INTRODUCTION TO

EPIDEMIOLOGY
Dr. Muhammad Bilal Shah
MBBS, MPH
Lecturer in BMC Bannu
 What is Health?

WHO Definition
• World Health Organization (WHO), defined
Health as being “a state of complete physical,
mental, and social well being and not merely
the absence of disease or infirmity” 
 Public Health
(Prof Winslow-1920)

The science and art of

 Preventing disease

 Prolonging life

 Promoting physical & mental health and

efficiency
Through Organized Community Efforts for the

 Sanitation of Environment

 Control of Communicable Diseases

 Education of the individual in Personal Hygiene

 Organization of Medical and Nursing Services for

the early diagnosis and preventive treatment of

disease

 Development of Social Machinery to ensure

everyone a standard of living adequate for the

maintenance of health
 Public Health ….

• Prevents epidemics and the spread of

disease

• Protects against environmental

hazards

• Responds to disasters and assists

communities in recovery
 Public Health ….

• Prevents injuries

• Promotes healthy behaviors

• Assures the quality and accessibility of

health services
 What is Epidemiology?

• 3 Greek roots:
• Epi: Upon.
• Demos: Human population.
• Logia: Science.

• “Science that deals with the distribution,

determinants & frequency of diseases in
human population”.
 What is Epidemiology?

• The study of the determinants, distribution

and frequency of disease or health-related
events in specified populations and
application of this study to the control of
health problems.

(Porta M, Last J, Greenland S. A Dictionary of Epidemiology, 2008)

 Determinants, Distribution &
Frequency Of Disease
DETERMINANTS DISTRIBUTION FREQUENCY

Agent Time Rate

Host Place Ratio

Environment Person Proportion

Types of Epidemiology
 5 W’s of Epidemiology

5 W’s Epidemiology

What? Diagnosis or health

event
Who? Person/population

Where? Place of occurrence

When? Time of occurrence

Why? Mode of transmission

The Epidemiologic Triad
(Ecological Triad)
(for infectious diseases)
 The Epidemiologic Triad
(for non infectious diseases)
Factors Associated with Increased Risk of
Human Disease
 Agent

An organism, a substance or a force, excessive

presence or relative lack of which may initiate a
disease process or may cause it to continue.
• Living or Non-living
• Tangible or Intangible
 Types Of Agents
• BIOLOGICAL AGENTS Bacteria, Viruses, Fungi,
Parasites (Helminthes, Protozoa, Arthropods)
• PHYSICAL AGENTS Heat, Cold, Light, Noise,
Radiation, Atmospheric Pressure, Mechanical Forces
• CHEMICAL AGENTS
 Exogenous Acids, Alkalis, Gases, Metals, Dusts
 Endogenous Urea, Ketone Bodies, Insulin,
Cholesterol
 Types of Agents (Contd)

• NUTRIENT AGENTS Fats, Carbohydrates,

Proteins, Vitamins, Minerals, Fiber & Water

• PSYCHOLOGICAL AGENTS Stress, Fear,

Anxiety, Emotions, Shock

 Host
• A person or animal (including birds
and arthropods) that affords
subsistence or lodgment to an
infectious agent under natural
conditions
 Host (Types)
Primary / Definitive Host
Host in which the parasite attains maturity or passes its
sexual stage e.g. mosquito for malarial parasite.

Secondary / Intermediate Host

Host in which the parasite is in a larval or asexual state
e.g. man for malarial parasite.
Obligate Host

Obligate host means the only host e.g. man in measles

and typhoid fever.

 Host Factors

• Demographic Characteristics
• Biological Characteristics
• Socioeconomic Characteristics
• Lifestyle
• Physical State of the body
• Psychological State & Personality
 Demographic Characteristics

Age
 Children Measles, Whooping cough, Diarrhea
 Old age Cataract, Parkinsonism
Sex
 Males Hemophilia, Gout
 Females Rheumatoid Arthritis
Demographic Characteristics (Contd)

• Marital Status
• Married Women Cancer Cervix
• Unmarried Adults STD

• Race
• Negroes Sickle cell anemia
• South East Asia Close-angle Glaucoma
 Biological Characteristics

• Genetic Constitution

• Chromosomal Disorders, Hemophilia,

Diabetes, Color Blindness

• Physiological & Biochemical Characteristics

• Serum Lipids, Blood Glucose levels

Biological Characteristics (contd)

• Nutritional Status

• Vitamin D deficiency, Iodine deficiency,

Fluorosis

• Immune Status
 Socio-economic

• Economic Status

• Occupation

• Social Class, Place of living

• Education

• Religion
 Life Style
• Living habits
• Food habits
• Use of alcohol, Tobacco, Drugs
• Physical activity
• Personal hygiene
 Physical State

• Fatigue
• Fasting
• Cold
Psychological State & Personality

• Compulsive habits, Behavior patterns &

Personality traits have great influence on health

• Too much worry and mental tension-

Psychosomatic conditions, Hypertension, Peptic
Ulcer, Coronary disease

• Accident-prone personality
 Environment

• Aggregate of all external conditions and

influences, which affects the life and
development of an organism, human
behavior or society
 Types of Environment
• Physical Air, Soil, Water, Climate, Seasons
• Biological Plants, Animals, Micro-
organisms
• Socio-Cultural Culture, Beliefs, Attitudes,
Economic factors, Urbanization &
Industrialization
 Distribution
• Epidemiologists study the distribution of
frequencies and patterns of health events within
groups in a population

• To do this, they use descriptive epidemiology,

which characterizes health events in terms of
time, place and person (or ‘when’, ‘where’,
‘who’)
 Cases

Person Time

Place
1200 25

1000 20
800
15
600
10
400
200 5

0 0
0-4 '5-14 '15- '45- '64+ 1 2 3 4 5 6 7 8 9 10
44 64
Age Group

Evaluate information

Pathogen? Source? Transmission?

Place
 Person
• Racial characteristics may also be important predictors of disease
risk
• For example:
 Glucose-6-phosphate dehydrogenase deficiency occurs mainly
among Africans and people from the Mediterranean region.
 Melanoma (skin cancer) is very rare among blacks, and much more
common among Caucasians.
 Poorer health status experienced by Indigenous people in Australia

 Often related to diet, behavioral and socioeconomic factors, rather

than genetic factors
 Determinants
• Epidemiologists also attempt to search for
causes or factors that are associated with
increased risk or probability of disease.

• We move from questions of ‘who’, ‘where’ and

‘when’ and start trying to answer ‘how’ and
‘why’ . This is referred to as Analytical
epidemiology
 Comparison - summary
Distribution Determinants
• Descriptive Epidemiology Determinants
Who, when, where • Analytical Epidemiology
How, why

• Measures of frequency • Measures of association

 Counts  Odds ratio
 Proportions  Relative risk
 Rates  Attributable Risk

• Data sources • Study design

 errors and biases  errors and biases

• Statistics • Statistics
 Health-related states
• Although infectious diseases were clearly the
focus of much of the early epidemiological
work, this is no longer true

• Epidemiology now applies to the whole

spectrum of health-related events including
chronic diseases, environmental problems,
behavioral issues and injuries in addition to
infectious diseases
 Population focus
• One of the most important distinguishing
characteristics of epidemiology is that it deals
with groups of people not with individual
patients
 Recommended Books
• K. Park
• Ilyas Ansari
• Leon Gordis
• Hennikens
Questions??
Thank You