Contents

1. Epidemiology.
2. Screening
3. Communicable Diseases
4. Non-communicable Diseases.
5. Family Welfare
6. Population and Demography
7. Health Care Administration
8. Nutrition
9. MCH
10. Environment
11. International Health
12. Health Information Systems
13. Concepts in PSM
14. Occupational Health
15. Social Medicine
16. IEC

1Epidemiology

1. Define
Epidemiology
A. Epidemiology
is defined as the
distribution and
determinants of
disease frequency
or health events
in man. Modern
dayepidemiology
is different from
the earlier period
where it just
referred to
as study of
epidemics. It
now
includescompreh
ensive methods
for control of
diseases,
including non-
communicable
diseases.
Distribution
refers to the time;
placeand person
characteristics of
disease while
the determinants
(what determines
disease)
are generally
characterized as
agent,host and
environmental
factors. Since
freedom from
disease allows an
individual to
remain healthy,
it is also
important tofind
out how and why
individuals do not
suffer from
disease and
remain healthy.
Such analyses
will help in
finding
solutionsto
disease and
maintaining good
health.
2. What are the
uses of
epidemiology?
A. The major
uses of
epidemiology
are:a. To assess
the magnitude or
burden of disease
in a community.
It, therefore,
helps in studying
the occurrence of
disease ina
population. b. To
assess the health
status of
communities. It,
therefore, helps
in establishing a
community
diagnosis.c. To
search for
determinants of
disease. To find
out how and why
disease is caused
is a major use of
epidemiology.d.
To estimate
an individual’s
risks and chances
of suffering from
a disease and to
establish the
prognosis in
an individualsuff
ering from
disease.e. To
plan comprehensi
ve health
services,
including
specific
strategies and
ways and means
of
implementation.f
. To evaluate
strategies and
interventions
for disease
control. Such
evaluation helps
in identifying
weaknesses and
tosuggest
remedial
measures for the
future.
Evaluation of
costs and
benefits or
effectiveness of
specific
interventions is
also anintegral
use.g. To
complete the
natural history of
disease. In a
hospital setting
only the terminal
cases are seen
and how disease
starts
and presents in
its initial
stages is only
possible by
studying disease
in the
community.h. To
forecast future
disease
trends.i.To
identify
syndromes.
3. What is the
epidemiological
triad?
A.Disease is
caused by an
interaction
between agent,
host and
environmental
characteristics.
When allthree
are in harmony,
health is ensured
but
maladjustment in
their
relationships
leads to
disease. These
threefactors
together
constitute
the epidemiologi
cal triad.
4. What is the
difference
between
retrospective
and prospective
studies?
A.Retrospective
studies start after
a disease
has occurred and
the investigator
looks back
in time to find
out what agents
or characteristics
(including habits)
the individuals
were exposed
to and which
could lead
to disease. Case
control studies
areexamples of
retrospective
studies. In
prospective
studies
individuals are
identified before
occurrence of
disease and they
arefollowed up to
see which
individuals
develop disease.
The
characteristics
or exposures of
these individuals
to diseasecausing
agents are
compared with
the
characteristics of
individuals who
do not suffer
from disease.
This helps
in searchingfor
determinants of
disease.
5. What is a case
control study?
A. A case control
study is
an epidemiologic
al study where a
group of
individuals with
disease are
compared with
a group
of individuals
who are not
suffering from
disease in
terms of specific
disease causing
exposures. Since
the starting point
is agroup of
people who
already have
suffered from the
disease, this
is labeled as
a retrospective
study.
Advantages of
case
control studies
– Relatively
quick and easy
to undertake. –
Relatively cheap
to undertake. –
Only method
useful in
rare diseases. –
Not enmeshed in
problems
of follow-up as
the data
iscollected at one
point in time. –
Can be used to
study the effect of
many
exposurevariable
s on a single
disease outcome.
 Drawbacks of
case control
studies
– Prone
to selection and
recall bias. –
Can’t measure
relative risk or
provide
incidence
estimates. –
Sometimes the
occurrence of the
exposure
in terms of time,
i.e. whether it
occurred before
the disease may
be difficult
todecipher. –
Can’t be used for
rare exposures. –
Designing the
study is not an
easy task.
6. What is a
cohort study?
A. Cohort studies
are forward
looking, i.e. they
look for the
development of
disease in
a group of
individuals (the
cohort)free of the
same at the
beginning. The
group is followed
up over a period
of time. During
this period some
persons
willdevelop the
disease under
study while
others
will remain free
of the disease.
The
characteristics(an
d exposure to
disease causing
factors) are
compared
between those
who suffer from
disease and those
free from
thedisease. The
literal meaning
of the term
‘cohort’ refers to
a group that
shares similar
characteristics.Th
us, it implies that
one needs to
identify groups
of populations
who are free of
the disease being
studied and who
aresimilar in all
respects,
except the
specific exposure
variable or
characteristic
whose effect is
being related to
the disease being
studied. These
groups are then
followed up for
the period of time
that it takes for
the disease to
develop.
7. What is a
Randomized
Controlled
Trial?
A. A randomized
controlled trial
is an
experimental
method where
individuals
are randomly
allocated to an
experimental or a
control group
and the effect or
response of a
drug
or intervention is
compared
between the two
groups. The two
keyfeatures are
‘randomization’
and ‘controlled’.
To ensure that
there is no bias
on part of the
investigator,
these trials
are‘blinded’ –
 single blind
means the
patients do not
know what the
intervention is;
‘double’ blind
means that
neither the patient
nor the
researcher knows
what the drug/
intervention
package is while
‘triple’ blind
means that
the analysis team
alsodoes not
know which
is the
experimental and
which is the
control group till
the study
has been
completed.
8. What is a
Community
Trial?
A. A community
trial is a
modification of
the clinical trial
where instead of
individuals being
allocated to
experimental
or control groups,
whole
communities are
randomly
allocated to
receive specific
interventions and
analysis is done
for
wholecommuniti
es rather than
for individuals
in the
communities.
Vitamin A
supplementation
trials, iron
supplementation
or iodine
supplementation
trials are all
examples of
community trials.
9. What is a
vaccine trial?
A. When a
randomized
control trial is
done to test the
efficacy of a
vaccine in
preventing
disease, it is
called a vaccine
trial.
10. What is the
difference
between
Descriptive and
Analytical
Epidemiology?
A.
The descriptive
methods are
mostly concerned
with the
distribution of
disease/health
condition, while
the analyticalmet
hods are
concerned with
the determinants
of disease/health
condition.
There are
a number of
different
descriptive
methods: –
Ecological
/correlational
studies. –
Case reports/cas
e series. – Cross-
sectional designs
Analytical
studies are
concerned with
the determinants
of disease rather
than with the
distribution.
They focus
attention onways
to prove a
hypothesis
suggested by the
earlier types of
studies. Based on
the analytical
method used,
they can
becategorized
into two types: –
Observational m
ethods –
Experimental m
ethods.In the
observational
methods, the
disease
phenomenon is
not in the grip of
the investigator.
The clinician –
investigator
onlyrecords the
sequence of
events as they
unfold in front of
his eyes. The
outcome events
are then related
to the different
inputvariables to
understand the
dynamics of
disease
causation. In the
experimental
studies or the
intervention
studies,
theresearcher
selects a group of
patients and then
decides how
to intervene/treat
the group, and
then records the
differences.Thus,
one group
of individuals
is labeled as an
experimental
group and
is given some
‘treatment’,
while the other
group islabeled as
the control group
among whom
either a placebo
may be used or
nothing may be
done.These
studies can
be further
categorized as
follows:Observat
ional Studies
Experimental
Studies –
Case control stu
dies –
Intervention stu
dies –
Cohort studies
with/ without co
ntrol –
Clinicaltrials
(RCT) –
Community trials
11. What is
sampling?
A. Sampling can
be defined as the
process of
selecting
a statistically
determined
number of
subjects from
the universe
or reference
population,
which provides
an accurate
estimate of the
problem being
studied. Thus,
only a proportion
of thereference
population is
covered, but the
results
approximate the
actual prevalence
of the disease
condition in the
reference populat
ion. Strictly
speaking, the
results obtained
are applicable
only to the
population from
which the sample
was drawn, but
the results
are generally
extrapolated to
other populations
that are similar to
the reference
population. A
sample
is theminimum
number of people
or units who
need to
be contacted or
examined to
obtain
statistically
acceptable results
andthereby
permit valid
inferences to be
drawn.
12. What are the
different
sampling
methods that
you know of?
A. The different
sampling
methods include
simple random
sampling,
systematic
random
sampling,
stratifiedrandoms
ampling, cluster
sampling,
multistage
sampling and
purposive
sampling.
Purposive
sampling is not
used
in epidemiologic
alor health
sciences as it
gives biased
results. All other
sampling
methods are
called
probability-
sampling
methods.
13. What is the
difference
between simple
and stratified
random
sampling?
A. In
this method,
every individual
has an equal
chance of
being selected in
the sample.
The first step
involves
enumerationof
the total
population
wherein every
individual is
sequentially
numbered from
1…n (n =last
member in the
population).
Theenumeration
list of the total
population from
which the sample
is drawnis called
the sampling
frame. The next
stage is theactual
selection of the
sample, which
can be done by
different methods
like drawing
numbers from a
hat or picking
numbersfrom a
random table, etc.
Stratified
sampling is done
to give the
different
population
subgroups an
equal chance of
beingselected. In
this way, male/
female or urban /
rural can
be given
adequate
representation to
reduce bias.
14. What is
systematic
sampling?
A. Systematic
sampling is a
method
of probability
sampling, which
is used to
simplify the
selection
procedure.
After enumeratin
g the units i.e.
villages, houses,
etc. they are
selected at
a predetermined
interval,
i.e. every nth
unit.
The procedure
has the
advantage of
easy administrati
on in the
field, but is
inferior
compared to
the simple
random sampling
15. What is
cluster
sampling? Give
examples of
wherecluster
sampling has
been used in
reproductivean
d childhealth?
A. For
conducting
surveys
or epidemiologic
investigationson
large population
groups, the
simple random
technique is not
of much use.
This is because
construction of
the sampling
frame becomes
very difficult
when there are a
large number
of individuals
to be
enumerated. In
such situations,
groups,
rather than
individuals, can
be selected in
the initial stage
of the sampling
process. In
the selection of
the final stage
units, instead of
randomly
selecting the
individuals to be
included, allthe
individuals in the
identified cluster
are
examined.EPI
vaccine coverage
surveys adopted
the cluster
sampling
technique and
now
this technique is
widely used in
manysituations
where coverage /
lameness /
disability
are surveyed.
16. What is an
epidemic?
A. The
occurrence of a
disease clearly
in excess of
normal
expectations is
called
an epidemic. The
number of cases,
whichshould be
diagnosed before
declaring an
epidemic status,
depends on
the number of
cases routinely
seen in that area.
In anarea where a
disease has not
been seen
for many years,
even the
occurrence of a
single case may
be sufficient to
call it
anepidemic.
Some people
look at the mean
(or average)
number of cases
and if the
cases are beyond
two standard
deviationsthey
call it
an epidemic.
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