Session 1: Introduction to Epidemiology

Avhinesh
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OBJECTIVES
At the end of the session you should be able to: Define epidemiology Identify its uses Discuss historical achievements Define specified terms and relate to community
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WHAT IS EPIDEMIOLOGY?

Originated from Greek words Epi: upon Demos: people Logy: study of

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Epidemiology Definition

Epidemiology is the study of the distribution and determinants of health related events in specified populations and the application of this study to control of health problems ( Last, 1995)

Beaglehole, Basic Epidemiology

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Epidemiology

A study or a systematic method of enquiry

Looks at distribution( what, where, when, who and frequency ( how many) of health problems and disease or health related events counting and calculation involved
looks at determinants = looks at risk factors that influence the

distribution of health related events

studies populations = interested in characteristics of groups of people

rather than individual persons

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Epidemiology
Epidemiologists

are concerned not only with DEATH, ILLNESS and DISABILITY, but also with MORE POSITIVE HEALTH STATES and with the means to IMPROVE HEALTH Epidemiology
Health
Disease Population

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Epidemiology
Historically epidemiology was developed in order to investigate infectious disease. Epidemic : is the occurrence in a community or region of cases of an illness, specific health related behaviour, or other Endemic: refers to the ongoing, usual, or constant presence of a disease in a community.

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Epidemiology
Pandemic is an epidemic affecting or attacking the population of an extensive region, country, or continent. Epidemics are often described by how they spread through the population. Two primary types of infectious-disease epidemics are common source and propagated epidemics.

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Epidemiology
Common-Source epidemic: arise from a specific source.(infected water, well) Propagated epidemics: arise from infections transmitted from person to person. Transmissions can be direct or indirect routes.(TB, Rubella)

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Phases of Epidemiology

In some text three phases are discussed while in others there are four phases. In both cases basic principles are same These include: 1. Descriptive Epidemiology 2. Analytical Epidemiology 3. Interventional / Experimental Epidemiology Evaluation Epidemiology

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Descriptive Epidemiology
Concerned with the distribution and frequency of disease or health related events Questions asked: what? problem and its frequency who ? .. Person where ? .. Place when ? time

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Analytical Epidemiology
Attempts to analyze the causes or determinants of disease or health related events Questions asked: how is the disease caused? why is it happening/ continuing? Through: hypothesis testing

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Interventional / Experimental And Evaluation Epidemiology

Concerned with evaluating and measuring the effectiveness of new and or alternative interventions Clinical and community trials are used Questions asked: what if? how effective is the intervention? have there been any improvements in health status?

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Epidemiology
Descriptive and evaluation epidemiology is extremely useful and frequently used, especially in the Pacific Analytical and experimental epidemiology are not used so often ( in Pacific) because they rely on complicated research methods. i.e. case control studies, cohort studies, clinical and community trials

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Population at Risk

Is the population made up of people who are healthy and unhealthy but who have the potential to develop the health event of interest Reference population from where the cases are taken Include those who are exposed to a disease agent, unimmunized, risk categories ( occupational injuries), population of country, town, city. Have the potential to get the disease and thus may contribute to the total number of cases Used for developing population needed for health planning, management of health programs and evaluation of health promotion and disease control activities E.g. Coverage for immunization Coverage is a measure of the percentage of people or households in need of a service of facility who actually receive it Higher coverage is better

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Uses of Epidemiology

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Natural History of Diseases

Natural history of disease is the course of disease overtime unaffected by treatment

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STAGES
Stage of susceptibility Disease has not developed but the groundwork has been laid by the presence of factors that favour its occurrence (risk factors). For example, smoking, alcoholism and stress are the risk factors for hypertension.
1.
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2. Stage of pre symptomatic disease

Pathological changes have started but asymptomatic (incubation period, latency period). For example, arthrosclerosis is happening but still undetected at clinical stage.

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3. Stage of clinical disease

By this stage sufficient changes have occurred so that person manifests signs and symptoms of disease. For example, patient may show signs and symptoms of hypertension like high blood pressure readings and dizziness.

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4. Stage of disability/ recovery.

Disease has run its course and resolved spontaneously with therapy. However for some conditions there maybe residual defect of long or short term duration. For example, if proper treatment was not instituted to the hypertensive patient then they may have stroke.

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Levels of Prevention

Primordial Prevention Aim at providing the emergence of conditions that leads to increased risk of disease. It requires policies and fiscal action to stop promotion of risk factors.
1.

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2. Primary Prevention

It prevents the occurrence of disease by minimising risk factors. For example immunization, seat belts, OHS laws, anti smoking campaigns, general health promotion on hygiene, good nutrition and chlorination of water.

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3. Secondary Prevention

It involves early detection and prompt treatment of disease. There is possibility to cure disease or slow the rate or progression or prevent complications. Requires screening by health workers. For example do pap smears, and routine blood checks.

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4. Tertiary Prevention

It consists of activities that prevent further deterioration or minimise complications on a person who has a disease. Disease has already occurred but there are rehabilitation attempts to restore an affected individual to maximal function

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Historical Overview The First Epidemiologists

THE FIRST EPIDEMIOLOGISTS Hippocrates ( 460 -377 BC) recognized association of disease with place ( geography), water conditions, climate eating habits and housing. Used terms epidemic and endemic" believed disease was result of imbalance in the bodys humors. Galen ( 129- 199AD) lifestyle factors and personality can influence health and disease. Miasma theory bad air caused disease
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Historical Overview The First Epidemiologists

T. Sydenham ( 1624 -1689) Observations should take precedence over theory in the study of the natural history of disease N. Webster(1758-1843)- Epidemics were related to certain environmental factors.

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Historical Overview The Concept of Contagion and Germ Theory of Disease

E. Jenner prevented smallpox infection by inoculating healthy people with cowpox L. Pasteur showed immunization prevented rabies. Dispelled miasma theory.

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Historical Overview Birth of Vital Statistics

J. Graunt first to quantify patterns of birth, death and disease occurrence, noting male female disparities, high infant mortality, urban rural differences and seasonal variations W. Farr looked at effects of marital status, occupation and attitude. Developed concept of mortality surveillance

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Historical Overview Early Classic Epidemiologic Studies

J. Lind (1735) Experimental epidemiologic study of the etiology and treatment of scurvy. Concluded eating citrus treated scurvy and would prevent its occurrence. Lead to British navy requiring limes or lime juice in seamens diet. How British seamen became known as limeys P.L.Panum. studied measles on Faroes Islands. Concluded measles transmitted by direct contact between infected and susceptible individuals. Suggested one attack of measles conferred lifelong immunity

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Historical Overview Early Classic Epidemiologic Studies

J. Snow (1813 -1858) Father of Field Epidemiology 20 years before discovery of the microscope, conducted studies of cholera outbreaks. Used spot maps to show case distribution. Believed water was source of infection. Removed handle to Broad Street pump to control epidemic.
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Achievements in Epidemiology
Elimination of smallpox Methyl mercury poisoning Rheumatic fever and rheumatic heart disease Iodine deficiency disease High blood pressure Smoking and lung cancer HIV/ AIDS.

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Epidemiology a way of asking questions and obtaining answers leading to further questions to be answered

What is the event/ problem? What is the magnitude? Where did it happen? When did it happen? Who are affected? Why/ how did it happen?

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Epidemiological Triangle
who (Host)

where (Envir)

what( Agent)

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