Community Medicine

Dr: Nasih Lec: -4-

9-Oct-06

Cross-sectional studies
(Prevalence studies/ Surveys)

Design
As cross-sectional studies collect data on existing (prevalent) cases so they
are also called prevalence studies.

 frequency of a particular exposure(s) and/or outcome(s)

 In a defined population
 At particular point in time
 We investigate prevalence of certain outcome OR exposures
( prevalence studies)

Example:
In an survey on smoking, we collect information on the smoking habits of
each individual (outcome) in a population. We can also collect information on some
potential risk factors, such as age, sex, occupation, education of the individual
(exposures).

Why Conduct surveys?

1) Health service planning

A survey describes the prevalence of a particular health related problem

(outcome) in a defined population at a particular point in time. This information
is valuable for understanding burden of disease and prioritization of
interventions

Examples:

 A survey can collect data on the utilization of services and this

information can be use for improving service delivery.

 Some countries undertake periodic surveys to obtain health-related data

from a random sample of the population (demographic health surveys,
multiple indicator cluster surveys).

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2) Evaluation of health interventions

Surveys can be conducted to evaluate the effectiveness of health

programmes

Example:
Vaccination coverage surveys are undertaken to asses the effectiveness of
EPI programmes

3) Generate hypothesis about etiology

Analytical cross sectional studies can help generate hypothesis about

possible causes of disease and are provide quick initial information on etiology.

Example:
The observation that coronary heart disease is more prevalent in men
than in women has led to hypotheses about the possible protective effects of
estrogens.

Steps in undertaking a survey

1) Defining the study question

 What question about prevalence we want to answer?

What is the prevalence of …anemia among the pregnant women in the

catchment area of this health center?

2) Defining the target population

 Define the target population of your study

 The target population is the population to which the main results of the
study will be extrapolated.

 If the target population is small à study all the members

 For large populations à study a sample

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  The sample must be representative of the target population otherwise we
would not be able to extrapolate the results

Example
In a cross-sectional study of smoking habits and risk factors for smoking,
the target population of our study could be all the children and adolescents in the
country within a certain well defined age group.

3) Sample selection

 The best way to ensure that a sample is representative of the target

population is by carrying out random sampling.

 Random sampling ensures that chance alone determines who will be

included in the sample. There are several different types of random
sampling.

4) Data collection

 Before data collection:

 have a clear case definition
 have a clear definition of the exposure(s) and outcome(s)

 Data collection methods depend on the nature of the measurements and

the financial and logistic issues

 Data collection methods:

 Personal interviews
 Questionnaires
 Medical records
 Physical examinations
 Diagnostic tests

5) Data analysis

 In descriptive studies we quantify the prevalence of an outcome or outcomes

amongst the study participants. We often report the prevalence in males and
females and in different age groups.

 In an analytic study, we quantify the association between the exposure and the
outcome by calculating the prevalence ratio.

 The prevalence ratio is the ratio of the prevalence of the outcome

in those exposed to the potential risk factor to the prevalence in
those unexposed.

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  If exposure has different levels, we can calculate prevalence and prevalence
ratio for different levels of exposure

Example:

 In a study of anemia in pregnant women, we could calculate a prevalence ratio

to quantify the association between anemia and literacy by comparing
prevalence of anemia among illiterate women and illiterate women.

Overall prevalence:

Total prevalence of anemia= number of women who are anemic/ total number of
women in the study

Prevalence in the exposed:

Prevalence of anemia among the illiterate women= number of illiterate women

who are anemic/ total number of illiterate women in the study

Prevalence in the unexposed:

Prevalence of anemia among the literate women= number of literate women who
are anemic/ total number of literate women in the study

Prevalence ratio:

Prevalence ratio= prevalence of anemia among the illiterate women/ Prevalence

of anemia among the literate women

6) Interpretation of results
During interpretation of results we must remember the following possible
sources of error.

 Bias is any error in the design and conduct of a study that makes the
results different from the truth

 Recall bias: have participants told us accurate answers/ have they

forgotten something? In a vaccination survey a mother may say
that her child is vaccinated while he is not. If inaccurate
information was provided then our results will be biased.

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  Observer bias: has the data collector made mistakes in obtaining/
recording the data? If he/she has done plenty of mistakes then our
results will be biased.

 Random error: was our sample really random? If it was not our results
will be biased.

 We collect data on exposure and outcome simultaneously so we must be

careful in interpreting the relationship between and exposure and an
outcome; we don’t know which one occurred first. Exception fixed
exposures like sex.

Strengths and Weaknesses of Cross-sectional Studies

Strengths
 Relatively quick, easy and economical to conduct

 Provide important information on the distribution and burden of disease

 Can provide initial information on exposure-outcome relationship

Weaknesses
 Measure prevalent rather than incident cases.

 It is difficult to establish the time-sequence of events and hence etiology