Epidemiology

Epidemiology
• study of the distribution and determinants
of disease frequency in human population

Two main areas of investigation

1. Study of the distribution of disease
2. Search for the determinants (causes) of the
disease and its observed distribution
 Anatomy of the definition
• Population of interest are human
populations
• Describe distribution of health and disease
by person, place and time
• Identifies determinants of health and
disease ( risk factors, causes)
• Health and disease ( injury, illness,
disability or death
 Uses of Epidemiology
• Elucidate disease etiology
• Explain local disease pattern
• Describe the natural history of disease
• Provide guidance in the administration and
evaluation of health services

ULTIMATE GOALS OF EPIDEMIOLOGY

Prevention of Disease
Maintenance of Health
Describing Disease Occurence
 WHO ?
 WHERE?
 WHEN?
 PERSON
• refers to the characteristics of the individual
who were exposed and who contacted the
infection of disease in question

• characteristics are important because:

o affect risk of exposure to a source of
infection
o affect host’s resistance or susceptibility
o to infection
 PERSON
• Inherent Characteristics
- age, gender, race

 Acquired characteristics
- socio-economic status, marital status,
family size, occupation, lifestyle, customs,
practices, diet, etc
 PLACE
• refers to the features, factor or conditions
which existed in or described the
environment in which the disease occurred
 PLACE
• Geographic distribution
 Features/ conditions which existed to
describe the environment in which the
disease occurred
 PLACE
• Some basis for distribution of cases by
place
- place of residence
- place of work
- place s visited / route of travel
- birthplace
 TIME
• refers both to the period during which the
cases of the diseases being studied were
exposed to the source of infection and the
period during which the illness occurred
 frequency over time
- epidemic
- cyclic fluctuation
- secular trend
 SOURCES OF DATA
• Types of Data
1. Primary data
2. Secondary data
 SOURCES OF DATA
2. Secondary data
- vital registration
- routine reporting from health facilities
- disease registries
- surveys
- screening
- patient records
 SOURCES OF DATA
 Notifiable Diseases (2001, FHSIS)
- Anthrax - Neonatal tetanus
- Cholera - Non – neonatal tetanus
- Diphteria - Meningococcal infection -
Leprosy - Viral encephalities
- Rabies - Paralytic shellfish
- Malaria poisoning
- Typhoid and paratyphoid
- Leptospirosis fever
- Measles - Perstusis
 SOURCES OF DATA
 Notifiable Diseases (Syndromes)
- Acute Flaccid Paralysis
- Acute Hemorrhagic Syndrome
- Acute Lower Respiratory Tract Infection &
Pneumonia
- Acute Watery Diarrhea
- Acute Bloody Dirrhea
- Food Poisoning
- Chemical Poisoning
EPIDEMIOLOGic
APPROACHES
Phases
Epidemiologic Approaches
 Descriptive studies
• explain the pattern of occurrence of
disease or condition by person, place or
time
• very useful to describe patterns of disease
occurrence as well as formulate reseach
questions
 Types of Descriptive Studies
• Case Report / Case Series
- describe the experience of a single patients or a
group of patients with similar diagnosis
Case Report

Case Series
- collection of individual case reports, which may
occur within short period of time
 Types of Descriptive Studies
• Ecologic Study / Correlational study
- Comparison of disease and exposure
between groups
 Types of Descriptive Studies
• Prevalence study
- provide information on prevalence of
disease or provide health
conditions/outcomes among individuals in
a defined population.
 Types of Analytical Studies
• Cross – Sectional Study
- examines the relationship between a disease
and other variables of interest as they exist in a
defined population at one particular point in time
- provide information about the frequency and
characteristics of a disease by furnishing a
“snapshot” of the health experience of the
population at a specified time
- also referred as prevalence survey or
prevalence study
 Types of Analytical Studies
• Uses of Cross – Sectional Study
- to determine the magnitude of disease
- to generate hypothesis with regard to
disease etiology
- to evaluate medical care or health
service delivery as a whole
- to establish baseline data
 Types of Analytical Studies
• Case Control Study
- cases of people who have the disease
are compared with controls – healthy
individuals chosen to match the cases
- to show that the probability of
exposure is greater in those with disease
that those without disease
- optimal for investigation of rare
disease
 Types of Analytical Studies
• Case Control Study Analysis of Data
- ODDS RATIO – measure of association
- calculated by dividing the ratio of exposed
subjects to nonexposed subjects in the case
group by the ratio of exposed subjects to
nonexposed subjects in the control group
- OR = 1 – no association
- OR = 1 – association; > 1 risk factor
< 1 protective factor
 Types of Analytical Studies
• Cohort Study/Follow-up Study
- a type of observational study in which a
group or groups of persons are defined on
the basis of presence or absence of
exposure to a suspected risk factor of a
disease
- starts with a group of individuals free
of disease
- prospective, retrospective studies
 Types of Analytical Studies
• Applications of Cohort Study
- to identify the risk factor for diseases
- to identify protective factors against diseases
- to identify prognostic factor for outcome of
disease
- to decribe the natural history of disease
- to project the number of new cases of disease in
the population over a period of time
- to assess the effectiveness of preventive
program/ measures
 Types of Analytical Studies
• Measure of strength of Association for
Cohort Study
- RELATIVE RISK – the ratio of the incidence
rate for persons exposed to the factor to the
incidence rate for persons in the unexposed
group.
- relative risk = 1 – no association
>1 – increased risk
< 1- decreased risk
 Types of Analytical Studies
• Randomized Clinical Trial
- usually done to test new treatment for a
disease
- one group is exposed to the intervention
while the control group is not exposed