EPIDEMIOLOGY

Health: Health is a state of complete physical, mental and social well- being of a person and not
merely absence of disease or infirmity
Epidemiology: The study of distribution and determinants of health- related states or events in
specified populations, and the application of this study to the control of health problems
HISTORY OF EPIDEMIOLOGY
 Epidemiology is derived from the word epidemic ( epi= among, demos= people, logos=
study) which dates back to 3rd century B.C.
 The foundation was laid in 19th century when a few classic studies made a major
contribution to saving life
 Epidemiological society in London in 1850 under the presidency of Earl of Shaftsbury did
investigations of infectious diseases
 The growth of bacteriology took epidemiology to universities
 Early 1920s: Winslow and Sedgwick both lectured in epidemiology but the subject did not
get departmental status
 1927: W.H. Frost became the first professor of epidemiology and medical statistics in
University of London

SCOPE OF EPIDEMIOLOGY

1. Its not just concerned with death illness and disability but also with positive health states
with means to improve health
2. The target study is usually human population
3. Early studies of epidemiology were concerned with the causes of communicable diseases,
in this sense epidemiology is a basic medical science with the goal of improving health of
the population
4. Epidemiology is increasingly used to study the influence and preventive intervention of
behavior and lifestyle through health promotions
5. It is also concerned with course and outcome of disease in individual groups. It lends a
strong support to both preventive and clinical medicine
6. It is often used to describe health status of the population group
7. Recently it has been used for evaluating efficiency and efficacy of health care services

AIMS OF EPIDEMIOLOGY

1. According to International Epidemiological Association (IEA) epidemiology has three

main aims
 To describe the distribution and magnitude of health and disease problems in human
population
  To identify etiological factors (risk factors) in the pathogenesis of disease
 To provide the data essential to the planning, implementation and evaluation of services
for the prevention, control and treatment and to the setting up of priorities among those
services
2. The ultimate aim of epidemiology is to lead to effective action:
 To eliminate or reduce the health problems or its consequences
 To promote the health and well being of society as a whole
COMPONENT OF EPIDEMIOLOGY
There are 3 main components in epidemiology.
1. Diseases frequency
2. Distribution of disease
3. Determinants of disease

Diseases frequency:
It is measurement of frequency of disease, disability or death and summarizing this
information in the form of rates and ratios (eg. Prevalence rate, incidence rate, death rate etc.). It
is also concerned with the measurement of health related events and states in the community (eg
health needs, demands, activities, tasks health care utilization) and variables such as blood
pressure, serum cholesterol, height, weight.
Distribution of diseases:
The basic tenet of epidemiology is that the distribution of disease occurs in patterns in a
community and that the patterns may lead to the generation of hypotheses about causative risk
factors. It is to study of distribution patterns in the various subgroups of the population by time,
place and person.
Determinants of disease:
Epidemiology is to test aetiological principles and methods. This requires the use of
epidemiological principles and methods. It is known as analytical epidemiology. Analytical
studies have contributed vastly to our understanding of the determinants chronic disease eg. Lung
cancer and cardiovascular diseases.

EPIDEMIOLOGICAL APPROACH

The epidemiological approach to problems of health and disease is based on two major
foundations:
 Asking Questions
 Making comparisons
Asking Questions
Epidemiology has been defined as a means of learning or asking questions….and getting answers
that lead to more questions. For example
Questions asked related to health events
 What is the event? (problem)
 What is the magnitude?
 Where did it happen?
 When did it happen?
 Who are affected?
 Why did it happen?
Related to health action
 What can be done to reduce problem and its consequences?
 How can it be prevented in future?
 What action should be taken by the community? By the health services? By other sectors?
Where and for whom these activities be carried out ?
 What difficulties may arise and how might they be overcome?
Making comparison
 Basic approach to epidemiology is to make comparisons and draw inferences
 Comparison of two or more groups: One group having disease or exposed to the risk factor
and the other group (s) not having disease or not exposed to the risk factor, or comparison
between individuals.
 Epidemiologist tries to find out the crucial differences in the host and environmental
factors between those affected and not affected.

EPIDEMIOLOGICAL METHODS

The primary concern of the epidemiologist is to study disease occurrence in people who are
exposed to numerous factors during the course of their lives. The epidemiologist employs
carefully designed research strategies to explore disease a etiology.
Epidemiology can be classified as observational studies and experimental studies with further
subdivision:
1. Observational study
 Descriptive studies
 Analytical studies
a. Ecological or Corelational, with Populations as unit of study
b. Cross-sectional or Prevalence, with Individuals as unit of study
c. Case-control or Case-reference, with Individuals as unit of study
d. Cohort or Follow-up with Individuals as unit of study
2. Experimental studies Intervention studies
 a. Randomized controlled trials or Clinical trials with Patients as unit of study
b. Field trails or Community intervention studies with healthy people as unit of study
c. Community trails, with communities as unit of study
Descriptive Epidemiology
 Descriptive studies are usually the first phase of an epidemiological investigation.
 Descriptive studies are concerned with observing the distribution of diseases or health
related characteristics in human populations.
Descriptive studies basically ask the questions as follows:
a. When is the disease occurring? Time distribution
b. Where is it occurring? Place distribution
c. Who is getting the disease? Person distribution
Descriptive studies may involves various procedures
a. Defining the population.
b. Defining the disease under study
c. Describing the disease by time, place person
d. Measurement of disease
e. Comparing with known indices

f. Formulation of an aetiological hypothesis

Uses of descriptive epidemiology
1. Provide data regarding the magnitude of the disease data and types of disease problems in
the community in terms of morbidity and mortality rates and rations.
2. Provide clues to disease aetiology and help in the formulation of an aetiological
hypothesis.
3. Provide background data for planning, organizing and evaluating preventive and curative
services.
4. It contribute to research by describing variations in disease occurrence by time, place and
person.
Analytical Studies
 Analytical studies are the second major type of epidemiological studies.
 In analytical studies, the subject of interest is the individual within the population.
 The object is not to formulate but to test hypotheses.
Two types of observational studies
1. Case control study
2. Cohort study
Analytic epidemiology
Case – control Individuals with particular disease} cases
Factors Present of absent Individual without Particular disease}
controls
Prospective (cohort) study

Individual exposed to particular factor (s) Presence or Absence of Particular

Individual unexposed to particular factors Disease

Time
Schematic diagram of the design of case control and cohort studies
1) Case control study
 Case control studies, often called “retrospective studies” are common first approach to test
causal hypothesis
 In recent years, the case control approach has emerged as a permanent methods of
epidemiological investigation.
Three distinct features of case control methods
a. Both exposure and outcome (disease) have occurred before the start of the study
b. The study proceeds backwards from effect to cause
c. It uses a control or comparison group to support or refute an inference
 By definition, A case control study involves two populations cases and controls
 In case control studies, the unit is the individual rather than the group
 The focus is on a disease or some other health problem that has already developed
 Case control studies are basically comparison studies.
 Case and controls must be comparable with respect to known “confounding factors” such
as age, sex, occupation, social status, eg. used as “cases” the immunized children and use
as “control” unimmunized children and look for factors of interest in their past histories
and other examples can be given cancer, cirrhosis of the liver, lupus erythmatosis of
congestive heart failure.
 If it is our intention to test the hypothesis that “cigarette smoking causes lung cancer”
using the case control methods, the investigation begins by assembling a group of lung
cancer cases (a+c) and a group of suitably matched controls (a+b).
 One then explores the past history of these two groups for the presence of absence of
smoking, which is suspected to be related to the occurrence of cancer lung.
 If the frequency of smoking a/ (a+b) is higher in cases than in controls b (b+d), an
association is said to exist between smoking and lung cancer.
  Case control studies have their major use in the chronic disease problem when the causal
pathway may span many decades.
Frame work of a case control study
Suspected or risk factors cases (disease present) Control (disease absent)
Present a b
Absent c d
a+c b+d
Basic steps in conducting a case control study
1. Selection of cases and controls ( to identify a suitable group of cases and a group of
controls)
2. Matching (is defined as the process by which we select controls in such as way that they
are similar to cases with regard to certain pertinent selected variables)
3. Measurement of exposure (information can be obtained by interviews like questionnaire,
studying past records of cases such as hospitals records, employment records.
4. Analysis and interpretation ( Exposure rates among cases and controls to suspected factor)

2) Cohort study
 Observational study
 To repute or support the existence of an association between suspected cause and disease
 Other names (cohort study) – prospective, longitudinal, incidence study, forward – looking
study.
Features of cohort studies
a. The cohorts are identified prior to the appearance of the disease under investigation
b. The study groups, so defined are observed over a period of time to determine the
frequency of disease among them.
c. The study proceeds forward from cause to effect.
Concept of cohort
 Cohort is defined as a group of people who share a common characteristic or experience
within a defined time period (eg. age, occupation, exposure to a drug or vaccine,
pregnancy, insured persons) eg. group of people born on the same day or in the same
period of time (year) from a “birth cohort”
 Persons exposed to a common drug, vaccine or infection within a defined period constitute
an exposure cohort.

USES OF EPIDEMIOLOGY

 The study of disease distribution and causation remain central to epidemiology but the
techniques of epidemiology have a wider application covering many more important areas
relating not only to disease but to health and health services
Morris has identified 7 distinct uses of epidemiology
 To study historically the rise and fall of disease in a population
 Community diagnosis
 Planning and evaluation
 Evaluation of individual’s risk and chances
 Syndrome identification
 Completing the natural history of disease
 Searching for cause and risk factors
To study the historical rise and fall of disease in a population
 To study history of a disease in a human population. The health and disease pattern never
remain constant in a community
 Epidemiology provides means to study disease profiles and time trends in human
population.
Community diagnosis
The study of these trends will enable us to make useful predictions in the future and
identify identification and quantification of health problem in a community in terms of mortality
and morbidity, rates and ratios and identification of their correlates for the purpose of defining
those individuals or population at risk or those in need of health care.
The community diagnosis may be defined as the pattern of disease in a community
described in terms of important factors which influence this pattern. The community diagnosis is
based on collection and interpretation of the relevant data such as
a) The age and sex distribution of a population; the distribution of population by social
groups;
b) Vital statistical rates such as the birth rate, and the death rate;
c) The incidence and prevalence of the important diseases of the area.
Quantification:
 Lay down priorities in disease control
 Using morbidity and mortality data to evaluate the efficiency of health care services at a later
date
 The quantification of health problem can be source of new knowledge about disease
distribution, causation and prevention
 Community diagnosis has gone even beyond to include and understanding of social cultural
and environmental characteristics of the community.
 Epidemiology is defined as diagnostic tool for community Medicine merging health
problems and their correlates
Planning and evaluation
  Planning: Epidemiological information about distribution of health problems over time
and place provides fundamental basis for planning and developing the needed health
services and for assessing the impact of these services on people’s problem
 Evaluation: Any measures taken to prevent or control must be followed by an evaluation
too find out whether the measures undertaken are effective in reducing the frequency of
disease. Its not enough to just find out if the programme was effective or not but
epidemiology helps to know how much benefit at what cost and risks.
Evaluation of individual’s risk and chances
 One of the most important task for an epidemiologist is to make a statement about the
degree of risk in the population
 An epidemiologist calculates various measures like absolute risk, relative risk and
attributable risk for a factor related to or believed to be a cause of the disease
Syndrome identification
 Medical syndromes are identified by observing frequently associated findings in
individual patients
 Epidemiological methods can be used to define and refine syndromes
Contemplating Natural History of Diseases
 Epidemiology is concerned with the entire spectrum of disease in a population
 The epidemiologist by studying the disease pattern in the community in relation to agent
host and environmental factors is in a better position to fill up the gaps in the natural
history of the disease
 Epidemiological studies have yielded a large amount of data on risk factors in relation to
chronic diseases
 Epidemiology by relating disease to inter population differences and other attributes of the
population or cohorts examined, tries to identify the cause of the disease
 The concept of risk factor gave a renewed impetus to epidemiological research
 It is a ceaseless effort as our ignorance about the disease etiology particularly chronic
disease, is profound and the ever emergence of new diseases
CONCEPTS OF CAUSATION OF DISEASE AND THEIR SCREENING
Concept of Disease
A pathological condition of a part, organ, or system of an organism resulting from various
causes, such as infection, genetic defect, or environmental stress, and characterized by an
identifiable group of signs or symptoms
Concept of causation
 Germ theory of disease: Disease agent→ Man → Disease
 Multifactorial causation: factors like socioeconomic, cultural, genetic and
psychological
  Web of causation (chronic diseases): it considers all the predisposing factors of any
type and their interrelationship with each other
Natural history of disease
It signifies the way in which a disease evolves over time from earliest stage of its
prepathogenesis to its termination as recovery, disability or death, in the absence of
treatment or prevention
Phases of natural history of disease
 Prepathogenesis ( process in the environment)
 Pathogenesis( Process in man)
1. Prepathogenesis phase: The interaction of agent host and environment to initiate the
disease process in man
2. Pathogenesis Phase: Begins with the entry of agent in susceptible host and ends with
recovery, disability or death

Agent Factors
 A substance living or non living, or a force tangible or intangible, the excessive presence or
relative lack of which may initiate or perpetuate a disease process
 Biological agents: viruses, bacteria, fungi, protozoa etc
 Nutrient agents: proteins, vitamins, fats etc
 Physical agents: heat cold
 Chemical agents: Endogenous or Exogenous
 Mechanical agents
 Social agents
 Absence, insufficiency or excess of a factor necessary for health
Iceberg phenomenon of disease
 Epidemiologists and others who study disease find that the pattern of disease in hospitals
is quite different from that in the community. A far larger proportion of disease is hidden
form view in the community then is evident to the physician or the general public.
Concept of screening
It is defined as “The search for unrecognized disease or defect by means of rapidly applied tests,
examinations or other procedures in apparently healthy individuals.”
 Capable of wide application
  Relatively inexpensive
 Requires little physician time, in fact the physician is not required to administer the test
but only to interpret it.
Difference between Screening and periodic health examinations
 Capable of wide application
 Relatively inexpensive
 Requires little physician time, in fact the physician is not required to administer the test
but only to interpret it.
Aims and objectives
 The basic purpose of screening is to sort out of large group of apparently healthy persons
those likely to have disease or at increased risk of the disease under study, to bring those
who are “apparently abnormal” under medical supervision and treatment.
Uses of Screening
I. Case Detection:
1) Also known as prescriptive screening
2) It is defined as the presumptive identification of unrecognized disease which does not
arise from a patient’s request
3) Since disease detection is initiated by medical and public health personnel, they are
under the special obligation to make sure that appropriate treatment is started early
II. Research Purposes
 Screening may aid at obtaining more basic knowledge about the natural history of such
diseases, e.g., initial screening provides a prevalence estimate and subsequent screening
provides incidence figure.
 When screening is done for research purpose the investigator should inform the participant
that no follow-up therapy will be available.
III. Educational opportunities:

 Screening programmes provide opportunities for creating public awareness and for
educating health professionals.
Types of Screening
Three types of screening:
 Mass Screening
 High Risk or Selective Screening
 Multiphasic Screening
Mass Screening
 Screening of a whole population or sub group
  It is offered to all irrespective of particular risk individual may run of contracting the
disease in question.
 However indiscriminate mass screening is not a useful preventive measure unless it is
backed by suitable treatment that will reduce the duration of illness or alter its final
outcome.
High Risk or Selective Screening
 Screening will be most productive if applied selectively to high risk groups, the groups
defined on the basis of epidemiological research
 One population subgroup where certain diseases tend to aggregate is the family, thus by
screening other members of the family the physician can detect additional cases
 Screening for risk factors as recent concept
 Economic use of resources
Multiphasic Screening
 Application of two or more screening tests in combination to a large number of people at
one time then to carry out screening tests for a single disease
 Health questionnaire, Clinical examination and a range of measurements and
investigations all of which is performed with the appropriate staffing organization and
equipment
 Added to the cost of health care services without any observable benefit
Criteria for Screening
 Before a screening programme is initiated, a decision should be made whether it is
worthwhile, which requires ethical, scientific and if possible financial justification.
The criteria is based o two things
 Disease to be screened
 Test to be applied

Disease to be Screened
 The condition sought should be an important health problem
 There should be a recognizable latent or early asymptomatic stage
 The natural history of condition including development from latent to declared disease
should be adequately understood
 There is a test that can detect the disease prior to the onset of signs and symptoms
 Facilities should be available for the confirmation if diagnosis
 There is an effective treatment
 There should be and agreed- on policy concerning whom to treat as patients
  There is good evidence that early detection and treatment reduces morbidity and mortality
 The expected benefits of early detection exceed the risks and costs
PREVENTION OF DISEASE
Successful prevention of disease depends on knowledge of causation, dynamics of
transmission, identification of risk factors and risk groups, availability of prophylactic or early
detection and treatment measures
Levels of prevention
1) Primordial prevention
2) Primary prevention
3) Secondary prevention
4) Tertiary prevention
 Primordial prevention: Prevention of emergence or development of risk factors in
countries or population groups in which they have not yet appeared. The main intervention
being through individual and mass education
 Primary prevention: action taken prior to onset of disease. It signifies intervention in the
prepathogenesis phase of disease.
1) Population ( Mass ) strategy: Directed to whole population irrespective of individual risk
levels
2) High- risk strategy: Bringing preventive care to individuals at high risk

 Secondary prevention: The action that halts the progress of disease at its incipient stage
and prevents complications. Interventions: early diagnosis and adequate treatment
1) A domain of clinical medicine
2) Perfect tool for controlling transmission of diseases
3) More expensive and less effective then primary prevention
 Tertiary prevention:
1) Intervention in the late pathogenesis phase
2) All measures available to reduce or limit impairments and disabilities, minimize the
suffering caused by existing departures from good health and to promote patients
adjustment to the irremediable condition.
BASIC MEASUREMENTS OF EPIDEMIOLOGY
1) Epidemiology focuses on measuring Mortality and Morbidity among other things.

2) The first thing is to establishment of criteria and standards by which it can be measured
(goal of epidemiology)
3) Unlike a clinician an epidemiologist requires a precise definition which is
4) Acceptable and applicable to its use in large population.

5) Precise and valid, to enable him to identify those who have disease from those who do not.
Measurements in Epidemiology
 The scope of measurements in epidemiology is broad and unlimited and includes
1) Measurement of Morbidity
2) Measurement of Mortality
3) Measurement of disability
4) Measurement of Natality
5) Measurement of the presence, absence or distribution of the characteristics or attributes of
the disease
6) Measurement of presence, absence or distribution of the environmental and other factors
suspected of causing the disease
7) Measurement of demographic variables
 The basic requirements of measurements are validity, reliability, accuracy, sensitivity and
specificity
Tools of Measurement
Rates:
A rate measures the occurrence of some particular event in a population during a given
period. It is the statement of the risk of developing a condition. It indicates the change in some
event that takes place in a population over a period of time. It is written as below
Death rate = No. of deaths in one year
Mid –year population

(A rate measures the occurrence of some particular event in a population during a given time
period e.g Death Rate)
The various categories of rates are:
1) Crude rates: these are the actual observed rates such as birth and death rates (usually
expressed per 1000)
2) Specific rates: These are the actual observed rates due to specific causes or occurring in
specific groups or during specific time periods
3) Standardized rates: These are observed by direct or indirect method of standardization or
adjustment, e.g age and sex standardized rates
Ratios: It expresses a relation in size between two random quantities. Broadly ratio is the result
of dividing one quantity by another. It is expressed in the form of:
X: Y or X
Y
The no. of females in population of a place at a specified period
The no. of males in the population of the same place during the same period
Other examples: sex ratio, doctor population ratio, child women ratio etc. (It expresses a relation
in size between two random quantities)
Proportion:
It is a ratio which indicates the relation in magnitude of a part of the whole. The proportion is
always expressed as a percentage.
Example: the no. of children with scabies at a certain time
_________________________________________ x 100
The total no. of children in the village at the same time
It is a ration which indicates the relation in magnitude of a part of the whole (usually expressed
as percentage)
Measurement of Mortality
1) Most epidemiological studies begin with mortality data
2) Easy to obtain and in most of the countries very accurate
3) International Death Certificate:
a. It was recommended by WHO for international use, for ensuring national and international
comparability
b. It is divided in two parts: the first part includes immediate cause and underlying cause
which started the whole events leading to death
c. The “underlying cause” is the essence of international death certificate and is defined as
d. The disease or injury that started the train of morbid events leading directly to death
e. The circumstances of accident of violence which produced the fatal injury
f. The second part records any significant associated diseases that contributed to death but
did not directly lead to it
g. Death certificate used in India
Uses and Limitations of Mortality Data
Uses:
 Explaining trends and differentials in overall mortality, indicating priorities for health
actions and allocation of resources
 Designing intervention programmes
 Assessing and monitoring of public health problems and programmes
 Important clues for epidemiological research
Limitation
 Incomplete reporting of deaths: Developing countries
 Lack of accuracy: age and cause of death
 Lack of uniformity: no uniform method
  Choosing a single cause of death: underlying cause, risk factor
 Changing
 Diseases with low fatality: mental diseases, arthritis

MEASUREMENT OF MORTALITY
Crude death rate
Number of deaths (from all causes) per 1000 estimated midyear population in one year in a given
place
Number of deaths during the year
X 1000
Mid year population
The major disadvantage with crude death rate is that they lack comparability for communities
with populations that differ in age, sex, race etc
Specific death rates: It help us to identify particular groups “at risk” for prevention action.
The specific death rates may be
 Cause or disease specific e.g., Tuberculosis
 Related to specific groups e.g., age specific, sex- specific
Specific death rate due to T.B = no. of deaths from T.B. during a
Calendar year x1000
Midyear population
Specific death rate for males = no. of deaths among males during a
Calendar year x 1000
Mid- year population.
Specific death rate in age group = no. of deaths of persons aged 15-20
15-20 yrs during a calendar year x1000
Mid-yr population of persons
Aged 15-20.
Case Fatality Rate (Ratio)
Total number of deaths due to a particular disease
X 100
Total number of cases due to the same disease
 It represents the killing power of the disease and its use for chronic diseases is limited
because the period from onset to death is long and variable
  It is closely related to virulence
Measurement of Mortality
 Proportional Mortality Rate
 Proportion of total deaths due to a particular cause (deaths in a specific age group) per 100
(or 1000) total deaths
 Proportional mortality rate from a specific disease: Number of deaths from a specific
disease in a year Total deaths from all causes in a year
 It is usually computed for a broad disease group or a specific disease of major public
health importance, such as cancer, coronary heart disease
 It is of little importance for making comparisons between population groups or different
time periods since it depends on two variable and both of which may differ
 It is however important indicator within any population group of relative importance of
the specific disease or disease group as a cause of death
 Mortality
Survival Rate
It is a method of describing prognosis in certain disease conditions from date of diagnosis or start
of treatment. Special interest in cancer studies
Total number of patients alive after 5 years X 100
Total number of patients diagnosed or treated
Adjusted or Standardized Rates
a. The rates are comparable only if the populations on which they are based is comparable,
thus crude rate is not always useful
b. Two types of Standardization
 Direct Standardization
 Indirect Standardization
c. Standard Population is defined as one for which the numbers each sex and age are known
Direct Standardization
 Apply to the standard population the age specific rates of the population whose crude
death rate to be adjusted or standardized
 As a result for each age group a expected number of deaths in the standard population is
obtained; this is added together for all the age groups to give the total expected deaths
 Divide the expected total number of deaths by the total of the standard population which
yields the standardized or age adjusted rate.
Indirect age standardization
 Standardized mortality Ratio
Observed deaths
X 100
Expected Deaths
 More stable rates of the larger population are applied to smaller study group
 IT gives a measure of the likely excess risk of mortality due to the occupation
 Advantage over Direct method: it permits adjustment for age and other factors where age
specific rates are not available or are unstable because of small numbers.
MEASUREMENT OF MORBIDITY
 Morbidity is defined as any departure, subjective or objective from the state of
physiological wellbeing
 Morbidity can be measured in terms of 3 units
a) Person who were ill
b) The illness periods that the person has experienced
c) The duration of these illnesses
The value of Morbidity Data
 They describe the extent and nature of the disease load in the community and thus assist
in the establishment of priorities
 They usually provide more comprehensive and more accurate and clinically relevant
information on patient characteristics than can me obtained from mortality data and are
therefore essential for basic research
 They serve as starting point for etiological studies and thus play a crucial role in disease
prevention
 They are needed for monitoring and evaluation of diseases control activities
Incidence
 It is defined as number of new cases occurring in a defined population during a specified
period of time
Number of new cases of specific disease
during and given time period X 1000
Population at risk during that period
Incidence rate refers
 Only to new cases
 During an gives period
 In a specified population or population at risk unless other denominators are chosen
  It can also refer to new spells or episodes arising in a given period of time, per 1000
population
Attack Rate
 It is type of incidence rate used only when the population is exposed to risk for a limited
period of time such as during an epidemic
No.of new cases of a specified disease during a specified time interval
X100
Total population at risk during the same interval
Secondary Attack rate
 It is defined as the number of exposed persons developing the disease within the range of
incubation period following the exposure to a primary case
Uses of Incidence Rate
 It is useful for taking action as a health status indicator
 To control the disease
 For research into etiology and pathogenesis of disease, distribution of diseases, and
efficacy of preventive and therapeutic measures
Prevalence
 The total number of all individuals who have an attributable or disease at a particular time
(or during a particular period) divided by the population at risk of having attribute or
disease at this point of time or midway through the period
 Types of prevalence
 Point prevalence
 Period prevalence
Point Prevalence
 The number of all current cases (old and new) of a disease at one point in time in relation
to a defined population
No. of all current cases of a specified disease
existing at a given point of time X 100
Estimated population at the same time
Period Prevalence
 It is the less commonly used kind of prevalence
 The number of all current cases (old and new) of a disease during a defined period of time
expressed in relation to a defined population
No. of all current cases of a specified disease existing
at a given period of time interval
X 100
Estimated mid interval population at risk
Uses and Limitations of Prevalence
Uses
 Prevalence helps to estimate the magnitude of health/ disease problems in the community
and identify potential high risk populations
 Prevalence rates are especially useful for administrative and planning purposes
Limitation
 It is not the ideal measure for studying disease etiology or causation and Limitations of
Prevalence
Relationship between Incidence and Prevalence
 Prevalence depends on two factors Incidence and Duration of illness
P=IxD
 The longer the duration of disease the greater is the prevalence
 At the same time if the duration of disease is low due to death or recovery then the
prevalence rates will be relatively low as compared to incidence
 It is an essential part of disease control.
 There are various ways of undertaking surveillance most important being reporting the
cases within health system. It requires continuous scrutiny of all aspects of occurrence,
spread and control of disease that are pertinent to effective control. The analysis of data
from a surveillance system indicates whether there has been a significant increase in the
number of cases
 Sentinel Health information system: a limited number of general practitioners report on a
defined list of carefully chosen topics that may be changed from time to time are
increasingly used to provide supplementary information for surveillance of both
communicable and non communicable diseases
 Sentinel network keeps a watchful eye on a sample of population by supplying regular
standardized reports on specific diseases and procedures in Primary health care
 It goes beyond passive reporting of cases
 It includes laboratory confirmation of presumptive diagnosis, finding out the source of
infection, routes of transmission, identification of all cases and susceptible contacts, and
still others who are at risk in order finally to prevent the further spread of disease
 Serological Surveillance: Identification of pattern of current and past infection
 Systemic collection of morbidity and mortality data, the orderly consolidation of these
data, special field investigation and rapid dissemination of this information to those
responsible for control or prevention
 Once the control measures are instituted their effectiveness should be evaluated. The
ultimate goal of Surveillance is prevention.
Sources and Methods of Demographic Data Collection
The lifeblood of a health information system is the routine health statistics. Information
requirements will vary according to the administrative level at which planning is envisaged. For
example, the information requirements of a public health administrator will be different from the
information requirements of a hospital administrator.
The main sources of demographic statistics in India are:-
1. Census:
2. Registration of vital events
3. Notification of diseases
4. Hospital records
5. Disease registers
6. Record linkage
7. Epidemiological surveillance:
8. Other health service records
9. Environmental health data
10. Health manpower statistics
11. Population surveys
12. Other routine statistics related to health
13. Demographic
14. Economic
15. Social security schemes
ROLE OF NURSES IN EPIDEMIOLOGY
1. Case finding: One of the nurse’s roles is case fining role in the community. Nurses work
closely with individual family and community.
2. Disease controller/Prevention: The nurse play a vital role in order to prevent and control
the disease in hospital an community settings by providing the different works.
3. Community Diagnosis: The one of the major role is to diagnose the different kinds of
health problems in the community.
4. Health care provider: The nurse provides and promotional care in both hospital and
community.
5. Health educator: The nurse performs the role both in the hospital and in the community.
The nurses provide the health education to the people so that they can change their lives.
6. Researcher: The nurse does scientific and systematic investigation of the services or
problem, collecting facts pertaining to the problems and developing theories to explain the
problems and suggest a solution, developing tentative solution, called hypothesis, setting
an a suitable method to study the problem, collect data needed to evaluate the hypothesis,
analyze the data, report the findings.
7. Coordinator: The nurse needs to work in different sectors of the society for promoting
health programmes.
8. Change agent: Nursing is the widest profession in the fields of health when change takes
place. Nursing has become more complex and has linked itself to social, behavioral and
management science. A community health nursing is a niw dimension of modern nursing,
which includes broad spectrum of services in the health care, health education, the
protection of mothers and children, family planning and the control of environmental
hazards. Science is also influencing the growth of nursing which has been rapidly advising
in medical science.
9. Planner: In each and every organization planning is imported. It is essential to plan
activities before performing action or implementing the proposed plan. Planning is
essential to achieve the goal of program. The goal of health planning is the achievement of
the optional level of health.
10. Advisor: Nurse is the key person who can give proper advice to others in related fields.
The nurse has to pass knowledge, skill and experience, enough to give proper
guidance/counseling to the people. Nurse should be tactful and also a good decision maker
in related areas.
11. Problem solver: One of the roles of a nurse is to solves problem. The nurse and
community leaders will make a community diagnosis and decide on action to solve
problem or deficits. In hospital, possible solutions are discussed with the clinets and
relatives to decide what are obtainable objectives.
12. Facilitator: A nurse needs good communication skills in order to be a facilitator with a
community. A facilitator should be a good listener in order to encourage ideas from other
in hospital. She facilitates the patients and relatives to understand regards the disease and
to take necessary steps in treatment and prevention. The community, nurse works as a
facilitator with the people who are the directs to enables them to make decisions and bring
about any needed action, themselves using their own recourses as much as much as
possible.
13. Motivator: A nurse is a key person in a community to motivate people to adopt heath
practices. Motivate is an inner force that drives an individual or community to a certain
action or behavior.
14. Communicator: A nurse is a person who transmits an idea of information. Nurses play a
vital role to disseminate the information in order to prevent the disease.
15. Guider/ Counselor: The nurse works as a guider and counselor in hospital setting and
community setting in order to maintain the health status of community people.
16. Manager: The nurse works as a manager, she has to supervise and control different
aspects of her service. She supervises to make sure that good work in being done by the
people.
17. Evaluator: The nurse evaluates the work done to improve its quality and effectiveness in
the community. Evaluation should be done continuously to determine the changes. The
nurse is providing health services, managing, doing research teaching or promoting
change in the community.