Epidemiology

Wali Omer
Department of Community Medicine
College of Medicine
 References
• Schoenbach VJ, Rosamond WD. Understanding
the Fundamentals of Epidemiology: an
Evolving Text
• Park, K. Textbook of Preventive & Social
Medicine.
• Lucas AO, Gilles HM. Short Text Book of Public
Health Medicine for the Tropics.
• …
 Objectives
• Understand the concepts of health and
disease
• Know the definition and approaches of
epidemiology
• Identify the importance and uses of
epidemiology
 Topics
• Background
• Health and Disease
• Definition(s)
• Aim
• Epidemiological Approaches
• Uses of Epidemiology
 Background
• Epidemiology?
– Epi
– Dem
– Logy
• Basic science of public health
• Diseases eradicated?
 Health and Disease
• Health is a state of complete physical, mental
and social wellbeing and not merely an
absence of disease or infirmity. (WHO, 1948)

• Problems with this definition?

• Alternative definitions?
Natural History of Disease
 Related Definitions
• Epidemic
• Endemic
• Pandemic
• ?
 Definition(s)
• epi=upon, demos=people, logos=study
• Before 1900
– study of epidemics
• Early 1900
– study of the infectious diseases
• Mid 1900
– Study of diseases (any disease)
• Late 1900-Now?
1900 vs 2000
 Definition
• Epidemiology is the study of distribution and
determinants of health-related states and
events
• DD
• D1: time, place, person
• D2: community, individual, organ, cell and
molecules
Clinical Medicine and Epidemiology
Individuals Community

Sick only Sick & healthy persons

Dx and Rx Primordial (?), primary, secondary,

tertiary prevention

Passive Active
 Aim
• Describe the distribution and magnitude
(extent) of health problems
• Identify etiological factors (risk factors)
• Provide the data for the prevention, control
and treatment of disease
 Epidemiological Approach
• Asking questions
• Making comparisons

• Clinical?
– History
– Examination
– Investigation?
Life Expectancy
 Some Achievements
• Cholera
• Smoking and lung cancer
• Smallpox
• HIV
• Legionnaires disease
• Lyme disease
• …
 Learning from History

"Hegel was right when he said that we learn

from history that man can never learn
anything from history."

George Bernard Shaw

1856 –1950
Irish playwright
 John Snow’s & Cholera
• In 1854, an epidemic of cholera occurred in
London and about 500 people died in just 10
days.

• Dr. John Snow

(Physician and Anesthetist)
Deaths from cholera
Pump sites

John Snow’s Cholera Map, 1854

 Lyme Disease
Several young children
developed a vague
arthritis that has been
diagnosed as juvenile
rheumatoid arthritis in
and around the town
of Lyme, Connecticut,
1975.
 Lyme Disease
• Polly Murray, the mother of one of the newly
diagnosed boys heard about other cases of recently
diagnosed arthritis nearby.
• Unsatisfied by the diagnosis, she spoke to pediatricians
and parents, and began to record her data
systematically. Along with the mother of another
victim, she acted as an epidemiologist.
• They located on a “map” the residence of each of the
cases that they had discovered and were surprised to
see they were all at the edge of a woods along the
Connecticut River.
 Lyme Disease
They presented their data to
the Rheumatology Division of
the Yale University Medical
School.

Dr. Allen Steere, a

rheumatologist with
epidemiology background,
soon recognized that the
mothers were showing him a
disease “cluster”.
 Summary
• Epidemiology is the study of distribution &
determinants of health related states and
events in the community
• Diseases can be detected, measured &
recorded
• Etiological factors of health related issues can
be identified and hence controlled and even
prevented