Penelitian Deskriptif

Trisasi Lestari

Design tree

Case study
Case-series
Surveillance
Ecological

Penelitian descriptive
the first scientific toe in the water
Dirancang untuk menjelaskan distribusi
variable
tanpa memperhatikan penyebabnya atau
hipotesis lainnya
6W: Who, What, Why,When, Where, so What

Who?
Who has the disease in question?
Usia, Jenis kelamin, ras, pekerjaan, hobi?
resiko venous thromboembolism meningkat bersama
dg pertambahan usia
Hanya 1% kanker payudara ditemukan pada pria,
tetapi riwayat kanker payudara pada keluarga atau
klinefelter syndrome akan meningkatkan resikonya
Ras mempengaruhi resiko terjadinya leiomyoma uteri
Nelayan masih merupakan profesi yang berbahaya
Mengendarai mobil saat mabuk bisa mematikan

What?
What is the condition of disease being studied?
Definisi kasus yang jelas, spesifik, dan terukur
Banyak kasus yang masih sulit didefinisikan dan sulit
diukur, misal TB anak, gangguan mental, diare spesifik

Dipengaruhi sensitifitas & spesifisitas kriteria

diagnosis
Mempersempit kriteria akan mengurangi jumlah
kasus, tetapi dg spesifisitas yang lebih baik
Definisi kasus toxic shock syndrome sekarang
ditambah multiple organ involvement
Memperluas definisi suatu penyakit akan menambah
jumlah kasus penyakit tsb.

Why & When?

Why did the condition/disease arise?
Sekedar petunjuk
Perlu di follow-up dengan penelitian lainnya

When is the condition common or rare?

Sekedar informasi waktu
Prevalensi TB di RS tahun 2010

Hubungan temporal
Vaginal adenosis atau clear cell carcinoma of the vagina
muncul beberapa tahun setelah mendapat paparan
diethylstilboestrol intrauteri
Kanker serviks terjadi beberapa dekade setelah
infeksi human papillomavirus
Kematian akibat pneumonia memiliki pola musiman

Where and so, What?

Where does or does not the condition arise?
Geografi memiliki pengaruh besar thd kesehatan
Contoh?

So What?
Dampaknya terhadap kesehatan masyarakat

Lain-lain:

Apa kepentingannya
Apakah serius
Apakah kasusnya banyak
Apakah implikasi sosialnya besar

Jenis penelitian deskriptif

Individual

Case report
Case-series report
Cross-sectional
Surveillance

Populasi
Ecological correlational studies

Case Report
Melaporkan kasus baru atau penyakit yang jarang terjadi, yang
membutuhkan penelitian lanjutan dengan desain yang lebih teliti.
benign hepatocellular adenomas, a rare tumour, in women who had
taken oral contraceptives
Follow up with a large case-control study

Tidak semua laporan kasus berhubungan dengan kasus-kasus

yang mengancam kesehatan.
Growth monitoring still has a place in selected populations of
children. M Hussain, C M John, K Mohamed, M Zbaeda, S M Ng, S
Chanderasekaran, M Didi, J C Blair. BMJ Case Reports Published 28
March 2011
The assessment and treatment of a complex geriatric patient by an
interprofessional primary care team. Stephanie H Bell, C Shawn
Tracy, Ross E G Upshur, on behalf of the IMPACT Team. BMJ Case
Reports Published 15 March 2011

the least publishable unit in the medical literature

We report a case of endometriosis of the appendix in a 25-year-old Caucasian

woman who presented with symptoms of acute appendicitis and was treated
by appendectomy, which resulted in a good outcome.
We discuss special aspects of acute appendicitis caused by endometriosis to
elucidate the pathologic entity of this variant of acute appendicitis.

Case-series report
aggregates individual cases in one report
the appearance of several similar cases in a
short period heralds an epidemic
they can constitute the case group for a casecontrol study

In this study of recent radiotherapy in HIV-positive

patients taking second generation PIs, no difference in
toxicities was observed in patients taking PIs compared
to patients not taking PIs during radiation therapy

The case reports clearly demonstrated

different ways of writing about problems that
arise during sickness certification, from being
neutral and not mentioning the problems to
being emotionally involved and asking for help

Criteria for publishable casereport

Teach humanistic lessons
to the health care
professional;

Report unlabeled or
unapproved uses of a
medication;

Review a unique job

description of a health
care professional that
improves patient care;

Use pharmacoeconomic
principles that improve
patient care;

Report new medical

errors or medication
errors;

Uncover barriers to
patient adherence;
Use technology to
improve patient
outcomes.

Further reading (kriteria penulisan laporan kasus): Cohen, 2006. How to

write a patient case report. Am J Health-Syst PharmVol 63: 1888-92.

Cross-sectional Study

Cross-sectional
(prevalence) studies
provide a snapshot of the population at a
point in time or short period of time.
both exposure and outcome are ascertained at
the same time
describe the health of populations
Estimate the prevalence of the outcome of
interest
Nasional: sensus
Local: survey pada seluruh karyawan kantor

 Mirip case-control jika ditinjau dari outcomenya

Mirip cohort jika ditinjau dari exposure-nya
Bisa jadi cohort jika semua subject di follow-up
Bisa jadi pseudolongitudinal study jika
dilakukan cross-sectional berulang untuk
mengukur perubahan pada subjek

Despite the universal health care system in B.C., we found patterns

of inequity in spending by income in the last year of life, even for
fully publicly covered services.

Sample selection and

response rate
Samples selected using a random technique
taken from the whole population
Responders must be representatives of the
whole population
Non-response is a common problem
Selection bias, response bias, information bias

Advantages & Disadvatanges

costs are small
short time to conduct
loss to follow-up is not a problem
Can estimate prevalence
Prevalence-incidence bias (Neyman bias)
Impossible to infer causality
Many outcomes and risk factors can be assessed
Only a snapshot, result may change at different time

Riskesdas 2010
Desain: cross-sectional
Setting: 33 provinsi, 400 kabupaten/kota
Populasi: semua rumah tangga, sampling BPS
untuk Susenas 2007
Unit observasi: semua anggota RT
10% sample diperiksa kadar Yodium urin (6-12th)
10% sample diperiksa spesimen darah (urban-rural)
28.000 RT
4 anggota RT/RT: 2 dewasa, 1 anak balita, 1 anak (514th)

Riskesdas (contd)
Sample frame
Multistage cluster sampling dengan blok sensus
BPS (2 stages di kota dan 3 stages di desa)
Besar sample : 280.000 RT

Kriteria inklusi

Anak usia 12-59 bulan

Anak usia 5-14th
Perempuan dewasa usia >14 th
Laki-laki dewasa >14th

Kriteria eksklusi:
Anak usia <1th, ibu hamil, sakit berat, jompo,
menolak jadi responden.

 Data yang dikumpulkan:

Pengenalan tempat, keterangan RT, keterangan
pewawancara, keterangan anggota RT,
mortalitas, autopsi verbal, manajemen
pelayanan kesehatan, sanitasi lingkungan,
konsumsi makanan RT, penyakit menular, tidak
menular, riwayat penyakit turunan,
ketanggapan pelayanan kesehatan, KAP,
disabilitas, mental health, imunisasi,
pemantauan pertumbuhan balita, kesehatan
bayi, pengukuran dan pemeriksaan

 Data biomedis yang dikumpulkan:

Penyakit menular: DHF, TB, malaria, rubella, HIV,
typhoid, PMS, CMV
Preventable disease: DPT, Polio, Campak, Hepatitis
NCD: DM, dyslipidemia, tyroid, CVD, thrombosis,
Neoplasma
Kelainan gizi (anemia, defisiensi nutrients)
Kelainan bawaan (thalassemia)

Informasi lebih lanjut:

http://www.litbang.depkes.go.id/riskesdas/index.htm

Surveillance
Definisi:
the ongoing systematic collection, analysis, and
interpretation of health data essential to the planning,
implementation, and evaluation of public health practice,
closely integrated with the timely dissemination of these data
to those who need to know

Passive surveillance: relies on data generally gathered

through traditional channels, such as death certificates.
Active surveillance: searches for cases
abortion-related deaths: US CDCP identifies about twice as
many deaths compare to the official statistic

Important contributions to health: smallpox eradication.

Semakin banyak jumlah

rumah ibadah dikota, semakin
banyak jumlah pekerja PSK

Ecological correlational
study
Mencari hubungan antara paparan dan outcome di
level populasi
Bisa digunakan untuk membuat hipotesis.
Limitations:
Tidak bisa menghubungkan antara paparan dengan
outcome di level individual untuk mengontrol
confounding : ecological fallacy

Example: death rates from coronary artery disease

also correlate with the number of colour television
sets per capita

Descriptive
statistics

Manfaat penelitian
deskriptif
Trend analysis
provided by ongoing surveillance
Contoh: ?

Planning
Healthcare planning
Contoh: ?

Clues about cause

To develop hypothesis about the cause
high concentrations of oxygen in incubators and blindness
in babies; this finding led to analytical studies, then a
randomised controlled trial, confirming the association

Advantages and
disadvantages
Advantages:
Often, the data are already available
inexpensive and efficient to use
few ethical difficulties exist.

Disadvantages:
Temporal associations between putative causes
and effects might be unclear
the investigators might draw causal inferences
when none is possible.

Overstepping the data

temporal association is incorrectly inferred to be a
causal one
In one egregious example, seven women in Pasadena, California, created
controversy around the world in the late 1980s. Seen in one physicians office, the
women had developed functional ovarian cysts while taking the new multiphasic
oral contraceptive pills. Based on this uncontrolled observation, a case-series
report warned that phasic pills might pose a threat to patient health and safety.
The media printed the story, and unknown numbers of women around the world
stopped taking their pills, because they did not understand the difference between
functional cysts and ovarian cancer. Since the report had no comparison group
eg, women using monophasic pills or those using nonethe authors could not
draw any conclusions about cause of disease.
5 years elapsed before cohort67 and case-control studies confirmed no
association between multiphasic pills and ovarian cysts. By this time, the publichealth damage had been done.

Conclusion
Often the first tentative approach to a new event or
condition.
Emphasise features of a new disease or assess the health
status of communities.
Health administrators use descriptive studies to monitor
trends and plan for resources.
By contrast, epidemiologists and clinicians generally use
descriptive reports to search for clues of cause of disease
Common pitfalls of descriptive reports include an absence
of a clear, specific, and reproducible case definition, and
interpretations that overstep the data.

http://www.strobe-statement.org/index.php?id=available-checklists

STROBE StatementChecklist of items that

should be included in reports of crosssectional studies
Title and abstract

a. Indicate the studys design with a commonly

used term in the title or the abstract
b. Provide in the abstract an informative and
balanced summary of what was done and what
was found

Background/rational
e

Explain the scientific background and rationale for

the investigation being reported

Objectives

State specific objectives, including any prespecified

hypotheses

Present key elements of study design early in the

paper

Introduction

Methods
Study design

Setting

Describe the setting, locations, and relevant

dates, including periods of recruitment,
exposure, follow-up, and data collection

Participants

Give the eligibility criteria, and the sources and

methods of selection of participants

Variables

Clearly define all outcomes, exposures,

predictors, potential confounders, and effect
modifiers. Give diagnostic criteria, if applicable

Data sources/
measurement

For each variable of interest, give sources of data

and details of methods of assessment
(measurement). Describe comparability of
assessment methods if there is more than one
group

Bias

Describe any efforts to address potential sources

of bias

Study size

10

Explain how the study size was arrived at

Quantitative variables

11

Explain how quantitative variables were handled in

the analyses. If applicable describe which groupings
were chosen and why

Statistical methods

12

a. Describe all statistical methods, including those

used to control for confounding
b. Describe any methods used to examine
subgroups and interactions
c. Explain how missing data were addressed
d. If applicable, describe analytical methods taking
account of sampling strategy
e. Describe any sensitivity analyses

13

a. Report numbers of individuals at each stage of

studyeg numbers potentially eligible, examined
for eligibility, confirmed eligible, included in the
study, completing follow-up, and analysed
b. Give reasons for non-participation at each stage
c. Consider use of a flow diagram

Results
Participants

Descriptive data

14

a. Give characteristics of study participants (eg

demographic, clinical, social) and information on
exposures and potential confounders
b. Indicate number of participants with missing data
for each variable of interest

Outcome data

15

Report numbers of outcome events or summary

measures

Main results

16

(a) Give unadjusted estimates and, if applicable,

confounder-adjusted estimates and their precision (eg,
95% confidence interval). Make clear which
confounders were adjusted for and why they were
included
(b) Report category boundaries when continuous
variables were categorized
(c) If relevant, consider translating estimates of relative
risk into absolute risk for a meaningful time period

Other analyses

17

Report other analyses doneeg analyses of

subgroups and interactions, and sensitivity analyses

Discussion
Key results

18

Summarise key results with reference to study

objectives

Limitations

19

Discuss limitations of the study, taking into account

sources of potential bias or imprecision. Discuss both
direction and magnitude of any potential bias

Interpretation

20 Give a cautious overall interpretation of results

considering objectives, limitations, multiplicity of
analyses, results from similar studies, and other
relevant evidence

Generalisability

21

Discuss the generalisability (external validity) of the

study results

22

Give the source of funding and the role of the funders

for the present study and, if applicable, for the original
study on which the present article is based

Other information
Funding