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Lecture 1 - Introduction To Epidemiology - 23052012

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18 views30 pages

Lecture 1 - Introduction To Epidemiology - 23052012

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victoromo196
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Introduction to Epidemiology

Prof. Deborah T. Esan

09/08/2011 1
Objectives
• At the end of this lecture, you should be able
to:
– Define Epidemiology and appreciate its scope
– Describe the evolution of Epidemiology
– Describe the types of Epidemiology
– List some of the application of Epidemiology in
health
Epidemiology
The word epidemiology comes from the Greek
words

epi, meaning on or upon, demos, meaning


people, and logos, meaning the study of.
Epidemiology
• In other words, the word epidemiology has its
roots in the study of what befalls a
population.
• Many definitions have been proposed, but
the following definition captures the
underlying principles and public health spirit
of epidemiology:
Definition
Epidemiology is
THE STUDY OF THE DISTRIBUTION AND
DETERMINANTS OF DISEASES AND HEALTH
RELATED EVENTS IN SPECIFIED (HUMAN)
POPULATIONS, AND THE APPLICATION OF
THIS STUDY TO THE CONTROL OF HEALTH
PROBLEMS
•Last JM, editor. Dictionary of epidemiology. 4th ed. New York: Oxford University
Press;2001. p. 61.

5
KEY WORDS
• STUDY – SCIENTIFIC DISCIPLINE
• DISTRIBUTION – FREQUENCY AND PATTERNS -
POPULATIONS AT RISK: WHO, WHERE AND WHEN
• DETERMINANTS – PREDISPOSING OR PROTECTIVE
FACTORS: AGENT, HOST AND ENVIRONMENTAL
FACTORS
• APPLICATION – APPLYING KNOWLEDGE GAINED
TO COMMUNITY BASED PRACTICE
• HEALTH RELATED EVENTS - NOT LIMITED TO
DISEASE ENTITIES BUT INCLUDES STUDY OF
OTHER HEALTH RELATED EVENTS

6
HEALTH RELATED STATES OR EVENTS
• Originally used to investigate outbreaks of
infectious diseases in the 19th century
• Now applied in:
– investigation of the causes and natural history
of all types of diseases (communicable and
non-communicable)
– development and assessment of preventive
programmes and treatment
– planning and evaluation of health services

7
SUMMARY - 1
• EPIDEMIOLOGY IS THE (Scientific,
Systematic, Data-driven) STUDY OF THE
DISTRIBUTION (Frequency and Pattern)
AND DETERMINANTS (Causes and Risk
Factors) OF DISEASES AND HEALTH RELATED
EVENTS IN SPECIFIED POPULATIONS (the
community is the patient) AND THE
APPLICATION OF THIS STUDY TO THE
CONTROL OF THE HEALTH PROBLEMS

8
Historical Evolution of
Epidemiology
• Although epidemiology as a discipline has
blossomed since World War II, epidemiologic
thinking has been traced from Hippocrates
through John Graunt, William Farr, John
Snow, and others. The contributions of some
of these early and more recent thinkers are
described below
• Hippocrates attempted to explain disease
occurrence from a rational rather than a
supernatural viewpoint.

• In his essay entitled “On Airs, Waters, and


Places,” Hippocrates suggested that
environmental and host factors such as
behaviors might influence the development of
disease
John Graunt
• Another early contributor to epidemiology
was John Graunt, a London councilman who
published a landmark analysis of mortality
data in 1662.
• This publication was the first to quantify
patterns of birth, death, and disease
occurrence, noting disparities between males
and females, high infant mortality,
urban/rural differences, and seasonal
variations
William Farr (1800)
• William Farr built upon Graunt’s work by
systematically collecting and analyzing
Britain’s mortality statistics.

• Farr, considered the father of modern vital


statistics and surveillance. He concentrated
his efforts on collecting vital statistics,
assembling and evaluating those data, and
reporting to responsible health authorities
and the general public
JOHN SNOW
• In the mid-1800s, an anesthesiologist named
John Snow was conducting a series of
investigations in London that warrant his being
considered the “father of field epidemiology.”
Twenty years before the development of the
microscope, Snow conducted studies of
cholera outbreaks both to discover the cause
of disease and to prevent its recurrence.
JOHN SNOW CONTD.
• John Snow, an English physician, formulated and
tested a hypothesis concerning the origin of an
epidemic of cholera in London. On the basis of the
available data snow postulated that cholera was
transmitted by contaminated water through a then
unknown mechanism.
• He observed that death rates from cholera were
particularly high in areas of London that were
supplied with water by the Lambeth Company or
the Southwark and Vauxhall Company, both of
which drew their water from the Thames River at a
• . Between 1849 and 1854, the Lambeth
Company changed its source to an area of the
Thames where the water was "quite free from
the sewage of London." Finally, Snow
concluded that the source of cholera outbreak
was contaminated water.
19 and 20 Centuries
th th

In the mid- and late-1800s, epidemiological


methods began to be applied in the
investigation of disease occurrence. At that
time, most investigators focused on acute
infectious diseases.
In the 1930s and 1940s, epidemiologists
extended their methods to noninfectious
diseases.
19 and 20 Centuries contd.
th th

• During the 1960s and early 1970s health


workers applied epidemiologic methods to
eradicate naturally occurring smallpox
worldwide. This was an achievement in
applied epidemiology of unprecedented
proportions.
• The 1980s, epidemiology was extended to the
studies of injuries and violence.
19 and 20 Centuries contd.
th th

In the 1990s, the related fields of molecular and


genetic epidemiology (expansion of epidemiology to
look at specific pathways, molecules and genes that
influence risk of developing disease) took root.
Meanwhile, infectious diseases continued to
challenge epidemiologists as new infectious agents
emerged (Ebola virus, Human Immunodeficiency
virus (HIV)/ Acquired Immunodeficiency Syndrome
(AIDS)), were identified, or changed (drug-resistant
Mycobacterium tuberculosis, Avian influenza
Types of Epidemiology
• Generally, there are two main ways of describing
epidemiology
– Descriptive – assesses variation in the
frequency (distribution) of disease in terms of
person, place, and time.
– Analytic – searches for the determinants of
disease or the reasons for relatively high or low
frequency in specific groups or for greater or
lesser risk associated with specific
characteristics.
• Applied Epidemiology - the application or practice
of epidemiology to control and prevent health
problems.

19
Forms of Epidemiology
• Classical – is population-oriented and explores
the community origins of health problems.

• Clinical – focuses on health care and explores


factors that affect the diagnosis, treatment
and outcome in patient care

20
Forms of Epidemiology cont..

• Infectious Disease – is more heavily dependent


on lab support (microbiology, serology).

• Chronic Disease – is more dependent on complex


sampling and statistical methods. Made of more
specific types e.g. Cancer epi, Psychiatric epi, etc.

21
Objectives of epidemiology
• Quantify burden (of disease or health
related events) and describe pattern –
Descriptive Epidemiology
• Search for “cause” - Inferential/
Analytical/Observational Studies
• Assess control options – Interventional/
Experimental Studies

22
Uses of Epidemiology
To make a community diagnosis.
Epidemiology helps to identify and describe
health problems in a community (for example,
the prevalence of anaemia, or the nutrition
status of children).
To monitor continuously over a period of time
the change of health in a community. (for
example, the effect of a vaccination
programme, health education, nutritional
supplementation).
Uses of Epidemiology
• To practice surveillance for a specific disease
in order to be able to act quickly and so cut
short any outbreak (example cholera).
To investigate an outbreak of a communicable
disease, analyze the reasons for it, plan a
feasible remedy and carry it out, and monitor
the effects of the remedy on the outbreak.
To plan effective health services. Effective
services, interventions and remedies all
depend on accurate community data
Uses of Epidemiology
• Identification of environmental determinants
• Define priorities

25
Example:Regional differences

26
Example: Time trends

Source: Nigerian Bulletin of Epidemiology, 6 (1); 2001


10_08_08 27
Time trends

Source: Barker DJP, Rose G. Epidemiology in Medical Practice. 2nd ed. Edinburgh: Churchill Livingstone; 1979

28
Core Epidemiologic Functions
• Public Health Surveillance
• Field Investigation
• Analytic studies
• Evaluation
• Linkages
• Policy development
10_08_08 29
Textbooks for the Course
• Barker DJP, Rose G. Epidemiology in Medical Practice, 2nd
Edition, Edinburg, London and New York, Churchill
Livingstone, 1979
• Kleinbaum DG, Sullivan KM, Barker ND. Active Epi: Companion
Textbook, New York, Springer-Verlag, 2003
• Morris JN. Uses of Epidemiology, 3rd Edition, Edinburg, London
and New York, Churchill Livingstone, 1975
• Farmer R, Miller D, Lawrenson R. Epidemiology and Public
Health Practice, 4th Edition, Oxford, Blackwell Science, 1996
• Lucas AO, Gilles HM. Short Textbook of Public Health
Medicine, 4th Edition, London, BookPower, 2009

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