MAMCJMS_21_17R5

MAMC Journal of Medical Sciences

Original article

Comparative analysis of study design and statistical test

utilization in Indian Journal of Community Medicine, Indian
Journal of Public Health and Bulletin of the World Health
Organization
Sandeep Sachdeva, Nidhi Dwivedi
Department of Community Medicine, North DMC Medical College and Hindu Rao Hospital, New Delhi, India

Abstract
Objective: To analyze study topic, study design, usage of statistical test, and other selected document parameters in published original
research articles. Materials and Methods: Three journals (1) Indian Journal of Community Medicine (IJCM), (2) Indian Journal of Public
Health (IJPH), and (3) Bulletin of World Health Organization (WHO) were reviewed and all original research article published during three
years, that is, January 2014 to December 2016, were considered, and selected document parameters were recorded using checklist. During this
period, IJCM released volumes 39 to 41, IJPH released 58 to 60, and WHO released 92 to 94. Results: A total of 318 original articles were
reviewed with the contribution of 28.9% in IJCM, 27.6% in IJPH, and 43.3% in WHO bulletin. Out of all the publications, highest (46.5%)
original article belonged to research domain category-I [communicable, maternal and child health (MCH)] followed by 104 (32.7%) category-
II (noncommunicable diseases) and 66 (20.8%) by category-III (health system, medical education, and environment). Overall 79.2% original
articles were cross-sectional in study design followed by cohort (15.4%), intervention/experimental study (3.4%), and case-control (1.8%).
Average number of authors per article in WHO bulletin was 8.1 [95% confidence interval (CI): 7.19.0] followed by IJCM 4.2 (95% CI:
3.84.6), and IJPH (3.84, 95% CI: 3.494.19). There were 95 (29.9%) articles where-in all the authors were from a single institution, whereas
in 223 (70.1%) articles coauthors were from different institutions. It was also found that most (80.1%) of the study papers did not contained
any background statement regarding statistical sample size estimation; 239 (75.2%) articles used statistical software; majority had utilized
SPSS (61.08%), followed by STATA (19.24%), SAS (8.76%), R-software (5.45%), EPI-info (3.76%), and EXCEL (1.25%); nearly 210 (66%)
original research articles utilized at least one of the inferential statistics (basic, advance, and survival analytical methods). Higher proportion of
advance (60.2%) inferential statistical test and survival analysis (92.3%) were used in Bulletin of WHO; 82% of references used were within
10 years of publications of articles in WHO while this figure was 66% (IJCM) and 63% (IJPH). Conclusion: This study provides an objective
snapshot of national and international public health journal that may aid researcher for better comprehension, situational, and trend analysis as
well as assist them in their future research endeavor.

Keywords: Author mapping, bibliometric evaluation, citation, document properties, developing countries, global burden of disease, research
publications, statistical test, study-design, study topic, statistical software

INTRODUCTION Address for correspondence: Dr. Sandeep Sachdeva, MD, DNB, Department
of Community Medicine, North DMC Medical College and Hindu Rao Hospital,
The conveyance of information by research publication is New Delhi-110007, India.
responsible for growth and development of the subject area, e-mail: sachdevadr@yahoo.in
journals as well as authors and readers. This further provides
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How to cite this article: Sachdeva S, Dwivedi N. Comparative analysis

DOI: of study design and statistical test utilization in Indian Journal of
10.4103/mamcjms.mamcjms_21_17 Community Medicine, Indian Journal of Public Health and Bulletin of
the World Health Organization. MAMC J Med Sci 2017;XX:XX.

2017 MAMC Journal of Medical Sciences | Published by Wolters Kluwer - Medknow 1

 Sachdeva and Dwivedi: Comparative analysis of study design and statistical test utilization
new insights and inspiration for new researchers to work on
the same or related field. Role of scientific journal ranges
from building a collective knowledge base, communicating
information, validating the quality of research, distributing
rewards, and building scientific communities across the
globe.[1-3] During last decade there has been increased
thrust being given to research in the developing countries
especially India due to various internal and external driving
forces. Interalia there has been rapid expansion of research
publications and appearance of new journals with a
considerable fear of diluting the quality of research
standards. An attempt has been made in the present study
to undertake selective bibliometric evaluation of original
research articles published in reputed national and
international public health journals.
Bibliometrics are quantitative technique of measuring output,
mapping pattern, emerging trend and obsolesce of
publications, authorship, citation impact, and use of
literature. It encompasses measurement of properties of
documents and document related processes.[4,5] However,
surveying peer-reviewed medical journals for their
contents in terms of study design and statistical methods is
not an uncommon practice.[6-8] This review is expected to
serve as an objective approach for improving the quantitative
and qualitative content of journal and learning amongst
readers as there are very limited studies available to throw
light on this dimension.
Indian Journal of Community Medicine (IJCM) and Indian
Journal of Public Health (IJPH) are peer-reviewed,
historically trusted, widely acknowledged quarterly
English language publications in the domain of
community medicine and public health managed by two
independent professional bodies in the country. Both these
free to access journals are indexed in large number of
database and earliest records of IJPH available in
PubMed dates back to year 1961 and 1974 (IJCM)
respectively. IJCM is available online (www.ijcm.org.in)
since September 15, 2007 and IJPH is available online
(www.ijph.in) since September 25, 2010. For comparison
purpose, we also evaluated international journal of
public health, Bulletin of the World Health Organization
(available in PubMed since 1948) on the same
parameters. Both IJCM and IJPH publish peer reviewed
quarterly (four issues per year) while bulletin of
the WHO is published on monthly bases (12 issues per
year). SCImago Journal Rank of IJCM was 0.62
with 1.14 cites/document; IJPH was 0.44 with 0.83 cites
and Bulletin of the WHO was 2.82 with 4.97 cites/
documents.
MATERIALS AND METHODS
Three journals (1) IJCM, (2) IJPH, and (3) Bulletin of World
Health Organization (WHO) journal were reviewed. All
original research published either as full-length paper or
brief/short communication during last three calendar years
2 MAMC Journal of Medical Sciences Volume XX Issue XX Month 2017
that is, January 2014 to December 2016 were considered,
downloaded from the respective website, and reviewed by
authors. Thus editorial, personal view-point, commentary,
oration, review article, student research section, field report,
essay, news or letters to editors were excluded from present
analysis. During this period IJCM released volumes 39 to 41;
IJPH released 58 to 60 and WHO released 92 to 94.
For every original research article following document
parameters were recorded using check-list: thematic topic of
research domain, study design, statistical methods, software,
inputs for proper calculation of sample size, number of authors,
department, and institution of first/corresponding authors,
number of pages and references used. The research domain
was classified and adapted according to global burden of
disease[9] categories: category-I = communicable, maternal,
perinatal, congenital, food-borne, vaccine coverage, and
nutritional disorders; category-II = noncommunicable
diseases, mental health, associated risk factors, geriatrics,
drug abuse, injuries, burn, occupational diseases, domestic
violence, and oral health; and category-III = miscellaneous
(health systems research, medical education, environment, and
information technology).
Papers containing statistical analysis beyond descriptive
statistics (percentage, mean, median, and standard
deviation) were classified into three categories of
inferential statisticsbasic, advance, and survival analysis.
We utilized SPSS ver. 16 (IBM, Armonk, New York, USA) to
summarize our study findings by descriptive statistics and
calculating chi-square value.
RESULTS
A total of 318 original articles were reviewed with the
contribution of 28.9% in IJCM, 27.6% in IJPH and 43.3%
in WHO bulletin with 256 (80.5%) original research articles
being full-length papers while rest (62, 19.5) were brief/
shorter format of original research articles.
Table 1 and Figure 1 depict thematic study domain of
published original research articles. Out of all the
publications, highest (46.5%) original article belonged to
research domain category-I (communicable, MCH etc.)
followed by 104 (32.7%) category-II (noncommunicable
diseases etc.) and 66 (20.8%) by category-III (health
system, medical education, environment, etc.). Highest
research articles with category-I (communicable diseases,
MCH etc.) domain was published in bulletin of WHO (70,
47.3%) followed by IJCM (41, 27.7%) and IJPH (37, 25.0%).
Amongst noncommunicable category, both the Indian
journals had similar but slightly higher publications than
WHO while category-III research domain was dominated
in WHO bulletin.
The study design of 79.2% original research articles was
cross-sectional in nature followed by cohort (15.4%),
intervention/experimental study (3.4%) and case-control
(1.8%). Details are shown in Table 2 and Figure 2.
 Sachdeva and Dwivedi: Comparative analysis of study design and statistical test utilization

Table 1: Broad thematic domain of original research publications (20142016)

Journal Research domain, n (%) Total
Category-I Category-II Category-III
IJCM 41 (44.56%)(27.7%) 37 (40.21%)(35.6%) 14 (15.21%)(21.2%) 92 (100%)(28.9%)
IJPH 37 (42.04%)(25.0%) 36 (40.90%)(34.6%) 15 (17.04%)(22.7%) 88 (100%)(27.7%)
WHO 70 (50.72%)(47.3%) 31 (22.46%)(29.8%) 37 (26.81%)(56.1%) 138 (100%)(43.4%)
Total 148 (46.54%)(100%) 104 (32.70%)(100%) 66 (20.75%)(100%) 318 (100%)(100%)
P = 0.01; Table depicting both column and row percentage in brackets; category-I (communicable, MCH etc.), category-II (noncommunicable diseases etc.),
and category-III (health system, medical education, and environment).

Table 2: Distribution of study design in original research articles (20142016)

Journal Study design, n (%) Total
Cross-sectional Cohort Case-control Intervention/experimental
IJCM 74 (80.4%)(29.3%) 13 (14.1%)(26.5%) 04 (4.3%)(66.6%) 01 (1.0%)(9.0%) 92 (100%)(28.9%)
IJPH 78 (88.6%)(30.9%) 08 (9.0%)(16.3%) 01 (1.1%)(16.6%) 01 (1.1%)(9.0%) 88 (100%)(27.6%)
WHO 100 (72.4%)(39.6%) 28 (20.2%)(57.1%) 01 (0.7%)(16.6%) 09 (6.5%)(81.8%) 138 (100%)(43.3%)
Total 252 (79.2%)(100%) 49 (15.4%)(100%) 06 (1.8%)(100%) 11 (3.4%)(100%) 318 (100%)(100%)
P = 0.009; Table depicting both column and row percentage in bracket.

Figure 2: Distribution of published original research articles by study

design

colleges, 18 (5.7%) were associated with hospitals other

Figure 1: Research domain of published original articles according to
journal (201416), category-I (communicable, MCH etc), category-II
(noncommunicable diseases etc), and category-III (health system,
medical education, and environment).
Average (mean) number of authors per article in WHO
bulletin was higher with 8.1 (95% CI: 7.19.0) followed
similarly by IJCM 4.2 (95% CI: 3.84.6), and IJPH (3.84,
95% CI: 3.494.19). There were 95 (29.9%) articles which
reported all the authors from a single institution and 223
(70.1%) articles where-in authors were from more than two
institutions. Is it a true indication of collaborative effort or
reflection of gifted authorship, difficult to infer. Highest
articles with multiinstitutional associated authors were
reported in bulletin of WHO (93.4%) with similar
representation in both Indian journals (50.0%). Overall,
168 (52.8%) authors were associated with medical
than medical colleges, 29 (9.1%) were involved with
research institute, and 103 (32.4%) had professional
linkage with other miscellaneous organization. Amongst all
publications in Indian journals, there were 10 (5.8%) research
articles where-in there was international coauthorship/
collaboration seen. Selected details are shown in Table 3.
Highest number of research publication with a source of
funding was published in bulletin of WHO (98, 71.01%).
There were 239 (75.2%) research articles that had utilized
statistical software while 79 (24.8%) articles used none. Out
of all the research articles using statistical software, majority
had utilized SPSS (61.08%), followed by STATA (19.24%),
SAS (8.76%), R-software (5.45%), EPI-info (3.76%), and
EXCEL (1.25%).
Average (mean) number of references used were 35.4 (95%
CI: 32.9138.01) in WHO bulletin while it was near similar in
both Indian journals (IJCM = 20.2 and IJPH = 17.8).

MAMC Journal of Medical Sciences Volume XX Issue XX Month 2017 3

 Sachdeva and Dwivedi: Comparative analysis of study design and statistical test utilization

Table 3: Selected characteristic of published original research manuscript (20142016)

Parameters IJCM IJPH WHO
Avg. number of authors Mean (95% CI) 4.2 (3.84.68) 3.84 (3.494.19) 8.1 (7.189.08)
Authors involved (n, %) Single center 42 (45.65%) 44 (50%) 09 (6.52%)
Multi center* 50 (54.34%) 44 (50%) 129 (93.47%)
Funded research (n, %) Yes 08 (8.69%) 03 (3.40%) 98 (71.01%)
No 84 (91.3%) 85 (96.59%) 40 (28.98%)
Statistical software (n, %) Used 73 (79.34%) 62 (70.45%) 104 (75.38%)
Not used 19 (20.65%) 26 (29.54%) 34 (24.63%)
Statement regarding sample size estimation (n, %) Given 24 (26.0%) 30 (34.0%) 09 (6.52%)
Not given 68 (73.91) 58 (65.9%) 129 (93.47%)
Avg. sample size Median value 347 367 945
Number of pages per document Mean (95% CI) 5.52 (5.15.95) 5.28 (4.945.62) 9.40 (9.049.76)
Number of references Mean (95% CI) 20.26 (18.3422.18) 17.84 (16.1719.51) 35.46 (32.9138.01)
Time-frame of total references used (%) Within 10 years 66% 63% 82%
More than 10 years 34% 37% 18%
*
Two or more institutions.

However, utilization of more recent (within 10 years of

publications) references was reported in WHO bulletin Table 4: Type and frequency of inferential statistical
than the Indian journals (Table 3). This might be methods used in all published original articles
suggestive of stringent quality parameters, such as focus of (20142016)
journal on advancement of knowledge base, build upon the Type of inferential statistics N (%)
current evidence and transmission of latest information to the Basic test Chi-square 111 (52.8)
readers, and/or updated extensive literature review by z test 49 (23.3)
researchers. OR/RR/AOR 45 (21.4)
t test 36 (17.1)
Table 4 depicts range of statistical test utilized. It was Simple logistic regression 25 (11.9)
observed that all articles used descriptive statistics Correlation 22 (10.4)
(percentage, mean, median, and standard deviation) as per MannWhitney 17 (8.1)
Fisher 14 (6.7)
need. On further scrutiny, 210 (66%) original research articles One way ANOVA 14 (6.7)
utilized at least one of the inferential statistics (basic, KruskalWallis 13 (6.2)
advance, and survival analytical) methods, whereas 108 Wilcoxon test 06 (2.9)
(34%) articles used none, including policy-level research Advance test Multivariate logistic regression 63 (30.0)
papers. The number of statistical method exceeds the total Other miscellaneous 21 (10.0)
number of articles since some of them reported more than one Agreement checking 17 (8.1)
Sensitivity 14 (6.7)
statistical method; 92 (28.9%) articles used single statistical KolmogorovSmirnov test 07 (3.3)
method while 118 (37.1%) articles reported two or more Bayesian analysis 06 (2.9)
methods. Most commonly utilized statistical method was chi- Meta-analysis 06 (2.9)
square test (52.8%) followed by multivariate logistic M ANOVA 03 (1.4)
regression (30%), z test (23.3%), and so on. Kappa statistic 03 (1.4)
Normality checking 02 (0.9)
Table 5 depicts the usage pattern of inferential statistics. Out Wald 01 (0.4)
of all the inferential statistical methods employed, highest Survival analysis Kaplan Meier 10 (4.8)
Cox proportional HR 08 (3.8)
(352, 67.56%) were basic test followed by advance test (143,
Hazard ratio 05 (2.4)
27.44%) and only 26 (4.99%) had utilized survival analysis. ROC curve 02 (0.9)
Amongst basic statistical methods, 42.7% were applied in Log-rank test 01 (0.4)
WHO bulletin followed by IJCM (30.8%) and IJPH (26.5%),
respectively. Higher proportion of advance test (60.2%) and
survival analysis (92.3%) were used in Bulletin of the WHO. future albeit that would require capacity building.
Currently, many of the document properties such as
mapping and others are being undertaken by publication
DISCUSSION houses with increase usage of newer information
This study, probably first of its kind, carried out technology tools and process in the form of bibliometrics,
comprehensively and simultaneously on Indian and almetrics, and other measurement indicators. However, this
international public health journal revealed interesting study is unique considering that learning emerging from peer-
findings that may aid scholar to uptake high-quality review of content evaluation would still hold its superiority
research work with more advance statistical methods in and importance over artificial intelligence.

4 MAMC Journal of Medical Sciences Volume XX Issue XX Month 2017

 Sachdeva and Dwivedi: Comparative analysis of study design and statistical test utilization
Table 5: Usage of inferential statistical methods according to journal
Journal Basic statistics Advance statistics
IJCM 109 (83.8%)(30.8%) 21 (16.1%)(14.7%)
IJPH 93 (70.9%)(26.5%) 36 (27.4%)(25.1%)
WHO 150 (57.6%)(42.7%) 86 (33.0%)(60.2%)
Total 352 (67.56%)(100%) 143 (27.44%)(100%)
Table depicting both column and row percentage.
The quality of publication in both Indian journals has evolved
for better since last couple of years. Both the Indian
community medicine (I = 44.5%, II = 40.2%, and III =
15.2%) and public health (I = 42.4%, II = 40.9%, and III =
17.04%) journal have published similar proportion of original
articles under broad three-research categories. However,
bulletin of the WHO published category-I = 50.7%,
category-II = 22.4%, and category-III = 26.8%, reflecting
the higher burden of communicable disease/maternal and
child health issues amongst substantial population of
developing and under-developed countries of the world.
Another study (20042009) carried out on four Indian papers did not contain any background statement regarding
journals also depicted that 43% of all published articles
were on noncommunicable diseases (category-II). It was
also reported that IJCM published about 30% of articles
on non-communicable diseases (NCDs).[10] In our study
(20142016), higher proportion (40.2%) of articles on probable reasons for this could be the word-count
NCDs were published reflecting the time evolution and
priority being received by NCDs in the recent times. Since
developing country like India is undergoing epidemiological
transition and experiencing double burden of disease, both the
Indian journal seems to be adequately reflecting the ground-
realities.
Considering the feasibility and applicability perspective,
cross-sectional studies are easy to conduct, and hence the
predominance (79.2%) of such designs in public health
research articles as noted in present analysis. This finding
seems to corroborate with other studies done amongst
international primary care, general, community medicine,
or public health journal too.[11] There are limited studies
available on public health journals for comparison purpose
especially in Indian setting. However, this is in contrast to
another study, evaluating predominantly 14 Indian clinical
journals wherein 60.8% research articles were prospective
study and least common was cross-sectional study (6.2%)
design.[12] McDermott, way back in 1991, found that 35.0%
papers published in JAMA, The Lancet, and New England
Journal of Medicine were clinical trials.[13] Another recent
study carried on these three clinical journals for the period
(20052009) reflected randomized clinical trial (30.9%), quality of research and publications yet the difference
clinical trial (3.7%), cohort and case-control studies
(19.2%), cross-sectional studies (2.4%), and case reports
(43.8%).[14]
In our analysis, there was no article with ambiguous research
design in any of the three journals that is suggestive of good-
quality research/write-up and/or editorial screening decision.
MAMC Journal of Medical Sciences Volume XX Issue XX Month 2017
Survival analysis Total N (%)
0(0) 130 (100%)(24.95%)
02 (1.5%)(7.7%) 131 (100%)(25.14%)
24 (9.2%)(92.3%) 260 (100%)(49.90%)
26 (4.99%)(100%) 521 (100%)(100%)
This is in contrast to Pakistan Journal of Medical Sciences
(20052015), where nonclarity of research design ranged
from 5 to 16%.[15]
An interesting study assessing the quality of reporting of
cross-sectional studies (20102011) in IJCM described that
58% of the articles reported less than 15 items of the desirable
22 in the Strengthening the Reporting of Observational
Studies in Epidemiology statement checklist.[16] This
information is needed to give readers a clear idea as to
what was planned and what was done. Similarly, in our
study, it was observed that most (80.1%) of the study
statistical sample size estimation, which is very crucial to any
efficient study design. Another important aspect noted was
that 134 (42.1%) articles did not report clear inclusion/
exclusion criteria for the sample recruitment. One of the
restriction imposed by journals in manuscript.
Rigby et al. found that articles reporting no statistics
constituted 29.1, 32.4, and 40.7% studies in the British
Medical Journal, British Journal of General Practice, and
Family Practice, respectively.[17] Nonutilization of statistics
in our analysis was 34%. On a corollary, 66% of articles had
utilized some statistical test that is in contrast as reported in
study published in Journal of Family and Community
Medicine (71%) and Chinese Medical Journal (78.1%).[11,18]
Majority of health journals prescribe Vancouver style of
reference formatting with increase focus on recent journal
publications as references. Number of references/article
allowed is directly related to type of manuscript, strength/
detail of write-up, word-limit restriction, and/or number of
pages per articles and should be visualized accordingly. The
Indian journals prescribe limits of 6 authors with 30 references
in full-length original articles and up to 6 authors with 10
references in short/brief research article. In our analysis, mean
number of references used with 20.2 (95% CI: 18.322.1) in
IJCM and 17.8 (95% CI: 16.119.5).
Both the Indian journals have evolved for better in terms of
observed on review of literature could perhaps be due to
specialty (clinical vs. public health journal). The scope of
publication in Indian journals could be enhanced with young
public health researchers exploring clinical epidemiology in
future. Both Indian journals have demonstrated certain
strength and similarities in present study and discussed by
authors elsewhere also.[19,20] Introspection and constructive
5
 Sachdeva and Dwivedi: Comparative analysis of study design and statistical test utilization
criticism when taken in positive perspective facilitates growth
and development leading to learning, expansion, and
retention of journal users in long run.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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