Debre Markos University College of Health Science Department of Public Health Epidemiology For 2 Year BSC in Medical Laboratory Science Students by Mengistie Kassahun (MPH in Field Epidemiology)
Debre Markos University College of Health Science Department of Public Health Epidemiology For 2 Year BSC in Medical Laboratory Science Students by Mengistie Kassahun (MPH in Field Epidemiology)
Debre Markos University College of Health Science Department of Public Health Epidemiology For 2 Year BSC in Medical Laboratory Science Students by Mengistie Kassahun (MPH in Field Epidemiology)
July, 2021
Debre Markos,
Ethiopia
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Sub clinical disease
Recovery
Clinical disease
Recovery Death
Disability
Levels of Disease Prevention
• Disease prevention means to interrupt or slow
the progression of disease
Screening
Learning objectives
• Define screening
Screening
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Diagnostic test Vs screening test
Screening tests
are tests done in individuals with no such
symptoms or signs
Diagnostic tests
tests performed in persons with a symptom or a
sign of an illness
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Differentiate Between Screening and
Diagnostic Tests
Screening Diagnostic
Asymptomatic Suggestive clinical
picture
Large group Single subject
Less accurate Accurate
Not conclusive Conclusive
Less expensive Expensive
Not basic for treatment Basic to treatment
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Uses of Screening
Uses of Screening
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Purpose of Screening
Reducing disease burden
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Aims of screening program
Changing disease progression efficiently
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Principles for Screening Programs
1. Condition should be an important health problem
2. There should be a recognizable early or latent
stage
3. There should be an accepted treatment for persons
with condition
4. screening test is valid, reliable, with acceptable
yield
5. The test should be acceptable to the population to
be screened
6. Cost of screening & case finding should be
economically balanced in relation to medical care
as a whole
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Criteria for selecting diseases for screening
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Criteria For Successful Screening Test:
Criteria for Disease:
Present in population screened
High burden & of high public health concern
Screening +Intervention must improve outcome
Known natural history of the disease
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Criteria For Successful Screening Test:
Criteria for Test:
Reliable
Valid
Simple and inexpensive
Very safe
Acceptable to subjects and providers
Cost-effective
Exit strategy
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Criteria For Successful Screening Test:
Exit strategy:
Facilities for diagnosis and appropriate
treatments should be available for positive
subjects
Ethically not acceptable to offer screening
without available management
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Criteria For Successful Screening Test:
Definition of Reliability:
• Repeatability, Precision
• Getting the same results, when the test
repeated in same target individuals in the
same settings
35
Criteria For Successful Screening Test:
Causes of unreliability:
• Observer variation
• Subject variation – Biological
• Technical method variation
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Criteria For Successful Screening Test:
ACCEPTABILITY :
• The test should not be:
• Painful
• Unsafe
• Discomforting /Embarrassing
• Socially/ believes not accepted
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Criteria For Successful Screening Test:
VALIDITY:
Ability of the test to distinguish between who
has the diseases and who does not
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Types of screening
1. Selective Vs Mass.
Selective – screening of people with selective exposure
Mass – screening of people without reference to specific
exposure
2. Multiple-Parallel Vs Series
Parallel testing – applying two screening tests and a positive
result on either test is sufficient to be labeled as positive
These tests are given concurrently
E.g. – Breast cancer screening
Results in
- greater sensitivity
- increased PVN
-decreased specificity
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Cont’…
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Validity of a categorical test: four possible
relationships b/t a diagnostic test & actual
presence of disease
Screening Disease status or Diagnostic test
or Reference Test
Test result (Gold standard)
Positive Negative
Positive True + (a) False + (b) ?
Negative False - (c) True - (d)
?
? ?
Definitions of cells
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Sensitivity
DISEASE TOTAL
No
Diseased disease
Test a b a+b
Ability of thetest +ve
TEST
to truly identify
those who have Test c d c+d
the disease -ve
True Sensitivity=
Positive a/(a+c)
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Sensitivity
[A 90% Sensitivity means that 90% of the diseased
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Specificity DISEASE TOTA
L
No
The ability of the Diseased diseas
e
test to correctly
Test a b a+b
identify those who
TEST
+ve
do not really have
the disease Test c d c+d
-ve
True Specificity=
Negative d/(b+d)
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Specificity
[[A 90% Specificity means that 90% of the non
diseased people screened by the test will give a “true
negative” result, and the remaining 10% a “false
positive results”]]
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Example
Assume a population of 1,000 people among
these 100 have a disease and 80 of them are
confirmed by the test. Totally the screening test
reported that 180 people identified as positive
during the test.
calculate sensitivity and specificity?
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Cont’……
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Specificity and sensitivity
Increased sensitivity decreases the specificity
• Leads to more false positives
• people wrongly diagnosed as having the
disease
• unnecessary panic among people & Health
workers
• Unnecessary exposure for treatment
• Unnecessary wastage of resource (human, time,
drug, etc)
• Unnecessary stress on the health system
• Wrong negative implication external relation
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Specificity and sensitivity
Increased specificity decreases the sensitivity
• Leads to more false negatives
• people wrongly diagnosed as not having
the disease
• delay in diagnosis
• Negative implication on prognosis of
disease
• Unnecessary wastage of resource
(human, time, drug, etc) for sever disease
• Unnecessary stress on the health system
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Predictive value
DISEASE TOTA
L
No
Diseased diseas
Positive Negative e
Predictive Predictive
value value Test a b a+b
TEST
+ve
Proportion of Proportion of
Individuals with Individuals with Test c d c+d
positive test really negative test
have the disease really have no -ve
disease
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Effects on Predictive Values
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Cont’....
Prevalence of a disease
The proportion of individuals with a disease
Prior/pre-test probability of a disease
Prevalence = P (D+)
= (a+c)/n
Yield of a test
Proportion of cases detected by the screening
program
Yield = a/n
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Thank you