Unit 8: Applications of Epidemiology in Community Health

Learning Outcomes

At the end of this unit, students will be able to:

1. Explain epidemiology and the components of its definition.

2. Elucidate the practical application of epidemiology.
3. Discuss the epidemiological models of disease causation.
4. Calculate epidemiologic measures that are used for assessing the health status
of the community.
5. Discuss the role of public health surveillance in disease prevention.
6. List the steps for conducting an outbreak investigation.
7. Differentiate monitoring and evaluation of health intervention.

Presentation of Contents

What is Epidemiology?
§ It is the study of the distribution and determinants of health-related states or
events in specified populations, and the application of this study to the
prevention and control of health problems.
§ Makes use of concepts and methods from fields of :
o Biology
o Sociology
o Demography
o Geography
o Environmental science
o Policy analysis
o Statistics

Definition of Terms:
1. Cases- people afflicted with a disease
2. Epidemic- an unexpectedly large number of cases of disease in a particular
population; disease occurrence in excess of normal expectancy
3. Endemic- a disease that occurs regularly in a population as a matter of
course; normally prevails in the community
4. Hyperendemic- persistent, high levels of disease occurrence
5. Pandemic- an outbreak of disease over a wide geographical area such as a
continent
6. Sporadic Disease- few scattered cases

Practical Applications of Epidemiology

1. Assessment of the health status of the community or community diagnosis
2. Elucidation of the natural history of disease
3. Determination of disease causation
4. Prevention and control of disease
5. Monitoring and evaluation of health interventions
6. Provision of evidence for policy formulation
Components of Epidemiology:
1. Studies of disease frequency
- Measurement of frequency of disease, disability, death
§ Prevalence
§ Incidence
§ May yield important clues to disease etiology and development of strategies for
disease prevention and control

2. Studies of the disease distribution

§ Characterize who, where, or when in relation to what (outcome)
- Person: characteristics (age, sex, occupation) of the individuals affected by
the outcome
- Place: geography (residence, work, hospital) of the affected individuals
- Time: when events (diagnosis, reporting, testing) occurred
§ “Descriptive epidemiology”
§ Generate hypothesis

3. Studies of determinants of disease

§ Test hypothesis
§ Answer why and how
§ “Analytical epidemiology”
§ Help in development of health programs, interventions, and policies

Scope of Epidemiology
1. To trace the source of epidemic
2. Limit the spread
3. Institute control measures
4. Prevent similar occurrence in the future

Ultimate Concern of Epidemiology

1. Prevention od Diseases
2. Maintenance of Health

Stages in the Natural History of Disease and the Levels of Prevention

1. Stage of susceptibility (Prepathogenesis stage)
§ The person is not yet sick but may be exposed to the risk factors of the
disease
§ E.g. multiple sex partners in the case of cervical cancer.
§ Primary level of prevention such as health education and immunization

2. Stage of subclinical disease

§ The person is still apparently healthy since clinical manifestations of the
disease are not yet shown, although pathologic changes have already
occurred.
§ Secondary level of prevention like Pap smear

3. Stage of clinical disease

§ The patient now manifests recognizable signs and symptoms, for example,
vaginal bleeding.
§ Tertiary levels of prevention
4. Stage of Recovery, Disability or Death
§ The patient either recovers completely from the disease, becomes a
chronic case, with, or without disability, or dies.

Models of Disease Causation

A. Epidemiologic triad or triangle model

AGENT: or microbe that causes the disease (“what”)

HOST: or organism (human/animals) harboring the disease (“who”)
ENVIRONMENT: or those external factors that cause or allow disease
transmission(“where”)
- physical factors such as geology, climate, and physical surroundings (e.g., a
nursing home, hospital)
- biologic factors (insects that transmit the agent)
- socioeconomic factors (crowding, sanitation, availability of health services)

B. Multi-causation disease model

 Prevention, Intervention, Control and eradication of Diseases

Prevention: the planning for and taking of action to forestall the onset of a disease
or other health problem
Intervention: efforts to control a disease in progress
Control: the limiting of transmission of a communicable disease in a population
Eradication: the complete elimination or uprooting of a disease

Outbreak Investigation
Disease outbreak
§ the occurrence of cases of disease in excess of what would normally be
expected in a defined community, geographical area or season
(WHO,2012)
§ an occurrence of one case of a CD is considered an outbreak provided the
disease is either a previously unknown disease , has never occurred in the
area where the lone case is observed, or has never been absent from the
population for a long time

Basic Steps in an Outbreak Investigation

1. Operationally, define what constitutes a case.
2. Based on the operational definition, identify the cases.
3. Based on the number of identified cases, verify the existence of an
outbreak.
4. Establish the descriptive epidemiologic features of the cases.
5. Record the clinical manifestations of cases.
6. Formulate a hypothesis regarding the probable etiologic agent, the sources
of infection, the MOT, and the best approach for controlling the outbreak.
7. Test the hypothesis by collecting relevant specimens from the patients and
from the environment.
8. Implement prevention and control measures to prevent recurrence of a
similar outbreak.
9. Disseminate the findings of the investigation through media and other forms
to inform the public.

Reflection

Now that you have reached this far, it is time to reflect and make a move by
answering the following questions?

1. Which strategies of this studying do you find effective? Which are not?

2. How can you improve your style?

3. How did you gain learning?

References:

Araceli S. Maglaya.(2009). Nursing Practice in the Community,

Cuevas, Frances Prescilla L.(2007). Public Health Nursing in the Philippines 10th
edition, c.

Guy, Howard.(2000)A guide for Communities and Community Health Workers,