Epidemiology Lecture 1

Dr: Eman Kammas Al-Sadi

Assist. prof. \ pediatrics
Chief of community
& family medicine department
:Objectives
• 1. What is epidemiology? Definition

• 2. What is scope of epidemiology?

• 3. What are the accomplishments of epidemiology.

Epidemiology
DEFINITION:
•Epidemiology is the study of frequency, distribution and
determinants of disease and health related events in population
groups. It helps in obtaining, interpretation and use of data to
improve, protect and restore health of the population.

Epidemiology is concerned with three aspects of health related problems:

1.The frequency (how many).

2.The distribution (pattern) .

3.The determinants (risk factors and causes of disease).

Epidemiologists : study variations of disease incidence in
relation to factors such as

1. Age, sex, race, Environmental factors, Lifestyle, Demographic

variables,

2. Occupational , social characteristics, place of residence,

susceptibility, exposure to specific agents, or other
characteristics.

3. Also of concern are the temporal and special distribution of

disease,

4. examination of trends, and intervals between exposure to

causative factors and onset of disease
Epidemiology is very helpful in understanding the
complexities of health and disease of population
groups within an ecological context.
Introduction to basic concepts
The epidemiology scope

• The scope extends from study of the patterns of disease ;(description

of the disease &analysis of its occurrence) & study the natural history
as well as the prognosis &causal association of the disease and it is
limitations and lastly, the goal of the control or prevention of disease
or event.

• What distinguishes epidemiology from other clinical sciences is

the focus on health problems in populations rather than in
individuals, with the focus on public health.
Phases of epidemiological work

1. Descriptive studies
2. Analytical epidemiology
.Intervention or experimental epidemiology .3
Evaluative epidemiology .4
1. Descriptive studies
Methods of epidemiology that are used to measure
the frequency of disease and its distribution are
.called descriptive methods or descriptive studies

1. What is the problem?

2. How frequent is it?
3. Who are the people involved?
4. Where does it take place?
5. When does it take place?
:1The problem is identified and described in terms of
1) characteristics of persons ( Who)
2) characteristics of place (Where )
3) characteristics of time ( When)
1. Who?
1. The most important variables are age, sex, education, occupation, income,
cultural and religious group, family size, nutritional state and immune status.
2. Other groupings might be by such characteristics as clinic attendance and non-
attendance, those with latrines and those without, or normal and low-birth-weight
infants.
3. Any relevant variable may be used, provided that subjects can be clearly placed
in one category or another.
Where?
1. The place where people live or work may partly determine which
health and disease problems they suffer from and what use they
make of the available health services. For example, the variables
might be:
2. • Town, village or isolated dwelling.
• High or low altitude.
• Proximity to rivers, forests, wild animals or sources of toxic
substances.
• Distance from dispensary, health center or hospital.
•
When?
It is important
to know when health problems are most severe, or when the incidence of new cases is
greatest.
To show it grouped according to new cases per day, week, month or year. The time
period depends on what is being analyzed, for instance:
1. • New cases of cholera per day.
• New cases of measles per week.
• New pregnant mothers registering per month.
• New cases of kala-azar in one year.
Analytical epidemiology .2

in which we attempt to analyze the causes or determinants of disease by

testing hypotheses
1. How is the disease
2. Why is it continuing ?
3. Why is it affecting some persons rather than others.?
Methods of epidemiology which test hypotheses are called analytical methods
or analytical studies.
.Intervention or experimental epidemiology .3

in which clinical and community trials are used to answer questions related to the
effectiveness of new drugs or methods for controlling disease or improving
underlying conditions. Usually, active efforts are involved
a. To interfere in the disease process .
b. To measure the effectiveness of such intervention in changing the
incidence, severity of disease or recovery from it.
. Evaluative epidemiology .4

A recent development in the epidemiological methods.

Attempts to measure the effectiveness of different health care

programs and to answer such question as: Have there been any
improvement in the health status of the population in response to the
application of the program?
e.g. ARI program, Nutritional rehabilitation program, immunization program,
and others

Evaluative epidemiology is not necessarily interventional in

nature.
Modern of epidemiology(SCOPES)
1. Infectious disease epidemiology
2. Nutritional -epidemiology
3. Cancer- epidemiology
4. Neuro-epidemiology
5. Ageing -epidemiology
6. Psychiatric -epidemiology
7. Genetic -epidemiology
8. Pharmacoepidemiology
9. Dermatoepidemiology
10. Occupational epidemiology
11. Chronic diseases epidemiology
1. Describing the pattern of disease:
1. Current pattern
2. Past time trends
3. Prediction of future trends
2. Describing the natural history of disease
3. Identifying risk factors and protective factors
4. Understanding the mechanism of disease transmission
5. Classifying disease on the basis of causes (etiological) or on the basis
of features (manifestation).
6.Testing the efficacy of interventions
7. Clinical decision analysis-clinical epidemiology.
8. Administrative uses- planning, organization and evaluation of
promotive, protective, curative or rehabilitative health care services.
9. Identifying population health needs
 Epidemiology is both
1.Routine activity (often called health or disease surveillance)
2.A research method applied to test hypotheses about causes
of diseases, to measure health risks or carry out an experiment.
:to achieve these purposes, epidemiologists make use of
1) Basic biomedical and clinical sciences.
2) Vital statistics and biostatistics.
3) Social sciences such as demography and
sociology.
4) Environmental sciences such as physics and

chemistry.
SOME OF THE CONTRIBUTIONS
OF EPIDEMIOLOGY:
A)Contribution to medical knowledge.
B)Contribution to health services.
C)Contribution to medical education.
D)Local contribution.
A) Contribution to medical knowledge
1.in communicable, nutritional and occupational diseases, in almost all fields of
health related aspects.
2.In Historical events related to the problems of cholera, scurvy and congenital
defects associated with thalidomide and German measles are unique
epidemiological contributions.
3.Human immune deficiency syndrome (AIDS) is another example on how
epidemiological observation can help in clarification of dilemmas in the field of
health and disease.

James Lind's
B)Contribution to health services: is the basic discipline for:
1. Diagnosis of population health problems.
2. Estimation of population health needs.
3. Determination of priorities .
4. Evaluation of services performance.
C) Contribution to medical education:
The curriculum of medical and health personnel is determined
by many factors. Some of these factors are shown in the
diagram below.
Medical curriculum Pattern of disease as determined by
epidemiological observation

Health care services organization

Professional Consumers sociopolitical

Values Values Values
:D) Local contribution
During the last 30 years, epidemiological methods became increasingly familiar
to local physicians and researchers. Many research works were carried out in
different parts of Iraq. These were very useful in determining health indicators, in
identifying risk factors of important diseases and in evaluation of the
.performance of health care services
Finally, epidemiology can be conducted with whole population,
with samples or with subset such as patients or other specific
.group
When it is conducted on samples or subsets, two requirements
:are crucial to the generalization of results
1. Randomness (equal chance for every individual to
appear in the sample) .
2. Representativeness (the sample is drawn from the
universe in such a way to be an image of the reference or
mother population. from which it is drawn.