COMMUNICABLE

DISEASES
MPU 480
■ Aim: This course is designed to provide the student with an understanding of the
epidemiology of communicable and non-communicable diseases, population dynamics
and demography, issues in family planning, health policy and planning. Additionally,
the course aims to teach leadership and general management skills.
■ Objectives
■ By the end of the course, the student should be able to:
– Appraise population distribution, its growth and impact on the health and
economy of the country.
– Identify and formulate solutions to public health problems.
– Facilitate community participation in problem identification and in decision
making
– Provide leadership to the health teams and communities and demonstrate
management skills.
– Communicable, Non communicable diseases and other threats to public health
■ Communicable diseases, Non Communicable diseases
■ Alcohol and substance abuse, Gender, trauma and violence
■ Child abuse, Child labor
Outline

■ Description of Communicable Diseases and terms used

■ Burden Of Communicable Diseases

■ Chain of Infection

■ Screening in public health

What are Communicable Diseases?

■ Communicable Diseases or Infectious diseases are illnesses which are

caused by pathogenic agents or microorganisms and can be spread
from one person to another
■ Disease caused by transmission of a specific pathogenic agent to a
susceptible host-passed from person to person, Tuberculosis
■ Pathogenic agents include viruses, bacteria, parasites, fungi
■ Pathogenic agents can be transmitted directly or indirectly through
vectors and vehicles
Communicable Vs Non-Communicable

■ Cause: Pathogenic agents

■ Spread: Transmissible

■ Duration: Chronic

■ Progression
What are Communicable Diseases?
■ Vectors are living organisms (insects or animals) that carry the infectious
agent from person to person e.g mosquitoes

■ Vehicles are non-living substances or objects which can be contaminated

with an infectious agent –contaminated food, surgical instruments

■ Zoonotic diseases are infectious diseases of animals that can cause

disease when transmitted to humans- Ebola virus, Rabies
What are Communicable Diseases?
■ Epidemic: The occurrence in a community/region, cases of an illness or
other health related event in excess of what is normally expected-
ebola,HIV
 Community or region, time period and particulars of the population in
which the cases occur must be specified
 Number of cases to indicate an epidemic varies according to the agent,
size and type of population exposed, previous experience or lack of
exposure time and place of occurrence
 In 1981, a report on 4 previously healthy homosexual men infected with
Pneumocystis carinii pneumonia was published. Was not common in
people with uncompromised immune systems
What are Communicable Diseases?
■ Endemic: a disease with a relatively stable pattern of occurrence in a
given geographical area or population group
■ Persist in a community at a relatively constant level for a very long time
and the number of individuals affected remains approximately the same
e.g Malaria
■ Neglected tropical diseases, a group of CDs prevalent in tropical
conditions and affect mostly the poor.
o Cause morbidity and suffering and perpetuate poverty-
Elephantiasis,Trachoma, schistosomiasis
(bilharziasis), trypanosomiasis, leprosy, 
Burden of Communicable Diseases
Africa Causes of Mortality
Zambia Causes of Mortality
Zambia Comparison 1990-2017

https://vizhub.healthdata.org/gbd-compare
Burden of Communicable Diseases
■ Globally the incidence of CDs has declined but they remain a leading
cause of mortality in developing countries
■ HIV/AIDS, Tuberculosis, Diarrhoeal diseases and lower respiratory tract
infections are some of the main causes of death in developing countries
including Zambia
■ Emerging infectious diseases such as Ebola, SARS also a public health
concern- recently appeared, incidence or geographical range increasing
■ Major cause of morbidity and mortality in Zambia. HIV/AIDS, Malaria,
Tuberculosis
Eliminating Communicable Diseases
■ Goal 3: Good Health and
Wellbeing
■ Target 3.3
■ By 2030, end the
epidemics of AIDS,
tuberculosis, malaria and
neglected tropical diseases
and combat hepatitis,
water-borne diseases and
other communicable
diseases
What of Zambia specifically?
■ To eliminate local malaria infection and disease in Zambia by 2021
■ To reduce the incidence and prevalence of HIV- Achieve HIV epidemic
control, reduce HIV new infections from 48000 to less than 5000
 90,90,90 strategy
■ To reduce the number of TB deaths in the population by 40% in 2021
compared to 2015
Chain of Infection
Infectious agent
Bacteria, virus, fungi

Susceptible
Host Reservoir

Route of
Entry Route of Exit

Mode of
Transmission
Chain of Infection
■ Susceptible host: person or animal that provides a suitable place for an
infectious agent to grow and multiply
■ Infectious agent: Bacteria, virus, protozoa, fungi
■ Reservoir: The habitat in which the infectious agent normally lives,–
humans, animals (rabies), environment (water)
■ Route of exit: the path of exit of the pathogen from the infected host, the
site on the infected host through which the pathogen gets out-respiratory
tract, GIT, skin
■ Route of entry: The site through which an infectious agent enters the
host 
Chain of Infection
■ Mode of transmission: how the infectious agent spreads, the route by
which it is transmitted from a reservoir to a another person or host.
o Direct transmission- Direct and immediate transfer of an infectious
agent to a portal of entry through which infection can occur.
Touching, kissing, sexual intercourse, childbirth, airborne short
distance (coughing)
o Indirect transmission- transfer of infectious agents through
intermediates i.e vectors or vehicles
Tackling Communicable Diseases

■ Vaccinations
■ Treatment
■ Action on social determinants of health: the conditions in which people
are born, grow, live, work and age
■ Active public health surveillance: ongoing Systematic collection,
analysis, interpretation and dissemination of public health data
o Aid planning, implementation and evaluation of public health policy
and practice
o Detect epidemics, time trends, monitor and evaluate health programs
Corona Virus (WHO information)

■ On 31 December 2019, the WHO China Country Office was informed of cases of

pneumonia of unknown etiology (unknown cause) detected in Wuhan City
■ A novel coronavirus (2019-nCoV) was identified as the causative virus by Chinese
authorities on 7 January.
■ Early on, many of the patients in the outbreak in Wuhan, China reportedly had some link to
a large seafood and animal market, suggesting animal-to-person spread
■ However, a growing number of patients reportedly have not had exposure to animal markets,
suggesting person-to-person spread is occurring
■ 22/01/20 residents of Wuhan city advised not to leave and public transport halted
■ Common signs of infection include respiratory symptoms, fever, cough, shortness of breath
and breathing difficulties
■ Common signs of infection include respiratory symptoms, fever, cough, shortness of breath
and breathing difficulties
Screening in Public Health

Screening for early detection and treatment

Primary Secondary Tertiary

Prevention Prevention Prevention
Screening
What is Screening?
■ “Screening is the systematic application of a test or inquiry,

to identify individuals at sufficient risk of a specific disorder to benefit from

further investigation or direct preventive action,

among persons who have not sought medical attention on account of

symptoms of that disorder”
■ the process of using tests on a large scale to identify the presence of
disease in apparently healthy people.
Types of Screening
■ Mass screening – whole or large subset of the population

■ Targeted/selective screening – high risk groups, groups with specific

exposures, e.g. workers in lead battery factories,

■ Multiple/multiphasic screening – several screening tests at the same time.

Use of two or more screening tests together among a large group of
people-health questionnaire, clinical examination

■ Opportunistic screening/active case finding – health care level, aimed at

patients who consult a health practitioner for some other purpose
Criteria for Screening
■ Well defined disorder- serious without early detection
■ Prevalence should be well known, have a significant burden
■ Natural history should be understood
o Treatment or intervention for those found positive widely accepted
o Long period between first signs and overt disease
■ Facilities available or easily provided, diagnosis and treatment
■ Test-simple and safe, acceptable, not discriminatory (ebola)
■ Financial-cost effective
Criteria for Screening

■ Acceptability – procedures after positive screening test are agreed upon

and accepted
■ Equity- equity of access to to screening services, to safe effective
treatment
Screening Test

The ability of a screening test to correctly

Disease
distinguish between individuals with or
Positive Negative without the condition of interest-Validity

True positive False positive SENSITIVITY: probability of an

Pos itive

a b individual with the disease or risk factor

to have positive test result
Test

False negative True negative

SPECIFICITY: probability of an
Neg ative

c d individual without the disease or risk

factor to have negative test result