LESSON PLAN

ON
EPIDEMIOLOGY
PREPARED BY,

K.SAGAR,

LECTURER,

DEPT OF COMMUNITY HEALTH NURSING,

MAMATA COLLEGE OF NURSING,

KHAMMAM

OBJECTIVES
GENERAL OBJECTIVES:

At the end of the objectives students will be able to acquire in depth knowledge regarding epidemiology in
community health nursing .

SPECIFIC OBJECTIVES:

The students will be able to

 define epidemiology
 state the objectives of epidemiology
 discuss the epidemiological aims, concepts, and uses.
 describe dynamics of disease transmission.
 explain various modes of transmission.

NAME OF THE INSTITUTION:

 PROGRAMME:

SUBJECT:

UNIT:

TOPIC:

GROUP:

NO OF STUDENTS:

DATE:

TIME:

DURATION:

VENUE

PREVIOUS KNOWLEDGE OF STUDENTS:

METHODS OF TEACHING:

AV AIDS:

S.N TIME SPECIFIC OBJECTIVES CONTENT TEACHING LEARNING AV EVALUATION

O ACTIVITY ACTIVITY AIDS
1 2 EPIDEMIOLOGY: Asking Responding Black Define
MINS Epidemiology provides the structure for systematically questions board epidemiology?
studying health, disease and conditions related to health
status. Epidemiologic concepts are used to understand
and explain how and why health and illness occur as
they do in human population.
The primary concern of the epidemiologist is to
study disease occurrence in people, who during the
course of their lives are exposed to numerous factors
and circumstances, some of which may have a role in
disease etiology.
2 2 To define DEFINITION:
MINS
epidemiology According to John M Last (1988)
“ It is the study of the distribution and
determinants of health related states or events in
specified populations, and the application of this study
of the control of health problems”.
According to Lilienfold
“ Epidemiology is concerned with the patterns of
disease occurrence in human populations and of the
factors that influence these patterns”.
According to Parkin
“a branch of medical science which treats of
epidemics”.
3 5 to describe the SCOPE OF EPIDEMIOLOGY: Asking Responding Powe Describe
MINS scope of Significant changes in the methodology used in questions r scope of
epidemiology epidemiology has occurred over the past 200 years, point epidemiology?
including shifts in basic ideas about its purpose methods
of analyzing data, and measuring exposure to disease
agents. These changes are significant because they
reflect the way that epidemiologists think about health
and disease, and they influence the manner in which
they study health and disease.
Florence Nightingale , the first nurse
epidemiologist, pioneered the use of statistics to
improve public health. During the Crimean War,
Nightingale collected data and systemized record
keeping practices to improve hospital conditions. Her
work is an example of the first era of epidemiology,
sanitary statistics, which emphasized controlling
miasma, poisoning by the foul vapours coming from
soil, air and water.
The focus of epidemiology changed dramatically with
the development of the germ theory because the cause
of disease could be traced to a single organism. Robert
Koch on March 24, 1882 discovered the causative agent
of tuberculosis.
Robert Koch on March 24, 1882 discovered the
causative agent of tuberculosis.
The concept of multiple
causation of disease has become the basic tenet of this
era of epidemiology.
The field of epidemiology has shifted
dramatically from the era of sanitary statistics and era of
infectious disease to today’s emerging Eco-
epidemiology era, contemporary epidemiology face a
vital and exciting future as new developments continue
to occur. Infectious disease is still the leading cause of
 death worldwide.
John snow is considered as father of
epidemiology. He is famous for his investigation into
the causes of the 19th century cholera epidemics.
4 3 state the CONCEPT OF EPIDEMIOLOGY: Asking responding Explain the
MINS concept of Epidemiologic concepts are used to understand and questions Powe concept of
epidemiology explain how and why health and illness occur as they do r epidemiology?
point
in human population. Nursing and medical sciences
employs these concepts to guide clinical practice and
influence health outcomes.
Few concepts of epidemiology are as follows-
Universe of study is a defined population.
Disease pattern in community is studied.
Both health and diseases are concerned.
Source of infection is a clue to control measures.
Should help national health programme.
Investigation is done in community.
Takes the help of clinical consideration in
identification.
Basic concepts of epidemiology:
To use the epidemiological process
effectively, community health nurses need to understand
the basic concepts of epidemiology.
The first and foremost concept is
biostatistics. Biostatistics helps to describe the extent
and distribution of health, illness and conditions in the
community. It aids in the identification of specific health
problems and community strengths. It also facilitates the
setting of priorities for program planning.
 Several basic concepts of epidemiology are:
1. Study of aggregrates at risk:
A key concept of epidemiology is that the study of
disease in population is more
Significant that the study of the
individual cases of disease.
A goal of epidemiological study is to
identify aggregrates at risk.
Definitions:
Aggregates:
Aggregrates are groups of persons who have one or
more shared personal or environmental characteristics.
Aggregates at risk:
The person are those who engage in certain activities or
who have certain characteristics that increase their
potential for contracting an illness, injury or a health
problem.
e.g., coal miners are daily exposed to dust containing
silica, a common mineral. This exposure is known as a
risk factor for the development of silicosis, a lung
disease.
to explain the 2. Natural history of disease:
5 5
MINS
natural history Definition of natural history of disease:
of disease Natural history of the disease is the course
of a disease from onset to resolution.
Leavell and clark (1965) identified two
distinct periods in the natural history of disease
a. Pre-pathogenesis period :- Disease has not
developed but interactions are occurring between
 host, agent and enivironment that produce disease
stimulus and increase the host’s potential for
disease. Eg: HIV.
b. Pathogenesis period:- it begins when disease
producing stimuli (tubercle bacilli) start to
produce changes in the human tissue
(development of granuloma).
 The process that occurs in the environment (pre
pathogenesis).
 The process that occurs in the humans
(pathogensis).
3. Epidemiologic triangle/ host-agent-
environment relationship:
Epidemiologists understand that disease results from
complex interactions among causal agent,
Definitions of agent, host and environment:
Changes in one element of the triangle can
influence the occurrence of disease by increasing or
decreasing a person’s risk for disease.

Examples of epidemiologic triangle:

1. Agent:
a) Infectious agents: Bacteria, viruses, fungi,
parasites.
b) Chemical agents: Heavy metals, toxic chemicals,
pesticides.
c) Physical agents: Radiation, Heat, Cold,
machinery.
 2. Host:
 Genetic susceptibility.
 Immutable characteristic: Age gender.
 Acquired characteristic: Immunologic status.
 Life style factors: Diet, exercise, smoking.
3. Environment;
 Climate: Temperature, rainfall.
 Plant and animals life: May be agents/reservoirs
or habitats for agents.
Human population distribution: crowding, social
support.
 Socioeconomic factors: Education, resources,
access to health care.
 Working conditions: level of stress, noise, job
satisfaction, pollutants.

4. Stages of human and intervention or levels of

prevention:
Public health professionals describe three levels
of prevention related to specific stages in the natural
history of disease.
 The natural history of disease is the course of the
disease process from onset to resolution or from
beginning to end.
 The table below illustrates the relationship among
the stages of disease and levels of prevention.
Nurses who work in the community use three
levels of primary, secondary and tertiary
prevention.
 a. Primary prevention: It refers to interventions
that promote health and prevent development of
disease processes.
Secondary prevention: It aims to detect disease in the
early stages before clinical signs and
Health habits and behaviours of lifestyles
Acquired resistance and susceptibility
Health history, natural resistance, hereditary
characteristics.
2. place: geographical distribution in subdivisions of the
area affected.
Physical environment: weather, climate, geography,
radiation, noise, pressure, pollutants, housing facilities,
sources of air, water and food contamination.
Social environment: population density and mobility,
community groups, occupations and other roles, beliefs
and attitudes, transportation, educational practices,
health care delivery system.
Economic environment: source of income, income
level, employement status, job fruatrations, income for
housing, nutrition etc.
Family environment: family history, family dynamics,
home atmosphere, family health and cultural patterns.
3.time : chronological distribution of onsets of cases by
days, weeks, months, seasonal trends, onset of event,
event duration.
Incubation period: determine life cycle factors
affecting multiplication and virulence of organism.
 Dissatisfaction
  Deviation from social norm
 Deviation from statistical norm
to enlist the
6 aims of AIMS OF EPIDEMIOLOGY
epidemiology According to the international epidemiological List out the
association (IEA), the aims of epidemiology are: aims of
 To describe the distribution and magnitude of epidemiology?
health and disease problems in human population.
 To identify etiological factors in the pathogenesis
of disease, and
 To prevent the data essential to the planning,
implementation and evaluation of services for the
prevention, control and treatment of disease and
to the setting up of priorities among those
services.
The ultimate aim of epidemiology is:
 To reduce the health problems or its
consequences.
 To promote the health and well being of society
to enlist the as a whole.
uses of USES OF EPIDEMIOLOGY List the aims
7 5 epidemiology  To study the disease risk in human population. of
MINS epidemiology?
 Community diagnosis.
 Clinical picture.
 Determinants and distribution.
 General practice.
 Investigation of epidemic.
 Mass survey – search the causes of health and
disease.
  Syndrome identification.
 Need and methods of control and prevention.
 Operational research.
 Risk chances.
 Social factors.
 Temporal variation.

TERMINOLOGY IN EPIDEMIOLOGY:
1. Antiserum: serum containing specific antibody.
Eg; ATS (anti-tetanus serum)
2. Carrier: A person who carries the disease agent
in his body but outwardly he appears healthy.
3. Case: person having disease and health disorder.
4. Case control: Two groups with same character
one for study and the other for control.
5. Cohort: Group of people who shares common
characteristics.
6. Communicable disease: An illness due to
specific infection agent, under certain conditions,
tends to spread among individual in a community.
7. Contagious disease: By contact transmission.
8. Contamination: Pathogens on non-living things
which do not show any response.
9. Endemic: (En= in; demos= people). The constant
presence of disease in a given geographic area, or
the usual prevalence of a given disease in
particular area.
10.Epidemic: (Epi= upon; demos= people). An
outbreak of disease in a community much morn in
 excess than expected and derived from a common
source.
11.Epizootic: epidemicity of zoonotic disease.
12.Eradicate: Absolute process to rule out disease
by terminating pathogen.
13.Fomites: Inanimate objects (handkerchief,
towels, pencils, toys, utensils) other than food or
water contaminated by the infectious discharges
from a patient and are capable of harbouring and
transferring the infectious agents to a healthy
person.
14.Incidence: Number of news cases in a defined
population during a year.
15.Incubation period: It is the time interval
between the entry of disease agent into the body
and appearance of first signs and symptoms of the
disease.
16.Infection: The entry and multiplication of a
disease- producing agent in the body of man or
animals.
17.Isolation: The separation of a person suffering
with infectious disease from contact with other
human beings, for the period of communicability.
18.Morbidity: Deviation from physiological basis.
19.Mortality: Deaths occurring by disease or event.
20.Non-communicable disease: The disease which
do not spread through infection to other person
eg: Hypertension, heart diseases, diabetes mellitus,
cancer etc.
 21.Pandemic: (pan= all; demos= people). An
epidemic which spreads from country to country
or over the whole world. Eg. Recent epidemic of
AIDS.
22.Pathogenicity: Ability to cause disease.
23.Sporadic: The incidence at intervals of single,
scattered cases of disease, eg. Polio.
24.Vector: An agent who transfers the infection
from an infected person to a healthy person.
Vector may be an arthropod ( eg. Insect or
parasite).
25.Virulence: Measurement of the severity of
disease.
26.Zoonosis: It is the disease or infection which is
transmitted between vertebrate animal and man
Eg. Rabies, plague, anthrax.
to explain the
9 5
dynamics of DYNAMICS OF DISEASE TRANSMISSION Explain
MINS disease Epidemiology enhances how disease spread and dynamics of
transmission how they may be managed both in individual and disease
community. Dynamics means the branch of science that transmission?
concerns movement or force. Diseases are transmitted
from the reservoir/source of infecting through mode of
transmission to susceptibility host. Nurses must know
the manner in which the diseases transmitted to be able
to plan suitable preventive and contol measures.
Communicable disease is a disease that is primarily
infectious in nature, requires interaction between the
host and the agent, direct or indirect
Transmission from the agent reservoir in the
environment and a host that can provide adequate living
conditions for the infectious agent.
There are three links in the chain of disease
transmission. They are-
 Reservoir or source
 Modes of transmission
 Susceptible host
1. Reservoir:
Definition of Reservoir: It is defined as “any person,
animal, arthropod, plant, soil or substance or
combination of these in which an infectious agent lives
and multiplies on which it depends primarily for
survival and where it reproduces it self, in such manner
that it can be transmitted to a susceptible host”.
Disease transmission depends upon
source of infection; source or reservoir means “any
person, animal, arthopod, plant, soil or substance in
which disease agent live and multiply”. The reservoir
may be of three types :
1. Human reservoir
2. Animal reservoir
3. Reservoir in non living things.
1. Human reservoir: reservoir of infection for
humans is man himself. He may be a case (or)
carrier.
a. Case:
“ a person in the population or study group
identified as having a particular disease
 condition or disorder is under investigation.
The presence of infection in a host may be:
i. Clinical.
ii. Subclinical.
iii. Latent.
The graphic representation of variations
in the manifestations of disease is
known as spectrum of disease.
i. Clinical: illness means mild or moderate
environment, this period may be more
important source of infection.
Subclinical: this period is apparent, this disease agent
may multiply in the host but
Does not manifest it self but contamination itself but
contamination the environment, as it has dominant
role.sub-clinical infection(measles) can be detected by
laboratory tests. E.g., antibody response, skin
sensitivity tests.
ii. Latent infection: host does not shed the
infectious agent which is waiting for right
conditions, time in order to grow (dormant)
within the host with out symptoms.
E.g herpes simplex.
b. Carriers:
Carrier means an infected persons or animals
that harbours a specific infectious agents in
the absence of clinical manifestation and
which serve as a potential source of infection
to others.
 Carriers are more dangerous because.
 They readily infect the susceptible host.
 Presence in the body of the disease
agent.
 Absence of signs and symptoms.
 The shredding of disease agent in the
discharges or exertion. So, carrier is
acting as a source of infection for other
persons.
Carriers may be classified as under

A. INCUBATORY CARRIERS:
Are those who shed the infectious agent during
the incubation period of disease, this occurs
usually during the last few days of the incubation
period. Eg; Measles, mumps, polio, diphtheria.
 Convalescent carriers: That is, those who
continue to shed the disease agent during the
period of convalescence. Eg; Cholera, Dysentry,
Typhoid fever.
 Healthy carrier: A person whose infection
remains subclinical may or may not be a carrier.
Eg; Poliomyelitis, meningitis.
B. Duration : Duration again sub divided into (a)
Temporary carriers (b) chronic carriers.
i. Temporary carriers: Are those who shed the
infectious agent for short period of time. In
this category, may be included the incubatory,
convalscence and healthy carriers.
 Chronic carriers: it is one who excretes the infectious
for indefinite period. The longer the carrier state, the
greater the risk to the community.it may be lost for a
year or longer. Chronic carriers are able to reintroduce
infection. E.g., malaria, hepatitis B
C. PORTAL OF EXIT: according to the portal of
exit of the infectious agent, carriers are classified.
Respiratory, intestinal, urinary, and open wounds,
blood e.g.,
 Animal reservoir: animals and birds also act as
reservoir of infection. The infections and diseases
are transmitted to man from vertebrates and are
called zoonoses, e.g., rabies, influenza, dust
mites, leads to allergy to man. Migration of
animals, birds, insects also creates major risks.
 Non-living things: in animal matter and soil
infection also may be transmitted from the
reservoir of infection. E.g., soil may harbour
to describe agents that cause tetanus, anthrax.
mode of MODE OF TRANSMISSION:
10 7 transmission Communicable diseases are transmitted from the
MINS
reservoir or source of infection to susceptible person by
different routes.
The mode of transmission may be classified into
two broad categories:
A B
Direct transmission Indirect transmission
 Through direct  Vehicle-borne
 contact transmission.
 Droplet infection  Vector-borne
transmission.
 Contact with  Air borne
infected soil. transmission
 Inoculation into the  Fomite-borne
skin or mucosa. transmission
 Transplacental (or)
vertical
transmission

 Direct contact: some diseases are transmitted

form person to person by direct contact.
Droplet infection: when droplets of saliva and naso-
pharyngeal secretions are spread to the air, droplet
infection occurs. Respiratory infection and T.B are
typical droplet infection occurs. Respiratory infection
and T.B are typical droplet infection. If droplet is tiny it
is called incubation period. Common diseases are
whooping cough,
 T.B., meningococcal meningitis.
 Contact with soil: the disease agent may be
acquired by direct contact with infected soil, as
example- tetanus , hook worm larvae.
 Inoculation into skin or mucosa: the disease
agent may enter directly into the skin or mucosa,
e.g., rabies virus through dog bite, hepatitis B
virus through contaminated needles and syringes.
  Transplacental or vertical transmission:
disease agents may be transmitted inutero from
mother to the foetus. This is also known as verical
transmission e.g., (TORCH) toxaplasmosis,
rubella virus, syphilis, hepatitis B etc. the disease
agent produces malformations of the embryo
during its development
 Indirect transmission: indirect transmission
takes place through this mechanism through
five F’s namely fingers, fluid, food, flies,
fomites. This depends upon the characteristics of
the agent, the inanimate object, the influence of
environmental factors such as temperature, and
humidity.
Vehicle borne transmission: the chief vehicles of
transmission are milk, food, other vehicles or agents
include blood, raw vegetables, tissues, organs etc.,
diseases transmitted through water, milk, food include
chiefly infections of the

Alimentary tract such as enteric fever, diarrhoea

and dysentery, hepatitis A , food poisoning.
 Vector borne transmission: vector means an
arthopod or any living carrier that transports an
infectious agent to susceptible individual. Vector
transmission may be biological or mechanical ,
malaria, filaria, plague are transmitted by insects.
This mode of transmission is known as vector
 transmission.
CLASSIFICATION OF VECTOR BORNE
DISEASES:
1. BY VECTOR
a. In vertebrate- eg: orthopetra-cockroaches
Copepoda-cyclops
b. Vertebrate- mice, rodents, bats.
2. BY TRANSMISSION CHAIN BASED ON
THREE PRINCIPLES:
a. Man- and arthopod-man (malaria).
b. Mammal and other vertebrate host, and a non-
vertebrate host. E.g., mammal-athopod-man
(plaque).
c. Man and 2 intermediate hosts.
Man –cyclops-fish-man (fish tape worm).
3. BY WHICH VECTOR TRANSMIT AGENT
a. Biting.
b. Scratching –in of infective faeces.
4. VECTOR ARE INVOLVED IN
TRANSMISSION
a. Mechanical transmission by crawling or flying
arthopod.
b. Biological transmission e.g., malaria parasite.
II. FACTORS WHICH INFLUENCE TO
TRANSMIT THE DISEASE:
1. Ability to transmit the disease agent(infectivity).
2. Preference- host feeding preference.
3. Susceptibility- ability to become infected.
4. Suitable environment.
 5. Degree of association with man.
III. AIR BORNE TRANSMISSION:
Air borne transmission includes transmission by
droplet nuclei and infected dust.
Droplet nuclei: those are extremely small (less than
0.1mm) which keeps floating in the air due to very light
weight. They are generated during coughing, or
sneezing. Diseases spread by droplet nuclei include
influenza, T.B, measles
And several other respiratory infections.
 Infected dust: when a person coughs or sneezes,
some of the larger droplets which are expelled or
settle down floor, clothes, bedding and another
objects in the immediate environment become
apart of dust. common diseases due to dust such
as tuberculosis, pneumonia, streptococcal,
staphycoccal infection.
 Fomite borne transmission: fomites are articles
(handkerchief, drinking glasses, towels, toys etc)
that convey infection to others because they have
been contaminated by pathogenic organisms, this
also comes under indirect transmission.
 Poor personal hygiene: unclean hands favour to
transmit infection directly or indirectly like, hand
to mouth and strepto to staphylococcal infection
e.g., dysentery.
IV. TRANSPLACENTAL TRANSMISSION:
Disease agents may be transmitted in utero from the
mother to the foetus. This is also known as vertical
transmission e.g., rubella, syphilis, toxoplasmosis,
hepatitis B, AIDS etc., in theses cases, the disease agent
produces malfomations of the embryo during its
development.
 Susceptible host:
In susceptible host disease transmission classified
into:
a. parasitism c. communicability
b. incubation period d. serial interval.
a. Parasitism: it is described in 4 stages those are:
 Infectious agent must find a portal of entry by
which it may enter the host e.g., respiratory tract,
alimentary canal, urinary tract.
 Site of selection: after entry, the organism must
reach the appropriate tissue.
 Portal of exit: the disease agent must find a way
out of the body.
Searching for new host: after leaving the human body,
the organism must survive in the external environment
until new host is found.
b. Incubation period: this is time interval between
the entry of the disease agent into the body and
the appearance of the first sign or symptom of the
disease. The incubation varies for different
infectious diseases, and also from one person to
another. The length of the incubation period is
characteristic of each disease. Incubation period is
 a fundamental importance in epidemiological
studies such as.
Tracing thre source of infection and
contacts.
Determining the period of surveillance.
Prevent clinical illness by antisera
Identification of point source.
Estimating the prognosis of disease.
Communicability: normally, diseases are not
communicable during the incubation period.
Communicable period means “the time during which an
infectious agent may be transferred directly or indirectly
from an infected person to another person” is also
known as infectivity.
c. Serial interval:
d. Commonly , we used to observe primary case in
the family and followed by 2or 3 secondary cases
with in a short time. The gap in between the onset
of the primary case and the secondary case is
called the “serial interval” from which we can
guess the incubation period of disease.

To explain EPIDEMIOLOGICAL TRIAD:

11 epidemiologica The term natural history of disease is applied to the
l triad course of disease process in man. It comprises two
phases.
a. Pre-pathogenesis.
b. Pathogenesis period.
a. pre-pathogenesis: this refers to the period
 preliminary to the onset of disease in man.
b. pathogenesis period: this period begins with the
entry of the disease agent in the human host.
In the ecology ( the science of mutual
relationship between living organisms and their
environment) of disease, these three factors namely the
agent, host and environment are referred to as
epidemiological triad. Germ theory of disease concept
is as a one to one relation ship between
casual agent and disease. The disease model is –disease
agent man disease but current concept is disease
rarely caused by a single agent alone, but it depends on
no of factors which contribute the occurrence is known
as multifactorial causation.
Disease cannot occur in the absence of any
one of the factors like agent, host and environment.

EPIDEMIOLOGICAL TRIAD
 agent

host environment

A. Agent: the first event in the disease transmission

is agent. It may be defined as a substance, living
or non living or a force, tangible, or intangible,
the excessive presence or relative lack of which is
the immediate cause of a particular disease.
Diseases agents may be classified into following
Classification of disease agents
 Biological agents: these are living agents
e.g., bacteria, fungi, protozoa virus etc. biologic
agents consists of certain properties like
 infectivity, pathogenicity, virulence.
 Physical agents: these are heat, cold electricity,
radiation, sound, humidity, pressure etc.
 Chemical agents: these are subdivided into 2
groups.
a. Exogenous: agents arising out side of human
host e.g: metals, fumes, dusts, gases etc.
b. Endogenous: agents produced in the body it
leads redamage of function. E.g., urea,
uricacid and ketones, etc.
 Mechanical agents: agents exposed to chronic
friction and other mechanical forces may cause
injuries, fractures, dislocations and death.
 Absence or insufficiency or excess of factor
ncessary to health- these may be due to lack of
structure, or part, chromosomal immunologic,
chemical factors.
Social agents: these are poverty, smoking, abuse of
drugs and alcohol, unhealthy lifestyle etc. above all the
agents are having border place to occurrence of the
disease.
B. Host factors: the host factors is complex one in
relation to disease occurrence. The host
contribution to disease is first through his inherent
characteristics. These are classified as:
 Age: the influence of age on susceptibility to
disease is well known. Certain diseases are more
frequent incertain age groups than in others.
  Sex: there are sex differences in disease
acquisition and severity owing to anatomical
between and hormonal differences between two
sexes.
 Hereditary: harmful genes in the constitution
may give rise to disease. E.g., haemophilia, color
blindness, congenital defects are due to genetic
factors.
 Immunologic and physiologic factors: blood
pressure fluctuation forced expiratory ventilation.
Nutrition: over eating, poor nutrition is frequently
associated with deficiencies like anemia,kwashiorkor.
 Socio economic: characteristics such as –
education, occupation, economic status may
predispose to certain occupational diseases.
e.g., accidents, lead poisoning, stress etc.
 Life style: smoking, poor exercise and eating
habits.
 Psychological: certain behavioural aspects like
drug abuse has adverse effect.
C. Environmental factors:
A healthy environment is crucial for the well
being of individuals and communities.
Environment is defined as “ The aggregate of all
external conditions and influences effecting the
life and development of an organism, behaviour
or the society.
Environment means the surroundings in which
people live. The concept of environment is
 complex it is not merely the air, water and soil
that from our environments but also the social and
economic conditions under which we live.
The internal and external environment’s comprise
the total environment, man is living in a highly
complicated environment. Maintaining healthy
environment of individual depends on external
Environment ( macro-environment). The external
environment consists of three main components.
1. Physical
2. Biologic
3. Psychosocial, all three are closely related.
1. Physical environment: physical environment is
applied to non-living things and physical factors.
Eg; Air, climate, Water, Soil, geography, light
with which man is in constant interaction. Much
of ill health is due to poor environment eg; Poor
housing unsafe water, contaminated soil, lack of
disposal.
Man has altered (every thing) practically in his
environment to his advantage. As his environment
is more indigenous, he is also creating new
environmental hazards such as, atmospheric
pollution, food additives, radiation etc.
Biologic environment: The biologic environment is
known as living things which surrounds man, including
man himself. The living thinks are the viruses and
insects, rodents, plants, animals. These are constantly
working for their survival. In this process some of them
 act as disease producing agents, reservoir of
infection, intermediate host and vector of diseases.
There is constant adjustment, and readjustment,
observed, knowledge is essential to achieve a state of
peaceful of co-existence.
2. Psycho-social environment: the third area of our
environment is psychosocial to includes a
complex of social and psychological factors and
conditions that include beliefs, customs morals
standard of living, availability of health services.
man is exposed to the social environment through
various means such as mass media, Radio, T.V
literature. Every individual is a member of social
group, there can be harmony or disharmony in
between members in dead man and is largely a
product of socio, cultural environment. It helps to
shape the individual.
Certain behaviours leads to psychological stress
such as birth of congenital malformed child. Loss
of employement, individual habits and
Their relationships with others may precipitate the onset
of psychosocial disorders such as bronchial asthma,
ulcers, hypertension mental illness. Psychosocial
components it is the harmonious balance of the human
individual integrated into his total environment
constitutes health.

SUMMARY:
Till now we have discussed about the epidemiology its aims, scope, uses, concept its terminology, dynamics of
disease transmission and its various modes of transmission.

CONCLUSION:

I conclude the topic by stating that epidemiology is very useful and important aspect in the community health
nursing its helps us to know prevention an control of various modes of the transmission of the diseases.

EVALUATION:

1. Define epidemiology ?
2. Explain scope of epidemiology?
3. Enlist aims and uses of epidemiology?
4. Explain epidemiological triad?
5. Describe in detail about dynamics of disease transmission?

BIBLIOGRAPHY:

1. D.Jyothi (2011). A Textbook of community health nursing-I. 1st ed. vijayam publications: vijayawada.pg no
193-201
2. I.Clement(2012).manual of community mental health nursing.1st ed. Jaypee brothers:delhi. Pg no 151-160
3. G. Kamala.(2010).community mental nursing-I. 1st ed. Florence publishers:Hyderabad. Pg no 191-217.
4. Park.k. (2002). Preventive and social medicine . (17th ed). Jabalpur: M/S Banarasidos Bhanot .
5. Ghulani. K.K (2005). Community health nursing , principles and practice. (1st ed). Delhi : kumar publishing
house.