Assignment 1

Using specific examples, describe three common epidemiological studies that have been carried out
in your country.
 
You should be able to write not more than 700 words for the whole assignment with Arial 12-point
font, conventional margins, and single-spaced.

Epidemiology
The word epidemiology comes from the Greek words’ epi, meaning on or upon, demos, meaning
people, and logos, meaning the study of (Centers for Disease Control and Prevention (CDC), 2012).
In other words, the word epidemiology has its roots in the study of what befalls a population. Many
definitions have been proposed, but the following definition captures the underlying principles and
public health spirit of epidemiology. Epidemiology is the study of the distribution and determinants of
health-related states or events in specified populations and the application of this study to the control
of health problems (CDC, 2012).
Epidemiological Study
Epidemiology is a scientific discipline with sound methods of scientific inquiry at its foundation
(Beaglehole et al., 2002). Epidemiology is data-driven and relies on a systematic and unbiased
approach to the collection, analysis, and interpretation of data (CDC, 2012). Basic epidemiologic
methods tend to rely on careful observation and use of valid comparison groups to assess whether
what was observed, such as the number of cases of disease in a particular area during a particular time
period or the frequency of an exposure among persons with disease, differs from what might be
expected (CDC, 2012). However, epidemiology also draws on methods from other scientific fields,
including biostatistics and informatics, with biologic, economic, social, and behavioral sciences
(CDC, 2012).
Epidemiology is concerned with the frequency and pattern of health events in a population (CDC,
2012). Frequency in epidemiological studies refers not only to the number of health events such as the
number of cases of meningitis or diabetes in a population, but also to the relationship of that number
to the size of the population (CDC, 2012). The resulting rate allows epidemiologists to compare
disease occurrence across different populations. On the other hand, pattern refers to the occurrence of
health-related events by time, place, and person (CDC, 2012). Time patterns may be annual, seasonal,
weekly, daily, hourly, weekday versus weekend, or any other breakdown of time that may influence
disease or injury occurrence (CDC, 2012). Place patterns include geographic variation, urban/rural
differences, and location of work sites or schools. Personal characteristics include demographic
factors which may be related to risk of illness, injury, or disability such as age, sex, marital status, and
socioeconomic status, as well as behaviours and environmental exposures (CDC. 2012).
Epidemiological Studies in Malawi
Having highlighted what epidemiological studies is, below summary is examples of few three
examples of common epidemiological studies that are conducted in Malawi mainly as response to
current public health challenges. Talking about public health challenges, we have observed recently
increase in epidemiological studies by public health experts as well as academia’s as a response to the
stated public health challenges. One of it has been COVID-19. It is therefore the purpose of this essay
to describe three common epidemiological studies that have been carried out in Malawi more recently.
Aron et al (2022) conducted epidemiological study titled attitudes toward COVID-19 Vaccines among
Patients with Complex Non-Communicable Disease and Their Caregivers in Rural Malawi. It should
be mentioned that the issues of COVID-19 have become major interest of public health experts in
Malawi recently.
As Aron et al (2022) has observed, current low COVID-19 vaccination rates in low- and middle-
income countries reflect an inequitable global vaccine distribution; however, local attitudes towards
the COVID-19 vaccine are an important factor to meet vaccination benchmarks (Aron, 2022). The
study describes attitudes toward the uptake of the COVID-19 vaccine and perceptions among patients
with NCDs and their caregivers using cross-sectional data collected through telephone interviews in
Neno, Malawi (Aron, 2022). Out of 126 survey respondents, 71% were patients, and 29% were
caregivers (Aron, 2022). Twenty-two percent of respondents had received at least one dose at the
interview (95% CI: 15–30%), with 19% being fully vaccinated (Aron, 2022). Only 24% (95% CI: 12–
40%) of unvaccinated respondents reported that they would accept an approved vaccine if it were
offered (Aron, 2022).
The study findings indicated that vaccines were perceived as unsafe or designed to harm and
commonly associated with death, severe disability, infertility, and evil (Aron, 2022). However, over
two-thirds reported high levels of trust in health care workers (73%) and community health workers
(72%) as sources of information for the COVID-19 vaccine (Aron, 2022). Although the uptake of
COVID-19 vaccine in this vulnerable population was three times nigh than the national average, a low
intention to be vaccinated persists among the unvaccinated (Aron, 2022). Strong trust in health care
workers suggests that community engagement could help increase vaccine acceptance ( Aron, 2022).
This study just supports the definition of epidemiological study and the concept of frequency and
pattern in establishing solutions to public health challenges, in this case uptake of vaccines.
Mmanga et al, (2023) also conducted epidemiological study titled, the world is coming to an end!
COVID-19, depression, and anxiety among adolescents in Malawi.
The study assessed the effects of Covid-19 on adolescent mental health in Malawi. Mmanga et al,
(2023) observed that there is minimal research on adolescent mental health in Africa, Malawi in
particular. The study shows a link between the pandemic and mental health (Mmanga et al., 2023).
Some factors that may have contributed to this link include; Covid-19 preventive measures, media
exposure and the increase in unemployment (Mmanga et al., 2023). The study used a mixed methods
approach, quantitative and qualitative methods (Mmanga et al., 2023). It was conducted in Malawi’s
four districts (Blantyre, Mangochi, Lilongwe and Karonga) (Mmanga et al., 2023).
Overall, 22%, 21%, and 23% of the respondents had depression, anxiety and post-traumatic stress
disorder, respectively (Mmanga et al., 2023). The study found no significant differences in the
proportions of adolescents with the three outcomes when comparing different groups within the
explanatory variable (Mmanga et al., 2023). The ratio of female and male adolescents with depression
and anxiety was the same (Mmanga et al., 2023). Similarly, as Aron and others above we can also
establish the concept of frequency and pattern as well as determinants of health in this
epidemiological study.
Aron et al (2022) again conducted another COVID-19 pandemic epidemiological study titled
syndromic surveillance with monthly aggregate health systems information data for COVID-19
pandemic response in Neno, Malawi: a monitoring study.
Aron et al (2022) observed that in the context of diminutive COVID-19 screening and testing,
syndromic surveillance can be used to identify areas with higher-than-expected SARS-CoV-2
symptoms for targeted public health interventions. Aron et al (2022) used syndromic surveillance to
monitor potential SARS-CoV-2 outbreaks in 14 health facilities in the Neno district of rural Malawi.
The epidemiological study monitored three indicators identified as potential symptoms of SARS-
CoV-2 infection: the proportion of outpatient visits for fast-breathing cases in children under 5 years
(FBC<5); the proportion of suspected malaria cases confirmed as non-malaria in children under 5
years (NMC<5); and the same indicator in individuals aged 5 years and older (NMC≥5) (Aron et al.,
2022). The study extracted data aggregated by month and at the health facility-level from the District
Health Information System (Aron et al., 2022). With data from January, 2016, to February, 2020, as a
baseline, Aron et al (2022) we used a linear model with a negative binomial distribution to estimate
expected proportions for the indicators in absence of the COVID-19 pandemic with 95% prediction
intervals (PI) for March, 2020, to July, 2021.

The findings were that the proportion of FBC<5 was consistently higher than expected, with a peak in
May, 2020, when 2·5% of outpatient visits were fast breathing cases in children younger than 5 years
of age (compared with the expected rate of 0·8% [95% PI 0·4–1·5]) (Aron et al., 2022). NMC<5 was
as expected throughout the study period (Aron et al., 2022). The NMC≥5 indicator remained as
expected, except for increases in suspected cases tested negative for malaria, to 31·3% (from the
expected 18·6% [95% PI 12·3–28·7]) in November, 2020, and to 32·5% (from the expected 21·7%
[95% PI 14·2–32·2]) in July, 2021 (Aron et al., 2022). Interpretation An increase in FBC<5 and
NMC≥5 before observed COVID-19 waves might indicate SARS-CoV-2 infections that were missed
before robust testing (Aron et al., 2022).
In summary it was established that this tendency was not seen in NMC<5, which can represent
differences in symptomatology leading to decreased health-seeking behaviours for this age group
(Aron et al., 2022). The study noted that syndromic surveillance can allow for real-time responses at
facilities, including increased and focused testing and screening to identify potential SARS-CoV-2
infections (Aron et al., 2022).

REFERENCES
Aron, M.B.; Connolly, E.; Vrkljan, K.; Zaniku, H.R.; Nyirongo, R.; Mailosi, B.; Ruderman, T.;
Barnhart, D.A.; on behalf of the Partners in Health Cross-Site COVID-19 Cohort Research Network
(2022): Attitudes toward COVID-19 Vaccines among Patients with Complex Non-Communicable
Disease and Their Caregivers in Rural Malawi. Vaccines 2022, 10, 792. https://
doi.org/10.3390/vaccines10050792
Aron, M.B., Connolly, M, Munyaneza, F., Fejfar, D, Mphande, I, Talama, G, Kachimanga, C,
Khongo, B and Fulcher, I (2022) Syndromic surveillance with monthly aggregate health systems
information data for COVID-19 pandemic response in Neno, Malawi: a monitoring study: Published
by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Supported by Canadian
Institutes of Health Research.
Beaglehole R, Bonita R, Kjellstrom T. (2002): Basic epidemiology. WHO.
Centres for Disease Control and Prevention (CDC)., (2012): Principles of Epidemiology in Public
Health Practice. An Introduction to Applied Epidemiology and
Biostatistics. Third Edition. October 2006, Updated May 2012.
Mmanga C, Ndasauka Y, Kainja J, Kondowe F, Mchenga M, Maliwichi L and Nyamali S (2023): The
world is
coming to an end! COVID-19, depression, and anxiety among adolescents in Malawi. Front.
Psychiatry 13:1024793. doi: 10.3389/fpsyt.2022.1024793