Summarizing statistical measures including rates, ratios and proportions using profile of risk factors for noncommunicable diseases in Afghanistan: a teaching case study
Khwaja Mir Islam Saeed, Shoaib Naeemi, Mir Salamuddin Hakim
Corresponding author: Khwaja Mir Islam Saeed, Technical Advisor for Afghanistan Field Epidemiology Training Program (AFETP), Eastern Mediterranean Public Health Network (EMPHNET) Afghanistan National Public Health Institute, Ministry of Public Health, Afghanistan 
Received: 25 Dec 2024 - Accepted: 25 Oct 2025 - Published: 17 Feb 2026
Domain: Biostatistics,Non-Communicable diseases epidemiology,Population Health
Keywords: Afghanistan, noncommunicable diseases, biostatistics, rate, ratio, proportion, case-study
Funding: This work received no specific grant from any funding agency in the public, commercial, or non-profit sectors.
This article is published as part of the supplement Teaching Case Studies in Field Epidemiology and Public Health for the Eastern Mediterranean Region, commissioned by Eastern Mediterranean Public Health Network (EMPHNET).
©Khwaja Mir Islam Saeed et al. Pan African Medical Journal (ISSN: 1937-8688). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Cite this article: Khwaja Mir Islam Saeed et al. Summarizing statistical measures including rates, ratios and proportions using profile of risk factors for noncommunicable diseases in Afghanistan: a teaching case study. Pan African Medical Journal. 2026;53(1):5. [doi: 10.11604/pamj.supp.2026.53.1.46337]
Available online at: https://www.panafrican-med-journal.com//content/series/53/1/5/full
PDF in process Case study 
Summarizing statistical measures including rates, ratios and proportions using profile of risk factors for noncommunicable diseases in Afghanistan: a teaching case study
Summarizing statistical measures including rates, ratios and proportions using profile of risk factors for noncommunicable diseases in Afghanistan: a teaching case study
Khwaja Mir Islam Saeed1,&, 
Shoaib Naeemi2, Mir Salamuddin Hakim3
&Corresponding author
Noncommunicable diseases (NCDs), including cardiovascular diseases, cancer, chronic respiratory disease, and diabetes, are the leading cause of morbidity and mortality worldwide. NCDs kill 41 million people each year, equivalent to over 7 out of 10 deaths worldwide. Each year, 17 million people die from a NCD before age 70 of whom 86% occur in low- and middle-income countries. Similarly, Afghanistan suffering from double burden of disease including communicable and noncommunicable diseases. According to WHO, NCDs are estimated to account for 62% of total deaths in Tajikistan, 79% in Uzbekistan, 50% in Pakistan and 76% in the Islamic Republic of Iran and Turkmenistan, all countries neighboring, conversely NCDs account for 37% of total deaths in Afghanistan. Similar results were found in the 2010 Afghanistan mortality survey: 33.3% of all deaths in the country were attributed to NCDs. Risk factors associated with NCDs are modifiable such as tobacco use, physical inactivity, unhealthy diet and the harmful use of alcohol which all increase the risk of NCDs and metabolic risk factors that contribute to four key metabolic changes including raised blood pressure; overweight/obesity; hyperglycemia; and hyperlipidemia. Detection, screening and treatment of NCDs, as well as palliative care, are key components of the response to NCDs. By this teaching case study, we aim to strengthen competencies and consolidate understanding of participants to develop summary measures of statistics including rate, ratio, and proportion. The baseline data for this case study is a published survey on risk factors of noncommunicable disease available in public domain. This case study stimulates the residents in field epidemiology training program to easily identify, calculate and compare summary statistics and plan and conduct surveys. The case study is designed for training novice field epidemiology trainees and could be administered in group of 4-6 residents in 2-3 hours. Used as adjunct training material, the case study provides the trainees with competencies in summarizing the data and calculating the measures.
General instructions: this is a teaching case study to be used as supporting raining materials for residents of field epidemiology training program at intermediated and advance level. Furthermore, the concept of biostatistics should have been clarified by facilitators in classroom ahead of working on this cases study. The case study could be practiced individually or in group of about 4-6 participants each. Participants are to take turns reading the case study, usually a paragraph per student. The facilitator should guide the discussion and calculation. The facilitator could use the flip charts or white board for making clarification and calculation if required.
Audience: basically, this case study is very basic and developed for residents on first workshop of field epidemiology. However, other residents of the same discipline could use it easily. These participants are commonly health care workers working in the country departments of health whose background may be medical doctors, nurses, environmental health officers or laboratory scientists who work in public health-related fields. Most have a health science or biology background.
Prerequisites: before using this case study, participants should have received lectures on introduction to biostatistics, basics of epidemiology and disease surveillance. The students should receive instruction on statistics including rates, ratios, proportions, prevalence, and incidence.
Materials needed: calculators, paper sheets, flip charts, markers, computers with Microsoft Excel and Epi info software.
Level of training and associated public health activity: Intermediate and advance training, summary of statistics, surveys, and public health surveillance.
Time required: 2-4 hours.
Language: English, could be translated to local language
- Download the case study student guide
- Request the case study facilitator guide
The authors declare no competing interests.
We would like to acknowledge The Eastern Mediterranean Public Health Network (EMPHNET) for their technical support. We also would like to thank the Afghan Ministry of Health for providing data for development of this case study.
Table 1: frequency of adults' population with differentiation of specific NCD variables
- CDC. About global NCDs. Centers for Disease Control and Prevention; 2021. Cited 2023 Jun 20.
- WHO. Non communicable diseases. World Health Organization; 2022. Cited 2023 Jun 20.
- Neyazi N, Mosadeghrad AM, AbouZeid A. Non-communicable diseases in Afghanistan: a silent tsunami. The Lancet. 2023 Jun 17;401(10393):2035-2036. PubMed | Google Scholar
- WHO. Noncommunicable diseases country profiles 201 Geneva: World Health Organization. 2014. Accessed 20 June 2023.
- Afghanistan mortality survey 2010. Calverton, Maryland: Afghan Public Health Institute, Ministry of Public Health, Central Statistics Organization (Afghanistan), ICF Macro, Indian Institute of Health Management Research, World Health Organization Regional Office for the Eastern Mediterranean. 2011. Accessed on 20 June 2023.
- Saeed KM, Rasooly MH, Nejaby M. Profile of risk factors for noncommunicable diseases in major cities of Afghanistan: WHO STEPwise approach. Eastern Mediterranean Health Journal. 2020 Apr 16;26(4):388-399. PubMed | Google Scholar
- Cho NH, Shaw JE, Karuranga S, Huang Y, da Rocha Fernandes JD et al. IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract. 2018 Apr:138:271-281 Epub 2018 Feb 26. PubMed | Google Scholar
- NSIA. Estimation for 2023 (1402) is 34971517 based on NSIA.
Search
This article authors
On Pubmed
On Google Scholar
Citation [Download]
Navigate this article
Similar articles in
Key words
Tables and figures
Article metrics
Recently from the PAMJ
Authors´ services
