COURSE : B.

Sc Nursing II Year

SUBJECT : Community Health Nursing I

UNIT : III – Epidemiology:Introduction

TOPIC :Epidemiological Approach and

Epidemiological triad

PREPARED BY : Mrs. R.Saraswathi, M.Sc(Nursing)

Assistant Professor

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LEARNING OBJECTIVES

The students will be able to:

• define epidemiology
• state the approaches of epidemiology
• mention about the epidemiological triad
• describe the agent, host and environmental fact
ors of epidemiological triad

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 OVERVIEW OF CONTENTS

1. Introduction 4. Epidemiological Triad

2. Definition 4.1 Agent Factors
3. Epidemiological 4.2 Host Factors
Approach 4.3 Environmental
3.1 Asking Questions Factors
3.1.1 Health events
3.1.2 Health action
3.2 Making comparison

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 1. INTRODUCTION

Classically speaking
• Epi = upon/ among
• Demos = people
• Ology = science or study
• Epidemiology = the science which deals with
what falls upon people…..
• Bridge between biomedical, social and
behavioral sciences

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1. INTRODUCTION contd.,

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 2. DEFINITION

• The study of the distribution and determinats of

health related states or events in a specified
populations, and the application of this study
toprevent and control of health problems

- John M Last(1988)

• It’s the study of the cause and effect of diseases

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3. EPIDEMIOLOGICAL APPROACH

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 3. EPIDEMIOLOGICAL APPROACH
contd.,
• The epidemiological approach to problems of
health and disease is based on two major
foundations.
• Another alternative is standardization which
usually has a limited application to a few
characteristics such as age, sex, and parity.
• The first requirement is therefore definition of
what is to be measured and establishment of
criteria or standards by which it can be
measured.
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3. EPIDEMIOLOGICAL APPROACH
contd.,

Asking Making
Questions comparisons

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 3.1 ASKING QUESTIONS

• Epidemiology has been defined as “a means of

learning or asking questions… and getting
answers that lead to further questions”. For
example the following questions could be asked.

1. Related to Health Events

2. Related to Health Action

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3.1.1 HEALTH EVENTS
-What is the
event?(the problem)

- What is its
magnitude?

- Where did it
happen?

- When did
it happen?

- Who are
affected?

- Why
did it
happen?

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 3.1.2 HEALTH ACTION

What can be done to reduce this problem and its

consequences?

How can it be prevented in the future?

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

services? By other sectors? Where and for whom these
activities be carried out?

What resources are required? How are the activities to be

organized?

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

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 3.1. ASKING QUESTIONS contd.,

• Answer to the above questions may provide

clues to disease etiology, and help the
epidemiologist to guide planning and evaluation.

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 3.2 MAKING COMPARISONS
• The basic approach in epidemiology is to make
comparisons and draw inferences
• This may be comparison of two (or more
groups)- one group having the disease (or
exposed to risk factor) and the other groups not
having the disease (or not exposed to risk factor)
or comparison between individuals.
• By making comparisons, the epidemiologist ties
to find out the crucial differences in the host and
environmental factors between those affected
and not affected.
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 3.2 MAKING COMPARISONS contd.,
• In short epidemiologist weighs, balances and
contrasts.
• Clues to etiology come from such comparisons.
• One of the first considerations beore making
comparisons is to ensure what is known as
“comparability” between the study and control
groups which means both the groups should be
similar so that ‘like can be compared with like’.
• For facts to be comparable, they must be
accurate and they must be gathered in a uniform
way.
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4. EPIDEMIOLOGICAL TRIAD

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 4. EPIDEMIOLOGICAL TRIAD contd.,

• Disease results from a complex interaction

between man, an agent (or cause of disease)
and the environment.
• The term epidemiological triad is a key concept
in epidemiology.
• Each disease has its own unique natural history
of causes, which is not necessarily the same in
all individuals.

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4. EPIDEMIOLOGICAL TRIAD contd.,

ENVIRONMENT

EPIDEMIOLOGICAL
TRAID

AGENT HOST

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 4.1 AGENT FACTORS
• The first link in the chain of disease transmission
is a disease agent.
• The disease agent is defined as a substance,
living or non-living or a force, tangible or
intangible, the excessive presence or relative
lack of which may initiate or perpetuate a
disease process
• A disease may have a single agent, a number of
independent alternative agents or a complex of
two or more facts whose combined presence is
essential for the development of the disease
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4.1 AGENT FACTORS contd.,
BIOLOGICAL AGENTS

SOCIAL AGENTS NUTRIENT AGENTS

ABSENSE OR
INSUFFICIENCY
OR EXCESS OF A
PHYSICAL AGENTS
FACTOR
NECESSARY TO
HEALTH

MECHANICAL
CHEMICAL AGENTS
AGENTS

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 4.1 AGENT FACTORS contd.,
• BIOLOGICAL AGENTS: These are living agents of
disease. viz, viruses, rickettsiae, fungi, bacteria,
protozoa and metazoa. These agents having
certain biological properties such as Infectivity,
pathogenecity and virulence
• Infectivity is the ability of an infectious agent to
invade and multiply in a host
• Pathogenecity is the ability to induce clinically
apparent illness
• Virulence is the proportion of clinical cases
resulting in severe clinical manifestations

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 4.1 AGENT FACTORS contd.,

• NUTRIENT AGENTS: These are proteins, fats,

carbohydrates, vitamins, minerals and water.
Any excess or deficiency of the intake of nutritive
elements may result in nutritional disorders.
Protein Energy Malnutrition, Anaemia, Goitre,
Obesity and Vitamin deficiencies are the some
of the current nutritional problems.

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 4.1 AGENT FACTORS contd.,

• PHYSICAL AGENTS :Exposure to excessive

heat, cold, humidity, pressure, radiation,
electricity, sound etc may result in illness
• CHEMICAL AGENTS: (i) Endogenous : Some of
the chemicals may be produced in the body as a
result of derangement of function eg. bilirubin
(jaundice)
• (ii) Exogenous: Agents arising outside of human
host. eg.allergens, metals, fumes and gases

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 4.1 AGENT FACTORS contd.,
• MECHANICAL: Exposure to chronic friction and
other mechanical may result in crushing, tearing,
sprains, dislocations and even death.
• ABSENCE OR INSUFFICIENCY OR EXCESS
OF A FACTOR NECESSARY TO HEALTH:
These may be (i) Chemical Factors eg.
Hormones (ii) Nutrient factors (iii) Lack of
structure (iv) Lack of part of structure (v)
Chromosal factors (vi) Immunological factors

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 4.1 AGENT FACTORS contd.,

• SOCIAL AGENTS: It is also necessary to

consider social agents of disease. These are
poverty, smoking, abuse of drugs and alcohol,
unhealthy lifestyles, social isolation, matenal
deprivation etc.

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 4.2 HOST FACTORS

• The human host is referred to as “soil” and the

disease agent as “seed”.
• In some situations, host factors play a major role
in determining the outcome of an individual’s
exposure to infection. Eg. Tuberculosis

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 4.2 HOST FACTORS contd.,

Social and
Life style factors
Biological economic
such as
characteristics characteristics
personality
Demographic such as genetic such as socio-
traits, living
Characteristics factors, blood economic status,
habits, nutrition,
such as age, sex, groups and education,
physical exercise
ethnicity etc enzymes, occupation,
and use of
immunological stress, marital
alcohol, drugs
factors, etc status, housing,
and smoking etc.
etc

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 4.3 ENVIRONMENTAL FACTORS

• The external or macro environment is defined as

all that which is external to the individual human
host, living and non-living, and with which he is
in constant interaction. This includes all of
man’s external surroundings such as air, water,
food housing, etc.
• For human beings the environment is not
limited, as it normally is for plants and animals,
to a set of climatic factors

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4.3 ENVIRONMENTAL FACTORS contd.,

PHYSICAL
ENVIRONMENT

BIOLOGICAL
ENVIRONMENT

PSYCHO SOCIAL
ENVIRONMENT

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 4.3 ENVIRONMENTAL FACTORS contd.,

• PHYSICAL ENVIRONMENT: Its apply to non

living things and Physical factors such as
Air,Water,Soil,Housing Etc With Which man is in
constant interaction.
• Man has altered practically every thing in his
physical environment to is advantage which has
created new health problems such as air, water
& noise pollution, Urbanization and Radiation
hazards.

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 4.3 ENVIRONMENTAL FACTORS contd.,
• BIOLOGICAL ENVIRONMENT: It’s the universe
of living things which surrounds man including
man himself the living things are the viruses, and
other microbial agents, insects, rodents, animals
and plants
• For the most part, the parties manage to effect a
harmonious inter-relationship, to achieve a state
of peaceful co-existence, even though this may
not be always enduring. When for any reason
this harmonious relationship is disturbed, ill
health results
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4.3 ENVIRONMENTAL FACTORS contd.,

• PSYCHO SOCIAL ENVIRONMENT: It includes

a complex of psycho social factors which are
defined as “those factors affecting personal
health, health care and community, well-being
that stem from the psychosocial make-up of
individuals and the structures and functions of
social groups”,

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 4.3 ENVIRONMENTAL FACTORS contd.,
• They include cultural values, customs, habits,
beliefs, attitudes, morals, religion, education, life
styles, community life, health services, social
and political organization.
• The impact of social environment has both
positive and negative aspects on the health of
individuals and communities.
• A favourable social environment can improve
health, provide opportunities for man to achieve
a sense of fulfilment, and add to the quality of
life.
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 4.3 ENVIRONMENTAL FACTORS contd.,

• It can also affect negatively man’s health and

well-being. For eg, poverty, urbanisation,
migration, loss of employment etc may produce
feelings of anxiety, depression, anger which may
affect the physical health manifested by physical
symptoms like headache, palpitations and
sweating.

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 SUMMARY

• Man today is viewed as an agent of his own

diseases, his state of health is determined more
by what he does to himself than what some
outside germ or infectious agent does to him.
• The epidemiologist are so much concerned with
psychosocial environment as with physical or
biological environment in search of etiological
causes of disease

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 REFERENCES

• K.PARK, “Essentials of Community Health

Nursing” Banarsidas Bhanot Publishers, 20th
edition
• Prof.Dr.E. Vijay, “Textbook of Community
Medicine” 2nd edition, Beacon zen publishers
• Kasthuri Sundar Rao, “Introduction to community
Health Nursing”, 4th edition B.I. Publications

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EXPECTED QUESTIONS

Essay: (15 marks)

• Describe about the Epidemiological triad in detail
Short Notes: ( 5 marks)
• Explain about the approaches of epidemiology
• Discuss the Physical agents in detail
Short Answers:(2 marks)
• Draw epidemiological triad
• Mention the factors of environment
•State about the psycho social environment

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