UNIT –I

EPIDEMIOLOGY

HISTORY

 Epidemiology is derived from the word epidemic (epi = among; demos = people; logos= study)
 It is a very old word dating back to the 3rd century B.C
 The foundation of epidemiology was laid in the 19th century,made a major contribution to the
saving of life
 Greenwood became the first professor of epidemiology and medical statistics in the University of
London
 Epidemiology has grown rapidly during the past few decades
 It has now become firmly established in medical education

DEFINITION

“ The study of the distribution & determinants of health-related states or events in specified populations &
the application of this study to the control of health problems”.

- John M.Last

EPIDEMIOLOGICAL APPROACH

The epidemiological approach to problems of health & disease is based on 2 major foundations:

a) Asking questions
b) Making comparisons
a) ASKING QUESTIONS
Epidemiology has been defined as “a means of learning or asking questions and getting answers
that lead to further questions”

RELATED TO HEALTH EVENTS

i. What is the event ? (the problem)

ii. What is its magnitude?
iii. Where did it happen?
iv. When did it happen?
 v. Who are affected?
vi. Why did it happen?

RELATED TO HEALTH ACTION

i. What can be done to reduce this problem & its consequences?

ii. How can it be prevented in the future?
iii. What action should be taken by the community? By the health services? Where & for whom
these activities be carried out?
iv. What resources are required? How are the activities to be organized?
v. What difficulties may arise & how might they be overcome?

Answer to the above questions may provide clues to disease aetiology & help the epidemiologist to guide
planning & evaluation.

b) MAKING COMPARISONS
 The basic approach in epidemiology is to make comparisons & draw inferences
 This may be comparison of two or more groups
 One group having the disease (exposed to risk factor)
 Other groups not having the disease (not exposed to risk factor)
 By making comparisons, the epidemiologist tries to find out the crucial differences in the host
& environmental factors
 Clues to aetiology come from such comparisons
 One of the first considerations before making comparisons is to ensure what is known as
“Comparability”
 Both the groups should be similar so that “Like can be compared with like”
 “Matching” is done for selected characteristics that might confound the interpretation of
results
 Standardization usually has a limited application to a few characteristics such as age, sex &
parity.
INVESTIGATION OF AN EPIDEMIC OUT BREAK OF DISEASE

The following are the Steps for Epidemic investigation:

1) Verification of diagnosis
2) Confirmation of the existence of an epidemic
3) Defining the population at risk
4) Rapid search for all cases & their characteristics
5) Data analysis
6) Formulation of hypothesis
7) Testing of hypothesis
8) Evaluation of ecological factor
9) Further investigation of population at risk
10) Writing a report
1) VERIFICATION OF DIAGNOSIS
 A clinical examination of a sample of cases
 Lab investigations done if necessary
2) CONFIRMATION OF THE EXISTENCE OF AN EPIDEMIC
 Comparing the disease frequencies during the same period of previous years
 Common source of epidemics of cholera, food poisoning, hepatitis etc ., no comparison is required
3) DEFINING THE POPULATION AT RISK
 Population is counted by house to house visit. The population census may help
4) RAPID SEARCH FOR ALL CASES & THEIR CHARACTERISTICS
 Medical survey – Screening of each member of the population
 Epidemiological Case sheet – This includes name, age, sex, occupation, social class, previous
exposure, time of onset of disease, signs & symptoms of illness
 Searching for more cases – The search is carried out till the area is declared free of epidemic
5) DATA ANALYSIS
 Data should be analyzed on ongoing basis using time, place & person
6) FORMULATION OF HYPOTHESIS
 Hypothesis is formulated on the basis of time, place & person or the Agent, Host, Environment
7) TESTING OF HYPOTHESIS
 All reasonable hypotheses need to be considered & weighted by comparing the attack rates in
various groups for those exposed & those not exposed to suspected factor
8) EVALUATION OF ECOLOGICAL FACTOR
 Disease should be related to environmental factors to know the source of infection, reservoirs &
modes of transmission
9) FURTHER INVESTIGATION OF POPULATION AT RISK
 The study of population at risk or a sample of it may be needed to obtain additional information
10) WRITING A REPORT
 The report should be complete & convincing
 Information to be included in the report consists of
 Background Information – Geographical location, Climatic condition, Demographic
status, Socio & economic situation
 Historical data – Previous occurrence of epidemic of same disease locally
 Methodology of investigation – Questionnaire used in the epidemiological investigation
 Analysis of data – Frequency of signs & symptoms, Course of disease, Differential
diagnosis
 Control measure – Definition of strategies & methodology of implementation like
constrains, results & preventive measures

BASIC MEASURES IN EPIDEMIOLOGY

The scope of measurements in epidemiology is very broad & unlimited & includes the following:

 Measurement of mortality
 Measurement of morbidity
 Measurement of disability
 Measurement of natality
 Measurement of the presence, absence or distribution of the characteristic of disease
 Measurement of medical needs, health care facilities & utilization of health services
 Measurement of the presence, absence or distribution of the environmental & suspected of
causing the disease
 Measurement of demographic variables
MEASUREMENT OF MORTALITY

 These data provide the starting point for many epidemiological studies
 They are the major resource for the epidemiologist

MORTALITY RATES

1) CRUDE DEATH RATE

CDR = Number of deaths during the year
___________________________ × 1000
Mid-year population
2) SPECIFIC DEATH RATE
3) CASE FATALITY RATE
CFR = Total number of deaths due to a particular disease
_________________________________________ × 100
Total number of cases due to the same disease
4) PROPORTIONAL MORTALITY RATE
a) Proportional Mortality from a specific disease
= Number of deaths from the specific disease in a year
__________________________________________ × 100
Total deaths from all causes in that year
b) Under 5 proportionate mortality rate
= Number of deaths under 5 years of age in the given year
_____________________________________________ × 100
Total number of deathsduring the same period
c) Proportional mortality rate for aged 50 years & above
= Number of deaths of persons aged 50 years and above
____________________________________________ × 100
Total deaths of all age groups in that year
5) SURVIVAL RATE
SR = Total number of patients alive after 5 years
_______________________________________ × 100
Total number of patients diagnosed or treated
6)