EPIDEMIOLOGY ..

AN
OVER VIEW

Faraz Siddiqui
Lecturer
DIONAM

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INTRODUCTION OF TEACHER
AND ROLE IN INSTITUTE

I am Faraz Siddiqui and working as Lecturer DIONAM

and I am serving in Dow University since 2008. I have
been assigned to different roles like program coordinator,
focal person for sports, LMS trainer and LMS focal
person. Currently I am teaching CHN-III to BSN
students in Semester VIII.

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 OBJECTIVES

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

 Integrate epidemiological designs in to community health nursing practice.

 Discuss the measures of diseases frequency and disease occurrence

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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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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: 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 problem Exposure to Clinical Stage: Resolution Stage:
development causative agent:
no symptoms Symptoms present Problem resolved.
present Returned to health or
chronic state or death

Primary Prevention Secondary Tertiary

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 illness Clin. latency Clin. AIDS

Viraemia
Antibody

CD4

1 12 1 2 3 4 5 6 7 8 9 10 11 12
weeks Years
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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 overall burden of disease at any  Measure of the risk or probability of developing a
one point in time disease 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 rate = Total population X 1,000

Total number of deaths

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

Number of deaths from a specific

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

Number of maternal deaths

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

Number of neonatal deaths

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

Number of infant deaths

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

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 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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