The Epidemiologic Approach

Presenter
Valerie Noble-Myrie
 Objectives
At the end of this session students will be able
to:-
• Explain what the epidemiological approach is
• Identify the steps that are used in the
approach
• Review and apply concepts of epidemiology
• Name and explain three (3) models of disease
occurrence
 Introduction

Today we seek to understand how the

Epidemiologist seek to identify the cause of a
disease.
 The Epidemiologic Approach
It is the method used by the Epidemiologist to
identify the cause of disease
The 1st step seeks to determine whether an
association exists between exposure to a
factor and the development of the disease in
question
Descriptive data is used to make comparisons
 Contd.
The Epidemiologist:-
• Counts
• Divides
• Compares
The Epidemiologic Approach contd.
• Counts – cases or health events are counted,
and they are described in terms of time, place
and person
• Divides – the number of cases are divided by
an approximate denominator to calculate
rates
• Compares – these rates are compared over
time or for different groups of people
 Steps Taken
Before counting, the Epidemiologist must decide on:-
• What a case is
• Develop a case definition
• Collect information about the case
• Characterise cases by time, places and person
• Calculate rates based on population size
• Use rates to determine the presence of a
particular disease or health event
 Case

A person in the population or study group

identified as having the particular disease,
health disorder, or condition under investigation

A variety of criteria may be used to identify

cases, e.g. screening, laboratory findings,
notification
 Case Definition

A set of diagnostic criteria that must be fulfilled in

order to identify a person or a case of a particular
disease
Case definition can be based on clinical,
laboratory or a combination of both. A scoring
system with points for each criterion that matches
the features of the disease can also be used
 Data Collection

• Information gathering from all sources

including clinical findings, laboratory results
surveillance and reviewing past records
• The information collected here is used to
guide the investigation
 Characterising Cases

Done by time, place and person

• Time – when did this happen
• Place – where is this happening
• Person – to whom is this happening
 Calculate Rates
• Addresses the frequency with which a
phenomenon occurs in a given population at a
specific time
• The components are the numerator,
denominator, the specific time that the event
occurs and a multiplier
• Comparisons are made based on these rates
 Concepts in Epidemiology
These are used to understand and explain how
and why health and illness occur as they do in
human population
Diseases do not occur by chance – there are
always determinants for the disease to occur
Diseases are not distributed at random –
distribution is related to risk factors that might
need to be studied
 Concepts contd.
Populations are at the heart of all epidemiologic
activities – epidemiologists are concerned
with disease occurrence in groups of people
rather than in individuals.
Common characteristics are noted – gender,
age, residence
 Concepts contd.
Disease distribution – the analysis of disease
patterns is based on the characteristics of
person, place and time (who, where, when).
Answers to these questions are useful in
understanding the health status of the
population, determining the cause, plan and
implement programmes to control and
prevent adverse health events
 Concepts contd.
Disease determinants – factors that bring about
change in a person’s health i.e.. Cause a healthy
person to become ill and an ill person to
recover
They include causal and preventive factors,
individual, environmental and social
characteristics
Individual – genetic makeup, gender, age,
immunity, diet, behaviour
 Concepts contd.
Environmental and societal – factors that are external
to the individual e.g. infectious agents, poor
housing, political instability, and economic events
Disease control – achieved through research and
surveillance
Surveillance is used to monitor aspects of disease
occurrence that are pertinent to effective control,
Studies are done to collect data about the
determinants of disease
 Causation
• The action of causing or producing
• The relation of cause to; causality
• Anything that produces an effect; cause
(Dictionary.com)
 Models of Disease Occurrence
• The Epidemiologic Triad
• The Beings Model
• The Web of Causation
 The Epidemiologic Triad/Triangle
The epidemiological triangle is a model for
explaining the organism causing the disease and
the conditions that allow it to reproduce and
spread.
It is made up of three (3) parts:
• Host
• Agent
• Environment
It’s useful to add a fourth agent – the vector
 Triad contd.

Host factors – These are responsible for the

degree to which the individual can adapt to
the stressors produced by the agent
 The Agent

The agent is the microorganism that actually

causes the disease in question.
An agent can be some form of bacteria, virus,
fungus or parasite
 Triad contd.
Agents can be divided into several categories
• Biologic – allergens, infectious agents
• Chemical – chemical toxins, dust
• Physical – trauma, radiation, heat, cold, noise
• Social and psychologic stressors –
socioeconomic issues
 The Environment
These are outside factors that can affect
epidemiological outbreaks. The environment –
influences the probability and circumstances
of contact between the host and the agent
Vectors – an effective transmitter of diseases.
Commonly include insects, rodents, humans
All factors work together to effectively transmit
diseases
 The BEINGS Model
Addresses risk factors and preventable causes of diseases.
Use the acronym (BEINGS) used in this model to
remember the categories of disease causation:
• Biologic and behavioural
• Environmental
• Immunologic
• Nutritional
• Genetic
• Services, social, spiritual
 Web of Causation
The model shows that diseases are not distributed
randomly
This is another causal paradigm
It implies that there are multiple causes of diseases
It indicates that cases of disease can be prevented
by cutting a few strands of the web
The factors closest to the disease are usually
targeted
 THE DISEASE PROCESS
The five steps of the disease process define the
progression of the disease from infection to
recovery.
1. Manifestation
2. Care of the patient
3. Aetiology
4. Treatment
5. Prognosis
 Natural History of Disease
• This is the course of a disease from its inception
to its resolution
• It refers to the progression of a disease process
in an individual over time, in the absence of
treatment
• The time frame and specific manifestations of
disease may vary from one individual to
another and are influenced by preventive and
therapeutic measures
 Natural History contd.
• The process begins with exposure of the
susceptible host
• Pathological changes take place that are
asymptomatic
• This progresses to the onset of symptoms
(incubation period)
• Pathologic changes may be detected with
laboratory, radiographic, or screening methods
 Natural History contd.
• The onset of symptoms is indicative of a
transition from sub-clinical to clinical disease
• The disease may progress to an illness that
ranges from mild to severe and is called the
spectrum of disease.
• The disease process ultimately ends in
recovery, disability or death
 LEVELS OF PREVENTION
There are three levels of prevention
• Primary Prevention
• Secondary Prevention
• Tertiary Prevention

• Premordial Prevention
 Primary Prevention
• Improving the overall health of the population
• Primary prevention denotes actions taken to
prevent the development of a disease in a
person who is well and does not yet have the
disease in question
• Immunization and Health Education are good
examples of primary prevention
• Primary prevention is aimed at preventing the
onset of disease
 Secondary Prevention
• Early detection of existing disease to reduce
severity and complications
• Secondary prevention involves identifying
people in whom a disease process has already
begun , but who have not yet developed
clinical signs and symptoms of the illness
 Tertiary Prevention
• This entails the rehabilitation of people with
established disease to minimize residual
disability and complications
• Antiretroviral therapy for HIV infection
• Rapid treatment of myocardial infarction to
reduce the likelihood of disability
 Primordial Prevention
This is the prevention of factors promoting the
emergence of risk factors
Lifestyles, behaviours and exposure patterns can
contribute to increased risk for many diseases
• Healthy eating programmes
• Social policies to reduce poverty and inequalities
• Healthy city programmes that promote walking,
cycling and public transportation
• Encouragement of positive health behaviours
• The prevention of adopting risk behaviour
• Elimination of established risk behaviour and
promotion of the concept of health as a socia
value
 The End

ANY QUESTIONS