INTRODUCTION TO

EPIDEMIOLOGY
 Learning Objectives
• At the end of this module, the
student will be able to:
• 1. Explain/discuss the definition of
epidemiology
• 2. Enumerate and discuss the
goals/aims of epidemiology
 Learning Objectives
• 3. Describe the background of this science as
to:
3.1 history
3.2 changing patterns of mortality
3.3 modern epidemiology
• 4. Describe the scope of epidemiology
• 5. Enumerate and discuss the uses of this
particular science
Epidemiology – science that forms the basis for public
health action and unites the public health professions
• 3 Greek Roots :
1. Epi – meaning upon
2. Demos – meaning people
3. Logia – meaning study

Basis of Epidemiology: Two Assumptions

1. Diseases do not occur by chance
2. Diseases are not distributed randomly in the population;
thus their distribution indicates something about how and
why that disease process occurred.
 Other Definitions of Epidemiology
• Frost (1936) states that Epidemiology “ at any given
time is something more than the total of its
established facts. It includes their orderly
arrangements into chains of inference which extend
more or less beyond the bounds of direct
observation”.
• This definition emphasizes the fact that Epidemiology
is primarily a method of reasoning – that is, a way of
looking at a complex population with many variables
and making sense out of the events that occur within
the population. It is applied common sense.
 THREE BASIC COMPONENTS IN THE
DEFINITION OF EPIDEMIOLOGY

• 1. Human Populations
• 2. Distribution of Disease
• 3. Factors Affecting
Distribution
 “
The Elephant’s Child” (1902) Rudyard Kipling

I keep six honest serving men,

(they taught me all I knew)
Their names are what, why, and
when
and how and where and who
 The six soldiers in epidemiology
• Epidemiology is a science that deals with
human populations. Through the use of
concepts and principles of epidemiology, you
will be able to:
• 1. determine who are suffering from a disease
• 2. how they may have acquired the disease
• 3. what the disease is or its signs and
symptoms and clinical course
 The six soldiers in epidemiology
• 4. where these affected people may be
found
• 5. when the disease will usually develop
as in seasonality and other factors which
affect the time when the disease will
develop
• 6. why these people developed the
disease in the first place
 Epidemiologists
• Since Epidemiology is a
multidisciplinary subject ,
epidemiologists have diverse
backgrounds including human and
animal medicine, microbiology,
statistics,, computer programming,
administration, toxicology and
entomology.
 The goals of the Epidemiologist
a. Identify factors that cause
disease or disease
transmission
b. Prevent the spread of
communicable and
noncommunicable diseases
and conditions
 What is the Difference between an
Epidemiologist and a Clinician?

• An epidemiologist is trained to
identify and prevent disease in a
given population while a clinician
is trained to identify and treat
disease in an individual.
 What is the Difference between an
Epidemiologist and a Basic Scientist?

• An epidemiologist studies diseases

in a population with many
variables over which one has no
control, while a basic scientist
studies diseases in a laboratory ,
modifying one variable at a time.
 AIMS/GOALS OF EPIDEMIOLOGY
• 1. To elucidate causal mechanisms
• 2. To explain local disease occurrence –
Ex. Localized outbreaks of food poisoning
and salmonellosis
• 3. To describe the natural history of a
disease – Ex. How the duration and
possible outcomes of a disease vary by
age, sex, geography etc.
 AIMS/GOALS OF EPIDEMIOLOGY
• 4. to provide guidance in the administration
of health services

Ex. Estimation of the number of hospital beds required

for patients w/ specific diseases (chronic nephritis,
mental illness) or for given segments of the
population ( prematurely born infants, elderly) req.
the knowledge of the frequency and natural history of
the specific diseases or of all diseases in the given
segments of the population.
 Uses of Epidemiology
1. Identify factors that cause disease
2. Identify factors or conditions that can
be used or modified to prevent the
occurrence or spread of disease
3. Explain how and why diseases and
epidemics occur
4. Evaluate the effectiveness of vaccines
and different forms of drug therapy
 Uses of Epidemiology
5. Establish a clinical diagnosis of a
disease
6. Identify the health needs of the
community
7. Evaluate the effectiveness of health
programs
8. Predict the future health needs of a
population
 Relating One’s Line of Work with the Use
of Epidemiology
• 1. If you are a program manager, then
you can make use of epidemiology for
planning and evaluation purposes.
• 2. If you are mainly a clinician, you make
use of knowledge gained from
epidemiology when you try to diagnose,
treat and predict the course of the
disease of your patient
 Relating One’s Line of Work with the Use of Epidemiology

• 3. A Rural Health Physician makes intensive use of

Epidemiology since he plans health programs at
the municipal or clinic level as well as treats and
evaluates patients during his morbidity clinics

• 4. When you prepare your charts and graphs for

the health center, you may be using knowledge
from Biostatistics but the ultimate interpretation of
the figure will be based on epidemiologic
principles.
 HISTORICAL BACKGROUND
• The history of epidemiologic methodology is largely
the history of the development of four ideas:
1. human disease is related to man’s environment
2. the counting of natural phenomena may be
instructive
3. “natural experiments” can be utilized to investigate
disease etiology
4. under certain conditions, experiments on man can
also be utilized for this purpose (intervention studies)
 HISTORICAL BACKGROUND

• DISEASE AND ENVIRONMENT – the idea that

disease may be connected with a person’s
environment was expressed by Hippocrates
almost 2400 years ago in his essay entitled “
On Airs, Waters and Places”. However, the
operative word in Hippocrates’ statement was
consider not count thus nothing is
quantitative.
 HISTORICAL BACKGROUND
• COUNTING AND MEASUREMENT – The
introduction of quantitative methods to
epidemiology –indeed to biology and medicine in
general-is credited to John Graunt, who in 1662
published his “ Natural and Political
Observations…on the Bills of Mortality” wherein
he noted the excess of males over females
among births and deaths, the high rate of
mortality among infants, seasonal variation in
mortality etc.
 HISTORICAL BACKGROUND
• “NATURAL EXPERIMENTS” - non-experimental
observations as evidenced by:
•
. John Snow’s demonstration of the spread of
1

Cholera by fecal contamination of drinking water in 1849

by comparing the cholera death rates in the districts of
London supplied by the Southwark and Vauxhall Company
which drew water from the most polluted area of the
Thames River and that supplied by the Lambeth Co. which
was relocated to a less polluted area of the river. Snow saw
that his observations were consistent with the hypothesis
that persons drinking water supplied by the S & V Co. had
greater risks of cholera than those drinking Lambeth water.
 HISTORICAL BACKGROUND
• “NATURAL EXPERIMENTS”
2. In recent years , a series of studies remarkably
comparable to those of Snow has resulted of “ Blackfoot
Disease” (peripheral vascular disease and gangrene) in
certain areas of Taiwan water from artesian, rather than
wells The provision of piped water to the affected areas
has resulted in
a dramatic reduction in frequency of the disease even
though the suspected etiologic agent – arsenic in the
artesian well water-has been incriminated only
inferentially.
 HISTORICAL BACKGROUND
• INTERVENTION STUDIES – Experimental
studies
• 1. Lind’s trial of fresh fruit in the treatment of
scurvy in 1747.
• 2. Jenner’s experiments with cowpox
vaccination in 1796
• 3. the demonstration of the mosquito-borne
nature of yellow fever by Finlay in 1881 and by
Reed et al. in 1900
 HISTORICAL BACKGROUND
• INTERVENTION STUDIES – Experimental
studies
4. Goldberg’s induction of pellagra by deficient
diet in 1915
5. The experiment of Fletcher assessing the
protective effect of cured rice against beri-beri
in 1905
 SCOPE OF EPIDEMIOLOGY AS FOUND IN
NEWSPAPER ARTICLES
• 1. Reports of epidemics
• 2. Dengue
• 3. Food poisoning
• 4. Red Tide poisoning
• 5. Leptospirosis
 SCOPE OF EPIDEMIOLOGY AS FOUND IN
NEWSPAPER ARTICLES
6. Acute gastroenteritis
• 7. news from WHO identifying or
reporting new risk factors for some non-
communicable diseases
• 8. Summaries of articles on disease
trends over several years
• 9. Reporting of injuries in a disaster
situation