EPIDEMIOLOGY

Definition of Epidemiology Epidemiology may be defined as the study of the distribution and determinants of health-related states or events including diseases - in populations and the application of this study to the control of diseases and other health problems

The word epidemiology consists of the Greek words (epi) = among, (demos) = people (so, population), and (logos) = doctrine. Epidemiology Focus in medicine is the individual Communities, groups, populations replaces the individual in epidemiology Integrating science: links to clinical & laboratory medicine, biostatistics, health economics.

Epidemiology till recently was confined to the study of infectious diseases, such as cholera, small pox, or typhoid. The scope has broadened considerably during the last few decades. The epidemiological approach is now used for understanding of non-communicable diseases and conditions such as heart disease, cancer, diabetes, accidents, alcoholism, drug addiction, suicides etc. i.e. In short all diseases , human blights and injuries.

Modern epidemiology is also concerned with the study of the health of the human population in relation to the environment. General Epidemiology: It is defined as the study of the distribution and determinants of disease prevalence in man. Two main areas are involved in the definition: 1. Study of the distribution of disease in human population. This is called descriptive epidemiology. 2. A search for the underlying cause of disease prevalence. This is called analytical epidemiology. The purpose is to find out the source and mode of spread of the disease.

The principle object of epidemiology is to find out the best means of preventing disease or controlling its spread. The ultimate aim of epidemiology is the complete elimination of disease in human population. Epidemiological Approach: It is concerned in the first place to uncover the causes of disease and in the second phase to find the best means to counteract these causes to effect both prevention and cure.

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To this end the epidemiologist addresses himself 5 basic questions. They are: 1.When did the disease occur? (Time distribution) 2.Where did the disease occur? (Place distribution) 3.Who were the people affected? (Person distribution) 4. Why should it appear ? (Search for causes) 5. So what should be done to prevent or control it? (Preventive and social measures

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The first three questions (when, where, and who ) relate to the distribution of disease in human population (Descriptive Epidemiology) In the 4th question (why) relates to the search for the underlying causes ( Analytical E) In the 5th question ( so what) deals with the implications in terms of preventive and social medicine.

1. Time Distribution: One of the first elements in an epidemiological inquiry is to study the time distribution of cases. The time interval between the first and last case constitutes the duration of the epidemic. The point of time when the maximum number of cases occur is called the peak of the epidemic. This method of time distribution of cases is now applied to the epidemiological study of all diseases and conditions. It may be confined to short periods of time or extended over a period of several years or decades.

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a) Secular trends: Changes that occur in disease frequency measured over a period of several years or decades are referred to as secular trends. Western countries in past 50 years cancer, diabetes and cardiovascular diseases showed upward secular trends. Measles has shown little change, these are called secular trends. b) Seasonal Trends: Small pox shows a seasonal trend. Maximum number of cases are during the summer months and declining with the onset of rains.

The peak of cholera epidemic occur during the second six months of the year. Respiratory diseases tend to occur as epidemic in winters. These are called as seasonal trends and not necessarily related to meteorological changes c) Cyclic Trends: These are fluctuations over short periods of time. A decade or less small pox shows a cyclic periodicity. Once in 5-7 years and measles every 2-3 years. It has been shown that the periodicity of disease is due to naturally occurring variations in the immunity of the population by a study of the distribution trends.

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We can make useful projections into the future plan for timely action in the prevention or control of disease The Geographic distribution of disease enables us: 1.To make international comparisons in disease prevalence. 2.For studying variations in disease prevalence within the same country. 3.For urban-rural comparisons. 4.For studying local distribution of disease.

International comparisons in disease prevalence are possible in comparing death statistics and statistics relating to notification of diseases in different countries: Most striking in this respect is the frequency of infective and parasitic diseases in tropical and temperate zones. Cholera, typhoid fever are endemic in tropical areas, whereas these are rare in temperate areas. Geographic variations are found even in regard to the prevalence of non-infectious diseases. For ex. Cancer cervix is excessive in india and relatively uncommon in other countries.

In Britain lung cancer is more common. Frequency not only between/among countries but also within the country. Ex: Beri-bei is endemic in A.P. where people eat polished rice. Goitre is endemic in the sub-himalayan regions whereas the other parts of the country are free from it. The distribution of leprosy is not uniform in our country.

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C) Urban-rural comparisons : Differences in disease pattern may be observed between rural and urban areas. Ex: venereal diseases are more common in urban areas. Intestinal infections a, eye infections and skin diseases are more common in rural areas. PERSON DISTRIBUTION: The 3rd question relates to the persons involved, here an attempt is made to study the relationship between the diseases and population characteristics such as age, sex, occupation, income, marital status, habitats etc

From the information gained as a result of Time, Place and Person Distribution of disease, the epidemiologist seeks to determine the factors that brought the disease situation into being. The factors are considered in terms of agent, host and environment (the epidemiological triad)

It is now widely accepted that although single agent is necessary to produce infection, it does not necessarily result in development and further spread of disease. Other factors involved are type and duration of the exposure. The physiological and nutritional status of the host behavior and a no. of environmental characteristics lead to diseases such as cholera, diarrhea, dysentery. Living conditions of people, population density, nutrition, income, education, occupation, migration, culture, public health service all influence course of diseased patterns occurring in human society.

Therefore study of causative factors of disease in terms of the agent,host, envt., is the backbone in epidemiological studies which illuminate origin & mode of spread of the disease . The epidemiologist provides clues about the origin, nature and size of the disease problem and the factors which brought the diseased conditions into being.

The Health administrator bases his course of action on the knowledge provided by the epidemiologist in solving the community health problems from time to time. Epidemiologist analyses the results accomplished and makes an assessment of the progress made in the field of prevention and control. This helps the health administrator to judge the efficiency of the technical methods employed by him.

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Epidemiology is not an independent science like Physics or Chemistry. It is a method or a diagnostic tool for investigating disease causation and for applying the existing knowledge in disease prevention. The epidemiological methods are: 1. Descriptive 2. Analytical

It is usually the first phase of an investigation. It involves the collection of facts under 4 major headings (i.e. disease, time, place and person) The signs and symptoms of each case are collected. The data collected provides the basis for formulating hypothesis concerning the source of infection and modes of transmission.

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This constitutes the second major type of epidemiological studies They look at individual in population. The objective is to test hypotheses. However inference is for population. They comprise: 1. Case control studies 2. Cohort studies. EPIDEMIOLOGICAL STUDIES Define the burden of the problem Identify individuals who are at the risk of getting affected . Generate knowledge to solve the problem

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1. Formulate Hypothesis 2. Develop Research Design 3. Develop Sampling Design 4. Prepare tools for data collection 5. Carry out Data Collection 6. Tabulation and coding 7. Analysis of data 8. Suggestions, recommendations and concl.

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I. Survey type of studies 2. Retrospective Studies 3. Prospective studies (or cohort studies more expensive and difficult) 4. Experimental studies 5. Serological studies ( study of human health and disease through blood samples for anti-bodies 6. Clinical

1.Epidemic: The occurrence in a community a group of illnesses of similar nature clearly in excess of normal expectation. 2. Endemic: (En-in; demos- people) A disease is said to be endemic when it is prevalent in a geographical area continuously at a relatively low level without importation from outside. EX: Typhoid, TB, Cholera.

3. Sporadic: The world means scattered, occassional or infrequent occurrence of cases Ex.Polio 4. Pandemic: A disease is said to be pandemic (Pan-all ) (demos-people) when it spreads form one county to another in a short time in different countries. Ex: Influenza , cholera 5. Exotic: Diseases which are imported into a country in which they do not otherwise occur Ex: Yellow fever in India 6. Zoonoses: Disease & infections which are naturally transmitted between vertebrate animals and man are called zoonoses. Ex: Rabies, Plague, TB,Anthrax etc.

5. Exotic: Diseases which are imported into a country in which they do not otherwise occur Ex: Yellow fever in India 6. Zoonoses: Disease & infections which are naturally transmitted between vertebrate animals and man are called zoonoses. Ex: Rabies, Plague, TB,Anthrax etc. 7. Epizootic: Epidemic occurring among animals. Ex: Plague in rats 8. Enzootic: An Epidemic occurring among animals (Ex: Plague in rats, TB, cattle)

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Detecting existence of a disease Identifying causes & modes of transmission Obtaining information on ecology & natural history Defining & quantifying impact and extent Planning & evaluating possible disease control strategies Monitoring & surveillance to prevent further disease episodes Asssess economic effects of disease & control Programmes.

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Disease doesnt occur at random Disease has causal and preventive factors Disease is not randomly distributed throughout a population Epidemiology uses systematic approach to study the differences in disease distribution in subgroups Allows for study of causal and preventive factors

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