Epidemiology

of
Non-communicable & Communicable Diseases
Malana, Jamaica Chelito D.
Post Graduate Intern
FMCH June 2023
Epidemiology
- Greek words:
a. “Epi” - on or upon
b. “Demos” - people
c. “Logos” - study of

“It 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 control of
health problems. ”
- Center for Disease Control and
Prevention
 Distribution
- Concerned with the frequency and pattern of health events

a. Frequency: number of health events in relation to the number

of the size of population; compares the disease occurrence
b. Pattern: occurrence of health-related events by time, place,
and person.
 Determinants
- Factors that influence the occurrence of the disease and other
health-related events

- “Potential risk factors” such as genetics, acquired, immunologic,

behavioral, environmental exposure
Health-related States
- Anything that affects the well-being of a population
- Applied to chronic diseases, injuries, birth defects,
maternal-child health, occupational health and environmental
health
Specified Populations
- Clinician: concerned about the health of an individual
- Epidemiologist: concerned about the collective health of the
people or the community
 Application
- Applying knowledge to community-based practice
- Epidemiology is both a science and an art
- Clinician: combines medical (scientific) knowledge w/ experience, clinical
judgement and understanding of patient
- Epidemiologist: uses scientific methods of descriptive and analytic
epidemiology in diagnosing the health of the community and proposing
appropriate, practical, and acceptable public interventions to control and
prevent the disease in the community
Non-Communicable VS Communicable Disease

NON-COMMUNICABLE DISEASES COMMUNICABLE DISEASES

➔ Gradual onset ➔ Sudden onset

➔ Multiple causes ➔ Single cause
➔ Long natural history ➔ Short natural history
➔ Prolonged treatment ➔ Short treatment schedule
➔ Quality of life after treatment ➔ Back to normalcy
➔ Prolonged follow up ➔ Short follow up
➔ Multidisciplinary ➔ Single discipline
➔ Care predominates ➔ Cure is achieved
Non-communicable
Diseases
- Group of conditions that are mainly not
a cause of acute infection resulting in
long term sequences and often create
a need for long term treatment or care.
Non-Communicable Diseases
- Leading cause of death worldwide (74% death)
- Global death due to NCDs: 41 million people each year
- Each year, 17 million people die (before 70 yo)
- 86% premature deaths (low and middle income countries)
- 77% all NCD deaths (low and middle income countries)
- Top four main causes:
a. Cardiovascular diseases (44%)
b. Cancer (23%)
c. Chronic respiratory diseases (10%)
d. Diabetes mellitus (4%)

World Health Organization

 Modifiable Behavioral
Risk Factors

Tobacco use Physical inactivity

01 - 7.2 million deaths
every year
02 - 1.6 million deaths

Unhealthy diet Harmful use of alcohol

03 - 4.1 annual deaths 04 - More than half of
the 3.3 annual
deaths

World Health Organization

 Metabolic Risk Factors

High blood pressure Obesity/Overweight

01 -
-
19% global death
Normal BP: less
02 - Normal weight: 18.5-22.9
- Overweight: 23-24.9
than 120/80 mmHg - Obese: >25

Hyperglycemia Hyperlipidemia
03 - Normal FBS: 04 - Normal total
70-100 mg/dL cholesterol: <200
- Normal HbA1c: mg/dL
<5.7%

World Health Organization

Philippine Statistics Authority
Communicable Diseases

Philstar global
Statista Research Department
World Health Organization
 NCD:
Prevention and
Control
DOH PROGRAMS FOR
NON-COMMUNICABLE
DISEASES
Vision:

Tobacco Free Philippines: Healthier People, Communities and Environment.

Mission:

Guarantee the design and Implementation of an Integrated Comprehensive and Whole

System of Government - Society Response
PhilHealth Benefit Packages

● PhilHealth Circular No. 20 s. 2013: Adoption of the Philippine Package of Essential Non-Communicable Disease
(NCD) Interventions (PhilPEN) in the Implementation of PhilHealth’s Primary Care Benefit Package
● PhilHealth Circular No. 31 s. 2013: All Case Rates (ACR) Policy No. 1 – Governing Policies in the Shift of Provider
Payment Mechanism from Fee-for-Service to Case-based Payment
● PhilHealth Circular No. 15 s. 2014: Primary Care Benefit 1 (PCB1) Now Called “Tsekap” Package Guidelines for CY
2014
● PhilHealth Circular No. 17, s. 2014: Implementing Guidelines for the Primary Care Benefit 2 (PCB2) Package
(Out-patient Medicines for Hypertension, Diabetes, and Dyslipidemia) at Selected Innovation Sites
● PhilHealth Circular No. 2, s. 2015: Governing Policies on the Expanded Coverage of the Primary Care Benefit
Package: “Tamang Serbisyo sa Kalusugan ng Pamilya” (Tsekap)

Trainings

● Training on Brief Tobacco Intervention

 HEALTHY
DIET:
PINGGANG
PINOY
FOOD FORTIFICATION PROGRAM
 FOOD FORTIFICATION PROGRAM
Republic Act 8976

“An act Establishing the Philippine Food Fortification

Program and for other purposes”
- November 7, 2004
Republic Act 8172

“An Act Promoting Salt Iodization Nationwide and for related

purposes”

- Approved: December 20, 1995

Food Fortification Program
There are 139 processed food products having Sangkap
Pinoy Seal (2008):
- 83% with vitamin A
- 29% with iron
- 14% with iodine
- 37% on snack foods
Communicable
Diseases
- Are caused by bacteria or viruses that
people can contract from one another
by touching contaminated objects,
through vectors or even by air
droplets.
Epidemiologic Triad
INCUBATION PERIOD

- The period from exposure to infection to the onset

of symptoms or signs of infectious disease.
- The length of incubation period depends on:
a. The portal of entry
b. The rate of growth of the organism in the host
c. The dosage of the infectious agent
d. The host resistance
PERIOD OF COMMUNICABILITY

● The time during which an infectious agent may

be transmitted directly or indirectly from an
infected person to a susceptible person or
animal.
● Its length varies from one disease to another.
Characteristics of
Agent Related to
Man
● Infectivity
● Pathogenicity
● Virulence
● Antigenicity
 01
Infectivity
- The ability of an agent to invade and
multiply to produce an infection in a
susceptible host.
 Secondary Attack Rate
- The proportion of exposed susceptible persons who become infected.

Infectivity:
● High: Measles, Chicken Pox
● Low: Leprosy
 02
Pathogenicity
- Is the ability of the organisms to produce
specific clinical reaction after infection
- It refers to the proportion of infected
persons who develop clinical disease.
 PATHOGENICITY
- Measured by the number of persons developing clinical illness to the number of
exposed.
Pathogenicity:
● High: Measles, Chicken Pox
● Low: Polio, Tuberculosis, Hepatitis A
 03
Virulence
- It refers to the ability of organisms to
produce severe pathological reaction.
- It is the proportion of persons with clinical
disease who become severely ill or die
(mortality).
 Virulence

Examples:
- Rabies
- Hemorrhagic fever
 04
Antigenicity
- The ability of an agent to induce immunity
in a host or to stimulate the host to
produce defense mechanism.
 Types of Immunity

IMMUNITY

INNATE ACQUIRED
● First line of defense ● Second line of response (if innate
● Relies on mechanism existing fails)
before infection ● Relies on mechanisms that adapt
● Examples: gastric acidity, after infection
cough reflex, skin barrier, ● Handled by T- and B-lymphocytes
mucosal secretions, cilia in the ● One cell determines one antigenic
respiratory tract determinant
 Adaptive Immunity

● Naturally Acquired: acquire the disease,

Active subclinical immunity
● Artificially Acquired: vaccination

● Naturally Acquired: maternal antibodies,

Passive colostrum
● Artificially Acquired: immunoglobulins
Classification of
Disease Agents
● Physical agents
● Mechanical Agents
● Chemical Agents
● Nutrient Agents
● Biologic Agents
 Physical Agents

● Cause disorganization within the cells, tissues,

organs, and body as a whole
● Examples:
a. Radiation: somatic and genetic effects
b. Sound: hearing impairment
c. Light: premature aging, photosensitization,
skin cancer
d. Heat: heat stroke, burns
e. Cold: frostbite
Mechanical Agents

● Caused by forces adding unusual stress to the

mechanism of the body resulting into an injury
● Examples:
a. Stab wounds
b. Fractures
c. Dislocation
 Chemical Agents

● Cause by:
A. ENDOGENOUS agents
- product of derangement of the body due
to abnormalities in function
- examples:
➔ Serum cholesterol
➔ Hormonal imbalance
➔ Serum bilirubin
➔ Lactic acid
Chemical Agents

B. EXOGENOUS agents
- agents brought by the environment
- examples:
➔ Inhalation of pollens or dust
➔ Accidents
➔ Ingestion of alcoholic beverage
 Nutrient Agents

- Substances which are necessary to sustain life

- Examples:
a. Vitamins
b. Minerals
c. Water
d. Protein
e. Carbohydrates
 Biological Agents

- Living organisms causing the disease and interfering

with the normal functions of the body
- Also known as: “pathogens”
- Examples:
a. Bacteria
b. Viruses
c. Fungi
d. Parasites
 PATTERN OF OCCURENCE AND
DISTRIBUTION OF DISEASES

EPIDEMIC/
SPORADIC OUTBREAK

ENDEMIC PANDEMIC
 01 SPORADIC
● means “scattered about”
● cases are few and separated widely in time and
place that they show no or little connection with
each other, nor a recognizable common source of
infection
● could be the starting point of an epidemic when the
conditions are favorable for its spread.
 02 ENDEMIC

● constant presence of a disease or infectious agent

within a given geographic area or population group.
● It is the usual or expected frequency of disease
within a population.
 ENDEMIC

HYPERENDEMIC HOLOENDEMIC

● disease is constantly ● high level of infection beginning early in

present at high incidence life and affecting most of the child
and/or prevalence rate population, leading to a state of
and affects all age groups equilibrium such that the adult
equally. population
● shows evidence of the disease much
less commonly than do the children
03 EPIDEMIC/
OUTBREAK
● unusual occurrence in a community of disease,
specific health related behavior, or other
health related events clearly in excess of
expected occurrence
● can occur upon endemic states
 04 PANDEMIC

● affects a large proportion of the population,

occurring over a wide geographic area such as a
section of a nation, the entire nation, a continent or
the world
ERADICATION
Termination of all transmission of infection by
the extermination of the infectious agent
through surveillance and containment; is an
absolute process, an “all or none” phenomenon,
restricted to termination of infection from the
whole world.
ELIMINATION
Used to describe
eradication of a disease
from a large geographic
region
 DISEASE INVESTIGATION
AND CONTROL

Implementation
Case of control
measures Follow-Up
Identification

01 02 03 04 05 06
Preliminary Data Collection & Dissemination
Investigation Analyzation of findings
 SURVEILLANCE
- Essential part of controlling the disease
- Requires a routine system of case
reporting within the health system
- Uses methods distinguished by:
Practicability, Uniformity, Rapidity
 MANAGEMENT
& CONTROL
- Treat the case
- Prevent spread of the disease
- Monitor the effects of control measures
DOH PROGRAMS FOR
COMMUNICABLE
DISEASES
 Vision: A Tuberculosis-Free Philippines
Mission: To Reduce the TB burden, To achieve catastrophic cost of TB-affected household,
To responsibly deliver TB service

National TB Month: AUGUST

372,367 (Notified Drug 3,632 TB Treatment 3,695 TB

Sensitive-TB and Drug Facilities Laboratories
Resistant TB Cases)
Program Components Target Population / Client

● Health Promotion Presumptive TB and TB affected

● Financing and Policy households
● Human Resource
● Information System Area of Coverage
● Regulation
● Service Delivery Nationwide
● Governance
 VISION: Aedes-borne Viral Disease-free Philippines

MISSION: Reduced disease burden of Dengue,

containment and prevention of transmission of
Chikungunya and Zika

TRAININGS

● Dengue Clinical Case Management and Program Management

● Nucleic Acid Amplification Test-Loop Mediated Isothermal Assay (NAAT-LAMP)
Training as One of Dengue Confirmatory Tests of the National Aedes-borne
Prevention and Control Program (NDPCP)
● National Dengue Death / Mortality Review
VISION COMPREHENSIVE PACKAGES

STH-Free Philippines ● Harmonized Schedule and Combined

Mass Drug Administration (HSCMDA) for
MISSION the month of January and July in health
centers, stations and schools.
Synchronized and
● Diagnosis and selective treatment in
harmonized public-private
health centers
stakeholders’ effort in the
● Provision of safe drinking water, basic
control of Soil-transmitted
sanitation and hygiene (WASH) in schools
Helminthiasis (STH) in the
and community
Philippines.
● Health promotion and hygiene education
VISION TRAININGS

A malaria-free Philippines by 2030 ● Online training on Malaria

Elimination Surveillance Strategy
MISSION and Tools
● Basic Malaria Microscopy
By 2022, malaria transmission will have
Training/ Intensive Malaria
been interrupted in all provinces except
Microscopy Training for Medical
Palawan, 75 provinces will have been
Technologists
declared malaria-free, and the number of
indigenous malaria cases will be reduced
to less than 1200, i.e. by at least 75%
relative to 2018.
VISION TRAININGS

Healthy and productive individuals ● Morbidity Management and Disability

and families for filariasis-free Prevention due to Lymphatic Filariasis (LF)
Philippines ● Orientation on Dossier Preparation for LF
Elimination online course
MISSION ● Orientation on Transmission Assessment
Survey
Elimination of Filariasis as public
● Orientation on Filariasis Test Strip
health problem thru a comprehensive
● Orientation of Post Validation Surveillance
approach and universal access to
quality health services
 KNOCKOUT TIGDAS 2007
● A sequel to the 1998 and 2004 “Ligtas Tigdas” mass measles immunization campaign.
● All children 9 months to 48 months old ( born October 1, 2003 – January 1,2007) should be
vaccinated against measles from October 15 - November 15, 2007 , door-to-door.
● All health centers, barangay health stations, hospitals and other temporary immunization
sites such as basketball court, town plazas and other identified public places will also offer
FREE vaccination services during the campaign period.
VISION TRAININGS

To achieve ZERO new ● HIV Counseling and Testing Training (This is designed
infections, ZERO for health care providers and lay people providing HIV
discrimination, and ZERO services to enhance knowledge, skills and attitude in
AIDS-related death. providing HIV counseling including pre and post-test
counseling to clients who access this service at the
MISSION health facilities. This is organized by the Centers for
Health Development)
To improve access and
● Primary HIV Care Training for health service providers
utilization of preventive
(This is designed for facilities that intend to become
primary health care services
an HIV treatment facility. This is organized by the
for HIV and STI
Centers for Development)
VISION TRAININGS

Leprosy-free Philippines by ● Slit Skin Smear Training for Medical

year 2022 Technologists
● Basic Clinical Management for Leprosy
MISSION

To ensure the provision of

comprehensive, integrated
quality leprosy services at
all levels of health care
MISSION: PHILHEALTH BENEFIT PACKAGE

To Declare Philippines ● PhilHealth for Animal Bite Package

Rabies-Free by year 2030 (Rabies Post-exposure Prophylaxis)

VISION:
TRAININGS
To eliminate human rabies
● Training Course on Rabies and Animal
by the year 2027
Bite Management
VISION: Trainings

Schistosomiasis Free Philippines ● Training on the Clinical Practice Guidelines

for the Diagnosis, Treatment and
Prevention of Schistosoma Japonicum
MISSION: infections in the Philippines
Synchronized and harmonized
public and private stakeholders’
efforts in the elimination of
schistosomiasis in the Philippines
EMERGING AND RE-EMERGING
INFECTIOUS DISEASE PROGRAM
PHILHEALTH BENEFIT PACKAGE
VISION:
● Leptospirosis Benefit Package
A health system that is resilient, ● SARS Benefit Guidelines
capable to prevent, detect and respond ● PhilHealth Coverage of Avian Influenza and
to the public health threats caused by Influenza Pandemic
emerging and re-emerging infectious ● Philippine Coverage for Confirmed Case of Novel
diseases Influenza A (H1N1) in Humans
● PhilHealth Coverage for Confirmed Cases of EBOLA
Virus Disease (EVD)
MISSION:
● PhilHealth Coverage for Confirmed Cases of Middle
Provide and strengthen an integrated, East Respiratory Syndrome Coronavirus
responsive, and collaborative health (MERS-CoV)
system on emerging and re-emerging
TRAININGS
infectious diseases towards a healthy
and bio-secure country. ● Training of Rapid Response Team (RRT) for
coordination mechanisms in outbreak response
Thank you
for
listening!
SHORT QUIZ
1. 1. The period from exposure
to infection to the onset of
symptoms or signs of
infectious disease.
2. Type of endemic causing a
disease which is constantly
present at high incidence
and/or prevalence rate and
affects all age groups equally.
1. 3. Normal Total Cholesterol level?
2. 4. Normal FBS level?
3. 5. BMI of Obese? (Asian
Classification)
1. Answers:
2. 1. Incubation Period
3. 2. Hyperendemic
4. 3. <200 mg/dL
5. 4. 70-100 mg/dL
6. 5. >25