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BASIC EPIDEMIOLOGY
Fantu Lombamo (MD, MPH-Field Epi, Assistant Professor)
SPHMMC, School of Public Health
Tel: +251916553959
Email:
• [email protected]
• [email protected]
 About the course
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 Module title/code: Basic Epidemiology/PHBE6014/

 Degree program: MPH
 Course Credit Hour: 3
 Course duration: 3 weeks
 Dates of course delivery: March 05 - 20, 2022 (Weekend)
 Course outline
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 Introduction to Epidemiology
 Epidemiology of communicable diseases
 Basic measurements in epidemiology
 Epidemiological study designs
 Measures of association and impact
 Critical Review of Epidemiological studies
 Screening and Diagnostic Tests
 Outbreak investigation and management
 Epidemiological surveillance
 Ethics in epidemiological research
 Teaching methods
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 Interactive lecture
 Group discussion
 Brain storming
 Take home assignments
 Assessment
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 Attendance ………………….. Mandatory

 Progressive assessments of group and individual

exercises …… 40%

 Final written exam ………………………….. 60%

 The learning pyramid
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7 Introduction to epidemiology
 Definitions…
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 Epidemiology:

 It is the study of frequency, distribution, and

determinants of diseases and other health-related
conditions in a human population
and
the application of this study to the prevention of disease
and promotion of health
 Components of the definition
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1. Study: Systematic collection, analysis and

interpretation of data

 Epidemiology involves collection, analysis and

interpretation of health related data

 Epidemiology is a science
 Components…
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2. Frequency: the number of times an event

occurs

 Epidemiology studies the number of times a

disease occurs
 It answers the question How many?

 Epidemiology is a quantitative science

 Components…
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3. Distribution: Distribution of an event by

person, place and time

 Epidemiology studies distribution of diseases.

 It answers the question who, where and

when?

 Epidemiology describes health events

 Components…
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4. Determinants: Factors the presence/absence of

which affect the occurrence and level of an event.

 Epidemiology studies what determines health

events
 It answers the question how and why?

 Epidemiology analyzes health events

 Components…
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5. Diseases & other health related events

 Epidemiology is not only the study of diseases

 The focus of Epidemiology are not only patients

 It studies all health related conditions

 Epidemiology is a broader science

 Components…
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6. Human population

 Epidemiology diagnoses and treats communities/

populations

 Clinical medicine diagnoses and treats patients

 Epidemiology is a basic science of public health

 Components…
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7. Application:

 Epidemiological studies have direct and practical

applications for prevention of diseases & promotion of
health

 Epidemiology is a science and practice

 Epidemiology is an applied science

 Definition of terms
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 Health: A state of complete physical, mental and social

well-being and not merely the absence of disease or
infirmity (WHO,1948)
 Disease: A physiological or psychological dysfunction
 Illness: A subjective state of not being well
 Sickness: A state of social dysfunction
 Public health: The science & art of preventing disease,
prolonging life, promoting health & efficiency through
organized community effort (Winslow, 1920)
 History of Epidemiology
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 Epidemiological thought emerged in 460 BC

 Epidemiology flourished as a discipline in 1940s
 History…
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 Eight land marks in the history of Epidemiology

1. Hippocrates (460BC): Environment & human behaviors affects health
2. John Graunt (1662): Quantified births, deaths and diseases
3. James Lind (1747): Scurvy could be treated with fresh fruit
4. William Farr (1839): Established application of vital statistics for the
evaluation of health problems
5. Ignac Semmelweis (1847): stablished causality of childbed fever by
demonstrating association with unclean hands
6. John Snow (1854): tested a hypothesis on the origin of epidemic of cholera
7. Alexander Louis (1872): Systematized application of numerical thinking
(quantitative reasoning)
8. Bradford Hill (1937): Suggested criteria for establishing causation
 History…
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 Originally, Epidemiology was concerned with

investigation & management of epidemics of
communicable diseases.
 Lately, Epidemiology was extended to endemic

communicable diseases and non-communicable

diseases.
 Recently, Epidemiology can be applied to all

diseases and other health related events

 Purpose/use of Epidemiology
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The ultimate purpose of Epidemiology is

prevention of diseases and promotion of health

Mention some of the uses of Epidemiology in

Public Health Practice:
 Purpose/use of Epidemiology
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Some of the uses of epidemiology in public health

practice are:
1. Elucidation of natural history of diseases
2. Description of health status of population
3. Establishing determinants of diseases
4. Evaluation of intervention effectiveness
5. Defining standards for normal values of biological and
social measures
6. Guiding health and healthcare policy and planning
7. Assisting in the management of diseases in individuals.
 Types of Epidemiology
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Two major categories of Epidemiology



Descriptive Epidemiology


 Defines frequency and distribution of diseases and other health related

events
 Answers the four major questions: how many, who, where, and when?

Analytic Epidemiology

 Analyses determinants of health problems
 Answers two other major questions: how? And why?

Generally, Epidemiology answers six major

 questions: how many,
who, where, when, how and why?
 Basic Epidemiological assumptions
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1. Human disease doesn’t occur at random or by

chance
2. Human diseases have causal and preventive
factors
 Basic features of epidemiology
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1. Studies are conducted on human population

2. It examines patterns of events in people
3. Can establish cause-effect relationship without
the knowledge of biological mechanism
4. It covers a wide range of conditions
5. It is an advancing science
25 Communicable disease epidemiology
 Disease causation
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 The cause of a disease:

 An event, a condition or a characteristic that comes

before the disease and without which the disease
wouldn’t occur
 Etiology of a disease
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 The sum of all factors contribution to the

occurrence of a disease

 Agent factors +Host factors +Environmental

factors = Etiology of a disease
 Disease models
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 How do diseases develop? Three best known models

1. Epidemiological triangle
 The interaction of an agent and host in an appropriate
environment results in disease
2. Web of causation
 Complex interaction of factors results in disease
3. Wheel model
 The hub (host) having a genetic make up as its core, surrounded
by an environment schematically divided in to biological,
physical and social
 Epidemiologic triad
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Age, Sex, Previous disability,

Behavior, Genetic inheritance,
Height

Host
Home overcrowding,
Air pollution, Workplace
Virulence of organisms, hygiene, Weather,
Serotype of organisms, Water composition,
Antibiotic resistance, Food contamination,
Cigarette-tar content Animal contact

Agent Environment
 Web of causation
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 Necessary Vs Sufficient
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 Necessary: the disease will not occur without the

presence of the factor
 Example: Mycobacterium TB for TB

 Sufficient: the presence of the factor always result in

disease
 Example: Rabies virus for rabies
 Wheel model
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Social Environment

Human Host
Biological
environment
Geneti
c Core

Physical
Environment
 Natural history of disease
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 The progression of disease process in an individual

overtime in the absence of intervention
 Four stages in the natural history of a disease
1. Stage of susceptibility:
 Presence of factors
 No disease
2. Stage of sub-clinical disease
 Presence of pathogenic changes (biological onset)
 No disease manifestations
3. Stage of clinical disease
 Presence of sign and symptoms (clinical onset)
4. Stage of recovery, disability, or death
 Levels of disease prevention
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 Three major levels of disease prevention

1. Primary prevention: Targeted at healthy people

2. Secondary prevention: Targeted at sick
individuals
3. Tertiary prevention: Targeted at people with
chronic diseases & disabilities that can’t be
cured.
 Infectious disease process
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 There are six components of the infectious disease

process constituting chain of disease transmission
1. The agent
2. Its reservoir
3. Its portal of exit
4. Its portal of entry
5. Its mode of transmission
6. Susceptible host
 The agent
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 Possible outcomes of exposure to an infectious agent

 Infection: invasion & multiplication in the host
 Infectivity: the proportion of exposed who becomes infected
 Infection rate= Infected/exposed
 Disease: A clinically apparent infection
 Pathogenicity: the proportion of infected who develop clinical disease
 Clinical-to-Subclinical ratio
 Virulence: the proportion clinical cases resulting in severe clinical disease
 Case fatality & hospitalization rate
 Immunogenicity: the infection’s ability to produce specific immunity
 Reservoir vs carrier
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 Reservoir:
 An organism or habitat in which an infectious agent
normally lives, transforms, develops and/or multiplies

 Carrier:
 A person who doesn’t have apparent clinical disease,
but is a potential source of infection to other people
 Types of carriers
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1.Incubatory carriers: transmits the disease during incubation

period
Example: Measles, mumps
2.Convalescent carriers: transmits the disease during
convalescent period
Example: Typhoid fever
3. Asymptomatic carriers: transmitting the disease without

showing manifestations
Example: polio, Amoebiasis
4. Chronic Carriers: transmitting the disease for long

time/indefinite transmission
Example: Viral hepatitis, typhoid fever
 Effect of carriers on disease
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transmission
• Ice-berg effect

 This is the fact that carriers constitute a

hidden reservoir of infection and that they
may outnumber actual cases
 Iceberg phenomena of disease
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 Modes of disease transmission
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1. Direct transmission
 Direct contact
 Direct projection
 Trans placental:
2. Indirect transmission
 Vehicle-borne
 Air-borne
 Vector-borne
 Time course of an infectious disease
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 Latent period: between biological onset and first

shedding
 Incubation period: between biological onset and
clinical onset
 Communicable period: time during which agent is
being shed
 Convalescent period: between recovery and time
when shedding stops
 Generation period: between exposure/infection and
maximum communicability of exposed host
 Time course of an infectious disease
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Communicable
Latent period
period

Sheddi
First Clinical Max. Recove
Infection communica ng
shedding onset bility ry
stops

Incubation Convalescent
period period

Generation
period
 Application of time periods
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 Latent period
 When should we investigate?
 Incubation period
 When was time of exposure?
 Communicable period
 When should we take care of infectiousness?
 Convalescent period
 When, after recovery an individual becomes non-infectious?
 Generation time
 When is the maximum risk for contacts?
 Factors which influence the development of disease
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Strain of the agent



Dose of the agent

Route of infection

Host factors (age, nutritional

status, immune status)

Influence of treatment

Influence of season
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Thank you!