Session One

Introduction to Epidemiology

BY:

Sisay S. (BSc, MPH in

Epidemiology)
Feb., 2020

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1. Introduction to Epidemiology
Definition: Originated from three Greek
words.
EPI Logus
demos

on, up on people Doctrine, Study

 The term epidemiology was originally

applied to the study of acute infectious
diseases and was defined as follows:
 “The science of epidemics”
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 Epidemiology
“Basic Science of Public Health”
Current definition
• 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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Sisay S. (Bsc., MPH in Epidemiology)
Terms taken from the definition

1. 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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Sisay S. (Bsc., MPH in Epidemiology)
2. 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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3. 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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Sisay S. (Bsc., MPH in Epidemiology)
4. 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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• 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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5. Human population
• Epidemiology studies the health of the
groups, communities and whole or specific
population.

6. 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
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Sisay S. (Bsc., MPH in Epidemiology)
• 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 effectiveness of health

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Sisay S. (Bsc., MPH in Epidemiology)
• History of Epidemiology
• 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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Sisay S. (Bsc., MPH in Epidemiology)
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 Purpose/Use of Epidemiology

• The ultimate purpose of Epidemiology is

prevention and control of disease, in an
effort to improve the health status of
populations.
• This is realized through:
– Elucidation of the natural history of disease
– Description of the health status of the
population
– Establishing the determinants/causation of
disease

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– Evaluation of intervention 13
Sisay S. (Bsc., MPH in Epidemiology)
 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
•
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Environmental health and etc 15
Sisay S. (Bsc., MPH in Epidemiology)
 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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• Theories of disease Causation
• Cause of disease: is an event,
condition, characteristic or a
combination of these factors which
plays an important role in producing
the disease.
• Not all associations between
exposure and disease are causal.

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1. Sufficient cause and component cause model
• Necessary cause/primary cause: A causal factor
whose presence is required for the occurrence of
the disease.
– Example: Tubercle bacillus is a necessary factor
for tuberculosis.
• Sufficient cause: A causal factor or collection of
factors whose presence is always followed by the
occurrence of the disease.
– Rabies virus is sufficient for developing clinical
rabies.

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Sisay S. (Bsc., MPH in Epidemiology)
2. The epidemiologic triad or triangle

• Is the traditional model of infectious disease causation.

• Infectious diseases result from the interaction between
the infectious agent, host/reservoir and environment.
Host

Environment
Agent

Fig 2. Epidemiological triangle model of disease causation

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• The epidemiologic triangle, depicts the
relationship among three key factors in the
occurrence of disease or injury: agent,
environment, and host.
• From the perspective of epidemiologic
triangle, the host, agent, and
environment can coexist harmoniously.
• Disease and injury occur only when there
is altered equilibrium between them.
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3. The web model

• It is response to the
idea of non-infectious
diseases having no
unique agent

• There is no single
cause

• Causes of disease are

interacting

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Levels of Disease Occurrence
• Diseases in a community occur
1. Expected levels of existence and
2. Excess of expected levels

1. Expected level of occurrence of disease

• Endemic: the usual presence of disease from low
to moderate level
• Hypo/Hyper-endemic: a persistently lower or high
level of disease
• Sporadic: occasional or irregular occur of disease

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Sisay S. BSc, MPH in epidemiology
 Excess of expected levels

• Epidemic: The occurrence of disease or other

health related condition in excess of the
usual frequency in a given area or among a
specific group of people over a particular
period of time.
• Outbreak: Epidemics of shorter duration
covering a more limited area.
• Pandemic: An epidemic that affects several
countries or continents. (e.g. HIV/AIDS, Swine
flue, etc)
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Broad Categories of Epidemiology
• Descriptive Epidemiology - Defines the
amount and distribution of health problems in
relation to person, place and time.
• Analytic Epidemiology – involves explicit
comparison of groups of individuals to
identify determinants of health and diseases.

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 Measurement: Key aspect of Epidemiology

• How many people are • Are there

affected? factors that
• What proportion of the predispose
population is affected?
people to the
• What is the geographic
health problem?
distribution of health
problem?
• Are there specific times in
which people are affected by
the health problem?
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Sisay S. (Bsc., MPH in Epidemiology)
 d !!
E n
h e
T
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