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The precision of estimated disease incidence can then be evaluated under a wide range of settings including the hierarchical sampling of groups of individuals, the various levels of spatial heterogeneity of disease, and the situation when all individuals are disease free. Precision, quantified with the standard error or the width of the confidence interval for incidence, is directly related to N and inversely related to the degree of heterogeneity (characterized by the intracluster correlation, rho). Based on direct estimates of rho (determined from the theta parameter of the beta-binomial distribution or from the observed variance) or a model predicting rho as a function of incidence (derived from the binary power law), one can calculate, before a sampling bout, the value of N needed to achieve a desired level of precision. The value of N can also be determined during a sampling bout using sequential sampling methods, either to estimate incidence with desired precision or to test a hypothesis about true disease incidence. In the latter case, the sequential probability ratio test is shown here to be useful for classifying incidence relative to a hypothesized threshold when the data follows the beta-binomial distribution with either a fixed rho or a rho that depends on incidence.

Authors: Madden LV., Hughes G.

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