RAYA UNIVERSITY

DEPARTMENT OF PUBLIC HEALTH

EPIDEMIOLOGY NOTE

FOR HEALTH SCIENCE TUDENTS

BY TSIRHA H (BSc, MPH IN EPI.)

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 Chapter one

Definition:

Epidemiology is the study of the frequency,

distribution and determinants of disease and
other health related Condition in human
population, and the application of this study
to the promotion of health, and to the
prevention and control of health problems.
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“Frequency” – this shows Epidemiology to
be mainly quantitative science. We
measure the frequency of disease using
morbidity rates, which quantify the
occurrence of illness, and mortality rates,
which quantify the occurrence of death.

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“Distribution” –This refers not only to the
geographic distribution of disease, but also
to its distribution in time (for example;
seasonal fluctuations in disease
occurrence), and according to the type of
persons most or least affected, (for
instance, certain occupations, or certain
age groups ),
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“Determinants” these are the factors which
determine whether or not a person will get a
disease, or in other words, the causative
factors for disease.

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” Health related conditions”- are conditions which
directly or indirectly affect or influence health.

These may be
Injuries

“vital events

Health related behavior

Social factors

Economic factors
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History of Epidemiology

Hippocrates - displayed an extraordinary awareness

of the impact of environment and behavior on
personal well–being. Hippocrates therefore
identified forces that epidemiologists today
recognize as major determinants of human health.

In 1849, John Snow, an English physician,

formulated and tested a hypothesis concerning the
origin of an epidemic of cholera in London.
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 John Graunt published Natural and Political
Observations on the Bills of Mortality. He
was the first to quantify patterns of birth,
death and disease occurrence, noting male-
female disparities, high infant mortality,
urban-rural differences, and seasonal
variations.

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William Farr in 1839 took responsibility for medical
statistics in the Office of the Registrar General for
England and Wales. He extended the
epidemiologic analysis of morbidity and mortality
data, looking at effects of marital status,
occupation, and altitude.

In 1747, Lind used an "experimental" approach to

prove the cause of scurvy by showing it could be
treated effectively with fresh fruit.
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Uses of Epidemiology
• To make a community diagnosis. Epidemiology
helps to identify and describe health problems in a
community (for example, the prevalence of
anaemia, or the nutrition status of children).
• To monitor continuously over a period of time the
change of health in a community. (for example,
the effect of a vaccination programme, health
education, nutritional supplementation).
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• To practice surveillance for a specific disease in
order to be able to act quickly and so cut short any
outbreak (example cholera).
• To investigate an outbreak of a communicable
disease, analyse the reasons for it, plan a feasible
remedy and carry it out, and monitor the effects of
the remedy on the outbreak.
• To plan effective health services. Effective services,
interventions and remedies all depend on accurate
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community data.
Scope of epidemiology

Originally, epidemiology was concerned

with epidemics of communicable diseases
and epidemic investigations. Later it was
extended to endemic communicable
diseases and non-communicable
diseases.
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At present epidemiologic methods are being
applied to:
Infectious and non-infectious
diseases
Injuries and accidents

Nutritional deficiencies

Mental disorders
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Maternal and child health
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 Congenital anomalies

 Cancer

 Occupational Health

 Environmental health

 Health behaviors

 Violence

Hence, epidemiology can be applied to all disease

conditions and other health related events.
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Basic Assumptions in Epidemiology

1. Non Random Distribution of Diseases.

2. Human disease has casual and

preventive factors that can be identified
through systemic investigation of different
population or subgroups of individuals with
in a population in different places or at

different
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time . Epidemiology 15
Major categories of Epidemiology

1. Descriptive Epidemiology

It asks: what is the problem and its frequency,

who is involved, Where and when?

2. Analytical epidemiology

Analyze the causes, or determinants of diseases.

It answers the question how, why

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 Disease Causation
Definition:

Cause of disease: is an event, condition,

characteristic or a combination of these factors
which plays an important role in producing the
disease

Not all associations between exposure and disease

are causal. A cause of a disease can be defined as a

factor (characteristic, behaviour, event, etc.) that

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influences the occurrence of disease.
 If disease does not develop without the factor
being present, then we term the causative factor
"necessary". If the disease always results from the
factor, then we term the causative factor "sufficient".
Example:
Tubercle bacillus is a necessary factor for
tuberculosis.

Rabies virus is sufficient for developing clinical

rabies.
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Theories of disease causation

In the effort to uncover the mysteries of diseases, human

curiosity led to many theories of disease causation:
 The Supernatural theory

 The Miasma theory

 The Ecological theory

 The Germ theory

 The classic epidemiologic theory

 The theory of web of causation

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1. Supernatural theory of disease causation

According to supernatural theory of disease

causation, illness is considered as an
intervention by a supernatural agent (as a
punishment from God) or sorcery performed
by one’s enemies (evil eye). This theory is
still held by people and is being an obstacle
to health intervention programs.
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2. Miasma theory of disease causation

Miasmas are poisonous emanations, from

putrefying carcasses, rotting vegetation or
molds. They were once believed to enter
the body and cause disease.

E.g. Malaria was explained as caused by

miasma (mala aria, meaning "bad air").

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3.The ecological theory of disease
causation

This theory was first stated by the father of

epidemiology, Hippocrates. In his book Air,
water and the earth, he theorized that the
environment is the main culprit in disease
causation.

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4. The germ theory of Disease causation

This theory is also called the single cause

model or the Henle-Koch model.

The germ theory of disease causation

postulates that “For every disease there is
an agent behind it which is invisible to the
naked eye.”

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This theory was able to explain many of the
prevailing diseases at the time it was
postulated: the infectious diseases.
However, it falls short of explaining many
other categories of diseases. Besides, even
in infectious diseases, it only explains the
primary causes of a disease ignoring the
important risk factors of diseases.
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5.The Classic Epidemiologic Theory of
disease causation

This theory states that disease is a result of

forces within a dynamic system consisting of

- the agent (an external agent)

- the host (a susceptible host) and

- the environment that brings the agent and

the host together
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The three basic components of the classic
epidemiologic theory of disease causation
are collectively known as epidemiologic
triads.

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The causes of disease can be classified in to
two:
1. Primary causes – these are the factors which

are necessary for a disease to occur, in whose

absence the disease will not occur. The term
”etiologic agent” can be used instead of
primary cause for Infectious causes of diseases.
For example “Mycobacterium tuberculosis” is the
primary cause (etiologic agent) of pulmonary
tuberculosis.
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2. Risk factors (contributing, predisposing,
or aggravating factors).
These are not the necessary causes of disease but
they are important for a disease to occur. A factor
associated with an increased occurrence of a
disease is risk factor for the exposed group; and a
factor associated with a decreased occurrence of a
disease is a risk factor for the non exposed group.
Risk factors could be related to the agent, the host
and the environment. Epidemiology
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The etiology of a disease is the sum total of
all the factors (primary causes and risk
factors) which contribute to the occurrence
of the disease.

It is the interaction of the agent, the host, and

the environment which determines whether or
not a disease develops, and this can be
illustrated using the epidemiologic triangle.
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 The epidemiologic triad or triangle is the
traditional model of infectious disease
causation. It has three components: an
external agent, a susceptible host, and an
environment that brings the host and gent
together.

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The epidemiologic triangle

The epidemiologic triangle, depicts the

relationship among three key factors in the
occurrence of disease or injury: agent,
environment, and host.
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• An agent is a factor whose presence or
absence, excess or deficit is necessary for
a particular disease or injury to occur.

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• The environment includes all external
factors, other than the agent, that can
influence health. These factors are further
categorized according to whether they
belong in the social, physical, or
biological environments.

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• The social environment encompasses a
broad range of factors, including
education, unemployment, culture regarding
diet; and many other factors pertaining to
political, legal, economic, communications,
transportation, and health care systems.

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• Physical environmental factors are
factors like climate, terrain, and pollution.

• Biological environmental influences

include vectors, humans and plants
serving as reservoirs of infection.

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 6. Theory of web of causation

Theory of disease causation states that

diseases are complex interactions of
causative factors. It was especially
developed for understanding of chronic
diseases.

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 Levels occurrence of disease

Diseases occur in a community

 at different levels at a point in time

at predictable levels or in excess of what

is expected

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1. Expected Levels
 Endemic: The usual presence of disease
from low to moderate level.
 Hyper or Hypo endemic: a persistently
high or lower level of disease.
 Sporadic: Normally does not occur, but
occasional cases occur at irregular
intervals.
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2. Excess of Expected Levels
 Epidemic: An excess occurrence of disease
above the expected level at certain time.
 Outbreak: Synonymous with epidemic, but
characterized by a sharp rise and fall in
incidence, limited to a defined area.

Pandemic: An epidemic that affects several

countries or continents.
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• Thank u!

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