Epidemiology

Epidemiology
Defined

Epidemiology is the study of factors that affect the health and cause diseases in
populations that is why it is known as the "backbone of disease prevention".
It is derived from the Greek words "epos" which means upon and "demos" which
means people. It is the systematic and scientific study of the distribution patterns
and determinants of health, diseases and conditions in a population for the purpose
of promoting wellness and preventing diseases or disease-causing conditions.
 Uses of Epidemiology
The objective of epidemiology is to provide effective solutions for controlling
diseases and preventive measures to populations that are at risk. The results of the
epidemiologic study could be used to formulate the control measures that could be
instituted to solve, if not completely eradicate the health problems.

1. Study the history of the health population and the rise and fall of diseases and changes
in their character,
2. Diagnose the health of the community and the condition of the people to find out the
distribution and dimension of illness in terms of incidence, prevalence, disability and
mortality, and to identify groups needing special attention;
3. Study the work of health services and improve them.
4. Estimate the risk of disease, accident, defects and how to avoid them;
5. Identify syndromes by describing the distribution and association. of clinical
phenomena in the population;
6. Complete the clinical picture of chronic disease and describe their natural history,

7. Search for the causes of health and disease by comparing the experience of
groups in terms of their composition, inheritance, experience, behavior and
environments; and Community Health Nursing and Community Health Development

8. Helps the nurse to analyze the different factors that contribute to disease
development by identifying factors related to time and place and person
characteristics to explain how the disease occurs or spreads.
Multiple Causation Theory

Multiple Causation Theory or Ecologic Concept of Disease states that health

conditions result from a multitude of factors which must be analyzed and
understood in terms of the relationship where a change in any of the three
components will alter the internal and/or external equilibrium which eventually
brings about disease or illness. Multiple causation is the canon of contemporary
epidemiology and its metaphor and model is the 'web of causation'.
 Web of Causation
Cause is a condition, reason or ground that plays a significant role in the
occurrence of a disease. It is often difficult to find causes for health-related
events or chronic disease as they are multiple and heterogeneous. All
these factors collectively form the "web of causation", where every cause
is interconnected just like the spider's web.
1. Microorganisms
2. Genetic abnormalities
3. Socio-economic factors
4. Environmental factors

The type, duration, rate of exposure to these different factors, the

general health status of the population and utilization of health resources
can result to different outcomes depending on the manner in which the
individuals and families respond to risk factors and even the disease
process itself.
Ecologic Triad
The triad talks of the three components of the disease process which
are the agent, the host and the environment. It is also known as the
Ecologic Triad or Epidemiologic Triangle. The epidemiology triad is a
model of how an infectious disease is spread. It consists of an agent, a
host and an environment.

1. Host - is any organism that harbors and provides

nourishment for another person or to a parasite which depends
on it for its survival.

a. It is the organism that is being infected by the agent.

b. The human is the host organism and others, like the

animals, are considered only as they relate to human health.
2. Agent - the cause, source or vehicle by which infectious organisms are
transmitted.

a. It is the organism that does the infecting such as a virus or a parasite.

b. It is the intrinsic property of the microorganism to survive and multiply in

the environment to produce disease.

c. Causative agent is the infectious agent or its toxic component that is

transmitted from the source of infection to the susceptible body.
3. Environment - is the sum total of all the external conditions (milieu,
surroundings) and influences that affect the development of an organism. It is
the place and correct conditions for the agent and to come together with the
host and infect it.

a. Physical environment are the inanimate surroundings or non-living

things like the climate or weather.

b. Biological environment is composed of all living things like plants and

animals, man, fungi, germs and other microorganisms.

c. Socio-economic environment like the presence or absence of economic

opportunities or enterprise within the community, social disruptions, problems
like prostitution, drug addiction, etc.
 Approaches to Epidemiology
Nature of Epidemiologic Approaches
One of the goals of epidemiology is to study the frequency of occurrences of health
related events. It has a major but not exclusive concern with causes and determinants of
disease patterns in populations. The premise is that a systematic investigation of different
populations can identify causal and preventive factors.

Thus, epidemiology is an observational rather than an experimental

science. Sample questions may take the form of the following:

✓Does population exposure to X increase the risk of a disease Z?

✓ Are dietary supplements (X, Y, Z} beneficial in lowering the risk of malady?

✓Do behavioral interventions reduce risk behaviors?

 Epidemiologic Classification
Descriptive Epidemiology
Descriptive epidemiology attempts to describe patterns of disease according to spatial
and temporal information about the members of a population. These patterns are described
by tabulations or summaries of surveys and polls or by parametric or non-parametric
population models. Some epidemiologists appear more interested in local patterns rather
than in global structure. This raises questions of how "realistic" certain patterns are.

Analytical Epidemiology
Analytical epidemiology attempts to explain and predict the state of a population's
health. A typical goal is to summarize the relationship between exposure and disease
incidence by comparing two measures of disease frequency.
These comparisons may be affected by chance, bias and the presence or absence of
an effect. This explains naturally why statistical methods play a major role in epidemiology
since bias is a central preoccupation of its practitioners. Bias means a systematic error
which results to an incorrect or invalid estimate of the measure of association.
Approaches to Epidemiology
Comparison is the essence of epidemiology. Although populations are the
focus of each study, specific characteristics and outcomes at the individual
level are essentially measured. The following approaches are used to analyze
and determine factors that affect rates of a particular disease:

1. Case-Control Studies

a. Individuals with and without the disease of interest are recruited

systematically from the same population, and their prior histories of
exposure to potential causative and protective factors are compared.
Similarly their genotypes can be measured and compared.
 b. Some characteristics of case-control studies include:
i. Relatively short term studies (2-5 years)
ii. Less expensive than cohort studies
iii. Unmeasured confounding factors (factors that are both associated with the
exposure of interest and with the outcome of interest) may influence the estimates
of risk
iv. Selective bias may influence the estimates of risk

2. Cohort Studies

a. A population with known levels of exposure to potential causative and

protective factors is recruited and followed over time to determine who gets and
who does not get the disease(s) of interest. Genotypes of individuals can also be
measured and compared.
 b. Some characteristics of cohort studies include:
i. Longer term studies (5-20 years)
ii. More expensive than case-control studies but can be used to study more than
one disease outcome
iii. Unmeasured confounding factors may influence estimates of risk
iv. Biases are less of a problem in cohort studies.
3. Meta-analysis

a. The results of several studies can be compared and even combined statistically to
determine strength of the association.

b. Some characteristics of meta-analysis include:

i. Studies may have involved different measurements- how can they be made
equivalent?
ii. It may not always be possible to have access to data from all of the relevant
studies either because not all are published or because not all investigators are prepared
to share data.
iii. If studies were done in different ways, but all lead to same association, this
adds to the strength of the causal inference.
Patterns of Disease Occurrence
1. Sporadic - intermittent occurrence or on-and-off presence of a disease.

2. Endemic - continuous or constant occurrence of a disease in a certain area

3. Epidemic - sudden increase in the number of cases in a short period of time in a

certain area
a. Point-source epidemic/common source - there is a common vehicle in the
transmission of disease
b. Propagated epidemic or person-to-person propagated epidemic
transmission of disease from one person to another; with slow onset
c. Vector propagated epidemic (number of cases is based mainly on the
number of vectors)

4. Pandemic-worldwide epidemic or global outbreak

 Epidemiologic Process
1. Determine the nature, extent and scope of the problem
a. Establishing the epidemic - sets of data that are needed include:
i. Present frequency of the disease in the community
(prevalence of the disease)
ii. Usual frequency of the disease at the community at the same time of the year
(incidence of the disease)
1. For close surveillance if present frequency is at peak of disease ("hot")
2. Declaration of an epidemic if present frequency is greater than usual frequency

b. Appraisal of facts - involves studying the characteristics of epidemic in terms of the

distribution pattern involving:
i. Person - demographic data (age, sex, occupational distribution pattern)
ii. Place - by using the spot map of the community
iii. Time - onset of outbreak

2. Formulate a tentative hypothesis - collect and analyze data to test the hypothesis
3. Testing the hypothesis - conducting a diagnostic exam to prove the source of the
disease

4. Making conclusion and recommendations significant results of investigation

emphasizing the

5. Plan for control of spread of the disease by suggesting what can be done to stop the
epidemic

6. Implement the control program

7. Evaluate the control program

8. Make appropriate report as basis for diagnostic purposes, preventive or pre-

emptive actions to prevent the reoccurrence of the same disease or condition and
research activities.
 Herd Immunity
Herd immunity refers to the general level of immunity of a population
against a particular disease. This is usually expressed in terms of % and
is used in making public health decisions.

Summary
1. The CHN nurse uses the data related to the health profile, health needs and
problems that are obtained to come up with community analysis or health needs
assessment which is used to formulate the community diagnosis.

2. Community diagnosis is a statement of the health and health related problems

of the community or which have a high risk of developing, and the possible
causes or causative organisms and the contributory factors.

3. Community diagnosis is the end-result of data collection and analysis.