EXAMINATIONS COUNCIL OF HEALTH SCIENCES/UNZA

FINAL EXAMINATIONS FOR DIPLOMA IN ENVIRONMENTAL SCIENCES

FOR
DIPLOMA IN ENVIRONMENTAL HEALTH TECHNOLOGY

EEP 332: ENVIRONMENTAL EPIDEMIOLOGY

(THEORY)

INSTRUCTIONS TO CANDIDATES

 There are FOUR (4) sections in this paper A, B, C and D

 Answer all questions in sections A, B and C
 Answer two (2) questions in section D

SECTION A MULTIPLE CHOICE QUESTIONS

1. The property of a test to identify the proportion of truly ill persons in a

population who are identified as ill by a screening test is called:

a. Sensitivity
b. Specificity
c. Positive predictive value
d. Negative predictive value

2. A study that measures the number of persons with influenza in a calendar year
a. Cohort study
b. Case control
c. Cross sectional
d. Case report

3. Stage by which the presence of factors favor the occurrence of disease is called
a. Stage of susceptibility
b. Stage of presymptomatic disease
c. Stage of clinical disease
d. Stage of disability
4. The following are measures of central tendency, except
a. Mean
b. Median
c. Mode
d. Variance

5. Range of values surrounding the estimate which has a specified probability of including
the true population values

a. Standard deviation
b. Standard error
c. Confidence interval
d. Correlation coefficient

6. Environmental Epidemiology studies a population in relation to

a. Morbidity and mortality

b. Disease occurrence
c. Epidemics
d. Population observation

7. What do we a call a study that measures the incidence of a disease

a. Case report
b. Cross sectional
c. Case control
d. Cohort

8. Name the type of sampling whereby subjects are assigned according to a factor that
would influence the outcome of a study

a. Simple random sampling

b. Systematic sampling
c. Stratified random sampling
d. Cluster sampling

9. Which of the following are examples of active immunization

a. BCG & OPV
b. BCG & DPT
c. BCG & Hepa B
 d. All of the above \

10. Prevalence refers to:

a. The number of existing cases of a disease, health condition or death in a population at some
designated time
b. All cases of a disease, a health condition or death that exist at a particular point in time
relative to a specific population from which the cases are derived.
c. The presence of a diagnosed disease at a given period of time
d. The number of new cases in a particular point in time.

11. The mode of transport of an infectious agent through the environment to a susceptible host is
called a:

a. Carrier
b. Reservoir
c. Vector
d. Vehicle

12. Active immunity refers to:

a. Immunity gained from person to person transaction

b. The development of immunity from previous exposure to an agent
before a vaccine or natural infection
c. Resistance of the entire community because of the people immunity
within the community
d. All of the above

13. Cohort studies are sometimes called:

a. Snapshort studies
b. Retrospective studies
c. Prospective studies
d. None of the above

14. Herd immunity is:

a. Immunity gained from a person to person transaction.

b. Acquired immunity from previous exposure to an agent before
vaccination or natural infection.
c. Resistance of the entire community because of the people immunity
within the community
d. All of the above

15. Population at risk is:

a. The group of people at risk from which the study participants will be sampled
b. The group of people to which the interpretation of study results will most likely be generalized
c. The group of people in the general population who could develop the disease of interest
d. The group of people sampled from the general population and included in the study

16. In the definition of epidemiology, "distribution" refers to all of the following except:
a. Who
b. When
c. Where
d. Why

17. John Snow's investigation of cholera is considered a model for epidemiologic field
investigations because it included all of the following except:

a. Biologically plausible hypothesis

b. Comparison of a health outcome among exposed and unexposed groups
c. Multivariate statistical model with time factor
d. Spot map
e. Recommendation for public health action

18. A reservoir of an infectious agent can be:

a. A symptomatic human
b. An animal
c. The environment
d. All of the above

19. Disease control measures are generally directed at the following except.

a. Eliminating the reservoir

b. Eliminating the vector
c. Eliminating the host
d. Interrupting mode of transmission

20. Physical environmental factors under the epidemiological triangle include:

a. Climate, terrain, and pollution.

b. vectors, humans and plants
c. host, agent, and environment
d. predisposing, or aggravating factors

21. Epidemiology is mainly a ____________________science.

a. measures of disease
 b. quantitative
c. collection,
d. compilation analysis

22. The...................... in the infectious process range from viral particles to complex multi-cellular
organisms

a. Reservoirs
b. Agents
c. Portal of exit
d. Mode of transmission

23. The amount of hazard that enters the body is termed as:

a. Exposure
b. Dose
c. Effect
d. Hazard

24. In the investigation of an epidemic of fatal disease such as SARS, the most appropriate measure
to describe the frequency of death from the disease is the:

a. Mortality rate
b. Case-fatality rate
c. Attack rate
d. Incidence rate

25. The strength of an association between exposure and disease is best measured by the:

a. Incidence rate of disease in the exposed

b. Attributable risk
c. Population attributable risk
d. Relative risk
26. Specificity is defined as:

a. The proportion of patients who do not have the disease who will test negative
b. The proportion of patients who have the disease who will test positive
c. The proportion patients who do not have the disease who will test positive
d. The proportion of patients who have the disease who will test negative

27. Epidemiologists are interested in learning about

a. The causes of diseases and how to cure or control them

b. The frequency and geographical distribution of diseases
c. The causal relationships between diseases
d. All of the above

28. Diseases that are always present in a community, usually at a low, more or less constant,
frequency are classified as having an _____________________pattern.

a. Epidemic
b. Endemic
c. Pandemic
d. All of the above

29. Which of the following statements is true concerning epidemic diseases?

a. They are usually not very contagious

b. At the end of an epidemic, a disease spreads at an increasing rate and then abruptly disappears.
c. They usually appear and disappear seasonally
d. All of the above

30. A disease vector is a(n)_________________

a. Organism that transmits a disease

b. Symptom of a disease
c. Environment condition associated with a disease
d. None of the above

31. Which of the following are elements of Risk Analysis?

a. Risk Assessment and Evaluation
b. Risk Communication
c. Risk Perception and Management
d. All of the above

32. During the first 9 months of national surveillance for eosinophilia-myalgia syndrome
(EMS), CDC received 1,068 case reports that specified sex; 893 cases were in females,
175 in males. Calculate the proportion of EMS cases that were males
a. 16%
b. 15%
c. 0.16%
d. 10%

33. Features of a study that produce systematic errors are generally referred to as:

a. Confounding
b. Bias
c. Randomisation
d. None of the above

34. For any potential environmental hazard one of the main principle for monitoring and controlling
is:

a. To identify the critical agents, pathways and the population at risk

b. For the agents to be classified correctly in that field
c. To have the correct measurements of the concentrates of the pollutants in the environment
d. None of the above.

35. All of the following are true of odds ratio except:

a. It is an estimate of relative risk

b. It is the only measure of risk that can be obtained directly from a case control study
c. It is the ratio of incidence in exposed divided by the incidence in nonexposed
d. It can be calculated without data on rates

36. In which of the following ways are Environmental Risk Assessment used:-

a. Compliance with legislation

b. Product safety
c. Financial planning
d. All of the above

37. Population risk difference refers to:

a. Difference between the rate of disease in the none-exposed segment of the population and the
overall rate in the population.
b. Forms of intervention studies of randomized controlled trials
c. Probability of test preventive measures
d. None of the above

38. Environmental Risk Assessment has:

a. Six steps
b. Five steps
c. Four steps
d. Three steps

39. What are the commonly used methods to control confounding in the design of an epidemiological
study are

a. Randomization
b. Matching.
c. Restriction
d. All of the above

40. Which of the following levels of disease prevention is used for promoting health, preventing
exposure and disease?

a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. None of the above
SECTION B: TRUE OF FALSE QUESTIONS

 There are Ten (10) Questions in this section

 Answer all Questions in this section
 Each Question carries one (1) mark
 Indicate the best answer of your choice either TRUE or FALSE in the answer booklet
(Total marks = 10)

1. Epidemiology is used to monitor continuously over a period of time the change of health in a
community T/F
2. Epidemiology triangle is not the interaction of the agent, the host, and the environment which
determines whether or not a disease develops T/ F

3. A ratio does not quantify the magnitude of one occurrence or condition to another. T/ F

4. A proportion does not quantify the occurrences in relation to the populations in which these
occurrences take place. T/ F

5. The environment includes all none external factors, other than the agent, that can influence
health. T/ F

6. The “natural history of disease” does not refer to the progression of disease process in an
individual over time, in the absence of intervention. T/ F

7. Risk difference is not the absolute difference in the incidence (risk) of disease between the
exposed group and the non-exposed (“reference”) group T/ F

8. Rate is the most important epidemiological tool used for measuring diseases. T/ F

9. Morbidity is the extent of illness, injury or disability in a defined population T/ F

10. Attack rate is a type of incidence rate which is mainly used during epidemics. T/ F
SECTION C: SHORT ANSWER QUESTIONS

 There are SIX (6) Questions in this section

 Answer all Questions in this section
 Each Question carries 5 marks each
(Total marks = 30)

1.

1) Define Attack Rate ; Attack rate is an incidence rate (Usually expressed as a per cent),
used only when the population is exposed to risk for a limited period of time such as
during an epidemic.
2) Of 75 persons who attended a church picnic, 46 subsequently developed a gastrointestinal
illness. Calculate and interpret appropriately the attack rate of GI illness.
Attack rate = Number of new cases of specific disease
During a given time period x 100
Population at risk during that Period

 2.Briefly describe the uses of epidemiology to research studies of environmental health.

-Used in accurate diagnosis and treatment of diseases
-identification of populations at high risk for a given disease so that the cause may be identified
and preventive measures implemented.
-information from epidemiologic frequently is used to plan new health services and to evaluate
the overall health status of a given population.
-promotes the health of all populations through etiologic and interventional research supported
by innovative methods and the accurate interpretation of research findings

 Outline the advantages of case control studies

-Good for studying rare conditions or diseases
-Less time need to conduct the study than cohort
-Useful as studies to establish an association
 -Relatively cheaper than cohort
-Can evaluate effects of multiple exposure

3. Briefly describe the major variables in descriptive epidemiology

-time

-place

-person

4. Define the following terms

- Crude death rate: The crude mortality rate is the mortality rate from all causes of death for a
population.
- Secondary attack rate: the of cases developing within the incubation period over the number
of primary cases.
- Age specific mortality rate: An age-specific mortality rate is a mortality rate limited to a
particular age group
- Proportionate mortality rate: the number of deaths from a given cause per 100 or 1000 total
deaths in the same period.
- Odds ratio: Odds ratio is the measure of association between exposure and outcome in case-
control studies and cross sectional studies.

5. Briefly describe in which studies the relative risk (RR) and the odds ratio (OR) are used.

6. Describe the three levels of disease prevention

Primary prevention:-The main objectives of primary prevention are promoting health, preventing
exposure and preventing disease. Primary prevention keeps the disease process from becoming
established by eliminating causes of disease or increasing resistance to disease.

Secondary prevention:- The objective of secondary prevention is to stop or slow the progression of
disease so as to prevent or limit permanent damage. Secondary prevention can be achieved through
detecting people who already have the disease as early as possible and treat them. It is carried out before
the person is permanently damaged.

Tertiary prevention:– is targeted towards people with permanent damage or disability. Tertiary prevention
is needed in some diseases because primary and secondary preventions have failed, and in others because
primary and secondary prevention are not effective.
SECTION D: ESSAY QUESTIONS

 There are FOUR (4) Questions in this section

 Answer Two (2) Questions only from this section
 Each Question carries 10 marks
(Total marks = 20)

1) Discuss in details the (4) four types of factors that may be necessary to play a part in the
causation of disease.
•Predisposing factors: create a state of susceptibility to a disease agent. e.g. age, sex, previous
illness. These may have no direct bearing on the cause of the disease but they aid other risk
factors e.g. salivary gland diseases for caries development.
•Enabling factors: environmental conditions which favour the development of disease. E.g. low
income, poor housing, poor nutrition, inadequate medical facility
• Precipitating factors: specific or noxious agent, exposure to which can be associated with the
onset of a disease. E.g. pollens in asthmatic attack.
•Reinforcing factors: factors which aggravates an already established disease or state. e.g.
repeated exposure and unduly hard work.
• Interaction: The effect of two or more causes acting together is often greater than would be
expected on the basis of individual effects. Two or more causes acting together to amplify
(greater than additive) the intensity of the effect produced.
E.g. risk of cancer in smokers exposed to asbestos is greater than the summation of effect of each
of the factors.

2) - Define Risk Difference

- Of 100 persons with high asbestos exposure,14 develop mesothelioma over 10 years,
Of 200 persons with low/no asbestos exposure, 12 develop mesothelioma over 10 years
Calculate and appropriately interpret the risk difference.
- Outline the advantages and disadvantages of a cohort study design

3) Discuss in details the components of Environmental Risk Assessment

4) Clearly discuss in details the potential errors in epidemiological studies