1.

The general etiologic categories that one might divide diseases which occur in epidemic form
are;
a. Intrinsic etiology where the disease will be coming from within the body for example the
genetic causes such as hemophilia, metabolic or endocrine diseases such as Diabetes
mellitus, immunologic conditions which include allergies like asthma and neoplastic diseases
like cancer.
b. Extrinsic etiology where the causes are from without the body for example bacterial, fungal,
viral. Fungal and parasitic infections. Animal bites and stings also are in this group as well as
lactogenic causes such as electricity, radiation and chemicals.
c. Idiopathic etiology where the cause is not known.
2. The Categories of information one would require in order to characterize an epidemic are as
follows;
a. Demographic Data
These include the case name, date of birth, home address, phone number and a unique
identifier for analysis purposes. The information helps to ensure the correct identity of the
client and easy of follow up.
b. Reporting source
Record of the source of information is required to ascertain reliability of the information.
The individual may be self-reporting or next of kin or neighbor or even a community
member.
c. Clinical data
Record of the information about the illness which include the chief complain, when and
where it started, any contacts to the client and some measures taken to relieve the illness
should be done for continuity of management. The lab results are needed for investigative
purposes. Contact details for the health care provider are required for follow up purposes.
d. Risk factors or relevant exposures
History of travel, immunization, diet, social activities, exposure to pets or other animals
helps to identify possible causes of the epidemic.
e. The person, place and time
Asking open ended questions that may help to better ascertain the risk factors for the
infection for example Who is at risk?, Where the cases are occurring? and When the cases
happened?
 3. a

Cases of The Diseases by Month of Onset in 24

Villages Surveyed for One year(Total
Population = 22653)
500
450
400
350
300
Number of cases
250
Rate per 1000
200
150
100
50
0
y y h il y e y t r r r r
u ar uar arc Apr Ma Jun Jul gus be obe be be
n r M u em ct em em
Ja Feb A pt O v ec
Se No D

Months

The number of cases started off at 0 in January and the trend was rising sharply until it reached a peak of
about 432 cases in June. There was a sharp descent from that time until august followed by a steady
decrease in the number of cases until November when it tailed off to 0 again. The rate per 1000
followed a normal curve too with the highest being 19.7 around June.
4. b.

Incidence of The Disease by Age and Gender in 24 Villages

Surveyed for One Year
12000

10000

8000
Males
P
o
p 6000 Females
u
l
a
t
i 4000
o
n

2000

0
p s) 1 1 2 3 4 -9 1 4 1 9 2 4 2 9 3 4 3 9 4 4 4 9 5 4 5 9 6 4 6 9 7 0 l
ou ear < `5 0 - 5 - 0 - 5 - 0 - 5 - 0 - 5 - 0 - 5 - 0 - 5 - > ta
r To
e g (y `1 `1 `2 `2 `3 `3 `4 `4 `5 `5 `6 `6
Ag

Females had a higher population of 11238 than males who were 10812 in total. The 5-9 year age
group had the highest number of cases and the incidence rate per 1000 of about 193 and122.3
for males as well as 174 and 113.7 in females respectively followed by10-14 year age group
which had 131 and 98.6 in males then 95 and 74.5 in females respectively. The graph shows
some fluctuations in values until the age group 5-9 years the trend started decreasing gradually
for males. Similarly the graph markedly fluctuated until the age group 15-19 then decelerated
with some fluctuations. Females had a total number of cases of 664 and the incidence rate of
59.1 while males had a total number of cases of 483 and incidence rate of 44.7.The number of
cases and incidence rates for the females from 4-9 year age group to 50-54 were competitively
high as compared to males
 4. The epidemiologic characteristics of the disease illustrated in graphs 3a and 3b
The time when there is high risk of spread for the disease is around winter from March to June
in the first graph while the high risk of spread is among the persons of age group between 5 to 9
years with 193 cases in males and 173 in females for graph 3b. The potential for affecting large
numbers occurs in winter time with the highest of 432 being in June for the graph 3b where as
for the second graph the disease has a potential for affecting large numbers among female
persons of up to 664 cases. During winter there is a potential for high mortality and fatality of up
to about 20 per 1000 according the first graph but in the second graph the potential for high
mortality and high case fatality rate is among the males and female persons of 122.6 and 113.7
respectively, aged between 4and 9 years. Generally, graph 3a concentrate on the characteristic
of the time when the cases happened while 3b concentrate on the person at risk.
5. Comparison between the rates of disease between married and single women
The highest rate of disease among all women occurs between the age group 30 to 49 although
married women have the highest rate of 58.2 per 1000 against the single women who have 28.4
per 1000. The second highest rates are in the age group 16 to 29 years where married women
have 46.7 per 1000 while the single women have 10.7 per 1000. There is a decrease in the rate
for married women to 10.3 per 1000 and to none per thousand. Overall, married women have
high incidence rate of 48 compared to single women who have 12.1.
6. a .The Overall Attack Rate for Mill workers and non-mill workers regardless of age

Overall Attack Rate = All mill workers and non-mill workers (cases) X 100 / Total population at
risk of developing the disease
= (0+2+4+…+4)X 100/( 0+332+198+…+30)
=115X100/ 4160
=2.76%
Therefore the Overall Attack Rate for Mill workers and non-mill workers regardless of gender is
2.76%

6. b The Overall Attack Rate for female Mill workers and non-mill workers

Female Mill workers and non-mill workers = casesX100/Total population at risk

= (0+2+4+…+1)100/(0+332+198+…+93)

=74X100/2089

=3.54%

Therefore, the Overall Attack Rate for female Mill workers and non-mill workers is 3.54%
6. c The Overall Attack Rate for male Mill workers and non-mill workers

Male Mill workers and non-mill workers = casesX100/ Total population at risk

= (0+3+…+4)100/ (358+…+30)

=41X100/2071

=1.98%

Therefore, The Overall Attack Rate for male Mill workers and non-mill workers is1.98%

7. a The Overall attack rate of the disease in the community

= number of cases of the diseaseX100/ Total population at risk of developing the disease
=115X100/4399
2.61%
Therefore, the overall Attack rate of the disease in the community is 2.61%

7. b The proportion of households affected by the disease

Proportion= households affected by the disease/ total number of households

Number of households affected= first cases in affected households = 77

Total households =798

Proportion = 77/798

=0.096

=0.1

Therefore, the proportion of households affected by the disease is 0.1

7. c The risk that other individuals in a household that already has a case will also have the disease

Let X be the individuals in a household that already has a case

P(X) =subsequent cases/ Total cases

= 38/115

= 0.33
 Therefore, the probability that, other individuals in a household that already has a case will also

have the disease is 0.33

7. d The Average household sizes for affected and for unaffected household

i) The average sizes for affected household =Population in affected household/ affected

households

= 424/77

=5.51

Therefore, the average affected household size is about 6 members

ii) The average size for the unaffected household

Number of unaffected households = total households –affected households

=798-77

= 721

The average sizes for unaffected household = population in unaffected household/ total

Unaffected household

=3975/721

=5.51

Therefore, the average household size for the unaffected is about 6 members

7. e There is low risk of the whole population developing the disease considering that the attack

Is low and the risk of transmission of the disease is less than 1.

8. a. The effect of socioeconomic status on the disease

the disease affects people with low socioeconomic status and the impact decreases with
increase in socioeconomic status as shown in the table , the incidence rate for stratum
1 which is the lowest level is 124.4 per 1000 going down to 2.6 as we reach the highest
level stratum 7.
8. b the factors which might influence the occurrence of the disease that are related to low
socioeconomic status
i) Poor dietary intake may result in poor nutritional status
 ii) Lifestyle such as alcoholism and smoking habits may result in poor eating habits
leading to poor nutritional status.
iii) Unemployment leads to failure to afford good nutrition.
iv) Geographical conditions may restrict production or expose individuals to risk factors
for example there could be limited space for gardening in crowded areas.

9. The relationship between the incidence of the disease and the sanitary rating;
The scatter diagram shows that there is no relationship at all between the incidence of the
disease and the sanitary rating.
10. Summary of the important epidemiologic characteristics of the disease determined at this point.
There is low risk of spread of the disease among the population. The incidence of the disease
has no relationship at all with sanitary rating. It has a potential for affecting larger numbers
during winter time among the 5 to 9 year age group and mostly married women especially those
of low socioeconomic status. The disease has a potential for high mortality and high case fatality
among the mentioned persons and during the mentioned time.

11.

CANNON EXAMPLE
The Method of Difference Incidence of the disease among women by
Marital status and by age
The Method of Agreement Cases of disease by month of onset in 24 villages
surveyed for one year(Total population =22653)
The Method of Concomitant Variation Incidence of the disease by economic status in 24
Villages Surveyed for 1 year.
The Method of Residues Number and Rate (per 1000 person- years) of
lung cancer deaths for current smokers and ex-
smokers by years since quitting. Doll and Hill
physician cohort study. Great Britain 1951-1961
The Method of Analogy Mortality Rates (per 1000 persons-years), rate
ratios and excess deaths from lung cancer and
cardiovascular disease by smoking status. Doll
and Hill Physician cohort study. Great Britain.
1951-1961
12. The disease affected large numbers of married women and persons belonging to the 5-9 year
age group from villages so dietary etiologic factors seem more compatible with the disease.
According to the first commission it was noted that the intestinal tract was affected and a
deficient animal protein was considered to be a predisposing factor in the contraction of the
disease.
13. Hypothesis testing for Infectious or dietary cause of the disease
Let I = the infectious cause of the disease
Let d = the dietary cause of the disease
Step 1: Formulation of hypothesis
a. H0 epidemic = d
H1 epidemic < d
b. H0 epidemic = i
H1 epidemic > i

Step 2: Identification of Distribution

The sample is greater than 30 so we use Z-distribution

Step 3: Determine the critical region

Hypothesis (a) has a right tailed critical region

Hypothesis (b) has a left tailed critical region

Step 4: Calculation of test statistic

The formula to be used is Zcalc = X~ - µ / σ/√n

Step 5: Making a decision

If the value falls in the Critical region we reject the null hypothesis but if it falls in the

Acceptance region we fail to reject it.

Step 6: Making a conclusion

If we reject the null hypothesis then we conclude that the alternative is true but if we

Fail to reject the null hypothesis then we conclude that the null hypothesis is true

14. The investigator was convinced that the disease was not an infectious disease. I would agree
with the findings considering that from the filth parties and all the studies he carried out none of
the respondents contracted the disease despite the exposure to what were considered risk
factors.
15. The data given in table 8 can be analyzed using a bar graph.
 16.

consumption paterns of various foods by presence or

absence of disease in the households in the seven villages
800

700

600

500
p
o
p 400 Disease Present
u Disease Absent
l Disease Total
a 300
t
i 200
o
n
100

0
t y y l ilk ty ty al k y l p y y l
ea lit lit ta m uali uali Tot or alit ality Tota ra alit alit Tota
m ua ua To h p
lt q u u y
S q qu u
h q q es q q
es h w Fr High Low Sa igh w q gh w
Fr Hig Lo H L o Hi Lo

Foods

Generally, all food staff recorded a higher number of diseases absent than disease present. The
disease present took extremely low proportions of the total population whereas the disease absent took
a significantly larger proportion of the total population. Those who took low quality food staff, the
figures for disease present were higher than those who consumed high quality food staff.

17. The probability that the disease was dietary related is high. More individuals who took low
quality protein food staffs would get the disease but very few among those who took high
quality protein food staffs would suffer the disease.