Epidemiology…An Overview

Objectives
By end of the session, students will be able to:

1. Verbalize the definition of epidemiology, objectives,

and history.
2. Review the basic concepts related to epidemiology
3. Compare the different phases of natural history of
disease transmission
4. Review the epidemiological measurements

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 Epidemiology
-Derived from Greek words;

• Epi = on/upon
• Demos =people
• Logos =study

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 Epidemiology
-Pertains to the study of 3Ds of disease/
health related conditions.
• Distribution
• Dynamics
• Determinants

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 Epidemiology
Epidemiology is a population-focused
applied science that uses research and
statistical data collection methodology to
find:
• Who in a population is affected by a disease,
disorder or injury?
• What is the occurrence of this health problem in
the community?
• Can the causative/ risk factors contributing to
the problem be determined?

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 Epidemiology
The study of the distribution, dynamics, and
determinants of health-related states or
events – including diseases in populations,
and the application of this study to the control
of diseases and other health problems.

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 Objectives of Epidemiology
• To identify the cause of health related
states
• To determine the health status of a
population
• To identify risk factors for disease
prevention
• To evaluate the efficacy of a community
program

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 History of epidemiology
• 500 BC, Hippocrates, a Greek physician
and father of modern medicine was the
first who use observation and data
collection to describe infectious disease
such as tetanus and mumps.
• John graunt (1620-1674) is credited with
the first analysis of birth and death records

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 History of epidemiology
• During 17 and 18 centuries vital record
collection and analysis became important tools
to determine the impact of epidemics on
communities by examining age distribution and
seasonal changes in the number of deaths.
• John snow(1813-1858) has carried out
epidemiological investigation, in that he
investigated an out break of cholera in London
and linked the cause of the epidemic to
contaminated water supply.
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10
 Basic concepts in the
epidemiological approach
• Epidemiological triad:
-Agent
-Host
-Environment

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 Basic Concepts in the
Epidemiological Approach
• Agent: a toxic substance, microorganism,
or environmental factor, such as radiation
or lifestyle, that must be present or absent
for the problem to occur.
• e.g:
• Smoking lung cancer
• Type A personalities heart disease

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Lilienfeld and stolley(1994) have classified
agents into four categories.
• Nutritive elements: excesses or
deficiencies with in a host.
… cholesterol hyperlipidemia
… iron levels anemia
• Chemical agents: include poisons and
allergens.
Carbon monoxide, some foods and
medicines.

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• Physical agents:
agents radiation, excessive sun
exposure, and mechanical agents.
….The widespread use of computer, many
people have develop a type of carpal tunnel
syndrome. This condition has been traced to
the position in which the hands are held for
longer period of time while working on
computer. Therefore frequent change of
hands positions and periodic breaks when
working on computer is recommended.

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• Infectious agent:

Bacteria
Viruses
Fungi

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 Basic concepts in the
epidemiological approach
• Host: The person/population on which the agent
acts.
 Major considerations:
 Genetic factors; sickle cell anemia and
hemophilia
 Age
 Gender
 Ethnic factors; higher rate of sickle cell anemia
among African Americans

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 Physiological/ psychological state;
 Pregnancy, obesity, high blood presser…
leads to disease, disability, or injury
 Stress…important factor in the
development of many diseases and
conditions.

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 Preexisting disease and immuno-
competence;
• Persons with AIDS are more likely to
develop tuberculosis
 Lifestyle factors;
• Amount and type of exercise, dietary
patterns/ elements, alcohol/ smoking
habits…key risk factors in the
development of certain diseases and
conditions.

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 Basic concepts in the
epidemiological approach
• Environment:
 comprises those factors outside of the host that are
associated with the development of disease, disorder, or
injury
 Elements of the environment that must be considered
when linking agent and host includes;
o Geographic factors (climate, latitude, altitude)
o Occupational hazards
o Personal trends (socio-economical status, housing
standards. E.g. sewage treatment, availability of
immunization

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Epidemiological triad

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The natural history of a disease
• The unaltered course that a disease would
take without any intervention such as
therapy or lifestyle change.
• The concept can be more clearly
understood by viewing it as a continuum.

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 Continuum of natural history of a
disease

Development of disease
Exposure to agent Sign/ symptoms Disability or death

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 Continuum of natural history of a
disease with detection via a screening
test in the preclinical stage
Development of disease
Exposure to agent Sign/ symptoms Disability or death

Detection by a Detection by routine

screening test clinical methods

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 Natural History of Disease
Exposure to Agent
Symptom
Development
Pre-exposure
Stage: Preclinical
Stage:
Factors present
leading to Exposure to Clinical Resolution
problem causative Stage: Stage:
development agent: no
symptoms Symptoms Problem resolved.
present present Returned to health
or chronic state or
death

Primary Secondary Tertiary

Prevention Prevention Prevention

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 Natural History of Untreated HIV
Disease
• Viral transmission
• Acute Retroviral Syndrome
• Recovery and seroconversion
• Asymptomatic chronic HIV infection
• Symptomatic HIV infection
• Death

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 Evolution of HIV Disease
Seroconversion Clin. latency Clin. AIDS
illness
Viraemia
Antibody

CD4

1 12 1 2 3 4 5 6 7 8 9 10 11 12
weeks Years
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Window
 Epidemiologic Measurements
 Disease frequency;
-Simple count of those individuals who have the
disease/ health condition of interest.

• Example;

“City A reports 55 cases of tuberculosis, while city B

reports 35 cases. With only this information the
provincial public officer would assume that city A had a
larger out breaks of tuberculosis and therefore required
more financial resources and public health nurses to
combat the spread of disease”.

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• However, if city A has a population of 75,000 and city
B has a population of 15,000, it can be seen that the
city B actually has the more severe problem with the
disease. The picture will be even more clear if a time
factor also consider; for example city A’s cases are
reported for a period covering one year, and city B’s
cases occurred during a six month period.
Where does the resources should be
deployed?

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 Epidemiologic Measurements
 Prevalence rate;
• The proportion (percentage) of the population
that has a disease/ health condition at a given
time.
 Point prevalence;
• The total numbers of diseased persons at a
specific point in time.

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Incidence rate;
• The rate of change from the non-diseased
state to the diseased state among persons
at risk
• Reflect new cases of the disease or
condition in a specified time period

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 Difference Between Prevalence
and Incidence
 Prevalence  Incidence
• Static measure • Dynamic measure
• Measure of the • Measure of the risk or
overall burden of probability of
disease at any one developing a disease
point in time during a specified
period of time.

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 Example: how prevalence and
incidence are determined
• A population of children < 5 year of age
was screened for malnutrition.
Anthropocentric measures were obtained
to determine the nutritional status.48 out of
1671 children were found with severe mal
nutrition. In this situation the prevalence
rate would be expressed as;
• Prevalence= 48 (1000)=28/1000
• 1671

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• To determine the incidence in the same
population we must start with the population at
risk of developing malnutrition . In this example
the ‘at risk’ population would be;
1671- 48 = 1623
The 48 children are not included because they
are already malnourished, therefore can not be
at risk of becoming mal nourished. Next during a
specified period of time, we determine all new
cases of severe malnutrition that develop in our
population at risk. If we found 100 new cases of
severe malnutrition over a period of one year,
the incidence rate would be;
• Incidence = 100/1623 (1000)=62/1000
•

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 Vital Statistics Formulas

Total number of live births

(Crude) live birth Total population X 1,000
rate =

Total number of deaths

(Crude) death rate = Total population X 1,000

Number of deaths from a

Cause-specific specific cause X 100,000
mortality rate = Total population

Number of maternal deaths

Maternal mortality Total number of live births X 100,000
rate =

Number of neonatal deaths

Neonatal mortality Total number of live births X 1,000
rate =

N Number of infant deaths

Infant mortality rate Total number of live births X 1,000
= 34
 Reference
Hitchcock. J & Schubert. P(2003). Community
Health Nursing: Caring in Action.(2nd ed.)
Delmar

Stanhope. M & Lancaster. J (2004). Community

and Public Health Nursing(6th Ed). Mosby

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