SPRING 2024

COURSE CODE: 5103 Unmilita Das Moon

CLASS 1: AN OVERVIEW OF Spring 2024

EPIDEMIOLOGY AND CLINICAL
RESEARCH
What is Epidemiology

The word ‘epidemiology’ is derived

from the Greek words:
• Epi which means on or upon
• Demos which means people, and
logos, meaning the study of.

In other words, the word epidemiology

has its roots in the study of what befalls
a population.
 EPIDEMIOLOGY?

Epidemiology is the cornerstone of public health.

It is the science that describes the relationship of health or disease with other health-related
factors in human populations, such as human pathogens.

Definition of Epidemiology:
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.

[Dictionary of Epidemiology 2001]

 EPIDEMIOLOGY?

Epidemiology: Distribution

Epidemiology is concerned with the frequency and pattern of health events in a population.

• Frequency refers not only to the number of health events but also to the relationship of that
number to the size of the population.
• Pattern refers to the occurrence of health-related events by time, place, and person. Time
patterns may be annual, seasonal, weekly, daily, hourly, weekday versus weekend, or any
other breakdown of time that may influence disease or injury occurrence.
 EPIDEMIOLOGY?

Epidemiology: Determinants

Epidemiology is also used to search for determinants which are the causes and other factors
that influence the occurrence of a disease and other health related events.

Epidemiologists assume that illness does not occur randomly in a population, but happens only
when the right accumulation if risk factors or determinants exists in an individual.
 EPIDEMIOLOGY?

Epidemiology: Determinants

Any factor that brings about a change in a health condition or other characteristics is
determinant.

• Social determinant
• Physical environment
• Biological determinant
• Lifestyle behaviors
 EPIDEMIOLOGY?

Epidemiology: Health related state or events

Epidemiology is concerned not only with disease but also with other health related conditions
because every thing around us and what we do also affects our health.
Health related conditions are conditions which directly or indirectly affect or influence health.
These may be injuries, births, health related behaviors like smoking, unemployment, poverty
etc.
 EPIDEMIOLOGY?

Epidemiology: Specified Population

What are the characteristics of the population in which we would like to understand the health
condition is specified population.

Example: Do we want to know the prevalence of diabetes in Dhaka city or in Dhaka Division
or in Bangladesh?
 IMPACT OF EPIDEMIOLOGY

Why epidemiology is important in public health?

 To identify the etiology or cause of a disease and the relevant risk factors
 To determine the extent of disease found in the community
 To study the natural history and prognosis of a disease
 To evaluate both existing and newly developed preventive and therapeutic measures and
modes of health care delivery
 To provide the foundation for developing public policy relating to environmental problem,
genetic issues and other considerations regarding disease prevention and health promotion.
 NATURAL HISTORY OF A DISEASE

Natural history of a disease

The “natural history of disease” refers to the progression of disease process in an individual
over time, in the absence of intervention.
There are four stages in the natural history of a disease. These are:
1. Stage of susceptibility
2. Stage of pre-symptomatic (sub-clinical) disease
3. Stage of clinical disease
4. Stage of disability or death
 NATURAL HISTORY OF A DISEASE

1. Stage of susceptibility
In this stage, disease has not yet developed, but the groundwork has been laid by the presence
of factors that favor its occurrence.
Example: unvaccinated child is susceptible to measles.

2. Stage of Pre-symptomatic (sub-clinical) disease

In this stage there are no manifestations of the disease but pathologic changes (damages) have
started to occur in the body. The disease can only be detected through special tests since the
signs and symptoms of the disease are not present.
Examples: Detection of antibodies against HIV in an apparently healthy
person
 NATURAL HISTORY OF A DISEASE

The pre-symptomatic (sub-clinical) stage may lead to the clinical stage, or may sometimes end
in recovery without development of any signs or symptoms.

3. The Clinical stage

At this stage the person has developed signs and symptoms of the disease. The clinical stage of
different diseases differs in duration, severity and outcome. The outcomes of this stage may be
recovery, disability or death.
Examples:
• Common cold has a short and mild clinical stage and almost everyone recovers quickly.
• Polio has a severe clinical stage and many patients develop paralysis becoming disabled for
the rest of their lives.
 NATURAL HISTORY OF A DISEASE

4. Stage of disability or death

Some diseases run their course and then resolve completely either spontaneously or by
treatment. In others the disease may result in a residual defect, leaving the person disabled for
a short or longer duration. Still, other diseases will end in death.
Disability is limitation of a person's activities including his role as a parent, wage earner, etc.

Examples:
• Trachoma may cause blindness
• Meningitis may result in blindness or deafness. Meningitis may
also result in death.
NATURAL HISTORY OF A DISEASE
 LEVELS OF DISEASE PREVENTION

Levels of disease prevention:

The major purpose in investigating the epidemiology of diseases is to learn how to prevent and
control them. Disease prevention means to interrupt or slow the progression of disease.
Epidemiology plays a central role in disease prevention by identifying those modifiable
causes.

There are three levels of prevention.

1. Primary Prevention
2. Secondary Prevention
3. Tertiary Prevention
 LEVELS OF DISEASE PREVENTION

1) Primary prevention:
The main objectives of primary prevention are promoting health, preventing exposure and
preventing disease. Primary prevention keeps the disease process from becoming established
by eliminating causes of disease or increasing resistance to disease.

Primary prevention has 3 components.

a) Health promotion,
b) prevention of exposure, and
c) prevention of disease.
 LEVELS OF DISEASE PREVENTION

A. Health promotion:- consists of general non-specific interventions that

enhance health and the body's ability to resist disease. Improvement of
socioeconomic status, provision of adequate food, housing, clothing,
and education are examples of health promotion.
B. Prevention of exposure:- is the avoidance of factors which may cause
disease if an individual is exposed to them. Examples can be provision
of safe and adequate water, proper excreta disposal, and vector control.
 LEVELS OF DISEASE PREVENTION

C) Prevention of disease:- is the prevention of disease development after

the individual has become exposed to the disease causing factors.
Immunization is an example of prevention of disease. Immunization acts
after exposure has taken place.
Immunization does not prevent an infectious organism from invading the
immunized host, but does prevent it from establishing an infection. If we
take measles vaccine, it will not prevent the virus from entering to the
body but it prevents the development of infection/disease.
 LEVELS OF DISEASE PREVENTION

2) Secondary prevention:
The objective of secondary prevention is to stop or slow the progression
of disease so as to prevent or limit permanent damage. Secondary
prevention can be achieved through detecting people who already have the
disease as early as possible and treat them.
It is carried out before the person is permanently damaged.
Examples: Early detection and treatment of breast cancer to prevent its
progression to the invasive stage, which is the severe form of the disease.
 LEVELS OF DISEASE PREVENTION

3) Tertiary prevention:
It is targeted towards people with permanent damage or disability. Tertiary prevention is
needed in some diseases because primary and secondary preventions have failed, and in others
because primary and secondary prevention are not effective.
It has two objectives:
• Treatment to prevent further disability or death and
• To limit the physical, psychological, social, and financial impact of disability, thereby
improving the quality of life.
This can be done through rehabilitation, which is the retraining of the remaining functions for
maximal effectiveness.
Example: When a person becomes blind due to vitamin A deficiency, tertiary prevention
(rehabilitation) can help the blind or partly blind person learn to do gainful work and be
economically self supporting.
 EPIDEMIOLOGY?

Epidemiologic Triangle
 EPIDEMIOLOGY?

Epidemiologic Triangle:

The Center for Disease Control (CDC) uses a model called the Epidemiologic Triangle to
pinpoint outbreaks of infectious diseases.

The triangle consists of an external agent, a susceptible host, and an environment that
brings the host and agent together.

Disease is produced by exposure of a susceptible host to a noxious agent in the presence of

environmental factors that aid or hinder agents of disease.
 HISTORY OF EPIDEMIOLOGY
HIPPOCRATES (400BC): The Greek physician Hippocrates is believed to be the first
epidemiologist. ‘On Airs, Waters and Places’- he was the first to link environmental exposures to
disease.

• The father of Medicine

• First epidemiologist
• He coined the terms endemic and
epidemic
 HISTORY OF EPIDEMIOLOGY
JOHN GRAUNT (1662): ‘Nature and Political Observations Made Upon the Bills of Mortality’
– First to employ quantitative methods in describing population vital statistics.

DOLL & HILL (1950): Used a case-control design to describe and test the association between
smoking and lung cancer.

FRANCES et al. (1950): Huge formal field trial of the Poliomyelitis vaccine in school children.
 HISTORY OF EPIDEMIOLOGY
Epidemiology is considered to have been truly born in 1854 during the cholera epidemic in
London.
 HISTORY OF EPIDEMIOLOGY

 John Snow (1813-1858) is a British anesthesiologist and a leader in adoption of anesthesia and medical
hygiene.

 He is considered to be the ‘Father of Epidemiology’ because of his work in tracing the source of a
Cholera outbreak in England in 1854.

 At that time, it was considered that Cholera was transmitted by a miasma (bad or malodorous air) which
was called the miasmatic theory.

 John Snow didn’t agree to that hypothesis. He believed that cholera was transmitted through
contaminated water.
 HISTORY OF EPIDEMIOLOGY

 John Snow reasoned his hypothesis based on different water supply companies and the areas
with high mortality rate.
John Snow carried out what we call today ‘shoe-leather epidemiology’ – going from house to
house, counting all deaths from cholera in each house, and determining which company
supplied water to each house.

 During that time, nothing was known about the biology of the
disease. Snow’s conclusion that contaminated water was associated
with cholera was based entirely on observational data.
RESEARCH
 RESEARCH

• Research is the systematic process of collecting and analyzing information (data) in order to
increase our understanding of the phenomenon with which we are concerned or interested.

• Research involves 3 main stages:

1. Planning,
2. Data collection,
3. Analysis
BASIC RESEARCH STUDY DESIGN
 RESEARCH QUESTION

• Research question is a statement which identifies the problem that the research is going to
address.
• Research question provides focal point of research and guidelines for methodologies.
• A good research question is essential to guide your research paper, project or thesis.
• A research question begins with a research problem, an issue someone would like to know
more about or a situation that needs to be changed or addressed.
 RESEARCH QUESTION

To develop a good research question the following things must be present:

• Focused on a single problem or issue

• Researchable using primary and/or secondary sources
• Feasible to answer within the timeframe and practical constraints
• Specific enough to answer thoroughly
• Complex enough to develop the answer over the space of a paper or thesis
• Relevant to your field of study and/or society more broadly
 RESEARCH OBJECTIVE

What are study objectives:

The objectives of a research summarize what is to be achieved by the study.
The objectives should be closely related to the statement of the problem.

For example, if the problem is higher rates of hypertension in urban population then the
objective should be: to identify the causes higher rates of hypertension in ‘…..’
 RESEARCH OBJECTIVE

General objective:
States what is expected to be achieved by the study in general terms.

Specific objectives:
It is recommended to break down the general objective into smaller and logically connected
parts.
Specific objectives should specify what you will do in your study, where and when.
 MEASUREMENT IN EPIDEMIOLOGY

Incidence, prevalence, and mortality rates are three frequency

measures that are used to characterize the occurrence of health
events in a population.
 MEASUREMENT IN EPIDEMIOLOGY

• Incidence: The number of new cases of a disease that occur

during a specified period of time in a population.

• Prevalence: The number of existing (new and old) cases of a

disease that occur during a specified period of time in a population.

• Mortality rate: Mortality is another term for death. A mortality rate

is the number of deaths due to a disease divided by the total
population.
 MEASUREMENT IN EPIDEMIOLOGY

Tools of measurements:

Rate: Measures the occurrence of some particular events in a population during a given time
of period. Types: Crude rates, Specific rates

Ratio: Relation of size between two random quantities. e.g. The ratio of males to females
(M:F) in Sylhet City.

Proportion: It is the ratio which indicates the relation in magnitude of a part of the whole.
RTM Al-Kabir Technical University (RTM-AKTU)

Thanks!
Campus: TB Gate, Tultikor| Sylhet Sadar, Bangladesh

E-mail: info@rtm-aktu.edu.bd
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Telephone: +880 1720 532169, +880 1766857322