Introduction to Epidemiology

Department of Public Health

Gulu University
05/05/2023

Dr. Akera Peter

Introduction to epidemiology
Definition- Epidemiology
• Comes from the Greek
language in which

• Epi • “upon”
• Demos • “population”
• Logos • “study of”
Some History
Some History
• John Graunt (1662)
First analyzed mortality data; patterns of
death, birth, disease occurrence, noted
female-male disparities, high infant mortality,
urban-rural differences and seasonal
variations.
Some History
• William Farr (mid 1800s)
father of modern vital statistics and
surveillance.
• Extended analysis of morbidity and mortality
data, factored in effects of marital status,
occupation and altitude.
Some History
• John Snow (1854)
 Anesthesiologist
 Studied Cholera 20 years before the
microscope was developed.
 Discovered the cause of cholera and ways of
preventing its recurrence
A map of cholera deaths in
London, 1840s
History
• His work illustrates
moving from descriptive
epidemiology to
hypothesis generation
to hypothesis testing
(analytic epidemiology)
to application.
• What is the population?
• What public health
action was done?
Some History

• Doll and Hill (1950s) linking smoking to lung

cancer using long term cohort studies.
Today
• Public health workers all over the world
accept and use epidemiology routinely e.g.
 Ebola out breaks in Uganda
 Nodding disease in Northern Uganda
informed– Ivermectin – antiepileptics –
nutrition- vit B6 supplement –water dousing-
MRI (USA study) etc.
 Not Dispelled – chemicals (bombs, air)-witch
craft/evil spirits-eating beans-etc
 Today
• Pandemic influenza
• HIV- strategies to combat – ABC-ABCD-SMC-
- Medications- ARVs Vs CD4 count,
septrin etc
• COVID 19
• Hypothesis generation
– Bats- pigs to lab in Wuhan China
• Hypothesis testing
– drop let or airborne
 Today
• COVID 19
• Application
– Masking
– Quarantine (2 weeks)
– Social and/or physical distance
– Hand washing/ sanitize
– Vaccination
 Today
• Often practiced or used by non-
epidemiologists to characterize the health of
their communities and to solve day-to-day
problems.
• E.g. waste disposal,
• By laws on health by politicians
Today
What is epidemiology?
• Definition
“Epidemiology is the study of the distribution
and determinants of health related states or
events in specified populations and the
application of this study to the control of
health problems.”
• What do the words in BOLD mean?
 Definition
Term Explanation
• Study includes: surveillance, observation, hypothesis
testing, analytic research and experiments.
refers to analysis of: times, persons, places and
classes of people affected. Deals with
• Distribution
frequencies and patterns
include factors that influence health: biological,
• Determinants chemical, physical, social, cultural, economic,
genetic and behavioural.
 Definition
Term Explanation
• Health-related refer to: diseases, causes of death,
states and events behaviours such as use of tobacco, positive
health states, reactions to preventive
regimes and provision and use of health
services.
include those with identifiable
• Specified characteristics, such as occupational
populations groups.

• Application to the aims of public health—to promote,

prevention and protect, and restore health.
control
Definition

• Study Epidemiology is a scientific discipline,

sometimes called “the basic science of public
health”
• How do you study?:
 Surveillance
 Observation
 hypothesis testing
 analytic research
 experiments.
 Definition
• Distribution Deals with frequency and
pattern of health events in a population.
Frequency is not only numbers of such events
in a population but also the rate or risk of
disease in the population
• Pattern refers to the occurrence of health
related events by time, place, and personal
characteristics.
Definition

• Time: annual, seasonal, daily or even hourly.

Place: geographic variation, urban-rural
variation etc.
Personal characteristics: demographic factors
like age, sex, race, marital status etc, as well as
behavior and environmental exposure
• refers to analysis of the above
 Descriptive Epidemiology
• This characterization of the distribution
(pattern and frequency) of health related
events or states is one broad aspect of
epidemiology called Descriptive
Epidemiology.
• It provides the what, Who, When and Where
of health related events.
• Do we need to know why and how?
Analytic Epidemiology
• Going back to our words in bold
• Determinants
Epidemiology is also used to search for causes
and other factors that influence the
occurrence of health related events.
Analytic Epidemiology
• Analytic Epidemiology attempts to provide
the Why and How of such events by
comparing groups with different rates of
disease occurrence and with differences in
demographic characteristics, genetic or
immunologic make-up, behaviors,
environmental exposures and other risk
factors
• Epidemiology asks (determines)(determines)
a) WHAT: Health related states (diseases, cases)
b) WHO: Person
c) WHEN: Time Time
d) WHERE: Place
e) WHY and How: Causes
a-d = Descriptive epidemiology
e) = Analytical epidemiology
Definition continued
• Health related states or events.
 In the past issues of communicable diseases
 Then endemic communicable diseases and
non-communicable diseases
 Recently applied to chronic diseases, injuries,
birth defects, maternal-child health,
occupational health, and environmental
health
Definition continued
 Now even behaviors related to health and
well-being (amount of exercise, seat-belt use
etc.).
 We can use the term “disease” to refer to the
range of health-related events or states.
 Definition
• Specified populations
• include those with identifiable characteristics,
such as occupational groups, children under 5,
pregnant mothers etc.
compare work of epidemiologist to
physician
• Clinicians are concerned with the health of an
individual; epidemiologists are concerned
with the collective health of the people in a
community or other area.
• Both are interested in diagnosis of disease
• E.g. Got diagnosis of diarrheal disease .
• What other roles does each play?
Comparison
Epidemiologist Clinician
• Diagnosis Diagnosis
• Exposure (action or source Treating
of disease) Curing
Caring
• Number of other persons
with similar disease or
exposure
• Potential for spread to
others in community
• Interventions to prevent
additional cases or
recurrences
Definition continued
• Application Epidemiology is more than “the
study of”, it provides data for directing public
health action.
• Action –
a. Clinical
– e.g. RDT, ARV, ACT etc
b.Behavioral
– e.g. abstinence, no hand shakes , hugging
 Definition continued
c. Community
– e.g. salt iodization, water fluoridation,
d. Environmental
– e.g. tree planting (reforestation)
 Epidemiology and Public Health
• Public health- collective actions to improve
population health.
• Epidemiology, one of the tools for improving
public health
• Early studies concerned with the causes
(etiology) of communicable diseases, and such
work continues to be essential it can lead to
the identification of preventive methods.
steps to public health action
 Uses
• Epidemiology therefore
is a basic medical
science with the goal of
improving the health of
populations, and
especially the health of
the disadvantaged
 Uses-generally
• It therefore can be used generally in the
following areas:
1.Causation of disease
2.Natural history of disease
3.Health status of populations
4.Evaluating interventions
 Causation of disease
• Some diseases are caused solely by genetic
factors
• Most result from an interaction between
genetic and environmental factors. E.g.
Diabetes
• Environmental components - biological,
chemical, physical, psychological, economic or
cultural factors that can affect health.
 Causation of disease
• Personal behaviors affect this interplay, and
epidemiology is used to study their influence
and the effects of preventive interventions
through health promotion
 Natural history of disease
• Epidemiology is also concerned with the
course and outcome (natural history) of
diseases in individuals and groups

• From good health through sub clinical signs

and clinical signs to recovery or death
– E.g. HIV, Malaria etc
 Health status of populations
• Knowledge of the disease burden in
populations is essential for health authorities
• Helps us use limited resources to the best
possible effect by identifying priority health
programs for prevention and care.
– Vaccinate entire population or not
– Sinovax verses Johnson and Johnson
– Bed nets or IRS or both
– Catch all the mosquitoes
 Health status of populations
• In some specialist areas, such as
environmental and occupational
epidemiology, the emphasis is on studies of
populations with particular types of
environmental exposure.
– Arsenic exposure among gold miners in eastern
Uganda
– Mercury exposure during dental procedures
 Evaluating interventions
• Options of health promotion, preventive
measures, public health services Vs treatment
or medical care
– the value of distributing face masks,
– the efficiency of sanitation measures to control
diarrheal diseases
– Cost of treating COVID 19 patients,
– Travel bans etc.
 Uses of epidemiology –Specific
• And specifically for;
1.Investigating the modes of transmission of a
new disease
2.Exploring the aetiologic factors of a given
disease
3.Determining the natural history/biologic
mechanisms of disease
4.Studying the biologic spectrum of disease (the
iceberg phenomenon)
 Uses of epidemiology –Specific
5. Setting disease control priority
6. Improving the diagnosis, treatment &
prognosis of clinical disease
7. Improving health services research
8. Providing expert testimony in courts of law
9. Evaluating community health intervention
 Uses of epidemiology –Specific
10. Setting policies, making work plans cf
disease burden
11.Individual decisions
– Start exercising
– Quit smoking
– use of method of contraception,
– Diet