In the name of ALLAH

The most Beneficent, the most

1

Merciful
Natural History of Disease
M.Saifullah
MSN*, MPH, BScN
LSN, UOL
Objectives
Upon completion of this Unit, the students
will be able to:
 Identify the concept of Epidemiology
and Disease with the help of
Epidemiological Triad; and
 Identify Epidemiological approach in
community setting.
Concept Of Epidemiology
And Disease
 Different diseases, in different
communities, show different patterns of
expected occurrence:
 Endemic: habitual presence of a disease
within a given geographic area.
 Hyperendemic :a persistently high level of
occurrence.
Conti…

 Sporadic : an irregular pattern of

occurrence, with occasional cases
occurring at irregular intervals.
(prevalence is zero)
 Epidemic: occurrence in a community or
region of a group of illnesses of similar
nature, clearly in excess of normal
expectancy and derived from a common
or from a propagated source.
Conti..

 Public health officials often use the term

outbreak, which means the same,
because it is less provocative to the
public.
 When an epidemic spreads over several
countries or continents, affecting a large
number of people, it is called a
pandemic(worldwide epidemic).
Phases of Disease

Disease
Process

Pre-
Pathogenesis
Pathogenesis
Pre-Pathogenesis

Period of disease before man is involved

Process of disease in the environment
Man in the Midst of disease
The disease agent has not yet entered man, but the

factors which favor its interaction with the human

host are already existing in the environment.
The Pathogenesis Phase
The pathogenesis phase begins with the
entry of the disease “agent’’ in the
susceptible human host. The disease agent
multiplies and induces tissue and
physiological changes, the disease
progresses through a period of incubation
and later through early and late
pathogenesis .
Epidemiological Triad

Natural history of the disease is the

process by which disease occurs and
progresses in humans involving the
interaction of three different kind of
factors:
 The causative agents;
 A susceptible host (man) ; and
 The environment.
These agents, host and environmental
factors form Epidemiological Triad.
Epidemiologic Triad
Spectrum of Disease

The term Spectrum of Disease is a graphic

representation of variations in the
manifestations of disease. It is similar to
the spectrum of light where the colors vary
from one end to the other but difficult
determine where one color ends and the
other begins.
Conti…

 At one end of the disease spectrum are

sub-clinical infections which are not
ordinarily identified and at the other end
are fatal. In the middle of the spectrum
lie illnesses ranging in severity from
mild to severe.
Spectrum of Disease
Leprosy is an excellent example of the spectral concept of disease.
Conti…

The sequence of events in the spectrum of

disease can be interrupted by early
diagnosis and treatment or by preventive
measures which if introduced at a
particular point will prevent or retard the
further development of the disease.
Conti..

 The concept of the spectrum of disease

provides for inclusion of all cases, both
subclinical and sub-clinical, in the study
of disease.
Epidemiological Approach
The epidemiological approach to the problems
of health and disease is based on two major
foundations:
 Asking Questions
 Making Comparisons.
Asking Questions

Epidemiology has been defined as “a means

of learning or asking questions and getting
answers that lead to further questions”.
For example, the following questions could
be asked, the answers to which may provide
clues to disease etiology and help the
Epidemiologist to guide planning and
evaluation.
 Questions Related To
Health Actions
 What can be done to reduce the problem and its
consequences?
 How can it be prevented in the future?
 What action should be taken by the community, by the

Health Services and by Other Sectors? Where and for

whom these activities be carried out?
 What resources are required? How the activities be

organized?
 What difficulties may arise and how can they be

overcome?
Making Comparisons
The basic approach of Epidemiology is to make
comparisons and draw inferences. This may be a
comparison of one group having the disease (or exposed
to risk factor) and the other group(s) not having the
disease (or not exposed to risk factor), or comparison
among individuals.
Conti…

 By making comparisons, the

Epidemiologist tries to find out the
crucial differences in the host and
environmental factors between those
affected and not affected. In short, the
Epidemiologist weighs, balances and
contrasts. The clues to etiology come
from such comparisons.
References

Basavanthappa, B.T. (2005). Community Health

Nursing. New Delhi: Jaypee Brothers.
Park, K. Park’s Textbook of Preventive and Social
Medicine (20th ed.).
Rao, B.S. Dr. (2005). Principles of Community
Medicine (4th ed.). Delhi: AITBS Publishers &
Distributors.
Sethi, N. Mrs. (2011). Community Health Nursing
(Principles & Practices) (1st ed.). Lahore:
Awami Book House.
www.googleimages.com
Thank you!