1 Introduction To Epidemiology

Yanet
Yanet-Liyana college of Health sciences
Introduction to Epidemiology
Tsegaye Alemu(PhD)
October, 2021
Hawassa
Yanet-Liyana college of health sciences
Presentation out line
• Overview of PH
• Overview of epidemiology
• Assumption of epidemiology
• Purpose of epidemiology
• History of Epidemiology
• Level of disease prevention

Objectives
At the end of the session, the students will be
able to:
• Define public health and its main function.
• Define Epidemiology and describe its components
• Distinguish between analytic and descriptive
Epidemiology
• Describe the basic assumptions in Epidemiology
• Understand history ,scope and uses of Epidemiology

• What is health ?
• What is the public health?

Health definition
It is defined as:-
• …. A state of complete physical, mental and

social well being and not merely the absence
of disease or infirmity (WHO,1948)

What is Public Health?
• “The science and art of preventing disease,
• Prolonging life and
• Promoting physical and mental health
• Organizing community efforts” ( Winslow 1923)

Main function of PH
Assessment
Provision of
Leadership
services

Main difference between Medicine vs PH
Characteristic Clinical Public health
What/who is studied Sick patient who comes Populations or
to health care communities at large
facilities/individual
Mainly diagnosis and treatment Prevention of disease,

focuses(Research goal) of disease individuals promotion of health
Focus on Evaluate health of a

“sick people who have “defined community”
presented themselves for
help”
Examples Internal medicine, Epidemiology,

pediatrics environmental health
science
PH cont……
NB. :-
• “Both ‘Clinical & Community medicine’ are not
separated;
• “ They are complementary disciplines. ”
• Community medicine needs ‘techniques & skills’
in addition to ‘clinical practices’.

The technique in community medicine
• Discussion with the community

1
• Health record survey

2
• Field survey
3

The technique in clinical medicine
History + physical Exam
Lab. Testes + X-ray + Other
Clinical Dx.” => Rx.=> Follow-up

Community diagnosis
• It is the process of “identification and

quantification of the most important health
problems of a given community.
• To define those at risk or
• Those in need of care and the opportunities and
resources available to address these factors

Community problem identification
criteria
1. Severity
2. Magnitude
3. Community concern,
4. Government concern
5. Feasibility

Definition of Epidemiology
The term epidemiology is derived from the Greek words
 Epi “on or upon”
“The study
upon the
 Demos “the common people” common
people.”
 Logy “study”
• It defined as “branch of medical science which treats

epidemics

Epidemiology: Definition
• The study of the frequency, distribution and

determinants of disease and other health
related events in specific populations, and its
application for prevention and control of health
problems(Last 1995).

Key term definition
Study: means a systematic collection, analysis &

interpretation of data.
.
So …..,
• Epidemiology involves this all,
• “Epidemiology is a science”

Key term definition cont….
Frequency: The number of times an event occurs.
• Epidemiology studies the number of times a

disease occurs; i.e.,…
• It answers the question “How many?”
• “Epidemiology is a quantitative science”

Key term definition cont….
Distribution: distribution of an event by person, place and

time (…PPT)
• Epidemiology studies the distribution of diseases
• It answers the question who , where and when?
• “Epidemiology describes health events”

Epidemiology: “Distribution”
Time(When)
• Person (Who) • Day/night
• Seasonal variations
• Long term variations
– Young Vs Old
– Female Vs Male Place(Where)

• Lowland vs
– Rich Vs Poor Highland
• Urban vs Rural
– Illiterate Vs educated

Epidemiology: Determinants
• Factors, the presence & absence of which affect the
occurrence and level of an event
• Epidemiology studies ‘what determines health

events?’
• It answers the question how and why?
• “Epidemiology analyzes health events”

Epidemiology: Determinants
The determinants of health include:
• Social and economic environment: income, education, social support

network, culture and traditional beliefs, social status…
• Physical environment: safe water and clean air, healthy
workplaces, safe houses, roads, access and use of services…
• Individual characteristics and behaviors: genetics, gender, balanced

eating, keeping active, smoking, drinking alcohol, drug consumption,
life’s stresses…
Epidemiology tries to determine

Yanet-Liyana thesciences
college of health mechanism for spread of ill
Epidemiology: Diseases & other health
related events
• Epidemiology is not only the study of diseases

• The focus of Epidemiology are not only patients
• It studies all health related conditions includes
injuries, malnutrition, vital events, health
behavior, life style
• “Epidemiology is a broader science”
Human population
• Epidemiology diagnoses and treats
community./popn.
• Clinical medicine diagnoses and treats patients
• “Epidemiology is a basic science of public

health”

Application
• Epidemiological studies have a direct practical
applications for prevention of diseases & promotion
of health
• Epidemiology is a science and practice
• “Epidemiology is an applied science”

Major categories of epidemiology
Two major categories of Epidemiology
1. Descriptive Epidemiology
2. Analytic Epidemiology
1)Descriptive Epidemiology –
Defines the frequency and distribution of diseases and
other health related events.
It answers four major questions: How many, who,
where and when.
2) Analytic Epidemiology
• Involves explicit comparison of groups of
individuals to identify determinants of health
and diseases.
• It answers two major questions: why? and
how?

Basic Epidemiologic Assumptions
• Two basic assumptions in epidemiology
1. Human disease does not occur at random:
there are patterns of occurrence in which some

behavioral and environmental factors (exposures)
increase the risk of acquiring/developing a particular
disease among group of individuals.

Epidemiologic Assumptions…..
2. Human disease has causal and preventive factors
• Identified through systematic investigation of populations
or group of individuals within a population in different
places or at different times.
• Thus, identifying these factors creates opportunity for
prevention and control of diseases in human population
either by eliminating the cause or introducing appropriate
treatment.
Basic features of Epidemiology
• Studies are conducted on human population
• It examines patterns of events in people
• Can establish cause-effect relationship without

the knowledge of biological mechanism
Smoking and lung cancer
• It covers a wide range of conditions
From infectious to non-infectious
From simple survey to complex drug trials
Scope of Epidemiology
• Epidemics
• Non-communicable diseases
• At present epidemiologic methods are being applied to

Maternal and Child health • Nutritional deficiencies
• Infectious and non infectious
Congenital anomalies
diseases
Cancer • Injuries and accidents
• Mental disorders
Occupational Health
• Health behaviors
Environmental Health
Purpose of Epidemiology
• To determine the burden/extent of diseases in a
community(diagnostic purpose)
• To identify the cause and risk factors of

disease(Identification of determinants)
• To study the natural history and progressive of diseases
• To evaluate both existing and new preventing and

therapeutic measures for a diseases
• To provide the foundation for providing services and

developing programs and policies
Historical Perspectives of Epidemiology

460 B.C – Hippocrates
• The “father of modern medicine”
• For the first time in the fifth century B.C.
• He suggested that the development of human

disease might be related to the external as well
as personal environmental of an individual.

John Graunt-1662
 A founder of demography
 The nature and political observation made up on the bills of
mortality
 He was the first to take quantify pattern of birth, death and diseases
occurrence
• Noting male-female disparities, high infant mortality, urban-rural
differences, and seasonal variations
 Analyzed births and deaths in London
 Excess of males born
 Infant mortality is very high
Seasonal variation for mortality
Assess the impact of plague

Life Table of the London Population
Constructed by John Graunt in 1662
Age(year) Deaths Survivors
0 - 100
6 36 64
16 24 40
26 15 25
36 9 16
46 6 10
56 4 6
66 3 3
76 2 1
80 1 0
Lind-1747
• Used experimental approach to prove the cause of
scurvy by showing it could be treated effectively with
fresh fruit.

1787-1872- Pierre Charles Alexander
Louis
• “Father of Epidemiology”
• Introduced the use of the numerical method in the field of
medicine
• systematized the application of numerical thinking and
championed its cause.
• Using quantitative reasoning,
• Numerically demonstrated that bloodletting was not
efficacious therapy.

William Farr(student of Louis )-1839
• Introduced a national system of recording causes of
death,
• Farr himself first analyzed the data with skill
• He extended the epidemiologic analysis of morbidity
and mortality data, looking at effects of marital status,
occupation, and altitude.

John Snow -1853
• “Father of modern epidemiology”
• In 1853: cholera outbreak in Soho district, in London
• Based on descriptive data, Snow suspected the

epidemics has some thing to do with the drinking water
source of the city
• He hypothesis that the cholera was transmitted by a

contaminated water through unknown mechanisms

Cholera epidemic in London
• Snow mapped the 13 public wells and all the known cholera deaths
around Soho, and noted the spatial clustering of cases around one
particular water pump on Broad Street.
• He compared the cholera mortality pattern across the drinking water

sources
• He removed the handle from the Broad Street pump and stopped the
outbreak.
• Snow's map, demonstrating the cholera deaths clustered around the

Broad Street well, provided strong evidence in support of his theory
that cholera was a water-borne disease.
• Snow found out that mortality rate was 10 times lower for the
districts Lambeth company compared with the others.
John Snow
Water Number of Deaths Death per
Company House (cholera ) 10,000 house
Southwark and 40,046 1263 315

Vauxhall
Lambeth 26,107 98 37
Rest of 256,423 1422 59

London
Bradford Hill-1937
• Bradford Hill founded the first randomized

clinical trial(Streptomycin tuberculosis trial)
• He developed criteria for assessing evidence of

causation
Level of diseases prevention

Disease prevention
• is really about avoiding disease before it starts.
• Defined as the plans for, and the measures taken, to
prevent the onset of a disease or other health problem
before the occurrence of the undesirable health event
• Disease prevention is any intervention that seeks to
reduce or eliminate diagnosable conditions
• Any measure which is directed to interrupted or slow
progress of the disease. 4 level of disease prevent…

A. Primordial prevention
• This aims at the establishment and maintenance of
condition that minimize hazards to health
• Its actions are measures that inhibit the emergency

and establishment of social condition that are
known to contribute to an elevated risk factor of
disease
• It is directed before the initiation of the disease

B. Primary Prevention
• The purpose of primary prevention is to keep healthy
people healthy, and
• Prevent them from getting disease or health related
problems.
• It directed before the initiation of disease
• Prevent the onset of illness or injury before the disease
process begins
• Example: vaccination, improved water supply, vector
control, and preventive services such as health
education, family planning.

C. Secondary Prevention
• Secondary prevention refers to a given
intervention(detection and treatment) at early stage
of a problem before it becomes serious, help to cure
• Its directed at the earlier stage of the disease
• Lead to early diagnosis and prompt treatment of a
disease to prevent more severe problems developing.
• Example: Early detection and treatment of trachoma
patient, screening for chronic disease
D. Tertiary Prevention
• People who have already been affected by a
disease,
• Activities to prevent an established disease from
becoming worse.
• This intended to limit progress or exacerbate of
diagnosis
• Preventive measures aimed at rehabilitation

following significant illness
Exercise: 1
1. Write the difference between community
medicine vs clinical medicine?
2. What is epidemiology? And list
epidemiological assumptions?
3. Write category of epidemiology?
4. Write the purpose of epidemiology?
5. Who is the father of modern epidemiology?
6. Write the level of disease prevention and
discuss and give example on each of it?
Thank you!

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Yanet

Yanet-Liyana college of Health sciences

• Level of disease prevention

Yanet-Liyana college of health sciences

• What is the public health?

Yanet-Liyana college of health sciences

• …. A state of complete physical, mental and

Yanet-Liyana college of health sciences

• Prolonging life and

• Promoting physical and mental health

• Organizing community efforts” ( Winslow 1923)

Yanet-Liyana college of health sciences

Yanet-Liyana college of health sciences

Mainly diagnosis and treatment Prevention of disease,

Focus on Evaluate health of a

Examples Internal medicine, Epidemiology,

• “Both ‘Clinical & Community medicine’ are not

• “ They are complementary disciplines. ”

• Community medicine needs ‘techniques & skills’

in addition to ‘clinical practices’.

Yanet-Liyana college of health sciences

• Discussion with the community

• Health record survey

Yanet-Liyana college of health sciences

History + physical Exam

Lab. Testes + X-ray + Other

Clinical Dx.” => Rx.=> Follow-up

• It is the process of “identification and

Yanet-Liyana college of health sciences

Yanet-Liyana college of health sciences

• It defined as “branch of medical science which treats

Yanet-Liyana college of health sciences

• The study of the frequency, distribution and

Yanet-Liyana college of health sciences

Study: means a systematic collection, analysis &

• Epidemiology involves this all,

Yanet-Liyana college of health sciences

• Epidemiology studies the number of times a

• It answers the question “How many?”

• “Epidemiology is a quantitative science”

Yanet-Liyana college of health sciences

Distribution: distribution of an event by person, place and

• Epidemiology studies the distribution of diseases

• It answers the question who , where and when?

• “Epidemiology describes health events”

Yanet-Liyana college of health sciences

– Female Vs Male Place(Where)

Yanet-Liyana college of health sciences

• Epidemiology studies ‘what determines health

• It answers the question how and why?

• “Epidemiology analyzes health events”

Yanet-Liyana college of health sciences

The determinants of health include:

• Social and economic environment: income, education, social support

• Physical environment: safe water and clean air, healthy

workplaces, safe houses, roads, access and use of services…

• Individual characteristics and behaviors: genetics, gender, balanced

Epidemiology tries to determine

• Epidemiology is not only the study of diseases

• Clinical medicine diagnoses and treats patients

• “Epidemiology is a basic science of public

Yanet-Liyana college of health sciences

• Epidemiology is a science and practice