SEMINAR ON

EPIDEMIOLOGY

ASHA KHOBRAGADE
READER, KNC
 DEFINITION
• Epidemiology is the branch of medical science
which deals with epidemics. (PARKIN,1873)
• Epidemiology is the study of the distribution
and determinants of disease prevalence in man
(MACMOHAN,1960)
• Epidemiology is the study of the distribution of
determinants of health related states and events
in population and the application of the study to
control health problems (LAST,1988)
 AIMS OF EPIDEMIOLOGY
• To describe the distribution and magnitude of
health and disease problems in human populations.
• To identify etiological factors(risk factors)in the
pathogenesis of disease.
• To provide the data essential to the planning,
implementation and evaluation of services for the
prevention, control and treatment of disease and to
the setting up of priorities among those services
 SCOPE OF EPIDEMIOLOGY

• According to disease group

• According to factors having relationship

with disease.
APPLICATION AND USES OF EPIDEMIOLOGY

• To study historically the rise and fall of

disease in the population

• Community diagnosis

• Planning and evaluation

• Evaluation of individuals risk and chances

• Syndrome identification

• Completing the natural history of disease

• Searching for cause and risk factor

 NATURAL HISTORY OF DISEASE
LEAVELL AND CLARK(1965) identified two
distinct period in the natural history of disease
prepathogenesis and pathogenesis.

• Prepathogenic phase
• Pathogenic phase
NATURAL HISTORY OF ANY DISEASE IN MAN
BEFORE MAN IS DISEASED
INTERACTION OF :

DISEASE HUMAN
AGENT HOST

ENVIRONMENTAL FACTORS WHICH PRODUCE

DISEASE STIMULUS
PRIMARY PREVENTION

HEALTH PROMOTION SPECIFIC PROTECTION

 THE COURSE OF THE DISEASE IN MAN

DEATH OR
EARLY ADVANCED CONVALE-
CHRONIC
DISEASE DISEASE SCENCE
DISABILITY

EARLY RECOVERY
PATHO-
GENESIS
INTERACTION OF
HOST & STIMULUS

SECONDARY PREVENTION TERTIARY PREVENTION

EARLY DIAGNOSIS
& PROMPT REHABILI-
DISABILITY LIMITATION
TREATMENT TATION
Epidemiological triad
HO
T
EN ST
AG

ENVIORMENT
 AGENT FACTOR HOST FACTORS
• Biological Agents: • Age & Sex
• • Hereditary
Nutrient Agents
• Nutrition
• Physical Agent
• Occupation
• Chemical Agent • Custom and Habits
• Mechanical Agent • Human Behavior

ENVIRONMENTAL FACTORS
• Physical Environment
• Biological Environment
• Social Environment
 Levels of prevention
• Primordial prevention
• Primary Prevention
- Health promotion
- Specific Protection
• Secondary Prevention
- Early detection followed by prompt treatment
• Tertiary prevention
- Disability limitation
- Rehabilitation
 The aims of rehabilitation

To make the disabled useful ,self sufficient and

productive members of the society.
 To make the life of disabled as rewarding as
possible.
 To allow the disabled to integrate themselves
to the society.
EPIDEMIOLOGICAL APPROCH
Asking question and making observations

epidemiologist asks question and makes observations

related to
magnitude
where?
when?
who?
The investigators tries to find out whether,
– increase or decrease in the incidence and
prevalence of disease over a time span.
– decrease or increase in the concentration of
disease in aerographical area.
– Whether the concentration is lower in one area
and higher in the other area.
– Disease occur more in women than in men or in a
particular age group.
 2. Making comparison

One group having the disease (cases)

Group not having disease (control group)

METHODS OF EPIDEMIOLOGICAL STUDIES

1) Descriptive Method
2) Analytical Method
3) Experimental Method
 Descriptive Method
concerned with the study of frequency and the
distribution of disease and health related
events in population in terms of person, place,
and time.

• Its purpose is to provide and overview of the

extend of health problem and to give clue to
possible etiological factors involved.
DATA COLLECTED ON THE BASIS OF

1. Personal Characteristics

2. Place distribution of cases

3. Time Distribution/Trends
Thus descriptive epidemiology provide
• disease nature of problem and measuring their
extend
• Clues to the etiology of disease
• Background information for planning, organizing,
implementing and evaluating ,preventive, curative
services
1) Cross sectional Studies
data is collected from cross section
of population at a one point in
time.
The results of the study are applied
on the whole population. It is also
called prevalence Study.
It is useful for details community
assessment, study of morbidity or
underline factors specially study of
diabetes or hypertension by
personal characteristics and life
style.
These studies are economical and
comparatively quick to perform.
2) Longitudinal Studies
data is collected from the same
population repeatedly over a
continues period of time by
follow up contract and there
examination.
It is useful for the studying the
natural history of disease,
finding out incident rate of
disease and identifying the risk
factors of the diseases.
More expensive and time
consuming than cross sectional
studies
2) ANALYTICAL METHOD
Descriptive study Generates the etiological clues
formulating a guess or hypothesis
e.g. “cigarettes smoking (10-20 in a day) causes lung
cancer in 10 to 15% smokers after 20 years of
exposures”,
‘wife battering is related to violence in victims
childhood family of origin ”.
hypothesis are further studied and tested by
analytical studies
Imore specific in focus, test, hypothesis and
attempt to determine casual factors of disease.
 TYPES

• Case control study

• Cohort study
Case control study :
• group of people who have been diagnosed as having a particular

problem are compared with a group of people who are similar in

characteristic to that of cases but they are free from problem

• Here the approach used is retrospective

• The data collected about the suspected factors is analyzed

statistically -- to determine the extent of its association with the

disease. This method therefore is, called as “retrospective method”.

It is also called case comparison design

 
 COHORT STUDY

It is a specific group of people at a certain time

sharing a common characteristics and experience
e.g. people born on the same day or the same year
(Birth Cohort),
couple married in same year(marriage cohort)
a class of nursing student(experience cohort)
people with the same occupation(occupation
cohort).
• COHORT STUDIES CAN BE DESIGNED IN THREE
DIFFERENT WAYS.

A. PROSPECTIVE COHORT
• prospective in nature
• expensive and time consuming
• Advantages
• this method can help in studying the natural history of
disease, estimating the incidence, rates and risk of the
developing disease.
 B. RETROSPECTIVE COHORT

It is also called historical cohort

To conduct cohort study there are three essential requisites.

1. It must be possible to identify the records of the members

of previous existing group e.g. industrial worker who were
exposure to suspected cause in past.
2. Information about the factor under study is available from
records or it can be reconstructed.
3. Information about the outcome e.g. Disease or dead for
the cohort is available.
Hospital records can helpful in cohort for determining casual
relationship for various diseases. These studies can be done
in short period and are economical in comparison to
prospective cohort study.
 
 COMBINATION OF PROSPECTIVE AND RETROPECTIVE COHORT
STUDY

• This design has characteristics of both

retrospective and prospective studies.
• The investigator identified the cohort from the
past records and traces forwards till date.
3) EXPERIMENTAL METHOD
• It is similar in approaches to cohort studies
except that conditional under the careful
control of investigator.
• Study is done to conform the etiology of
disease, establish the efficacy of
preventive or therapeutic measures and
evaluate Health care services.
• The investigator, administrator, an
intervention/gives treatment to the
experimental group.
 MORTALITY AND MORBILITY
• In epidemiological study morbidity and
mortality data are used to provide a
foundation for examining the levels of health
in community.
 Crude death No.of deaths during year
1000
rate Midyear population

Specific death No.of deaths from T.B. during year

Midyear population 1000
rate
 CASE FATALITY RATE
Case fatality = total no. of death due to
rate particular disease 100

total no. of cases due to same

disease
 PROPIONATE MORTALITY RATE
• Propotional mortality from a specific disease

number of deaths from the specific disease in a year 100

total death from all causes in that year

• Proportional mortality in specific age group

Number of death under 5 year age in the given year 100
total number of death in same year
 SURVIVAL RATE
total no. of patients alive after 5 years
Survival rate = -------------------------------------------------------- X 100
total no. of patients diagnosed or treated
 Measurement of morbidity
number of new cases of specific disease
during a given time period
Incidence rate = --------------------------------------------------------------------------- X 100
population of risk during that period
 Prevalence rate
Number of existing cases ( old or new)
in a place during a particular period
--------------------------------------------------- X 100
Number of people in a given place
during the same period
 EPIDEMIOLOGY AND NURSING
• Participate in early diagnosis and treatment
• Notification of certain specific diseases
• Trace the contacts, keep them under
surveillance
• Identify source of infection, method of spread
of infection
• Heath education of people in general
CONCLUSION
THANK YOU