] lalQs} /f]u s] sf/0fn] nfu]sf] xf] eGg] s'/f zL3| kQf nufpg'

kb{5 . ;?jf /f]usf] hfFrk8tfn, zf/Ll/s hfFr tyf k|of]uzfnf k/LIf0f u/]/ zL3|

lgbfg ug'{ kb{5 . lgbfg u/]kl5 t'?Q} pkrf/ ug'{ kb{5 . o;/L zL3| lgbfg / pkrf/

ubf{ /f]usf] e08f/ lgoGq0f x'G5 / /f]u km}lng kfpFb}g .

v_ ;"rgf ug]{ (Notification)

;d'bfodf ;?jf /f]u b]vf kg]{ lalQs} :yfgLo :jf:Yo ;+:yf tyf sfo{stf{nfO{ ;"rgf

ug'{{ kb{5 . /f]usf] af/]df ;dodf hfgsf/L u/fPsf] v08df ;DalGwt lgsfon]

hfFrk8\tfn ug]{ / /f]u km}lngaf6 lgoGq0f ug{sf nflu ;d'bfodf ljleGg ultljlw

;~rfng ub{5 . o;/L ;dodf ;"rgf k|jfx ug]{, ;/sf/sf] ;DalGwt lgsfon] /f]usf]

klxrfg tyf lgoGq0f ug]{ k|of; u/]sf] v08df /f]usf] e08f/df klg lgoGq0f x'G5 /

/f]u km}lng kfpFb}g

u_ cnu /fVg] (Isolation)

103

3/ ;d'bfodf s'g} JolQmnfO{ ;?jf /f]u nfUg] lalQs} cnu} sf]7fdf /fVg] / pkrf/

ug{] u/]sf] v08df c?nfO{ /f]u km}lng kfpFb}g . h:t}M ;d'bfo jf ljBfnodf 7]pnf

/f]u, cfFvf kfSg] /f]u jf cGo ;?jf /f]u nfUg] lalQs} cnu} /fVg] u/]sf] v08df

/f]usf] e08f/af6 hLjf0f'x¿ cGo JolQmx¿df k|;f/0f x'g kfpFb}g .

3_ Sjf/G6fOgsf] lgod cjnDag ug]{ (Quarantine)

dxfdf/L /f]u km}lnPsf] ;dodf /f]u km}}lnPsf] If]qaf6 cfPsf jf /f]usf] hf]lvddf

k/]sf JolQmnfO{ /f]usf] nIf0f b]vf kg]{ cjlw;Dd lgu/fgLdf /fVg] / ;Lldt If]qdf

dfq lx8\8'n ug{ kfpg] u/L lgoGq0f /fVg'nfO{ Sjf/G6fOg elgG5 . ;fdfGo ;?jf

/f]udf of] lgod nfu" x'Fb}g . Kn]u, tyf dxfdf/L kmn km}lnPsf] ;dodf /f]u km}lnPsf]

If]qaf6 cfPdf dflg;nfO{ k|j]z ug]{ 7fpF tyf cWofudgdf ;f]wk'5 u/L cfjZostf

cg';f/ Sjf/G6fOgdf /fVg' kb{5 . of] sfo{n] dxfdf/L /f]u km}lngaf6 lgoGq0f ug{

d2t ub{5 .

ª_ pkrf/ ug]{ (Treatment)

w]/} k|sf/sf ;?jf /f]unfO{ k|efjsf/L cf}ifwLåf/f pkrf/ ug{ ;lsG5 . ;+qmldt JolQm

g} /f]usf] e08f/ x'g] ePsf]n] /f]u nfu]sf JolQmnfO{ lgbfg u/]/ plrt / k|efjsf/L

tl/sfn] pkrf/ ug'{ kb{5 . s'g} ;?jf /f]u h:t}M Ifo/f]u, s'i7/f]u tyf le/ËLsf

ls6f0f'x¿ nfdf] ;do;Dd ;'if'Kt cj:yfdf /xg ;Sb5 . /f]usf nIf0f b]vf gk/] klg

oL /f]usf ls6f0f' ePdf JolQmn] /f]u ;fg]{ ub{5g\ . To;}n] o:tf ;?jf /f]ux¿sf] k"0f{

pkrf/ u/]/ /f]usf] e08f/nfO{ lgoGq0f ug'{ kb{5 .

r_ lgu/fgL tyf hfFrk8tfn sfo{ (Epidemiological surveillance and

investigation)

;?jf /f]usf] af/]df lg/Gt/ cg'udg ug{], ;"rgf ;+sng tyf ljZn]if0f ug]{ sfo{nfO{

Olk8]ldof]nf]lhsn lgu/fgL elgG5 . o; k|sf/sf] lgu/fgL ubf{ s'g} /f]u b]vf kg]{

lalQs} kQf nufpg ;lsG5 . s'g} ;?jf /f]u ;fdflhs, cfly{s, Jojxfl/s tyf

jftfj/0fLo cflb dWo] s'g sf/0fn] ubf{ km}lnPsf] xf] eGg] s'/f kQf nufpg

Olk8]ldof]nf]lhs cWoog tyf cGj]if0f ug{' kb{5 . /f]usf sf/0f tyf sf/s tTjsf]

klxrfg ePdf /f]u lgoGq0f tyf /f]syfdsf] pkfo cjnDag ug{ ;lhnf] x'G5 .

5_ lg;ª\qmd0f tl/sf ckgfpg] (Disinfection)

104

dflg;sf] z/L/ eGbf aflx/ s'g} j:t' jf ;|f]tdf /x]sf hLjf0f'x¿ dfg{] sfo{nfO{

lg;ª\qmd0f elgG5 . hLjf0f' dfg]{ /;folgs kbfy{ h:t} Phenol, alcohol,

formaldehyde tyf halogen compound cflb b'lift tyf ;+qmldt If]qdf

k|of]u u/]/ lg;ª\qmd0f ug{ ;lsG5 . k|of]u u/]sf sk8f tyf j:t'nfO{ 3fddf ;]sfP/

lg;ª\qmd0f ug{ / /f]usf ls6f0f'x¿ gi6 ug{ ;lsG5 .

@= /f]u ;g]{ dfWod jf k|;f/0fdf cj/f]w ug]{

(Blocking or interrupting disease transmission)

;?jf /f]usf] lgoGq0f / /f]syfd ug{sf nflu ckgfOg] d'Vo kIf dWo /f]u ;g]{ af6f] tyf

z[ª\vnfnfO{ cj?4 kfg'{ jf /f]u k|;f/0f cj?4 ug'{ xf] . o; cGtu{t /f]usf hLjf0fx¿

/f]usf] ;|f]taf6 lg/f]uL JolQmdf k|j]z x'gaf6 /f]Sg jf k|j]z u/]sfnfO{ gi6 ug{sf nflu

JolQmut tyf jfx\o jftfj/0f kl/jt{g ug]{ s'/fx¿ o; cGtu{t kb{5 . emf8fkvfnf,

cfpF, 6fOkmfO8, hl08;sf] nflu k|b"lift kfgL /f]u ;g]{ dfWod x'g ;S5 . kfgLdf Snf]l/g

/fv]/ jf kfgL k|zf]wg u/]/ /f]u ;g]{ k|lqmofnfO{ cj?4 kfg{ ;lsG5 . o; cGtu{t lgDg

lnlvt pkfox¿ kb{5 .

s_ vfg]kfgL z'4Ls/0f tyf Snf]l/g];g ug]{

v_ vfgfnfO{ /fd|f];Fu ksfpg] / b'wnfO{ kf:rnfOh -ls6f0f'/lxt_ ug]{

u_ vfgf tyf df;'sf] :jR5tfdf Wofg lbg]

3_ JolQmut tyf xftsf] ;kmfOdf Wofg lbg]

ª_ /f]usf] e]S6/ h:t} nfdv'§] tyf e';'gfsf] lgoGq0f ug]{ / nfDv'§]sf] 6f]sfOaf6 aRg]

em'nsf] k|of]u ug]{

r_ kof{j/0fsf] kl/dfh{g tyf jftfj0fLo ;/;kmfOdf ;'wf/ ug]{

5_ ;'/lIft of}g ;Dks{ sfod ug]{ /f]u ;fg]{ dfWodx¿ / cj:yf l;h{gf x'g glbg] .

#= /f]u u|x0f nfos JolQmsf] ;'/Iff (Protecting susceptible host)

;?jf /f]un] c;/ kfg]{ tyf cfqmd0f ug{ ;Sg] dflg;nfO{ /f]u u|x0f ug{ nfos JolQm

elgG5 . /f]u k|lt/f]w Ifdtf sdhf]/ ePdf lzz', afnaflnsf, s'kf]lift tyf vf]k gkfPsf

JolQmx¿df ;?jf /f]un] l56f] cfqmd0f ub{5 . /f]u u|x0f ug{ nfossf cfd

dflg;x¿nfO{ lgDg tl/sf tyf pkfon] ;'/Iff ug{ ;lsG5 .

105

s_ vf]k nufP/ (Immunization)

;?jf /f]u tyf dxfdf/L /f]u h:t} x}hf, 6fOkmfO8, OGkmn'P]Ghf, Ifo/f]u, nx/vf]sL,

Yellow fever cflbsf] vf]k ;]jf pknAw 5 . sltko vf]kx¿ h:t} Ifo/f]u,

kf]lnof], nx/vf]sL, Eofu'6] /f]u, bfb'/f, /f]usf vf]k lgoldt ¿kdf pknAw 5 . oL

vf]kx¿ aRrf hGd]kl5 ;'? u/]/ Ps jif{ leq k"/f ug'{ kb{5 . x}hf tyf 6fOkmfO8sf]

vf]k dxfdf/L km}lnPsf] cj:yfdf k|of]u u/]/ /f]u u|x0f nfos JolQmnfO{ arfpg

;lsG5 . w]/} vf]kx¿ nufPkl5 nfdf] ;do sfd ug{ ;Sg] u/L /f]u k|lt/f]w Ifdtf

pTkGg ug{ ;Sb5 . o;nfO{ Active immunization elgG5 . sltko vf]kx¿

Antisera tyf Human Immunoglobin af6 agfOPsf] x'G5g\ . o; k|sf/sf]

vf]kn] ! b]vL ^ xKtf;Dd sfd ub{5 . o;nfO{ Passive immunization elgG5 .

o;/L cfjZostf cg';f/ Active / Passive immunization sf] tl/sf

ckgfP/ dflg;x¿nfO{ ;'/Iff k|bfg ug]{ ;lsG5 .

v_ /;fog /f]u lg/f]w (Chemoprophylaxis)

;?jf /f]u km}lnPsf] cj:yf jf /f]u ;g{ ;Sg] hf]lvd ePsf] 7fpFdf uPsf] cj:yfdf

dflg;nfO{ /f]uaf6 ;'/Iff ug{ /;fog /f]u lg/f]w tl/sf ckgfpg ;lsG5 . z/L/df

;?jf /f]usf] hLjf0f' k|j]z ug]{ k|an ;+efjgf ePsf] cj:yfdf /f]usf] ls6f0f'

;ª\qmd0f x'g glbg /f]usf] nIf0f b]vf kg'{ cl3 g} lrlsT;ssf] ;Nnfx cg';f/ cf}ifwL

;]jg ug]{ tl/sfnfO{ /;fog /f]u lg/f]w jf Chetrorophylaxis elgG5 . h:t}

x}hf km}lnPsf] ;dodf Tetracycline, doxyclycline, cf}nf]+ k|efljt If]qdf

Chloroquine, d]lgghfOl6;df Sulphadiacine, Kn]u/f]udf Tetracycline /

Influenza df Amantadine cf}ifwL Chemoprophylaxis sf] ¿kdf k|of]u

ug{ ;lsG5 . dxfdf/L] km}lnPsf] ;dodf o:tf] cf}ifwL ;fd"lxs ¿kdf k|of]u

ug{;lsG5 . s'g} /f]u ;'if'Kt ¿kdf ;d'bfo 5 t/ s'g JolQm jf ;d"xnfO{ 5 eGg]

s'/f yfxf 5}g eg] klg /f]u lgoGq0f tyf pGd"ng ug{sf] nflu ;fd"lxs ¿kdf

cf}ifwL v'jfpg] ul/G5 . xfQL kfOn] /f]usf] lj?4 g]kfndf ut s]xL jif{b]lv ;fd"lxs

cf}ifwL v'jfpg] ul/Psf] 5 .

106

u_ /f]u lgoGq0fsf ;xfos pkfox¿ (Non-specific measure)

dflg;n] hLjgsf] u'0f:t/, kf]if0f :t/ tyf afgL Jojxf/, cfrn0f ;'wf/ u/]/ klg

/f]u ;g]{ dfWodx¿nfO{ cj?4 kfg{ ;Sb5 . ;/sf/n] sfg'gL pkfox¿ nfu' u/]/ klg

/f]usf]] lgoGq0f tyf /f]syfd ug{ ;Sb5 . lgDg lnlvt ;fdfGo tyf u}/–ljlzi6

pkfox¿ ckgfpg ;lsG5 .

– hLjgsf] u'0f:t/ tyf hLjg z}nLdf ;'wf/ ug]{

– vfg]kfgL / kf]if0f :t/df ;'wf/ ug]{

– dfgjdnd"qsf] plrt lj;h{g u/L jftfj/0fLo ;/;kmfOdf ;'wf/ ug{

– :jR5 / ;'/lIft vfg]kfgLsf] cfk"lt{ ug]{

– ;fj{hlgs 7fpFdf kmf]x/ ˆofSg tyf lb;f lk;fa ug{ k|ltaGw nufpg]

– :j:ys/ cfjf;sf] Joj:yf ug]{

– :Jf:Yo lzIff lbg] / /f]u lgoGq0fdf hg;xeflutf j[l4 ug]{

– df;' tyf tof/L vfgfsf] ljqmL ljt/0fsf] cg'udg ug]{

– vfgf e08f/ ug]{ ksfpg] tyf tof/L ubf{ ;t{stf ckgfpg] .

lqmofsnfk

!= ;?jf/f]usf] lgoGq0f ug]{ ljlw / l;4fGtsf] af/]df 5f]6s/Ldf j0f{g ug'xf];\<

@= g]kfndf ;?jf /f]u lgoGq0f ug{ s] s:tf ljlw tyf pkfox? ckgfOPsf 5g\ <

o;sf af/]df ;f]wvf]h u/L Ps 5f]6f] k|ltj]bg tfo/ kfg'{xf];\ .

;f/f+z

of] PsfOdf ;?jf /f]u cWoog;Fu ;DalGwt ;}¢flGt tyf Jojxfl/s kIfsf]af/]df cfjZos

kg]{ ljifoj:t'x? h:t} ;?jf /f]usf] l;¢fGt, ;?jf /f]usf] jlu{s/0f, /f]u k|;f/0f x'g]

107

tl/sf, dxfdf/L/f]usf] cGj]if0f, /f]usf] lgu/fgL tyf g]kfndf b]vf kg]{ d'Vo ;?jf/f]usf

Olk8]ldof]nf]hL af/]df ;dfj]z ul/Psf] 5 .

PsfO tLgsf] cEof;sf nflu k|Zgx?

s_ ljifout k|Zgx?


!= dxfdf/L/f]u l;4fGt cg';f/ ;?jf/f]u ;d'bfodf km}lng'sf] sf/0f s] xf] <

@= ls6hGo /f]usf]af/]df pbfx/0f ;lxt 5f]6s/Ldf rrf{ ug'{xf];\ .

#= ls/fn] h}ljs / oflGqs ljlwaf6 s;/L /f]u ;fb{5 <

$= ædflg; cfkm}df /f]usf] e08f/ xf]Æ of] egfO{ k'li6 ug'{xf];\ .

%= /f]usf] 5gf}6 eGgfn] s] nfO{ hgfp5 < 5gf]6 k/LIf0fsf] pkof]lutf pNn]v ug'{xf];\ .

^= ;lqmo / lgiqmo lgu/fgLsf] af/]df pbfx/0f ;lxt j0f{g ug'{xf];\ .


!= ;?jf/f]usf] l;4fGtx? pbfx/0f ;lxt j0f{g ug'{xf];\ .

@= g]kfndf emf8fkvfnf / :jfzk|Zjf; k|0ffnLsf] s8f ;+qmd0fsf] Olk8]ldof]nf]hLsf]

tYofª\s ;lxt j0f{g ug'{xf];\ .

#= Ifo/f]u tyf PrcfOeL P8;\sf] Olk8]ldof]nf]hLsf] tYofª\s ;lxt j0f{g ug'{xf];\ .

$= /f]u lgu/fgLsf] k|sf/ / rn0fx? JofVof ug'{xf];\ .

%= ;?jf/f]u lgoGq0f tyf /f]uyfd ug]{ tl/sf tyf l;4fGtsf]af/]df JofVof ug'{xf];\ .

v_ j:t'ut k|Zgx?

!= tnsf dWo s'g rflx ;?jf/f]usf] tTj cGt/ut kb}{g <

s_ sf/s tTj v_ /f]u k|lt/f]w Ifdtf

u_ jftfj/0f 3_ /f]u u|x0f ug{ nfos JolQm

108

@= dflg;n] k|of]u ug]{ sk8f tyf j:t'af6 ;g]{ /f]unfO{ s] elgG5 <

s_ e]S6/ag{ /f]u v_ k'm8ag{ /f]u

u_ Pc/ag{ /f]u 3_ kmf]dfO6ag{ /f]u

#= tnsf dWo s'g kl/hLljn] ;+qmd0f ePdf k|f0f3f6s cf}nf] Hj/f] nfUb5 <

s_ Plasmodium vivax, v_ Plasmodium falciparum

u_ Plasmodium ovale 3_ Plasmodium malarie

$= g]kfndf s'g ;d"xsf dflg;x?df PrcfOeL ;+qmd0f a9L kfOPsf] 5 <

s_ 3/df a:g] dlxnf v_ hfF8/S;L ;]jg ug]{ k'?ifx?

u_ a;fOF;/fO ug]{ dhb'/x¿ 3_ k'?if / k'?ifsf] lardf of}g ;Dks{ ug]{x?

%= tnsf dWo s'g /f]u H5N1 sf] gfdn] kl/lrt 5 <

s_ :jfOg ˆn" v_ a8{ˆn"

u_ ;f;{ 3_ :kflg; ˆn"

^= g]kfndf PrcfOeLsf] ;+qmd0f b/ s'g tl/sfaf6 k|fKt tYofª\s cfwf/df cg'dfg

ul/G5 <

s_ ;]G6Lg]n lgu/fgL v_ ;lqmo lgu/fgL

u_ lgliqmo lgu/fgL 3_ ;j]{If0f

&= g]kfndf k|To]s jif{ slt afnaflnsfx? ARI Aff6 ;+qmldt x'G5 <

s_ s/La @) nfv v_ s/La @% nfv

u_ s/La #) nfv 3_ s/La $) nfv

109

PsfO rf/ (Unit Four)

h}ljs tYofª\szf:qsf] cjwf/0ff / dxfdf/L lj1fg cWoogdf tYofª\ssf] ;+u7g

(Concept of biostatistics and organization of data in epidemiologic

studies)

$=! kl/ro (Introduction) :jf:Yo ;DaGwL cWoogdf ljleGg lsl;dsf] tYofª\ssf] cfjZostf kb{5 . o:tf tYofª\sx?

;+sng ug{ ljleGg ljlw / ;fdu|Lx? k|of]u ul/G5 . :jf:Yo ;DalGw ;d:ofx? / To;sf

ljifox? w]/}h;f] h}ljs tTj;+u ;DalGwt x'G5g\ . oL ;d:ofx?sf] dfkg ug{ ljz]if lsl;dsf]

tYofª\szf:q k|of]u ul/G5 . To;}n] o; PsfO{df dxfdf/L lj1fg cWoogdf h}ljs

tYofª\szf:qsf] cjwf/0ff / o;df k|of]u ePsf tYofª\ssf] ;+u7g s;/L ug{ ;lsG5 eGg]

af/]df hfgsf/L k|fKt ug]{ Woon] lgDg lnlvt p2]Zox? lgwf{/0f ul/Psf] 5 .

$=@ ljlzi6 p2]Zox¿ (Specific Objectives and Contents)

p2]Zox? ljifoj:t'x? h}ljs tYofª\szf:qsf] cjwf/0ff ljsfz ul/ To;nfO{ :ki6 kfg{ . dxfdf/L lj1fg cWoogdf h}ljs tYofª\szf:qsf] dxTj bzf{pg . rnx? / dfkgsf ljleGg txnfO{ dgg ul/ To;nfO{ k|of]u -sfo{jog_ ug{ . dxfdf/L lj1fg cWoogdf q'l6, kIfkft / ;Gb]xhgs sf] wf/0f 5nkmn ug{ . dxfdf/L lj1fg cWoogdf ljZj;lgotf / j}Btfs] k|sf/x? JofVof ug{ . dxfdf/L lj1fg tYofª\snfO{ Psn rn, bLrn / ax'rn a0f{gfTds tYofª\ssf] k|of]u ul/ dgg ul/ ljZn]if0f ug{ .

$=! :jf:Yo cg';Gwfgdf h}ljs tYofª\szf:qsf] cjwf/0ff / dxTj -Concept and importance of biostatistics in health research) $=@ rn /kl/jTo{sf] / dfkgsf] tx cjwf/0ff agfpg] / To;sf] lqmofTds kl/efifLtug]{ (Conceptualization and operationalization of variables and level of measurement) $=# dxfdf/Llj1fgdf q'l6x?, kIfkft / ;Gb]xhgs -clgl:rt_ (Concept of Error bias and confounding in Epidemiology _ $=$ dxfdf/L lj1fgdf ljZj;gLotf / j}Btf -Concept and types of reliability and validity in epidemiology) $=% Ps rnLo, bLrnLo / ax'rnLo a0f{gfTds ljZn]if0fsf] cjwf/0f -Concept and techniques of univariate and bivariate descriptive analysis (frequency

110

dxfdf/L lj1fg cWoogdf kl/sNkgf k/LIf0fsf] wf/0ff 5nkmn ug{ . ;}4flGts tYofª\s (t-test, correlation and chi-square test) wf/0ff / ljlwx? JofVof ug{ . dxfdf/L lj1fg cWoogdf sfo{sf/0f / ;DaGwsf] wf/0ff ;lrq JofVof ug{ . :jtGq rn / cfl>t rnlar sf/0f / qm[ltd ;DaGwsf] af/] j0f{g ug{ . pQmlnlvt p2]Zox? k'/f ug{sf nflu lgDg lnlvt ljifoa:t'x? k|:t't ul/Psf] 5 .

tables, cross tables and figures) $=^ kl/sNkgf k/LIf0f / ;}4lGts tYofª\ssf] cjwf/0ff / ljlw -Concept and techniques of hypothesis testing and inferential statistics (t-test, correlation, coefficient and chi-squire test) in epidemiology)$=& sf/0f / ;DaGwsf] cjwf/0f -Concept ot Causation and Association) $=* g]kfn tyf cGo /fi6|\df ;+rfng ul/Psf j0f{gfTds cWoog, 36gf-lgoGq0f cWoog, ;fd'lxs cWoog, ;fd'lxs cWoogsf] ljz]iftfx?, ;+of]ufTds -/]G8f]dfOH8_ lgoGq0f k/LIf0f

$=@ h}ljs tYofª\szf:qsf] cjwf/0ff (Concept of Biostatistics)

h}ljs tYofª\szf:q lhjlj1fgaf6 pTklQ ePsf] dflgG5 . Statistics arising out of biological

sciences, particularly from the field so medicine and public health. ljz]if u/]/ lrlsT;fzf:q,

lhjlj1fg / hg:jf:Yosf] If]qdf k|of]u ul/g] tYofª\szf:qnfO{ lng ;lsG5 . o;n] ;DalGwt

If]qdf of]hgf ug{, ;+rfng ug{ / tYofª\s ljZn]if0f ug{ k|of]u ul/G5 .

:jf:Yo cg';Gwfgdf h}ljs tYofª\ssf] dxTj (Importance of Biostatistics in health research):

h}ljs ljlebtfsf] sf/0f (valid inferences) j}w l;4fGt of lgisif{ lgsfNgsf] nflu h}ljs

tYofª\ssf] cfjZos kb{5 . h}ljs tYofª\szf:q h}ljs tYofª\s ;+sng ug{, d"Nof+sg ug{ /

To;nfO{ k|:t'tug{ o;sf] Jofks k|of]u ul/G5 .

h}ljs tYofª\szf:q lrlsT;fzf:q / hg:jf:Yosf] cg';Gwfgdf cg'dfg ug{ (estimation),

kl/sNkgf k/LIf0f ug{ (hypothesis test) / cg';Gwfgsf] 9fFrf (study design) tof/ kfg{ o;sf]

dxTj /x]sf] 5 . o;af6 lrlsT;fzf:qsf] Oltxf;sf] qmddf lrlsT;sLo dxfdf/Llj1fgsf]

cWoogdf :jf:Yo ;DaGwL 36gfx?, To;sf] ;DalGwt vt/f / ;Defjgf cGt/ cg';Gwfg

odds ratio lgwf{/0f ug{ ;xof]u ub{5 . pkrf/fTds k/LIf0f Therapeutic trials / ;''/IffTds

111

k/LIf0f prophylactic trials of]hgf / sfof{joGgg ug{, lgbfgfTds Ifdtfsf] diagnostic

efficacies cf+snug{ / z/L/sf] cj:yf sf] ;fdfGo / c;fdfGo jf /f]u u|:t cj:yfsf] kl/efiff

ug]{ ljlw k|bfg ub{5 . /f]u ;DaGwL ljleGg k|lqmofsf] 7Ls dfkg k|bfg ub{5 .

o;n] ;fd'bfoLs :jf:Yosf] a9\bf] cj:yfx? h:t} k'/f ePsf] / k'/f gePsf cfj:ostfsf ;fy}

/f]usf] klxrfg / k|KIf]k0f ug{ ;xof]u ub{5 . h;n] ;fdflhs cfly{s, /fhg}lts /

hg;f+lvsdf cfwfl/t :jf:Yo l:ylt, / ;?jf tyf g;g]{ /f]ux?sf] lgoGq0f, lg/fs/0f,

pGd'ngsf] ;DefJo pkfPx? k|bfg ub{5 . o;n] :jf:Yo lzIff sfo{qmd / :jf:Yo k|0ffnL

cg';Gwfgsf] d"Nof+sg ul/ n]vfhf]vf ug]{ / ;fd'bflos :jf:Yosfo{qmdsf] of]hgf,

sfof{joggsf] ;fy} cg'udg / lg/LIf0fug{ ;d]t ;xof]u ub{5 .


!= h}ljs tYofª\szf:q / Olk8]ldof]nfhLsf] ljr s] ;DaGw 5 <

lqmofsnfk

h}ljs tYofª\szf:qsf] cjwf/0ff / dxTjnfO{ cWoog / 5nkmn ul/ o;sf] pTklQ / k|of]u

x'g] If]qx? lgSof}{n ug'{xf]; \.

h}ljs tYofª\szf:q s'g s'g sfo{sf]nflu dxTjk"0f{ 5 / o;n] s] s] ug{ ;xof]u k'/\ofp5

To;sf] ;"lr tof/ kfg'{xf];

112

$=# rn jf kl/jTo{sf] / dfkgsf] tx cjwf/0ff agfpg] / To;sf] lqmofTds kl/eflift ug]{ (Conceptualization and operationalization of variables, and level of measurement )

s_ rn jf kl/jTo{sf] cjwf/0ff (Concept of Variable)

rn eGgfn] s'g} j:t' tyf JolQmsf] o:tf] ljz]iftf xf], h;nfO{ b'O{ jf b'O{ eGbf a9L d"No jf

k|sf/df dfkg ug{ ;lsG5 . s'g} lrh h'g rfxLF ;do tyf kl/l:ylt cg';f/ kl/jt{g x'G5,

To;nfO{ rn elgG5 . leGg leGg d"No x'g] ljz]iftf jf 36gfnfO{ rn elgG5 . lnË, pd]/,

?lr ;d:of, k];f, lzIff, cfDbfgL cflb ljz]iftfx¿ JolQm / kl/l:ylt cg';f/ km/s x'g]

ePsf]n] leGg leGg d"Nodf dfkg ug{ ;lsG5 .

Collins “A characteristic which can be measured and which may vary along a

continuum, continuous variable e.g. height, be more discrete e.g. family size or

bipolar e.g. sex.”

PV Young sf] cg';f/ ljeGg ;+VofTds d"No jf ju{÷kb u|x0f ug{ ;Sg] ljz]iftf jf

;VofnfO{ rn elgG5 (A variable is any quantity of characteristics which may

possess different numerical values or categories) .

rnx¿ s'g} :jtGq / s'g} cfl>t x'G5g\ .

s_ :jtGq rn (Independent Variable): o;df olb s'g} rnx?df cGo s'g} rndf

cfPsf] kl/jt{gaf6 k|efljt x'b}gg t/ oLgLx?df cfPsf] kl/jt{gn] cGo rnx?df kl/jt{g

cfpF5 eg] To:tf rnx?nfO{ :jtGq rn (Independent Variable) elgG5 . h:t} pd]/,

lnª\u, hft hflt, :yfg, xfjf, kfgL, vfgf, a:g] 7fp cflb Olk8]ldof]nf]lhs cWoogsf] nflu

:jtGq rn x'g ;Sb5 . pd]/ kl/jt{g x'g] s'/f cfkm} x'b} hfG5 . t/ afnssf] pd]/ a9\b}

uPkl5 p;sf] tf}n tyf l;Sg] Ifdtf klg a[l4 x'b} hfG5 . To;}n] pd]/ :jtGq rn xf] .

v_ cfl>t rn (Dependent Variable): :jtGq rnaf6 k|efljt jf kl/jtL{t x'g] rnnfO

cfl>t rn Dependent Variable elgG5 . h:t} aRrfsf] tf}n pd]/df cfl>t x'g] ePsf]n]

tf}nnfO{ cfl>t / pd]/nfO{ :jtGq rn elgG5 . kmf]xf]/ kfgLn] kvfnf nfU5 eg] kmf]xf]/ kfgL

113

:jtGq rn / kvfnf cfl>t rn x'g\ . /f]u, lj/fdL, kf]if0f cflb Olk8]ldof]nf]lhs cWoogsf]

nflu cfl>t rn x'g ;Sb5 . h:t} aRrfsf] tf}n pd]/df cfl>t x'g] ePsf]n] tf}nnfO{ cfl>t

/ pd]/nfO{ :jtGq rn elgG5 . kmf]xf]/ kfgLn] kvfnf nfU5 eg] kmf]xf]/ kfgL :jtGq rn /

kvfnf cfl>t rn x'g\ .

u_ ;Gb]xhgs rn (Confounding Variable): Confounding Ps lsl;dsf] kIfkft -Bias) xf] .

cg';Gwfgdf s'g} klg cWoogsf] ljifo;+u ;DalGwt tTjsf] c;/ ;+u;+u} ck|ToIf ?kdf

;+nUg tTjsf] k|efj ldl;Psf] x'G5 . To:tf ck|ToIf?kdf ;+nUg e} k|efj kfg]{ tTjnfO{

;Gb]xhgs rn elgG5 . h:t} ;fdfGotof s /f]u v tTjsf] c;/af6 pTkGg x'G5 . t/

slxn]sflx v tTjsf] c;/ ge} cs}{ tTjsf] c;/ x'g ;S5 jf v tTj / cGo s'g} u tTjsf]

c;/ x'g ;S5 eg] u tTjnfO{ ;Gb]xhgs rn (Confounding Variable) eGg ;lsG5 .

;Gb]xhgs rn (Confounding Variable) Ps kIfkft Bias ePsf]n] cWoogsf] j}BtfnfO{

c;/ u/]sf] xG5 . o;nfO{ tYofª\sLo ;dfof]hgaf6 ;Rofpg ;lsG5 . pbfx/0fsf]nflu r'/f]6

;]jg ug]{ / h}ljs ;+qmd0faf6 klg u|l;t e} kmf]S;f]sf] SofG;/ePsf] 5 eg] pQm SofG;/sf]

sf/0f ;Gb]xhgs x'g;S5 . o:tf] cj:yfdf SofG;/sf] sf/0f r'/f]6 ;]jg xf] ls egL k/LIf0f

ubf{ lglZrt ePdf cl>t rn x'G5 eg] olb lglZrt x'g g;s]f cj:yfdf ToxfF csf]{ s'g}

rnsf] k|efj 5 elg cg'dfg nufOG5 To:tf rnnfO{ ;Gb]xhgs rn elgG5 . h;n]

cWoogsf] lgisif{df c;/ kb{5 .

cWoog cg';Gwfgdf 36gfnfO{ k|efj kfg]{ ljleGg tTjnfO{ rnsf] ?kdf lnO{ ltlgx?sf]

ljrsf] ;DaGwsf cfwf/df cg';Gwfgsf] lgisif{ lgsflnG5 . cfl>t rn Dependent Variable

:jtGq rn Independent Variable oL rnx? s'g} :jtGq jf oLgLx?df s;}sf] klg k|efj kb}{g

eg] s'g}df c?sf] k|efj kb{5 . olb XnfO{ :jtGq rn / YnfO{ cfl>t rn dfGg] xf] eg]

Xsf] k|efj Ydf kb{5 . oL b'O{ y/Lsfrnx?sf] ljrsf] ;DaGwn] 36gfsf] jf:tljstf lgSof}{n

ub{5 . cg';Gwfgdf :jtGqrnx? 36gf cj:yfsf] sf/0f;+u ;DalGwt x'G5g eg] cfl>t

rnx? kl/0ffd;+u ;DalGwt x'G5g . o;}ul/ cljl5Gg (Continuous variable) rnx?n] ;fwf/0f

114

cj:yfsf] ljz]iftf b]vfp5 . h:t} pd]/, prfO{, tf}n Hofnf cflb . j0f{gfTds (Descriptive

Variable) rnx?n] s'g}klg cj:yfsf] ;fdfGo auL{s/0f jf j0f{g ub{5 . h:t} k|f0Lf, 3/hUff,

pBf]unfO{ hgfp5 .

ljleGg rnx?dWo s'g} 5'6\6} (Discrete) cj:yfsf] b]vfp5 h:t} kl/jf/sf] cfsf/, ljjfxsf]

k|sf/ cfbL . b'O{a6f dfqsf] cj:yfnfO{ ;DalGwt u/fpg] rnnfO{ låeflht (Bipolar) rn

elgG5 . h:t} dlxnf, k'?if, lzlIft, clzlIft cfbL . o;}ul/ b'O{ eGbf a9L u'0fsf] ;DaGw

b]vfpg] rnnfO{ ax'ljeflht rn (Politomous variable) elgG5 . h:t} dlxnf, k'?if, plgx?sf]

a}jflxs tyf z}lIfs :t/ /f]huf/sf] :t/ cfbLnfO{ Ps};fy ljZn]if0f ul/G5 . ;fdflhs

cg';Gwfgsf] If]qdf s'g} cWoogdf cfl>t ePsf rnx? s'g} cGo cg';Gwfgdf :jtGq rnsf

?kdf /xg ;Sb5g .

u'0fsf] cfwf/df u'0ffTds / ;+VofTds rnx?df (Qualitative and Quantitative variables)

ljefhg ul/Psf] 5 . bof, dfof, ln+u, hflt cfbL u'0ffTds rnx? x'g eg] gfd, tf}n, pd]/

cfbL ;+VofTds rnx? x'g . cg';Gwfgdf b'O{ jf b'O{ eGbf a9L rnx?sf] ;DaGwnfO{ b]vfpg]

ul/G5 . o;df cg';Gwfgsf ljifo ;DaGwL cj:yfx? larsf] sfo{ sf/0f k|efjnfO{ a'em\g

rnx?sf] ;DaGwnfO{ JofVof Pj+ d"Nof+s ub}{ lgisif{ lgsflnG5 . s'g} rnx¿nfO{ ;ª\VofTds

PsfOdf h:t} dlxnf jf k'?if, wgL jf ul/a eg]/ dfkg ug{ ;lsG5 eg] u'0ffTds rn elgG5

. s'g} rnnfO{ ;ª\Vofdf h:t} pd]/nfO{ ! jif{ @ dlxgf, cfDbfgLnfO{ @#) ¿k}+of tf}nnfO{ $)

s]hL @!) u|fd cflb dfkg ug{ ;lsG5 eg] ;ª\VofTds rn elgG5 .

rnx?sf] cjwf/f0fut kl/efiff (Conceptual definition of variables)

wgL, u/La, lzIff, ;fdflhs cj:yf, /f]uL, lg/f]uL, :j:y, c:j:y, s'kf]if0f, emf8fkvfnf, cfpF,

Ifo/f]u, cf}nf]/f]u cflb Olk8]ldof]nf]lhs cWoogdf rnsf]?kdf k|of]u x'G5 . o;nfO{ zAbsf]if

jf o;;Fu ;DalGwt k':tsx?df :t/Lo kl/efiff lbOPsf] x'G5 . oL zAb jf rn jf kbsf]

k':ts jf zAbsf]zdf n]lvPsf] kl/efiff g} rnx?sf] cjwf/0fut kl/efiff xf] . k|z:t wg

;DklQ ePsf] JolQmnfO{ wgL elgG5 eg]/ zAbsf]if jf k':tsx?df kl/eflift ul/Psf] x'G5 .

115

To;} u/L lZfIff eGgfn] 1fg tyf ;Lk k|bfg u/L JolQmsf cGt/lglxt Ifdtfsf] ljsf; ug]{

u/fpg] k|lqmofnfO lzIff elgG5 . s'g} zAb jf rnsf] cjwf/0fut kl/efiffn] a[xt\ cy{ u|x0f

ub{5 . o;k|sf/sf] kl/efiffn] pQm rn jf kbsf] k|of]u x'g] If]qnfO{ Vofn u/L ;a}n] a'e\mg]

u/L cYof{pg] u/]sf] kfOG5 . o; k|sf/sf] kl/eiff cd't{ / dfkg ug{ g;lsg] vfnsf] x'G5

rnx?sf] sfdrnfp jf ck/];gn kl/efiff (Operational definition of variables)

cjwf/f0fut kl/efiff cfwfl/t eP/ rnsf] ljz]iftf dfkg ug{ ;lsb}g . To;}n] cWoog

cg';Gwfgdf rnx?nfO{ sfd rnfp tl/sfn] kl/eflift ug'{ kb{5 . cyf{t\s'g} Ps rnnfO{

To;sf] ljz]iftf cg';f/ dfkg ug{sf] nflu dfkb08 / k|lqmof ;dfj]zu/L agfPsf]

kl/efiffnfO{ rnsf] sfdrnfo jf ck/]zgn kl/efif elgG5 . (The operational definition

of a variable specifies the procedure and criteria for taking measurement of that

variable for individual cases)

wgL sf] ck/];gn kl/efiff kl/j]z cg';f/ km/s km/s x'g ;Sb5 . h:t} ufpFdf ;Gbe{df

cfˆg} hUufaf6 pTkfbg ePsf] cGgn] aif{ lbg vfg k'Ug] / a9L ePsf] pTkfbg laqmL u/L

cfDbfgL ug{ ;Sg] kl/jf/nfO{ wgL elgG5 eg]/ k/LIfflift u{g ;lsG5 . cyjf !) /f]kgL eGb

a9L hUuf ePsf] / pQm hUuf hldgaf6 pTkfbg ePsf] cGgn] aif{ lbg eGbf a9L vfg k'U5

eg] To:tf kl/jf/nfO{ wgL elgG5 . o;/L kleflift ubf{ wgL dfkg ug]{ tl/sf / dfkb08 b'j}

JoQm x'G5 . o;sf] cfwf/df rnnfO{ ;VofTds ljz]iftfsf] cfwf/df dfkg ug{ ;lsG5 . To;}

u/L lzIff eGgfn] ljBfno jf sn]hdf cWoog u/]/ k|fKt u/]sf] l8u|L jf ljBfnodf cWoog

u/]sf] jif{ egL kl/efifflt ug{ ;lsG5 . o;sf] cfwf/df JolQmn] cfh{g u/]sf] lzIff dfkg ug{

;lsG5 . sfdrnfp jf ck/]zgn kl/efiffsf] pbfx/0f tn k|:t't ul/Psf] 5 .

116

lqmofsnfk

!=_ rnn] s] nfO{ ;+s]t ub{5 / k|ltlglwTj u5{ ?

@=_ rnsf lnz]iftfx? l6kf]6 ug'{xf]; .

#=_ rnsf k|sf/x?sf ;"rL agfpg'xf];\ .

$=_ ;Gb]xhgs rnsf] pbfx/0f ;lxt j0f{g ug'{xf];\

%=_ 5'6\6} rn (Discrete) låeflht rn (Bipolar) / ax'ljeflht rn (Politomous

variable) pbfx/0fx? lbg'xf];\.

^=_u'0ffTds / ;+VofTds rnx?df km/s b]vfpg'xf];

117

v_ Dffkgsf] tx (Level of Measurement) s'g} klg j:t', zlQm, lqmof jf k|lqmofx?sf] lglZrt dfqf x'G5 . olx ef}lts jf cef}lts

u'0fsf] dfqfnfO{ lglZrt lgodx?sf] k|of]u u/L hgfpg] sfo{nfO{ dfkg (Measurement

elgG5 . Tylor sf] cg';f/ (Measurement is the assignment of numerals according to

rules) lgod cg';f/ c+s k|bfg ug]{ sfo{g} dfkg xf] . o:t} Campbell sf cg';f/

(measurement is the assignment of numerals to represent properties) u'0fx?nfO{

k|ltlglwTj ug{ c+s k|bfg ug]{ sfo{g} dfkg xf] . dfkgn] s'g} klg j:t' jf k|lqmofsf] dfgnfO{

k|ltlglwTj ul/ tLgLx?sf] u'0ffTds d"Nof+sg ub{5 . ;lx dfkgsf nflu dfkg cf}hf/df

cfj:os kg]{ lgDg lsl;dsf ljz]iftfx? /x]sf] x'g' kb{5 .

dfkgsf ljz]iftfx? (Characteristics of a good measurement)

dfkg cf}hf/df ;/ntf Simplicity

k'j{3f]if0ff ug{ ;lsg] u'0f Predictive

cf}hf/df ;Totf / :ki6tf Clarity

ljZj;gLotf Reliability

j}Btf Validity

dfkgsf rn0fx? (Steps of Measurement)

;fdflhs cg';Gwfgdf ljleGg ;+VofTds tyf u'0ffTds rnx?nfO{ lglZrt dfgsf cfwf/df

cWoog ub}{ sf/0f k|efj (Cause-feffect) kQf nufpg] k|of; ul/G5 . dfkg k|lqmofsf] cfwf/df

cg';Gwfgstf{n] kl/sNkgfsf] k/LIf0f tyf gofF l;4fGtsf] vf]hL ug ;lsG5. Dfkg k|lqmofsf

dfWodaf6 k|ToIf cg'ej ug{ g;lsg] cd't{ u'0fx?nfO{ n]vfhf]v fug{ ;lsg] ePsfn]

;dfhzf:qLo tyf z}lIfs If]qsf] cg';Gwfgdf o;sf] /fd|f] pkof]lutf /xg] ub{5 . dfkg

k|lqmofnfO{ lgDgfg';f/ ;Dkfbg ug{ ;lsG5 .

u'0fx?sf] klxrfg / kl/efiff Identification and Definition of Attributes

118

u'0fsf] ;}4flGts lqmofTds kl/efiff Theoretical Operational Definition of Term

dfg lgwf{/0f Determination of Value

:s]nsf] lgwf{/0f Formation of Scale

dfkgsf] tx (Scale or level of Measurement)

rnnfO{ sfd rnfp jf ck/];gn tl/sfn] kl/eflift u/]kl5 To;sf] u'0f jf ljz]iftfnfO{ s'g

txdf dfkg ug]{ eGg] s'/f klg lgwf{/0f ug'{ kb{5 . s'g} klg rnnfO{ :k:i6?kdf kl/eflift

u/]sf] v08df To;nfO{ s;/L s'g txdf dfkg ug]{ eGg] s'/f klg dfu{lgb]{zg ub{5 . rnnfO{

d'Vo lgDg rf/ txdf dfkg ug{ ;lsG5 .

s_ gfd?kL dfkg (Nominal Scale of Measurement)

v_ qmdfut dfkg (Ordinal Scale of Measurement)

u_ cGt/fn dfkg (Interval Scale of Measurement)

3_ cg'kflts dfkg (Ratio Scale of Measurement)

s_ gfd?kL dfkg (Nominal Scale of Measurement): s'g} rnsf] ljz]iftf cfwf/df

gfd dfq ;+s]t ug'{ g} gfd dfkg xf] . o; k|sf/sf] dfkgn] tYofª\snfO{ juL{s/0f ug{ dbt

ub{5 (A nominal sce of measurement only indicates the category of variable that

119

a case fall into) . h:t} cg'';Gwfgstf{ lnª\u / wd{sf] cfwf/d tYofª\s ljZn]if0f ug{ rfx]sf]

5 eg] lnª\unfO{ b'O ;d"x h:t} dlxnf / k'?ifdf dfkg ug{ ;Sb5 . To;} u/L wd{nfO{ lxGb',

O:nfd, af}4 / lqmlZrog u/L rf/ ;d"xdsf] gfddf dfq dfkg ug{ ;Sb5 . dlxnf k'?ifnfO{

;Vofdf ?kfGt/ ubf{ dxln Ö ! k'?if Ö @ jf k'?if Ö ! / dlxnf Ö @ sf] ?kdf ;+s]5t ug{

;Sb5 . t/ Ps eg]sf] klxnf] / b'O eg]sf] bf];|f] jf Ps eg]sf] sd / b'O{ eg]sf] a9L eGg]

cy{ nfUb}g . oxf ! jf @ klg gfd dfq ePsf] x'gfn] ! n] Pp6f ;d"xsf] k|ltlgwTj ub{5 eg]

@ n] csf] ljz]iftf ePsf] ;d"xsf] ;+s]t ub{5 .

v_ qmdfut dfkg (Ordinal Scale of Measurement): s'g} rnsf] ljz]iftfsf] cfwf/df

juL{s/0fu/L To;nfO{ qmd jf >]0fLdf /fVg ;lsG5 eg] qmdfut dfkg elgG5 . (An ordinal

level of measurement, in addition to the function of classification allows cases to

be ordered by degree according to measurement of the variable) o; k|sf/sf]

dfkgn] sdaf6 a9L jf a9Laf6 sd, /fd|af6 g/fd|f], alnof]af6 sdhf]/ cflbsf] >]0fLa4u/]/

tYofª\ssf] ljZn]if0f ug{ ldNb5 . h:t}, clt u/La, u/La, dWo / wgL, jf sd cfo, dWod

cfo / a9L cfo qmlds?kdf dfkg ug{ ;lsG5 . lzIffnfO{ k|fylds tx, lgDgdfWofld tx,

dfWoflds tx / pRr lzIff u/L sd lzIff kfPsfb]vL pRr lzIff kfPsf JolQmx?sf] >]0fLdf

dfkg ug{ ;lsG5 .

u_ cGt/fn dfkg (Interval Scale of Measurement): qmdfut dfkgn] b'O{ ;d"xsf]

ljrfdf s]xL b"/L jf vf8n jf leGgtf 5 eGg] s'/f ;+s]5 ub{5 t/ slt b"/Lsf] km/sdf 5

eGg] s'/f ;+s]t ub}{g . cGt/fn :s]ndf JolQm tyf a:t'df kfOg] u'0fsf] kl/df0ffTds

dfqfnfO{ a/fa/ PsfO{sf] cGt/ ePsf] :s]ndf ?kfGt/0f u/L Go"gtdb]lv clwstdsf] qmddf

/flvPsf] x'G5 . o; :s]nsf] dfkgaf6 a:t' jf JoQmdf lglxt u'0fsf] pkl:yltsf cfwf/df

lgwf{/0f u/]sf] qmd (Rank) sf ;fy} tLgLx? larsf] cGt/sf] klg hfgsf/L x'G5 . o; k|sf/sf]

dfkgdf z'Go lg/k]If geP/ ;fk]lIfs x'G5 . rnx?sf] ljz]iftfsf] cfwf/df qmd lgwf{/0f u/L

af/fa/ b/Ldf dfkg u/L cy{k"0f{ tl/sfn] JoQm ug{ ;lsG5 eg] o;nfO{ cGt/fn dfkg elgG5

120

. h:t} Ps ;d"xsf dlg;n] dlxgfsf] ?= @),))) sdfpF5 / csf]{ ;d"xsf] dflg;n] #),)))

xhf/ sdfpF5 eg] oL b'O{ k|sf/sf] cfDbfgLsf] lar!),))) km/s5 . To;} u/L Psn] dfl;s

%),))) cfo cfh{g ub{5 / csf]{n] ^),))) cfh{g ub{5 eg] cGt/fn !),))) g} x'G5 .

o;/L af/a/L b'/Ldf dfkgug{ / lx;fa ug{sf] nflu o; k|sf/sf] cGt/fnsf] dxTj x'G5 . t/

o;n] qmlds dfkgsf] ;d"xdf o;sf] cy{ lg/y{ klg x'g ;Sb5 . h:t} #),))) cfo ug]{ sf]

t'ngfdf ^),))) sdfpg] b'O{ u0ff wgL xf] eGg] cy{ nfUb}g . 3_ cg'kflts dfkg (Ratio

Scale of Measurement): of] dfkg clGtd / pRr txsf] dfkg xf] . of] dfkgsf] txn] JolQm

cyjf j:t'sf] u'0fsf] kl/df0ffTds qmd, cGt/sf ;fy{ cg'kflts dfqfaf/]df klg hfgsf/L

lbG5 . of] dfkgsf] dxTjk'0f+ ljz]iftf eg]sf] lg/k]If z"Gosf] pkl:ylt x'g' xf] . s'g} rnsf]

lgk]If?df ;'Go d"No x'g ;S5 / z'Godf klg dfkg ug{ ;sG5 eg] To; k|sf/sf] dfkgnfO{

cg'kflts dfkg elgG5 (A scale has a value of absolute zero that indicates cases where no

quantity of variable is present) . h:t} s'g} JolQmsf] cfDbfgL ;'Go 5 eg]/ dfkg ug'{sf] cy{

p;sf] cfDbfgL s]xL klg 5}g eGg] x'G5 . cfhsf] tfkqmd ;'Go l8u|L ;]lN;o; 5 eGgsf] cy{

eg] Hofb} hf8f] 5 eGg] x'G5 . cg'kflts dfkg ug{sf] nflu ;'Gosf] cy{ s'g} ;+VofTds dxTj

xg'x'Fb}g . ef}lts gfkx? h:t} nDafO, rf}8fO, tf}n OToflbx?nfO{ cg'kflts :s]ndf dfkg

ul/G5 . of] :s]ndf $) ld6/ nfdf] j:t'nfO{ @) ld6/ eGbf bf]Aa/ nfdf] 5 egL JofVof ug{

;lsG5 t/ cGt/fn :s]nsf] dfkg df $) l8u|L tfk|sdnfO{ @) l8u|L tfkqmdsf] bf]Aa/ tfk

egL JofVof ug{ ;lsb}g .

121

Examples of relation between conceptual, operational and scale of measurement


!= Olk8]ldof]nf]hLdf txut dfkg ug{ lsg cfjZos 5<

@= Olk8]ldof]nf]hLsn cWoog ubf{ rnsf] ck/]zgn kl/eiff s;/L ug'{ kb{5 < o;/L

rnsf] kl/efiff ubf{ s] kmfObf x'G5 <

lqmofsnfk

dfkgnfO{ cfkm\g} zAbdf cYof{pg'xf]; .

dfkgsf ljz]iftfx?sf] ;"rL tof/ kfg'{xf]; .

dfkgnfO{ s;/L ;Dkfbg ug{ ;lsG5 . j0f{g ug'xf]; \.

Olk8]dLof]nf]lhsn cWoog ubf{ ;dfj]z x'g] rnx?sf] ;'rL tof/ kf/L ck/]zgn kl/eiff

122

tof/ kfg'{xf]; .

$=$ dxfdf/Llj1fgdf q'l6x?, kIfkft / ;Gb]xhgs -clglZrt_ (Concept of Error,

bias and confounding in Epidemiology )

s_ q'l6sf] cjwf/0f (Concept of Error)

dflg;n] s'g} klg sfd ubf{ s]xL q'l6 x'g ;Sb5 . /f]u tyf :jf:Yo;Fu ;DalGwt 36gfx¿sf] cWoog ubf{ klg q'l6 x'G5 . cWoogsf] s'g} klg rn0fdf x'g] uNtLn] cWoogdf

em'6f] glthf cfpg'nfO{ q'l6 elgG5 (Error is defined as the false or mistaken results in a study that takes in an any stage of conducting research) . /f]u cWoog lj1fgdf b'O{ k|sf/sf] q'l6 x'G5 M–

i) /]08d q'l6 (Random error) ii) Jojl:yt q'l6 (Systematic error or bias)

i) /]08d q'l6 (Random error)

cWoogsf] qmddf ;+of]ujz÷cfsl:ds ¿kdf x'g] uNtLnfO{ /]08d q'l6 elgG5 . cjnf]sg tyf dfkg k|lqmofdf s]xL uNtL eP/ Ps¿ktf ePg eg] o; k|sf/sf] uNtL x'G5 . JolQmut

leGgtf gd'gf q'l6 tyf dfkgdf x'g] q'l6n] ubf{ /]08d cWoogdf q'l6 x'G5 . o; k|sf/sf] q'l6

k"0f{ ¿kdf x6fpg ;lsFb}g t/ sd ug{ ;lsG5 . o; k|sf/sf] q'l6nfO{ ljZj;gLo / j}w ;fwg

k|of]u u/]/ 7Ls tl/sfn] dfkg ug]{ / cWoog gd'gfsf] ;ª\Vof a9fP/ sd ug{ ;lsG5 .

ii) kIfkft Jojl:yt q'l6 (Systematic error or bias)

cWoogsf] qmddf hfgfhfgL ul/g] uNtLnfO{ Jojl:yt q'l6 elgG5 . cyf{t\ cWoogdf x'g]

Jojl:yt q'l6nfO{ kIfkft klg elG5 elgG5 .

dxfdf/L lj1fgdf dfkg k|lqmfofdf ljleGg q'l6x? X'g] ub{5g\ . cg';+Gwfgsf] lgisif{ :jtGq,

ljZj;gLo / j}w x'gsf] nflu q'l6x? bf]xl/g x'b}g . o:tf q'l6x? gbf]xl/gsf]nflu q'l6x?sf]

>f]tx¿ klxrfg x'g cfjZos 5 . dxfdf/L lj1fgdf dfkg k|lqmfofdf lgDg lsl;dsf

q'l6x?nfO{ lng ;lsG5 .

123

c= dfgjLo q'l6 (Human Error) dxfdf/L lj1fgdf cg';Gwfg k|lqmofdf cg';Gwfgstf{n]

pko'Qm / k|of{Kt ;"rgfx? ;+sng ug{ g;s]sf] cj:yfnfO{ dfgjLo q'l6 elgG5 . oL dfgjLo

q'l6x? tLgLx?sf] ;"rgfx? k|lt k"jf{u|lx k|j[ltsf] sf/0fn] ubf{ x'g] ub{5 .

cf= dfkgdf q'l6 (Measurement Error) cg';Gwfgsf] qmddf dfkgx?df q'l6 x'g]ub{5 .

o;df k|ljlw / dfkg oGqx?sf sf/0fn] o:tf q'l6x? X'g] ub{5g . ;fdflhs hLjgsf cg]sf}+

36gf, cj:yf, dgf]j[lQ, jf}l4stf, :jefj cfbLdf s'g} lglZrttf x'b}g . cg'dfgsf] e/df

dfkg ubf{ ;lx dfkg ug{ ;lsb}g . o;n] ubf{ Pp6} ljifodf klg k6s k6s dfkg ubf{ leGbf

leGb} ;"rgfx? cfpg ;S5 .

O= dfkg ;fdu|Ldf x'g] q'l6 M pko'Qm / kof{Kt dfkg ;fdu|x?sf] ;lx 5gf}6 / k|fKttf ug{

gs]sf] cj:yfdf s'g ;"rgfnfO{ s'g ;fdu|Ln] s;/L dfkg ug]{ yfxf gePsf] sf/0fn] q'l6x?

x'g ;S5g .

O{= kl/l:ylt / ;Gbe{af6 x'g] q'l6 M ;a} JolQmsf] ;w}el/ Pp6} kl/l:ylt / ;Gbe{ jf

cj:yf x'g ;Sb}g . o:tf] cj:yfdf pQ/bftfx?n] ;lx] / kof{Kt ;"rgf glbg ;S5g . o;n]

cg';Gwfgsf] lgisif{df km/s kg{ ;S5 .

P= ;"rgf ljZn]if0faf6 x'g] q'l6 M cg';Gwfgdf ;+slnt ;"rgfx? ljZn]if0fu/L lgisif{df

k'Ug] ul/G5 . ljZn]if0fubf{ ;+slnt ;'rgfx?nfO{ cfj:os ;Dkfbg ug{ g;Sbf / rnx?sf]

ljrdf x'g] ;DaGwdf cfj:os ;fjwfgL / pko'Qm ljZn]if0f ckgfpg g;s] cg';Gwfgsf]

dfkgdf k|;:t q'l6x? X'g ;S5g –cfrfo{, @)%*M !(&, !(*_ .

gd'gf 5gf}6df q'l6 M cg';Gwfgsf] lgisif{df vf; d"No True Value / ul0ftsf] l:y/ /fzL

Parameter Value ljrdf cfpg] km/s cj:yfnfO{ gd'gf 5gf}6df q'l6 elgG5 . A sample

error is the difference between a parameter and estimate of that parameter which

is derived from a sample.

s= cg';Gwfgsfo{df ;du|tf / k|j[ltdf tndfly jf cl:y/tf cfp5 . ;du|tf d"No /

gd'gf d"No ljr leGgtf cpF5 . h;n] gd'gfsf] cWos d"No Mean Valuue n] ;du|tfsf]

dWos d"NonfO{ ;fdh:o ug{ ;Sb}g .

124

v= gd'gfsf] cfsf/sf] q'l6 M cg';Gwfg ubf{ kof{Kt gd'gf 5gf}6 ug{ g;Sbf o:tf] q'l6 x'g

cfpF5 . oLlgx? lgDgfg';f/ /x]sf5g .

gd"gf 5gf}6df q'l6x? Sampling Errors

gd"gf 5gf}6df k"jf{u|xx? Sampling Bias

gd"gf afx]ssf q'l6x? Non-Sampling Errors

gd"gf 5gf}6 afx]ssf k"jf{u|xx¿ Non-Sampling Bias

rn q'l6 (Variable Error)

gd"gf 5gf}6df q'l6x? eGgfn] kof{Kt, pko'Qm / ljZj;gLo k|ltlglwd"ns gd"gf 5gf}6

g;lsPsf] q'l6nfO{ lng ;lsG5 . gd"gf 5gf}6df k"jf{u|xdf cb}jLn 5gf}6 ljlw / sd ;+Vofsf

sf/0f gd"gf 5gf}6df k"jf{u|x b]lvg] cj:yfnfO{ lng ;lsG5 . cjnf]sg / ;fIffTsf/, dfkg,

ljZn]if0f tyf pQ/bftfaf6 x'g ;Sg] q'l6nfO{ gd"gf afx]ssf q'l6x? elgG5 . o;}u/L gd"gf

5gf}6 afx]ssf k"jf{u|x eGgfn] cjnf]sg / dfkgdf /xg] k"jf{u|xaf6 x'g] q'l6nfO{ hgfpF5 .

kl/jTo{ q'l6x? gd"gf 5gf}6df q'l6 / k"jf{u|xaf6 pTkGg x'g] ub{5g\ .

cg';Gwfg k|lqmofdf ;Defljt q'l6x¿ / kIfkftx? (Possible Errors and Biases in Research) cg';Gwfg k|lqmofdf ljleGg lsl;dsf q'l6x? x'g;S5g . gd'gfut q'l6x? ( Sampling Errors) M w]/} hg;+Vof ePsf ljifo tyf 36gfx?sf]

cg';Gwfg ubf{ x'g;Sg] sldsdhf]/LnfO{ gd'gf q'l6 elgG5 . of] q'l6nfO{ hg;+Vof kf/fld6/ /

gd'gfsf] ljrdf x'g] km/snfO{ lng ;lsG5 . of] km/s gd'gf ;+sng ubf{ ;fjwfgL gckgfpg]

cfpg] ub{5 .

u}/gd'gfut q'l6x? (Non-Sampling Bias) M gd'gf 5gf}6 ubf{ ge} cg';Gwfgsf cGo

k|lqmofut sldsDhf]/Ln] x'g] q'l6 xf] . o;df tYofª\s ;+sng ug]{ ;fdu|L, ljlw, pQ/bftfsf]

125

a'emfO, pgLx?sf] OdfGbfl/tf, tYofª\ssf] ljZn]if0f / JofVof cflbnfO{ u}/gd'gfut q'l6x?sf]

?kdf lng ;lsG5 .

v_ kIfkftsf] cjwf/0ff (Concept of Bias)

cWoogdf x'g] Jojl:yt uNtLnfO{ kIfkft elgG5, h;n] cWoogsf] kl/0ffdnfO{ aª\UofpF5 (Bias is a systematic error in a study that leads to a distortion of the results) . cWoogstf{n] k"jf{u|xL eP/ jf cfkmn] rfx] h:tf] glthf k|fKt ug{sf] nflu hfgfhfgL dfkgnfO{ 36La9L ug]{ / glthfnfO{ k|efj kfg]{ u/L juL{s/0f / ljZn]if0f ubf{ ;TotYoaf6 o;k|sf/sf] ljrng x'g uO{ glthf kIfkftk"0f{ x'G5 . Jojl:yt q'l6 jf kIfkftnfO{ d'Vo tLg ;d"xdf ljefhg ug{ ;lsG5 M–

!_ 5gf]6 kIfkft÷k"jf{u|x (Selection bias) @_ ;"rgf÷dfkg kIfkft÷k"jf{u|x (Information/measurement bias) #_ ;Gb]xhgs kIfkft÷k"jf{u|x (Confounding bias)

!_ 5gf]6 kIfkft÷k"jf{u|x (Selection bias)

cWoogdf cfjZos kg]{ ;xefuLx¿ ljleGg tl/sfn] 5gf]6 ul/G5 . s'g} vf; ljz]iftf ePsf

JolQmx¿nfO{ 5gf]6 ubf{ /fd|f] kl/0ffd cfpF5 eg] k"jf{u|xL eP/ ;xefuL rog u¥of] eg]

5gf]6df kIfkft x'G5 . cWoogdf ;xefuL x'g] hg;ª\Vofsf] klxrfg tyf 5gf]6 k|lqmofdf x'g]

s'g} k|sf/sf] uNtLnfO{ 5gf]6 kIfkft elgG5 . cWoog / lgoGq0f ;d"x jf s]; / sG6«f]n

;d"xdf 5flgPsf JolQmx¿sf] ljz]iftf /Ltk"j{s tl/sfn] leGg 5g\ eg] o;k|sf/ kIfkft x'G5

. pko'Qm ;|f]taf6 kof{Kt dfqfdf ;xefuL 5gf]6 ubf{ ;dfj]z ug]{ jf gug]{ :ki6 dfkb08

gagfP/ cWoogstf{n] cfkm"v';L klxrfg / 5gf]6 ubf{ 5gf]6df kIfkft x'G5 . ;xefuL 5gf]6

ubf{ :ki6 dfkb08 agfP/, hf]8f ldnfg tyf /]G8f]dfOh]zg ljlw k|lqmof ckgfP/ x6fpg

;lsG5 .

@_ ;"\rgf÷dfkgsf] kIfkft (Information/measurement bias)

pko'Qm 9ª\un] ;"rgf ;ª\sng tyf dfkg ubf{ x'g] uNtL tyf k"jf{u|xnfO{ ;"rgf jf dfkgsf]

kIfkft elgG5 . ;+of]uj+z jf hfgLhfgL cg'ko'Qm tl/sfn] dfkg u/]sf] v08df ;"rgfdf

kIfkft cfpF5 (Information bias can occur when there is random or

systemeatic inaccuracy in measurement) . cyf{t\ h'g s'/f dfkg ug{ vf]h]sf] xf],

126

ToxL s'/fnfO{ 7Ls 9ª\un] dfkg gubf{ jf hf]lvd / /f]unfO{ 7Ls 9ª\un] juL{s/0f ug{ g;Sbf

/ :t/Lo k|lqmof gckgfP/ unt dg;fo /fv]/ dfkg jf tYofÍ ;ª\sng ubf{ ;"rgf tyf

dfkgdf kIfkft x'G5 . o;k|sf/sf] kIfkftnfO{ d'Vo tLg efudf ljefhg ug{ ;lsG5 M–

i) :d/0f k"jf{u|x÷kIfkft (Recall bias)

/f]u cWoog ubf{ ljutsf] 36gfx¿sf] af/]df pQ/bftfnfO{ ;f]w]/ ;"rgf k|fKt ug'{ kb{5 .

36gf ePsf] / ;"rgf ;ª\sngsf] aLrdf nfdf] ;dosf] cGt/fn ePDff pQ/bftfn] /fd|f];Fu

;Demg g;sL unt ;"rgf lbg ;Sb5 . o; k|sf/sf] q'l6nfO{ :d/0f k"jf{u|x elgG5 . uDeL/

36gf jf s8f vfnsf] la/fdL ePsf] 36gfnfO{ ;DalGwt JolQmn] nfdf] ;do;Dd :d/0f ug{

;Sb5 t/ emf8fkvfnf jf ;fdfGosf] vfnsf] /f]u ladf/nfO{ l5§} la;g]{ ;Defjgf x'G5 .

o:tf] cj:yfdf pQ/bftfn] 7Ls ;"rgf lbg ;Sb}g / unt ;"rgf k|fKt x'g ;Sb5 . :d/0f

kIfkftnfO{ x6fpgsf] nflu 36gf eP nuQ} ;"rgf ;ª\sng ug'{ kb{5 . w]/} ;do cl3

ePsf 36gfx¿nfO{ cfwf/ agfP/ cWoog ug'{ x'Fb}g . uDeL/ vfnsf] 36gfnfO{ ^ dlxgf jf

jif{ lbg;Dd 36]sf] 36gfx¿sf] af/]df ;"rgf ;ª\sng ug{ ;lsG5 . t/ emf8f kvfnf tyf

?3fvf]sL, Hj/f] (ARI) sf] af/]df cWoog ubf{ !% b]lv @) lbgleq 36]sf 36gfx¿ dfq

;f]Wg' kb{5 .

iii) ;IffTsf/stf{÷cjnf]sgstf{sf] k"jf{u|x kIfkft (Interviewern observer bias)

cGtjf{tf{ lng] JolQm jf cjnf]sgstf{n] cWoogsf] glthfnfO{ k|efj kfg]{ u/L hfgL hfgL

tf]8df]8 u/L clen]v /fVg] / tYofÍ ubf{ x'g] uNtL jf kIfkftnfO{ ;fIffTsf/ jf

cjnf]sgstf{sf] kIfkft elgG5 . h:t}M ;fa'g kfgLn] xft w'g] afgLn] emf8f kvfnf

lgoGq0f ub{5 eGg] af/]df cWoog ubf{ s]; / sG6«f]n ;d"x agfP/ ljutsf] afgL

Jojxf/sf] af/]df k|Zg ;f]Wg' kb{5 . s]; ;d"xsfn] ;fa'g kfgLn] xft w'G5f}F eg] klg ;fa'g

k|of]u gug]{ pQ/df lrgf] nufpg] / sG6«f]n ;d"xsf] dflg;x¿n] slxn] sfxL+ k|of]u u5f}F

eg] klg lgoldt u5f}{ eGg] pQ/df lrgf] nufpg] ubf{ cGtjf{tf{ lng] JolQmsf] k"jf{u|x

b]lvG5 . o;k|sf/sf] kIfkft x6fpg cGtjf{tf{ lng] JolQm lgikIf eP/ b'j} ;d"xnfO{ ;dfg

tl/sfn] cGtjf{tf{ lng' kb{5 .

127

iii) l/kf]l6{Ë kIfkft (Reporting Bias): cg';Gwfgsf] qmddf s'g} klg pQ/bftfn] 36gfsf]

jf:tljs hfgsf/L glbO{ em'7f] hfgsf/L lbg'nfO{ va/ lbg] kIfkft elgG5 . o;df of

pQ/bftfn] 36gf la;]{/ unt ; 'rgf lbG5 of p;n] s'g} sf/0fj/ jf:tljstf eGg c;dy{

x'G5 .

iv) k|ltlqmof kIfkft (Response Bias) M cg';Gwfgstf{n] cjnf]sg ubf{ jf cGt/jftf{

lnbf pQ/bftfn] ljifoj:t' jf k|Zgx? ga'em]/ jf cfj:of pQ/x? glbP/ jf plgx? k|lt

b]vfPsf] k'jf{u|xL efjgfn] o:tf kIfkftx'g ;S5g .

v) unt juL{s/0f kIfkft (Misclassification bias)

cWoog ubf{ ljleGg ;d"xdf juL{s/0f u/L t'ngf ug'{ kb{5 . s]; / sG6«f]n jf hf]lvddf

k/]sf / gk/]sf jf wgL / ul/a, :j:y / c:j:y Jojxf/ ug]{ cflbsf] juL{s/0f 7Ls 9ª\un]

gubf{ x'g] Jojl:yt q'l6nfO{ unt juL{s/0f kIfkft elgG5 . :t/Lo ljlw tyf k|lqmof

gckgfO{ cfkm" v';Ln] cWoog ;xofqLnfO{ ljleGg ;d"xdf ljefhg u/]/ tYofÍ ;ª\sng

tyf ljZn]if0f ubf{ o:tf] kIfkft b]vf kb{5 .

#_ ;Gb]xhgs kIfkft (Confounding bias)

/f]u jf :jf:Yo cj:yfnfO{ Ps eGbf a9L tTjx¿n] k|efj kf/]sf] x'G5 . slxn]sfxLF b'O{ j6f

tTjx¿n] ldl>t ¿kdf c;/ kf/]sf] x'G5 . o:tf] cj:yfdf Pp6f hf]lvd tTj / /f]usf]

lar;DaGwsf] dfq ljZn]if0f ubf{ kIfkft x'g uO{ unt lgisif{ lg:sG5 . h:t} dlb/f ;]jg

ug]{ afgL / kmf]S;f]sf] SofG;/ larcWoog ug{ rfx]sf] cj:yfdf w'd|kfg ug]{ afgL

;Gb]xhgs tTj x'G5 ls dlb/f ;]jg ug]{n] w'd|kfg klg ub{5 . dlb/f ;]jg ug]{ ;d"xdf

kmf]S;f] SofG;/ /f]usf] b/ a9L b]lvof] eg] /S;L vfg] afgLn] kmf]S;f]sf] SofG;/ pTkGg ug{

d2t ub{5 eGg] lgisif{ lg:sG5 . olb pgLx¿sf] w'd|kfg ug]{ afgLnfO{ klg cWoog ubf{

Wofg lbPg / ljZn]if0f ul/Pg eg] ;Gb]xhgs kIfkft x'G5 . jf:tjdf dlb/f ;]jg ;d"xdf

JolQmn] r'/f]6 ;]jg u/]sf]n] ubf{ kmf]S;f] SofG;/ ePsf] x'g ;Sb5 . lsgeg] dlb/f ;]jg /

kmf]S;f] SofG;/ aLrdf k|ToIf ;DaGw 5}g . ;Gb]xhgs tTjx¿nfO{ a]jf:tf u/]/ cWoog

ubf{ unt glthf lg:sG5 . o;sf] af/]df lj:t[t ¿kdf cufl8 g} ljZn]if0f ul/Psf] 5 .

128

u_ ;Gb]xhgssf] cjwf/0ff (Concept of Confounding)

Pp6f c;/ jf 36gfnfO{ Ps eGbf a9L hf]lvd tTjx¿ (Risk factors) n] k|efj

kf/]sf] x'G5 . o:tf] cj:yf Pp6f hf]lvd jf sf/s tTj / c;/sf] aLrdf ;DaGw :yfkgf

u/L cGo hf]lvdnfO{ a]jf:tf u/]sf] v08df unt ;DaGw :yfkgf x'g] / unt lgisif{df k'Ug]

;+efjgf x'G5 . cª\u|]hL zAb Confounding Nofl6g zAb Confundere af6 cfPsf] xf]

. Confundere sf] cy{ x'G5, ;Fu;Fu} ldl;g' (To mix together) eGg] x'G5 . hf]lvd /

c;/sf] aLrdf ePsf] k|ToIf / ck|ToIf sf/s ;DaGw ;lDd>0f x'g'nfO{ ;fdfGo cy{df

Confounding jf ;Gb]xhgs elgG5 . cWoog ug{ rfx]sf] hf]lvdsf] k|efj;Fu csf]{

jfx\o tTjsf] k|efj ldl;P/ cWoog ug{ rfx]sf] /f]unfO{ c;/ kfg'{nfO{ ;Gb]xhgs elgG5

(Confounding refers to the mixing of the effect of an extraneous variable with the effect of the exposure and disease of interest) . cWoog

ug{ rfx]sf] hf]lvd tTj / c;/÷/f]u b'j};Fu ;DalGwt eP/ s'g} csf]{ hf]lvd tTj cWoogdf

cjl:yt 5 eg] ;Gb]xhgs 5 eGg ;lsG5 . o;/L c;/ kfg]{ t];|f] tTjnfO{

Confounder elgG5 . hf]lvd tTj / /f]usf] aLrdf ePsf] b]vfj6L ;DaGwnfO{

aª\UofOlbG5 . ;Gb]xhgs 5 / To;nfO{ a]jf:tf u/L hf]lvd / c;/sf] aLrdf ;DaGw

:yfkgf ug{ vf]h]sf] cj:yfdf lgisif{ e|dk"0f{ x'G5 lsgeg] ;Gb]xhgs tTjsf] c;/ a9L 5 eg] /f]usf] oyfy{sf/s tTj, t];|f] tTj ;Gb]xhgs tTj x'G5 . o;nfO{ a'‰gsf] nflu tnsf]

lrqn] d2t ug]{5 .

dfly lrqdf skmL vfg] afgL / d'6'sf] /f]u lar;DaGwsf] af/]df cWoog ug{ vf]lhPsf] cyf{t\

skmL vfg] afgLn] d'6'sf] /f]u pTkGg ub{5 eGg] cg'dfg ul/Psf] 5 . lgoldt skmL vfg] w]/}

JolQmsf] ;'tL{ jf w'd|kfg ug]{ afgL klg x'g]5 . o;/L skmL vfg] hf]lvd afgL, ;'tL{sf] k|of]u

ug]{ afgL;Fu ;DalGwt x'G5 . ;'tL{sf] ;]jgn] d'6'sf] /f]u klg a9fpF5 . o:tf] cj:yfdf skmL

hf]lvd (Exposre) (Coffee

d i ki )

/f]u (Disease) (Heart disease)

True association with disease

Confounding Association

Confounding variable

( b )

129

;]jg / d'6'sf] /f]u lar;DaGwnfO{ dfq ljZn]if0f u/]sf] v08df skmL d'6' /f]usf] hf]lvd tTj

(Risk factor) xf] eGg] lgisif{ aGb5 . oyfy{df skmL ;]jgn] dfq d'6'sf] /f]u nfUb}g . skmL

vfg] JolQmn] r'/f]6 ;]jg u/]sf] x'gfn] skmL vfg] ;d"xdf d'6'sf] /f]u a9L b]lvPsf] xf] . ;'lt{ jf

r'/f]6;]jg / d'6'sf] /f]u lar;frf] ;DaGw 5 . ;Gb]xhgs tTj g} /f]usf] d'Vo hf]lvd tTj xf]

.

dflysf] lrqdf cfdfsf] lzIffn] aRrfsf] kf]if0f l:yltdf k|efj kfb{5 eGg] s'/fsf] cWoog ug{ vf]lhPsf] 5 . oL b'O{ aLrsf] ;DaGw ljZn]if0f u¥of] eg] clzlIft dlxnfsf] aRrfsf] kf]if0f l:ylt g/fd|f] / lzlIft dlxnfdf hGd]sf] aRrfsf] kf]if0f cj:yf /fd|f] b]lvG5 . t/ kf]if0fnfO{ k|efj kfg]{ csf]{ k|an sf/0f cfly{s cj:yf 5 . cfly{s cj:yf ;DkGg ePsf]n] afnaflnsfnfO{ kof{Kt vfgf v'jfpg] ub{5g\ / s'kf]if0f ;d:of sd x'G5 t/ lzlIft dlxnfsf] cfly{s cj:yf /fd|f] x'G5 . cyf{t\ cfly{s cj:yf /fd|f] ePsf kl/jf/sf dlxnfx¿n] a9L k9\g] cj;/ kfpF5g\ . dlxnfsf] lzIff / cfly{s cj:yfsf] klg ;DaGw 5 . dlxnfsf] lzIff afnkf]if0fsf] ck|ToIf sf/0f xf] . o;/L lzIff / kf]if0fsf] ;DaGw ;Gb]xhgs xf] eg] cfly{s cj:yf / kf]if0fsf] lark|ToIf / ;fFrf] ;DaGw 5 .

Cause (Mother education)

Effect (Child nutrition

True association

Economic condition (Confounding variable)

130

lqmofsnfk/cEof;

!= dfkgnfO{ kl/eflift ub}{ o;df s:tf s:tf q'l6 x'g ;S5g\ < pNn]v ug'{xf];

@= dxfdf/L lj1fgdf k|of]usf] cfwf/df q'l6x?, kIfkft / ;Gb]xhgsnfO{ kl/eflift ug'{xf];\ .

#= q'l6sf k|sf/x? 5'6\ofpg'xf];\ .

$= gd"gf 5gf}6df q'l6x? –Sampling Errors / gd"gf afx]ssf q'l6x? Non-Sampling Errors

t'ngf ug'{xf];\ .

%= dfkg kIfkftx?sf] Measurement Bias ;'lr agfO{ tLgLx?sf] ljj]rgf ug'{xf];\ .

^= gd"gf 5gf}6df k"jf{u|xx? Sampling Bias / gd"gf 5gf}6 afx]ssf k"jf{u|xx? -Non-

Sampling Bias aLrsf] leGgtf b]vfpgxf];\ .

&= ;Gb]xhgs kIfkft (Confounding Bias) sf] e'ldsfaf/] ljj]rgf ug'{xf];\ .

$=% dxfdf/L lj1fgdf ljZj;gLotf / j}wtf (Concept and types of reliability and validity in epidemiology)

s_ ljZj;gLotfsf] cjwf/0ff (Concept of Reliability)

/f]u cWoog lj1fgdf cWoog ubf{ /f]u, :jf:Yo l:ylt, :jf:Yo Jojxf/, 1fg wf/0ff, hf]lvdsf] c;/x¿ dfkg ug{ ljleGg dfkgsf ;fwg tyf k|lqmofx¿ k|of]u ul/G5 . s'g} ;fwg k|of]u u/]/ ;dfg cj:yfdf bf]xf]¥ofP/ dfkg ubf{ p:t} kl/0ffd cfpF5 eg] dfkg ljZj;gLo 5 eGg ;lsG5 . ToxL ;fwg / k|lqmof ckgfP/ ;dfg cj:yf bf]xf]¥ofP/ dfkg ubf{ leGg kl/0ffd cfpF5 eg] ljZj;gLo 5}g elgG5 .

131

æs'g} ;fwgn] s'g} rLh jf j:t'nfO{ ;dfg cj:yfdf pxL tl/sfn] k|To]s k6s dfkg ubf{

slt xb;Dd dfkgsf] Ps¿ktf b]vfpF5 eGg] s'/f ljZj;gLotf xf]Æ (Reliability is the

stability of measurement of the degree to which an instrument measures the same

way each time if it is used under the same condition) .

Reliability is accuracy or a precision of a measuring instrument. F.N. Kerlinger

k6sk6s dfkg ubf{ klg ;dfg ?kn] kfOg]] dfkgsf] ;fwgsf] u'0fnfO{ ljZj;gLotf elgG5 .

o;n] dfkgdf Ps?ktf, l:y/tfsf] eljiojf0fL ug{ ;lsg] u'0f / z'4tfsf] hfgsf/L lbG5 .

;fk]lIft ?kdf uNtL gePsf] dfkg cf}hf/af6 ul/Psf] dfkgnfO{ ljZj;gLotf elgG5 .

Pp6} j:t' jf JolQmsf] ljz]iftf pxL cj:yfdf pxL tl/sfn] ;dfg kl/0ffd lbg ;S5 eg] To;nfO{ ljZj;gLo elgG5 . h:t} tf}n dfkg ubf{ klxnf]k6s dfkg ubf{ %) s]hL, bf];|f] / t];|f] k6s dfkg ubf{ klg %) s]hL g} b]vfpF5 eg] o;nfO{ ljZj;gLo dflgG5 . t/ klxnf] k6s dfkg ubf{ %) b]vfpF5 bf];|f] / t];|f] k6s dfkg ubf{ $* / %! b]vfpF5 eg] o:tf] dfkg ljZj;gLo 5}g elgG5 . /f]u cWoog lj1fgdf /f]u tyf :jf:Yo;Fu ;DalGwt 36gfsf] dfkg ug{sf nflu pko'Qm / ljZj;gLo ;fwg / k|lqmof ckgfpg' kb{5 . dfkg ljZj;gLo eP dfq cWoogsf] glthf klg ljZj;gLo x'G5 . oyfy{ s'/f kQf nufpg :jf:Yo ;d:of tyf cj:yfnfO{ ljZj;gLo tl/sfn] dfkg u/]/ ;xL ;"rgf ;ª\sng ug'{ kb{5 .

ljZj;gLotf hfFrsf ljlwx? Method of Reliability Test M

k/LIf0f k'gMk/LIf0f ljlw Test and Retest Method

cw{ljefhg ljlw Split Half Method

ax'ljlw Multiple Method

v_ k|dfl0fstf /j}wtf (Validity)

/f]u, ;d:of tyf :jf:Yo cj:yf / JolQmsf] cGo ljz]iftf dfkg ug]{ ;fwg tyf dfkg ug]{

ljlw ljZj;gLo dfq eP/ k'Ub}g j}w klg x'g' kb{5 . s'g} ;fwg tyf k|lqmofn] h'g s'/f dfkg

132

ug{ vf]h]sf] xf] ToxL s'/f dfkg ug]{ ljz]iftf 5 eg] To;nfO{ j}w eGg ;lsG5 . cyf{t\ h'g

s'/f dfkg ug'{ kg]{ xf] ToxL ToxL s'/f slt xb;Dd dfkg u¥of] eGg] s'/fsf] cleJolQm g}

j}wtf xf] (Validity is an expression of the degree to which a measurement

measures what it purports to measure) .

of] s'g} klg j:t', ljifo j:t' jf cj:yfsf] dfkgdf x'g' kg]{ u'0f xf] . o;n] h'g j:t'nfO{ gfKg

vf]h]sf] xf] To;nfO{ gfk]sf] x'g' kb{5 . cg';Gwfg sfo{df tYofª\ssf] z'4tf, tfls{stf /

lglZrttfn] j}wtf k|bfg ub{5 . cg';Gwfgdf p2]Zog';f/ rnx?sf] dfkg ubf{ dfkgsf] tl/sf,

cf}hf/ tyf ljlw pko'Qm 5 ls 5}g eGg] tYosf] k|dfl0fs 5 5}gf eGg] yfxf x'5 .

Validity is a property of a measuring instrument that you want to test for.

T.L. Bankar. tkfFO{n] gfKg vf]h]sf] -s] xf] Tof] gfkLPsf] 5 ls 5}g_ dfkg cf}hf/sf] u'0fnfO{

j}Btf elgG5 . Are you measuring what are we think are measuring. F.N.

Kerlinger sf] cg';f/ tkfO{n] h] gfKg vf]h]sf] ToxL gfkLPsf] 5 eg] To;nfO{ j}wtf elgG5

. tf}n dfkg ug]{ cf}hf/n] k6s k6s dfkg ubf{ Pp6} tf}n b]vfpF5 t/ Tof] cf}hf/n] Ps

s]hLnfO{ Ps s]hL ¿kdf dfkg ug{ ;Sb}g . cyf{t\ Ps s]hL eg]/ dfkg ul/Psf] j:t' csf]{

d]l;gn] hfFr ubf{ *)) u|fd dfq b]vfpF5 eg] tf}nnfO{ 7Ls 9ª\un] dfkg ug{ ;s]sf] 5}g .

o:tf] ;fwgnfO{ j}w dflgb}g . tf}n dfkg ug]{n] s]hL / u|fddf ;xL 9ª\un] dfkg ug{ ;Sb5

eg] j}w dflgG5 . /utdf 6fOkmfO6sf] ls6f0f' eP jf gePsf] kQf nufpg] ;fwg÷tl/sfn]

ToxL ls6f0f' kQf nufpg ;Sg' kb{5 . dflg;sf] :jf:Yo ;DaGwL ;Lk tyf Jojxf/ dfkg ug]{

k|ZgfjnL jf ;fwgn] ToxL s'/f dfkg ug{ ;s]df j}w dflgG5 t/ ;Lk dfkg ug]{ ;fwgn] 1fg

dfkg u¥of] eg] j}w dflgFb}g . ;fwg tyf dfkg ug]{ ljlw÷k|lqmof j}w x'g ljZj;gLo klg x'g'

kb{5 . ljZj;gLo / j}wtfsf] ;DaGwnfO{ tn lrqdf b]vfOPsf] 5 .

j}Btf hfFrsf] tl/sfM Logical validation tfls{s j}wtf, Jury opinion ljz]if1x?sf]

ljrf/, Known group kl/lrt ;d"x, Predict measures :j3f]if0f ug{ ;lsg],

Content validity ljifoj:t' j}wtf, Construct validity lgld{t j}wtf a0f{gfTds

ljZn]if0fsf] cjwf/0f

u|Lg ju{ / ;fyLx¿sf] (Green berg etal. 1996) sf] cg';f/, æj}wtfsf] cjwf/0ff Pp6f

dfkg jf cWoog slt xb;Dd ;xL lgisif{df k'Ug ;S5 eGg] s'/f;Fu ;/f]sf/ /fVb5 . (The

133

concept of validity concerns the degree to which a measurement or study

reaches a correct conclusion.) cWoog ubf{ j}w / ljZj;gLo ;fwg tyf k|lqmof k|of]u

ePsf] 5, gd'gf 5gf]6 ubf{ / ;"rgf ;ª\sng ubf{ :jtGq / lgikIf sfod ePsf] 5 /

hfgLhfgL klg ul/g] q'l6x¿ ul/Psf] 5 / dfgj q'l6nfO{ sd k|of; ePsf] 5 . tYofÍ

ljZn]if0f ubf{ JolQmut wf/0ff tyf ljZjf;nfO{ a]jf:tf u/L j:t'ut s'/fnfO{ Wofg lbP/

pko'Qm vfnsf] ;fwg k|of]u u/]sf] cWoog j}w x'G5 . /f]u cWoog lj1fgdf

cWoogstf{n] cWoognfO{ a9L j}w agfpg] k|of; ug'{ kb{5 .

j}Btfsf] k|sf/ (Types of Validity in Epidemiology)

Olk8]ldof]nf]lhs cWoogsf] b'O{ k|sf/sf] j}wtf x'G5 M–

i_ cfGtl/s j}wtf (Internal validity)

ii_ afx\o j}wtf (External validity)

i_ cfGtl/s j}wtf (Internal validity)

s'g} klg cWoogn] cWoog ul/Psf] ;d'bfo jf ;d"xsf] oyfy{ lrq0f ug{ ;Sg' kb{5 . Pp6f

cWoog kl/0ffdn] cWoog hg;ª\Vofsf] oyfy{ cj:yf ;Dd 7Ls 9ª\un] k|ltlaDa÷phfu/

ug'{nfO{ cfGtl/s j}wtf elgG5 (Internal validity is the extent to which the results of

an investigation accurately reflect the true situation of the study population) .

cWoognfO{ j}w ljZj;gLo / pkof]uL agfpgsf] nflu cWoogstf{n] cfGtl/s j}wtf a9fpg]

k|of; ug'{ kb{5 . cWoogsf] qmddf kIfkft, q'l6 / ;Gb]xhgs tTjx¿nfO{ x6fpg] / pko'Qm

tl/sfn] cWoog vfsf agfpg], sfof{Gjog, ljZn]if0f tyf JofVof u/]/ cfGtl/s j}wtf sfod

ug{ ;Sg' kb{5 . s'g} ;d'bfodf dfgl;s ;d:of a9]sf] / Tof] a9\g'sf] sf/0f 3/]n' lx+;f xf]

eGg] s'/f JofVof ul/Psf] 5 . t/ of] glthf tyf JofVofnfO{ cWoog hg;d'bfon] :jLsf/ ug{

sl7g eof] / ToxfF dflg;x¿n] cfˆgf] ;d'bfodf 3/]n' lx+;fsf] ;d:of 5}g, s;/L of] x'g

;Sb5 eGg] k|Zg u/]sf] v08df o:tf] cWoog cfGtl/s j}wtf x'Fb}g . cfGtl/s j}wtf ePg eg]

cWoog hg;ª\Vofdf cWoogsf] lgisif{ / ;'emfjsf] s'g} sfd nfUb}g . To;}n] cWoogstf{n]

cWoognfO{ ;s];Dd a9L j}w agfpg s8f d]xgt ug'{ kb{5 .

134

ii_ afx\o j}wtf (External validity)

s'g} cWoog u/]kl5 clGtddf d'Vo s'/fnfO{ ;fdfGoLs/0f u/L cGo hg;d'bfosf] nflu klg

pkof]uL agfpg] k|of; ug'{ kb{5 . Pp6f cWoogaf6 k|fKt glthfnfO{ cGo hg;d'bfodf

slt xb;Dd pkof]u ug{ ;lsG5 eGg] s'/fnfO{ jfx\o j}wtf elgG5 (External validity is

the extent to which the results of a study are applicable to other populations) .

cWoogsf] jfx\o j}wtf k|fKt ug{sf] nflu cfGtl/s j}wtf klg x'g' kb{5 . /fd|f];Fu l8hfOg,

u'0f:t/ sfod u/]/ Jojl:yt tl/sfn] pko'Qm hg;ª\Vofdf cWoog u/]/ lgsflnPsf] glthf

tyf ;fdfGoLs/0fnfO{ p:t} ljz]iftf ePsf] cGo hg;ª\Vofdf pkof]u ug{ ;lsG5 . cGo

;d'bfodf pkof]uL x'gsf] nflu Sample size k|ltlglwTj ug]{ / w]/} ;ª\Vofdf x'g' kb{5

eGg] 5}g . ;w}F ;fa'g kfgLn] xft w'g] afgLn] emf8fkvfnf /f]u /f]syfd ug{ d2t ub{5 eGg]

s'/f ;fgf] ;d'bfodf cWoog ul/Psf] eP klg of] glthf j}w xf] eg] cGo w]/} ;d'bfodf nfu"

ug{ ;lsG5 . To;}n] cWoogstf{n] cfGtl/s / jfx\o j}wtf x'g] u/L Olk8]ldof]nf]lhsn

cWoog ug'{ kb{5 .


!= ljZj;gLotfsf] af/]df s] l;Sg' eof] < Olk8]ldof]nf]lhsn cWoogdf ljZj;gLotf

lsg cfjZos kb{5<

@= Olk8]ldof]nf]lhsn cWoogdf s;/L cfGtl/s / afXo a}wtf k|fKt ug{ ;lsG5 <

lqmofsnfk/cEof;

@= cg';Gwfdf k|dfl0fstf /j}Btf Validity / Reliability ljZj;gLotfsf] k|of]u s;/L

ul/G5 ljj]rgf ug'{xf];\ .

#= Reliability ljZj;gLotfsf] hfFrsf ljlwx? 5nkmn ul/ lgrf]8 lgsfNg'xf];\ .

$= j}wtf hfFrsf] ljlwx?sf] ;"rL tof/ kfg'{xf];\ .

%= Olk8]ldof]nf]lhs cWoogdf slt k|sf/sf] j}wtf x'G5g\ < JofVof ug'{xf];

135

$=^ Ps rnLo, lårnLo / ax'rnLo j0f{gfTds ljZn]if0fsf] cjwf/0ff (Concept and techniques of univariate and bivariate descriptive analysis (frequency tables, cross tables and figures)

tYofª\s sf] ljZn]if0f ul0ftLo ljZn]if0fdf cfwfl/t x'G5 . o;df rnx?sf] ljrsf] ;DaGwnfO{

tYofª\szf:qLo lgod / ljlw cg';f/ /fv]/ JofVof ul/G5 . o:tf ljZn]0f Ps rnLo

Univariate, bLrnLo Bivariate, ax'rnLo Multivariate cfwf/df ul/G5 . o:tf ljZn]if0fdf

cfl>t rn :jtGq rnx?sf ljrsf] ljZn]if0f u/L sfo{sf/0f ;DaGw kQf nufOG5 .

JofVofTds ;f+lVosLo ljZn]if0fsf] lgDg k|sf/x? 5g .

s_ Ps rnLo jf rnLo ljZn]if0f (Univariate Analysis)

cg';Gwfgsf] qmddf Pp6fdfq rnsf] ;+sng u/L To;sf] ljZn]if0f ul/G5 eg] To;nfO{ Ps

rnLo lnZn]if0f elgG5 . o;df s'g} Pp6f ;d"x, JolQm, ;+:yf, jf j:t'nfO{ cg';Gwfgsf] rn

To;df ePsf] ljleGg ljz]iftfx? ljZn]if0f ul/G5 . o; ljZn]if0fdf cfj{lQ ljt/0f Ps klIfo

tfnLsfsf] dfWodaf6 ul/G5 . o;df b/ / juf{Gt/ gfksfnflu s]lGb|o k|j[ltsf gfkx?sf]

k|of]u x'G5 . o;df dfgx?nfO{ cfj[lQ ljt/0f / k|ltztdf b]vfpg ;lsG5 . ;fwf/0f

tflnsfdf tYofÍx¿df cGtlg{lxt s'g} Ps u'0fnfO{ dfq k|:t't ul/g] ePsf]n] o;nfO{

Psu'0fLo tflnsf (Single variable or one way table) klg elgG5 . Ps rnLo lnZn]if0f ug{sf]

nflu agfOPsf tflnsf lgDgfg';f aGb5 .

lnª\usf] cfwf/df pQ/bftf

lnª\u ;ª\Vof k|ltzt

k'?if 96 48 dlxnf 104 52 hDdf 200 100

136

:jf:Yo cj:yfsf] tflnsf

;ª\Vof k|ltzt

w]/} :jf:y 56 28 :jf:y 80 40 la/fdL 36 18 w]/} la/fdL 20 10 yfxf 5}g 8 4 hDdf 200 100

wd{ cg';f/ hg;ª\Vof

v_ lårnLo ljZn]if0f (Bivariate Analysis)

o; k|sf/sf] ljZn]if0fdf b'O{j6f rnx?ljr t'nfgfTds ljZn]if0f ul/G5 . o:tf] ljZn]if0f

cGt/ tfnLsLs/0f Cross Tabulation af6 klg ug{ ;lsG5 . o;df rnx?sf]

ljt/0fdf tflnsfx? K|ltztdf cfwfl/t x'G5 / Pp6f rnsf] ;DaGw csf]{ rn;+u s]

s:tf] 5 eGg] hfgsf/L lbG5 . o:tf ljZn]if0fdf Ps rnsf] t'ngfTds ljZn]if0f csf]{

rn;+u ul/G5 . o;n] Psrnsf] sf/0fn] csf]{df k/]sf] k|efjsf] ljZn]if0f ub}{g . o:tf]

cj:yfdf b'O{ rn ljZn]if0f ug{' kb{5 . o;sf] nflu b'O{ rn rflxG5 . Pp6f rnnfO{

t];|f] kª\lQm (Row) / csf]{nfO{ 7f8f] :tDe (Column) /fVg' kb{5 . h:t} ;d'bfosf

dlxnf / k'?ifnfO{ cfˆgf] :jf:Yo cj:yf cfkm}nfO{ JoQm ug{ ;f]lwPsf] lyof] eg] b'O{ rn

ljZn]if0f ug{sf] nflu pQ/bftfnfO{ dlxnf / k'?if b'O{ ;d"xdf ljefhg ug'{ kb{5 .

wd{ ;ª\Vof k|ltzt

lxGb' 136 90.70

af}4 11 7.30

d'l:nd 3 2.00

hDdf 150 100

137

dlxnf / k'?ifdf :jf:Yo :t/ :jf:Yo :t/ lnª\u hDdf

k'?if dlxnf

w]/} :j:y 32 (33%) 24 (23%) 56 (28%) :j:y 40 (42%) 40 (38%) 80 (40%) la/fdL 16 (17%) 20 (19%) 36 (18%) w]/} la/fdL 8 (8%) 12 (12%) 20 (10%) yfxf 5}g 0 (0%) 8 (8%) 5 (4%) hDdf 96 (100%) 104 (100%) 200 (100%)

;d'bfosf dflg;x¿÷pQ/bftfnfO{ ;fIf/ lg/If/df ljefhg u/]/ vfgf vfg' cl3 ;fa'g

kfgLn] xft w'g] kfgLsf] ljZn]if0f ubf{ lgDgfg';f/sf] 6]an agfpg' kb{5 .

;fIf/ / lg/If/df ;fa'g kfgLn] xft w'g] afgL ;fa'g kfgLn] xft w'g] afgL ;fIf/tf hDdf

lg/If/ ;fIf/

w'g] 14 (28%) 90 (60%) 104 (52%) gw'g] 36 (72%) 60 (40%) 96 (48%) hDdf 50 (100%) 150 (100%) 200 (100%)

oL b'O{ rnx?sf] ljrdf ePsf] ;DaGwnfO{ lgSof}{n ug{ kl/sNkgf k/LIf0f ul/ To;sf]

;DaGwsf] tx Degree of Association sf] af/]df tYofª\sLo tyf kl/sNkgfsf] k/LIf0f ug{

;lsG5 .

u_ ax'rnLo ljZn]if0f (Multivariate Analysis)

ax'rnLo ljZn]if0fdf tLg jf tLg eGbf a9L rnx? larsf] ;DaGwnfO{ ljleGg tYofª\s

zfl:qo dfWodaf6 ljZn]if0f ug]{ ul/G5 . o;df ax'k|ltudg ljlw Multiple Regression

analysis af6 b'O{ eGbf a9L rnx? larsf] ;DaGwsf] ljZn]if0f ubf{ Ps rndf kl/jt{g cfpFbf

csf]{rndf cfpg ;Sg] ;Defljt kl/jt{gsf] cg'dfg ug{ ;lsG5 . o;n] ljZn]if0fdf rnx?sf]

ljleGg ljz]iftfx?nfO{ cfwf/ agfP/ ax' ljZn]if0f Multiple Analysis ug{ ;lsG5 .

138

Multivariate Analysis ax'rnLo ljZn]if0f ubf{ hl6n k|sf/sf] tYofª\s zfl:qo ljlw k|of]u ug{

kb{5 . h;df a9L eGbf a9L rnx?ljrsf] Ps csf{dfly kg]{ jf b]lvg] k|efjx? x]g{ ;lsG5 .

o;df JolQmsf] hft, ln+u, wd{, pd]/, j}jflxs l:ylt, lzIff, k]zf, / /f]usf] ljj/0fnfO{ x]g{

;lsG5 .

hfthflt cg';f/ rkL{sf] k|of]u

rkL{ k|of]u If]qL a|fxd0f hghflt blnt hDdf

k|of]u ug]{ 52 (65%) 38 (54%) 20 (40%) 110(55%) gug]{ 28 (35%) 32 (46%) 30 (60%) 90 (45%) hDdf 80 (100%) 70 (100%) 50 (100%) 200(100%)

hflt, cfDbfgL / zf}rfnosf] cj:yf -;ª\Vofdf_

hft

dfl;s cfDbfgL

hDdf # xhf/;Dd #–% xhf/;Dd % xhf/eGbf dfly zf}rfno zf}rfno zf}rfno

ePsf] gePsf] ePsf] gePsf] ePsf] gePsf] a|fXd0f 1 3 6 5 8 2 25If]qL 2 2 4 2 5 1 16 du/ 1 1 4 1 3 - 10 yf? 1 1 3 2 1 - 08 blnt 3 2 1 1 - - 07hDdf 8 9 18 11 17 3 56

139

lqmofsnfk/cEof;

!= Ps rnLo, lbrnLo / ax'rnLo ljZn]if0fsf] ljj]rgf ug'{xf]; \.

@= dxfdf/L lj1fgdf k|fKt tYofª\sx?nfO ljleGg tflnsfdf Ps rnLo ljZn]if0f ug'{xf]; \.

#= dxfdf/L lj1fgdf ;+slnt tYofª\sx?nfO lårnLo ljZn]if0fsf] pbfx/0f;lxt j0f{g ug'{xf];\

.

$= ax'rnLo a0f{gfTds ljZn]if0fsf ax'k|ltudg ljlw Multiple Regression analysis af6

b'O{ eGbf a9L rnx?l arsf] ;DaGwsf] ljZn]if0f s;/L ug{ ;lsG5 . rnx? larsf] ;DaGwsf

cGt/ tflnsLs/0f Cross Tabulation ug'{xf];\ .

$=& kl/sNkgf k/LIf0f / ;}4flGts tYofª\ssf] cjwf/0ff / ljlw (Concept and techniques of hypothesis testing and inferential statistics (t-test, correlation, coefficient and chi-squire test) in epidemiology)

kl/sNkgf Ps k"j{cg'dfg jf wf/0f xf] . of] ck|dfl0ft l;4fGt xf] . of] ck|dfl0ft l;4fGtnfO{

tYox?af6 k/LIf0f ul/ 7Ls xf] jf a]7Ls xf] kl5 lglZrt ul/G5 . cg';Gwfgsf] s|ddf b''O{ jf

b'O{ eGbf a9L rnx?sf] cGt/;DaGwnfO{ JoQm ug]{ k|lqmofnfO{ cg';Gwfg kl/sNkgf elgG5 .

t;y{ s'g} klg cg';Gwfgsf] sfo{ ;'? ug'{eGbf cufl8g} cWoog k'/f ul/;s]kl5 cfzftLt

kl/0ffdsf] k"jf{g'dfgnfO {g} cg';Gwfg kl/sNkgf elgG5 .

kl/sNkgfn] cg';Gwfgstf{nfO{ cWoog hf/L /fVg / ;d:ofpGd'v u/fpg'sf] ;fy}o;nfO{

;dfwfg ug{ ;xof]u ub{5 . o;n] tYofª\s ;ª\sng ubf{ lgl:rt l;df leq /fVg ;xof]u

ub{5 . o;n] cg';Gwfgsf] p2]Zo to ug{, o;sf] wfFrf agfpg, tYof8=s ;+sng ug]{ k|lqmof

lgwf{/0f ug{ / ;f]xL cg'?k lgisif{ lgsfNg d2t ub{5 .

kl/sNkgfsf] k|sf/x? M kl/sNkgfsf] lgDg k|sf/x? 5g . != lgikmn kl/sNkgf Null Hypothesis @= j}slNks kl/sNkgf Alternative Hypothesis #= cg';Gwfg kl/sNkgf Research Hypothesis

140

lgikmn kl/sNkgf M kl/sNkgfdf pNn]v ePsf rnx?ljr sg} klg ;DaGw /xb}gf elg

tof/ kf/LPsf] kl/sNkgfnfO{ lgikmn kl/sNkgf elgG5 . o; kl/sNkgf c;To k|dfl0ft

geP;Dd ;To g} dflgG5 . k|foh;f] o;nfO{ gsf/fTds cy{df lgdf0f{ ul/G5 .

j}slNks kl/sNkgfM hj lgikmn kl/sNkgf c:jLs[t xG5 tj j}slNks kl/sNkgf k|of]u

ul/G5 . To;}n] o;n] rnx?ljr cGt/ 5}g eGg]] dfGotf /fv]df k/LIf0f c:k:t ePdf

j}slNks kl/sNkgfsf\] k|of]u ul/G5 . o;df lgikmn kl/sNkgfdf ;dfj]z ul/Psf ;a}

;Defjgfx?nfO{ ;dfj]z ul/ k/LIf0f ul/G5 .

cg';Gwfg kl/sNkgf Research Hypothesis M cg';Gwfg sfo{ ug{ eGbf klxn]g} cfkm\gf]

cg;Gwfg k|lqmofnfO{ lglZrt lbzfdf n}hfgsf] nflu tof/ kl/Psf] kl/sNkgfnfO{ cg';Gwfg

kl/sNkgf elgG5 . o;nfO{ csf]{ zAbdf sfo{fTds kl/sNkgf Operational Hypothesis klg

eGg ;lsG5 . o; k|sf/sf kl/sNkgfx? k/LIf0fkl5 dfGo ePdf ;j{dfGo l;4fGt aGg] ub{5 .

kl/sNkgfx? lgwf{l/t ;dodf k/LIf0f ug{ ;lsg] x'g' kb{5 . o;df rnx?ljrsf] ;DaGw :ki6

pNn]v ul/Psf] x'g' kb{5 .

s= ;DaGwM ;x;DaGw / sfo{sf/0f ;DaGw -Relationship: Correlation and Casuality)

;DaGw Relationship: A relationship is a set of ordered pairs (Kerlinger) Reciprocal relationship, cGofGofl>t ;DaGw =+C o;df kl/jTo{x?ljr Ps cfk;df

;DaGw /x]sf] x'G5 . h:t} s = v . s sf] k|efj v df / v sf] k|efj s df k/]s]f x'G5 .

;dfldtsf/ ;DaGw Symmetrical relationship To;} u/L rnd"Nox?ljr k|ToIf ;DaGw geO{

cGo rnx?sf] sf/0fn] ubf{ k|efljt e} Ps cfk;df ;DaGw / k|efj b]lvG5 . h:t} lzlIft

JolQmn] ;kmf n'uf nufpg] / ;kmf vfg] ub{5 . oxfF ;kmf n'uf / ;kmf vfgfsf] s'g} ;DaGw

5}g .

c;dldtsf/ ;DaGw (Asymmetrical relationship)

o;df Pp6f rnn] dfq csf]{ rnnfO{ k|efj kfb{5 . ljz]if u/]/ cfl>t rnsf] k|efj :jtGq

rndf kb{5 . /lS; ;]jg / sn]hf]sf] SofG;/ nfO{ lng ;lsG5 . oxfF /S;L ;]jg :jtGq rn

xf] eg] sn]hf]sf] SofG;/ cfl>t rn xf] .

141

;DaGw eGgfn] cg';Gwfgdf ;+nUg ljleGg rnx?sf] ljrsf] ;DaGwsf] t'ngfTds ;ldKonfO{

lng ;lsG5 . rnx?sf] ljrsf] ;DaGwnfO{ a'em\g ;s]dfq 36gf k|s[ltsf] l:ylt, k|lqmof tyf

Psfn] csf]{nfO{ kf/]sf] k|efjnfO{ a'em\g ;lsG5 . To;kl5 dfq cg';Gwfgsf] lgisif{ lgsfNg

;lsG5 .

;DaGwsf] tx -Degree of Relation) eGgfn] b'O{ jf b'O{ eGbf a9L rnx?sf] ;DaGw / Psn]

csf{nfO{ kfg]{ k|efjsf] :t//nfO{ lng ;lsG5 . o;df ljleGg rnx?dWo] s'g} Psdf ePsf]

;sf/fTds kl/jt{gsf] kl/0ffd csf]{df klg ;sf/fTds / gsf/fTds kl/jt{gsf] kl/0ffd

gsf/fTds b]lvG5 eg] o;nfO{ ;sf/fTds txsf] ;DaGw -Positive level of Relation)

elgG5 . h:t} :jf:Yodf nufgL a9fPdf :jf:Yo :t/ a9\g] / nufgL 36fPdf :jf:Yo :t/

36\g] xG5 .

Pp6f rndf cfPsf] ;sf/fTds kl/jt{gn] s'g} csf][ rndf gsf/fTds kl/jt{gnfO{

gsf/fTds txsf] ;DaGw -Negative level of Relation) elgG5 . h:t} :jf:Yosf] :t/ a9\b}

hfFbf d[To' b/ 36\b} hfg'nfO{ lng ;lsG5 . olb s'g} Ps rndf kl/jt{g cfpFbf csf]{ rndf

s'g} klg k|efj kb}{g eg] o:tf ;DaGwnfO{ t6:y txsf] ;DaGw (Neutral level of

Relation) pbfx/0fsf] :jf:Yosf] :t/ a9\b} hfFbf klg d[To' b/df s'g} kl/jt{g gcfpg' nfO{

lng ;lsG5 .

;x;DaGw (Correlation) M cg';Gwfgsf] qmddf 36gfdf ;+nUg kl/jt{gsf] sf/0fx? s] s] 5g

tLgx?sf] k|efj s:tf] 5 To;sf] :j?k s:tf] 5 s] s:tf] k|j[tLsf] ljsfz ePsf] 5 egL

a'em\g] ;DaGwnfO{ (Correlation) ;x;DaGw eGg ;lsG5 . o;nfO{ b'O{ lsl;daf6 ljZn]if0f

ug{ ;lsG5 .

;x;DaGwsf k|sf/x? (Types of Correlation)

Pp6f rndf ePsf] ;sf/fTds kl/jt{gsf] kl/0ffd csf]{df klg ;sf/fTds / gsf/fTds

kl/jt{gsf] kl/0ffd gsf/fTds b]lvG5 eg] o;nfO{ ;sf/fTds txsf] ;DaGw positive

corelation elgG5 . h:tf} :jf:Yodf nufgL a9fPdf :jf:Yo :t/ a9\g] / nufgL 36fPdf

:jf:Yo :t/ 36\g] x'G5 . o;k|sf/sf] ;x;DaGwsf] txfnfO{ ) b]lv +!;Ddsf dfgn] ;+s]t

ub{5 .

142

Pp6f rndf cfPsf] ;sf/fTds kl/jt{gn] s'g} csf] rndf gsf/fTds kl/jt{gnfO{

gsf/fTds txsf] ;DaGw (Negative corelation elgG5 . h:t} :jf:Yosf] :t/ a9\b} hfFbf

d[To' b/ 36\b} hfg'nfO{ lng ;lsG5 . o;k|sf/sf] ;x;DaGwsf] txfnfO{ ) b]lv -! ;Ddsf

dfgn] ;+s]t ub{5 .

olb s'g} Ps rndf kl/jt{g cfpFbf csf]{ rndf s'g} klg k|efj kb}{g eg] o:tf ;DaGwnfO{

t6:y txsf] ;DaGw (Zero correlation) z"Go ;x;DaGw elgG5 . pbfx/0fsf] :jf:Yosf]

:t/ a9\b} hfFbf klg d[To' b/df s'g} kl/jt{g gcfpg'nfO{ lng ;lsG5 . h;nfO{ ) n] ;+s]t

ul/G5 .

/]lvo ;x;DaGw (Linear Corelation)

Pp6f rndf h'g dfqfdf kl/jt{g cfpF5 csf]{df klg 7Ls Tolx dfqfdf kl/jt{g cfpFg'nfO{

/]lvo ;x;DaGw elgG5 . h:t}M

s = !) @) #) $) v = $% #% @% !%

Analysis of Correlation; x ;DaGwsf] ljZn]if0f (Analysis of Casuality) sfo{sf/0f

;DaGwsf] ljZn]if0f

;x;DaGwsf] ljZn]if0f (Analysis of Correlation) cg';Gwfgsf] qmddf Pp6f rndf

kl/jt{g cfpFbf csf]{ rndf klg kl/jt{g cfpg'nfO{ ;x;DaGw elgG5 . h:t} ul/jL / v/fj

:jf:Yo lar ;x;DaGw x'g ;S5 . ul/jLn] :jf:Yo ;]jfdf k|efj kb{5 eg] ul/jLn] u'0f :t/Lo

:jf:Yo ;]jfdf c;/ kfb{5 . ;x;DaGwn] b'O{ rnx?sf] ljrsf] cfk;L ;DaGwsf] u0fgf ub{5 .

t/ sf/0f / k|efjsf] af/]df (Casual Relation) x'g} k5{ elg ls6fgL lgisif{ lgsfNg ;lsb}g

. o;df s'g rnn] csf]{ s'g rndf s] s;/L k|efn kf/]sf] 5 hfgsf/L lngnfO{ sfo{sf/0f

Casual df x]g]{ ul/G5 . ;x;DaGwdf Pp6f rnsf] csf]{ rn;+u ;DaGw 5 eGg] x]l/G5 eg]

sfo{sf/0f Casual df s'g rnn] csf]{ s'grnnfO{ k|efj kf/]sf] 5 / oLgdf s'g sf/0f xf] /

s'g kl/0ffd xf] eGg] cWoog u/L lgisif{ lgsflnG5 .

Concept of causation and association Null Hypothesis, Alternative Hypothesis,

Research Hypothesis Operational Hypothesis

143

u'0ffª\s ;x;DaGw (Coefficient Correlation)

;x;DaGwsf] u'0ffª\sn] s'g} b'O{ rnx?lar;DaGw 5 ls 5}g, oL ;DaGwx? wgfTds 5g ls

C0ffTds 5g / ;DaGwsf] lj:tf/ s:tf] 5 eGg] hfgsf/L lbG5 .

sfn{ lko;{gsf] ;x;DaGw u'0ffª\s ljlw (Karl Pearson’s Coefficient of Correlation

Method)

o; ljlwdf ;x;DaGwnfO{ a'emfpg r cIf/n] ub{5 . o;df rnx? larsf] ;x;DaGwsf]

d"NonfO{ ;ª\Voftds cfwf/df JoQm ul/G5 . o;sf] ljifd d"Non] (Extreme Value) k'0f{

;DaGw (Positive or Negative) nfO{ k|ltlglwTj ub{5 . oxfF r sf] d"No ;w}+ -1 / +1 sf]

aLrdf /xG5 . r=1 ePdf wgfTds / r=-1 ePdf C0ffTds ;DaGw x'G5 eg] r=0 ePdf

rnx? lars'g} ;DaGw gePsf] eGg] a'lemG5 . r sf] dfg +1 jf -1 sf] hlt glhs x'G5

;x;DaGw Tolt g} a9L pkof]uL / dxTjk'0f{ x'G5 .

Formula for Karl Pearson’s Coefficient of Correlation r= Ƹ xy or Ƹ xy

N σx x σy Ƹx2 x Ƹy2

r = x / y rnx?sf] aLrsf] ;DaGw, dWosaf6 lnO{Psf] y ljrng σx = x sf] k|dfk ljrng (Standard Deviation)

σy= y sf] k|dfk ljrng (Standard Deviation)

x=x sf] dWos y=y sf] dWos x= dWosaf6 lnO{Psf] x ljrng (x=x-X) y= dWosaf6 lnO{Psf] y ljrng (y=y-Y) N= kbx?sf] ;+Vof (Pairs of Observation) Inferential statistics: ;}4flGts tYofª\szf:qn] cg';Gwfgaf6 k|fKt ljleGg rnx?sf] dfkgsf]

k/LIf0f u/L ;DefJotfsf] ;fdGoLs/0f ug]{ sfd ub{5 . o;af6 gd'gf tYox?sf] ljZn]if0faf6

;du|tf Population df tYofª\sLo cf+sng Estimation ul/G5 . o;df lgDg lsl;dsf

tYofª\sLo l;4fGtnfO{ Statistical Inference lng ;lsG5 .

144

tYofª\sLo cf+sng (Statistical Estimation) df ljz]if u/L cg';Gwfgdf ;+nUg hg;+Vofaf6

lglZrt gd'gf 5g}6 u/L 5gf}6 ePsf gd'gfsf] cWoogaf6 k|fKt lgisif{nfO{ ;du|tfdf

(Universe) cf+sng ul/G5 . o;sf]nflu cg';Gwfgsf] ;du|tfsf] cfsf/ / :ki6 kl/efiff x'g'

kb{5 . o;df cg';Gwfgsf] ljljwtfnfO{ Wofgdf /fvL ;du|tfsf] pko'Qm / kof{Kt gd'gfsf]

cfsf/ (Sample Size) lng' kb{5 . cg';Gwfgdf ;dfj]; ul/Psf rnx?ljrsf] ;+efJo

;DaGwsf] ul/ ljZj;gLotfsf] (Reliability) sf] cg'dfg ul/G5 .

kl/sNkgf k/LIf0f (Hypothesis Test) :jtGq / cfl>t rnx? larsf] ;DaGwnfO{ cg';Gwfg

cl3g} cg'dfg ul/g k/LIf0fof]Uo sygnfO{ kl/sNkgf elgG5 . rnx? larsf] ;Defljt

;DaGw cg'dfg ug{sf nflu kl/sNkgf k/LIf0f ug]{ ul/G5 . cg';Gwfgdf p7fOPsf

kl/sNkgfx?sf] cg'dfg ul/ k'jf{g'dfg ul/Psf] k|fKt lgisif{nfO{ ;du|tfdf ;fdfGoLs/0f

(Generalization) ug]{ ul/G5 . o;n] cg';Gwfgdf ;+nUg rnx? larsf] sfo{sf/0f

(Causual Relationship) nfO{ :ki6 kfg]{ ul/G5 .

kl/sNkgf k/LIf0fnfO{ o;sf] k|s[ltsf cfwf/df jf:tljs kl/sNkgf (Real Hypothesis)jf

(Substantive Hypothesis) / ;fª\lvsLo kl/sNkgf (Statistical Hypothesis) af6 ug{ ;lsG5 .

jf:tljs kl/sNkgf b'O{ jf b'O{ eGbf a9L rnx?sf]ljrsf] ;Defljt ;DaGwsf] k'j{ cg'dfg

ul/Psf] x'G5 . o;}ul/ ;f+VosLo kl/sNkgfx?nfO{ af:tljs kl/sNkgf klg elgG5 .

kl/sNkgfsf] k/LIf0f / To;;+u ;DalGwt rnx? / ;f+VoLsLo dfgsf] ;+efljt ;DaGwsf]

k/LIf0f g} kl/sNkgf k/LIf0f (Hypothesis Test) xf] .

kl/sNkgf k/LIf0f (Hypothesis Test) cg';Gwfgdf 5gf}6 u/L k|fKt ePsf] dWos M a9L jf 36L

s] slt 5 egL k/LIf0f ulG5 . o;df Null Hypothesis nfO{ H0 n] ;+s]6 u/L k/LIf0f ul/Psf]

x'G5 h;df s'g} ;DaGw jf km/s 5}g eGg] x]l/G5 . o;df cg';Gwfgstf{n] cg'dfg u/]sf]

dWosd"No Mean Value / ljZn]if0f u/L k|fKt ul/Psf] d"No Calculated Value a/fa/ 5 eGg]

k'jf{g'dfg ul/Psf] x'G5 . pbfx/0fsf] nflu M1=M2, olb of] Null Hypothesis cl:js[t ePdf

a}slNks kl/sNkgf Aternative Hypothesis k|of]u ul/G5 h;nfO{ H1 n] ;+s]t ul/G5 . olb

M1=M2 5}g eGg] lgl:rt ePdf a}slNks kl/sNkgf k/LIf0f ul/G5 . h:t} H0:M1=M2

145

5}g eGg] lgl:t ePdf H1:> jf <M2 5 eGg] lgisif{ lgsflnG5 / ;DaGwsf] pkof]uLtfsf]

tx (Level of Significance) hfFr ul/G5 .

pkof]lutfsf] tx (Level of Significance) kl/sNkgf k/LIf0f eof] sL ePg eGg] lgZro

ug{ pkof]lutfsf] tx x]g]{ ul/G5 . cg';Gwfgdf rnx?sf] larsf] ;DefJo ;DaGwsf] tx s]

slt clws jf Go"g 5 elg x]g'{ kb{5 . o;af6 pkof]lutfsf] rxsf cfwf/df z"Go kl/sNkgf

k/LIf0f ubf{ l:js[t jf cl:js[tsf] glthf yfxf kfpg ;lsG5 . pkof]lutfsf] txnfO{ cNkmf

tx klg elgG5 . cg pkof]lutfsf] tx;Gwfgdf z"Go kl/sNkgf k/LIf0fsf] k/LIf0faf6 b'O{

txsf] x]g{ ;lsG5 . ;fdfGotM )=)% -%% _ / )=! -)!%_ df /x]/ pkof]lutfsf] tx x]g]{

ul/G5 . o:tf] cj:yfdf )=)% ePdf kfFr k|ltzt / )=)! ePdf Ps k|ltzt ck|dfl0f

;DefJo lgisif{ cfPdf !)) df kfFr k|ltztfsf] txdf z"Go kl/sNkgf cl:js[t x'G5 . o;n]

z"Go kl/sNkgf ;xL 5 eGg] a'lemG5 . olb cl:js[t ePdf (% k|ltzt ljZjf;sf]

(Confidence) sf] cj:yf /xG5 h;df z"Go kl/sNkgf c;To ;fjLt x'g ;S5 . )=)%

pkof]lutfsf] tx (Level of Significance)n] z"Go kl/sNkgfdf kfFr k|ltzt q'l6 (Error)

b]vfpF5 . olx ;Defljt :jLs[t / c:jLs[tsf] txnfO{ g} pkof]lutfsf] tx elgG5 . c:jLs[t

z"Go kl/sNkgfn] cg';Gwfg kl/sNkgfnfO{ ;dy{g Support ub{5 .

:jtGqtfsf] tx (Degree of Freedom) cg';Gwfgdf gd'gfsf] cfsf/ yfxf e} o;df lglxt

d"NonfO{ :jtGq ?kdf 5gf}6 ul/g'nfO{ :jtGqtfsf] tx elgG5 . kl/sNkgf k/LIf0f ubf{

:jtGqtfsf] tx 5'6\6ofpg cfjZos 5 . o;nfO{ tYofª\szf:qdf df n] ;+s]6 ul/G5 . The

degree of freedom in a distribution is the number of observation or values that are independent

each other and can not be deduced from each other, i.e. the number of values which we can

choose freely (OR. Krishnaswami, p: 432). s'g} l:y/ /fzL j/Lk/L km/s kg{ ;Sg] :jtGq

lgl/If0fsf] ;+VofnfO{ :jtGqtfsf] >]0fLsf] tx elgG5 . s'g} b'O{ d"Nox? s / v 5g eg] /

tLgsf] dWos jf cf};t $) 5 eg] h;sf] s'n of]u *) 5 . o; cj:yfdf *) n] @ n] efu

ul/ -*)/@_ $) dWos lg:sG5 . olb s ;+u @* 5 eg] v sf] d"No *) eGbf dfyL x'g

;Sb}g . o; cj:yfdf *)-@*=%@ u0fgf ug{ ;S5f} . o;df b'O{j6f d"No dWos ;lxt lbPsf]

5 eg] s'g} Pp6f d"No dfgnfO{ lglb{i6 ug{ :jtGq x'G5 . o; cj:yfdf :jtGqtfsf] tx Pp6f

146

dfq x'G5 . To;}u/L s'g} $* dWos;+u gd'gfdf * j6f d"No 5 eg] To; cj:yfdf:jtGqtfsf]

tx h;nfO{ d"Nofsf] ;+Vof klg elgG5 To;nfO{ :jtGq ?kdf lglb{:t ug{ ;lsG5 -s-!_ jf

*-!=& . o;df :jtGq?kdf ;ftj6f lgl/If0fnfO{ s'g} d"No lbg ;lsG5 / cf7f}+ d"No

clGtddf :jtx lgwf{/0f x'G5 . olx kb d"No lgwf{/0f ug]{ k|lqmofnfO{ :jtGqtfsf] tx (Degree

of Freedom) elgG5 .

Ps k[i7 efu / b'O{ k[i7 efu k/LIf0f (One Tailed Test and Two Tailed Test) (H1: Ө ≥ Ө

1) ljt/0fsf] jfofF tkm{ kg{ hfG5 eg] To;nfO{ bfofF k[i7 k/LIf0f (Right Tailed Test) elgG5 .

j}slNks kl/sNkgfsf nflu olb ljj]rs If]q z"Go kl/sNkgfsf] k/LIf0fdf Ps k[i7efu / b'O{

k[i7efu k/LIf0f clgjfo{ x'G5 . Ps k[i7efu k/LIf0fdf cl:js[tsf] If]q (Region of Rejection)

gd'gf ljt/0fsf] bfofF jf afofF k[i7efudf cjl:yt /x]sf] x'G5 . cyjf Pp6f k[i7efudf dfq

cl:jsf/ If]q /xG5 . a}slNks kl/sNkgfsf nflu olb ljj]rs If]q (H1: Ө < Ө 1) afofFtkm{

kg{ hfG5 eg] To;nfO{ jfofF k[i7 k/LIf0f (Left Tailed Test) elgG5 . oxfF Ө n] l:y/ ul0ftLo

/fzLnfO{ hgfpF5 . o;df k|Tos tYofª\sLo kl/sNkgfx? /xG5g h;sf] ljsNk b'j} k[i7If]qdf

/xg ;S5 . h:t} M

Null Hypothesis H0: Ө = Ө 0 Alternative Hypothesis H1: Ө Ө 0 either Ө > Ө 0

or Ө < Ө 0)

sfO{ :Sjfo/ k/LIf0fsf] u0fgf / ljj]rgf Calculation and Interpretation of Chi square (x2)

Test: sfO{ :Sjfo/ k/LIf0f cul0ftLo k/LIf0f (Non-Parametric Test) ug]{ ul/G5 . sfO{ :Sjfo/

b'O{ jf b'O{ eGbf a9L ;fwf/0f rnx? (Nominal Variable) larsf] ;DaGw kQf nufpgnfO{ sfO{

:Sjfo/ k/LIf0f elgG5g . o;df ljz]if u/]/ cfj[ltx?, cg'kftx?, tyf k|ltztdf tYofª\sx?

cfj4 ePdf oLlgx? larsf] ;DaGw t'ngf ug{ vl08t >]0fLsf tYofª\sx?df dfq o;

k/LIf0fsf] k|of]u ul/G5 . o; k/LIf0fdf cjnf]sg ul/Psf] cfj[lQx? (Observed Frequency) /

ck]R5Lt cfj[lQx? (Expected Frequency) lar jf:tljs km/s l:yltsf] u0fgf ul/G5 . Chi

Square nfO{ x2 ;+s]t u/L x2 Test klg eGg] ul/G5 . o; k|sf/sf] k/LIf0fdf u0fgf u/LPsf]

147

X2 sf] dfg ljj]rs d"No (Critical Value) sf] a/fa/ jf a9L x'g' kb{5 . h;n] z"Go

kl/sNkgfnfO{ cl:jsf/ l;4 ug{ pkof]lutfsf] tx 0.5% jf 0.01 :jtGqtf /xx]sf] xf];\.

Formula x2 = Ƹ (Fo-Fe)2/Fe

X2 = Chisquare Test, Fo = Observed Frequency, Fe = Expected Frequency (interms of the null hypothesis or theoretical hypothesis)

l6 6]:6 / h]8 6]:6 (T. Test and Z. Test)

cg';Gwfgdf b'O{j6f dWodfg (Two mean Value) larsf] k/LIf0f ubf{ l6 6]:6 / h]8 6]:6sf]

k|of]u ul/G5 . T. Test nfO{ t- test n]Vg] ul/G5 . hg;+Vof sf] e]b -Variance) c:ki6 5 /

gd'gf #) eGbf sd 5 eg] b'O{ gd'gfsf] dWodfg aLrsf] km/ssf] pkof]uLtf kQf nufpg

k|of]u ul/G5 . o;sf] ;fy} o; k/LIf0fnfO{ k'/s / ;fwf/0f ;x ;DaGwsf] pkof]lutfsf] hfFr

ug{ klg k|of]u ug{ ;lsG5 . gd'gf tYosf] t test u/L z"Go kl/sNkgf l:js[t jf cl:js[tsf

nflu l6= ljj/0f tfnLsfdf o;sf] ;+utL ljj]rs d"No (Consistant Critical Value) ;+u

t'ngf ul/G5 . t- test sf] nflu pkof]lutfsf] tx, :jtGqtfsf] tx, z"Gokl/sNkgf / Psk[i6 /

b'O{k[i6 k/LIf0fsf] cjwf/0ff :ki6 x'g' cfj:os 5 .

;fwf/0ftof gd'gfsf] cfsf/ #) eGbf a9L 5 / b'O{ gd'gf aLrsf] dWodfgsf] b/ km/s 5 eg]

z- test k|of]u ul/G5 . o;n] ;DalGwt dfksf] pkof]uLtfsf] k/LIf0f ug{sf nflu pkof]lutfsf]

;/nLs[t txdf o;sf] ;DefJodfg u0fgf / t'ngf ul/G5 . o;sf] nflu T ratio kQfnufpg

cfj:os 5 . o;sf] nflu lgDg cj:yfx? /x]sf5g / oLg} ;d"xsf] k|s[ltsf] cfwf/df t- ratio

kQfnufpg ;lsG5 .

t ratio from independent group, correlation group and matched group. x1-x2

Formula: t = S12

+ S22

N1 N2

x1= Mean of the Experimental Sample x2 = Mean of Control Sample N1 = Number of Case in Experimental Sample N2 = Number of Case in Control Sample S1

2 = Variance of Experimental Sample S2

2 = Variance of Control Sample

Z –test Z = x – μ

148

σ

n

tkfOFn] s] a'‰g' eof] O

!= Olk8]ldof]nf]hLdf kl/sNkgfsf] k/LIf0f s;/L ul/G5 <

@= s:tf] k|sf/sf] tYofª\s / cWoogdf l6 6]:6 k|of]u ul/G5 <

#= s:tf] k|sf/sf] tYofª\sdf Chi-squire test k|of]u ul/G5 <

$=* sf/0f / ;DaGwsf] cjwf/0ff (Concept of Causation and Association)

s_ sf/0fsf] cjwf/0f (Concept of Causation)

Olk8]ldof]nf]lhs cWoogsf] d'Vo p2]Zo /f]u jf :jf:Yo ;DaGwL 36gfsf] sf/0f kQf nufpg'

xf] . s'g} 36gfsf] sf/0f / c;/sf] af/]df 1fg cfh{g ug'{ eg]sf] j}1flgs cWoog jf

Olk8]ldof]nf]lhs cWoogsf] pRrtd pknlAw xf] . /f]u jf :jf:Yo ;DaGwL 36gfsf] sf/0f /

c;/sf] klxrfg ug{ ;lsof] eg] /f]u jf 36gfnfO{ lg/fs/0f ug{ jf /f]usf] pkrf/ ug{ jf /f]u

jf :jf:Yo ;d:of Go"g ug{ nflu cfjZos kg]{ sfo{qmdsf] of]hgf agfpg / sfo{qmdsf]

pknlAwsf] k"jf{g'dfg ug{ dbt k'/fpF5 .

/f]u pTkGg ug{sf] nflu dxTjk"0f{ e'ldsf v]Ng] s'g} 36gf, cj:yf jf ljz]iftf jf tTjx?nfO{

sf/0f jf sf/s tTj elgG5 . sf/0f ;Fw} /f]u eGbf cl3 b]vfkb{5 . h:t} b'lift kfgL vfPkl5

emf8fkv nfU5 . b"lift kfgL emf8fkvfnfsf] sf/0f xf] . w]/} dfqf nfdf] ;do ;Dd dlb/f ;]jg

ug]{ JolQmx? sn]hf]sf SofG;/ ePsf] kfOG5 . sn]hf]sf] SofG;/sf] sf/0f dlb/f ;]jg xf] .

sfo{sf/0f ;x;DaGw (Causality) j}1flgs cg';Gwfgdf sfo{sf/0f ;x;DaGw b]vfpg

ljj]sk'0{f / tfls{s JofVof cfjZos x'G5 . :jf:Yo lj1fgdf s'g}klg 36gfsf] rnx? larsf]

sf/0f / k|efj ;DaGw a'em\g'nfO{ sfo{sf/0f ;DaGw (Causality) elgG5 .

149

sf/s tTjsf] k|sf/ (Types of causal factors)

c_ cfjZos sf/0f (Necessary cause): h'g sf/0fn] /f]u nfU5 elgPsf] 5 eg] To;sf]

cg'kl:yltdf /f]u nfUg ;Sb]g eg] To;nfO{ cfjZos sf/0f elgG5 . /f]u nfUgsf] nflu xg'

kg]{ tTj jf cj:yfnfO{ cfjZos sf/0f elgGg5 . h:t} Ifo/f]u nfUgsf] nflu

dfOsf]AofS6]/Lod 6\o'a/s'nf]l; gfds AofS6]l/of z/L/df k|j]z x'g' kb{5 . To;}u/L 6fOkmfO8

Hj/f] x'gsf] nflu ;fNdf]g]nf 6fOkmL gfds AofS6]/Lof dflg;sf] zl//df k|j]z u/L /utdf b]vf

kg'{kb{5 .

cf_ kof{Kt sf/0f (Sufficient cause): cGo tTjx? eP klg geP klg s'g} tTjn] dfq /f]u

pTkGg ug{ ;Sb5 ;Sb5 eg] To;nfO{ kof{Kt sf/0f elgG5 . cyf{t\/f]u pTkGg ug{sf] nflu

pk'Qm cj:yfdf l;hgf{ ug]{ tTjnfO{ kof{Kt sf/0f elgG5 .

cfjZos sf/0f / k|of{Kt sf/0f lardf ;DaGw 5 . h:t} Ifo/f]u nfUgsf] nflu cfjZos kg]{

ls6f0f'sf] ;+qmd0f eP/ klg Ifo/f]usf] nIf0f b]vf k/]g eg] /f]u nfUgsf] nflu kof{Kt sf/0f

5}g eGg] ub{5f}{ . olb s'kf]lift / /f]u k|lt/f]w Ifdtf sd ePsf] JolQmddf Ifo/f]usf]

hLjf0f'sf] ;+qmd0f ePsf] s]xL ;dofdf Ifo/f]usf] nIf0f b]vf kb{5 . s'kf]if0f tyf /f]uk|lt/f]w

Ifdft sdhf]/ x'g' Ifo/f]usf] nflu kof{Kt sf/0f xf] .

slxn] sfFxL kof{Kt sf/0f x'Fbf klg /f]u gnfUg ;Sb5 . h:t} w'nf] w'Fjf / cf]l;nf]df a:g] /

v]Ng] afnaflnsfnfO{ lgdf]lgof /f]usf] nflu kof{Kt sf/0f x'g ;Sb5 t/ kof{Kt sf/0f eP/

klg lgdf]lgof /f]u gnfUg ;Sb5 . slxn] sfFxL cfjZos / kof{Kt sf/0f eP/ klg /f]u gnfUg

;Sb5 . h:t} lgdf]lgof /f]usf] ls6f0f' Zjf;gnL k|j]z u/]sf] 5 / afnaflnsf w'Fjf w'nf] tyf

cfl;nf] 7fpFdf a;]sf] cj:yfdf klg lgdf]lgofsf] /f]u gnfUg ;Sb5 . To;}u/L nfdf] ;do

;Dd w'dkfg ug]{ JolQmnfO{ klg kmf]S;f]sf] /f]u gnfUg ;Sb5 . SofG;/, d'6'sf]/f]u tyf bL3{/f]u

nfUgsf nflu w]/} sf/0fx?sf] cfjZos kg]{ ePsf]n] cfjZos tyf kof{Kt sf/0fn] dfq /f]usf]

sf/0f JofVof ug{ ;lsb}g .

v_ ;DaGwsf] cjwf/0f (Concept of Association)

/f]usf] jf:tljs sf/0f kQf nufpgsf] nflu k|of]ufTds cg';Gwfg ug'{ kb{5 . t/ dflg;df

/f]unfUg] sf/sf tTj hfgf hfg k|j]z u/fP/ jf k|of]u u/]/ cg';Gwfg ug{ ;lsb}g . To;}n]

150

Olk8]ldof]nf]lhs cWoogdf /f]u pTkGg u/fpg] tTjx?sf] / /f]usf] aLrdf ;DaGw :yfkgf

u/]/ /f]usf] sf/0f kQf nufOG5 . w'dkfgn] kmf]S;f]sf] SofG;/ x'G5 eGg] s'/f w'dkfg ug]{

JolQmx?df kmf]S;f]sf] SofG;/sf] k|efljt b/ / w'dkfg gug]{ JolQmx?df SofG;/sf] k|eflbt

b/sf] ljZn]if0f u/L w'dkfg / kmf\]S;f] SofG;/ lar ;DaGw :yfkgf u/]/ kQf nufOPsf] lyof] .

o;sf] nflu :jtGq rn -w'dkfg ug]{ afgL_ / cfl>t rn -kmf]S;f]sf] SofG;/_ cfjZos kb{5 .

cyf{t\/f]u pTkGg ug{ ;Sg] cj:yf jf tTjx?nfO{ :jtGq rn elgG5 / o;af6 pTkGg x'g]

c;/nfO{ cl>t rn elgG5 . sf/s ;DaGw :yfkgf ug{sf] nflu :jtGq rn jf hf]vd tTj /

cfl>t rn, ;+efJo c;/ lar;DaGw :yfkgf ug]{ u/L kl/sNkgf agfP/ ljZn]if0ffTds

cWoog u/]/ sf/0f / c;/sf] lar;DaGw :yfkgf ul/G5 . sf/0f / c;/sf] ;DaGw :yfkgf

u/]kl5 /f]usf] sf/0f kQf nufpg ;lsG5 .

c_ sf/s ;DaGw -Causal Association: Direct Causal Association/single cause,

multi-factorial causation)

hf]lvd tTj jf :jtGq rn / c;/ jf cfl>t rnsf] ;DaGw lar;DaGw 5 / :jtGq rndf

s]xL kl/jt{g x'bf cfl>t rndf klg kl/jt{g cfpF5 eGg] s'/f k|dfl0ft ePsf]5 eg] o;nfO{

sf/s ;DaGw elgG5 . Ps :jtGq rn / csf]{ cfl>t rn aLrdf sf/0f / c;/sf] k|ToIf

;DaGw 5 eg] o;nfO{ k|ToIf sf/s ;DaGw elgG5 . h:t} 6fOkmfO8sf] ls6f0f'sf] ;+qmd0f x'g'

/ Hj/f] cf[pg'sf] lark|ToIf ;DaGw x'G5 . o; k|sf/sf] ;DaGwnfO{ Psn sf/s tTj klg

elgG5 . /f]usf] hLjf0f' l;4fGtsf] cg';f/ /f]u Psn sf/0fn] x'G5 .

g;g]{ /f]u tyf bL3{sf] sf/0f Ps eGbf a9L x'G5 . d'6'sf] /f]u x'gsf] nflu Psf eGb a9L

sf/s tTjx? / /f]usf] lar ;DaGw x'G5 . h:t] a9L lrNnf] lk/f] vfg], a9L tf}n x'g', /Qmrfk

a9L x'g', dlb/f tyf r'/f]6 ;]ag ug]{ dflg;x?df d'6'sf] /f]u ePsf] kfOG5 . Pp6 /f]u;Fu w]/}

sf/s tTjx?sf] aLrdf ;DaGw :yfkg ePsf] 5 eg] o;nfO{ ax'sf/s tTj ;DaGw elgG5 .

o; k|sf/ ;DaGwnfO{ sf/s tTj gegL hflvd tTjx? (Risk Factor) elgG5 .

cf_ qm[ltd/unt ;DaGw (Spurious/False Association)

151

slxn]sfFxL /f]u / /f]usf] sf/s tTj jf hf]lvd tTjx?sf] aLrdf b]lvPsf] ;DaGw oyfy{

geP/ s[lqd jf e'm7f ;DaGw x'G5 . h:t}, a9L skmL vfg] JolQmx?df d'6'sf] /f]u a9L kfOPsf]

lyof] . o;af6 skmL d'6'/f]usf] sf/s tTjxf] eGg] lgisz{ cfpg ;S5 . t/ oyfy{df skmL

d'6'/f]usf] sf/s tTj xf]Og . skmL a9L ;]jg ug]{ JolQmx?n] a9Ldfqfdf w'dkfg klg ub{5g\ .

w'dkfgn] ubf{ d'6'sf] /f]u ePsf] xf] . ;+of]uaz, ;Gb]xhgs cj:yf jf tYofª\sf] unt

ljZn]if0fsf] sf/0f jf /f]u / cGo tTjx?aLrsf] ;DaGwnfO{ lgoGq0f ug{ g;Sbf s[qd unt

;DaGw :yfkgf 5 .


!= Olk8]ldof]nf]hLdf sf/s / ;DaGw eg]sf] s] xf] <

@= Olk8]ldof]nf]hLsn cWoog :jtGq / cfl>t rnsf] ljrdf ;DaGw xF'b}df /f]usf]

sf/0f oxL xf] eg]/ lgWff{/0f ug{ ;lsG5 . <

$=( j0f{gfTds cWoog, 36gf lgoGq0f cWoog tyf ;fd"lxs cWoogsf] k'g/fjnf]sg

-Review of some descriptive studies, case-control studies and cohort studies, randomized control trial and field trials conducted in Nepal and other countries)

of] ;fdu|L;Fu} pknAw u/fOPsf] ljleGg Olk8]ldof]nf]lhs cWoogx? Jf ljBfyL{x? cfkm}n]

vf]h]/ k|sflzt cWoog cg';Gwfg ;DalGwt n]v tyf k|ltj]bg k'g/fjf]nsg jf ;ldIff

(Review) tyf d"Nofª\sg (Evaluation) ug'{ kb{5 . k|sflzt ePsf Olk8]ldof]nf]lhs cWoog

;DaGwL n]v tyf k|ltj]bgx? ;dfrf]nfgfTd tl/sfn] n]vfhf]vf tyf k'g/fjnf]sg ubf{ lgDg

rn0f ckgfpg' kb{5 .

!= r/0f PsM kl/sNkgf jf cg';Gwfg k|Zgdf Wofg lbg] (Stage 1: Consider research

hypothesis or research questions)

Olk8]ldof]nf]lhs cWoog cg';Gwfgsf] k'g/fjf]nsg tyf d"Nofª\sg ubf{ ;j} eGb klxn]

cg'';Gwfgsf] kl/sNkgf jf cg';Gwfg k|Zgdf Wofg lbg' kb{5 . s] kl/sNkgf :ki6?kdf

152

n]lvPsf] 5 < s] kl/sNkgf k"jf{Woog jf s'g} l;4fGtdf cfwfl/t 5 < s] cg'';Gwfg k|Zgx?

:ki6 ?df k|:t't ul/Psf] 5 < s] kl/sNkgf k/LIf0f ug{ nfos jf k|Zgx?sf] pQ/ vf]Hg

cWoog ug'{ kg]{ vfnsf] 5 < cflb k|Zgx?sf] cfwf/df kl/sNkgf jf cg';Gwfg k|Zgsf] af/]df

ljrf/ ljj]rgf u/L cWoogsf] nflu pko'Qm eP gePsf] s'/f n]vfhf]vf ug'{ kb{5 .

@= r/0f b'OM kl/sNkgf jf cg';Gwfg k|Zgdf Wofg lbg] (Stage 2: Consider research

design)

bf];|f] rn0fdf cWoogdf k|of]u ePsf] cWoog 9frf pko'Qm 5 5}g eGg] af/]df ljrf/ ug'{

kb{5 . cWoogsf] kl/sNkgf jf cg';Gwfg k|Zg jf p2]Zo cg';f/ cWoog 9frf pkof]u ug'{

kb{5 . h:t} kl/sNkgfn] sf/0f / c;/sf] lar;DaGw :yfkgf ug]{ vfnsf] 5, t/ cWoog

9frfdf j0f{gfTds n]lvPsf] 5 eg] cWoog 9frf pko'Qm 5}g . sf/0f / c;/sf] lar;DaGw

:yfkgf ug{sf] nflu ljZn]ifgfTds 9frf pk'Qm x'G5 .

#= r/0f tLgM pknlAw rnx?sf] ljrf/ ug]{ (Stage 3: Consider outcome variables)

s'g} sf/0f jf hf]lvd tTjaf6 nfUg] /f]u jf pTkGg x'g] kl/0ffd g} pknAwL rn xf] . :jtGq

rndf cfl>t rn g} pknlAw rn xf] . o; k|sf/sf] rn pko'Qm 5 5}g < jf c;/ jf

pknlAw:jtGq rndf cfl>t 5 5}g eGg]af/]df n]vfhf]vf ug'{ kb{5 .

$= r/0f rf/M k"jf{g'dfg rnsf] ljrf/ ug]{ (Stage 4: Consider predictor variables)

s'g} :jtGq rn jf sf/s jf hf]lVftTjn] cg'dfg u/] cg';f/ c;/ b]vfpg ;Sg] vfnsf] 5

5}g < o; k|sf/sf] sf/s tTj jf hf]lvdsf] af/]df klxn] slt cWoog ePsf] 5 < cWoogdf

;dfj]z ul/Psf] :jtGq rnsf] cfwf/df c;/sf] k'jf{g'dfg ug{ ;lsG5 < eGg] s'/fxnfO{

cfwf/ agfP/ k"jf{g'dfg rnx?sf] n]vfhf]vf ug'{ kb{5 .

%= r/0f kfFr M tYofª\s ljZn]if0f ljlwsf] ljrf/ ug]{ (Stage 5: Consider methods of

data analysis)

153

sf/0f / c;/sf] ljr ;DaGw :yfkgf ug{ jf /f]usf] sf/0f klxrfg ug{sf] nflu tYofª\s

pk'Qm tl/sfn] tYofª\s zfl:qo ;fwg k|of] ug'{ kb{5 . cWoogdf k|of]u ul/Psf ljZn]if0fsf

tl/sf tyf ;fwgx? pko'Qm 5 5}g eGg]af/]df n]vfhf]vf ug'{ kb{5 .

^= r/0f 5M ;+efJo kIfkftsf] ;|f]tsf] ljrf/ ug]{ (Stage 6: Consider possible sources

of bias)

cWoog k|lqmofdf ckgfOPsf gd'gf 5gf]6, tYofªs ;ª\sng, dfkg, juL{s/0f tyf

ljZn]zif0f ubf{ s] slt q'l6 ePsf 5g\ < s] tL q'l6x? hfghfgL Jojl:yt tl/sfn] ul/Psf]

5 < kIfkft ug'{ kl5 s] /x:o cleJoQm ePsf] 5 < eGg] s'/fsf] ljrf/ u/L cWoogdf x'g

;Sg] kIfkft / o;sf] >f]tsf] af/]df n]vfhf]vf ug'{ kb{5 .

&= r/0f ;ftM glthfsf] JofVofsf] ljrf/ ug]{ (Stage 7: Consider the inpretation of

the results)

cWoogaf6 k|fKt glthfx? ;lxtl/sfn] JofVof ul/Psf] 5 5}g eGgaf/]df ljrf/ ug'{ kb{5 . s]

glthfsf] JofVof tYodf cfwfl/t 5 < s] glthf sf/0f / c;/sf] ;DaGw b]vfpg vfnsf] /

ToxL cg';f/ JofVof ul/Psf] 5 < s] JofVof ubf{ p:t}vfnsf] cWoogaf6 k|fKt glthfnfO{ klg

;dfj]z ul/Psf] 5 < cflb s'/fnfO{ Wofg lbP/ glthfsf] JofVof oyft{ w/ftn jf kl/j]z tyf

tYo;Fu d]nvfg] tl/sfn] eP gePsf] af/]df n]vfhf]vf ug'{ kb{5 .

*= r/0f cf7M cWoogsf] glthf pkof]uL eP gePsf] ljrf/ ug]{ (Stage 8 : Consider

the how te results of the study can be used in practice)

s] cWoogsf] glthf c? cWoog;Fu d]nvfg] 5 < s] cWoogsf] glthf tyf lgisz{nfO{ o:t}

vfnsf] c? hg;Vofsf] nflu ;fdfGos/0f ug{ ;lsg] vfnsf] 5 < s] cWoogaf6 k|fKt

glthfsf] cfw/df /f]u lgoGq0f jf :jf:Yo ;'wf/ ;DaGwL sfo{qmd lgdf0f{ / sfof{Gjog ug{df

pkof]uL 5 < cflb kIfsf] af/]df ljrf/ u/L k|sflzt n]vf tyf k|ltj]bgsf] n]vfhf]vf tyf

k'g/fjnf]sg ug'{ kb{5 .

154

lqmofsnfk

!= k|fylds txdf cWoo ug]{ afnaflnsfx?sf] tf}n / prfO dfkg u/L kf]if0f cj:yf lgwf{/0f ug]{ tTjx?sf]af/]df kl/sNkgf agfP/ 6L 6]:6 k|of]u u/L kl/sNkgfsf] k/LIf0f ug'{xf];\ .

@= glhsf] :jf:Yo ;+:yfaf6 kfFr aif{ d'lgsf afnaflnsf x?sf] /f]usf] af/]df tYofª\s ;ª\sng u/L correlation coefficient and chi-squire test sf] k|of]u u/L kl/sNkgfsf] k/LIf0f ug'{xf];\ .

#= /fli6«o tyf cGt/fli6«o hg{ndf k|sflzt /f]u;Fu ;DalGwt cg'";GwfgfTds n]vsx? ;ldIff u/L Pp6f n]v tof/ kfg'{xf';\ .

cEof;

!= kl/sNkgfnfO{ cfkm\g} zAbdf kl/eflift ug'{xf];\. kl/sNkgf k/LIf0f s] sf nflu ul/G5?

:ki6 kfg'{xf];\ .

@= lgikmn kl/sNkgf Null Hypothesis, j}slNks kl/sNkgf Alternative Hypothesis,

cg';Gwfg kl/sNkgf Research Hypothesis x?sf] larkm/s b]vfpg'xf];\ .

#= ;dfldtsf/ ;DaGw Symmetrical relationship, c;dldtsf/ ;DaGw Asymmetrical

relationship km/s b]vfpg'xf]; \.

$= ljleGg k|sf/sf ;x;DaGwsf k|sf/x? (Types of Corelation) af/]df ljj]rgf ug{'xf];\ .

%= ;}4lGts tYofª\ssf] inferential statistics df lgDg lnlvt terms nfO{ ljj]rgf ug'xf];\

^= pkof]lutfsf] tx (Level of Significance), :jtGqtfsf] tx (Degree of Freedom),

cl:js[tsf] If]q (Region of Rejection), cul0ftLo k/LIf0f (Non-Parametric Test), ;Fult

ljj]rs d"No (Consistant Critical Value)

t- test / z- test sf] k|of]u s] sf nflu ul/G5 ?

&= cjwf/0ff / ljlw Concept and techniques of and (t-test, correlation coefficient and chi-

squire test) in epidemiology

155

;f/;+If]k (Summary):

lrlsT;fzf:q, hLjlj1fg / hg:jf:Yosf] If]qdf k|of]u ul/g] tYofª\szf:qnfO{ h}ljs

tYofª\szf:q eGg ;lsG5 h;n] ;DalGwt If]qdf of]hgfug{, ;+rfng ug{, cg'dfg ug{,

kl/sNkgf k/LIf0f ug cg';Gwfgsf] 9fFrf tof/ kfg{ / tYofª\s ljZn]if0fug{ / o;nfO{ k|of]u

ug{ ;xof]u ub{5 .

cEof;

!=tnsf k|Zgx?sf] 5f]6f] pQ/ lbg'xf];\ .

s=_ h}ljs tYofª\szf:qnfO{ kl/eflift u/L o;sf] dxTj bzf{pg'xf];\ .

v=_ rnnfO{ kl/elift u/L cfl>t rn (Dependent Variable) :jtGq rn

(Independent Variable ) ljrsf] km/s b]vfpg'xf];\ .

u=_ ;Gb]xhgs rn (Confounding Variable) sf] pbfx/0f ;lxt ljz]iftfx? n]Vg'xf];\ .

3=_ dfkg (measurement nfO{ cfkm\g} zAbdf kl/eflift ug'{xf];\ .

ª=_dfkgsf ljz]iftfx? (Characteristics of a good measurement) sf] ;"rL tof/

kfg'{xf];\ .

r=_ dfgjLo q'l6 Human ErrorM / gd"gf 5gf}6df q'l6x? -Sampling Errors ljr

leGgtf b]vfpg'xf];\ .

5=_ ;x;DaGwsf k|sf/x? (Types of Corelation) pbfx/0f ;lxt ljZn]if0f ug'{xf];\ .

h=_ Ps rnLo, bLrnLo / ax'rnLo a0f{gfTds ljZn]if0fsf] cjwf/0f Concept and

techniques of univariate and bivariate k|i6 kfg'{xf];\ .

156

em=_ Multivariate Analysis ax'rnLo ljZn]if0faf6 s] s:tf rnx?ljrsf] ;DaGwsf

ljZn]if0f ug{ ;lsG5 ? j0f{g ug'{xf];\ .

`=_ tYofª\sLo cf+sng (Statistical Estimation) s] sf] nflu k|of]u ul/G5 ?

6=_ t- test / z- test sf] k|of]u s;/L ul/G5 pNn]v ul/G5 ?

7=_ sf/0f / ;DaGwsf] (Concept ot Causation and Association) cjwf/0f k|:6

kfg'xf];\ .

8=_ h}ljs tYofª\szf:q s] sf nuL k|of]u ul/G5 ?

9=_ tnsf k|Zgx?sf] nfdf] pQ/ lbg'xf];\ .

0f=_ Test and Retest Method k/LIf0f k'gMk/LIf0f ljlw / Split Half Method

cw{ljefhg ljlwaf6 ljZj;gLotf s;/L k|fKt ug{ ;lsG5 ? JoVof ug'{xf];\ .

t=_ kl/sNkgfsf] cjwf/0ff :ki6 kfb}{ lgikmn kl/sNkgf Null Hypothesis, j}slNks

kl/sNkgf Alternative Hypothesis, cg';Gwfg kl/sNkgf Research Hypothesis /

sfo{Tds kl/sNkgf Operational Hypothesis sf]k|of]usf] JofVof ug'{xf];\ .

y=_ pkof]lutfsf] tx (Level of Significance) / :jtGqtfsf] tx (Degree of

Freedom) sf] pkof]uLtf af/] ljj]rgf ug'{xf];.

b=_ g]kfndf ;+rfng ePsf ;fd'bfoLs k/LIf0f Community trial / sfo{If]q -lkmN8_

k/LIf0f Field trial sf pbfx/0f ;lxt j0f{g ug'xf];\.

157

j:t'ut k|Zgx?

;lx pQ/df -_ lrGx nufpg'xf];\.

!= tnsfdWo] s'g cj:yfnfO{ cfl>t rn elgG5

-s_ :jtGq rnaf6 k|efljt jf kl/jtL{t x'g] rn

-v_ s'g} rndf cfPsf] kl/jt{gaf6 k|efljt gx'g] rn

-u_ ck|ToIf ?kdf ;+nUg e} k|efljt x'g] rn

-3_ s'g }klt kl/jt{gaft k|efljt x'g] rn

@= tnsf s'g rn kIfkft -Bias) xf]

-s_ cfl>t rn -v_ :jtGq rn -u_ ;Gb]xhgs rn -3_ clglZrt rn

#= tnsf dWo s'g dfkgsf ljz]iftf xf]Og

-s_ dfkg cf}hf/df ;/ntf -v_ ;lhn} kl/jt{g ug{ ;lsg] -u_ cf}hf/df ;Totf /

:ki6tf -3_ k'j{3f]if0ff ug{ ;lsg] u'0f

$= tnsfdWo] s'g dfkgsf tx xf]Og

-s_ cg'kflts dfkg -v_ qmlds dfkg -u_ ;dfg'kflts dfkg -3_ juL{s[t

dfkg

158

:jtGq rnaf6 k|efljt jf kl/jtL{t x'g] rnnfO cfl>t rn Dependent Variable

elgG5

%= cg';Gwfgstf{n] pko'Qm / kof{Kt ;"rgfx? ;+sng ug{ g;s]sf] cj:yfnfO{ s:tf]

q'l6nfO{ elgG5

-s_ dfkgdf q'l6 -v_ dfkg ;fdu|Ldf x'g] q'l6 -u_ dfgjLo q'l6

-3_ ;"rgf ljZn]if0faf6 x'g] q'l6

^= tnsfdWo] s'g ljZn]if0fn] tLg jf tLg eGbf a9L rnx?ljrsf] ;DaGwnfO{ ljleGg

tYofª\szf:qLo dfWodaf6 ljZn]if0f ug]{ u5{

-s_ ax'rnLo ljZn]if0f -v_ åLrnLo ljZn]if0f -u_ Ps rnLo ljZn]if0f -3_

qLrnLo ljZn]if0f

&= tnsfdWo] s'g j}slNks kl/sNkgf xf]

-s_ kl/sNkgfdf pNn]v ePsf rnx?ljr sg} klg ;DaGw /xb}gf elg tof/ kf/Losf]

kl/sNkgf

-v_ k/LIf0f c:k:6 ePdf k|of]u ul/g] kl/sNkgf

-u_ cg';Gwfg k|lqmofnfO{ lglZrt lbzfdf n}hfgsf] nflu tof/ kl/Psf] kl/sNkgf

-3_ lgwf{l/t ;dodf k/LIf0f ug{ ;lsg kl/sNkgf

*= s'g} Ps rndf kl/jt{g cfpFbf csf]{ rndf s'g} klg k|efj gkg]{ ;DaGwnfO{ t6:y

s'g txsf] ;DaGw elgG5

-s_ ;sf/fTds txsf] ;DaGw -v_ gsf/fTds txsf] ;DaGw -u_ t6:y txsf] ;DaGw -3_

cltl/Qm txsf] ;DaGw

159

(= Null Hypothesis nfO{ tnsf] s'g ;+s]tn] k|lglwTj ub{5

-s_ H0 -v_ H0 -u_ H1 -3_ H1

!)= cjnf]sfTds cWoog s'g cWoog cGt/ut kb{5

-s_ 36gf-lgoGq0f cWoog -v_ ljZn]if0ffTds cWoog -u_ j0f{gfTds cWoog -3_

nlDao cWoog

! s @ 3 # v $ u % u ^ 3 & s * v ( s !) v

Answer to check your progress/self-test

h}ljs tYofª\szf:q ljz]if u/]/ lrlsT;fzf:q, hLjlj1fg / hg:jf:Yosf] If]qdf k|of]u ul/g]

tYofª\szf:qnfO{ lng ;lsG5 . h}ljs tYofª\szf:q lrlsT;fzf:q / hg:jf:Yosf]

cg';Gwfgdf h}ljs tYofª\s ;+sng ug{, To;nfO{ k|:t't\ ug{ d"Nof+sg ug{, cg'dfg ug{

(estimation), kl/sNkgf k/LIf0f ug{ (hypothesis test) / cg';Gwfgsf] 9fFrf (study

design) tof/ kfg{ o;sf] dxTj /x]sf] 5 .

s'g} u'0f, ljz]iftf jf tYox?sf] hfgsf/L lbg] jf k|ltlglwTj ug]{ c+s, tx jf ;+s]tnfO{ rn

elgG5 . dfkg ug{ ;lsg] 36gfcj:yfsf] ljz]iftfnfO{ rn elgG5 . c?sf] k|efj kg]{ jf

csf{df e/ kg]{ rnnfO{ cfl>t rn elgG5 eg] c?nfO{ k|efj kfg]{ t/ cfkm'dfyL c?sf]

s'g}klg k|efj gkg]{ rnnfO{ :jtGq rn elgG5 . ck|ToIf ?kdf ;+nUg e} k|efj kfg]{ tTjnfO{

;Gb]xhgs rn elgG5

ef}lts jf cef}lts u'0fsf] dfqfnfO{ lglZrt lgodx?sf] k|of]u ul/ hgfpg] sfo{nfO{ dfkg

(measurement) elgG5 . c+s k|bfg ug]{, dfqf tf]lsg] jf k|lqmofsf] dfgnfO{ k|ltlglwTj ul/

tLgLx?sf] u'0ffTds d"Nof+s ul/g'g} dfkg xf] . gfd jf juL{s[t dfkg, qmlds dfg, cGt/fn

dfkg tyf cg'kflts dfkgsf txx? x'g\ .

160

dxfdf/Llj1fg cGt/ut cWoogsf] qmddf x'g] uNtLn] cg';Gwfgdf em'6f] glthf cfpg'nfO{

q'l6 elgG5 . cg';Gwfg k|lqmfofdf cg;Gwfgstf{n] pko'Qm / kof{Kt ;"rgfx? ;+sng ug{

g;]sf] cj:yfnfO{ dfgjLo q'l6 elgG5 . k|ofKt, pko'Qm / ljZj;gLo k|ltlglwd"ns gd"gf

5gf}6 ug{ g;lsPsf] q'l6nfO{ lng ;lsG5 . gd'gf ;+sng ubf{ ;fjwfgL gckgfpgfn] cfpg]

ub{5 .

k|dfl0fstf/j}wtf s'g} klg j:t', ljifo j:t' jf cj:yfsf] dfkgdf x'g' kg]{ u'0f xf] . h;n] h'g

j:t'nfO{ gfKg vf]h]sf] xf] To;nfO{ gfk]sf] x'G5 . cg';Gwfg sfo{df tYofª\ssf] z'4tf,

tfls{stf / lglZrttfn] j}wtf k|bfg ub{5 . dfkgdf Ps?ktf, l:y/tfsf] eljiojf0fL ug{

;lsg] u'0f / z'4tfsf] hfgsf/L lbg'nfO{ ljZj;gLotf elgG5 .

cg';Gwfgsf] qmddf 36gfdf ;+nUg kl/jt{gsf] sf/0fx?sf] :j?k s:tf] 5 / ltgLx?sf]

k|j[LQsf] ljsfzsf] s:tf] ePsf] 5 egL a'em\g] k|lqmofnfO{ ;x;DaGw Correlation eGg ;lsG5 .

;sf/fTds txsf] ;DaGw (positive correlation), gsf/fTds txsf] ;DaGw (Negative

correlation), t6:y txsf] ;DaGw (Zero correlation), /]lvo ;x;DaGw (Linear

Corelation)

Pp6fdfq rnsf] ;+sng ul/ To;sf] ljZn]if0f ul/G5 eg] To;nfO{ Ps rnLo lnZn]if0f

elgG5 . o;df s'g} Pp6f ;d"x, JolQm, ;+:yf, jf j:t'nfO{ cg';Gwfgsf] rn To;df ePsf]

ljleGg ljz]iftfx? ljZn]if0f ul/G5 . b'O{j6f rnx? lar t'nfgfTds ljZn]if0f ul/G5 . o;df

rnx?sf] ljt/0fdf tflnsfx? K|ltztdf cfwfl/t x'G5 / Pp6f rnsf] ;DaGw csf]{ rn;+u s]

s:tf] 5 eGg] hfgsf/L lbG5 . . o:tf] ljZn]if0f cGt/ tfnLsLs/0f (Cross Tabulation) af6

klg ug{ ;lsG5

tLg jf tLg eGbf a9L rnx?ljrsf] ;DaGwnfO{ ljleGg tYofª\szfl:qo dfWodaf6 ljZn]if0f

ug]{ ul/G5 . o;df ax'k|ltudg ljlw (Multiple Regression analysis) af6 b'O{ eGbf a9L

rnx? larsf] ;DaGwsf] ljZn]if0f ubf{ Ps rndf kl/jt{g cfpFbf csf]{ rndf cfpg ;Sg]

;Defljt kl/jt{gsf] cg'dfg ug{ ;lsG5

161

cg';Gwfgdf ;+nUg hg;+Vofaf6 lglZrt gd'gf 5gf]6 u/L 5gf}6 ePsf gd'gfsf] cWoogaf6

k|fKt lgisif{nfO{ ;du|tfdf (Universe) cf+sng ul/g] k|lqmofnfO{ tYofª\sLo cf+sng elgG5

. o;sf] nflu cg';Gwfgsf] ;du|tfsf] cfsf/ / :ki6 kl/efiff x'g' kb{5 .

cg';Gwfgsf] s|ddf b''O{ jf b'O{ eGbf a9L rnx?sf] cGt/;DaGwnfO{ JoQm ug]{ k|lqmofnfO{

cg';Gwfg kl/sNkgf elgG5 . o;n] cg';Gwfgsfo{ ;'? ug'{eGbf cuf8Lg} cWoog k'/f ul/;s]

kl5 cfzftLt kl/0ffdsf] k"jf{g'dfg ug]{ ub{5 . lgikmn kl/sNkgf, j}slNks kl/sNkgf /

cg';Gwfg kl/sNkg kl/sNkgfsf] k|sf/x? x'g .

T. Test nfO{ t- test n]Vg] ul/G5 . hg;+Vof sf] e]b (Variance) c:ki6 5 / gd'gf #) eGbf

sd 5 eg] b'O{ gd'gfsf] dWodfg aLrsf] km/ssf] pkof]uLtf kQf nufpg k|of]u ul/G5 . t-

test sf] nflu pkof]uLtfsf] tx, :jtGqtfsf] tx, z"Gokl/sNkgf / Psk[i6 / b'O{k[i6 k/LIf0fsf]

cjwf/0ff :ki6 x'g' cfj:os 5 .

;}4flGts tYofª\szf:qn] cg';Gwfgaf6 k|fKt ljleGg rnx?sf] dfkgsf] k/LIf0f ul/

;DefJotfsf] ;fdGoLs/0f ug]{ sfd ub{5 .

;fwf/0ftof gd'gfsf] cfsf/ #) eGbf a9L 5 / b'O{ gd'gf aLrsf] dWodfgsf] b/ km/s 5 eg]

z- test k|of]u ul/G5 . o;n] ;DalGwt dfksf] pkof]uLtfsf] k/LIf0f ug{sf nflu pkof]uLtfsf]

;/nLs[t txdf o;sf] ;DefJodfg u0fgf / t'ngf ul/G5 . o;sf] nflu T ratio kQfnufpg

cfjZos 5 .

cg';Gwfgdf gd'gfsf] cfsf/ yfxf e} o;df lglxt d"NonfO{ :jtGq ?kdf 5gf}6 ul/g'nfO{

:jtGqtfsf] tx elgG5 .

cWoog cg';Gwfgdf 36gfnfO{ k|efj kfg]{ ljleGg tTjnfO{ rnsf] ?kdf lnO{ ltgLx?sf]

ljrsf] ;DaGwsf cfwf/df cg';Gwfgsf] lgisif{ lgsflnG5 . cfl>t rn (Dependent

Variable) :jtGq rn (Independent Variable) oL rnx? s'g} :jtGq jf oLgLx?df

s;}sf] klg k|efj kb}{g eg] s'g}df c?sf] k|efj kb{5 . olb XnfO{ :jtGq rn / YnfO{

cfl>t rn dfGg] xf] eg] Xsf] k|efj Ydf kb{5 . oL b'O{ y/Lsfrnx?sf] ljrsf] ;DaGwn]

36gfsf] jf:tljstf lgSof}{n ub{5 . cg';Gwfgdf :jtGqrnx? 36gf cj:yfsf] sf/0f;+u

;DalGwt x'G5g eg] cfl>t rnx? kl/0ffd;+u ;DalGwt x'G5g . o;}u/L cljl5Gg

162

(Continuous variable) rnx?n] ;fwf/0f cj:yfsf] ljz]iftf b]vfp5 . h:t} pd]/, prfO{,

tf}n Hofnf cflb . j0f{gfTds (Descriptive Variable) rnx?n] s'g}klg cj:yfsf] ;fdfGo

auL{s/0f jf j0f{g ub{5 .h:t} k|f0Lf, 3/hUff, pBf]unfO{ hgfp5 .

&= k[i7kf]if0f

h}ljs tYofª\szf:qsf] cjwf/0ff / dxTjaf/] cWoog / 5nkmn ug'{xf]; .

rnn] s] nfO{ ;+s]t ub{5 / k|ltlglwTj u5{?

rnsf lnz]iftfx? l6kf]6 ug'{xf];\ .

rnsf k|sf/x? u'0ffTds / ;+VofTds rnx?df pbfx/0f;lxt JofVof ug'{xf];\ .

dfkg (Measurement) dfkgsf ljz]iftfx?

dfkgsf rn0fx? dfkgsf] tx

dfkgsf q'l6 tyf dxfdf/L lj1fgdf k|of]usf] cfwf/df q'l6x? / kIfkftx?

dxfdf/L lj1fgdf ljZj;gLotf / j}wtf

dxfdf/L lj1fgdf ljZj;gLotf / j}Btfsf] cjwf/0ff / k|sf/x?

ljZj;gLotf hfFrsf ljlwx?

JofVofTds ;fª\lvsLo ljZn]if0f

kl/sNkgfsf] k|sf/x?kl/sNkgf k/LIf0f / ;}4lGts tYofª\ssf] cjwf/0ff / ljlw

163

;DaGwM ;x;DaGw / sfo{sf/0f ;DaGw

;DaGwsf] / sfo{sf/0f ;DaGwsf ljZn]if0f

;}4flGts tYofª\szf:q

tYofª\sLo cfFsng

kl/sNkgf k/LIf0f

pkof]lutfsf] tx

:jtGqtfsf] tx

sfO{ :Sjfo/ k/LIf0fsf] u0fgf / ljj]rgf

sf/0f / ;DaGwsf] cjwf/0f / s[lqd/unt ;DaGw

ljZn]if0f ug]{

;fd'lxs cWoog

hf]lvdsf] cg'dfg

k|of]ufTds cWoog

164

;Gbe{u|Gyx? (References)

Adeney, K.L., & Weiss, N.L. (Eds.) (2009). Biostatistics and epidemiology. New York: Springer.

Adhikari, K. (2009). Principles of Epidemiology: The essentials. Kathmandu: Highland Publication Pvt. Ltd.

Beaglehole, R.; Bonita, R. & Kjellstrom, T. (2001).Basic epidemiology. Geneva: World Health Organization.

Bhopal, R. (2002). Concepts of Epidemiology An integrated introduction to the ideas, theories, principles and methods of epidemiology. New York: Oxford University Press.

Budhathoki, C.B., & Wagle, B. (2012). Community Health and Organization. Kathmandu: Pinnacle Publication.

CDC, Principle of epidemiology in public health practice. Available from www.cdc.gov/training/products/ss1000

Greenberg, R.S. et al. (1996). Medical epidemiology (Second Edition).London: Prentice-Hall International, Inc

Gregg, M.B. (2008). Field epidemiology (3rd edition). New York: Oxford University Press.

Kerlinger, F. N. (1986). Foundations of Behavioral Research.(3rd ed.) New York: Holt, Rinehart & Winston.Killewo, J. Heggenhougen, H.K., &Quah, S.R. (Eds.) (2008).Epidemiology and demography in public health.Amsterdam: Academic Press.

MoHP, New Era & Macro International Inc. (2011).Nepal demographic and health survey 2010. Preliminary report Kathmandu: Ministry of Health and Population.

MoHP, New Era & Macro International Inc. (2007).Nepal demographic and health survey 2006. Kathmandu: Ministry of Health and Population.

National Planning Commission (2007). Three Year Interim Plan.Kathmandu: Government of Nepal, National Planning Commission.

Park, K. (2011). Park’s textbook of preventive and social medicine. Jabalpur, India: M/S Banarsidas Bhanot Publishers.

Rao, P.S.S., & Richar, J. (2012). Introduction to Biostatistics and Research Methods. (5th edi.). New Delhi:PHI Learning Private Limited

Webber, R. (2005). Communicable diseases epidemiology and control: A global perspective. Massachusetts Avenue: CABI Publishing

WHO(1994). Basic Epidemiology,printed by Orient Longman Ltd.India

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