ARBA MINCH UNIVERSITY

SCHOOL OF PUBLIC HEALTH

EPIDEMIOLOGY AND BIOSTATISTICS UNIT

INTRODUCTION TO EPIDEMIOLOGY

BY MATHEWOS A. (MPH/EPIDEMIOLOGY AND BIOSTATISTICS)

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 Learning Objectives

At the end of this unit the student is expected to:

• Define Epidemiology
• Describe the history of epidemiology
• Discuss the basic epidemiologic assumptions
• Describe the scope of epidemiology
• Describe uses of epidemiology
• Describe the categories of epidemiology
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What is Epidemiology ?

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 Definition

• The word epidemiology comes from the Greek

words:
– epi, meaning “on or upon,”
– demos, meaning “people,” and

– logos, meaning “the study of.”

Many definitions have been proposed, but the following

definition captures the underlying principles.
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 Definition cont…

• Epidemiology: Is the study of the distribution and

determinants of disease frequency in human
populations and the application of this study to control
health problems.
• “Disease” refers to health-related states and events
including diseases, injuries, disabilities, and death.
 Cont…
Definition of epidemiology has five key words or phrases:
(1) Population,

(2) Disease frequency,

(3) Disease distribution,
(4) Disease determinants, and
(5) Disease control.
 Population
• Population refers to a group of people with a
common characteristic such as place of
residence, gender, age, or use of certain medical
services.
• Epidemiologists are concerned with disease
occurrence in groups of people rather than in
individuals.
 Cont…
• Determining the size of the population in which
disease occurs is as important as counting the
cases of the disease,
• This is because it is only when the number of
cases is related to the size of the population that
we know the true frequency of disease
 Disease Frequency
• This refers to quantifying the existence or
occurrence of disease.
• Frequency includes the number of events in a
population, and the rate or risk of disease in the
population (It is a quantitative science).
• Is prerequisite for any systematic investigation of
patterns of disease occurrence.
 Cont…
• Counting, which is a key activity of
epidemiologists, includes three steps:
(1) Developing a definition of disease,

(2) Instituting a mechanism for counting cases of

disease within a specified population, and

(3) Determining the size of that population.

 Disease Distribution
• Disease distribution refers to the analysis of
disease patterns according to the characteristics
of person, place, and time.
• In other words,
– who is getting the disease,

– where is it occurring, and

– how is it changing over time?
 Disease Determinants

• Disease determinants are factors that bring about a

change in a person’s health, that is, factors that either
cause a healthy individual to become sick or cause a
sick person to recover.
• Thus, determinants include both causal and preventive

factors.
 Cont…
This include individual:
 Environmental, and societal characteristics.
 Individual determinants include:
 A person’s genetic makeup,
 Gender,

 Age,

 Immunity level,

 Diet,

 Behaviours, and

 Existing diseases
 Cont…
• For example, the risk of breast cancer is increased
among women:
– Who carry genetic alterations such as BRCAI and BRCA2,
– Are elderly, give birth at a late age, have a history of benign
breast disease, or
– Have a history of radiation exposure to the chest.
 Cont…

• A major focus of epidemiology is informing

efforts to prevent and control disease and
promote health.
• To do this, we need to know the causes of
disease or injury and the ways in which these
causes can be modified.
 Disease Control

• Epidemiologists accomplish disease control through

epidemiologic research, as described above, and
through surveillance.

• The whole aim in studying the frequency, distribution,

and determinants of disease is to identify effective
disease prevention and control strategies.
 Cont…

• Epidemiology is more than “the study of.”

• As a discipline within public health, epidemiology

provides data for directing public health action.

• The aims of public health: to promote, protect and

restore health.
Community Medicine Vs Clinical Medicine

What/ who is studied in Clinical Medicine?

Sick patients who come to health care
facilities
What/ who is studied in Community Medicine?
Populations or community at large
E.g. Epidemiology
– In both case intervention is preceded by diagnosis.
– Basically, the two are complementary to each other

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 Cont…

Community diagnosis: The process of identification

and detailed description of the most important health
problems of a given community.

Tasks of community diagnosis requires statistical

and epidemiological knowledge.

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 Cont…
• Example 1: For the patient with diarrheal disease, the clinician
and the epidemiologist have different responsibilities.

• The clinician usually focuses on treating and caring for the

individual.

• The epidemiologist focuses on:

– the exposure (action or source that caused the illness),

– the number of other persons who may have been similarly exposed,

– the potential for further spread in the community, and

– interventions to prevent additional cases or recurrences.

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 cont…
Example 2:
 Malaria affects many people in Ethiopia but lung cancer is
rare.
 If an individual develops lung cancer, it is more likely that
he/she will die.
 Even though lung cancer is more killer, epidemiology gives
more emphasis to malaria since it affects many people.
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 Cont…

• NB: Epidemiologists are concerned not only

with death, illness and disability, but also with
more positive health states and, most
importantly, with the means to improve health.

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 Components of Epidemiology
1. Measure disease frequency
– Quantify disease
2. Assess distribution of disease
 Who is getting disease?
 Where is disease occurring?
 When is disease occurring?
 Formulation of hypotheses concerning causal and
preventive factors
3. Identify determinants of disease
– Hypotheses are tested using epidemiologic studies
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 History of Epidemiology

• Although epidemiological thinking has been traced to

the time of Hippocrates, the discipline did not
flourish as an independent discipline until the 20th
century.
• Some key dates and contributions to the development
of epidemiologic thinking and methods include:

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 Hippocrates - 5th century

• The father of modern medicine.

• For the first time in the fifth century B.C. he

suggested that the development of human
disease might be related to the external as well
as personal environment of an individual.

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 Cont …

“Whoever wishes to investigate medicine properly should proceed thus:

in the first place to consider the seasons of the year, and what effects
each of them produces… when one comes into a city in which he is a
stranger, he should consider its situation, how it lies as to the winds
and the rising of the sun…One should consider most attentively the
waters which the inhabitants use…and the ground… and the mode in
which the inhabitants live, and what are their pursuits, whether they
are fond of drinking and eating to excess, and given to indolence, or
are fond of exercise and labor”. (Hippocrates)

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 Cont…
• John Graunt - 1662

–Published “The nature and political observations Made Up on the Bills

of mortality”

– The first to quantify patterns of birth, death and disease occurrence in

London,

– Noting male-female disparities,

– High infant mortality, urban-rural differences

– Seasonal variation for mortality

– Assess
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the impact of plague 27
 Cont…

• His recognition of the value of routinely

collected data in providing information about
human illness forms the bases of modern
epidemiology.

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 Lind -1747

Used an "experimental" approach to

prove the cause of scurvy by showing it
could be treated effectively with fresh
fruit.

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William Farr - 1839
 Set up system for routine compilation of the numbers and cause of
diseases.
 Recognized that data collected from the population could be used to
learn about illness.
 Compared mortality pattern of married and single as well as those
workers in different occupation.
 Defined:
– population at risk
– Choosing appropriate comparison group
– Other factors
o Age,
o Duration of exposure,
o General health status

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 John Snow - 1853
• Postulated that cholera was transmitted by contaminated water
through unknown mechanism.
• Death rate by cholera were high in London supplied by:
– Lambeth, Southwark and Vauxhall Company (1949 – 1954)
polluted by the sewage from London.
– Lambeth changed the source
• Rate of Cholera declined in the area supplied
– Southwark and Vauxhall Company continued
No change in rate of cholera.
• His unique contribution in epidemiology lies in his recognition
of an opportunity to test the hypothesis implicating the water
supply.
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 1937-Bradford Hill:
• Successes in the area of:
 Mainly worked on the
Principles of Medical
Statistics and suggested the
criteria for establishing
causation.
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1950's-1970's:
- fluoride
- tobacco
- blood pressure & stroke
- CHD risk factors
- toxic shock syndrome
- endometrial cancer
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 Some of the important factors that lead to
progressive development of epidemiology are:

• The need for quantitative reasoning in public health

• Possibility of conducting comparative studies comparison of
groups or populations

• Increasing availability of vital statistics system

• Hygienic and public health movement
• Improvements in diagnosis and classification

• Advances in the field of statistics

• Advances in computer applications and development of user-
friendly statistical software

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Basic Epidemiologic Assumptions

• In order to fully grasp the notions of

epidemiology it is important to understand the
two basic assumptions in epidemiology:

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 Cont…
1.Human disease does not occur at random:

There are patterns of occurrence in which some behavioral and

environmental factors (exposures) increase the risk of acquiring/developing

a particular disease among group of individuals.

2. Human disease has causal and preventive factors that can be

identified through systematic investigation of populations or group of

individuals within a population in different places or at different times.

Thus, identifying these factors creates opportunity for prevention and

control of diseases in human population either by eliminating the cause or

introducing
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appropriate treatment. 35
Scope of Epidemiology
• Epidemics
• Non-communicable diseases.
• 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 all diseases
conditions
– Cancer and related events
– Occupational health
– Environmental health
– Health behaviors
– violence, and hygienic practices

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 Uses of Epidemiology
 Describe the health status of the population
 Elucidate the natural history of disease.
 Provide understanding of what causes or sustains
disease in populations.
 Define standards and ranges for normal values of
biological and social measures.
 Guide health and healthcare policy & planning.

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 Uses of Epidemiology …
 Assist in the management and care of health and disease
in individuals.
 Evaluate the effectiveness of intervention.
 Supply information for decision:
– Individual: behavioral change, contraception, sexual
– Public health : Interventions, priority setting, resource
allocation, evaluating effectiveness of intervention
(evaluation)

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 Categories of epidemiology

Epidemiology can be categorized into two:

1. Descriptive Epidemiology

2. Analytic Epidemiology

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 Categories of epidemiology…

1. Descriptive Epidemiology :

 Is limited to a description of the occurrence of a disease in a population

and is often the first step in an epidemiological investigation.

 Defines the amount and distribution of health problems in relation to

person, place and time.

It answers the questions who, where and when.

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 Descriptive Epidemiology…

To describe the occurrence of a disease fully, the

following questions must be answered.
– Who is affected?
– Where? and

– When do the cases occur?

– How many?

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 Descriptive Epidemiology…

Person: people can be categorized with

respect to many variables.
– Age
– Sex
– Ethnic group and Race
– Other personal variables

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 Descriptive Epidemiology…

Place

• Environmental or climatic conditions, such as temperature,

humidity, rainfall, altitude, mineral content of soil, or water supply.

• helpful to see the nature and etiology of diseases.

• Political boundaries.

- intended for planning and allocation of resources

• Urban-rural differences in disease occurrence in terms of migration,

style of living and differential environmental exposures is also
helpful.
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 Descriptive Epidemiology…

• Time:
Long term variations (years) ,
Seasonal Variations (week or month),

Day of week and

 Time of day.

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 Analytic Epidemiology
2. Analytic Epidemiology – involves explicit comparison of
groups of individuals to identify determinants of health and diseases.
 It is concerned with the search for causes and effects, It answers the
questions why and how.
 It is sometimes said that epidemiology can never prove that a
particular exposure caused a particular outcome.
 Epidemiology may, however, provide sufficient evidence for us to
take appropriate control and prevention measures.

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 THANK YOU
VERY MUCH

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