Community Health: CHP 310

Introduction to Epidemiology

Module Instructor: Professor Dr. Amen Bawazir,

BMBS, Dr. Epid, PhD
abawazir@mcst.edu.sa OR bawazir56@gmail.com
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Learning outcomes

At the end of the session, the students have to:

➢Understand the term epidemiology and it is related to public health
➢Define the term epidemiology as a science
➢Identify the different classifications of epidemiology
➢Describe the purpose, and uses of epidemiology
➢Explain the interrelation between the three components of the epidemiological
Triangle.
➢Describe epidemiological factors (PPT) which influence the pattern of disease and
its public health impact.
Epidemiology and public health

➢Public health, broadly speaking, refers to collective actions to improve population

health. Epidemiology, one of the tools for improving public health, is used in several
ways.

➢Early studies in epidemiology were concerned with the causes (etiology) of

communicable diseases, and such work continues to be essential since it can lead to
the identification of preventive methods. In this sense, epidemiology is a basic
medical science to improve the health of populations, especially the health of the
disadvantaged.
What is Epidemiology?

“Epidemiology is the study of the determinants, distribution, and frequency of disease (who
gets the disease and why)”

➢epidemiologists study healthy people

➢epidemiologists study sick people
to determine the crucial difference between those who get the disease and those who are
spared.

➢epidemiologists study exposed people

➢epidemiologists study non-exposed people
to determine the crucial effect of the exposure
What is Epidemiology? definition:
“Last’s dictionary”

“The study of the distribution and determinants of

health-related states or events in specified
populations, and the application of this study to
control health problems”.

John M. Last. A dictionary of Epidemiology. 4th Edition. 2001. Oxford University Press. New York.
CONCEPT OF EPIDEMIOLOGY

➢This definition emphasizes that epidemiology is concerned not only with

death, illness, and disability but also with more positive health states and
with the means to improve health.

➢Epidemiology is concerned with mass outbreaks of diseases, not only

with their onset but also with disease-related attributes such as
immunological status, unapparent infection identifiable by a laboratory
test, physiological abnormalities, such as elevated blood pressure or
elevated levels of sugar in the blood, etc.
Historical development of epidemiology
Throughout its historical development, epidemiology has passed four recognized stages, named:

1. Clinical individualistic stage: characterized by aiming all the effort at studying the clinical picture and describing the
characteristics of signs and symptoms of the diseases.

2. Stage of great epidemics: In this period all the efforts were aimed at studying the illness of great human groups due
to the fearful epidemics that affected Asia and Europe in the Middle Age.

3. Etiological Unicistic stage: In this period arise big precursors of modern epidemiology; great contributions were done
to the knowledge of the way of transmission of some diseases such as Louis Pasteur who demonstrated the inconvertible
relationship between bacteria and the process featuring infectious diseases, but all scientists at that epoch had the
erroneous belief that in any disease specific Etiological agent should be recognized as a single cause in the patient.

4. Ecological multi-causal stage: This stage has its origin in the appearance of contradictions in the Etiological
Unicistic theory, as a result of the development of other sciences contributing to clarifying different new points.
EPIDEMIOLOGY AS A SCIENCE
➢Epidemiology also studies the causation of the disease in the human population,
and the discovery of essential or contributory factors to the occurrence of any
particular disease and/or any health deviation state.

➢Epidemiology, the study of both communicable diseases and non-

communicable diseases.

➢Epidemiology remains of vital importance in developing countries where

malaria, poliomyelitis, and other common diseases as well as in developed
countries with the emergence of new communicable diseases such as
Legionnaires’ disease and acquired immunodeficiency syndrome (AIDS).
Multi-Causality Concept
We can state that no disease or health disorder has a unique or isolated factor, as the cause, but a group of
them.
In any health problem intervene multiple factors. A cause is termed a sufficient factor when it inevitably
produces or initiates a disease and is termed necessary if a disease can not be developed in its absence.
➢ A sufficient cause is not usually a single factor, but often comprises several components.
➢ Each sufficient cause has a necessary cause as a component. For example, in a study of an outbreak of
food-borne infection, it may be found that cream cake or ice cream can be sufficient causes of
Salmonellosis. The presence of salmonella is a necessary cause of this disease.
➢ Similarly, there are different components in the causation of Leprosy, but the presence of the
Mycobacterium Leprae is the necessary one; as well as the dysfunction of the pancreas in producing insulin
is a necessary factor in the causation of diabetes, and some aspects of the lifestyle or the way of life are the
necessary factor for the appearance of other diseases, for example, smoking cigarette for lung cancer, non-
proper dietary habits are the cause of the obesity, hypertension, etc.
Multi-Causality Concept
Four types of factors play a part in the causation of the disease:
➢Predisposing factors, such as age, sex, and previous illness;
➢Enabling factors, such as low income, poor nutrition, bad housing, not
adequate medical care, etc.
➢Precipitating factors, such as exposure to a specific disease agent or noxious
agent may be associated with the onset of disease.
➢Reinforcing factors, such as repeated exposure and unduly hard work may
aggravate an established disease.
However, all these factors are found in complex integrative forces and involved
in a reciprocal action, but they are not equivalent.
 to determine, describe, and report on the
natural course of the disease, disability,
injury, and death.

Uses of to help in the planning and development

Epidemiology of health services and programs

to provide administrative and planning

data
Objectives of Epidemiology

➢to study the cause (or etiology) of disease(s), conditions, disorders,

disabilities, etc.

➢to determine the primary agent responsible or ascertain causative factors

➢to determine the characteristics of the agent or causative factors

➢to determine the mode of transmission

➢to determine contributing factors

➢to identify and determine geographic patterns

Purpose of Epidemiology

➢to provide a basis for developing disease control

and prevention measures for groups at risk.

➢this translates into developing measures to

prevent or control disease
 Epidemiology Purposes in Public Health Practice

❑ Discover the agent, host, and environmental factors that affect health

❑ Determine the relative importance of causes of illness, disability, and death

❑ Identify those segments of the population that have the greatest risk from

specific causes of ill health

❑ Evaluate the effectiveness of health programs and services in improving

population health
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 Role of epidemiology
Epidemiology developed from the study of outbreaks of communicable
disease and of the interaction between agents, hosts, vectors, and reservoirs.

 The ability to describe the circumstances that tend to spark epidemics in

human populations –e.g., during war, migration, famine, and natural
disasters – has increased human ability to control the spread of
communicable disease through surveillance, prevention, quarantine, and
treatment.
Natural history and prognosis
➢Epidemiologists are also concerned with the natural history, or the course and outcome, of
disease, both in individuals and in groups.

➢Prognosis often implies the course of disease after the intervention, but the terms tend to be used
rather interchangeably.
➢Such knowledge has obvious value for discussing treatment options with individual patients, as
well as for planning and evaluating interventions.

➢Of particular interest is whether the early disease is present for long before symptoms drive
someone to seek medical attention. If this ‘sub-clinical’ disease can be detected and if, as a result,
treatment is more effective, this opens the way for screening programs that aim to improve
treatment outcomes.
Achievements in epidemiology
The elimination of smallpox contributed greatly to the health and well-being of
millions of people, particularly in many of the poorest populations. (1970).
A good understanding of the epidemiology of smallpox was central to its eradication.
• providing information about the distribution of cases and the model, mechanisms,
and levels of transmission; mapping outbreaks of the disease; • evaluating control
measures

➢ Iodine deficiency diseases

➢ Methyl mercury poisoning
➢ Hip fractures
➢ Rheumatic fever and rheumatic heart disease
➢ HIV/AIDS
➢ Tobacco use, asbestos, and lung cancer
➢ Covid -19
Two Broad Types of Epidemiology:
Covid-19 March 2020-June 2022

➢descriptive epidemiology: examining the

distribution of disease in a population and
observing the basic features of its distribution.

➢analytic epidemiology: investigating a

hypothesis about the cause (factors) of disease by
studying how exposures relate to disease

Most SARS-CoV-2 deaths were associated with older age, male sex.
Descriptive Epidemiology:

descriptive epidemiology is an antecedent to descriptive analytical

analytical epidemiology (starting point):

Analytical Epidemiology:
analytical epidemiology studies require information to ...

➢know where to look

➢know what to control for
➢develop viable hypotheses
Essential elements for Descriptive Epidemiology:

Person
➢Three essential characteristics of

the disease we look for in

descriptive studies are (PPT):

Place Time
Characteristics of the
Person
➢age, gender, ethnic group

➢genetic predisposition

➢concurrent disease

➢diet, physical activity, smoking

➢ risk-taking behavior

➢Socioeconomic status (SES), education, occupation

 Characteristics of the
Place (geographical)
➢presence of agents or vectors

➢climate

➢geology

➢population density

➢economic development

➢nutritional practices

➢medical practices
 Characteristics related to Time

➢calendar time

➢time since an event

➢physiologic cycles

➢age (time since birth)

➢seasonality

➢temporal trends
The Epidemiologic Triangle (Triad)
➢The Epidemiologic Triangle: three characteristics that are examined to study the
cause(s) of disease in analytic epidemiology

Host

Agent Environment
The Epidemiologic Triangle

Host
Host
➢personal traits

➢behaviors

➢genetic predisposition Agent Environment

➢immunologic factors

What are the differences between the characteristics of the person and the host?
The Epidemiologic Triangle
Agent

➢ Biological (e.g., viruses, bacteria, fungi, parasites, Host

helimenthesis)

➢ Physical (radiation, water, air, etc.,)

➢ Chemical (toxins, minerals, gases, etc.,)

➢ ...
Agent Environment
➢ influence the chance for disease or its severity
The Epidemiologic Triangle
Environment

Host

➢Macro and microenvironment

➢external conditions: atmosphere,

hydrosphere, lithosphere, and biosphere
Agent Environment
➢physical/biological/social

All that contributes to the disease process

What happens when those three elements (host, agent, and environment) were not in balance?

An epidemic occurs
Due to

- a new agent (e.g. sars-2 virus: COVID-19)

- change in the characteristics of the existing agent (infectivity, pathogenicity, virulence. E.g.,
Omicron vs. delta vs. Mers-Cov)

- change in the number of susceptible in the population (due to migration or displacement)

- environmental changes that affect the transmission of the agent or growth of the
agent (new mosquito breeding places or prolonged breading time)
Epidemiologic Activities

➢often concentrate on PPT (person, place, and time)

➢demographic distribution

➢geographic distribution

➢seasonal patterns and temporal trends

➢frequency of disease patterns

Epidemiologic Activities

➢are built around the analysis of the relationship between

➢exposures
➢disease occurrence
➢are built around the analysis of differences between
➢cases
➢healthy controls
Epidemiologic areas of Activities

Activities related to communicable diseases include

epidemics and outbreaks.

Activities were related to non-communicable diseases such

as heart diseases, diabetes mellitus, obesity, renal failure, and
more.

Activities related to health conditional and risk factors:

tobacco use, alcohol addiction, drug addiction, and suicidal
tendency.
 • It is important to know • COVID-19 has
Why do we need to why people die to improve highlighted the importance
know the reasons how people live. for countries to invest in
Measuring how many civil registration and vital
people die?
people die each year helps statistics systems to allow
to assess the effectiveness daily counting of deaths,
of our health systems and and direct prevention and
direct resources to where treatment efforts.
they are needed most.
Leading causes of death globally

❑The world’s biggest killer is ischaemic

heart disease, responsible for 16% of
the world’s total deaths in 2019.

❑ Stroke and chronic obstructive

pulmonary disease are the 2nd and 3rd
leading causes of death, responsible
for approximately 11% and 6% of
total deaths, respectively.
WHO. The top 10 causes of death. 2020. https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death
Further readings

➢ Principles of Epidemiology in Public Health Practice. Third Edition. U.S. Department of Health and Human
Services. Centers for Disease Control and Prevention (CDC). Office of Workforce and Career Development.
Atlanta, GA 30333

➢ Basic epidemiology / R. Bonita, R. Beaglehole, T. Kjellstrom. 2nd edition. 2006

➢ Epidemiology. Manuals. Beaglehole, Robert. Kjellstrom, Tord. World Health Organization

➢ Epidemiology for Public Health Practice. Robert H Friis, Thomas A. Sellers. 5th Edition

➢ Anna Lydia Svalastog1, Doncho Donev2, Nina Jahren Kristoffersen1, Srećko Gajović3. Concepts and
definitions of health and health-related values in the knowledge landscapes of the digital society. Croat Med
J. 2017;58:431-5. https://doi.org/10.3325/cmj.2017.58.431

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Thank you

Any question