EPIDEMIOLOGY

Presented by: CHERRY ANNE L. PINGAD, LPT

 OBJECTIVES
• TO ELIMINATE OR REDUCE THE HEALTH
PROBLEM OR ITS CONSEQUENCES AND
• TO PROMOTE THE HEALTH AND
WELLBEING OF SOCIETY AS A WHOLE
 AIMS OF EPIDEMIOLOGY
ACCORDING TO THE INTERNATIONAL EPIDEMIOLOGICAL
ASSOCIATION(IEA) EPIDEMIOLOGY HAS 3 MAIN AIMS.
• TO DESCRIBE AND ANALYZE DISEASES OCCURRENCE AND
DISTRIBUTION IN HUMAN POPULATIONS;
• TO IDENTIFY ETIOLOGICAL FACTORS IN THE PATHOGENESIS OF
DISEASES;
• TO PROVIDE DATA ESSENTIAL TO THE PLANNING, IMPLEMENTATION
AND EVALUATION OF SERVICES FOR THE SETTING UP OF PRIORITIES
AMONG THOSE SERVICES.
 INTRODUCTION OF EPIDEMIOLOGY
• THE TERM EPIDEMIOLOGY IS DERIVED FROM
THE GREEK WORD EPIDEMIC.
-Epi means Among, upon
- Demos means study of population or people
and
- Logos means scientific study
 DEFINITION
• THE STUDY OF DISEASE, ANY DISEASE, AS A MASS
PHENOMENON. (GREENWORD 1935).
• THE STUDY OF CONDITION KNOWN OR REASONABLY
SUPPOSED TO INFLUENCE THE PREVALENCE OF DISEASE.
(LUMSDEN 1936).
• STUDY OF THE DISTRIBUTION AND DETERMINANTS OF
DISEASES FREQUENCY IN MAN. (MAC MOHAN AND PUGH).
 GENERAL DEFINITION

• “THE STUDY OF THE DISTRIBUTION AND

DETERMINANTS OF HEALTH RELATED
STATES OR EVENTS IN SPECIFIED
POPULATION AND THE APPLICATION OF
THE STUDY TO CONTROL OF HEALTH
PROBLEMS”
 HISTORY OF EPIDEMIOLOGY
• THE HISTORY OF EPIDEMIOLOGY HAS ITS ORIGIN IN THE IDEA, GOES BACK
TO (400 BC). HIPPOCRATES THROUGH JOHN GRAUNT(1662), WILLIAM
FARR, JOHN SNOW AND OTHERS THAT ENVIRONMENTAL FACTORS CAN
INFLUENCE THE OCCURENCES OF DISEASE INSTEAD OF SUPERNATURAL
VIEWPOINT OF DISEASE.
• JOHN GRAUNT ANALYSIS AND PUBLISHED THE MORTALITY DATA IN 1662.
HE WAS THE FIRST QUANTIFY PATTERN OF DEATH, BIRTH AND DISEASE
OCCURENCES.
• NO ONE BUILT UPON GRAUNT’S WORK UNTIL 1800’S. WHEN WILLIAM FARR
BEGAN TO SYSTEMATICALLY COLLECT AND ANALYZE THE BRITAINS’S
MORTALITY STATISTICS. FARR CONSIDERED AS THE FATHER OF VITAL
STATISTICS AND DISEASE CLASSIFICATIONS.
• MEANWHILE JOHN SNOW WAS CONDUCTING THE SERIES OF
INVESTIGATION IN LONDON THAT LATER EARNED HIM A TITLE FATHER OF
FIELD EPIDEMIOLOGY. SNOW CONDUCTED HIS CLASSICAL STUDY IN 1854
WHEN AN EPIDEMIC OF CHOLERA DEVELOPED IN THE GOLDEN SQUARE OF
LONDON. DURING THE TIME OF MICROSCOPIC DEVELOPMENT, SNOW
CONDUCTED STUDIES OF CHOLERA OUTBREAK BOTH TO DISCOVER THE
CAUSES OF DISEASES AND PREVENT ITS RECURRENCE.
• DURING THAT TIME TWO MEN (FARR AND SNOW) HAD MAJOR
DISAGREEMENT ABOUT THE CAUSE OF CHOLERA. FARR ADHERE TO WHAT
WAS THE CALLED MIASMATIC THEORY OF DISEASE, ACCORDING TO THIS
THEORY WHICH WAS COMMONLY HELD AT A TIME DISEASE WAS
TRANSMITTED BY MIASMA OR CLOUD THAT CLUNG LOW ON THE EARTH
SURFACE.
• HOWEVER SNOW DID NOT AGREE. HE BELIEVED THAT
CHOLERA TRANSMITTED THROUGH CONTAMITED WATER. HE
BEGAN HIS INVESTIGATION BY DETERMINING WHERE IN THIS
AREA PERSON WITH CHOLERA LIVED AND WORKED. HE THEN
USED THIS INFORMATION TO MAP FOR DISTRIBUTION OF
DISEASES. SNOW BELIEVED THAT WATER WAS THE SOURCE OF
INFECTION FOR CHOLERA. HE MARKED THE LOCATION AND
SEARCHES THE RELATIONSHIP BETWEEN CASES AND WATER
SOURCES. HE FOUND THAT CHOLERA WAS TRANSMITTED
THROUGH CONTAMINATED WATER. THIS WAS THE MAJOR
ACHIEVEMNET IN EPIDEMIOLOGY
 USES OF EPIDEMIOLOGY
• INVESTIGATION OF CAUSATION OF DISEASE

GENETIC FACTORS

GOOD HEALTH ILL HEALTH

ENVIRONMENTAL FACTORS
 USES OF EPIDEMIOLOGY
• STUDY OF THE NATURAL HISTORY AND PROGNOSIS OF
DISEASES.

DEATH

GOOD HEALTH SUB CLINICAL CHANGES CLINICAL DISEASES

RECOVERY
 USES OF EPIDEMIOLOGY
• DESCRIPTION OF THE HEALTH STATUS OF THE
POPULATIONS. IT INCLUDES PROPORTION
WITH ILL HEALTH, CHANGE OVER TIME,
CHANGE WITH AGE.
• EVALUATION OF THE INTERVENTIONS
• PLANNING HEALTH SERVICES, PUBLIC POLICY
AND PROGRAMS.
 3 COMPONENTS OF EPIDEMIOLOGY

•DISEASE FREQUENCY
•DISTRIBUTION OF DISEASE
•DETERMINANTS OF DISEASE
 DISEASE FREQUENCY

• IT MEASURE THE FREQUENCY OF

DISEASES, DISABILITY OR DEATH IN A
SPECIFIED POPULATION. IT IS ALWAYS
THE RATE, RATIO AND PROPORTION.
 DISTRIBUTION OF DISEASE
• HEALTH EVENTS OCCUR IN PATTERN IN COMMUNITY AND THIS PATTERN
VARIES FROM COMMUNITY TO COMMUNITY.
• ALSO HEALTH EVENTS OR DISEASES CONDITION AFFECT POPULATION AT
VARIOUS AGE, GROUP, DIFFERENT SEXES, DIFFERENT SUBGROUPS OF
POPULATION.
• DISTRIBUTIONS OF EVENTS ARE BASED ON TIME, PLACE AND PERSON.
WE CAN ANALYZE WHETHER ANY INCREASES OR DECREASES OCCUR
FOR A PARTICULAR CONDITION. EPIDEMIOLOGY ADDRESSES ITSELF TO A
STUDY OF THESE VARIATIONS OR PATTERNS, WHICH MYA SUGGESR OR
LEAD TO MEASURE TO
CONTROL OR PREVENT THE DISEASES.
 DETERMINANTS OF DISEASES

• EPIDEMIOLOGY HELPS IN
IDENTIFYING THE CAUSATIVE
AGENT OR THE RISK/
PREDISPOSING FACTORS OF
DISEASES.
 CONCEPT OF DISEASE
CAUSATION
•GERM THEORY OF DISEASE
•EPIDEMIOLOGICAL TRIADS
•MULTIFACTORIAL CAUSATION
•WEB CAUSATION
 GERM THEORY OF DISEASE

• THE THEORY THAT CERTAIN

DISEASES ARE CAUSED BY THE
INFECTION OF THE BODY BY
MICROORGANISM.
 EPIDEMIOLOGICAL TRIAD
• AGENT- BIOLOGICAL, CHEMICAL, PHYSICAL, NUTRITIONAL, SOCIAL

• HOST FACTOR- AGE, SEX, HEREDITY, NUTRITION, OCCUPATION,

CUSTOM, HABITS, IMMUNITY POWER, BIOLOGICAL- BLOOD SUGAR,
CHOLESTEROL, HOUSING, MARITAL STATUS, SOCIO-ECONOMIC
STATUS

• ENVIRONMENTAL FACTOR- PHYSICAL, BIOLOGICAL, PSYCHOSOCIAL

 MULTIFACTORIAL CAUSATION
• MULTIFACTORIAL CAUSATION IS THE GENETIC
AND ENVIRONMENTAL FACTORS CONTRIBUTE TO
THE DISEASE PROCESS WHEREBY A DISEASE CAN
BE CONSIDERED THE RESULT OF “PHENOTYPIC
DEVELOPMENT OCCURING WITHIN AN
ENVIRONMENT”. (MAX VON PETTENKOFER
1818-1901)
 WEB CAUSATION
• WEB CAUSATION IS THE EMPHASISES PROXIMATE
DETERMINANTS OF DISEASE AMENABLE TO
INTERVENTION THROUGH INDIVIDUAL LEVEL HEALTH
CARE BUT TAKING INTO ACCOUNT LARGER SOCIAL
NETWORKS. (VENKATAPURAM 2011).
• IT IS ALSO THE STUDY OF DISTRIBUTION OF DISEASES
WITHIN AND ACROSS POPULATIONS AND LOOKS FOR THE
CAUSES OF SUCH DISTRIBUTIONS.
 DYNAMIC OF DISEASE TRANSMISSON

•SOURCE OF INFECTION OR
RESERVIOR OF INFECTION
•MODE OF TRANSMISSION
•SUSCEPTIBLE HOST
 RESERVIOR OF INFCETION
• HUMAN RESERVIOR

-CASE- CLINICAL, SUB-CLINICAL, LATENT

-CARRIER- INCUBATORY, CONVALESCENT, HEALTHY

• ANIMAL RESERVIOR

-ZOONOTIC
• RESERVIOR OF NON-LIVING THINGS

-THINGS
• SOURCE OF INFECTION- SECRETION/ EXCRETION OF RESERVIOR,
SOMETIMES RESERVIOR
 MODE OF TRANSMISSION

DIRECT INDIRECT

• DIRECT CONTACT • VEHICLE BORNE DISEASE

• DROPLET INFECTION • VECTOR BORNE DISEASE

-BIOLOGICAL
• INOCULATION IN TO SKIN OR MUCOSA
- MECHANICAL
• CONTACT WITH INFECTED SOIL
• VECTOR BORNE DISEASE

-DROPLET NUCLEI

-INFECTIVE DUST

• FOMITE

• FINGERS
 SUSCEPTIBLE HOST
LOW IMMUNITY PERSON. HIGH RISK PERSON

• PORTAL OF ENTRY

-MODE OF TRANSMISSION

• SUITABLE PLACES

• DEVELOP/MULTIPLICATION/DISEASE/CARRIER

• PORTAL OF EXIT

-RESPIRATORY

-GASTROINTESTINAL

-URINARY

-SKIN

-BODY FLUIDS
 DISEASE PREVENTION AND CONTROL
• PREVENTION OF SOURCE OR RESERVIOR

-EARLY DIAGNOSIS
-NOTIFICATION
-ISOLATION
-TREATMENT
-QUARANTINE
• INTERRUPTION OF THE DISEASE TRANSMISSION
• PREVENTION OF SUSCEPTIBLE HOST
 EPIDEMIOLOGICAL INVESTIGATION
• VERIFICATION OF DIAGNOSIS
• CONFIRMATION OF THE EXISTENCE OF AN EPIDEMIC
• DEFINING THE POPULATION AT RISK
-OBTAINING THE MAP OF THE AREA
-COUNTING THE POPULATION
• RAPID SEARCH FOR ALL CASES AND THEIR CHARACTERISTICS
-MEDICAL SURVEY
-EPIDEMIOLOGICAL CASE SHEET
-SEARCHING FOR MORE CASES
• DATA ANALYSIS
-TIME, PLACE, PERSON
• FORMULATION OF HYPOTHESIS
• TESTING OF HYPOTHESIS
• EVALUATION OF ECOLOGICAL FACTORS
• FURTHER INVESTIGATION OF POPULATION AT RISK
• WRITING THE REPORT
 STUDY DESIGN IN EPIDEMIOLOGY

OBSERVATIONAL STUDY EXPERIMENTAL STUDY

• DESCRIPTIVE STUDIES
• RANDOMIZED CONTROL
• ANALYTICAL STUDIES
TRIALS
-Ecological study- correlational study unit is
population. • FIELD TRIALS
-Cross sectional study- prevalent study • COMMUNITY TRIAL
individual is a unit of study.

-Case control study- case-reference with

individual is a unit of study.

- Cohort-study- follow up study with

individual is a unit of study.
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