PUBLIC HEALTH

NURSING
EPIDEMIOLOGY
CHAVUMA COLLEGE OF NURSING AND
MIDWIFERY
NTEBEKA BUSELICK(MR)
OUTLINE
• Introduction.
• Objectives.
• Definition of terms.
• Modes of disease transmission.
• Determinants of disease.
• Natural history of disease.
• Levels of prevention.
• Epidemiology and health expenditure.
05/07/2024 2
INTRODUCTION

• Epidemiology a study that is concerned with

distribution, frequency and determinants of disease
focusses on the modes of disease transmission,
preventive measures and the levels of prevention.
• Diseases are transmitted in different modes from the
source to a susceptible host.
• The host will eventually manifest with signs and
symptoms and is capable of transmitting the disease
to others.
05/07/2024 ntebeka 3
INTRODUCTION CONT’

• The host in the environment progresses from being

susceptible to disease manifestation.
• For disease transmission to occur there has to be an
interplay among the agents in the epidemiological
triangle.
• Prevention therefore, remains an important element
in epidemiology for the purpose of driving the
community to optimum health or living with minimal
complications
05/07/2024 4
GENERAL OBJECTIVE

At the end of the lecture/discussion, students should

be able to acquire knowledge on Epidemiology.

05/07/2024 5
SPECIFIC OBJECTIVES
At the end of the lecture/discussion, students should
be able to
1. Define terms in Epidemiology.
2. Outline the modes of disease transmission.
3. State the Determinants of Disease.
4. Describe the Natural history of disease.
5. Explain the levels of Disease prevention
6. Describe the Epidemiology and health
Expenditure
05/07/2024 6
DEFINITION OF TERMS

• Disease – An abnormal condition that negatively

affects the structure or function of a part or whole
organism (Porta, 2008).
• Reservoir – An environment in which an infectious
pathogen lives and multiplies (Porta, 2008).
• Source - is the origin of the disease causing organism.
This could be an infected person, animal, place or
object (Porta, 2008).

05/07/2024 7
DEFINITION OF TERMS CONT’
• Susceptible host - is an individual who has low
resistance to a particular disease (Lancaster, 2004).
• Transmission – the main route through which a
disease is passed on to a susceptible host from the
source. E.g. Direct contact (Lancaster, 2004).
• Prevention – Specific population or individual based
interventions put in place to reduce chances of a
disease occurring or being transmitted to a
susceptible host (Porta, 2008).
05/07/2024 8
MODES OF DISEASE TRANSMISSION
Depending on the infectious agent involved, diseases
can be transmitted from source to susceptible host in
various ways which Include;
DIRECT TRANSMISSION
• Direct contact of a susceptible host with the source of
infection.
• Through biting, kissing, sexual intercourse and touch.
• It can also be as a result of direct projections of
droplet sprays during coughing, sneezing, laughing or
talking
05/07/2024 9
INDIRECT TRANSMISSION

Embraces a number of vectors including the traditional 5

F’s. I.e. Food, Flies, Finger, Fomites, Fluids.
• Vehicle Borne – Passage of an infectious agent through
media like plasma, blood serum, biological material,
water, fruits, food, milk.
• Vector Borne – Sole transmitter is a living carrier or
organism. E.g. A snail, mosquito, cats, dogs, tsetse flies.
• Air Borne – Air as a medium e.g. Small droplets passed
into the air during sneezing or coughing.
05/07/2024 10
DETERMINANTS OF DISEASE

• Often called the Epidemiological triangle or circle in

which there is interaction of all parts involved.
Agent: Disease causing organism and its
characteristics, e.g. malaria parasite
Host: Biological makeup of vulnerable individuals e.g.
physical condition, genetic makeup, nutritional status.
Environment: Ecological conditions favouring the
interaction of the host and agent e.g. sanitary
conditions, swampy areas, bushes etc.
05/07/2024 11
NATURAL HISTORY OF DISEASE
• The process of disease progression from its
pathological onset until its eventual resolution
through complete recovery or death.
Pre-pathogenesis period: Period before the disease
infects an individual.
• Agent and host interact in the environment
• Host defence system capable of handling the agent.
• Disease does not manifest.

05/07/2024 12
NATURAL HISTORY OF DISEASE CONT’
Pathogenesis period - Body defence mechanism has
been overcomed by the agent and takes various stages;
• Sub clinical horizon: No signs or symptoms.
• Clinical horizon: Manifests with signs and
symptom.
• Early disease stage: Massive cell damage that
affects tissue functions.
• Advanced disease: Profound damage in which
there can be recovery, permanent disability or
death.
05/07/2024 13
LEVELS OF PREVENTION

Achieved at three main levels.

PRIMARY PREVENTION
• Reduction of chances of disease occurrence.
• Targets pre-pathogenesis period by employing;
i. General measures - Health education, safe
water supply and healthy behaviour.
ii. Specific measures - Prophylaxis medication,
vaccination.

05/07/2024 14
 SECONDARY PREVENTION

• Aimed at preventing the spread of disease after the

disease has occurred.
• Achieved by:
• Screening – Tests done in subclinical stage to sort
out apparently well persons who probably have a
disease from those who do not.
• Contact tracing – Discovery of those who came into
contact with the client diagnosed with a
communicable disease e.g. TB and STIs.
05/07/2024 15
TERTIARY PREVENTION

• Aims at minimising complications or improving quality

of life during advanced disease stages.
• Main interventions are treatment and rehabilitative in
nature which include physical therapy, occupational
therapy, psychotherapy, rehabilitative surgery,
chemoprophylaxis, isolation, quarantine etc.
• Tertiary prevention is the most taxing on the health
care system due to the substantial costs of surgery
and lifelong management of chronic disease.
05/07/2024 16
EPIDEMIOLOGY AND HEALTH EXPENDITURE
• Comparison of disease trends and funds allocation is a
vital component in alleviating health problems.
• Best alternative use of limited resources is considered.
• Comparison supports fund allocation towards health
services or public health initiatives. Are there better uses
of funds?
• Alternative social uses of funds help in determining the
right amount to spend.
05/07/2024 17
SUMMARY
• Diseases can be transmitted through direct and
indirect transmission.
• For disease to occur there has to be an interplay of
determinants to disease which include; the agent,
host and the environment.
• The natural history of disease has two phases pre-
pathogenesis and pathogenesis period.
• Prevention of disease is at levels of primary,
secondary and tertiary.
05/07/2024 18
ASSIGNMENT

• Discuss the measures of disease impact to

populations.
• Describe the pathophysiology of cholera and
measures you are going to put across to stop the
spread
• Handwritten assignment (writing must be clearly
visible) in less than 10 pages .
• Due date :29/01/2024
05/07/2024 19
 REFERENCES
• Mpofu, N. (2015). General nursing council Public
health nursing eLearning training guide.
• Porta, M. Last. J.M. and Greenland, S. (2008). A
Dictionary of Epidemiology. 5th edition. Oxford.
Oxford University express.
• Stanhope, M. and Lancaster, J. (2004). Community
and Public Health Nursing. 6th edition. St Louis –
Missouri. Mosby.
• Watkins, D. and Cousins, J. (2010). Public health and
community nursing. 3rd Edition. Edinburgh. Bailliere
Tindal.
05/07/2024 20