Principles of

Epidemiology
Basic Epidemiology
OBJECTIVES
 Define Epidemiology and understand its objectives

 Understand the epidemiologic approach and use

the following terms: population, sample,
distribution, case definition

 Identify the exposure and outcome in a study

 Distinguish between endemic, epidemic and

pandemic
 EPIDEMIOLOGY
& ITS OBJECTIVES
EPIDEMIOLOGY: The Study of Public
Health
 Basic science of public health
 One of the 5 core areas of PH

 Derived from the Greek word epidemos - epi meaning

"upon" and demos meaning "people".
 Study of health and disease at the population level

 Answers the who, what, when, where, why, and how

regarding health and disease
 Applies data and research to improve public health
 EPIDEMIOLOGY

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 public health problems
(Porta and Last, 2008)
EPIDEMIOLOGY: The study of the
distribution and determinants…

 Study - includes surveillance, observation and

analytical research and experiments

 Distribution – who, where, when

 Determinants - factors that influence health, causes

of disease (physical, biological, social, cultural and
behavioural)
EPIDEMIOLOGY: …the control of
public health problems
Control
• How to handle the problem
• Planning, setting priorities
• Evaluation of risks & benefits of interventions
e.g. Smoking cessation programme
Pap smears
Vaccination programme
EPIDEMIOLOGY: …determinants of
health-related states or events…

Health related states or events includes diseases,

causes of death and health related behaviours
HEALTH RELATED STATES OR
EVENTS
 Communicable diseases

 Non-communicable diseases

 Deaths

 Accidents

 Injuries

 Birth defects

 Health behaviours

 Provision and use of health services

EPIDEMIOLOGY: …events in
specified populations…

Population
• All units (people or things) under investigation
• A measurable group
 EPIDEMIOLOGY

 Focus is on the community, not just the individual

 Is concerned with both the sick and the well

 Requires tools to measure the health status of the

population. E.g. mortality rate, immunization level
 Clinical Medicine Epidemiology

 Cure patient of disease  Improve health status of the

 Clinical history, physical community
examination, test results  Population data, health
 Probable or confirmed problems, disease trends
diagnosis  Community diagnosis &
 Treatment & rehabilitation priorities for action
 Follow-up & assessment  Community health
programmes
 Evaluation of changes in
health status
4 Major Roles of Epidemiology:

1. Describing the patterns of health and disease within

populations

2. To interpret these differences

3. To apply the results into public health practice

4. To evaluate the effect of these health-related

interventions
OBJECTIVES OF
EPIDEMIOLOGY
 To identify the etiology or cause of a disease and the
relevant risk factors in order to intervene and reduce
morbidity and mortality from the disease
 To determine the extent of the disease in the community
which is important information critical for planning health
services and facilities and for training future health care
providers
 To study natural history and prognosis of the disease so
that one can develop new modes of intervention, either
through treatment or new ways of preventing complications
OBJECTIVES OF
EPIDEMIOLOGY
 To evaluate both existing and newly developed
preventive and therapeutic measures and modes of
health care delivery

 To provide foundation for developing public

policy relating to environmental problems and
other considerations regarding disease prevention
and health promotion
THE EPIDEMIOLOGIC
APPROACH
17 POPULATION
 All the inhabitants of a given country or area considered
together; the number of inhabitants of a given country or
area.

 The whole collection of units (the “universe”) from

which a sample may be drawn; not necessarily a
population of persons – the units may be institutions,
records, or events.

17
 SAMPLE
Sample
 A selected subset of a population. A sample may be
random or non-random and may be representative or
non-representative.

 The sample is intended to give results that are

representative of the whole population; it may deviate
from that goal owing to random and systematic errors.
 CASE DEFINITION

 A set of criteria (not necessarily diagnostic criteria)

that must be fulfilled in order to identify a person as
representing a case of a particular disease.

Example: WHO SARI case definition

 An acute respiratory infection with:
 history of fever or measured fever of ≥ 38 C°;
 and cough;
 with onset within the last 10 days;
 and requires hospitalization.
20 DISTRIBUTION

 Distribution refers to analysis by person, place and

time – who, where and when

 In epidemiology, we are interested in describing

the distribution of a disease in terms of person,
place and time.
Person

Place
20
Time
21 DISTRIBUTION
CHARACTERISTICS
 PERSON - Broken down by demographic,
biological, behavioural, environmental variables such
as:
◦ Age
◦ Sex
◦ Marital Status
◦ Race and ethnicity
◦ Nativity and migration
◦ Religion
◦ Socioeconomic status
PERSON
DISTRIBUTION
CHARACTERISTICS
PLACE - Broken down by variables such as:
 Geographic variations
 International
 Country
 Region
 Parish
 County
 Urban/Rural
PLACE

Legend
No reported confirmed cases
<10 confirmed cases
10-50 confirmed cases
50-100 confirmed cases
100-1000 confirmed cases
≥ 1000 confirmed cases
DISTRIBUTION
CHARACTERISTICS
TIME - Broken down by variables such as:
 Cyclic fluctuations
 Point epidemics
 Secular time trends
 Year
 Month
 Day
 Hour
 Clustering
 Temporal
 Spatial

Can show seasonal variations & cyclical fluctuations

Time
 THE EPI-APPROACH
Epi questions when studying Questions are referred to as..
events.

 What  Case definition

 Who  Person
 Where  Place
 When  Time
 Why  Causes
28 Person, Place or Time?

Figure 2-17 Lyme disease, reported cases by county, United States,

2005. (From Centers for Disease Control and Prevention: Summary
of notifiable diseases, United States, 2005. MMWR 54[53]:2-92, 02/29/2024
2007.)
29 Person, Place or Time?

Figure 2-15 Pertussis (whooping cough), reported numbers of cases by

age group, United States, 2004. (From Centers for Disease Control and
Prevention: Summary of notifiable diseases, United States: 2004. 02/29/2024
MMWR 53[53]:1-79, 2006.)
30
Person, Place or Time?

Figure 2-14 Pertussis (whooping cough), reported cases per 100,000

population by year, United States, 1974-2004. (From Centers for Disease
Control and Prevention: Summary of notifiable diseases, United States:
2004. MMWR 53[53]:1-79, 2006.)
02/29/2024
EXPOSURES &
OUTCOMES
MEASURES IN EPIDEMIOLOGIC STUDIES

 The common measures in Epidemiologic studies

include:
 Exposure
 the agent that comes in contact with a person or
animal which can lead to developing the
relevant outcome, such as a disease
 Outcome
 the disease, or event, or health-related state
which we are interested in
EXPOSURES AND OUTCOMES

 The outcome need not be a disease

 Some further examples of outcomes which are not

diseases include:
 Growth
 Intelligence
 Multiple pregnancy
 Fertility
 Score Report
 EXPOSURES AND OUTCOMES

In a study of the effect of intake of alcohol on liver cirrhosis.

 Alcohol intake is the exposure, or risk factor, that we are

interested in.

 The outcome is liver cirrhosis.

In a study of the influence of health education on decreasing incidence of

diabetes in the community

 Is diabetes the exposure or the outcome?

 Outcome
EXPOSURES AND OUTCOMES

 A study was conducted on the effect of chewing

tobacco on oral cancer

 Is tobacco chewing considered an exposure or the

outcome?
36 EXPOSURES AND OUTCOMES

Example

 In a study of the effect of cigarette advertising on

smoking.

 Exposure of interest is ?

 Outcome is ?
37 EXPOSURES AND
OUTCOMES
Example

 In a study of the influence of advice from a midwife on

whether a mother breast-feeds or not.

 Is breast-feeding the exposure or the outcome?

 Answer:
38 EXPOSURES AND OUTCOMES

Example

 In a study of the effect of breast-feeding on diarrheal

disease in childhood.

 Is breast-feeding the exposure or the outcome?

 Answer:
 ENDEMIC,
EPIDEMIC & PANDEMIC
 Epidemic, Endemic & Pandemic
 Endemic
 is defined as the habitual presence of a disease within a given
geographic area
 It may also refer to the usual occurrence of a given disease within
such an area e.g DHF in Saint Lucia

 Epidemic
 is defined as the occurrence in a community or region of a group of
illness of similar nature, clearly in excess of normal expectancy
and derived from a normal or a propagated source eg. EHF in West
African countries

 Pandemic
 refers to worldwide epidemic. Eg. HIV/AIDS and Avian Flu
ENDEMIC VS EPIDEMIC
Sentinel Surveillance is Important
Table 1. Dengue Data by Epi Week (1-26)

Year 2011 Year 2012 Year 2011 Year 2012

Epi Epi
wk Frequency Frequency End-Date wk Frequency Frequency End-Date
1 74 90 07-Jan-12 27 07-Jul-12
2 85 97 14-Jan-12 28 14-Jul-12
3 61 80 21-Jan-12 29 21-Jul-12
4 52 67 28-Jan-12 30 28-Jul-12
5 67 67 04-Feb-12 31 04-Aug-12
6 92 55 11-Feb-12 32 11-Aug-12
7 97 55 18-Feb-12 33 18-Aug-12
8 58 42 25-Feb-12 34 25-Aug-12
9 74 81 03-Mar-12 35 01-Sep-12
10 69 50 10-Mar-12 36 08-Sep-12
11 95 51 17-Mar-12 37 15-Sep-12
12 83 48 24-Mar-12 38 22-Sep-12
13 46 57 31-Mar-12 39 29-Sep-12
14 38 37 07-Apr-12 40 06-Oct-12
15 58 58 14-Apr-12 41 13-Oct-12
16 51 37 21-Apr-12 42 20-Oct-12
17 38 46 28-Apr-12 43 27-Oct-12
18 05-May-12
44
31 27 03-Nov-12
19 12-May-12
45
31 45 10-Nov-12
20 19-May-12
46
41 41 17-Nov-12
21 26-May-12
47
60 40 24-Nov-12
22 56 66 02-Jun-12 48 01-Dec-12
23 62 71 09-Jun-12 49 08-Dec-12
24 38 30 16-Jun-12 50 15-Dec-12
25 33 40 23-Jun-12 51 22-Dec-12
26 42 103 30-Jun-12 52 29-Dec-12
Total 1 532 1 481 Total
 Graph of Dengue Data by Epi Week against Endemic Channel

Figure 1. Endemic Channel. Suspected Dengue Fever Cases. Trinidad and Tobago, 2012
450

400

350

300

250

200

150

100

50

0
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51

NB: Values surpassing the alarm range constitute an Epidemic

= Control = Endemic = Alarm

44 Excess!!! How do we know?

 Ongoing surveillance

02/29/2024
THANK YOU

Questions??