SUBJECT: COMMUNITY

HEALTH NURSING NURSING

presentation on
epidemiology
EPIDEMIOLOGY
 Epidemiology is the basis of preventive and
social medicine . It is health related decipline
and directly applicable to community health
and community health nursing. It not only
helps to understand the health and disease
concept, their determinants but also help in
planning , implementing and evaluating
health services.
Epidemiology is
the study of the Epidemiology is the study
distribution and of various factor and
determinants of conditions that determine
disease prevalence the occurrence and
in man. distribution of health,
disease, defect, disability
{Mac Mohan} and death among groups of
individuals.

{Clark 1965}
 NATURAL HISTORY OF DISEASE
 In the absence of any intervention i.e.
prevention or treatment, all disease follow a
natural course of events which refers to
“Natural History of Disease”.
 The concept was defined and associated with
preventive and control strategies in 1953 by
Leavell and Clark with the help of Schema of
natural history of disease.
 Leavell and Clark have defined the Natural
History of Disease model as under
 THIS MODEL IS BASED ON THE FOLLOWING
ASSUMPTIONS
 Health is a relative state: it is assumed that
every one possesses some degree or level of
health & it depends upon factors related to
people(host)- inherent or acquired
characteristics, factors related to agents or
factors related to environment in which
people (host )live.
 Disease is a process: it is assumed that
disease is not static. It is a process and
begins before the individual is affected.
 Disease is effected due to multiple causation:
the occurrence of any disease depends upon
the epidemiologic triangle composed of
agent, host and environment
 The natural history of any disease as viewed
1. Pre-pathogenesis stage/phase
2. Pathogenesis stage/phase

1. Pre-pathogenesis stage/phase:
This stage is before the onset of disease and
is also called as Pre-disease stage.
 This means people living in any particular
environment are always predisposed to the
risk of disease i.e. they are in pre-
pathogenesis stage of many infectious and
non-infectious diseases.
 The disease will not occur in man unless
these three factors i.e. agent, host and
environment confront and interact to produce
disease provoking stimuli.
2. Pathogenesis Stage:
 This phase begins with entry of causative
agent in the susceptible human host.
 As the agent enters the body through
appropriate channel (e.g. in case of
Chickenpox, the agent Varicella Zoster virus,
must enter through the respiratory tract ), it
induces tissue and physiological changes in
the body.
These changes are subclinical i.e. clinical sign
and symptoms of disease are absent. The
host remains apparently healthy and
ambulant.
 After a lapse of some period which is variable
from disease to disease and ranges in a
specific disease, the health equilibrium within
the body is lost and the sign and symptoms
of the disease begin to appear.
 Incubation Period
 1.DETERMINANTS OF DISEASE- CAUSATIVE/
RISK FACTORS
 Definition and Concept of Risk factors
 Definition :
 The risk factor is defined as “a factor/ or an
attribute that is significantly associates with
the development of a disease and when
modified reduce the possibility of occurrence
of disease or other specified outcomes.”
2,Concepts:
 The risk factor may be truly causative
 The risk factors may be just contributory
factors
 The risk factors may or may not be
modifiable.
3.Agent, Host and Environmental Risk Factors
1. Agent Factors:
 The disease agents are usually classified as
under:
 Biological agents
 Physical agents:
 Chemical agents:
 Mechanical agents:
 Nutrient agents:
 Host is one of the epidemiological
determinants of disease.
 These host related attributes or risk factors
include:
 Demographic characteristics
 Biological factors:
 Psychosocial and economic characteristics
 Life style:
 Past history of exposure
 The Germ Theory
 Theory of Epidemiological Triad
 Multifactorial Causation Theory
 Web of Causation
 Dever’s Epidemiologic Model
 Definition and Concept of Risk factors
 Definition :
 The risk factor is defined as “a factor/ or an
attribute that is significantly associates with
the development of a disease and when
modified reduce the possibility of occurrence
of disease or other specified outcomes.”
 Concepts:
 The risk factor may be truly causative
 There is strong statistical relationship between
the risk factor and disease.
 e.g. smoking and lung cancer.
 But one can neither conclude that all individuals
with the risk factor (i.e. all smokers) will develop
disease (i.e. will have lung cancer) nor the
absence of risk factor (who never smoked) will
ensure the subsequent absence of disease (i.e.
will not have lung cancer).
 The risk factors may be just contributory factors
 e.g. high blood pressure, diabetes, obesity for
heart diseases.
 Agent Factors:
 A disease agent is the primary link in the
development of disease.
 The disease agent is defined as “an element,
a substance-living or nonliving, or a force-
tangible or intangible, the presence or
absence of which may following the effective
contact with susceptible human host under
proper environmental conditions serve as a
stimulus to initiate or perpetuate a disease
process
 Biological environment:
 Physical environment:
 Psychosocial environment:

LEVELS OF PREVENTION OF DISEASE

1. Primordial prevention
2. Primary prevention
3. Secondary prevention
4. Tertiary prevention
 Biological environment
 Physical environment
 Psychosocial environment:
 EPIDEMIOLOGICAL APPROACH

 The Epidemiological Approach to problems of
health and disease is based on two major
foundations.
 asking questions
 making comparison
 RELATED TO HEALTH EVENTS:
 What is the event?
 What is its magnitude?
 Where did it happen?
 When did it happen?
 Who are affected?
 Why did it happen?
 RELATED TO HEALTH ACTION:
 What can be done to reduce this problem and its
consequences?
 How can it be prevented in the future?
 What action should be taken by the community
by the health services? By other sectors? Where
and for whom these activities be carried out?
 What resources are required? How are the
activities to be organized?
 What difficulties may arise, and how might they
be overcome?
 Answer to the above questions may provide clues
to disease actiology, and help the epidemiologist
to
CONCLUSION
THANK YOU