Epidemiological Concepts of

Disease Causation

By:
Abdusamed M., PhD fellow

May, 2022
12/31/2023 Harar, Ethiopia
 Learning Outcomes
After completion of this session, the learners will be able to;
• Describe the concepts of disease causation
• Discuss the epidemiological models in disease causation (epidemiological
triangle, web of causation, wheel model)
• Identify factors in causation
• State Time, Place and Person concept in disease causation
• Establish causation
• Designate the natural history of diseases (communicable and non-
communicable)
• Discuss the level of disease prevention

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 Definition of Epidemiology
• Epidemiology comes from the Greek words:
• Epi, meaning on or upon
• Demos, meaning people
• Logos, meaning the study

• The word epidemiology has its roots in the study of:

• What befalls a population?

Comprehensive Definition:
• Epidemiology is the study of the health of human populations

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Epidemiology
• Is the study of
 The distribution and determinants of health-related states or events in
specified populations, and
 The application of this study to the control of health problems
• What does mean by:
• Study?
• Distribution?
• Determinants?
• Health-related states or events?
• Specified populations?
• Application?
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Key terms in the definition…… Study
Epidemiology is;
• A scientific discipline with sound methods of scientific inquiry at its
foundation
• Data-driven and relies on a systematic and unbiased approach to the collection,
analysis, and interpretation of data
• A method tends to rely on careful observation and use of valid comparison groups to
assess whether what was observed
• The basic science of public health, and for good reason
 How???
• Epidemiology is a quantitative discipline that relies on a working knowledge of;
 Probability, and statistics, and
 Sound research methods
• Epidemiology is a method of causal reasoning based on developing and testing
hypotheses 5
Key terms…… Distribution
• Epidemiology is concerned with the frequency and pattern of
health events in a population
Frequency:
• Refers to the number of health events and the
relationship of that number to the size of the population
• The resulting rate allows epidemiologists to compare
disease occurrence across different populations

Pattern
• Refers to the occurrence of health-related events by time, place, and
person
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Person (Who??)
• It defines a given health problem by using:
 Inherent characteristics of people: e.g. age, sex, race,
 Biologic characteristics: e.g. immune status,
 Acquired characteristics: e.g. marital status, activities (occupation,
leisure activities, use of medications/tobacco/drugs),
 The conditions under which they live: socioeconomic status, access to
medical care

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Place
 Answering Where do they live?
• Describing the occurrence of disease by place provides insight into the geographic extent
of the problem and its geographic variation
• Such as urban/rural differences, and location of work sites or schools
• The unit may be as large as a continent or country or as small as a street address, hospital
wing, or operating room

 Time
 When did they become ill?
 The occurrence of disease changes over time
 Displaying the patterns of disease occurrence by time is critical
• For monitoring disease occurrence in the community
• For assessing whether the public health interventions made a difference
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Key terms…… Determinants
• Any factor, whether event, characteristic, or other definable entity,
that brings about a change in a health condition or other defined
characteristic

• Are the causes and other factors that influence the occurrence of
disease and other health-related events

• What is the background fact about illness?

• Illness does not occur randomly in a population, but happens only

when the right accumulation of risk factors or determinants exists in
an individual

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Health-related states or events
• Anything that affects the well-being of a population such as
• Infectious diseases, injuries, maternal-child health, occupational health,
environmental health, behaviors, genetic markers, etc.

Specified populations
• Epidemiologist is concerned about the collective health of the people in a
community or population
• Focuses on
• Identifying the exposure or source that caused the illness;
• The number of other persons who may have been similarly exposed;
• The potential for further spread in the community; and
• The interventions to prevent additional cases or recurrences

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Scope and Application of Epidemiology

•What does epidemiology offer?

 Description of health status of populations
 Causation
 Evaluation of interventions
 Natural history and prognosis

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Functions of Epidemiology

• To discover the factors (agent, host, and environmental) which affect

health, in order to provide the scientific basis for the prevention of
disease and injury and the promotion of health
• To determine the relative importance of causes of illness,
disability, and death, in order to establish priorities for research and
action
• To identify those sections of the population which have the
greatest risk from specific causes of ill health, in order that the
indicated action may be directed appropriately
• To evaluate the effectiveness of health programs and services
in improving the health of the population

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Infectious Disease Epidemiology
• Is the study of
 Circumstances under which both infection and disease occur in a
population and
 The factors which influence their frequency, spread and distribution of
infectious diseases

o Descriptive epidemiology components: frequency, spread, distribution

o Analytical epidemiology components: factors that bring a change on

frequency, spread, distribution

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Scientific Questions of Infectious Diseases Epidemiology

 Is a disease communicable? What infectious organism is causing a

disease? – Etiologic Agents

 What is the mode of transmission? How fast is the infectious agent

transmitted? - Transmission mode

 What are the contact and spread patterns with in the host
population? - Susceptibility

 What is the source or reservoir of a point source epidemic? -

Reservoir
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  What is the natural history of infection in individuals?
• Latent period, and the duration and degree of infectiousness
• Probability of becoming symptomatic
• Incubation period from acquisition of infection to symptoms
• Duration of symptoms
• Probability of dying

Source: Centers for Disease Control and Prevention. Principles of epidemiology, 2nd ed. Atlanta: U.S.
Department of Health and Human Services;1992. 15
12/31/2023
 What are the dynamics of the infectious agent and any
vector?
• Is the microbe endemic or epidemic?
• Is a disease reemerging?
• Temporal and spatial aspects of the agent and any vectors
• Genetic variants of the microbe
• Is the microbe developing drug resistance?
• Does transmission intensity influence microbial diversity?

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 What are the effects of covariates or interventions on
infection, disease, and infectiousness?
 Infection (risk factors for exposure/susceptibility)
 Disease progression (risk factors)
 How can infection and disease be prevented?
 Effect of intervention
• Individual level
• Population level
• Community level

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Concepts of Disease Causation
• A critical premise of epidemiology is to identify the factors that
place some members at greater risk than others

• Specifically;
Disease and other health events do not occur randomly in a population
More likely to occur in some members of the population than others-
exposure opportunity
Risk factors may not be distributed randomly in the population

• Not all associations between exposure and disease are causal

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 Cause:
• A cause of a disease can be defined as a factor that influences the
occurrence of disease
• This can be explained by either of;
 Necessary Cause: A causal factor whose presence is required for the
occurrence of the disease OR
 Sufficient Cause: A causal factor or collection of factors whose presence
is always followed by the occurrence of the disease
 For example,
• Necessary cause for AIDS: HIV exposure
• Sufficient cause for AIDS: exposure to an individual with HIV,
repeatedly engaging in risky sexual behavior, absence of antiretroviral
drugs that reduce viral load of HIV
 Assignment 2:
• List the Necessary and Sufficient causes for Covid-19 (5 points)
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Epidemiological Model/Triad in Disease Causation

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Agent:
• Is parasite, or other microbe
• Generally, the agent must be present for disease to occur;
• However, presence of that agent alone is not always sufficient to cause disease
• A variety of factors influence whether exposure to an organism will result in
disease,
E.g. the organism’s pathogenicity (ability to cause disease) and dose
Environment
• Refers to extrinsic factors that affect the agent and the opportunity for exposure
• Include
Physical factors such as geology and climate,
Biologic factors such as insects that transmit the agent, and
Socioeconomic factors such as crowding, sanitation, and the availability of
health services
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 Host
• Refers to the human who can get the disease
• A variety of factors intrinsic to the host, sometimes called risk factors, can influence
an individual’s exposure, susceptibility, or response to a causative agent
• Opportunities for exposure are often influenced by
Behaviors such as sexual practices, hygiene,
Personal choices
Age
Sex

• Susceptibility and response to an agent are influenced by factors such as

 Genetic composition,
 Nutritional and immunologic status,
 Anatomic structure,
 Presence of disease or medications, and
12/31/2023  Psychological makeup 23
 Agents of Disease-Etiological Factors
 Nutritive elements  Inherent characteristics
 Excess: cholesterol, obesity • Genetic: Haemophilic, diabetes,
 Deficiencies: vitamins, proteins, asthma
calories, minerals • Age
• Sex:
 Chemical agents: Carbon monoxide,  Thyrotoxicosis, obesity- females
lead, asbestos, benzene, drugs  Peptic ulcer, accidents- males
• Race: sickle cell, haemophilia
 Physical agents: Ionizing radiation,  Acquired characteristics
heat, sound • Immune status
• Life style difference
 Infectious/biological agents: • Nutritional status
Metazoan, Protozoa, Bacteria, Fungi,  Activities related
Rickettsia • Work, recreation, religious practice,
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 Disease Prevention
• It is commonly refers to interventions (either population or
individual-based) which aim to minimize the burden of diseases
and associated risk factors (WHO, 2017)

• Focuses on specific efforts aimed at reducing the development

and severity of chronic diseases and other morbidities

 Level of Disease Prevention

• It is defined as all the measures available
To reduce or limit impairments and disabilities, and
To promote the patients' adjustment to irremediable conditions

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 Levels of Disease Prevention
• There are three levels of prevention:
1. Primary Prevention— intervening before health effects
occur
2. Secondary Prevention— screening to identify diseases in
the earliest
3. Tertiary Prevention— managing disease post diagnosis to
slow or stop i.e. Improving treatment and recovery

 Assignment 3:
• Describe the three levels of disease prevention in detail
for nCovid-19 viral infection (10 points)
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Primary Prevention
Designed to prevent a disease or condition from occurring in the first place
• Examples: immunization, physical activity to reduce risk

Secondary Prevention
Identify a disease at its earliest stage so that prompt and appropriate management
can be initiated
• Example: A person gets a mammogram to detect breast cancer or gets screened
for glaucoma
Successful secondary prevention reduces the impact of the disease

Tertiary Prevention
Reduce or minimize the consequences of a disease once it has developed
• Example: most medical interventions
Eliminate, or at least delay, the onset of complications and disability due to the
disease
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Assignment 4 (10 points)

• Title: Epidemiology of childhood pneumonia in the context of climate

• Describe how childhood pneumonia results from the interaction between the
agent and the susceptible host in climate variability that supports
transmission of the agent from a source to that host by addressing issues of
equilibrium state in which causal factors balancing

 Hint:
• Climate parameters: Temperature, relative humidity, rainfall
• Etiologic agents suitability
• Host susceptibility or opportunities for exposure 28