UNIT 2: EPIDEMIOLOGY

By
Mamata Manandhar
Classically speaking

• Epi = upon. among

• Demos = people

• Ology = science, study of

• Epidemiology = the science or the study of epidemics

• Typically involves the disciplines of biostatistics & medicine

• Bridge between biomedical, social and behavioral sciences

 History of Epidemiology
Hippocrates (460-377 B.C).)

On Airs, Waters, and Places

(Idea that disease might be
associated with physical
environment)
 Thomas Sydenham (1624-1689)
✓Recognized as a founder of
clinical medicine and
epidemiology
✓Emphasized detailed
observations of patients &
accurate record-keeping
 James Lind (1700’s)

✓ Designed first experiments

to use a concurrently treated
control group
 John Snow (1813-1858)
✓ English physician & Modern
day Father of epidemiology
✓ Careful mapping of cholera
cases in East London during
cholera epidemic of 1854
✓ Traced source to a single well
on Broad Street that had
been contaminated by
sewage
 History of Epidemiology (Contd…)

• Vital Statistics
• John Graunt (1620-1674)
• William Farr (1807-1883)
• Occupational medicine
& Industrial Hygiene -Bernardino
Ramazzini (1633-1714)
• Role of carriers in transmission
• Typhoid Mary & George Soper
 What is Epidemiology?

The study of distribution and determinants of health, disease or

injury in human population and the application of this study to the
control of health problems.

• Epidemiologists study sick people

• Epidemiologists study healthy people
-to determine the crucial difference between those who get the disease and
those who are spared

• Epidemiologists study exposed people

• Epidemiologists study non-exposed people
-to determine the crucial effect of the exposure
 Epidemiologists are required to have
knowledge of:
• Public health: because of the emphasis on disease prevention
•Clinical medicine: because of the emphasis on disease
classification and diagnosis (numerators)
• Pathophysiology: because of the need to understand basic
biological mechanisms in disease (natural history)
• Biostatistics: because of the need to quantify disease frequency
and its relationships to antecedents (denominators, testing
hypotheses)
• Social sciences: because of the need to understand the social
context in which disease occurs and presents (social determinants
of health phenomena)
 A Modern Definition
Study of the occurrence and distribution of
health-related diseases or events in specified
populations, including the study of the
determinants influencing such states, and the
application of this knowledge to control the
health problem
(Porta M, Last J, Greenland S. A Dictionary of Epidemiology, 2008)
 Purposes of Epidemiology
1. To investigate nature/extent of health-related
phenomena in the community/identify
priorities.
2. To study natural history and prognosis of
health-related problems.
3. To identify causes and risk factors.
4. To recommend/assist in application
of/evaluate best interventions (preventive and
therapeutic measures).
5. To provide foundation for public policy.
 Uses of Epidemiology
1. To study the cause (or etiology) of disease(s), or
conditions, disorders, disabilities, etc.
2. To determine the primary agent responsible or
ascertain causative factors
3. To determine the characteristics of the agent or
causative factors
4. To determine the mode of transmission
5. To determine contributing factors
6. To identify and determine geographic patterns
 The Practice of Epidemiology
• Distribution refers to the relationship between
the health problem and the population in
which it exists and it includes:
• The persons affected.
• The place and time of the occurrence.
• Patient parameters such as age, sex, race,
occupation, income and educational levels, and
social and environmental features.
Cont…
 The Practice of Epidemiology…
• Determinants refer to the causes and factors that affect
the risk of disease and these are typically divided into
two groups:
• Host factors such as age, sex, race, nutrition status,
and physiologic state, which determine an individual’s
susceptibility to disease.
• Environmental factors, such as living conditions,
occupation, geographical location, and lifestyle, which
determine the host’s exposure to a specific agent.
Cont…
 The Practice of Epidemiology
• Investigating Causes of Diseases
• Examining a community’s health status
• Epidemiology can be used to describe a
community’s particular health problems and to
determine where its overall health is improving or
getting worse.
 The Practice of Epidemiology
Investigating Causes of Diseases …

• Surveillance and Related Activities

• Public health data have also been used to develop
surveillance methods for identifying women at high
risk for giving birth to a child with fetal alcohol
syndrome and to design and implement prevention
activities.
The Practice of Epidemiology

Investigating Causes of Diseases …

Based on vital statistics, such as age at death and cause
of death, recorded on death certificates, the
epidemiologic method can also be used to calculate an
individual’s risk of dying before a certain age.
 Aims of Epidemiologic Research
1. Describe the health status of a population
2. To assess the public health importance of Descriptive
diseases epidemiology
3. To describe the natural history of disease,
4. Explain the etiology of disease
5. Predict the disease occurrence
6. To evaluate the prevention and control of Analytic epidemiology
disease
7. Control the disease distribution
Applied epidemiology
 Broad Types of Epidemiology
DESCRIPTIVE ANALYTIC
Examining the distribution of a Testing a specific hypothesis about
disease in a population, and the relationship of a disease to a
observing the basic features of specific cause, by conducting an
its distribution in terms of time, epidemiologic study that relates the
place, and person. We try to exposure of interest to the outcome
formulate hypothesis, look into of interest
associations? (? Cause-effect relationship)

Typical study design: Typical study designs: cohort, case-

control, experimental design
community health survey
(cross-sectional study,
descriptive study)
• Descriptive Epidemiology is a necessary antecedent
of Analytic Epidemiology
• To undertake an analytic epidemiologic study you
must first:
Know where to look
Know what to control for
Be able to formulate/test hypotheses compatible
with a-priori lab/field evidence
 Basic Triad of Descriptive
Epidemiology
The Three essential characteristics of disease in Descriptive
Epidemiology are:
• PERSON
• PLACE
• TIME
Contd…
Person
• age, gender, ethnic group
• genetic predisposition
• concurrent disease
• diet, physical activity, smoking
• risk taking behavior
• SES(socio-economic status), education, occupation
Contd…
Geographic place
• presence of agents or vectors
• climate
• geology
• population density
• economic development
• nutritional practices
• medical practices
Contd…
Time
• calendar time
• time since an event
• physiologic cycles
• age (time since birth)
• seasonality
• temporal trends
 Basic triad of Analytical epidemiology

The three phenomena assessed in analytic

epidemiology are:

HOST

AGENT ENVIRONMENT
Epidemiologic Study Designs
Some Common terms
Infection
The invasion and multiplication of pathogens (disease causing
microorga-nisms) such as bacteria, viruses, and parasites in the body.
There are several levels of infection: colonization, subclinical or
inapparent infection, latent infection and clinical infection.
• Epidemic (Epi=upon; demos=people).
The usual occurrence of disease, specific health-related behaviour
(smoking) or other health-related events (e.g., traffic accidents)
clearly in excess of “expected occurrence” in a community or region.
For e.g. epidemic of diarrhea in Jajarkot.
• Endemic
The constant presence of a disease or infectious agent within a given
geographic area or population group; may also refer to the usual
prevalence of a given disease within such area or group e.g. malaria in
Terai, iodine deficiency in mountain region of Nepal
• Sporadic
The occurring of disease at irregular intervals or only in a few places;
scattered or isolated. E.g. polio, tetanus etc.

• Communicable diseases
An infectious disease transmitted from an infected person, animal, or
reservoir to a susceptible host through an intermediate plant, animal,
or the inanimate environment.
• Non-communicable diseases
Non-communicable - or chronic - diseases are diseases of long
duration and generally progress slowly.
The four main types of non-communicable diseases are
cardiovascular diseases (like heart attacks and stroke), cancer, chronic
respiratory diseases (such as chronic obstructed
pulmonary disease and asthma) and diabetes.
• Incubation period
A period of subclinical or unapparent pathologic changes following
exposure, ending with the onset of symptoms of infectious disease.

• Isolation
The social separation of a person who has or is suspected of having a
contagious disease.
• Virulence
The degree of the pathogenicity of an infectious agent. In other word,
the ability of an infectious agent to produce disease. The virulence of
a microorganism is a measure of the severity of the disease it causes.
• Disinfection
The process of cleaning, especially with a chemical, in order to
destroy bacteria. The instruments must undergo high-level
disinfection before reuse.
• Quarantine
a state, period, or place of isolation in which people or animals that
have arrived from elsewhere or been exposed to infectious or
contagious disease are placed.

• Notification
the act or an instance of notifying especially : the act of reporting
the occurrence of a communicable disease or of an individual
affected with such a disease.
Epidemiological Approach

• Epidemiological Approach to problems of health & disease is

based on two major foundation:
• Asking questions
• Making comparisons
 Contd…

Asking questions

Epidemiology has been defined as “a means of learning or asking questions and

getting answers that lead to further questions”. For e.g.

• Related to health events

• What is the event? (problem)
• What is its magnitude?
• Where did it happen?
• When did it happen?
• Who are affected?
• Why did it happen?
 Contd…
• Related to health action

• What can be done to reduce this problem and its consequences?

How can it be prevented?

• What action should be taken by the community? By the health services? By

other sectors? Where and for whom these activities carried out ?

• What resources are required ? How are the activities to be organized?

• What difficulties may arise, and how might they be overcome?

• Answers to above questions may provide clues to disease aetiology, and help
epidemiologist to guide planning and evaluation.
Any Questions ???
 Thank you…

7/16/2021 11:15 AM 42