PHS301 APPLIED EPIDEMIOLOGY

REVIEW OF BASIC CONCEPTS AND

PRINCIPLES OF EPIDEMIOLOGY
By
Dr. Yusuf F. Issa, MBBS, MPH, FCAI, FWACP, FRSPH, Cert. Proj. Mgt.

Department of Public Health,

Faculty of Pure and Applied Sciences,
Kwara State University, Malete
 INTRODUCTION
 Epi : Among ; Demos: People ; Logos: Study
 Epidemiology is the basic science of Preventive and Social Medicine.
 Epidemiology is scientific discipline of public health to study diseases in the
community and to acquire knowledge for health care of the society.
(prevention, control and treatment).
 Epidemiology is based on two fundamental assumptions:
 First, human disease does not occur at random
 Second, human disease has causal and preventive factors
 Epidemiology contributes to the rationale for public health policies and
services and is important for use in their evaluation.
 But the delivery of those services or the implementation of those policies is
not part of epidemiology
 INTRODUCTION contd.
Epidemiological principles and methods are applied in:
 Clinical research
 Disease prevention
 Health promotion,
 Health protection
 Health services research.
 The results of epidemiological studies are also used by other scientists, including health economists,
health policy analysts, and health services managers.
Modern Epidemiology:
 - Infectious disease Epidemiology.
 - Chronic disease Epidemiology.
 - Clinical Epidemiology.
 - Genetic Epidemiology.
 - Occupational Epidemiology.
 - Cancer Epidemiology.
 - Neuro-Epidemilogy.
 WHAT IS EPIDEMIOLOGY?
 As defined by John M. Last in 1988, Epidemiology is ‘’the study of the distribution and determinants of
health-related states or events in specified populations, and the application of this study to the prevention
and control of health problems”. (A Dictionary of Epidemiology, Edition 2. New York, Oxford University
Press, 1988. 51).
 There are three closely interrelated components: distribution, determinants and frequency and it
encompass all epidemiological principles and methods.
Frequency of Disease
 The measurement of disease frequency involves quantification of the existence or occurrence of disease.
 The availability of such data is a prerequisite for any systematic investigation of patterns of disease
occurrence in human populations
Distribution of Disease
The distribution of disease considers such questions as:
 who is getting the disease within a population
 where and when the disease is occurring (TPP: time, place, persons).
 Knowledge of such distribution is essential to describe patterns of disease as well as to formulate
hypothesis concerning possible causal and / or preventive factors
 WHAT IS EPIDEMIOLOGY? Contd.
 Distribution of disease occurs in a PATTERN viz- Time, Place, Person .
 PATTERN – Hypothesis for Causative/Risk factor; Etiological Hypothesis; Descriptive Epidemiology
Determinants of Disease
 The determinants of disease is derived from the first two; since knowledge of frequency and distribution of
disease is necessary to test an epidemiological hypothesis
 Identifying the causes and risk factors for diseases.
 Testing the Hypothesis – (Biostatistics)
 Analytical Epidemiology
Functions of Epidemiology
 Discover the agent, host, and environmental factors that affect health, in order to provide the scientific basis
for the prevention of disease and injury and the promotion of health.
 Determine the relative importance of causes of illness, disability, and death, in order to establish priorities for
research and action.
 Identify those sections of the population which have the greatest risk from specific causes of ill health, in
order that the indicated action may be directed appropriately.
 Evaluate the effectiveness of preventive and therapeutic health programs and services in improving the health
of the population.
 Aims and Objectives of Epidemiology
1. To describe the distribution and magnitude of health and disease
problems in human population.
2. To identify etiological factors (risk factors) in the pathogenesis of
disease.
3. To provide data essential to the planning, implementation and evaluation
of services for the prevention, control and treatment of disease and setting
priorities among those services.

 The ultimate aim of Epidemiology is:

1. To eliminate or reduce the health problems of community.
2. To promote the health and well-being of society as a whole.
 Scope of Epidemiology
1. Causation of the disease.
 Most of diseases are caused by interaction between genetic and environmental factors.
(e.g Diabetes)
 Personal behaviors affect this interplay.
 Epidemiology is used to study their influence and the effects of preventive
interventions through health promotion.
2. Natural history of the disease.
 Natural history of the disease Epidemiology is also concerned with the course and
outcome (natural history) of diseases in individuals and groups.
3. Health status of the population.
 • Epidemiology is often used to describe the health status of population.
 • Knowledge of the disease burden in populations is essential for health authorities. •
To use limited resources to the best possible effect by identifying priority health
programmes for prevention and care.
 Scope of Epidemiology contd.
4. Evaluation of Interventions.
 • To evaluate the effectiveness and efficiency of health services.
 • This means determining things such as –
- Impact of Contraceptive use on Population Control.
- the efficiency of sanitation measures to control diarrheal diseases and
- the impact of reducing lead additives in petrol.
Uses of Epidemiology
 o To study historically the rise and fall of disease in the population
 o Community diagnosis
 o Planning and evaluation
 o Evaluation of individual’s risks and chances
 o Syndrome identification
 o Completing the natural history of disease
 o Searching for cause and risk factor
1. Asking questions Epidemiological Approach
Related to Health Events:
1. What is the event? (Problem) 2. What is magnitude? 3. Where did happen?
4. When did happen? 5. Who are affected? 6. Why did it happen?
Related to Health Action:
1. What can be done to reduce the problem? 2. How can be prevented in future?
3. What action should be taken by community? 4. What resources required?
5. How activities to be organized? 6. What difficulties may arise?
 Epidemiology is “a means of learning by asking questions and getting answers that lead
to further questions. These questions can be referred to as: 1. Case definition - (what) 2.
Person - (who) 3. Place - (where) 4. Time - (when) 5. Causes - (why)
2. Making Comparisons.
 To find out the differences in the AGENT, HOST and ENVIRONMENT conditions
between two groups. Weighs, balances and contrasts give clues to ETIOLOGICAL
HYPOTHESIS.
 Applications of Epidemiology
 Applying epidemiological principles and methods to problems encountered in the
practice of medicine has led to the development of- “Clinical
Epidemiology”
 Applications of epidemiology in public health
 1. Preventing disease and promoting health.
 2. Community health assessment (Community Diagnosis) and priority setting.
 3. Improving diagnosis, treatment and prognosis of clinical diseases.
 4. Evaluating health interventions and programmes.
Epidemiology and public health
 Public health, refers to collective actions to improve population health.
 Epidemiology, one of the tools for improving public health, is used in several ways.
 Epidemiology and Clinical Medicine
 In Clinical Medicine the unit of study is a ‘case’, but in the Epidemiology the unit of
study is ‘defined population’ or ‘population at risk’.
 Physician is concerned with the disease in the individual patient, whereas
Epidemiologist is concern with the disease pattern in entire population.
 So, the Epidemiology is concern with the both Sick & Healthy.
 In Clinical Medicine, the physician seeks to diagnosis for which he derives prognosis
and prescribes specific treatment.
 The Epidemiologist is confronted with the relevant data derived from the particular
epidemiological study. (Community Diagnosis)
 He seek to identify the source of infection, mode of transmission, and an etiological
factor to determine the future trends, prevention and control measure.
 In Clinical Medicine patient comes to the Doctor.
 Epidemiologist, goes to the community to find out the disease pattern and suspected
causal factors in the question.
 Basic Measurements in Epidemiology
Scope of Measurements in epidemiology
 Measurement of mortality
 Measurement of morbidity
 Measurement of disability
 Measurement of natality
 Measurement of disease attributes
 Measurement of health care needs
 Measurement of health care services
 Measurement of the risk factors
 Measurement of demographic variables
 Measurement of presence or absence of attributes.
 Measurement of environmental & other risk factors.
Basic Measurements in Epidemiology contd.
TOOLS OF MEASUREMENTS
 Basic tools are –
 Rate
 Ratio
 Proportion
 Rate
 • Used for expression of disease magnitude
 • A “Rate” measures the occurrence of some specific event in a population
during given time period.
 • Example – Death Rate = total no of death in 1 yr / Mid-year population x
1000.
Basic Measurements in Epidemiology contd.

ELEMENTS – Numerator, Denominator, time & multiplier.

 Numerator – Number of events in a population during specified time.
 Denominator - 1. Total population - Mid-year population - Population at risk
2. Total events
Ratio
 • Ratio measures the relationship of size of two random quantities.
 • Numerator is not component of denominator.
 • Ratio = x / y
 • Example- - Sex – Ratio, Doctor- Population Ratio.
Proportion
 • Proportion is ratio which indicates the relation in a magnitude of a part of whole.
 • The Numerator is always part of Denominator.
 • Usually expressed in percentage.
 EPIDEMIOLOGIC RESEARCH METHODS
 Epidemiological Studies
1. Observational Studies
• Observational studies allow nature to take its course.
• The investigator measures but does not intervene.
Example – Descriptive and Analytical Studies
2. Experimental Studies
• Active involvement to change disease determinants.
• such as an exposure or a behaviour – or the progress of a disease
through treatment.
• are similar in design to experiments in other sciences.
Example- 1. Randomized Control Trials. 2. Field Trials &
Community Trials.
EPIDEMIOLOGIC RESEARCH METHODS
contd.
 Revise ASSOCIATION AND CAUSATION