EPIDEMIOLOGY THE

BASIC SCIENCE OF
PUBLIC HEALTH
EPIDEMIOLOGY
The study of the distribution of health outcome or
disease within population and the factors that
determines the broader health outcomes and diseases
(risk factors)
In health care system epidemiologists focus mainly
their attentions from population level rather than
individual level.
HISTORY OF EPIDEMIOLOGY AND PIONEERS
OF EPIDEMIOLOGY
EARLY 20TH CENTURY Primary focus of epidemiology was
on infection diseases
END OF 20TH CENTURY The advent of the computer and
new methodology approaches in the health system completely
altered the field of epidemiology, which at that point is now a
standard area of medical science and the most fundamental
basic science of public health.
 THE EPIDEMIOLOGY TRANSITION
▷ Described as the changes in population, age, distribution,
mortality fertility, life expectancy and causes of death.

▷ The human population since the early aged has gone into
four major disease transitions since the start of the
agricultural period ten thousand years ago.
 THE EPIDEMIOLOGY TRANSITION
THE 1ST TRANSITION
Emerging of infectious disease and nutrition related diseases
and the beginning of the agriculture

THE 2ND TRANSITION

Patients develop physical and genetic changes to minimize
the effect of disease
THE EPIDEMIOLOGY TRANSITION
THE 3RD TRANSITION
This came when the disease pattern changed from infectious
to a chronic and degenerative disease in developed part of
the world due to improved med scheme nutrition, public
health and nutritional medicine.
THE 4TH TRANSITION
This started at the end of the 20th century when new
diseases and the re emergence of infectious disease occur
and the rapid spread of diseases due to globalization
Field of Epidemiology
and a Public Health
FIELD OF EPIDEMIOLOGY AND A PUBLIC HEALTH

a. INFECTIOUS DISEASE EPIDEMIOLOGY

▷ The epidemiological study of infectious or communicable diseases.

▷ Caused bu an infectious agent, or a by product of an infectious

agent, and it happens through transmission from an infected
individual, an animal, or a reservior to a susceptible host.
Transmission may be direct or indirect via plant or animal host,
vector, or an object.
FIELD OF EPIDEMIOLOGY AND A PUBLIC HEALTH

b. CHRONIC DISEASE EPIDEMIOLOGY

▷ The study of diseases that have prolonged duration such as cancer.
diabetes, epilepsy, stroke, arthritis, glaucoma, and asthma

c. MATERNAL AND CHILD HEALTH EPIDEMIOLOGY

▷ Focuses more on improving the health and wellbeing of women,
children, and families ang investiating off course the risk factors for
health outcomes that affect children and women specifically.
FIELD OF EPIDEMIOLOGY AND A PUBLIC HEALTH

e. ENVIRONMENTAL EPIDEMIOLOGY
▷ Focus on factors that can affect health outcomes and examples of
environmental exposure and factors.

f. NUTRITIONAL EPIDEMIOLOGY
▷ Examines association between nutrition and health outcomes, and
may focus on a diet and physical activity.
FIELD OF EPIDEMIOLOGY AND A PUBLIC HEALTH

g. HEALTH BEHAVIOR EPIDEMIOLOGY

▷ Does reasearch in the distribution and determinants of health
behavior and also evaluate interventions and services for behaviors
such as substance abuse and psychiatric disorders.

h. HEALTH POLICY EPIDEMIOLOGY

▷ The knowledge gained from epidemiology studies becomes very
important when planning for health outcomes, a disease control
program and the policy both at population and individual levels.
Epidemiology in public health is used to develop, to target, and evaluate prevention
strategies which could be primary, secondary or tertiary
PRIMARY SECONDARY
PREVENTION PREVENTION
Usually occurs before a occur when the disease
health outcomes is is already there but
present for example; of most importantly before
such primary health the symptom is noticed
prevention is and a typical example is
vaccination the doctor checking a
skin growth in order to
detect skin cancer
TERTIARY PREVENTION
Is when a person already
has symptoms of the
disease and the objectives
of this prevention is to
prevent damage and pain
from the illness and
slowdown disease
progression, complications
and a better prognosis. A
typical example of tertiary
prevention is to advice on
diet to help manage
diabetes symptoms
2 LEVELS OF PUBLIC INTERVENTION
INDIVIDUAL INTERVENTION
Focus more on bringing changes on individual risk factors or behavior, by
always putting in consideration that human being ability and affinity to
make choices, and follow through on their choices. individual on a health.

STRUCTURAL INTERVENTION
It focuses on changing physical, social, and/or economic factors in the
environment to improve public health.
DESCRIPTIVE EPIDEMIOLOGY
▷ Characteristics of person such as age, sex weight and socio-economic
status.
▷ Characteristics of place such as a country, a province, a state, a city
zip code or census track and;
▷ Characteristics of time such as long term, short term variation, by
week or day so descriptive epidemiology deals with the frequency and
the distribution of diseases and the risk factors of the population and
can be used for the hypothesis generation but not to test the
hypothesis.
USES DESCRIPTIVE
EPIDEMIOLOGY

▷ Evaluate trends of health outcomes such as smoking or if a health

status is improving or worsening

▷ Evaluate public health programs and services

▷ Identify problems or task to be studied by analytic epidemiology

ANALYTIC EPIDEMIOLOGY

▷ It primary aim is to do research and study risk factors and mostly

preventive factors for diseases.
▷ The strategy used hereby analytic epidemiology is normally a
comparison group, and focuses on the causes and effects, the why
and the how, of what causes the health outcome
In the cases of diseases and health there are two perspectives

BIOMEDICAL PERSPECTIVE
▷ It focuses more on agents that cause disease and their mechanisms
and also on individual risk factors for health outcomes however social
and environmental factors are not part of biomedical prospective

POPULATION PROSPECTIVES
▷ It focuses on social, psychological, and environmental factors linked
to health outcomes.
Epidemiology Study
Design
A. EXPERIMENTAL STUDY DESIGN
▷ Commonly provide participants with an exposure of the drug that can
be either therapeutic or preventative. There are both individual and
community experimental studies
two types of experimental study design.....
1. RANDOMIZED CONTROL TRIALS
▷ Seek to measure and compare different events/outcomes that are
present or absent after the participants received the intervention
▷ In this epidemiological study design, there is a direct comparison
between two or more treatment groups, with one serving as a control
for other
A. EXPERIMENTAL STUDY DESIGN
B. THE CLINICAL CROSSOVER TRIAL
▷ Subjects switch from one treatment to the other, (after a certain
period of time exposure), that is crossing over to the other treatment
or exposure, as we don't want the effect of the first treatment to
carry over when a person switches to another treatment. There is
usually a period in between the two exposures called a wash-out
period, when no treatment is given
B. OBSERVATIONAL OR NON-EXPERIMENTAL
STUDY DESIGN
A. COHORT STUDY DESIGN
A type of observational study design that provides the foundation for
understanding other types of non experimental study design, and here
researchers follow mostly at risk study population overtime and evaluate
exposure overtime, then determine subsequently the rate or risk of
disease or health outcome.
B. OBSERVATIONAL OR NON-EXPERIMENTAL
STUDY DESIGN
A. COHORT STUDY DESIGN
A type of observational study design that provides the foundation for
understanding other types of non experimental study design, and here
researchers follow mostly at risk study population overtime and evaluate
exposure overtime, then determine subsequently the rate or risk of
disease or health outcome.
B. OBSERVATIONAL OR NON-EXPERIMENTAL
STUDY DESIGN
B. CASE CONTROL STUDIES DESIGN
▷ In this study design researcher begins by selecting diseased Individual
or individuals with the health outcome of interest which are known as
cases and researcher also select a group of individuals without a
disease known as control.
▷ Case-control study proceeds logically from the fact, the disease or
health outcome to cause the exposure of interest, as the researcher
look back in time what the exposure was in both the case groups and
the control group.
B. OBSERVATIONAL OR NON-EXPERIMENTAL
STUDY DESIGN
C. THE CROSS-SECTIONAL STUDY DESIGN
▷ Population base within which the occurrence of disease or health
outcomes are studied, or sometime both occurrences and the
exposure are studied simultaneously.
▷ Cross-sectional studies are often used to describe the occurrence of
the health outcome or exposure of a population and the measure
used to describe this occurrence is the prevalence.
▷ The cross-sectional study is also different from the case controlled
study which starts by selecting cases and control and then looks back
at the exposure in the past.
B. OBSERVATIONAL OR NON-EXPERIMENTAL
STUDY DESIGN
D. ECOLOGIC STUDY DESIGN
▷ It is an observational study design with a main characteristic that the
exposures or health outcomes are measured at group level. Let
compares the individual exposure and the group exposure
measurements.