Session One

Introduction to Epidemiology

BY:

Sisay S. (BSc, MPH in Epidemiology)

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• Session Objectives:
• At the end of this session, the students will be able to:

• Define the term epidemiology

• Describe the historical perspective of epidemiology

• Discuss the scope and purpose of epidemiology

• Explain the basic epidemiologic assumptions

• Describe the major approaches in epidemiology

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• Introduction
• Epidemiology is considered as the basic science of
public health.

• Epidemiology is:

–A quantitative basic science built on a working

knowledge of probability, statistics, and sound
research methods;

–A method of causal reasoning based on

developing and testing hypotheses
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 • Epidemiology…
• A tool for public health action to promote and protect
the health based on science, and causal reasoning

• Provides useful tools and methods to describe

variations in disease occurrence and identify factors
that influence the occurrence of disease

• Studies the nature of diseases and their causes

• Uses systematic methods of measurement to test

ideas, questions and hypotheses
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Sisay S. (Bsc., MPH in Epidemiology)
Definition of Epidemiology
• Originated from three Greek words.

EPI
demos Logus

On, Up on People Doctrine, Study

 It was originally applied to the study of acute infectious
diseases and was defined as follows:

 “The science of epidemics”

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Current definition of Epidemiology

• The study of frequency, distribution and

determinants of Disease and other health
related events in specific populations, and the
application of it to prevention and control of
health problems.

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• Terms taken from the definition
• Frequency:
• It is a quantitative science (it measures frequency of
occurrence)
• Example

– Number of exposed people

– Number of people with the outcome of interest

– Proportion of exposed people

– Proportion of people with the outcome of interest

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• Distribution
• It is the occurrence of diseases and other health
problems in terms of person, place and time.

• This attempts to answer

Who? Where? And When?

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• Determinants

• The causative factors for the occurrence of a disease.

• It attempts to answer questions like:

How?  Mechanism

Why?  Causal link

• More on possible cause or means for disease

occurrence.

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• Disease and health-related problem

• It includes – both diseases and physiological and/or

psychological dysfunction of the body

• Time course (acute and chronic)

• Cause (infectious and none infectious)

Cause Acute Chronic

Infectious
Non infectious

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 – Disease and health-related…
• It also includes other health related problems like:

• Vital events, which include births, deaths, marriage,

divorces etc…

• Health related behaviour – sexual behaviour,

smoking, alcoholism, drug abuses

• Social factors, such as poverty.

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• Human population
• Epidemiology studies the health of the groups,
communities and whole or specific population

• Application
• On the prevention and control of disease
• It is applied science, i.e. direct practical applications
• The aim of all about frequency, distribution of
diseases is to identify effective prevention and
control strategies
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• History of Epidemiology
• 460 B.C – Hippocrates, the father of modern medicine. Suggested
human disease might be related to personal and environmental
factors.

• 1662 - John Graunt – tried to quantify patterns of birth, death and

disease occurrence, noting male-female disparities, high infant
mortality, urban-rural differences, and seasonal variations.

• 1747 - Lind used an "experimental" approach to prove the cause of

scurvy

• 1787-1872. Alexandre Louis, sometimes called the “Father of

Epidemiology”, Using quantitative reasoning, he demonstrated

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 • History…
• 1839 - William Farr extended the epidemiologic analysis of
morbidity and mortality data, looking at effects of marital status,
occupation, and altitude.
• 1854 - John Snow demonstrated that the risk of mortality due to
cholera was related to the drinking water provided by a particular
supplier in London.
• 1937 Austin Bradford Hill, suggested the criteria for establishing
causation from epidemiological studies.
• 1950's-1970's. Major epidemiology successes in the area of non-
infectious diseases
• 1970-: development of the 21st century epidemiology
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• Purpose/Use of Epidemiology
• The use of epidemiology in advancing health sciences
and improving public health practices has been
greatly expanded in the last few decades

• It is used in laboratory sciences, clinical medicine and

public health

• The ultimate purpose of Epidemiology is prevention

and control of disease, in an effort to improve the
health status of populations.
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• Core functions of epidemiology

– Five major tasks of epidemiology in public health

practice

• Public health surveillance

– It is an on going, systematic collection, analysis,
interpretation and dissemination of health data to guide
public health decision making and action.

• Field investigation
– Identification of unreported or unrecognized ill person
who might be continue to spread infection to other
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 • Core functions…
• Analytic studies
– Test the hypothesis

• Evaluation
– Systematically and objectively determine the relevance,
effectiveness, efficiency and impact of activity with respect
to established goal.

• Policy development
– It provide input, evidence and recommendations regarding
disease control strategies, reportable disease regulations,
and health care policies.
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• Scope of Epidemiology
• Originally, epidemiology was concerned with
epidemics of communicable diseases and epidemic
investigations.

• Later it was extended to endemic communicable

diseases and non-communicable diseases.

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 • Scope…
• At present epidemiologic methods are being applied to:
• Infectious and non infectious diseases
• Injuries and accidents
• Nutritional deficiencies
• Mental disorders
• Maternal and child health
• Congenital anomalies
• Health behaviors
• Occupational health
• Environmental health and etc
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• Basic Assumptions in Epidemiology
• There are two basic assumptions in epidemiology.

• Non random distribution of diseases i.e. the

distribution of disease in human population is not
random or by chance.

• Human diseases have causal and preventive

factors that can be identified through systematic
investigations of different populations.

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• Major approaches in epidemiology
• Descriptive epidemiology: one of the basic approaches of
epidemiology concerned with describing the frequency and
distribution of diseases and other health related conditions
with time, place and person

• It answers the questions who, where and when

• Person: people can be categorized with respect to many

variables such as age, sex, ethnic group, race, and other
personal variables.

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 • Approaches…
• Place:
• Natural barriers: environmental or climatic conditions, such
as temperature, humidity, rainfall, mineral content of soil,
water supply.
– It helps to see the nature and etiologic condition of diseases

• Political boundaries: important for planning and allocation

of resources

• Urban-rural differences: in disease occurrence in terms of

migration, style of living and environmental exposures
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 • Approaches…
• Time:
– There are three kinds of changes in disease
occurrence over time.
• Secular trends: years or decades, e.g. AIDS, lung cancer
• Periodic or cyclic changes: Refers to recurrent alterations
in the frequency of diseases.
– Cycles may be annual or have some other periodicity, e.g.
malaria, meningitis

• Sporadic: at irregular and unpredictable intervals

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 • Approaches…

• Analytic epidemiology:
• Deals with the causes and determinants of diseases.

• Involves explicit comparison of groups of

individuals to identify determinants of health
diseases

• Answers the questions why? and how?

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• Features of Epidemiology
• Studies are conducted on human population

• Examines patterns of events in groups of people

• Can establish cause and effect relationship without

the knowledge of biologic mechanism, e.g. smoking
and lung cancer

• Covers a wide range of areas

– From infectious to non-infectious

– From simple survey to complex drug trials

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• Fields in Epidemiology
• As epidemiology continues to develop and to expand
into new areas, the field has diversified into many
forms:

• Surveillance epidemiology: outbreak investigations

and epidemic control

• Microbial epidemiology: Biology and ecology of

pathogenic microorganisms, their lifecycles, and their
interactions with their human and non-human hosts
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 • Fields in…
• Descriptive epidemiology: Examination of
patterns of occurrence of disease and injury
• Risk factor epidemiology: Searching for exposure-
disease associations that may provide insights into
aetiology and roads for prevention
• Clinical epidemiology: Assess accuracy, efficacy,
effectiveness, and unintended consequences of
methods of prevention, early detection, diagnosis,
treatment, and management of health conditions
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Sisay S. (Bsc., MPH in Epidemiology)
 • Fields in…
• Molecular epidemiology: Investigate disease at the molecular level
to precisely characterize pathological processes and exposures, to
elucidate mechanisms of pathogenesis, and to identify precursor
conditions

• Genetic epidemiology: The confluence of molecular biology,

population studies, and statistical models with an emphasis on
heritable influences on disease susceptibility and expression

• Social epidemiology: Interpersonal and community-level factors

influencing health at the population level

• Global epidemiology: Assessing the effects of human activity on

the ecosystem that supports life on Earth.
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Sisay S. (Bsc., MPH in Epidemiology)
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